Post-match pints led to virus surge, says ex­pert

Maeve Shee­han re­ports on how Covid-19 trav­elled from post-match pint, to stu­dent digs, to a flat - and ul­ti­mately to a health care worker

Sunday Independent (Ireland) - - FRONT PAGE - Maeve Shee­han

POST-MATCH cel­e­bra­tions have emerged as one of the most com­mon sources of the es­ca­lat­ing out­breaks that have brought the coun­try to the brink of lock­down, ac­cord­ing to a public health ex­pert.

In one case in­ves­ti­gated last week, a stu­dent’s trip to the pub for a post-match cel­e­bra­tion re­sulted in the in­fec­tion spread­ing to four of his house­mates, two stu­dents in a neigh­bour­ing flat and a woman who worked part time in a nurs­ing home. She was the sis­ter of one of those stu­dents.

Dr Una Fal­lon, di­rec­tor of public health in the mid­lands, said the case demon­strates how the virus spreads.

Dr Breda Smyth, di­rec­tor of public health in Gal­way, Mayo and Roscom­mon, said the virus has been re­pro­duc­ing at such a rate that “you can no longer con­trol it and it just takes off”.

TWO weeks ago, a young man went to the pub to cel­e­brate with his mates af­ter a match. Un­known to him, the virus was al­ready in his sys­tem. Some of his rel­a­tives were al­ready har­bour­ing Covid. The day af­ter his match cel­e­bra­tion he be­came ill and tested pos­i­tive for the virus.

At the public health de­part­ment in Tul­lam­ore, Co Of­faly, a team of ex­perts on the trail of the rapidly mul­ti­ply­ing virus no­ticed that a group of young peo­ple who tested pos­i­tive for Covid-19 had vis­ited the same pub the week­end be­fore.

One of them was a univer­sity stu­dent who shared ac­com­mo­da­tion with four house­mates. The four were con­tact-traced and all tested pos­i­tive for the virus.

The con­tact trac­ing did not stop there. The univer­sity stu­dent who un­wit­tingly car­ried the virus back with him had also vis­ited two other stu­dents who lived in a nearby flat where they all viewed an on­line course to­gether.

They also tested pos­i­tive. Mean­while, the par­ents of one of the four house­mates col­lected him from his stu­dent ac­com­mo­da­tion af­ter he was iden­ti­fied as a close con­tact and be­fore he tested pos­i­tive. Then his sis­ter con­tracted the virus. She worked part-time in a nurs­ing home, which made public health staff par­tic­u­larly wor­ried, given the po­ten­tial ex­po­sure of vul­ner­a­ble peo­ple.

“Luck­ily, she was not at work while in­fec­tious so there was no im­pact on the nurs­ing home. That is how cases get into health care and this was a nar­row es­cape,” said Dr Una Fal­lon, di­rec­tor of public health in the Health Service Ex­ec­u­tive’s mid­lands re­gion. “This is in­dica­tive of what hap­pens and how the virus spreads.”

That was not the only thread of in­fec­tion from that “spiderweb”. A Leav­ing Cert stu­dent was also at the pub for that post-match cel­e­bra­tion. She be­came in­fec­tious while in school and 28 of her class­mates had to be ex­cluded and screened for Covid-19, said Dr Fal­lon. It turned out none con­tracted the virus but they were out of school for 14 days.

In the past week, the hus­band of a health worker de­vel­oped symp­toms, which he put down to get­ting the flu vac­cine. How­ever, both he and his wife tested pos­i­tive for Covid-19.

Then there are the work­ers who pool cars each day. Dr Fal­lon could go on. She and her team were deal­ing with 10 cases in Septem­ber. That dou­bled to 24 cases per day and on Fri­day there were 87 cases on their list.

There are so many ways the es­ca­lat­ing virus has man­i­fested it­self to the public health teams around the coun­try.

For the past two weeks, the chief med­i­cal of­fi­cer Dr Tony Holo­han, has warned with ever-in­creas­ing ur­gency that Covid-19 is get­ting worse.

“All of the ma­jor in­di­ca­tors of this dis­ease have got­ten worse — our con­cern is get­ting greater and faster,” he said a week ago af­ter the Gov­ern­ment re­jected the Na­tional Public Health Emer­gency Team (Nphet) ad­vice to move the coun­try to Level 5 lock­down.

On Fri­day, he warned that the virus was “not in con­trol”, its tra­jec­tory was rapidly de­te­ri­o­rat­ing, and he pre­dicted a po­ten­tial 2,500 cases a day by the end of the month.

His alarm­ing pre­dic­tions are based not just on maths and mod­el­ling, but on the vi­tal work of public health doc­tors who in­ves­ti­gate the sources of the es­ca­lat­ing out­breaks that have brought the coun­try to the brink of lock­down.

In the mid­lands, teams of public health doc­tors are deal­ing with out­breaks in seven schools per day as the virus rips through com­mu­ni­ties.

“We had no in­ter­ac­tion with schools in the first week of Septem­ber,” said Dr Fal­lon.

Then the out­breaks started — small at first. Ini­tially, they screened about four schools a week, that in­creased to 13 schools screened for the virus last week­end alone. In the past seven days, they have been screen­ing about seven schools a day.

Ac­cord­ing to Dr Fal­lon, the in­fec­tion rate in schools is around 2pc — less than in the wider com­mu­nity. Of the 8,606 staff and stu­dents in 354 schools that have or are be­ing screened, 172 have tested pos­i­tive. “We try to de­ter­mine what the case is linked to, whether it is some other source, and they in­vari­ably are,” she said.

They have found that chil­dren usu­ally pick it up from some­one in their home or com­mu­nity en­vi­ron­ment — an older rel­a­tive who’s been to a party for in­stance.

“We are not find­ing ma­jor trans­mis­sion in the schools, a lit­tle but not much and that is con­sis­tent with the in­ter­na­tional pic­ture,” she said.

The spread, it seems, is hap­pen­ing in com­mu­ni­ties, with young adults as the pri­mary driv­ers. Ac­cord­ing to Dr Fal­lon, peo­ple in the 19 to 24 age group are ex­tremely mo­bile and so­cial and, she said, “suf­fered” a sig­nif­i­cant im­pact on their health un­der the last lock­down.

The list of peo­ple with Covid-19 dis­patched to public health cen­tres each day gets longer and the con­nec­tions be­tween those peo­ple has be­come in­creas­ingly labyrinthi­ne. At the De­part­ment of Public Health in Gal­way, public health teams trace the com­plex cases of Covid-19, track­ing the virus as it seeds from one per­son to next.

Two weeks ago, Dr Breda Smyth, HSE di­rec­tor of public health for Gal­way, Mayo and Roscom­mon, and her team linked 30 cases of Covid-19 back to one cou­ple’s week away, the virus mush­room­ing al­most ev­ery­where they went.

Yes­ter­day, Dr Smyth said in the past week 100 peo­ple who were in­fected with the virus all con­nected back, through var­i­ous com­plex routes, to one source.

The ex­po­nen­tial growth in the virus con­trasts with re­search pub­lished by the De­part­ment of Health that shows in­creas­ing anx­i­ety and a de­sire for more re­stric­tions. But there is a time lag, said Dr Smyth. The cases that public health doc­tors have been in­ves­ti­gat­ing for the past week prob­a­bly seeded 10 days be­fore that.

Trac­ing the virus is com­plex. When lock­down lifted, busi­nesses were open, peo­ple were mov­ing. “If they are in­fected, they are bring­ing the virus with them,” Dr Smyth said. “We are see­ing very com­plex out­breaks that in­volve a lot of con­tacts.”

Peo­ple of­ten don’t know they have it be­cause they are asymp­to­matic or pre-symp­to­matic and keep mov­ing. “We’re see­ing par­tic­u­larly trans­mis­sion into bars and restau­rants, when they were open, which led to fur­ther trans­mis­sion. It jumps across coun­ties and re­gions, de­pend­ing on where peo­ple are mov­ing to.”

She cited cases of fu­ner­als and com­mu­nion par­ties, where a rel­a­tive has trav­elled from an­other county, stopped at a re­tail out­let on the way, and re­turned to work in a su­per­mar­ket in a dif­fer­ent county again.

Right now, the virus is “out of con­trol”. It is re­pro­duc­ing at such a rate that “you can no longer con­trol it and it just takes off”, she said. “That is what’s hap­pen­ing in the last fort­night. There are too many mush­rooms.”

One of the most wor­ry­ing man­i­fes­ta­tions of the ex­po­nen­tial growth over the past two weeks has been an in­crease in out­breaks in nurs­ing homes.

“We are now see­ing

‘They bring the virus with them. We have out­breaks that in­volve a lot of con­tacts’

out­breaks in vul­ner­a­ble set­tings such as nurs­ing homes and we sim­ply do not want this to es­ca­late any fur­ther,” Dr Smyth said.

Dr Sarah Doyle, public health spe­cial­ist and the HSE’s clin­i­cal lead for the con­tact man­age­ment pro­gramme, said ris­ing case num­bers of the past fort­night in­cluded out­breaks in nurs­ing homes, in sports events and a marked in­crease in cases among the Trav­eller com­mu­nity.

The coun­try has moved into a “high phase” of Covid-19 and the con­tact-trac­ing pri­or­i­ties have changed. Now they look for on­ward trans­mis­sion: look­ing for its next vic­tim, as op­posed to hunt­ing out where it’s been.

Public health depart­ments con­tinue to in­ves­ti­gate com­plex cases. But the con­tact-trac­ing pro­gramme does not have the re­sources to keep up the de­tailed level of virus in­ves­ti­ga­tion it has been do­ing.

“We do ask if you were in con­tact with any­one who has symp­toms, and ad­vise them to get a test, but, yeah, we are in a phase now where the ca­pac­ity to do that for ev­ery case isn’t there. What we are try­ing to do is iden­tify the high-risk sit­u­a­tions and the linked cases,” Dr Smyth said.

As the coun­try faces an­other lock­down, public health doc­tors sur­vey the wreck­age of Covid-19 from a van­tage point few can en­joy: they can see the hu­man be­hav­iours that clear a path­way for the virus to grow and mul­ti­ply.

Dr Doyle said: “What­ever level it is, to me this is about peo­ple un­der­stand­ing what is re­quired of them. I think one of the con­cerns is whether peo­ple were com­ply­ing with Level 3. If I have Covid-19 now, am I spread­ing it? And how many peo­ple will I spread it to?”

As de­bate fo­cuses on the po­ten­tial move to Level 5, Dr Doyle be­lieves these are ques­tion ev­ery­one should ask them­selves.

Dr Una Fal­lon

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