GPs see worrying trends at ground level as virus takes hold again in communities
Doctors battling against wilful ignorance of the serious risks,
MARTIN Coyne wasn’t going to sit around and wait for Level 3 restrictions to quell the rapidly rising tide. The “tsunami” of infections that had started to stream through the door of his Donegal GP practice two weeks ago was continuing to rise, only now it was spilling over, into the group it has the potential to damage the most.
“This is classic stuff,” he says. “First we had the social gatherings and that was the young people. They got it, they were asymptomatic, and they started to spread it to older relatives, or we had young people and carers bringing it into other settings. That’s where we are at, two weeks into Level 3.
“We have had about 98 positives in the last three weeks and the first half of those, about 50pc, were less than 35 years old. From the second half of those cases, who we have seen in the last 10 days, about 25pc are over 60. Now that we have community spread, the average age is going up and that’s the worrying part. That’s where the pathology is going to be.”
Since the Lifford/Stranorlar district where Dr Coyne’s practice is based was declared a Covid hotspot two weeks ago, the impact of Level 3 restrictions have not yet had full effect. Before the move from Level 2, the 14-day Covid incidence rate in the district was the highest in the country at 336 per 100,000.
The latest Health Protection Surveillance Centre (HPSC) figures for the 14 days up to Monday, October 5, show that the rate of infection in the area per 100,000 was 602.6.
Dr Coyne didn’t sit on his hands. Frustrated at the lack of local compliance, particularly with regard to the wearing of masks, this week he wrote a letter to local business owners, asking them to implement a “no mask, no service” policy.
Separately, having recognised that tracing is taking too long through overwhelmed public health channels, himself and his colleagues are doing it themselves.
“GPs can’t just sit around and do nothing in the face of this,” he said.
“And it’s not just with the masks and the tracing. The other issue is the people who just will not isolate when they need to. There was a phonecall this week to the practice about a family who were supposed to be isolating but they were out and about, calling taxis, going to Strabane to do their shopping, with not even a mask on. That’s what you are up against.”
Establishing where the virus is now is a task that has been undertaken by David Higgins, an economist with data analyst firm Carraighill, who has been following the statistical trends.
Alongside Donegal, he says, Cork is “becoming a big problem”.
“Cork is a county that would have joined Dublin and Donegal in Level 3 if the county-by-county approach was still being taken,” he says
“If you go back about a month ago, Cork’s incidence rate was only about 11 per 100,000. Last week it was 62 and now it stands at 105. There have been 571 new cases in the past few weeks and on October 3 alone there were 55 new cases.”
Cork GP Dr Ronan Boland is at the coalface of the recent surge. Like his colleagues in other parts of the country, after a quiet summer he is now dealing with rapidly increasing numbers of Covidpositive patients.
“I’m very worried,” he says. “I think all GPs are worried. This virus is now circulating in our community. We have a ten-fold increase in the space of two or three weeks and there is very little to give me confidence at the minute that the rate of increase is going to change over the next two or three weeks. I hope I am wrong, but I’m not convinced that Level 3 restrictions can put a stop to this.”
Much like the experience in Donegal, GPs in Cork are struggling to get patients to realise the risk they pose to others if they do not isolate at home while they await results. Others believe that a negative test result automatically means they aren’t infectious.
“People are not heeding the message that if any member of a household is awaiting testing they need to stay at home,” says Dr Boland.
“Instead, people are carrying on as normal. For close contacts of confirmed cases, people are wrongly taking the view that if I’ve had a negative test, I’m in the clear. In reality, you have to isolate for 14 days whether negative or not.
“A colleague of mine recently called a patient to inform her of a negative case and she was in the shopping centre with the kids.”
A degree of complacency, says Dr Boland, has set in, leading to a growing number of patients “bringing Covid home and infecting their own families”.
Such is the scale of spread within the community, there is now a very real fear that public health teams are overwhelmed.
“This is really starting to rear its head,” he says. “For every one case you have, you have several more possible contacts, family friends, teachers, all have to be contacted.”
It’s a “constant battle” to get patients to understand the risks they pose to others, he adds. One colleague had a patient who returned from a non-Green List country after undergoing liposuction, asking to come into the practice to have stitches removed having not quarantined. Another fellow Cork GP had a patient who was told by their boss to keep
coming to work despite a colleague, deemed a close contact, testing positive.
“I have looked at the numbers in Dublin and Donegal and I’m not convinced that Level 3 has turned the truck around,” says Dr Boland. “We are dealing with something that is now embedded in the community and spreading. There are too many fires to put out at once.”
In Monaghan, where the latest data shows that there are 226.44 cases per 100,000 people, an incidence rate that is coming close to Donegal, GP Illona Duffy is coming close to tipping point. Having dealt mainly with outbreaks in nursing homes and meat plants in April and May, where clusters could be dealt with in a targeted fashion, community transmission is posing a much bigger challenge.
“It was easier when it was in a factory because you could send all those people home and isolate them. It’s in our community now and it’s harder. Over the last two weeks we have just seen cases rising and rising. It’s become a real problem,” she says.
In line with similar trends in other hotspots, the cohort now affected is mainly the older age group.
“Initially it started with a younger age group,” she says.
“We were able to trace it back to travelling over the Border or socialising locally and being out together, but we are now seeing rising cases in older people.
“What we are seeing now is that each case has more close contacts, and more close contacts becoming infected. Earlier this year, people weren’t in touch with each other, they were staying in, so if one person did get it you don’t see it spreading to the same levels as it is spreading at the moment.
“The way things are at the moment, if we want to have a Christmas where we can spend it together with families, we need to dampen this down now.”