Doubts cast over Ireland's Covid-19 testing and contact tracing system

Fresh doubts have arisen over Ireland's Covid-19 testing and contact tracing system.
Doubts cast over Ireland's Covid-19 testing and contact tracing system
Irish defence force cadets assisting in contact tracing

Fresh doubts have arisen over Ireland's Covid-19 testing and contact tracing system.

Those who test positive for Covid-19 are supposed to be contacted by someone from Public Health to inform them of their result, and to begin contact tracing.

However, concerns have been raised previously over the speed of Public Health's tracing, with some GPs saying they received test results before their patients.

Now reports are emerging that GPs and patients alike are waiting days to be informed of their results, even in priority cases.

A concerned daughter has told the Irish Examiner how her mother, a cancer patient, waited 12 days for a result and was never contacted by Public Health.

Aoife O'Donoghue says her mother, who lives in Monaghan, was referred by her GP for a test on April 24.

Her mother was tested later on that day at Cloghan testing centre.

"She was told she'd have her results in three to seven days and her GP would be in contact," says Aoife.

However, Aoife says her mother only received a positive result after family members made contact with the National Virus Reference Laboratory themselves.

"Mam rang her GP on April 29, and (the GP) hadn't heard anything back from the lab at that stage.

"Dad and my sister rang the National Virus Reference Laboratory (NVRL) a couple of times over the weekend but couldn't get through. Dad eventually got through to the NVRL on Monday afternoon (May 4).

"So Dad obviously explained the situation to them, that they had received no results after 12 days. They located her test results for him and they told him that she had tested positive for the virus.

"They said that her number must have been taken down incorrectly at the testing centre, as they had tried to contact her a few days earlier."

Aoife says she is not sure when her mother's results were processed, but it seemed like someone should have gotten in touch sooner.

"(The GP) didn't know about the results until my mother rang her, after she got the diagnosis. She's a good GP who knows Mam really well, and she would have contacted her straight away if it was her responsibility."

Aoife says she was shocked that it took so long for her mother's results to be obtained.

"I was thinking that if it was taking so long to get results back they must be negative. I thought as a high risk person, she would have gotten results quickly.

"It's also hard when she's going through chemotherapy to know what are side effects and what aren't, so we weren't sure what to think."

However, Aoife is currently living in Galway, and she wasn't seeing the day to day reality. "My Dad, my sister and her husband and their two kids, who are two years old and four weeks old, live in the house.

"They could see that she was really sick, which is why they started putting the pressure on to hunt down the results.

It's very scary for them at home because it's difficult to self-isolate while caring for children and a sick parent. We're angry about the situation too, and feel let down by the system.

As for her mother, Aoife says she was relieved to have finally gotten an answer. "I think she has so much to think about at the minute that she's trying to keep the frustration at bay, but it has definitely annoyed her. It's also left her in a very uncertain place with regards to her upcoming treatment.

"She's going to ask to postpone the treatment until she builds her strength up a bit again."

After the result turned out to be positive, the rest of the family members living in the house were tested.

"My sister rang the HSE helpline [on Wednesday May 6] and they were horrified at the situation and are trying to help them now as much as they can. My sister says she's helping them do the contact tracing.

Dr Nick Flynn of MyCorkGP
Dr Nick Flynn of MyCorkGP

A Cork-city based GP has raised similar concerns about contact tracing.

Dr Nick Flynn of MyCorkGP says he referred a nurse for testing and after five days, he tracked down the results himself as he was concerned the process was taking too long.

"I referred a patient for testing on Tuesday April 28. I flagged it as urgent as she was a nurse. She was tested after lunch time that Thursday in Páirc Uí Chaoimh, so that was a 48 hour delay already."

After hearing nothing over the weekend, Dr Flynn logged into his computer system on Monday May 4 to see if the results had been made available to him. "I could see other results coming in, from people who had been tested on the same day."

On Tuesday May 5, Dr Flynn tried to ring the National Virus Reference Laboratory's results line, but was left on hold as too many people were trying to get through. "It was very frustrating. There is no queuing system, you just have to keep ringing."

Dr Flynn kept ringing the NVRL number and got through to a Covid-19 call centre. "The person on the other end of the phone was very pleasant, but totally unable to help me. I asked if they knew where the test was, but they could not see where it was taken to be [analysed]. They said they could see it was received on April 28, but that was when I referred my patient for testing, not when the testing had been done."

Dr Flynn asked could he augment the situation to a critical incident as the patient was a nurse. "I asked if I could speak to a supervisor, but they didn't know who their supervisor was. They told me I'd get a call back."

Dr Flynn assumed the results were in a lab close to where the test occurred, and he eventually tracked them down in Cork University Hospital's microbiology unit. "They told me they had passed the result onto Public Health on Friday May 1. This was now Tuesday afternoon, May 5."

Dr Flynn rang his patient immediately to inform her of her result. Public Health had not yet been in contact when he rang.

Dr Flynn says he got a call back from the National Virus Reference Laboratory on Tuesday afternoon, after he had found his patient's results.

They told him the number he rang that morning connected to a Covid-19 volunteer call centre, and the NVRL did not have governance over it. "But they had access to [some] of their data."

He was also told that there are now many labs processing coronavirus tests and it was not possible to see which lab each swab is sent to.

Dr Flynn says for the easing of restrictions to work, the testing and contact tracing system needs to be efficient, robust and deliver next day results.

"[Situations like these] are not common, but it is worrying it is happening at all. We receive up to ten results a day. We are sometimes the first person to contact the patient when their results come in."

Mr Flynn believes that GPs receive the test results electronically, while Public Health contact tracers have to print off a list and work their way through it daily, leading to potential delays.

"We are not there yet in terms of contact tracing. There is no agency or department which has oversight over all of the tests. No one I spoke to was able to say 'ring this number and they will get you the test results'.

"I don't even know who to go to, to make sure this doesn't happen again."

In a statement, the HSE said they were now using 43 laboratories to process Covid-19 tests. 38 are hospital labs and five are community diagnostic testing laboratories.

The HSE said they were awaiting a response on whether contact tracers can see which lab each swab is sent to.

"All contact tracing would normally be carried out by Public Health (PH) departments, but given the scale of the challenge presented by Covid-19, the HSE has established a number of contact tracing centres, to support the PH departments.

"Contact tracing can be routine or complex. The complex cases, such as residential care settings, healthcare workers and outbreaks are managed by PH departments. The routine cases are managed by the contact tracing centres.

"The length of time to notify a person of a positive result varies, but for routine cases it will usually occur within 24 to 36 hours of receipt of the lab result. Each person will receive five phone calls each, one hour apart, with the fifth call being the next day in the attempt to contact the person.

"There are a number of cases where the lab result does not have a valid contact number. The HSE uses a number of different techniques to try and source the number, and is successful most of the time, but this does slow the process of notification.

"Where a valid number does not exist, but there is a valid address a letter is sent to the person asking them to contact their PH department.

"GPs will usually be notified of the test result before the HSE can notify the person tested. The notification to the GP happens at the same time the HSE is notified of the lab result. "The HSE then has to manually review the file and clean the data before it can be uploaded onto the Covid Care Tracker, for contact tracing to commence."

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