Covid-19: First case of community transmission in Ireland had 780 contacts

The first community transmitted case of Covid-19 in Ireland had 780 close or casual contacts, it can be revealed.

The case was detected at Cork University Hospital (CUH) in March this year.

It has since been revealed that the patient in question had presented with symptoms at CUH four days before any cases of Covid-19 were confirmed in Ireland.

Following confirmation of those first imported cases, hospital staff decided to test the patient in question, outside the national guidelines in place at the time, and the test came back positive.

Sources in public health said because the case was undiagnosed for a time, a total of 780 contacts were identified and traced, but the source of original transmission has not yet been detected.

Those 780 close or casual contacts consisted of household, family and social contacts, as well as healthcare workers and patient contacts, as the patient had spent time in the emergency department prior to diagnosis.

Contacts were also detected in the patients’ GP clinic, where the patient originally presented with symptoms.

A source in public health explained that all contacts were contacted.

“Most were advised as casual contacts – no need to restrict movements but to be aware and look out for any Covid-19 related symptoms for 14 days from the date of exposure.

“Household contacts are by definition close contacts and some hospital contacts, both healthcare workers and patients, were also close contacts,” they explained.

A report on the case published by CUH earlier this year explained that a male patient presented at CUH on February 25, four days before the first reported case of Covid-19 in Ireland.

The patient presented with a cough and a headache, and required ventilation but had no history of “recent travel abroad or unusual exposures”, according to the report.

The decision was made to test the patient for Covid-19, outside the national guidance that was in place at the time.

However, the report notes the test resulted in a “crucially important diagnosis” as it came back positive.

The report also revealed that tracing is ongoing but that so far, the source of transmission, in this case, has not yet been detected.

“This had implications for management, prognosis and family contact-tracing,” the report said.

From a hospital perspective, it allowed immediate staff and patient contact-tracing and isolation to commence.

“Thus far there have been a number cases of onward transmission from this index case including healthcare staff and patient contacts,” the report adds.

This case had “far-reaching implications” on the wider epidemiology of Covid-19 in Ireland as it provided evidence of community transmission in spite of only six imported cases having been reported nationally at time of diagnosis, the report explains.

The case also resulted in immediate changes to the Covid-19 testing algorithm and led to further cases of community transmission being detected.

The report claims the case and its response informed the national response to Covid-19, “which has suppressed the curve and saved countless lives nationally”.

This case also highlights the importance of clinical judgement in deciding appropriate clinical investigation and management, it adds.

“In an unprecedented moment in the history of modern medicine, where evidence-based guidance and high-quality clinical trials are lacking, individual clinical acumen and reasoned decision-making are more important than ever,” the report concludes.

CUH and the HSE were contacted for comment.