Covid one year on: Frontline workers tell all after rolling lockdowns and infection waves

Just over a year since authorities confirmed the first case of Covid-19 in Ireland, healthcare staff at the Covid-19 coalface reveal their highs and lows

Dr Mary O'Mahony, specialist in public health medicine, HSE South, Department of Public Health at St Finbarr's Hospital, Cork. Picture: Denis Minihane

Over the past year, we’ve seen three waves of infection and rolling lockdowns, while our health service came under significant pressure in January and is still dealing with the third, more lethal, wave. Here, healthcare staff talk about their experiences.

Dr Mary O'Mahony: The Public Health Doctor

One year into the Covid-19 pandemic and staff morale among the country’s 60 plus public health doctors remains at an all-time low.

The specialist group of doctors has been crying out for more resources for over two decades and while threatened strike action was called off in January, it has not gone off the table.

The lack of resources and, at a basic level, an outbreak management system has hampered the ability of the frontline medics to keep on top of Covid-19, much to their frustration.

Across Cork and Kerry, the regional public health team has managed over 1,100 viral outbreaks in hospitals, schools, nursing homes, direct provision centres, workplaces and other settings.

Dr Mary O’Mahony, one of five public health doctors working at the Covid-19 coalface in the Cork and Kerry region, said the IT system in place to manage outbreaks — the Computerised Infectious Disease Recording (CIDR) system — is “not fit for purpose” and continues to impact on the public health response.

 “It is very slow. Just putting up one case can take a quarter of an hour and if you’re trying to put up 100 or a thousand cases, there aren’t enough minutes in the day. 

We have a surveillance system that can look at trends but we have no information system for our response and control activities.

One outbreak last summer at a workplace with more than 500 staff, 23% of whom tested positive, illustrated how quickly the virus could spread as it reached into several local towns and was linked to 20 household clusters and other workplace outbreaks. 

The arrival of the more infectious UK variant before Christmas also showed how quickly the picture could change.

“As a country we were among the best in class internationally for most of 2020 but over Christmas and the new year unfortunately we became the example of how things can change for the worst and very quickly,” Dr O’Mahony said.

Comprehensive contact tracing was possible in the first wave when public health departments were strengthened through the redeployment of public service staff. 

That boost, however, was short-lived as staff returned to their posts in May and June last year.

“Supports that we built up in the first surge were all removed so you’re trying to build it up again and retrain, supervise, and support staff, it’s like we’re back to square one,” she said.

While more surveillance staff are being recruited, a lack of clinical staff means that bottlenecks remain, as does the pressure.

We are working at a pace and at a level that is not sustainable.

The failure of Government to deliver on commitments to recognise public health doctors as medical consultants at a time when they were needed most was a “slap in the face”.

“Staff morale is pretty low and colleagues are very frustrated. It has been hard to be a public health doctor in the past year.

We are the experts, the first line of defence, but we have struggled to be utilised to the extent we should be or to be listened to. 

"In the midst of a pandemic, what we do is neither appreciated nor respected,” the frontline medic said, adding that recruitment difficulties will persist unless the consultant status issue is addressed.

Looking to next year, Dr O’Mahony said keeping on top of Covid-19 variants and maximising vaccine uptake will be key to getting back to any form of normality.

“Viruses evolve and mutate so there will be new variants. I think we will be managing coronavirus and keeping it under control for the foreseeable future.”

Dr Diarmaid Quinlan: The GP

The arrival of Covid-19 last year brought significant challenges for the health service but also brought some positive change, such as telemedicine, that could stay with us into the future.

That is according to Glanmire GP Dr Diarmaid Quinlan, one of hundreds of GPs across the country dealing with Covid-19 on a day-to-day basis for the past year.

Dr Quinlan, who is also medical director of the Irish College of General Practitioners (ICGP), said lockdowns and the widespread use of telemedicine were “alien” concepts a year ago, but have now become the norm.

GP Diarmaid Quinlan is based at Woodview Family Doctors in Glanmire, Cork. Picture: Eddie O'Hare

“I remember in our practice looking at what was happening in Wuhan and saying to each other ‘imagine if they tried to lockdown a county town like Fermoy, Bandon or Mallow here?’ The concept that we could lockdown a whole country was completely alien to us,” he recalled.

Very quickly we saw what was happening in Italy where trucks were coming at night to take away dead bodies. It really brought it home to us at a very early stage.

The health service, he said, responded quickly to the emerging threat and ensured GPs had access to personal protective equipment or PPE and “begged, borrowed, and stole” to make sure that PPE was available to train staff in how to use it. 

When infection levels “exploded” in January, GPs were dealing with tens of thousands of Covid-19 test referrals every week, each one requiring a consultation to ensure other illnesses were not missed.

“From mid-December to the end of January, there was a massive pressure point and it was particularly difficult,” he said.

The virus also came closer to home when his son tested positive before Christmas, meaning Dr Quinlan had to work from home for a period, which put an additional burden on the six-doctor practice.

The past year of going from crisis to crisis has left many staff feeling burnout and they will need time and space to recharge their batteries, he said.

Staff working in retail and other essential services, he said, should also be recognised for the valuable contribution they made to keep society functioning over the past year.

As a society we have pulled together. Everyone has had a role to play in this. It shows how resilient people are in the face of a global crisis and how they pulled together when needed.

In his practice, he could see first-hand the challenges that some people testing positive for Covid-19 faced because of cramped living conditions.

“We have had patients where there are eight people across three generations sharing a three-bedroom house. That’s the challenge that some people face; if one of them gets Covid, essentially, the whole house gets it.

“Covid-19 discriminates against existing disadvantaged groups, where people are living in overcrowded conditions and where they simply cannot self-isolate and inevitably the virus spreads,” he added.

Given the scale of the crisis and the social and economic impacts across society, he anticipates a “substantial” burden on mental health.

We are certainly aware of the increase in mental health challenges that people are facing and we are seeing substantially more of that.

The rollout of vaccines one year into the pandemic, however, marked a significant milestone and GPs were ready to play their part, he said. 

Vaccines will pave the way for society to reopen and for people to reconnect, he said, with patients warmly welcoming their rollout and saying ‘bring it on’. 

“We will deliver this on time and on schedule in a safe environment for patients,” he said, adding that “speed matters” and he expects the rollout to scale up substantially in the second quarter of the year.

Linda Heaney: The hospital housekeeper

Housekeeping staff at Cork University Hospital have been to “hell and back” over the past year and should be acknowledged for their contribution.

That is according to Linda Heaney, one of the 300 strong housekeeping team at the hospital, who were plunged into the middle of the Covid-19 action for the past 12 months.

“I’ve been there nearly 20 years and it has been the hardest and toughest year I’ve ever put in in my life,” Ms Heaney said.

Linda Heaney, one of the 300 strong housekeeping team at Cork University Hospital. Picture: Larry Cummins

At the outset of the pandemic, a fear of the unknown gripped staff but by the second wave they were more prepared and knew what to expect.

The third wave, however, proved to be the most challenging and “scariest” experience to date.

The third wave was totally different. It was the scariest of them all. People were sicker, there were a lot more admissions, almost every ward in the hospital had Covid. It was horrific.

The importance of hygiene in infection control meant that their workload “quadrupled” and put “huge pressure” on staff.

Rooms had to be deep cleaned for every suspected case of Covid, which required housekeeping staff to don and doff PPE several times in a shift.

There were times that she felt “terrified” by the scale of Covid-19 infections and seeing colleagues fall ill, but she never felt unsafe in her work at the hospital.

The third wave in January, she said, left staff “broken” and emotionally and physically drained.

“I never saw my colleagues like this before; this absolutely floored anyone working at the hospital.

There were times where I went to my car and cried and asked myself ‘how am I going to get through this day?’. How can I keep going? It’s so mentally and emotionally exhausting. 

While infection levels are falling, staff are also conscious that the virus is not yet under control.

“The pressure is easing and we can breathe a bit more now but the virus is still there. It has not gone away and people need to realise that.” 

Working at the hospital at the height of the third wave also impacted on family life, especially as her husband also works in housekeeping in the emergency department.

Concerned over the scale of infections, Ms Heaney's teenage son stayed with family for three weeks as an extra precaution.

“It was only after we both got the second vaccine dose and that numbers were falling that he came home, as we felt it was a bit safer,” she said.

While there was great comradery among staff at the hospital throughout the crisis, there was little recognition of their contribution at government level.

Frontline support staff had proven their worth throughout this pandemic and should not face a job evaluation process linked to a pay increase.

The Government need to scrap the job evaluation process for support staff. They’ve seen what we’ve done. They’ve seen us go in day in and day out for the past year and I don’t think we should have to sit in an interview to prove that we are worth paying.

“We don’t want a round of applause. We want the Government to acknowledge our contribution and pay us what we are worth,” she added.

On a personal note, Ms Heaney is hoping that by this time next year she will be able to sit down with friends and family and maybe even enjoy a hug.

“The pandemic has opened people’s eyes and brought us back to the simple things in life.

“With the vaccine there is massive hope and we may not be back to normal, but we’ll definitely be in a better place next year.” 

Siobhán Kennedy: The healthcare assistant

The risk of contracting Covid-19 changed how healthcare assistant Siobhán Kennedy and her frontline colleagues have worked and lived over the past year.

It not only meant donning and doffing personal protective equipment (PPE) at work, but also impacted on family life and the time she shared with her children and grandchildren.

While Cork University Maternity Hospital, where she works, did not feel the brunt of Covid-19, it did impact on staff and patients, in particular Covid-positive expectant mothers whose partners could not attend during delivery.

Siobhán Kennedy, healthcare assistant at Cork University Maternity Hospital. Picture: Denis Minihane

“We have Covid rooms for mothers who are Covid- positive. They would be isolated, making it a very lonely experience for them,” she said.

As the pandemic took hold, staff were fearful of the new and emerging threat and took extra precautions to keep the virus out of their homes.

At the beginning we were very frightened because it was the unknown. We were scared of bringing the virus home to our own families.

At work, Ms Kennedy and her colleagues have adjusted to a new normal of dining alone at lunchtime and limiting any social interactions because of the inherent risks. 

Healthcare staff have stepped up to the plate to take on new roles when needed, such as manning a new tented reception area outside the maternity hospital, where patients and visitors are screened before entry.

The recent surge in Covid-19 infections, however, did take its toll on frontline staff, who Ms Kennedy said should be recognised for the contribution they made during the public health crisis.

Instead, healthcare assistants in the southern region have yet to receive agreed pay increases, while other support staff are facing a job evaluation process to secure a pay rise.

“We shouldn’t have to prove ourselves. I think we have proven ourselves and shown that we are capable and can step up to any measure that is required.

We got hand-claps but we got absolutely nothing beyond that. We’re not doing our job to expect a bonus but it would be nice to be appreciated.

In terms of home life, working on the frontline has also meant limited contact with her children and grandchildren over the past year, although she is now “delighted” and feels a bit more relaxed having received the Covid-19 vaccine.

The rollout of the vaccine to most healthcare staff has come as a “comfort” given the significant number of staff that became ill and had to take leave at the height of the third wave.

“We’re not out of the woods yet but I think it is getting a bit better. Because of the vaccine the amount of sick leave within the hospital has fallen a lot. Two months ago, an awful lot of staff were out because of Covid-19,” she said.

By next year, she hopes the country will have returned to some form of normality, although she cautions that everyone will have to continue adhering to public health measures and wearing masks, socially distancing, and washing their hands.

“Putting on your mask is like putting on your jacket or your coat at this stage. It’s like getting dressed; everyone should be putting it on straight away,” she said.