Ireland’s first national Covid lockdown was announced by then taoiseach Leo Varadkar on March 27, 2020. But by then the man responsible for infection control in Irish prisons had not only been warning his colleagues about this new virus for three months, but had also persuaded his boss to allow him to buy truckloads of personal protective equipment (PPE).
Nationally, we have lost almost 8,000 people to Covid. Incredibly, though, just one person in an Irish prison has died from the virus, an extraordinary record compared to prisons internationally. This week, there were around 4,200 people in Irish prisons.
Just before Christmas 2019, Emmett Conroy, national infection control manager at the Irish Prison Service (IPS) told his immediate boss that this virus coming out of China was something they needed to be concerned about. His boss listened to him. If you heard Emmett talk you would understand why.
Emmett had been at home watching news bulletins about a new
pathogen identified in a Chinese city, which said it had originated in a bat and transferred to humans. Then it was turning up in places outside of Wuhan. He remembers thinking about all the people who fly regularly between China and Ireland, indeed from China to the rest of the world. He listened carefully to the details of the incubation period and how the numbers were rising. Then it started turning up in other countries.
“I thought to myself, we are in trouble here,” he says.
Ireland has its first Covid case on February 29, 2020, but the first positive case in a prison setting, so tightly knit and with a vulnerable population, was not until an incredible eight months later, on October 28.
When you look up the word ‘perspicacity’ in the dictionary the definition is “having a ready insight into and understanding of things”. Emmett clearly has that in spades, but he also has the respect of colleagues to ensure that when he speaks they listen. Not many people could speak so passionately, and manage to hold your attention, on the best way to clean prisons and how to break a chain of infection. Emmett, who has a masters in healthcare infection management from Trinity and who trained as a nurse in the UK, can.
He’ll engage with you on how a flat-head mop, which is “positively charged”, is the only one to use on floors. None of your string head ones, spreading infection with every swipe. Take the Midland Prison. It has over 1,000 prisoners and 500 staff, meaning there are around 15,000 daily “walking throughs” there.
A while back, Emmett organised that groups of prisoners be trained up on how to clean industrially. They are awarded ‘clean pass’ certificates. When they leave prison, they can get jobs in this sector. One has already set up his own cleaning company.
The approach of the IPS to infection control was not always so
impressive. Much of the transformation and openness to change is a result of previous tuberculosis outbreaks. A 2011outbreak in Cloverhill Prison led to claims from prisoners and prison staff and cost the State €5m in compensation.
As straight-talking Emmett tells it, the State Claims Agency told the IPS to get its house in order. A comprehensive infection control module was introduced for all staff. When Covid-19 arrived, a specific module incorporating use and removal of PPE, as well as an understanding of the virus was designed and delivered to all staff.
It was late December 2019 when he had first spoken to John Devlin, IPS clinical leader, about the Wuhan situation.
“I was blessed with him. He got it straight away,” says Emmett. He also mentions Fergal Black, director of care and rehabilitation, who “supported me on every level”.
He remembers how even the PPE suppliers were “laughing” at him at that early stage. It had only been New Year’s Day when IPS director general Karen McCaffrey gave him the purchasing go-ahead.
“When I put mind to it I’m full metal jacket so she believed me… I bought every FFP mask I could find, gloves, aprons, gowns, shoe protectors.”
A Covid training module was put together.
The prison officers thought I was a lunatic. I told that them in six months time it’s going to be a different world.
He could not stress more the “vital” importance of the training everyone received on the putting on and taking off — donning and doffing — of PPE. There is no instance of an IPS staff member picking up Covid from this, unlike virtually everywhere else.
He waxes lyrically about getting buy-in from staff and prisoners, as well as the importance of the Red Cross community-based health in prisons programme. Prisoners become special-status Red Cross volunteers, and then peer educators. They educated the rest of the prison population on things like hand washing, distancing, respiratory etiquette, cleaning of cells.
“Prisoners don’t listen to me, they listen to other prisoners,” says Emmett. He explains how, back at the beginning, he attended inter agency meetings that were “pre Nphet” along with agencies such as the Garda National Immigration Bureau, the Defence Forces, and the HSE. He did share there what he was doing, but knew that, largely, “they thought I was mad”.
In future, he believes there should far more inter-agency co-operation, as well as the sharing of resources. He has a very good contact in An Garda Siochana who “gave me a source for gloves and one for masks. I rang him yesterday and told him what I’m doing for this winter.”
A key reason for the Covid success in prisons was the contact tracing model
introduced. Unlike in the outside world, the process kicked in as soon as someone showed symptoms, rather than after they tested positive. Contacts of probable cases were immediately quarantined. Over 240 prison officers were trained as contact tracers.
“They would press play and go through camera after camera looking at footage,” says Emmett.
The prestigious Journal of Public Health published a paper on the IPS approach to Covid in June 2020 and this was submitted to the World Health Organization.
“Our contact tracing model is being used across the world. At one stage, I was on a Zoom call with 123 countries explaining it,” says Emmett.
It’s too easy to imagine the work he could have done elsewhere if he’d been let loose. As someone who worked in nursing homes in his youth, he’d love to have been able to share his expertise in that sector.
Emmett has a presentation which has one slide on prisoner Covid deaths that stops you in your tracks. The top line states that worldwide, in 47 countries, there were over 3,941 deaths. In England and Wales, there were 195 deaths, 3.3 times the rate of death among people the same age and gender in the general population. In Ireland there was one death — a tragedy, but a success story for prisons which are clearly particularly vulnerable settings with prisoners a high risk population and living cheek by jowl.
“We had one death and that was one too many but other prisons across the world had hundreds,” says Emmett. “That first case of ours was Delta but when Omicron arrived there was no stopping it. Now if someone is positive only a cellmate is deemed a close contact.”
He pays tribute to the staff in his office who worked so hard over the last few years.
“No one in my office took a sick day in all that time. Without all the staff doing what they did and without prisoners buying in we would have been screwed. Prison nurses swabbed 18,000 prisoners, and every prisoner that came in they went and assessed them for Covid, as well as doing their regular job. And it was very tough on prisoners — the lockdowns and restrictions on visitors.”
What about this winter? What advice does the IPS infection sage have for the coming months?
He already has heaps of gloves, masks, aprons and gowns on order. Depressingly he is preparing for the possibility of “a multi-pathogen winter” where you have “Covid, possibly a new strain of it, maybe along with influenza, always a threat of TB — all of these could be circulating at the same time — and don’t forget Monkeypox. Prison populations are always at higher risk.
“Hopefully we won’t need it but you don’t want to be caught with your pants down.”