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How the new restrictions in Donegal are highlighting the lack of cross-border co-operation on Covid-19

The Level 3 restrictions in Donegal highlight the lack of on-the-ground co-operation along the border.

Derry, which sits alongside the border, has a high rate of Covid-19.
Derry, which sits alongside the border, has a high rate of Covid-19.
Image: Shutterstock/ronniejcmc

AS DONEGAL FACES new Covid-19 restrictions, healthcare workers and local politicians say on-the-ground co-operation to tackle the virus falls far short of what is needed. 

At the start of the pandemic, then-Taoiseach Leo Varadkar stressed that the virus knows no borders. Yet six months later there is little cross-border co-operation on testing, while locals say any agreement on guidelines is more ‘coincidence than co-operation’. 

As Brexit highlighted, many towns and villages crisscross the border as people move freely and easily between the two jurisdictions. This is no exception in Donegal, where Lifford and Stranorlar – worst hit by Covid-19 in recent days – sit close to the border with Tyrone and Derry. 

But outbreaks are handled separately, depending on what side of the border communities live on – with only limited co-operation in crucial areas such as contact tracing. 

Testing

Rapid testing, as health officials around the world have stressed, plays a key role in tracking and containing the spread of the virus. And yet where rates of the virus are high – in Donegal, Derry and west Tyrone – locals on each side of the border face a vastly different testing experience. 

In the south, people are being asked to call their GP for a test if they experience either a fever, a cough, a shortness of breath or a loss of smell or taste, with over 14,000 tests carried out in the last 24 hours. 

In Northern Ireland, access to tests has been widened in recent months after the early period of the crisis saw testing prioritise healthcare workers and other essential workers amid concerns about capacity and resourcing. But concerns remain about whether the system is currently fit to cope

Yet regardless of capacity or ease of access, people living in border communities must access tests in different places and under different systems. This is the case, for instance, in Strabane in Tyrone and Lifford in Donegal, which are separated only by a short drive over the River Foyle but have equally high rates of Covid-19. 

Indeed, to locals the differences between Lifford and Strabane are largely indistinguishable – with many crossing over and back every day.  

The gap in co-operation will be brought into stark relief by the decision to impose Level 3 restrictions in Donegal, where the worst-affected area of Lifford-Stranorlar has a 14-day incidence rate of 336.1 per 100,000. 

The average 14-day incidence rate in the Republic of Ireland is 74.1

Derry and Strabane in Tyrone also have one of the fastest-growing rates of Covid-19 across the North – latest figures put the seven-day incidence rate at 141 per 100,000.

Yet restrictions in those areas, alongside the rest of Northern Ireland, are currently much less strict than those under the Irish government’s Level 3 plans. In the North, households are prohibited from mixing but pubs and restaurants remain open. 

The Donegal restrictions will come into force at midnight tonight. Acting Chief Medical Officer Ronan Glynn met counterpart in the North Michael McBride today, with both asking people to “avoid all but necessary travel across the border”. 

“We realise that for those living in border areas this will not be welcome news but we must prevent further spread of this virus and we can only do so by working together to protect each other,” they said. 

Yet despite this appeal, little co-operation exists between healthcare staff on either side of the border trying to tackle the same virus – and potentially linked outbreaks.

download (1) The Lifford-Stranorlar area is one of the worst hit parts of the country. Source: Gov.ie

Dr Denis McCauley, a GP in Stranorlar, said that any kind co-ordination so far has been more “coincidence than co-operation”. 

On guidelines, risk levels and testing, there is “essentially no co-operation North and South”. 

“The incidence level in Strabane would be exactly the same as the incidence level in Lifford,” McCauley said, speaking to TheJournal.ie in advance of yesterday’s announcement strengthening Donegal restrictions.  

“That cohort of people do the same things every day and meet the same people.”

The lack of co-operation is not new. While there have been links forged in some healthcare areas in recent years – such as emergency cardiac care or in the treatment of children – at the level of primary care there is little to no interaction between services on both sides of the border.

Much of this is understandable when two distinct health systems co-exist on the same island. Apart from the separate jurisdictions, the difference between Ireland’s health system and the North’s NHS-led system make regular coordination in treatment and care largely impossible.

And yet some experts suggest an all-island approach is the only way the country can properly tackle the virus. 

“We should work within the structures of the Belfast Agreement, including the East-West one, to share and co-ordinate and plan an all-island medium and long-term strategy to deal with Covid-19,” Dr Tómas Ryan, a neuroscientist at Trinity College Dublin and an advocate of a ‘Zero Covid-19 strategy’, said this week. 

Contact tracing

Contact tracing is likely to come under greater strain in the days and weeks ahead, as the number of outbreaks and close contacts on both sides of the border multiplies. 

Public health specialists were used to co-operation on contact-tracing before the pandemic struck. Before, colleagues from the HSE and the Public Health Agency in Northern Ireland would have spoken a few times a month about infectious illnesses such as tuberculosis or meningitis. 

The pandemic has significantly scaled up those informal contacts. 

The level of co-operation is a significant change in approach from the last time both jurisdictions faced a such a large-scale threat from a dangerous, contagious disease. 

During the foot-and-mouth disease crisis of 2001, which threatened livestock and farmers’ livelihoods, the Irish government banned the importation of animal and dairy products from the UK, with cross-border travellers checked and some vehicles disinfected as they crossed from one side of the border to another.

Yet the experience of foot and mouth, some experts say, gave health experts at least some experience of what clinical tactics could be used to track and control the virus.

One local politician, Sinn Féin senator Elisha McCallion, said that while there’s a “degree of co-operation”, gaps remain in the contact tracing system. 

She praised the roll-out of the Covid-19 contact tracing apps north and south, hailed as a ‘world first’ for their ability to work together. 

But she also said that she’d written to the Minister for Health Stephen Donnelly about problems in border areas. 

She said that she was aware of a company in Derry who had an employee who lived in Lifford and tested positive for Covid-19. They were forced to carry out their own, informal, contact tracing after received mixed advice from public health teams about the sharing of data, she said. 

A spokesperson for the HSE said that under data protection rules, the Northern Ireland Public Health Agency “sends all cross-border notifications of confirmed cases and details of close contacts directly to the [HSE] Health Protection Surveillance Centre”. 

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This data is then forwarded to public health teams, before being uploaded to Ireland’s national Contact Management Programme platform for contact tracing. 

A “reciprocal” relationship exists for sending data to the North, the spokesperson said.  

irish-unity-march Supporters of Irish unity gathered on the Strabane-Lifford bridge in November last year. Source: Niall Carson/PA Archive/PA Images

High-level talks

There is a general consensus among insiders and officials that talks between high-level government figures have been productive and useful in recent months.

In April, in an early key moment that highlighted the scale of the pandemic, the two health departments here and in the North signed a memorandum of understanding ”to underpin and strengthen North South co-operation on the public health response”. 

But even at the political level, there are signs of missed opportunities.

While the Dáil’s Special Covid-19 Response committee has heard from experts around the world about how to tackle the virus since the start of the crisis, the Chief Medical Officer in Northern Ireland, Michael McBride, has not been one of those who attended.

Committee Chair Michael McNamara told TheJournal.ie that it would have been “very beneficial” to hear from him, but “time” was an issue. 

McNamara said he supported the idea that people should be able to get a Covid-19 test wherever there is capacity nearest them, regardless of the border. He suggested it was something the Oireachtas Health Committee might want to discuss.

TheJournal.ie understands that an invite has also been issued by the Northern Ireland Assembly’s Health Committee for Glynn and McBride to appear together at Stormont to take questions from MLAs. 

The Department of Health in Dublin did not respond to a request for comment when asked if an appearance was being planned. 

More locally, Donegal County Council said earlier this week that it worked closely with Derry and Strabane District Council and Covid-19 hadn’t changed this.  

“Donegal County Council and Derry City and Strabane District Council have a close working relationship and we work together at a number of levels and across a range of objectives for the cross border region. We continue to do so during this Covid pandemic,” a spokesperson said.

This morning, HSE CEO Paul Reid insisted there were robust links between staff north and south, but acknowledged there was more to do. 

“There’s very good relationships between our public health doctors and public health teams,” Reid told RTÉ’s Today with Claire Byrne. 

“There has been an overwhelming number of cases over there, which has overwhelmed the system for a period of time.”

The coming days will determine how closely the two systems can – and are willing to – work together to suppress the virus. 

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