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Dublin: 7°C Wednesday 25 November 2020

GPs 'inundated' with calls from close contacts of Covid-19 cases due to HSE backlog issue

More than 2,000 people are being expected to do their own contact tracing this week.

Image: Shutterstock

GPS SAY THEY have been “inundated” with calls since early this morning from people who believe they are a close contact of a confirmed case of Covid-19, after the HSE revealed it would be asking those who received a positive test over a three-day period to inform their own contacts.

The HSE is to ask between 2,000 and 2,500 people who received positive results on Friday, Saturday and Sunday of last week to alert their own contacts due to what it described as “unprecedented pressure” on the contact tracing system.

Those who received positive tests on those days will receive a three-part message explaining what they are expected to do, with a link to detailed information.

This includes tips on what to consider when compiling their list of close contacts such as visitors to their homes, taxi journeys, sports activities and hair appointments.

“You may not know the names and numbers of everyone you were in contact with. For example, if you were at an event or in shared accommodation. In these cases, call the Covid officer or manager of the event or venue.

“If you were at work 48 hours before your symptoms began, or 24 hours before your positive Covid-19 test result, phone your employer to let them know.”

People are advised to follow-up their text message with a phonecall to their close contacts. The HSE has provided guidance on how to manage these “difficult calls”, including acknowledging their concern or upset and telling them to call their GP with any questions they have.

People who tested positive from Friday to Sunday will also be sent a message template they can forward to their close contacts. It says:

“The HSE is asking [person who has tested positive for Covid-19] to pass on this text to their close contacts.

“As a close contact of this person you need to phone your GP within 2 days to get a free Covid-19 test. You must restrict your movements (stay at home) for 14 days from when you were last in contact with [name of positive case], even if you have no symptoms.”

The message also includes a link to further advice for those impacted, such as restricting their movements for 14 days from the time they last had contact with the confirmed case.

One man who received this second message, who is a close contact of a confirmed case, told TheJournal.ie the person who tested positive received their result four days ago. The man said he had been restricting his movements for four days as the person who tested positive had already informed him of the result.

“In my opinion putting this in the hands of the people won’t go well,” he said. “It’s fine for responsible people, not so fine for lazy, uninterested or careless people.”

‘A flurry of calls’

The HSE has come under criticism today for failing to inform the government of the decision over the weekend to take this action. Taoiseach Micheál Martin told the Dáil this afternoon that the HSE did not inform him of the problem and that he found out when someone sent him a news article about it. The Minister for Health also learned of the decision last night.

GPs have said they were equally left in the dark until last night when they received a notification – not from the HSE, but from the Irish Medical Organisation (IMO), which provided information to its members.

Drogheda GP Dr Amy Morgan told TheJournal.ie that she was “surprised” to read the email from the IMO and said she still has not received any direct communication from the HSE.

“I wasn’t expecting this at all, I was aware the tracing system, from my own experience in the surgery was obviously coming under overwhelming pressure, but I didn’t see this coming.

“We had previously been advised that we were not meant to have a role in contact tracing. We were told that the IMO notification was in advance of a HSE notification that was to come today but I haven’t seen that yet.”

She said this kind of work is time consuming for GPs, and not something they’ve received training in.

“Straight away as soon as we opened the phone lines this morning there were people who had received the text and wanted to organise testing, it’s been a flurry of calls. It involves us taking some history from the patient over the phone – is it a family member for example. People are getting confused about the difference between a close contact and a casual contact and also confused about the timing of exposure [48 hours].”

The HSE defines a close contact as:

  • spending more than 15 minutes of face-to-face contact within 2 metres of someone who has Covid-19, indoor or outdoor;
  • living in the same house or shared accommodation as someone who has Covid-19;
  • sitting within 2 seats of someone who has Covid-19 on public transport or an airplane.

A casual contact can mean:

  • spending less than 15 minutes of face-to-face contact within 2 metres of an infected person, indoor or outdoor;
  • being in the same room as an infected person for less than 2 hours;
  • being on public transport or an airplane with an infected person but not sitting near them.

However the HSE says spending more than two hours in an indoor space with someone who has Covid-19 will “sometimes count as close or casual contact”.

This could be an office or a classroom.

In its guidance on close vs casual contacts, the HSE says it will depend on the size of the room and other factors.

It also says “public health doctors or contact tracers will let you know if you are at risk during contact tracing and public health risk assessments”. However in this case this job is left to those who tested positive and the GPs of their close contacts. 

Dr Morgan said she is concerned that confusion about the definition and the 48-hour time period for contact tracing may lead to those who test positive telling more people than they need to that they are close contacts and this is something GPs will have to work through when those people call.

“It’s creating confusion and stress and we’re a generally pragmatic group of people as a profession, we want to help people but this all feels hurried and like we’re in a damage control space at the moment.”

‘Everything is dumped on us’

Dr Illona Duffy, a Monaghan GP, told TheJournal.ie that she had also “heard nothing ” from the HSE and relied on the guidance issued by the IMO last night. 

She said because of the way the information came out – through the media for the most part – her surgery had been receiving calls from anyone who considers themselves a close contact. 

“It’s only meant to be those who received a positive result Friday to Sunday but that message hasn’t been clearly communicated and we’re fielding calls from close contacts or perceived close contacts full stop. People saying ‘I know so-and-so has it and I had coffee with them or I work with them’.

Dr Duffy said she is concerned that her office will be “inundated” with calls ahead of the bank holiday weekend.

“The HSE has now put this role onto an already overloaded acute service, we are the only frontline available now because people can’t just rock up to the Emergency Department,” she said.

“We have to be able to talk to our patients, we are really busy with really unwell patients. Our referral rate to hospital is up – not massively – but we have sicker patients who need to talk to and potentially see us.

“If our phone line is clogged up by people who are well and should just be self-isolating, it’ll be a big problem. Why is this being landed on GPs?

“I’m quite angry about it, it’s again this lack of respect for GPs and a lack of understanding of what we do and how hard we’re working. Everything is dumped on us, including the rollout of the flu vaccine for children which many of us are doing in clinics outside our normal hours and on weekends.”

Dr Darach Ó Ciardha, Tallaght GP and co-founder of GPBuddy.ie, also expressed concern about the burden being placed on people who have been diagnosed with Covid-19, a disease that can make people very ill.

“It is an extraordinary demand to make of people and not one we’d dream of in normal circumstances,” he said.

“The diagnosis can be a shock for people, it can be really upsetting, particularly if they are in a vulnerable group, if they are older or have an underlying conditions.

It’s really important that these connections are made, but people are naturally reticent, they may feel embarrassed and also may not be sure exactly who their contacts are. If they were sitting outside a cafe or shop for example, it may be hard to be precise and that’s where contact tracing teams come in. They can contact the premises who might have a slightly better record of who was there.

He said asking people to do their own contact tracing removes the possibility of anonymity and also asks people to engage in “the really difficult human interaction of having to inform another person”.

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“That intermediary function of contact tracing is so important. It’s a huge burden to put on people, but it looks like we’ve no choice for now,” he said.

Recruitment of contact tracers

The HSE has been recruiting for staff to beef up its contact tracing system. Back at the end of September, the HSE said it had 280 tracers in eight contact tracing centres and was building capacity for 500 tracers. 

The HSE has said there are now over 400 staff working in this contact tracing centres. 

However there is confusion over the recruitment figures.

In the Dáil today, the Taoiseach said the first 700 people are through the interview process the HSE today said this figure is 600.

Micheál Martin said 20 new staff have started already – the HSE said 135 have started, including 70 last week.

At the start of the crisis, public service workers were transferred to contact tracing centres to help with the workload and these people are due to return to their roles when the recruitment drive is complete.

There is concern at government level that the return of these workers to their old jobs could leave the contact tracing system understaffed, even with the new recruits. 

In a statement, the HSE said it expects to continue bringing in 60-70 new staff to the service every week over the coming period.

“The HSE plans to recruit up to an initial 800 tracers, and then review the requirement for further recruitment.”

The statement went on to say there is a plan to increase the number of community swabbers to 1,000.

 - With reporting by Christina Finn.

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