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Notes from a GP: '20% of Christmas Covid tests have been positive in our practice'

Our GP outlines the spike in Covid cases and says he agrees with NPHET’s decision not to automatically test close contacts of confirmed cases.

Anonymous GP

LAST TUESDAY WAS my first day back after a four-day Christmas break. It was the first Christmas in years I wasn’t scheduled to work in the Out Of Hours (OOH) service, though my Practice Partner didn’t get away unscathed this year.

I knew from chatting to him the day before, that the return would be busy, as the OOH service was slammed since Christmas Day.

So when my first patient on Tuesday made contact at 7 am about Covid-19 it wasn’t much of a surprise. Their Covid swab was done by 10:30 am. Results were back later that evening.

That level of efficiency didn’t surprise me either. I knew from the previous weeks that the HSE had massively ramped up capacity. They had to, as the surge in cases started about two weeks before Christmas and was only ever going in one direction.

Unprecedented numbers at Christmas

By 1 pm on Tuesday, my practice had received 48 calls about Covid-19. Thankfully I had been in a position to employ another GP for the day who could deal with all the other usual illnesses that were presenting.

Nationally, things were no better. From what I know, 14,000 requests for Covid swabbing were made by lunchtime and a further 10,000 by the day’s end. The surge in testing requests expected over Christmas was turning into a tsunami.

By Wednesday afternoon, the symptomatic patients I was referring for testing were being given swab appointments for 5 pm the next day.

The number of positive cases being returned from Tuesday’s patients far exceeded any levels I’d seen in the run up to Christmas - 20% of cases in my GP practice were coming back positive. Colleagues of mine in other parts of the country were telling me of rates in the 40-50% range.

The situation had deteriorated even faster than anticipated. It was no surprise then when the Chief Medical Officer, Dr Tony Holohan announced a change in policy on New Year’s Eve. Close contacts of positive cases who had no symptoms would no longer be tested. A cull of existing swab orders for these patients was undertaken.

Testing changes were necessary

From looking at the situation in my own locality this made sense to me. Many of the positive cases that came back were clustered around family groups.

The previous weeks’ cases seemed to theme around wakes and funerals or boyfriends/girlfriends hanging out in each other’s houses with the respective partner’s family.

All of this is normal healthy behaviour in normal times but explosive behaviour from a virus transmission perspective. More than once I attended a home to pronounce death only to be met by kitchens and hallways packed with relatives and neighbours.

The human desire for each other’s company to help sustain us and comfort us is our greatest strength to each other. It is also Covid’s most hoped-for Christmas present. This week’s pattern of cases amply showed that Santa didn’t fail to deliver.

As Christmas Day passed, whole families of patients were making contact on Tuesday, Wednesday and Thursday this week seeking Covid testing. Some had symptoms and were acting responsibly by seeking testing.

Many were asymptomatic family contacts wanting tests due to concerns about their own, or older parents’ health. However, this is the role of the HSE’s Contact Tracing Service and not something your GP is allowed to do for you.

It was clear though that the service was failing to deliver as speedily as patients expected. More than a few contacts to my practice were outright lying about symptoms so as to get a test quicker.

When multiple people from the same family all develop the same two symptoms on the same day it doesn’t take a detective to know the timing is suspicious. More so when you know their household contact tested positive the previous day.

The problem with such behaviour isn’t the outright absurdity of lying to game the system. Rather it is the pointlessness of asymptomatic contacts looking for a speedier test. A negative test in their case doesn’t change the fact they are required to restrict their movements for 14 days. The most depressing part is that this fact seems like news to people after nine months of Covid-19 and three lockdowns.

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The guidelines

If your family member who you live with, or visited with for more than 15 minutes, tests positive for Covid, then you can’t go out to work, or mix with friends, or freely shop etc for two weeks.

Even if you think you are young and healthy and couldn’t possibly get sick from a Covid infection, the impact on you and your contacts from any one of you testing positive is enormous. The ripple spreads far and wide.

Small business owners cannot open their shops. Elderly parents who get care from daughters and sons are left without if a grandchild tests positive after an evening out.

Visiting your in-laws in other counties or Northern Counties, where the Covid rates are many multiples that of your own locality risk seeding infection into your homes, your families, your workplaces, your schools.

Hospitals are filling up with cases again, ICU beds are being taken, A+E departments are full. Even if the levels of illness or death aren’t at the peak of March and April when there was very little Covid testing happening, the displacement effect of impact on normal healthcare is massive.

A Covid patient in an ICU bed stays longer and takes out more staff than a post-operative patient. A ward of Covid positive patients knocks out a floor of hospital capacity.

While you might believe your personal risk of serious illness from Covid is low, your risk of needing other healthcare services remains the same. The availability of such care is speedily diminishing as case number rapidly rise.

We needed to avoid as much social contact as possible in December. That was always a tough call to meet. We now need to avoid all social contact outside of the home that isn’t absolutely essential.

The human need for company and companionship is strong and that is our weakest point. Let’s make every effort to minimise that weak point by maximising the boring but effective basics: Wash hands, Wear Masks, Physically Distance. Use technology to socially connect. Keep each other safe.

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Anonymous GP

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