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Opinion: How Ireland established links with China to secure Covid-19 medical support

In the early moments of the pandemic a group of Chinese experts took time to brief Irish doctors on what they knew so far about Covid-19, Paul O’Brien explains how those connections were made.

Paul O'Brien Paul O’Brien has an academic background in genetics, food science and medicine. He has spent over a decade working and travelling in Asia.

Paul O’Brien lives in China and for the last decade he has worked as a trade policy and regulatory analyst covering China. In March 2020 he helped to organise the first China-Ireland Covid-19 Medical Conference and to procure Ireland’s supply of PCR testing equipment through his connections in China’s medical sector. 

AS IRELAND’S VACCINATION programme shifts up through the gears, the country is moving in an increasingly optimistic trajectory towards a critical mass of vaccinated people that will theoretically signify an end to the potential for widespread community transmission of Sars-COV-2. 

Hopefully, it will also signify a return to some semblance of normality for the herd. By all metrics things are looking positive in Ireland. 

We can catch our breath now and reflect on our collective successes and failures with a view to learning and implementing new systems, new methods, and developing new competencies. 

We must ensure that going forward Ireland is in a better position to deal with future outbreaks of infectious diseases. This was a warning. We must do better. 

One of the key issues exposed by Covid-19 is the necessity for global cooperation, the need to implement robust systems to support multilateralism and effective communication between countries and to dissolve the cultural, social, and economic barriers which stymie an efficient and effective global response to infectious disease.

While geopolitics often makes this goal seem like a utopian dream, I am proud to say within the medical community early communication between Irish and Chinese doctors was crucial in positively shaping Ireland’s response and saving Irish lives.

In attendance were Professor John O’Halloran, Prof of Therapeutics at UCC David Kerins, President of RCPI Prof Mary Horgan, intensive Care doctors from Oxford, the respiratory, microbiology, and ICU from Bon Secours along with their CEO.
Also on the call was an ICU, respiratory, microbiologist or Infectious diseases consultant from each of the medical Schools in Ireland.
The 1st China Ireland Covid-19 Emergency Conference 

The Bons Secours Hospital Cork, March 10th, 2020. There was a war room atmosphere to the Bons Secours conference room that day. 

The charged atmosphere further heightened by the then-alien requirement to wear surgical masks indoors, based on early advice from the medical experts in China. 

The unfamiliar Zoom-based conference format was a foreshadowing of what would become the new normal in the weeks and months to come. 

The context was stark and the anxiety palpable, all against a backdrop of macabre events and images of mass graves that were unfolding in northern Italy and across the world. 

This was the calm before the storm in Ireland. The tsunami was fast approaching. We were all very worried. 

At the head of the table sat Micheál Martin, his presence making the occasion at once even more surreal but also reinforcing the devastating seriousness. 

 The conference between Ireland and China was a hybrid online-to-offline event attended by Irish industry leaders, politicians, key representatives from the NUI-affiliated hospitals and medical luminaries from a diverse range of medical fields 

Across a great but digitally connected divide were the Chinese, beamed in via zoom. Thousands of miles away but metaphorically very close in a time of need.

Frontline ICU doctors from Wuhan, and experts in medicine, infectious disease, pulmonology and public health from the 2nd Affiliated Hospital in Hangzhou, Zhejiang Province, China. 

All experts taking time out from their own fight at ground-zero out, to arm Ireland, our doctors, and our healthcare system with vital knowledge. 

Knowledge that would save lives by positively shaping our national public health strategy, guide medical treatment, expedite lockdown, and ensure utilisation of state-of-the-art public health measures here in Ireland. 

Co-organiser of the event Dr Oisin O’Connell, consultant pulmonologist at Bons Secours Hospital Cork, recalls: 

The Bon Secours had been liaising with Chinese Covid medical experts from the first week in March 2020.

The Chinese highlighted to us that without population control measures the doubling time of this virus in a population could increase every 3.5 days.

They also stressed the importance of pre-symptomatic Covid spread and that uncontrolled spread would quickly overwhelm hospital capacity in Ireland and that avoiding this in the initial phase would be critical to avoid similar scenes as we were seeing in Lombardi.

Their advice in early March was to pursue a strong Covid suppression or Covid eradication regime and that the only way to achieve this was a strong early lockdown.

In addition to the conference the Chinese gave us their 180-page English translated National Covid management strategy covering all aspects of Covid management which I was able to share with the Irish medical community through the Royal College of Physicians of Ireland masterclass lecture series in March 2020.

During the conference, the Chinese provided detailed guidance and instructions on their national, local and hospital Covid management strategy. 

This guidance included detailed advice on how to leverage the tech sector and big data to vastly increase the efficiency of contact tracing. 

Details were also provided on how to plan hospital admissions and how to design makeshift wards to increase ICU surge capacity. 

Guidance on the establishment of fever clinics, PPE usage, healthcare worker behavioural adjustments were also provided with details on how to reduce hospital transmission and minimise spread amongst health care workers and patients. 

The Chinese heavily stressed the importance of facemask use both in hospitals and at a public level and outlined compelling evidence for this based on their assertion that aerosol transmission was the primary method of spread. 

The greatest takeaway was their guidance on ventilation strategies, the significance of pre-symptomatic transmission and most importantly the use of steroids. 

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Much of this advice predated European guidelines by several months and was advice that ultimately became incorporated into the Irish Covid management response several months later as further evidence mounted globally for all these issues. 

Paul O’Brien: Our key message is test, test, test

The test, test, test mantra of Tedros Adhanom, leader of the World Health Organization is probably one of the most iconic phrases of the Covid-19 pandemic.

Catchy but also extremely apt. Robust and efficient testing capacities and capabilities form the bedrock upon which all countries Covid-19 response strategy must be built. 

Without this foundational element everything else fails. In March and April 2020 Ireland was going in the opposite direction. 

Test centres around the country were being closed. Tests were being cancelled. Tests were being delayed. Diagnostic criteria were being tightened. People were dying.  

Global lockdowns and massively increased demand had precipitated massive global shortages on both testing equipment but more importantly the testing reagents specifically the chemicals needed to extract nucleic acid to perform the PCR test. 

Demand vastly outstripped supply and as a tiny island nation nestled in the far reaches of Western Europe, we were far down the global pecking order. Normal supply lines were dry, and we were facing a national crisis. 

Building on the strong bonds of friendship developed during the First Ireland-China Covid-19 Emergency Response Conference (ICCERC), Professor Paddy Mallon, a professor in infectious disease at UCD and a consultant at the Mater hospital) reached out to experts at the 2nd Affiliated Hospital in Hangzhou, China. 

Within several hours Irish medical experts were connected directly with the Chinese hospital’s technical procurement and their own suppliers of testing equipment. 

Several hours later we were tied in with Damien McCallion (HSE national vaccination/testing lead) and after a detailed consultation the green light was given to a massive procurement of testing equipment (PCR machines and testing reagents). 

A week later the equipment was on an Aer Lingus flight where it was taken and validated against Irish and EU national standards by the national virus testing lab. 

Just a few days later discussions in the Dail and newspapers were full of stories of Ireland’s newfound 100k a week testing capacity. Now we had a fighting chance. 

This work is co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work is the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.

About the author:

Paul O'Brien  / Paul O’Brien has an academic background in genetics, food science and medicine. He has spent over a decade working and travelling in Asia.

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