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COVID-19 Initiatives within Public Health and Primary Care

Report led by Dr Steve Thomas for the European Observatory and conducted for the Health System Performance Assessment Group of the European Commission.

https://www.euro.who.int/en/about-us/partners/observatory/publications/policy-briefs-and-summaries/strengthening-health-systems-resilience-key-concepts-and-strategies-2020

GP Community Tracker data playing a key role in fight against COVID-19 
Principal Investigator, Dr Darach Ó Ciardha, GP and Assistant Professor, Public Health and Primary Care, TCD 

The COVID-19 Community Tracker has been operational for the last two months, allowing GPs to report the number of clinically diagnosed cases they see on a daily basis. As many cases do not fulfil the criteria for testing currently, this is the sole means of estimating the true burden of disease in the community. The tracker serves as an early warning system for Public Health, identifying national and regional COVID-19 clusters in real time. Aggregate data is now provided to the Department of Health and CSO daily to assist COVID-19 considerations and related public health measures. The GP COVID-19 Community Tracker has been developed by a group including Dr Darach Ó Ciardha, GP and Assistant Professor, Public Health and Primary Care, TCD and Dr Dylan Creane, Data Analyst, Institute of Population Health, TCD. The group also includes Dr Shane McKeogh, GP and Co-founder of GPBuddy.ie, Dr Knut Moe, GP and Tony Ryan, CEO of Medvault, Joe Newell and Eoin Newell of GPBuddy. ie. 

Dr Tony Holohan applauded the initiative during his daily RTE broadcast on 30/04/2020.

To listen: 

 

Development of a public health toolbox in response to COVID-19.

PI: Professor Catherine Darker, Associate Professor of Health Services Research, (interim) Head of Discipline, Public Health & Primary Care (Catherine.darker@tcd.ie) 086 3711959

Institutions involved: TCD (lead); University College Dublin; Queens University Belfast; University of Bristol, UK; Health Service Executive

TCD: Professor Lina Zgaga, Dr Nicola O’Connell, Dr Ann Nolan, Dr Katy Tobin, Ms Niamh Brennan, Ms Emma Burke, Ms Gail Nicolson

UCD: Dr Cliodhna O’Connor

Queens University Belfast: Dr Martin Dempster, Dr Christopher Graham

University of Bristol, UK: Professor Gabriel Scally

Health Service Executive: Dr Philip Crowley, Professor Joe Barry (also TCD)

FUNDERS: Health Research Board and Irish Research Council

COVID-19 represents a serious challenge to governments and healthcare systems. In addition to testing/contact tracing, behavioural response (e.g., hand washing) and social responses (e.g., social distancing/cocooning) are the most effective tools for stopping the spread of the disease. Psychological (e.g., how likely you believe it is that you will contract the disease) and contextual factors (government, public health messaging etc.) are likely to drive these behaviours.

On the island of Ireland we have a natural experiment - there are two different governments and public health jurisdictions (Republic of Ireland (ROI) and Northern Ireland (NI)). This represents a unique opportunity to explore the implications of COVID-19 on two very similar populations.

Trinity is leading this project and we have brought together experts from University College Dublin, Queens University Belfast and University of Bristol in the UK; those academics are working in tandem with public health leaders in the HSE

We are going to do 4 things:

  1. We are going to talk to people through both survey’s and focus groups to assess key behavioural, social and psychological factors of the disease.
  2. We will investigate social media messaging and formal media responses in both jurisdictions to investigate the spread of (mis)information.
  3. We will model data from Studies 1 and 2, plotting the psychosocial/behavioural and media messaging information with incidence and mortality data.
  4. We will conduct an assessment of health policy in terms of the most significant public health and political insights from each jurisdiction.

 At the end of this research we will produce:

An evidence-based toolbox for targeting of public health and political leadership in terms of messaging and measures for any further waves of COVID-19, and subsequently for future epidemics/pandemics.

Quote:

COVID-19 is one of the biggest threats to public health in a generation. On the island of Ireland there are two different governments and public health jurisdictions. This represents a unique opportunity to explore the implications of different measures and messaging across these two jurisdictions as they relate to this virus on two similar populations. Arising from this research we will produce a public health toolbox that will guide both public health and political leaders for any further surges of COVID-19 or indeed for future epidemics or pandemics. 

I’m a GP in practice in Citywest, and we are looking after the Covid Isolation Unit in the Citywest Hotel.

This is a HSE unit staffed by nurses, HCA'S, and the hotel staff. We take patients who are either Covid positive, suspected patients waiting for results, or contacts of known cases. The function of the unit is to allow people to complete their self-isolation period when they cannot safely do so at home - typically because they share rooms, live in overcrowded situations, or have vulnerable household members. The GP’s role is to determine when people can safely return home and deal with any medical issues arising during their stay. Many of the residents are healthcare workers, or from vulnerable groups such as those living in Direct Provision Centres.

The average length of stay is 9 days, and in the first 6 weeks of operation we have had in excess of 450 people admitted.

Dr Aisling Ní Shúilleabháin.

Catherine Hayes work on the dedicated helpline set up to deal with COVID- related queries

In my role as a public health specialist I work on the dedicated helpline set up to deal with COVID-related queries from health professionals. The helpline operates from the Public Health Department at Dr Steevens’ Hospital.

Callers to the helpline typically include GPs, Directors of Nursing in Residential Care Facilities, Hospital Consultants, Health Care Workers (HCW). Calls are triaged by a nurse. My role is to manage complex queries and to sign off on all queries.

The nature of the queries varies depending on when new guidance or change in guidance are issued. Commonest queries include public health management of cases and outbreaks in general practice and assistance with nursing homes/residential service outbreaks. The HSE Health Protection Surveillance Centre www.hpsc.ie is an excellent source of information on all aspects of COVID-19.

Prof Lina Zgaga is a co-applicant on a project that will examine whether immunosuppressant therapy could in fact provide protection against severe Covid-19 illness and death.

We know that suppressed immune system impairs our ability to fight infection. However, in severe Covid-19 disease, overactive immune system causes the “cytokine storm” which can be very damaging. We aim to examine whether being on immunosuppressant therapy for chronic autoimmune disease protects against the cytokine storm associated with COVID-19 and reduces the severity of the clinical syndrome, thereby paradoxically improving rather than worsening clinical outcome. Findings from this project might inform treatment of severe Covid-19 infection and the application of a ward-based ceiling of care, clarifying whether immunosuppressive therapy is an additional vulnerability factor.

Links:
https://www.youtube.com/watch?v=8mIh0jPkV8Y
https://www.adaptcentre.ie/news/could-immunosuppressant-therapy-provide-protection-against-covid-19