PUBLIC health teams across Ireland are the first line of defence in the fight against Covid-19 but they entered the pandemic understaffed and under resourced, according to a public health specialist.
This under-resourcing has not been addressed since the pandemic arrived and, with Covid-19 cases rising and an overwhelmed health workforce tiring, Ireland’s public and economy is at risk as a result, Ina Kelly warns.
Dr Kelly is a doctor in public health medicine in HSE Midlands, a former lecturer in public health at University College Cork, and current chair of the Irish Medical Organisation’s (IMO) Public Health and Community Health committee.
Speaking to The Echo, Dr Kelly said that public health workers were in the process of trying to reform the sector in Ireland towards the end of last year in a bid to provide better-resourced public health teams across the country.
Then the Covid-19 pandemic arrived, and this reform took a back seat in terms of the Government’s priorities, she explained.
Dr Kelly warns that the failure to properly resource public health teams could lead to difficulties in curbing Covid-19 outbreaks.
Dr Kelly explained the role the eight public health departments play across Ireland in the fight against Covid-19.
“Our job is to investigate notifiable infectious diseases and this year,” she said.
“Covid-19 has taken centre stage.
“We have to try to investigate the virus in terms of contacts, who has it and who might have it and so forth.
“The contact tracing centre was set up this year in response to the virus and it does support us — but they don’t do the control part of it, apart from organising testing and instructing people to restrict their movements.
“We deal with the outbreak control element so when there is complexity in cases and in the system, it all comes back to the department of public health.
“When there is a large number of cases, each case may have many complex contacts — which means they may have put people at risk in multiple different settings.
“That means we have to go back and carry out public health risk assessments to see if there is a risk there and if we need to take further action.
“Our role is not about blaming anyone, it’s about figuring out where the virus came from in these cases and where it could have spread, and about getting controls in place.
“Covid-19 is so transmissible, so any drop in attention to detail can allow it to spread.”
In normal emergencies, the gardaí or emergency services take the lead. But in cases of infectious diseases, which Dr Kelly labelled “biological hazards”, public health is the first line of defence.
But she says that first line of defence has been left under strength as it takes on the biggest threat it has ever faced.
While redeployments have helped, Dr Kelly said initiatives like contact tracing have not filled large gaps in Public Health resources.
“We came into this pandemic already under strength,” she said.
“The plan was to introduce larger, consultant-led public health teams in July this year but that has not happened.
“We’re trying to negotiate a consultant contract with the Department of Health so we can establish public health teams that are fully resourced. We need data analysts, surveillance scientists, nurses, and doctors.
“Public health staff across the country have really stepped up to the challenge here but in reality, we need more staff.”
Dr Kelly said the lack of a consultant contract for public health specialists is making it more difficult to retain people in the area. She also said that it makes training and recruitment in the field of public health very difficult.
“We’ve lost doctors at specialist level in recent years to New Zealand, Australia and more,” she said.
“As bad as things are now, they are going to get a lot worse in the department of public health, and that’s not just a problem for us — it’s a problem for everybody.
“This is our emergency system for pandemic control and it’s creaking. Everyone is worn out.”
When the first wave of Covid-19 hit Ireland, there were concerns that, like parts of Northern Italy or the US, the hospital system, particularly intensive care units (ICUs), would be overwhelmed. Public health departments played a key role in ensuring that was not the case by curbing the spread of Covid-19 in the community.
Now however, cases are increasing once again and Dr Kelly warned that repeating such a performance is a much more difficult prospect.
“Our job, in a way, is to try to protect hospital beds, especially ICU beds,” she explained.
“After the first wave, we got an awful lot of thanks from our ICU colleagues because, based on international evidence, they felt they were going to be inundated.
“They weren’t really because public health was really able to control it as much as possible.
“But this is getting much harder for us now and the energy levels have dropped while the resources haven’t got any better.
“We were supposed to be sorted from the reforms and consultant-led teams since July, but we’re in October now and that hasn’t happened yet.
“That reform is needed immediately, we can’t wait until the end of the year — it’s critical.”
Dr Kelly said Covid-19 is here for the foreseeable future, but that it can be managed, even in the absence of a vaccine for now, with proper resourcing of public health departments.
Failure to resource and support public health in such a scenario leaves the public at risk, she warned.
“This is an ongoing thing,” said Dr Kelly.
“This is an infection that has a transmissibility that means we can’t live with it unless we suppress it to very low figures.
“That means we can’t live a normal life — the lives we had in 2019 are gone for the next few years. If we can get a good vaccine and ensure that everyone works together to tackle it, we have a good chance of tackling it effectively.
“Until then, it’s a life of restrictions but those restrictions could actually be minimised more if public health was resourced to do its job. We have the knowledge and the skills to do it but we just don’t have the numbers or resources.
“That should be a worry for Ireland’s population and businesses.”
Asked for comment, the HSE said that its recently-unveiled winter plan will assist the HSE in managing its services safely, while continuing to operate in a Covid-19 environment.
A HSE spokesperson said the plan indicates additional workers for the HSE across all professions, and that the HSE has recruited almost 4,700 extra staff this year.
“In excess of 200 temporary resources are currently in place in the departments of public health,” the spokesperson concluded.