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Covid front-line staff felt ‘forgotten and abandoned by the HSE’

Confusion, infection and distress dominate a stark picture painted by 400 respondents

Nobody in Ireland was left untouched by the disorienting new reality of Covid-19. But healthcare workers were uniquely exposed. They worked in a world where Covid infection was a reality that others were protected from by lockdown.

That first wave of Covid accounted for less than 2 per cent of the total diagnosed infections recorded to date but about a quarter of the deaths associated with the virus.

Afterwards, the HSE and Nphet wanted to understand how and why healthcare workers were infected. The report was led by Prof Mary Codd of UCD's school of public health, who also ran the Contact Tracing Centre that had been set up in the university.

The information is from the front line – of 400 interviewees, 81 per cent were in direct patient contact, and 327 had a notified Covid outbreak in their workplace. It skews disproportionately towards nursing home and other residential care facility workers – representing 40 per cent of respondents, only slightly fewer than acute hospitals. Given the structure of the nursing home sector, dominated by the private sector, the experiences recorded show the reality on the ground in both State and non-State-run institutions.

While the report finds that, in many instances, there were good levels of compliance with return-to-work protocols and other areas, it also portrays a stark picture of life on the front line, characterised by confusion, infection and distress. Its findings are detailed in a new book, Pandemonium, by this reporter and my fellow journalist Hugh O’Connell.

One worker says no training was provided in the catering section and they were told “because they were young and healthy, they did not need a mask and [the] facility did not want them being tested”. Three spoke of how there were single oral or ear thermometers on a ward “for use on everybody”, with plastic coverings changed between use. Some spoke of how blankets and beds were being moved in and out of Covid wards, while staff “share the same pair of goggles, [with] wipes provided to clean” them.

Vulnerable spouse

Another spoke of how a staff member requested time off to protect their immunosuppressed spouse but “was denied this and told they would lose their job if they did not show up to work”, and about workers who felt they had to come to work in order to earn, despite having Covid symptoms. Many spoke of PPE rationing, and of confusing or contradictory guidance.

One described how management was “very loose in their interpretation of the rules about PPE”, and how in one instance in March they were “not allowed to use masks”. Respondents told of feeling “forgotten and abandoned by the HSE”, and how they lived in a world of constantly shifting advice.

While PPE shortages and the threat of a novel virus may not have been avoidable, the report also raises questions about training in infection prevention and control. While training did happen, the report found that “for over half the [healthcare workers] in this review, infection control training was reactive to this pandemic situation rather than being proactive and delivered on an ongoing basis”.

The HSE has concerns about the report. It refused to release it under the Freedom of Information Act, only doing so after a review. In a note accompanying it, the health service said there were “methodological considerations” and raised the possibility of “participant bias”, arguing there is an emphasis on “quotations that are very negative about infection prevention and control” in some instances where the target of criticism is “not within the scope of IPC practice”, and argues many of the recommendations of the report are not practicable, or were already in place.

Nonetheless, the report was compiled by professionals, and is an unparalleled repository of the experiences of 400 people who left the safety of lockdown for essential work, and contracted the disease. And yet, months after Nphet was disbanded, and even as the latest wave is subsiding without recourse to any public health intervention, the Government is making no discernible progress on its plans for a review of how Ireland handled the pandemic.