Tuarascáil Eatramhach maidir le Tástáil agus Rianú An Coiste Speisialta um Fhreagra ar Covid-19 Lúnasa 2020 Interim Report on Testing and Tracing Special Committee on Covid-19 Response August 2020
SCCR003
Interim Report on Testing and Tracing – August 2020
1 Tithe an Oireachtais An Coiste Speisialta um Fhreagra ar Covid-19
Tuarascáil Eatramhach maidir le Tástáil agus Rianú
Lúnasa 2020
Houses of the Oireachtas Special Committee on Covid-19 Response
Interim Report on Testing and Tracing
August 2020
33 SCCR 003 Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
TABLE OF CONTENTS CHAIRMAN’S FOREWORD
Contents I welcome the publication today of the Special Committee’s TABLE OF CONTENTS ...... 2 Inte im epo t on estin and acin CHAIRMAN’S FOREWORD ...... 3 s the epo t outlines a obust system of testin and contact SUMMARY OF RECOMMENDATIONS ...... 6 t acin is the cent al to allowin the phased eopenin of Section 1: The importance of testing and tracing ...... 6 comme cial and social acti ity the ma o ity of which we e closed 2 Section 2: Detailed test and trace planning ...... 6 du in the shut down in a ch Section 3: Capacity and turnaround times ...... 7 Its effecti eness will depend in pa t on the implementation of Section 4: Travel testing and tracing...... 8 othe cont ols in pa ticula hand washin and maintainin an ade uate distance f om othe s in social settin s Section 5: Healthcare staff ...... 9 Section 6: The app ...... 9 M M N D 1. Introduction ...... 11 he Committee unde stands that the system that was put in place 2. Evidence From Committee Meetings And Submissions ...... 12 in a ch was done in a hu y and a lot of contin ency measu es had to be ta en i en the is of a pandemic sweepin the State ecause of the effo ts of all ou people those measu es we e not TABLE 1 – WRITTEN SUBMISSIONS ...... 12 needed howe e what became clea to the Committee is that anothe loc down would be TABLE 2 – MEETINGS WITH STAKEHOLDERS ...... 13 unsustainable estin and contact t acin will allow the State to li e with and t eat outb ea s of 3. The importance of testing and tracing ...... 15 Co id as they a ise
4. Detailed test and trace planning ...... 17 numbe of new testin and t acin measu es will be put in place late this month and will ha e to 5. Capacity and turnaround times ...... 20 be ept unde e iew
5.1 Turnaround time ...... 20 inally we will need a system that has capacity to deal with a sudden su e in demand which will 5.2 Supply of tests ...... 21 happen if we et a flu epidemic in the utumn i en the o e lap on symptoms between the flu and 5.3 Cost ...... 22 Co id and ou al eady o e c owded hospitals and epa tments hese issues a e also hi hli hted in the epo t 6. Travel testing and tracing: ...... 24 7. Healthcare staff: ...... 26 I want to than the sta eholde s who en a ed with the Committee embe s of the Committee and the Sec eta iat fo thei wo on this issue 8. The app: ...... 28 Appendix 1: Terms of Reference ...... 31 Appendix 2: Committee Membership ...... 33 I commend the epo t to the il Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil
Chai man
th u ust Interim Report on Testing and Tracing – August 2020
TABLE OF CONTENTS CHAIRMAN’S FOREWORD
Contents I welcome the publication today of the Special Committee’s TABLE OF CONTENTS ...... 2 Inte im epo t on estin and acin CHAIRMAN’S FOREWORD ...... 3 s the epo t outlines a obust system of testin and contact SUMMARY OF RECOMMENDATIONS ...... 6 t acin is the cent al to allowin the phased eopenin of Section 1: The importance of testing and tracing ...... 6 comme cial and social acti ity the ma o ity of which we e closed Section 2: Detailed test and trace planning ...... 6 du in the shut down in a ch 3 Section 3: Capacity and turnaround times ...... 7 Its effecti eness will depend in pa t on the implementation of Section 4: Travel testing and tracing...... 8 othe cont ols in pa ticula hand washin and maintainin an ade uate distance f om othe s in social settin s Section 5: Healthcare staff ...... 9 Section 6: The app ...... 9 M M N D 1. Introduction ...... 11 he Committee unde stands that the system that was put in place 2. Evidence From Committee Meetings And Submissions ...... 12 in a ch was done in a hu y and a lot of contin ency measu es had to be ta en i en the is of a pandemic sweepin the State ecause of the effo ts of all ou people those measu es we e not TABLE 1 – WRITTEN SUBMISSIONS ...... 12 needed howe e what became clea to the Committee is that anothe loc down would be TABLE 2 – MEETINGS WITH STAKEHOLDERS ...... 13 unsustainable estin and contact t acin will allow the State to li e with and t eat outb ea s of 3. The importance of testing and tracing ...... 15 Co id as they a ise
4. Detailed test and trace planning ...... 17 numbe of new testin and t acin measu es will be put in place late this month and will ha e to 5. Capacity and turnaround times ...... 20 be ept unde e iew
5.1 Turnaround time ...... 20 inally we will need a system that has capacity to deal with a sudden su e in demand which will 5.2 Supply of tests ...... 21 happen if we et a flu epidemic in the utumn i en the o e lap on symptoms between the flu and 5.3 Cost ...... 22 Co id and ou al eady o e c owded hospitals and epa tments hese issues a e also hi hli hted in the epo t 6. Travel testing and tracing: ...... 24 7. Healthcare staff: ...... 26 I want to than the sta eholde s who en a ed with the Committee embe s of the Committee and the Sec eta iat fo thei wo on this issue 8. The app: ...... 28 Appendix 1: Terms of Reference ...... 31 Appendix 2: Committee Membership ...... 33 I commend the epo t to the il Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on
Chai man
th u ust Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
S I S CI C I C I S S
S D S O S S 4 C C M C M N F F F F F
M C M C D C D S F R I S F S F
S D N F M M N M F F F F C F F I Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil
F O D O R M S R S F S F R I S D Interim Report on Testing and Tracing – August 2020
S I S CI C I C I S S
S D S O S S C C M C M N 5 F F F F F
M C M C D C D S F R I S F S F
S D N F M M N M F F F F C F F I Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on
F O D O R M S R S F S F R I S D Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
S MMAR OF RECOMMENDA IONS ecommendation
Alternati e channels for accessing testing and tracing should be made a ailable as part of the plan Section 1: The importance of testing and tracing for people who are unable to a ail of oice calls e. g. people who are deaf .
R
I ecommendation S 6 The Committee recommends that detailed anon mised data about infections – including geographical and demographic information – should be made public as uic l as possible and that this practice should be pro ided for in the official plan. This will help to inform public safet .
Section 2: Detailed test and trace planning
Section 3: Capacity and turnaround times R
ecommendation The detail of the HSE’s August test and trace plan will be crucial to public health outcomes. The C Acute settings ha e a faster median end to end turnaround time than the communit healthcare sector. The Committee recommends that solutions which can bridge this gap and shorten test I and trace time from first presentation in the communit sector be aggressi el pursued.
R ecommendation
The Committee recommends that the HSE e plore utilising e isting testing channels between s C and laboratories for the use of Co id testing to uic en testing time. f this is not a iable solution for Co id testing the reasons should be stated clearl .
ecommendation R The Committee recommends that the importance of see ing testing earl in onset of s mptoms The Committee recommends that the HSE’s target turnaround time for end should be emphasised in public health messaging.
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil Interim Report on Testing and Tracing – August 2020
S MMAR OF RECOMMENDA IONS ecommendation
Alternati e channels for accessing testing and tracing should be made a ailable as part of the plan Section 1: The importance of testing and tracing for people who are unable to a ail of oice calls e. g. people who are deaf .
R
I ecommendation S The Committee recommends that detailed anon mised data about infections – including 7 geographical and demographic information – should be made public as uic l as possible and that this practice should be pro ided for in the official plan. This will help to inform public safet .
Section 2: Detailed test and trace planning
Section 3: Capacity and turnaround times R
ecommendation The detail of the HSE’s August test and trace plan will be crucial to public health outcomes. The C Acute settings ha e a faster median end to end turnaround time than the communit healthcare sector. The Committee recommends that solutions which can bridge this gap and shorten test I and trace time from first presentation in the communit sector be aggressi el pursued.
R ecommendation
The Committee recommends that the HSE e plore utilising e isting testing channels between s C and laboratories for the use of Co id testing to uic en testing time. f this is not a iable solution for Co id testing the reasons should be stated clearl .
ecommendation R The Committee recommends that the importance of see ing testing earl in onset of s mptoms The Committee recommends that the HSE’s target turnaround time for end should be emphasised in public health messaging.
– August 2020 Tracing and Testing Interim Report on Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
Section 5: Healthcare staff
8
Section 4: Travel testing and tracing
Section 6: The app literacy gap is not negatively impacting effective usage or people’s meaningful ability to consent.
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil analysis should be made public. A false positive rate in the app’s performance should also be Interim Report on Testing and Tracing – August 2020
Section 5: Healthcare staff
9
Section 4: Travel testing and tracing
Section 6: The app literacy gap is not negatively impacting effective usage or people’s meaningful ability to consent.
– August 2020 Tracing and Testing Interim Report on analysis should be made public. A false positive rate in the app’s performance should also be Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
ecommendation ntroduction
he ommittee recommends that an issue trac er should be made available for the app that oogle and Apple should be as ed to publish more information on the A A and that more he Special Committee on Co id esponse unde too as pa t of its wo p o amme to information should be provided about the use of oogle irebase and ilio. e amine the State’s efforts on testing and contact tracing, with particular regard to readiness for potential futu e outb ea s of Co id
he Committee held th ee meetin s which included consideration of this matter. The Committee’s ecommendation meetin of une contained the most e tensi e t eatment of testin and t acin issues ue to the Co id est ictions on the len th of sessions and numbe of witnesses these 10 The Committee recommends that a full description of all network devices and logging in the app’s meetin s focused on en a ement with the epa tment of ealth the S and a limited numbe operation should be shared. of e pe ts
o counte balance the est icted natu e of sittin s and in o de to et a wide iew of the issue the Committee also ecei ed w itten submissions f om medical and testin e pe ts communications and data p i acy e pe ts and othe indi iduals and o anisations with e pe tise ecommendation in the a ea he ommittee recommends that the criteria by hich the sunset clause ill be invo ed should om an e amination of the submissions ecei ed by it and f om the o al e idence i en at be shared. meetin s the Committee hea d e idence which illust ates the ital impo tance of an effecti e and efficient testin and t acin system For this, the HSE’s forthcoming detailed plan will be of crucial impo tance
The plan’s ability to maintain strong testin capacity on the ound in pa ticula e a din uic end to end tu na ound times will be of c ucial impo tance
he e idence ecei ed also hi hli hts a eas of special conce n in the continued ope ation of Ireland’s Test ace Isolate I system – whethe ent ants f om o e seas and healthca e staff should be sub ect to e t a testin and the is s a ound hospital unde capacity and potential o e c owdin
Co id t ac e app fo I eland was launched on uly to supplement manual contact t acin by usin luetooth p o imity technolo y on mobile phones hile some conce ns about the app ha e been a ticulated it contains potential to cont ibute to contact t acin
his epo t aims to summa ise succinctly the ma o issues which the Committee encounte ed in its e plo ation of the e idence and to a ticulate ecommendations which help to focus effo ts to make Ireland’s testing and tracing system as effective as it can be. Our society’s ability to operate safely into the futu e depends on the achie ement of that oal Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil Interim Report on Testing and Tracing – August 2020
ecommendation ntroduction
he ommittee recommends that an issue trac er should be made available for the app that oogle and Apple should be as ed to publish more information on the A A and that more he Special Committee on Co id esponse unde too as pa t of its wo p o amme to information should be provided about the use of oogle irebase and ilio. e amine the State’s efforts on testing and contact tracing, with particular regard to readiness for potential futu e outb ea s of Co id
he Committee held th ee meetin s which included consideration of this matter. The Committee’s ecommendation meetin of une contained the most e tensi e t eatment of testin and t acin issues ue to the Co id est ictions on the len th of sessions and numbe of witnesses these 11 The Committee recommends that a full description of all network devices and logging in the app’s meetin s focused on en a ement with the epa tment of ealth the S and a limited numbe operation should be shared. of e pe ts
o counte balance the est icted natu e of sittin s and in o de to et a wide iew of the issue the Committee also ecei ed w itten submissions f om medical and testin e pe ts communications and data p i acy e pe ts and othe indi iduals and o anisations with e pe tise ecommendation in the a ea he ommittee recommends that the criteria by hich the sunset clause ill be invo ed should om an e amination of the submissions ecei ed by it and f om the o al e idence i en at be shared. meetin s the Committee hea d e idence which illust ates the ital impo tance of an effecti e and efficient testin and t acin system For this, the HSE’s forthcoming detailed plan will be of crucial impo tance
The plan’s ability to maintain strong testin capacity on the ound in pa ticula e a din uic end to end tu na ound times will be of c ucial impo tance
he e idence ecei ed also hi hli hts a eas of special conce n in the continued ope ation of Ireland’s Test ace Isolate I system – whethe ent ants f om o e seas and healthca e staff should be sub ect to e t a testin and the is s a ound hospital unde capacity and potential o e c owdin
Co id t ac e app fo I eland was launched on uly to supplement manual contact t acin by usin luetooth p o imity technolo y on mobile phones hile some conce ns about the app ha e been a ticulated it contains potential to cont ibute to contact t acin
his epo t aims to summa ise succinctly the ma o issues which the Committee encounte ed in its e plo ation of the e idence and to a ticulate ecommendations which help to focus effo ts to make Ireland’s testing and tracing system as effective as it can be. Our society’s ability to operate safely into the futu e depends on the achie ement of that oal Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
vidence rom Committee eetings nd u missions –
ate ession ession . Table below provides details relating to written evidence received by the Special Committee on a this topic. The submissions have been uploaded to the Oireachtas website and links are provided in the table. . Table below identifies all stakeholders who gave oral evidence to the Special Committee, together with the date and the session during which they gave such evidence. inks to the Official 12 une eport of those meetings are available in this table. T E – ITTE S ISSIO S ame of organisation ate received Chime une
efence Forces une une epartment of Health une Health roducts egulatory uthority une
Health Service E ecutive une Irish Council for Civil iberties and igital ights Ireland une
Irish edical Organisation une Irish urses and idwives Organisation une Irish heelchair ssociation une Medical Laboratory Scientists Association and the Academy une of Clinical Science and Laboratory Medicine
r. Stephen Farrell and rof. oug eith TC une r. Tom s . yan TC une rof. Eugenia Siapera C une rof. atrick allon C une
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil
Science Foundation Ireland r. rendan ennings, aterford IT une Interim Report on Testing and Tracing – August 2020
vidence rom Committee eetings nd u missions –
ate ession ession . Table below provides details relating to written evidence received by the Special Committee on a this topic. The submissions have been uploaded to the Oireachtas website and links are provided in the table. . Table below identifies all stakeholders who gave oral evidence to the Special Committee, together with the date and the session during which they gave such evidence. inks to the Official une 13 eport of those meetings are available in this table. T E – ITTE S ISSIO S ame of organisation ate received Chime une
efence Forces une une epartment of Health une Health roducts egulatory uthority une
Health Service E ecutive une Irish Council for Civil iberties and igital ights Ireland une
Irish edical Organisation une Irish urses and idwives Organisation une Irish heelchair ssociation une Medical Laboratory Scientists Association and the Academy une of Clinical Science and Laboratory Medicine
r. Stephen Farrell and rof. oug eith TC une r. Tom s . yan TC une rof. Eugenia Siapera C une rof. atrick allon C une
– August 2020 Tracing and Testing Interim Report on
Science Foundation Ireland r. rendan ennings, aterford IT une Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
The importance of testing and tracing . s in n r in is on r o on ro nis s i o o r n s r o Co i . i on i on si o r ri r sur s o n s in , ou i u , so i is n in n rin o s s r so i is n in is no ossi . on o r r n ion sur i o is o o n o u ss n i i i i s i r in r ions or in s o . n i Mr. Muiris O’Connor, s in n r in s s is ss n ro us n i i in i o r urn o r s ri ions n is us oi . 14 . is i or n o no , s s Co i usin s, r o r s n ri n onsi r or i i n ro on r o r i s. . n o on oin o uni r ns ission is in o o u i n ono . . Co i r i r in r r n is s i i in o r i i ris on or Co i 19 and an expert opinion that “it is ine i i ri n r sur n of cases as we relax restrictions and permit more travel”.
. n rn ion s, su s in r n n M ourn , us r i , s o r s i irus un r on ro n ui ri n in ion o s o s, i n u ori i s s r in o in r s s in i . r or , i i o r s on ui o r u s i ro us s in i in is ru i .
. Co i s o uro i on inu o s n ou r s o is s , n public monitoring will be necessary to ensure they remain as “manageable outbreaks” rather n o in si ni i n r sur n s.
. Co i s so o i should be possible for Ireland to “effectively eliminate” irus ro oun r usin n r ssi s r iso s r i n or n , in o in r u r n in , s s n so i is n in . ossi i i o ss s o i s in usin s i s s s so oo . Co i is uss is i o n i in ion o irus, u i s is s no r i so u ion in on r s i ou r uir n i on r s u o n o n on rio o s iso ion i s no r i .
. Our s s o s in n r in is i o o s r s r ss s s or s s in o in on s. irs is in u us , n in on o u r o urs, o ro
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil o rs s n n i r n r s o r r r r in s o
Co i , un – ro . M on, . Co i , un – ro . M on, . Co i , un – ro . o n, . ro . n su ission o Co i Interim Report on Testing and Tracing – August 2020
The importance of testing and tracing . s in n r in is on r o on ro nis s i o o r n s r o Co i . i on i on si o r ri r sur s o n s in , ou i u , so i is n in n rin o s s r so i is n in is no ossi . on o r r n ion sur i o is o o n o u ss n i i i i s i r in r ions or in s o . n i Mr. Muiris O’Connor, s in n r in s s is ss n ro us n i i in i o r urn o r s ri ions n is us oi . 15 . is i or n o no , s s Co i usin s, r o r s n ri n onsi r or i i n ro on r o r i s. . n o on oin o uni r ns ission is in o o u i n ono . . Co i r i r in r r n is s i i in o r i i ris on or Co i 19 and an expert opinion that “it is ine i i ri n r sur n of cases as we relax restrictions and permit more travel”.
. n rn ion s, su s in r n n M ourn , us r i , s o r s i irus un r on ro n ui ri n in ion o s o s, i n u ori i s s r in o in r s s in i . r or , i i o r s on ui o r u s i ro us s in i in is ru i .
. Co i s o uro i on inu o s n ou r s o is s , n public monitoring will be necessary to ensure they remain as “manageable outbreaks” rather n o in si ni i n r sur n s.
. Co i s so o i should be possible for Ireland to “effectively eliminate” irus ro oun r usin n r ssi s r iso s r i n or n , in o in r u r n in , s s n so i is n in . ossi i i o ss s o i s in usin s i s s s so oo . Co i is uss is i o n i in ion o irus, u i s is s no r i so u ion in on r s i ou r uir n i on r s u o n o n on rio o s iso ion i s no r i .
. Our s s o s in n r in is i o o s r s r ss s s or s s in o in on s. irs is in u us , n in on o u r o urs, o ro
o rs s n n i r n r s o r r r r in s o – August 2020 Tracing and Testing Interim Report on
Co i , un – ro . M on, . Co i , un – ro . M on, . Co i , un – ro . o n, . ro . n su ission o Co i Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
transmission. he second will be during flu season as a large number of people with relevant etailed test and trace planning symptoms will be seeking testing at the same time. . ue to the serious importance of effective testing and tracing as outlined above, the 19. npreparedness for ovid 19 resurgence will also increase the likelihood of individuals ommittee is of the opinion that the plan for its continuing operation needs to be both attending healthcare settings for other treatments contracting ovid 19 nosocomial ambitious and realistic. infection . ospital overcrowding which will aid the spread the infection is a real risk. Ireland’s comparatively low healthcare capacity makes robust testing and tracing particularly . he ommittee was told that infectious diseases physicians and leading figures within the important for this tate. oyal ollege of hysicians Ireland have called for
. he ommittee was also advised that testing and tracing will be “the beating pulse of our … 16 country”. If it fails, we risk losing the gains made so far in containing the virus. 1. he ommittee recently received evidence from the that 1 1 contacts of confirmed cases did not attend to receive day or day tests. his is very concerning and undermines the effectiveness of the test and trace system. he shared the ommittee’s concern in this matter and posited that there may be reluctance to engage due to the implications for restrictions on movement and work. he was keen to emphasise that its public messaging around the importance of testing is strong and it put “a lot of time and effort” into trying to . follow up with avoidant identified contacts.
. he ommittee was also told that for an effective and scientifically oriented I operation, which is informed by all necessary e perts, ideally a new agency would be created to implement it, and that this would be the responsibility of a dedicated inister. ecommendation . he ommittee accepts that the current test and trace service was an emergency structure t is apparent that man people are not attending for testing after eing identified as contacts of put in place to meet the immediate re uirements of the crisis, and it welcomes the work of confirmed cases The tate must respond more vigorousl to do this to ensure that eing tested the to design a new and more robust model that will operate until ovid is no longer in such circumstances is understood to e a mandator pu lic health responsi ilit an issue.
. he target for implementation of the detailed model is late ugust. Its focus is on building a testing service with short turnaround times and maintaining long term capacity and fle ibility for future surges.
. ospital settings will also be a vital component of necessary planning for the future because of the potential for patients or staff to bring in infections. hese will have to be addressed as part of that plan.
. anaging ovid in hospital settings will be challenging due to the already s uee ed nature of hospital settings in Ireland, which have often e perienced trolley overcrowding. he whole issue of creating e tra physical space and of scheduling appointments will have to be Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil
ommittee ebate une rof. allon p. 9 ommittee ebate, une rof. allon, p. ommittee ebate une rof. allon p. rof. yan submission to the ommittee ommittee ebate une rof. allon p. ommittee ebate, une r. enry, p. ommittee ebate 1 uly r. oherty pp. ommittee ebate, une rof. allon, p. Interim Report on Testing and Tracing – August 2020
transmission. he second will be during flu season as a large number of people with relevant etailed test and trace planning symptoms will be seeking testing at the same time. . ue to the serious importance of effective testing and tracing as outlined above, the 19. npreparedness for ovid 19 resurgence will also increase the likelihood of individuals ommittee is of the opinion that the plan for its continuing operation needs to be both attending healthcare settings for other treatments contracting ovid 19 nosocomial ambitious and realistic. infection . ospital overcrowding which will aid the spread the infection is a real risk. Ireland’s comparatively low healthcare capacity makes robust testing and tracing particularly . he ommittee was told that infectious diseases physicians and leading figures within the important for this tate. oyal ollege of hysicians Ireland have called for
. he ommittee was also advised that testing and tracing will be “the beating pulse of our … country”. If it fails, we risk losing the gains made so far in containing the virus. 17 1. he ommittee recently received evidence from the that 1 1 contacts of confirmed cases did not attend to receive day or day tests. his is very concerning and undermines the effectiveness of the test and trace system. he shared the ommittee’s concern in this matter and posited that there may be reluctance to engage due to the implications for restrictions on movement and work. he was keen to emphasise that its public messaging around the importance of testing is strong and it put “a lot of time and effort” into trying to . follow up with avoidant identified contacts.
. he ommittee was also told that for an effective and scientifically oriented I operation, which is informed by all necessary e perts, ideally a new agency would be created to implement it, and that this would be the responsibility of a dedicated inister. ecommendation . he ommittee accepts that the current test and trace service was an emergency structure t is apparent that man people are not attending for testing after eing identified as contacts of put in place to meet the immediate re uirements of the crisis, and it welcomes the work of confirmed cases The tate must respond more vigorousl to do this to ensure that eing tested the to design a new and more robust model that will operate until ovid is no longer in such circumstances is understood to e a mandator pu lic health responsi ilit an issue.
. he target for implementation of the detailed model is late ugust. Its focus is on building a testing service with short turnaround times and maintaining long term capacity and fle ibility for future surges.
. ospital settings will also be a vital component of necessary planning for the future because of the potential for patients or staff to bring in infections. hese will have to be addressed as part of that plan.
. anaging ovid in hospital settings will be challenging due to the already s uee ed nature of hospital settings in Ireland, which have often e perienced trolley overcrowding. he whole issue of creating e tra physical space and of scheduling appointments will have to be Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on
ommittee ebate une rof. allon p. 9 ommittee ebate, une rof. allon, p. ommittee ebate une rof. allon p. rof. yan submission to the ommittee ommittee ebate une rof. allon p. ommittee ebate, une r. enry, p. ommittee ebate 1 uly r. oherty pp. ommittee ebate, une rof. allon, p. Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
addressed, as will the issue around managing better the admissions to emergency e o e datio departments of acute hospitals. The ote tial fo hos ital o e o di to e ati el i a t o i s o tai e t is a se io s . hen asked whether a one day turnaround on testing and tracing would be part of the ugust is The o ittee e o e ds that li iti hos ital o di eeds to e add essed ithi plan, the told the ommittee that the Is have not yet been defined. he ommittee the test a d t a e la a d that a i est e t hi h o ld hel to esol e the iss e e will recommend that a one day turnaround time be put in place as a minimum re uirement de lo ed for a robust model of testing.
. In its submission to the ommittee, hime stated that reliance on voice calls for arranging tests and consultations had restricted deaf people’s access to testing and results, with 18 potentially very few deaf people being tested as a result. he ommittee is of the opinion that e o e datio awareness of this issue should inform the HSE’s plan for testing pathways going forward. The Committee recommends that the HSE’s target turnaround time for end to e d testi sho ld . he ommittee is also of the opinion that, as a matter of course, making data publicly e at ost o e da available in a timely manner, including demographic and geographical information about infection rates, is a useful component in enhancing public alertness.
. If cases rise in a particular cohort, the above information may help to alert people to needed behavioural change . e o e datio
lte ati e ha els fo a essi testi a d t a i sho ld e ade a aila le as a t of the la . he eputy hief edical fficer wrote to the ommittee on uly , providing links to fo eo le ho a e a le to a ail of oi e alls e eo le ho a e deaf websites which contain publicly available data
data hub to be updated daily https covid ireland geohive.hub.arcgis.com
ealth rotection urveillance entre which produces daily reports https www.hpsc.ie a respiratory coronavirus novelcoronavirus e o e datio
The o ittee e o e ds that detailed a o ised data a o t i fe tio s – i l di eo a hi al a d de o a hi i fo atio – sho ld e ade li as i l as ossi le a d ecommendation that this a ti e sho ld e o ided fo i the offi ial la This ill hel to i fo li safet The detail of the HSE’s ugust test and trace plan will e crucial to pu lic health outcomes The Committee recommends that this plan should include am itious targets on testing capacit and turnaround times with matching investment in healthcare facilities including isolation rooms mplementation through regional specialist networks should e considered for the plan Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil
ommittee ebate, une Ms Niamh O’Beirne, p. 34 hime submission to ommittee ommittee ebate, une , p. Interim Report on Testing and Tracing – August 2020
addressed, as will the issue around managing better the admissions to emergency e o e datio departments of acute hospitals. The ote tial fo hos ital o e o di to e ati el i a t o i s o tai e t is a se io s . hen asked whether a one day turnaround on testing and tracing would be part of the ugust is The o ittee e o e ds that li iti hos ital o di eeds to e add essed ithi plan, the told the ommittee that the Is have not yet been defined. he ommittee the test a d t a e la a d that a i est e t hi h o ld hel to esol e the iss e e will recommend that a one day turnaround time be put in place as a minimum re uirement de lo ed for a robust model of testing.
. In its submission to the ommittee, hime stated that reliance on voice calls for arranging tests and consultations had restricted deaf people’s access to testing and results, with potentially very few deaf people being tested as a result. he ommittee is of the opinion that e o e datio 19 awareness of this issue should inform the HSE’s plan for testing pathways going forward. The Committee recommends that the HSE’s target turnaround time for end to e d testi sho ld . he ommittee is also of the opinion that, as a matter of course, making data publicly e at ost o e da available in a timely manner, including demographic and geographical information about infection rates, is a useful component in enhancing public alertness.
. If cases rise in a particular cohort, the above information may help to alert people to needed behavioural change . e o e datio
lte ati e ha els fo a essi testi a d t a i sho ld e ade a aila le as a t of the la . he eputy hief edical fficer wrote to the ommittee on uly , providing links to fo eo le ho a e a le to a ail of oi e alls e eo le ho a e deaf websites which contain publicly available data
data hub to be updated daily https covid ireland geohive.hub.arcgis.com
ealth rotection urveillance entre which produces daily reports https www.hpsc.ie a respiratory coronavirus novelcoronavirus e o e datio
The o ittee e o e ds that detailed a o ised data a o t i fe tio s – i l di eo a hi al a d de o a hi i fo atio – sho ld e ade li as i l as ossi le a d ecommendation that this a ti e sho ld e o ided fo i the offi ial la This ill hel to i fo li safet The detail of the HSE’s ugust test and trace plan will e crucial to pu lic health outcomes The Committee recommends that this plan should include am itious targets on testing capacit and turnaround times with matching investment in healthcare facilities including isolation rooms mplementation through regional specialist networks should e considered for the plan Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on
ommittee ebate, une Ms Niamh O’Beirne, p. 34 hime submission to ommittee ommittee ebate, une , p. Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
Ca acit and turnaround times 2 The Committee heard that a 2 hour turnaround of testing and tracing should be achie ed to ensure a robust system 2 34. As of 25 June, the HSE’s testing rate was 18,000 per week due to decreased demand, but it Howe er, the HSE told the Committee that median end to end time from the point of referral to claimed still to ha e capacity for , tests per wee . the end of contact tracing is 1 days – median in the acute sector being 1 5 days and 2 1 days in the community This timeframe includes a notice to contacts that tests ha e been scheduled, 3 . his capacity has not yet een a ailed of and as of une the num ers eing tested were but not the testing of contacts itself 2 elow , per wee . he pea num er of tests was o er , per day in mid pril. The Committee heard that in the last flu season, appro imately 10 of e ery 100,000 people reported flu like symptoms to their e ery week That corresponds to a need for 5,000 tests a 20 3 . ue to a decreased need for contact tracing and decreased positi e test results, contact week, as well as the tests needed for actual symptomatic Co id 1 cases elays in tests during tracing has een centralised in one unit in alway. his unit has the capacity to follow up on this time could e acerbate Co id 1 outbreaks, leading to a further increase in testing need 25 positi e tests. 5 rof allon e pressed concern to the Committee that the current turnaround with low community transmission is a worrying indication for potential surge scenarios in the future 2 3 . Other centres will e reopened if there are three consecuti e days of at least positi e tests. total of , people ha e een trained in contact tracing. The Committee was informed that turnaround time is significantly lower in hospitals than in community settings as, in the former, the patient can be tested where they are present 2 3 . he HSE confirmed to the ommittee that e ery contact of a confirmed case is now automatically tested on ay and ay . Some , identified contacts were tested as of une and the This discrepancy appears to be a key gap where any solution to e pedite the time between infection positi ity rate for them was a out . presentation in a community setting and the subse uent testing and analysis should be aggressi ely sought in systemic planning 3 . The Committee is also mindful that Ireland’s general healthcare capacity pre o id was lower 8 In its joint submission, the edical aboratory Scientists Association and Academy of Clinical than many other European countries and this may heighten the ris of failing to realise the Science and Laboratory Medicine, stated that e isting timely electronic reporting pathways e ist olume and speed of testing needed. between s or primary care centres and that a more sustainable testing model for Co id 1 would utilise these pathways 28
ey points identified by the HSE to impro e the response to a surge in future include the speed at . urnaround time which cases can be responded to, increasing awareness about the importance of presenting early with symptoms, and the dogged pursuance of close contacts of each known case for testing 2 4 . he ommittee is of the opinion that the turnaround times for testing, results and contact tracing are of crucial importance and that this should e ept in mind when discussing capacity the turnaround time is a ey component of capacity. 5 2 Supply of tests 4 . he HSE stated that, in contact tracing, the positi e test rate among symptomatic contacts is 4 , 50 Cognisant that testing capacity had been constrained around the world at the height of the and among asymptomatic contacts it is . his underlines the importance of uic testing and pandemic by a limited global supply of tests, the Committee uestioned the updated status of tracing, ecause if asymptomatic positi e cases are identified uic ly, their spread of the irus can sourcing testing e uipment In that regard, the HSE admitted that this was a “constant challenge” e limited. and that while the current supply was secure, if multiple countries e perienced surges Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil ommittee e ate, une r. Henry, p. 2 Committee ebate, 25 June 2020 rof allon, p 5 ommittee e ate, une r. Henry, p. 3 2 Committee ebate, 25 June 2020 rof allon, p 12 ommittee e ate, une r. Henry, p. 3 25 Committee ebate, 25 June 2020 rof allon, p 1 i id 2 ibid i id 2 Committee ebate, 25 June 2020 r Henry, p 18 ommittee e ate, une rof. Mallon, p. 28 The Medical Laboratory Scientists Association and Academy of Clinical Science and Laboratory ommittee e ate, une r. Henry, p. Medicine submission to Committee 2 ibid Interim Report on Testing and Tracing – August 2020
Ca acit and turnaround times 2 The Committee heard that a 2 hour turnaround of testing and tracing should be achie ed to ensure a robust system 2 34. As of 25 June, the HSE’s testing rate was 18,000 per week due to decreased demand, but it Howe er, the HSE told the Committee that median end to end time from the point of referral to claimed still to ha e capacity for , tests per wee . the end of contact tracing is 1 days – median in the acute sector being 1 5 days and 2 1 days in the community This timeframe includes a notice to contacts that tests ha e been scheduled, 3 . his capacity has not yet een a ailed of and as of une the num ers eing tested were but not the testing of contacts itself 2 elow , per wee . he pea num er of tests was o er , per day in mid pril. The Committee heard that in the last flu season, appro imately 10 of e ery 100,000 people reported flu like symptoms to their e ery week That corresponds to a need for 5,000 tests a 3 . ue to a decreased need for contact tracing and decreased positi e test results, contact week, as well as the tests needed for actual symptomatic Co id 1 cases elays in tests during 21 tracing has een centralised in one unit in alway. his unit has the capacity to follow up on this time could e acerbate Co id 1 outbreaks, leading to a further increase in testing need 25 positi e tests. 5 rof allon e pressed concern to the Committee that the current turnaround with low community transmission is a worrying indication for potential surge scenarios in the future 2 3 . Other centres will e reopened if there are three consecuti e days of at least positi e tests. total of , people ha e een trained in contact tracing. The Committee was informed that turnaround time is significantly lower in hospitals than in community settings as, in the former, the patient can be tested where they are present 2 3 . he HSE confirmed to the ommittee that e ery contact of a confirmed case is now automatically tested on ay and ay . Some , identified contacts were tested as of une and the This discrepancy appears to be a key gap where any solution to e pedite the time between infection positi ity rate for them was a out . presentation in a community setting and the subse uent testing and analysis should be aggressi ely sought in systemic planning 3 . The Committee is also mindful that Ireland’s general healthcare capacity pre o id was lower 8 In its joint submission, the edical aboratory Scientists Association and Academy of Clinical than many other European countries and this may heighten the ris of failing to realise the Science and Laboratory Medicine, stated that e isting timely electronic reporting pathways e ist olume and speed of testing needed. between s or primary care centres and that a more sustainable testing model for Co id 1 would utilise these pathways 28
ey points identified by the HSE to impro e the response to a surge in future include the speed at . urnaround time which cases can be responded to, increasing awareness about the importance of presenting early with symptoms, and the dogged pursuance of close contacts of each known case for testing 2 4 . he ommittee is of the opinion that the turnaround times for testing, results and contact tracing are of crucial importance and that this should e ept in mind when discussing capacity the turnaround time is a ey component of capacity. 5 2 Supply of tests 4 . he HSE stated that, in contact tracing, the positi e test rate among symptomatic contacts is 4 , 50 Cognisant that testing capacity had been constrained around the world at the height of the and among asymptomatic contacts it is . his underlines the importance of uic testing and pandemic by a limited global supply of tests, the Committee uestioned the updated status of tracing, ecause if asymptomatic positi e cases are identified uic ly, their spread of the irus can sourcing testing e uipment In that regard, the HSE admitted that this was a “constant challenge” e limited. and that while the current supply was secure, if multiple countries e perienced surges Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on ommittee e ate, une r. Henry, p. 2 Committee ebate, 25 June 2020 rof allon, p 5 ommittee e ate, une r. Henry, p. 3 2 Committee ebate, 25 June 2020 rof allon, p 12 ommittee e ate, une r. Henry, p. 3 25 Committee ebate, 25 June 2020 rof allon, p 1 i id 2 ibid i id 2 Committee ebate, 25 June 2020 r Henry, p 18 ommittee e ate, une rof. Mallon, p. 28 The Medical Laboratory Scientists Association and Academy of Clinical Science and Laboratory ommittee e ate, une r. Henry, p. Medicine submission to Committee 2 ibid Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
s ltaneo sl so c ng challenges o l ec he an the e a t ent o ealth state 58. rof. allon told the ommittee that public health measures generally see more take up, and are, that they have “looked at diversification across platforms” to try to make us less reliant on a small therefore, more effective if there is no cost to the public. aking flu vaccines and masks free at n e o lat o s an that oc e ent has ens e e s cat on ac oss the hos tal the point of provision, therefore, should be considered. This may be an efficient and rewarding la o ato net o investment on the part of the State. The cost to the public needs to be factored in when considering the effectiveness of public health measures.3 he also tol the o ttee that as a ac as a eagent s l ag ee ents ha een a e th t o a o o e s ase n elan oche an ott an a s l l ne ecommendation so ce o h na – which at that point in time was supplying the HSE’s 41 labs with reagents. cute settings ha e a faster median end to end turnaround time than the communit hea thcare he Academy of Clinical Science and Laboratory Medicine and e cal a o ato c ent sts sector The Committee recommends that so utions hich can ridge this ga and shorten test ssoc at on state n ts joint s ss on to the o ttee that the e s a nee to nc ease the 22 and trace time from first resentation in the communit sector e aggressi e ursued n e o e cal sc ent sts act s ng n elan to hel s sta n la ca ac t o t e o t ea s h s s so eth ng the e a t ent o ealth sho l ta e th the ne e a t ent o ghe cat on an th c ence o n at on elan
ecommendation ost The Committee recommends that the HSE e ore uti ising e isting testing channe s et een s he tol the o ttee that the e s a e ange o costs o test ng n hos tals the and a oratories for the use of Co id testing to uic en testing time f this is not a ia e marginal cost per test is €75, while tests procured from commercial laboratories can cost up to so ution for Co id testing the reasons shou d e stated c ear €140. The average budgeted rate per test is around €120, but it was operating ell elo those le els as o ne
he l o n est ent has een n ac te hos tals an sh la o ato es s ch as the at onal s e e ence a o ato an that t s engage n stoc l ng an a ance chas ng o tests ecommendation to t to a o s l cha n ss es ng t e s ges The Committee recommends that the im ortance of see ing testing ear in onset of s m toms hen as e hethe ate la s a e e ng a o a ce ta n n e o tests th th s ca ac t shou d e em hasised in u ic hea th messaging e ng n e t l se the sa that as at ne t as not the case t that s sta n ng ca ac t n sh la s l c o ate necess tates n est ent eca se o the otent al o eocc ence o glo al co et t on o s l es
he o ttee ece e a e ng note o the e a t ent o l c en t e an e o ecommendation ate l o ng n o at on a o t test ng costs total o €208 million has so a een The Committee recommends that ensuring a sufficient su of testing e ui ment shou d allocate o test ng an t ac ng ca ac t an t as state that the os t on o l e eassesse remain a riorit n addition the num er of testing e erts or ing needs to e maintained at by the end of August. The expenditure to 3 July was €84 million. When once o costs a e e cl e a sufficient e e the expenditure is €44 million for 447,000 processe tests h s es lts n an a e age n t cost o €98 per test, with variation across providers.
The note also stated that the cost of retaining capacity which is unused are “relatively small” – acco ng to a est ate it is €0.3m €0.7m per week (approximately €10m €20m until the end ecommendation
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil o the ea o not t l s ng the ll test ng ca ac t h ch s a a la le The Committee recommends that the State shou d aim to achie e ca acit here free at the oint of ro ision rotections such as f u accines and face mas s cou d e ro ided as reduced cost o ttee e ate ne c all on an e asc n for the u ic is i e to im ro e the effecti eness of u ic hea th measures o ttee e ate a e The Medical Laboratory Scientists Association and Academy of Clinical Science and Laboratory Medicine submission to Committee o ttee e ate ne c all on o ttee e ate ne c all on 3 ommittee ebate, 25 June 2020 rof. allon, pp. 2 , 27 Interim Report on Testing and Tracing – August 2020
s ltaneo sl so c ng challenges o l ec he an the e a t ent o ealth state 58. rof. allon told the ommittee that public health measures generally see more take up, and are, that they have “looked at diversification across platforms” to try to make us less reliant on a small therefore, more effective if there is no cost to the public. aking flu vaccines and masks free at n e o lat o s an that oc e ent has ens e e s cat on ac oss the hos tal the point of provision, therefore, should be considered. This may be an efficient and rewarding la o ato net o investment on the part of the State. The cost to the public needs to be factored in when considering the effectiveness of public health measures.3 he also tol the o ttee that as a ac as a eagent s l ag ee ents ha een a e th t o a o o e s ase n elan oche an ott an a s l l ne ecommendation so ce o h na – which at that point in time was supplying the HSE’s 41 labs with reagents. cute settings ha e a faster median end to end turnaround time than the communit hea thcare he Academy of Clinical Science and Laboratory Medicine and e cal a o ato c ent sts sector The Committee recommends that so utions hich can ridge this ga and shorten test ssoc at on state n ts joint s ss on to the o ttee that the e s a nee to nc ease the and trace time from first resentation in the communit sector e aggressi e ursued 23 n e o e cal sc ent sts act s ng n elan to hel s sta n la ca ac t o t e o t ea s h s s so eth ng the e a t ent o ealth sho l ta e th the ne e a t ent o ghe cat on an th c ence o n at on elan
ecommendation ost The Committee recommends that the HSE e ore uti ising e isting testing channe s et een s he tol the o ttee that the e s a e ange o costs o test ng n hos tals the and a oratories for the use of Co id testing to uic en testing time f this is not a ia e marginal cost per test is €75, while tests procured from commercial laboratories can cost up to so ution for Co id testing the reasons shou d e stated c ear €140. The average budgeted rate per test is around €120, but it was operating ell elo those le els as o ne
he l o n est ent has een n ac te hos tals an sh la o ato es s ch as the at onal s e e ence a o ato an that t s engage n stoc l ng an a ance chas ng o tests ecommendation to t to a o s l cha n ss es ng t e s ges The Committee recommends that the im ortance of see ing testing ear in onset of s m toms hen as e hethe ate la s a e e ng a o a ce ta n n e o tests th th s ca ac t shou d e em hasised in u ic hea th messaging e ng n e t l se the sa that as at ne t as not the case t that s sta n ng ca ac t n sh la s l c o ate necess tates n est ent eca se o the otent al o eocc ence o glo al co et t on o s l es
he o ttee ece e a e ng note o the e a t ent o l c en t e an e o ecommendation ate l o ng n o at on a o t test ng costs total o €208 million has so a een The Committee recommends that ensuring a sufficient su of testing e ui ment shou d allocate o test ng an t ac ng ca ac t an t as state that the os t on o l e eassesse remain a riorit n addition the num er of testing e erts or ing needs to e maintained at by the end of August. The expenditure to 3 July was €84 million. When once o costs a e e cl e a sufficient e e the expenditure is €44 million for 447,000 processe tests h s es lts n an a e age n t cost o €98 per test, with variation across providers.
The note also stated that the cost of retaining capacity which is unused are “relatively small” – acco ng to a est ate it is €0.3m €0.7m per week (approximately €10m €20m until the end ecommendation
o the ea o not t l s ng the ll test ng ca ac t h ch s a a la le The Committee recommends that the State shou d aim to achie e ca acit here free at the oint – August 2020 Tracing and Testing Interim Report on of ro ision rotections such as f u accines and face mas s cou d e ro ided as reduced cost o ttee e ate ne c all on an e asc n for the u ic is i e to im ro e the effecti eness of u ic hea th measures o ttee e ate a e The Medical Laboratory Scientists Association and Academy of Clinical Science and Laboratory Medicine submission to Committee o ttee e ate ne c all on o ttee e ate ne c all on 3 ommittee ebate, 25 June 2020 rof. allon, pp. 2 , 27 Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
Tra e testing and tracing . The reiterated that testing upon entry has point in time limitations but that it has to be considered and is “under active discussion by NPHET”. 59. The ommittee took a range of evidence on the risk of the spread of the virus caused by . The ommittee was also warned about the e istence of privately supplied testing including international travel, especially if travel is from to other countries which have higher infection antibody tests which may not be sensitive enough to offer meaningful information. ery rates. ssues around uarantine of those who visit or return to the State and in particular the uick turnaround times e. g. minutes should be considered suspect and any test which difficulty of policing uarantine protocols and guidelines remains a live issue. The ommittee is not officially validated should not be trusted. The ommittee is of the opinion that strong remains concerned about international flights from areas of the world with very high messaging is needed to inform the public as to why they should get tested through the official incidences of ovid 19 and this has to be addressed by overnment (see also paragraph 2 channels. below . 24 0. As of 25 June 2020, reland did not track everyone entering the country to ensure adherence to the 14 day uarantine.37 While a uarantine system is in place, compliance is not ecommendation guaranteed and carriers entering the country may spread the infection. nfections entering the countr through tra e from o erseas is a strong ris The Committee 1. Screening at points of entry is an important element of continued virus control. The level of recommends that a entrants shou d e tem erature screened on arri a and e tested at east screening, restrictions and follow up udged to be necessary could be influenced by the virus t ice due to the imitations of oint in time testing levels in the point of origin of entrants.38
2. Allowing unrestricted movement of people from any area of the world where there is uncontrolled community transmission presents a strong risk.39 The ommittee did examine ecommendation the issue of foreign travel and it is clear that there are inconsistencies that make reland an outlier amongst E States. reland has taken a less restrictive approach to access from The Committee recommends that mandator uarantine u on entr shou d e monitored more countries outside the E such as the SA (especially in respect of direct flights from southern c ose uarantine shou d e enforced so that entrants are re uired to ro e that the are states of the SA where the incidence of ovid 19 is high . At the same time there was com iant ith this u ic hea th im erati e criticism of the Government’ “Green List” which was described as more restrictive than in any European country.
3. The ommittee heard that the fastest test available has an upper turnaround time of one hour, but that getting a sufficient supply of these will not be feasible for some time. f ecommendation laboratories were next to points of entry, with current reliable testing methods available in sufficient uantity, testing would take three to four hours.40 nofficia ri ate tests ma not e re ia e and can gi e fa se confidence The Committee recommends that the dangers of such tests e em hasised in messaging to the u ic 4. oint of entry testing is limited by the fact that results can only give information about the point in time they were taken. eople who were not identified as positive can still develop symptoms subse uently.
5. The nature of this “point in time” characteristic of testing means that follow up testing after the “day zero” test would further help to limit infections from entrants. This should be kept in mind especially for entrants from high risk ones.41 However, the ommittee is aware that
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil other E states are relying on point in time testing of entrants.
37 ommittee ebate, 25 June 2020 r. Henry, p. 7 38 ibid 39 ommittee ebate, 25 June 2020 rof. allon, p.15 40 ommittee ebate, 25 June 2020 rof. allon, p. 10 ommittee ebate une r. enry p. 41 ommittee ebate, 25 June 2020 rof. allon, p. 11 ommittee ebate une rof. allon p. Interim Report on Testing and Tracing – August 2020
Tra e testing and tracing . The reiterated that testing upon entry has point in time limitations but that it has to be considered and is “under active discussion by NPHET”. 59. The ommittee took a range of evidence on the risk of the spread of the virus caused by . The ommittee was also warned about the e istence of privately supplied testing including international travel, especially if travel is from to other countries which have higher infection antibody tests which may not be sensitive enough to offer meaningful information. ery rates. ssues around uarantine of those who visit or return to the State and in particular the uick turnaround times e. g. minutes should be considered suspect and any test which difficulty of policing uarantine protocols and guidelines remains a live issue. The ommittee is not officially validated should not be trusted. The ommittee is of the opinion that strong remains concerned about international flights from areas of the world with very high messaging is needed to inform the public as to why they should get tested through the official incidences of ovid 19 and this has to be addressed by overnment (see also paragraph 2 channels. below . 25 0. As of 25 June 2020, reland did not track everyone entering the country to ensure adherence to the 14 day uarantine.37 While a uarantine system is in place, compliance is not ecommendation guaranteed and carriers entering the country may spread the infection. nfections entering the countr through tra e from o erseas is a strong ris The Committee 1. Screening at points of entry is an important element of continued virus control. The level of recommends that a entrants shou d e tem erature screened on arri a and e tested at east screening, restrictions and follow up udged to be necessary could be influenced by the virus t ice due to the imitations of oint in time testing levels in the point of origin of entrants.38
2. Allowing unrestricted movement of people from any area of the world where there is uncontrolled community transmission presents a strong risk.39 The ommittee did examine ecommendation the issue of foreign travel and it is clear that there are inconsistencies that make reland an outlier amongst E States. reland has taken a less restrictive approach to access from The Committee recommends that mandator uarantine u on entr shou d e monitored more countries outside the E such as the SA (especially in respect of direct flights from southern c ose uarantine shou d e enforced so that entrants are re uired to ro e that the are states of the SA where the incidence of ovid 19 is high . At the same time there was com iant ith this u ic hea th im erati e criticism of the Government’ “Green List” which was described as more restrictive than in any European country.
3. The ommittee heard that the fastest test available has an upper turnaround time of one hour, but that getting a sufficient supply of these will not be feasible for some time. f ecommendation laboratories were next to points of entry, with current reliable testing methods available in sufficient uantity, testing would take three to four hours.40 nofficia ri ate tests ma not e re ia e and can gi e fa se confidence The Committee recommends that the dangers of such tests e em hasised in messaging to the u ic 4. oint of entry testing is limited by the fact that results can only give information about the point in time they were taken. eople who were not identified as positive can still develop symptoms subse uently.
5. The nature of this “point in time” characteristic of testing means that follow up testing after the “day zero” test would further help to limit infections from entrants. This should be kept in mind especially for entrants from high risk ones.41 However, the ommittee is aware that other E states are relying on point in time testing of entrants. – August 2020 Tracing and Testing Interim Report on
37 ommittee ebate, 25 June 2020 r. Henry, p. 7 38 ibid 39 ommittee ebate, 25 June 2020 rof. allon, p.15 40 ommittee ebate, 25 June 2020 rof. allon, p. 10 ommittee ebate une r. enry p. 41 ommittee ebate, 25 June 2020 rof. allon, p. 11 ommittee ebate une rof. allon p. Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
Hea thcare staff . he ommittee heard from rof. Mallon that he thinks a change in regulations to categorise instances of ovid 19 contracted in workplaces as notifiable occupational illnesses would be useful, as it would help to provide information on how many people are contracting the virus in . T e o ittee is a are t at t e rates o in ection or ea t care or ers in re and ave been workplaces.52 a ar in y i . T e ris Nurses and id ives r anisation stated in its sub ission to t e o ittee on une t at ea t care or ers ade u a t ird o a cases and t at o t ose . Prof. Mallon also warned the Committee that Ireland’s healthcare staffing levels, including of ere t e in ection source as no n o nurses ot t e virus in a ea t care settin as infectious disease specialists, are comparatively low and that this poses a risk in relation to 44 sta . resurgences of the virus. He said that we got away with the first wave “by the skin of our teeth” due to public lockdown and not because of capacity in our healthcare system and that “we cannot . n ay t e ie edica icer to d t e o ittee t at t e in ection rate or 53 healthcare workers at that point in time was 31.5%, “a high percentage”. operate safely with the current footprint and current staffing levels”. 26 . When asked on 25 June whether Ireland’s infection rate for healthcare workers was the highest in the world, the HSE stated that countries cannot be compared because “ e ave been ecommendation easurin ea t care or ers as a riority ro t e abso ute o even en e ad testin di icu ties and because e ad a very ide de inition o ea t care or ers”. The rate of infection for hea thcare or ers in re and has een high The Committee . i e t e e act nature o t e in ection rate co arative to ot er countries ay be o en to so e recommends that a hea thcare or ers shou d e tem erature screened u on entering settings eve o debate or inter retation it is i ortant t at ea t care sta in ection s ou d be if the e idence indicates that there is an ad antage to doing so in irus recognition ini ised inso ar as is ossib e.
. T e N as ca ed or dai y te erature testin or or ers enterin os ita s and ot er countries ave seen t e de oy ent o te erature screenin in ot er bui din s as e as ecommendation ea t care settin s. Pro . a on to d t e o ittee t at i e t is easure ust be inc uded in a ar er ac a e o easures and cannot be so e y re ied u on it ou d de inite y e . urther the Committee recommends that a hea thcare or ers shou d e tested regu ar as art of ongoing mass testing as nursing home or ers ere to identif instances of . T e H E said t at suc screenin a ready a ens in nursin o es and is under consideration or as m tomatic carriers ot er ea t care settin s. T e e art ent o Hea t stated t at it as as ed H to er or an evidence census for it on this matter but that “at this point in time... the majority of our patients in re and do not actua y ave a te erature associated it ovid 19”.
. T e H E said t at on une it co enced seria testin o a ea t care or ers in nursin ecommendation o es envisa ed as art o a our ee ti e ine invo vin a ro i ate y eo e. t said t at t is ou d e to dee en its understandin o t e ode o trans ission o t e virus in The Committee recommends that Co id ac uired in or aces shou d e considered a asy to atic ea t care or ers. notifia e occu ationa i ness
. T e N stated in its sub ission t at t is ractice o routine testin or ea t care or ers s ou d be ro ed out across a ea t care settin s.
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil ris Nurses and id ives r anisation sub ission to t e o ittee o ittee ebate ay r. Ho o an . o ittee ebate une r. Henry . o ittee ebate une Pro . a on . o ittee ebate une r. Henry . v o ittee ebate une r. e ascun . o ittee ebate une Ms O’Beirne and Dr. Henry, pp. 18 & 29 52 ommittee Debate, 25 June 2 2 rof. Mallon, p. 31 ris Nurses and id ives r anisation sub ission to t e o ittee 53 ommittee Debate, 25 June 2 2 rof. Mallon, p. 3 Interim Report on Testing and Tracing – August 2020
Hea thcare staff . he ommittee heard from rof. Mallon that he thinks a change in regulations to categorise instances of ovid 19 contracted in workplaces as notifiable occupational illnesses would be useful, as it would help to provide information on how many people are contracting the virus in . T e o ittee is a are t at t e rates o in ection or ea t care or ers in re and ave been workplaces.52 a ar in y i . T e ris Nurses and id ives r anisation stated in its sub ission to t e o ittee on une t at ea t care or ers ade u a t ird o a cases and t at o t ose . Prof. Mallon also warned the Committee that Ireland’s healthcare staffing levels, including of ere t e in ection source as no n o nurses ot t e virus in a ea t care settin as infectious disease specialists, are comparatively low and that this poses a risk in relation to 44 sta . resurgences of the virus. He said that we got away with the first wave “by the skin of our teeth” due to public lockdown and not because of capacity in our healthcare system and that “we cannot . n ay t e ie edica icer to d t e o ittee t at t e in ection rate or 53 healthcare workers at that point in time was 31.5%, “a high percentage”. operate safely with the current footprint and current staffing levels”. 27 . When asked on 25 June whether Ireland’s infection rate for healthcare workers was the highest in the world, the HSE stated that countries cannot be compared because “ e ave been ecommendation easurin ea t care or ers as a riority ro t e abso ute o even en e ad testin di icu ties and because e ad a very ide de inition o ea t care or ers”. The rate of infection for hea thcare or ers in re and has een high The Committee . i e t e e act nature o t e in ection rate co arative to ot er countries ay be o en to so e recommends that a hea thcare or ers shou d e tem erature screened u on entering settings eve o debate or inter retation it is i ortant t at ea t care sta in ection s ou d be if the e idence indicates that there is an ad antage to doing so in irus recognition ini ised inso ar as is ossib e.
. T e N as ca ed or dai y te erature testin or or ers enterin os ita s and ot er countries ave seen t e de oy ent o te erature screenin in ot er bui din s as e as ecommendation ea t care settin s. Pro . a on to d t e o ittee t at i e t is easure ust be inc uded in a ar er ac a e o easures and cannot be so e y re ied u on it ou d de inite y e . urther the Committee recommends that a hea thcare or ers shou d e tested regu ar as art of ongoing mass testing as nursing home or ers ere to identif instances of . T e H E said t at suc screenin a ready a ens in nursin o es and is under consideration or as m tomatic carriers ot er ea t care settin s. T e e art ent o Hea t stated t at it as as ed H to er or an evidence census for it on this matter but that “at this point in time... the majority of our patients in re and do not actua y ave a te erature associated it ovid 19”.
. T e H E said t at on une it co enced seria testin o a ea t care or ers in nursin ecommendation o es envisa ed as art o a our ee ti e ine invo vin a ro i ate y eo e. t said t at t is ou d e to dee en its understandin o t e ode o trans ission o t e virus in The Committee recommends that Co id ac uired in or aces shou d e considered a asy to atic ea t care or ers. notifia e occu ationa i ness
. T e N stated in its sub ission t at t is ractice o routine testin or ea t care or ers s ou d be ro ed out across a ea t care settin s.
ris Nurses and id ives r anisation sub ission to t e o ittee – August 2020 Tracing and Testing Interim Report on o ittee ebate ay r. Ho o an . o ittee ebate une r. Henry . o ittee ebate une Pro . a on . o ittee ebate une r. Henry . v o ittee ebate une r. e ascun . o ittee ebate une Ms O’Beirne and Dr. Henry, pp. 18 & 29 52 ommittee Debate, 25 June 2 2 rof. Mallon, p. 31 ris Nurses and id ives r anisation sub ission to t e o ittee 53 ommittee Debate, 25 June 2 2 rof. Mallon, p. 3 Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
The a 5. Days prior to the app’s public release, Digital Rights Ireland and the Irish Council for Civil Liberties issued another joint document on the app, a “pre release report card”. The overall “grade” given was a . . Covid tracker app for Ireland, which was created by the H , was launched on uly . ccording to the H product e plainer for the app, it has three functions contact tracing, . The document acknowledged that the HSE had listened to concerns about the app and allowing users to share symptoms in “daily health check ins”, and as a trusted source of news on commended it and the epartment of Health for publishing the ata Protection mpact the virus. Assessment, Data Protection Commissioner’s review of the assessment, and the app source code, thereby improving transparency and public confidence around the pro ect. However, there were . he contact tracing element of the app is based on using luetooth pro imity technology, and not remaining criticisms. These included location data. he idea behind luetooth pro imity apps is that people who have been in close contact with infected persons, but who would not be identified through manual contact tracing, 28 could be informed through pro imity data collected on their smartphone. issue tracker is “required for the kind of transparency and accountability inherent in open source” and would help inevitable bugs to be reported, discussed and resolved. . Knowledge of users’ location is not necessary in this model, only that they were proximate to an identified infected person. he epidemiologically significant definition of close contact, as specified by NPHET, is as “greater than 15 minutes face to face (<2 metres distance)”. . ingapore first developed its own luetooth pro imity app, but the app was not approved by source. There is “limited documentation” about GAEN’s API (Application Programming pple, which limited its uptake. In pril , oogle and pple announced a oint pro ect – the Interface) and “very limited information” about its design. “Google Apple Exposure Notification” (GAEN) system. This is embedded software in Apple iOS and oogle ndroid mobile operating systems. It facilitates the development of contact tracing apps which can use this embedded system. . Concerns about the efficacy of an app based solution for contacting tracing had been raised in submissions to the Committee. Professor ugeniera iapera told the Committee that a based been in contact with a positive case) during app testing to help inform assessment of the app’s study found that of the population, or of smartphone users, need to use a smartphone app which is based on luetooth pro imity in order for it to be effective. It is unclear to what extent Google Firebase is being used in the app. This service’s . he igital conomy and ociety Inde found that Ireland is behind in terms of proportion may lead to data processing in US service’s and data therefore being available to US state of the population who have basic digital literacy skills – the skills to “use digital devices, agencies. Its use could also create a conflict of interest for Google, “whose primary business is communication applications, and networks to access and manage information”. his may impact advertising based on collection of user personal data”. ability to meaningfully consent and understand privacy considerations as well as impacting ability to effectively operate an app.
. nother submission to the Committee, from r. tephen arrell and Prof. oug eith, stated that While the inclusion of a sunset clause is very welcome, the criteria for the app’s effectiveness their tests of the system showed that it will be challenging for it to work effectively, with factors such as being on a bus or the way a phone is held impacting on it, but that as an e periment . r. Stephen arrell and Prof. oug eith stated that the use of this system risks further entrenching it is worth trying, as long as messaging is clear so that people are aware of its limitations. If the the duopoly of Google and Apple, and that these companies’ decision not to open source their use of Bluetooth technology for this purpose does not work it will be “due to the laws of physics” code as the HSE has done is damaging to transparency and that “Google or Apple could at any but it is still unknown as to whether it may be beneficial. time affect the false positive false negative rates of the HSE App with no control or oversight by the HSE, rish government or the technology community”. Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil . The risk of private entities, such as employers, re uiring the use of similar technologies would have privacy and security implications for individuals and this should be scrutinised closely. 1 H Covid racker app cience oundation Ireland submission to the Committee ibid 5 HSE ovid 1 Tracker App Pre elease eport ard Prof. iapera submission to the Committee r. arrell and Prof. eith submission to the ommittee r. arrell and Prof. eith submission to the Committee 1 ibid Interim Report on Testing and Tracing – August 2020
The a 5. Days prior to the app’s public release, Digital Rights Ireland and the Irish Council for Civil Liberties issued another joint document on the app, a “pre release report card”. The overall “grade” given was a . . Covid tracker app for Ireland, which was created by the H , was launched on uly . ccording to the H product e plainer for the app, it has three functions contact tracing, . The document acknowledged that the HSE had listened to concerns about the app and allowing users to share symptoms in “daily health check ins”, and as a trusted source of news on commended it and the epartment of Health for publishing the ata Protection mpact the virus. Assessment, Data Protection Commissioner’s review of the assessment, and the app source code, thereby improving transparency and public confidence around the pro ect. However, there were . he contact tracing element of the app is based on using luetooth pro imity technology, and not remaining criticisms. These included location data. he idea behind luetooth pro imity apps is that people who have been in close contact with infected persons, but who would not be identified through manual contact tracing, could be informed through pro imity data collected on their smartphone. 29 issue tracker is “required for the kind of transparency and accountability inherent in open source” and would help inevitable bugs to be reported, discussed and resolved. . Knowledge of users’ location is not necessary in this model, only that they were proximate to an identified infected person. he epidemiologically significant definition of close contact, as specified by NPHET, is as “greater than 15 minutes face to face (<2 metres distance)”. . ingapore first developed its own luetooth pro imity app, but the app was not approved by source. There is “limited documentation” about GAEN’s API (Application Programming pple, which limited its uptake. In pril , oogle and pple announced a oint pro ect – the Interface) and “very limited information” about its design. “Google Apple Exposure Notification” (GAEN) system. This is embedded software in Apple iOS and oogle ndroid mobile operating systems. It facilitates the development of contact tracing apps which can use this embedded system. . Concerns about the efficacy of an app based solution for contacting tracing had been raised in submissions to the Committee. Professor ugeniera iapera told the Committee that a based been in contact with a positive case) during app testing to help inform assessment of the app’s study found that of the population, or of smartphone users, need to use a smartphone app which is based on luetooth pro imity in order for it to be effective. It is unclear to what extent Google Firebase is being used in the app. This service’s . he igital conomy and ociety Inde found that Ireland is behind in terms of proportion may lead to data processing in US service’s and data therefore being available to US state of the population who have basic digital literacy skills – the skills to “use digital devices, agencies. Its use could also create a conflict of interest for Google, “whose primary business is communication applications, and networks to access and manage information”. his may impact advertising based on collection of user personal data”. ability to meaningfully consent and understand privacy considerations as well as impacting ability to effectively operate an app.
. nother submission to the Committee, from r. tephen arrell and Prof. oug eith, stated that While the inclusion of a sunset clause is very welcome, the criteria for the app’s effectiveness their tests of the system showed that it will be challenging for it to work effectively, with factors such as being on a bus or the way a phone is held impacting on it, but that as an e periment . r. Stephen arrell and Prof. oug eith stated that the use of this system risks further entrenching it is worth trying, as long as messaging is clear so that people are aware of its limitations. If the the duopoly of Google and Apple, and that these companies’ decision not to open source their use of Bluetooth technology for this purpose does not work it will be “due to the laws of physics” code as the HSE has done is damaging to transparency and that “Google or Apple could at any but it is still unknown as to whether it may be beneficial. time affect the false positive false negative rates of the HSE App with no control or oversight by the HSE, rish government or the technology community”. Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on . The risk of private entities, such as employers, re uiring the use of similar technologies would have privacy and security implications for individuals and this should be scrutinised closely. 1 H Covid racker app cience oundation Ireland submission to the Committee ibid 5 HSE ovid 1 Tracker App Pre elease eport ard Prof. iapera submission to the Committee r. arrell and Prof. eith submission to the ommittee r. arrell and Prof. eith submission to the Committee 1 ibid Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
A T C . The Department of ealth told the Committee that the app adds value by identifying more r nn r ppo n Co , o no n p Co on Co contacts than is possible in a manual tracing process, particularly applying to strangers who might pon (hereinafter referred to as ‘the Committee’), to consider and take n on State’s become close contacts. r pon o Co p n
. The reported that there had been one million downloads of the app within hours of its r p o Co no n n n r , ppo n no n launch. r n o C nn Co r o o
a o rn n , nn , n nn n n o ppo n o r r ecommendation b r n r , o r r , o o r , o r op or ro , on ro p, r n p n n ro p, n n p n n ro p 30 The Committee recommends that usage of the a shou d e assessed to ensure that a digita n o ppo n on r literacy gap is not negatively impacting effective usage or people’s meaningful ability to consent. 3 C nn Co r nno n n o r ppo n p r n o p r r p or n or on o on r n o o n r ppo n n
or o Co n ecommendation 5 Co on o r o C r n The Committee recommends that ongoing assessment shou d a so e done on the technica erformance of the a and the e tent to hich it is adding a ue to test and trace efforts such n n r on o Co n o or n ro n on n analysis should be made public. A false positive rate in the app’s performance should also be or ro p o n n n on no o r n shared u ic n n o r no n o r on Co , on no n n or n n n r r or o o r on o Co ro on no n pr or r n no o C r o Co ecommendation on propo Co , n Co r rr n n or The Committee recommends that an issue trac er shou d e made a ai a e for the a that n o Committee’s business as part of the Business Committee’s weekly report n r n n oog e and e shou d e as ed to u ish more information on the E and that more r r 3 , n n no o, n or n , n o n , n or o n , n n or pr n on n on n information shou d e ro ided a out the use of oog e ire ase and T i io o p r r p n , Co o o n po r
a po r o n n r or n r n n , or pr n on n r n ecommendation on ro n r n n n or n n n r r n b po r o ppo n Co n or n n n r r The Committee recommends that a full description of all network devices and logging in the app’s o eration shou d e shared c po r o r r o n on or n n or n on n or n n n r r 5 , n o n n or n r n on r r n o or r o r r n n or n n n r r n
d po r o r r r o o rn n or n r o n or ecommendation Co o po , propo pr r or on r on, po n n
Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil r por on on, or r r n o n o r n Co n o n r The Committee recommends that the criteria hich the sunset c ause i e in o ed shou d , n op n on o Co , r o or r o r r n n or e shared r o o rn n or n r o o r pon n or n n n r r , , n
e po r o r r pr n p o o r n o n r p r or Committee Debate, une r. ’Connor, p. 35 o n or r or ppo n r o Covid Trac er App downloads Interim Report on Testing and Tracing – August 2020
A T C . The Department of ealth told the Committee that the app adds value by identifying more r nn r ppo n Co , o no n p Co on Co contacts than is possible in a manual tracing process, particularly applying to strangers who might pon (hereinafter referred to as ‘the Committee’), to consider and take n on State’s become close contacts. r pon o Co p n
. The reported that there had been one million downloads of the app within hours of its r p o Co no n n n r , ppo n no n launch. r n o C nn Co r o o
a o rn n , nn , n nn n n o ppo n o r r ecommendation b r n r , o r r , o o r , o r op or ro , on ro p, r n p n n ro p, n n p n n ro p The Committee recommends that usage of the a shou d e assessed to ensure that a digita 31 n o ppo n on r literacy gap is not negatively impacting effective usage or people’s meaningful ability to consent. 3 C nn Co r nno n n o r ppo n p r n o p r r p or n or on o on r n o o n r ppo n n
or o Co n ecommendation 5 Co on o r o C r n The Committee recommends that ongoing assessment shou d a so e done on the technica erformance of the a and the e tent to hich it is adding a ue to test and trace efforts such n n r on o Co n o or n ro n on n analysis should be made public. A false positive rate in the app’s performance should also be or ro p o n n n on no o r n shared u ic n n o r no n o r on Co , on no n n or n n n r r or o o r on o Co ro on no n pr or r n no o C r o Co ecommendation on propo Co , n Co r rr n n or The Committee recommends that an issue trac er shou d e made a ai a e for the a that n o Committee’s business as part of the Business Committee’s weekly report n r n n oog e and e shou d e as ed to u ish more information on the E and that more r r 3 , n n no o, n or n , n o n , n or o n , n n or pr n on n on n information shou d e ro ided a out the use of oog e ire ase and T i io o p r r p n , Co o o n po r
a po r o n n r or n r n n , or pr n on n r n ecommendation on ro n r n n n or n n n r r n b po r o ppo n Co n or n n n r r The Committee recommends that a full description of all network devices and logging in the app’s o eration shou d e shared c po r o r r o n on or n n or n on n or n n n r r 5 , n o n n or n r n on r r n o or r o r r n n or n n n r r n
d po r o r r r o o rn n or n r o n or ecommendation Co o po , propo pr r or on r on, po n n
r por on on, or r r n o n o r n Co n o n r – August 2020 Tracing and Testing Interim Report on The Committee recommends that the criteria hich the sunset c ause i e in o ed shou d , n op n on o Co , r o or r o r r n n or e shared r o o rn n or n r o o r pon n or n n n r r , , n
e po r o r r pr n p o o r n o n r p r or Committee Debate, une r. ’Connor, p. 35 o n or r or ppo n r o Covid Trac er App downloads Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020
o ernment or by the ireachtas shall attend meetin s of the Select Committee, as Appendi Committee embership appropriate, to discuss issues in relation to Co id for which they are officially responsible in accordance with Standin rder ( ) and ( ) eputies (f) power to en a e the ser ices of persons with specialist or technical knowled e in accordance with Standin rder ( ) and Colm Brophy ( )
(g) power to report to the il in accordance with Standin rder ( ) Colm Burke ( )
ary Butler ( )
ennifer Carroll ac eill ( ) 32 att Carthy (S )
ichael Collins ( )
a id Cullinane (S )
earse oherty (S )
Stephen onnelly ( )
orma oley ( )
ichael c amara ( ) Chairman
Fergus O’Dowd
Louise O’Reilly (SF)
att Shanahan ( )
is n Shortall (S )
Br d Smith (S B )
uncan Smith ( )
ssian Smyth ( )
otes
eputies appointed by rder of the il of ay
Chairman elected at Committee meetin of ay Tuarascáil Eatramhach maidir le Tástáil agus Rianú – Lúnasa 2020 maidir le Eatramhach Tuarascáil Interim Report on Testing and Tracing – August 2020
o ernment or by the ireachtas shall attend meetin s of the Select Committee, as Appendi Committee embership appropriate, to discuss issues in relation to Co id for which they are officially responsible in accordance with Standin rder ( ) and ( ) eputies (f) power to en a e the ser ices of persons with specialist or technical knowled e in accordance with Standin rder ( ) and Colm Brophy ( )
(g) power to report to the il in accordance with Standin rder ( ) Colm Burke ( )
ary Butler ( )
ennifer Carroll ac eill ( ) 33 att Carthy (S )
ichael Collins ( )
a id Cullinane (S )
earse oherty (S )
Stephen onnelly ( )
orma oley ( )
ichael c amara ( ) Chairman
Fergus O’Dowd
Louise O’Reilly (SF)
att Shanahan ( )
is n Shortall (S )
Br d Smith (S B )
uncan Smith ( )
ssian Smyth ( )
otes
eputies appointed by rder of the il of ay
Chairman elected at Committee meetin of ay Interim Report on Testing and Tracing – August 2020 Tracing and Testing Interim Report on Houses of the Oireachtas Leinster House Kildare Street Dublin 2 D02 XR20 www.oireachtas.ie Tel: +353 (0)1 6183000 or 076 1001700 Twitter: @OireachtasNews
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Mr. Ted McEnery Clerk to the Committee Special Committee to COVID-19 Response
By email: [email protected]
16th June, 2020
Dear Ted I refer to your letter of 5 June 2020 Your Ref: SCC19R-I-0147seeking a written submission from the Department on the topic of testing and tracing.
As requested the Department is providing relevant information. I trust that this satisfies the Committee’s requirements.
Yours sincerely
Pamela Carter Principal Officer Parliamentary and Ministerial Support Unit (01) 6354048/0874151046
SCC19R-R-256(ii) D
Submission to Special Committee on COVID-19 Response (Oireachtas Committee)
Topic: Testing and Tracing 16 June 2020
1. Context 1. This submission contains a summary overview of (1) the testing strategy (2) the types, objectives, limitations of testing and (3) contact tracing. The HSE will provide a detailed overview of operational matters covering the end-to-end COVID-19 testing infrastructure incorporating referral, community swabbing, laboratory testing, provision of results, effectiveness of testing, contact tracing and the new COVID Tracker App.
2. Testing Strategy 2.1 Ireland has adopted a robust process of testing, isolation and contact tracing as a key strategy for containing and slowing the spread of COVID-19, as advocated by World Health Organisation (WHO), the European Centre for Disease Prevention and Control (ECDC) to “break the chain of transmission”.
2.2 The capacity for testing has been expanded incrementally as capacity has developed. Over the course of the pandemic this has included the broadening of the case definition to include anyone exhibiting one symptom of cough, fever or shortness of breath, a comprehensive programme of testing in long term residential care facilities, a continued focus on healthcare workers and the automatic routine testing of all close contacts. The NPHET has most recently recommended that health care workers in nursing homes be tested weekly for an initial 4 weeks to inform an ongoing surveillance programme. This is in recognition of the vulnerability of nursing homes to this virus.
2.3 The HSE has planned for a full testing and contact tracing pathway to undertake up to 15,000 tests per day. In line with the current lower levels of prevalence of the virus, testing levels have reduced. Over the past four weeks the average weekly number of tests processed was 22,862. As of 15 June 2020, a total of 384,501 tests have been carried out to date, with a 7% positivity rate overall.
2.4 Countries that do very few tests per confirmed case are unlikely to be testing widely enough to find all cases. At the WHO media briefing on 30 March, 2020, Dr Michael Ryan expressed this in terms of the positivity rate “…In general where testing has been done fairly extensively we’ve seen somewhere between 3 and 12% of tests being positive… we would certainly like to see countries testing at the level of ten negative tests to one positive as a general benchmark of a system that’s doing enough testing to pick up all cases”.
2.5 The median number of close contacts per case was 3 over the past two weeks, slightly up from 2 during most of May 2020. Despite maintaining the key public health messages to limit interactions as much as possible, to continue to practice social distancing and to keep a record of all close contacts, increases in the number of close contacts per case are to be expected given the progressive relaxation of restrictions.
2.6 Turnaround times have improved significantly. Recent reports from the HSE indicate that the turnaround time from referral to completion of contact tracing is now 3 days or less in around 86% of cases. The median time across community and hospital settings is now 1.8 days and has been improving each week.
2.7 The cost identified by the HSE for the full testing and tracing process is now in the region of c.€400 million for 2020, based on 100k tests per week being undertaken each week for the remainder of 2020. This figure reduces commensurately for lower testing numbers.
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3. Types, objectives and limitations of testing 3.1 Real-time reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for diagnosing suspected cases of COVID-19.
3.2 Diagnostic testing is but one component of a comprehensive public health led, infection prevention and control response to SARS-CoV-2. Combined with tracking where infected people are to provide the most appropriate management of the case, their isolation to prevent further spreading of the virus and tracing all the people that were in close contact with the index case, testing, tracking and tracing has become the central tool for preventing transmission in controlling the spread of SARS-CoV-2 in Ireland.
3.3 A test for SARS-CoV-2 can only provide information at a single point in time and in the case of an ‘RNA not detected’ result for any person at one point in time does not reflect or indicate the level of ongoing risk. That person could have a repeat test the next day with a different result.
3.4 The focus of diagnostic testing should continue to be on those who meet the case definition in operation and the close contacts of confirmed cases. Any testing approach needs to be grounded and evolve based on emerging evidence and guidance.
3.5 Where outbreaks of SARS-CoV-2 occur in the community or in settings where vulnerable populations are cared for or reside, decisions regarding the most appropriate testing strategy in response to such an outbreak must be taken on a case by case basis, informed firstly by a public health risk assessment and guided by epidemiological data and scientific evidence that impact on risk of transmission at the time or relevant to the particular setting.
3.6 The role of serological [antibody] tests is limited at present. Once they have been assessed to be of sufficient sensitivity and specificity these tests can be used to estimate the prevalence of immunity in the general population. However, it must be noted that based on current evidence uncertainty remains as to (i) whether antibodies fully protect from subsequent infection (ii) whether the antibody response is durable and (iii) while the individual may have sufficient immunity to prevent development of disease, they may still spread infection until the virus is cleared. This limits the usefulness of antibody testing at an individual level.
3.7 The first use of antibody testing in Ireland, as has occurred in other countries, will be to estimate the prevalence of immunity in the general population by conducting a population based sero- prevalence survey to measure the prevalence of antibodies to SARS-CoV-2 virus in a representative sample of the Irish population in two geographically defined areas, Dublin and Sligo. Ethics approval for the study, submitted by the Health Service Executive (HSE), Health Protection Surveillance Centre (HPSC) and the National Virus Reference Laboratory (NVRL), was granted by the National Research Ethics Committee for COVID-19 on 4 June 2020. Those randomly selected, aged 12-69 and who consent to participate, will complete a questionnaire and have a blood sample taken. Samples will be analysed at the NVRL for the detection of antibodies to the virus. The study commenced on 15 June 2020, and initial results will be available toward the end of August 2020.
3.8 The results from similar international seroprevalence studies conducted to date indicate a low level of exposure to the virus. Studies from Spain and France indicate that just 5.0% and 4.4% of their populations respectively have ever contracted covid-19. The results from these early studies indicate that fewer people have been infected than what many mathematical models initially
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predicted. They also suggest that many people remain susceptible to infection, which is important in planning for any subsequent resurgence in the virus 1.
3.9 There is particular interest internationally in the potential for rapid antibody tests to identify those who are already immune which may be useful in allowing more people to safely return to work. However significant questions remain, (see section 3.6), as to the accuracy of these tests. The Royal College of Pathologists of Australasia published a position statement on the use of rapid point of care [antibody] tests in which it states that (i) Australia’s public health response will be compromised by the use of these tests in the early stages of COVID disease and (ii) Australia’s excellent laboratory response to the COVID-19 pandemic would be jeopardised by inappropriate widespread use of rapid tests2. The WHO to date has recommended that the use of point-of-care rapid antibody tests should only be used in research settings and not in any other setting, including clinical decision-making, until evidence supporting their use for specific indications is available3.
3.10 While oral fluid (saliva) is very useful for the diagnosis of a number of viruses, including measles, mumps, and rubella, saliva is not a recommended specimen type for respiratory viruses, primarily because saliva contains substances that interfere with the polymerase chain reaction (PCR) used in test assays to detect Covid-19, and so it lacks sensitivity compared with specimens obtained from the nasopharynx. In addition, the primary site of replication for respiratory viruses is the respiratory tract rather than the mouth. Consequently, nasopharyngeal swabs remain the preferred specimen choice for SARS CoV 2 testing.
1 Wise J, Covid-19: Surveys indicate low infection level in community. BMJ 2020;369:m1992 doi: 10.1136/bmj.m1992 (Published 18 May 2020) 2 Royal College of Pathologists of Australasia. Position Statement (March 2020). COVID19 IgG/IgM Rapid POCT Tests. 3 WHO. Advice on the use of point-of-care immunodiagnostic tests for COVID-19. Available at https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care- immunodiagnostic-tests-for-covid-19
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4. Contact Tracing 4.1 Contact tracing is a core public health intervention that plays an important role in the control of COVID-19. The aim of contact tracing is to rapidly identify potentially newly infected persons who may have come into contact with existing cases, in order to reduce further onward transmission. Contact tracing consists of three key steps consisting of (1) contact identification, to identify persons who may have been exposed to SARS-CoV-2 as a result of being in contact with an infected person; (2) contact listing, to trace and communicate with the identified contacts, and to provide information about suitable infection control measures, symptom monitoring and other precautionary measures such as the need for quarantine; and (3) contact follow-up, to monitor the contacts regularly for symptoms.
4.2 Contact tracing is an effective public health measure for the control of COVID-19. The prompt identification and management of the contacts of COVID-19 cases makes it possible to rapidly identify secondary cases that may arise after transmission from the primary cases. This enables the interruption of further onward transmission. Contact tracing, in conjunction with robust testing and surveillance systems, is central to control strategies during phases of de-escalation. Contact tracing has been a key part of the response in countries that have successfully reduced case numbers.
4.3 Traditional contact tracing by following up cases and contacts using public health staff is resource intensive. Moving some tasks away from public health professionals to trained non public-health staff (e.g. staff working in other areas of the public service, or volunteers such as students, retired healthcare professionals, etc.) can enable the overall contact tracing programme to be scaled up. The staff can be tasked with interviewing cases to obtain a list of contacts and following up these contacts to provide information on self-quarantine and physical distancing, the monitoring of developing symptoms and advice on what to do if symptoms develop. The use of non-public- health staff or volunteers for contact tracing can also free up speciality public health input in more complex settings such as healthcare facilities or outbreak situations.
4.4 To meet the scale of contact tracing capacity required, the HSE established 9 contact tracing centres (CTCs), and trained 1,700 public servants in contact tracing. The contact management programme operates a three-call process to contact trace a confirmed case. These centres generally deal with the high volume but generally low complexity cases. The 1,700 pool of trained people can be drawn on as needed. Of the 1,700 people trained approximately 300 were deployed to Departments of Public Health and approximately 700 were deployed in CTCs. The remaining trained staff were not required to date. Currently there are six CTCs in operation on rotation. Only one CTC is used per day given the current low numbers of confirmed cases.
4.5 In addition to the CTCs, contact tracing activity is also carried out in Departments of Public Health, who generally deal with more complex cases and facilities. Infection Prevention and Control Teams in hospitals conduct the contact tracing for in-patients within their facility and occupational health departments complete workplace contact tracing for healthcare employees.
4.6 The timeliness of contact tracing has improved over the course of the pandemic. Over the past 14 days, the HSE has reported that the median time to complete contact tracing (all three calls) is now one day.
4.7 Using new technologies such as mobile apps is another approach that can be used to complement the traditional public health approach summarised in 4.1-4.6 above. The contact tracing app that has been developed for Ireland is very much aligned with the advices and guidance issued by the EU Commission, the OECD and the WHO. The European Centre for Disease Control recently stated
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that "the use of mobile contact tracing apps for contact tracing offers several benefits; they do not rely on the memory of the case (who may be very ill at the time of interview); they allow contacts unknown to the case to be traced (e.g. passengers who sat close on a train); they can potentially speed up the process; they may facilitate further follow-up of contacts by health authorities via a messaging system. A symptom-checker feature could facilitate this, although it is not essential".
4.8 The primary purpose of the contact tracing app is to complement the conventional public health approach to contact tracing. The app also permits citizens to anonymously report symptoms in real-time and this data can assist the health services in mapping, predicting and ultimately preventing the spread of Covid-19. Finally, the app provides direct access to an authoritative and trusted source of news, the purpose of which is to ensure that information and up-to-date guidance in relation to Covid-19 is readily available to anyone carrying the app.
4.9 Since adoption of contact tracing apps is voluntary, transparency and trust are fundamental to their success. The contact tracing app developed for Ireland uses a ‘decentralised’ architecture. The ‘decentralised’ approach is best placed to support contact tracing because it maximises the effectiveness of contact tracing across all mobile phone platforms and maximises the protection of privacy. It achieves this by minimising the amount of data required, ensuring most data is held on the users own phone rather than on a centralised (HSE or government controlled) server, and uses anonymised and encrypted data.
4.10 The provision of anonymised information through the symptom tracker - such as gender, age category, county of residence is all consent based. Users of the app can opt out at any time and have the right for their data to be forgotten. The app does not use location services. Furthermore, it is important to note that the identity of the index case is never disclosed via the app and that the privacy of all app users is protected at all times.
4.11 Privacy-by-design has underpinned all aspects of app development. The Irish app is being developed to comply with recent European Commission Data Protection recommendations and guidance documents on privacy. The project has developed Data Protection Impact Assessment (DPIA) which has been submitted to the Data Protection Commissioner. The HSE will publish the DPIA and the source code publicly to ensure that there is full transparency about the app and the data utilised within the app.
4.12 App development and technical tests are now complete. The app and all app features, data flows, and supporting software are functioning well. These tests have covered all relevant aspects of the functionality of the app, including download and registration; symptom check-in; daily information updates; security and vulnerability; and the close contact exposure notification service (ENS). A further large-scale field trial is underway with An Garda Síochána to gather a modelling dataset that can be used to further understand the operation of proximity detection and exposure notification in a near-to-real-life environment, to inform any further fine-tuning required.
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