DÁIL ÉIREANN COISTE SPEISIALTA UM FHREAGRA AR COVID-19 SPECIAL COMMITTEE ON COVID-19 RESPONSE Déardaoin, 25 Meitheamh 2020 Thursday, 25 June 2020 Tháinig an Coiste le chéile ag 9.30 a.m. The Committee met at 9.30 a.m. Comhaltaí a bhí i láthair/Members present: Teachtaí Dála/Deputies Richard Boyd Barrett,* Colm Brophy, Colm Burke, Mary Butler, Jennifer Carroll MacNeill, Matt Carthy, Michael Collins, David Cullinane, Stephen Donnelly, Norma Foley, Kathleen Funchion,+ Gary Gannon,* Gino Kenny,* John McGuinness, Fergus O’Dowd, Donnchadh Ó Laoghaire,+ Aodhán Ó Ríordáin,* Matt Shanahan, Ossian Smyth. * In éagmais/In the absence of Deputies Róisín Shortall, Bríd Smith and Duncan Smith. + In éagmais le haghaidh cuid den choiste/In the absence for part of the meeting of Deputies Matt Carthy and Louise O’Reilly. Teachta/Deputy Michael McNamara sa Chathaoir/in the Chair. 1 SCR Covid-19: Testing and Tracing Chairman: We have a quorum and we are now in public session. We have been notified that Deputy Gannon is substituting for Deputy Shortall. There may be other such notifications later. I welcome our witnesses to our hearing on testing and tracing. We are joined in the Dáil Chamber by Professor Paddy Mallon, professor of microbial diseases in the school of medicine at University College Dublin, and I welcome him. I also welcome in Committee Room 1 from the HSE Mr. Damien McCallion, national director of emergency management and director general of the co-operation and working together partnership; Dr. Colm Henry, chief clinical officer; and Ms Niamh O’Beirne, national lead for contact tracing and testing; from the Depart- ment of Health Dr. Cillian De Gascun, consultant virologist and director of the National Virus Reference Laboratory and member of the National Public Health Emergency Team, NPHET; Dr. Alan Smith, deputy chief medical officer; Mr. Muiris O’Connor, assistant secretary of the research and development and health analytics division; and Ms Laura Casey, principal officer. I wish to advise the witnesses that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a manner as to make him, her or it identifiable. We expect witnesses to answer questions asked by the committee clearly and with candour, but witnesses can and should expect to be treated fairly and with respect and consideration at all times in accordance with the witness protocol. If the witnesses have any concerns in this regard I ask them to raise them immediately. I invite Professor Mallon to make his opening statement and, as is customary at this stage, I ask him to confine it to five minutes as it has been circulated in advance. Professor Paddy Mallon: I thank the Chair and the committee for inviting me to appear to- day and for the opportunity to make this opening statement. Ireland is making steady progress in emerging from the first wave of the Covid-19 pandemic that has caused a significant number of deaths and has damaged our economy, the education of our children and the provision of healthcare. Ireland has arrived at this point largely due to the unprecedented support, sacrifices and actions of the Irish people at the request of the Government following the advice of public health officials. The Irish people have chosen this path at considerable personal cost primarily to protect the lives of their families and fellow citizens. As a result, Ireland’s now holds the advantage in our war against the SARS-CoV-2 virus, with the potential to maintain infections at an absolute minimum. It is vital that we do this properly. We are only beginning to under- stand the impact of this first wave on the health of our citizens. There is no effective pharma- ceutical treatment or vaccine to prevent the acquisition or spread of this infection. In addition to the large number of deaths we have witnessed in Ireland, as highlighted earlier this week to the committee, many of those affected - even young and healthy individuals - experience considerable morbidity and prolonged recovery times. Accepting any level of ongoing com- munity transmission puts people’s health at risk and will further hold back economic recovery. 2 25 JUNE 2020 Ongoing community transmission, such as that seen in the United States, Sweden and parts of the United Kingdom, together with a resurgence of cases in Lisbon and the outbreaks reported in Germany, serve to highlight that Ireland is still within a geographical high risk zone for Co- vid-19. I and others in the infectious diseases clinical community believe that it is inevitable that we will experience a resurgence of cases as we relax restrictions and permit more travel. In this context, control of the SARS-CoV-2 virus within our communities through a highly effective programme of rapid testing, contact tracing and community actions becomes a prior- ity in maintaining our national biosecurity. Effective community control permits a more stable and meaningful economic recovery, a recovery of education for our children, a recovery of our health services, including vital screening services, and a restoration of quality of life and improvements in mental and physical well-being. In many ways, this programme becomes the beating pulse of our country. As society reopens, the Irish people are handing back some of the responsibility for controlling SARS-CoV-2 in Ireland to the State. If this programme fails to work effectively, we risk losing the gains provided to us through the sacrifices of the people. Both infectious diseases physicians and leading figures within the Royal College of Physi- cians in Ireland, RCPI, have called for a detailed and coherent written plan to deal with the control of the SARS-CoV-2 virus on the island of Ireland. This should include a detailed end-to-end testing and contact tracing plan, embedded with rapid turnaround times and clear key performance indicators, KPIs. Alongside this, greater investment should be made in the coming weeks to rapidly upscale emergency department capacity, and isolation room facilities in hospitals are also required. These actions would be best achieved through the establishment and resourcing of specialist networks operating regionally under a common governance struc- ture. These networks should comprise relevant specialists and be linked to our extensive aca- demic university infrastructure. This will enable rapid and scalable regional responses to both current and future threats as they arrive and evolve as well as enabling the rapid implementation of national guidance and adherence to national KPIs. Despite the optimism in some quarters in recent weeks, we are still in the midst of a national health emergency and our citizens are no less at risk of severe illness and death if they contract Covid-19 infection now than they were back in March. Lessons learned from the first wave of Covid-19 need to be translated into actions and resources but we have a narrow window of op- portunity. At a time the incidence of Covid-19 infections in Ireland is relatively low, we need to avoid complacency and ensure that this time is used wisely to improve our infrastructure. Failure to learn or delays in the planning and resourcing for what is ahead would not only be potentially negligent but would be a travesty to the memories of those who have died from Co- vid-19, some avoidably, during the first wave. Dr. Colm Henry: I thank the Chairman and members for the invitation. I am joined by my colleagues: Mr. Damien McCallion, HSE national director; Ms Niamh O’Beirne, national lead for testing and tracing; and Dr. Cillian De Gascun, consultant virologist in UCD and director of the National Virus Reference Laboratory. As requested by the committee, we submitted a detailed document on testing and tracing for Covid-19. I will, therefore, use this opening state- ment to make some summary comments. Since the onset of the Covid-19 pandemic, the HSE has worked tirelessly to build a robust testing and tracing infrastructure with the aim of monitoring and reducing the transmission rate of Covid-19 in order to protect public health. It is important to acknowledge the extent of what has been achieved as part of this response. To date, we have developed a testing system that has enabled us to complete over 400,000 tests. Our World in Data ranks Ireland sixth in the number 3 SCR of tests per head of population within the EU and the UK. There have been many complexities to the infrastructure that have needed to be considered and overcome. Carrying out polymerase chain reaction, PCR, testing for Covid-19 has proved challenging at times. The process involves more than simply taking swabs; there are multiple layers to the process that impact the end result. In order to take swabs, we had to set up 48 test centres. The first of these opened on 16 March. Within ten days, more than 40 were open. We then had to consider how we would increase laboratory capacity to meet the expected demand. We then had to ensure we could increase our ability to contact-trace to a larger scale than had ever been performed in the country to date.