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We can't waste our best shot to get a grip on crisis

Dr Carmen Regan



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Emergency: Medical staff transport a patient towards a helicopter at the Emile Muller Hospital in Mulhouse, eastern France, yesterday. Photo: SEBASTIEN BOZON / AFP

Emergency: Medical staff transport a patient towards a helicopter at the Emile Muller Hospital in Mulhouse, eastern France, yesterday. Photo: SEBASTIEN BOZON / AFP

AFP via Getty Images

Emergency: Medical staff transport a patient towards a helicopter at the Emile Muller Hospital in Mulhouse, eastern France, yesterday. Photo: SEBASTIEN BOZON / AFP

Covid-19 continues to spread across Europe. On March 10, the European Council identified four priorities: limiting the spread of the virus, provision of medical equipment, promotion of research, and dealing with the socio-economic consequences.

Limiting the spread of the virus is key.

On St Patrick's Day, our Taoiseach addressed the nation and gave a clear message to the people: stay at home to save lives.

The international experience tells us that an exponential increase is expected in the absence of drastic action. We are beginning to see the surge.

Now, on a daily basis, we see harrowing images of Italian healthcare workers attempting to cope with increasing numbers of patients.

These patients are rapidly succumbing to severe pneumonia and other life-threatening complications. Our Italian colleagues, like those in Wuhan, have urged us to act quickly and shut down all non-essential services.

Our own intensivists are pleading with the public not to become one of these patients by staying apart, staying in, staying at home.

Healthcare workers are becoming increasingly concerned about numbers of cases, staffing, vital equipment and protective gear. Medical experts agree that testing needs to be expanded, particularly to include those who are contacts of confirmed cases, not just those who are showing symptoms. This is because of the possibility of asymptomatic transmission of the virus.

Testing also needs to be available for frontline healthcare workers who are exposed. More than ever now they need to be protected. Supply chains (of medical equipment) will be under strain despite our best efforts.

Everyone is working to ensure that we are as prepared as we can be, but it may not be enough. In Ireland many retail outlets and small businesses are already acting, closing for health and economic reasons. Financial packages and supports will surely help with these brave decisions.

There has been a phenomenal public response to this effort in terms of engagement with social distancing, social isolation for high risk groups, and community support for the vulnerable.

It is heartening to see the incredible response to the HSE 'Be on call for Ireland' campaign. We are a hugely connected and compassionate nation. But it is not enough and more is required. Countries and regions which have managed to curb the spread of the transmission are those which introduced early stringent measures.

Taiwan and Singapore have experience of the Sars epidemic and were prepared for Covid-19. Because of the Sars outbreak, Singapore had a strong disease surveillance policy and fastidious contact tracing.

Key to their success was early aggressive action. Travel restrictions were introduced (despite contrary recommendation by WHO), a policy of rigorous detection and quarantine was imposed and school, work and public communication policies drawn up.

China imposed strict containment measures in Wuhan on January 23, the largest known quarantine in history. On March 18, they reported no new local infections.

In Europe, Denmark was one of the first countries to close its borders, among other measures. Other countries with emerging epidemics, such as Italy, France and Spain, have closed all non-essential businesses and imposed public transport restrictions while keeping food suppliers and pharmacies operational.

The Department of Foreign Affairs now advises against all non-essential overseas travel until March 29, and those returning home are advised to restrict their movements for a period of 14 days. Exemptions are in place for essential services. Border closures restrict the transport of key items such as food, equipment and medical supplies and cannot be implemented without greater cost to the health and economy of the population.

However, non-essential travel should be defined and limited.

Quarantine imposition or testing those returning from epidemic areas should be mandatory.

We need to introduce more stringent measures, and now. This is required to slow down the spread of disease and protect our frontline staff.

We need time to organise and equip our hospitals and healthcare workers, and time to increase our testing facilities. What we did last week, and do this week, will dictate what happens next. The only way to reduce the exponential rise in the number infected during this epidemic is to isolate, contact trace and test as many as possible.

We need to do as other countries have done, lock down, to buy time.

What would this look like? More stringent measures would require that, for a period of time, non-essential work would also cease, with work from home mandated. Many factories and businesses would close.

Travel restrictions would apply and public transport be minimised. Again for a limited period of time only.

In this crisis, no country has regretted action, rather they've regretted delay. Procrastination in the hope that we will not require "the authoritarian response" of other countries ignores the most recent experience in northern Italy and Wuhan.

The surge has begun. There is no time for half measures. This is our best shot.

Dr Carmen Regan MD, FRCPI, FRCOG, is an obstetrician at the Coombe Hospital, Dublin

Irish Independent