COMMUNITY ASSESSMENT CENTRE SET UP IN CASTLEBLAYNEY FOR CORONAVIRUS CASES

15 April 2020 No Comments by The Northern Standard

Michael Fisher

As part of the HSE’s response to the Covid-19 pandemic, a community assessment hub has been set up in Castleblayney to serve Co Monaghan.

It has been established at the Crannog Day Care Centre at Bree. People who have been tested in this area and are confirmed as having Covid-19, and who require a face-to-face clinical assessment, can attend this community based unit, following referral from a GP.

The HSE says the aim of the unit is to divert those who are mildly symptomatic and require medical assessment away from the acute hospital system by providing a facility in the community. Clients can be seen and clinically assessed by a team of nurses, doctors and allied health professionals, including physiotherapist, occupational therapists and paramedics.

The HSE anticipates that the centre will be brought into operation this week. Currently there are clear dependencies involved which must be met before each unit opens, according to the Health Service Executive. 

People can only access these units for assessment by GP referral. A standard telephone assessment will be completed by the patient’s doctor, who can then refer patients to the local hub if there are concerns about deteriorating symptoms. Referrals to the assessment hub will also be accepted from the GP Out of Hours service.
Referred patients will be assessed by a team of nurses and GPs at the hub and a clinical decision can then be made as to whether they can be supported by continuing to recover at home or be referred to acute hospital for treatment. Patients may also be referred to a self-isolation unit if they cannot self-isolate at home. For Co Cavan, there will be an assessment hub at Ballinagh Health Centre.

The hub units will provide service Monday to Sunday, with opening hours agreed locally and within the hours of 08:00 am to 08:00pm as staffing and referrals allow.

APPOINTMENT ONLY
Attendance at the hub assessment unit will be by appointment only. There is no walk-in capacity. Each facility has parking on site for staff and patients. Wheelchair accessibility is available on site. Ambulance access can also be facilitated on each site. 

This new service is being provided by community healthcare organisations and represents a new way of working in response to the Covid-19 challenge.  

COMMUNITY TESTING CENTRE AT CLOGHAN
The HSE says the Covid-19 Community Testing Centre at Cloghan GAA Centre is continuing to operate but is strictly by appointment.
The facility is a drive through clinic for testing for Coronavirus and operates from the hours of 8 am to 8 pm, from Monday through to Sunday. A similar centre for Co Cavan is operating at Kingspan Breffni Park in Cavan Town. Testing is by way of GP referral only and the HSE stresses that those coming for testing must have an appointment.   

On March 24 changes were recommended in relation to Covid-19 testing to ensure that it was targeted to high risk groups and those at risk of exposure to Covid-19. People who were referred for Covid-19 testing on or before March 24 will have received a text confirming that their referral has been cancelled and to contact their GP if they meet the new testing criteria.
 
Testing capacity has been constrained since Sunday March 29 owing to stock limitations of testing kits; however testing kit stocks have now been replenished, according to the HSE.  Unfortunately there are ongoing challenges in terms of supplies of reagent for the Covid-19 test in laboratories. This is a global challenge with major suppliers having to ration provision across the world. Every effort to procure new stocks is being made.

Over the last number of weeks the number of hospitals providing Covid-19 testing has increased. However provision of reagent and extraction kits will remain a major challenge for the foreseeable future until the major suppliers ramp up production.

The HSE says it continues to prioritise testing of healthcare workers and in-patients in acute hospitals and across residential facilities. It apologises to all those waiting for test results and wishes to reassure the public every effort is being made to improve turnaround times within the current international constraints. Testing is performed for public health as opposed to clinical reasons, and patients waiting for results should continue to self-isolate for fourteen days. 

On Saturday the Health Service Executive and the National Virus Reference Laboratory at UCD secured a contract to obtain enough reagent to complete 900,000 Covid-19 tests. Genomics Medicine Ireland Limited (GMI) is supplying the test kits, and the components for the first 200,000 have already been delivered to its laboratory in Dublin. It says the laboratory will operate seven days a week to formulate the reagents, shipping out 3,000 units a day initially, and this will build to 10,000 a day in the coming weeks.

The Director of the NVRL, Dr Cillian De Gascun said that while the reagents to be supplied are not those currently in the shortest supply, the deal is still very important and will help boost Covid-19 testing.

Dr De Gascun said that the reagents being supplied by GMI would go to the Enfer laboratory in Sallins, Co. Kildare, which came on stream last weekend as a full Covid-19 testing facility. Dr De Gascun said this deal will enable it to build up to carrying out 8,000 tests a day.

REDUCING THE TESTING BACKLOG
On Monday, the Health Service Executive said the COVID-19 testing backlog would be “reduced completely” this week. At a press briefing in Dublin, HSE Chief Executive Paul Reid said Ireland had built up a backlog of 35,000.

That figure has since been reduced to 11,000 tests. He said the backlog had been reduced by increasing Irish laboratory capacity and using a German laboratory for testing.

The HSE’s goal was to carry out 4,500 tests a day by last week while 7,900 tests were carried out on Sunday, according to Mr Reid. Testing carried out in hospitals now has a turnaround time of between 24 and 36 hours.

Paul Reid said there was further work to do in relation to community testing, which is a more complex process. He confirmed there are now 25 laboratories carrying out COVID-19 tests. This figure is made up of 20 hospital laboratories, the lab in Germany, the National Virus Reference Lab, and three other testing facilities in Ireland.

Mr Reid said that Ireland has had a “significant delivery” of testing reagents from China. The testing reagents are currently undergoing quality testing.

An average of 2,800 laboratory tests are being conducted daily and more than 72,000 coronavirus tests have now been completed.

Mr Reid said the HSE had doubled the number of tests completed in a very short time, as this number was just over 30,000 last week. 55,000 swab samples have been taken at 48 community testing centres nationwide and by the National Ambulance Service. 

Paul Reid said 800 people either have appointments to be swabbed or will be given appointments in the coming days. 

Mr Reid also said there is a significant issue with the availability of gowns across the health system.

He said there are supplies, but that “we will be tight on gowns in some places” until a further delivery of Personal Protective Equipment from China arrives. He said that the HSE’s Chief Clinical Officer Dr Colm Henry would be issuing a note setting out the best use of gowns and prioritisation for their use. Mr Reid said that we are in a better position than most countries are in this regard. Delivery of the first batch of PPE worth €31m was completed on Good Friday, he added.

He said that although there were issues around respiratory masks, the Chinese supplier has sent a revised specification which is now being assessed to see if it meets Irish standards. 

A second batch of PPE worth €67m will begin arriving on 17th April. However, Mr Reid outlined what he said was a “major issue” that could impact on Ireland. He said that new regulations in China to ensure the standard of the PPE could affect how quickly the PPE can be delivered here.

VERY DIFFICULT PHASE
Mr Reid said that the country was “not through this by any stretch” and that he believes we are heading into “a very, very difficult phase” in the coming weeks. He said the measures that have been taken are making a difference, but that it “will need continued diligence and support over the coming weeks”.

There are currently 862 people being treated for Covid-19 in hospital. 

Chief Operations Officer at the HSE Anne O’Connor gave the figure, which she said was correct up to 8:00pm on Sunday night. She said this was an increase of 8.5% on the previous week, but a smaller increase than had seen in previous weeks. 

A total of 148 patients with Covid-19 are being treated in ICU, while a further 127 people with non-Covid-related illnesses are also in intensive care.

Ms O’Connor said there are 135 ICU beds available, while there are more than 2,000 hospital beds available generally. Ms O’Connor said there have been 268 “outbreaks” of Covid-19.  She said these are not clusters, and that the HSE is working closely with people where there is just one case. Of these 268, 214 are in nursing homes, 32 are in disability services, 14 are in mental health services, four are in non-HSE direct provision centres, three in prisons, and one in addiction services. 

UNCERTAINTY
The HSE’s Chief Clinical Officer said there is uncertainty about what is going to happen next. Dr Colm Henry said that it does not seem like we are going to have a peak, followed by a fall, and then go back to normal. 

“That doesn’t seem to be a plausible narrative anymore,” he said. Dr Henry said that the modelling around this virus is extremely sensitive to the tightening or loosening of restrictions.

Dr Henry said that “if we all suddenly decide to congregate at beaches and stadiums and marches”, the numbers will go up rapidly again. 

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Ireland is heading into “a very, very difficult phase” in the coming weeks – HSE Chief Executive Paul Reid

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