It’s all about the hand-washing, and not just for Covid-19

Dr Breda Smyth's job has changed radically since the outbreak of Covid-19 in Ireland. As director of public health in HSE West, she had responsibility for the surveillance of infectious diseases and the protection of the population's health in Galway, Mayo and Roscommon.

This role included overseeing the investigation of food or water contamination as well as monitoring and preventing the spread of infectious diseases including meningitis, influenza, e-coli, cryptosporidium, measles and mumps.

However, since January, like public health doctors throughout Ireland, she has been monitoring the spread of Covid-19 across the world. And, in March, she was seconded into the Department of Health as part of the Irish epidemiology modelling advisory group.

“Covid-19 has taken over all our lives and it is important that we continue to test rigorously and contact trace rigorously until it is controlled in our communities and a vaccine becomes available,” explains Dr Smyth.

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She reminds the public that the average number of contacts for individuals with Covid-19 has reduced dramatically with new social distancing and lockdown measures.

“The average contacts were between 16 and 20 people for earlier cases. Then, the social distancing measures [closure of schools, creches, universities and restrictions on indoor/outdoor gatherings] brought it down to six. With most people confined to their homes, the average number of contacts went to three and the most likely form of contact is in households,” she explains. It has since fallen below two.

Public health doctors interview every confirmed Covid-19 patient and keep in daily contact with that person until they have recovered. If they are admitted to hospital, the hospital-based staff take over their care.

“The public health doctor passes their contacts to the contact tracing teams who will then speak to each person the confirmed Covid-19 patient has been close to,” she says. From the start of April, contact tracing has also been carried out on contacts for those waiting for test results.

Awareness

Dr Smyth finds it fascinating to see how people’s knowledge about how infectious diseases spread through our hands and what we touch has grown since the outbreak of Covid-19.

“People have such awareness now about the importance of hand-washing when they come in and go out of the house, when they come back from shopping and in other situations. Even though this has been a public health message [for years], it has never gained such traction.”

Dr Smyth says hand-washing and respiratory etiquette (coughing and sneezing into the crook of your elbow or into a tissue which is put in a bin straight afterwards, followed by hand-washing) are very powerful measures in reducing the chain of transmission of infectious diseases.

“We have created a behaviour change movement in our society which will have potential effect on the transmission of other infectious diseases. It will be interesting to see the impact of this behaviour change during the next flu season,” says Dr Smyth.

However, her attention and that of the other 40 public health consultants, nurses, administrators and surveillance teams remains firmly on Covid-19 for the moment.

“We hope to see a stabilisation in new cases with the lockdown measures but it depends on compliance with this intervention. Flattening the curve [reducing a spike of hospital admissions for Covid-19] will allow the healthcare system to cope with demand and give us time to put more testing and contact tracing in place to control infection in the community,” she explains.

She acknowledges that “flattening the curve” does not mean that the disease will no longer be in communities across Ireland. “It is important to identify every case and contact trace and identify every contact so that this pandemic can be appropriately managed until a vaccine and treatment are identified,” she says.

In time, Covid-19 will join other infectious diseases which are monitored by public health doctors throughout the world.

“We continue to contact trace tuberculosis and meningitis all the time. Covid-19 has heightened people’s awareness of public health practice,” says Dr Smyth, who also trains specialist registrars in public health at the Royal College of Physicians of Ireland and lectures medical students at the National University of Ireland in Galway.