Coronavirus: Test-and-trace system could cost €700 million, says HSE chief Paul Reid

The Health Service Executive (HSE) is embarking on an “enhanced surveillance project” to look further back in time during the contact tracing process, the Oireachtas Covid-19 committee was told on Tuesday.

Dr John Cuddihy, director of the Health Protection Surveillance Centre, told Social Democrats co-leader Roisin Shortall the project will focus on activities over a 14-day period by new community transmission cases.

Dr Cuddihy said the project would look at “the previous 14 days for more recent community transmission cases”, and the information gleaned would then be incorporated back into the contact tracing process. He said the project may begin as early as next week.

A spokeswoman for the HSE later said that in some instances, people with Covid are already asked to give details of their activities for up to 14 days prior to symptoms. However, the new project will apply to all confirmed cases of community transmission notified in the previous seven days.

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Questions will focus on visits to relatives or friends’ homes, eating out, entertainment, special events, sport and exercise, public transport or religious services, among other criteria. This, the HSE said, will enable quantitative analysis “to identify key settings where exposure to infection most likely occurred and potential hot spots for infection”.

The commitee was told by HSE chief executive Paul Reid the full-year cost of running the test-and-trace system could be as high as €700 million.

Mr Reid told the Oireachtas Covid-19 committee he expects the system to cost in the region of €450 million this year but that this will increase for 2021.

Mr Reid told Ms Shortall he is “estimating a full annual figure for next year, 2021, will be €700 million”.

Mr Reid is giving evidence on Ireland’s Covid response, with a specific focus on testing and tracing.

Earlier the HSE chief said the State may need to increase its lab testing capacity if growth in Covid-19 cases continues.

Mr Reid said the HSE is “modelling [testing] out through the winter – if we keep running the way the virus is running, we’ll need some more capacity in our labs”.

He told Sinn Féin’s David Cullinane it was difficult to “put a number” on the potential capacity as it depends on the progress of the disease in the community.

The HSE’s lead on testing, Niamh O’Beirne, said 91 per cent of swabs get a result within 48 hours. The median end-to-end turnaround time for a negative sample is around two days, she said, growing to three days for a positive sample.

For the completion of contact tracing to take place, the median time stretches to 3.5 days, she said.

Mr Reid said there are two recruitment campaigns ongoing to increase the staffing resource for testing and tracing, with 700 people being sought for swabbing and 500 contact tracers.

The HSE expects a total workforce of between 2,500 and 3,500 across all parts of the testing system, the committee was told. The HSE is hoping to bring the first of its new cohort of contact tracers on board this week.

The committee also heard of the “quite concerning” mental health impacts and other impacts of the virus on the health service. Dr Colm Henry, the HSE’s chief clinical officer, warned of the risk of “diagnostic tunnel vision” emerging, which could lead to serious infectious diseaes being missed due to a focus on testing for Covid.

The rise in hospitalisations associated with Covid is having an impact on the health service, Mr Reid told Labour’s Duncan Smith, with wards being frozen and isolated when cases emerge. He also said there is an “increasing trend of healthcare workers being infected by Covid or having to isolate”.

Mr Reid said critical care capacity has grown from 225 beds at the outset of the pandemic, to 280 beds, with another 17 beds approved for funding in the winter plan.

In his opening statement, Mr Reid had warned “it is increasingly evident that we can expect and should therefore plan for subsequent waves” of the disease.

Amid admissions to hospital which are “definitely rising”, he said “a difficult winter season, coupled with a resurgence in Covid-19, is the worst possible scenario for our health services”.

Mr Reid told the committee even with a vaccine “the reality is that we will be dealing with Covid-19 for a long time yet”, and that behavioural and societal changes are needed to manage the pandemic.

In his opening statement, he also addressed the State’s Covid test-and-trace programme, which has been the subject of ongoing commentary since the increase in cases emerged in recent weeks.

The HSE is examining ways to bring down the turnaround time for tests, and the State compares well with other European countries – including Germany, France, Norway and Italy – when measured by the number of tests done per one million of population, he said.

“In order to speed up test notification periods we are also looking at additional equipment, robots and process methodologies to increase our domestic testing capacity and turnaround,” Mr Reid told the committee.

In the last week, the HSE completed 87,940 tests, according to Mr Reid’s opening statement, bringing the total to 1.12 million. Last week, some 15,381 contact tracing calls were completed, the highest number to date.

The committee also heard the testing capacity of the State is 100,000 per week, with “surge capacity” of 2,000 per day provided by German labs.

The first deliveries of flu vaccines started to GPs, nursing homes and pharmacists on September 17th, Mr Reid said, adding all shipments are expected to be delivered before the end of October. He said the HSE has “secured sufficient doses to vaccinate all the at-risk groups”.

Change approved by the Cabinet last month mean the vaccine is offered to a wider group of people without a charge, including children aged two to 12.