As an elaborate machine carries out 374 simultaneous tests for coronavirus in a Co Kildare lab, Dr Ciara Conlan tells how the Omicron variant has left officials bracing for a Christmas surge of infection.

“We’re not like another office that’s winding things down for Christmas. We’re keeping going and we’re ramping up where we can,” she says. “There’s no foot off the pedal.”

Dr Conlan is registrar in medical virology at the satellite lab of the UCD National Virus Reference Laboratory. The Covid-19 testing operation opened last January at the Backweston campus near Celbridge, home of the State Laboratory and Department of Agriculture labs.

Hospital Report

Back then the Alpha variant was dominant but it ultimately gave way to the Delta, which remains a potent threat with up to 5,000 cases still being detected daily. Now the Omicron variant has sent the pandemic in a new direction, spreading with remarkable speed around the globe and prompting the World Health Organisation to warn it should not be dismissed as a “mild” infection.

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The lab is set up to process 3,000-4,000 tests every day with a 24-hour turnaround, although it can do more than 4,000 if required

For Dr Conlan and colleagues, Omicron’s rapid growth in Ireland is unfolding before their very eyes as high-throughput analyser machines churn out thousands of test results every day. “We were at 1 per cent a week ago and now we’re at around 11 per cent, so I imagine the trend is likely to continue.”

Busy times

It all makes for exceedingly busy times at the Backweston, where staff in lab coats prepare PCR tests kits for distribution to testing centres and process samples when they come for evaluation. Each test pack is assigned a unique bar code which is used to relay the results back to patients via text message.

Despite a titanic effort to vaccinate millions of people throughout the State, the latest surge demonstrates that the pandemic is far from beaten.

Eibhlín Moss, manager of the Backweston lab, says testing has reached a new peak. “With the level of vaccination that we were seeing, you would never have anticipated that we’d be testing the numbers we’re testing at now, which is greater than it’s ever been at any point in the pandemic.”

The lab employs about 58 staff. They work shifts between 6am and 7.30pm, four days on and then four days off, with no weekend break in the cycle. The place opened on January 4th, issued its first test result three days later and hasn’t stopped since.

“The split shifts enable the continuity of service covering those longer days. It is also somewhat of a contingency should we have an outbreak on one team so the other team on the other shift is completely separated,” Moss says.

The lab is set up to process 3,000-4,000 tests every day with a 24-hour turnaround, although it can do more than 4,000 if required. It is but one nerve centre in a network of public and private labs that can process 24,000-30,000 daily.

Without precedent

In historical terms that level of testing for any condition is without precedent. But coronavirus has long since proved its capacity to break records around the world, take life, impair health and disrupt day-to-day living. That Omicron was never heard of before the end of November reflects how quickly the drama can change.

Specialists examining test samples these days are on the lookout for a phenomenon known as “S gene target failure”, a key indicator of the new variant. “If we see that S gene dropout, that would make us suspicious for Omicron, but it still needs to go from here for confirmatory whole-genome sequencing,” says Dr Conlan.

“All of the confirmed Omicron cases we have so far have shown this S gene dropout but not all S gene dropout has been shown to be Omicron.”

But much remains unknown about the new variant. Despite signs that Omicron spreads faster and more easily than earlier mutations, there are some indications that it can give rise to less severe infection.

Still, Dr Conlan says it is too early to tell from the data. “In terms of a variant being less severe, that would obviously be great news, but even with a less-severe variant you could still see an increase in hospitalisations and that could be just purely as a function of maths with the increased case numbers,” she says.

“If it’s X amount more transmissible, that can lead to the potential of exponential growth and – even though the proportion of severe cases is smaller in absolute numbers – that can still be quite high. So we don’t know yet how exactly that’s going to evolve.”

Growing anxiety

Such thinking underpins growing anxiety in health policy circles about the potential for Omicron to overwhelm the health service as people gather for Christmas. The variant’s progress remains under high scrutiny ahead of a crunch meeting on Thursday of the National Public Health Emergency Team (Nphet), with the prospect of recommendations on any new restrictions a matter of intense political speculation.

Still, one thing appears clear: there will a lot more testing in weeks to come. “We’re trying to brace staff,” says Moss.

“Certainly from an operational point of view we’ve stocked up and we have cover with staff. Not that annual leave is cancelled or anything like that with staff. But it’s certainly limited. We do need all hands on deck.

“There certainly will be swabbing and testing all over Christmas and we will be operational over Christmas. Christmas Day remains to be seen. But there will be swabbing and testing.”