School virus outbreaks likely but ‘bespoke’ responses will avoid closures - HSE

Covid-19 cases and outbreaks will emerge in schools across the country but health officials will take a “bespoke” approach to investigations to avoid school closures, the HSE has said.

Responding to public anxieties about the possibility of outbreaks as schools reopen, Paul Reid, the chief executive of the HSE, said at a briefing that some people expected a checklist to be followed if there were outbreaks but the response would be "very defined" to prevent closures.

“There is no doubt positive cases and likely outbreaks will emerge in schools across the country but the public should be assured that our public health teams have very significant experience in how we manage an outbreak,” he said.

Targeted public health measures being taken now to respond to the increase in Covid-19 cases were “adapted” to avoid another national lockdown, the health chief said.

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“It is not a second surge; it is a significant ramp-up of cases in different geographies and locations and we have to respond to that,” he said.

Mr Reid said the response to school outbreaks would be similar to those in meat plants, direct provision centres and nursing homes and follow a “case by case” and “risk-based approach.”

Dr Abigail Collins, a consultant in public health medicine at the HSE, said that investigating school outbreaks was "not a tick-box exercise" where a score of three or six out of 10 to a yes-no questionnaire would drive how public health officials react to infections in schools.

Investigators would assess details such as where infected children had been sitting in a classroom, how they entered classrooms and access toilets and what happened at break times.

Dr Collins said that “bespoke restrictions” will be based on “bespoke information” gathered in the risk assessment of a school and that staff or pupils may be asked to restrict movements.

“We might temporarily restrict certain activities in certain areas to keep a hold of any transmission risks within the school facility,” she told the HSE’s weekly briefing at DCU in Dublin.

‘We will act fast and hard’

The HSE hoped schools follow public health recommendations so that “we won’t see large-scale exclusions or school closures” but those actions would be taken if necessary, Dr Collins said.

Health officials would avoid a “wide, sweeping first brush approach” initially and that she “would not routinely expect” whole classes to be excluded if there is a single case found.

“I would hope that we would be more measured than that,” she said, but did not rule out more severe restrictions on schools or potential closures if there was a risk of infections spreading.

“We will do what is necessary and if we deem through our investigations that there is genuine concern of onward spread and transmission in a class or a broader setting within the school, then we will act fast and hard,” she said.

Dr Collins warned that information on school outbreaks was "not open information to put on Facebook or Twitter feeds" but private as with any interaction with health services.

HSE chief clinical officer Dr Colm Henry said that internationally it has been found that transmission between children in schools is uncommon and not the main cause of infection amongst them.

Just 2.8 per cent of Irish cases were in children under 15 and any symptoms have been mild.

“The risks of closures of schools now outweigh the risks of Covid-19 to children,” he said.

Anxiety

Mr Reid spoke about the importance of schools reopening, citing a new HSE report being published today showing that the Covid-19 lockdown has had “significant adverse consequences” for children’s educaiton and that primary school children have been most affected.

The report finds that anxiety levels for children may increase due to lack of socialisation and the loss of routines, and that children requiring additional learning were disproportionately affected.

On infection levels, Mr Reid said there had been 1,400 new cases in the 14 days to August 24th, up from 833 over the previous 14-day period and that the incidence of the disease in the country was 27.5 cases for every 100,000 people, though it remains high at 159 in locked down Kildare.

Ireland’s incidence of the disease compares with an EU average of 37 per 100,000 and a low of 2.3 cases per 100,000 in Latvia and a high of 176 in Spain.

The Irish rate is higher than the UK at 22.6 cases per 100,000, Greece at 28.9 and Italy at 17.9 and but lower than Croatia at 74 cases per 100,000, France at 70 and Portugal at 29.7, according to the most up to date figures from the European Centre for Disease Prevention and Control.

The number of confirmed Covid-19 cases in Irish hospitals was 28, which “is a little bit of a concern because it has been creeping up, albeit with lower numbers each day,” he told the briefing.

There are four confirmed cases of Covid-19 in hospital intensive care units.

Mr Reid said the HSE plan for the winter was at an “advanced” stage of planning and that it was preparing figures on costs before presenting the plan to the Government.

Part of the plan includes the establishment of community assessment hubs to keep the examination of rising respiratory illnesses during the winter months out of hospitals.

Testing

The average turnaround time for people being sent for a Covid-19 test and the result being given along with their contacts traced was 2.2 days, down from 2.7 days, he said.

Some 52,700 Covid-19 tests have been conducted in the past seven days and serial testing in meat plants had involved 3,000 tests being completed since they began last Friday.

The HSE will begin serial testing in direct provision centres this weekend, said Mr Reid.

The limit of 100,000 weekly tests was not a target but capacity and that carrying out all 100,000 on serial testing to check asymptomatic spread was “not the best outcome,” he said.

Dr Henry said that there had been a delay of two weeks in the supply of flu vaccines from the manufacturer but that he was confident they would arrive by late October.

He said that he did not expect “undue delay” in the uptake of the vaccine.