How did a remote Mayo town become Ireland’s most Covid-infected place?

Dr Keith Swanick's car swings into the carpark of his modern, well-equipped family practice in Belmullet after yet another weekend house call – this time to a 95-year-old man with Covid who is being cared for by his 62-year-old son.

This remote part of north-west Co Mayo, an area similar in size to Co Louth but with just 12,600 inhabitants, has seen an explosion of Covid cases since Christmas. And the frequency of funerals is rising.

“I’ve been qualified 23 years and I’ve never worked as hard,” he says opening the boot of his car to show a yellow plastic safe disposal sack. It is stuffed with spent personal protective equipment (PPE), each medical gown used just once after which, because of the extreme transmissibility of the virus, it must be destroyed.

Winter Nights

“I’ve three nurses here referring people with symptoms. Fifty, 60 referrals a day. The positivity rate is now down to under 50 per cent but it’s still very high . . .”

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Dr Swanick was on call last weekend because his colleague at the town's other practice, Dr Fergal Ruane, was isolating, having come into close personal contact with Covid, outside of his work as a doctor. On Friday, Dr Ruane confirmed he had tested positive for Covid, thus further depleting Belmullet's severely stretched healthcare capacity.

The town achieved national – indeed international – notoriety recently because of the post-Christmas infections surge. The State’s national rate between January 4th to 18th ran to 1,334.6 infected people per 100,000. Around Belmullet, with 700 confirmed cases, the rate ran, incredibly, to 5,556.6 per 100,000.

And this is an improvement on previous numbers, because Belmullet previously hit 6,031.7 per 100,000 population – meaning that one in every 17 people in the locality had the virus.

"There is a sense of quiet terror, of fear, in the whole area," says Kilmore Erris priest Fr Kevin Hegarty. "[People are asking themselves] 'Where will is strike next? If I or my family get it, will I get healed?' You can sense it in the area, this sense of desolation."

Last Sunday, Fr Kevin helped officiate at the funeral of 81-year-old Paddy Conroy, a local publican, popular retired principal of St Brendan's Secondary School and brother of retired Garda deputy commissioner Noel Conroy. Two days before saw the funeral of Peter Gaughan, a farmer also in his 80s.

Both died of Covid but the death that really pulled people up short was that of 57-year old retired nurse Bernie McAndrew. Mrs McAndrew, who had an underlying condition, died suddenly at her Belmullet home on January 10th. Mrs McAndrew worked part-time with a local healthcare provider.

Football final

How one of the most remote parts of Ireland became the most Covid-infected place in the entire country is unclear. Locally, people and healthcare professionals cite three probable infection drivers, all relating to people letting their guard down compared to how they reacted during the initial Covid surge in March and April 2020.

The first was the All-Ireland GAA football final on December 19th when, amid excitement and hopeful anticipation that 2020 might be Mayo’s year, people gathered in each other’s homes, in food-serving bars and hotels to watch the match.

At the same time, people had started to come back for Christmas, many from the UK, some bringing with them the more easily transmitted UK Covid variant and then not isolating fully when they arrived.

Finally, there was Christmas itself and the apparent determination of some to celebrate the season in local restaurants and hotels.

A lot of people ended up in a limited number of social settings

Dr Swanick says: “Even though this is a large geographic area and hotels and restaurants were allowed to reopen, if you count how many there are, a lot of people ended up in a limited number of social settings.”

According to local sources, this amounted to hundreds of people gathering, particularly on the night of December 26th. The Talbot Hotel in the town had closed from the 23rd.

Gardaí have confirmed they carried out Covid patrols in Belmullet on the 26th. The Irish Times understands they called twice on the night of the 26th/27th to the largest hotel in the town, the Broadhaven Bay Hotel.

The hotel owner, Eamon Padden, says the 2020 Christmas season was rather quiet compared to other years.

“Our hotel wouldn’t have been busy,” he told The Irish Times. “We were open only three or four days . . it [the hotel wasn’t any busier than normal. Everything was carried out [according] to the Covid rules. We had security and all.”

The hotel's Facebook page emphasises adherence to Covid restrictions. When asked about three specific days over Christmas, and local assertions of large crowds at the hotel, the hotel's management said the information in the questions put to them was "incorrect on many levels".

“As we are unaware of the source of these highly un-accurate [sic] comments, I’m afraid we cannot comment any further,” management said in a statement to The Irish Times.

Hired rooms

According to one healthcare worker, one premises was overwhelmed by crowds of drinkers. Individuals hired rooms for the night and invited friends to join them and party.

“There was four of five hundred people there,” said this person. “The bar was full, the foyer was full, the back bar was full, the restaurant was full. Very few masks.

“Personnel were overpowered with it; they couldn’t do anything; the guards came and cleared people out but they couldn’t clear people out that were staying there.”

Chief Superintendent Tony Healy, the senior garda in the region, confirmed that an investigation is being conducted because of the explosion of cases in and around Belmullet.

“We’re looking at it and [checking] if there was any breach of the Covid regulations,” he said.

Part of what has prompted the investigation is local chatter about causes of the sudden spread of the virus, though people are wary of “shaming” others and do not want to be seen to point the finger of blame.

This perspective is shared by a local well-known businessman, not in the hospitality sector.

“The staff weren’t letting them in,” he said, “but they got in through windows and drink was also being handed out through windows to people outside.”

He added: “A lockdown should be lockdown.”

By early January, local medics realised the virus was ripping through Belmullet as the 14-day incubation period over Christmas drew to an end.

“We thought that the incidence from December 24th to January 4th, the 2,100 per 100,000, was bad,” says Dr Swanick. “But anecdotally, I always knew it was worse than that and on Monday the 5th, we referred a record number of patients, over 200 patients, for testing and we were getting 50 to 60 percent positivity when the rest of the country was only on 20 to 30 percent.

“Even though this is a large geographic area and hotels and restaurants were allowed to reopen, if you count how many there are, people congregated in a limited number of social settings.”

‘900 per cent rise’

Dr Swanick's colleague, Dr Breda Smyth, the director of Public Health at HSE West, which covers Galway, Mayo, Roscommon, says the region experienced a 900 per cent increase in the seven-day average of daily cases between December 20th and January 3rd.

She puts the surge down to the increased socialising over Christmas. She says there were many outbreaks in family households and extended families due to increased socialising in the lead-up to Christmas, on Christmas Eve and Christmas Day and on St Stephen’s Day, a day when hotels remained open, despite Covid-19 relaxations being shortened.

“On Stephen’s Day, restaurants had closed down but hotels had stayed open. I don’t have direct evidence with regards to any hotel holding any particular event, but I know there were gatherings, family, extended family gatherings, parties,” she said.

The result is that ambulances have become an unusually common sight in and around Belmullet. Patients are treated initially in their homes, mainly with steroids to help boost lung strength.

If people continue to deteriorate, oxygen intake can be boosted at home with a nebuliser. However, removal to Galway for more intensive hospital care, including, in the worst cases, in the Intensive Care Unit (ICU) may be required.

At present, it is understood that several Belmullet residents are in Galway ICU.

Dr Smyth’s suspicions are reinforced by the initial finding of contact tracers. They have tracked several positive cases of Covid in Belmullet back to the night of December 26th.

Galway-based GP Dr Martin Daly, a former president of the Irish Medical Organisation, is familiar with the Belmullet area and believes an explanation for the unprecedented Covid surge is needed urgently.

“We need to know why those numbers are so high,” he said. “The idea that a rural community like Belmullet was so off the range compared to the rest of the country needs to be understood so other communities can learn from their experience and avoid a similar catastrophic situation.”

In the meantime, the community – and local medics -- must soldier on, as best they can.

“The virus has damaged our sense of community,” says Fr Hegarty. “People miss that sense of togetherness. There are so many people one knows that are broken now [because] either they or a family member has the virus.

“I’m fearing a lot more deaths.”