David Cullinane
Ceist:82. Deputy David Cullinane asked the Minister for Health his plans for enhancing the testing and tracing system to make it more robust and proactive; and if he will make a statement on the matter. [33738/20]
Amharc ar fhreagraTuesday, 3 November 2020
Ceisteanna (82)
Freagraí ó Béal (6 píosaí cainte)
This question seeks an outline from the Minister on his and the Government's plans to enhance testing and tracing, to put in place a more proactive and robust system, and to have a system in place that is fit for purpose and that can be used to hunt down the virus but also stay ahead of it so that when we get to a situation, which I hope we will, where the numbers are much lower and we can come out of this current lockdown, we will have strength in numbers in terms of a robust system to aggressively keep the virus in check.
I agree wholeheartedly with the Deputy. The answer may be a bit long but I will supply the Deputy with the full text if we do not get through it.
On the advice of the National Public Health Emergency Team, NPHET, the HSE developed the capacity to conduct 100,000 tests per week. I subsequently met the HSE and requested that it look at increasing the capacity. This is now in place and the HSE currently has standing capacity to test 120,000 people every week and progress is being made on looking at going higher than that should we need it. The testing and tracing regime compares very favourably internationally in terms of tests per size of population. Ireland ranks eighth highest out of 24 EU countries and the UK in terms of the number of tests being completed at the moment.
The median time it takes from a swab being taken to the communication of a laboratory result is now 29 hours in community testing, 28 hours in serial testing and 28 hours in acute settings. In the week to 27 October, the median time to complete all calls for contact tracing was 1.8 days.
A significant number of staff from other areas of the HSE were deployed to assist in the testing and tracing programme. The HSE is now moving these professionals back and redeploying them to their front-line posts, which is important.
My focus is on what must be done to minimise the risks of future large increases in positive cases. One of the really important tools is an effective testing and contact tracing programme. The HSE is currently running a nationwide recruitment campaign for swabbers and contact tracers. Some 180 additional swabbers have been appointed to date, while additional candidates are currently going through the process. Some 500 additional contact tracers are being hired to provide sufficient capacity for contact tracing with 280 already in place and a further 60 to 70 being appointed every week. By way of comparison, by mid-September, there were 292 people deployed to contact tracing. By 30 October, this had gone up to 683 people deployed to contact tracing and it is rising.
Additional information not given on the floor of the House
At the request of NPHET, HIQA recently undertook a rapid health technology assessment, HTA, on the use of alternatives to laboratory-based real-time RT-PCR to detect cases of current infection with SARS-CoV-2, the virus causing Covid-19 disease. HIQA’s report was published 21 October. HIQA advised that adoption of alternative approaches to testing requires consideration of factors including clinical performance, sensitivity and specificity, turnaround time, and ease of use. However, while rapid antigen detection tests have the potential to expand test capacity, reduce test turnaround times and improve access, the antigen tests available or currently in development show lower sensitivity than that observed with the rRT-PCR Test, the current gold standard.
I have asked the HSE to put in place a systematic and robust process for the rollout of a series of clinical validation exercises across a range of targeted settings and population cohorts. The HSE has established a group to review the antigen tests currently available and how they might be deployed in clinical and non-clinical settings.
The HSE has worked intensively over the past number of months to put in place a comprehensive testing and tracing operation. We will continue to pursue a robust testing strategy. This will include continuation of my Department’s work with the HSE to improve turnaround times, consistency and our end-to-end testing pathway. This ensures the system is responsive to nature of the current and expected future demand for testing and tracing. Testing and contact tracing continues to be a key component of the Government’s response to the pandemic.
We need more capacity both in testing and tracing. On the testing side, we need to increase lab capacity. We can have more swabbers but if we end up with a bottleneck in the labs to do the testing, then we have a problem. With regard to tracing, the problem is the system collapsed for a couple of days and more than 1,900 patients, unfortunately, became contact tracers themselves. When the head of testing and tracing was before the health committee, she said that the metric used to ascertain how many tracers are actually needed in this State showed the figure is 800. However, on the day she was at the committee, and when we are in the middle of a second wave, she said we only had 581 tracers.
This proved the point that many of us had been making for some time, namely, that we wasted the summer months by not putting in that capacity. The temporary collapse of the tracing system was due to lack of capacity and that it became overwhelmed. The Minister should not waste the next number of weeks in the way the summer was wasted. He must ensure the numbers are brought up to the levels to which the Government committed.
We discussed this in the Chamber before. I do not accept the system collapsed. I absolutely accept that what happened should not have happened. Many people were asked to contact their own close contacts. That is not what we want. I would not see that as the system collapsing, however. In some European countries where cases rose, one essentially saw contact tracing stopping. We did not see it stop, however. It was a one-off event.
It now has the capacity to rapidly contact trace up to 1,500 new cases per day. In the current situation, the highest number was just short of 1,200. It is falling now thanks to the work of people across the country.
I absolutely agree with the Deputy. What needs to happen now, as the numbers come down and when we come out of level 5, is that we must make sure the contact tracing system in place is quick and comprehensive, as well as doing both forward and backward contact tracing for the very reasons the Deputy laid out.
Several Members here attended the committee hearing with the head of testing and tracing. There was much spin beforehand in terms of the public commentary from Ministers and even the press statements from the Government that we would see an additional 800 tracers. As it turns out, it was to bring us to 800. We were going to go from 581 to 800.
We were told by the head of testing and tracing at the committee that the number needed to ensure we had a safe service, according to the metric used, was 800. At that point, we were in the middle of a second wave with 1,200 cases a day at its height. We were left only with 581 tracers, however. How did that happen? It happened on the Minister's watch because he did not use the summer months to recruit the staff necessary to ensure we had at least sufficient capacity.
I do not buy it even that 800 would be enough. The Minister must not leave us exposed again. When we get the numbers down, we must have a testing and tracing system that we can use to hunt down Covid, to keep ahead of it and that we do not lose control in the way we lost control this time.
We will just have to agree to disagree on the system collapsing. As I said, obviously one does not want people having to contact their own close contacts. As a one-off event in nine months or so of a global pandemic, I certainly do not believe that constitutes a collapse at all.
I cannot speak to people saying an additional 800. I am pretty sure what I have been saying is that it is scaling up to 800. It will have gone from 231 in mid-September to 800, a significant increase. What is important now is that the capacity is there to rapidly contact and trace 1,500 cases a day. We all need to make sure we never get close to 1,500 cases a day. While we do not know what the future will hold, the cases are certainly coming down now. The focus for the short term, but, hopefully, for the medium and longer term as well, will be less on having to do the high numbers and more around speed, getting to people, getting to their close contacts, going deep and doing both the backwards and forwards contact tracing.