LAST UPDATE | 4 Mar 2020
THERE ARE NOW 13 confirmed cases of the Covid-19 virus in the Republic of Ireland.
There has been public concern in Ireland about the spread of the virus, particularly after cases were confirmed in both the Republic and Northern Ireland.
We’ve been asking readers for their questions about Covid-19 and Ireland’s response to it. We’ve done the research – here are the answers to your questions:
Several readers asked us questions about how the virus can spread/how this can be prevented:
Covid-19 can spread from person to person, usually after close contact with a person infected with the virus, for example in a household, healthcare facility or workplace. The virus can be spread either:
Directly, through contact with an infected person’s body fluids (eg. droplets from coughing). It is believed that the virus can spread if these fluids are passed onto another person through their eyes, mouth or nose, after an infected person coughed beside them, for example.
or
Indirectly, through contact with surfaces that an infected person has coughed or sneezed on which are, therefore, contaminated with the virus. It is still not known how long the virus survives on surfaces. According to the European Centre for Disease Prevention and Control (ECDC), similar viruses such as Sars an Mers can withstand more than 48 hours at average room temperature on different surfaces.
Scientists have said a person needs to be within two metres of an infected person for fifteen minutes or more to risk catching the virus directly.
It can not get into a person’s system through their skin, so even after touching a surface contaminated with the virus, a person would have to touch their mouth, nose or eyes to be at risk.
Cleaning: When it comes to cleaning surfaces, people who have confirmed Covid-19 and who are at home, rather than in hospital, are recommended to:
The ECDC has said common disinfectants should be enough, but there is a lack of specific evidence for their effectiveness against Covid-19.
Washing clothes: The US Centre for Disease and Control Prevention (CDC) recommends washing laundry thoroughly if there is an infected person in the home. Use disposable gloves while handling items that may have body fluids on them.
The CDC says normal washing detergent can be used and the items can be washed according to the instructions on the labels. It is recommended that they are then dried using the warmest temperatures recommended on the clothing label.
It does not specify temperatures for washing dishes, but suggests they should be washed thoroughly with soap and water.
Here, health officials have been stressing the importance of hand washing – it is one of the best ways to prevent the spread of the virus.
It’s important to note that the above advice in relation to cleaning surfaces, throwing used tissues in the bin and washing clothes/dishes relates to people who are suspected or confirmed cases, and those who are living with them.
There are 13confirmed cases of coronavirus in Ireland – this is not a spread of the virus. Health officials have said there is no need to implement strict precautions among the general population.
Supermarkets: To address the final questions about grocery shopping, in order for someone to catch the virus from an item in an Irish supermarket, one of the 13 confirmed cases in Ireland would have had to visit this store while sick and coughed on an item, or touched the item after coughing on their hand.
The chances of catching the virus from an item in a supermarket in Ireland are extremely low. Health officials have advised people to regularly wash their hands – this should be done before preparing food/before eating, to help stop the spread of all illnesses.
Banknotes: Similar to the advice about items in supermarkets, it is likely that someone could catch the virus from a banknote. However the WHO has said it is possible, as money changes hands frequently.
A WHO spokesperson told The Telegraph that people are advised to wash their hands after handling bank notes and avoid touching their faces.
The first confirmed case of the virus was a student at a school in Glasnevin. This school will be closed for two weeks and all pupils and teachers have been asked to restrict their movements until the end of the incubation period.
Two schools in the west of Ireland have also closed because of a connection to the four cases there.
A number of other Irish schools have taken precautions recently after students returned from ski trips in Italy.
Both parents and teachers contacted us with their questions:
The schools that have taken precautions took advice from the HSE on how to proceed and if a school suspects a student may be infected, this is the best course of action.
Public health officials will be able to assess the specific circumstances of these situations as they arise.
Dr Tony Holohan also issued this advice for parents whose children have travelled from affected regions.
The most important advice for children is to encourage them to wash their hands thoroughly after toilet use, before they eat and if they have been in contact with someone who is sick.
The Department of Education and Skills has updated its information for schools, preschools and third level institutions. It has also provided two posters – one for primary schools and one for post-primary schools – to tell children to cover their coughs and sneezes, throw away their tissues and wash their hands.
A child’s risk: Few infections of Covid-19 have been reported in children or infants. A study published in Jama identified all infected infants (aged under one year) in China from 8 December to 6 February. It found there were only nine infected infants, aged from one month to 11 months – at the time this study was published, there were more than 31,000 confirmed cases in China.
Families of all nine infants had at least one infected family member and they had all become infected after this family member. None of the infected infants required intensive care or had any severe complications.
Speaking to your child about it: Because this issue is now dominating both the news agenda and public conversation in general, this is filtering down to children.
Some are talking to their friends or teachers in school about it, while others are asking questions of their parents.
We spoke to some experts about advice for parents on how to reassure their children if they are anxious about it. You can read the article in full here, but the main takeaways are:
One of the most common questions about the spread of the virus is in relation to working arrangements for those who have been asked to self-isolate and for those who catch the virus.
While health officials here are expecting have been expecting confirmed cases of the virus in Ireland, they are not expecting it to spread rapidly through a town or city, infecting every person in it.
According to preliminary research by the World Health Organisation, in Shenzhen City in China, just 2.8% of 2,842 close contacts of infected persons were found to be infected.
In Sichuan Province, among 25,493 close contacts, 0.9% were found to be infected. In Guangdong Province, among 9,939 close contacts, 4.8% were found to be infected. Close contact means either:
There have been reports of some employers asking staff to work from home for a period of time as a precautionary measure, in cases where one of their employees has been to a country or area with confirmed cases.
Recruitment firm Indeed recently told staff to work from home after concerns about an employee whose family members had visited a facility where patients with the virus were being cared for.
This employee tested negative for the virus and all workers were told they could return to work.
This week Google told staff to work from home after an employee reported flu-like symptoms, but the company said it wanted to test its operational readiness should employees have to work from home for an extended period.
Without a confirmed case in a workplace, it is unlikely that advice from public health professionals would be for all workers in that company to self-isolate for two weeks.
If there is a suspected case in a workplace, right now test results can be given within 24 hours, which means any request for a worker or multiple workers to self-isolate would be short-term.
That is the situation as things stand now, with just 13 confirmed cases in the Republic of Ireland. However, there is has been a lack of clarity about how things would play out for workers if there was an increase in cases.
Not all employees are entitled to sick leave if they have to self-isolate for the two-week period recommended by the HSE. While office workers may be able to work from home during a self-isolation period (if they are not sick with the virus, of course), others such as bus drivers or retail workers, for example, would not have that option.
In the UK, Prime Minister Boris Johnson has said anyone in self-isolation will receive statutory sick pay from the first day off work. This will be included in emergency coronavirus legislation.
Health Minister Simon Harris told reporters that the Irish government is “looking at this as we speak”.
He said the first meeting of the Cabinet sub-committee n Covid-19 will meet on Monday. He pointed out that statutory sick pay is already in place, but if there is a need to make amendments to support people, the government will look at how best to do that.
The Department of Social Protection has issued advice for workers who are diagnosed with the virus, as well as those who need to self-isolate as a precautionary measure.
Anyone who is not advised to self-isolate in accordance with the HSE guidelines, but who has been asked by their employer to stay home as a precaution, can apply for income support (jobseeker payment or supplementary welfare allowance) if their employer cannot continue to pay wages.
However in cases where self-isolation is done at the request of the employer, the employer should continue paying workers.
The department pointed out that an employee is entitled to paid leave known as ‘force majeure leave’ where they are urgently required to attend to the needs of a person affected by an illness or injury, including an actual or probable case of Covid-19.
The person they are providing care to must be in a relationship with them or of domestic dependency – so parents staying home with children who have the virus should be covered by this.
Richard Grogan, employment law specialist, told TheJournal.ie that there has been no specific advice issued to employers and it is not clear whether there will be government support for firms if they are hit by an outbreak.
“There really needs to be something there to assist employers being good employers, and there’s got to be financial stress on many companies, and those companies now will need assistance to be able to pay people who are out sick, and that really is going to have to be looked at very carefully.”
It is unlikely that an employer would refuse to pay someone who has been advised by the HSE to self-isolate, as this person may decide to keep coming to work rather than lose out on wages. And this could put other employees at risk.
Employers in that situation really would be looking at the other workers because if they insist upon the worker coming into work in that situation, and other workers get ill, could they be held liable for the fact of bringing Covid-19 into their workplace when they knew there was a risk? There is a health and safety issue there for employers that they have to balance.
Self-employed workers: There is currently no policy in place to provide financial support for self-employed workers, who would not be entitled to welfare payments.
A taxi driver who drove the woman from Northern Ireland who was the first diagnosed case on the island of Ireland, told RTÉ’s Sean O’Rourke that he had to self-isolate, even after he tested negative.
During this time, he said he would not be able to work – he was not offered financial support from the State.
Health officials in Ireland have said more than 100 suspected cases have been tested for the virus. Readers wanted to know how the test works, where it can be done and how long they would have to wait for a result.
If a persons suspects they may have the virus they are advised to contact their GP or local Emergency Department by phone.
Public health doctors will ask a number of questions about country/cities of travel, dates of travel, arrival in Ireland, contact with confirmed or suspected cases and visits to markets. They’ll also ask about the date of the onset of symptoms.
People only need to be tested if they have symptoms and have in the last 14 days:
If a doctor suspects a patient may have the virus, they will tell them where the swab will be taken- this could be in a hospital, or in their own home.
The HSE has said all acute hospitals have identified isolation facilities specific to Covid-19. If a hospital has the ability to create an isolated area, it should be able to facilitate taking a swab from a suspected case.
A respiratory sample will be taken from the patient – this is a swab taken from the nose or throat. At the UCD National Virus Reference Laboratory, a molecular diagnostics method is used to detect small amounts of the genetic material of the virus.
All swabs are sent to this lab for testing – no testing of swabs takes place in the hospital setting. Healthcare staff at the hospital are responsible for taking the swabs that are sent to the lab and providing any necessary treatment to the patient.
The estimated turnaround time for results of 12 to 24 hours has not changed, despite the increase in numbers being tested here after the outbreak in Italy.
False negatives: Readers may have read some reports about patients initially testing negative and later testing positive for the virus.
Dr Li Wenliang, the whistleblower doctor in China who died of the virus, had several negative tests before he was finally confirmed on 30 January as one of the thousands of Covid-19 patients in the country.
In a study published in the journal Radiology found five patients out of 167 who were experiencing symptoms initially tested negative. After isolation for presumed Covid-19 pneumonia, all patients were eventually confirmed with virus infection by repeated swab tests.
The study suggested a combination of repeated swab tests and CT scanning may be helpful where doctors believe a patient is infected but tests have come back negative.
Speaking to the BBC, Dr Nathalie MacDermott of King’s College in London said in these cases, the patients may not have been infected when they were first tested.
Another option, she said, is that patients did have the virus, but it was at such an early stage there was not enough to detect.
There could also be a problem with the way the swabs are being taken.
“Is it a dangle or a good rub? she asked.
She said it is not possible to say exactly why these false negatives are coming back, but said it flags that health officials should test people again if they continue to have symptoms.
Joe Ryan, National Director of National Services for the HSE, in response to a question from TheJournal.ie in recent weeks, said there have been “a small number of retests” among suspected Irish cases.
There have also been reports globally of a small number of patients who were released from hospital after recovering from the virus, only to test positive shortly after their release.
Experts have said tie most likely reason for this is that patients still harboured low levels of the virus when they were discharged and tests failed to pick this up.
Readers were also curious about treatment for patients who have the virus:
There is no specific treatment for the coronavirus, but many of the symptoms can be treated.
The HSE has said supportive treatments like oxygen therapy can be given while your own body fights the virus. Life support can also be used in extreme cases.
If you get the virus, healthcare professionals will advise on the best treatment for the symptoms you have.
Antibiotics do not work against any viruses and so would not be effective against Covid-19.
Work is ongoing now on a vaccine for the virus, but this is expected to take months as it has to go through a number of trials before it can be made widely available.
Several readers had questions about how self-isolation should work and why only those showing symptoms are being advised to self-isolate, even if they had been to one of the affected areas.
There have been some criticisms of the approach by health officials and the government here, who are advising only those who have symptoms (or who have had direct contact with a confirmed case) to self-isolate until they are cleared by a test.
They have explained these decisions in recent weeks, but first let’s go over the symptoms:
There have been a small number of examples of confirmed cases across the globe who do not have symptoms, but who have the virus.
However experts do not believe that the virus is likely to be passed on by someone who is not symptomatic. Dr Sarah Doyle, HSE Consultant in Public Health Medicine, in response to a question from TheJournal.ie, explained:
The evidence so far is that the likelihood of transmission is far greater from those with symptoms, there’s no clear cut evidence of transmission from those without symptoms although I know there are anecdotal reports.
So our advice to those who have returned from affected areas and have no symptoms is that they may go about their usual activities. However if they do develop symptoms, we’re asking them to immediately self isolate and to phone their doctor for advice.
As the numbers of cases across the world increase, the numbers of suspected cases is going to increase – this increases the pressure on health services.
Before the outbreak of cases in Italy, any suspected cases here would have been taken to hospital for testing in an ambulance.
Now, people are being asked to make their own way to the hospital (following advice from health experts on the best way to do this) or they can be tested in their own homes.
If the numbers of people being tested increases significantly – for example, if Ireland started testing every person who came in on a flight from Italy – this could result in much longer waiting times for results from the lab and could delay a diagnosis of a confirmed case.
The HSE is advising people to self-isolate if they have symptoms, and have, in the last 14 days, been:
For those who are being told to self-isolate, the advice is to:
If you are living with a person who has been told to self-isolate:
The Irish government has not released any public advice in relation to food or supplies for those in self-isolation, but the British government has said: “It is fine for friends, family or delivery drivers to drop off food for you.”
However they should leaves the items they deliver outside your home or in the porch.
During the flu season, Irish hospital were under serious pressure, with severe overcrowding reported in some. There are concerns about whether hospitals will have the resources needed to deal with a spread of the virus.
Chief Medical Officer Tony Holohan told reporters this week that the National Public Health Emergency Team (NPHET) is “very aware” that Intensive Care Unit (ICU) is “well used right now”.
So from our point of view, as we plan and as the situation develops, we will ensure our national crisis management team look at capacity and surge and various requirements around search, not just for isolation but for overall capacity both in the hospital and community.
Speaking to RTÉ News, Sam McConkey, associate professor and head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons in Ireland (RCSI), said there is “a fixed capacity” to do respiratory ventilation and intensive care in Ireland.
“There are things that we could do to expand that – for example, probably in the face of extensive coronavirus infections, a lot of elective surgery would actually stop. No one’s going to want to go to hospital to have your hip done electively when you can wait a few months in the middle of this coronavirus outbreak.
So the ventilators in the operating rooms could be used to supplement our ability to ventilate people who need it for coronavirus. Similarly, private hospitals might be asked to help.
Without knowing ahead of time the numbers of confirmed cases Ireland may have to deal with in the coming weeks and months, it is not possible to say whether or not there are enough ventilators or oxygen. However, it is worth noting here that not all patients who have the virus will need to be hospitalised.
In fact, according to the most extensive study done so far, the novel coronavirus was benign in 80.9% of cases, “serious” in 13.8% and “critical” in 4.7%.
Personal protective equipment for hospital staff: The ECDC has issued guidance for the wearing and removing of personal protective equipment (PPE) in healthcare settings for the care of patients with suspected or confirmed Covid-19.
According to this guidance, the suggested minimum PPE set protects from contact, droplet and airborne transmission. This set is composed of:
The HSE has advice for healthcare professionals in relation to personal protection equipment. This HSE video demonstrates how to use an FFP2 respirator:
If there is a shortage of respirators, the use of surgical face masks is recommended. The ECDC recommends that when this type of PPE is used, the limitations and risks connected to its use should be assessed on a case-by-case basis.
The HSE has said the winter flu season is officially over, with numbers of new cases falling below baseline levels.
One reader wanted to know:
The quick answer to this question is that no one knows whether this will be the case.
The common cold and flu tend to be most prevalent during the winter. But Covid-19 is a new virus and health experts are still learning about it.
Time has done a helpful report on this topic, quoting Dr Nancy Messionnier of the CDC who said it is “premature” to assume that the number of cases will slow as the weather warms.
“We haven’t been through even a single year with this pathogen,” she said.
Elizabeth McGraw, director of the Center for Infectious Disease Dynamics at Pennsylvania State University, told Time that there will likely be many factors that determine when and how the outbreak ends.
“Rate of virus spread, effectiveness of infection control practices, weather and human immunity will likely all play a role in determining its future,” she said.
She explained that the droplets that carry viruses do not stay suspended in human air as long as in cold, dry air, so warmer temperatures can lead to a more rapid degradation of viruses like this.
However, it is not summer all across the globe at the same time.
We also got a lot of questions from readers about travel – restricting travel to Ireland, their own planned holidays and concern about the travel plans of people around them.
Screening: Some European countries have taken extra precautions following the Covid-19 spread in Italy.
Here, the government is advising citizens to avoid all non essential travel to China or to four regions in northern Italy - Lombardy, Veneto, Piedmont and Emilia-Romagna – but is not placing any restrictions on those travelling from affected areas.
Health officials have also said temperature-checking will not be happening at entry points. Chief Medical Officer Dr Tony Holohan told reporters that this is because “it doesn’t work”.
“With an infectious disease, maybe only a certain percentage of people will have fever. It’s also possible for people who don’t wish to be screened to take medication like paracetamol to reduce a fever,” he said.
It’s also possible that a person who comes back from that region will have been exposed and will develop infection but the screening might be negative on the basis that the symptoms haven’t developed – they develop symptoms after they come through the airport. So you’re getting false reassurance that you’re picking cases up.
A high percentage of people who might go on to develop infection having come through the airport could be negative at the point at which they travel through the airport. And it would be a significant waste of resources.
He said that contact tracing involves public health expertise and that staff in this area could be tied up with “an ineffective method of control” if they were doing this kind of screening.
The evidence is pretty clear on border control measures that screening of this nature doesn’t really impact.
Instead, the HSE is asking people who believe they are showing symptoms and who have returned from these areas to self-isolate and to contact their GP or Emergency Department by phone to seek advice.
Restricting travel: Today, Health Minister Simon Harris said restricting flights arriving from northern Italy “wouldn’t be effective”.
He said stopping all flights from Italy will not stop people from Italy from coming to Ireland. We would have to stop all entry into the country, including by Irish citizens, until the outbreak is contained it is unclear how long that could take.
France: As of 3 March, there were 212 confirmed cases of Covid-19 in France in 12 regions. This includes the region Paris is in, Ile-de-France, which has had 37 confirmed cases.
Four deaths have been reported in the country – these patients were aged between 60 and 91 and two of these deaths were in Paris.
However, France is not listed as a place where there is a spread of coronavirus – these are the countries/regions people need to be concerned about travelling to. The places where there is a spread of the virus are:
The Department of Foreign Affairs’ travel advice in relation to France notes there have been a number of cases of Covid-19 in the country. It does not advise against travelling to France.
Citizens should be alert to signs of infection in themselves and seek medical advice if they experience any.
London: The Irish government does not advise against travelling to England, or the UK in general.
There have been 51 confirmed cases – some of those are in London – but only two cases were transmitted in the community, the others had returned from an area where there is a spread of the virus.
Germany: The Department of Foreign Affairs here has updated its advice on the country to include a mention of the confirmed cases of Covid-19. However, the government here is not advising citizens to avoid travel to Germany, where there have been 240 confirmed cases.
The town mentioned by our reader is a more than three hour drive to the area that has the highest number of cases. Hamburg train station is also more than a five hour drive away (and there are just two confirmed cases in Hamburg).
In Berlin, there have been 13 confirmed cases and a small number of schools are closed as a precaution (in one case, a teacher who had been on a skiing holiday in northern Italy had tested positive).
The German health ministry has said the risk to public health in the country is moderate.
In general, you can reduce your risk level while travelling by:
Tenerife: The HSE has updated its own advice to include Tenerife, which has a case of Covid-19 at one hotel. However, there is no widespread transmission on the island.
If you have travelled from Tenerife and did not stay in the affected hotel, you are advised to continue your normal routine. Our reader’s colleague was staying a ten-minute drive away from the area that the affected hotel was in and is unlikely to have had contact with the infected person.
If this colleague becomes unwell, they would be advised to phone their doctor for advice.
And if they were to be confirmed as having the virus – note that this is unlikely considering they were not in close contact with the infected person – then they would be advised to stay away from older people, those with long-term medical conditions or pregnant women.
Some readers expressed concern that their pre-existing conditions could make them more vulnerable to the virus/to severe symptoms if they do catch it.
The ECDC has said infections of humans with common coronaviruses are mostly mild and asymptomatic, but severe and fatal infections have also been observed.
Occasionally, these viruses are able to cause lower respiratory tract infections and pneumonia in humans, although this is more likely in immunocompromised individuals, people with underlying cardiopulmonary conditions, the elderly and young children. Only very rarely do the human viruses cause severe disease.
The HSE has said it is likely you are at more risk if you catch the virus and:
In relation to asthma in particular, The Asthma Society of Ireland said it is in contact with the HSE on the matter, but the HSE has not provided any additional advice or information on Covid-19 specific to people with asthma.
People who have asthma are not believed to be more likely to catch the Covid-19 virus, but if a person did catch it, the Asthma UK charity says respiratory infections can set off asthma symptoms. Their advice is:
Anyone who is in the vulnerable categories above is advised to follow all of the usual prevention advice – especially washing hands and not touching your eyes, nose or mouth with unwashed hands.
However health officials are not recommending that people in the vulnerable category restrict their movements, as was referenced in the final question above. There are only 13 confirmed cases in Ireland at the moment – both in the east of the country.
Both of these patients are now in isolation and those who were in contact with them have been asked to restrict their movements.
And people who have symptoms of the virus and who have been to an affected area are being advised by public health officials to stay away from older people, those with long-term medical conditions and pregnant women.
If you’re concerned or curious about something in relation to Covid-19, please feel free to continue to send your question to answers@thejournal.ie and we’ll do our best to find out the answer for you.
- With reporting from Grainne Ní Aodha, Nicky Ryan and Conor McCrave.
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