ON TUESDAY, THE Irish Nurses and Midwives Organisation (INMO) and Taoiseach Leo Varadkar gave contradictory information about the rate of Covid-19 infection among healthcare workers in Ireland.
The INMO General Secretary, Phil Ní Sheaghdha, told the Dáil’s Special Covid-19 committee that the Covid-19 infection rate among healthcare workers in Ireland is the highest in the world. On RTÉ’s Prime Time programme on Tuesday, Varadkar disputed this.
Is it true? Does Ireland have the world’s highest rate of coronavirus infection among healthcare workers?
Ní Sheaghdha appeared before the Special Covid-19 committee yesterday. In her opening statement, she said:
The second major issue that has affected staffing levels has been the infection rate among healthcare workers. At present, Ireland is top of the league and has the highest infection rate of healthcare workers globally. That is an absolute scandal. We have sought figures and the Minister for Health, Deputy Harris, instructed that figures be issued on a weekly basis when he met us two weeks ago.
During the committee meeting, Ní Sheaghdha was asked by Fianna Fáil’s Stephen Donnelly why she believed that the infection rate was so high. “Why did we have such a high infection rate, as an island on the edge of Europe with an advanced healthcare system that had more time to prepare than most European countries? Was enough done to protect Ms Ní Sheaghdha’s members?” he asked.
“First, we had a call last Friday with the International Council of Nurses and our figures were the highest. That is not something we are proud of,” Ní Sheaghdha replied.
As well as prompting concern among members of the committee, the claim by Ní Sheaghdha was widely reported in Irish media.
Last night, Taoiseach Leo Varadkar questioned the figures during an interview on RTÉ One’s Prime Time programme.
He said that the figures provided by Ní Sheaghdha were “not accurate”.
Referencing data from the Health Protection Surveillance Centre, Varadkar said that Ireland had 8,000 positive cases out of a healthcare workforce of 250,000. “That’s between 3% and 4% positivity rate,” Varadkar said.
An analysis of data by the Health Protection Surveillance Centre, dated 21 June, shows that Irish healthcare workers made up 8,172 Covid-19 cases out of a total of 25,381.
That would account for 32.2% of all Covid-19 cases in Ireland since the start of the pandemic.
The claim by the INMO is that this figure is high by international standards.
The data the INMO is relying on comes from the International Council of Nurses (ICN), which is a federation of over 130 national nursing associations – including the INMO.
The ICN has been collecting data on the rate of healthcare worker infections and the deaths of nurses with Covid-19 since March. There is currently no standardised global method of data collection on the rates of infection among healthcare staff, something the ICN has been lobbying for.
In a press release on 6 May, the ICN said that it had “gathered further information from its member National Nursing Associations (NNAs), some official government figures and media reports”.
The organisation successfully gathered data from 30 countries, based on reporting by national nursing associations, government statistics and media reports. It has been calling on governments to keep accurate records of infections and deaths among healthcare workers and the ICN’s figures for healthcare worker infections globally were widely reported.
Speaking to TheJournal.ie, CEO of the ICN, Howard Catton, said that Ireland’s figure of 32.2% was the highest figure the organisation was aware of.
Based on 30 countries, the average infection rate – the percentage of healthcare worker infections as a total of confirmed cases – was 7%. The comparable figure in Singapore was less than 1%, while in Italy it was 12%. In Mexico the figure was 15%, while in Spain it was 22%.
Catton said that the “Irish figure is high”. He also said that there were “lots of caveats around the data”.
“There are definitional issues. There are probably some countries that are being more open and transparent about the reporting of data,” he said.
“The Irish figure is high, but it may be that the quality of the data processing is better than in other countries. All of these caveats we have been clear about.”
He confirmed that this type of data is “not being collected in systematic and standardised ways”.
In a statement to TheJournal.ie, a spokesperson for the INMO said: “One in three Covid-19 cases in Ireland are healthcare workers. 1 in 10 cases are nurses or midwives. There is no official international comparison on these rates, so the International Council of Nurses has been tracking the rates across thirty countries. Ireland has the highest rate they have come across.”
“We echo the ICN’s call for a formal, structured official dataset to compare. But it is clear that Ireland has a high rate of healthcare worker infection, which is why regulation change is needed,” the spokesperson said.
The approach to infection rates taken by Varadkar last night was different. He said that the 3% to 4% rate of infection was based on a healthcare workforce of 250,000.
The Department of the Taoiseach did not respond to an email from TheJournal.ie asking for information on the source of this data.
While neither the HSE nor the Department of Taoiseach stated the source of the data, a 3-4% infection rate tallies with the proportion of healthcare workers infected if the total workforce is 250,000.
The HSE did not provide a source for the claim that there are 250,000 staff who work in healthcare in Ireland.
According to HSE employment reports, the latest whole-time equivalent data on staff in the HSE and Section 38 hospitals and agencies is just over 123,000. This data would also include administrative and managerial staff.
When contacted by TheJournal.ie, a spokesperson for the HSE said that “there have been several studies worldwide of HCW [healthcare workers] Covid-19 infection rates which have shown a prevalence rate of 5 to 10% of HCWs, whereas in Ireland this prevalence rate is close to 1% of HCWs”.
The spokesperson said that the “1% prevalence is the prevalence rate of COVID-19 in HCWs in Ireland at the peak of the pandemic (ie 2,500 HCWs were infected at that point out of 250,000 HCWs who work in healthcare in Ireland).”
At a press briefing on Wednesday, HSE Chief Executive Paul Reid said that the overall percentage of infected healthcare workers was between 3% and 4% of the total workforce.
“The experience across other countries has been, in some cases, much higher,” he said.
The reason for the difference between the claims by Ní Sheaghdha and the HSE is simply that they’re not counting the same thing.
The former is counting the infection rate as the total number of healthcare workers infected as a proportion of the general population, while the latter is looking at the proportion of healthcare workers who contracted the virus as a total of the number of healthcare sector staff working in Ireland.
As the ICN acknowledges, international comparisons are difficult and the data used by the organisation has significant caveats. In April, the European Centre for Disease Control released some figures for infection rates among healthcare workers. In China, 3.8% were healthcare workers, while in some US states the figure reached 11%.
Countries have been recording Covid-19 cases very differently, while the extent of testing regimes also differs. In Ireland, testing for healthcare workers was prioritised. However, this wasn’t the case in every country.
For example, one study in April tried to deduce how many healthcare workers were infected in the UK. While the authors estimated that as of 16 April, 30.5% of all infected cases were related to healthcare workers, it noted that “without comprehensive testing of HCWs, we will never really know how [many] are infected”.
The reporting of Covid-19 also differs. Ireland’s approach to counting cases and deaths has been praised by World Health Organisation officials, while the capacity for testing and tracing has been increased over the course of the crisis.
This capacity is not equal among all countries.
The definition of healthcare worker may also differ. Ireland has a very broad definition of healthcare worker, compared to other countries.
A HSE spokesperson said that “here, a HCW is anyone who works in any area of healthcare across community and hospital settings. It would include administrative staff, catering, maintenance, IT etc whereas in many other countries it is a narrower definition of frontline workers or even just doctors and nurses”.
“This very broad definition of HCW along with extensive HCW testing contribute to our proportion of all Covid-19 infections that have been in HCWs,” the spokesperson said.
Most likely source of infection for all cases is self-reported, so HCWs may genuinely feel that they contracted their infection in a healthcare setting, whereas their infection may have been community or travel associated, or due to unknowingly being in contact with a case outside of hospital or due to contact with another HCW case.
HSE Chief Executive Paul Reid also urged caution in making global comparisons.
He said people need to be “careful in terms of comparisons of data across the world”.
“Some countries may not be testing to the same level that we are testing,” he said.
Ireland’s healthcare worker infection rate may be high – but without formalised data from other countries, a direct comparison is difficult.
The HSE pointed TheJournal.ie towards two studies that might offer an international comparison.
The first, published in the widely-respected journal The Lancet in May, saw researchers from the Newcastle upon Tyne Hospitals National Health Service Foundation Trust carry out Covid-19 tests on staff.
Between 10 and 31 March, 1,654 staff were tested – 14% tested positive for Covid-19. Between 30-31 March, 20% of 146 staff tested positive.
In another paper, published by Eurosurveillance, healthcare workers in the Netherlands were sampled. Over two days across nine hospitals, researchers found 4.1% of hospital staff with mild respiratory symptoms had Covid-19.
A HSE spokesperson said:
The disease here in Ireland was suppressed quickly after the restrictions were put in place on the 28th of March but a lot of patients were still hospitalised at that stage, so HCWs were more at risk than the general population. Hence the number of HCWs divided by a smaller number of cases in the general population gives an apparently high percentage of HCWs with Covid-19 relative to the general population.
While neither study claimed to – and tried to – offer a nationally representative model for the rate of infection among healthcare workers, they do indicate the varying levels of infection across regions and countries.
Another study, in an Italian hospital, found that 2.7% from a sample of 2,057 healthcare workers tested positive for Covid-19, while another study of patients in Lombardy estimated that the virus transmission rate in healthcare workers reached over 16% of all cases studied.
However, neither study can be fully relied upon as illustrative of the infection rate among healthcare workers in Italy.
Like many things in this pandemic, international comparisons are difficult to make. Ireland appears to have a high rate of infection among healthcare workers – 32% of cases in Ireland were among that cohort.
But whether other countries had similar experiences or whether Ireland’s rate is exceptionally high is difficult to tell. The best measures are approximate and have obvious caveats, while contrasting approaches to testing and recording of cases among countries may mean a comprehensive data set of infection rates among healthcare workers globally may prove elusive into the future.
Ireland’s infection rate figure may be lower than many other countries if the same testing regime here was applied elsewhere. Alternatively, it could still be comparatively higher. The problem is that a straightforward, definitive comparison is not possible.
As a result, we rate the claim that Ireland’s healthcare worker infection rate is the highest in the world: UNPROVEN
As per our verdict guide, this means: The evidence available is insufficient to support or refute the claim, but it is logically possible.
TheJournal.ie’s FactCheck is a signatory to the International Fact-Checking Network’s Code of Principles. You can read it here. For information on how FactCheck works, what the verdicts mean, and how you can take part, check out our Reader’s Guide here. You can read about the team of editors and reporters who work on the factchecks here.
To embed this post, copy the code below on your site
have your say