By Michael O’Farrell – Investigations Editor
FOR Dr Nick Eichler it started with Aeroflot flight AFL2590 from Moscow to Dublin on Saturday, February 1.
On board was a passenger with Covid symptoms who had flown into Moscow from China before connecting onto the Dublin flight.
This was what Eichler, an internationally-trained public health specialist from New Zealand, had been readied for.
And it was what the 30-strong HSE team he worked for at the HSE’s Eastern Public Health Unit were in place to cope with.
Together the team are responsible for the 1.6m residents of Dublin, Kildare and Wicklow.
‘We went out to the airport very late that night and an ambulance turned up with people in hazmat suits to ask this guy to come out of the plane,’ Eichler recalled.
In the end the passenger tested negative, giving Eichler and his fellow public health specialists a last-minute reprieve before the virus really broke shore here at the end of February.
‘There was a lot of stuff in the media coming out of Northern Italy where there’d been quite a few cases,’ he told the MoS this week.
Throughout February calls to the team – based in Dr Steevens’ Hospital just opposite Dublin’s Heuston Station – had been steadily increasing.
But that changed utterly after the weekend ending February 29 as Ireland’s first case – a pupil returning from a ski trip to Italy – was confirmed positive.
‘We had a normal weekend that weekend as everyone was flying back from their skiing holidays Saturday and Sunday. Then on Monday morning we walked into our building and every single phone in the building was ringing,’ recalled Eichler.
‘There was a set of phones in a big room and each call would divert to a different phone if another was busy, so it was pretty chaotic. There were just phones ringing the whole time.
‘It was kind of at that moment that we knew there was something really, really bad happening.’
That day 400 calls swamped the public health team entirely.
After years of neglect and underfunding, the team were ill-prepared for the onslaught facing them.
‘There was no management software or anything like that,’ said Eichler.
In fact there was no system at all for recording the contents of each call or the outcome. So the team winged it as best as they could.
‘We started with an Excel sheet actually,’ Eichler said.
‘But there were far too many calls and only one person could have it open at any one time so we reverted to paper.’
Every time someone picked up a phone they had no idea who was on the other end.
‘It could be anybody. A GP, a member of the public, an airline, an airport – it could just be anybody because the department phone number was on the HSE website.’
Everyone available – including public health doctors on €120,000 a year who were supposed to be meticulously managing clusters and outbreaks – were marooned answering frontline phones, scribbling notes on paper.
‘It was a bit of panic stations really,’ Eichler said.
‘Everything went on a piece of paper and the paper got put in a Manila folder at the end of each day and that was that for quite a while. We weren’t storing it in a way that if that same case came up two days later anyone would have known any of the background to it.’
Amid the mayhem they pleaded for more resources to little avail.
‘We were very quickly trying to advocate for getting more resources which didn’t really happen quickly enough because it’s very difficult to find extra resources in Ireland in terms of clinical staff,’ he said.
In those early days the team mostly organised and authorised tests and followed through depending on the results.
But the ground kept shifting as limited testing capacity meant the criteria for those requiring tests was repeatedly changed.
Looking back, Eichler believes the ‘case definitions’ applied to those requiring tests ‘were always a couple of steps behind where the pandemic actually was’.
Initially the ambulance service volunteered to carry out testing but they too were swamped.
‘They were fantastic but they were very quickly overwhelmed,’ Eichler recalled.
‘As soon as they had a capacity for maybe 100 tests a day there were 200 tests a day needed.’
By mid-March the team had been allocated 90 Army cadets to train up as basic contact tracers. This attracted positive PR for the Army and the HSE – but the whole operation was still suboptimal.
‘We were still working in paper then, so we had in and out trays and runners going between different floors of the building.’ Slowly, painfully, things improved in some areas.
‘We realised we had to digitise and tag the paperwork so the chief information officer for the HSE got a couple of people to come in full time and just scan in all the pieces of paper we’d been writing on and tag them with key words and dates and things.’
Even so, many elements of the job remained cumbersome. For example, there were people tasked with manually going down through positive test lists to pull out nursing home addresses in order to establish where clusters might be.
Then a minor miracle happened. Within the space of three weeks, software consultants pooled together and broke through digital transformation barriers that had prevented progress for years in the health service.
Suddenly the entire system went digital – and it worked.
‘The development of that software was heroic,’ said Eichler.
‘I think it’s one of the best things that Ireland did do was to set that up and then to set up the national network of contact tracers.’
The outsourcing of the basic contract tracing function allowed medical experts like Eichler and his colleagues to focus on tackling clusters and outbreaks.
‘That basic contact tracing – that’s not really the bread and butter of what public health pandemic management is about,’ he said.
‘Outbreak identification and management is really where the specialists work at.’
Soon that’s what he got, but too much of it.
‘Once we’d offloaded that factory line bread-and-butter contact tracing to a different system it all became about nursing homes. That’s where the real nightmare was. Those places became really, really difficult to manage.’
Eichler said Ireland’s nursing home sector was ‘a really precarious system that was hugely vulnerable to really rapid spread and that’s what happened’.
As the team encountered awful scenarios in care homes, it became difficult to see a way past the desperation.
‘We would have nursing home managers call us up and tell us every one of their staff had called in sick and they wouldn’t be sure who was actually sick and who was feigning it because they were vulnerable themselves,’ he said.
‘There were a couple of instances of nursing home managers calling us up and saying I’ve got one staff member for this weekend for 40 residents and we desperately, desperately need more staff.’
According to Eichler, Ireland even came close to seeing nursing home residents abandoned to die in their beds.
‘The HSE was scrambling to backfill that so you didn’t have seniors left in their beds unfed. That was a real risk,’ he said.
‘It happened in Spain. People would go into a nursing home that had essentially been abandoned and find people passed away in their beds. That came very close to happening in Ireland.
‘It was pretty nightmarish because there were just people dying all over the place. Lots of people were not even making it to hospital – they’d just die in the rest home.’
The 80-hour weeks and constant pressure took a toll and, according to Eichler, working relationships suffered.
‘At that point the relationships between people working in the department were getting quite frayed,’ he said.
Relations with the HSE bosses pulling the purse strings also soured.
‘Every day we were asking for a lot more resources and it just comes a lot slower than you need it to,’ he said.
It was the kind of pressure you can’t leave behind at work – can’t stop thinking about the few hours a day you get to leave it behind.
‘You can’t leave it behind – definitely not.
‘Not when you’re dealing with people ringing you up crying saying they don’t know how to manage from nursing homes and from your own department just because they’re hearing these horrific stories all the time.’
He added: ‘I was going home – and my wife was incredibly supportive – but I was pretty emotionally drained whenever I wasn’t at work …and when you were at work it was just adrenaline-fuelled.’
In mid-April – just as the first wave reached its peak in Ireland – Eichler looked around and made a decision. He was going to go home to New Zealand.
‘There was a chance there was going to be a normal life there,’ he told the MoS this weekend from his new job with the Auckland Regional Public Health Service.
‘I saw the writing on the wall for Europe and Ireland,’ he said.
‘I saw there was a very strict lockdown – just as strong as New Zealand’s – but there was no plan for what to do after that.’
Looking from afar now, Eichler can’t see how his former colleagues – many of whom were already burning out in April – are going to be able to cope with the rising second wave about to crash down on them.
‘You’ve just had the highest number of daily cases ever and that’s got no sign of turning around at the moment.
‘Even if the Level 5 lockdown comes in nationwide this week it won’t turn around for two weeks.
‘If you think about the cumulative effect of 1,200 cases a day – that is so much more than the first wave threw up – and it’s kind of built up slowly, so they’ll already be dealing with so much more than that first wave now with no appreciable change in the resources available.’
