Dr Mike Ryan Webinar - Tuesday 8th December 2021 - Tuesday 8 December 2021 "Bloody ...

COVID-19 Contact Management Programme

               Dr Mike Ryan Webinar - Tuesday 8th December 2021

                “Bloody Well Done” … But More Still to be Done

Introduction
The COVID-19 CMP Education and Training team has never experienced anything like the stam-
pede that followed when the invitation to have an “insights” call with Dr Mike Ryan of the World
Health Organisation (WHO) presented itself. Over 1,200 people registered and an unprecedented
actually 873 took part in the call. And they weren’t disappointed.
Mike Ryan spoke just short of an hour, together with his WHO colleague Patrick Drury. He ad-
dressed questions from the panel of Dr Deirdre Mulholland, Dr Sarah Doyle and Dr Philip Crowley
as well as excellent questions from contact tracers and public health colleagues across Ireland out
of over 100 submitted facilitated by Dr Mary Browne and James Begley from the Ed and Training
Team.
Though delivered in his now familiar easy, conversational style, full of rich language and common
sense examples, his message was structured, clear and uncompromising. Ireland has done well –
“bloody well” in fact - but now is the time to consolidate and “leverage” the work we’ve done to en-
sure we’re prepared for the next shock to our community. “Was this just nature’s warning shot and
is there much worse to come?”
The following is a summary of the conversation. The full recordings is available at
https://bit.ly/37jAGPw

Observations
“Well done!”
Opening with the comment, “All of us who know how difficult and important contact tracing is know
what a great job you’ve done in Ireland”, Dr Ryan immediately embraced all on the call as being at
one with him and the World Health Organisation. He sketched the scale and difficulty of the chal-
lenge we’ve had to address together. “The global statistics of over 66 million cases and five million
deaths show the scale, but the problem is also that we’re not talking about ‘epidemiological equilib-
rium’ here. Every region’s experience was different.”
Some regions, he said, kept a lid on the spread, largely because they had a “muscle memory” of
recent similar experience like SARS, or because they were able to limit influx of new cases and
snuff out outbreaks when they occurred. Others, like Ireland, endured the first wave and managed
the virus well enough, but then experienced a second wave after something of a respite in the
summer months. “Ireland has done extremely well in the second phase,” he said, but added that
other countries, mainly the Americas, haven’t done so well, treating the virus like a normal flu and
are now fighting for their lives with acute services stretched to the limit. “You can set up ICU beds
and equipment if you have the money, but you can’t magic up nurses and doctors to service them,”
he said.

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The world had many varied reactions, but those with a muscle memory had the capability to re-
establish contact tracing quickly and did better than others. These included South Korea, China
and Japan. But contact tracing also needs a vigorous testing regime and rapid lab returns to make
it work and these countries also tended to do well in integrating these functions, or “avoiding silos”

Avoid Silos
Dr Ryan’s second observation was that a critical success factor in dealing with the pandemic is to
use joined-up thinking, or to avoid silos, as he put it. “Contact tracing, testing, IT systems and op-
erational processes need to be integrated and there needs to be a lot of support at a national lev-
el,” he said. He stressed the importance of addressing these challenges swiftly, as the speed of
spread of COVID-19 is 4 – 6 days. MIRS is 7.5, SARS is 8.5 and the flu is 3.6. “So 5 days is the
golden period in which you have to stop the spread from Index One to spreading to a new genera-
tion and a very sick community.”
But he acknowledged that this creates huge demands on a system and a community. “There
needs to be a rapid recruitment and training of the workforce and also solidarity in the community.”

Technology and Humanity must go Hand in Hand
Dr Ryan said that the pandemic has seen the introduction of some new technologies and process-
es and the successful road testing of others. He included NUIG originated Go Data among a num-
ber of examples that have been particularly effective. “But Apps don’t replace shoe leather,” he
said. “Qualities like reciprocity, solidarity and humanity can be supported by technology, but never
replaced by it, especially in Public Health led interventions”
The point was particularly relevant for contact tracing, he said. “A contact tracer doesn’t only trace
contacts, he or she also greatly affects what information the person receives, what support they
receive and how they behave. You can put these processes and messages on a sheet of paper or
on a wall, but it is very, very different in a real, human setting,” he said.

Take Away Message – a Stronger Public Health Community
He drew his introductory observations to a close with a call to arms, not surprisingly calling for a
strengthening of the Public Health community. “This pandemic isn’t a once off”, he said. “This isn’t
an episode of McIvor where the hero saves the day with some duck-tape and a scissors! We need
to learn from our experience of this pandemic to prepare for other major public health crises that
may follow. There is an under-appreciation of the need to resource serious and ongoing Public
Health infrastructure. It’s not a cost, it’s an investment and a way to reduce much greater cost in
the future.”

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Dr Philip Crowley thanked Dr Ryan and before opening up the discussion to questions addressed
some points about Ireland’s response and in particular efforts made to use joined up thinking and
avoid “the silo issue”. He said we had made a significant effort to integrate contact tracing with
Public Health best practices. He added that from the earliest stages there was support for people
needing psychological as well as clinical support and the response in the community has been
positive. The virus, he noted, exposes inequalities in a society, such as low paid workers and peo-
ple working in highly congregated settings making them particularly high risk of getting the virus
and also spreading it. But we supplied hotel accommodation for those people that might struggle to
effectively isolate in their normal settings.

Question 1
What were specific attributes of different countries’ responses and what lessons can be learned?
Dr Ryan responded by saying that the pandemic impacted on most countries differently and no one
country got their response all right or all wrong. He gave some examples. “Singapore responded
quickly and efficiently and managed to keep schools open, but they didn’t anticipate the spikes that
could come from influx of foreign workers. Japan too focused on clusters but a few slipped through
the net. South Korea had already quite a strong infrastructure in place for contact tracing from
SARS etc., but they too were caught out by break outs in complex settings such as among young
people and also in religious settings. Australia did very well keeping the virus numbers low, but
there was still a serious outbreak in Victoria which the government there responded to with very
strong restrictions of movement, coming in for a lot of criticism in the process”.
One common issue was that a lot of countries delayed action, waiting for perfection. This gives the
virus the advantage, he said. “It’s better to be quick than perfect.”
Another universal problem that arose, especially in the Northern Hemisphere, was the way coun-
tries relaxed their efforts in their summer, as soon as the first wave passed. “People should have
followed through and seen this drop in numbers as just a respite, not the end.”
He added that countries needed to balance containment with mitigation. “It’s not a binary thing, ei-
ther one or the other, but a nuanced question of balancing both in ways that are sensitive to the
specific local circumstances”.
He concluded that no two countries addressed the crisis in the same way and none was perfect.
“Those that did best”, he said “tended to be Consistent, Practical and Comprehensive.”

Question 2
Do countries need to maintain a “Pandemic task force” on standby during healthy times?
The response from Dr Ryan was a resounding “Yes!” He reiterated how in South East Asia there
was a recent memory of a major epidemic event, which had had a major social, political and eco-
nomic impact, so they only had to reinvigorate their Public Health infrastructure, not build from
scratch as others did. “And lo and behold”, he said “when COVID came, they were in relatively
good shape.”

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However, he said you can’t just take a pandemic solution “out of the box” when the need arises.
You need ongoing commitment to epidemiology, response frameworks, constantly trialling practic-
es in real time. He admitted it isn’t an easy thing to persuade governments to make this invest-
ment, seeing it as a cost rather than a long term saving. “People have short memories,” he said.
“The problem is that with an infection rate of only 10% of the population, COVID isn’t exactly an
‘earth-killer’ … Maybe it’s just Mother Nature sending us a warning shot.”

Question 3
What might Contact Tracing in Future look like in Ireland?
Dr Deirdre Mulholland addressed this question first, noting that when the pandemic hit first, Con-
tact Tracing was new to a lot of people, but a pillar of the Public Health thinking “for ever”. “What’s
important for the future”, she said, “was that leaders and decision makers recognise the im-
portance of preparing for a fully integrated Public Health response and resource accordingly”.
Handing over to Dr Ryan, she asked him how important were regional responses to contact tracing
in the future.
Integration is critical to future success, Dr Ryan replied. As well as integration across different func-
tions, he said vertical integration was vital too. “We have to think global and act local!” He gave an
example from his time in the Congo during the Ebola virus outbreak. “We were introduced to many
officials and dignitaries involved in planning, but we really got a different picture when we spoke to
the people working on the ground … 90% women incidentally. Their experience was so real, so
practical and much of the time quite angry, but you just knew they had a far clearer understanding
of what was really happening”. He said that Ireland has an excellent culture and tradition of com-
munity support with some of the best community based organisations he’d ever seen in the world,
such as the GAA. “But have we fully leveraged that support?”, he wondered.
He added that Contract Tracing was the flagship in our fight against this and any future viruses.
“Now we can add vaccine and vaccination programmes in to the toolbox, but it’s important not to
see the vaccine as a silver bullet. We still need mitigation for at least another six months.”

Question 4
How do we combat “Covid Fatigue” and are there any uplifting examples?
Dr Ryan agreed that everyone was pretty tired of Covid and the whole range of medical, social and
economic woes it has heaped on our communities, but the way to combat the fatigue is to say
“Well done” to people. People in the community have done a brilliant job of adapting their behav-
iour to limit the spread. It’s important not to criticize people, he said, for not being perfect, but to
praise the vast majority of people that have done really well most of the time. It’s also a mistake to
throw “science bombs” at people all the time, or for different people in authority to disagree in pub-
lic, “like Mum and Dad fighting in front of the kids!”
The message now he said should be, “We’re in the last 20 minutes of the game. I know you’re
tired, but you just have to suck it up and follow this through to the end.”
“And,” he concluded, “keep saying, ‘you’re bloody brilliant!’”

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Dr Philip Crowley wrapped up the call, thanking Dr Ryan and summarising the key takeaways of
his message as follows:

      We should work in an integrated manner, avoiding silos;

      Technology is great but we must be aware of its limitations – the human touch is always
       necessary;

      Solidarity is a key message, within the health services, within the community and globally;

      We must act with speed rather than wait for perfection;

      We must defend against the danger of people dropping their guard because of the arrival of
       the vaccine; and

      Bad as Covid has been, there may be worse to come …it’s worrying but it’s a fact, so we
       need to be vigilant and prepared.

The final summary message is to build public health capacity to prepare for future public health
shocks.

For further information, please contact bronwyn.clinton@hse.ie

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