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[00:00:01]

Imploding the Mirage, the incredible new album from The Killers. Featuring the hit singles Caution and My Own Soul's Warning. That killers imploding the mirage out now that Pat Kenny show on Newstalk. It's been described as the second line of defense in the fight against covid-19, but what exactly does contact tracing do? Has the app made life easier? And with recent spikes in confirmed cases as the knock on effect for contact tracing centers have been overwhelming? Well, to get the detail of this, I'm joined now by the person tasked with running the contact tracing center at UCD, dean of Public Health at UCD, Professor Mary Card.

[00:00:52]

Mary, good morning and welcome.

[00:00:54]

Good morning, Pat. How are you today? I'm very well now. I'd love to get just a sense of exactly what happens when you are told that someone has tested positive with covid-19. What's the next step as far as you're concerned?

[00:01:08]

So when we receive the information about cases who have tested positive, we also get with that information that makes it possible for us to get in touch with them. We get their telephone number and we get some details about where they live. And that's really what we do. We call the person to say who we are, introduce ourselves. We're calling on behalf of U.S. public health, and we are about to give them the results of the tests that they had recently.

[00:01:38]

So you are the persons who who give the results of the tests. It's not the GP or whatever other mechanism might have been used to go and get a test or be prescribed a test. You're the people who give the the bad news effectively.

[00:01:53]

Well, to some extent, we we are we're not the only ones. Sometimes people have tests in hospitals and then the information is given to them by their occupational health department. It is also available through GPS. But this is the national system where all of the positive results are channeled into one system and there are a group of contact tracers in different locations around the country. As you know, we had nine centers early on in the first wave and in the in the lull period, that number was at diminished down to one sixth standard center, which is the National Center that continued throughout.

[00:02:34]

And then over these last three weeks, other centers have obviously been escalated to cope with the new demand. So we're not the only people who would tell a person that they're positive. And, you know, while you may say people may think of it as bad news, for the most part, a lot of people are not terribly surprised.

[00:02:56]

Some of them may already have had the news. Others have suspected that they were infected in some way, hence the reason for the test in the first place. So they're positive.

[00:03:04]

Just one thing that is that just to say that there are now increasingly people who are positive, even though they have no symptoms, we call them asymptomatic, positive. And so for them, it may come as a surprise.

[00:03:17]

What's your first question? Is it have you a smartphone and is the app installed?

[00:03:22]

No, we don't start out with that. We asked them how they are and then we go through the various symptoms that they may or may not have had. And we asked them about underlying health conditions. We asked them about their occupations and their work environments and their living situations. And we do indeed get to talking about the app at a later point in the conversation. Now, what constitutes a contact?

[00:03:47]

Because what you're trying to do, obviously, is to see whether this person is now known to be positive, might have given it to somebody else, or indeed, are you trying to find out where they got it?

[00:04:00]

So both of those so contacts, obviously, once you have established, you know, the circumstances of the person you're speaking with, provided also after all of the previous information that I had gone through there, providing them with the advice about self isolation, discussing them with them, their potential for self isolation, you know, in their house or in their living environment, if that's not possible, advising them about the idea of isolation facilities that are available, for example, at City West in Dublin, but other places as well.

[00:04:34]

Once that's how old been gone through, then we begin to talk about their contacts. The contacts fall into, I suppose, two categories, really. We talk about close contact. Close contacts are, for the most part, the people that you live with, the people that you are in close contact with on a regular basis, perhaps even people that you have dined with in the last 48 hours or in the 48 hours prior to the symptoms starting and really documenting all of the details, the name, address and telephone number of the contacts.

[00:05:12]

That's how the contact information comes to the contact tracing center in relation.

[00:05:18]

We know that, for example, in Woollam and Professor Luchini was talking about this when it emerged.

[00:05:25]

That one group of people at a table in a restaurant, in fact, had, you know, seven people in other tables at nearby, all you can do, I suppose, to say, well, I was in so-and-so restaurant at a certain time on a certain day, but I don't know who the hell was around me.

[00:05:42]

No, this is very true. Of course, we don't know fully the circumstances of that particular event in Wuhan. And since then, we have learned a great deal about physical distancing. I prefer to call it. I suppose we refer to it as social distancing, but physical distancing and the importance of maintaining that physical distance. And I know that it has been a challenge for restaurants to provide for that physical distancing, which, you know, would guarantee to some extent I shouldn't say guarantee, but at least, you know, provide some assurance that transmission is reduced.

[00:06:19]

Lots of restaurants, as you well know, have put in the Plexiglas partitions, let's say, between booths or whatever. And so, you know, we hope that this is what limits the transmission of the virus.

[00:06:35]

Now, we know when you had a terrible virus like Ebola, that if a case was found which had traveled on the plane, for instance, you know, everybody on the plane would be checked because they'd have seat numbers and boarding cards and all the rest of it. If someone says, well, they took the number 23 bus to work for every day for five days, what can you guys do about that?

[00:06:59]

Very little in relation to travel on a bus. But I should have mentioned in relation to restaurants and cafeterias, you know, those locations are taking people's names and telephone numbers at this point. So they do have ways of contacting people if that's required. Public transport is a whole different matter. We don't give our telephone numbers when we get on the bus. But I do need to say that airline travel is we're looking at that very, very carefully. Passengers on a flight.

[00:07:26]

If there is a proven case, let's say, among passengers or among cabin crew, no passengers are our close contacts. And that information is made available to the Health Protection Surveillance Center in Pakistan.

[00:07:42]

So a close contact then, by your definition, obviously, the people you're living with are close contacts, people who may have dined with our close contacts, we're told, and it's still on a lot of the information. You've got to be, you know, 15 minutes in the company of someone at close quarters unmasked to to be deemed at risk. How far do we go with this definition of a contact that must be traced?

[00:08:08]

So the 15 minutes unmasked? Yes, we use this definition. Obviously, there's not a huge amount of science underpinning that. If it could be 12 minutes, it could be 18 minutes. And we need to use what it could if it's a direct call from a person who's already positive case. So we really do need to use our judgment there. Obviously, people you live with, you're in their vicinity for longer periods of time at any one time.

[00:08:40]

So, yes, we need to use our judgment there. And the other situation, of course, where there are close contacts is work environments, which we haven't really discussed yet and work environments. We actually refer to those situations as complex, complex contacts. It entails being in touch with the managers and the other departments of of workplaces. And as you well know, in recent times, a number of work environments have had all of their staff tested when there are some positive cases.

[00:09:13]

The other situation where close contact arises, of course, is in private travel and transport, people sharing cars or teams sharing transportation to and from games. So, as I say, every situation, lots of situations are very, very different. And it's really where the experience of contact tracers comes into play in detailing and ascertaining the environment in which a positive person, a person with who's positive for covid-19, has been moving within the defined period of 48 hours prior to them becoming symptomatic or in the event of someone being asymptomatic, we use 24 hours prior to their to their positive test.

[00:09:56]

OK, so with the person who's tested positive, you now have a list of contacts and you contact each one. What do you say to them, though?

[00:10:04]

Do you do you do you say you need to be tested or do you say have you any symptoms or what's the protocol?

[00:10:10]

Yes, all of the above you start out by, of course, again, introducing yourself and then someone's wondering why they're being called. And you obviously need to say you have been identified as the close contact of a known positive case of covid-19. So tell them who it is. No, we're not permitted to do that, many of them will may know already. And some of them are taken by surprise. And they say, oh, really? This is you know, I have no idea who this might be.

[00:10:39]

Can you tell me we're not permitted to say who that is? OK, so what do you say to them then, do they need to be tested or not? Oh, yes, they they do. So so we asked them if they have any symptoms. Sometimes they do. Mostly they don't. Sometimes people who have been close contacts may turn out positive, of course. So then we go through for example, we will have asked the case if they've been using the app.

[00:11:09]

If they do, then there's a mechanism whereby the contacts that are identified through the app are made available. It's all got to do, you know, your bank code, your authentication code and all of that. We we provide an authentication code for the user of the app that goes into our computer system and it generates the list of contacts that have been identified through the app. We don't know people's names at that point. We only have the telephone numbers for sometimes.

[00:11:42]

But how far does this go? You know, you've done that and then you've got a whole new bunch of contacts through the app and then each one of those might have contacts and and so on and so forth. I mean, you could be phoning everyone in the country by the end of it.

[00:11:56]

Well, you know, this is one of the features of this second time round, the numbers of cases. While none of us are happy that there are the number of cases that there are on a daily basis. Truth to tell. If you think back to April, if you think back to Easter time, we were looking at hundreds of cases every day, six, 700, 800 cases. You know, we're managing managing to keep it at a level.

[00:12:22]

Hopefully we managed to keep it there over these last two to two weeks. It has been I know there have been, you know, ups and downs, but 200 has been the highest. But what has really changed are the numbers of contacts in lockdown. Most people had between two and four close contacts. Most people were not at work. But now it is much, much bigger landscape because we've just, you know, coming towards the end of August, it's traditionally holiday time.

[00:12:53]

It's family time. People get together. And, you know, I really don't want to point a finger at any particular age group. We've all participated in very nice social gatherings, family gatherings, August bank holiday weekend and through the following two weeks. So the numbers of contacts has really skyrocketed. I mean, it's not at all unusual for someone to have had, let's say, 20, maybe even 30 contacts within their infective period, if you know what I mean.

[00:13:25]

And and that can be very challenging. And of course, sometimes because of linkages between groups, we find the same contacts identified by different cases. So, yes, it's a number of phone calls has gone through the roof and have you the resources to deal with this.

[00:13:42]

OK, so resources and I know that contact tracing took a bit of criticism there for a period. Truth to tell is that there has been an escalation plan and that was in place and there was a particular threshold at which point the escalation plan was to be activated. And it was obviously getting people back in, getting people upscaled again, though they had previously been contact tracing, there are always small changes. They were changes relating to the app. They were changes relating to the landscape, the contacts and so on.

[00:14:16]

So the capacity is there. In fact, there are times when we're waiting for information to come into the system.

[00:14:24]

So, yes, the question that arises this week, next week and beyond is schools. What happens when a student or indeed a teacher is test positive for school? What happens?

[00:14:37]

Well, you know, and for any member of the of the general public, whether it's at whatever age, you know, whether it's school teachers or or workers elsewhere or for children at school, the guidelines remain the same. And the number one is to follow the guidelines that are provided by Department of Education, by the schools, whether that is in relation to the physical distancing, the use of masks, hand hygiene. And I really would encourage if your school policy has put in place that policy to follow it as closely as possible.

[00:15:12]

It may not be very fashionable at 15 or 16 to wear a mask, but just remember that this is really one of the best ways that we can.

[00:15:22]

But if someone does test positive, we've talked about this in terms of what happens in the school. They're isolated and they go home, a test is organised, et cetera, et cetera. What happens to the rest of the class? What happens to the teachers? So, you know, technically, everybody in it depends on the configuration of the classrooms and they would also fit into the into the category of close contacts. Now, you know, I'm not necessarily the person to talk to about the exact school situations.

[00:15:55]

We're just embarking on it. And I wouldn't in any way wish to, you know, cut across the policies that have been put into.

[00:16:01]

We will find someone who can talk to us specifically about the rules and the protocols for schools. Finally, Mary, I should ask you about where the cases are happening, because we know there's community transmission, this family transmission, there's transmission in meat plants and all of that.

[00:16:17]

We know that.

[00:16:18]

But when I hear, for example, that there's a rise in the number of cases in Dublin, Dublin is absolutely huge and it's densely populated compared to, say, Killdeer or Leisha, hopefully it would be helpful for us to know, you know, are all these cases in Docky?

[00:16:33]

Are all these cases in Balibo? Are all these cases, are many of them in Talla, you know, tell us a little bit more or can you?

[00:16:41]

Well, I'd start out by saying that, you know, one particular message and I'm delighted to hear our acting chief medical officer this morning or requoted this morning on radio saying that it's really not going to be possible to eliminate the virus. I think we all need to really get our heads around the fact that we we can't kill this virus. We cannot get rid of it. We can't eliminate or eradicate. We've got to live with it. Our best hope will be when there's a vaccine available.

[00:17:09]

And let's will and hope that that happens fairly quickly. Michael Osterholm, a very eminent USC professor, was on radio here just 10 days ago, and he made this point very clearly. So the virus is here and it's not going to be eliminated. And therefore, we need to, you know, protect ourselves. Given that it's here and the mode of transmission is known, it's person to person. When you think about the networks we all have and very much have had since the last release of lockdown, it's not very surprising when you have people who work in, let's say, a particular location, perhaps they're exposed to the virus.

[00:17:50]

Perhaps they're a positive case, but they also have families, they have family members of their family who work in supermarkets or who work in the in a nursing home or in a health care environment. I didn't get your point.

[00:18:03]

You're saying basically, you know, just because there's a cluster in one particular area, because of the way we move about to take public transport, meet each other, that it would be foolish to say, well, it's dangerous in Docky, but it's OK.

[00:18:18]

And Valley Park, you could not say no, you live in one place, but the people in your work environment come from all parts of the city. I have no doubt. Likewise, I live, you know, close to you. But in actual fact, people that I work with everyday come from right across the city. So they're in a sense, it's it's impossible to to say that it can exist in just one location without spreading out into other locations.

[00:18:46]

So I presume it's everywhere. Exactly. I have one or two things I'd really like to say. And one is I would really appeal to people. If you have symptoms, please don't go to work. And that you know, that that really is an indication that you are infective. So please don't go to work. And I would also appeal to employers and managers to give their employees the time that's required if they are close contacts, clearly, if their cases to not be at work and to self isolate.

[00:19:19]

But if they're close contacts and the close contact could have been someone in their social context to provide them with that facility to quarantine for the required period, that's really important. Otherwise, we're perpetuating the transmission.

[00:19:37]

Well, it's fascinating stuff and it's a great job at that you have been given and a great job that you're doing.

[00:19:43]

Professor Mary Card, who has been tasked with running the contact tracing center at USC, dean of public health at that university. Thank you very much for joining us.

[00:19:58]

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[00:20:28]

Dotti.