Limited transmission of SARS-CoV-2 in schools in Ireland during the 2020-2021 school year.

BackgroundThe role of schools in SARS-CoV-2 transmission has been a debated topic since the beginning of the COVID-19 pandemic.AimTo examine SARS-CoV-2 transmission in all schools in Ireland during the 2020-21 school year.MethodsIn a national descriptive cross-sectional study, we investigated PCR-confirmed cases of COVID-19 among students (aged < 20 years) and staff (aged ≥ 20 years) who attended school during their infectious period to identify school close contacts. SARS-CoV-2 PCR test results of all school close contacts were pooled to obtain an overall positivity rate and to stratify positivity rate by school setting and role (i.e. student or staff).ResultsIn total, 100,474 individuals were tested as close contacts in 1,771 schools during the 2020-21 school year. An overall close contact positivity rate of 2.4% was observed across all schools (n = 2,373 secondary cases). The highest positivity rate was seen in special schools (3.4%), followed by primary (2.5%) and post-primary schools (1.8%) (p < 0.001). Of the close contacts identified, 90.5% (n = 90,953) were students and 9.5% (n = 9,521) were staff. Overall, students had a significantly higher positivity rate than staff (2.4% vs 1.8%, p < 0.001).ConclusionThis study demonstrated that a low level of SARS-CoV-2 transmission occurred in Irish schools during the 2020-21 academic year. In the event of future pandemics, and as the COVID-19 pandemic continues, there is a need to carefully weigh up the harms and benefits associated with disrupted education to mitigate infectious disease transmission before reflexively closing classes or schools.

Lessons from inter-disciplinary collaboration to mitigate SARS-CoV-2 transmission in schools, Ireland, 2020/2021, to inform health systems and multisectoral recovery.

Introduction: School closures associated with the COVID-19 pandemic resulted in the loss of educational and social supports for up to 1,000,000 students in Ireland and disproportionately affected students from lower socio-economic backgrounds. For the 2020/2021 school year, multisectoral and interdisciplinary "Schools Teams" were established within Public Health departments to maintain in-person education by minimizing transmission of SARS-CoV-2 in schools. This study aimed to describe this model and explore the experiences of Schools Team members in the East of Ireland to identify factors that influenced effective working that can be sustained in the context of health systems and multisectoral recovery. Methods: Schools Teams were comprised of multidisciplinary staff from regional Public Health departments and redeployed staff from the Education sector. Governance rested with Public Health departments. All staff operated to nationally agreed protocols following training. The experiences of the East Schools Team members were explored through an online survey and semi-structured interviews. Results: The survey response rate was 53/70 (75.7%). Participants reported clear channels of communication within the team (44, 83.0%), feeling comfortable in their role following training (43, 82.7%) and a positive team culture (51, 96.2%) as key facilitators of effective inter-disciplinary working. Insufficient administrative support and mixed messaging to schools were identified as barriers to efficient team collaboration. Discussion: The Schools Team model illustrates the potential for multisectoral partnerships to effectively address complex public health priorities and contribute toward health system resilience to health threats. By recognizing and leveraging the ability of allied sectors such as the education sector, to contribute to public health goals, countries can move toward the kind of whole-of-government approach to health recognized as key to health system resilience. The strong links between the education and public health sectors developed through this collaboration could be extended and strengthened to more effectively pursue public health priorities in school settings. More broadly, mechanisms to support multisectoral working should be developed, expanding beyond reactive interventions to proactively address key health priorities and build resilience across health systems and communities. Such collaborations would promote healthier populations by promoting and encouraging a public health perspective among other sectors and embedding "health in all policies".

Hospice@Home to palliative response team

BackgroundOur Hospice at Home (H@H) service supports 31 GP practices (population 315,000 patients).Pre- COVID-19 pandemic service provision of seven-days 9am-5pm was reviewed.Enhanced model developed supporting people wishing to die at home. (DIUPR local CCG 45.9 vs 46.6 England 2017 ONS).DIUPR increased during the pandemic.AimsIncrease ease of access to care provision at home through increased service hours.Increase medical support to develop a specialist palliative care virtual beds model.Uphold hospice’s strategic aims and values of ‘widening access’ and ‘reaching more people’.Uphold ‘Ambitions for Palliative Care’ - ‘each person gets fair access to care’ (National Palliative and End of Life Care Partnership, 2015).MethodsCollaborative appointment (Hospice and NHS) of new community palliative consultant.Use of triage priority rating.Agreed a rapid service pathway for those unstable/dying.New service launched September 2020 with increased hours (8 am to 10 pm) and ability to review patients same day.Supported out of hours by on-call palliative consultants.Virtual beds model supported by daily ‘ward rounds’ and updated plan of care.Data collection – number of referrals, referral source, diagnosis, place of death.Results Nov 20-May 21 Referrals 362 Patients seen 144 Died 166 Discharged 221 Death Location% Hospital 4% Patient‘s own home 80% Hospice 11% Care Home 4% ConclusionService activity increased. 84% of patients died in their usual place of residence. Daily review of patient plans enabled continuity of care. Clear contact information required for patients and families as different service involvement can be confusing. Referral process between partner organisations needed re-discussion and review.Future planningPriority ratings to be reviewed.Strengthen relationships with GP practices by attending Gold Standards Framework meetings.Increase use of data collection including user feedback to support the development of service to enable more patients to be reached in line with identified growing demand.