Exploring the psychological impact of contact tracing work on staff during the COVID-19 pandemic.

BACKGROUND: Contact tracing is a key control measure in the response to the COVID-19 pandemic. While quantitative research has been conducted on the psychological impact of the pandemic on other frontline healthcare workers, none has explored the impact on contact tracing staff. METHODS: A longitudinal study was conducted using two repeated measures with contact tracing staff employed in Ireland during the COVID-19 pandemic using two-tailed independent samples t tests and exploratory linear mixed models. RESULTS: The study sample included 137 contact tracers in March 2021 (T1) and 218 in September 2021 (T3). There was an increase from T1 to T3 in burnout related exhaustion (p < 0·001), post-traumatic stress disorder (PTSD) symptom scores (p < 0·001), mental distress (p < 0·01), perceived stress (p < 0·001) and tension and pressure (p < 0·001). In those aged 18-30, there was an increase in exhaustion related burnout (p < 0·01), PTSD symptoms (p < 0·05), and tension and pressure scores (p < 0·05). Additionally, participants with a background in healthcare showed an increase in PTSD symptom scores by T3 (p < 0·001), reaching mean scores equivalent to those of participants who did not have a background in healthcare. CONCLUSIONS: Contact tracing staff working during the COVID-19 pandemic experienced an increase in adverse psychological outcomes. These findings highlight a need for further research on psychological supports required by contact tracing staff with differing demographic profiles.

Obstacles to Public Health that even Pandemics cannot Overcome: The Politics of Covid-19 on the Island of Ireland 1//A RESPONSE/A REPLY

The relationship between politics and public health is increasingly evident as governments throughout the world vary in their acceptance and implementation of technical guidance in the response to the SARS-CoV-2 pandemic. This paper reports a qualitative study of public health policies for CoviD-19 in Northern Ireland (NI) and the Republic of Ireland (RoI) across a timeline emphasising the first wave of the pandemic (February to June 2020). Inter-jurisdictional commitments for health as contained in the Good Friday Agreement provide a framework for cooperation and coordination of population health on the island of Ireland. This study of north-south cooperation in the response to CoviD19 applies ten indicators from the Oxford CoviD-19 Government Response Tracker (OxCGRT) codebook to establish if cooperation and policy alignment of key public health measures are evident in the Northern Ireland Assembly and Government of Ireland responses. The study concludes that notwithstanding the historical and constitutional obstacles to an all-island response to CoviD-19, there is evidence of significant public health policy alignment brought about through ongoing dialogue and cooperation between the health administrations in each jurisdiction over the course of the first wave of the pandemic.

Non-adherence to COVID-19 containment behaviours: results from an all-Ireland telephone survey.

BACKGROUND: COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines. METHODS: A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and self-efficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health. RESULTS: 3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9). CONCLUSIONS: Non-adherers to handwashing differ to social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour.

Obstacles to Public Health that even Pandemics cannot Overcome: The Politics of Covid-19 on the Island of Ireland

The relationship between politics and public health is increasingly evident as governments throughout the world vary in their acceptance and implementation of technical guidance in the response to the SARS-CoV-2 pandemic. This paper reports a qualitative study of public health policies for Covid-19 in Northern Ireland (NI) and the Republic of Ireland (RoI) across a timeline emphasising the first wave of the pandemic (February to June 2020). Inter-jurisdictional commitments for health as contained in the Good Friday Agreement provide a framework for cooperation and coordination of population health on the island of Ireland. This study of north-south cooperation in the response to Covid-19 applies ten indicators from the Oxford Covid-19 Government Response Tracker (OxCGRT) codebook to establish if cooperation and policy alignment of key public health measures are evident in the Northern Ireland Assembly and Government of Ireland responses. The study concludes that notwithstanding the historical and constitutional obstacles to an all-island response to Covid-19, there is evidence of significant public health policy alignment brought about through ongoing dialogue and cooperation between the health administrations in each jurisdiction over the course of the first wave of the pandemic.

Quality improvement in a crisis: a qualitative study of experiences and lessons learned from the Irish National Ambulance Service response to the COVID-19 pandemic.

OBJECTIVES: The COVID-19 pandemic has produced radical changes in international health services. In Ireland, the National Ambulance Service established a novel home and community testing service that was central to the national COVID-19 screening programme. This service was overseen by a multidisciplinary response room. This research examined the response room service, particularly areas that performed well and areas requiring improvement, using a quality improvement (QI) framework. DESIGN: This was a qualitative study comprising semi-structured, individual interviews. Maximum variation sampling was used. The data were analysed using an established thematic analysis procedure. The analysis was guided by the framework, which comprised six QI drivers. SETTING: Response room employees, including clinicians, dispatchers and administrators, were interviewed via telephone. RESULTS: Leadership for quality: participants valued person-oriented leadership, including regular, open communication and consultation with staff. Person/family engagement: participants endeavoured to provide patient-centred care. Formal patient feedback mechanisms and shared decision-making could be beneficial in the future. Staff engagement: working in a response room could affect well-being, though it also provided networking and learning opportunities. Staff require support and teambuilding. Use of improvement methods: improvements were made in a relatively informal, ad hoc manner. The use of robust methods based on improvement science was not reported. Measurement for quality: data were collected to improve efficiency and accuracy. More rigorous measurement would be beneficial, especially formally collecting stakeholder feedback. Governance for quality: close alignment with collaborators and clear communication with staff are essential. Information and communications technology for quality: this seventh driver was added because the importance of information technology specially designed for pandemics was frequently highlighted. CONCLUSIONS: The study provides insights on what worked well and what required improvement in a pandemic response room. It can inform health services, particularly emergency services, in their preparation for additional COVID-19 waves, as well as future crises.

Contact tracing during the COVID-19 outbreak: a protocol for enabling rapid learning from experiences and exploring the psychological impact on contact tracers.

Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system required the redeployment of public sector staff and the recruitment of dedicated contact tracing staff in the effort to contain the spread of the virus. Contact tracing is crucial for effective disease control and is normally carried out by public health teams. Contact tracing staff are provided with rapid intensive training but are operating in a dynamic environment where processes and advice are adapting continuously. Real-time data is essential to inform strategy, coordinate interconnected processes, and respond to needs . Given that many contact tracers have been newly recruited or redeployed, they may not have significant experience in healthcare and may experience difficulties in managing the anxieties and emotional distress of the public. Aim: (i) identify emerging needs and issues and feed this information back to the Health Service Executive for updates to the COVID-19 Contact Management Programme (CMP); (ii) understand the psychological impact on contact tracers and inform the development of appropriate supports. Methods: We will use a mixed-methods approach. A brief online survey will be administered at up to three time points during 2021 to measure emotional exhaustion, anxiety, general health, and stress of contact tracing staff, identify tracing systems or processes issues, as well as issues of concern and confusion among the public. Interviews will also be conducted with a subset of participants to achieve a more in-depth understanding of these experiences. Observations may be conducted in contact tracing centres to document processes, practices, and explore any local contextual issues. Impact: Regular briefs arising from this research with data, analysis, and recommendations will aim to support the work of the CMP to identify problems and implement solutions. We will deliver regular feedback on systems issues; challenges; and the psychological well-being of contact tracing staff.

Media Representations of Science during the First Wave of the COVID-19 Pandemic: A Qualitative Analysis of News and Social Media on the Island of Ireland.

COVID-19 is arguably the most critical science communication challenge of a generation, yet comes in the wake of a purported populist turn against scientific expertise in western societies. This study advances understanding of science-society relations during the COVID-19 pandemic by analysing how science was represented in news and social media coverage of COVID-19 on the island of Ireland. Thematic analysis was performed on a dataset comprising 952 news articles and 603 tweets published between 1 January and 31 May 2020. Three themes characterised the range of meanings attached to science: 'Defining science: Its subjects, practice and process', 'Relating to science: Between veneration and suspicion' and 'Using science: As solution, policy and rhetoric'. The analysis suggested that the COVID-19 pandemic represented a platform to highlight the value, philosophy, process and day-to-day activity of scientific research. However, the study also identified risks the pandemic might pose to science communication, including feeding public alienation by disparaging lay understandings, reinforcing stereotypical images of scientists, and amplifying the politicisation of scientific statements.

Bordering on crisis: A qualitative analysis of focus group, social media, and news media perspectives on the Republic of Ireland-Northern Ireland border during the 'first wave' of the COVID-19 pandemic.

RATIONALE: International border controls were among the earliest and most effective of measures to constrain transmission of COVID-19. However, such measures are complex when established borders are open yet politically contested, as for the border that divides the Republic of Ireland (ROI) from Northern Ireland (NI). Understanding how this border affected the everyday lives of both populations during the pandemic is important for informing the continued development of effective responses to COVID-19 and future health crises. OBJECTIVE: This multi-methods study aimed to explore public perspectives on how the ROI-NI border affected experiences of and responses to the 'first wave' of the pandemic. METHOD: The study collated data from focus groups (n = 8), news articles (n = 967), and Twitter posts (n = 356) on the island of Ireland, which mentioned the ROI-NI border in relation to COVID-19. Thematic analysis was used to explore the range of perspectives on the role played by the border during the early months of the pandemic. RESULTS: Analysis identified three themes: Cross-Border Interdependencies illustrated the complexity and challenges of living near the border; Interpretations of Cross-Border Policy Disparities showed that lay publics perceived NI and ROI policy approaches as discordant and politicised; and Responses to Cross-Border Policy Disparities revealed alternating calls to either strengthen border controls, or pursue a unified all-island approach. CONCLUSIONS: Results reveal clear public appetite for greater synchronisation of cross-border pandemic responses, emphasise the specific vulnerability of communities living near the border, and highlight the risk of long-term socio-political repercussions of border management decisions taken during the pandemic. Findings will inform implementation of pandemic responses and public health policies in jurisdictions that share a porous land border.

Rapid response and learning for later: establishing high quality information networks and evaluation frameworks for the National Ambulance Service response to COVID-19 - the ENCORE COVID Project Protocol.

Background: The National Ambulance Service (NAS) is at the forefront of Ireland's response to the COVID-19 pandemic. As directed in Ireland's National Action Plan, NAS significantly expanded prehospital services, including provision of a novel COVID-19 testing service. Additionally, other health services rely on NAS's capacity to assess, transport and/or treat COVID-19 patients. In a climate of innovation and adaptation, NAS needs to learn from international ambulance services and share experience. Evaluation of the NAS response to COVID-19 is required to facilitate evidence-based planning for subsequent waves or future pandemics, and to identify innovative practice for mainstreaming into routine service provision. Aims: This project aims to test the utility of novel information networks and develop a tool that is tailored to evaluating pandemic-imposed change in an emergency medical service. Methods: The first aim will be to introduce and measure the impact of ambulance-specific research and information updates for NAS. Secondly, the usefulness to members of an international network of senior ambulance and research personnel ('AMBULANCE+COVID19' network), and the clarity and feasibility of a short-survey instrument, the Emergency Medical Services Five Question Survey (EMS-5QS), will be assessed. Finally, an evaluation framework for assessing pandemic-imposed change will be developed to enable NAS determine innovations: (1) for reactivation in another wave or new pandemic; (2) to be sustained as part of routine service. The framework will be developed in collaboration with NAS and the National Quality Improvement Team. The Research Team includes expertise from academia, ambulance services and the National Public Health Emergency Team. Conclusions: This project will facilitate the prompt introduction of information sharing processes to an emergency medical service and assess the impact of those processes. By developing a process for evaluating pandemic-imposed change in NAS, this project will add to the toolbox for future pandemic planning in emergency medical services internationally.