No epidemiological link saw first coronavirus patient enter CUH through non-Covid pathway

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The senior author of a report into the first Irish case of Covid-19 has said that because the patient had no epidemiological link to other cases, he entered Cork University Hospital (CUH) through non-Covid pathway and subsequently hospital staff and other patients were infected.

Dr Corinna Sadlier told RTÉ radio’s Morning Ireland that the 43-year-old man presented to CUH with a headache, then developed respiratory symptoms. 

He was treated as one would treat someone with community-acquired chest infection, she said, unfortunately, his condition deteriorated and he required non-invasive ventilatory support and then went on to require admission to the intensive care unit.

“There were some features of his pneumonia that were atypical, obviously we were aware of the evolving Covid-19 epidemic internationally, but at that point in time in Ireland we were very much in the containment phase of the epidemic,” she said.

“There had been six cases identified nationally, all had a relation to travel and our patient had no epidemiological link to either an area where Covid infection was being transmitted widely or had no contact to anyone who had travel – his case is the first community-acquired case of Covid-19 infection that we know about in Ireland.

“His pneumonia appeared atypical, the clinical characteristics of the pneumonia that he had made us consider the possibility of the diagnosis so we proceeded to test him. 

He had no epidemiological link to anyone with Covid-19 infection or to travel so it was unexpected at the time when his test came back positive.

Dr Sadlier thanked the family of the man for allowing medics to write about his case in the Irish Medical Journal.

Following the man’s case there was an extensive public health look back, she said. 

“Identification of this case triggered a rapid and intense public health look back to try and identify where the case emerged from, but to date we haven’t identified any source of infection for this index case in the country.

“It’s very tragic for his family and for the many families around the country who have lost loved ones to Covid-19 infection.

“This patient went through the non-Covid pathway when he came into hospital because at the time he met no criteria for the diagnosis to be considered, so he was being managed in our general intensive care unit, standard infection control precautions were being carried out, but the level of PPE that we use for Covid-19 infection would not have been in place at that time.

“Obviously there would have been a large number of close contacts in health care workers and in patients at that time and there was a very rapid and intense response in the hospital following identification of this case, to make things as safe as possible for both health care workers and patients who would have had contact with this patient.

“Unfortunately there were some cases of health care workers and patients who were infected with Covid.” 

Dr Sadlier explained that there was still uncertainty to when Covid-19 arrived in the country, “obviously our case antedated the first known case, or what we thought was the initial known case of Covid-19 in Ireland.”

She said: “Clearly there were chains of community transmission before this gentleman presented to hospital, so I imagine as further research in terms of the national antibody testing emerges we will have further information on that in time.” 

Only time will tell when Covid-19 actually arrived in Ireland, she added. 

The diagnosis of this patient was unexpected at that time.

“But one I’m glad we considered because identifying a community-acquired case at that time showed us that we were much further along in the epidemic at a national level once we had evidence of transmission of chains of transmission in the community it made it much more likely that we were going to see an outbreak in Ireland of Covid-19 infection and that is what has emerged, it would have prompted the government, the national public health or it would have informed the national public health emergency team in terms of when to introduce measures in terms of changing guidelines – broadening screening at rapid intervals following identification of this first case and there were further cases identified in the community – in fact within three days there was a second case of community-acquired Covid-19 identified in Cork, very shortly after we had further cases in the east of the country.”



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