Dr. Tony Holohan:

I will take Deputy Conway's questions on the disposal of the waste. The waste is termed "category A waste". It is highly infectious and there needs to be specific arrangements in place for its disposal. It is generated largely through the secretion of bodily fluids which, unfortunately, are secreted in copious amounts by individuals when they are symptomatic. Obviously, all the materials used form part of that waste so, in the first instance, it has to be handled appropriately and, in the second instance, it has to be disposed of appropriately. The arrangements the Deputy referenced in the US, in terms of industrial autoclaves and so on, are the kinds of appropriate arrangements, including things like incineration, to dispose of that waste.

There is an ongoing discussion on arrangements for that. There are two potential methodologies. We are in discussion with the Environmental Protection Agency, through the HSE, around the licensing of an appropriate facility to provide for disposal of that waste in this country, should the need arise and, in the interim, to provide for a mechanism, should it be necessary, for it to be disposed of through international agreements - essentially, its exportation out of the country through channels that are appropriate to handle that form of waste. It is an important consideration in the context of the handling of these issues.

To go back to Senator Crown's question, I think his information is correct in terms of the current designation of those beds but again I stress the point that this is a dynamic situation and I go back to swine flu, for example. We had a static capacity in terms of ICU. It became clear, in the context of that particular epidemic, that it was not sufficient and a plan was put in place to ramp up that capacity very quickly. Extra machines, ventilators and so on were required and new areas were identified within our hospitals to allow them to ramp up that capacity quite quickly. On that basis, similar discussions are beginning to happen with the Mater hospital about what would be the eventualities if there was pressure on that existing static capacity. How would it ramp up that procedure? How would it commission and bring into effect other areas that could operate to the same standard of isolation? That is a discussion that is going on between the HSE and the people in that particular unit. We would not sit here and say this is the static capacity and it will always be sufficient for any given scenario. We have to be able to adapt, based on what we get.

I will also go back to the discussion around repatriation. When we have a question that may arise, in the context of repatriation, there will, in spite of our need to have in place agreements and mechanisms to repatriate individuals when that need might arise, still have to be an assessment on the basis of the clinical status of that particular individual as well as all the considerations like, for example, capacity, which I mentioned, around the repatriation of that individual at that point in time. This is important in terms of people who might be making decisions about going to these areas and potentially becoming involved in activity which involves high risk. We would not for a moment say that people should not do that. It is a very appropriate and worthwhile thing for people to do, but they should do it in an informed way. Some of the information we have provided, through the Department of Foreign Affairs and Trade and the aid agencies, deals with some of this and reminds people of the importance of understanding that even if they do not pick up Ebola but become ill in some other way or injured and find themselves using health care facilities in these affected countries, they will become exposed to these viruses. That is a specific risk of which they need to be aware. The repatriation of those individuals in those situations could be challenging.