Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

On the open source issue, I do not know but I will check that out and come back to the Deputy. It is not an area I have particular expertise in.

We do not have exact numbers for the criteria yet. If there are to be magic numbers, they have not been set yet and we do not have any advice on that from NPHET yet. The criteria are the instance of transmission, including in relation to outbreaks in residential and other healthcare settings, ICU occupancy, which is an indicator of transmission in the community, and public health capacity, that is, having adequate testing and contact tracing in place. Those are the criteria.

In the time allowed, I will try to touch on some of the other matters Deputies mentioned. On the Government's response to Covid-19, and it is not just the Government but it is the wider Government, including the HSE, healthcare staff and all of us who are fighting this virus, I have always felt we are fighting it on six fronts, namely: PPE to make sure our staff are protected; testing and tracing; ICU capacity; ventilators and bed capacity; the economic and welfare package to protect businesses and livelihoods; societal actions such as social distancing and lockdown; and protecting vulnerable groups, including those in care homes, prisoners, Travellers, Roma, the homeless and those in asylum seeker accommodation centres. People often ask which one of those has been prioritised over the other but it has never been a case of prioritising one over the other. We have always tried to fight this battle on all six fronts. I never attended a meeting where anyone ever said we should prioritise nursing homes over PPE or testing over social distancing, for example. That is not how it works. There are six fronts with six battles and we are trying to fight on every front every day in order to give each one equal attention and as much attention as possible. We have been running into problems every day, whether that is with PPE, testing, vulnerable groups or the economic and welfare questions but we are trying to do our best on each of those every day. It is a misunderstanding of how this pandemic is happening and of the challenges we are facing to think we would ever somehow set out a ranking order and say that PPE was less important than nursing homes or that testing was less important than the homeless. That is not how it works on the six front lines I am fighting on and it misunderstands the challenges we are facing.

On transparency, I accept the points Deputies are making about the need for greater transparency but I ask for their understanding. People are busy and they are swamped. They are struggling to read their emails and to read the interesting and important documents being sent to them every day from people all over the country who want to help and make good suggestions. This is a rapidly changing situation. Facts and data change by the day. Things we thought were true a few days ago may not be true today. Even our understanding of what the symptoms of the virus are has changed in recent weeks. The data changes on a daily basis and is very often out of date.

On testing, I am advised by the HSE that there is capacity to ramp up testing to 10,000 people per day in the testing centres and ideally the testing centres will provide an appointment time 24 hours from referral. Hospitals are doing testing for patients and healthcare workers in the hospitals at a rate of about 1,500 tests per day. The National Ambulance Service has ramped up testing to an average of 1,500 tests per day. The testing criteria have changed over the course of the pandemic and they will change several times. Initially anyone with symptoms was eligible for testing. That had to be changed in line with the World Healthcare Organization guidance when we had a particular backlog to only include those who had fever as well as respiratory symptoms and also healthcare workers. NPHET intends to widen the criteria again. We have more capacity than demand at the moment, as was mentioned, so it will be possible to widen the criteria and NPHET will advise on that, perhaps as soon as tomorrow, with a view to widening the criteria next week so we can test more people. However, I need to be frank and honest with people. When the criteria are widened, it is done so on the basis that it is thought there will be extra demand but that is not known for sure. Therefore, there is an inherent risk in widening the testing criteria that we may find ourselves overwhelmed and running into problems with backlogs and so on all over again. That is not a mistake or a failure on behalf of anyone. It is just that one can only guess how much a change in criteria will impact demand. Everyone is doing their best on that front.

Deputies mentioned testing asymptomatic patients. Until a few weeks ago, the scientific advice around the world was that it was not useful to test asymptomatic patients because the viral load would be so low that the test would be negative even if the patient had coronavirus. That has changed and it now appears that SARS-CoV-2 can be picked up in patients who are asymptomatic.

People will be aware now that for the first time we are probably one of the few countries in the world, if not the only one, testing asymptomatic patients in nursing homes where there has been an outbreak. Two or three weeks ago, the science was that those tests would not be valuable and we did not have the capacity to do them anyway. However, we were always testing symptomatic patients in the community and in nursing homes.

On nursing homes more generally, the funding package is live and applications have been made to it. I believe that, so far, they have been small, but money, it has not been issued, will be soon. Personal protection equipment, PPE, deliveries are regular. As I said, testing is under way. I absolutely would have preferred that it would have been sooner if it had been possible. It was not possible because of the backlog and the prioritisation advice.

On staffing, there is an agreement with the unions to allow HSE staff to work in the nursing homes. It is voluntary and we are now asking people to volunteer to take up posts in nursing homes to help out there. In some cases, local hospitals have taken over governance. Dealgan House Nursing Home is example of that and there may be more. For the record, there are different types of nursing homes in this country: public, private, and voluntary. I have seen no evidence yet that shows that any one sector has performed better than the others in terms of cases, deaths or infection control. Those which have made the news have largely been public ones, but some of those are excellent institutions. Even in really good institutions where there are great staff, where there has been PPE available and there are single or double rooms, and where everyone has done everything right, we have still seen the virus get in just as flu does in the winter season. It is important to bear that in mind.

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