Wednesday, 20 May 2020
Department of Health
In the first instance it is the responsibility of individual businesses to determine whether they are in compliance with the requirements of the Roadmap for Reopening Society & Business. If guidance is required in relation to a business activity in a particular sector of the economy that advice should be sought from the Government Department with responsibility for that sector.
772. To ask the Minister for Health when the 14 day self-isolating guidelines will be lifted for persons coming here in order to provide guidance to companies and groups which operate educational based tourism activities and had anticipated the arrival of students on exchange from Spain in the summer and for the 2020-2021 school year; and if he will make a statement on the matter. [6597/20]
NPHET has considered issues in relation to overseas travel, informed by World Health Organisation and European Centre for Disease Prevention and Control guidance, approaches and learning from other countries, and reports of importation of cases in a number of countries following relaxation of restrictions.
As the number of indigenous cases here declines and Ireland eases some restrictions, the relative importance of the risk of importation of cases from overseas increases. The impact of any imported cases on disease spread would be all the greater in the context of easing of domestic restrictions and the resultant increased movement and contact between people. In addition, a significant increase in the number of cases in Ireland as a result of importation could have an impact on public compliance with public health guidance and restrictions. Ultimately, the suppression of community transmission which has been achieved and which should allow for greater resumption of social and economic life in Ireland could be endangered.
To date, Ireland has introduced a range of travel related measures including issuing advice against non-essential international travel on 13th March. As of 24th April, passengers arriving into Ireland from overseas are expected to complete the Public Health Passenger Locator Form and to self-isolate for 14 days. Self-isolation means staying indoors and avoiding contact with other people and is a more stringent measure than the stay at home requirements that apply to the wider public.
Intensive work is underway by my Department, in consultation with other relevant Departments and the Attorney General’s Office, to finalise regulations to come into effect in the coming days that will make it mandatory for passengers arriving to the State from overseas to present a completed Public Health Passenger Locator Form.
My Department, in consultation with other relevant Departments, is also developing proposals to strengthen the 14 days self-isolation arrangements for travellers from overseas. These proposals will include possible enforcement measures. The issue of imposing mandatory quarantine for a 14 day period, to be considered as the situation evolves, was mentioned in the Roadmap for Reopening Society & Business.
It is intended that self-isolation arrangements will continue to apply to passengers arriving from overseas, irrespective of the country from which they are travelling. Passengers transiting to another jurisdiction and who will not be residing in the State, including transiting to Northern Ireland, will be exempt.
773. To ask the Minister for Health his views on the claim by the NPHET that following the introduction of guidelines, patients are not discharged from hospitals into nursing homes unless they test negative twice for Covid-19 before being moved; and if he will make a statement on the matter. [6598/20]
The National Public Health Emergency Team (NPHET) for COVID-19 oversees and provides national direction, guidance, support and expert advice on the development and implementation of a strategy to contain COVID-19 in Ireland.
The NPHET is the mechanism for coordinating the health sector response to significant public health emergencies. It facilitates the sharing of information between the Department of Health and its agencies, including the HSE. It provides a forum for agreement on strategic approaches to public health emergencies. This approach is in line with the advice of the World Health Organization.
HSE guidelines aim to assist staff in residential care facilities, including nursing homes, in their management of COVID-19 cases, including in relation to decisions on transfer of residents, to hospitals, where appropriate.
The HSE through the Health Protection Surveillance Centre has developed an extensive body of guidance and support tools to assist staff in residential care facilities, including nursing homes, in their management of COVID-19 cases, including in relation to decisions on transfer of residents, to hospitals, where appropriate. The current relevant guidelines are the “Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities and Similar Units" (version 4.1 dated 4 May 2020).
The advice states that “People with confirmed COVID-19 should not be transferred to a residential care facility [RCF] until 14 days after onset of symptoms with the last 5 days free of fever. In addition, they should have two nasopharyngeal samples taken at least 24 hours apart reported as not detected. Residents who fulfil the above criteria are not infectious and do not need any special considerations in terms of placement within the RCF.”
The advice notes that: “For those hospitalised patients with a persistent positive PCR test for COVID-19, IPC precautions should be kept in place for another 7 days (i.e. for a total of 21 days) and then removed, provided the patient has no symptoms consistent with ongoing COVID-19 infection at this point. No further retesting is required, as the risk of transmission is extremely low at this point. After 21 days, they can then be discharged from hospital to residential settings, if well enough for discharge.”
The Government’s Roadmap for Reopening Society & Business, published on 1 May 2020, sets out an indicative path to the easing of COVID 19 restrictions and other actions in order to facilitate the reopening Ireland’s society and economy in a phased manner. The Roadmap specifies that decisions in relation to which actions will be taken and which public health measures might be lifted will be made in accordance with the Framework for Future Decision-Making which is as follows:
1. Before each Government consideration of the easing of restrictions, the Department of Health will provide a report to the Government regarding the following on/off trigger criteria:
a. The latest data regarding the progression of the disease,
b. The capacity and resilience of the health service in terms of hospital and ICU occupancy,
c. The capacity of the programme of sampling, testing and contact tracing,
d. The ability to shield and care for at risk groups,
e. An assessment of the risk of secondary morbidity and mortality as a consequence of the restrictions.
2. It will also provide risk-based public health advice on what measures could be modified in the next period.
3. The Government would then consider what restrictions could be lifted, having regard to the advice of the Department of Health as well as other social and economic considerations, e.g. the potential for increased employment, relative benefits for citizens and businesses, improving national morale and wellbeing etc.
4. It is acknowledged that there is also an ongoing possibility that restrictions could be re-imposed and this process will be carried out on an ongoing basis once every 3 weeks.
As is clear from the framework, it is the Government rather than I or my Department that will decide on any modifications to the current public health measures in place and those decisions will be informed by the status of the on/off trigger criteria and the public health advice received at the time that a decision is being made.
776. To ask the Minister for Health if Article 2 of the European Convention of Human Rights dealing with the right to life will be taken into account when preparing guidelines in respect of ethical decision making by health professionals during the Covid-19 pandemic; and if he will make a statement on the matter. [6612/20]
Article 2 is one of the European Convention on Human Rights (ECHR’s) most fundamental Articles and is non-derogable. Article 2(1) places an obligation on the State not only to refrain from the intentional and unlawful taking of life but also to take appropriate steps to safeguard the lives of those within its jurisdiction.
The Ethical Framework for Decision Making in a Pandemic published by the Department of Health on 27th March seeks to ensure that public health measures in response to a pandemic are implemented in a manner that is equitable, reasonable, proportionate, in compliance with national and international law (including the ECHR) and which does not discriminate against particular groups or individuals. The ethical framework sets out clear ethical principles that will guide people in acting so as to produce the greatest good, to ensure the best use of resources and to ensure fairness. It also sets out the values or principles governing how decisions are going to be made.
The positive obligation of Article 2 finds its expression in particular in the ethical principles of minimising harm, duty to provide care and reciprocity contained in the Framework. Building on the Framework, on April 7th the Department published the “Ethical Considerations Relating to Critical Care in the context of COVID-19”. In line with the principle of minimising harm, the document discusses the duty to use limited resources prudently and fairly to minimise the loss of life and suffering and produce the maximal benefit possible for individuals served by those interventions. The document makes clear that everyone is morally equally; that every life matters and that everyone should receive care. As per the procedural values outlines in the framework, any allocation procedure must be fair, clinically justified, transparent and documented. In recognition of the duty of care that State has regarding healthcare workers, the Department issued a paper entitled “Ethical Considerations for PPE Use by Health Care Workers in a Pandemic” on 21 April 21st which considers to what extent health care workers have an obligation to provide, or participate in the provision of, a medical intervention where there are constraints on supplies of PPE.