Radiographers are a key part of the country’s frontline fight against COVID-19. Every day thousands of imaging examinations are performed on patients suspected of having COVID-19 and patients with confirmed COVID-19. Medical imaging, in the form of conventional chest X-rays, computed tomography (CT) scans, ultrasound, and interventional radiology, has a role to play in the diagnosis and management of COVID patients.
The imaging of COVID patients, on the scale we are seeing here in Ireland, presents significant additional challenges for radiographers as they perform their duties in hospitals across Ireland. Radiographers are having to adapt their imaging techniques, use equipment in new ways in imaging departments, emergency departments, wards, and ICUs, often in full PPE.
Now more than ever is their expertise, professionalism, skills, care and compassion, resilience, and ability to work effectively in teams (in the imaging department and across the hospital), evident as they go above and beyond in playing your part in this battle against the pandemic.
Across Ireland, and beyond, we are hearing stories of UCD graduates showing a strong, united, and supportive approach to dealing with these once in a lifetime circumstances. We must also acknowledge our radiography students who will be working in the frontline over the weeks and months ahead. Our final year radiography students are currently working in hospitals across Ireland, supporting departments and the radiographers, radiologists, and other staff across medical imaging, as they work toward the completion of their final clinical module.
As we continue to fight against this pandemic, we should remember the role of medical imaging in support of an accurate diagnosis of COVID-19; its role in the management of patients hospitalised with COVID-19; the availability of the required imaging equipment; the need for appropriate PPE to be available to all radiographers; and we must not forget that radiographers also have a responsibility for all other patients, with acute and chronic presentations, who still require care.
When we do overcome the surge of COVID-19 in our hospitals, there will be significant backlogs in non-urgent imaging examinations and procedures which will place pressures on radiographers but again, they will continue to work effectively in teams, with other colleagues, to help get our Health service back on track.
| Group | Link |
|---|---|
| Journalists and Media | link |
| The Guys* in the Lab | link |
| The NCHD's (not junior doctors) | link |
| Public Health Doctors | link |
| Interns | link |
| Infectious Disease Experts | link |
We know that there will be many heroes of this emergency and we hope to profile some of them in the coming weeks. We’d be happy to receive your nominations and testimonials for inclusion in our #FrontlineFriday. Suggestions to comms.medicine@ucd.ie.
Leonardo DaVinci’s ‘Vitruvian Man’ is a recognised symbol of the symmetry inherent in the universe. The canon of proportions puts our world in context with a concept which began with Protagoras’ declaration that “man is the measure of all things”. At UCD we provide the right fit for medical trainees.
The research focus in Physiology at UCD currently involves but is not limited to:
The one year (or possible extension for the duration of research degree) full-time scholarship programme offers an €18,000 tax free stipend along with payment of 100% of EU student fees covered.
Successful candidates will undertake a graduate taught or research degree programme and gain experience teaching in small groups along with adding to their research portfolio.
Strong academic skills and competency in Physiology are desirable along with clinical training and proficient communications skills
Emanuela Pizzi
Course Administrator
E: physiology@ucd.ie
T: +353 1 716 6634
W: www.ucd.ie/medicine
Closing Date: Monday, 4th May 2020 (5pm)
Aristotle held that the heart was the seat of intelligence until Herophilos, one of the founders of Anatomy, showed it to be the brain. While many may see Anatomy as being a largely discovered field, there is still much we can learn from the human form.
The research focus in Human Anatomy at UCD currently involves:
The one year (or possible extension for the duration of research degree) full-time scholarship programme offers an €18,000 tax-free stipend along with payment of 100% of student EU fees. Scholarships are reviewed on an annual basis and may be extended based on satisfactory progression in teaching and research.
Successful candidates will undertake a graduate research degree while gaining skills and experience teaching functional and clinical anatomy to medical and allied health students. Strong academic skills and competency in Anatomy are desirable as part of but not a mandatory requirement.
Steven Masterton
Course Administrator
E: anatomy@ucd.ie
T: +353 1 716 6634
Closing Date: Monday 4th May 2020 (5pm)
*Please indicate which studentship you wish to apply for on your cover letter.
What a difference a week can make. Last Friday the daily Covid-19 media briefings was tetchy and descended into something of a farce with journalists disputing case figures, repeating questions and generally being frustrated by what they suspected was deliberate obfuscation by public health officials.
Perhaps everyone was getting tired – it was after all Day 41 of our pandemic of indefinite duration and four weeks since the Schools had closed. Everyone wanted to know had we flattened the curve. In a refrain not too dissimilar to that at the height of the Cervical Check controversy, the assembled media sought a single, clear figure around which they could build their reports. The public health officials would not (could not oblige). There is no single number and all numbers come with caveats and asterisks.
The more thoughtful journalists – of which there are many – to a step back and a deep breath. One eloquently described the difference in priorities of the public health guys and the media.
“Everybody looks at data from their own perspective. Perfect example: people love county-by-county breakdowns even tho they mean very little. Counties don’t have walls.”
The sense is that ‘both sides’ (though of course we are all on the same side) regretted their less than finest hour. Media briefings since have been respectful, informative and significantly enhanced by intelligent questioning.
The medical profession is often critical of media coverage of health matters, frustrated by what they perceive as sensationalism, spin or even an ‘anti-doctor’ bias. However we should recognise that this country is blessed with some incredible journalist – brave, insightful and articulate. They are professionals who don’t want to be told what to right or that there is ‘nothing to see here’.
They also work under incredibly difficult conditions. Precarious work, poor career prospects and a declining public support for quality media production. They are under as much time pressure as anyone – and more so given that everyone is at home awaiting the grim read-out.
In a week that saw the widespread dissemination of a 5G Coronavirus conspiracy hoax, critical journalism and excellent communications of complex matters has never been more important.
The men and women of the Irish media are as important and as influential as anyone in this public health emergency response. They are in the frontline too as they bring the complex information and insights to the general public, influencing behaviours and maintaining public confidence in the restrictions being applied.
We would like to thank the Irish media for their diligence and hard graft. Perhaps tell us your favourite journalist who is covering the Covid-19 pandemic and we will add them to our Twitter list. Show your support for this important profession by subscribing to news media outlets.
| Group | Link |
|---|---|
| The Guys* in the Lab | link |
| The NCHD's (not junior doctors) | link |
| Public Health Doctors | link |
| Interns | link |
| Infectious Disease Experts | link |
We know that there will be many heroes of this emergency and we hope to profile some of them in the coming weeks. We’d be happy to receive your nominations and testimonials for inclusion in our #FrontlineFriday. Suggestions to comms.medicine@ucd.ie.
Over the past 12 years, the School has run an undergraduate student summer research initiative which aims to give our students an early exposure to research methods. The hope is that these 8-week supervised projects give our students an appreciation for how challenging but rewarding research can be, and that it helps develop their critical thinking capacity.
Our students have enthusiastically embraced these opportunities to undertake clinical and translational, laboratory, educational research, literature reviews, clinical audit or data-centric projects. They give oral and poster presentations of their projects in October, competing for our Student Summer Research Awards, and many have gone on to present their work at national and international conferences.
Despite the impact of the COVID-19 pandemic, we are determined that our students should continue to benefit from this research programme. Indeed, now more than ever, our students want to engage in generating new knowledge through research. This, of course, may mean that projects need to be adapted. The current restrictions have however meant a small number of projects have had to be cancelled. We are now calling on faculty to come forward with any additional opportunities for research students they may have, so that we can ensure all students who want to undertake research are provided with the opportunity to do so.
Proposals are sought from our academic and clinical faculty for eight-week supervised projects that our students can undertake over the summer months. We would be grateful if they could submit their projects through our SSRA Portal before 5pm, Thursday April 30th 2020.
On behalf of all at the UCD School of Medicine, we would like to thank everyone for their support for this important programme in these difficult times. Together we are helping to prepare inquisitive doctors, radiographers and scientists who will incorporate critical thinking into their daily practic.
The School was saddened to learn of the recent untimely death of Mr Thomas Lynch, Chairman of the Ireland East Hospital Group and Chairman of the Mater Hospital. We send our sincere condolences to his wife Deirdre, to his children Jennifer, Rebecca and Mark, to his family, friends and former colleagues.
Highly successful and entrepreneurial in business, Tom had a clear vision of how Irish health could be transformed by combining academic health sciences with excellence in clinical care. He used his considerable talents and leadership skills to pursue that objective over the past 15 years. In 2007, Tom was appointed as the inaugural Chair of the Dublin Academic Medical Centre (DAMC), the commitment of Mater Misericordiae University Hospital, St Vincent’s Healthcare Group and the UCD School of Medicine to establish an academic health system.
Recognising that these two voluntary hospitals had a combined patient caseload comparable to many major international health centres, he encouraged both to benchmark themselves against best-in-class and challenged both hospitals to make the necessary difficult decisions to improve patient outcomes. His vision for a clinical enterprise with education and research at its heart became a compelling call to action for the University. It heralded the creation of first, a Vice President for Health Affairs in the University and subsequently a UCD College of Health Sciences which saw more formal integration of the activities of the Schools of Medicine, Nursing & Midwifery, and Public Health & Physiotherapy with those of their long-time clinical partners.
The Academic Health Sciences Centre subsequently evolved to a wider hospital group construct comprising 11 general, specialised, acute and maternity hospitals with the establishment of the Ireland East Hospital Group, of which he became Chairman in 2013. While some saw the hospital groups as a challenge to the nascent DAMC, for Tom, this was a welcomed re-affirming of his vision for integrated academic health systems. The creation of the IEHG also represented the successful rebutting of a lazy geographical split of healthcare in Dublin along political boundaries. Tom recognised the historical links between Irish Medical Schools and their traditional clinical partners, and he used his considerable persuasive powers to protect these important connections. The continued evolution of Irish hospital governance structures to embrace integrated regional health organisations was a development Tom optimistically embraced and represents the realisation of his characteristically grand vision.
Long before it was popular, Tom was committed to strategic change in the Irish public health system to improve access, quality and patient outcomes. He was a member of the Expert Group on Resource Allocation in the Health Service from 2008 to 2010 which recommended, inter alia, the creation of hospital trusts. He was appointed to the Board of the Mater Misericordiae University Hospital in 2012 and succeeded Mr John Morgan as its chairman in 2015. He has also been a member of the board of St Vincent’s University Hospital.
He had extensive experience in the global pharmaceutical and biotechnology industries as an investor, executive and non-executive director, and chairman. Mr Lynch was Chairman of Icon plc, one of the world’s largest clinical research organisations between 2012 and 2016, having served as a board member from 1993. He has been executive or non-executive director of a number of publicly and privately held biotechnology companies including GW Pharma plc, Sigmoid Pharma, Prospectus Inc, Chrontech AB and Microbiotica. He was chairman of Profectus Biosciences, Inc., Adherium Ltd, Evofem Biosciences, Inc. and Amarin Pharmaceuticals (Ireland) Ltd and board member of Stamford Devices Ltd, Aerogen Ltd and GW Pharmaceuticals plc. Mr Lynch served as a member of the board of IDA Ireland from 2001 to 2010 and chaired its property and finance and audit committees.
His extensive board level experience in the biotechnology industry began with a number of senior roles in Elan Corporation plc where he was chief financial officer, vice chairman and senior advisor over an eight year period that saw the contract drug delivery R&D company transition into a biotechnology discovery enterprise. He founded Warner Chilcott plc and was both chairman and chief executive officer of Amarin Corporation plc, repositioning the latter’s focus to cardiovascular diseases. Prior these, Mr Lynch was a partner in KPMG and is a fellow of the Institute of Chartered Accountants in Ireland.
A strong and long-time supporter of Irish academia, the Belfast-born, economics graduate served as chairman of the board of the Queen’s University of Belfast Foundation from 2004 to 2016, having served as a member of the board since 2000. Tom also became deeply involved with the UCD Foundation and made personal contributions to major UCD fundraising campaigns including the UCD Science Centre. He championed the cause of many Irish clinician scientists at home and aboard, and continually advocated for clinical research and evidence-based medicine. He was chairman of the Dublin Molecular Medicine Centre (an innovative TCD, RCSI and UCD research collaboration) and oversaw its expansion to Molecular Medicine Ireland (and its re-positioning as Clinical Research Development Ireland) to encompass all Irish medical schools. It was typical of Tom Lynch’s vision that he sought to use his influence at Queen’s University to advocate for an all-island medical research initiative. Mr Lynch was also a board member at the Institute for Human Virology in Baltimore. During his distinguished career, he received honorary doctorates from both University College Dublin and Queen’s University Belfast and he was appointed a Knight of St Gregory by Pope Benedict XVI.
Tom was also a great patron of the arts, served as a board member and trustee of the Royal Opera House, Covent Garden from 2000 – 2010, as a member of the Royal Opera House Foundation Advisory Board, an honorary director of the Royal Opera House and as a Governor of the Royal Ballet. Mr Lynch was Chairman of Opera Ireland, Ireland’s first permanent opera national opera company until its demise in 2010. He was chairman of The Place, the UK’s premier contemporary dance centre from 2014.
Those who knew Tom Lynch will miss his irrepressible enthusiasm to make substantial change to Irish healthcare, a role he continued even during his recent illness. Announcing the sad news to the Ireland East Hospital Group, CEO Prof Mary Day quoted Tom’s words from the first IEHG Annual Report.
“No-one should doubt the commitment of healthcare professionals at every level to do their very best for the citizens of Ireland... It is a privilege to work with my colleagues who serve the nation 24 hours a day, seven days a week and 365 days a year. We never stop!”
As Prof Day noted, Tom didn’t stop right until the end and his colleagues will strive to deliver his vision.
Ar dheis Dé go raibh a anam
Today’s #FrontLineFriday shout out goes to the fantastic folk beavering away in our laboratories, testing samples, preparing reagents, studying the disease and formulating putative therapies to combat the coronavirus.
It takes a particular type of person to want to work in a laboratory or to be successful in that role. You have to have the patience of a saint, the resilience and persistence of Sisyphus. You need to be prepared to be meticulous and painstaking in your work, expect much failure and not get too excited by rare successes. You stand on shoulders of giants, or at least a long line of post-docs who went before you. You doubt yourself and question everything and everyone around you. You run positive and negative controls. You repeat things multiple times just to be sure. You prepare standards and graphs and hope, often in vain, for a good correlation coefficient.
Over the past number of weeks, we’ve heard a lot about samples, backlogs and waiting for test results. More folk don’t know that scientists must get things right rather than get it quick. Then they must get it both right and right now! Many forget that but a few weeks ago, no-one had heard about Covid-19, no-one knew the assay or how to source reagents and supplies.
What we do know is that an army of highly trained scientists got to work doing what they do best – problem-solve. Patiently, step-by-step, testing, proving and validating as they went, they prepared to deliver the analysis required by our public health officials. Laboratory scientists are resourceful, enthusiastic and committed.
Many abandoned their own ongoing research efforts to dedicate themselves to the new and urgent priority. For some, this is years of work. For some, essential experiments that they hoped to form a chapter of their thesis that describes their 4 year-long pursuit of knowledge. Like a team of Hollywood superheroes, they assembled and developed the tools, resources and protocols necessary to track, measure, quantify and inform. Some prepared reagents. Some re-purposed 3-D printing machines. Some extracted. Some moved equipment. Some wrote code.
Delays are inevitable as the world gears up to perform the same analysis with the same priority using the same materials. This just presents another problem for our laboratory scientists to solve. Find the bottleneck, develop the workaround. Pause, reflect, test and get going again.
Whatever role you played in helping those at the frontline, we salute your efforts. We know that that world doesn’t always see what you do but know that when we pause to think, we are in awe.
A Day in the Life of a Covid-19 Test Volunteer
*In my experience, it is always ‘guys’, a non-gendered term that describes a multitude of genders, nationalities, seniorities, personality types, etc. – all multi-talented people.
| Group | Link |
|---|---|
| The NCHD's (not junior doctors) | link |
| Public Health Doctors | link |
| Interns | link |
| Infectious Disease Experts | link |
We know that there will be many heroes of this emergency and we hope to profile some of them in the coming weeks. We’d be happy to receive your nominations and testimonials for inclusion in our #FrontlineFriday. Suggestions to comms.medicine@ucd.ie.
My research at the University College Dublin (UCD) Conway Institute focuses on resolving inflammation in the context of the complications that arise in diabetes. We are particularly interested in an anti-inflammatory messenger called Lipoxin A4. This molecule is relatively instable in the body and expensive to make.
We work with colleagues in the UCD School of Chemistry who designed new synthetic versions (analogues) in order to stabilise this molecule. My job was to help screen around 30 lipoxin analogues in the laboratory (in vitro). I worked with Dr Eoin Brennan on some promising analogues. We tested one in a diabetic mouse model last year to study the potential anti-inflammatory effect of this new molecule in vivo.
With the Covid-19 crisis, the institute is closed so, like all of my colleagues, I have had to stop my research. However, I replied to an email calling for Covid-19 testing volunteers that was circulated in the Conway Institute.
I was trained by Alejandro Garcia, who helped to set up the Covid-19 lab in St Vincent’s University Hospital (SVUH) with Prof Kirsten Schaeffer in the National Virus Reference Laboratory, and Dr Guerrino Macori and Dr Evonne McCabe – all brilliant research scientists.
Volunteers at SVUH work in three teams of two people, seven days a week, with one person on call each day. Each team works five to six days a week. We try to have two days off but this can vary each week depending on the number of patients and staff being swabbed daily.
In a typical day in the Covid-19 laboratory, the samples come from the BL3 (biosafety level three) laboratory where the virus is inactivated and lysed. We triple-check all samples received before moving on to the extraction and purification of the viral RNA with a high-throughput extractor robot.
The reverse transcription step and the qPCR (quantitative, or real-time, polymerase chain reaction) happens straight after this step. We detect the mRNA coding for the spike protein of the SARS-CoV-2 in the patient samples. When the run is successfully completed, we pass the results to the microbiologists. These steps are repeated for every batch of samples coming through from the BL3 lab.
Through this experience, I have learnt to work with an automated nucleic acid extractor, which I was not familiar with as I have always been doing my extraction manually. I also manage my stress better now since adjusting to this hectic hospital setting. The experience has improved my problem-solving skills as well. And I have met some amazing scientists and doctors here who I am glad to work with.
I feel a huge sense of responsibility with this work. The fear of making technical or interpretation mistakes that can have serious consequences on people’s lives is always there when you work under pressure. This is not something we are used to dealing with in a research lab, but we rely on each other in the team to proofread everything.
Like all Covid-19 test centres, we are encountering difficulties due to the worldwide shortage of lysis buffers, extraction and qPCR kits. Finding new kits, testing and validating them, or designing our own primers in a very short period while patients are still waiting for their results is extremely challenging.
It is difficult to balance this volunteering work with my day job. I am writing my thesis at the moment so I am trying to find some time on my days off to keep going on this big task.
By Mariam Marai, in conversation with Elaine Quinn, institute manager for communications and education at UCD Conway Institute
Mariam Marai is a PhD candidate and research assistant in the UCD Diabetes Complications Research Centre, based in UCD Conway Institute. From Paris originally, Marai has an undergraduate and master’s degree in virology from the University of Strasbourg, and was employed in both medical research and industry laboratories in France. Four years ago, she relocated to Dublin and began working in Prof Catherine Godson’s research group in UCD.
Published in Silicon Republic, April 2020
The Hospital Saturday Fund has awarded a grant to UCD School of Medicine towards the Summer Student Research Awards programme. Assistant Professor Noreen Sheehy, SSRA Chair and Professor Amanda McCann represented UCD to accept this grant for the SSRA International Programme.
Twenty six Irish charities received donations from The Hospital Saturday Fund (HSF) at a special reception at the Mansion House in Dublin on Thursday, 20 February 2020. In total, €120,000 was donated to the charities at the event, which was hosted by The Hospital Saturday Fund Vice President, The Lord Mayor of Dublin, represented on the evening by Deputy Lord Mayor, Councillor Tom Brabazon.
Among the beneficiaries were Central Remedial Clinic which received a grant towards its multi-sensory room refurbishment. Debra Ireland’s community care programme received a grant and Temple Street Foundation will use their donation for the purchase of a new ECG machine. Also receiving grants were
Dublin Swifts who will put their grant towards the refurbishment of their sports wheelchairs, Heart Children Ireland’s grant will be used for their Family Psychology Support Service and Dublin Wicklow Mountain Rescue Team will purchase medical equipment with their grant.
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A medical elective grant was made to University College Dublin towards their Summer Student Research Award Programme. Assistant Professor Noreen Sheehy (Chair of the SSRA committee) and Professor Amanda McCann represented UCD to accept this grant for the SSRA International Programme.
The Lord Mayor’s nominated charity, Fighting Blindness, will use their grant for their Opthalmology Genetic Counselling Programme. Speaking at the event, The Deputy Lord Mayor paid tribute to all the charities attending and wished them every success in their continuing worthwhile work.
Paul Jackson, Chief Executive of the Hospital Saturday Fund said: “We are delighted to continue the tradition of supporting many wide-ranging charities in Ireland, many of which are less well-known. The Hospital Saturday Fund is honoured to support the efforts of such deserving charities and help in some way towards the exceptional, tireless work that they do in making such a huge and positive difference to people’s lives.”
The reception also celebrated HSF health plan, a type of medical insurance product, and its 70th Anniversary of working in Ireland in 2019. Mr Jackson commented, “It is reassuring to know that since 1949 we have been helping families and individuals in Ireland with the cost of their everyday medical bills. Our wide range of benefits are valued by our policyholders and their dependents, with some people using our benefits in conjunction with their Private Medical Insurance, whilst others use HSF health plan as a stand-alone product. Regardless of what cover people have, we offer outstanding value for money”.
“With all of our profits going to our parent charity, The Hospital Saturday Fund, which then makes donations to medical charities, hospitals and hospices, everyone who takes out a policy with us is really helping to make a difference to their local community”.
In 2020 the Hospital Saturday Fund will give €2 million in donations and grants to medical charities for care and research, hospices and hospitals across Ireland and the UK. Assistance will also be given to individuals whose illness or disability has caused financial difficulties.
Charities receiving grants at the Reception:
Alzheimer Society of Ireland
Aspire – Asperger Syndrome
CASA
Central Remedial Clinic
Cleft Lip & Palate Association
Coeliac Society of Ireland
CRY Ireland
Cystic Fibrosis Ireland
DEBRA Ireland
Dublin Simon Community
Dublin Swifts (Irish Wheelchair Association)
Dublin Wicklow Mountain Rescue Team
Dyspraxia Association of Ireland
Fighting Blindness
Heart Children Ireland
Huntington’s Disease Association of Ireland
Irish Therapy Dogs
LauraLynn - Ireland’s Children’s Hospice
MS Ireland
Neurofibromatosis Association of Ireland
Oesophageal Cancer Fund
Parkinson’s Association of Ireland
Spina Bifida Hydrocephalus Ireland
St John of God Foundation (Suzanne House)
Temple Street Foundation
University College Dublin School of Medicine (Medical Elective grant)
For further information, please contact:
Louise Kent, Charity Manager, HSF – louise.kent@hsf.eu.com or +44 (0)20 7202 1365
Social media handles:
www.twitter.com/hsfcharity or @hsfcharity
www.instagram.com/hsfcharity or hsfcharity
www.facebook.com/hsfcharity or @hsfcharity
We’d like to dedicate our Frontline Friday to non-consultant hospital doctors across our health system. A diverse group of individual who are defined by something that they are not, they encompass the full swath of medical and surgical specialities, subspecialties and generalities.
Sometime referenced as ‘junior doctors’ these individuals are anything but junior. They are among the frontline staff who will have most patient contact. They are also referenced by archaic names like ‘Senior House Officer’, ‘Registrar’, ‘Senior Registrar’ and ‘Specialist Registrar’. Most people know them as ‘Doctors’ and this is what we should call them.
Yes, some are still ‘doctors in training’ but then every doctor is a doctor in training, obliged to continuously develop and maintain their professional competence throughout their careers in Medicine. Having completed between 6 – 8 years of undergraduate education, they will have anything up to another 10 – 13 years of additional formal training and subspecialising ahead of them before they get to call themselves ‘consultant’.
They are a key interface between our Interns and our Consultants. They work as part of a multi-disciplinary team and often lead their medical team. They often are required to rotate between locations, hospitals and specialties perhaps every 3-6 months as part of their training. This is a major disruption to family lives. With the advent of graduate entry medicine, many of these NCHD’s will be married and have their own families. By virtue of their years of extensive training, their parents may be elderly or retired.
Many have gone abroad to further their education and training. Many have returned to Ireland bringing fantastic experience and expertise to our health systems. Many hail from other countries and work here far away from their families and loved ones.
They are first and foremost people and they experience everything that everyone experiences – plus a lot more. They rent, seek a home, have relationship difficulties, experience depression, get injured, get caught speeding, play sports, climb mountains, get stressed, like a glass of wine, hate going to the gym, have kids doing the leaving certificate….etc.
They also work exceptionally hard, in stressful conditions for long hours, often alone, invariably carrying full responsibility, with people who are at their most vulnerable. There isn’t enough of them and so each has to work exceptionally hard. Some are bullied for not being super-super-heroes or perhaps just because their colleague has to vent to someone. They must park their own particular issues and concerns, put on a brave face and lead their colleagues in the face of seemingly insurmountable odds.
Some are visible. Others less so. Special personal shout out to two who are known to me through their twitter accounts but who I don’t know. @MROC_rockinit and @IRE_FJD, who try to speak out for other NCHD’s.
“I have good supports. I try to speak up for all of us as there are plenty less fortunate than me. Look after yourself in these challenging times and thank you as ever for the online support.”
“It’s hard to express stress in work because registrars are trying to keep it together for the SHOs and interns.”
Although they number in their 1,000’s, we’d like each and every one to know that we appreciate the sacrifices they make every day. But especially during these times.
| Group | Link |
|---|---|
| Public Health Doctors | link |
| Interns | link |
| Infectious Disease Experts | link |
We know that there will be many heroes of this emergency and we hope to profile some of them in the coming weeks. We’d be happy to receive your nominations and testimonials for inclusion in our #FrontlineFriday. Suggestions to comms.medicine@ucd.ie.
Three Irish academic clinicians reflect on the current COVID-19 pandemic and its wider implications for our mental health. Writing in the Quarterly Journal of Medicine, Professor Walter Cullen (UCD Full Professor of General Practice, UCD School of Medicine), Professor Gautam Gulati (UL Adjunct Associate Clinical Professor, Graduate Entry Medical School, UL) and Professor Brendan Kelly (Professor of Psychiatry, Trinity College Dublin) describe why attention needs to be paid to the population’s mental health needs. They outline actions which should be taken immediately to minimise the psychological and psychiatric impacts of this pandemic.
During any outbreak of an infectious disease, the population’s psychological reactions play a critical role in shaping both spread of the disease and the occurrence of emotional distress and social disorder during and after the outbreak. Despite this fact, sufficient resources are typically not provided to manage or attenuate pandemics’ effects on mental health and wellbeing. While this might be understandable in the acute phase of an outbreak, when health systems prioritise testing, reducing transmission and critical patient care, psychological and psychiatric needs should not be overlooked during any phase of pandemic management.
There are many reasons for this. It is known that psychological factors play an important role in adherence to public health measures (such as vaccination) and in how people cope with the threat of infection and consequent losses. These are clearly crucial issues to consider in the management of any infectious disease, including Covid-19. Psychological reactions to pandemics include maladaptive behaviours, emotional distress and defensive responses. People who are prone to psychological problems are especially vulnerable.
All of these features are in clear evidence during the current Covid-19 pandemic. One study of 1,210 respondents from 194 cities in China in January and February 2020 found that 54% of respondents rated the psychological impact of the Covid-19 outbreak as moderate or severe; 29% reported moderate to severe anxiety symptoms; and 17% reported moderate to severe depressive symptoms. Notwithstanding possible response bias, these are very high proportions - and it is likely that some people are at even greater risk. During the 2009 H1N1 influenza outbreak (‘swine flu’), a study of mental health patients found that children and patients with neurotic and somatoform disorders were significantly over-represented among those expressing moderate or severe concerns.
Against this background, and as the Covid-19 pandemic continues to spread around the world, the authors hypothesise a number of psychological impacts that merit consideration now rather than later. In the first instance, it should be recognised that, even in the normal course of events, people with established mental illness have a lower life expectancy and poorer physical health outcomes than the general population. As a result, people with pre-existing mental health and substance use disorders will be at increased risk of infection with Covid-19, increased risk of having problems accessing testing and treatment, and increased risk of negative physical and psychological effects stemming from the pandemic.
Second, they anticipate a considerable increase in anxiety and depressive symptoms among people who do not have pre-existing mental health conditions, with some experiencing post-traumatic stress disorder in due course. There is already evidence that this possibility has been under-recognised in China during the current pandemic.
Third, it can be anticipated that health and social care professionals will be at particular risk of psychological symptoms, especially if they work in public health, primary care, emergency services, emergency departments and intensive or critical care. The World Health Organization has formally recognised this risk to healthcare workers, so more needs to be done to manage anxiety and stress in this group and, in the longer term, help prevent burnout, depression and post-traumatic stress disorder.
There are several steps that can and should be taken now to minimise the psychological and psychiatric effects of the Covid-19 pandemic.
First, while it might be ostensibly attractive to re-deploy mental health professionals to work in other areas of healthcare, this should be avoided. Such a move would almost certainly worsen outcomes overall and place people with mental illness at disproportionate risk of deteriorations in physical and mental health. If anything, this group needs enhanced care at this time.
Second, the clinicians recommend the provision of targeted psychological interventions for communities affected by Covid-19, particular supports for people at high risk of psychological morbidity, enhanced awareness and diagnosis of mental disorders (especially in primary care and emergency departments) and improved access to psychological interventions (especially those delivered online and through smartphone technologies). These measures can help diminish or prevent future psychiatric morbidity.
Finally, there is a need for particular focus on frontline workers including, but not limited to, healthcare staff. In the United States, the Centers for Disease Control and Prevention offer valuable advice for healthcare workers in order to reduce secondary traumatic stress reactions, including increased awareness of symptoms, taking breaks from work, engaging in self-care, taking breaks from media coverage and asking for help. This kind of advice needs to be underpinned by awareness of this risk among employers, enhanced peer-support, and practical assistance for healthcare workers who find themselves exhausted, stressed and feeling excessive personal responsibility for clinical outcomes during what appears to be the largest pandemic of our times. Even in this emergency circumstance, or especially in this emergency circumstance, we neglect mental health at our peril and to our long-term detriment.
W Cullen, G Gulati, B D Kelly, Mental health in the Covid-19 pandemic, QJM: An International Journal of Medicine, , hcaa110, https://doi.org/10.1093/qjmed/hcaa110
Professor Alistair Nichol, UCD Full Professor of Critical Care Medicine and a Consultant in St Vincent’s University Hospital, Dublin, is leading clinical trials with COVID-19 patients in intensive care. The aim is to determine the most suitable treatments against the pandemic virus.
“We didn’t know when exactly the pandemic would come, but we knew it would.” UCD’s Professor Alistair Nichol is leading clinical trials for critically ill patients with COVID-19 thanks to extensive preparation over the last decade.
“The issue with COVID-19 is that it is a new disease, and we need to find out what treatments work effectively for patients who are critically ill with it. In the trial, we will randomise patients who are admitted to the ICU with COVID-19 such that some of them will receive specific treatments, and we will track the progress of those patients compared to those who get the standard care.”
“They will take place around Ireland and in other countries across the world. This is very important, as it means we will have relatively large numbers of patients taking part in the trials, which increases our confidence in the results.
In Ireland, where I am leading the trial, we are starting to enrol patients in ICUs in St Vincent’s University Hospital and University Hospital Galway, and other hospitals will come on board over the next few weeks, including Beaumont Hospital, Cork University Hospital and University Hospital Limerick as well as the Royal Victoria Hospital in Belfast. Internationally, the trial involves teams in the UK, Ireland, Netherlands, Germany, Belgium, New Zealand, Australia and Canada.”
“We will look at interventions where there is strong rationale from pre-clinical evidence or early clinical evidence. In practice, that will mean initially looking at the use of steroids in critically ill patients with COVID-19, as well as anti-viral drugs and medicines that could alter the patient’s immune response. One of the problems in COVID-19 is that the patient’s immune system can over-respond, and this additionally damages the lungs, so we want to reduce that.”
“If a patient is able to make an informed decision when they are admitted to ICU, we will ask them if they want to take part. If they are not in a position to give consent, and many of them are not, we ask the family or next of kin. This is more difficult with COVID-19. It is a cruel aspect of the disease, but families are not permitted to be with the patient because of the risk of infection for themselves and for other healthcare workers and patients. So in this case we will talk to the family over the telephone. If the patient survives, then they can decide whether they want to continue to be in the trial.”
“We didn’t know when exactly the pandemic would come, but we knew it would, and we prepared in advance.
In the 2009 ‘swine flu’ pandemic, it took so long to get approvals and protocols in place that big trials were not possible. We learned from that. We set up an ongoing trial called REMAP-CAP across 13 countries and 50 sites around the world, where we ran clinical trials with ICU patients with community-acquired pneumonia.
This meant we had the infrastructure and protocols in place for carrying out trials and sharing information in good time for the next pandemic, and it is here now.
In Ireland, we have been able to be part of REMAP-CAP and the rapid-response COVID-19 trial because the Health Research Board has invested in the Irish Critical Care Clinical Trials Network based at the UCD Clinical Research Centre over the past five years. The HRB will invest a further €400,000 in the COVID-19 trial.”
“I am quite worried. The medical staff and ICU experts I work with are awesome, but if the health facilities are overwhelmed it is impossible to function properly. It is the public health response that will tamp this down. As medical professionals, we will do what we can but we need the public at large to work with us, to follow the distancing instructions, slow the spread of the virus and bend that curve. This will reduce the numbers coming into ICU at any given time, so that we can help as many people as possible.”
Prof Alistair Nichol, UCD Full Professor of Critical Care Medicine in conversation with science writer Dr Claire O’Connell