Niall Conroy
@NICU_doc_salone
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Public Health Physician (Health Protection). Outbreak doctor. Adjunct Professor of Public Health @uccpublichealth Neonatology in Sierra Leone. My opinions 🛸
Dublin City, Ireland
Joined August 2017
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One of the worst things I’ve seen on the M50. Huge queues and we all waited hours because of fatal crash (3 hours for me). But some people didn’t want to queue so many many cars jumped ahead and queued in hard shoulder. Then ambulance on blue lights arrives and can’t pass 😡
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I mean, racists are gonna be racist. But imagine looking back on your life and knowing that the housing of asylum seekers was the only thing that got you mobilised. Not the crumbling health service, homelessness, child poverty. Just different colour people living near you.
Protesters have gathered in Galway to form a blockade at the entrance of the Ross Lake House Hotel in Rosscahill over plans to house 70 asylum seekers on the premises
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Just imagine you had 900 non-smokers and 100 smokers. Imagine there were 50 cases of lung cancer in each group. Then imagine the paper of record tried to imply the risk of lung cancer is the same in smokers and non smokers 🤷♀️
Some 50% of Covid patients in hospital, intensive care are fully vaccinated
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The pandemic response in Ireland has understandably led to quite a bit of confusion and things are changing rapidly, from lockdowns to school closures. So I thought I’d write a thread on what might, and might not, work well in a country like Ireland with over 1000 cases per day..
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Weird how “the Irish” have never had enough of the Kinahans and all the other drug gangs that rob children of their lives and futures and parents around the country. I just can’t put my finger on what might be the difference 🧐
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No universal hotel quarantine, hardly any walk-in testing, not a single solitary consultant in public health medicine hired, obsolete public health legislation and no IT system for outbreaks. Over a year into a pandemic. Need to get this sorted out, Ireland. This isn’t complex.
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So sad. Since 2017 we’ve been putting 24-hour open access defibrillators around Kilnamanagh in Tallaght where I live. They’re in unlocked cabinets and we’ve ignored all the people who said u can’t do that in Tallaght. But tonight someone just took one out and smashed it 😞😡
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“Disproportionate” to what? This would just boil your piss. Look around you Leo. To me, “disproportionate” is suspending the functioning of society so that some people don’t have to stay in a hotel room.
Leo Varadkar effectively ruling out mandatory quarantine for people arriving to Ireland. Says locking people in hotel rooms 'disproportionate' and Northern Ireland being used as a backdoor would undermine the move anyway
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Just been on a WhatsApp call with old colleagues in Sierra Leone. All reporting friends and family dying. No covid testing and nobody is counting them. They’re bemused that anyone in the west thinks they can put a number on their losses. Asked me can I please help with vaccines…
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It will be an absolute 100% avoidable crying shame if we let measles establish itself in Ireland again. Make no mistake, it’s a choice. We have to be V careful about who we listen to, and who we amplify, in terms of vaccine messaging. We need at least 95% of our kids vaccinated.
The World Health Organization has called for an 'urgent' vaccination campaign after Europe saw 30,000 measles cases last year, 30 times higher than in 2022
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Five things I’ve done in the last year as a public health doctor that, like most of what we do, flies under the radar....
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Today I was enjoying a cuddle with my 5-week old on a bench at the beach when a passer-by commented on how beautiful he was. Proud dad came back to earth with a bang when he asked if it was my grandson 😂To anyone who told me that having a baby would keep me young-you were WRONG!
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Ok folks this isn’t a drill anymore. Get your kids vaccinated tomorrow if they don’t have the MMR. Don’t listen to conspiracy theorists. Breda is the real deal. Has been frontline managing outbreaks for years. Believe her when she says this is urgent, not the randos on twitter
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I’ve been delighted to see the sudden surge in support for mandatory hotel quarantine (MHQ) in Ireland, with the aim of achieving zero covid. While it is, on balance, the best option, I fear that some commentators have underestimated the challenges. Here are some examples....
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I know its an absolute long shot, but has anyone seen this toy on sale anywhere? My son has
#autism
and is absolutely obsessed by it. It spins, lights up and plays music. Of course, it’s stopped working and he’s pretty upset. His mother bought it for him on a beach in Majorca…
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Nearly 2 years of managing covid19 cases now and it strikes me that the vast majority of transmission occurs in households but the vast majority of transmission mitigation discussions focus on non-household spread.
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One of the consistent things about covid, no matter which country’s media I’m watching, is that 99% of the experts brought on to tell the public how we should manage the covid outbreak have never managed an outbreak of anything in their life.
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Spectacular hospital leadership....As the only public health consultant for the entire region I’m working round the clock, so our director of medical services cleared my diary this morning and made me take a few hours off to go and enjoy the ocean. Amazing workplace culture here
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When you’re getting up off your arse to actively protest against the housing of asylum seekers, then you really need to look at where your life has gone wrong. A lot of this stems from people peddling the populist nonsense that vulnerable people like this are the enemy.
Hundreds of protesters gathered in East Wall, Dublin to protest at the housing of a number of asylum seekers in the old ESB building in the area
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@culturaltutor
@itsthatgirlsuzi
Great thread. The Magpie by Monet is my favourite winter painting
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Had my booster covid vaccine today. Like a lot of healthcare workers, I’m really conflicted about it. I’m glad of the extra protection, but it’s another dose that would have been better used by one of my old colleagues in Sierra Leone, some of whom are waiting on their first dose
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@rtenews
Almost every single person on that county council will have had numerous relatives go abroad in less urgent circumstances than those arriving at our shores.
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@Independent_ie
@DebsNaylor
The irony of these useless guys thinking we’ve lost the country to foreigners, when I’d say way more think we’re losing our country to the far-right, who contribute literally nothing to society
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Hello Dublin! So good to be home at last. It’s an uncertain time professionally for public health doctors in Ireland, which is a worry. But the happiness of watching our baby finally getting to know his grandparents and extended family makes all of the work worries fade away 👨👩👦🇮🇪
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In an outbreak, the media can be part of the solution or part of the problem. If, as happens in many countries, every kid in a school with Covid makes national news, that doesn’t help with rolling out a proportionate response to these cases
A primary school in Dublin has sent home a class of students after one of them tested positive for Covid-19
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In watching the Irish covid commentary in last 24 hours there are some recurring teams, to which I’d like to offer some counter-opinions: - The Covid PCR test is fine. It’s not perfect and it’s not suitable as a screening test. But it’s v good and it works well in practice....
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If you go to 1:10 here you will see a STAGGERING statistic…..20% of our college-aged population don’t have any immunity to measles. That is an absolute ticking time-bomb! Make sure your teenagers have their measles vaccines before they go to crowded halls and lecture theatres 🙏
A man in his 40s has died after contracting measles, in the first reported death linked to the disease here in more than two decades |
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…That’s as powerless to help as I’ve felt in a long time! Just madness that vaccines aren’t been divided equally. It’s unforgivable.
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The covid news from Ireland today 1)Ernst&Young doing the epidemiology, not epidemiologists. 2) A physicist, not a public health expert, is put in charge of the covid vaccine programme 3) The public health doctors are being forced to strike because they’re being under-utilised 🤷♀️
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The reason we don’t have a world-beating vaccine distribution programme is because we’ve never resourced public health. But that doesn’t make for a punchy tweet. Remember where we’re starting from....Ireland still can’t report the amount of people getting a 2nd dose MMR vaccine.
Why are our Ireland’s vaccine plans so slow? Contrast with the 250,000 Israelis vaccinated already & they plan to vaccinate 150,000 a day, operating 24 hours a day, 7 days a week. Can a medic tell me why we can’t replicate this or something close it it? This is an emergency!
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Ireland has mounted a political response to the pandemic, rather than a public health response.
Cabinet looks set to not accept latest NPHET advice to move country to Level 5 restrictions
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The top 5 and bottom 5 are basically a hundred years of public health theory on one graph
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One small, swift lockdown since Perth introduced mandatory quarantine, which punctuated a completely normal existence for people living there, but with the absence of travel. Leo Varadkar either doesn’t know what he’s talking about or he’s misleading the public. Neither is great.
Leo Varadkar tells Dáil that there's no strategy "that avoids the risk of rolling lockdowns, or snap lockdowns" - gives example of Perth, a reasonably isolated city; says Ireland in similar situ would face them regularly. Says 'living with Covid' means keeping it at low levels
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Just been on the phone home to Ireland. There seems to be very little reason to travel in or out of the country at the minute. So, given that mandatory border quarantine could massively reduce community transmission very quickly, I can’t work out what the opposition to it is....
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I don’t really care all that much who’s in charge. They’re pretty much all the same and I don’t vote for any of them. But I find it really strange that a guy who only got elected on the 5th count in his own constituency is now the leader of our country for the second time.
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Another 5 cases in NSW today...ALL were detected in hotel quarantine. That’s 12 cases in the last 48 hours. That’s 100% of their total cases. Imagine the spread that could result if even 3 or 4 of those cases went undetected. This is why I’m a big fan of mandatory quarantine
Dear Ireland..I know I sound like a broken record on this but look what happens when you get to very low levels of COVID-19. Imported cases often make up 100% of your cases. You will NOT find all imported cases by relying on arrivals to voluntarily present for testing if unwell..
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So many loud calls for drastic action because of a new variant.
So much louder than the calls for drastic action because of half the world’s population being unvaccinated.
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I manage outbreaks for a living and I wouldn’t change much with Omicron, except ramp up surveillance and make sure were doing the basics of outbreaks control well, and faster. There are others who manage outbreaks for a living who would shut the borders. What that means is….
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Well deserved. Even people who disagree with the pandemic response would find it hard to deny TH’s service to 🇮🇪 during the crisis. Working round the clock 24/7 for 18months under constant scrutiny despite real personal adversity. Don’t know many who’d step up and do his job 👏
It was our great honour to award an Honorary Fellowship of RCSI to Dr Tony Holohan
@CMOIreland
, in recognition of his outstanding leadership during the COVID-19 pandemic.
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....Vilifying groups doesn’t work. Young people, for example, are getting a hard time. Not only is it not nice to see, but fear of blame stops them coming forward for testing when they’re sick, which leads to further chains of transmission. We need to be kinder in that regard...
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....”Pandemic politicisation” doesn’t work. When you have more political advisors than public health doctors working for government, you have a culture problem. Think of your experts as a resource, but a political nuisance. Be Jacinda, not Boris or Donald....
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5 things that really worry me looking from the outside in at the Irish covid response: 1) The absence of walk-in, no-referral-needed community testing clinics despite the fact that there is widespread community transmission. “Fever clinics” should be a pandemic standard of care..
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For me it’s the awful use of resources. I pay half my wages in tax yet need private health insurance, pay multiple road tolls each day, no ambulances where I live, volunteer fire brigade, gardai stretched to breaking point AND then huge sales tax on everything. Where does it go??
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This 👇Ronan is a public health physician. One of v few advising govt. He knows his onions. He also knows 1st hand what public health teams need and what they’re not getting. I think he’s asking people to do a little more because he knows government wont do any more. Tough gig.
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In trying to make sense of what might seem like confusing or inconsistent decisions around
#COVID
ー19 interventions at the population level it might be helpful to look at the different phases of a pandemic and what type of control measures happen during each phase. This is....
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..Recurring lockdowns don’t work. Well, it depends on what you mean by “work”. They’re v good at getting cases numbers low. But they don’t change any of the underlying conditions that allowed the virus to multiply in the first place. So, once society opens up, cases go up again..
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We’re relocating back to Ireland in February and, much as I love Trim, I’ll miss having Urangan pier in
#HerveyBay
as my morning walk
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...frontline public health unit doctor on NPHET, and many of my colleagues back home tell me that they have no way to make their ideas heard. When your outbreak experts aren’t being listened to in an outbreak, you have a culture problem......
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Of course they did. They’re pretty sensible people. The often-repeated notion that NPHET have too much power and are basically running the show while elected government are just passive observers isn’t grounded in reality.
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I think if people are being really honest with themselves, they probably know that Ronan Glynn wasn’t talking to the 80 year-olds cocooning since march ‘20, but rather people like the group of lads I know who are still going from home to home converting people’s attics.
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..I’m slightly concerned that people are being fed a narrative that reads “if we do this lockdown right, we can stop this virus”. It may well get us low cases for Xmas, but I’d anticipate another lockdown around Easter, though I hope I’m wrong about that...
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Ireland is utterly unique amongst other developed countries in that it hasn’t hired a single solitary consultant in public health medicine. During a pandemic!! Some media have been very supportive of the PH doctors , but mostly the government gets a total free ride on this issue.
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So sad to be leaving Australia for good in the next hour 😭😭 But super excited to be seeing our family and friends back home in Ireland for the first time in over two years. Few days holiday in Dubai first, though. Thank you Oz for being awesome. See you again soon 😃
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...referrals for testing is bad for testing coverage. Testing criteria needs to be widened, as Ireland’s is too narrow and will miss cases. Ultimately, testing capacity needs to be increased significantly. Don’t know why it hasn’t happened up to now. I’d love to hear from my....
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Of all the cockups in the global management of Covid (and there have been many), a picture that stays like this will one of the biggest. Neglecting low-income countries is not only immoral, it provides perfect opportunity for mutations to develop and will seed new imported...
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@Antcon7062
And switching to age-based prioritisation was bang on the right decision too, in the face of a lot of criticism
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...1 or 2 people helping them, and they won’t have their own team. These guys desperately need to be resourced. You need to use the lockdown to let them build up their teams, to drown them in resources. Whether the HSE does this or not will have a VERY significant impact on...
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Really simple things from Oz/NZ to make life as a non consultant hospital doctor a but easier, in my experience
#StandingUp4NCHDs
1) Free meals in the canteen in NZ every day, and free dinner when working late. This included weekends and public holidays. 2) In Oz, the hospitals..
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People losing it because they think that public health are just concealing the type of contaminated food from the public. When 2 mins of looking at the UKHSA website tells you this is STEC 0145. Labs around the country noticed that a lot of the cases were genetically similar
BREAKING: An urgent health warning has been issued after an E.coli outbreak was linked to a "nationally distributed food item"
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...puts their public health doctors forward to give advice to the public. This can only be because they want to control the narrative. It suggests they don’t trust their experts. This bewilders me, as our public health doctors are so highly regarded globally. Yet we gag them...
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....Listening to your experts works. Ireland is very lucky to have some proper world-class public health doctors. They’re the country’s foremost experts in outbreak management. It’s a niche skillset and very few people have it. These guys have it in spades. But there’s only 1....
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...-There is an economic cost to NOT going for elimination and living in a world of recurring lockdowns. We should bear that in mind. As my colleague
@nick_eichler
said, “you can have border quarantine or you can have interminable lockdowns, but you can’t have neither”.
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None of this is very glamorous, but it’s the grunt work that keeps our population safe. That’s just 1% of what we do and only focuses on the infectious diseases stuff. Generally, nobody knows we do this stuff every day. Because we are so low key, the public don’t get very.....
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All of the above is specifically non-covid, to try and show that we’re not one-trick ponies. It also describes work that I’ve been involved in in Ireland and Oz. I’ve been intentionally vague with details for the sake of confidentiality.
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..Trusting your experts works. Many people can name very many TV and media pundits in the covid space in Ireland. Most of them have never managed an outbreak of anything in their life or a case of covid, yet are beaming advice into Irish living rooms every night. The HSE rarely..
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@newschambers
The line from the premier where he says “nothing is more important than following public health advice” is why Australia have stayed ahead of this virus.
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I’m ok with whatever view anyone takes on zero covid after they’ve had a long hard look at it. But surely this lad is just making it up as he goes at this stage 🤷♀️
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I know a thread on a contractual issue is never going to be one of the greats. But my Irish colleagues might take industrial action and it’s important to tell people why, before inevitable political mudslinging starts. This issue is about pandemic safety, so I’ll try to explain..
IMO AGM votes to support the decision of Public Health doctors to ballot for industrial action in their campaign for Consultant contract.
Surprise motion follows “deeply disappointing” meeting on issue with Department of Health
#RespectPHD
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This can’t surprise many people, given that there are no effective border restrictions, a half-arsed level 5 lockdown, no mandatory quarantine for close contacts of cases, and a public health workforce treated so badly they’re going to strike during a pandemic 🤷♀️
The Department of Health has confirmed 938 more cases of Covid-19 and 13 further deaths, while the number of people in ICU is down three from yesterday to 25
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If/when Ireland gets its 1st monkeypox case, it will be the lab scientists that confirm it for us. They’ll take some fluid that’s been taken from a vesicle and come make a diagnosis by analysing it. It’s super smart stuff and we should really value their expertise
Thousands more hospital appointments set to be cancelled due to industrial action
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...Strict laws work. I hate to say it, as I’m generally against using legal avenues in a public health context. But strict laws are needed for the few who will continually put others at risk with their behaviour. You can (rightly) be fined for smoking in a pub, so you should be..
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....So, what works in a high-incidence setting? Testing is super important. You don’t need mass testing (outside of specific outbreak settings). You can get out of the hole by concentrating on testing sick people. But it needs to be walk-in testing at a time that suits. Needing..
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Thank you to
@UCCPublicHealth
for appointing me Adjunct Professor of Public Health. Adjunct roles are a great way for those of us not working in academia to formalise our links with colleagues and students at universities. Especially glad that it’s
@UCC
because it’s full of…
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...designed for 1000+ cases per day. It is used in household meningitis outbreaks, for example. It’s a great tool, but people saying that we need to “improve our test, trace, isolate system” are looking at the wrong solution. Of course, public health units should be DROWNING...
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Situation in Oz is a perfect example of why Ireland needs mandatory hotel quarantine for returned travellers. Victoria is the one state where MHQ hasn’t been implemented properly and they’re suffering badly, while most of Oz is Covid-free. Why is Ireland CHOOSING to be Victoria??
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My favourite thing about this week is that the Irish government went to outbreak school 😂 Naturally, the department of finance and Ernst&Young led the teaching. Public health weren’t needed because they had “data guys” instead.....
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....Incentives work. It’s not just about laws. Sick pay + other financial assistance packages work well. PUP is a great idea. People often do what we regard as foolish things out of necessity. Staying out of work while unwell isn’t an option for some. Helping them also helps us..
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Getting the whole world vaccinated against covid MUST be a priority. It’s unconscionable that close to zero people in low-income countries have been vaccinated so far. This is important to absolutely everybody for three reasons...
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1) Our surveillance system found disease-causing mosquitoes in an area where they shouldn’t be. We developed a plan to eradicate them, which we did, and followed up with continued surveillance to make sure they were gone. Nobody became unwell.
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If I were a pandemic overlord, I’d probably accept that Omicron has brought us into a new phase of the response. I’d meet with my advisors to discuss the utility of population-level restrictions, for the sake of sensible use of resources and the mental health of the public….
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@TadghMurphy10
I came home as a doctor and had my years in Oz counted in my pay. Same if I’d gone to any other country. Bonkers that we only recognise experience in teachers when gained in Ireland. We should reward diverse experiences.
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Clearly what happened at CHI needs full investigation. But I’m always amazed at politicians displaying horror at stories like this when the entire health service has been brought to its knees and children are suffering every single day because of multi-party multi-decade neglect
Maybe you could explain to me how a device, walked into a theatre that isn't packaged, and CE marked,- I don't understand -
@neasa_neasa
'I've worked on building sites and you couldn't put a non, up to grade window into a building because somebody would stop you'
#TempleStreet
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We need to reframe our expectations around mostly viral illnesses. We should be going to the GP “to get assessed”, not “to get an antibiotic”. GPs are very highly skilled and will know if you need an antibiotic or not. Let them make that decision without added pressure.
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With all the chat about covid vaccines, it’s easy to forget how amazing our standard childhood immunisation programme is. I was delighted to bring our little man for his first set of shots today. Feeling very protected now 💪💪 Thanks to
@PaulVanBuynder
for the vest!
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Cant believe today’s excuse is “we can’t do zero covid because if we get cases down to low numbers we won’t resource public health units to keep them low”. If only there was something we could do about that 🤔
'We simply couldn't realistically seal the borders of this country and stop movement of people in and out,' Chief Medical Officer Dr Tony Holohan has said, in response to a question about a 'Zero Covid ' strategy | Follow live updates:
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Dear Europe, whatever your opinions on lockdowns are, this is how you have to do it if you want it to work. Photos below are in response to ONE case in Brisbane. Major inconvenience for a few days and then they’ll get on with life. You can’t faff around with this virus.
This is Brisbane in lockdown.
The more we stay away - for now - the sooner we’ll all be back.
It’s a new strain of the virus but we’ll beat it the way we always have.
Together.
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Hello? Yeah, is that the lab? Just giving you a heads up. I’ve got 4.5 million samples coming down the chute to you 😂 Do you think they’ll be ready for the ward round in the morning?
Richard Boyd Barrett says there is a view that if we screened the entire population in the way we screened cattle, we could chase down the virus. Instead we are being bounced around by the virus and we could be ‘overrun’ he says. | Read more:
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Out for a lovely Xmas walk with my lazy-ass buggy-demanding toddler 🎅🎄 As a separated dad, I’m really fortunate that I can see my boy anytime I want. On days like today, my heart goes out to the parents who don’t have that option.
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Just waiting for half of twitter to start shouting “but it was EASY in Oz. You’re an island!!!” 🙄 🙄🙄
“Australia not only flattened that curve, it destroyed that curve ... That didn’t happen by accident, it didn’t happen because of luck.” Mike Ryan
@WHO
We are now bringing this expertise to the Indo-Pacific region with COVID-19 vaccine access initiatives.
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Yesterday was a year to the day from when I started my consultant job in Oz. I left brilliant colleagues like Marie in HSE because the Irish government treat public health unit doctors so badly. No authority to manage outbreaks. No autonomy. And any infrastructure.....
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2) Managed a pertussis (whooping cough) outbreak in a shelter for a vulnerable population with quite a few very young babies living there. After we implemented the outbreak management plan, nobody else became unwell.
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...in Ireland because they get treated worse than other specialist doctors in Ireland. I get very few cases of civid to manage in Oz these days, yet I have a team of 16. My Irish colleagues are managing many many more cases then me, yet a doctor in an Irish PHU might have....
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I’m not against antigen tests. But I’m against laboratory academics with no public health experience framing complex issues as being simplistic when talking to the public.
#NPHET
opposition to the widespread use of
#AntigenTesting
is “just a complete mystery at this stage.”
Professor Luke O’Neill on
@PatKennyNT
#PatKenny
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Agreed. People who say “we can’t open schools and control the outbreak” are approaching it wrong. We need to come at it and say “we can’t keep schools closed, so how do we re-open them and control case numbers?”. Re-frame the conversation.
To open schools or to keep them closed is a false dichotomy. What we need are the resources to enable the safe opening of schools.
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Trying to compromise with this virus is what gets countries into trouble. Half measures just aren’t worth it. Do it properly or don’t do it at all.
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Good simple message. I’ve sadly watched quite a few children die of measles. I’ve seen very many hospitalised. MMR vaccination can prevent almost all of it. Also, the link between MMR and autism does not exist. It is 100% pure fantasy. We need our kids to be vaccinated.
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While I’ve been no fan of the Irish response to covid, where do you even start with this horse-shit commentary? “ herd immunity”, “less dangerous than flu” “pre-existing conditions” and many other greatest hits all get some airtime in this piece.
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Doesn’t really matter. The idea that you can keep a new variant out by focusing restrictions on two countries where they happened to originate is amongst the government’s more naive ideas. It’s exactly why they need to include public health doctors in this sort of decision making
UK and Brazil passengers allowed in to Ireland without Covid test results
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