Cluster of pneumonia cases caused by a novel coronavirus in Wuhan, China REF HLT 00112-20 AUTHOR: Daniel Shine TD: Minister OWNER: Daniel Shine STATU S: Completed REVIEWERS: Tony Holohan,Jim Breslin PURPOSE: Forlnformation DECISION BY: DIVISIONKOFFICE: Chief Medical Of?cer Final comment Noted Action required Submitted for Information Executive summary Since 31 December 2019 and as of 17January 2020, 198 laboratory con?rmed cases of novel coronavirus infection, including three deaths (case fatality ratio: have been reported in Wuhan City, China. In addition, three cases of 2019-nCoV have been reported in Beijing (2) and Guangdong (1) in China, all with a travel history to Wuhan. A further four imported cases ex?Wuhan have been reported in Thailand (2), Japan (1) and South Korea (1), bringing the total number of con?rmed cases of 201 9-nCoV to 205 globally. At the moment, there is no information on the exact source ofinfection or how the virus is transmitted. The likelihood of importation of cases of this new virus to Ireland or other European countries is considered to be low according to an ECDC risk assessment of 17January. HSE is closely monitoring this situation via WHO and ECDC risk assessments of the outbreak and has issued several advisory notices and updated their website to inform national agencies, public health authorities, healthcare providers, airports and the public. Comments Daniel Shine - 20/01f2020 16:46 Please see attached brie?ng document, agreed with Dr Bonner Matthew O'Gorman - 24102120201050 Noted Detailed information Background Since 31 December 2019 and as of 17January 2020, 198 laboratory confirmed cases of novel coronavirus 2019-nCoV infection, including three deaths (case fatality ratio: have been reported in Wuhan City, China. In addition, three cases of 2019-nCoV have been reported in Beijing and Guangdong (1) in China, all with a travel history to Wuhan. A further four imported cases ex?Wuhan have been reported in Thailand (2), Japan (1) and South Korea (1), bringing the total number of confirmed cases of 201 9-nCoV to 205 globally. The clinical information on confirmed 2019-nCoV cases reported so far suggests a milder disease course than that observed in SARS and MERS cases, however it is early days as yet. Most of those affected worked or visited a seafood market in Wuhan, which also sells live animals. Environmental sanitation of the involved seafood market took place and the market was closed on 1 January 2020 . According to Wuhan Municipal Health Commission, samples from the market tested positive for the novel coronavirus. In addition, according to media quoting health authorities, these positive environmental samples were from floors, tabletops and gloves from the areas where aquatic products were sold. At the moment, there is no information on the exact source of infection or how the virus is transmitted. However, there is no clear indication of sustained human-to-human transmission. (The report of two small family clusters in Wuhan and the exposure history of the imported Japanese case suggest that person-to?person transmission may have occasionally occurred. So far, there are no reported instances ofdisease transmission to healthcare workers in China, Japan and Thailand. Risk The likelihood of importation of cases of this new virus to Ireland or other European countries is considered to be low according to an ECDC risk assessment published on January 17th. . There are no direct flights between Ireland and Wuhan City. Only three EU airports have direct flight connections to Wuhan-Rome, Paris and London. To prevent the spread of the virus to other countries, Wuhan Tianhe international Airport has implemented exit screening for passengers travelling from Wuhan. Passengers? temperatures are measured and those found to be febrile are put under temporary quarantine. The WHO does not recommend entry screening at receiving airports at this time. The likelihood of infection for travellers visiting Wuhan, but not visiting seafood or live animal markets, is also considered low, because so far there is no indication of virus circulation in the community. The risk for those visiting any seafood or live animal markets in Wuhan is considered to be moderate, even though the implicated market has been closed. Ifthe sources of the infection are indeed certain animals sold in that market, other markets in the city may still be selling those animals and they may continue to pose a risk of infection. Travellers to Wuhan should therefore minimise contact with birds and animals in markets in Wuhan as a precaution. Travellers are also advised to take simple precautions such as practicing good hand, respiratory and personal hygiene. The upcoming Chinese New Year celebrations at the end ofjanuary will cause an increased travel volume tozfrom China and within China, hence increasing the likelihood ofarrival in the EU of possible cases. Should a case of the new virus be identified in the EU, the evidence oflimited human-to-human transmission and the vigorous infection prevention and control measures that would be applied, mean the likelihood of further spread in the community setting within the EU is considered very low. HSE Response - HSE is closely monitoring this situation via WHO and ECDC risk assessments of the outbreak HSE-HPSC has issued several advisory notices and updated their website to inform national agencies, public health authorities, healthcare providers, airports and the public about this outbreak. - HSE is currently updating guidance and algorithms about this novel coronavirus (as per WHOKECDC guidance) which will be circulated to the wider health system to assist response should a case be imported to Ireland. These will be reviewed and updated as the situation evolves. - HSE has established a standing group to optimise domestic and international coordination of new and emerging threats - The National Virus Reference Laboratory, in conjunction with EU laboratories, will have capacity to detect 2019-nCoV Related submissions HLT 00145-20: Cluster of Pneumonia cases caused by a novel coronavirus in Wuhan, China- Updated position User details INVOLVED: Daniel Shine Action log ACTION Create Submission sent Submit for review Submit for review Submit for review Complete Dep Sec Holohan Tony HoIohan Sec Gen Office Jim Breslin Ministers Office Simon Harris DESCRIPTION Submission HLT 00112-20 to Minister created. Submission sent by email to Eddie O'Reilly, Colette Bonner, Pauline Brady, Helen Reddin. Submission sent for review to Tony Holohan. Submission sent for review to Secretary General on behalf of Tony Holohan. Submission sent for review to Minister on behalf of Secretary General. Submission completed by Matthew O'Gorman. READ RECEIPT: Daniel Shine Tony Holohan Lisa Williamson Jim Breslin Helen Reddin Matthew O'Gorman Sarah Bardon Eileen Ryan USER Daniel Shine Daniel Shine Daniel Shine Tony Holohan Jim Breslin Matthew O'Gorman DATE ?2020 1 6:43 201?01 {2020 16:51 20f01f2020 16:51 ZOXOUZOZD 17:12 21r01r2020 12:04 241'02/2020 10:50 20 January 2020 Briefing Note for Minister: Cluster of Pneumonia cases caused by a novel coronavirus in Wuhan, China Summary On 31 December 2019, the Wuhan Municipal Health Commission [Wuhan City, Hubei province, China} reported a cluster of pneumonia cases of unknown aetiology, with a common reported link to Wuhan's Hua nan Seafood Wholesale Market (a wholesale fish and live animal market selling different animal species}. (in 9 January 2020, China?s Centre for Disease Control and Prevention reported that a novel coronavirus {2019-nCoV) was detected as the causative agent. Sequence analysis showed that the newly identified virus is related to the clade. As of 17' January 2020, a total of 198 laboratory confirmed cases of novel coronavirus 2019- nCoV infection, including three deaths {case fatality ratio: have been reported in Wuhan City. An additional three cases have been reported in Beijing and Guangdong (1). Four travel-associated cases (Thailand Japan (1), South Korea have also been identified. The onset of ranged from 8 December 2019 to 5 January 2020 and included fever, coughing, and Chest radiology showed the typical features of a viral pneumonia with diffuse bilateral infiltrates. The majority of cases were male, aged between 40-69 years old. Seven cases developed a severe disease and two with chronic and severe underlying conditions subsequently died. Epidemiology Most cases are epidemiologically linked to a specific food market in Wuhan, which was cleaned and closed to the public on 1 January 2020. Among the cases reported, two small family clusters were identified. In one cluster, all three members of the family had attended the specific Wuhan market before disease onset. in the other cluster, one member was the spouse of a salesman in the market. No cases have been reported in health-care workers and there is no evidence of nosocomial transmission so far. The source of infection is unknown however, the occurrence of a few cases with no history of contact with the implicated market nor with any similar market suggests the possibility of the infection source being more widely distributed or of instances of human-to-human transmission similar to other coronaviruses like and The occurrence of a few family clusters supports this hypothesis. However, there is currently no knowledge on the transmission mode nor on risk factors for transmission. As of 1? January 2020, 263 close contacts have been identified and monitored in China. Of these, 644 have completed the observation period - 119 remain under medical observation. So far, none has tested positive for 2019-nCo?v?. There is substantial uncertainty regarding the epidemiological characteristics of the nCoV- 2019, with limited epidemiological and clinical information on the cases of 2019nCov O:\Communicable Diseases Control Policy Unit\Brie?ng\Coronvirus in China_Brie?ng Request_DS_20 January 2020.docx identified so for: eggs an infection sources, the aetiological agent, risk factors for infection, risk factors for severe illness, potential person-to?person transmission modes, e?ective preventive measures, and clinical presentation and evolution. Therefore, the level of uncertainty of this risk assessment is high. Reported travel-related cases Four travel-related laboratory- confirmed cases have been reported in Thailand Japan and South Korea Risk for travellers, importation and further spread in the EU Three EU airports (Paris, London, Rome} have direct flight connections to Wuhan and there are indirect flight connections to other EU hubs. The likelihood for travellers to become infected while visiting any wet or live animal markets in Wuhan is considered to be moderate as the source of infection is unknown and could still be active. The likelihood of infection for travellers visiting Wuhan, but abstaining from visiting these markets, is considered low. According to the most recent ECDC Risk Assessment, the likelihood of introduction of the virus to the EU is considered low. The upcoming Chinese New Year celebrations at the end of January will cause an increased travel volume to/from China and within China, hence increasing the likelihood of arrival in the EU of possible cases. Should a case of the new virus be identified in the EU, the evidence of limited human-to?human transmission and the vigorous infection prevention and control measures that would be applied, mean the likelihood of further spread in the community setting within the EU is considered very low. HSE Response to Date The HSE has advised that it has taken a number of measures on foot of the emergence of the coronavirus in Wuhan, as follows: 3* Close monitoring of the situation via WHO and ECDC risk assessments of the outbreak The Health Protection Surveillance Centre has issued several advisory notices and updated its website to inform national agencies, public health authorities, healthcare providers, airports and the public about the outbreak fr? Established a standing group to optimise domestic and international coordination of new and emerging threats Ensuring that the National Virus Reference Laboratory, in conjunction with EU laboratories, will have capacity to detect 2019-nCo?v' it? Liaising with the Department of Foreign Affairs and Trade regarding travel advisories. The HSE has also advised that it is currently updating guidance and algorithms about this novel coronavirus (as per WHOXECDC guidance) which will be circulated to the wider health system to assist response should a case be imported to Ireland. These will be reviewed and updated as the situation evolves. Communicable Diseases Control Policy Unit 0:\Communicable Diseases Control Policy Unit\Brie?ng\Coronvirus in China_Briefing Request_DS_20 January 2020.docx O:\Communicable Diseases Control Policy Unit\Brie?ng\Coronvirus in China_Brie?ng January 2020.d0cx Outbreak of Coronavirus (2019-nCoV) in Wuhan, China. Briefing Note for Minister - (Update as of 5/2/20) REF HLT 00226-20 AUTHOR: Daniel Shine TO: Minister OWNER: Daniel Shine STATUS: Completed REVIEWE RS: Tony Holohan,Jim Breslin PURPOSE: Forlnformation DECISION BY: Chief Medical Officer Final comment Noted Action required Submitted for Information Executive summary The attached brie?ng note is an update from previous briefing submitted to the Minister on 21 January 2020 and a Memo for Information to the Government submitted on 29 January 2020 and focuses upon developments arising since that date. Key Updates are as follows: To date, there are no confirmed cases of Coronavirus (2019-nCoV) in Ireland. The latest position, published by the EEOC on its website, is that (February} a total of 24,530 laboratory-con?rmed coronavirus (2019-nCoV) cases have been reported. A total of 493 deaths have been reported among the cases - all of which, bar one (in the Philippines) have been in China. 28 cases of coronavirus (2019-nCoV) have been reported in Europe to date. 2 of these cases were reported in the UK. The ECDC, in its latest Risk Assessment (dated 5 February} advises that there is a moderate to high likelihood of further case importation into countries. The National Public Health Emergency Team (NPHET) has met three times An expert advisory group has been established - The Health Threats Coordination Group (a sub-committee of the Government Task Force chaired by the Dept.) has met twice. - Both the HSE's National Crisis Management Team and its High Consequence Infectious Disease Group are meeting regularly. Protocols and guidelines for risk assessment and management of novel coronavlrus have been issued to GPs, Acute Hospitals, National Ambulance Service, airports and Public Health. Comments Daniel Shine - 0502/2020 12:51 Updated briefing re coronavirus, incl. updated ecdc ?gures Text cleared by Dr Bonner (Head of function on leave) Matthew O'Gorman - ?l?ll03/2020 12:16 Noted Detailed information The attached briefing note is an update from previous brie?ng submitted to the Minister on 21 January 2020 and a Memo for Information to the Government submitted on 29 January 2020 and focuses upon developments arising since that date. Key Updates included in the note are as follows: - To date, there are no confirmed cases of Coronovirus {2019-nCoV) in ireiond. - The latest position, published by the European Centre for Disease Prevention and Control (ECDC) on its website, is that (February) a total of 24,530 laboratory-con?rmed coronavirus (2019-nCoV) cases have been reported. A total of 493 deaths have been reported among the cases - all of which, bar one (in the Philippines) have been in China. - 28 cases of coronavirus (2019-nCoV) have been reported in Europe to date. 2 of these cases were reported in the UK. - The ECDC, in its latest Risk Assessment (dated 5 February) advises that there is a moderate to high likelihood of further case importation into countries. However, there is low likelihood of sustained human-to-human transmission within the if infection prevention and control measures are stringently applied. This is the focus of Ireland's current response. - The National Public Health Emergency Team has, to date, held three meetings in relation to the outbreak (Monday 27January, Thursday 30january and Tuesday 4 February). The National Public Health Emergency Team is the forum for managing the interface between the Department of Health and the Health Service Executive during the planning and response phases ofa public health emergency. Weekly meetings are scheduled, depending on the progression of the outbreak. - An Expert Advisory Group has also been established, the first meeting of which will take place on Wednesday 5 February. This Group will provide scienti?c advice and assistance to the NPHET in its work. Two meetings of the Health Threats Coordination Group (which is a sub* committee of the Government Task Force on Emergency Planning, chaired by the Department of Health and comprising representatives from the HSE, relevant Departments and Agencies) have been held to date (Friday 24January 3; Monday 4 February) where relevant officials of other Departments and Agencies were briefed by the Department of Health and the HSE as to the measures being taken in relation to the outbreak. Issues such as port health, travel advice, communications as well as advice and guidance to various sectors, including the public, were also discussed. Both the HSE's National Crisis Management Team and its High Consequence Infectious Disease Group are meeting regularly. Protocols and guidelines for risk assessment and management of novel coronavirus have been issued to GPs, Acute Hospitals, National Ambulance Service, airports and Public Health. Advice has also been issued to educational settings, community pharmacists and dentists. These will be reviewed and updated as the situation evolves. The HSE's Health Protection Surveillance Centre (HPSC) is closely monitoring the emerging situation and is collaborating with the Department, other Departments and various Agencies in relation to preparedness measures. Related submissions There are no related submissions. User details INVOLVED: Daniel Shine READ RECEIPT: Daniel Shine Dep Sec Holohan Helen Reddin Action log Tony Holohan Sec Gen Office Jim Breslin Ministers Office Simon Harris Tony Holohan Jim Breslin Matthew O'Gorman Joanne Lonergan Lisa Williamson Maurice O?Donnell Simon Harris Sarah Bardon David Keating Eileen Ryan ACTION Create Submission sent Submit for review Submit for review Submit for review Take ownership Take ownership Submit for review Complete DESCRIPTION Submission HLT 00226-20 to Minister created. Submission sent by email to Pauline Brady, Helen Reddin, Eddie D'Reilly. Ronan Colette Bonner. Submission sent for review to Tonyr Hoiohan. Submission sent for review to Secretary General on behalf of Tony Hoiohan. Submission sent for review to Minister on behalf of Secretary General. Submission ownership taken by Daniel Shine. Submission ownership taken by Matthew O'Gorman. Submission sent for review to Minister. Submission completed by Matthew O'Gorman. USER Daniel Shine Daniel Shine Daniel Shine Tony Hoiohan Jim Breslin Daniel Shine Matthew O'Gorman Matthew O'Gorman Matthew O'Gorman DATE OSIOZIZDZO 1 2:36 OSIOZXZOZO 12:49 05102132020 12:51 USIOZIZOZO 12:55 051?02/2020 13:31 UWOZIZOZD 1 8:53 1 12:15 11f03f2020 12:15 12:15 5 February 2020 Outbreak of Coronavirus (2019-nCoV) in Wuhan, China Brie?ng Note for the Minister (Update as of 512/20) Context The following note is an update from previous brie?ng submitted to the Minister on 21 January 2020 and a Memo for Information to the Government submitted on 29 January 2020 and focuses upon developments arising since that date. Declaration of a PHEIC In accordance with the provisions of the International Health Regulations (2005), the World Health Organisation declared, on 30th January 2020 that the outbreak of Coronavirus (20] 9-nCoV) originating in Wuhan, China, met the criteria for a Public Health Emergency of International Concern (PHEIC). A PHEIC is de?ned in the International Health Regulations (II-IR) 2005 as, ?an extraordinary event which is determined to constitute a public health risk to other States through the international Spread of disease and to potentially require a coordinated international response?. A PHEIC is intended to mobilize international response to an outbreak. It?s an opportunity for the WHO, with guidance from its International Health Regulations Emergency Committee, to implement ?non-binding but practically politically significant measures that can address travel, trade, quarantine, screening, treatment. WHO can also set global standards of practice.? Europe is now in containment phase where the focus is on surveillance, early detection, isolation of cases, contact management and prevention of onward transmission. Lots of unknowns still remain in relation to 2019- nCoV extent of clinical severity, source of the virus, vaccines, therapeutics ete.). Risk communication is an integral part of the containment phase, including the importance of avoiding stigmatisation etc. Epidemiological Situation 3? To date, there are no confirmed cases of Coronavirus (2019-1100 V) in Ireland. 5 February 2020 The latest position, published by the European Centre for Disease Prevention and Control (ECDC) on its website, is that (February) a total of 24,530 laboratory-con?nned coronavirus (2019?nCoV) cases have been reported. A total of 493 deaths have been reported among the cases - all of which, bar one (in the Philippines) have been in China. 28 cases of coronavirus (2019-nCoV) have been reported in Europe to date. 2 of these cases were reported in the UK. Risk Assessment ?9 In all matters relating to emerging international public health incidents, Ireland follows the advice and guidance of the WHO and the European Centre for Disease Prevention and Control (ECDC). The ECDC, in its latest Risk Assessment (dated 5 February) advises that there is a moderate to high likelihood of further case importation into countries. However, there is low likelihood of sustained human- to-human transmission within the if infection prevention and control measures are stringently applied. This is the focus of Ireland?s current response. EU Response 33> The EU response to the health issues raised by the outbreak is being coordinated through the EU Health Security Committee and the Department participates at these meetings along with the other Member States and the EU Commission. The ECDC, WHO and EEA countries also participate as observers. At their meeting in Brussels today (Wednesday 5 February), the EU Ambassadors (Coreper I) will be briefed on the current position regarding the coronavirus by both the Presidency and the EU Commission. In addition, the Croatian Health Minister spoke by telephone over recent days with EU Ministerial counterparts and agreed to hold a video conference for EU Health Ministers for this Friday, 7 February (time to be con?rmed). 5 February 2020 Preparedness and Response in Ireland Ireland has advanced plans in place as part of its comprehensive preparedness to deal with public health emergencies such as novel Coronavirus (2019-nCoV). These plans have previously assisted in responding to similar incidents such as pandemic in?uenza, SARS and MERS. Ireland is, therefore, well-positioned to detect and respond to any case of the novel Coronavirus (2019-nCoV) that might arise here. In line with National Emergency Management structures, the National Public Health Emergency Team (NPHET) has, to date, held three meetings in relation to the outbreak (Monday 27 January, Thursday 30 January and Tuesday 4 February). The National Public Health Emergency Team is the forum for managing the interface between the Department of Health and the Health Service Executive during the planning and response phases of a public health emergency. Weekly meetings are scheduled, depending on the progression of the outbreak. An Expert Advisory Group has also been established, the ?rst meeting of which will take place on Wednesday 5 February. This Group will provide scienti?c advice and assistance to the NPHET in its work. ?9 Two meetings of the Health Threats Coordination Group (which is a sub-committee of the Government Task Force on Emergency Planning, chaired by the Department of Health and comprising representatives from the HSE, relevant Departments and Agencies) have been held to date (Friday 24 January 8.: Monday 4 February) where relevant of?cials of other Departments and Agencies were briefed by the Department of Health and the HSE as to the measures being taken in relation to the outbreak. Issues such as port health, travel advice, communications as well as advice and guidance to various sectors, including the public, were also discussed. Both the National Crisis Management Team and its High Consequence Infectious Disease Group are meeting regularly. Protocols and guidelines for risk assessment and management of novel coronavirus have been issued to GPs, Acute Hospitals, National Ambulance Sewice, airports and Public Health. Advice has also been issued to educational 5 Februaryr 2020 Settings, community pharmacists and dentists. These will be reviewed and updated as the situation evolves. The HSE's Health Protection Surveillance Centre (HPSC) is closely monitoring the emerging situation and is collaborating with the Department, other Departments and various Agencies in relation to preparedness measures. 3* The website currently provides the following information (which is updated regularly): I Algorithms for Irish healthcare settings I Clinical management for novel coronavirus (link to WHO guidance) I Educational settings guidance I Infection Prevention and Control guidance for hospitals and primary care I Laboratory testing guidance I Frequently Asked Questions. Travel Advice of the Department of Foreign Affairs and Trade The Department of Health is in regular contact with the Department of Foreign Affairs and Trade (DFAT) with regard to travel advice. Currently, (as at 4 February and still current as at 5 February website includes the following in this environment, the advice of the Department [of Foreign A?airs and Trade] is to avoid non-essentiai travei to and within China. Citizens with ancieriying medicai conditions sitottici not naive! to China at this time. As a_ precautionary measure, Jyoar continued presence in Citina is not essentiai, citizens are advised to contact their travel agency or airlines regarding avaiiabie routes oat. Communicable Diseases Control Policy Unit 5 February, 2020 Outbreak of Coronavirus (2019-nCoV) in Wuhan, China. REF HLT 00246-20 AUTHOR: Daniel Shine TO: Minister OWNER: Daniel Shine STATUS: Completed REVI EWERS: Eddie O'Reilly, Tony Holohan,lim Breslin PURPOSE: For Decision DECISION BY: 10/02f2020 DIVISIONIOFFICE: Chief Medical Officer Final comment Minister Harris attended the Extraordinary EPSCO on Thursday 13th Feb Action required Decision required in relation to the Minister's participation in the EPSCO meeting in Brussels on Thursday 13 February. Executive summary Decision required in relation to the Minister's participation in the EPSCO meeting in Brussels on Thursday 13 February. An update on previous briefing in relation to the outbreak of coronavirus (2019-nCov) is also provided Comments Matthew O'Gorman - 24f02/2020 10:51 Minister Harris attended the Extraordinary EPSCO on Thursday 13th Feb Detailed information Outbreak of Coronavirus (2019-nCoV) in Wuhan, China. Briefing Note for the Minister - (Update as of 7IZIZO) Update on outbreak of coronavirus (2019-nCoV) The purpose of this briefing note is to provide an update of previous briefing submitted to the Minister on 5 February 2020. Key Updates: An extraordinary EPSCD (Health Ministers) Council meeting will take place on Thursday morning, 13 February, beginning at 10 am C.E.T. A decision is required on the Minister's participation The Department took part in a High-Level EU Videoconference on Public Health implications in Europe ofthe ongoing disease outbreak on 7 February. The Department?s contribution was well received and the text as delivered is attached at Appendix 1. Following the issue of a press statement yesterday evening, 6 February (see Appendix 2), the Department and the HSE HPSC participated in a series of media engagements today, Friday 7 February Department of Health, HSE HPSC and Department of Foreign Affairs and Trade officials met the Chinese Ambassador and his officials today, 7 February To date, there are no con?rmed cases of Coronavirus (2019-nCoV) in Ireland. The latest position, published by the ECDC on its website, is that (February) a total of 31,503 laboratory-confirmed coronavirus (2019-nCoV) cases have been reported. Atotal of 638 deaths have been reported among the cases - all of which, bar one (in the Philippines) have been in China. 29 cases of coronavirus (2019-nCoV) have been reported in and the UK to date. 3 of these cases were reported in the UK. The National Public Health Emergency Team (NPHET) has met three times An expert advisory group has been established and its ?rst meeting took place this week The Health Threats Coordination Group (a sub-committee of the Government Task Force chaired by the Dept.) has met twice. Both the National Crisis Management Team and its High Consequence Infectious Disease Group are meeting regularly. Protocols and guidelines for risk assessment and management of novel coronavirus have been issued to GPs, Acute Hospitals, National Ambulance Service, airports and Public Health. EPSCO, Thursday 13 February An extraordinary EPSCO (EU Health Ministers) Council meeting will take place on Thursday morning, 13 February, beginning at 10 am C.E.T. A decision is required on the Minister's participation. Coronavirus (2019-nCoV) will be the sole item on the agenda. There will be an exchange of views followed by the adoption of Council Conclusions on the topic. From Monday next, Health Attaches will prepare the draft text of these Council Conclusions in consultation with their capitals. ENDS High-Level Videoconference Public Health implications in Europe of the ongoing disease outbreak caused by the novel coronavirus 2019-nCoV Friday, 7 February 2020 at 11:00 CET Speaking Notes - Thank You Mr President for giving us this opportunity to discuss the Public Health implications in Europe of the ongoing disease outbreak caused by the novel coronavirus 2019-nCoV. - My thanks also to the Commissioner and to ECDC for their presentationsicontributions. Ireland supports the comments of the ECDC and other Member States around the need for ongoing communication regarding good respiratory etiquette, hand hygiene and, of course, the need to continue to reiterate the importance of flu vaccination. - And now turning to the questions posed in your discussion paper, - to say that, while we have had no con?rmed cases to date in Ireland, we have activated our national public health emergency system. - We have a National Public Health Emergency Team in place and this is the forum for managing the interface between our Health Ministry and our Health Service during the planning and response phases ofa public health emergency. - We have also established an Expert Advisory Group to provide scienti?c advice and assistance to our Health Ministry and Health Service. Our Health Ministry chairs a Health Threats Coordination Group, which is a sub- committee of our Government's Task Force on Emergency Planning. We use this Group to inform our colleagues in other Ministries and agencies about the measures being taken in relation to the outbreak. Our Health Service has both a National Crisis Management Team and a High Consequence Infectious Disease Group in place. Protocols and guidelines for risk assessment and management of the novel coronavirus have been issued to General Practitioners, our Acute Hospitals, National Ambulance Service, airports and Departments of Public-Health. These will be reviewed and updated as the situation evolves. All of the above Groups are now meeting on a regular basis Our Health Protection Surveillance Centre (HPSC) is closely monitoring the emerging situation and it is collaborating with the Health Ministry and other Ministries and Agencies in relation to the progression of the outbreak. In terms of challenges, I agree with the views expressed by some colleagues that risk communication remains a priority and it is important that we continue to counter misinformation and disinformation, particularly online, regarding the evolving situation. In terms of further cooperation and preparedness for public health emergencies at EU level, Ireland strongly supports the views of Denmark regarding the importance of ensuring that all Member States are kept regularly updated of developments and measures being taken within those States. Moving to the second question regarding the availability of emergency personal protective equipment, Ireland has secured stock, and has activated a dedicated Coronavirus Central Procurement Team within our health service. We are currently conducting a demand planning exercise and have already activated a supplier engagement process. However, it is clear that the market is highly volatile at present. All healthcare providers globally appear to be stockpiling and there has been a rapid escalation in market price. - Ireland has indicated its interest in a joint procurement procedure for personal protective equipment. Particularly challenging product groups are appropriate face masks and protection. . Finally, regarding the third question and access to medicines in the EU if the public health emergency persists in China, we are considering the possible short? and long- term impacts of this on the supply of medicines in Ireland. - Thank You Mr President Appendix 2 Press Release 6 February 2020 Statement from the National Public Health Emergency Team 15 suspected cases of Coronavirus (2019-nCoV) tested in Ireland There have been 15 suspected cases of Coronavirus (2019-nCoV} tested in the National Virus Reference Laboratory (NVRL) as of Monday 3 February. To date, there are no confirmed cases of Coronavirus (2019-nCoV) in Ireland. Chief Medical Of?cer of the Department of Health, Dr. Tony Hoiohan, said; ?The event of a confirmed case of Coronavirus (2019-nCoV) in Ireland is possible, given the increase in cases we are seeing internationally. Ireland has comprehensive Public Health and Emergency Plans in place and is prepared for the event of a con?rmed case, should one arise.? Dr. Ciliian De Gascun, Chair of the Coronavirus Expert Advisory Group, a sub group of the National Public Health Emergency Team said; "We have not seen sustained human-to- human transmission in any other country outside China, which is a positive indicator for our containment measures. We will continue to monitor the spread and evolution of the virus because there is still a lot to learn, and advise the National Public Health Emergency Team accordingly." Ireland is well positioned to detect and respond to a case of novel Coronavirus (2019- nCoV) that might arise here. Dr Vida Hamilton National Clinical Advisor and Group Lead, Acute Hospitals, HSE said; "The HSE has been working with frontline staff in our health service over recent weeks in response to Coronavirus (2019-nCoV). 3,000 personal protection packs have issued to GPs and clinics around the country and will be received in the coming days. All acute hospitals have multi-disciplinary Coronavirus (2019?nCoV) preparedness committees to oversee implementation of the Health Protection Surveillance Centre algorithms and actions." "The critical care service has developed management guidance for the care of any patients with Coronavirus (2019-nCoV) who should require their services and the National Ambulance Service is actively engaged in risk assessment and the co-ordinated response to case recognition and containment.? "Coronavirus (2019-nCoV) is spread through contact and droplets so good cough and sneeze hygiene, with regular hand washing, is the best way to keep well." The general public is encouraged to inform themselves on prevention measures issued by HSE and to follow HPSC for regular daily updates. Notes to the Editor: No information will be provided about individual activations of these plans or about individual cases of novel Coronavirus (2019-ncCoV) other than confirmed cases. The Health Protection Surveillance Centre website is updated daily at 13.00 with the latest information about the novel Coronavirus (2019-nCoV). Visit It can take up to 14 days for of Coronavirus to show. may include: -a cough shortness of breath -breathing difficulties -fever (high temperature) Coronavirus can also cause more severe illness including: pneumonia severe acute respiratory ~kidney failure Things you can do to protect yourself from getting Coronavirus include: -Wash your hands properly and regularly *Cover your mouth and nose with a tissue when you cough and sneeze Wash your hands properly and regularly with soap and water or an alcohol-based hand rub: -After coughing or sneezing -After toilet use *Before eating Before and after preparing food -If you are in contact with a sick person, especially those with respiratory -Ifyour hands are dirty -Ifyou have handled animals or animal waste Read a step-loy-step guide on how to properly wash your hands and help avoid infection Related submissions There are no related submissions. User details INVOLVED: Daniel Shine Eddie O'Reilly Dep Sec Holohan Tony Holohan Sec Gen Office Action log ACTION Create Submit for review Take ownership Submit for review Submit for review Submit for review Submit for review Complete Jim Breslin Ministers Of?ce Simon Harris DESCRIPTION Submission HLT 00246-20 to Minister created. Submission sent for review to Eddie O'Reilly. Submission ownership taken by Daniel Shine. Submission sent for review to Eddie O'Reilly. Submission sent for review to Tony Holohan. Submission sent for review to Secretary General on behalf of Tony Holohan. READ RECEIPT: Daniel Shine Eddie O'Reilly Tony Holohan Jim Breslin Denise Kelly Lisa Williamson Matthew O'Gorman Sarah Bardon Pauline Brady Eileen Ryan USER Daniel Shine Daniel Shine Daniel Shine Daniel Shine Eddie O'Reilly Tony Holohan Submission sent for review to Minister on Jim Breslin behalf of Secretary General. Submission completed by Matthew O?Gorman. Matthew O'Gorman DATE 07102! 2020 ?17:20 072'0212020 18:44 071'021'2020 8:54 07/02! 2020 18:56 07/022020 19:00 07f02f2020 9:01 1 0f02f2020 09:54 241?0212020 10:51 Proposal for amending the Infectious Diseases Regulations 1981 to make Covid-19 a notifiable disease 8 Text of EPSCO Speaking Notes and associated Briefing Material RE HLT 00272-20 AUTHOR: Daniel Shine TO: Minister OWNER: Daniel Shine STATUS: Completed REVIEWERS: Eddie O?Reilly, Daniel Shine, Tony Holohan,llm Breshn PURPOSE: For Decision DECISION BY: Chief Medical Officer Final comment Approved by Minister Harris Briefing and Speech material provided to Minister in advance of Extraordinary EPSCO meeting on Thursday 13th Feb Action required For Decision (proposal to draft an amendment to the Infectious Diseases Regulations 1981 to make Covid-19 a notifiable disease For Minister's Information and Attention - Speaking Notes and Brief (for EPSCO 12 February 2020) Executive summary 1. Decision Sought The Minister?s approval is sought to draft a proposal to amend the Infectious Diseases Regulations 1981 (SJ. No. 390 of1981)for the purpose of making 'Covid?2019' a notifiable disease and to provide for related matters, including powers for an attending physician to detain a person involuntarily, in the unlikely event that such a course of action is necessary. A separate submission to the Minister will be made shortly. 2. For information 8: attention of the Minister EPSCO (13f2f20) Briefing Material and Speaking Notes are attached Comments Daniel Shine - 121022020 17:52 Please see attached brief as prepared by Eddie 0' Reilly. Noelle Waldron Collette Bonner. This eSub also seeks the Minister's approval for drafting proposed amendments to the Infectious Diseases Regulations 1981 Tony Holohan - 12f02f202018:20 As discussed Daniel Shine - 130220201837 Tony As discussed, Eddie and I have added the line re powers of detention in both the brie?ng note and the executive summary of this eSubmission Matthew O'Gorman - 24/032020 10:52 Approved by Minister Harris - Briefing and Speech material provided to Minister in advance of Extraordinary EPSCO meeting on Thursday 13th Feb Detailed information Please find attached brie?ng and speaking notes for EPSCO meeting (12 February 2020) Related submissions There are no related submissions. User details INVOLVED: Matthew O'Gorman READ RECEIPT: Daniel Shine Daniel Shine Eddie O'Reilly Eddie O'Reilly Tony Holohan Dep Sec Holohan Lisa Williamson Tony Holohan Jim Breslin Sec Gen Office Matthew O'Gorman Jim Breslin Eileen Ryan Ministers Office Simon Harris Action Iog ACTION DESCRIPTION USER DATE Create Submission HLT 00272-20 to Minister Daniel Shine 12702/2020 created. 17:30 Submit for Submission sent for review to Eddie Daniel Shine 1270212020 review O'Reilly. 17:55 Submit for Submission sent for review to Tony Eddie O?Reilly 1270272020 review Holohan. 18:01 Revert Submission reverted to Daniel Shine by Tony Holohan 1270272020 Tony Holohan. 18:20 Attachment Attachment Briefing note - Covid-19 - 13 Daniel Shine 1270272020 removed February 2020.docx removed. 18:35 Submit for Submission sent for review to Tony Daniel Shine 1270272020 review Holohan. 18:37 Submit for Submission sent for review to Secretary Tony Holohan 1270272020 review General on behalf of Tony Holohan. 18:45 Submission Submission sent by email to Matthew Tony Holohan 1270272020 sent O'Gorman. 18:45 Add involved Submission shared with Matthew Lisa 1210272020 user O'Gorman. Williamson 18:53 Submit for Submission sent for review to Minister Jim Breslin 1370212020 review on behalf of Secretary General. 10:57 Complete Submission completed by Matthew Matthew 2470272020 O'Gorman. O'Gorman 10:52 Council Meeting of Health Ministers Brussels, 13 February 2020 Brie?ng note: Covid-19 Extraordinary EPSCO Meeting An Extraordinary EPSCO meeting will take place on Thursday 13 February 2020 in Brussels to discuss the ongoing Covid-19 situation. Covid?19 will be the sole item on the agenda. The Presidency has provided a discussion paper to help structure the discussion and, in their interventions, Minister?s will be asked to endorse Council Conclusions as well as responding to the questions posed. Adoption of draft Council Conclusions Ministers will be asked to adopt draft Council Conclusions on the topic. Amongst other things, the draft conclusions express the view that, on the basis that the epidemiological situation is still evolving. ?the EU and its Member States should continue to act in a strong and coordinated manner to tackle the threat caused by Covid-19 and to prevent further the transmission of the virus into and within the EU. Health Attaches in Biussels have been preparing the text. Among other things, some Member States would like to include stronger language regarding the use of quarantine measures. COREPER is currently preparing the ?nal draft text and it is expected that a softer line on quarantine measures will remain in the ?nal draft for Ministers? consideration and adoption. Ireland ?illy supports this position which in line with advice and WHO guidance. Discussion The Presidency invites Health Ministers to address the following questions: 1. How can cooperation between Member States be strengthened in cases where an aligned approach to preventive and preparatory measures is necessary to protect public health? How do you see the role of the Commission in terms of providing support to Member States? 2. Bearing in mind that disease outbreak and other severe events in third countries can affect the European market for pharmaceuticals and medical 1 equipment, what steps should be jointly undertaken in order to ensure a sustainable supply for the internal market? Which would be the most appropriate tools for achieving this goal? Background to Covid-19 On 31 December 2019, a cluster of pneumonia cases of unknown cause was reported in Wuhan City, China. 0n 9 January 2020, China?s Centre for Disease Control and Prevention reported that a novel coronavirus was detected as the causative agent. On 24 January 2020, the first imported cases (3) of 20 9-nCoV were identi?ed in France. As of 12 February 2020, a total of 45,179 laboratory-continued cases have been reported. 1,1 15 deaths have been reported among the cases. In the and UK, a total of 43 laboratory-con?rmed cases have been reported. The ECDC, in its latest Risk Assessment (dated 12 February) advises that the risk of infection for the and UK population in Europe is currently low. On 1 1 February 2020, the World Health Organisation continued that the of?cial name ofCoronavirus disease is ?Covid-IQ'. are no continued cases of Covid-19 in Ireland. Declaration of a Public Health Emergency of International Concern (PHEIC) In accordance with the provisions of the International Health Regulations (2005), the World Health Organisation declared, on 30 January 2020, that the outbreak of Covid-19 originating in Wuhan, China, met the criteria for a Public Health Emergency of International Concern (PHEIC). A PHEIC is de?ned in the International Health Regulations (IHR) 2005 as, ?an extraordinary event which is determined to constitute a public health risk to other States through the internationai spread of disease oner to potentiaiiv require a coordinated internationai response?. A PHEIC is meant to mobilize international response to an outbreak. It?s an opportunity for the WHO, with guidance from its International Health Regulations Emergency Committee, to implement ?non-binding but practicaiiy poiiticaiht signm?eant measures that can address travel, trade, quarantine, screening, and treatment. WHO can aiso set global standards of pro ctice.? Containment Phase Europe is now in containment phase where the focus is on surveillance, early detection, isolation of cases, contact management and prevention of onward transmission. Risk communication is an integral part of the containment phase, including the importance of avoiding stigmatisation and ensuring that the public are kept apprised of the measures being taken to facilitate an appropriate response in the event of a con?rmed case or cases. International Issues In all matters relating to emerging international public health incidents, lreland follows the advice and guidance of the WHO and the European Centre for Disease Prevention and Control (ECDC). The latest position, published by the European Centre for Disease Prevention and Control (ECDC) on its website, is that (as of8 a.m. CET on 12 February) a total of 45,179 laboratory- con?rmed Covid?I9 cases have been reported in 28 countries (incl. Hong Kong and Macao, which are Special Administrative Regions of China) 44,665 of these cases have been in mainland China. A total of 1,115 deaths have been reported among the cases all of which, bar one (in the Philippines) have been in China. 43 cases of Covid-19 have been reported in EUJEEA and UK to date. 8 of these cases were reported in the UK. The ECDC, in its Rapid Risk Assessment (dated 31 January) advised that there was a moderate to high likelihood of ?irther case importation into countries. The ECDC, in its latest Risk Assessment {dated 12 February) advises that the risk of SARS- GOV-2 infection for the and UK population in Europe is currently low. This assessment is based on the following factors: II Probability of infection for the and UK population is considered very low. While there have been imported cases reported from seven countries and from the UK, the overall number of cases reported in the area remains low and containment measures are in place. There are, however, uncertainties regarding transmissibility and under-detection particularly among mild or cases. If an infection is acquired, the impact for the infected individuals is considered high. For the population, the impact of one or more infections is also considered high. To date. there are no con?rmed cases of Covid- 9 in Ireland. High?level video-conference meeting of EU Members States On 6 February 2020, Ireland participated in an informal high-level meeting of Member States related to the outbreak in China of Covid-l 9. Following the discussion, the ECDC and the EU Commission presented their views as follows: The ECDC thanked Member States for supporting their work. They agreed with some Member States that a discussion on quarantine and point of entry measures is needed. They also commented that there is currently some diversity in approaches among the Member States and that this issue was also raised in the European Parliament. ECDC feel that a more harmonised approach would be helpful. The EU Commission supported those Member States that referenced better coordination and alignment with ECDC recommendations on travel, health care settings and that views regarding quarantine and point of entry measures have been very diverse. The Commission also noted that it is important for Member States to continue to inform ECDC and Commission (Health Security Committee) regarding measures taken and those envisaged. Chinese Embassy On February 2020, officials from the Department of Health and the HSE met with the Chinese Ambassador and his of?cials in relation to the outbreak and ?Jture joint cooperation in relation to it. Irish Preparedness Current Governance Structures Ireland has advanced plans in place as part of its comprehensive preparedness to deal with public health emergencies such as Covid-l9. These plans have previously assisted in 4 responding to similar incidents such as pandemic in?uenza, SARS and MERS. Ireland is, therefore, well-positioned to detect and respond to any case of Covid-l9 that might arise here. In line with National Emergency Management structures, the National Public Health Emergency Team (NPHET) has, to date, held four meetings in relation to the outbreak. The NPHET is the forum for managing the interface between the Department of Health and the HSE during the planning and response phases of a public health emergency. Weekly meetings are scheduled, depending on the progression of the outbreak. An Expert Advisory Group has also been established, the ?rst meeting of which took place on Wednesday 5 February. This Group will provide scientific advice and assistance to the NPHET in its work. Three meetings of the Health Threats Coordination Group (which is a sub-committee of the Government Task Force on Emergency Planning, chaired by the Department of Health) have been held to date (Friday 24 January, Monday 4 February Wednesday 12 February) where relevant of?cials of other Departments and Agencies were briefed by the Department of Health and the HSE as to the measures being taken in relation to the outbreak. Issues such as port health, travel advice, communications as well as advice and guidance to various sectors, including the public, were also discussed. Both the National Crisis Management Team and its High Consequence Infectious Disease Group are meeting regularly. Protocols and guidelines for risk assessment and management of novel coronavirus have been issued through the Health Protection Surveillance Centre (HPSC). Testing for Covid?19 Ireland is well positioned to detect and reapond to a case of Covid-l9 that might arise here. The capacity to test for Covid-l9 has been available in the National Virus Research Laboratory since 3] January 2020. There have been 65 suspected cases of Covid-l9 tested in the National Virus Reference Laboratory (NVRL) as of Tuesday 1] February. Health Protection Surveillance Centre The Health Protection Surveillance Centre (HPSC) is closely monitoring the emerging situation and is collaborating with the Department, other Departments and various Agencies in relation to preparedness measures. Details regarding guidance material posted on its website can be seen at Appendix 1. Guidance Material for Educational Facilities Guidance and other resources previously circulated to educational facilities (such as colleges, language schools and pro-schools) have recently been updated these have been forwarded to the Department of Health and then cascaded out via the Department of Education and Science. Home Management guidance is also being developed. A more detailed outline of actions taken by the HSE in relation to preparedness measures implemented by the HSE is included in Appendix 2 to this document. Travel Advice of the Department of Foreign Affairs and Trade The Department of Health is in regular contact with the Department of Foreign Affairs and Trade (DFAT) with regard to travel advice. The DFAT monitors the travel advice of EU Member States and other like-minded countries regularly, as well as advice from other relevant organisations, to ensure it is aware of all developments. On 29 January, DFAT increased the security status rating on our Travel Advice for China from ?High Degree of Caution" to ?Avoid Non-Essential Travel?. Additionally, it advises Irish Citizens not to travel to Wuhan or the province of Hubei. Currently (as at 12 February), website includes the following advice: ?In this environment, the advice of the Department [of Foreign Affairs and Trade] is to avoid non-essential travel to and within China. Citizens with underlying medical conditions should not travel to China at this time. As a precautionary measure, if your continued presence in China is not essential, citizens are advised to contact their travel agency or airlines regarding available routes out.? On the main page of its Travel Advice for China, it has provided detailed advice and links to the HPSC, as well as links to the WHO and the ECDC. information and links to use?il websites have also been placed on the DFAT Travel Advice for countries neighbouring China. The DFAT has not changed the security status rating for any of those countries. Department of Foreign Affairs Repatriation Related Matters The Department of Foreign Affairs and Trade (DFAT) has advised that it is actively monitoring developments regarding the Novel Coronavirus in China. Working with the Irish Embassy in Beijing, and in close cooperation with the European External Action Service, EU Member States, and other like-minded countries, DFAT has been working to assist Irish citizens who want to be evacuated from Hubei Province, which is currently the only region under lockdown. Of the approximately 20 Irish citizens/dependents in Hubei Province, six have requested evacuation. These were evacuated aboard two separate UK ?ights three on January, and three more on 9th February and are being quarantined in the UK. Quarantine ends for the original three this weekend, when they will be free to travel back to Ireland. Ireland?s Embassy in Beijing and Consulate General in Shanghai is also in regular contact with members of the Irish community in China, and has been providing information and advice to them. The DFAT continues to deal with a wide range of concerns and queries from Irish citizens across China and the wider region. Interaction with the UK The Department of Health and the HSE maintain regular close contact with their counterparts in both Northern Ireland and the UK regarding potential cross-border threats to health. This cooperation and communication remains the case during the course of the current outbreak of Covid-l9 and the recent declaration of a Public Health Emergency of International Concern by the World Health Organisation. While no longer a member of the EU, the UK has attended teleconference meetings of the Health Security Committee and briefed Member States as to actions it has taken. Proposed legislative amendment The Minister?s approval is sought to draft a proposal to amend the Infectious Diseases Regulations 1981 (3.1. No. 390 of1981) for the purpose ofmaking a noti?able disease and to provide for related matters, including powers for an attending physician to detain a person involuntarily, in the unlikely event that such a course of action is necessary. A separate submission to the Minister will be made shortly. Potential impact of Covid-19 on global supply of medicines and medical devices No medicine shortages, currently affecting the Irish market are resulting ?'om the impact of Covid-l9 in third countries. The Health Products Regulatory Authority (HPRA), which coordinates Ireland?s response to medicine shortages, as part of the multi-stakeholder Medicine Shortages Framework, has not received any signals of future medicine supply issues as a result of the impact ot?the Covid-19. The HPRA continues to monitor for possible supply issues and have maintained communication with stakeholders domestically, via the Medicine Shortages Framework so that no unilateral or uncoordinated actions are taken that could disrupt the domestic supply chain. This issue is a global one and needs therefore requires coordinated action in terms of communication, collaboration and information sharing across multiple regions. In Europe, the European Medicines Agency (EMA) is leading out on this approach. The (EMA) has already consulted with the EU network on availability of medicines and none, including the EMA, so far have identi?ed any issues that impact the supply of medicines resulting from the coronavirus. Additionally, the EMA is setting up, in consultation with the European Commission and the Heads of Medicines Agencies, a coronavirus Steering Group on the availability of medicines to provide a strategic steer in case of shortages of medicines due to the coronavirus that require urgent and coordinated action within the Network to manage and control the situation. The EMA has also had meetings with other agencies such as the US Food and Drug Administration (FDA), Health Canada, the Australian medicines agency TGA and the UK Medicines Healtheare products (MHRA) where it is apparent that other jurisdictions are looking at a similar landscape. There is poor information relating to devices on the EU market, which makes the impact of Covid-19 on devices in the EU more dif?cult to estimate. A coordinated approach as outlined for medicines considering communications, collaboration and information sharing remains likely the best approach in this regard. APPENDIX 1 HPSC INFORMATION AND GUIDANCE The website currently provides: Advice for anyone travelling to or returning from Wuhan Guidance on management of persons suspected of having Covid-19 Assessing exposure 3: contact identi?cation for a confirmed case Risk assessment by ambulance services Risk assessment in Primary Care Risk assessment in Hospital Settings. It also provides the following information (which is updated regularly): Algorithms for Irish healthcare settings Clinical management for novel coronavirus (link to WHO guidance) Educational settings guidance Infection Prevention and Control guidance for hospitals and primary care Laboratory testing guidance Frequently Asked Questions. These are reviewed and updated as the situation evolves. 10 APPENDIX 2 HSE PREPAREDNESS HSE Preparedness Measures (as at 6 February 2020) HSE has Public Health and Emergency Management Frameworks that constantly monitor for issues and threats and ensure appropriate plans for responding to these threats are up to date and rehearsed. HSE Public Health and HSE Health Protection Surveillance Centre (HPSC) have been monitoring the Covid-l9 situation since it was noti?ed and have been developing plans to respond. The HSE High Consequences Infectious Diseases Planning and Coordination Group (HCID) is comprised of Public Health, National Ambulance Service, HPSC, Acute Operations, Community Operations, the National Virus Reference Laboratory and Logistics and Inventory Management. The HCID has been working at a detailed level on this situation since early January, and have put in place detailed plans and issued guidance and information in preparedness across the health service. This group has been meeting three times weekly and will adjust this as appropriate. The HSE Emergency Management Protocols are in place alongside the Public Health Emergency Plans and we are using these to effectively manage the situation as it evolves. The NCMT and the HCID are making decisions regarding speci?c operational requirements as they emerge: Agreeing and signing off protocols, procedures and updates to be followed by, Primary Care, Acute Hospitals, National Ambulance Service and Public Health in dealing with the disease. Agreeing logistical arrangements regarding testing and transport required for dealing with any cases that may arise. Communicating with Educational Institutions, NGOs and other relevant agencies regarding protocols in place for dealing with suspect cases. Engaging with Sea Ports and Airports health management regarding queries and suspect cases. . Securing Personal Protective Equipment supplies. 11 Winter Action Teams are also addressing any actions related to Coronavirus at the local Community and Hospital Group Level. All hospitals have critical care surge plans to deal with any increase in capacity demand as a result of this virus. The National Ambulance Service have triage and treatment protocols in place Speci?cally related to the virus and are coordinating with other agencies to ensure the appropriate response, c.g. Dublin Fire Brigade. The Health Protection Surveillance Centre is monitoring the outbreak and associated risks closely in collaboration with ECDC and WHO. Daily updates are being provided by the HSE through its Health Protection Surveillance Centre on its website and The website currently provides the following information (which is updated regularly): I Algorithms for Irish healthcarc settings Clinical management for novel coronavirus (link to WHO guidance) . Educational settings guidance I Infection Prevention and Control guidance for hospitals and primary care . Laboratory testing guidance - Frequently Asked Questions. These will be reviewed and updated as the situation evolves. 12 Council Meeting of Health Ministers Brussels, 13 February 2020 Speaking note: Covid?19 Thank You Mr President for arranging this meeting and giving us the opportunity to discuss the Public Health implications in Europe of the ongoing disease outbreak caused by Covid-19. My thanks also to the Commissioner and to ECDC for their presentations! contributions. I want to say that Ireland ?illy endorses the draft Council Conclusions. In all matters relating to emerging international public health incidents, Ireland follows the advice and guidance of the WHO and the European Centre for Disease Prevention and Control. It is important that all Member States have access evidenced based information in relation to this virus in a timely fashion. I also agree that all Member States should act together in a coordinated and proportionate manner in order to limit the spread of the virus. As you will be aware, Ireland has no con?rmed cases of Covid- 19 to date. Nevertheless, we have activated our national public health emergency system and I want to give colleagues a brief outline of the structures we have in place. We have a National Public Health Emergency Team in place and this is the forum for managing the interface between our Health Ministry and our Health Service during the planning and response phases of a public health emergency. We have also established an Expert Advisory Group to provide scienti?c advice and assistance to our Health Ministry and Health Service. Our Health Ministry chairs a Health Threats Coordination Group, which is a sub?committee of our Government?s Task Force on Emergency Planning. We use this Group to inform and collaborate with our colleagues in other Ministries and agencies on issues relating to preparedness. Our Health Service has both a National Crisis Management Team and a High Consequence Infectious Disease Group in place. Protocols and guidelines for risk assessment and management of the novel coronavirus have been issued to General Practitioners, our Acute Hospitals, National Ambulance Service, ports of entry, and Departments of Public Health. These will be reviewed and updated as the situation evolves. All of the above Groups are now meeting on a regular basis. Our Health Protection Surveillance Centre (HPSC) is closely monitoring the emerging situation and it is collaborating with the Health Ministry and other Ministries and Agencies in relation to the progression of the outbreak. And now turning to the questions posed in your discussion paper: in relation to how cooperation between Member States can be strengthened, Ireland strongly supports the view that we as Member States should harmonise our approach towards containment and mitigation and do our utmost to inform each other of developments and proposed measures. The Commission can play a lead role here in supporting the efficient exchange of information, as well as promoting the dissemination of key scienti?c information as it emerges. Secondly, regarding what steps should be jointly undertaken to ensure a sustainable supply of pharmaceuticals and medical devices for the internal market, Ireland?s view is that a coordinated approach for medicines and medical devices, which considers communications, collaboration and information sharing, remains likely the best approach in this regard. 0 Thank you Mr President. Infectious Diseases (Amendment) Regulations 2020 REF ti: HLT 00320-20 AUTHOR: Daniel Shine TC): Minister OWNER: Daniel Shine - STATUS: Completed REVIEWE RS: Eddie O'Reilly, Tony Holohan,jim Breslin PURPOSE: For Signature DECISION BY: DIVISIONKOFFICE: Chieflvledical Officer Final comment Approved by Minister Harris - SI signed and will be returned to the unit. Action required The Minister's signature is required on the hard copy version of the attached Statutory Instrument. Executive summary The World Health Organisation (WHO) declared on 30thjanuary 2020 that the outbreak of Coronavirus (Covid-19) originating in Wuhan, China, meets the criteria for a Public Health Emergency of International Concern (PHEIC). On 12 February 2020, the novel coronavirus was named severe acute respiratory coronavirus 2 while the disease associated with it is now referred to as COVID-19. It is a new strain of coronavirus that has not been previously identi?ed in humans. These Regulations amend the Schedule to the Infectious Diseases Regulations 1981 No. 390 of 1981) to include Covid-19 amongst the list of diseases designated as an ?infectious disease? for the purposes of the Health Act 1947 - all diseases that are so designated are required to be noti?ed to a medical officer of health. For the purposes of the attached Regulations, is referred to as the causative pathogen and Covid-?iQ is referred to as the Disease infectious Disease . These Regulations also amend Regulation 8 of the Infectious Diseases Regulations 1981 to provide for the inclusion of Covid-19 amongst the list of infectious diseases that a person (who is a probable source ofinfection with the disease) may be detained and isolated. Inclusion of this provision is in line with precedent for other infectious diseases ofa serious nature and is included in the Regulations largely as a precautionary measure. It is not envisaged that such powers would be used in practice. Comments Daniel Shine - 19102/2020 19:08 Eddie The Minister is in the Oireachtas tomorrow - Minister's Office has advised that it can bring a copy of this brief and the 5! over to him in the morning. I will ask Eileen or Alan to prepare a folder for the Minister to include a copy of this submission and the SI such that we can get sign off and progress speedily to getting SI number 1 ?nal publication. I'm including Pauline, Helen and Matt 0' Gorman as having access to this submission such that all are in the loop re sign-off. Daniel Daniel Daniel Shine - 20/02/2020 10:17 Eddie - text of submission revised as discussed. Note that some of the references re the purpose of the regs can't be added to the exec summary without going over the word count Eddie O'Reilly - 20/022020 11:18 Tony, The of?cial stamped version of the Regulations is now in the Minister's office in Leinster House and ready for signature. Matthew O'Gorman - 20102f2020 17:32 Approved by Minister Harris - SI signed and will be returned to the unit. Detailed information Background The World Health Organisation (WHO) declared on 30th January 2020 that the outbreak of Coronavirus (Covid-19) originating in Wuhan, China, meets the criteria for a Public Health Emergency of International Concern (PHEIC) in accordance with the provisions of the international Health Regulations (2005). On 12 February 2020, WHO of?cially named the novel coronavirus as Severe Acute Respiratory Coronavirus 2 while the disease associated with it is now referred to as COVID-19. It is a new strain of coronavirus that has not been previously identi?ed in humans. Europe is now in containment phase where the focus is on surveillance, early detection, isolation of cases, contact management and prevention of onward transmission. Lots of unknowns still remain in relation to Covid-19 extent of clinical severity, source of the virus, vaccines, therapeutics etc). Ireland has advanced plans in place as part of its comprehensive preparedness to deal with such public health emergencies as Covid-19. These plans have previously underpinned Ireland's response to similar incidents such as pandemic in?uenza, SARS and MERS. In line with the procedures previously used for the above-mentioned emergencies, it is now necessary to provide statutory recognition of Covid-19 as an ?infectious disease' for the purposes of implementation of the relevant provisions of the Health Act 1947 (as amended) and the Infectious Diseases Regulations 1981 (as amended). In particular, statutory recognition of Covid-19 as an 'infectious disease' ensures that medical practitioners are required to notify any case of the disease that they become aware of, or suspect, to a medical of?cer of health (which is subsequently relayed to the HSE's Health Protection Surveillance Centre). For the purposes of the attached Regulations, is referred to as the causative pathogen and Cavid-19 is referred to as the Disease infectious Disease (in the amended Schedule to the 1981 Regulations). Detail of Regulations These Regulations amend the Schedule to the Infectious Diseases Regulations 1981 (SJ. No. 390 of 1981) to include Covid-19 amongst the list of diseases designated as an ?infectious disease? for the purposes of the Health Act 1947, in accordance with Regulation 6 of those Regulations all diseases that are so designated are required to be notified (by a medical practitioner who becomes aware of or suspects an instance of such disease) to a medical of?cer of health and are subsequently relayed to the HSE's Health Protection Surveillance Centre in accordance with Regulation 14 of the 1981 Regulations (as amended). These Regulations also amend Regulation 8 of the Infectious Diseases Regulations 1981 to provide for the inclusion of Covid-19 amongst the list of infectious diseases that a person (who is a probable source of infection with the disease) may (as a necessary safeguard against the spread of the disease) be detained and isolated for, in accordance with the Health Act 1947. In practice, any such detention i isolation measure requires an order in writing by a chief medical of?cer a Director of Public Health in the HSE) and counter-signed by another medical practitioner a Specialist in Public Health Medicine). Inclusion of this provision is in line with precedent for other infectious diseases of a serious nature and is included in the Regulations largely as a precautionary measure (as any suspected cases are far more likely to adhere to self-isolation procedures implemented by the HSE). These Regulations (Regulations 3(b) and (CD also provide for the preliminary noti?cation immediate noti?cation by telephone as well as transmission in writing) of Covid-1 9. The text of the Regulations have been considered and approved by the Department's Legal Unit and prepared and signed off by the Office of the Parliamentary Counsel. A hard-copy of this submission and the attached regulations (with Ministerial Sea!) be forwarded to the Minister. The Minister's signature is required on the Reguiations. The Minister's attention is drawn to the preamble to the Regulations which differs from the standard version that the Minister would have received in previous cases. Parliamentary Counsel advises that this is the phrasing used where the Government is operating in an acting capacity. Next Steps Once the Regulations have been signed by the Minister, Legal Unit will obtain an Number and the ?nal published version of the SI. will be provided by the Printers. Details as to the number of the SI. and a copy of the published document will be provided to the Office of the Attorney General. Given the significance ofthe S.I. in relation to the safeguarding of public health, it is preposed that the following steps be taken on foot of final publication ofthe S.I.. The Department, on behalf ofthe Minister, shall issue a copy copy will also be provided to the Assistant National Director of Public Health of the HSE, the Acting Director of the HPSC and the Director of the National Virus Research Laboratory for information. Related submissions HLT 00352-20: Letter to CEO of the HSE - infectious Diseases (Amendment) Regulations 2020 (SJ. No. 53 of 2020) User details INVOLVED: Daniel Shine READ RECEIPT: Daniel Shine Eddie O'Reiily Eddie O'Reilly Dep Sec Holohan Tony Holohan Tony Holohan Jim Breslin Sec Gen Of?ce Joanne Lonergan Jim Breslin Matthew O'Gorman Ministers Of?ce Pauline Brady Simon Harris Sarah Bardon Eileen Ryan Action log ACTION Create Submit for review Submission sent Take ownership Submit for review Submit for review Submission sent Submit for review Submit for review Complete DESCRIPTION Submission HLT 00320-20 to Minister created. Submission sent for review to Eddie O'Reilly. Submission sent by email to Pauline Brady, Helen Reddin, Matthew O?Gorman, Ronan Colette Bonner. Message: Colleagues Please see attached submission, being forwarded to you for information Daniel Submission ownership taken by Daniel Shine. Submission sent for review to Eddie O'Reilly. Submission sent for review to Tony Holohan. Submission sent by email to Pauline Brady, Helen Reddin. Message: Pauline 2' Helen Including you on memo such that Tony is kept aware of progress Submission sent for review to Secretary General on behalf of Tony Holohan. Submission sent for review to Minister on behalf of Secretary General. Submission completed by Matthew O'Gorman. USER Daniel Shine Daniel Shine Daniel Shine Daniel Shine Daniel Shine Eddie O'Reilly Eddie O'Reilly Tony Holohan Jim Breslin Matthew O'Gorman DATE 19102/2020 17:41 19/02f2020 19:1 1 19/02/2020 19:13 20/02! 2020 09:24 20/021?2020 10:17 20!02!2020 1 1:18 20r02/2020 11:21 20/02/2020 11:32 2010212020 1 1 :52 20f02f2020 17:32 STATUTORY INSTRUMENTS. SJ. No. of 2020 INFECTIOUS DISEASES (AMENDMENT) REGULATIONS 2020 2H SJ. No. of2020 INFECTIOUS DISEASES (AMENDMENT) REGULATIONS 2020 The Minister for Health, in exercise of the powers conferred on him by sections 5, 29 and 3] of the Health Act l947 (No. 28 of 194'?) hereby makes the following regulations: 1. These Regulatioos may be cited as the Infectious Diseases (Amendment) RegulatiOns 2020. 2. In these Regulations, ?Regulations of 2007? means the Infectious Diseases (Amendment) Regulations 2007 (SI. No. 559 of 2007). 3. The Infectious Diseases Regulations 1931 (8.1. No. 390 of IQSI) are amended - in Regulation 8 (amended by Regulation 4(3) of the Regulations of 2007) by the insertion before ?diphtheria? of in Regulation (amended by Regulation 4(6) of the Regulations of 2007) by the insertion before ?diphtheria? of in Regulation 15(2)(a) (amended by Regulation 4(7) of the Regulations of 2007) by the insertion before ?diphtheria? of and by the substitutiOn of the following Schedule for the Schedule (amended by Regulation 2(b) of the Infectious Diseases (Amendment) Regulations 2018 (SJ. No. 567 of 20] to those Regulations: [13 Diseases speci?ed to be infectious diseases and their respective causative pathogens Disease Acute anterior poliomyelitis Ano-genital warts Anthrax Bacillus cereus food-borne infectionlintoxicatiOn Bacterial meningitis (not otherwise speci?ed) Botulism Brucellosis Campylobacter infection Carbapenemase producing enterobacteriaceae, infection or colonisation Chancroid Causative Pathogen Polio virus Human papilloma virus Bacillus anthracis Bacillus cereus Clostridium botulinum Brucella species Campylobacter species Enterobacteriaceae I-Iaernophilus ducreyi 4H Chickenpox - hospitalised cases Chikungunya disease Chlamydia trachomatis infection (genital) Cholera Clostridium dif?cile infection Clostridium perfringens (type A) food- borne disease Covid-19 Creutzfeldt Jakob disease variant Creutzfeldt Jakob disease Cytomegalovirus infection (congenital) Dengue Fever Diphtheria Eehinoeoccosis Varieella-zoster virus Chikungunya virus Chlamydia trachomatis Vibrio cholerae Clostridium difficile CIostridium per?'ingens parvum, hominis Cytomegalovirus Dengue Virus Corynebacterium diphtheriae or uleerans (toxin producing) Echinococcus species Enterococcal bacteraemia Escherichia coli infection (invasive) Giardiasis Gonorrhoea Granuloma inguinale Haemophilus in?uenzae disease (invasive) Hepatitis A (acute) infection Hepatitis (acute and chronic) infection Hepatitis infection Hepatitis Infection Herpes simplex (genital) Herpes simplex (neonatal) Human immunode?ciency virus infection In?uenza Enterococcus species (blood) Escherichia coli (blood, CSF) Giardia lamblia Neisseria gonorrhoeae Klebsiella granulomatis Haemophilus in?uenzae (blood, CSF or other normally sterile site) Hepatitis A virus Hepatitis virus Hepatitis virus Hepatitis virus Herpes simplex virus Herpes simplex virus Human immunode?ciency virus In?uenza A and virus 6H Klebsiella pneumoniae infection (invasive) Legionellosis Leprosy LeptoSpirosis Listeriosis Lyme disease (neurobOrreliosis) venereum Malaria mcr?positive Enterobacteriaceae infection or colonisation Measles Meningococcal disease Mumps Non-specific urethritis Novel or Rare Antimicrobial-resistant Klebsiella (blood or CSF) Legionella Species Mycobacterium leprae Leptospira species Listeria monocytogenes Borrelia burgdorferi Chlamydia trachomatis Plasmodium falciparum, vivax, knowlesi, ovale, malariac Enterobacteriaceae Measles virus Neisseria meningitidis Mumps virus Organism (NRAO) Noroviral infection Paratyphoid Pertussis Plague Pseudomonas aeruginosa infection (invasive) Fever Rabies Respiratory virus infection Rotavirus infection Rubella Salmonellosis Severe Acute Respiratory (SARS) Shigellosis H7 Norovirus Salmonella Paratyphi Bordetella pertussis Yersinia pestis Pseudomonas aeruginosa (blood or CSF) Coxiella bumetii Rabies virus Respiratory virus Rotavirus Rubella virus Salmonella other than S. Typhi and S. Paratyphi SARS?associated coronavirus Sbigella species 3i] Smallpox Staphylococcal food poisoning Staphylococcus aureus bacteraemia Streptococcus group A infection (invasive) Streptococcus group infection (invasive) Streptococcus pneumoniae infection (invasive) Syphilis Tetanus Toxoplasmosis Trichinosis Trichomoniasis Tuberculosis Tularemia Variola virus Enterotoxi gen ic Staphylococcus aureus Staphylococcus aureus (blood) Streptococcus pyogenes (blood, CSF or other normally sterile site) Streptoccus agalactiae (blood, CSF, or other normally sterile site) Streptococcus pneumoniac (blood, CSF or other normally sterile site) Treponema pallidum Clostridium tetani Toxoplasma gondii Trichinella Species Trichomonas vaginalis Mycobacterium tuberculosis complex Francisclla tularensis Typhoid Typhus Verotoxigenic Escherichia coli infection Viral encephalitis Viral haemorrhagic fevers Viral meningitis West Nile fever Yellow fever Yersiniosis Zika virus infection [19 Salmonella Typhi Rickettsia prowazekii Verotoxin producing Escherichia coli West Nile virus Yellow fever virus Yersinia enterocolitica, Yersinia pseudotuberculosis Zika virus". 10H GIVEN under the Of?cial Seal of the Minister for Health, 2020. Minister for Health. lI EXPLANATORY NOTE (This note is not part ofthe Regulation and does not purport to be a legal interpretation) These Regulations (Regulation amend the Schedule to the Infectious Diseases Regulations 1981 (SJ. No. 390 of I981) to include Covid?19 amongst the list of diseases designated as an ?infectious disease? for the purposes of the Health Act 1947, in accordance with Regulation 6 of those Regulations all diseases that are so designated are required to be noti?ed (by a medical practitioner who becomes aware or Suspects an instance of such disease) to a medical of?cer of health and are subsequently relayed to the Health Protection Surveillance Centre in accordance with Regulation 14 of the 198] Regulations (as amended). These Regulations (Regulation also amend Regulation 8 of the Infectious Diseases Regulations 1981 to provide for the inclusion of Covid-19 amongst the list of infectious diseases that a person (who is a probable source of infection with the disease) may (as a necessary safeguard against the spread of the disease) be detained and isolated for, in accordance with the Health Act 1947. These Regulations (Regulations 3(b) and also provide for the preliminary noti?cation immediate noti?cation by telephone) of Covid-l 9. BAILE ATHA CLIATH ARNA FHOILSIU AG OIFIG AN ISOLATHAIR Le ccannach direach (3 FOILSEACHAIN RIALTAIS, 52 FAICI-IE STIABHNA, BAILE ATHA CLIATH 2, no: 076 6834 r-posl: pub] ications@opw.ie DUBLIN PUBLISHED BY THE STATIONERY OFFICE To be purchased from GOVERNMENT PUBLICATIONS, 52 ST. GREEN, DUBLIN 2, [302 DR67. Tel: 0'26 I 6834 E?mail: publications@opw.ic 3.50 7?5. 02m. Propylon. 8.. This ?le was generated using an evaluation version of Muhimbi's Document Converter. Visit for more information. Submission HLT 00408-20: Correspondence in relation to Acute Hospital Preparations for 9 TO: . Minister AUTHOR: Lisa Williamson STATUS: Completed OWNER: Lisa Williamson PURPOSE: For Information REVIEWERS: DNISIDN: Corporate Division BY: Finai comment Noted. with thanks: Simon Action required Please see attached correspondence for information from CED Paul Reid, HSE and Reply from 56 Breslin Executive su mmary lCorrespondence received from CED Paul Reid HSE in relation to Acute Hospital Preparations for on 2 March 2020 and a reply was issued by Secretary.r General Breslin on 3 March 2020. Detailed information Related submissions There are no related submissions. Comments Lisa Williamson - 04/03f2020 1?:36 For information of the Minister Simon Harris - 31f03x?2020 11:21 Noted, with thanks. Simon User details INVOLVED: Lisa Williamson READ RECEIPT: Lisa Williamson Ministers Of?ce Sarah Bardon Simon Harris Matthew D'Gorman Simon Harris Denise Kelly Priornhotfigeach Feidhmiuchain Feidhmeannacht na Stainte Urlar 1, Osptdeal an Dr Steevens' Bails Atha Cliath 8 DUB W2AB 01 635 2000 2 Match 2020 Mr. Jim Breslin Secretary General Department of Health Block 1, Miesian Plaza 50?53 lower Baggot St. Dublin 2 D02 X0314 Re: Acute i Dearjim, The HSE continues our preparation for Chief Executive Officer Health Service Executive 1??Floor, Dr Steevens' Hospital Dublin 8 D08 W2A8 E: 01 535 2000 I: Our Ref: PRIAM CEO Ref: 01241 the likely increase in activity associated with COVE-19 across the health services. We are regularly presenting update reports on actions completed and in train to NPHET Broadly our strategy will be to differentiate between generally well people with who can self-isolate at home or in a health setting and require primary community health service support and those who either require hospital admission or are at clinical risk of deteriorating and will need clinical monitoring. For the latter group, we have been working on a range of acute hospital actions that will maximise the available acute hospital capacity to provide appropriate care for patients. To respond to the next instances of major surge we have already undertaken the following actions: 0 Identi?ed general acute isolation capacity in hospitals 4' Incorporated the specialised isolation capacity of the National Isolation Unit within the general operational response I Updated our National and each hospital?s Critical Care Major Surge Capacity Plans Commenced the process of identifying additional major surge critical care capacities within hospitals I Augmented inter-hospital transferring capabilities to decant patients from ICU services and implement a mandatory repatriation policy to assist hospitals in surge We will continue to identify further general isolation and critical care capacity within the current services that we can utilise if needed. It is important to flag that the HSE may need to also implement a range of actions such as the curtailment of non-essential ICU dependent activity within hospitals to lessen the requirement for day to day critical care capacity where we experience an increased need for critical care beds. Initial indications from our modelling group and international experience to date suggest that we now need to plan for a signi?cant increase in volume for ICU services beyond the actions listed above. Building a Seirbhis Slainte Better Health Nlos Fearr Service a Forbairt to operationalise. It is clear however that we need in the short term to put in place additional critical care capacity. Our strategic options for additional capacity in the short term are: Commission an additional 20 adult and 2 paediatric critical care beds in hospitals with existing ICU spaces to augment current capacity Commence discussions with private hospital providers with critical care capacity to support local hospitals when needed Appendix I lists the speci?cs of these action areas and the anticipated costs. It is important to note that the lead in time to operationalise these actions is typically signi?cant but we will ensure there is a focus on delivery of this additional capacity in as short a timescale as possible if you can agree to support our proposal. We also wish to augment the capacitg,r of the National Isolation Unit both for general medical patients and critical care and Appendix II contains a separate proposal on this requirement. Yours sincerely, Eat to. Paul Reid Chief Executive Of?cer Appendix I Critical Care Capacity Requirements Additional ICU capacity in strategic locations Phase I - Immediate Commissioning Hospital Additional Capacity Cost Beaumont 2 additional ICU beds ?115 St. James 2 additional ICU beds ?113 University Hospital Waterford 1 additional ICU bed 6&8 Limerick 2 additional ICU beds 2 ?13 additional I-IDU beds CUH 3 additional ICU beds ?24 St. Vincent?s 3 ICU beds (upgrade of HUD) ?13 Mater Hospital 3 additional ICU beds upgrade ?24 of ?1 ICU bed for isolation Tullamore 2 additional ICU beds ELIS CHI 2 additional ICU beds 61.1 Total 20 Adult ICU Beds ?14.7m 2 Paediatric ICU Beds Phase II - 3 ?6 month Commissioning Timeframe Hospital Additional Capacity Cost Mercy Hospital 1 additional ICU bed 60.8 Kerry Hospital 1 additional ICU bed 60.3 Tuliamore 1 additional ICU bed ?03 St. Vincent?s 2 additional ICU beds ?237 Total 5 Adult ICU Beds 95.1 Temporary Critical Care Capacity Seek contingency funding for private ICU hospital capacity at following locations II Blackrock 1' Mater Private 0 Hemlitagc I Galway Clinic I Beacon Hospital II Others as appropriate Expenditure would only be incurred if patients require transfer. This could be funded through the NTPF if agreed. Appendix 11-? Mater Hospital National Isolation Unit Capacity Requirements Phase I Staf?ng: 3 FTE medical registrars 5 FIE staffnurses 2 FTE Health Care Assistants Overheads ?Sc Consumables Equipment: PD 140 2 station telemetry monitor with ECG, 31302, NIBP, ABP Capability 6 Classic Littman Stethoscope Phase II Staf?ng: 2 CNMZ 1 Laboratory Medical) Scientist Overheads 6c Consumables Infrastructure: Room 1 remodel Room 1 Autoclave Training Space <31 ED Subtotal: Capital/ Once Off Equipment] Once Off Reoccurring Total: 1X FTE cost Total 611, 70.00 183,528.00 42,723.40 213,642.00 35,79 0.00 71,580.00 140,625.00 609,375.00 7008.68 14017.36 1 90. 00 17,790.00 30.00 430.00 32,287.36 55,843.00 107,686.00 44,264.00 44,264.00 45,585.00 197,535.00 300,000.00 300,000.00 45,000.00 45,000.00 5,000.00 5,000.00 35,000.00 35,000.00 385,000.00 385,000.00 32,237.00 i 806,910.00 0102400700 An Roinn Slainte Department of Health Secretary General Mr Paul Reid Chief Executive Of?cer Health Service Executive Dr Steevens? Hospital Dublin 8 3 March 2020 Our ref: Re: Acute Hospital Preparations for COVID-IQ Dear Paul, I refer to your letter of yesterday evening in relation to Acute Hospital Preparations-for Covid-19. A sub?group of NPHET has been established on acute hospital preparedness and I expect that further HSE preparations will be identi?ed and put in train through this process. However, at this stage the Department is happy to agree to support the proposals outlined in your letter and their early implementation. Of?cials will engage ?trther in this context. I can con?rm the Department of Public Expenditure and Reform has been advised of this - matter. Yours sincerely, :3 at Jim Breslin Secretary General Blue 1. Flu: Mlsead?l, 5D - SB Srild Bhagold iodttarach. Bailo?lha Cliath 2. D02 Block 1. Mission Plaza. 50 - SB Lower Basset Street. Dublin 2. DOE XW14 +353 1 635 4361 lnfo?health.gov.ie caitngovJe This ?le was generated using an evaluation version of Muhirnbi?s Document Converter. Visit for more information. Submission HLT 00446?20: Cervical Check Tribunal - Establishment TD: Minister AUTHOR: Stephen Brophy STATUS: Completed OWNER: Stephen Brophy PURPOSE: For Decision REWEWERS: greg dempsey Jim Breslin Governance and Performance DECISION BY: Final comment Approved Action required statement to that effect. Executive summary - As the Minister is aware. previous submission 00355-20 contained a Memo for Information of Government that was not brought to Government following discussion with Government Secretariat. Following correspondence with the Chairperson, the Department is of the view that to proceed to establishment now would cause significant distress to the cohort of eligible claimants - all ofwhom have had cancer and many ofwhom are at elevated risk in relation to COlv'lD- 19. circumstances. Officials will finalise the necessary preparations so that the Tribunal can proceed to establishment as soon as possible. The Unit will keep the situation under review and will make a recommendation as soon as it is possible to proceed. in considering this position. the'Department has reviewed the policy of the Courts Service - the High Court will not be hearing any new personal injury cases for the rest of the current term. and has substantially limited other sittings. As such no Cervical Check Claimant will be able to proceed in the Courts at this time. Detailed information The administrative arrangements in respect of the Tribunal are close to finalisation. The chairperson has visited the premises and has expressed her satisfaction with these. She feels that they will be very suitable and comfortable for claimants and has commended the OPW and the Department. in fact. she feels that they demonstrate a level of facility that should be the model for future developments in family law and other cases of vulnerable individuals. The remaining preparations for the Tribunal will be concluded by the end of March 2023-, notwithstanding the disruption caused by The Minister is empowered to establish the Tribunal at any point. Giving the developing situation regarding comb-19, the Department has engaged in a brief email consultation with the 221+ representative group. who have indicated ?all are in agreement that the public health concerns at the moment clearly warrant delaying the establishment of the Tribunal for the time being". The Tribunal Chairperson also agrees and of?cials have discussed the proposal with the office of the Chief Medical Officer, who have indicated that, in their view. a postponement is appropriate due to the advice on social distancing that is issuing. standard. Statement re: Cervical Check Tribunal (for website} Given the ongoing and quickly evolving situation in relation to torrid-19 the decision has been made to delay the Establishment of the Cervicalcheck Tribunal. This decision has been made in response to both the measures which were This ?le was generated using an evaluation version of Muhimbi?s Document Converter. ?v'isit mvwmuhimbioom for more information. announced by the Taoiseach on the 1 2th March and the understanding that the intended claimants have all experienced medical dif?culties and may be considered to be at risk if they were to contract the virus. The situation will be monitored and further updates in relation to the establishment of the Tribunal will be posted on this website and communicated to the relevant support groups. As soon as medical advice recommends that it would be safe and prudent to establish the Tribunal all steps necessary to do so will be taken as expeditiously as possible Related submissions There are no related submissions. Comments - Stephen Brophy - 13/032020 16:24 Greg As discussed greg dempsey - 13;03i2020 16:42 We'll run the ?nal communication past the experts before we issue. Jim Breslin - 13;'03f2020 16:53 What is the position with the civil Courts generally? Would seem relevant. For those determined to achieve an early resolution a delay in establishing the Tribunal would leave them with the High Court as their only option. Also what is the status of the 221 consultation. Can we reference it when asked? Stephen Brophy - - inserted info as requested by SE. I think OK to reference correspondence with 221+ if required but trust it should not be necessary. greg dempsey - 131039020 17:2? Jim. Position re Civil courts now included. 1 think there is a difference between existing bodies remaining open, and establishing a new body [and in so do effectively starting the clock in terms of the period claimants have to make a claim}. We can reference the response of the 221 representative, but would have to make clear that we sought their view. rather than they pushed for this Jim Breslin - 13f03f2020 1?:33 Can you clarify the issue on the period within which claims have to be made please. Is this set out in law? Could we provide a longer period post making of claims for hearings so that if someone did not want to participate in a hearing during the COVIDJB outbreak there would be no requirement to do so. Stephen Brophy - 1E!03f2020 10:04 Greg As we discussed. the Courts substantially changed their position on Friday evening after the last draft of this statement was submitted. I have updated the submission with this new information. Stephen grey dempsey - 16f03f2020 17:22 Jim. Separate submission to come re RM appeal. You'll see latest position. which I think supports the recommendation to postpone the tribunal. I'd like to get this formalised so that we can inform judge and 221 etc (3 Joanne Lonergan - 20f03f2020 13:21 Approved User details INVOLVED: Stephen Brophy READ Stephen Brophy greg dempsey . greg dempsey This file was generated using an evaluation version of Muhimbi?s Document Converter. ?v'isit W.muhimbi.oom for more information. Sec Gen Office Jim Breslin Jim Breslin Joanne Lonergan Ministers Office Sarah Bardon Simon Harris Dave McGrath Amy Brennan Denise Kelly Action log ACTION USER DATE DESCRIPTION Create Stephen Brophy 1210312020 11:19 Submission HLT 00446-20 to Minister created. Submit for review Stephen Brophy 1310312020 16:24 Submission sent for review to greg dempsey. Submission sent Stephen Brophy 13/03/2020 16:25 Submission sent by email to Paula Cummins. Dave McGrath. Submit for review greg dempsey 1310312020 16:42 Submission sent for review to Secretary General. Revert Jim Breslin 1310312020 16:53 Submission reverted to grey dempsey by Jim Breslin. Take ownership Stephen Brophy 1310312020 16:51 Submission ownership taken by Stephen Erophy. Submit for review Stephen Brophy 13103120201109 Submission sent for review to greg dempsey. Submit for review greg dempsey 1310312020 11:21 Submission sent for review to Secretary General. Revert Jim Breslin 1310312020 11:33 Submission reverted to greg dempsey by Jim Breslin. Take ownership Stephen Brophy 1610312020 09:46 Submission ownership taken by Stephen Brophy. Submit for review Stephen Brophy 1610312020 10:04 Submission sent for review to greg dempsey. Take ownership Stephen Brophy 1610312020 14:09 Submission ownership taken by Stephen Brophy. Submit for review Stephen Brophy 1610312020 14:09 Submission sent for review to greg dempsey. Submit for review greg dempsey 1610312020 17:11 Submission sent for review to Secretary General. Take ownership Stephen Brophy 1610312020 11:19 Submission ownership taken by Stephen Brophy. Submit for review Stephen Brophy 1610312020 11:20 Submission sent for review to grey dempsey. Submit for review greg dempsey 1510312020 11:22 Submission sent for review to Secretary General. Submit for review Jim Breslin 16/03/2020 11:33 Submission sent for review to Minister on behalf ofSecretary General. Complete Joanne Lonergan 2010312020 13:21 Submission completed by Joanne Lonergan. This file was generated using an Evaluation version of Muhimbi's Document Converter. Visit mvwmuhimbioom for more information. Submission HLT 00462-20: Covid?19 travel restrictions TO: Minister AUTHOR: Colm O'Conaill STATUS: Completed OWNER: Colm O'Conaill PURPOSE: Forlnformation REVIEWERS: Jim Breslin Chief Medical Officer BY: 1UU3I202U Final comment Noted. S. Action required To note arrangements for decision-making on travel restrictions Executive summary 1. Secretary General 2. Minister Harris As requested by the Secretary General, to note that a process has been agreed with DFAT to allow time for consideration of any DFAT proposals to change travel advice to countries or regions abroad, on grounds. Future DFAT proposals will be considered by the National Public Health Emergency Team. on the basis of expert advice from the Currently the DFAT security status levels are elevated. on grounds. for China, Iran. Spain and the Republic of Korea (Daegu. Cheongdo or Gyeongsanl. all of which have travel advisories to Avoid non-essential travel. along with Italy {Do Not Travel). DFAT is expected imminently to recommend elevating the security level for Germany (currently Normal Precautions. the lowest of four security rating levels]I and for France {currently High Degree of Caution}. The four DFAT levels are: Normal Precautions, High Degree of Caution, Avoid Non-Essential Travel. and Do Not Travel. NPHET has had pl'E?v'iOUS discussions on travel advice and restrictions, including on 12th March when a proposal that everyone returning from Spain (and other countries with elevated security ratings. listed above} should restrict their movements for 14_days. Further update: DFAT has subsequently proposed this afternoon that important decisions on changing travel advice. for reasons of Covid-19. represent agreed positions between both Departments, and be Government decisions. Colm Conaill 19 Taskforce Detailed information Related submissions There are no related submissions. Comments Jim Breslin - 13f031?2020 15:58 For Minister's meeting with Tanaiste and Taoiseach's Chief of Staff please. This ?le was generated using an evaluation version of Mubimbi's Document Converter. ?v'isil for more information. Simon Harris - 11:15 Noted. User details INVOLVED: Colm O'Conaill Sec Gen Office Jim Bresiin Ministers Office Colm O'Conaill Jim Breslin Maurice O'Donnell Sarah Bardon READ RECEIPT: Simon Harris Matthew G'Gorman Jennifer Lyons Simon Harris Denise Kelly Action log ACTION USER DATE DESCRIPTION Create I:Zoln'i O'Conaill 15:52 Submission HLT to Minister created. Submit for review Colm O'Conaill 13f93f2020 15:53 Submission sent for review to Secretary General. Submit for review Jim Breslin 1310312020 15:53 Submission sent for review to Minister on behalf of Secretary General. Take ownership Colm O'Conaill 130312020 19:0? Submission ownership taken by Colrn O'Conaill. Submit for review Colm O'Conaill 13f?3f2020 19:10 Submission sent for review to Minister. Complete Simon Harris 31l03f2020 11:16 Submission completed by Simon Harris on behalf of Minister. IQ) 'llzis hie was generated usms an ovaluaho't cl Docurt'rcnt Converter. VISI: more information Submission l-iLT 00471?20: Covid-19 - PPE - Approval of HSE CEO request for funding of ?208,000,000 in respect of decsion by the HSE to enter into a commercial framework contract arrangement T0: Minister AUTHOR: Paul Bolger STATUS: Completed OWNER: Paul Bolger PURPOSE: For Priority REVIEWERS: Jim Breslin Finance and Evaluation DECISION BY: WKCIBEEDZU Final comment Approved in line with Sec Gen's comment Action required 1. Approval of expenditure of {Edam 2. Signature of letter of authorisation Executive summary The HSE CEO has requested approval for expenditure in the amount of (SIDS m. This cash request Is In resoect of an arrangement the HSE intends to enter into with China Resources Pharmaceutical Commercial Group International Trading Co.. today March) for . hEn by the HSE board last night subject to and PER funding and also at Cabinet Committee yesterday. Approval for additional funding of ?208 million received from the DPER. The HSE CED has confirmed that this expenditure Is "absolutely necessary and Is associated with the (SQUID-19 epidemic". Given the very tight timeframes. it is not possible to go through our normal due diligence process between the Department and the HSE and the Department and DPER. This risk has to be expenditur?WWHEFt?enable the HSE to be In a position to execute the transaction this evening. Attached letter for the 56's signature and draft letter of assurance for Minister's signature attached. Other aspects of the transaction etc) are a matter for the HSE. Letter of assurance provided by the HSE Is also attached. However, I am awaiting confirmation from the HSE regarding their legal advice on the letter. Detailed information - Funding request received from CED Reid attached. - Briefing note provided on 14 March is also attached. 0 Approval from 56 Watt attached, in addition to the attached documents the HSE has provided the following additional details: Letter of Assurance 1. "We do not consider the Letter of Assurance places any unreasonable restrictions on us receiving goods from any other Chinese suppliers. The arrangement we are entering into relates to PPE. We are perfectly Tins frl-i: was arr versiarr c-f [reorient Converter Vrnr: multirnbr torn for more infornratrc-r free to source other products such as medical devices from other suppliers. Infect. the arrangement we will enter into today does not preclude us from using existing supplier or brokers to secure additional PPE. I would also point out that given current market conditions and the unprecedented scarcity of supply. the Letter of Assurance should be viewed as an asset as it considerably improves our ability to secure the stocks we require. Delivery Schedule 2. "In terms of delivery schedules, these will be agreed with each batch order. In general terms and based on discussions to date. the general lead times applying are 10 to 15 days. Production capacity varies from product to product. For example on respirator masks CRP have confirmed a daily production output of ".700. 000 units, on gowns they have confirmed a daily production output of 620,000 units etc. I would also point out that what we will sign with CRP today is an overarching framework agreement that ensures primacy of supply to HSE. We will generate multiple batch orders for specific volumes and values and each batch order will have delivery dates, volumes etc. A call is scheduled with CRP later this evening to agree the first batch order." Quality Standards 3. "The quality standards applying are those that issued by the World Health Organisation in their Disease Commodity Package (val. CRP have confirmed their ability to produce to this standard and will be providing the relevant certificates to us to con?rm the standards. You might also note the following a. We have sourced a reference through who has procured products from CRP previously and he confirmed that in his dealings with CRP he has not experienced any quality issues and consider them to be honest and reliable manufacturers b. We are currently sourcing an Infection Control specialist in Beijing who will act as a quality checking agent for HSE and periodically confirm that the goods being manufactured comply with the specification and are suitable for the use for which they are intended." Related submissions HLT 00722-20: Sanction request for Personal Protective Equipment and Associated Air Transport costs Comments Paul Eloiger - 1W03r?202l} 14:1? 56 - recommended for your approval and see attached letter for your signature. I am awaiting Sean's response on the letter of authorisation. Paul Jim Breslin - 17I03f20201dald Minister. in the circumstances I am satisfied to provide the HSE with funding assurance on this financial commitment. Regarding the Letter of Assurance we are awaiting some clari?cation from HSE following receipt of which we will advise you on issuing it. Jim Joanne Lonergan - 15:11 Approved in line with Sec Gen's comment Paul Bolger- lsi?3f2020 ram HSE con?rmation of legal advice of letter of authorisation and singed letter attached. Slight modification to letter from HSE legal aligns the authorisation to the PPE equipment that is subject to the order only. - User details INVOLVED: Paul Bolger READ RECEIPT: Paul Bolger Sec Gen Office Jim Breslin Jim Breslin Joanne Lonergan Ministers Office Lisa Williamson Simon Harris "this file was genera-ted using on oval-Lemon voters-n of Dosult'ent Com-one: Viol: nmhm?-msm to" mom- information i Fiona Prendergast Eoin Holoin Cooimhe Dolan Megan Coll David ?olger Denise Kelly Action log ACTION USER DATE DESCRIPTION Create Paul Bolger Submission HLT OWN-20 to MinistEr Created. 12312 Submit for Paul Boiger 17:?0332020 Submission sent for review to Secretary General. review 14:1? Submit for Jim Breslin Willy-2020 Submission sent for review to Minister on behalf of Secretary General. review 1431-1 Complete Joanne 1?f03r2020 Submission completed by Joanne Lonergon. Lonergan 15:11 Submission Paul Bolger Submission sent by email to Kevin Colman. Louise Carrigan. Fergal Goodman, sent 15:22 Mary Hyland. Message: F?rl on the financials. Of?ce ofthe Chief Executive Of?cer Floor, Dr. Steevens' Hospital Dublin D03 WZAS no Seiriahlse Slainte Tel: 01 635 2701 Heat?: Sen-ice Exocrine-3 Mr?m Breslin Secretary General Department of Health Approval Request for Expenditure associated with COVID-IEJ Dear jim, At the HSE Board Meeting convened last wetting it was agreed that for the duration of the COVlD-lil epidemic, that the Board delegate to me, in my capacity as Chief Executive Of?cer, all the necessary authority to approve any expenditure associated with the COVID-ID epidemic once approved by the Department of Public Expenditure s: Reform and the Department of Health and to accept any offer (which may be termed as gifts) from the private sector that may assist in the management of the epidemic. In this regard, i would be grateful ifyou could approve the expenditure in the amount of ?2ll3,0?li,000 in respect ofa framework contract arrangement we must enter into with China Resources Phannaceutical Commercial Group International 'l'rading Co.. for the supply of Personal Protective Equipment (PPR . I can confirm that this expenditure is absolutely necessary and is associated with the 9 epidemic. I would be grateful ifyou could revert to me with the necessary approvals as a matter of extreme urgency as the contract needs to be executed no later than 3pm today 17 March 2020. Kind Regards, Paul Reid Chief Executive Of?cer f7 :l-lun'b 202i? Brie?ng Note - Personal Protective Equipment (PPE2.1 2.2 2.3 2.4 2.5 Wicca A key commodity required for the management of is PPE. Market conditions are highly volatile market with unprecedented demand now in the marketplace. All traditional supply channels and sourcing mechanisms will not meet IE demand Appendix 1 illustrates the volatility of the marketplace. W91: HSE has conducted some demand modelling. This demand modelling has been conducted in the absence of visibility of the detailed epidemiological modelling. The key assumptions made in the demand modelling are as follows - 1.5m infections 0 Allocation of PPE as per ECDC Technical Report needs in healthcare settings for care of patients with suspected or con?rmed novel coronavirus as per February 2020 which recommends a PPE pack for care of patients with suspected or confirmed Each PPE Pack comprises of the following: Protection Suggested PPE Respiratory protection N95. FFP2 or FFPS respirator protection Goggles or is ca shield Body protection Long-sleeved water-resistant gown Hand protection Gloves The Technical Report sets out the allocation of PPE sets based on a needs assessments of PPE supplies per patient per day. Based on this Report the following is the estimate of demand for the Irish Health Sector Scenario 1 Scenario 2 Scenario 3 Product 1.5m infections 1.25m infections . 1.5m infections 3:1 allocation 1:1 allocation - FFP masks (each) Surgical Masks {each} Gloves pairs) . Goggles {sash} . Gowns {each} Total Estimated Value Further demand modelling was conducted to sense check the figures above. This second demand modelling exercise generated volumes not materially different to those arrived at through the first modelling exercise. Given the lack of visibility on epidemiological modelling HSE decided to take a prudent approach to entering into a transaction of this scale and value. Accordingly. the approach taken was to place an ?initial order" for PPE in the following quantities with an option to issue further purchase order should the need arise; 2Product FFP masks teach} gurgical Masks {ea-ch] Gloves [pairs] Protection (Face Shields Goggles (eachl) . Gertie. {each} Total Estimated Value An ?initial order" of this magnitude represents in excess of 5 years' worth of normal stock holdings. Given that traditional supply routes are non-existent. HSE engaged with IDA in an effort to secure manufacturing capacity. IDA have through their China Office secured a PPE manufacturer {China Resources Pharmaceuticals} who is willing to conclude a transaction with HSE for the purposes of supplying PPE. Discussions have been ongoing in recent days resulting in a conference call at 06:00 on 14 Mar between HSE and China Resources Pharmaceuticals. This call was facilitated by IDA. These discussions were extremely positive and agreement in principle between the parties was reached on supply of PPE to HSE. HSE is satisfied that there is low risk in concluding a transaction with China Resources Pharmaceuticals on the following grounds . China Resources Pharmaceuticals are a State Owned Entity (SUE) - China Resource Pharmaceuticals were introduced to HSE through government and diplomatic networks . A desk top due diligence exercise by has returned no obvious issues of concern Developments Highly credible and highly reliabie intelligence has emerged in the past number of hours suggesting that supply lines are tightening significantly and there is a need to conclude this transaction in the shortest possible timeframe. A further issue on supply line contraction arises and that is the distinct likelihood that HSE may only be able to conduct one transaction with the secured manufacturer. It is therefore prudent and appropriate to consider increasing the "initial order" to a volume that will reduce any risk of under supply. 4.4 HSE suggest a 2.5 times uplift to the total initial order. This estimate is in the absence of any detailed epidemiological modelling data and is based solely on commercial and inventory considerations. The estimated volume and value of a revised order is as follows; Ptoduct. masks (830W Surgical Masks leach) Gloves (pairs) Protection {Face Shields Goggles (eachll Gowns (each) Total Estimated Value :mum Egg ?win: .n (Magi; Re: Approval Requests to DPER and 3? Robert .?Vatt to. ?Ronnie Downes ?FergaLGoodman@health.gov.ie' 17t'03t'202?' 10:05 Approved - Robert Sent from my iPhone On 16 Mar 2020. at 1 1:12 pm, "secgcn@l1ealth.gov.ie" {secgcn@hcaltlt.gov.ic> wrote: Robert As discussed at Cabinet Committee on 9 today. the HSE with support of the IDA has identi?ed a supplier of PPE (Personal Protection Equipment) which is a critical pre-requisite for management of COVID-19. This is in a situation of unprecedented. extreme. growing global shortage and therefore urgent execution of the proposal is required. I intend to con?rm to the HSE CEO that the commerciallcontractuai details are a matter [or the HSE out that the Department of Health - on behallofthe Government - is in a position to provide an assurance that the necessary' funding will be provided to meet this commitment. i would appreciate if. as outlined at today's meeting. you could confirm by return that the funding will be provided to the Health Vote to support this necessary ?nancial commitment by the HSE. Thank you Jim Breslin m? Forwarded by James on 22.55 m? From Dl'?ce? To. "Jim Breslin. (PA Clare Ftuddeni? Date: 15ft13I2020 22:52 Subject: FW: Approval Requests to and Jim See attached. Raga rds, Paul Paul Reid Chief Executive Pol Maoildearg Feidlimearmach Phriomhoifigigh Feidhmit?rcliain iUrlair LDspid?ai an Dr. Steeyensl Baile i?itha Cliath 3 DOS w2h3 Rphost: ceo.oilice@hse.ie Teii: [335 [Greastim Cuimhnigh or an timpeallacht sula eclobhuaiann tti an Rpltost see Paul Reid Chief Executive Dilice of the CEOIHSE I Floor, iJr. Steeyens' Hospital IDuhiin 8 Eircode DDS Email: g1 IWeb: Please consider the Environment before printing this e-mail @iiseliye Important Information in this email (including attachments] may be confidential. it is intended for receipt and consideration only by the intended recipient. If you are not the intended recipient. any use. dissemination. disclosure, pubiicationorcopying of iniormation contained In this email tin eluding attachments} is strictly prohibited. Opinions expressed in this email may be personal to the author and are not necessarily the opinions of the Health Service Executive. If this email has been received by you In error, please notify the sender and then delete the email from your system. Original message From: SEAN BRESNAN Date: 16i03i'202ii 22:28 To: CEO Of?ce Subject: RE: Approval Requests to DPER and Doi-I No prohiEm Paui. i have changed dates 0 both fetters to re?ect issue date of tomorrow. There is one further doe required and that is a ietter of authorisation {attached} which Minister Harris is required to sign. will have to out ch headed paper. Itincl Regards. Sean Sean Bresnan National Director of Procurement Health Business Services. Health Service Executue Dr. Steerens' Hospital. Dublin and oliop?ihsom DD 3531635 22 51 mass? From: CEO Of?ce Sent: Monday 15 March 2020 22:19 To: SEAN BFIESNAN Subject: RE: Approval Requests to DPER and 00H Sean Thanks. Int exhausted! Can i send these ofi??rst thing In morning. Regards, Paul Paul Reid Chief Executive Pc'rl Maoildearg I Priomhoifigeach Feidhmeannach an Phriomltoiligigh Feidhmitichain Urlar LOspideal an Dr. Steevens Baile tithe Cliath I 003 WIZA3 Rphost: Mm Teil: .IGreasan: Cuimhnigh ar an timpeallacht sula gclobhualann it's an Rphost see Patti Reid] Chief Exeurtive Ollicer Oflice of the HSE I 11- Floor, 0r. Steevens' Hospital 0uh in SIEircode 003 WZr?tSl Email: cenollice?hseieITeI: (135;. Iii-Job: Please consider the Environment before printing this email @liselive youtulsororn?li?tIreland Important Information in this email (in eluding attachmentsi may be con?dential. It is intended for receipt and consideration only by the Intended recipient. Ifyou are not the Intended recipient. any use. disSeminatinn, dIsclosare, publication or copying ol intermation contained In this email [including attachments] is strictly prohibited. Opinions expressed in this email may be personal to the author and are not necessarily the opinions of the Health Service Executive. If this email has been received by you In error, please notify the sender and then delete the email lrorn your system. Original message From: SEAN BRESNAN Date: l6i03f2020 22:02 To: CEO Of?ce ltse.ie>~ Subject: Approval Requests to DPER and Deli Paul. As reanested. please find attached letters requesting approval for expenditure. I have drafted one for each Sec Gen in each Dept. I have dated them as of this evening. I trust these are in order. Kind Regards. Sean Bean Bresnan National Director of Procurement Health Business Sen-lees. Health Service Dr. Steeiens' Hospital. Dublin and ohog??hseie 1-00 3531635 22 51 M: 00353! Need information and advice on Go to "Ta an thelsneis sa riomhphost seo iceangattain san aireamh) taoi run. Baineann se leis an to or seoladh chuige amhdin agus ta se or intinn go bht?aigh?dh siadsan amhain agus gurb iadsen amhain a dheanfaidh breithniir air. Mtis rud nach tusa an duine ar leis e. to cos: iornlan or sun lhalsn?ls ata arm. a usaid. a chraohhscaoileadh. a scalpeadh. a nochtadh. a thoilsit'r. no a choipeail . Seains gurb iad tuairirni pearsanta an odor ala san riomhphost agus nach tuairimi 35 fad. Ha fuair to an riomhphost see tri dhearmad. bheadh muid buioch da gcuiriea in tuit don Deasc Seirbhisi ECT or an nguthan ag ?353 813303300 no or an riomhphost chuig agus ansin glen an riomhphost sec- ded' chdras.? ?interruption in this email {including attachments} ls con?dential. It is intended for reneipt and consideration only by the intended recipient. it you are not an addressee or intended recipient. any use. dissemination. distribution, disclosure. publication or copying oi information contained in this email is strictly prohibited. Opinions expressed in this email may be personal to the author and are not necesswily the opinions of the HSE. this email has been received by you in error we would be grateful it you could immediately notify the ICT Service Desk by telephone at 353 etc 10:1an or by email to tier'irice dest?hseie and thereafter delete this e-rnail from your system? Email Disclaimer and; Legal Notice: . iirr' r'rr rirr?i' r'ri is um! rit- riri' use white ifl?l'ul'l? mt' rm rri'rirrit rrirrsr rfis'r?i'ust'. rirr?x it! it. this terror"! in grit-tru- imir'ii' my rritrr? rft'i?t'rr' rrir? t'uytr't'n rif'ritis' i?r't'm'r- this r?tyrii' tiri'i't'r'rr r'rr .t'rrirfi'i-i remit-Jr firr' in . it Ta an are? so Homhphasr 5330 {signs in am] Cheanyu?jnu .I'am ram agus J's don na rcifgmcoiu' beanar?me agus e'?'ad sin amh?m. Mum msa an far'gmeoir {Jearra?ha ?For chem! duff "m leacmaneacm 50v mi 3cm chm?! a lis?fd a nochradh. a woman. a chair?cad? m} a chor'mm?ff. Sc: 12'th gm fn' caught! a Mm} an riomhphosr sea. {airman {Gym dam Fairfhrenm'r faor sin aym: scuos gash cam den sec: (3 do Tabhm?r fan! yo J'Jhr?adfar'dh an .r'r'omhphosl sea agus am: mreaym cs Hg air hher'rh faoi r?a?r mum-rm a: a {H'sn'rim d0 Mum an Achm um Shanr?r'! afsu?r'se HES EH: Page 1 of 3 RE: FW: Approval Requests to DPER and BRESNAN to: 17/039020 20:43 Ce: From: SEAN BRESNAN To: Cc: - History:This message has been replied tof 1 Attachment a Letter of Authorisation v0.2.docx Paui, My apologies for the delay in reverting on the query you raise in reiation to the Letter of Assurance. Today has been hectic! . mew-Ini- i terms of delivery of batch '1 we are aiming to have delivery towards the end of this month and includes for example the following . 6.5m surgicai masks asks face shields goggles The total order value for batch 1 is circa ?3lrn in terms of iogistics, are sopporting us in securing the carrier. Once the first consignment has landed we take stocks to a centre! and secure location for built breaking and issue to frontiine. We are intending to secure the support of the Defence Forces to transport stock from airport to secure location. i trust this is in order and i look forward to receiving the to aiiow us to proceed Kind Regards, Sean Sean Bresnan National Director of Procurement Health Business Services. Health Service Executive Dr. Steevens' Hospital. Dublin 8 and ohop@hse.asa? 1C5N~web3 8132.th 1 Page 2 of 8 with 3 {teem-s: TN rum. a? d. . e! Hi! From: [mailto:Paul Bolper@health.eoy.iel Sent: Tuesday 1? March 2020 11:09 To: SEAN BRESNAN Cc: Subject: RE: Fw: Approval Requests to DPER and Del-I Seen Can you please include Mary Hyland on the reply - Mary is the lead from the Department on this subject. Thanks Paul Paul Bolger Director, Resources Division An Roinn Sl?inte Department of Health Bloc 1. Plaza Miesach. so - sa Braid Bhagoid iocmaraoh, Belle Atria Cliath, one Block 1. Miesien Plaza. 50 - 58 Lower 83990! Street. Dublin. DDZ XWM paul boloeriaheallhooyje DeSiynefed Pubiio O?iciai under the Reguialion oi Lobbying Act 2015 From Paul BolgeriSLAlNTE To' Ce: "seeoenr?lheallheomie" ssecoenriiheallhooyjee. ofocaJhseje Dale: 1?i03i2020 10:40 Subject; RE: Approval Requests to DPER and - Im? - - - . Just copying Stephen leu'iiC :f em pinotes?tl CSAf~web3 382.htm 13i03i2020 Page 3 of3 Sean, Many thanks for the letters and well done to you on your team. With regard to the tetter of assurance 'for the Minister - your assurances below are welcome - the letter the Minister is being asked to sign does state the this companv will be the "sole purchasing entrusting part3.r for the Government of Ireland in China in relation to the medical equipment necessary;' to support the managementof new corona-virus pneumonia epidemic in Ireland" Do vou have legals advise underpinning the response to ill so that I can assure the Minister. Also, what is the expected date of first delivery.r and can I get some detail on the logistics on the ground in Ireland - to provide to the Minister. Given the circumstances and the time frame we are operating under, the Departments is considering the ?nancial aSpEEts onlv. ltind regards Paul Paul Bolger Director. Resources Division An Roinn Sl?inle Depanment of Health Blot: 1. Plaza Miesach. SD - 58 Braid Bhagdid iochtarach. Baile ?rtha Clialh. D02 XW14 Block 1, Miesian Plaza. 50 - 58 Lower Baggot Street, Dublin. D02 XWM +35316354?ii? paul holoer@health.oov.ie Designated Public Otticiat under the Regulation of Lobbying Act 2015 From: BRESNAN Paul Boleer@health.g0v.ie; Fergal Goodman@health.pov.ie Subject: Re: FW: Approval Requests to DPER and Thanks Paul.That's gone to DPER. Some questions in the meanwhile: Does the HSE consider that the Letter of Assurance restricts to an unreasonable degree the HSE receiving goods from any other Chinese suppliers connected with the pandemic e.g. existing suppliers or potentially. for exparnple. the Huawei contact I sent on earlier? I understand that delivery would commence in the coming days but it would be helpful if you could provide the delivery schedules referred to please? What quality standards will govern contract for these products? You mentioned HPRA involvement at the Cabinet Committee today. It will be important that ef?cacy is assured while minimising regulatory delays. From. Of?ce? 10' "Jim Breslin. (PA Clare Ruddenj' ssecgeng?iheaithgouie: Date: 1 22:52 Subreciz FW: Approval Requests to DPEH and WA Jim See attached. Regards, Paul Paul Fteid Chief Executive Pol Maoildearg Priomhoiligeach foidltmeannatir Oilig an Phrr?omhoifigigh Feidhmirichain Urlar LOspideal an Dr. Steevens Baile ritha Cliatir 3 DDS WZAS Rpirost: ceo.oilice@hse.ie Teii: 635 Gr?asan: Cuimhnigh ar an timpoallacitt sula gciobhualann to an Rphost seo Paul Reidl Chief Executive Officer Of?ce of the HSEI 1? Floor, Dr. Steevens' Hospital Dublin SlEircode DDS led/{C amp/note554 CSAf~web3 332.]1tm 18f03r?2020 Page 6 of 8 WZAEJ Email: (eo.ofiitul?ihse.ie ITel: 01 (:35 .-IWeb: wwarseJe Please consider the Environment before printing this e-mail @hselive youltilio.cnranSEirolend Important Information in this email tincluding attachments} may be con?dential. It is intended for receipt and consideration only by the intended recipient. If you are not the inte nd ed recipient. any use. dissemination, disclosure, publication or copying of Information contained in this email [including atlachme ls strictly prohibited. Opinions expressed In this email may be no tsunal to the author and are not necessarily the opinions oi the Health Service Executive. ll this email has been received by you In error, please notify the sender and then delete the email lrom your System. - Original message From: SEAN BRESNAN Date: l6l03f2020 22:23 To: CEO Of?ce Subject: RE: Approval Requests to DPER and No problem Paul. have changed dates 0 both letters to rellect issue date of tomorrow. There is one further doe required and that is a letter of authorisation (attached) which Minister Harris is required to sign. will have to put on headed paper. Kind Regards. Sean Sean Elresnan National Director of Procurement Health Busmess Services. Health Service Eseeutrvo Dr. Stc-et-ens' Hospital. Dublin 3 and ohop?hwm 1:033531635 22 51 0035; From: CED Office Sent: Monday 16 March 2020 22:19 To: SEAN BRESNAN cseanhresnan hse.ie> Subject: RE: Approval Requests to DPER and Sean Thanks. Im exhausted! Can I send these off?rsl thing in morning. Regards, 1C5Al~web3331htm I 8l03l2020 Page 7 of8 Paul Paul Reid Chief Executive Pol Maoildearg Feirlhmeannach I Dilig an Feid "chain Urlrir 1,Dspid?a an Dr. Steeyensl Belle Atha Cliath 3 DDS WZAE II-lphost: ceo.oflice@hse.ie Tei : 635 Greasan: t-rww.ltse.ie Cuimhnigh ar an timpeallacht suia gclohhualann it] an Rphost see Paul Reid Chief Executive Dilicer I Office of the Floor, Dr. Steeyens' Hospital IDublin 3 Eircode DDS WZASI Email: ceo.oflire@hse.ielTel: (ii 635 - Web2 Please consider the Environment before printing this e-mail wwatseJe I @hseliue youtuliemrimmSEIreland Important Information in this email [including attachments) may be confidential. It is intended for receipt and consideration only by the intended recipient. If you are not the intended recipient, any use. dissemination, disclosure, publication or copying ol information contained in this email [including attachments} is strictly prohibited. Opinions expressed In this email may be personal to the author and are not necessarily the opinions of the Health Service Executive. If this email has been received by you In error. please notify the sender and then delete the email from your system. Original message From: SEAN BRESNAN Date: 161?03f2020 22:02 To: CEO Of?ce ll'licurr'rilise.ie> Subject: Approval Requests to DPER and Doll Paul. As requested. please find attached letters requesting approval for PPE expenditure. I have drafted one for each See Gen in each Dept. I have dated them as of this eyemng. I trust these are in order. Kind Regards. Sean Sean Bresnan National Director of Procurement Health E'lhsmess Sen-ices. Health Sen-lee Executive Dr. Stcet'ons' Hospital. Dublin and ohopr?hse it- 1:00 3531535 22 51 353? eid:imageDliE.j [3.25003 1 CU Need information and advice on Go to mrrw.Eiseler?coronavirus "Ta an fhaisn?is sa seo {oeangallain san aireamh) laoi rt'in. Baineann so leis an id at seoladh ehuige amh?in aQUs ta se or intinn go hhfaigh?dh siadsan amhaln agus gurb iadsan amhain a dh?anfaidh bteithniti air. Mats rod naeh lose an dulne ar leis t? cost: pfnotesS4 lCSN~web3381htm 1310322020 Page 8 of 3 iomian ar aon fhaisn?ls ata arm. a (radio, a chraohhscaoileadh. a scalpeadh. a nochladh. a fhoilsiu. no a choipeail . Seains gurb iad tuairimi pearsanta an udar ata san riomhphost agus naeh tuairimi F55 lad. hula fuair to an riomhphost seo tri dhoarmad. oheadh moid huioch da gratirfea in tail don Dease Seirohisl ECT ar an nguthan an .353 are 300300 no ar an riomhphest chuig agus ansin glen an riomhphost sec ded? mores.? ?Information ln this email (including attachments} is con?dential. it Is intended for receipt and consideration only by the intended recipient. If you are not an addressee or intended recipient. any use. dissemination. distribution. disclosure. publication or copying of information contained in this email is strictly prohibited. Opinions expressed In this email may be personal to the author and are not necessarily the Opinions of the HSE. If this email has been received by you in error we would be grateful if you could immediately notify the Service Desk by telephone at *353 313 300300 or by email to serve-attesti??hseie and thereafter delete this e-mail trom your system' Email Disclaimer and; Legal Notice: Need information and advice on 9? Go to ?To an mane-s rim-mphost teenngalum an ?l?ll'l'lh} taoi rart Benson so has In to or see-loom returns- ?than and: to so or tram no pertains-man siaoun nous euro too son ornham I one: Motor: mete-no lrr. in: red noel-r tus- an done or leis s. to cos: lomtan or sort moist-16.1 son. a asaid. I maehhscaode eon. I a nod-men. Mimi. no a mar-ear. Sean: euro tad mainml pennant: an odor can rternt-rphosl anus rum minmr F55 ind, Isl: their to an see orient-road. breach more outed-i as emu-lea in not aim Dense Seironlsl eer or on a: .353 eta or on nanny-.031 comp senu- new: he: re onus enstn plan an nomhormt see ded' mores.? 1nterrnerion in this err-at [Inducing ornaments} is con?dential. It is intended for receipt and mmemm only by the ?ooded recount If you are not an odor-om or intended moment. Il'ly use. dissemhation. common. diatom. copy-1n of infant-moon contained in this errant rs strictly prohibited. Opinion-ts expressed to this era-rel may be Personal to the outlet and are not necessarily me opinions oi the HSE. It Du ems-I has been reoened by you in error we mud on oratetul you cook! immediately natty the In! Service Desk hy telephone ll +353 MEI aoosoo or by emit-J to Len-?4: dosh-'1 Ilse Ie Ind thereafter delete an e-mn-I from your system' [attachment "dep-neov.pdf" deleted by Paul Email Disclaimer and; Legal Notice: Need information and advice on 9? Go to mvw.hse.iefeoronavirus on nurses-rs so nomhphost see tulogo'tain son Mean-I ht foo: rim. Baneann so leis on to or sectadh ctr-um amt-Lain I?u! to so or inonn no bmli?hn?r?h stud son mun nous out iadsnn amt-lain orient-stators orerdsnu sir. Mas rud rte-:1 ton on dame or lei: e, to cost: tendon or Ion hast-leis Ito um. I used. a a ourpeaan. nest-rum. a mind. no I mental . Seams port: rad tomnmi pennants In that out Ian lit? nadl Minna: :55 m. fuitr to an sec in cnesrrnao. cocoon oufoc-t ca omitted tn don Beast: Seimnist ECT or on naudtln ID 0353 Btu seasoo no or on riomhpho it We serum-designate anus ansin glen an rtemhphu-u ded' mas} 'tntormeoon in this errta: (including enactments) corrodermal. ft is intended for receipt and Gomlde?w} onty by the istenoed monient. t! you are not on addressee or intended Witter-l. In! It". dissemmeon, out?ow-on. e-sdowe. or copy-no oil mtorrnatro-n contained in this emei I'l- Iu-i-ctfy promoted. Opinions expressed to ln's em- I may be ?ctional to the author Ind are not necessarily the opinion: at the HSE. If this smart has been receneo by you no error we would be numeral it you could trornedotely natty the ICT Ben-ice Desk ey telephone at +353 BIB aoosoo or by Etna-i to and thereafter delete this e-rnsi from your system? 13f03r'2020 This file was {rent-rand using an evaluation version of Convener. 'v'isil wrnv.mulumbicdrn lo: more information. March 2020 Mr Paul Reid Chief Executive Office Office of the Chief Executive Of?cer Dr. Steevens? Hospital Dublin DUB W2A8 Dear Paul Re: Approval Request for Expenditure associated with in refer to your correspondence received last night regarding the framework contract the HSE intends to execute today for the supply of Personal Protective Equipment at a cost of ?208 million. I note that this issue was also discussed at the Covid-lB Cabinet Committee yesterday. i can confirm that the necessary funding of up to ?208 million will be provided to the HSE to meet this commitment. The commercial and contractual details of the transaction are a matter for the HSE. Following completion of the transaction please provide: Final and full details of the transaction, Full details ofthe financial commitment and specifically timeline for cash drawdowns, Detail of the agreed delivery schedule, and A report on the progress against the delivery schedule and cash drawdown. Kind regards Jim Breslin Secretary General Tlus file was generator: using an evaluation version of Documenl Convener. Vlad for mom Information. Department of Health approve the expenditure in the amount of 003,000,000 in respect of a framework contract arrangement we must enter into with China Resources Pharmaceutical Commercial Group International Trading Co., for the supply of Personal Protective Equipment (PPE). I can confirm that this expenditure is absolutely necessary and is associated with the COUID- 19 epidemic. I would be grateful if you could revert to me with the necessary approvals as a matter of extreme urgency as the contract needs to be executed no later than 3pm today 17 March 2020. Kind Regards, Paul Reid Chief Executive Officer 1 March 2020 This Me was. germaled usmg an evaruatiun DI Muhimln'ti Bowmanl Convener. Visit mun-muhimhi.c0m to: mate information. Eff-?F: Appendix II Ihzs file was generated usmg an evaluarian versron of l.?.uhuntn?s Docmnen: Converter. \I'rsl: lot rrtore inlotruatiort. I7 March 2020 Mr Paul Reid Chief Executive Of?cer Of?ce of the Chief Executive Of?cer Dr. Steevcns' Hospital Dublin DOS W2A8 Dear Patti Re: Approval Request for Expenditure associated with I refer to your correSpondence received last night regarding the framework contract the HSE intends to execute today for the supply of Personal Protective Equipment (PPE) at a cost of ?208 million. I note that this issue was also discussed at the Covid-I9 Cabinet Committee yesterday and at the HSE Board last night. I can con?rm that the necessary funding of up to ?208 million will be provided to the HSE to meet this commitment. The commercial and contractual details of the transaction are a matter for the HSE. Following completion of the transaction please provide: Final and full details of the transaction. Full details of the ?nancial commitment and Speci?cally timeliae for cash drawdowns. Detail of the agreed delivery schedule, and A report on the progress against the delivery schedule and cash drawdown. More generally, on foot of discussion yesterday allied to last week?s Government approval, our two Finance teams should meet to review the ?nancial implications of all other proposals and agree a formal process for approval. monitoring. reporting and cash management. Yours sincerely Bresr'r'n Secretary General