iSpeak Blog

COVID Alliance - How the ISPE Helped Ireland Respond to COVID 19

Eamon P. Judge
COVID Alliance Structure

Early in March 2020, many around the world viewed the sight of collapsing intensive care units in Northern Italy, overwhelmed by COVID19, with great anxiety and we wondered how we might address the inevitable arrival of the virus at our doorsteps. This concern led to a home-grown initiative in Ireland that brought together representatives of health, commercial and academic organisations working on a voluntary basis with professional and business societies to anticipate and support the needs of the Irish Health System (HSE) as it responded to the pandemic. This informal voluntary grouping of organisations was called the COVID Alliance.

Figure 1
COVID Alliance Structure

The Alliance was led by the Ireland Affiliate of the International Society for Pharmaceutical Engineering and early members were some pharma companies including Eli Lilly and four of the major engineering firms, (Arup, DPS, Jacobs and PM Group) who quickly offered pro bono or at cost staff to assist the effort and join the daily conference calls.

Figure 2
COVID Alliance

An early and somewhat depressing but necessary need identified by the HSE was the construction of additional temporary mortuary capacity across the country. In less than 24 hours the partners assisted by pharma procurement personnel worked with modular refrigerated storage suppliers and specialist stainless steel fabrication companies to establish proper dignified resting places for the deceased at 13 of the country’s hospitals. It is positive to hear that the subsequent magnificent response across the country that ‘suppressed the curve’ meant that most of these facilities have been not been used but the country was ready if they were required. The activity demonstrated the scale of the response capabilities of the Alliance and it quickly led to other requests.

Many hospitalised COVID19 patients require respirator support in the form on an oxygen mask or for very seriously impacted patients a ventilator. While the country had sourced adequate ventilator supplies very quickly attention turned to the capacity of the acute hospital oxygen supply infrastructure to support those ventilators. Most such systems were designed to service a proportion of beds at any one time but now with COVID19 arriving almost all outlets in some wards would be required and there was uncertainty as to whether the hospitals had adequate capacity and redundant systems to support this increased load. In other countries over the past year a number of hospitals had declared emergencies when their oxygen systems had failed.

Temporary Oxygen Installation in CityWest, Dublin patient recovery Step Down Facility
Temporary Oxygen Installation in CityWest, Dublin patient recovery Step Down Facility

The Alliance membership was expanded with the addition of other companies including Biopharma, Exyte, IPS, Prochem and RPS and the nine engineering firms mobilised teams of engineers who surveyed and modelled the oxygen systems of over 30 acute hospitals in just under 10 days. In anticipation of piping changes to debottleneck these systems, ten of the largest construction firms in the Ireland including, BMD, Dornans, Jones Group, Kirby, MSL, Radley, Mercury and Sisk joined the daily Alliance coordination calls and prepared craft teams to respond and implement any changes identified. A call out to the pharma and other industrial sectors produced a list of over 50 pieces of equipment that could be borrowed from sites and repurposed for healthcare use if additional back-ups were required. Learnings from rapid build hospitals in China were sourced with the assistance of colleagues in MNC pharma manufacturing sites in China Lilly Suzhou. Through ISPE, and partner engineering societies, volunteer utility and maintenance staff were identified to support hospital facility staff if required as it was expected that they would now have to maintain medical gas systems at maximum capacity for many weeks.

Over the subsequent few weeks, many oxygen tanks were moved around the country to support hospital needs including ones that were ‘borrowed’ from pharma manufacturing sites. The modelling studies showed that most hospitals could be configured to meet the surge patient needs but construction projects went ahead in five hospitals including for example running new supply headers to new wards that were going to be part of a COVID response. The Alliance was also asked to service wards at the new temporary ‘step down care’ facilities near Dublin with oxygen and a design and construction team had the system in place in two weeks. It was a great effort by all the companies involved many of whom are great ISPE corporate partners and in the end there were no oxygen supply issues encountered at any Irish hospitals.

As COVID19 cases increased across the country, the focus turned to constraints on testing as a key testing reagent called lysis buffer (used to extract viral RNA from test swabs) was in very short supply. At the request of the Alliance, a team of industry (Lilly, BMS, Alexion, Wuxi), hospital and academic scientists very quickly developed a scaled up optimised process to make this critical reagent. Eli Lilly assisted the development of small-scale volumes of reagent and the process research team published a paper to share their optimized process with countries around the world.

COVID19 Testing buffer reagent produced by NIBRT and Lilly
COVID19 Testing buffer reagent produced by NIBRT and Lilly

With the support of other pharma companies in BioPharma Chemical Ireland (BPCI), scarce raw materials for the optimised process were sourced by the Alliance in Switzerland and within a few weeks, NIBRT, the National Institute for Biotechnology Research and Training, another ISPE partner, was making the lysis buffer for the HSE’s testing labs. In the end a lysis buffer reagent supply-chain to support over 5 million COVID19 RT-PCR tests was created by all the partners involved.

Over the course of the past year the 50+ organisations who are members of the COVID Alliance (Figure 2) have followed up on many other needs identified by the HSE. They have been as diverse as: creating local supply chains to produce PPE such as goggles for healthcare workers from a local medical device manufacturer; to developing sanitisation processes for reuse of PPE; to the provision of ‘deep clean’ teams from the pharma facility management firms working to support the nursing home sector; and assisting a university research team begin commercialising a novel ’20 second’ home use test for active COVID19 virus.

PPE Goggles design developed by PPE Workstream with 1,000,000 units to be produced locally in Dublin.
PPE Goggles design developed by PPE Workstream with 1,000,000 units to be produced locally in Dublin.

All of voluntary assistance to the health services was provided on a pro bono or discounted cost only basis.

Midway through 2020, after sharing the activities of the Alliance at the ISPE European Affiliate Committee, the Ireland Affiliate joined with the United Kingdom ISPE Affiliate to share experiences as they partnered with the IChemE to develop a ‘knowledge exchange’ amongst companies in the UK.

Many ISPE Ireland Affiliate members have assisted many of the Alliance workstreams with the active support of their companies, many of whom are corporate supporters of ISPE activities. ‘How can I help’ was the common response by all approached about any need. Some Alliance workstreams are winding down now while others develop as new needs are identified and the current breadth of activities covered is reflected in the Figure 1 (Organogram). Malcolm Goggin and Kevin Smyth ISPE Ireland Committee members led a couple of the Alliance workstreams.

Many families have experienced tragic COVID related losses over the past year and we all hope that going forward the virus will remain under control but it’s reassuring to know that an organisation like ISPE can ‘roll up its sleeves’ and respond to any future needs in the battle as demonstrated by its role in launching and facilitating the actions of the COVID Alliance.