Our hospitals are once again on a war footing and there is a concern in doctors’ voices that has not been heard at such a level since they faced into the unknown at the start of the pandemic.
orecasts that 400 to 500 Covid-19 patients may need an intensive care bed by next month are chilling.
The crisis no hospital wants to have to cope with is where doctors, faced with a serious shortage of beds, have to make stark decisions to prioritise treatment for patients with the best survival chances.
There are just 301 permanent intensive care beds across the country. In March 2020 there were 256.
With surge capacity – where other parts of the hospital such as anaesthetic rooms are scaled up – that could now potentially be increased to around 360.
Staff will need to be redeployed and brought from other wards to service these surge beds, which means they are lost to other patients with inevitable cancellations.
The highest peak in the number of Covid-19 patients in intensive care was seen during January, when they reached 215.
The highest number of Covid and non-Covid patients at any one time was on January 26 last when 330 were seriously ill.
Exhausted frontline workers hoped that with the arrival of Covid-19 vaccines they would never have to battle that kind of emergency again.
But with soaring cases of the virus in recent weeks, the frightening spectre has returned – and there isn’t the safety valve of lockdown this time.
Around half the Covid-19 patients in intensive care are unvaccinated, the others are fully vaccinated.
The vaccines are very good at preventing serious illness but much less so at stopping people getting infected.
Fully vaccinated vulnerable people – such as those with very low immune systems and older age groups – respond less well.
Intensive care consultants and managers from around the country are back to holding evening Zoom meetings to help them plan.
The transfer of critically ill patients during the worst of the last wave helped in the management of the caseload.
Earlier this week, Dr Colman O’Loughlin, intensive care specialist in Dublin’s Mater Hospital, said: “Each time we faced into this from a frontline perspective we were reassured lockdown would work and turn the numbers around. It is now unclear to us what the trigger event will be to turn this around.”
It remains to be seen what level of impact the measures announced by the Government yesterday will have, or how soon.
They include the widening of the Covid-19 booster shot roll-out, the work from home recommendation, and new rules around restriction of movements in households with a positive case.
But, in the meantime, a significant portion of people who recently tested positive are already destined for hospital. The hidden victims again are the non-Covid patients whose planned surgery or other procedures are cancelled.
Hospitals have been spending the last few months trying to catch up with delayed waiting list patients but they are now having to impose another round of postponements.
Record numbers of patients, many very sick or over 75, are attending emergency departments. The HSE’s €77m winter plan is very much dependent on the same formula as last year with a reliance on private hospitals with 1,100 bed days per week.
As well as an option of some intensive care beds, it is rolling out more community supports to reduce the chance of people having to go to hospital.
The HSE has to have the staff if it wants to open 143 more beds before the end of the year. And there is the threat of a flu outbreak looming around Christmas and the New Year that was absent last winter.