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'Is the care of the same standard? No': Hospitals under pressure as ICU capacity approaches surge limit

There are 211 Covid-19 patients in ICU, with a further 330 patients receiving advanced respiratory care on wards.
Jan 22nd 2021, 7:14 AM 54,263 83

Updated Jan 22nd 2021, 1:00 PM

HEALTH OFFICIALS HAVE warned the situation in hospitals is now “extremely high risk” as the system approaches the limit of its critical care surge capacity.

There are 211 people with Covid-19 in Irish intensive care units and a further 330 patients are receiving advanced respiratory support on wards outside of an ICU.  Almost 20% of all hospital beds are occupied by Covid-19 patients.

Speaking to the Oireachtas Health Committee this morning, Dr Vida Hamilton, national clinical advisor and group lead, acute hospitals, said now that hospitals are at surge capacity they had to “deploy different methods of staffing” to ensure the best care.

“Our critical care nurse escalation plan is in place. We trained over 1,600 non-critical care staff to support critical care services,” she said.

“We deployed them initially in a one-to-one ratio, working directly with a critical care nurse in a buddy arrangement in the first instance.

“Then as we entered surge, we had one critical care nurse supervising two and then three non-critical care nurses, but maintaining a nurse-patient ratio of one-to-one for optimal safety.”

She said there is daily contact with staff and monitoring of the situation in each hospital.

“Is the care of the same standard? No,” she added. 

Also addressing the committee, the HSE’s Liam Woods said that there are currently over 6,500 health workers on sick leave in acute hospitals.

He said 2,500 are nurses and 600 are patient-facing administration staff.

Woods said the situation in hospitals now is different and “even more challenging”, in part due to the increased transmissibility of the virus. 

“Clearly in a system where we have significant staff absences and very significant surge and high community infection we are concerned about risk,” Woods said.

“We are working and staff across the system are working to mitigate that risk but it would be unrealistic to expect the same outcomes as in previous times.”

Currently there are 500 vacant beds in the hospital system primarily due to staffing. 

‘Battling hard in hospitals’

“We’ve never seen 66% of patients in ICU (211) being treated for the same illness. We’re battling hard to sustain safe levels of care, but its getting harder,” HSE CEO Paul Reid said earlier today.

There were a further 2,608 cases of Covid-19 reported yesterday, and 51 deaths.

Speaking on Newstalk Breakfast, Paul Reid said that something is “very different” about the level of transmission and the number of cases.

“Something is extremely different, where we’re seeing whole families sick within a household, sometimes families admitted into our hospitals… We’re seeing something extremely different happening with transmission levels.”

In the past 14 days alone, there have been 2,700 admissions to hospital, and 33 patients with Covid-19 moved between hospitals to manage capacity issues.

Responding to the statistic that third of patients contracted Covid-19 while in hospital, Reid said that healthcare systems are “extremely exposed” to the levels of Covid-19 in the community, and it’s impossible to put a “ring of steel” around our healthcare system.

On the vaccine, Reid said that if the AstraZeneca vaccine is approved, there will be “1 million deliveries per month from April/May onwards”.

“All the data is predicated on a huge, huge level of assumptions that we hope come true.”

Responding to lobbying groups’ requests to be moved up the priority list for the vaccine, Reid said that he understands the call from people asking to get the vaccine sooner, but said that it will be guided by the National Immunisation Advisory Committee – and not politicians.

Mandatory quarantine

Several members of the Oireachtas Health Committee this morning questioned Deputy Chief Medical Officer Dr Ronan Glynn on the need to implement a mandatory quarantine on those arriving into the country.

He said travel imposes a very significant risk to the suppression of the disease in Ireland.

“NPHET is in favour of avoiding all non-essential travel in the first instance, that’s the most important measure. And beyond that, our advice is there, it’s published, we’ve preciously asked for mandatory quarantine and recently we asked for any element of discretion as it applies to travel to be removed insofar as is possible,” he told the committee members.

“But we’re not the experts on what’s possible. What we want is a situation is where non-essential travel is reduced to the greatest extend possible through whatever means are required.”

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Yesterday’s briefing

The R number has reduced to between 0.5 to 0.8. If it remains at that level, then it’s expected that there will be between 1,600-1,700 cases per day by the end of the month.

NPHET members said yesterday that it has concerns about the incidence rate in people over 75 years of age, and the “worrying” number of outbreaks in longterm residential and healthcare settings.

Professor Philip Nolan said that from now, we can expect the number of people in hospital to slowly reduce as Covid-19 cases have “plateaued”.

In a letter Dr Tony Holohan wrote to the Health Minister Stephen Donnelly last week, he said that there would be between 500-1,000 deaths in the month of January alone. 

At last night’s Department of Health briefing, Holohan said that he had no reason to change his view. So far, there have been 523 deaths of people with Covid-19 in January.

- With reporting by Michelle Hennessy.

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