New Year periods are always busy in the Irish health service, but this one is different from any other.
The combination of winter, flu and the Christmas holidays usually sees trolleys lined up in the corridors of hospitals in early January. This time last year, about 750 patients were hospitalised with flu and in the first week of January a new record for trolleys was set, with 760 patients left waiting for admission.
This year, there is, strangely, no flu, far fewer trolleys and the number of respiratory patients in hospital is in line with that seen in a bad flu season. But not for long, given the steep upward graph of Covid-19 infections of recent days.
Hospital Report
By Sunday morning, there were 673 coronavirus patients in hospital, up 100 in a single day, and by 2pm that number had further increased to 685.
Health Service Executive chief executive Paul Reid says the growth rate of the disease is now 15 per cent, up from 11 per cent before Christmas.
While expressing concern about these increases, Reid says the system is not overwhelmed “at this stage” and describes the situation in intensive care as “not too bad”, despite a recent rise in the number of very sick patients.
There were 643 free general beds and 43 in ICU on Sunday. The HSE has yet to make use of its surge capacity in either area and could call on private capacity in extremis.
However, as infections rise the ability of the service to respond lessens as more staff are forced to go off work due to being a case or a contact. As a result, more than 400 beds are currently out of commission.
The number of hospital patients could reach 1,300 and those in ICU 300 by the end of the month, HSE chief clinical officer Dr Colm Henry forecast on Sunday – and that’s assuming complete adherence to Level 5 restrictions.
In the community, GPs are seeing about 10 times the number of likely Covid-19 cases they were a month ago, according to Dublin family doctor Shane McKeogh. Since March, McKeogh has been surveying GPs daily to track the progress of the virus, thereby providing an early-warning system for what might lie ahead.
The tracker system, run with GPBuddy, TCD and the Irish College of General Practitioners, shows the sharp rise in cases started in the week before Christmas and has continued.
On average, GPs were seeing one likely virus case a day in their surgeries in the first week of December, he says. Before Christmas, that jumped to three to four, and by December 29th it was up to nine. Though the trend was national, the tracker showed up particularly big surges in specific areas, such as the steep rise in cases in Wexford that has been linked in part to funerals.
It is difficult to compile reliable figures over the Christmas/New Year holiday season and the most recent data from the tracker is from December 31st, but McKeogh says out-of-hours services were “incredibly busy” over the weekend.
“We would expect the numbers to continue rising at this level until, eventually, the lockdown breaks the chains of transmission,” he says.
‘Difficult few weeks’
Dr Catherine Motherway, immediate past-president of the Intensive Care Society of Ireland, predicts a “difficult few weeks” ahead.
“If people do what has been asked of them, we’ll be able to stop transmission of the virus and the rise in pressure on the health service,” she says.
A failure to bring the disease will place hospitals and the wider health service under “tremendous pressure”, the Limerick-based consultant added.
Compared with the first wave, patients coming into hospital in this surge tend to be slightly older and sicker, she says, and so mortality rates may rise.
Motherway says the reason infections have taken off since before Christmas is simply because “we mixed too much” and are now paying the price.
Hospitals still have capacity at present but those without single rooms for patients may be the first to see services affected by the need to control infections and protect patients.
She remains sanguine about our ability to turn the tide.
“The Irish public have done this really well on two occasions; they’re just going to have to do it again now,” she says.
“The best way of not dying of Covid is not to get it in the first place.”