It was towards the end of November when health chiefs began signalling influenza was circulating at high levels in the community. The winter illness surge was earlier than normal.
This, Bernard Gloster, head of the HSE, said indicated the flu virus was likely to peak at a time of key socialisation: during the weeks of Christmas and new year.
Adding to this, the current strain in circulation – called A(H3N2) subclade K – is particularly virulent, making it more infectious and more severe than those that circulated in more recent years.
The European Centre for Disease Prevention and Control (ECDC) issued a risk assessment, stating this strain of the virus had not been the dominant virus in recent seasons, which may lead to lowered immunity in populations without recent exposure. However, the ECDC said it was still important to get vaccinated.
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“Even if a less well-matched A(H3N2) virus dominates this winter, the vaccine is still expected to provide protection against severe disease, so it remains a vital public health tool,” the ECDC said.
Concerns have been raised about how well-matched the vaccine is to this season’s strain, but Dr Colm Henry, chief clinical officer of the HSE, believes the vaccine on offer is “highly effective”.
The health service earlier this year cancelled a tender for “enhanced” flu vaccines – designed to better protect those aged 65 or older from severe illness and hospitalisation – on cost grounds.
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While the Irish health system acknowledges the greatest tool in its arsenal against influenza is vaccination, uptake rates are well below target levels.
Figures from the Health Protection Surveillance Centre up to the end of November show 18 per cent of children aged between two and 17 have received a nasal flu vaccine, compared to a target of 50 per cent.
For adults aged 60 and older, the uptake rate is 56 per cent compared to a target of 75 per cent, while HSE healthcare workers are at 26 per cent against a target of 75 per cent.
Uptake rates are much better among those in nursing homes under the State’s Fair Deal Scheme at 80 per cent, higher than the target of 75 per cent.
Appeals to the public to get vaccinated have stepped up.
Pressures on the health system are already beginning to show.
HSE figures show there were 434 patients on trolleys as of 8am on Wednesday, with 308 of those being in an emergency department. Furthermore, 70 patients were waiting more than 24 hours for a bed.
Some hospitals in the Munster region have had to impose visitor restrictions to help stem spread of the virus.
Latest figures show a 12 per cent increase in children attending hospitals this November, when compared to last.
Kim Price, clinical nurse manager at Temple Street Hospital’s emergency department, said they were seeing “huge numbers of patients presenting”.
“We’ve seen an additional 500 patients this November in comparison to last. A lot of them are respiratory illnesses. Lots of fevers, lots of respiratory illnesses,” she said.
“We’re now seeing a backlog of admitted patients in the emergency department. We’ve had patients who are over 24 hours in the emergency department.”
The hospital and the Children’s Health Ireland hospital group were “working hard and there are lots of escalation meetings to avail of beds, but it’s a challenge”, Ms Price said.
Last year was the first the State offered free vaccination against respiratory syncytial virus (RSV) to neonatal babies, resulting in a significant drop in the numbers in hospital with the virus.
This year, eligibility for the jab was expanded to children aged six months and younger.
Ms Price said this would have a positive impact on RSV in hospitals, but she said the numbers were beginning to rise currently.
The main issue for health officials is whether hospitals will be able to withstand the pressure in coming weeks.
The answer really comes down to capacity, which is something the Government has sought to address by opening an additional 1,218 acute inpatient beds between 2020 and 2024.
But it is clear current provision of beds is still not enough to meet demand, and the Economic and Social Research Institute (ESRI) forecasts this disparity will become more pronounced unless additional beds are provided due to our ageing population.
All of these things combined – a highly virulent strain, lower-than-optimal vaccine uptake, an ageing population and bed shortages – paint a daunting image of how much pressure the hospital system could be under this Christmas.
