Coronavirus: State at ‘tipping point’ in Covid-19 struggle, says expert medic

Tallaght’s intensive-care-medicine chief says hospitals are facing a critical moment

ICU consultant Dr Arabella Fahy: ‘We haven’t been able to empty out spaces in the same way so that is a real concern for us.’ Photograph: Tallaght Hospital

ICU consultant Dr Arabella Fahy: ‘We haven’t been able to empty out spaces in the same way so that is a real concern for us.’ Photograph: Tallaght Hospital

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The Republic is at a “tipping point” in the fight against Covid-19, according to director of intensive care medicine at Tallaght Hospital in Dublin.

Intensive care unit (ICU) consultant Dr Arabella Fahy said hospitals are facing a critical moment in transmission of the virus given the rising levels of coronavirus infections again.

Tallaght Hospital has three Covid-19 patients in ICU, the most countrywide. Dr Fahy said that in March the hospital went from three patients in intensive care to nine in just two days.

“I feel over the next couple of weeks what happens in the community will determine what happens on the ground in the hospital,” she said.

There are 16 coronavirus patients across critical care units, including two each in the Mater and St James’s in Dublin, Portlaoise, Tullamore and University Hospital Limerick.

Dr Fahy said that the difference between the fight now and the infections in March and April was most healthcare services were then stopped to prepare hospitals for increasing Covid-19 cases.

This time regular care must be managed also and Tallaght’s 12 ICU beds are already full.

“Even if the numbers aren’t as high as before at the peak, our concern is the capacity to manage patients is restricted now. We haven’t been able to empty out spaces in the same way so that is a real concern for us,” said Dr Fahy, who is honorary secretary of the Intensive Care Society of Ireland.

Early response in the pandemic back in March had the benefit of being able to use redeployed staff from other parts of the hospital and repurpose areas of the hospital where elective surgeries had ceased. Now the hospital must manage Covid and normal services.

“We are now in a situation where we would be above capacity – and we are – and now we have to look after another group of patients as well,” she said.

“We are seeing more patients on the wards and more patients in ICU again.”

In all, 32 patients with Covid came through Tallaght’s intensive care unit. The total number of patients in the hospital’s ICU peaked at 16 in early April along with three or four non-Covid patients treated in additional critical care beds created in the hospital, including requisitioned children’s intensive care unit beds.

Covid-19 impact on the young

Dr Fahy hopes that some of the 17 new critical-care beds announced by the Health Service Executive at the launch of its winter plan this week will go to Tallaght which has been awaiting funding for 12 additional ICU beds since the hospital secured planning for them 18 months ago.

She said Tallaght’s intensive care unit is having the same critical illness in patients as earlier this year, but doctors are better resourced with information and experience now. This includes knowing the benefit of proning sick patients earlier – or putting them lying on their stomach during ventilation – as well as using steroids, non-invasive ventilation and high-flow oxygen on wards.

She warned that young people with no underlying health conditions, including teenagers, ended up critically ill in intensive care, some of whom are still suffering the effects of the disease.

“We are fighting a much longer war and the first battle now I feel was in March and April. It is as if we are in the trenches and we have to keep going for longer,” she said.

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