Covid-19: Current wave is squeezing hospitals from both ends

The number of Covid-19 patients in hospital is emerging as the main pinch point in the current wave of the pandemic.

Cases in intensive-care units (ICU) have stayed mercifully stable over recent weeks and, if Ireland replicates the experience of other countries, will not rise significantly as the impact of the Omicron variant of the virus is fully felt in our hospitals.

The number of Covid-19 patients in hospital went under 40 at the end of June and stood at 378 on Christmas Day past. Now they’re almost three times that number, at 936 on Friday.

The number of patients in hospital for whom Covid-19 is not their primary diagnosis is probably higher now than at any time in the pandemic

This kind of growth cannot be sustained for long, even if there's a bit to go before we reach the previous high of more than 2,000 hospitalised patients. As of Friday, the Health Service Executive had just 121 free hospital beds – St Vincent's in Dublin and five smaller hospitals reported having no free beds.

Disruption to court sittings in weeks ahead due to ‘unprecedented’ number isolating

---

Covid death toll in Northern Ireland exceeds 4,000

---

Third-level colleges set to reopen from Monday

---

Another 21,926 Covid cases confirmed, with 936 virus patients in hospital

---

Hospital numbers have actually stabilised in the past three days, but it is too early to say this is a lasting trend. The current plateau may be down to higher discharges as more consultants returned to work after Christmas.

Not everyone in hospital with Covid-19 is there because of the virus, and the number of patients in hospital for whom Covid-19 is not their primary diagnosis is probably higher now than at any time in the pandemic.

The HSE was unable to provide a breakdown along these lines, but publicly available figures show that of 161 Covid-19 hospitalisations on Friday, 90 were admitted with the virus.

In other words, almost half of those admitted (71 patients, or 44 per cent) were diagnosed with Covid-19 only when they were in hospital.

This is a disparate group. Because there are so many infections in the community and testing is so overloaded, some patients will have deteriorated to the extent that they need to be admitted to hospital before being able to access a PCR test.

But there will be other patients whose primary diagnosis is something other than Covid-19.

Regardless of how incidental their illness is, all these patients have to be managed using resource-intensive infection-control procedures. Unless isolated quickly, they are likely to pass the virus on to other patients and staff.

The current wave is squeezing hospitals at both ends of the demand and supply equation. While more and more people need to go to hospital, the current wave is knocking out more and more staff through infection or the need to restrict movements.

More patients means more single-room accommodation is needed, or reductions in the capacity of multi-bed wards. More outbreaks means beds and wards have to be closed and thoroughly cleaned. And more workers on leave also depresses capacity with beds stood down because there is no one to staff them.

In ICU, there are currently 269 beds open, well below the 300 available. All but two of these are occupied, 89 of them with Covid-19 patients.

The indications from all other countries where Omicron struck earlier are good, so there is growing confidence ICU numbers can be kept low

Winter is always busy in our hospitals. There were fewer patients attending emergency departments last week, and admitted to hospital from them, than in the same week two years ago. That was before the pandemic, but in the middle of a busy wave of flu.

More than 12 per cent fewer over-75s were admitted to hospital last week compared with two years earlier. Trolley numbers were down by half.

And while 1,000 Covid-19 patients were in hospital, almost 500 beds were taken up by well patients for who no “egress” route had been found (referred to as delayed transfers of care or, formerly, delayed discharges).

Waiting lists fell only marginally last year, despite massive investment. By year’s end, 75,463 patients were waiting for inpatient or day-case treatment, down less than 8 per cent; a hefty 617,448 people were waiting for an outpatient appointment, down 1 per cent. The waiting list for colonoscopies was cut by a quarter.

The Omicron wave started soaring just before Christmas but cases seem to be converting to hospital admissions at a lower rate than before – less than 1 per cent. That could change if more older people fall ill, but nearly all these are vaccinated and boosted.

The lag between infection and the need for ICU admission is at least two weeks, so we will only find out in the coming days how many patients need the highest level of care. But as HSE chief clinical officer Dr Colm Henry remarked, Omicron doesn't infect the lung as easily as previous variants.

The indications from all other countries where Omicron struck earlier are good, so there is growing confidence ICU numbers can be kept low. If this were not the case, the National Public Health Emergency Team would surely have recommended more restrictions this week.

For every patient in ICU, about two require respiratory support on the general wards. However, the numbers requiring high-flow oxygen and non-invasive ventilation are staying stable.

A high number of those currently in intensive care require invasive mechanical ventilation – 57 out of 89 – but many of these have been there for some time and are likely infected with the Delta variant. This hasn’t gone away, and is probably still accounting for hundreds of infections every day.

In summary, cases are up tenfold in a few months, hospital admissions two- to threefold and ICU cases not at all. Vaccination and Omicron appear to have taken the sting out of the Covid-19 tail.