Hospitals may not be able to provide intensive care beds to patients with non-Covid emergencies if there is a surge in critically ill coronavirus patients, an ICU doctor has said.
Dr Colman O'Loughlin, intensive care consultant at the Mater hospital in Dublin and president of the Intensive Care Society of Ireland, said the number of Covid-19 patents in hospital ICUs was "manageable" but added that there was a "concerning rise" in critically ill patients.
Moving to “surge” capacity to manage an increase in Covid-19 ICU patients was complex and would take staff from other parts of hospitals and deny “some very valuable services.”
“It is not something that we do lightly. It does have that nasty connotation of having to rob Peter to pay Paul so other services suffer badly when we go to surge and that is why we are so nervous of it,” said Dr O’Loughlin.
The number of Covid-19 patients in hospital ICUs increased to 88 on Wednesday – more than double the figure six days ago – after 18 admissions and six discharges over the previous 24 hours.
The first wave
The last time the figure was this high was in early May during the first wave of the coronavirus pandemic when Covid-19 cases in ICUs peaked at 155 in mid-April.
Latest figures from the National Public Health Emergency Team (Nphet)on Wednesday showed also there were 7,836 new cases of Covid-19 in the State and 17 further deaths.
There has now been a total of 121,154 confirmed cases of Covid-19 in the State since the pandemic began and 2,299 Covid-related deaths.
Chief medical officer Dr Tony Holohan said the country was in a “serious phase” of this surge. He said there was evidence of an increasing presence of the more contageous UK variant in the State.
“There is concerning escalation of admissions to hospital and ICU. We are very likely to see escalating mortality and ICU admissions in the coming days and weeks,” he said.
Enda O’Connor, a medical consultant and director of the ICU at St James’s Hospital in Dublin, said there were 11 Covid-19 patients in the hospital ICU, which is more than half the patients treated at the peak of the first wave.
‘Steepness of the rise’
“We are concerned that it is not showing any sign of abating in terms of the steepness of the rise,” he said of the increase in Covid-19 patients requiring ICU treatment in this third wave.
“There would be a strong suspicion here that we are going to exceed the maximum number of patients and that it is going to be harder in the intensive care here than it was in March and April.”
For every Covid-19 patient in the ICU, there was at least one non-Covid patient, he said.
“All the worries are on Covid-19 at the moment but throughout the next two to three months we are going to have a fairly sizable non-Covid contingent,” he said.
Dr O’Loughlin said the “real worry” was how to deal with Covid alongside patients coming in in other medical emergencies such as heart attacks and road traffic incidents.
“We may not have a bed for them in the intensive care,” he said.
The Mater’s “surge capacity” involved extending the ICU unit into the hospital’s high-dependency unit and then into other areas of the hospital, he said.
He cautioned the public that there were not many new therapies developed since the peak of the pandemic in March and April “to make a huge difference” in the outcome of critically ill Covid patients in ICUs and that the benefit of vaccinations would not be felt for some time.
“The vaccine will have a huge impact but it will not be for many months,” he said.