Irish hospital system ‘far from being overwhelmed’ by Covid-19

Hospitals in Dublin are under pressure because of Covid-19 but the intensive care capacity of the Irish health system is far from being overwhelmed, president of the Intensive Care Society of Ireland Catherine Motherway has said.

There have been discussions about drafting guidelines for helping doctors decide who should get access to intensive care treatment, if the crisis reaches a stage where demand exceeds the resources available.

“We are nowhere near having to produce it, and I am praying hard that we never do.”

It could be the case that such a document, which would “score” patients as an aid to the doctors providing treatment, might take into account a patient’s age, she said.

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A recent document produced by the Department of Health called Ethical Framework for Decision-making in a Pandemic, said that when allocating resources, the “starting point for any rationing is to consider which patients are most likely to benefit from intervention.”

Among the issues that should be considered, the document said, is the patient’s frailty, independently of age.

Unusual indicator

However, Ms Motherway said that it may be the case that with Covid-19, age is an indicator of mortality, independently of the person’s frailty. This is unusual, she added.

But if it is the case, then age could influence a doctor’s decision about whether a patient should get intensive care.

She said that if a guidance document is produced, she would be strongly of the view that it should be used nationally, and that it should be published. “The people have a right to know.”

She said patients who did not get access to intensive care would still get the best care possible.

Guidance that scores patients is only a support to clinical judgment, and nothing can replace sound clinical judgment, she said.

The most important thing was that people did what they are being asked to do, to help prevent a surge of cases overwhelming the system.

“We will all end up, I think, having restrictions on our personal movements and our personal freedoms, for quite some time. I don’t think it’s going to be weeks, it’s going to be months.”