Madam, – As we move from containment to mitigation of H1N1 influenza, we can expect an exponential rise in numbers, with a significant proportion of the population infected between now and December. Most people will have a mild illness and should stay at home to diminish spread in the school or work place. A minority will develop complications requiring hospital admission, but this will constitute a substantial number.
A combination of absenteeism of healthcare workers and increase in demand has the potential to overwhelm our hospitals.
Medical beds, isolation rooms and intensive care beds will be under particular pressure. Without influenza, these units operate at 100 per cent of capacity. In the past week we have had overcrowding in our emergency department, such that patients on trolleys have had to be doubled-up overnight in spaces designed for one trolley and other patients were in chairs. Such overcrowding will lead to spread of influenza from patient to patient and to healthcare workers.
Overcrowded emergency departments have persisted despite hospital policies to discharge patients as expeditiously as possible. At the root of this is the failure to fund long-term care for elderly patients. This summer, 100 to 120 of a total of about 600 beds at the Mater hospital have been occupied by such patients. Six of the 12 beds of the Mater Infectious Diseases ward, designated as the National Isolation Unit, have patients awaiting long-term care.
Other Dublin hospitals have had a similar high proportion of beds unavailable for acute admissions. Over the past decade, funding has usually only emerged after persistent severe overcrowding in the emergency department. Once funding is released, patient transfer can take up to four weeks, in the best of circumstances. When influenza numbers become large, such transfer will be fraught with additional difficulties, including shortage of staff in both nursing homes and acute hospitals.
We have generally prepared well for pandemic influenza and have been blessed with luck compared with England. We should now prepare our acute hospitals by moving as many long-term patients as possible to nursing homes. Despite the obvious budgetary difficulties, I would urge the HSE to fund the transfer of decisive numbers of patients to nursing homes and to organise appropriate home supports for elderly patients now.
The roll-out of our compliance with the European Working Time Directive for junior doctors should also be postponed until the first year of this influenza pandemic has passed. – Yours, etc,
Dr GERARD SHEEHAN,
MB FRCPI,
Consultant in general medicine
infectious diseases,
Nashville Road,
Howth,
Co Dublin.