Unprecedented pressure on local hospitals as infection runs rampant in community

More people hospitalised now with Covid-19 than at any other time during the pandemic.

The local acute hospital system remains under “severe pressure”, the like of which it has never experienced before, the chief executive of the Saolta University Health Care Group, which runs the seven public hospitals in the west and north-west of the country, said this week.

There are more people hospitalised now with Covid-19 than at any other time during the pandemic.

Tony Canavan was speaking as Covid-19 numbers continue to rise in Galway, almost 2,800 new cases of the virus were confirmed in the past two weeks in the region. There are currently 129 Covid positive patients in University Hospital Galway with 11 of these being treated in the intensive care unit. At the peak of the first wave, the highest number of patients in the hospital with the virus at any one time was 18, according to UHG manager, Chris Kane.

Galway is one of the few counties in the country where the case numbers continue to grow; the 14 day incidence rate is now 1,082 cases per 100,000, Dr Breda Smyth, the director of public health West outlined this week. “This means infection is everywhere in the community. In particular, the case rate is currently high in Tuam, Galway city, and Oranmore.”

129 Covid patients

In terms of hospitals, University Hospital Galway, the west’s biggest hospital, still remained the busiest site, treating 129 Covid patients, Mr Canavan said.

Eight patients had suspected Covid-19. However, these numbers “turn around quickly”, he said, because the test results come back in a matter of hours, unlike at the start of the pandemic. There are seven Covid wards at the 700-bed hospital now. “There are so many wards affected at the hospital that we have to configure and reconfigure.”

'We are sailing very close to the wind and are just managing'

The number of Covid-19 patients at Portiuncula University Hospital remain “steady but at a very high level,” said the head of Saolta, which employs 10,000 people and has an annual budget of just under one billion euro. There were currently 10 patients with the virus in the Ballinasloe Hospital, an increase of one on last week. The 220-bed facility, which was established in 1943, has “very few” individual rooms and its physical layout, with its narrow wards and corridors, is challenging from a Covid-19 management point of view, he said.

The overall number of Covid-19 positive cases in all the group’s hospitals in the west and north-west, in Galway (UHG, Merlin Park and Portiuncula ), Mayo, Roscommon, Sligo, and Donegal totalled 394, an increase of 300 on the number recorded at the peak of the first wave in mid-April of last year. The latest figure is more than four times larger than that reported (94 cases ) at the height of the first wave. It is also up by almost 60 on last week’s figure. The number of patients in ICUs (22 ) across the hospital group remains the same as it was in mid-April.

The hospital chief stated that the situation in the hospitals was likely to continue or worsen over the coming weeks. It had deteriorated in the past week. He explained that staff were dealing with a huge increase in admissions and a significant strain on capacity. “We are sailing very close to the wind and are just managing”, he added.

There was a daily increase in Covid-19 hospitalisations, the number of staff on Covid-related leave was rising, and hospitals were having to set aside more Covid wards as well as dealing with outbreaks of the coronavirus in various areas. All of this, coupled with rising patient numbers, was putting the public hospitals under severe pressure.

There are Covid-19 outbreaks both at UHG and Mayo University Hospital. “This means that Covid-19 transmission is taking place in the hospitals.” A possible scenario is that people living in the community may be Covid positive, become unwell because of this or some other illness, and are then admitted to hospital. They may not test positive for the virus at the time. The coronavirus may also be transmitted from one patient to another while in hospital.

“Then, you start to lose staff as Covid-19 is transmitted from patients to them and both they and their contacts [at work] are off duty. Even with the strongest possible resources and controls, Covid-19 was so rampant in the community that it is extremely difficult, almost impossible, to ensure there is no transmission in hospital.”

385 UHG staff off work

As Covid-19 hospitalisations rise daily, the pressure on the local hospitals’ intensive care units (ICUs ) increases. There are few vacant beds available right now. There are four in UHG (there are 27 ICU beds in total there ), and all of Portiuncula University Hospital’s ICU beds (five ICU and two high dependency/critical care beds ) are occupied. ICUs tend to operate at almost full capacity normally so staff are very adept at dealing with intense pressure and demanding workloads.

If ICUs become full, patients can be transferred to hospitals anywhere in the country if they need critical care. This safety net proved useful during the first wave of the pandemic when patients requiring ICU care were transferred from Letterkenny, Sligo, and Mayo hospitals to UHG. Mr Canavan said that it would never be a question of one hospital “being swamped and being left to struggle”.

UHG has capacity to provide “a high level of care” outside its ICU facility because it has the space and additional ventilators to do so. However, staffing these additional facilities is a concern because there are high numbers of healthcare workers on Covid-19 related leave.

“It is possible to provide high levels of support in ordinary wards for Covid and non-Covid-19 patients. Some require oxygen therapy. We try to do that and reserve ICU for the sickest people.

“We have a total capacity of 27 beds in our ICU [at UHG], there are four vacant beds currently. To go beyond 27 is a question of staffing. We have the ventilators and the physical space, it is a question of having the staffing available.”

There are 385 UHG staff currently off work due to the virus. The vast majority, more than 200, are nurses and healthcare assistants. There is a small number of doctors included. In all, there are about 5,000 staff employed in UHG, 3,000 of whom are nurses.

Some 53 staff members are on Covid-leave at Portiuncula Hospital, a very high number relative to the size of the facility, according to the Saolta boss.

'Our concern is that people would start to give up. Don’t do that. The number of cases [in the community] has started to reduce because people are complying with Level 5 restrictions'

Saolta decided earlier this month to cancel all non-emergency scheduled operations and out-patient hospital appointments to free up staff to help cope with this shortfall. “This has allowed us to redeploy staff, theatre staff, for instance, went to ICU where they are helping us currently.” Mr Canavan is hopeful with each passing day that more staff will be well enough to return to work.

While the local hospitals are under enormous pressure, he said they are coping, largely due to the trojan efforts of their staff.

“While the hospitals are under very, very significant pressure, we are managing on the backs of everybody who is working very hard under significant pressure. People can see what is happening in our hospital system, wards, ICUs, and EDs are under severe pressure, the like of which we have never seen before. The [patient] numbers continue to rise but we are managing.”

Hope

He stressed that there was hope, both in the context of the number of cases in the community having started to decrease and the fact that a vaccine against Covid-19 is being rolled out.

“This means that the efforts people continue to make now are absolutely worthwhile. We are doing everything we can to keep the hospital system functioning. We are asking people in the community who are worried about the hospitals [becoming overwhelmed] to continue to support us by staying at home. It’s a very simple message. These people are doing lots and lots of things to comply with Level 5 restrictions, such as home schooling, minding relations, and caring for themselves. We are asking them to keep doing that, they are making headway and it will help us in the hospitals.

Tony Canavan 2 Saolta

Stay the course

“Our concern is that people would start to give up. Don’t do that. The number of cases [in the community] has started to reduce because people are complying with Level 5 restrictions. The second thing that gives us hope is the vaccination programme. We have every reason to be hopeful and to keep doing what we are doing. It will have an impact on the hospitals and will bring the [patient] numbers down in the hospitals and in the ICUs.”

The focus of the vaccination programme this week is on the 83 nursing homes in Galway, Mayo, and Roscommon. A little more than half of these residents have received the first dose and will receive the second by Sunday, which is ahead of schedule. Separately, a small number of healthcare staff, who received the first dose of the vaccine on December 29, 30, and 31 will get the second dose this week.

The focus of the innoculation programme last week was on healthcare workers, GPs were a particular focus. “That went very well, every single drop of the vaccine was used,” Mr Canavan said. More than 7,000 people in the west and north-west have been vaccinated so far.

 

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