People who are not vaccinated against Covid-19 are at "extremely high risk" of contracting the disease in the next few months due to the highly transmissible Delta variant of the virus being prevalent in the community.
That was the stark warning this week from Dr Pat Nash, the clinical director of the Saolta University Health Care Group, which runs the public hospitals in the west and north-west of the country.
"I would encourage people to get vaccinated, it is the most important thing," he told this newspaper. "A minimum are not vaccinated [about 10 per cent of the adult population nationally]. There is very easy access to vaccines through pharmacies and online registration for the vaccination centres.
"If people are not vaccinated, the risk of getting Covid-19 in the next few months is extremely high. The Delta variant is so infectious and prevalent in the community."
He said a "significant" number of patients are presenting with Covid-19 at local hospitals. There were 27 Covid positive patients at University Hospital Galway on Tuesday, two of whom were being treated in the intensive care unit. There were some five people hospitalised with the virus that day at Portiuncula University Hospital. The numbers are smaller at the Ballinasloe hospital but have remained consistent, said Dr Nash.
"The numbers [in Galway] have remained fairly consistent in the last couple of weeks. They are in the high twenties and low thirties, mainly in the high twenties, not like the figures in January.
It is a challenge because we need to keep separate pathways in hospital for Covid and non Covid care. It has an impact on bed availability because we have to keep beds [for these patients]. We have been struggling, it is a real challenge to manage that." There are two Covid-19 wards at UHG, one has 21 beds, the other 20.
"We are seeing patients coming in who are vaccinated but the number of vaccinated people being hospitalised is in the minority and they don't tend to get as sick. The aim of the vaccine is to reduce serious illness."
Covid patients are presenting with upper respiratory symptoms, such as coughs and fever. Those who need hospital care usually have pneumonia, he said, and require oxygen and close observation.
There are people from all age groups hospitalised. Some are children but these numbers are small because children do not tend to get sick with the virus, according to Dr Nash. There are some older people being treated for Covid-19 as well as younger people in their 20s, 30s, and 40s. The average length of stay for patients being treated in wards is four to five days. ICU patients spend weeks in hospital and their recovery is very slow, he said.
A Covid-19 outbreak occurred at UHG last week and one ward remains closed because of this. He stated there were "a number of cases" involved. More than two Covid-19 patients in a ward is considered an outbreak.
There are sufficient ICU beds at UHG currently to meet the needs of Covid-19 patients. Dr Nash said if the numbers rose above 12, more beds would be required and the hospital's theatre recovery area could be used for ICU purposes. "Thankfully, we have not had to do that and we don't see that as being imminent."
Have we reached the peak of the fourth wave of the pandemic? "It does look like the numbers are not going up, they are falling a little."
UHG is battling with the twin challenges of Covid-19 and "extremely high" attendance rates at its emergency department. There were 80 patients awaiting beds on trolleys on Tuesday, a figure that is believed to be the highest ever. The bed situation was described as "critical" earlier this week by hospital management.
"Attendance at the ED is extremely high," said Saolta's clinical director. "There were 233 patients on Monday and 256 on Friday. We are seeing record numbers of people attending. Even at the best of times, that would be a huge challenge to manage. We are doing a detailed audit to obtain a profile of ED attendances. The numbers are high not just here in Galway but around the country, particularly for this time of year. It's not winter yet. It is concerning.
"We want to assure people we are open and are trying to manage. We are asking the public to only present to the ED if you absolutely need to."
The high attendances are believed to be due to people having delayed seeking hospital treatment during the pandemic because of fears of contracting the virus. Their conditions may be at a more advanced stage now and they can no longer defer care.
"Attendances really dropped, [during the year] especially during January and February. We are looking to get additional bed capacity on site. But that is not a quick fix, it will take a number of years. We are making sure there are no delays in terms of tests and those who can be discharged, that there is no delay in leaving hospital. We are trying to make sure we prevent delays."
Dr Nash said frontline staff were working under "very difficult" conditions. "There is huge pressure on the system, not just one day, but every day. It is relentless.
"We would assure people that the emergency department is open for urgent cases. Only come in, if you need to."