Local hospitals are under "extreme pressure" and it would not take a lot to "push them over the edge" - the chief executive of the Saolta University Health Care Group warned this week.
Tony Canavan who heads up the group, which runs seven public hospitals on five sites in the west and north-west and employs 10,000 people, appealed to the public to stay at home and comply with the Level 5 regulations. This was vital to arrest the spread of Covid-19, protect hospitals from being overwhelmed, and save lives, he said.
"My message to people is to stay at home for the next four weeks," said the Saolta chief. "This is the most important thing, to comply with the Level 5 restrictions. It could not be more simple. This will protect lives. Any success we have achieved has been through [people following] this advice.
"Our hospitals are under extreme pressure and it would not take a lot to push us [the hospitals] over the edge. If you stay at home and reduce the opportunity of the transmission of the virus, it will help the health service remain open and available."
The increasing numbers of people being hospitalised with the virus, more patients on trolleys, rapidly decreasing general hospital and intensive care beds, significant outbreaks of the virus in hospitals, and high rates of staff on leave because of contracting the coronavirus or being a close contact of an affected case, are a major worry for the local hospitals.
Mr Canavan said that he is "very concerned" at the significant outbreaks of Covid-19 in the last week, both in the 700-bed University Hospital Galway and the 280-bed Mayo University Hospital. Six wards are affected in Galway and at least five areas in the Mayo hospital.
There were 157 Covid positive patients in Saolta's hospitals in Galway, Mayo, Roscommon, Sligo, and Donegal on Tuesday, a major increase on figures reported during the peak of the first wave on April 15. There were 94 cases recorded then.
A total of 50 people with confirmed Covid-19 were patients on Monday night in Mayo, 47 at UHG and five in the 220-bed Portiuncula University Hospital in Ballinasloe on Tuesday morning.
It was important to remember, he said, that the concern sometimes is not just about Covid case figures but the number of hospital departments affected by these cases. Some of these departments have very specialised staff and losing one of these key employees has a "huge effect" on the area.
"The issue that gives me most concern is the impact that Covid-19 is having on staff and how that impacts our ability to deliver services. A number are out with Covid. The most significant impact on staff is in Galway which is the biggest single hospital [in the group].
"In the last week in Galway, there were a very significant number of staff on leave related to Covid-19, they either have it or were close contacts. There were over 200 in UHG, the numbers in Mayo [University Hospital] were under 50, and in Portiuncula there are fewer than 30 currently on Covid leave," he said.
As the virus sweeps through the region, the demand for intensive care beds is increasing. UHG has 27 ICU beds but only two of these were vacant on Monday. Portiuncula Hospital, which has five ICU and two high dependency/critical care beds, did not have any free, while Mayo University Hospital, which has eight intensive care beds, had four free. There are "a very small" number of vacant general hospital beds in all the hospitals, according to Mr Canavan, but these are empty because of infection control reasons, both due to Covid-19 and other infections, and will not be opened until it is safe to do so.
The growing number of patients awaiting hospital admission on trolleys is another major concern for the Saolta group. The figure rose throughout December and this number has "significantly increased" since the New Year, the CEO explained.
There were 54 patients on trolleys in three separate locations, including the emergency department, in UHG, on Tuesday morning. There were 11 on Monday morning in Mayo University Hospital, which was a high figure for the Mayo hospital. There were 11 people on trolleys in Portiuncula Hospital on Tuesday morning, a "very high" figure for the Ballinasloe hospital, the Saolta chief said. The trolley numbers had been small there since New Year's Day but began to climb on Monday when there were eight patients awaiting admission.
Mr Canavan said caring for people on trolleys creates a "very pressurised" environment for staff as well as being a difficult situation for patients. The fact that hospitals have reduced staffing levels due to Covid-19, coupled with providing care for Covid and non-Covid streams, is very challenging.
He said Saolta introduced a number of measures this week to manage the latest wave of the pandemic. One of the key decisions taken was to cancel all elective surgery and non-essential outpatient attendances.
"This will reduce footfall, there will be less patients travelling to and coming into hospital. The most important reason however is that it will free up staff in elective surgery and out-patients [departments] and these can be redeployed to the areas where they are needed most."
Greater knowledge about Covid-19 gained over the past 10 months means the hospitals have a more targeted approach now and some plans are being stood down in favour of different strategies, according to Mr Canavan. These action plans are changing and improving all the time, he said. "We know more about Covid-19 now and we have targeted our approach. There was so much we didn't know in March/April. Even from a clinical perspective, our clinical teams have learned a lot from their colleagues around the world."
A number of hospital developments, such as work undertaken at Portiuncula University Hospital to increase ED space, and the opening of an acute medical unit at Mayo University Hospital to create extra beds, will make a difference during the pandemic, said the health chief.
"We opened the acute medical unit in Mayo in November which gave us additional capacity of seven beds. In Portiuncula, work is ongoing moving outpatient departments.
"We want to provide additional bed capacity but it will be spring, likely March, before this happens. It won't solve the problem right now. We have completed temporary works on the ED.
"This has increased the capacity of the department but it does not give us additional beds, it gives us increased 'treating spaces'. However, because of the increased size of the department it is more manageable from a Covid and non-Covid stream perspective."
Saolta is currently re-examining the surge capacity in the ICU departments of all its hospitals. There were 10 Covid-positive patients in ICUs across the region on Tuesday. There were none in Mayo, most were in Galway. "Relative to the first wave, that is not high," he said. But what is concerning is that the ICU situation changed overnight and Covid patient numbers have started to increase."
As part of the hospitals' surge capacity appraisal, the authorities are examining the scope for the expansion of ICU bed numbers.
"We are worried about capacity overall. Mostly when we think [about capacity], we think about rooms, beds, and wards and that is all relevant. But with ICU we are talking about beds and the right staff to provide care.
"We are looking specifically to see, on the basis of the number of staff we have now available, what is the maximum number of beds [in ICU] that we can open if we have to. As far as equipment, such as ventilators and PPU (personal protective equipment ) is concerned, we are OK for that. The key issue is around staffing, how many staff will be available when we need them. ICU cares for the sickest patients in hospital and this requires very specialised staff.
"What we have seen in the last couple of days is an increase in [ICU] admissions for Covid-19 and we are concerned these [numbers] will continue to grow. That increase was almost overnight."
Mr Canavan is very concerned about the growing pressure on the hospital system as the country battles the third wave of the pandemic and people eagerly await the Covid-19 vaccine.
"When I look at where we are now, I'm really, really concerned because the hospital system is under considerable strain," he said.