The local acute hospital system remains under "severe pressure", the like of which it has never experienced before, Tony Canavan, 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.
The overall number of Covid-19 positive cases on Wednesday 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 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; with 97 Covid-positive patients at the 280-bed Mayo University Hospital currently, up six from last week, when Mr Canavan spoke to the Advertiser.
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 is so rampant in the community that it is extremely difficult, almost impossible, to ensure there is no transmission in hospital," he said.
He continued: "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 ), four of Mayo's eight ICU beds are free, 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."
The Saolta Chief said it would never be a question of one hospital "being swamped and being left to struggle" and continued: "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."
While there are ICU beds available at Mayo University Hospital, if additional capacity were required, and the hospital were to initiate its surge capacity, it would need more staff. However, staffing levels are reduced due to so many people being on Covid-leave. There are 158 staff at Mayo University Hospital absent due to the virus.
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."
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.
"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 inoculation 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.