The latest surge in coronavirus cases in Ireland is overwhelming many intensive care units, causing hospitals to run out of ICU beds in some locations.
The chief executive of the University of Limerick Hospital Group said on Friday that the ICU in the hospital was full, creating extra pressure for staff.
Collette Cowan said that by next Wednesday she believed all elective procedures will be paused as the hospital group prepares for a surge in Covid patients.
So how has the country found itself in this situation again? Many factors are at play, but central is the State's capacity to treat patients in intensive care.
How many intensive care beds does Ireland have?
The State has only about 300 ICU beds. This number can be expanded to reach about 350 by redeploying staff and resources when needed, though it means curtailing other scheduled care.
If more than 350 ICU beds are required at any one time then the system risks becoming overwhelmed, according to a report into the State's critical care capacity from December last year.
Ireland has historically lagged behind other developed nations in intensive care capacity. The State had just over five beds per 100,000 population in 2019. The UK had more than seven, France had 16 and Germany had 28. Only Sweden and New Zealand had fewer beds than Ireland.
There has been further investment into the hospital system since the onset of the pandemic. At the beginning of 2020 the State had a baseline capacity of just 204 ICU beds, but this was increased to 280 by last November, and now stands at about 300.
Sourcing equipment was once a major issue, but now the biggest restraint on ICU capacity is the supply of experienced staff, particularly nurses.
Even before Covid, Ireland's hospitals were often near capacity. The Organisation for Economic Co-operation and Development’s recent Health at a Glance report showed the State had the highest bed occupancy in Europe in 2019.
What happened during the last Covid surge?
At the worst of last January’s wave of infections, there were 330 patients in intensive care, including 221 with Covid.
A total of 2,021 patients were in hospital with Covid on January 18th.
The ICU system approached peak capacity because of Covid, but it was not overwhelmed in the end. A mass cancellation of other services had to take place to create extra capacity within the system.
What are experts predicting could happen this time?
On Wednesday Nphet’s chief epidemiological advisor, Dr Philip Nolan, shared several scenarios for how the situation in the country’s hospitals might play out this winter if no action is taken.
The “optimistic scenario” he outlined “sees about 1,000 in hospital and 200 in critical care” in December. The “pessimistic scenario” would see more than 2,000 people in hospital and at least 400 requiring critical care.
This translates into more than 2,000 people in hospital and at least 400 people requiring critical care – these people couldn’t all be cared for in ICU, many would receive advanced respiratory support on wards and in high-dependency units. 18/20 pic.twitter.com/2oUKo0baSv
— Professor Philip Nolan (@PhilipNolan_SFI) November 17, 2021
Even the more optimistic scenarios have alarmed those managing hospitals and working in ICUs across the country.
Dr Colman O'Loughlin, president of the Intensive Care Society of Ireland, spoke to The Irish Times about his fears for this winter. “There’s only 300 ICU beds in the country. So even if 500 require ICU beds only 300 will get them, and they’ll be a mixture of Covid and non-Covid.
“There’ll be cardiac arrest, there’ll be bad pneumonias, there will be pancreatitis, and there will be Covid. And we’ll have nowhere to put those patients,” he said.
Collette Cowan, who heads the University of Limerick Hospital Group, said if the Republic saw 200,000 cases in December, as outlined by public health officials, it would “collapse” healthcare.
“It would cause a collapse of the health services and I don’t mean to be stark,” she told RTÉ radio on Friday.
“We can manage to a certain level, but alongside that we also have a lot of people attending the emergency department for treatments for other illnesses.”
Health officials are warning of a difficult few weeks for the country, but said the situation could still be turned around by “small changes” in behaviour.
“Anyone who is going to get Covid-19 in December has not yet been infected,” said the chief medical officer, Dr Tony Holohan. “Their infection is not inevitable and there is still time to prevent it by small changes in our behaviour.”