Critical care staff concerned over capacity to cope with Covid surge

There is a growing concern among hospital staff over the system’s capacity to cope with a surge of coronavirus patients during the winter season, a senior intensive care nurse has said.

John Gilmore, an intensive care nurse and assistant professor of nursing at University College Dublin, said the "biggest concern is we're going into a busy winter."

The intensive care system had been “chronically under resourced” for years, and already was under pressure at present, he said. “ICU’s are busy, extremely busy with extremely sick patients … Staff are tired, staff are stressed,” he said.

During the first wave of the coronavirus pandemic Dr Gilmore worked in St Vincent’s Hospital intensive care unit. “The challenge is a busy system is already swelled, and adding Covid into that,” he said.

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“We were able to do it in March because we cancelled many elective procedures. The flu isn’t elective, road traffic accidents aren’t elective, those all go up in winter. There is a lot of concern in the critical care community,” he said.

The National Public Health Emergency Team (Nphet) on Sunday recommended the Government introduce a national lockdown for four weeks, to halt the concerning increase in Covid-19 cases. The team cited concerns over low ICU capacity and a steady increase in coronavirus hospitalisations in recent weeks.

The Government rejected the recommendation and instead placed the country on Level 3 of its Living with Covid-19 plan, rather than Level 5.

There were 147 confirmed Covid-19 patients in hospitals as of 8pm on Monday, according to a daily HSE operations report.

There were 243 patients in intensive care units, including 23 coronavirus patients, eight of whom were on ventilators. This left 39 critical care beds vacant currently, according to the report.

“I think we do need to listen to what they (Nphet) are saying … I know the Government have to make decisions,” Dr Gilmore said.

It would not be easy to quickly ramp up ICU capacity within a number of weeks in response to a surge of Covid-19 cases in hospitals, he said. “For every single ICU bed you need 6.5 registered nurses, who have specialist training, that’s not got over a two week induction period,” he said.

“I would worry if our capacity was stretched we would end up doubling up,” he said.

Balance

Dr Michael Power, critical care consultant at Beaumont Hospital, said during normal winter seasons intensive care units came under strain. The country was again seeing "slowly growing, but steadily growing Covid hospitalisations," he said.

Commenting on the Government’s decision to opt for lower Level 3 restrictions against Nphet’s advice, Dr Power said there had to be a “balance,” which took “livelihoods into account” as well as public health, he said.

Dr Jack Lambert, professor of medicine and infectious diseases at the Mater Hospital, said the current process between Nphet and Government was "flawed." He called for different groups to have more input into the decision-making process, including frontline organisations, scientists, restaurateurs and travel representatives.

“The numbers are going up - I work in a hospital, and I don’t want to see people dead. But there are ways to solve this problem without going back into a massive lockdown. We need to come up with solutions quickly,” he said.