The Mater Hospital has locked its front doors, while at St Vincent's and St James's hospitals staff have their "fingers crossed". The 'vomiting' bug in hospitals is halting life- saving treatment, writes Kathryn Holmquist.
A humble but unpredictable virus, which has been making the rounds of hospitals around the country in the past year, is now "threatening to devastate the health services and we're not out of the woods yet", says Dr Ed Smyth, microbiologist at Beaumont Hospital, the worst affected.
On any given day since October 5th, between 70 and 80 patients have shown the symptoms. Throughout Dublin hospitals overall, the Eastern Region Health Authority has recorded about 500 cases. "We've never seen anything like it," says Smyth. "We're trying not to compromise patient care, but life-saving admissions are being deferred."
Ironically, one of the first known appearances of the "winter vomiting bug" - a small round structured virus (SRSV) - occurred at Beaumont in 1993. This virus was so "extraordinary and potent" that Smyth and others published their account of its ravages in the medical journals. In the past year, 400 hospitals in the UK and this country have been affected.
The current outbreak at Beaumont is far worse than in 1993. Smyth fears that if the other main tertiary hospitals in Dublin start to suffer what Beaumont is experiencing, the virus "will bring the health service to its knees this winter". While the other Dublin hospitals affected have the situation under control, the erratic nature of this virus is such that a rash of cases may arise in any hospital at any time, forcing ward closures and cancellations.
Symptoms of the SRSV may develop within as little as six hours of contact. At Beaumont, 50 staff have fallen ill. SRSV does not kill, as long as patients remain hydrated, but it does cause massive psychological stress to staff, patients and their families.
Hospitals are taking different stances. Michael Moloney, representing St Vincent's and St James's, acknowledges the seriousness of the situation, but wants to avoid panic. Visiting is being limited at both hospitals, but this is largely voluntary, with families being discouraged from bringing children in.
At the Mater, which the local community tends to treat as a drop-in centre, the front doors are locked but others are open, so there is no question of families being prevented from visiting. Ideally, the Mater would like families to make arrangements with the ward sister first. At all three of these hospitals, elective admissions are continuing.
At Beaumont, however, families may visit only in "exceptional circumstances", and 45 elective admissions have been cancelled every day of the outbreak, while admissions to A&E are strictly limited. So far, more than 500 admissions have been cancelled and if the crisis continues for six weeks, as Smyth suspects it will, then nearly 2,000 patients will join a backlog of elective admissions that cannot be addressed until the epidemic subsides.
The word "elective" is misleading, Smyth points out. What we're really talking about are "scheduled" admissions for life-saving procedures and investigations. People with cancer and other life-threatening conditions are being forced to wait for treatment. When you consider that each patient whose admission is delayed is surrounded by a family group who are feeling equally anxious, you get some handle on the scope of the problem.
A measure of the dramatic impact of SRSV at Beaumont is the fact that 16 out of 19 wards are affected at any one time. When a patient comes down with the bug on a ward - sometimes having brought it with them from home - the affected patient is put in isolation and the entire ward has to be emptied and disinfected. The frustration for staff is that when patients return to the cleansed ward, another patient comes down with symptoms, so the ward has to be disinfected again. More than 100 beds are closed as a result. In a hospital that prides itself on "101 per cent occupancy", with beds being used by two patients in one day in some cases, there is no room for such flexibility.
In Australia, the policy in this situation is to close a unit down and open one in another location, says Dr Smyth. In Irish hospitals, which rely on efficiency and maximum bed occupancy, this simple virus is taking advantage of a tight situation where there are too few acute beds, and thus closing down units is not an option.