A leading GP has warned that Ireland is going to face a crisis in providing intensive care beds over the coming weeks if moves are not taken to urgently tackle the growing numbers of Covid 19 cases.
Former President of the Irish College of General Practitioners and member of the National Public Health Emergency Team, Dr Mary Favier said that the growing number of cases of Covid 19 was particularly worrying.
Dr Favier said the fact that the numbers of Covid 19 cases were currently doubling every fortnight or so was a huge worry given the capacity to provide ICU beds for people needing intensive treatment for the disease.
Hospital Report
According to a 2019 HSE report there were 255 Critical Care beds in the system but a HSE daily report on October 16th said there were currently just 36 ICU beds available as the numbers hospitalised with Covid 19 continues to rise.
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Dr Favier said there were a number of elements to bear in mind in relation to people with Covid 19 being admitted to hospital including a rough rule of thumb that for every 1,000 people who get the disease, five will end up in ICU.
“The other important thing that should be noted is that the average stay in ICU for most patients is two to three days but the average stay for somebody with Covid-19 is ten to 14 days so it’s much longer,” she said.
“And that’s the average stay but we have had cases of people with Covid-19 spending four weeks or six weeks or even three months in ICU so you don’t have the same turnover of ICU beds with those who have Covid.”
Dr Favier said that although the number of patients with Covid-19 in ICU this weekend, 30 is around the same as last weekend, it’s misleading to think there has been no change as there is a time lag with people developing the disease.
“The people in ICU today got Covid two weeks ago but we know the overall numbers of people with the disease has doubled over the last fortnight so at that rate, the numbers needing ICU in a fortnight will probably double.”
Dr Favier said that the growing numbers of people requiring ICU due to Covid-19 will impact on other people with serious conditions such as those with lung or bowel cancer or heart conditions that require major surgery and ICU care.
“People facing into major surgery for lung or bowel cancer or a cardiac condition have to undergo a lot of preparation – blood tests, cardiac and anaesthetic work up, a Covid test so it takes several days,” she said.
“Normally a consultant would be looking a few days ahead and would see there will be 15 ICU beds available, say four days ahead and the likelihood in the normal course is that most of those would still be available.
“But now, if you are a consultant and you have only three beds available due to Covid and there’s a chance they may not be available in four days time, you won’t take the chance and defer the surgery so there’s this knock-on effect.”
Dr Favier said this deferring of procedures – even though the patient may only require ICU care for 24 or 48 hours – is hugely stressful for patients with serious conditions and there is no guarantee it will proceed even on the deferred date.
According to Dr Favier, who is based in Cork, the problem is particularly acute in the city with one consultant having to ring around other hospitals at the weekend to secure a bed for a patient as all ICU beds in Cork were occupied.
Last week, the HSE said that Cork University Hospital had 20 ICU beds with the capacity to add a further 16 ICU beds if necessary while the Mercy University Hospital had six ICU beds with the capacity to add another 12 beds.
However, Dr Favier said that the problem with using surge capacity as the HSE was proposing in relation to CUH and MUH was that it requires both additional places to put the beds and trained nurses to staff the new temporary ICUs.
“You have to have somewhere to put the extra ICU beds and very often they end up in operating theatres where the hospital closes down an operating theatre to accommodate the temporary ICU so procedures are cancelled.
“It takes six ICU staff to staff one bed so you have to get them from somewhere else such as coronary care or theatre nurses as there is a limit to the number of people with the necessary skills so you are taking staff from other areas.
“As well as that there is some evidence from the UK where they have done that to set up additional ICUs to deal with Covid that the survival rates aren’t as high when you use staff from other areas compared to regular ICU staff.”
