Dr Joe McEvoy spent Friday delivering vaccinations not against Covid-19, but as part of the annual flu jab programme; the hope, he says, is that efforts such as this will help preserve the North’s teetering health system during the winter.
"We know it's going to get worse, it's just trying to minimise how much worse it's going to get," said the Derry GP.
The North's Minister for Health, Robin Swann, spelled the situation out in a written statement to the Stormont Assembly on Friday, warning that health and social care (HSC) services were "most likely facing into the most difficult winter ever experienced".
One example, he said, was that Northern Ireland’s hospitals had consistently been operating above capacity during the summer and autumn, with many patients waiting on trollies for admission.
“This situation is unheard of during the summer months and is an indication of the scale of unscheduled pressures likely facing the HSC system this winter,” he said.
The chair of the British Medical Association in Northern Ireland, Dr Tom Black, warned on Friday of "a health service on the brink of collapse" due to a shortage of beds and staff as well as the continuing impact of Covid-19.
This is something Dr McEvoy has seen first hand, as high levels of Covid-19 infection are coupled with hospital pressures. On Friday the deaths of a further seven people with coronavirus were reported by the North's Department of Health, and 1,355 new cases.
Intensive care
The hospital network in Northern Ireland was operating at 106 per cent capacity; there were 358 inpatients with Covid-19 and 33 in intensive care.
“We’re looking very much at a rising tide at the moment,” said Dr McEvoy. “we have a member of staff who works between general practice and A&E, and she said she was in tears at the weekend in A&E that now it is considered fairly routine to have a 48-hour trolley wait to get into a ward.
“The system is already grinding to a halt because of undercapacity, overoccupancy, and that is likely to get worse unless we do something drastic,” he said.
On both sides of the Border the Covid-19 rules are now broadly similar; easements around hospitality venues and the reopening of nightclubs, permitted in the South from Friday, will come into effect in the North at the end of the month.
A key difference is the current lack of a mandatory vaccine passport scheme in hospitality and entertainment venues in the North, with division within the Northern Executive over whether to make an existing voluntary certification scheme compulsory.
For Dr McEvoy, it makes sense: "More than half of the staff here are coming across the Border, we know what the situation is with people wanting to go out or go to restaurants in Donegal and having to show proof, we know it's not that onerous, we know it can be done."
On the other side of the Border in Monaghan town, GP Dr Illona Duffy admits to some concern over the reopening of nightclubs given the high level of not just new Covid-19 infections, but hospital and ICU figures.
“That’s impacting on the hospital services and it’s impacting on people’s general health with non-Covid issues, and that’s a big concern.
“Here in the practice, every day we have positive cases ... the numbers, definitely, are that bit too high, but again I know we have to continue opening up, every level we open up we always know there’s going to be a bit of a surge.”
‘Ultrasounds delayed’
In her surgery, Covid-19 “is not our busiest work at the moment, whereas this time last year it would have been ... our big thing is all the non-Covid stuff, the delayed diagnoses, people who are having tests deferred, having ultrasounds delayed, surgeries delayed, and all that’s happening in the intervening time is that they’re becoming sicker and we’re becoming busier.”
On top of this, she is expecting “an onslaught of continued rise” in respiratory viruses and seasonal flu in a population in which its natural immunity has been weakened. “More people are mixing and mingling and that’s also going to create sicker people.”
