The simple truth is we haven't got enough hospital beds, writes Dr Muiris Houston, Medical Correspondent
New figures to be published tomorrow by the National Disease Surveillance Centre will show a significant rise in flu-like illnesses.
The number presenting with flu-like symptoms to a network of medical practices jumped from 48.7 per 100,000 population in the last week of December to 81.4 per 100,000 population for the week ending January 7th.
This is undoubtedly one of the reasons why we have seen yet another accident and emergency crisis so early in 2005.
Other microbes, such as the respiratory syncytial viruses, are also in circulation, leading to higher levels of respiratory illness in the community.
It is significant, however, that A&E departments are reporting no major rise in demand due to respiratory infection. According to one A&E consultant, there is a simple explanation for the dramatic rise in the numbers lying on trolleys: "The major problem is that hospitals have started working to full capacity again after the Christmas/New Year break. While we have been consistently busy for the past few weeks, it is the increased elective activity that means fewer beds are available for A&E patients."
Most who succumb to this wave of flu-like illness will get better either with self-treatment or with the help of the family doctor. But for a growing section of the population, those aged 65 and over, a severe viral infection can have knock-on effects that require urgent hospital treatment. In particular people with established coronary heart disease, heart failure, asthma and chronic bronchitis may find the previously stable chronic illness becomes acute under the pressure of a viral respiratory illness.
Acute infection can cause severe heart strain, a worsening of heart failure or an exacerbation of respiratory disease. Such patients require acute hospital admission and management with intravenous drugs, intense physiotherapy and other treatments to get them over the knock-on effects of viral illness.
The cold weather can render coronary heart disease unstable with the result that a person with previously stable angina can develop acute chest pain or even suffer a heart attack.
So the main problem this week would appear to be the same one that caused the last crisis in October/November: there is no outlet valve from A&E in the form of available in-patient beds. These are occupied by patients being treated for cancer, kidney and liver disease and the myriad other semi-acute treatments and investigations that represent the normal activity of any hospital.
This week we heard in detail of the frustrating experience of Wexford General Hospital in its seven-year battle to add just 19 beds to its complement. The tale is one of inertia at health board and Department of Health level. It was this frustrating run-around, as much as the unprecedented numbers sitting in their hospital's A&E department, that precipitated the resignation of two clinical directors at Wexford hospital this week.
With a growing and an ageing population on top of 20 years of health service neglect, we can be sure that the A&E crisis in our hospitals is set to run and run.