Covid-19 ‘to bring added winter crisis in hospitals’

WINTER last year was one of the worst on record for crises in A&Es but ‘this winter is going to be worse again,’ an emergency medicine consultant has warned.

According to the Irish Nurses and Midwives Organisation’s Trolley Watch figures, there were 197 people on trolleys yesterday, with the number down dramatically on last year.

In September last year, the number peaked at 598, in October, it rose to 610 and in November peaked at 679.

The highest one- day figure in December was 614.

Emergency medicine consultant Dr Fergal Hickey told the Irish Daily Mail that the numbers on trolleys are down ‘because certain things that would normally be taking place are not taking place as a result of Covid’.

He said: ‘We’re not doing the same amount of elective surgery we would have previously.’

Covid is going to pose a significant problem this winter because it will be ‘indistinguishable’ from other winter viruses such as cold or flu when people present at the emergency departments.

‘All that is going to happen during the winter is that we’re going to have the complexity of Covid plus influenza, plus the normal winter respiratory viruses all appearing to be the same, and we have to treat them as if they might have Covid or influenza and we have to basically be able to separate them from patients with normal conditions. That is going to prove impossible in the current environment,’ said Dr Hickey.

He said the issue will again be bed capacity which can result in emergency departments getting clogged up. ‘Our big problem is that we process people in the emergency departments, we decide that they need admission and there is nowhere for them to go,’ he said. ‘So they stay in the emergency department, that clogs up the emergency department’, which means they may not be able t o ensure social distancing between patients.

‘We do not have the capacity to keep people with potential Covid away from people with vulnerabilities because there aren’t the beds into which to admit people and therefore they are not admitted in a timely way. That is the single biggest pinch point in the system,’ Dr Hickey said.

He said the worst of the winter crisis could hit any time, but it’s usually between late November and Christmas.

Deputy general secretary of the INMO David Hughes told the Mail that the winter spike in trolley numbers usually comes as a result of a l ot more colds and flu circulating, which can hit vulnerable people ‘very hard’.

He said: ‘People with Chronic Obstructive Pulmonary Disease ( COPD) or any other of the chronic illnesses tend to be more vulnerable than the rest of us so they end up in hospital from what would be a normal flu for healthy people.’ This i ncreases t he demand for beds.

The other problem that causes the build-up in people on trolleys is that Irish hospitals are always operating at peak capacity, which means there is little room to deal with spikes.

‘Hospitals nowadays are running at 100%, or slightly below it, occupancy all of the time even during the summer. So when they get any mild increase in demand there is a delay because there are already patients i n the beds because all of the beds are full and you have to wait until someone is discharged before you have a free bed,’ he said.

And the norm in other countries is to keep hospitals at an 85% occupancy. That way they will have space to absorb an increase i n demand. ‘ The process of admission and discharge becomes critical to just how overcrowded you are,’ he said.

Addressing the particularly bad trolley crisis experienced last year, Mr Hughes said that there was an accumulation of problems but there was also a bad flu.

Dr Hickey added that one of the few hopes for this year is that Australia had its flu season during our summer and thanks to the cough etiquette and social distancing it was not as bad as previous years.

Should t hose behaviours continue here, the impact of the flu might be reduced, he said.

‘Indistinguishable’ from other viruses