As the country's acute hospital system comes under extreme pressure from rising Covid-19 numbers, the head of the local hospital group fears that the worst has yet to come.
Tony Canavan, the chief executive of the Saolta University Health Care Group, which runs seven public hospitals on five sites in the west and north-west, employs 10,000 people, and has an annual budget of just under one billion euro, believes that the current health crisis will worsen in the coming days.
"The situation will get worse before it gets better," he warns. "Do I think there will be more than 335 [Covid-19] patients in hospital beds [the current figure across the region], I do. It will get worse over the coming days."
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His comments come this week as the number of people with the virus in the region's hospitals (335 ) has almost quadrupled when compared with the previous pandemic peak of 94 which was recorded in mid-April last year.
This week local intensive care units report there are "very low" numbers of vacant beds available, at least 10 per cent of hospital staff in the Saolta group are on leave due to either contracting the coronavirus or being a close contact of a case, and the region's three main Covid-19 testing centres at Galway Airport, MacHale Park in Castlebar, and Castlerea Fire Station are "extremely busy" and are working at "full capacity", according to Mr Canavan.
Concerned
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He is very concerned at the way in which the Covid situation has disimproved. The number of patients hospitalised with the virus has more than doubled in a week.
"Last Tuesday there were 157 people with Covid-19 in hospitals across the whole group. Today [Tuesday] that figure is three hundred and thirty five, that is a very significant increase."
There are two aspects of this which concern him greatly. "335 beds is a huge number. At the height of the first wave on 15 April we had 94 Covid patients in hospital. That will give you a sense of the difference in scale."
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The second worrying aspect is how rapidly the situation has changed. "Hospitals are divided into Covid and non-Covid streams to keep patients separate and to keep them safe. When numbers increase we have to adapt the physical infrastructure of the hospital. All of our hospitals are maintaining Covid and non-Covid pathways and dedicated Covid and non-Covid wards, the challenge this week is to adapt very quickly to the rising numbers. In UHG, for example, we had to increase the number of Covid wards to accommodate all of these patients. We have six Covid wards in UHG now."
There were 116 Covid positive patients hospitalised at UHG on Tuesday, 10 of whom were in ICU. There are 700 in-patients beds in this, the west's biggest hospital. There were 91, none of whom was in intensive care, in Mayo University Hospital. Mr Canavan said that was a "very, very high number" for Mayo because the 280-bed facility is a medium-sized hospital, while there were nine Covid patients at the 220-bed Portiuncula University Hospital in Ballinasloe.
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Local acute hospitals are not just grappling with increasing Covid-positive patient numbers, they are also coping with significant staff shortfalls due to the virus. Some of these are very specialised personnel who are not easily replaced.
Staff shortfalls
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"Across the group, there are around 10 per cent of staff on Covid-related leave, 370 at UHG, over 100 at Mayo University Hospital, and over 60 at Portiuncula University Hospital. That is a very high rate all round. Both the numbers and the fact that some of these are specially trained staff is a major issue."
There are "very, very low numbers" of vacant ICU beds in the Saolta group's hospitals, particularly in UHG. ICUs are normally quite full in non-Covid times and very often work "at the margin", close to 100 per cent capacity. he says. The pandemic is putting a huge additional strain on an already busy department. However, there are arrangements in place to expand ICU capacity.
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"We have been planning for that and hoping that it would never arise. In UHG, for example, we have the physical space in other locations in the hospital. We purchased additional equipment, such as ventilators, during the year [2020]. Last week we cancelled all elective surgery and the majority of out-patient appointments to free up staff, particularly theatre staff, to enable them to go to ICU."
Opening additional beds is entirely dependent on having the staff to manage these beds, of course. "We are under severe pressure but we are managing," says Mr Canavan. "We are, all the time, trying to recruit additional staff, particularly nursing staff, but it is not easy to do so these days because everybody is trying to recruit them."
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There have been positive changes in the clinical management of Covid-19 since the virus first arrived here 10 months ago. There is more known about the condition and doctors manage it more efficiently now, he says. The average stay for Covid-19 patients [in general hospital beds] has reduced from in excess of two weeks in March/April to under a fortnight now. ICU stays are shorter too, they are just over a week now.
Excellent ICU staff
He says the local hospitals are "extremely fortunate" to have excellent ICU staff. Indeed, employees in all departments are working really hard. Many are working additional hours to provide services as the hospitals cope with reduced staff numbers. "They recognise there is pressure on the system and they are responding accordingly."
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The CEO's biggest concern is the rate at which hospitalisations are growing and the fact that they are still increasing. "We are looking at the numbers very closely and we hope we are coming close to the peak of the current wave. The numbers rose last night over the day before, every day the numbers are rising. We have not reached the top of the wave yet and it is hard to know if we will reach it soon.
"We know the number of contacts with GPs are starting to slow down as Level 5 restrictions take hold but it will take time for that to filter down."
Is the worst yet to come? "Yes, I am very sure of that. It will get worse before it gets better. We have 335 patients in hospitals today [Tuesday]. It will take weeks for those people to be cared for and be ready to be discharged.
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"The numbers will increase and those requiring ICU care will increase. It will take time for the pressure to ease off. It will be at least a number of weeks before the hospital system starts to recover."
He says while many older people "suffered disproportionately" during the first wave of the virus, this third wave is affecting a broader group of patients. "We have seen adults from a wide variety of age groups. There are people in their 50s in ICU."
The number of patients on trolleys awaiting hospital beds in Saolta's hospitals has decreased significantly since last week. There were 53 in the group then, there are 29 now. The fall in numbers has helped ease pressure on the hospital system.
Hope
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There is a "palpable sense of hope" in the air since the rollout of the vaccination programme began, according to the CEO. "It shows us that there is light at the end of the tunnel. The vaccine came into the country on 26 December and we started our vaccination programme in UHG on 29 December. The first morning we were training staff to vaccinate and by that lunch-time, they were vaccinating. Thirteen staff were vaccinated that first day." As of this Monday, 5,526 people, all healthcare workers, were vaccinated.
"This week, the focus is being shifted to vaccinating healthcare workers in the community. There are two streams, there is a huge focus on vaccinating residents and staff in our public and private nursing homes. The other stream we are concentrating on this week, is GPs."
He says he is very grateful to the "brilliant" healthcare staff who are working under extreme pressure to provide the highest quality of care to their patients. "I'm a long, long time in the health service and I have always been proud of working in it. But I have never been as proud as I am now, I am hugely proud of everyone."
