Aoife Moore: Nphet recommends Level 5 but how did we get here?
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The recommendation by public health officials to put the entire country into Level 5 came as a shock to the public on Sunday night but the National Public Health Emergency Team (Nphet) says Ireland's lack of healthcare capacity was the driving force behind the advice.
On Thursday — just three days before the bombshell recommendation was made — Nphet noted: “While current trajectory is very concerning, current epidemiological data does not strongly support move to Level 3 nationally at this time”.
By Sunday, the group had recommended that the entire state move to Level 5.
While some counties appear to be managing their cases, and a total of five are either in or have been in localised lockdowns, Ireland continues to battle a second wave which has shown no real sign of abating.
Hospital admissions are just one of the factors studied by the public health experts but it was noted as a major cause of concern over the weekend.
As of Monday morning, there were 150 patients with confirmed Covid-19 in Irish hospitals, with 15 admissions over the course of Sunday, with a significant rise in new cases among people over 65.
On August 5, there were 17. A month later, on September 5, that number was 48, and a month on again, on October 5, there were 150 Covid-19 patients in hospital.
These admissions had alarm bells ringing when NPHET held their Sunday meeting early in the afternoon, the first chaired by chief medical officer (CMO) Dr Tony Holohan since his return to the post from months on compassionate leave.
The treatment required for severe Covid-19 cases means adequate access to general and intensive care beds remains the highest priority.
Across OECD countries, Ireland is at the low end with just five beds per 100,000 of population and remains the only Western European country without universal coverage for primary care.
Ireland has almost no capacity to deal with a rapid influx of patients, Covid-19 or otherwise, with a bed occupancy rate of 95%, which is around 20% higher than OECD average of 75.2% and the highest in the European Union.
It also has a history of patients waiting on trolleys for treatment; on Monday morning, according to the Irish Nurses & Midwives Organisation (INMO), there were 240 patients waiting on trolleys.
Public health officials warned that the service could become quickly overwhelmed.
The former president of the Irish College of General Practitioners and a member of Nphet, Dr Mary Favier, said that the “absolute reality” and “inevitable truth” of the current Covid-19 figures was that a lockdown would be necessary because of the vulnerability of the health care system.
“Something needs to be done to protect it,” she told RTÉ radio.
"We are an evidence-based profession," she said, noting that if the Covid-19 numbers continue at their current trajectory then there could be 1,500 cases per day by the beginning of November and hospitals would be at full occupancy.
“GPs are concerned at what this winter is going to look like. It’s not just a fear, it’s a reality," she added.
Dr Favier said there are concerns that if there was a serious traffic accident or a cardiac incident that there would not be an ICU bed available as they would be occupied by Covid-19 patients and that moving to Level 3 in Dublin and Donegal had made “some difference” but not enough.
"Something needed to be done to protect the health service," she said.