Explainer: Why are our hospitals under pressure?
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Very quickly after it reached these shores, Covid-19 caused pressure on our health service and hospital system.
Now, cases, hospitalisations, and admissions to intensive care units (ICU) have all increased again, and are projected to continue to rise over the coming weeks.
As of Friday morning, there were 457 Covid patients in hospital, with 51 new admissions over the past 24 hours.
There has also been a “very significant rise” in the number of Covid patients in ICU, at 90 on Friday morning – the highest since March 10.
This means more than 30% of the country’s ICU capacity is taken up by Covid-19 patients.
HSE chief executive Paul Reid has already warned that if hospitals reach 150 ICU patients, as has been projected by public health experts, then scheduled care will not be able to continue, as had been hoped, to reduce waiting lists.
In fact, some hospitals, including Cork University Hospital, Limerick and Galway, have already had to begin curtailing some surgeries due to capacity issues.
But the impact of this increase in the virus is a lot more complicated as we arrive into the winter system with other contributory issues.
The early arrival of respiratory conditions such as RSV, norovirus (the winter vomiting bug) and the first indication of the presence of flu add to the threat currently facing the health service.
As of the week ending October 10, there has been one confirmed case of the seasonal flu.
While that is a small number, and not yet having a significant impact on daily operations of the health service, a combination of a surge of both Covid and flu is not a mix the health service wants to see.
Added to this, the lack of flu circulating last year, largely as a result of Covid measures, could make some people extra vulnerable.
Respiratory syncytial virus (RSV) is also having a huge impact on children’s hospitals, with a “significant” increase in presentations with RSV in recent weeks.
In fact, all paediatric ICU beds were occupied at the end of this week, largely as a result of RSV, while health officials have said the illness in children is an indicator the same in the adult population will soon follow.
The problem, as well, is the similarity of symptoms between respiratory conditions and Covid-19, according to HSE chief operations officer Anne O’Connor.
This means every patient who is presenting with these symptoms must be treated as though they are a possible Covid patient until it is proven they are not. This adds to the workload in hospitals.
So why wasn’t this an issue last year? Well, by October 2020, many counties had already returned to stricter public health rules, meaning there were fewer people mixing, resulting in a reduction of respiratory illnesses being spread.
Now that the majority of restrictions have been lifted, and mixing is occurring at much higher levels than last year, these respiratory illnesses are going to continue to be prevalent.
Furthermore, emergency departments (EDs) are already busy with people presenting with non-Covid care needs, particularly over 75s, who are most likely to be admitted, and tend to have a longer hospital stay.
Some 3,047 over 75s attended EDs last week, a 15% increase on the same week last year, though a decrease week-on-week.
In terms of the number of people waiting for a bed while on a trolley, it is lower than it was pre-pandemic, but remains higher than last year.
On Friday morning, there were 352 patients on trolleys, the vast majority of whom were waiting in EDs.
It also varies geographically, with hospitals in the south and west of the country being under more pressure than those in other regions.
With all of these issues combined, it really comes as no surprise that health officials are waving a flag of caution about the system's capacity to deal with the rising cases as we move into the winter.