The government and HSE insist we are prepared for a worst-case scenario of Covid-19. But are their strategies sufficiently robust, asks
Despite the ever-increasing coronavirus stats, health officials insist we are prepared for the worst, with all hospitals on standby.
But, as well as trusting this is the case, it’s difficult not to wonder how the overstretched Irish health system will cope.
The first case in CUH — the first incidence of community transmission in the country — led to up to 100 frontline workers being sent home to self-isolate.
And while the health service is already at least 10% short of the number of doctors and nurses it should have, Ireland also has far fewer intensive care beds per head of population than our EU counterparts.
Across the EU, the average is just over 11 beds per 100,000 people, while here it is just over five.
Added to that are the country’s long waiting lists. For example, in January it emerged there were more than 550,000 people waiting for a first hospital outpatient appointment at the end of 2019 — an increase of more than 30,000 on the same period in 2018.
The HSE has responded in part by lifting a recruitment embargo. But given that it can take months to recruit new staff — especially for specialist positions — like ICU nurses and radiographers — you have to ask if the move will have much, if any, impact.
The dynamic around this crisis shifted dramatically when The Business Post reported on Sunday that government forecasters are looking at between 30% and 50% of the population catching the virus.
The lower figure was the best-case scenario, while the higher figure was the worst, according to the paper’s sources.
The paper also reported that health chiefs expect half of the estimated 1.9m people predicted to get the virus to fall sick during a three-week “concentrated burst”, although it didn’t specify when this would happen.
If widespread community transmitted infection spreads in Ireland as it has in Italy, this could happen in a short space of a few weeks and involve thousands of people.
If, as is more likely, it spreads here as it has in Britain, there will still be widespread infection, but it is unlikely to be on such a large scale.
Either way, regardless of the intensity, widespread transmission is likely in the coming weeks, as happened in Italy and as the British government has already warned its own people.
The HSE is basing its predictions on modelling exercises that are due to conclude over the coming days.
And while it might be easy to dismiss The Business Post figures as speculation, HSE CEO Paul Reid was — when asked by RTÉ news on Sunday — unable to dispute them.
Initially regarded as something of a doom monger, much of what infectious diseases expert Professor Samuel McConkey had warned about the potential scale of the crisis before The Business Post article now seems more real.
“We have to scale-up our responses quite dramatically to be ready for what’s coming,” he told Feelgood.
“You can map it out with the best-case scenario, a worst-case scenario, and an expected scenario in between, so there is a lot of uncertainty. You’re constantly working with uncertainty and there are ways of doing that in a rational, organised, calm, and thorough way.
“We know from the data from China there is approximately 2% mortality and there are some hints it could be even 3% or 3.2% from (World Health Organisation) data.
“So, if you do the mathematics, we could be looking at large numbers of deaths. Our healthcare system could easily be overwhelmed,” he said.
Beyond building new hospitals or upgrading our existing facilities, he said, we need to take a countrywide approach to the health crisis.
“This requires a whole-of-government response [to protect] agriculture, essential services, water, electricity, food supply, and the basic essentials we need, like GPS and internet.
“It is quite likely the people who maintain those are going to be in quarantine in some cases, so we need extra staff on those services.
“So whatever comes, we don’t lose things like water and electricity, GPS and internet and communications that our lives depend on.”
According to the Department of Health, Ireland has advanced plans in place as part of its “comprehensive preparedness to deal with public health emergencies” such as Covid-19.
It says these are the same plans that helped the country respond to previous incidents such as pandemic influenza, SARS, and MERS.
The National Public Health Emergency Team, chaired by the chief medical officer Tony Holohan, meets regularly to assess the international data, receive guidance regarding the outbreak and to review Ireland’s ongoing preparedness in line with advice from the World Health Organisation (WHO) and the European Centre for Disease Prevention and Control (ECDC).
As part of the government’s strategy, we are currently in what is known as the delay phase. The next phase is the mitigation phase.
Last week, when criticism from certain quarters about just how the country can cope with the virus was put to it by Feelgood, the Department of Health was in no doubt regarding its ability to cope.
A spokesperson said: “Public health protocols have been in place in Ireland since January and are operating effectively.
It referred to the decision to use National Ambulance Service paramedics to community testing, assess, and investigate suspected cases of Covid-19 as “a very welcome innovation”.
“We have invested significantly to bring extra ICU beds into operation and to allow further investment for the national isolation unit in the Mater Hospital, Dublin.
“We will also keep the winter flu beds open. Isolation units have been identified across all our hospitals.
“We are closely monitoring medical and pharmaceutical supplies and have large stockpiles of equipment, including 13,500 kits for GPs, and ventilators to support the hospital system.”
While the chances of catching the virus are high, in most cases, the symptoms will be mild and much like the usual winter flu bug.
Dr Nuala O’Connor, the lead advisor on Covid-19 with the Irish College of General Practitioners, said: “The vast majority of people who become infected will have a relatively mild respiratory type of illness, with fever, cough, and shortness of breath.
“It’ll be more like the usual winter bugs we are used to getting and they will recover and they will require no specific treatment.
“They will take a bit of time out from work or school, rest at home, take plenty of fluids and paracetamol, and they will recover by themselves. They will not even need to see a GP.
“The problem is where high-risk people — the elderly and those with underlying medical conditions — catch it.”
People’s first port of call should be the HSE’s “very good website”, she said.
“This is because we have a limited capacity in all of our health system. That includes a limited public health time to be responding personally to phone calls, limited GP time to respond to phone calls. Where possible, we want people to go to the HSE website and there is also an HSE phone line and to see if the questions can be answered there.”
According to the ECDC, 80% of cases will be mild, the impact can be anything from severe to critical, and even fatal, for the remaining 20%, with an estimated 6% ending up as “critical”.
Worryingly, the World Health Organisation reported on March 1 that up to 50% of critical cases ended up being fatal.
And in Ireland’s case, that could end up being tens of thousands of deaths.
It’s a grim prediction, but one that’s backed by general global statistics from WHO and the ECDC — the lead agency for Europe’s response to the virus.
It is also an agency whose advice Tony Holohan has been referencing in his daily updates.
Cork City centre general practitioner Dr Phil Kieran believes that a spike in the number of cases is on the horizon.
“I think over the next two to three weeks, we’ll probably see a significant climb in the number of notifications of illness,” he said.
“That may be a function of screening more because we have more contacts, and when you start looking for something, the more you start finding it. But we are likely to have a higher rate of infection as well. That is in the short to medium-term.”
However, he added: ”I would hope if people do follow the advice of self-isolation, and if we get a big improvement on handwashing and good respiratory hygiene in public, that initial burst of symptoms will be pretty short.”
And if that happens, then “what we will start getting is a slow tapering off and a steady decline in numbers”.
Of the predictions, he said: “For anyone dealing with projections and trying to prepare the country for what might happen, I think they would be absolutely negligent if they weren’t looking at the worst-case scenario.”
He is also concerned about frontline and other medical staffing and resources in hospitals, and hopes this crisis helps solve the issues once and for all.
“I suppose the big concern will be how many ICU beds do we have,” he said.
“And you have a situation where 80% of GPs are not able to take on new clients and there are the waiting lists in the hospitals.
“I think the health service will do quite well. But it will do quite well off the back of the frontline staff going above and beyond like they always do. I don’t think it will do well because of inherent systemic stability.”
Asked if Ireland could compare to what happened in Italy, he said: “I would think not, because we don’t have the areas of tightly packed public interaction.
“I would expect our rise to be similar to Britain and Germany. I think it would be surprising if we managed to get away with less than what is predicted to happen there.
“This is because the outbreak in Italy was in densely populated tourist destinations.”
Regardless of how robust the Department of Health’s plans are for the virus, not everybody is relying entirely on it for direction, and some organisations are refusing to wait.
Last week, nursing home visiting restrictions came into place across Cork and the rest of the country — at a time when there has already been at least one Covid-19 death in a US nursing home.
Nursing Homes Ireland decided on its own initiative that all non-essential visits are banned in the best interests of residents and staff.
And on Monday, the Irish College of General Practitioners issued a call for people to not turn up at their GP practice without an appointment.
This came as it has emerged that GPs up and down the country have started asking their patients to wait in their cars before they are called in when it’s their turn to be seen, rather than sitting in a waiting room.