Munster's two largest hospitals are at breaking point amid spiralling Covid-19 cases and new warnings that burnt-out frontline healthcare workers could be pushed to the brink in the fourth wave.
As new figures showing the number of stressed medics seeking help has doubled this year, the CEO of the University of Limerick Hospital Group said projections of up to 200,000 cases of the virus in December "would cause the collapse of the health service", while the Irish Nurses and Midwives Organisation said it had written to the HSE calling for urgent curtailment of services in Cork University Hospital.
The INMO also called for an emergency meeting next week to discuss the issues at CUH, which it said included failure to curtail non-emergency services, overcrowding in the emergency departments, and intensive care unit (ICU) demand that exceeds staffing levels.
INMO industrial relations officer for CUH, Liam Conway, said: “This is a very dangerous situation across the acute hospitals in Cork, and staff can’t wait any longer for management to intervene."
The situation in Limerick is also stretched. Group chief executive officer of the ULHG, Colette Cowan, told RTÉ Radio that University Hospital Limerick had 12 ICU beds and 16 high-dependency beds, and currently had 13 people in ICU. She said staffing requirements meant the hospital could only deal with another three ICU cases.
She said she expects that all elective work in the hospital group will stop by the end of next week.
Head of ICU at UHL, Dr Catherine Motherway, said at national level, based on current projections, "We don’t have enough ICU nurses to staff ICU beds."
With 130 staff currently off work in Limerick due to Covid-19, Ms Cowan said derogation for healthcare workers — in which hospital staff would be exempt from the new five-day rule to self-isolate if a member of their household becomes infected with Covid-19 — was necessary, adding: "We need them on the frontline."
The INMO disagrees, and the organisation's general secretary, Phil Ni Sheaghdha, said it was unfair to expect healthcare workers to act as "sandbags" for the current crisis, stressing that they should be entitled to the same protections as other citizens.
The INMO was due to meet the HSE to discuss the derogation yesterday, with more meetings on the issue likely next week.
Rising Covid-19 cases are bringing more pressure on staff, and the clinical lead of the Practitioner Health Matters Programme, Dr Íde DeLargy, said an extra 100 healthcare professionals had come to the service this year, including some senior medics, often burnt-out.
The programme is a care and support service for health professionals who have mental health issues, and Dr DeLargy told the: "The system was already creaking pre-pandemic, then we took another hit in the pandemic, and here we go again.
"We also know that we are seeing the tip of the iceberg in our service.
"I don’t want to overegg that and say every presentation [is like that], but we would certainly have some as far gone, as burnt-out as that."
As for the derogation debate, she said: "Somebody who is already under pressure and has a lot of things going on, and now we are going to say: 'We want the troops in on the ground regardless'.
"It's an understandable sentiment, that you have all hands on deck, but we have to recognise that not all are able for it."
Latest figures show 3,138 new cases here, with 643 people with Covid-19 in Irish hospitals yesterday, and 118 people in ICU.
Elsewhere, Austria has imposed a fresh lockdown and fears that Germany could follow suit impacted on investment markets yesterday.
Dermot O’Leary, chief economist at Goodbody, said “the surprising moves” had put lockdowns back on the agenda in Europe.