THE PANDEMIC IS still ongoing but Covid-19 hospitalisations and admissions to intensive care are declining. 

In recent months, the focus largely shifted from emergency measures to reflection and planning for the future. 

The Taoiseach said last year that an inquiry into the State’s handling of the pandemic would be carried out to learn lessons for “the next pandemic or the next emergency”.

This has come in the form of a Public Health Reform Expert Advisory Group to identify the learnings from the public health response to Covid. 

A report is due out in the coming months from this group. 

The World Health Organization is pushing for a global accord to help prevent and fight future pandemics. A recent study also showed that climate change will produce more opportunities for viruses to spread between animals and humans, possibly leading to more pandemics. 

So there is work underway to remember the lessons learned in Ireland, and an emphasis that the learnings across the world might be needed again in future. 

Dr Catherine Motherway, head of the intensive care unit at University Hospital Limerick, said she is hopeful but not confident that these lessons will be fully remembered. 

“Not because I don’t believe in people who are in politics or anything like that, but it seems to me that we’re swinging from one crisis to another,” she told The Journal. 

The issues in Europe at the moment will divert them, but I’m pretty confident that they’ve given a commitment certainly to open extra critical care beds. I do think they won’t forget that message.

She said ICUs were not sufficiently prepared for the Covid pandemic.  

“While there was no critical care service in the world that could actually totally support any new pandemic of a viral or respiratory disease without some degree of anxiety and worry, we certainly were very, very worried when we realised what was coming down the track potentially.

“There had been multiple attempts to identify and show that we needed more ICU beds and our ICU capacity was below par, certainly well below the European average per head of population.”

Figures from the Organisation for Economic Co-operation and Development (OECD) show that Ireland had five adult intensive care beds per 100,000 population in 2016, compared with an average of 12 per 100,000.

Before the pandemic, there were 225 ICU beds in the public system. Temporary surge capacity in the earlier part of the pandemic brought this number to 354 with the help of temporary beds.

There were 302 permanent adult critical care beds in the health service as of last August, according to a HSE report on critical care capacity. 

“We were already struggling, and we struggled every winter when we had increased admissions with respiratory diseases as you do in the winter time in the Northern Hemisphere,” Dr Motherway said. 

We already were cancelling high-risk elective procedures every winter before Covid came.  

“I think what Covid did was expose to perhaps a wider population the problem that there was within the critical care part of our relatively stretched healthcare service.”

She said having enough capacity and empty beds with trained staff available is the key lesson to remember in intensive care. This issue was already well-known, but highlighted during Covid-19. 

“What we essentially now know is that you do need a certain amount of redundancy [empty ICU beds],” she said. 

“You’re supposed to have empty beds. They’re not supposed to be full, we’re supposed to have empty beds so we can take patients as soon as they get sick with no delay so that we can actually fix them. 

We needed more beds, we still need more beds, we need to continue to increase our beds.

Effect on nursing homes 

A sector hit very hard during the pandemic was nursing homes. 

Around one-third of all Covid-19 deaths in Ireland since the start of the pandemic occurred in nursing homes, according to data from the Health Protection Surveillance Centre. 

Tadhg Daly, the CEO of Nursing Homes Ireland, said the sector was familiar with flu and norovirus outbreaks before the pandemic, but Covid brought this to “a whole new level”. 

“It’s still my strong view that Ireland probably over-focused on the acute hospitals and getting the acute hospital settings ready [in the early days of the pandemic],” Daly told The Journal. 

“Whereas in fact, the pandemic presented initially in the nursing home sector.”

CMO Dr Tony Holohan said on 20 April 2020 that it was “not realistic for us to think that we could keep [Covid] entirely out of nursing homes”.

At the time, there were positive cases in almost one-third of all nursing homes. 

Daly said a major lesson for him from this pandemic is a heightened need for more integrated healthcare services. 

“I think we need to focus on the person, on the resident in our case, irrespective of who the provider is, or the location of care,” he said. 

The whole integration of the sector, the private-involved sector, into the wider health service is the key lesson for me.

“And there’s a number of legs to that. There’s the whole area of strategic workforce and planning, there’s funding, clinical governance, the whole area of access to services for residents.

“Once we put the person, the care recipient, at the centre then we need to build those services around that person. Not around the provider or not around whether it’s public or private.”

Similar to Dr Motherway, he said the pandemic “illuminated” many of the issues that may have already been discussed before in the sector.

“We have definitely better engagement now with government, with the HSE,” he added. 

“But I would be concerned that once the light dims on the sector that we all move on.

We need to move on in making sure that collaboration, that engagement is not just maintained, but is enhanced as we go on.

“Nobody will thank anybody if we don’t learn the lessons and if we don’t ensure that those elements of integration, of workforce planning, of resourcing of older person’s care isn’t addressed.”

Vaccines

There will also be lessons to learn from the HSE’s Covid vaccination campaign. From the outset, Ireland had much less vaccine hesitancy compared to other parts of the world. 

The country was even hailed as having the highest vaccination rates in the EU at one stage. 

Damien McCallion, the HSE’s vaccination national director, said the health service is “translating” learnings from the Covid vaccination campaign in several ways.

“There was a lot of learning in our communications on this vaccination programme,” he told The Journal recently for the coronavirus newsletter. 

“We’ve had challenges even in the healthcare system in the past in getting the flu vaccine through in terms of staff, although that had improved prior to Covid.”

He said officials are looking at how to strengthen existing immunisation systems “on the basis that it’s most likely we will need to do this again”. 

“Given that we could well have an annual programme around Covid or we could get hit with something else,” McCallion said. 

We’ve had SARS and MERS and things in the past and thankfully they didn’t affect us, but we need to have a stronger what I call ‘first level of floodwall defence’ in our system so that we can respond more quickly in an agile way.

Keeping staff is key 

Retaining staff left overworked by the pandemic is at the core of the key learnings from Covid-19 in the healthcare system. 

Some efforts have been made by the government – public sector healthcare staff are set to receive a €1,000 tax-free bonus to acknowledge their “heroic” work during the pandemic. 

Tadhg Daly said workforce in the private nursing home sector will be the “single biggest challenge” in the years ahead. 

“What people have been through has been very, very challenging. People are tired, that’s one of my concerns. People are exhausted.”

More than two-thirds of nurses and midwives considered leaving the profession due to the impact of Covid, according to a survey conducted last year by the Irish Nurses and Midwives Organisation.

One-quarter said they were likely or very likely to leave the profession within the next year.  

Daly said there needs to be more investment and a focus on treating private nursing home workers “the same as those in the public system”. 

“I like to think that one of the legacies will be that people have a better understanding and appreciation for the care that’s provided, and more particularly for the staff.”

Dr Catherine Motherway said: “If you make it easy and nice to work at home [in Ireland], people will do so. They’ll always travel, but they will come back if it’s good.

“And coming back to a properly staffed, properly run, single-room ICU would be so much nicer than coming back to poor infrastructure and difficult staffing situations.” 

This work is also co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.