A GREATER FOCUS on flu vaccination could be at the heart of how Ireland sustains a fragile health system through the pressure of winter, although experts say the country will need to do more than that if it’s to cope with both Covid-19 and the annual challenge of influenza.
While health officials in Ireland have played down the suggestion that a second wave of the virus is inevitable, countries around the world are finding that easing lockdown and keeping the virus suppressed is a complex task.
Even if there is disagreement about the likelihood of a second wave, there is a consensus that seeing a large spike in the virus in winter would pose a serious challenge to Irish hospitals – which usually find themselves under pressure from seasonal influenza.
Every year, 200-500 Irish people die because of the flu, with people over 65 especially vulnerable. Unlike Covid-19, a flu vaccine has been developed and is widely available – although it’s only 40-60% effective.
Having to cope with bad outbreaks of both flu and Covid-19 could add unprecedented strain on the health system.
And in the cold, wet months at the end of the year, staying socially distanced outdoors or in well-aerated rooms becomes much more difficult.
Dr Nuala O’Connor, the Clinical Lead on Covid-19 at the Irish College of General Practitioners, told TheJournal.ie that the main difficulty “is that there will be a big increase in patients going to GPs and in hospitals as is usual in the winter”.
“How large the increase will be if Covid-19, influenza, respiratory syncytial virus, winter vomiting bug and other viruses all arrive together is hard to predict.”
GPs, she said, were mostly worried about “capacity”.
At the moment it is taking twice as long to process normal patients because we have to phone triage everyone first. The surgery’s car park is the new waiting room. We are calling patients in as we are ready to see them unless you have a very large waiting room. We need to take on and off PPE. We have to clean after everyone leaves. All this takes time.
“We hope the winter flu vaccination will be ready earlier than usual so we can start
vaccinating but nothing is confirmed yet,” she said.
Last month, health minister Simon Harris confirmed that the flu vaccine will be available for children aged between two and 12 for free this winter, while at-risk groups defined by the HSE aged from six months to 69 years will also be able to get the vaccine for free.
People aged 70 and over already have access for free.
“A resurgence of Covid-19 during the coming flu season could present a significant challenge to the delivery of healthcare services in the coming winter,” Harris warned.
O’Connor said that the winter months would be all about “public co-operation”.
“People will need to take themselves out of circulation when they have any symptoms of infection, fever aches and pains, sore throat, cough, vomiting, diarrhoea,” she said.
Similar symptoms
Dr Kim Roberts, leader of the Virology research group in Trinity College Dublin, echoed this. “In terms of mild cases – people with Covid-19 when the symptoms are mild – it will be hard to identify if they have one virus or the other,” she said.
“Any symptoms, staying at home is the safest course of action.”
Roberts stressed that we still don’t know how Covid-19 reacts with other respiratory viruses such as flu. “There’s data suggesting that people can be co-infected,” she said.
“Being infected with one virus is not looking like that protects you from being infected with another respiratory virus.”
However, there is more optimistic data from Australia. The country’s flu season, which takes place from June to August, has been relatively mild this year – something attributed to the social distancing measures introduced to suppress Covid-19.
This suggests that Ireland might see lower rates of flu come November and December as social distancing guidance keeps us all further apart.
“If we maintain the measures we have in place,” says Roberts, “then transmission of flu will hopefully be reduced”.
Nonetheless, all experts stressed that a wider take-up of the flu vaccine could be a crucial part of resisting a simultaneous wave of coronavirus and the flu.
Professor Sam McConkey, from the RCSI University of Medicine and Health Sciences, said it was “certainly a legitimate concern if we were to get a big flu epidemic and to come with that was a Covid-19 outbreak in a big way”.
“The two together could overwhelm the health services,” he said.
He suggested that by winter we might have a potentially crucial innovation in testing – a multiplex PCR test. Put simply, it would allow medical professionals to test for both influenza and Covid-19 at the same time.
McConkey says that the decisions taken in the coming weeks will decide what our winter looks like. And while he said that people shouldn’t be afraid to return to some kind of normal, he stressed that there were big political decisions to be made in the months ahead.
“It’s not rocket science to build in surge capacity” in health systems, he said. “Is surge capacity in the programme for Government?”
Criticism
At least one medical group has already argued that the new programme for government between Fianna Fáil, Fine Gael and the Green Party doesn’t bode well for the future.
In a statement last night, the Irish Medical Organisation said that the plan – agreed yesterday morning – failed to address the limited capacity of the health service.
“We are facing a potential second surge of the virus while unprecedented capacity and recruitment and retention issues blight our health system,” said Dr Padraig McGarry, the President of the IMO.
“It is very disappointing that the incoming government does not appear to fully grasp the need to support patients, doctors and everyone who works in our healthcare system.”
If that charge is correct, it means that the fate of our medical staff and patients in the winter are likely to be shaped by the new government in the next few weeks of summer.
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