HEALTH AUTHORITIES ARE taking great encouragement from a levelling off in the number of Covid-19 patients in intensive care units but cautioning that the illness continues to heap pressure on frontline services.

Official Covid case numbers have skyrocketed since Omicron arrived on Irish shores, with over one quarter of all cases from the last 12 months being recorded since 1 January this year.

Further to this, officials say there’s hundreds of thousands of cases that were never recorded for a variety of reasons, including difficulty securing PCR tests.

Chief Medical Officer, Dr Tony Holohan, said that up to 500,000 people, around 10% of the population, were likely infected with the coronavirus disease during the space of a week recently.

Despite the country regularly racking up record-breaking case numbers, the amount of people in hospital with Covid-19 is far short of the previous peak. 

That peak – which saw 2,020 people in hospitals across the state – was recorded on 18 January last year. The highest number of Covid-19 patients in intensive care (221) was also recorded around that time, on 24 January.

The HSE says recent weeks of stable deaths and ICU admissions shows that case numbers are being “decoupled” from the severe harm associated with the disease.

This scenario in Ireland is in line with international evidence showing that the Omicron variant is not as severe as previous coronavirus strains.

At this week’s HSE briefing the health service’s chief executive Paul Reid said ICU statistics are “really encouraging”. Chief clinical officer Dr Colm Henry also noted that said the ICU situation is “not nearly as hot as it was in January 2021″.  

However, health bosses have also cautioned that hospitals remain under very significant pressure. This, in turn, is heaping stress on other parts of the health system, including ambulance services.

‘Incidental Covid’

With a less virulent strain of the virus rampant in many communities it is to be expected that this is also reflected in Ireland’s hospitals.

Indeed, a review carried out by the Infectious Diseases Society of Ireland (IDSI) this week found that just 42% of patients in hospital with the disease had Covid-19 symptoms at presentation. 

The Chief Medical Officer had earlier said that around 30% of patients with Covid-19 in hospital were admitted for other reasons. 

Dr Holohan noted that these incidental cases of Covid – where the patient is in hospital  for a separate purpose but happens to have Covid – still represent a “significant risk to the staff and other patients, in particular, in the hospital environment”.  

The review also found that nearly three-quarters (71%) of patients with Covid admitted to hospital were not receiving supplemental oxygen, which the IDSI said reflects “a significantly less severe form of disease than seen during previous waves”. 

Inside the ICU

At University Hospital Limerick, Dr Aidan O’Brien says there is now a much higher percentage of incidental Covid cases than earlier stages of the public health crisis.

“We’re getting a much lower percentage of people who are positive for Covid that get admitted actually due to Covid pneumonia, or a Covid directly related disease, and a much greater percentage due to something else, like a heart attack or a stroke,” Dr O’Brien explained.

The consultant respiratory physician added that it’s likely the stress contracting Covid places on the body can also trigger heart attacks and strokes in people who are susceptible to them.

It can push some people over the edge and flare that disease up… The stress of the virus and the infection can stimulate that underlying disease to exacerbate.

He noted that this is regularly seen with patients every year during flu season.

The average stay for Covid patients in hospital is currently around six to seven days.

Covid is causing a raft of issues in hospitals, particularly on the staffing front. There are currently around 15,000 hospital staff absent directly due to the coronavirus.

With less staff available to provide care, even a smaller number of patients can place enormous pressure on hospitals and intensive care units.

HSE Chief Operations Officer Anne O’Connor said this week that staff absences are affecting the west and south of the country in particular.

O’Connor said the pressure on hospital sites means that many are left with only a “trickle” of elective care being performed at present. 

“The more Covid cases we have the less we can do of other things… the only control we have is to not book elective care,” she said.

O’Brien said the disease is also having a direct impact on the care Covid-positive patients receive as it restricts what diagnostic tests can be performed due to the risk to the operator.

“You don’t want to do a scope with someone who has Covid because the risk of Covid to the operators will be substantial. Particularly bronchoscopies… or certain scans like an ultrasound.

Because the person doing the ultrasound is right there in the patient’s face with a probe doing it on their belly or their heart. That puts them at a high risk of acquiring Covid from the patient.

O’Brien added that doctors are more likely to admit someone with a medical problem, if they are also Covid positive, as a precaution.

The number of procedures being carried out is also being reduced and time taken to do them is prolonged because of the contact precautions required for the procedure.