By Michael O’Farrell – Investigations Editor
The healthcare system is facing an unprecedented wave of deaths with as many as 1,000 further Covid fatalities feared in the coming weeks.
The anticipated death toll comes amid:
- Soaring levels of new outbreaks in nursing homes, hospitals and residential institutions;
- A 135% increase in Covid infections among elderly home care clients in the past week alone;
- A rising rate of infection among the over-65s generally;
- And unprecedented levels of infection among healthcare staff in hospitals, nursing homes and home care firms.
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Although case numbers are on the decline, from a daily peak of 8,248 a week ago, they still remain in excess of 3,000 new cases a day – 3,231 yesterday – far more than April’s first wave peak.
Immunologist Professor Luke O’Neill has been warning that daily deaths are likely to rise to 100 or more, when those infected over Christmas become ill.
And now, as those infected as restrictions were lifted over Christmas become symptomatic and sick, health authorities are pre- paring for an unprecedented increase in deaths.
A further 60 deaths were con- firmed yesterday. During the first two weeks of the year more than 310 deaths were confirmed.
These likely relate in large part to the over 14,000 cases between December 18 – when restrictions were lifted – and New Year’s eve. Based on Ireland’s Covid fatality rate of 1.42% to date, more than 200 expected deaths could have been predicted.
The most common expectation for the coming weeks is that the almost 80,000 positive cases reported since January 1 – based on the 1.42% fatality rate to date – will likely result in more than 1,000 deaths. This figure will increase or decrease depending on various factors.
If the fatality rate is calculated in this manner on the 93,000 cases since December 18 to yesterday, it works out at over 1,300 deaths.
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With 5,000 hSe staff infected in the past two weeks alone, Siptu’s health division chief Kevin Figgis told the MoS last night of the fears being expressed by healthcare workers at the coalface.
‘Back when Covid hit us first in Ireland we were looking at interna- tional photographs of other countries such as Italy and we were terrified of the images we were see- ing,’ he said.
‘People in basically field hospitals on portable ventilators lined up, one by one. I do think there is a real fear that what we saw in the first wave in other european countries will be a reality for us in the coming weeks during this third phase in our country,’ Mr Figgis said.
‘I’m saying that because members have said that to me. People are fearful of what the ultimate effect of this is going to be.’
Siptu is particularly concerned about the impact of a rising wave of infection among healthcare staff in the past two weeks.
‘It is quite alarming when you see that prior to Christmas the total workforce infections at that time was in and around 13,000 – and in two weeks it went to 18,000. That’s just healthcare workers. It’s quite incredible,’ Mr Figgis said.
‘I think people are right to be fearful – particularly when they see more staff out sick every day on every ward in their location and every department in their location.’
Nursing homes, meanwhile, are also bracing for further fatalities with new outbreaks emerging in more than seven facilities every day last week.
Since Christmas and the new year some homes are once again suffering double-digit fatality rates and there are now more than 112 active outbreaks nationally – representing a fifth of all homes.
Of these 52 occurred in the first week of the new year and although figures for this week are still pending insiders say the pace of infection in nursing homes has not slowed.
Outbreaks in long-term residential institutions are also on the rise with 39 new clusters reported in the first week of the year – up from 10 the previous week.
‘In the second wave we were seeing clusters closing all the time – but what we’ve seen since January 1st has been a fairly significant increase,’ Nursing homes Ireland CeO Tadhg Daly told the MoS.
‘Regrettably its increasing literally day by day.’
The new nursing home outbreaks have been accompanied by a worry- ing rise in deaths in the sector.
On Thursday Chief Medical Officer Dr Tony holohan confirmed that 38 (almost 20%) of the 208 deaths in January were associated with nursing home clusters.
By Thursday, another 23 deaths had been linked to hospital outbreaks.
That means that close to 30% of all deaths are now occurring in nursing homes and hospitals – a worrying indication of things to come.
‘It is worrying with the numbers over the last week to 10 days. Really, really worrying,’ said Mr Daly.
At hospital and ICU level, units throughout the country remain under intense pressure and are bracing for the continuing rise in illness and fatality that inevitably follows every surge in positive cases.
Those working on the ground are preparing for a steep rise in deaths as the impact of those infected over Christmas and new year works through the time lag between infec- tion, illness and death.
‘That seems to be what’s starting to happen,’ said Beaumont ICU consultant and Intensive Care Society vice president, Dr Alan Gaffney.
‘There’s a lag between when you get a positive result until you get sick or until you die. The numbers of positive cases are followed a period later by the associated sick- ness and death,’ he told the MoS.
Dr Gaffney pleaded with the public to abide by public health rules.
‘We don’t want to panic people in any shape or form about what’s going on in the hospital.
‘We want to be as honest as we can to let people know that things are under strain while at the same time saying we all have some control over this by how society reacts to the public health measures,’ he said.
‘At the same time you’re trying to be positive to say – and it is the case – that we will look after every single person who comes into the hospital and every person who comes to ICU.’
Dr Gaffney said this wave was proving to be ‘bigger then anyone expected’ but was taking place in a situation where hospitals and Covid protocols had been hugely strengthened since the first wave.
‘It has been manageable. We look across and we see other places where it hasn’t been manageable and you would certainly be concerned if we got anywhere near those situations. But, so far, all I can say is we have been able to manage,’ he said. ‘It’s hard work and it’s protracted but as far as we can see it’s manageable.’
But Dr Gaffney said he was hopeful that an extra surge capacity of 70 ICU beds across the system would see ‘reasonable outcomes’ maintained in critical care.
‘That’s certainly what we would hope for,’ he said.
‘The question would be if you go beyond that – then you start getting into more uncertainty but that would be the same with any country, any city or any hospital that gets pushed beyond that again.’
There is cause for alarm in other sectors too, particularly among the 20,000 older and vulnerable citizens who are clients of home care serv- ices funded by the HSE.
Until now this sector has remained remarkably Covid-free thanks to the relative isolation of those being cared for at home.
But in the last week alone new Covid infections among this vulnerable and elderly population have risen by 135% to 108 cases. A further 194 are awaiting test results.
Infection among home carers has also risen by 70% to 204 cases in the past week with another 480 isolating and awaiting test results.
With more than 500 employees now out of work the sector is close to a tipping point where services may have to be withdrawn if absenteeism – currently at close to 9% – increases further.
‘This is the first time we have seen exponential growth rates in the course of a week in the virus amongst our client and our carers. We haven’t seen that before. I’m very concerned about next week’s figures,’ said Joseph Musgrave, CEO of Home and Community Care Ireland (HCCI).
‘The next two weeks will really test how resilient home care is. If we reach north of 10% of carers unavailable nationally then our providers will have to start reducing service levels. We’re quite close to that point.’
To prevent this scenario HCCI is calling on the Government to allow better access to testing for home carers – and the approval of rapid antigen testing to facilitate a faster return to work.
Mr Musgrave described the present situation as ‘very challenging’ and frightening.
‘It is scary but we don’t have time to be afraid in the home care sector. We have to get on with it like the rest of the healthcare sector does.
‘Our carers continue to do amazing work and we need to keep supporting them as best we can.’
HCCI has in recent months been critical of the Government’s failure to consider the home care situation and confusion over PPE requirements.
But following a meeting with Health Minister Stephen Donnelly and Minister for the Elderly Mary Butler on Friday, Mr Musgrave is now hopeful progress can be made on a vaccination roll-out for home care staff and HCCI suggestions that home care nurses and staff can help vaccinate those in care.
Now We Know The Real Cost Of Opening Up.
THOSE who warned of the dangers of easing restrictions before Christmas included leading Trinity College scientist Dr Tomás Ryan, a prominent campaigner for a zero-Covid strategy.
‘It’s not acceptable for us to not be learning from our own experience,’ he said. ‘Now we know beyond all shadow of a
doubt the real risks – not the theoretical risks – of managing things the wrong way. It’s not just the lives we’re going to lose – we’re in a three-month lockdown.’
He said that you cannot take gambles with Covid-19, remarking: ‘We were campaigning against opening up significantly at Christmas principally because we knew it
would result in a third lockdown. We didn’t want a third lockdown, and that would have happened even if we had only suffered minor deaths.
‘The most important thing is that we learn we shouldn’t gamble with this virus… if we want to get the economy back to normal, we have to reduce virus numbers and keep them low.’
OAP Homes Demand Jabs For Patients Transferring From Hospital.
NURSING homes called for clarity last night on the vaccination status of patients being transferred from hospitals to nursing homes. Transfers of Covid-positive and untested patients from the acute sector to nursing homes contributed to the horrific death toll in the first wave.
Now the sector wants assurances from the Government and the HSE that any new transfers will be vaccinated first.
‘One of the challenges we
have now is ensuring that
people coming out of hospitals are vaccinated before they leave hospitals,’ Tadhg Daly of Nursing Homes Ireland said.
Mr Daly said he had engaged with the HSE on the issue.
‘We need to get the policy position in place,’ he said.
Another issue is the mounting number of outbreaks and associated deaths.
These outbreaks disrupt the complete vaccination of all nursing home residents and staff because any Covid-positive individuals cannot be vaccinated until four weeks after they have received a negative test result.
Mr Daly said many were worried that an outbreak may prevent them from being vaccinated early – while it was too late for those already affected by an outbreak.
