Covid-19: ‘Best case scenario’ is 200 patients in ICU next week

Doctors could be forced into difficult decisions on who gets treatment if there are more than 350 patients in need of intensive care unit (ICU) beds as a result of Covid-19, doctors have warned.

Health Service Executive (HSE) chief medical officer Dr Colm Henry said there are currently 286 ICU beds in the system with a surge capacity of up 350.

Dr Henry said a best case scenario is a figure of 200 people in intensive care units with Covid-19 in the next week, but a worst case scenario would see figures in excess of the existing surge capacity and “beyond”.

After that he said it would be “very difficult” to provide an acceptable level of care.

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Dr Henry said hospitals in the State had never gone beyond their ICU capacity before during the pandemic, but other countries had and the outcome for many patients had been “very poor”.

“We don’t want to see that happen here. Once you go beyond 350, staff will do what they can and try to make the maximum use of resources for those ... most likely to benefit.”

The HSE is expecting between 1,500 patients in hospital in a best case scenario with Covid-19 to a worst case scenario of 2,500 by mid-January with 400 in ICUs.

On a day that the numbers in hospital with Covid-19 surpassed 1,000 for the first time, HSE chief executive Paul Reid said the healthcare service is "under extreme pressure" with 2,500 staff currently out with Covid-19 or as a close contact of somebody with Covid-19.

In addition 880 nursing home staff are out with Covid-19 or as a close contact of someone with the virus.

The Irish Nurses and Midwives Organisation (INMO) said on Thursday evening that staffing levels in the health service are “in freefall” and its executive council will hold an emergency meeting on Friday to discuss the crisis and receive updates from across the country.

The union pointed to staff rosters “decimated” by Covid absences, surging patient numbers, and a lack of childcare for frontline staff.

Karen McGowan, INMO president, said the staffing situation has reached dire levels in many hospitals. “I am getting constant reports from colleagues across the country, speaking of wards closing, rosters unfilled, and services under pressure and unmanageable workloads.”

HSE chief executive Paul Reid said medics were “literally fighting to save people’s lives” at present.

“We are looking at quite extreme situations in our hospitals and in our healthcare settings in the next 10 days unless we urgently retract back to our homes,” he warned.

“There is nothing positive about the scenario we are in at present. Restrictions are having an impact on society and people’s mental health, but we do know what we have to do right now today.”

Prof Clíona Ní Cheallaigh, an infectious diseases specialist at St James’s Hospital in Dublin, said doctors were “terrified of being in a position” to recommend intensive care for a patient in a scenario were there are not enough beds available for them.

“We are really worried if that happens, it will be very difficult to deal with psychologically. You never want to make a decision around intensive care when somebody is crashing in front of you. You want to make that decision days ahead if you can,” she said.

“We really want the public to hear that going into intensive care is a massive burden on that person.

“You are very unwell, you have a tube down your throat. You have a huge mountain to climb.”