Emergency chief braced for new wave of hospital Covid cases as schools and colleges prepare to reopen
St Vincent’s hospital in Dublin is admitting a “worrying” number of double-vaccinated patients for treatment for Covid-19, emergency department head Professor John Ryan has said.
He emphasised that just because people are double-jabbed does not mean they are immune to the virus.
“Right now, we’re seeing a significant number of breakthrough cases,” he said.
“These are people who are double- vaccinated but still getting Covid. It is worrying.
“In the main, though, more of our Covid cases here are in the young and unvaccinated.
“There is no doubt that without vaccines we would be seeing much more cases in ICU. But it is also an issue, people who are double-vaccinated thinking they are immune.
“I would advise everyone to still continue with public health measures, and I’d advise anyone who can get vaccinated to do so.
“This is a horrendous illness. We are seeing it every day. It makes people very unwell, including the very young, fit and healthy.”
Prof Ryan said Ireland is “coming into uncharted territory” in terms of Covid because of population movement as schools and colleges prepare to reopen in the coming weeks.
“This is like New Year’s Eve, essentially,” he said. “There is about to be a lot of population movement with schools and colleges reopening.
“We know this virus spreads with people moving, so we have to be prepared for an increase in cases.
“I don’t know if we could ever get back to the high infection cases we saw in January — I hope not. I do think the only way out of this is through vaccination.
“I do a hospital report every week, and each week I write the same thing: ‘Next week will tell us a lot’.
“Things keep changing with Covid.
“I’m not optimistic or pessimistic. I’m a pragmatist. It is what it is. But we have to be cautious and prepared.”
At St Vincent’s, which is “at capacity” across all departments, the oldest Covid patient is aged 99.
Within its Covid emergency department, it has 12 closed cubicles, two resuscitation beds and designated Covid wards. The non-Covid emergency department is coming under sustained pressure.
“We have 15 Covid patients at the moment and three of them are in ICU,” Prof Ryan said. “The numbers are going up. The reality is, we don’t know what will happen next. There’s a nervousness and uncertainty right now.
“We’re seeing a lot of people who have been diagnosed with Covid but who are deteriorating at home, so they come into hospital feeling miserable and very unwell.
“We call them the ‘worried unwell’. They have a lot of reserve, a lot of them are fit and healthy young people.
“I’m nervous about restrictions easing further. I think we’re doing everything about a month too soon. There are still people left to vaccinate.
“In the UK, they had their so-called Freedom Day. It’s an interesting experiment. I would rather watch from afar than it being done over here.
“The UK’s Covid numbers initially dropped, but the numbers are back on the way up now.”
The fact that winter is looming is also a worry, Prof Ryan said.
“Winter is a concern. We had zero influenza last winter, but if influenza cases come back, it will be tricky.
“The other issue is that we’ve all been able to be outside so much the past few months, which really helps to stop the spread of Covid. But we will all be back inside again this winter. That concerns me.”
Prof Ryan said he finds it “frustrating” when people choose not to be vaccinated, because he has witnessed the damage Covid can inflict.
However, he also acknowledges the vaccine uptake in Ireland is one of the highest in the world.
“We’re second only to Malta in Europe, but there are still 500,000 people in Ireland who are not vaccinated,” he said.
The problem globally with mass unvaccinated populations is that this is how new variants develop and thrive. This, in turn, can affect Ireland’s own fight against Covid-19, with the potential for vaccine-resistant variants to emerge.
“Nigeria has just 1pc of its population vaccinated,” Prof Ryan said.
“And Delta hasn’t got its teeth into Brazil yet. In the ‘Red States’ in America, they’re in the fourth wave because so many of them are unvaccinated.
“New variants develop within large unvaccinated populations. Parts of the United States are an example of how bad it’s going to get.”
The world should now be concerned over the impact of new variants. “If we get a variant that is vaccine resistant, we’re goosed,” Prof Ryan said.
“Ethically, there needs to be equitable access to vaccines regardless, but it will have an impact on us all because there is not.
“The last thing the world needs is a Covid vaccine-resistant strain.”
Prof Ryan and his colleagues at St Vincent’s are dealing with other issues — a major increase in hospital presentations for non-Covid-related medical emergencies.
The hospital has divided its emergency department into two sections — Covid and non-Covid.
“Vincent’s has one of the busiest emergency departments in the country.
“We have our regular emergency department and our Covid emergency department. In our regular emergency department, we’ve just had the two busiest months of all time.
“We have in excess of 200 patients a day into our regular emergency department. That’s unheard of.”
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As society has reopened, St Vincent’s has seen a gradual increase in more “traditional” hospital presentations.
“There’s more ankle sprains, hip fractures, drugs and drink-related presentations as well as people with mental health issues,” Prof Ryan said.
“The GPs are busier than ever because of Covid, so hospitals are under pressure.
“We also have a zero-tolerance for people on trolleys in Vincent’s now because of Covid.
“But we’re getting squeezed, and the regular emergency department is under severe pressure.
“The waiting times are longer and it’s never been busier. We’ve cut our Covid emergency department in two because we had to get back to dealing with orthopaedic and rheumatology patients. We have also had to make sure we’re providing a safe environment.”
Patients arriving at the St Vincent’s emergency department are carefully screened to ensure safety for everyone, but it takes its toll on its stretched services and staff.
“At the beginning of the pandemic, that was a lot to deal with because it was the unknown,” Prof Ryan said. “We handled it, but it was very tough.
“Then the Covid situation in January became terrible again and there was serious pressure with the number of patients in ICU.
“Now that there are other pressures and problems emerging we can’t be complacent.
“Covid has not gone away. My advice to everyone is to continue to keep your distance, wear your mask and get vaccinated.
“We have an amazing staff here. We have a motto: ‘Treat often, care always’.”