Longford's Dr Padraig McGarry | Covid-19: Where to now?

Dr Padraig McGarry

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Dr Padraig McGarry

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Longford's Dr Padraig McGarry | Covid-19: Where to now?

The problem with writing an article about Covid-19 in these fast moving times is remaining current – with each day bringing a new twist to the story and each day bringing thousands of new cases - each with their own story – each with their own degree of illness and concern.

The figures of the past few weeks have been staggering by any metric and unfortunately we are where we just did not want to be, with rising numbers of very ill people requiring hospitalisation - some requiring Intensive Care; some, unfortunately, who simply will not make it.

The risk of the hospital health service being overwhelmed is very real with each passing day and the abominable spectre of healthcare rationing becoming a reality.

Operating theatres have been converted into Intensive Care Units for ventilated patients. The capacity within hospitals is being stretched to breaking point. Increasing numbers of hospital staff necessary to deliver care to these very patients are becoming ill with the never ending exposure to Covid-19 and with little possibility of replacing them at short notice. This is the reality of Covid- 19 as we start 2021.

A bleak message, I know, but there is no real way to sugarcoat it.

And it is going to get worse over the next number of weeks before we will see a reversal of the current situation. And that reversal is purely dependent on the behaviour of each and every one of us.

What we are seeing now are the vulnerable and not so vulnerable patients who had become exposed to the virus 14 to 17 days ago. They are translating into very ill patients requiring hospitalisation.

With the exponential growth in the numbers of positive cases we have witnessed in the past 10 to 14 days, these will translate into the same type of patient over the next two to three weeks, with increasing hospitalisation and specialised care.

It is unclear whether the hospitals can cope with this projected number – a frightening scenario. Speaking to colleagues in various hospitals across the country there is real concern as to what lays ahead.

What we can influence is to determine how bad it can get thereafter. We can limit the growth in numbers and help reduce the numbers requiring hospital care going forward .

The numbers requiring hospital care over the next two to three weeks are pre-determined

For every 1,000 patients who prove to be Covid-detected, on average 50 will require hospitalisation; five will require Intensive Care and one will die. This is the harsh reality.

With figures reaching thousands of new cases each day, the problem facing patients and the healthcare system is self evident.

What we can do as individuals is to affect the numbers of new cases emerging who subsequently may require hospitalisation.
Stay at home. There is no other effective option available.

This wave of Covid-19 is different from the previous waves insofar as it has now become local. In the second wave and to a lesser extent the initial wave, Covid-19 was something that happened elsewhere, didn’t really affect us here. And behaviour reflected this. There was certainly a laissez faire approach, with no real discernible concern for the individual.

This third wave is entirely different, with transmissibility dramatically increased. There is hardly an individual who has not been touched by Covid, whether it is a family member, a friend, a work colleague.

Suddenly it has become very real. Suddenly it has become very local. There is not a town , a village or a parish which has been left untouched by Covid-19. Suddenly it has developed an urgency and a topic of conversation – and unfortunately a source of anxiety and concern.

The emergence of the mutant strain has conferred increasing transmissibility and this strain will become the dominant strain over the next while, further increasing the ease of spread.

This strain does not bring with it increased virulence but it is a moot point as to which is more significant - virulence or transmissibility. The increased transmissibility reinforces the message – limit the spread – stay at home.

I would like to have brought a more hopeful message at the start of 2021. It has been hugely difficult for many in the past year, with the direct effect of illness on patients and families; with , unfortunately, the reality of loved ones dying from Covid 19; with the physical and psychological effect it has had on so many; with the crushing effect on so many businesses and people's livelihoods. But unfortunately I can only call it as it is.

It is somewhat a cliché - it is always darkest before the dawn – and indeed in this case it was never truer. But there is a glimmer of hope – a chink of light is breaking through with the arrival of the various vaccines.

Who would have thought in June of 2020 that a vaccination programme would commence at the end of December 2020? Pie in the sky dreaming, but this is exactly where we currently are.

We expect to see a rapid roll out of vaccines to Nursing Home residents over the next few weeks – a group who are most vulnerable and unfortunately took the brunt of the first wave. These are a group who have been isolated from their families in the autumn of their lives – hopefully this will offer them some respite.

Healthcare workers are needed at the coal face to deliver care to those who are and will continue to get sick. Vaccination for this group needs to be a priority as their expertise will be needed as never before.

There is a planned programme being developed for the future rollout of the vaccines as they become available, with priority being given as determined by expert groups. I have full faith in this group in determining need.

We are in a global market for vaccines and the government has secured, through the power of being an EU member, sufficient vaccines as will be required. But these will come in a staggered timeframe – the whole world is seeking vaccines.

The initial advice is that the efficacy of the vaccine will not be affected by the emergence of the current mutations and hopefully it will remain so, although some questions are being asked about the South African mutation.

This is a positive note to end with: the patience and forbearance of the community is something which needs to be commended. But for the next number of weeks in particular until the curve can be again flattened and the effect of the vaccinations can start to take effect, stay at home and follow Public Health advice.