Irish Update Covid-19

Speakers:
Catherine Motherway -Pres ICU Soc Ireland
John Laffey - Prof Anaes and ICM
John Bates - Dean Joint Faculty ICM Ireland
Chair: Kevin Bailey
Organiser: Andrew Mortimore

(Please note I expect some of this to not be applicable to Au/NZ - don't @ me) https://twitter.com/AAGBI/status/1253738096883089409

Kevin Bailey chair begins. All speakers involved in national response. Recording to be available from Sunday. 400 online at the moment.

Rory Dwyer first speaker. First case in Ireland 8 weeks ago.

14% of those admitted to hospital require ICU admission. 18/204 died without ICU referral - ie ICU deemed not appropriate. (9%). Re: deaths in ICU not complete as some patients still in ICU. Death rate lower than UK.

COVID ICU discharges Ireland vs UK. Length of stay shorter in UK in survivors and those who died in ICU. Notes can't make firm conclusions yet as data not complete.

Early modelling had a peak of 120,000; would equate to 2,500 who would die from no ICU bed. Key choke point in the system in a pandemic is ICU availability. Accurate information is vital. Even with an R of 1.2 9 (purple) = overwhelmed ICU.

Lockdown decreased R.

Effect of lockdown on cases.

Kudos to team and those in the hospitals who created and have inputed data into the National ICU bed information system. Every hospital included, assists transfer decisions.

System gives real time data, including covid cases, allows tracking progress of disease. Notes lag of 2 - 3 weeks with the course of infection.

Notes has peaked, but slow decline reflecting long stay in ICU.

Median length of stay survivors = 8 days, died = 7 days.
Notes that gap has persisted between occupied beds and open beds, including invasively ventilated beds. This shows covid patients in ICU at peak day (first 6 are hospitals in Dublin).

Widespread difference in availability of ICU beds in European countries.

ICU increased overall 36% from baseline, but varied across hospitals. Notes smallest % of expansion small in some larger h's. Notes that expansion should be proportionate to existing infrastructure.Emphasised importance of accurate information to inform decisions re restrictions.

Modelling shows that lockdown release will cause a peak. Need to be prepared. Pressure to release restrictions. Again emphasises importance of accurate data to inform DoH decisions esp re ICU capacity.

Q for RD: is it fair to say the system coped over last week? A = yes overall. However some hospitals were very busy, transfers facilitated care for all.

Q for RD: why is mortality in Ireland lower than UK? RD: Suggests that perhaps system under less pressure, able to provide more (however data not complete ... anecdotal).

Q for RD: how much activity should we continue to prepare for? Says that system can be easily overwhelmed. Will depend on degree of lifting of restrictions.

Notes specialist surgery which requires ICU post-op had to stop to allow capacity for covid19 patients. Notes there is a move to open elective surg,but option to cease this remains. Concern re staffing for next 3 months? Yes, concerned. Patients need high level care, are complex.

Q for RD re ?staff affected. Notes about 10% of ICU admissions healthcare workers. (I'm not sure if I quite heard that correctly ...)