THE pandemic brought to the fore many challenges still to be addressed in the health system but it has also shone a light on the amazing job healthcare staff have been able to do despite the need for more infrastructure, updated IT systems, and staff.
Clinical lead and consultant in emergency medicine at Cork University Hospital (CUH), Conor Deasy, said that the onset of Covid-19 “highlighted glaring deficits in our infrastructure and bed capacity”, an issue that he said still needs to be addressed.
“We went into the Covid pandemic with a severe bed shortage; more beds were stripped out of the system, particularly in the community because they were not compliant with infection control due to Covid and these are yet to be replaced,” said Prof Deasy.
Reflecting on the last two years of working through the pandemic, he said his biggest fear has been the fear of losing colleagues and friends to Covid-19.
Speaking about how he had to adapt within his role at the hospital when Covid-19 hit, he said: “We had a cohesive multidisciplinary leadership team in the emergency department (ED) who were agile and responsive to new information, guidelines, and developments as they came in. At times, we had to pre-empt national decisions so staff and patients would be kept safe.
“In the first few weeks of Covid, attendances at the emergency department dropped to very few. This gave us time to set up for the Covid pandemic, to identify isolation rooms and make sure they were equipped and stocked to provide resuscitation to crashing patients. It gave us time to train our staff in the use of PPE, in how to stay safe and how to treat patients with possible Covid.
“Now, we have unprecedented numbers of patients attending, many of whom because they are not able to get to see their GP in a timeframe they are satisfied with.
“We frequently see patients wait 18 hours to be seen by a doctor in the emergency department for a condition that would ordinarily have presented to their local GP.
“There is a great increase in healthcare needs and healthcare anxiety resulting in patients presenting to EDs and GPs. This is a far more challenging part of the pandemic, with fraught and tired patients and staff, than was the initial months of the Covid pandemic.”
Prof Deasy said that the pandemic has highlighted the requirement to invest in health to provide “transformational change”.
“Physical infrastructure and IT investment would ensure that staff work to their optimal efficiency and capacity.
“We need to recruit and retain staff and fundamental to this is ensuring staff do not always feel like they need to be heroes to deliver day-to-day routine care because there aren’t enough of them and they’re working to compensate for inefficiencies in the physical and IT infrastructure.
“Every staff member I work with is a hero. They put up with challenges and create workarounds that in other sectors would not be tolerated,” he said.
Consultant medical oncologist at the Department of Medical Oncology at CUH, Seamus O’Reilly, said that looking back on the past two years, the core issue for people has been isolation.
“The core issue I feel is isolation for so many people and isolation compounding existing distress —distress of cancer, distress of financial hardship, distress of abusive relationships, distress of preexisting loneliness,” said Prof O’Reilly.
Speaking about how the pandemic affected cancer patients, in particular, he said that patient fear at the onset of the virus which led to delayed presentation and non-attendance for tests and scans was “huge”.
In 2020, 1,000 patients in Irish hospitals acquired the virus and in January 2021 when we had the highest Covid-19 incidence per capita in Europe, 800 acquired the virus in hospitals across the country, numbers which Prof O’Reilly said would have been “significantly greater” without the changes and lessons from the first and second waves.
“The data shows the real risk of hospital-acquired infection for patients. This fell rapidly with vaccination but it remains an issue on inpatient wards and is hugely disruptive at multiple levels.”
Professor O’Reilly said that the effect of the pandemic on delayed diagnoses of cancer “will take years to play out”.
“If you disrupt a service for six months, mortality increases for a decade afterward. Our services have been affected for almost two years. A 2cm cancer is now 3cm with a higher risk of returning. You would also be concerned about hidden cancers in the 1m people on waiting lists.”
He said that in February 2020, there were 60,000 people on the waiting list to see a consultant in Cork.
“The cumulative impact of delays in presentation and deferred, later presentations due to lack of screening is concerning. I feel it is also important to emphasise that later presentations mean more cancer-related symptoms, more treatment, and more suffering.
“Equally, non-cancer services have been impacted, many of which are time-dependent such as cleft palate surgery in children.”
He said that another concern would be screening programmes and patients who should have been screened but have not been.
Reflecting on how his role changed during the pandemic, Prof O’Reilly said: “When it hit, the overwhelming emotion was uncertainty — how bad would it be, how long, impact at work, the impact for my family.
“It then evolved to constant concern that someone would become ill or die because they had contracted Covid from me. Clinics became very focused on time and distance, patient safety through infection control measures became the most important aspect of work.
“As a team, we also set boundaries — communication curfew on email and WhatsApp except for on-call staff, double rotas in case of illness.
“At home, my family were fantastic but when I got vaccinated on December 31, 2020, the kids were ecstatic. I had totally underestimated the impact of my job on them and their constant fear that a patient could die because they brought Covid home with them.
He said that Covid has shown that we have “wonderful human capital and when we pull together it’s fab to see” but that it has also magnified inequalities and exposed vulnerabilities, including outdated infrastructure that is not infection control-proof, non-cyber-resilient IT systems, institutional inertia, and discrimination against non-EU healthcare workers, without whom he said the health service “would have collapsed”.
He said that Covid-19 and the Ukrainian crisis have shown that we can change things quickly when we have the will to do so.
Prof O’Reilly suggested ways in which the health system can improve and future-proof itself, including accelerating citizenship for the healthcare worker, improving IT and infrastructure, prioritising prevention and public health, and addressing the mental health crisis.
“I would suggest IT and infrastructure task forces to address deficits and future proof our system. Additional cyberattacks and pandemics will occur in the decades ahead by not addressing these issues, non-pandemic outcomes will be poorer with greater suffering in our communities, more expensive and extensive treatments.
“We need to prioritise prevention and public health. They were what guided us out of the pandemic and they will prevent illness in communities. We focus too much on illness rather than health.
“Consider splitting our boards and agencies into two strands as EY did in the pandemic. Half their board dealt with the here and now, the other half looked at building and looking to the future. I thought that was visionary.
“We have a huge mental health legacy from Covid in our young people, particularly. We won’t solve that unless we address recruitment and retention in healthcare. The consultant contract negotiations seem to have become trench warfare. In England, the Royal College of Surgeons has a new deal for surgery and it’s visionary, flexible, and designed to meet Covid backlogs — we should embrace it here.”
University College Cork (UCC) professor John Wenger, chairperson of the Expert Group on the Role of Ventilation in Reducing Transmission of Covid-19, became involved in educating people about the virus due to his background in atmospheric science.
He said that when Covid-19 hit, he was amazed to find out that the virus was spread through these respiratory articles but said that, despite expert opinion, infection prevention control agencies including the HSE refused to accept the virus was airborne until much later in the pandemic.
He said that when finally the World Health Organization (WHO) and other agencies accepted that it was airborne, it was “too little too late”.
“If we talk about what lessons we’ve learned, the refusal to accept the virus is airborne and the very slow begrudging acceptance that it was has actually cost lives,” said Prof Wenger. “It added to our disruption, it caused economic damage, as well as social damage, and that is for me the biggest mistake.”
He said that he was trying his best to educate people and get the message out there that public health authorities were not communicating at the time, which was the importance of wearing high-quality masks and paying more attention to our environment in terms of air quality.
“Focus has been very much on vaccines, great, brilliant, but what we’re seeing now is that even vaccinated people are still getting it and this has been the message that we’ve been trying to put out all along is that we should have paid much more attention to preventing transmission of the virus and that means educating people properly about how the virus is spread and to have high-quality masks and well-ventilated spaces.”
Prof Wenger said he believes the lifting of mandatory mask-wearing was announced by Government too soon and that the last few weeks have seen the most disruption in terms of people being out of work, school, and college.
“In reality, we’re seeing cases increasing and we’re still on a bit of a rollercoaster as far as I’m concerned because we’re not quite sure where the evolution of the virus is going to go and we may end up getting something that could evade the vaccine and that’s a big concern for me.”
Looking back, he said that a core memory for him was when he, along with one other Irish scientist, signed a letter to the WHO asking it to recognise the virus as airborne, which he said was “knocked back”.
“I actually thought they would listen to the experts but they just didn’t and I actually just couldn’t believe it.”
He said a positive aspect was when Government departments recognised the importance of ventilation.