Patients with severe Covid-19 in Ireland had an increased risk of mortality if they were cared for outside of an ICU, a new study has revealed.

The findings are particularly important given that Ireland has one of the lowest numbers of ICU beds in Europe.

The study was carried out by researchers from Trinity College’s School of Medicine and St James’s Hospital. They highlighted that providing high-quality care to severely ill patients is very complex, requiring trained personnel, a designated setting, monitoring equipment and specialised management.

They studied, for the first time, the clinical characteristics and the relative impact of caring for severe Covid patients outside of the ICU setting in Ireland. Until now, the impact and outcomes related to this have been unknown.

Throughout the pandemic, many international healthcare systems became overwhelmed. Medical interventions that would traditionally be delivered in an ICU by specially trained personnel, had in some cases to be delivered in other hospital areas, sometimes by healthcare workers without equivalent training. Ireland was no different in this regard.

According to the findings, severe Covid patients were frequently male, older adults with at least one comorbidity. The overall median length of stay in hospital was 10 days, although this tended to be longer if the patient was admitted to ICU.

When it came to mortality, patients with severe Covid-19 admitted to ICU had significantly lower 28-day fatality ratio than those cared for outside of ICU. They also had lower 90-day fatality ratios.

This was independent of age, disease severity, number of comorbidities, healthcare system saturation (i.e. the number of new cases per day) and treatments received, when compared with patients that were cared for outside of ICU (in an interim setting).

Commenting on the importance of this research, lead investigator and consultant in intensive care medicine, Prof Ignacio Martin-Loeches of TCD and St James’s Hospital, noted that Covid has shown us why critical care is important. However, it has also shown us that this type of care “cannot be provided anywhere”.

“Critical care is not simply a bed and a ventilator. It needs adequate staff including specialised nurses and doctors and an adequate place to deliver care. Investment in critical care saves lives.

“The findings of research conducted in ICUs are not reaching the public and is not a part of the national discourse throughout this pandemic. It is imperative that we reach the public audience and that they understand the reality of this virus and how it is impacting our ability to keep those in critical care safe and alive,” he commented.

He explained that this study is “strictly clinical”, providing a “snapshot of what has happened during a terrible pandemic”.

“Currently most patients in critical care are unvaccinated and the system is under pressure. Bed occupancy represents a huge concern. Ireland has one of the lowest critical care beds per capita. Germany and the US have respectively five and six times more ICU beds than Ireland,” Prof Martin-Loeches added.

This study represented the Irish cohort in a wider EU project that observed over 14,000 patients in 43 countries. The study is published in the journal, ERJ Open Research, and can be viewed here.