Work on setting up coronavirus field hospitals is to begin immediately.
In a stark letter, the Department of Health has told Northern Ireland's health and social care trusts that hospitals do not presently have enough intensive care beds for the number of Covid-19 patients they expect to see.
It is understood that several large 'field hospitals' are to be set up within weeks to cope with demand.
Some accident and emergency departments are expected to temporarily close, with some staff moved to the field hospitals.
Doctors will also have to categorise all their patients, with treatment delayed for up to three months for the lowest priority group.
Chief medical officer Dr Michael McBride has already warned that many thousands of people in the north may have the virus.
BREAK: DoH issues letter to trusts delivering stark message about weeks ahead: at outbreak peak they warn NI "may not have sufficient capacity to provide critical care" to seriously ill patients.
— Seanín Graham (@SeaninGraham22) March 26, 2020
Large Covid 'field hospitals' to be built "immediately". Urgent cases will be seen.
Department of Health permanent secretary Richard Pengelly today announced huge changes to deal with the outbreak.
In the letter, he acknowledged that the north's hospitals need more critical care beds.
“Even if the social distancing measures have the impact we hope, our modelling still indicates that we will require more critical care capacity than is currently available," the letter read.
The sweeping changes will include:
- Doctors will have to categorise patients, with treatment delayed for up to three months for the lowest priority group
- All medically fit patients will be discharged
- Hospital visits will be stopped
- Health staff offered the option of staying in hotels to curb spread of disease
- Any extra space will be freed up for Covid-19 patients
Trusts had already postponed all non-urgent elective appointments in order to free up staff for additional training.
The next stage will see a reduction in other services.
“In some cases, it is recognised that this may mean that other services are temporarily reduced as the focus is on providing essential services and helping those most at risk access the best possible treatment," the letter read.
“It is therefore suggested that clinicians should begin to categorise patients into priority groups. The lowest prioritisation would be where treatment can be delayed for 2-3 months with no predicted negative outcome. Urgent and emergency treatments should continue to be given top priority.”
The letter also discussed provision of Personal Protection Equipment (PPE), supply of ventilators and other respiratory equipment, Covid-19 testing, and staff accommodation.
“For those staff affected by the 14-day household isolation policy, staff should - on an entirely voluntary basis - be offered the alternative option of staying in hotel accommodation while they continue to work. This should be organised locally by HSC Trusts.”
The announcement comes after a solicitor revealed she has been contacted by "fearful" frontline nurses seeking legal advice about treating Covid-19 patients without proper masks and protective clothing.
Claire McKeegan, of Phoenix Law, said she received "legal instruction" from staff working in two Northern Ireland health trusts to write to health minister Robin Swann seeking "public assurances".
They said urgent provision of kits - known as Personal Protective Equipment (PPE) - is needed, particularly "full gowns that are disposable, aprons, footwear that can be decontaminated, fluid shields and FFP3 masks".
They also want testing for all staff exposed to suspected and positive coronavirus patients to be prioritised.
