1 November 2021

Dear Fellows and Members,

How the vista has changed in a month! Last Thursday's headline in the Irish Times 'Stark warning on COVID-19 trajectory' makes sobering reading. The prospect of 4,000-8,000 cases per day with up to 200 patients in ITU is truly disheartening in the face of the expectations that achieving close to 90% vaccination of the adult population would protect us from another winter surge.

Dr Antoni Fauci in his Martin Memorial Lecture delivered to the American College of Surgeons Clinical Congress last Monday made it clear that immunity following a two dose vaccine schedule wanes over time and that a third dose dramatically increases protection. He quoted a large study from Israel found that a third ‘booster’ vaccine given to those over the age of 60, at least 5 months following a second dose of vaccine, reduced subsequent infection rates by a factor of 11.3 and the rate of severe illness by a factor of 19.5 (NEJM 2021; 385:1393-1400). Based on the evidence, the FDA has now approved a third vaccine dose in the over 60 age group, those over 18 who are deemed vulnerable and in those working in high risk areas including healthcare. It seems inevitable that we should follow this route once NPHET has considered the evidence.

Our GP, physician, and intensivist colleagues and most especially our nursing and allied professional colleagues now face yet another winter stretched beyond any reasonable expectation. One Dublin hospital reported 120% occupancy during the past week. As surgeons we help as we can, but yet again we face the inevitable bed and theatre closures. The National Clinical Programmes in Surgery report on the impact of COVID-19 on surgical services found that 17% fewer emergency and 30% fewer scheduled procedures have been performed during the COVID-19 pandemic than in the equivalent period in 2019. Of great concern is the 150% increase over the past year in the number of surgical patients waiting longer than 12 months for a procedure. General surgery is the specialty with the highest number of patients on waiting lists (31,517 patients), followed by orthopaedics (10,393) and urology (9,797). You can download a copy of the report here.

The current difficulties were discussed by RCSI Council at its October meeting. Council agreed that RCSI should continue to strongly advocate for the separation of urgent from scheduled case, increased theatre access and protected surgical beds. Similar discussions took place at the quarterly meeting of the Joint Surgical Colleges in Glasgow. It is of little consolation for us to know that colleagues in our sister Colleges face the same difficulties as we do in Ireland.

The October Council received the College Annual Report for 2020-2021. The report is truly up-lifting, highlighting success in the face of COVID adversity. In numbers, success looks like 9,600 Fellows and Members in 83 countries, 26,000 alumni in 94 countries, 508 surgical and emergency medicine trainees, €31.5M in research grant income (2020), maintaining RCSI’s position in the top 250 Times Higher Education (THE) University Ranking (joint 2nd in Ireland) and joint 2nd globally for good health and well-being in the THE Impact Rankings 2021. Immense credit is due to the Senior Management Team, the academic and administrative staff and of course our students and post graduate trainees. All associated with the College should receive a well-deserved pat on the back.

Our Fellows and Members team led by Catherine Jordan and Jenelle Sherlock organised a very successful "Coffee and Connect" Webinar in lieu of the RCSI Reception for Fellows, Members, Alumni and friends at the annual ACS Clinical Congress. The Congress has been taking place virtually this week. It is a great personal disappointment that for a second year I have not been able to attend one of the academic and social highlights of the surgical calendar, however the "Coffee and Connect" Webinar more than made up for it. In-coming ACS President Dr Julie Freischlag gave a very gracious welcome and we were joined by RCSI Fellows Conor Delaney, Hilary Sanfey, Noel Williams, John Monson and Nicholas Mouswad in discussion with Council members. Prof Ciaran O’Boyle, Director, Centre for Positive Psychology completed the evening with an interesting reflection. My recommendation is to pour yourself a coffee (or something stronger) and have a listen.

The Wednesday evening webinars continue on alternate weeks. Both October sessions are well worth view. The first, a regional update from Cork and the HSE SSWHG, chaired by Prof. Paul Redmond, featured a fascinating update on parathyroid surgery by Mr Zeeshan Razzaq, a presentation on the work of the emergency general surgery service in CUH and an excellent update on targeted cancer therapy by Dr Derek Power. Last week’s webinar on Chest and Thoracic Trauma chaired by Mr Keith Synnott featured talks on resuscitative thoracotomy by Dr Fran O’Keeffe, interventional radiology in trauma by Dr Leo Lawlor and an international perspective by Prof James O’Connor, University of Maryland Shock Trauma Center. All presentations are of the highest quality and can be accessed here.

Professor Mark Shrime, O'Brien Chair of Global Surgery at RCSI, will address the complex issues around surgery, poverty and international development during a special Kapuscinski Development Lecture on 1 November. The lecture series offers students from European Union member states an opportunity to learn and discuss about development issues such as climate change, human rights, aid effectiveness, Europe-Africa relations and Sustainable Development Goals, among others. The high-level events also contribute to the debate and formulation of the European development policy. Over 30,000 participants have enjoyed more than 100 lectures since they began in 2009. The lecture is open to those interested in global development. Find out more about this event which takes place at 13:00 GMT on 1 November.

I hope that November will not prove as foreboding as the newspaper headlines this week predict and that my next newsletter will be more upbeat.

Best wishes

P. Ronan O'Connell

President