17th November 2020
UK COVID Deaths – Daily 598 / 7-Day average 425
Total UK COVID Deaths within 28 days – 52,745
Total UK Deaths with COVID-19 on the death certificate – 63,873 (up to 6th Nov)
James Cook Hospital – Total COVID deaths – 329
All COVID cases within South Tees Hospitals Trust – 123
James Cook Critical Care:
COVID cases – 16 (8 ventilated)
Non-COVID cases - 29 (11 ventilated)
We are hoping that we should start seeing the effects of the second national lockdown this week. This should result in the numbers of new COVID patients being admitted to hospital declining. It’s possible that this may already be happening although it’s a little too early to be sure just yet.
A reduction in the numbers of such patients would be most welcome as we are becoming increasingly busy. We are also treating a significant number of non-COVID patients and beginning to realise that if things continue as they are we will soon be in some real trouble. This is worrying as it’s only autumn after all; we have not yet reached the time of year that we would normally expect to experience ‘winter pressures’. This term is often used to describe the significant increase in workload that begins each year at the beginning of December and continues through to the end of February. It’s the time of year when operations get cancelled, A&E waiting times increase and the newspapers are full of stories of little old ladies stuck on hospital trolleys for hours at a time.
I think it’s safe to assume that we will see many more of these stories in the forthcoming months. We are already beginning to struggle to find nursing staff to deal with the number of sick patients we are seeing and to staff the extra ‘surge’ beds that we are using. We are especially short of trained ICU nurses and this is likely to be an ongoing problem. Today saw the arrival of a few of our recently retired staff and we are imminently expecting more nurses who have volunteered to join us from elsewhere in the hospital. These nurses have previously worked in ICU over the years before moving on to pastures new. Their return will allow us to open up more Critical Care beds and be better prepared for the winter.
Whilst on the subject of retired staff returning to work, it’s worth pointing out that one of our nurses, Ted, is a few days short of his 70th birthday. This makes him older than all the previously retired staff who are returning to work. Ted has been working in ICU for as long as any of us can remember. He is believed to have started his nursing career in 1892 and fondly remembers steam-powered ventilators and clockwork infusion pumps. It really will be the end of an era when he goes.
The past few days have been especially busy for the Critical Care team. By Sunday we had fourteen patients who were receiving CPAP on the wards. This is the same number that we had at the peak of the first wave. It may not sound like a lot for a hospital as big as ours but it’s worth remembering that under more ‘normal’ circumstances we would admit all of these patients to a Critical Care Unit. We do not have enough beds for this and so are having to provide this service elsewhere. These patients are being primarily looked after by the Acute Medicine teams with back up from Critical Care via the Outreach Team. The medical and nursing staff on the wards are coping surprisingly well with this influx of seriously ill patients. We are very grateful; without their help we would be swamped.
As a result, we have been working more closely with our Acute Medicine consultant colleagues. It was therefore something of a shock when I discovered over the weekend that one of them had been admitted to his own ward with COVID-19. Hamad has been around almost as long as Ted and is something of a South Tees institution. For many years, Hamad pretty much was the Acute Medical service at the hospital. To say he is held in high regard by everyone at James Cook is a huge understatement. It was therefore very worrying to find him on my list of patients that morning. We had decided that we would have a low threshold for admitting him to the ICU if warranted but fortunately, this was not necessary and Hamad has remained on his own ward, experiencing COVID-19 from a patient’s perspective. He freely admits to being very scared by the degree of breathlessness he experienced. However, apart from a brief spell of grumpiness when the junior doctors kept missing his veins whilst inserting a cannula, he seems to be weathering his ordeal well.
This is a relief. The ICU is rather like a big, ludicrously expensive hotel but not one that a VIP like Hamad would want to stay at. None of us like looking after members of staff, friends or family for obvious reasons. The stakes seem so much higher when things are close to home.
Most of my shifts over the last few days have been dominated by the lack of Critical Care beds. Whilst dealing with the parade of cardiac arrests, trauma calls, ward referrals and complications amongst the ICU patients, I have been juggling beds and trying to work out where and when I can admit patients. By the time I went home, all fingers and toes were crossed that we wouldn’t see a deluge of new patients overnight. Fortunately, the night remained quieter than the day and we were able to start afresh today with a few empty beds.
I’ve been taking part in some remote, Zoom-enabled, junior doctor teaching today which has provided a welcome break from the recent mayhem. As I left the hospital, I popped into see Hamad and he still looks like he’s doing well. When I arrived home I found that some beer I ordered on-line recently had arrived. Given that I’m no longer on-call, it seemed as good a time as any to celebrate Dominic Cummings’ recent departure from office.
Cheers!
Barnard Castle Eye Test: Great beer. Poor role model