Fear

28th January 2021

UK COVID Deaths – Daily 1239 / 7-Day average 1221

Total UK COVID Deaths within 28 days – 103,126

Total UK Deaths with COVID-19 on the death certificate – 103,602 (up to 15th Jan)

James Cook Hospital – Total COVID deaths – 484

All COVID cases within South Tees Hospitals Trust – 225

James Cook Critical Care

COVID cases – 32 (17 ventilated)

Non-COVID cases – 30 (11 ventilated)

Earlier this week the UK passed the grim milestone of 100,000 deaths within 28 days of a positive COVID-19 test. The figure for deaths with COVID-19 on a death certificate also passed the same milestone with the release of data that included all deaths registered up to 15th January.

We are now into the third week of the third lockdown. Both nationally and locally, case numbers appear to be falling, albeit slowly. Certainly, infection rates are not falling like they did during the first lockdown. Imperial College’s ongoing REACT-1 study tests a large sample of the population at random and provides a more accurate picture of the proportion of people infected. Of the 170,000 people tested during the week ending 22nd January, 1.57% of people were positive for COVID-19. This was not so different from the figure of 1.58% the week before.

But at the moment, any decrease in case numbers is welcome. The number of people currently in hospital across the country has fallen slightly as has the number at our hospital. We are admitting slightly fewer patients each day than we were last week and the number of patients needing admission to Critical Care has stopped increasing.

That’s not to say that life is much easier yet. We still are looking after a record number of very ill patients and as usual, last night was another fairly awful shift for Nicky. Three COVID patients who had not responded to CPAP, required intubation and ventilation. We have also seen an increased number of deaths over the past few days and overnight a further three of our ventilated patients sadly died.

One of the indelible memories of this pandemic for Nicky and me will be the fear we have witnessed in those patients that we have had to intubate. A few of them are spared this as they arrive at the hospital in extremis and often require intubating immediately. Most of these are so unwell and events unfold so rapidly that there is little time for them to dwell on the fact that they are about to go to sleep and may not wake up.

Unfortunately, this is not the case for a lot of our CPAP patients. These patients have usually spent a few days on the ward and, when their condition worsens, are transferred to the ICU as a precaution in case they continue to deteriorate. Over the next few days, whilst wearing CPAP masks or helmets, they cannot fail to notice what is happening to the patients in the beds nearby. Whilst they are shielded from the graphic detail of what happens behind the curtains, they know all too well when things are going wrong. They watch others who are also struggling with CPAP and eventually see curtains drawn as their neighbours are sedated, intubated and ventilated. They watch as doctors and nurses repeatedly adjust ventilator settings, check X-rays and they see and hear the alarms chiming as oxygen levels fall. They witness the proning teams visit twice a day to flip these patients back and forth in a bid to improve the situation. Finally, they watch as family members are called into the hospital to sit with their loved one when it is clear that we can do no more.

If they too fail to respond to CPAP, then, by the time intubation and ventilation becomes inevitable, their fear is palpable. We explain what is about to happen as we ready our equipment. We try to project an air of calm, never appearing hurried or anxious, even if the situation is unravelling fast. The controlled atmosphere helps but it’s clear that, whilst our patients have great faith in us, they are understandably terrified. Over the last few days we will have got to know them and this helps us to be able to reassure them. Some want a straightforward explanation, gentle reassurance and are calmed by a matter-of-fact approach. Others can be distracted by light-hearted banter and mundane conversation. Many need us to promise them that they will recover and offer them a guarantee that they will see their families again. Others just want the nurse who has been by their side for the past few days to hold their hand.

It’s an emotionally-charged moment as you can imagine and not one that any of us likes to dwell on. There is not much chance of doing so at the time as there is work to be done. We quickly move to stabilise the patient on the ventilator and ensure adequate oxygenation. Then there is always someone else to attend to and it’s easy to become distracted by another problem.

However, once some calm returns, these memories tend to stay with you. I fear that for many ICU staff, some of the most vivid recollections of the pandemic will be the promises that we made to our patients. Sadly, all too often, they were promises that we were unable to keep.