All Quiet on the Northern Front?
Wednesday 8th April 2020
COVID Figures for 7th April
UK Hospital Deaths 786 / Total 6159
James Cook Hospital – Total deaths – 69
James Cook cases on wards – 117
James Cook cases in Critical Care – 21 / 8 ventilated
I’m at home today before my night shift this evening. Nicky is at work today so we will briefly see each other at handover later.
As things stand, we have both been surprised by the relatively few coronavirus patients we have seen to date. That’s not to say that we haven’t been busy; we have doubled our total ICU capacity from 26 beds to 53 and we are constantly reviewing ward patients on CPAP. This represents a significant increase in workload, obviously, but as a result of us stopping non-essential work, increasing our hours and the help offered from our colleagues, both medical and nursing, it has been manageable.
We still have intensive care capacity and we believe we are still offering as high a standard of care as we would normally do. We have realistic plans to expand our ICU bed numbers further to 104 which is four times our normal capacity. After that, we still have plans to increase further but things start to get a little hazy regarding equipment such as ventilators and monitors. Staffing levels are also impossible to predict at this point as we don’t know the rate at which staff will contract and (hopefully) recover from the virus.
We are nowhere near having to consider denying any patient life-saving treatment, which is everyone’s biggest fear should the situation get completely out of control.
You will have all seen the graphs on the Government news briefings. There were two curves showing the spread of the virus in the UK under two distinct circumstances. The first was when we did nothing and carried on as usual – the result was a huge spike in the number of cases. There would be a tsunami of hospital admissions and deaths as the NHS would be unable to cope with the workload.
The second curve showed the ‘flattening’ of cases that would occur if social isolation was implemented. A longer, flatter curve with a much lower peak was generated that showed how the NHS would cope with a longer, protracted but less intense workload. Many more lives would be saved. It was this data that led to the change in the Governments plans and the current lockdown.
So far this appears to be working. In fact, within our region there is evidence that it is working very well and the number of case appears to be below the predicted ‘flattened’ curve. I suspect that this is because we had fewer cases in our region when lockdown began. With the exception of Newcastle, it looks like the other hospitals in the North of England network are also seeing fewer patients than expected. We know that a ‘peak’ will come and that we will be tested, but now we are just starting to believe that it could be manageable.
However, yesterday I read the disconcerting news that Middlesbrough is apparently the worst place in the country for social distancing. According to a health app, 25% of Middlesbrough residents admitted they were not staying at home. Just down the road in North Yorkshire however, that rate was down to less than 2%. Given that our hospital serves both populations, hopefully the good will offset some of the bad and we won’t start to see a worrying jump in the numbers of new cases.
Stay at home, Middlesbrough!
On the subject of more patients, it’s worth pointing out that nearly all of our planning has been toward increasing the numbers of COVID ventilated beds. Yesterday we discovered that we were close to running out of beds for regular, non-COVID patients. We are currently using the Cardiothoracic ICU for this purpose but that’s now full. To be honest we are normally jammed to the rafters with regular patients so going over-capacity is nothing unusual. It’s just that now our ‘normal’ overflow options are gone.
We have decided that it’s best to use the Paediatric ICU beds for this rather than for COVID patients as we had planned. We now have all seven beds available for us to use and thankfully, they have all been de-Disneyfied. Not a Minion or a Little Mermaid in sight!