Autumn

21st September 2021

UK COVID Deaths – Daily 203 / 7-Day average 144

Total UK COVID Deaths within 28 days – 135,455

Total UK Deaths with COVID-19 on the death certificate – 158,664 (up to 10 Sep)

James Cook Hospital – Total COVID deaths – 667

All COVID cases within South Tees Hospitals Trust – 75

James Cook Critical Care

COVID cases – 12 (11 ventilated)

Non-COVID cases – 47 (22 ventilated)

It’s been a month since I last wrote anything about the pandemic. After my holiday I had been feeling fairly refreshed and relaxed. Taking a break from all things COVID has been good for me. Sadly, once back at work, I could feel the effect starting to wear off fast.

The children are back at school and it’s feeling colder in the mornings. Autumn has arrived and, with it, the fear that hospital admissions will begin to rise. There is much talk in the media about what might happen over the winter and whether the NHS will be able to cope. The Government’s Scientific Advisory Group for Emergencies (SAGE) has issued another warning that COVID admissions could increase dramatically over the next month. Such warnings are usually greeted with either apprehension or disdain depending on your particular world-view. It doesn’t help that the media sensationally report the worst-case scenario and the poor boffins are then accused of crying wolf when the viral apocalypse fails to show up.

Whilst the colder weather is guaranteed to raise infection rates, trying to predict just what and when it might happen is fraught with peril. There are simply too many variables to consider, not least the unpredictability of human behaviour. It certainly feels like everyone is more relaxed about COVID than they were at the beginning of the summer. People are socially-distancing less and there are far fewer facemasks being worn in supermarkets, pubs, restaurants and on public transport. In fact, the only thing still guaranteed to raise heads and remind everyone that there’s a pandemic on is when someone coughs in public.

The daily number of recorded cases has been falling recently and, in the last fortnight, so too has the number of people being admitted to hospital. Sadly this has not been the case on Teesside. Last week Middlesbrough was, once again, one of the worst affected areas in the country. Worryingly, the rate of vaccine uptake in the town remains poor, especially in the most deprived areas. In one part of the town, fewer than 40% of those over 15 years of age have been vaccinated twice.

Every day there are currently about 900 COVID patients being admitted to hospitals across the UK. Our hospital is admitting about ten such patients each day but the number who are recovering to leave hospital is similar and the overall number of COVID patients in the hospital has remained fairly static. Of course, some of our patients do not survive, but we are continuing to see far fewer deaths than we did back at the beginning of the year.

However, the situation within Critical Care has worsened somewhat. Our plan to manage all our COVID patients in a single ICU didn’t last long and, once again, the partition between the two ICUs has been torn down and ICU3 has become a red unit. This means that we now have to attempt to squeeze all our non-COVID patients into the General High Dependency Unit and the Surge ICU. We have commandeered some of the beds on the Cardiac ICU and sometimes use beds on the Cardiac and the Neurosurgical High Dependency Units. In turn, this invariably means that our colleagues working in these areas find it difficult to find room for their patients.

The pressure to admit routine non-emergency cases is also increasing. After all, there is a huge backlog of routine work for the hospital to get through. There are a handful of patients every day who need a Critical Care bed after their routine operation. There simply isn’t enough room and every day is filled with the challenge of finding beds and nurses for everyone.

We are managing of course – we always manage. We have to. What’s worrying is that we are in this situation before winter has even begun. This leaves us with little room to manoeuvre. If the number of Critical Care admissions, COVID or non-COVID, rises further we will once again need more nurses, more doctors, more equipment and more beds. Just like in the first two waves, the disruption that this would cause would be extensive and would lead to the hospital suspending some routine services.

We are not in a happy place and we all know it. The anxiety over what the next few months will bring is palpable. This is to be expected; every winter brings hardship for the NHS, even when there isn’t a pandemic pouring petrol on the bonfire. Everyone is tired and drained and the large degree of uncertainty over what might be coming only serves to amplify the worry.

The Government tells us that the protection against infection and severe illness that is conferred by vaccination should be enough to prevent large numbers of people needing hospitalisation. This is what they are calling Plan A – Booster vaccines for the over 50’s and the vulnerable, vaccinating the over 12’s and some rather nebulous advice that we should all remain cautious. Should these measures not be enough then Boris will implement Plan B which will involve the return of some measures to limit the spread of the virus. These might include the wearing of facemasks, a vaccine passport system for crowded indoor events and more working from home. There is no talk of a plan C and, whilst Boris has refused to completely rule out further lockdowns, I am hopeful that they shouldn’t be necessary.

We will have to wait and see what the next few months bring. Were we to gaze into crystal balls, cast bones or read tea leaves to divine the future, there isn’t a great deal more we can do to prepare anyway. Even if we were handed a big wad of cash – perhaps some of that Brexit bus money or a tiny chunk of the £5.4 billion National Insurance levy - it’s too late for us to build another ICU, purchase equipment and recruit and train staff to help cope this winter. The cards in our hand are the same ones we had last year and we will have to play them as best we can.