22nd January 2021
UK COVID Deaths – Daily 1401 / 7-Day average 1241
Total UK COVID Deaths within 28 days – 95,981
Total UK Deaths with COVID-19 on the death certificate – 95,829 (up to 8th Jan)
James Cook Hospital – Total COVID deaths – 458
All COVID cases within South Tees Hospitals Trust – 233
James Cook Critical Care
COVID cases – 40 (24 ventilated)
Non-COVID cases – 27 (11 ventilated)
There are no signs of things quietening down at the hospital just yet. We are continuing to see the same number of COVID patients admitted every day and, as a result, the number of Critical Care patients continues to rise. The ICUs are getting busier and busier and we currently have a large number of very sick patients. As I have said before, our COVID patients appear to be getting younger. Over the last week we have seen young adults in their 20’s, one patient in their late teens, a couple of pregnant patients and a growing number of 40-somethings.
However, there are some signs that the lockdown is beginning to have an effect, albeit a smaller one than we had hoped for. The Office for National Statistics (ONS) figures showed that during the week ending 16th January, the number of people infected with coronavirus in England decreased slightly. However, cases increased in Northern Ireland and remained static in both Wales and Scotland. It is hoped that the reduction in viral transmission will begin to translate to a reduction in hospital admissions and then, ultimately, a decrease in the number of patients that need Critical Care.
Every hospital across the country has a predicted Critical Care ‘surge’ capacity which was calculated at the start of the pandemic. This varies from hospital to hospital and depends on their size, equipment stockpile and their ability to staff beds. At maximum surge capacity, our hospital can provide 79 ICU beds but this will not be easy. It will involve a significant dilution of our ICU nurses with volunteers from other parts of the hospital.
If we exceed this total then we will move into the uncharted territory of what is called ‘super-surge’ capacity. At this point things will not be looking good. This would be the very limit of what we can safely achieve. Our super-surge capacity tops out at 89 beds, which would be one hell of a lot of sick people for us to look after.
We currently have a total of 67 patients within Critical Care but this does not paint the full picture. We are also helping to care for an additional 20 CPAP patients out on the wards. These are all sick enough to warrant admission to an ICU and at many other hospitals, this is exactly what is happening. Had we not planned to do this from the outset, we would already be nearing our super-surge limit. Of course, having beds and equipment ready is not enough; it is doctors and nurses that are nearly always the limiting factor when it comes to expanding ICU care.
It’s worth pointing out that our hospital is faring pretty well when compared to some others. Whilst a lot of routine work has stopped, the hospital is still managing to conduct a surprising amount of elective surgery and urgent cancer work is continuing. I have been told that our cancer surgery waiting lists are even decreasing at the moment. This is quite a remarkable achievement given the pressure that the hospital is under and everyone involved in ensuring that this work goes on deserves a hearty pat on the back.
In order to prevent hospitals entering their maximum surge capacity, an increasing number of patients are beimg transferred from one hospital to another. Because the transfer of a ventilated patient is not without peril, most of these transfers are between local hospitals. Obviously, the longer distance you plan to travel in an ambulance, the more chance there is that things will go wrong. Last week we transferred two ICU patients to the Royal Victoria Hospital in Newcastle because their capacity was lower than ours. This week we have, in turn, received transfers from other nearby hospitals who are struggling to find beds, including those in Carlisle and Stockton.
The two patients we transferred last week were two gentlemen who I have written about before. Both of them arrived in A&E at the same time, got placed on CPAP at the same time and were transferred up to ICU together. As their condition worsened, I intubated and ventilated both of them, one after the other, and they later underwent tracheostomy operations within the same 24 hour period. By sheer coincidence, when we temporarily ran out of beds, our two ‘COVID buddies’ ended up being transferred to Newcastle one after the other. The reason they both went is because they were our two most stable ventilated patients. Both of them had become horribly unwell in the days after they were ventilated but I’m pleased to report that over the past month they have both improved and are on the road to recovery. One of the reasons we would like to see our numbers fall is that we might then be able to take them back. We would very much like to be part of their recovery again.
Nicky and I have this weekend off and it’s my son’s birthday. He’s a bit disappointed that he can’t get together with his friends but we intend to help him make the most of a family weekend. Nicky and I are pretty tired but I’m certain he'll let us catch up on some sleep rather than make us get up really early in order to open his presents…