2nd May 2021
UK COVID Deaths – Daily 14 / 7-Day average 16
Total UK COVID Deaths within 28 days – 127,538
Total UK Deaths with COVID-19 on the death certificate – 151,243 (up to 16 Apr)
James Cook Hospital – Total COVID deaths – 612
All COVID cases within South Tees Hospitals Trust – 12
James Cook Critical Care
COVID cases – 3 (3 ventilated)
Non-COVID cases – 56 (25 ventilated)
I am pleased to report that we have now closed our single remaining COVID Intensive Care Unit. Well, that’s not strictly true – closed is perhaps not the best description; we have simply turned the red, COVID beds into blue, non-COVID ones.
Over the past fortnight we have discharged a couple of our recovering COVID patients to the ward. One of them has subsequently improved to the point where they have been able to leave hospital and are back at home. We do still have three people in the ICU who were admitted to hospital with COVID pneumonitis but, after spending many weeks on the ICU, they continue to test negative and are no longer infectious. Whilst I have still included them in the total above, they are officially no longer classified as COVID patients. This is a new policy – up until now, ‘once COVID, always COVID’ seemed to be the mantra for each admission. This new policy does make everything a lot simpler. It means that there is now no need for a separate COVID ICU. Any future COVID patients will be looked after in our isolation rooms.
We had hoped that we would be able to close our remaining ‘surge’ unit as a result of this change. Unfortunately, this has not been possible as we still have too many patients. Whilst this obviously means things are not back to normal, things still seem very quiet in comparison with where we were back in January. We remain hopeful that at some point over the next few months we will be back within our usual footprint but it seems likely that extra ICU beds will again be needed, come the winter. Our hospital, like many others up and down the country, will need to expand its critical care capacity in order to deal with what will surely be a busier winter than usual.
However, for now, we are making the most of the relative lull in activity. Some of our COVID patients have recovered to leave the hospital and Nicky and I are working fewer hours and fewer anti-social shifts. Everyone is looking forward to taking leave and time-off that they are owed. May is traditionally a time when ICU doctors begin to relax a little. Our workload normally begins to lessen at this time of year and the pattern of work begins to change; winter-related respiratory illnesses give way to summer trauma calls as temperatures rise and the population spends more time outdoors.
The media is still full of stories confirming the efficacy of vaccination. This week, research was published showing that people who became infected three weeks after receiving a single dose of the Pfizer or AstraZeneca vaccine were 65% less likely to develop a symptomatic infection. They also were 38%-49% less likely to infect others within their household.
More good news came from the Isaric Coronavirus Clinical Characterisation Consortium. This group analysed 52,280 patients admitted to hospital with COVID-19 after the UK vaccine rollout began in December. They found that people who were infected whilst ‘protected’ (defined as those who were infected at least three weeks after a single vaccine dose) made up just 1% of all hospital admissions. About one-fifth of this group subsequently died but those were mostly frail and elderly.
The Office for National Statistics (ONS) estimates that just over 1 in 1000 people within England would test positive for COVID-19 during the week ending 16th April. The death rate continues to fall and is currently lower than it was last September. This good news at home contrasts horribly with that coming out of India. The collapse of their healthcare system is a stark demonstration of what can happen if you drop your guard and allow COVID-19 to spread, unfettered, throughout an unvaccinated population. The dreadful tales of people dying outside overflowing hospitals, the desperate attempts to find oxygen and the images of make-shift funeral pyres are horrors that no-one was expecting to witness this late into the pandemic.
Complacency seems to be the overriding reason for India’s unfolding catastrophe. Back in February, the ruling political party declared victory over COVID-19. There appeared to be a widespread view that the nation had achieved herd-immunity. This view was propagated by the Government, the media, the public and even sections of the scientific community. There was a belief that a large second-wave was very unlikely and that society should reopen to minimise ongoing economic damage. In the last few months, many mass-gatherings, including huge political rallies and festivals have been attended by millions. At the same time, the nation has vaccinated less than 10% of its population with a single dose. The steep rise in cases and deaths was, sadly, inevitable.
A new, potentially dangerous COVID-19 variant was discovered in India in October. How much of the disastrous rise in infections is due to this new, home-grown variant, remains to be seen. Like the UK ‘Kent’ variant which ushered in our second-wave, the Indian variant may prove to be more infectious. It looks likely that it will join the ever-growing list of ‘variants of concern.'
The worry is that a single shot of a vaccine may not be enough to protect you from one of these variants. A study involving researchers at Imperial College London, Queen Mary University of London and University College London looked at the immune response in healthcare workers who had received a single dose of the Pfizer vaccine. They found that, in those who had not previously been infected by Covid-19, the immune response generated by the vaccine looked “very, very feeble”. Those who had been infected in the past before being vaccinated generated a “stupendous reaction”. Of course, the degree of ‘real-life’ protection from serious illness should still be significant but the researchers recommended that people wait until they get their second dose before letting their guard down.
The mood amongst the UK population is improving dramatically. There is a growing sense of optimism and it is the opinion of many that the pandemic is now firmly in the rear-view mirror. This is, of course, not dissimilar to the mood in India prior to their second wave. Fortunately, as a result of our vaccination campaign, we will not suffer the same fate. The next deadline for lifting restrictions in England approaches on May 17th and I wholeheartedly believe that relaxing restrictions further is the right thing to do. After all, people need to ultimately manage their own risk now that the situation is under control. However, it is important that those who have yet to receive their second vaccination understand that they might not be as well-protected as they imagine. It may be prudent to remain cautious a while longer.