12th November 2020
UK COVID Deaths – Daily 563 / 7-Day average 401
Total UK COVID Deaths within 28 days – 50,928
Total UK Deaths with COVID-19 on the death certificate – 61,648 (up to 30th Oct)
James Cook Hospital – Total COVID deaths – 313
All COVID cases within South Tees Hospitals Trust – 111
James Cook Critical Care COVID cases – 19 (9 ventilated)
Monday was a good day. The drug companies Pfizer and BioNTech announced that initial testing suggested that their new, very clever, ‘messenger RNA’ vaccine was 90% effective in preventing infection with COVID-19. This was a rare piece of good news and for once, nearly everyone agreed. Stock markets around the world responded with big gains in share prices for businesses whose profits rely on a more ‘normal’ world. Companies like British Airways, Rolls Royce, Cineworld and the cruise-ship company Carnival saw big rises in the price of their stock. Other companies like Zoom, Peloton and Just Eat who have benefitted from lockdown and social-distancing did not fare so well and saw their share prices fall.
Unfortunately it’s not all sunshine, rainbows and lollipops just yet. This new vaccine is hoping to gain approval from the Medicines & Healthcare products Regulatory Agency (MHRA) by the end of this month. The vaccine has been tested on 43,000 people with no important adverse effects so it is highly likely that this approval will be granted and distribution can begin. The Government has assured the public that they will be ready to begin distributing the vaccine once this happens. However, there are logistical problems with vaccinating large numbers of people with this particular vaccine. It needs to be given in two doses, three weeks apart, and must be kept stored at -78 degrees centigrade. It is unlikely that any mass vaccination campaign will provide widespread protection for the vulnerable population before spring arrives next year.
China currently has thirteen vaccines undergoing development and has already started using three of these in healthcare workers and other high-risk groups. Safety information is not readily available although, perhaps not surprisingly, the Chinese authorities have yet to report any adverse effects. Not to be outdone, Russia has announced that its snappily-titled, ‘Sputnik-V’ vaccine is 92% effective. That’s a whole 2% better than the filthy imperialist vaccine from Pfizer.
Here in the UK, it is expected that the Oxford/Astra Zeneca group is not far from announcing the efficacy of its own vaccine. This would be even better news than that announced on Monday as this vaccine has been designed using more traditional methods, and so is cheaper and can be stored in ‘normal’ medical refrigerators. This would speed up distribution significantly.
So, how does the flurry of cheery vaccine-related news help us at the hospital? Well, right now, not very much. I feel better knowing that there is now a good chance that I will get a well-earned foreign holiday next year but I don’t expect that this coming winter is going to be any better as a result of the promise of mass vaccination. There are still many more COVID patients coming our way before then.
Yesterday saw the sombre announcement that the United Kingdom was the fifth country to reach the milestone of 50,000 COVID-19 deaths. The other nations that make up this unenviable top five are the USA, Brazil, India and Mexico. Of course, comparing ourselves to other nations is fraught with inaccuracy as there are many different ways to count deaths. For example, our figure of 50,000 deaths has been calculated using the blunt ’28 days after a positive test’ metric. The more accurate death toll is the one that counts any death with COVID-19 on the death certificate. This currently stands at 61,648 deaths.
Looking at the local situation, Teesside continues to see a rise in both COVID-19 cases and deaths and there is speculation about what local restrictions will need to remain in place once lockdown is lifted at the beginning of December. Middlesbrough Council has urged the public to do their best to adhere to the national lockdown restrictions and avoid contact with people outside their family group.
At the hospital the total number of COVID patients is still increasing. There is now a total of seven wards that are being exclusively used for such patients. Last week we started using half of the Female Surgical Admissions Unit as an extra High Dependency Unit (HDU). We initially persisted in retaining the title ‘Female SAU’ which prompted one of my colleagues to jokingly suggest renaming it the ‘Pig Pen’. This was, understandably, not considered appropriate. We settled instead on the more mundane ‘Surge HDU’.
In response to the growing numbers of COVID patients this week, we have now taken over the other half of the Female SAU. This eight bedded area has been kitted out as an Intensive Care Unit so I guess it’s now the ‘Surge ICU’. Each bed has a shiny new Beijing Aeonmed ventilator next to it. These are extra ventilators that we have been given to help manage the second wave of ventilated patients. No prizes for guessing what their country of manufacture is. Conspiracy theorists will doubtless claim that this is all part of some Chinese plot and that the ventilators contain Huawei-manufactured listening devices that are monitoring our every word. Quite what the Chinese authorities will do with hours of audio recordings of staff discussing their holiday plans, their favourite Netflix show and what takeaway they are picking up on the way home is beyond me.
The Aeonmed ventilators are actually quite handy machines. They have one big advantage over our existing ventilators, in that they do not require a piped air supply. You can simply plug them into a wall oxygen port and they entrain air from the atmosphere. This means they are ideally suited to being used in a temporary ‘ward’ environment rather than a purpose-built ICU.
The biggest problem that we face when creating such an extra ICU is not a lack of equipment but a lack of staff. Specifically, a lack of nursing staff. We have temporarily lost a number of nurses as a result of the Government issuing new shielding letters instructing them to stay at home. We are attempting to make up our numbers by welcoming nurses from other parts of the hospital who have graciously volunteered to join our ranks. We are also set to see the return of many of our retired colleagues who helped us out during the first wave.
Another problem we have to contend with, is staff who are absent due to being infected with COVID-19. Yesterday I bumped into Sister Pugh (the World’s Smallest Nurse) and remarked that I hadn’t seen her for a while. She told me that she’d been off for the past five weeks after catching the virus. Fortunately she hadn’t been too unwell and had recovered reasonably quickly, although she had continued to test positive, delaying her return to work. I told her how relieved I was that she hadn’t been admitted to hospital although I reassured her that, should the need have arisen, I had a special ventilator set aside for her that I keep squirreled away in a match-box in my office. I could tell she was grateful…
The spotless converted Female SAU – as far removed from a pig-pen as you can get