7th November 2020
UK COVID Deaths – Daily 413 / 7-Day average 333
Total UK COVID Deaths within 28 days – 48,888
Total UK Deaths with COVID-19 on the death certificate – 60,051 (up to 23 Oct)
James Cook Hospital – Total COVID deaths – 301
All COVID cases within South Tees Hospitals Trust – 93
James Cook Critical Care COVID cases – 14 (9 ventilated)
It’s the first weekend of the new lockdown and for the last couple of days, things didn’t seem very different. The streets were a bit quieter but with children still going to school, there was a surprising amount of traffic around. More shops and businesses appear to be remaining open this time around as it seems more retailers and companies are proclaiming themselves ‘essential’ in the run-up to Christmas.
For Nicky and I, today has certainly been rather different. As a result of the effects of lockdown, we don’t have to take the girls swimming or my son to cycling. There’s no tennis, rugby or horse-riding either. If all of this sounds horribly middle-class then that’s because it is. We have clearly created rods for our own backs and it would be wrong to complain about how busy we normally are. However, it’s really, really nice not to have to get up at 6am on a Saturday morning for a change.
Exactly what effect this lockdown will have on the march of the virus remains to be seen. There has been much discussion in the press regarding the accuracy of the information used to justify its implementation. The scary, worst-case scenario graph that Patrick Vallance displayed at the briefing last Saturday was based on four different long-term projections. One of these, from Public Health England and the University of Cambridge suggested that the death rate could reach as high as 4000 deaths a day by the beginning of December if no action was taken.
This large figure surprised all of us and we have subsequently discovered that this particular projection was based on an outdated model from October that had inaccurately indicated there would be significantly more daily deaths by now. It would therefore not seem prudent to bet the farm on it’s predictive power.
Sir Vallance also presented another graph illustrating a medium-term projection of the death rate from the government's advisory committee, the Scientific Pandemic Influenza Group on Modelling (SPI-M). This showed that the death rate might be a more realistic 1500 deaths a day by 8th December. Yesterday, Downing Street admitted that there had been a mistake in the way this data had been presented but said the underlying analysis was unchanged. They produced a revised graph with altered confidence intervals suggesting that the upper limit of this projection is now 1000 deaths a day instead. The median value of this projection was 800 deaths a day by 8th December and remains unchanged by this correction.
The lack of availability of the supporting data used for these projections has been strongly criticised by the UK Statistics Authority (I bet their Christmas party is super-fun) who cast doubt on the accuracy of such models. This lack of transparency does little to build public trust in the Government and, as Theresa May put it, “for many people it looks as if the figures are chosen to support the policy rather than the policy being based on the figures.”
It is important to understand that, even allowing for these mistakes and inaccurate conclusions, something did need to be done. Whilst the rate of hospital bed occupancy would not have risen as quickly as the spooky Halloween projection, it would still have risen, as would the subsequent death rate. We were always heading for a rocky December with local projections predicting that there was a good chance that James Cook would see a second wave of cases that was significantly worse than the first. In order to avoid being the elf that ruined Christmas, Boris did need to act. It’s just a shame that he had to over-egg the justification for his actions.
On a more positive note, there is some hope that things may start to improve soon. The most recent data from the Office of National Statistics (ONS) shows that the rate of increase of new infections in England is slowing. In the week ending 30th October, their study showed that there were 46,000 new infections every day. This is slightly less than the figure of 52,000 new cases a day that they reported the week before. The ONS study looks at community, household infections and does not measure infections in hospitals, care homes, university halls of residence or similar institutions.
This is encouraging as it suggests that the three tier system of restrictions that was in effect prior to lockdown was beginning to take effect. However, it’s important to understand that cases are still rising everywhere except the North East of England with the highest infection rates in the Northwest and the Yorkshire/Humber regions. This is the justification for further action. The lockdown should ensure that this rise in cases begins to slow further and ceases before ultimately reversing.
My hospital now has a total of six wards (including the A&E COVID ward) put aside for COVID patients as admissions continue to rise. We are still faring reasonably well in Critical Care with the numbers of COVID patients in the two COVID ICUs remaining relatively unchanged. The hospital continues to do its very best to continue to function normally but it is anticipated that there will continue to be some disruption to the elective surgical programme in the weeks ahead.
As a result of the lockdown, we are now hopeful that we will avoid a worse situation than we saw seven months ago, at least for the near future. It’s still very difficult to know what the New Year will bring us. However accurate you think your crystal ball is, as Mark Twain said “prediction is difficult, particularly when it involves the future.”