Deadly

Saturday 9th May 2020

Figures for 8th May

UK COVID Deaths 626 / Total 31,241

James Cook Hospital – Total COVID deaths – 204

All COVID cases within South Tees Hospitals Trust – 72

James Cook Critical Care COVID cases – 11 (9 ventilated)

James Cook Critical Care non-COVID cases – 33 (20 ventilated)

Another day spent working on the one of the COVID ICUs. I’m pleased to say that the two patients on CPAP are doing well and are not, as yet, showing signs of deterioration. They are joined by a third patient who is also admitted for CPAP, a gentleman in his early 40’s with no underlying medical conditions.

Now, if I’m honest, two of these patients don’t really need to be on the ICU. Only a few weeks ago we would have managed them on the ward. The Acute Medical team, based in the Acute Assessment Unit (AAU) and the ‘Tower Block’ have been doing sterling work in caring for their patients. They have managed a surprising number of patients on CPAP and without their help we would undoubtedly have suffered a very torrid April. At one point they had twelve patients on CPAP who would otherwise have needed admission to Critical Care. During this crisis, we have been able to provide Critical Care to every patient who has needed it and this is due in no small part to their efforts.

However, because our numbers of COVID patients have decreased we are finding that we can now admit patients that are not quite as sick as we have seen over the past few weeks. This is no bad thing. One of the inevitable ‘side-effects’ of Acute Medicine looking after these patients, is that the only patients we see have been the very ill ones.

Indeed, we have seen a large number of deaths over the last few weeks. As ICU doctors and nurses, we are no strangers to death but we have had to deal with unprecedented numbers recently. It has been good for morale over the past few days to be looking after patients who stand a very good chance of surviving their illness.

The Government plans to address the nation tomorrow evening in order to lay out plans to relax the current lockdown restrictions. I have sensed a growing degree of complacency amongst the public with regard to this. It is true that we are definitely past the peak of new infections and the death rate is falling but I would like to caution everyone that this is far from over.

I know that I am not being objective. I know that the cure cannot be worse than the disease. However, my colleagues and I have spent the last few weeks watching many more patients than we would care to remember, die as a result of this pandemic. We have talked to the families of the dying, we have witnessed their grief and we see the tragedy that is associated with each and every one of these deaths. These are not just statistics.

It is important to understand how deadly this disease is. For those unlucky ones who require admission to hospital, the mortality rate is approximately 30%. For those admitted to Critical Care, that rate increases to 50%. If you are ventilated it goes up to 65% and if you then develop kidney failure it increases further to 75%. Finally, if you develop multiple organ failure, the mortality rate tops out at nearly 90%.

In a small number of patients this is a devastating, relentless, untreatable disease. We can provide supportive care only. There is no ‘cure’. It is worth remembering this when contemplating how we, as a nation proceed.