17th October 2020
UK COVID Deaths – Daily 150 / Total 43,579
UK COVID Deaths with COVID-19 on the death certificate - Total 57,690 (up to 2 Oct)
James Cook Hospital – Total COVID deaths – 273
All COVID cases within South Tees Hospitals Trust – 39
James Cook Critical Care COVID cases – 4 (1 ventilated)
The number of COVID patients admitted to the hospital continues to increase slowly, as does the number of deaths. Fortunately, the number of patients we are looking after in our COVID ICU remains static. We are also managing to accommodate all our patients within our existing beds and so are faring better than some of the other hospitals in the North of England.
During the first wave back in March and April, Teesside saw more cases admitted to Intensive Care than our sister hospitals further north. This time, the Newcastle and Northumbria hospitals are currently treating many more COVID patients than we are. They have had to create temporary Intensive Care Units in other parts of the hospital in order to deal with the increased demand. This is inevitably having a knock-on effect on their ability to deal with their regular workload.
We too are worried about how the rising number of cases will affect the way we operate our day-to-day service. One of the biggest concerns is how we will continue to look after patients undergoing routine surgery who need Intensive or High-Dependency care after their operations. This need arises either because of the high-risk operation they are undergoing or the fact that the patient may have significant existing health problems. Sometimes, both the patient and the operation are classified as high-risk. These cases cannot be cared for on the wards; they require specialist nursing and/or medical care to ensure they don’t come to any undue harm.
Currently, all patients undergoing elective, routine surgery are being asked to self-isolate for 14 days. This allows them to be classified as ‘green pathway’ patients. The reason for this is that if you contract COVID-19 before your operation and become symptomatic in the post-operative period, your risk of survival plummets. Clearly, these patients are also at risk of contracting COVID-19 whilst they are recovering in hospital and so we are trying to find ways of minimising this risk of this happening. One of these is to create an entirely separate High-Dependency Unit (HDU) that will only look after these ‘green’ patients. They will be geographically separated from the ‘amber’ and ‘red’ patients.
As I’ve explained before, red patients are those who have tested positive for COVID-19 and amber patients are those who have tested negative but have not self-isolated for those 14 days before admission. The use of this traffic-light nomenclature avoids terms like ‘clean’, ‘dirty’ or ‘a bit grubby’ which we have been strongly discouraged from using.
The green HDU is to be created within the existing neuro-surgical HDU. We will accommodate the neurosurgical patients into our existing, super-sized General HDU. If we run short of beds we can use some of the capacity within the Cardiothoracic ICU. We realise that with all this shuffling around it is only a matter of time before, like our friends in the north, we will have to create a separate, new COVID ICU but this is something we don’t want to do until absolutely necessary. The impact of doing this on the hospital’s normal workload is not to be underestimated.
One of other changes the hospital has made is to change the Acute Assessment Unit (AAU) on Ward 15 over to a COVID area. The AAU is where emergency medical patients are admitted when sent in by their GP. They can also be transferred directly from the A&E Department next door. Confirmed or suspected COVID patients can be brought straight into the unit without having to enter A&E and be assessed and treated as necessary. The advantage to the ICU team is that they will create an ‘intubation room’ for us to deal with the sickest COVID patients who need ventilating. We can stabilise the patient there before transferring them up to the ICU.
We currently use the decontamination room in A&E for dealing with these sickest COVID patients but we all hate it. The decontamination room is right at the front of the A&E Department and can be accessed by ambulance directly from outside. It’s essentially a tiled wet-room with multiple shower-heads and some rather special cleaning products. It exists in order for us to be able to deal with a chemical and/or poisoning incident where the patient is contaminated and would pose a risk to the doctors and nurses treating them. One look at Teesside’s chemical industry landscape and it’s easy to see how important it is to have such a room in a Middlesbrough hospital. When the first wave of the pandemic arrived, we decided to use this room as a COVID-19 isolation facility. Unfortunately, the room looks very much like a dystopian school gym shower, only smaller. The Feng shui is awful. It is not a great place to do anything as complicated as stabilising an ICU patient. I’m constantly dreading the moment when, instead of the piece of specialised medical equipment I’ve asked for, I get handed a Hai-Karate soap-on-a-rope.
The COVID wards are also planning to utilise CPAP in the way they were during the first wave of patients. This is a big deal. Normally, patients on CPAP are deemed too sick to be cared for on the ward. During the first wave, the COVID wards looked after as many as 15 CPAP patients at any one time. These are patients that we avoided having to admit into our critical care beds, greatly relieving the pressure on the hospital as a whole.
Whilst this is good news, it is all worryingly familiar. We are moving steadily towards the exact same setup we saw during the first wave – a place none of us want to go again.