5th February 2021
UK COVID Deaths – Daily 1014 / 7-Day average 985
Total UK COVID Deaths within 28 days – 111,264
Total UK Deaths with COVID-19 on the death certificate – 112,660 (up to 22nd Jan)
James Cook Hospital – Total COVID deaths – 543
All COVID cases within South Tees Hospitals Trust – 180
James Cook Critical Care
COVID cases – 30 (17 ventilated)
Non-COVID cases – 34 (13 ventilated)
According to NHS England, the number of patients in Critical Care beds across the country has peaked. Bed occupancy has been declining for the past five days but remains high. During the pandemic, an extra 2500 ICU beds have been created in hospitals up and down the country and about 86% of them still have patients in them.
At James Cook, our overall number of patients within ICU remains fairly static. There has been a small fall in the number of COVID patients but we have had to reopen the third Surge ICU in order to deal with a concurrent increase in the number of non-COVID patients.
I was dismayed to find out that we had admitted our 300th COVID patient to ICU earlier this week. Of these patients, approximately 30% have died but I have to say that, sometimes, it feels like the mortality rate is higher than this. This is especially true when working on one of the COVID ICUs. We now have a total of four COVID units. Two of these make up our original ICU footprint and are purpose-built intensive care units. The third is our existing High Dependency Unit which normally has a mixture of ventilated and non-ventilated patients. The fourth is one of our temporary ‘surge ICUs’. We tend to try to admit the more stable patients to the temporary unit and keep the sickest COVID patients within the purpose-built units.
The end result is that the nurses and doctors who are working within these ‘proper’ ICUs end up only ever looking after the sickest COVID patients. The death rate on each unit is therefore high and there is a danger that this is taking its toll on our staff. On my ward round yesterday I bumped into a gentleman in his 50’s who I had seen a few days before when he was receiving CPAP on the ward. His condition had worsened and he had been moved up to the ICU in case he needed intubating and ventilating. I’m pleased to report that this didn’t happen and by the time I saw him, he was looking a lot better. This meant that we would normally be moving him out to the Surge ICU as a stable, ‘low-dependency’ patient. This is frustrating for some of the nurses as it feels like, just as a patient is starting to recover, they are whisked away before being promptly replaced with another horribly sick, ventilated one.
I therefore asked, in the interests of staff morale, if we could try to keep our recovering patient for another day. My cause was helped by the fact that he’s a nice guy who is no trouble to look after and that the ICU was relatively calm for once. It was good for all of us to have a smiling patient who could talk to us and, more importantly, one that we didn’t have to worry about too much.
There is a lot of talk in the press about potentially bringing forward the plans to lift the current restrictions. Both the Government’s daily case figure and the one published by the Office of National Statistics show that cases are falling throughout most of the United Kingdom. It seems that this recent improvement combined with the success of the nation’s vaccine programme is lifting hopes that we will soon be back to ‘normal’. Of course, if restrictions are lifted too early there is a danger that we will see a resurgence in both cases and deaths. This was dramatically demonstrated following the end of the second lockdown when the number of new cases rose alarmingly during December.
There is a hope that the over-70s will all have been offered vaccination by mid-February. It takes twenty-two days following a single dose of a vaccine to obtain a significant level of protection. This protection ranges from 76 to 90% depending on which vaccine has been given and whose data you look at. You might therefore expect a high level of immunity throughout this at-risk population by early March. People over the age of 70 make up 89% of all COVID deaths so it would seem that this would tie-in well with the potential plan to start reopening schools on March 8th.
Getting children back to school as soon as possible is a huge concern for many of us but increasing numbers of people are citing effects on their mental health as the main reason why restrictions should be eased sooner. I do have some sympathy but can’t help but feel that when most of them are talking about ‘depression’ they are really talking about unhappiness. God knows that happiness is very much in short supply at the moment but being unhappy does not necessarily imply mental illness. The medicalisation of unhappiness has been an ongoing problem for some time now but it seems that lockdown is shining a light on the problem.
As a result, I can’t help but get irritated when I hear people talking about lifting lockdown so they can go to the pub 'for the sake of their mental health'. Don’t get me wrong, there are many people who are suffering from serious mental illness as a result of the imposed social isolation and removal of their usual support mechanisms. Others are facing financial hardship, loss of employment and a very uncertain future. Many of these are deeply concerning side effects of the current restrictions and remind us how important it is that case numbers are driven down quickly; it’s important that lockdown doesn’t last any longer than it needs to.
None of us are enjoying lockdown. It’s just a necessary evil. Who among us wouldn’t like life to return to normal so we can all feel happier? I, for one, would love to be able to go to the pub with my friends again. It might be the distraction I need to stop me worrying about the patients for a while. One might even go so far as to suggest that it might help my mental health.