19th August 2020
UK COVID Deaths - Daily 16 / Total 41,397
James Cook Hospital – Total COVID deaths – 255
All COVID cases within South Tees Hospitals Trust – 4
James Cook Critical Care COVID cases – 0
Public Health England (PHE) has changed the way it records deaths in England from COVID-19. The previous ‘daily death toll’ figure used by the press counted the death of anyone who had ever tested positive as a death due to COVID , no matter how many days had passed since the test. Now PHE will now use two definitions of death from COVID-19:
1. The first definition is a death that occurs within 28 days of a positive COVID test.
2. The second definition is someone who either died within 60 days of their positive test or, if
COVID-19 is mentioned on the death certificate, died more than 60 days after their test.
PHE’s analysis showed that 88% of all deaths from COVID-19 in England occurred within 28 days of a positive test result, while 96% occurred within 60 days or had COVID-19 on the death certificate. PHE will publish the 28 day figures daily and the 60 day figures weekly.
This change is understandable because as time went on, the original way of counting deaths would become increasingly inaccurate. However, it’s easy to be cynical because the use of the less accurate 28-day figure provides an appreciably lower total and so is a more appealing statistic for public release.
One could also endlessly debate whether the figures from the Office of National Statistics which look at the excess number of deaths compared to a 5 year average are the most representative. This invariably leads to a heated discussion around which of these deaths are directly due to COVID-19 and which are due to the effects of lockdown, deprivation of healthcare for other medical problems, mental-health related deaths and to be perfectly honest, I’m not going there…
Getting back to the James Cook Hospital, we are still yet to see any new COVID patients. We are admitting the odd ‘persistent positive’ patient with other problems and we still have one or two patients who remain hospitalised due to COVID-related complications. I realise that this makes for a rather dull pandemic diary but that’s something I can easily live with.
The hospital is making great efforts to minimise the risk of viral transmission amongst patients and in this regard they are being very successful. I’m not aware of any patients contracting COVID-19 as a result of their hospital stay over the past few months. This is achieved by strict attention to hygiene, use of face-masks and social distancing wherever practical. However, one of the consequences of increasing the distance between hospital beds and clearing the areas around thoroughfares and sinks is that you end up with fewer beds overall. This is far from a good thing for a busy (or should I say hectic) hospital like ours. The hospital is currently very close to being ‘full’ and we are having difficulty in discharging our critical care patients to the wards once they have recovered due to a lack of ward beds. This situation is currently manageable and is not having any real impact on patient care but we are all worried about what happens when winter rolls around and the numbers of admissions begin to rise.
There remains plenty of bread-and-butter work for us to be getting along with. We have seen increasing numbers of trauma patients of late with a significant increase in the numbers of car and motorcycle accidents. There are a lot more patients with brain-injuries due to road-traffic accidents, falls and assaults. We even had a patient the other day who had been stabbed in the back with a potato-peeler which is something I’d not seen before. Classic kitchen-related assaults tend to be performed with knives, rolling pins or, if one is going for maximum comedic effect, a frying pan.
This week we also ended up with an intubated and ventilated pregnant patient on the ICU. Thankfully, this is not something that we see very often. Our patient had developed pre-eclampsia which is a disorder of late pregnancy that causes high blood pressure, excretion of protein in the urine and can, in severe cases lead to breathing problems, blood clotting issues, kidney and liver failure and convulsions. The exact causes are not understood but it can be very dangerous for both mother and baby. There are a variety of treatment options but ultimately the only ‘cure’ is to deliver the baby. Eventually our patient required an urgent Cesarean section and I’m pleased to report that both mother and baby are doing well.
The most entertaining case I saw over the past few days was a referral from the ward. We were asked to see a lady who had been admitted following a series of seizures. The lady has had many problems over the years due to alcohol-dependency. She was reportedly confused and agitated and there was no way that she would lie still for the CT brain scan that her medical team wanted her to have.
I went to assess the patient and was surprised to see her staggering around her bed. It was clear that she had been terrorising the nurses for some time. I introduced myself and was promptly told in a broad Scottish accent that if I didn’t ‘go away’ (she used stronger language) I would be ‘going through that window’. I assumed that this was some sort of traditional Glaswegian salutation but it appeared she meant it. I commented that, given her diminutive stature that she might struggle with the task but she informed me that she intended to enlist the help of Paul, my registrar. For a few seconds, Paul almost looked tempted, but, presumably fearing a poor appraisal he declined to assist. We hastily made our excuses and left.
I told the medical team that it was my opinion that the seizures were unlikely to be due to any new brain pathology and suggested that the hospital security team may be of more help. I returned back to the ICU and put the kettle on. At least there the patients were all tucked-up and asleep and not capable of such mischief.