3rd November 2021
UK COVID Deaths – Daily 217 / 7-Day average 163
Total UK COVID Deaths within 28 days – 141,181
Total UK Deaths with COVID-19 on the death certificate – 164,491 (up to 22 Oct)
James Cook Hospital – Total COVID deaths – 694
All COVID cases within South Tees Hospitals Trust – 85
James Cook Critical Care
COVID cases – 8 (6 ventilated)
Non-COVID cases – 47 (31 ventilated)
The past week has been a very busy one in Critical Care. The hospital has been feeling the effect of the previous rise in COVID cases with the number of patients being admitted to the hospital continuing to increase slowly, day by day. There are over a dozen patients who are sick enough to require CPAP on the COVID wards and we have admitted a number of them to the ICU to be ventilated.
The number of patients on Intensive Care remains fairly static and most of our current pressure is a result of the increasing number of non-COVID patients that require ventilation. Each has a different reason for needing Intensive Care. It’s an eclectic mix of aliments that includes bacterial pneumonias, pyelonephritis, dental abscesses, septicaemia, heart attacks, cardiac arrests, car accidents, motorbike accidents, horse-riding accidents, tractor accidents, falls up stairs, falls down stairs, acute pancreatitis due to gallstones, acute pancreatitis due to alcohol, diabetic ketoacidosis, liver failure, kidney failure, bone marrow failure, hypoxic brain injury, Guillian-Barre syndrome, weird neurology, even weirder neurology, genetic disorders, epilepsy, sub-arachnoid brain haemorrhages, sub-dural brain haemorrhages, intra-cranial brain haemorrhages, strokes, assorted surgical complications, treatable cancer, untreatable cancer and various assorted drug overdoses.
Last week saw us break a new record for the number of non-COVID patients we were ventilating. The closest we have come in the past was during the swine ‘flu pandemic of 2009. Swine ‘flu was very different from regular influenza in that it could cause serious illness in young people who then often required ventilation. The strain of influenza responsible for swine ‘flu could cause direct lung inflammation in a similar way to COVID-19 but, much more commonly, infection would lead to secondary bacterial pneumonias. Despite being labelled as a pandemic by the WHO, swine ‘flu led to fewer deaths worldwide than a regular seasonal ‘flu epidemic. This was thought to be due to older people, who normally are most at risk of death from 'flu, having some residual immunity following past influenza infections or vaccinations. So, whilst fewer people died overall, the significant number of younger, sicker patients on ventilators resulted in a heavy burden for Intensive Care Units up and down the country.
The winter of 2009 was, in my opinion, the last time we experienced what I would call a really bad winter. Don’t get me wrong, the NHS has been very busy every winter since and there are always horror stories about people having to wait hours for an ambulance, patients being cared for on trolleys in corridors and ambulances backed up outside hospitals but, on the whole, we have got away with it. Just. As a result, most of the nation is unaware of just how much havoc a truly bad winter could unleash on its beloved NHS.
Last week the Office for National Statistics (ONS) announced that, during the week ending 22nd October, an estimated 1 in 50 of the English population was infected with COVID-19. The figure in Wales was much worse at 1 in 40. This is the highest level of infections that the ONS has yet recorded and is higher than the figure seen at the peak of the second wave. Cases were highest amongst teenagers but were also rising in those over 50. Luckily, the number of daily reported cases has since fallen, both nationally and locally and so we may soon start to see the number of hospital admissions decrease a little.
Modelling from the London School of Hygiene and Tropical Medicine has predicted that the number of people being infected with COVID-19 could fall dramatically over the next month. They even predicted that, by the end of December, the number of new cases could fall as low as 5000 a day. This would effectively mean that the third wave would be done and dusted by Christmas. The rationale for this prediction is that we will have achieved ‘herd immunity’ by then as a result of letting COVID run its course. In young people this immunity is a result of so many of them being recently infected and in the older population, it is the result of the vaccination programme.
The number of people dying from COVID-19 is continuing to rise. The country's Intensive Care Units are struggling to cope with the current level of demand for both COVID and non-COVID patients. The idea that the number of new COVID infections is about to plummet is very beguiling. The sooner the number of COVID patients being admitted to hospital falls, the better. We might then stand a chance of finding room for everyone else. Unfortunately, over the past 20 months, I have seen many different models and predictions of what COVID-19 will do and when it will do it. None of them has been on the money and so, as much as I would dearly love to believe that it’ll all be over by Christmas, I won’t be hanging up my PPE just yet.