19th December 2020
UK COVID Deaths – Daily 534 / 7-Day average 436
Total UK COVID Deaths within 28 days – 67,075
Total UK Deaths with COVID-19 on the death certificate – 76,287 (up to 4th Dec)
James Cook Hospital – Total COVID deaths – 374
All COVID cases within South Tees Hospitals Trust – 80
James Cook Critical Care
COVID cases – 15 (9 ventilated)
Non-COVID cases – 39 (13 ventilated)
The big news today is the announcement of a new tier of restrictions. Tier four is to be introduced in London and the South East where the numbers of new cases have risen dramatically. Tier four restrictions resemble those of the first lockdown. People should ideally not leave their homes and non-essential retail businesses, ‘personal care centres’ and gyms must close. Travel in and out of tier four is not allowed unless deemed essential.
At an emergency briefing, the Prime Minister went on to explain that the plans to relax restrictions over Christmas have been scrapped for those in tier four. For the rest of England, the rules that allowed three households to meet over five days during the Christmas holiday have changed. They will now be allowed to meet only on Christmas Day.
The surge in cases that London and the South-East are seeing is believed to be due a new variant of the coronavirus that may have originated in the UK. Its prevalence appears to be increasing and it may now be the dominant variant in London. The main concern is that this new variant of the virus may well be more infectious. Catchily named VUI-202012/01 (‘Variant Under Investigation’ and the date it was classified), it has 23 different mutations but the important one is a mutation in the virus spike protein. The spike protein is the part of the virus that binds to receptors on human cells and gains entry, causing infection.
Viruses mutate constantly and the SARS-CoV-2 coronavirus that causes COVID-19 has already mutated many thousands of times. There have been up to 4000 different mutations of the spike protein alone. Very few of these have changed the virus in any meaningful way. The only variation that has altered the virus’ behaviour is the D614G variant which appears to have increased its ability to spread. This mutation arose back in March and is now the most common variant around the world. However, the D614G variant mutation did not seem to lead to any increase in the severity of the disease.
The UK has now officially informed the WHO that this new VUI-202012/01 variant appears to spread more quickly. Whilst this is clearly worrying, there is no suggestion that this new mutation would prevent vaccines from working. COVID-19 vaccines produce antibodies against many regions in the spike protein, so it’s unlikely that change to one part of the protein would render any vaccine ineffective. COVID-19 cases are also rising in all other areas of the country, with the exception of the Yorkshire and the Humber region which was the only area where case numbers fell last week. On Teesside, case numbers have slowly risen in most areas but we are much better off than London and the south-east where the growth in new cases is alarming. The virus appears to be spreading amongst all age groups but the largest increase in cases has been seen amongst 30-39 year-olds.
As case numbers rise, inevitably so do hospital admissions. Hospitals in Kent are postponing all non-urgent treatment as the number of COVID-19 patients has risen above that seen during the first wave. Teesside remains in tier three and we are fortunate at James Cook that we are yet to see any increase in admissions over the past fortnight; our number of COVID patients remains fairly static. In a rare, glass-half-full moment, we have decided to turn one of our two COVID ICU’s over to the care of non-COVID patients, whose numbers are increasing as winter draws on. This means that we have placed all the ventilated COVID patients in just the one ICU. We have moved all the CPAP and recovering COVID patients to the Female SAU. This move enables us to use all our beds as efficiently as possible and allow us to be more flexible.
However, separating the two ICUs involves re-erecting the ‘wall’ again. Honestly, that bloody partition goes up and down quicker than my teenage daughter’s mood. Sadly, the way things are going, I’m certain it won’t be long before we see our COVID numbers start to rise and we’ll have to tear it down again.
Sigh.