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  • Richard Cree

New Normal

Monday 27th April 2020

COVID Figures for 26th April

UK Hospital Deaths 413 / Total 20,732

James Cook Hospital – Total deaths – 166

James Cook Critical Care COVID cases – 10 / 6 ventilated

James Cook Critical Care non-COVID cases – 17 / 7 ventilated

Nicky was working overnight last night. Once again we admitted more non-COVID patients to Intensive Care than COVID ones. The patients included another case of pancreatitis caused by gallstones, a patient with alcohol-induced liver disease and a patient with a rare inflammatory condition that had caused heart failure. Whilst they will all be isolated and tested for coronavirus it is unlikely that any of them will test positive.

We have changed one of our COVID units back into a non-COVID one. The General High Dependency Unit (HDU) was cleared of patients, cleaned and then ‘fogged’. This involves using a portable vapour generator which fills the unit with a hydrogen peroxide mist. This kills any residual bacteria, viruses or fungi. It leaves no residue and is safe to use around expensive electrical equipment (like ventilators and ICU monitors). Once completed, the area is safe to enter after about 30 minutes. Before then and you may unintentionally end up bleaching your hair and looking like you’re in the middle of a particularly sad mid-life crisis.

We had opened extra COVID beds in the Theatre Recovery Area but have found out that it’s far from ideal. It is the location, bang in the middle of the operating theatre area that is problematic. It does not have a separate entrance and there are no changing rooms nearby. There’s no coffee room and no nearby separate toilets for staff. It’s also difficult to set up anterooms for ‘donning’ and ‘doffing’ of PPE.

We have therefore moved into a different area that is part of the separate Surgical Daycase Unit. We are just using their recovery area initially. This has none of the above problems. In fact the only thing wrong is that we have decided to call it the ‘Day Unit Recovery’ or DUR. Not the most inspiring name but it’s better than us moving into the Daycase Orthopaedic Hospital and having to abbreviate that…

This then leaves us with the following current Critical Care setup:

COVID Units - ICU 2 (8 beds), ICU 3 (8 beds), DUR (10 beds)

Non COVID Units – General HDU (17 beds), Paediatric ICU (7 beds)

It’s worth pointing out that we also have some non-COVID patients on the Cardiothoracic ICU and the Cardiothoracic and Neurosurgical HDUs. They were moved there at the start of the outbreak and we will plan to bring those back to our units soon.

This is all in preparation for a return to a ‘new normal’. Over the last few weeks we have only been performing emergency surgery and a scattering of other operations. As of today the Trust is restarting the elective surgery programme. We will only be operating on a relatively small number of cases a day, mostly cancer cases or major surgery that can’t wait. Many of these big cases require Critical Care admission after the operation to minimise the risk of complications. Some patients will need to remain ventilated following their operation. Prior to now we hadn’t been confident to give Critical Care beds away for this purpose in case we needed them for COVID patients. However, we plan to remain flexible and can increase the number of available COVID beds again at short notice.

We are continuing to see a decline in the numbers of COVID patients within Critical Care. This appears to be true all across the country. We have not had to deny Intensive Care to any patient who could benefit from it. We are all thankful for that as initial reports coming out of Italy and Spain were very disturbing.

The daily death rate due to coronavirus has also fallen over the past two days. It is tempting to see this as the end of the peak. However, one thing remains constant; no-one has been able to reliably predict the course of the virus yet. According to the press, Middlesbrough has a high infection rate and new cases are rising. A resurgence or second peak is still possible and we need to be cautious for the next week or two before we can breathe a collective sigh of relief.

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