One In, One Out

10th October 2020

UK COVID Deaths - Daily 81 / Total 42,760

UK COVID Deaths with COVID-19 on the death certificate - Total 57,347 (up to 25 Sep)

James Cook Hospital – Total COVID deaths – 268

All COVID cases within South Tees Hospitals Trust – 27

James Cook Critical Care COVID cases – 6 (2 ventilated)

The nation awaits the Prime Minister’s announcement on Monday with baited breath. Boris is expected to outline a ‘three tier system’ in order to simplify the, at times, rather confusing current COVID-19 restrictions. The hospitality industry in the North of England is particularly worried as they have been told to expect mandated closures in the worst-hit areas.

The number of daily cases of COVID-19 continues to rise quickly. The number of cases is also rising quickly in many other European countries but the rate of growth in the UK appears to be a whole lot faster than anywhere else. I must confess that I’m surprised (and depressed) at how quickly cases are rising.

There are several ways of measuring this growth in cases. The published daily number of cases is the most obvious one but I am aware that many do not have much faith in the numbers reported, given the failings of the testing system.

The Office for National Statistics (ONS) Infection Survey has reported that approximately 1 in 240 people in households in England had coronavirus in the week ending 1 October. This means 224,000 people in England were infected. This figure has doubled when compared to the figure for the preceding two weeks.

The COVID-Symptom Study App which has input from 4 million people and 12,000 swab results estimates that 21,903 people are developing symptoms of COVID-19 every day.

The latest results from Imperial College London‘s REACT-1 study also confirms that the rise in case numbers is accelerating. It looked at swab tests from 175,000 random people between 18th September and 5th October. They found that on average 1 in 170 people in England are currently infected. This figure rises to 1 in 80 amongst those aged 18-24. More worrying is that the infection rate continues to rise in people over 65 years of age with 8 times as many infections in this age group compared to the previous report.

Leaked information from a Government briefing on Friday revealed that in one study, pubs, restaurants and cafés were responsible for nearly 24% of COVID-19 infections. This rose to 30% if you included infections amongst the people working in such venues. Amongst the under-30’s, those figures rose to nearly 33% and 41% respectively. In contrast, viral transmission amongst people visiting each other in their private homes was significantly lower at around 2.5%.

However, this data comes from a very small sample size and may not be completely reliable. Previous Public Health England data from the Test and Trace system had suggested that transmission amongst visitors to private homes was greater than that seen in the hospitality industry. I suspect that what we are seeing is that transmission in pubs, restaurants and cafés is increasing as the case prevalence in the community increases. Whether it’s possible for such venues to remain ‘safe’ is open to question and the answer will be what guides the Government’s policy-making decision on Monday.

There is a marked north-south divide when it comes to both the number of cases of COVID-19 and the number of patients being admitted to hospital. This is a reversal of what happened during the first wave of the pandemic. Cases appear to be doubling twice as fast in the North West and Yorkshire. Many experts believe that we are in a similar situation to the beginning of March with hospital admissions doubling every fortnight.

At James Cook, cases are continuing to rise slowly and the hospital has had to open another COVID ward. Critical Care is still able to contain our cases in a single COVID ICU but this is only because our patients are dying at roughly the same rate that we are receiving new ones. I am saddened to report that we have had two new deaths amongst our ventilated group of patients and staff are becoming increasingly demoralised as the workload and death toll begin to increase.

We are also beginning to run out of beds. We are ventilating four patients on our High Dependency Unit and have had to transfer a few patients to other hospitals due to a lack of critical care beds. I fear it will not be long before we will have to expand our bed base in order to cope with the workload.

Nicky had a very busy day yesterday. She had been working on the COVID ICU during the day and then was on-call overnight dealing with emergency admissions. There were a few COVID patients on the ward who were not doing very well but given their advanced age and significant existing medical problems it was felt inappropriate to offer them intubation and ventilation on the ICU. Such treatments unfortunately cannot help everyone.

Nicky had a busy night as usual. There were two road traffic accidents involving cars and motorbikes that left three young people seriously injured and requiring a lot of attention from the hospital’s Trauma and Critical Care Teams. There was a medically interesting but very unfortunate case of meningitis due to tuberculosis. These cases sadly often present very late after irreversible damage has been done by the infection. There were also patients with septic shock, complicated cancers and patients requiring emergency surgery needing ICU support before and after their operations. Realising that Nicky would not be home anytime soon, I gave up waiting for her to come home and went to bed.

I woke just before six o’clock this morning to realise that Nicky still hadn’t come home. As I’ve stated before, Nicky is far from lucky when it comes to her on-call workload but it’s still unusual for her to have to remain at work for nearly a full 24 hours. She arrived shortly afterwards and wearily climbed into bed, informing me that she intended to get up after only an hours sleep in order to take our daughter, Millie, swimming. Needless to say I ignored such insanity, turned off the alarm and left her to sleep.