Past the Peak?

27th July 2021

UK COVID Deaths – Daily 131 / 7-Day average 69

Total UK COVID Deaths within 28 days – 129,303

Total UK Deaths with COVID-19 on the death certificate – 153,342 (up to 16 Jul)

All COVID cases within South Tees Hospitals Trust – 92

James Cook Critical Care

COVID cases – 12 (11 ventilated)

Non-COVID cases – 43 (16 ventilated)

The total number of daily cases of COVID-19 recorded in the UK has fallen significantly over the past week. This is the first time during the entire pandemic that case numbers have fallen without a lockdown being in place. On the face of it, this is obviously very encouraging news. It’s just that no-one, including me, is quite sure exactly why it is happening.

There could well be many reasons why the number of daily cases has fallen. Fewer people are taking COVID tests than they were, although this cannot be solely responsible for the decrease in case numbers. It’s possible that the recent spike in cases was partly due to people congregating in crowded pubs to watch the football. Many children have been self-isolating at home over the past fortnight and schools have now closed for the summer holidays. It’s also likely that the recent hot weather will have played its part as there will have been less socialising going on indoors.

These factors may go some way to explaining why the number of new infections is decreasing but what everyone is hoping is that this is the first sign that we might be closer towards herd immunity than we thought.

Whether true herd immunity is actually achievable for a disease like COVID-19 is debatable. The concept of herd immunity is a pretty simple one: eventually enough people will have been vaccinated or will have recovered from infection to ensure that there is widespread immunity to COVID-19 throughout the population. This collective immunity will then prevent the virus spreading to those who remain susceptible to infection.

The Office for National Statistics (ONS) has suggested that 92% of adults in the UK now have antibodies to COVID-19 due to either a previous infection or at least one dose of a vaccine. There is no doubt that this represents a significant amount of immunity. The big question is whether it will be enough.

Unfortunately, factors such as the uneven vaccine rollout across the globe, lack of vaccine uptake amongst the young, short-lived natural immunity from infection, the emergence of new variants and doubts over the efficacy of our vaccines to prevent ongoing transmission all seek to work against the development of truly effective herd immunity. The elimination of COVID-19 is not currently something we can currently look forward to. This is why we are all talking about ‘learning to live with the virus’.

Looking at the subject of vaccine effectiveness, a study in the New England Journal of Medicine has reported just how effective vaccines are at preventing symptomatic COVID-19 infections. The Pfizer/BioNTech vaccine was 88% effective against symptomatic infection with the Delta variant, whilst the AstraZeneca vaccine was 67% effective. Recent data from Israel contradicts these figures, with their Health Ministry stating that the Pfizer vaccine is only 41% effective at preventing symptomatic infection and 39% effective against asymptomatic infection. Reassuringly, they did state that the vaccine was 92% effective at preventing hospital admission. The Israeli Health Ministry have not released their data for scrutiny and so the validity of these figures is not yet known. What is clear though is that our vaccines seem very good at preventing serious infection but less good at preventing milder or asymptomatic infections.

It’s been a hot and humid week in the hospital. Relatively few of the clinical areas are air-conditioned and working in PPE during the current heatwave has not been fun. The Trust arranged for an ice-cream van to visit the hospital on Friday, although the long queues for free ice-cream meant that relatively few of us got to spend the afternoon unwinding with a Strawberry Mivvi. The good news is that, following the announcement of our pay rise, we’ll all be able to buy our own ice-creams in the future.

Despite the number of daily cases falling, we are yet to see any reduction in the number of COVID patients admitted to James Cook Hospital. Over three quarters of the patients who are currently ventilated on our two COVID ICUs are unvaccinated. A similar situation is to be found amongst the CPAP patients that the Acute Medical Teams are caring for across the four COVID wards. There are still an awful lot of unvaccinated people out there.

Over the past month we have seen a surprising number of pregnant patients become unwell due to COVID-19 and require admission to hospital. Pregnancy causes complicated changes to your immune system and we know that pregnancy increases the likelihood of developing serious complications following many viral infections, including COVID-19. Unfortunately, the vaccine uptake amongst pregnant women is not what it should be and so we are seeing more and more pregnant patients.

Luckily, most of the women we have seen have only needed high-flow oxygen or CPAP and have managed to avoid ventilation. However, being critically ill when pregnant is far from desirable; anything that reduces a pregnant woman’s oxygen levels can reduce the baby’s oxygen levels too. In this situation, the baby may need to be delivered early to avoid disaster.

This week, one of our pregnant patients became so unwell that it was clear that there was no choice other than to deliver the baby. Our lady was sufficiently late on in her pregnancy that we did not have to worry too much about the risks of premature birth but this was obviously a very troubling situation.

Fortunately, everything went well. The baby was delivered by emergency caesarean section with a minimum of fuss thanks to the combined efforts of the team of obstetricians, anaesthetists, midwives and nurses. Baby is doing fine and whilst Mum remains ventilated on the ICU, her condition is showing some signs of improvement.

Currently, 95% of all pregnant women who are admitted to hospital with COVID-19 are unvaccinated. Pregnant women with severe COVID pneumonitis are at greatly increased risk of stillbirth or premature delivery and I would urge all pregnant women to take up the offer of vaccination.

Hopefully, with cases falling, we may start to see hospital admissions decreasing soon. Quite what effect Freedom Day will have on the number of people in hospital remains to be seen. It won’t be until the beginning of next week that we will see whether abandoning restrictions will cause cases to rise again or whether they will plateau. Would it be too much to hope that they will continue to fall? Probably, but let’s wait and see. I don’t think there can be anyone who can reliably claim that they know what path the pandemic will take next.