Thursday 2nd April 2020
COVID Figures for 1st April
UK Hospital Deaths 563 / Total 2352
James Cook Hospital – Total deaths – 17
James Cook Hospital confirmed cases on wards – 90
James Cook Hospital Critical Care cases - 24 / 12 ventilated
I am back on the High Dependency Unit (HDU) today. I am accompanied by a growing number of junior doctors, registrars and nurses. We are preparing for the surge and will spend the next couple of weeks bringing everyone up to speed in order to do our very best to provide critical care for the wave of patients that is coming.
Our preparatory work appears to be on-track. We are well-led and so far, are getting the staff and some of the equipment we have asked for. There is however, a national shortage of ventilators, CPAP machines and breathing circuits. What’s even worse is that my request for a Buck Rogers 80’s pinball machine for the coffee room has yet to be approved.
We did get a number of ventilators from the neonatal unit today. Not sure they are as much fun to play on as the pinball machine and they don’t feature a picture of Erin Gray as Colonel Wilma Deering on the front. They also don’t award you with an extra life if you hit Twiki the robot three times. However, the LED lights and alarms are quite entertaining and it does appear that they do a fine job of ventilating adult patients, which is nice.
We were also joined on the ward round today by one of our Orthopaedic Trauma Surgeons. His workload has decreased due to the cancellation of elective surgery and the fact that fewer people are crashing their cars or falling down stairs whilst drunk. He has offered to help wherever he can and today he spent the day re-learning how to insert central lines under ultrasound guidance. Being a surgeon, he is rather good at that sort of thing and will be extremely useful in the months ahead.
Quite a few of our patients remain very ill despite having been ventilated for several days now. It appears that for many COVID patients, the time it takes them to recover whilst on the ventilator is likely to be in the order of 2-3 weeks. This is a worry as the longer you spend ventilated, the less likely you are to survive or make a complete recovery.
On the other hand, two of the patients who were not poorly enough to be ventilated are doing very well. They received Continuous Positive Airway Pressure (CPAP) and are now back on normal oxygen masks. Hopefully by tomorrow they will be ready to return to the ward.
Another COVID patient who was ventilated because of a stroke has made a better recovery than expected. He now has a tracheostomy (the breathing tube in the mouth is replaced by one that reaches the lungs through a hole in the front of the neck) and is close to breathing entirely by himself. We have been told by our Infectious Diseases Consultant that soon he can be considered immune and can be transferred to the non-COVID part of the hospital.
This prompted a coffee-room discussion about immunity. Once antibody testing has been developed it will possible to identify which members of the population are immune and can presumably integrate back into ‘normal’ society. There would have to be a way of identifying these immune people and I proposed that they could wear some sort of badge. I suggested this could be in the shape of a golden toilet roll. After all, the shortage of toilet roll has come to symbolise the pandemic for many. A strangely inappropriate icon for these troubled times.
Nicky’s job today was to explore the creation of extra bed spaces within the existing critical care units. The more patients we can place together, the easier it will be to cope with the large numbers we are expecting. I was surprised at how successful she and her colleague Caroline were. They managed to shoe-horn beds into almost impossible spaces and I am worried that, once this is all over, hospital management may see this as an innovative way of cheaply improving productivity.
Whilst writing this at the kitchen table this evening, I was interrupted by loud noises coming from outside. As I went to investigate I realised that it was 8pm. We live outside the village and only have a few neighbours nearby. Every one of them was standing in front of my door (at a respectful 2 metres from each other) clapping and cheering as part of the NHS Clap for Carers event. I was genuinely moved by this display of gratitude and thanked them all before quickly heading back inside before they noticed the tear in my eye.