Plan A

25th October 2021

UK COVID Deaths – Daily 38/ 7-Day average 135

Total UK COVID Deaths within 28 days – 139,571

Total UK Deaths with COVID-19 on the death certificate – 162,620 (up to 8 Oct)

James Cook Hospital – Total COVID deaths – 687

All COVID cases within South Tees Hospitals Trust – 66

James Cook Critical Care

COVID cases – 7 (6 ventilated)

Non-COVID cases – 45 (28 ventilated)

The pandemic has, once again, muscled its way back into the headlines. No sooner had I written about my hope that case numbers might not rise too quickly, than they did just that. The number of hospital admissions and the number of people dying has also been increasing, leading to arguments about whether or not it is time for the Government to implement their ‘Plan B’.

At the hospital, the total number of COVID patients on the wards is creeping slowly upwards. Whilst we are seeing more CPAP patients, we are yet to see any significant increase in the number being admitted to ICU. This is just as well as we are being kept busy with plenty of non-COVID patients and would currently find looking after more than one COVID ICU very challenging. As case numbers in the community have risen, so has the number of nurses and doctors who are having to isolate due to members of their family testing positive. We currently have fewer staff than usual and this is making things difficult for us.

The Office for National Statistics estimates that last week, one in 55 people in England was infected with COVID-19 which is getting close to the 1 in 50 figure seen at the peak of the second wave. As alarming as this might initially sound, the situation is very different from how it was at the beginning of the year. Back then we were seeing over 1200 deaths a day whereas the current death toll is approximately a tenth of that figure. At the moment about 1000 patients are being admitted to hospital with COVID-19 every day. This figure is a quarter of what it was back in January indicating that, whilst vaccines are very good at stopping you becoming severely ill and dying, they are not proportionately as good at keeping you out of hospital.

Compared to the rest of Europe, the UK appears to not be doing very well. We are seeing many more cases than they are and our rate of COVID hospital admissions per head of population is six times higher than our neighbours. This begs the question: Why are we faring so badly?

Part of the reason is doubtless due to our increasingly lackadaisical attitude to mask-wearing and social-distancing but a lot of it is due to our early vaccination success. We were much quicker than other nations in vaccinating our population. Whilst this is no longer the case, we were still the first European nation to completely remove restrictions. Whilst it was expected that cases would rise as a result, there had been a hope that the proportion of people who needed admission to hospital would remain low. The fact that so many people are still being admitted to hospital suggests that the immunity conferred by this early vaccine programme is waning.

Immunity slowly decreases following vaccination and there is an increasing amount of evidence to suggest that, after six months, the level of protection remaining may be less than ideal. Our use of the Astra Zeneca vaccine may also have contributed to lower levels of immunity as we know that it does not protect against hospitalisation as well as the Pfizer or Moderna jabs. Studies suggest that, at 20 weeks after a second dose, the AstraZeneca vaccine is 77% effective against hospitalisation following infection with COVID-19 but that the Pfizer vaccine affords 92% protection. The booster vaccine programme seeks to remedy this waning immunity by administering a single dose of the Pfizer or Moderna vaccine to all those over 50, care home residents, healthcare staff and those with underlying health conditions.

The hospital’s vaccination hub has been busy delivering booster vaccinations to members of staff over the past few weeks and Nicky and I have both now had our jabs. We both experienced the usual sore arm, headache and a day or two of fatigue but otherwise were fine. My eldest daughter has been vaccinated at school and has had similar side-effects but my son missed his chance after catching yet another cold. He really does not like needles and I’ve never seen him so delighted to be ill and be unable go to school.

Unfortunately, the national booster programme and the school vaccination programme are not proceeding at anywhere near the same pace as the initial vaccine rollout. Ultimately, 30 million people in the UK will be eligible for booster vaccinations. Of these, 8.5 million had their second dose over six months ago and so are currently at risk of waning immunity. So far, only 3.7 million of this group have received a booster dose, leaving 4.8 million of them at risk. In English schools, less than 15% of eligible children have been vaccinated and a shortage of nurses seems to be to blame.

We also may have to contend with the arrival of the more infectious ‘Delta-Plus’ variant. This is a version of the ubiquitous Delta variant that may be a little leaner and meaner than its cousin. It’s not yet been labelled a variant of concern but the fact that it currently accounts for more than 6% of UK COVID infections is a little worrying.

Ultimately, keeping people out of hospital is what it’s all about this winter. The Health Secretary, Sajid Javid has told us that he does not believe the pressure being faced by the NHS is currently “unsustainable”. There are plenty of people at the hospital, myself included, who would beg to differ with this opinion and we are worried that, once again, the Government may let things get out of hand before taking action. They do have form in this regard after all.

I think that the next few weeks will give a clearer picture of where we are headed and whether further action is needed. We have seen case numbers fluctuate regularly since restrictions were lifted and it’s not always apparent why this happens. Cases may already be falling again and, hopefully, the half-term holiday will help. The Government is clearly betting on rates falling significantly but that’s a big gamble. We all know that getting it wrong is likely to lead to the imposition of more draconian restrictions. No-one wants a repeat of last year’s Christmas debacle.

The ongoing reluctance to consider any intervention designed to restrict the spread of COVID-19 surprises me. Measures like mask-wearing in indoor spaces that vulnerable people can’t avoid seem sensible and proportionate and I wish we hadn’t got rid of them. After all, COVID-19 has not become endemic just yet. This is still the third wave. There will come a time soon when we will have ‘learnt to live with it’ but I don’t think we’re there just yet. The NHS is poorly equipped to deal with a significant number of COVID admissions this winter and there is still a good chance that we could be looking at a very unpleasant New Year. I simply can’t bring myself to believe Mr Javid’s prediction that it’ll all be over by Christmas.

Of course, if you are going to stick doggedly to Plan A, then you have to make sure you deliver on that plan. The Government needs to throw everything it has at the booster programme to ensure that the most vulnerable are protected before winter sets in. Anyone who is eligible for a booster vaccine must make sure they get it as soon as possible. Everyone else should cross their fingers. This seems to me to be an increasingly important part of Plan A.