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  • Richard Cree

Plateau

Wednesday 27th May 2020

Figures for 26th May

UK COVID Deaths 134 / Total 37,048

James Cook Hospital – Total COVID deaths – 226

All COVID cases within South Tees Hospitals Trust – 41

James Cook Critical Care COVID cases – 7 / 5 ventilated

James Cook Critical Care non-COVID cases – 32 / 10 ventilated

Nicky was on-call for emergency admissions again today. Once more, another day that seems quiet when compared to how busy we were just a few weeks ago but still enough work to go around. There has been one COVID admission to Critical Care today and a few non-COVID cases but on the whole things remain fairly stable.

It looks like the numbers of COVID patients within the hospital have stopped falling and have plateaued. Over the past month there has been a slow, steady decline in patient numbers as the effect of the lockdown is seen at the hospital. For the past 4-5 days, numbers have stopped falling and remained fairly static, barring some day-to-day fluctuation. The hospital is still admitting a few cases each day but there are, as yet, no signs of a sustained increase in numbers.

There is lots of discussion and debate about how we need to work in what is essentially, a brand new environment for us. The initial surge in cases is over and whilst there is an awful lot we don’t know about what’s around the corner, we certainly have a better idea than we did a month ago.

It will be a long time before we can contemplate things returning to ‘the way they were’. I believe that things will never go back to being exactly as they were BC (Before Covid). We will need more ICU beds than we used to have for the foreseeable future. These beds will have to be on a separate COVID unit. We will need more doctors and nurses to look after them. This is easily achievable at the moment because the hospital is doing relatively little ‘regular’ work but this could be problematic when staff are returned to their usual departments.

There will need to be thought given to how the COVID patients will access hospital services, such as CT or MRI scans, surgery, endoscopy, physiotherapy and rehabilitation whilst the same services are trying to maintain a full service for non-COVID patients.

Social distancing will be vital in hospitals for these non-COVID patients. Hospitals will obviously be ‘hot-spots’ of infection in any community by the very nature of their work. Anyone who has ever been to a busy outpatient clinic or A&E on a Saturday afternoon will be able to understand how difficult these social-distancing arrangements could be.

We have already heard about plans for any patient undergoing surgery to self-isolate for 14 days before surgery. This could affect thousands of patients each month. It may not be much of a problem for patients undergoing life-saving major cancer surgery but there won’t be many patients who wouldn’t want to postpone their minor operation if that is what it entails.

This will all be necessary because of the significant effect on mortality that contracting COVID-19 whilst in hospital will have. There are already temporary measures taken to ensure that this risk is minimised but these will have to become permanent.

At the beginning of the pandemic, phrases like ‘this is a marathon, not a sprint’ were being used. Although horribly trite, many of us are only now beginning to realise the validity of such clichés.

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