21st February 2021
UK COVID Deaths – Daily 215 / 7-Day average 488
Total UK COVID Deaths within 28 days – 120,580
Total UK Deaths with COVID-19 on the death certificate – 129,498 (up to 5th Feb)
James Cook Hospital – Total COVID deaths – 581
All COVID cases within South Tees Hospitals Trust – 120
James Cook Critical Care
COVID cases – 24 (14 ventilated)
Non-COVID cases – 42 (24 ventilated)
Over the past week, the number of patients within the ICU has not changed a great deal which is disappointing. The hospital is still admitting about ten COVID patients every day and the fall in the overall number of patients in the hospital has slowed somewhat. Despite this, the total number of COVID wards within the Trust has reduced further to six, meaning that more and more staffed beds are now available for non-COVID patients.
Last week we received the latest report from the Intensive Care National Audit & Research Centre (ICNARC). They collect data from Intensive Care Units across the country and provide detailed information about those COVID patients that are sick enough to require Critical Care. This information includes patient characteristics and demographics, the length of ICU stay, organ support needed and outcome.
These ICNARC reports are now broken up into two parts. The first part deals with patients admitted to ICU during the first wave and includes all admissions up until 31st August 2020. The second part deals with the COVID patients that were admitted between 1st September and 31st December during the current, second wave.
Along with the national report, we also received a report that was specific to our hospital. This allows us to see how we measure up when compared to the national average.
During the first wave we admitted 104 patients with an average age of 60 years. Sixty-five percent were men and 90% of all patients were classified as non-dependent, meaning they were able to perform daily activities without assistance. Nearly 41% of our patients were classified as obese and 47% of all patients fell into the worst category for socio-economic deprivation.
Of all those admitted to ICU during this period, 30% were ventilated within 24 hours of arrival. In total, 53% of all admissions required mechanical ventilation and 22% needed dialysis for kidney failure. The average length of stay in ICU was seven days for those that survived and just over seven days for those that died.
Looking at the second wave of patients, in the period from 31st August up until 31st December we admitted 96 patients. The patients were slightly younger with an average age of 58.5 years. Fifty-eight percent were men and 84% of patients were classified as non-dependent. Fifty-five percent of our patients were obese and nearly 52% of all patients were in the worst category for socio-economic deprivation.
Amongst this second wave of patients, 17% were ventilated within 24 hours of arrival. In total, nearly 42% of patients were ventilated and 11% needed dialysis for kidney failure. The average length of stay in ICU remained at seven days for who survived but rose to 12 days for those that died.
When we look at patient outcomes, our mortality rate during the first wave was 36.5%. That means that 36.5% of all COVID patients admitted to our ICU died. The mortality rate across ICUs throughout the UK during this period was 39.5%. During the second wave, our mortality rate decreased to 26.9% whilst the national ICU mortality rate was 37.5%. Amongst our ventilated patients, our mortality rate was 51.3% compared to 61.5% nationally.
These figures are very encouraging but it’s worth remembering that there are a few differences between our patient population and the national one. Whilst illness severity and the need for organ support was similar to the national average, our patients have a different ethnic makeup. Over 91% of our patients were classified as white compared to the overall national figure of 73%. We should therefore expect fewer deaths. However, we do have significantly more obese and deprived patients when compared other areas so we would expect that this would increase our mortality rate. It’s also worth pointing out that this data does not include the ward CPAP patients and we would expect that if it did, our death rate may be even lower as these patients tend to do better than the ones that are admitted to ICU.
Of course, this data only includes those patients admitted up until 31st December. It was in January that we saw the huge rise in admissions and a situation that started to rapidly get out of hand. As a result it would not be surprising if our mortality rate rose as a result of the intense pressure that we were under at that time.
Despite this caveat, there is no getting away from the fact that this is very good news. By the end of 2020, 71% of our COVID patients were surviving to leave ICU compared to 58.1% nationally. Whilst we are all physically and mentally exhausted from working at the intensity that the pandemic has demanded, we can justifiably be proud of what we have achieved. Knowing that our efforts are leading to many more patients surviving will enable us to strengthen our resolve and help us to carry on doing what we do,