Risk Factors

Saturday 4th April 2020

COVID Figures for 3rd April

UK hospital deaths 684 / Total 3645

James Cook Hospital total deaths – 35

James Cook confirmed cases on wards – 90

James Cook Critical Care confirmed cases – 20

Critical Care North of England (North of Leeds) current cases – 115 / 62 ventilated

Another day off but I have been surprised how much email correspondence from work there is. I foolishly believed that people would be too busy to write emails and that everything would become more succinct and streamlined. How wrong I was!

Amongst the endless updates, one of the things I have been reading today is a report by the Intensive Care National Audit & Research Centre (ICNARC). These wonderful people collect data from the vast majority of ICUs in the country and can currently provide extremely useful information about the case-mix of COVID patients that are being admitted to Critical Care throughout the UK. They will continue to report this information throughout the pandemic.

This is their first report, and deals with 775 COVID patients admitted to Critical Care Units up until 27th March 2020.

It will come as no news to us all, that London and the South East have been hit the hardest by the pandemic. Birmingham and the South West have had also had more COVID cases than the rest of the country.

But what about the type of people who are being admitted to Critical Care? The report shows that the median age of those admitted is 61 years. Nearly 71% of them are men. Out of the 228 women admitted, thankfully only 1 of them was pregnant.

72% of people admitted were significantly overweight. To put this in perspective 62% of the general population is normally significantly overweight but it does appear that being overweight is a risk factor for ICU admission.

Regarding ‘underlying health conditions’, 91% of people who were admitted did not require any input from a carer (i.e. they could do all their day-to-day tasks by themselves). Only 8.7% of patients had what could be described as ‘very severe’ health problems.

The ICNARC Critical Care mortality figure at the moment is high at 47%. But this is misleading as this figure only includes the patients admitted to Critical Care during the first two weeks of the UK outbreak. The patients who died will have been the sickest patients who were not expected to survive. There will be many patients who would have been stable on a ventilator on 27th March and will go on to survive. When some of these patients recover they will, in time, bring this figure down.

From a personal viewpoint, our COVID patients are different to those we normally see. Our regular patients are older, frailer and have more complicated medical problems. When I conduct a ward round on a COVID ICU I am struck by the fact that nearly all the patients appear to be men in their 50’s-70’s. They are all overweight, hypertensive and/or diabetic but without any more serious health problems.

These are not our usual ICU ‘customers’ and it worries me. We would normally expect to save the majority of these patients. The stories coming out of China, Italy and Spain appear to indicate that we can no longer count on this.