Sunday 10th May 2020
Figures for 9th May
UK COVID Deaths 346 / Total 31,587
James Cook Hospital – Total COVID deaths – 204
All COVID cases within South Tees Hospitals Trust – 67
James Cook Critical Care COVID cases – 9 (7 ventilated)
James Cook Critical Care non-COVID cases – 30 (18 ventilated)
So the Government have set out their plans to reduce some of the restrictions that have been in place since 23rd March. More details will be released tomorrow but this is not the joyous liberation that some were expecting. I am relieved. Figures suggest that new infections are rising in Germany after their recent relaxation of their restrictions.
In order to inform us of the level of danger, there is a new ‘COVID Alert System’ with the level of danger rated from 1-5. Level 1 signifies sunshine and lollypops with occasional unicorns, whilst level 5 implies the Grim Reaper is stalking the land, laying waste to all and sundry. We are currently at level 4 on this scale, apparently.
This seems at odds with the new slogan ‘Stay Alert, Control the Virus, Save Lives’. I have no problem with the second and third parts but I confess that the intention behind the ‘Stay Alert’ part is not clear. The primary message still appears to be ‘stay home whenever possible’ and I don’t think the new slogan does this message justice.
Clearly the Prime Minister has an impossible task in trying to give people hope that ‘normal life’ can restart at some point whilst attempting to tell them that they need to act responsibly in order to stop widespread proliferation of the virus. I do sense there is a feeling that the authorities are fighting a losing battle when it comes to public engagement with social-distancing.
Meanwhile, back at the hospital it doesn’t feel like COVID Alert Level 4. There were no admissions to critical care today. The team reviewed a number of patients around the hospital but no-one was ill enough to require admission. Our existing patients remain relatively stable although a number of them are still seriously ill. Nicky and her team even managed to find time to have lunch together today which is rather unusual, especially at the moment.
I wrote yesterday about how we have recently been looking after a large number of patients, many of whom did not go on to survive. I described the effect that has had on the morale of the ICU staff. What I hadn’t realised until yesterday was the effect that this was having on some of our patients.
Now, a lot of patients spend their time in ICU sedated. Once awake, the majority of them tend to make reasonably quick progress towards breathing by themselves and coming off the ventilator. They then spend the remainder of their time convalescing on the ward. However, some of the patients, for various reasons, take a while to wean from the ventilator. They normally end up with tracheostomies and spend many days awake and fully aware of what is going on around them.
We have a patient on one of our COVID units who fits this description. She has kidney failure and because we have grouped these patients together, she is surrounded by other patients who also have kidney failure. Such patients are our sickest and usually have the lowest chance of survival. Our awake patient has been aware that a significant number of her neighbours have not survived.
I must point out that the patient is not able to witness any of this directly; the screens and curtains stop them seeing anything distressing. However they are all too aware of what is happening when alarms start sounding and the nurses quickly pull the curtains around their neighbour. They recognise the anxious looks on the faces of the doctors as they pass by. They know all too well what has happened when eventually the curtains are pulled back and the bed is now empty.
Our patient told us all about this the other day. This is not an unfamiliar thing for our patients to be worried about. It is a factor that contributes toward the psychological impact of an ICU stay. However we had not quite appreciated the effect that so many of these deaths were having on her. Simply acknowledging it and talking about it with her has been a big help. She is now less anxious than she was; she does know that she is getting better and that whilst she still has a long way to go, she knows we expect her to make a good recovery.