12th December 2020
UK COVID Deaths – Daily 519 / 7-Day average 410
Total UK COVID Deaths within 28 days – 64,026
Total UK Deaths with COVID-19 on the death certificate – 73,125 (up to 27th Nov)
James Cook Hospital – Total COVID deaths – 366
All COVID cases within South Tees Hospitals Trust – 87
James Cook Critical Care
COVID cases – 11 (6 ventilated)
Non-COVID cases – 41 (16 ventilated)
I am pleased to report that Nicky’s father, Gordon, has left hospital following his first course of chemotherapy and is now recovering at home. Not surprisingly, he feels pretty lousy but is greatly relieved that he’s out of hospital. He has just over a week before he has to attend for further treatment. While he will, thankfully, be able to spend Christmas at home, the timing of this next cycle of chemotherapy will unfortunately guarantee a far from ideal Christmas for him.
At the hospital, we have seen the total number of COVID patients continue to slowly decline. As a result, the number of wards that are being used for COVID patients has decreased from seven to five. Following lockdown, we saw a reduction in the daily number of new COVID cases admitted to the hospital. This reduction has now stopped and we are continuing to admit about ten patients every day.
The number of COVID patients in Critical Care has also decreased and we are seeing proportionally more non-COVID patients. This is just what we would expect at this time of the year and, using our ‘pop-up’ ICU, we have enough beds to cope with the current workload.
We are still sometimes having problems finding Critical Care beds for ‘green’ patients. These are patients who need an ICU or HDU bed following their routine operation. There are usually one or two such patients who need a bed every day. They may need Critical Care due to the complicated, high-risk nature of their operation or they may have serious heart or lung problems that require specialist care. They will have isolated for 14 days prior to admission in order to prevent being infected with COVID-19 before their operation and so they can remain relatively isolated on a 'green' ward whilst in the hospital. The green patients obviously need to be admitted into one of our isolation rooms and we only have a few of these. If we are busy, there may be none of these available and surgery may have to be cancelled and rescheduled for the following week.
Yesterday, for the first time since the pandemic began, I had a COVID-19 test. I have not needed one before as I have never had any of the symptoms of COVID-19 and still don't. However, in accordance with an NHS-wide initiative, the hospital has distributed Innova Lateral Flow COVID testing kits to members of staff to allow regular screening for asymptomatic infection. The idea is that this will limit any potential for infection to spread amongst patients and co-workers and avoid unnecessary staff absence.
These lateral flow antigen tests detect the presence of the COVID-19 viral antigen from a nasal swab sample. Testing can be done at home and it can produce results in just 30 minutes. The plan is for NHS staff to test themselves twice a week. The process involves inserting a swab into each nostril before mixing it in a reagent and then dropping the nose juice-reagent-cocktail onto the test cartridge. You then read the result 30 minutes later. Two lines indicate you are positive. It’s a little like a pregnancy testing kit but thankfully, no urine is involved.
Inserting the swab into both nostrils was not a barrel of fun to be honest. I discovered later that I had perhaps been overly enthusiastic and that the recommended technique does not necessarily require you to keep inserting the swab until your eyes water and the swab comes out of your ear.
These Innova test kits are the same ones that were used during the community testing programme in Liverpool. Unfortunately, according to the Government’s own policy paper, they only picked up half the COVID-19 cases that were detected by the standard polymerase chain reaction (PCR) test. Even in infected people with high viral loads, they missed three out of ten cases.
It is these testing kits that are going to be used to screen visitors to care homes this Christmas. The official line is that the Innova lateral flow test is 99.6% specific and, when in ‘ideal hands’ is 76.8% sensitive. The specificity of a test is its ability to correctly identify those without COVID-19 (so-called ‘true negatives’) whilst the sensitivity of a test is its ability to correctly identify those who have the disease (so-called ‘true positives’). So if the sensitivity of this test is 76.8%, it will miss 23.2% of genuine positive cases, reporting them as negative. This may not seem too bad, but an earlier assessment of the Innova test by Public Health England’s Porton Down laboratory and the University of Oxford found that this sensitivity dropped to 58% when testing was carried out by self-trained members of the public.
This last figure raises doubts about their reliability when it comes to using them to green-light visiting in care homes. They’re certainly a lot better than no test at all but it would seem that they are far from ideal for this purpose.
Anyway, thirty minutes later I discovered that I had tested negative. No-one was convinced by my claim that there was at least a 23.2% chance that I might, in fact, be positive and should avoid my weekend on-call shift just to be on the safe side…
Care home admission ticket?