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  • Writer's pictureRichard Cree

The Incredible Shrinking ICU

Sunday 24th May 2020

Figures for 23rd May

UK COVID Deaths 282 / Total 36,675

James Cook Hospital – Total COVID deaths – 223

All COVID cases within South Tees Hospitals Trust – 36

James Cook Critical Care COVID cases – 9 / 6 ventilated

James Cook Critical Care non-COVID cases – 33 / 10 ventilated

I have been working in the COVID Intensive Care Unit today. Prior to today we had two COVID ICUs but the numbers of COVID patients within the hospital and Critical Care continue to fall. Yesterday one of the units was deep cleaned and ‘fogged’ with hydrogen peroxide. I arrived this morning to find an empty ICU with the doors flung wide open. Now an empty ICU is not something we are used to seeing and it was a little eerie, especially after all the frenzied activity that had taken place within its walls over the past two months.

The end result is that we are now are now only ‘overflowing’ into the Paediatric ICU and, to a lesser extent, the Cardiac ICU. This makes caring for our non-COVID patients a lot more straightforward.

I must admit to being a little surprised that we have been able to do this. Of course, we can reverse this fairly quickly if necessary but we are just starting to wonder if that may not be necessary. A lot of us thought that we might be seeing a few new COVID cases within the hospital by now, or at the very least, numbers stopping falling. It has been over two weeks since the VE day weekend and that was when most of us felt that we started to see a relaxation of the lockdown rules, albeit in an unofficial capacity.

I received a new hood for my ventilated PPE system today. The old one has seen a fair bit of use over the past two months and a week or so ago a tiny crack had appeared at the part where the visor joins the fabric at the neck collar. This was not really noticeable and wasn’t cause for alarm as the whole point of the system is that the positive pressure generated by the fan unit will stop any contamination. The system is not designed to be airtight as this is unnecessary. Replacement hoods are in short supply but on the ward round today, I noticed that Pixie, my registrar was sporting a shiny new one. She told me that the same thing had happened to hers and that it had been replaced when a new shipment had arrived the other day.

Once I showed the Command Centre how and where I had repaired mine with sticky tape, I was granted permission fairly quickly to take a new one. They offered to dispose of my old one but I told them I intended to keep it as a souvenir. I told them that it would be fun to add it to the kids dressing-up box at home but they just gazed at me open-mouthed. I did point out that it had been thoroughly cleaned and that I was planning to quarantine it for seven days beforehand, after which time any residual virus would have died. They laughed nervously as they contemplated calling Social Services. It was as if I had suggested filling the kid’s water pistols with pus from an abscess…

We did not see any COVID cases admitted to Critical Care today. At least, no cases that are currently testing positive. We have had a number of admissions over the past few weeks with strokes, heart attacks or pulmonary emboli due to blood clot formation within brain, heart and lung blood vessels respectively. There is nothing too unusual about this but we are seeing some of these problems occurring in patients who we wouldn’t normally expect to be affected. For example, the patients may be younger than the usual stroke or heart attack victims or they will lack the usual risk factors for blood clot formation. We know that COVID-19 infection can result in blood clots in a significant number of people and our suspicion is that these patients have become infected, recovered and then developed thrombosis later. Some of them will give a history of classic coronavirus symptoms a couple of weeks before but others do not. Those that test negative may well have recovered.

It will be interesting, once this is over, to look at the rate of thrombosis-related diseases and see how much of an increase there is, over and beyond the expected rate at this time of year.

Most of my patients in the ICU today were either stable or moving in the right direction, We even have a couple of patients that are improving to the point where we may be considering removing their breathing tubes within the next week. This is very gratifying and it does seem that we are starting to see a few more patients that are doing better than we expected. We hope that when they are discharged we won’t find too many others to replace them.

Of course, there is still time for cases to rise but if we do not see numbers increasing over the next week then we might just start to relax a little.


ICU Ghost Town

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4 commentaires


Richard Cree
Richard Cree
26 mai 2020

Hi Mick That’s very kind of you . Thanks! Cheers, Richard

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Richard Cree
Richard Cree
26 mai 2020

Hi Jon The cases of thrombosis are being seen world-wide. The timing of thrombosis and in what percentage of people is a question that can’t really be answered at the moment. The large number of asymptomatic patients make forming a timeline difficult. The sickest COVID patients are more likely to get thromboses and this has been estimated at approximately 30-40% in some ICUs. It’s also not clear whether the risk of thrombosis persists for longer than a few weeks in the hospitalised patients. Other ICUs within the Northern Critical Care Network are quiet in comparison to us. James Cook and North Tees have significantly higher numbers of patients. A number of ICUs in the north of the region have very few…

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mickaelwarwick
25 mai 2020

Hello Richard, I hope this message finds you and your team well. I came across your blog by a pretty roundabout route. My niece, a Middlesbrough nurse, sent the link to my elderly mother (in Stockton) who’s been shielding since 10 Feb – and I came across it only tonight while checking my Mam’s bills, etc. I’m locked-down in West Yorkshire because I was visiting my partner when the self-isolation ‘rules’ kicked in, but I’m originally from Middlesbrough – from right across the road from James Cook, in fact. Because my Mam is ultra high risk and because most of my family live within a stone’s throw from JC, I’ve been keeping an eye on…

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irommanjon
25 mai 2020

That's mostly very positive and pleasing news to hear Richard. Thank you.


Although the untypical thrombosis patients are a concern. Do you have a feel for the time gap between recovery and thrombosis?


Is there information on whether your pattern of a shrinking ICU, and also the untypical thrombosis patients for whom you suspect Covid-19 may be the cause, is also showing elsewhere?


I hope you and your colleagues can relax a little, and generally take advantage of fewer seriously ill patients and less stress. You have all had a rough time yourselves and should take any opportunity to recuperate somewhat. Especially because it's possible another onslaught may follow. Although we must all hope this doesn't happen.


Jon

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