9th June 2021
UK COVID Deaths – Daily 6 / 7-Day average 9
Total UK COVID Deaths within 28 days – 127,860
Total UK Deaths with COVID-19 on the death certificate – 152,289 (up to 28 May)
James Cook Hospital – Total COVID deaths – 612
All COVID cases within South Tees Hospitals Trust – 8
James Cook Critical Care
COVID cases – 2 (1 ventilated)
Non-COVID cases – 50 (27 ventilated)
I feel I need to apologise for the fact that I haven’t posted anything in a while. Nicky and I have been on holiday and have just come back from a glorious week in the Cairngorms in Scotland with the kids. It was great to get away from everything for a while although it did serve to highlight just how little time we have all spent together as a family over the past year.
The other reason I have been remiss about posting an update is that, in all honesty, not a great deal has been happening at work, at least not on the COVID-19 front. Before I went away on holiday we had managed to finally close our last temporary ‘surge’ Intensive Care Unit. Another of our long-stay COVID patients had recovered to the point where they were able to be discharged to the ward and we were starting to see fewer non-COVID patients. The wards were continuing to admit a small number of COVID cases but none of these were unwell enough to warrant input from our team. Most of us seemed to be making the most of the calmer situation and unwinding a little.
Upon my return things were pretty much as I had left them. We even had a few empty beds in which to admit new patients which made for a refreshing change. One of the first of the day’s admissions was a patient with COVID pneumonitis - the first one to need Critical Care in nearly a month. The patient was in their 30’s and had not been vaccinated. They had spent a few days on the ward but had not managed with standard oxygen therapy. They needed CPAP and so were admitted into one of our brand new isolation cubicles that have been designed specifically for such patients. We now have a total of seven isolation cubicles and are hopeful that we can manage our future COVID patients in these without having to resort to a stand-alone COVID unit.
However, across the country the number of COVID cases in the community is increasing with the number of new infections roughly doubling every week. It does look like we are witnessing the beginning of a third wave of infections. This is not at all surprising and was to be expected; the lifting of restrictions that prevented indoor mixing was always going to lead to a higher infection rate. The rise in cases is very similar to that seen at the beginning of the second wave with the majority of infections once again occurring amongst the younger population.
What is very different this time around is the fact that so many of the UK population have been vaccinated. This should prevent the dramatic rise in hospital admissions and deaths that followed the ultimate spread of infection to the older population in October last year.
The rapid pace of vaccination has not let up; in England 53.6 per cent of the country’s adult population has now been fully vaccinated and 76.4 per cent have received at least one jab. This week those aged over 25 are able to book their first vaccination appointment and the initial response suggests that large numbers of young people will take up the offer. Nevertheless, despite the roaring success of the vaccination programme, it is looking increasingly unlikely that the Government will stick to their original timetable for the relaxation of all restrictions. Given the rise in the number of new cases and the increasing dominance of the highly infectious Indian, or Delta variant, ‘Freedom Day’ on 21st June could well be put back.
The primary argument for any delay is that we should wait longer to ensure more of the population have received their second dose before abandoning social-distancing all together. It appears that two doses of the AstraZeneca or Pfizer vaccine afford similar protection against the Indian/Delta variant as they do against the UK or Alpha variant as it is now known. Unfortunately, it would appear that a single dose of either vaccine is only 33% effective against the Delta variant. This compares to a figure of around 50% for the efficacy of a single vaccine against the Alpha variant.
Whilst this is discouraging, it does still look like vaccination is successful at preventing serious illness in those infected with the Delta variant. On Monday, the Health Secretary told Parliament that out of 126 people hospitalised following infection with the Delta variant, 65% percent of them not been vaccinated at all. Approximately a third of them had only received a single dose of a vaccine. Reassuringly, only three of these 126 patients had received both doses of a vaccine.
Of course, the recent rise in case numbers in Bolton and other areas has still resulted in an increase in hospital admissions. Whilst there was no danger of the number of admissions rivalling those seen earlier in the year, one hospital trust reported in-patient COVID numbers that were approaching 25% of the number they saw during the second wave. This is a timely reminder that there are still plenty of people who remain at risk of hospitalisation. Fortunately, following the rollout of surge testing and a drive to improve vaccination uptake, the situation has improved significantly. The same tactics are now to be used in Greater Manchester and parts of Lancashire; these areas are also seeing a surge in the number of infections caused by the Delta variant.
I’m pleased to report that, across the country, the vast majority of Intensive Care Units continue to admit very few COVID patients. The average age of those that are being admitted to ICU has fallen from 60 to 50 years of age. This again appears to be proof of the protective effect of vaccination amongst the older population who have received both jabs. Even in the Northwest of the country, far fewer of the patients that were admitted to hospital required Intensive Care treatment.
This is the argument that many cite for not delaying ‘Freedom Day’ – even with the number of cases rising, the evidence to date suggests that there is little chance of the NHS being overwhelmed and running out of ICU beds. Many believe that the priority should be the restoration of individual liberty and to minimise the adverse economic effects of ongoing restrictions. There is an argument that people can manage their own risk and can exercise caution if they are in a high-risk group or have not been fully vaccinated.
Exactly how many more patients we are going to see over the next few months is unclear at the moment. Obviously those who have only received a single dose of a vaccine remain at risk. We are bound to still see some young patients requiring ICU care - after all, we have seen such patients throughout the pandemic. What we shouldn’t see again are lots of makeshift Intensive Care Units packed with older patients on ventilators. We will, of course, still see critically ill patients. There are those who cannot be vaccinated or have chosen not to be and those in whom the vaccine may not work as well as intended.
Ultimately the decision to lift all restrictions is a political one. It’s a difficult call to be honest and your opinion will depend on what your individual priorities are and whether you have been vaccinated twice. Any rise in hospital admissions will place more strain on an NHS that is trying to regain lost ground after the first two waves. Not surprisingly, there are many of us that would wish to see fewer COVID patients in hospital and so I believe that waiting a bit longer is the sensible thing to do. However, I fully understand the pressure on Boris to stick to his original timetable. We shall find out on Monday what he ultimately decides but, whatever decision is made, I remain confident that the third wave is not going to mirror the first or second ones.