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  • Richard Cree

Tier Three

28th November 2020


UK COVID Deaths – Daily 521 / 7-Day average 467

Total UK COVID Deaths within 28 days – 57,551

Total UK Deaths with COVID-19 on the death certificate – 66,713 (up to 13th Nov)

James Cook Hospital – Total COVID deaths – 350

All COVID cases within South Tees Hospitals Trust – 103

James Cook Critical Care

COVID cases – 18 (9 ventilated)

Non-COVID cases – 37 (14 ventilated)



Things have been far calmer this week at the hospital. The number of COVID patients that are being admitted to the hospital each day has flattened off and is beginning to decrease. The same is true for the total number of COVID patients currently in the hospital. We have fewer CPAP patients on the wards and, whilst Critical Care numbers remain relatively unchanged, we are now dealing with increased numbers of non-COVID patients.


We have been using the Female Surgical Admissions Unit as our ‘Surge HDU’. It is currently half-full with COVID patients and it now looks like we will have to use the other half for non-COVID admissions. This is straightforward as the two halves are separated from each other by walls and doors, meaning we won’t have to bother with any of that temporary partition nonsense. Back in the first wave we saw a lot of hastily deployed polythene and sticky tape screens. It was a touch shoddy to be honest, almost as if the ICU had been designed by Blue Peter. The current setup is a lot better and enables us to be flexible with how we use our beds.


We are now expecting that the situation in the hospital should remain relatively under control until Christmas. The new tier system that will take the place of the national lockdown appears to be unpopular with many. Most appear to argue that it is too strict and will have devastating economic consequences whilst public health officials worry that it’s not enough and that the Government is following the politics and not the science.


When lockdown ends on 2nd December, the whole of Teesside will be placed into tier three. This is the top tier, otherwise known as ‘very high alert’. Nearby North Yorkshire is better off and will be placed in tier two or 'high alert'. Despite these strict measures, the Scientific Advisory Group for Emergencies (SAGE) have warned that the prevalence of COVID-19 could double over the Christmas period unless people are careful. They have issued the somewhat ludicrous advice that people should help to minimise the spread of infection by avoiding playing board games during the holidays. Whilst this is technically a route of transmission it seems very small beer when compared to the overall risk of having multiple people spend five days together in the same household. Presumably they are worried about a particularly depressing game of Cluedo in which the big reveal is that Granny was killed in the dining room with the coronavirus?


As a result of the likely post-Christmas surge in cases, we are expecting the peak of ‘wave 2.2’ to arrive by the end of January. Any vaccination programme is highly unlikely to have had any significant impact by then, so there will still be time to witness COVID’s last hurrah.


To be honest, we are all trying not to worry about such things just yet. I have been working on one of the COVID ICUs over the past few days and have been enjoying some relative calm. This gave me the opportunity to spend more time on the ward round, more time to review patients, more time for some teaching and even a chance to get some proper lunch. A coronation chicken baked-potato from the Voluntary Services Coffee Lounge is tastier and, apparently, nutritionally superior to the handfuls of custard creams that I’ve had to make do with recently.


There are still a significant number of patients with COVID pneumonitis who require ventilation but we are certainly seeing fewer of them than we did during the first wave. According to the Intensive Care National Audit & Research Centre (ICNARC), COVID patients across the country who are admitted during the second wave are less likely to be ventilated. Approximately 72% of all ICU admissions during the first wave ended up being ventilated whereas currently, that figure stands at 40%. Of course, the total number of patients admitted so far in this second wave is far fewer than we saw during the first, but these figures are still very reassuring. The mortality rate across the country is significantly lower too. During the first wave, approximately 40% of all patients admitted to an ICU died, whereas the current figure is about 27%. It’s worth pointing out that a significant number of patients who were admitted to an ICU after 1st September are still there, many of them still being ventilated. Such outcome data is therefore far from complete but still encouraging.


It certainly feels to us like more of our ventilated patients are surviving at James Cook. One of our long-stay patients who was admitted at the very start of the second wave has had his tracheostomy removed recently and is currently back on the ward awaiting discharge to a rehabilitation hospital. He spent over two months ventilated in the ICU and was extremely unwell. I think it’s fair to say that there were many who doubted that he would survive his ICU stay and so we are all delighted with the progress he has made.


The other good news to report is that Hamad went home today. In what has now become an established NHS tradition, he was surrounded by staff from all the acute medical wards who clapped and cheered as he made his way out of the hospital.


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