Weathering the Storm

18th January 2021

UK COVID Deaths – Daily 599 / 7-Day average 1129

Total UK COVID Deaths within 28 days – 89,860

Total UK Deaths with COVID-19 on the death certificate – 89,243 (up to 1st Jan)

James Cook Hospital – Total COVID deaths – 436

All COVID cases within South Tees Hospitals Trust – 225

James Cook Critical Care

COVID cases – 33 (20 ventilated)

Non-COVID cases – 27 (11 ventilated)

It will come as no surprise to find that this weekend has been busy. The total number of COVID patients in the hospital continues to rise but we are seeing fewer patients admitted than last week. There are now a total of ten COVID wards within the Trust, nine at James Cook and one at the Friarage Hospital. We are continuing to admit about 30 patients a day but the number of patients in Critical Care has remained relatively stable over the past three days. We have discharged some recovering patients to the wards but we have also seen a significant number of deaths. I’m sad to say that this is the main reason that we have coped with the numbers of patients coming our way.

Unfortunately, many of us are slowly becoming more accustomed to the high number of deaths that are occurring. Whilst, in some respects, this is inevitable, I can’t believe that it is a sign of good mental health. Everyone is now very tired. We are still managing to keep the ship afloat but the effort required to do so is starting to take its toll. I am finding it very hard to attempt to convey to people outside of work just how physically and mentally demanding the workload is. Even an average day in Intensive Care Medicine can be fairly bonkers but, unless you’ve worked in a busy ICU, it’s quite hard to understand what it’s like when everything is dialled up to eleven.

We anticipate that it will be another ten days or so before we start to see a decrease in the number of patients requiring admission to Critical Care. Theatre Recovery B has therefore been earmarked as the next makeshift ICU and it is being made ready to receive patients. This will be the seventh Intensive Care Unit that we are covering. We normally operate just three units so you can begin to understand how stretched we are at the moment. However, I’m pleased to report that the whole hospital has recognised the pressure we are under and everyone seems to be rallying around us. We have been offered help from every corner of the building. Our surgical colleagues have been helping us turn patients prone, nurses have volunteered to join us for the next few weeks and even paediatricians and radiologists have offered to come and answer the telephones for us.

Our anaesthetic consultant colleagues have also come to our aid and more of them are joining our ranks this week. They are able to use their skills to perform many of the practical procedures that an ICU patient may require, such as central venous cannulation, arterial line insertion, transferring patients for CT scans and securing the airway when placing patients prone. They can also intubate, ventilate and stabilise any sick COVID patient as they demonstrated during the first wave when they formed the Emergency Airway Team. Their help will allow us to see many more patients and is what makes us able to entertain the somewhat crazy idea of running seven different Intensive Care Units.

There are signs that the number of new cases in the community is falling and this will inevitably lead to a reduction in the number of people being admitted to hospital. I am told that the new variant of the virus is now responsible for over 65% of cases in Middlesbrough. Of course, we have no way of telling which variant of COVID-19 is responsible for any given infection and I can’t honestly say that you can look at two patients and see a significant difference in the way they present to the hospital or in the clinical course of their infection. However, we believe that we are seeing some differences between the patients we are admitting now and those that we saw during the first wave. The patients seem younger, their X-ray and CT appearances are a little different and it’s possible that they are sicker. We feel we are seeing more patients who ultimately require CPAP or ventilation.

I have spent the weekend working on the converted Female Surgical Admissions Unit (Female SAU) which has been converted into two Intensive Care Units. One of the problems with any temporary unit is that, invariably, they are not really fit for purpose. An ICU patient’s bed area occupies an enormous amount of space. By the time you have allocated space for a ventilator or CPAP machine, the monitors, the infusion pumps and allowed enough space for a dialysis machine or a temperature management system, you have filled quite a large area. On top of this you then need to allow room for the whole team to work if something goes wrong. This means that ICUs tend to be really big, in a way that theatre recovery areas aren’t.

This means that working in these temporary areas can be challenging if your patient becomes very unwell. We have attempted to avoid this problem by keeping the sickest patients in the original ICUs and the more stable patients in the temporary ICUs. This invariably means shuffling beds around every time a patients get sicker or improves but it would be wrong to complain about this too much. We are hearing horror stories from other hospitals that are struggling to cope with the influx of COVID patients and are faced with ventilating patients in clinical areas much smaller than ours.

Another problem with these recovery areas is that they tend to be located far away from the regular Intensive Care Units. Our nursing staff and junior doctors often feel rather isolated and trapped, separated as they are from the rest of their colleagues. We had a pizza delivery on Saturday and I did my best to ensure that the Female SAU got an appropriately large share. Things quietened down a little bit in the early afternoon and we all managed to have lunch together. Just for a short while, things felt vaguely normal which only served to highlight just how frantic everything has been recently.

I am optimistic that our situation may start to improve by the time February rolls around. Across the country, vaccination is proceeding at a pace. We just need to weather the storm for a bit longer.

'Trapped’ in Female SAU