Welcome to Covidland

Easter Saturday - 11th April 2020

COVID Figures for 10th April

UK Hospital Deaths 980 / Total 8953

James Cook Hospital – Total deaths – 79

James Cook cases in Critical Care – 29 / 17 ventilated

My wife Nicky, also an ICU Consultant working in the same unit as me, was resident last night. Two patients required admission to Critical Care.

The first had typical respiratory failure due to coronavirus pneumonitis. He was in his 60’s with the usual risk factors – male, diabetic and on medication for hypertension. He had tried CPAP on the ward and whilst he hadn’t got much worse, he was not improving. It was decided to play it safe and admit him to the ICU. He wouldn’t receive any different treatment for now but he was in a place where, should the worst happen, he could be rescued quickly and put on the ventilator.

One of the other things we can do in ICU that’s not possible on the ward is the insertion of an arterial line. This is a cannula that sits in an artery, much like a venous cannula or ‘drip’ sits in a vein. The cannula can be connected to a pressure-transducer, giving you a second-by-second blood pressure reading but can also be used to extract blood for sampling on demand. This blood is arterial, rather than the usual blood taken from a vein. We can process the arterial blood through a blood-gas analyser and get measurements of the amount of oxygen and carbon dioxide as well as other useful parameters. This is vital information in guiding the effectiveness of CPAP or ventilation and can help to predict a deterioration in the patient’s breathing before it happens.

On the wards they conduct one-off arterial sampling at intervals. Anyone who has ever had a junior doctor ‘ferreting’ about in their wrist with a needle trying to take such a sample will testify to how painful this can be and how much more pleasant it is to be able to have the samples taken ‘on tap’ in the ICU.

The second patient has other medical problems including severe obesity that have resulted in respiratory failure but they have tested positive for coronavirus. It is unlikely that the virus is playing much of a part but we obviously have to admit them into one of our COVID units.

Whilst in Accident & Emergency, Nicky notices how eerily quiet it is. All but the most desperately unwell COVID patients are now taken straight to the Acute Assessment Unit (AAU). The current waiting time to be seen is 10 minutes! I don’t remember it ever being that low since they introduced the target back when I was in Medical School. Unfortunately, this is quite a long time ago…

It would appear that people are simply staying away. This is perhaps not surprising as the public are not keen on visiting ‘Covidland’, The UK’s newest and least fun theme park, with branches up and down the country. The usual crowds of ‘worried well’ and the time-wasters are scared.

Trauma cases are down because people are not driving as much or going out, getting drunk and falling down stairs. However, every day a hospital as big as ours will admit a number of emergencies – ruptured appendixes, sub-arachnoid brain haemorrhages, heart attacks, strokes, kidney failure, septicaemia etc. You would not expect these to stop during a pandemic, but they are. Numbers are down and I can’t work out why.

Initially, during the first week of lockdown I thought it was because people were just staying at home despite being ill. I thought that they would all eventually present to A&E over the next few days, horribly unwell and in desperate straits. Except that hasn’t happened. Even overdoses are down which is very surprising. In the second week of lockdown we had a few and we were anticipating a wave as the weeks of social isolation took their toll on the mental health of the nation, but so far… nothing.

Of course, this is probably just a statistical anomaly and by bringing it to everyone’s attention I’ve jinxed it now. My colleagues will undoubtably hate me when we are inundated with ‘regular’ patients next week.

Sorry!