CSI: Middlesbrough

Good Friday - 10th April 2020

COVID Figures for 9th April

UK Hospital Deaths 887 / Total 8129

James Cook Hospital – Total deaths – 73

James Cook cases in Critical Care – 27 / 15 ventilated

I hadn’t planned on working last night but my colleague has injured his back whilst exercising and is currently unable to work. Another colleague was knocked off his bike travelling to work the day before and has injuries that will take weeks to recover. We were expecting to be short of Consultants by this stage but thought that the coronavirus would be responsible, not exercise or trauma.

Fortunately things are still relatively under control. Our numbers of patients within critical care have not been increasing too quickly. This is due to the fact that many patients are receiving CPAP on the ward instead and patients are leaving ICU at a similar rate to those coming in. A few of our patients are recovering and leaving but sadly, a significant number of our patients are not surviving despite our best efforts.

Today is the start of the Easter Bank Holiday weekend, the time when we were told that we could expect the start of our ‘peak surge’ of patients. That has not yet come to pass but in preparation we have opened another ICU in what was the main Theatre Recovery Area. With the amount of surgery being performed grinding to a near halt, theatre cases can be recovered in a smaller, second recovery area. We will now have another ICU ready for any increase in patient numbers over the long weekend.

Our first patient into the new ICU was a transfer from nearby North Tees Hospital. We had originally planned not to transfer COVID patients between hospitals but North Tees has is now getting close to their maximum current ICU capacity. They have half as many hospital beds as we do but already have a similar number of ICU cases as us. Transferring patients seems a sensible use of resources under these circumstances; it will allow them to admit sicker patients into their ICU beds whilst moving more stable patients to us for ongoing care.

Our hospital has now been formally split into two halves – a COVID half and a non-COVID half. We have been instructed that we are NOT to call them the ‘clean’ and ‘dirty’ parts of the hospital to avoid stigmatising patients and staff. Fat chance! Within the first few minutes of the handover briefing, that is exactly what they are accidentally referred to as.

To be honest, we are now wearing Personal Protective Equipment (PPE) for all patients undergoing aerosol-generating procedures, whether they are COVID positive or not, so the two areas are not that diiferent. An aerosol-generating procedure is defined as a treatment or activity where there is a likelihood of discharging virus into the surrounding air. These procedures include CPAP, bag & mask ventilation in anaesthesia or resuscitation or even insertion of a feeding tube. The PPE protects you from inhaling a high viral load. This high viral load is felt to be responsible for the higher than expected death rate amongst medical and nursing staff around the world.

You will have read about the shortages of PPE that are facing many hospitals around the country. We have been fortunate in that we are yet to experience any of these. We may not be getting the same type of gowns, visors or face masks that we had the week before but all of them offer the same high level of protection.

Last night we realised that we were running out of theatre gowns. It turns out that we are getting through a staggering 1200 gowns a day! The trust has sourced alternatives and today we took a delivery of a huge supply of white all-in one ‘suits’ that we can use instead. These are the sort of thing you see medical staff wearing on TV in posher Intensive Care Units in places like South Korea. They also look like the suits that detectives wear for Crime Scene Investigation. I do love a bit of dressing up and was looking forward to trying on my new costume. Despite my enthusiasm, the nurses tell me that I need not bother to apply for a role in the hit TV show ‘CSI: Middlesbrough’. Sigh, another dream shattered…

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