Bump

17th November 2021

UK COVID Deaths – Daily 201 / 7-Day average 146

Total UK COVID Deaths within 28 days – 143,460

Total UK Deaths with COVID-19 on the death certificate – 166,730 (up to 5 Nov)

James Cook Hospital – Total COVID deaths – 701

All COVID cases within South Tees Hospitals Trust – 73

James Cook Critical Care

COVID cases – 10 (8 ventilated)

Non-COVID cases – 48 (27 ventilated)

There is a clear pattern that has emerged as the number of COVID-19 cases rises and falls across the country. Any increase in the number of cases ultimately leads to a rise in the number of people being admitted to the hospital. But this won’t happen straight away; it takes time for people to become unwell and for their condition to worsen enough to the point where they need to go to hospital. Many hospitalised patients tested positive for COVID-19 some ten to twelve days prior to admission. This means that, allowing for COVID-19’s relatively long incubation period, they were probably infected some two to three weeks earlier.

As the number of hospital admissions rises, so too, eventually, does the small proportion of people who need Intensive Care treatment. Some of our patients are desperately sick when they arrive at hospital and need intubation and ventilation immediately. Others, unfortunately, don’t make it to hospital alive. However, most of our patients spend a few days becoming increasingly unwell on the ward before their arrival in Intensive Care. Inevitably, this means that there is a long delay before any rise in cases results in an increased demand for Intensive Care Beds.

The nation has recently seen the end of a month-long rise in cases and, since the end of October, cases had been decreasing. Any hope that this might be due to herd-immunity was dashed when cases began to rise again last week, suggesting that the half-term holiday may be more to blame for the downturn rather than the virus running out of new people to infect. There still seem to be plenty of people catching COVID and some of my friends, neighbours and their children have become unwell over the last fortnight. Not surprisingly, the adults have fared less well than the children but, thankfully, no-one has been sick enough to require more than bed-rest and paracetamol.

Sadly, that is not the case for our current crop of COVID ICU patients. Our patients have the usual mix of ages, including three patients who are either in their 20’s or early 30’s. Most of our patients have respiratory failure caused by COVID pneumonitis, a direct inflammatory effect of the virus on the lungs. Others have pulmonary emboli (blood clots within the lung blood vessels) as a result of the tendency of COVID-19 to cause blood clots. The remainder have secondary bacterial pneumonias that follow on from their initial COVID infection.

We are also starting to see increasingly more unvaccinated patients. Currently, about 60% of our ICU patients have not received a single jab and, as a result, some of them are very sick indeed. Until recently, across the country, the proportion of unvaccinated people being admitted to hospital had been falling. Back in May, roughly 70% of patients who were hospitalised following infection with COVID-19 were unvaccinated but by the end of October, this figure had dropped to 35%. This is hardly surprising as the number of people who have been vaccinated has been steadily increasing over time. Whilst the majority of the population who have the most to fear from COVID-19 have now been vaccinated, it still surprises me that there are a significant number of at-risk people who have declined to take up the offer of vaccination.

I try to keep an open mind when dealing with unvaccinated patients. One of our ventilated twenty-something patients has not been vaccinated and is very unwell after developing severe COVID pneumonitis. I feel it would be unfair to be too critical of their decision not to get jabbed. After all, at this age, if you are fit and healthy, the statistical chances of you becoming unwell enough to need ventilation following infection with COVID-19 are extremely small indeed. What I find less understandable is making a similar decision when you are overweight, diabetic and in your 60’s or 70’s. Still, each to their own. We have long since given up asking patients why they have declined the offer of vaccination. The patients feel uncomfortable being asked and we usually don’t feel we get an honest answer anyway. It’s unimportant and it’s simply not worth it. You can’t be judgemental and expect your doctor-patient relationship to flourish.

The number of COVID patients in the hospital peaked at the beginning of November when we briefly had to open another COVID ward to accommodate everyone. Since then the number of patients has been slowly falling and we are now back down to just the two COVID wards. Despite this improvement, we are still admitting more COVID patients into ICU and today we found ourselves temporarily running out of COVID beds. This hasn't happened for some time as we have usually had space in the COVID ICU or one of our isolation cubicles. We are desperate to avoid opening another COVID ICU unless absolutely necessary as this would severely limit the space available to look after all our non-COVID patients. We also don’t want to have to re-open the temporary Surge ICU as we will struggle to staff it. However, just in case, we have decided to give the Surge ICU a dust-down and reverse-mothball it (is that the correct term? Perhaps it’s demothball? Or unmothball?)

The only way we have been able to find beds for everyone today is by re-classifying one of our recovering COVID patients as non-infectious and moving them to a non-COVID unit and by transferring other patients to Intensive Care Units at nearby hospitals. Our sister hospitals in the Northern Region are faring a little better than we are and some of them still have unoccupied ICU beds. We have been told that we should be using these beds first before we can consider opening a temporary ICU in our own hospital.

Our best hope currently is that, given the time lag between infection and ICU admission, we should see the number of COVID ICU patients begin to decrease again soon. If we can weather this temporary surge (or ‘bump’ as one hospital manager described it today) then the situation should gradually get better over the next two to three weeks. Given that cases are on the rise again we can then look forward to another increase in COVID admissions just before Christmas. Woo-hoo!

Whether and when the number of COVID admissions might reach a steady-state is currently unclear. On the whole, case numbers have slowly oscillated upwards since August and, whilst the number of hospital admissions hasn’t fluctuated as much, even a small ‘bump’ is enough to test a hospital that is under as much pressure as ours.