Again and Again…. And Again

16th July 2021

UK COVID Deaths – Daily 49 / 7-Day average 40

Total UK COVID Deaths within 28 days – 128,642

Total UK Deaths with COVID-19 on the death certificate – 152,856 (up to 02 Jul)

All COVID cases within South Tees Hospitals Trust – 82

James Cook Critical Care

COVID cases – 12 (7 ventilated)

Non-COVID cases – 32 (14 ventilated)

The number of new cases of COVID-19 continues to rise. Today 51,850 new positive tests were recorded across the UK, the biggest figure since January. Cases are particularly high in the North East of England and the incidence of new cases in Middlesbrough is now appreciably higher than it was at the peak of the second wave. However, we are still better off than some of our neighbours. South Tyneside has the dubious honour of being the worst affected area in the country and Sunderland has also been badly hit. This rise in cases has, inevitably, resulted in an increase in the number of people needing hospital treatment. In the last 24 hours, our hospital has admitted 32 COVID patients and the total number of such patients in the hospital has risen dramatically.

There are now a total of four wards that are being used solely to treat COVID patients and today we opened a second COVID ICU. Once again, the Estates team have been called to remove the COVID-proof partition in the service corridor connecting ICU2 and ICU3. They never tire of this, apparently.

ICU3 was emptied of regular patients this morning and will be given a clean before the new COVID patients start moving in. Fortunately, we have far fewer non-COVID ICU patients than we had a few weeks ago and so we are able to manage this without having to reopen a ‘surge’ ICU. A similar situation is to be found in other hospitals throughout the Northern Region although, as usual, we seem to have significantly more patients than other ICUs.

I have spent the day with the Critical Care Outreach nurses reviewing the sickest of the ward patients with Jane and Andrea. The patients we saw were the ones needing high flow oxygen or CPAP. There are ten of these with six of them needing CPAP. In many ways they are quiet a disparate bunch. Some of them are in their 20’s and 30’s and have not been vaccinated. Others are elderly and have become unwell despite receiving both doses of a vaccine. They usually have underlying health problems that explain their vaccine failure but these may not be as serious as you might like to think. Bridging these two groups are the middle-aged patients, a significant number of whom have not been vaccinated or have only received one dose of a vaccine. Reasons for not being vaccinated are many and include fears about side-effects (most notably a fear of blood-clots), being too busy or ‘not getting around to it’, being unable to get a vaccine appointment or, more rarely, as a result of anti-vaccine beliefs or COVID-denial.

We have also seen multiple members of the same household become unwell. We currently have husbands, wives, brothers, sisters and cousins all being admitted to hospital at the same time. It’s not unusual to come across whole households who have not been vaccinated and so we are likely to see more of this as time goes on, especially given that vaccine uptake in Central Middlesbrough is far from ideal. Over 46% of our local adult population have received a first dose and 27% have had both jabs. This leaves 27% that have not been vaccinated at all and are therefore vulnerable to severe COVID pneumonitis and other complications of infection. We know that the hospitals workload can only rise further over the next few weeks.

However, whilst the number of patients that we are admitting is concerning, there is no doubt that vaccination is preventing patients becoming ill in the same way that they were during the first two waves. With the exception of one or two unvaccinated patients, we are finding that the current group are easier to ventilate, less likely to require prone ventilation and less likely to develop multiple organ failure.

Sadly, despite this, two of our ICU COVID patients have died this week. These are the first of our patients to die during this third wave. The fact that we are not seeing anywhere near as many deaths as we saw previously is a result of the success of the vaccination programme. The national daily death rate is about a tenth of what it was back at the end of December when we last saw a similar number of cases.

Whilst the death rate remains low the impact of the pandemic on the operational efficiency of the hospital is not to be underestimated. The ongoing circus of self-isolation continues with many more members of staff at the hospital currently off work as a result of being ‘pinged’ by the NHS Contact Tracing App. Others have friends and family who have tested positive. Of course, there are also staff members who have had to isolate because they have become infected with COVID-19. Some departments have been hit particularly badly and are left with skeleton crews. Some have even had to suspend non-essential services.

Closer to home, my son has finished his period of self-isolation and has been back at school for a few days. Unfortunately, it is now my eldest daughter’s turn to be confined to the house after a close COVID contact, again at school. She was initially quite upset about missing the last week of term but only yesterday, the school announced that there have been so many cases amongst both staff and pupils, that they have been forced to close next week and move everyone back to on-line teaching.

Nicky is working this weekend but we both have the day off on Monday and so are looking forward to starting our official ‘Freedom Day’ celebrations early on. I can’t believe that the pandemic will soon officially be over. Sometimes I have to pinch myself to make sure I'm not dreaming...

The Partition: What goes up must come down. Again.