COVID? – Here, There, Everywhere?

Saturday 2nd May 2020

COVID Figures for 1st May

UK Deaths 739 / Total 27,510

James Cook Hospital – Total deaths – 189

All cases within South Tees Hospitals Trust - 76

James Cook Critical Care COVID cases – 8 / 4 ventilated

James Cook Critical Care non-COVID cases – 32 / 11 ventilated

Nicky is at work today but I have the day off. Under our new working pattern, both of us should have been at work today but because it has been a bit quieter, we have made subtle changes to allow for everyone to spend a bit more time away from work. I am available should one of my colleagues become unwell or if things get crazy but this is unlikely, so I can look forward to a day at home.

The numbers of COVID admissions, both in the hospital as a whole and in critical care, are gradually falling. There is one patient with suspected coronavirus infection but the other two admissions are both trauma cases.

The first is a road traffic accident brought in by the Great North Air Ambulance (GNAAS). The patient has extensive head, chest and abdominal injuries and suffered a cardiac arrest at the scene. After a lot of work by the helicopter crew, the A&E trauma team and us, their condition stabilises and they are admitted to ICU for ongoing assessment and treatment. James Cook Hospital is the regional Major Trauma Centre so we are no strangers to this sort of thing but this is the first severe road traffic accident we have seen in a few weeks; another indirect effect of the lockdown and quieter roads.

The second case is a lady who has fallen and suffered a traumatic sub-arachnoid haemorrhage. This is where a bleed occurs on the surface of the brain. Unlike spontaneous sub-arachnoid haemorrhages where the bleed is due to the rupture of a cerebral aneurysm, these patients often do not need any specific surgical treatment. However, they do need to be observed closely. The bleeding can sometimes cause a blood clot to block the normal drainage of cerebro-spinal fluid (CSF) out of the base of the brain. This can lead to an increase in pressure inside the skull and rapidly cause a coma or worse. This is a neurosurgical emergency. Insertion of a drain in the operating theatre to allow the CSF to drain externally will fix the problem but this may need to be done in a bit of a hurry. The other reason for close observation is that the injury itself may have caused other brain damage that is not immediately apparent on the CT scan. This can subsequently cause further bleeding or brain swelling which can also require a hasty trip to the neuro-surgical operating theatre to deal with.

The patient is doing well at the moment but is currently being looked after on the medical ward due to concerns over whether she is COVID positive. Her trauma CT scan has shown some changes in the upper part of her lung. This is most likely due to aspiration (inhalation of stomach contents or being sick) at the time of the accident. However, currently there is a tendency to see everything as a manifestation of COVID-19 and so there are concerns that she has COVID pneumonitis.

There has to be a balance between not missing and treating COVID-19 and doing the same with a condition that isn’t anything to do with coronavirus. The clinical picture does not fit for COVID pneumonitis and so Nicky arranges to move the patient to the neurosurgical ward to allow observation by staff used to dealing with head injuries. The potential for COVID-19, albeit small, has to take a back seat. It is more important that the patient is in the safest place.

As our numbers of COVID patients fall it is important that we are not blinkered into diagnosing everything as ‘the virus’. We now have enough experience to be able to make considered decisions regarding the likelihood of coronavirus infection. We need to keep an open mind in order to treat everyone effectively.

Meanwhile, back at home, I am taking the kids for a run. Well, I say run, but I’m on my bike. It’s not that I’m lazy, just that I hate running. It actually goes quite well for a change, no walking, stitches or tears from anybody, including me.

In the afternoon I persuade my son, Jamie to join me for a bike ride up to the village shop for some provisions. I did have to bribe him with chocolate but that’s par for the course. On our way home we drop by my friend Mike’s house. At short notice, Mike has decided to run around his driveway for 12 hours in order to raise money for Teesside Hospice.

Now, as much as I detest running, I have to admire someone who is prepared to run around the drive he shares with his neighbours for the entire day. When I catch up with Mike he is two hours short of finishing and has run about 40 miles. He looks remarkably fresh and the only thing he is complaining about is some motion sickness from running around in a circle whilst looking at block paving for 10 hours!

If any of you are interested in rewarding his heroic, albeit ludicrous effort and donating to a very worthwhile cause, then please click on the link below:

https://www.justgiving.com/fundraising/michael-shakesheff

Mike: Everybody wants to run the... drive