Fourth Wave

29th December 2021

UK COVID Deaths – Daily 57 / 7-Day average 100

Total UK COVID Deaths within 28 days – 148,089

Total UK Deaths with COVID-19 on the death certificate – 171,801 (up to 10 Dec)

James Cook Hospital – Total COVID deaths – 724

All COVID cases within South Tees Hospitals Trust – 67

James Cook Critical Care

COVID cases – 7 (4 ventilated)

Non-COVID cases – 39 (23 ventilated)

Christmas at the hospital was mercifully quiet for once. My colleagues who were working over Christmas saw fewer Critical Care patients than usual and, by the time I returned to work on 27th December, we had a handful of empty beds for a change. There were only four patients on the COVID ICU and I was struck by how much calmer things seemed.

Unfortunately, this festive tranquillity doesn’t look like it’s going to last. The hospital has been admitting increasing numbers of COVID patients over the past 72 hours and the total number of such patients in the hospital is almost double what it was a week ago.

This is not unexpected. Omicron is now responsible for well over 90% of English COVID-19 infections. Case numbers within the Tees Valley have increased significantly over the Christmas holiday and an increase in hospital admissions was bound to follow. We have been told we can expect less severe illness in the Omicron patients and there are some signs that this is true. None of the recent admissions to hospital have required ventilation. However, there are still a significant number who have required CPAP to treat their respiratory failure and we have admitted three of the most unwell CPAP patients to the ICU for close observation.

Currently, over two-thirds of the patients admitted to our ICU are unvaccinated. They are all relatively young and nearly all of them have the usual risk factors for severe COVID pneumonitis; they tend to be male, overweight and have type 2 diabetes. Some of these patients are fundamentally opposed to vaccination but many more seem to have simply not appreciated that they might be more at risk of severe illness. When offered vaccination, they have simply told their GP that they would rather ‘take their chances’.

Just like last year, the intergenerational mixing that tends to take place over the holiday period has led to severe illness striking different members of the same family. We recently admitted a father and son to the COVID ICU within days of each other and, as I’m sure you can appreciate, this makes for a very emotionally charged situation. It’s hard to imagine the worry and distress that comes from having two members of your family in the same Intensive Care Unit at the same time.

The rest of our COVID ICU patients are all fully vaccinated and boosted. Unfortunately, they have significant underlying health problems and are all on potent immunosuppressive treatments. A number of them are kidney transplant patients who are very much at risk of severe illness should they become infected with COVID-19.

As bad as all this might sound, it’s worth keeping a sense of perspective; the current number of COVID patients within the hospital is still relatively low. We have been dealing with similar or higher numbers of patients on-and-off since July and so there’s no cause for alarm just yet. Indeed, some would argue that all we are seeing is a continuation of the third wave. A rise in cases after Christmas was always to be expected. However, the recent decline in hospital admissions has been much better than any of us anticipated and we have been allowed an all-too-brief respite. As a result, the current increase in hospital admissions feels very much like the unhappy beginning of a fourth wave.