Into the Red

Friday 1st May 2020

COVID Figures for 30th April

UK Deaths 674 / Total 26,771

James Cook Hospital – Total deaths – 185

All cases within South Tees Hospitals Trust - 80

James Cook Critical Care COVID cases – 12 / 8 ventilated

James Cook Critical Care non-COVID cases – 36 / 14 ventilated

Another good day today. We have had another number of non-COVID patients admitted overnight but the numbers of COVID patients remain relatively low compared to a few weeks ago.

We’re not entirely sure why we are seeing a rise in non-COVID cases. Some of it is certainly explained by the fact that patients have been trying to avoid hospital over the past few weeks. This lead to an initial fall in numbers, but we now have more ventilated patients than we would expect and our patients are sicker. Some of this is due to patients who delay seeking medical attention until they are in a bad way and end up being admitted to Intensive Care for ventilation in a hurry.

Another topic that people are discussing are the figures released from the Office of National Statistics that reveal that Middlesbrough has the sixth highest COVID-19 mortality rate in the country. The other areas include three parts of London, Liverpool and Salford. This follows on from earlier news that Middlesbrough has the fourth highest infection rate in the UK.

These two figures are linked but it comes as no surprise to learn that these ‘hot-spots’ are areas of significant deprivation and poverty. Such areas usually have a higher housing density, more people in low-paid ‘essential’ jobs who are unable to work from home and, most importantly, a population with many underlying health problems.

In spite of this news, the COVID patients I see today all are continuing to improve. In particular, two of the patients are appreciably better than I had anticipated. One lady has improved so much that she is able to have a ‘virtual visit’ from her daughter via our new 4G enabled tablets. These have a special secure app and have been provided by the Lifelines Charity which aims to provide a means of communication for patient’s families whilst they are not allowed to visit:

https://justgiving.com/campaign/life-lines

This very worthwhile charity was set up by Dr Joel Meyer and Prof Louise Rose from Guy's and St Thomas', and Kings College Hospital in London. We took delivery of three of these tablets the other day and they are proving very popular with patients and families.

My other patient had improved to the point that he had not required prone ventilation overnight. His airway pressures and oxygen levels were lower and so we were able to perform a tracheostomy today. We have tried to wake our patient up on a couple of occasions but it is clear that we would be unable to remove the breathing tube without a significant likelihood of failure. A tracheostomy will allow the sedation to be turned off, the patient to wake up calmly and ultimately wean from the ventilator.

I perform the tracheostomy whilst Tom, one of our registrars, provides anaesthesia and uses a fibreoptic bronchoscope to inspect the trachea from inside and ensures the tracheostomy is placed correctly. It’s usually a straightforward procedure and today is no exception. A small incision is made in the front of the neck, the tissues overlying the trachea are dissected and the trachea is punctured using a small cannula. A guidewire is then inserted into the trachea and a relatively large rhino-horn shaped dilator is used to enlarge the hole. This is then removed and the tracheostomy tube inserted through this hole before being fastened in place by a strap around the neck. Tom then checks the final position of the tracheostomy tube using the bronchoscope before we connect it to the ventilator and remove the original breathing tube from the mouth.

The afternoon is spent reviewing the patients on the Surgical Assessment Unit (SAU) which is currently being used to provide High Dependency Care for COVID patients. This is the first time I’ve visited and I’m impressed at how well organised it is. It seems to suit being an HDU better than it did a day-surgery unit. If the need arises we could turn it into an ICU fairly quickly by wheeling in some ventilators and increasing the number of nurses.

I had been asked earlier in the day if I could do a brief interview for BBC Radio Tees in the afternoon. I retreat to my office and use the landline to answer questions on air about our fall in COVID case numbers, Middlesbrough’s high death rate and how we, as a unit are coping. All goes well although when I ring Nicky and the kids to ask how I got on, I am told that they forgot to listen!

But by far and away the best thing to happen today was a delivery of new PPE. We have sourced some larger all-in-one suits which are a better fit for me. These are bright red and I seize upon the opportunity to wear one on when I visit the General High Dependency Unit later.

I am quite taken with the colour. I like to think that I cut a dashing figure, a bit like Commander Koenig from Space 1999 perhaps? Everyone else seems to think I look more like Po from the Teletubbies…

Time for Tubby Bye-Bye...