It’s Grim Up North?

Friday 22nd May 2020

Figures for 21st May

UK COVID Deaths 338 / Total 36,042

James Cook Hospital – Total COVID deaths – 223

All COVID cases within South Tees Hospitals Trust – 45

James Cook Critical Care COVID cases – 7 (6 ventilated)

James Cook Critical Care non-COVID cases – 35 (12 ventilated)

We have just received another COVID report from the Intensive Care National Audit & Research Centre (ICNARC). ICNARC report data on patients that have been admitted to Critical Care Units throughout the UK. This time we have a chance to look at a report that focuses on the North of England Critical Care Network and compare this to the accompanying national report.

The North of England Network includes all English Intensive Care Units north of Leeds – this includes those in Middlesbrough, Stockton, Darlington, Cumbria, Durham, Sunderland, Gateshead, Newcastle upon Tyne and Northumberland.

This report deals with 428 patients admitted to Critical Care Units with confirmed COVID-19 up until 18th May 2020. Of these, they have complete data on 380 patients. The outcome of 319 patients is known and the other 61 remain within ICU, still being treated.

The median age of those admitted is 62 years (the national figure is 60) and 65% of these patients are men (the national figure is 71%). The ethnicity of patients is different, with 92% of all Northern patients being registered in the ‘white’ ethnic group compared to the overall national figure of 67%.

Nearly 36% of the Critical Care Admissions in the North of England fall into the worst of five categories for social deprivation. This compares with 25% of the population across the UK.

Almost 11% of all our patients admitted to Critical Care had what can be described as a ‘very severe’ underlying illness compared to 8.4% across the whole country.

Interestingly, 40% of patients in our region needed intubation and ventilation within the first 24 hours of arrival in Critical Care. The national figure is 63.2%. The indicators of severity of illness on admission are the same, meaning the patients were equally as sick when they arrived in Critical Care. Overall, 55% of all our ICU patients were intubated and ventilated compared with rate of nearly 72% nationally.

Across the Northern Region, 18.5% of our patients required dialysis, compared with 24.6% nationally.

Moving on to the all-important statistic, of the 319 patients within our region whose outcome is known, 38.6% have died and 61.4% have survived to leave ICU alive. The survivors have been treated for an average of 5 days. Across the country, 45.8% of Critical Care patients have died, with 54.2% surviving to leave ICU. The national average length of stay for survivors was 9 days.

So, what do these figures tell us? We must be careful not to jump to conclusions. The average North of England Critical Care patient with COVID-19 appears to be slightly older, a little more likely to be a woman and they are nearly always ‘white’. They are more likely to come from deprived areas and are a little more likely to have significant health problems.

Our patients are more likely to receive ‘basic respiratory support’. This means high-flow oxygen, CPAP or non-invasive ventilation (NIV). They are less likely to be intubated and ventilated. Our patients appear more likely to survive their ICU stay.

The lower rate of invasive ventilation amongst our patients warrants further discussion. Right from the outset we have used CPAP where necessary and I believe that in a significant number of patients we have avoided intubation and ventilation. I inherently believe that mechanical invasive ventilation is bad for you and is best avoided unless absolutely necessary.

I must stress that this is just observational data. There are differences in our patient population when compared to that seen nationally. The number of patients in our region is small when compared to the national figure, increasing the potential for statistical error. Other factors may also be at play. Different parts of the country have a different ethnic make-up; we know that BAME patients are more likely to die from COVID-19. The North of England had more time to plan and prepare for the surge of cases that we saw in March and April. We were not overwhelmed like other parts of the country and were able to continue to provide a high standard of care to our patients.

Having said all of that, I will take this as an indication that Critical Care units in the North of England are not doing badly.

In fact, I’m going to go further and take it as a sign that we might be doing well.