Lockdown 3: So Very Tired

5th January 2021

UK COVID Deaths – Daily 830 / 7-Day average 677

Total UK COVID Deaths within 28 days – 76,305

Total UK Deaths with COVID-19 on the death certificate – 82,624 (up to 18th Dec)

James Cook Hospital – Total COVID deaths – 396

All COVID cases within South Tees Hospitals Trust – 141

James Cook Critical Care

COVID cases – 21 (13 ventilated)

Non-COVID cases – 22 (13 ventilated)

Not a great title for a sequel, I’ll admit, but it does seem to capture how we are all feeling.

We’re back into lockdown again today for the third time. Nicky has subsequently spent her day experiencing the joy of home-schooling once more after the sudden announcement last night that the youngest of our three children was not going to primary school today. We had known that the other two, who are in secondary school, would be staying at home; the school has a schedule of virtual lessons all arranged for them. However, the poor primary school teachers have been caught out by Boris’ sudden change of plan and have had precious little time to organise anything. To his credit, Sophie’s teacher, Mr Johnson, was in school at 7am this morning, filming a video for the class that laid out a teaching schedule for the next few days.

Across the country, infection rates are relentlessly rising. It is estimated that 1 in 50 people in England were infected in the week after Christmas. Locally, case numbers appear to have risen significantly in all areas as has the number of COVID patients being admitted to the hospital. We have now set aside seven wards for COVID patients at James Cook and one ward at the Friarage Hospital in Northallerton. We have seen a number of new admissions to Critical Care but, sadly, we have also had a few deaths meaning our patient numbers have remained relatively static.

The North East and Yorkshire Region is currently at nearly 80% of total Critical Care capacity whilst London and the South East are at 130%. Of course, this picture does not tell the full story. Critical Care beds are classified as either level 2 (High-Dependency beds) or level 3 (Intensive Care, ventilated beds). The important distinction between the two is not whether there is a ventilator by the bed, but rather the number of nurses required for each patient. One Critical Care nurse can look after two level 2 patients but only one level 3 patient. So, the more ventilated patients you admit, the more nurses you need. It’s therefore possible to still be ‘within capacity’ despite using up all your nursing staff to look after an increased number of ventilated patients. This is very much the situation we have been in over the past few weeks. Luckily, our number of non-COVID ICU patients has fallen recently which has prevented us from becoming swamped.

Unfortunately, the situation is only going to get worse. We know that the next two weeks are likely to be very busy. There is nothing now that can be done about this. The people who will be admitted to Critical Care over the next fortnight will already have been infected. Many of them will already have symptoms and some will be experiencing breathlessness. A few days later they may be admitted to hospital for oxygen therapy and then perhaps go on to join the growing number of patients receiving CPAP on the wards. If they are unlucky they may end up being transferred to the ICU as their condition worsens and, if CPAP fails, they may require intubation and ventilation. Subsequently, many of these patients will not survive.

In preparation for what is coming, the hospital has cancelled all elective surgery at the Friarage Hospital for the next eight weeks. Some of this work will now be undertaken at the James Cook site but many patients will have their surgery postponed. Theatre staff will join their colleagues at James Cook and many of them will be redeployed to Critical Care for short periods of time in order to allow us to adequately staff the extra beds. Our numbers have also been bolstered by a group of retired nurses who have returned to work and some of the paediatric ICU nurses have offered their help again.

So, are we prepared? Yes, but what we don’t know is when we will begin to feel the effects of this lockdown and how quickly new hospital admissions will fall. There is no doubt that we are in for a stormy time. The new variant of the virus is significantly more infectious and it is unlikely that this lockdown will be as successful as the one that took place during March last year. Of course, any lockdown will ultimately only be as effective as we make it so everyone needs to play their part.

I have spent a torrid few days desperately trying to keep people alive and failing. We have all seen far too many people die. Please, please stay at home.

Yes we can!

(Model – Michelle, Designer - Scott)