New Admission

26th August 2020

UK COVID Deaths - Daily 16 / Total 41,465

James Cook Hospital – Total COVID deaths – 255

All COVID cases within South Tees Hospitals Trust – 5

James Cook Critical Care COVID cases – 0

A few days ago we admitted a new patient with COVID-19 into Critical Care. This is the first such case that we have seen in many weeks. As far as I’m aware this is also the first acute COVID patient the hospital has seen in that time. The patient was in his twenties and whilst he had some existing medical problems, admitting such a young patient was initially quite disconcerting.

Fortunately, he responded to treatment very quickly and did well. To our delight, he was well enough able to return to the ward within a couple of days. In all honesty, had we seen such a patient during the initial surge of cases back in March, we would have probably safely left him on the ward. At that time we had many more serious cases that required the ICU beds we had available. However, given that we are no longer jam-packed with COVID patients, we felt we could afford the luxury of being cautious and admitted him for observation.

Unlike the ‘first wave’, the arrival of a single COVID case has not been followed by a viral tidal wave. Case numbers within the UK, whilst rising slowly are not increasing at the rate first seen at the end of March. Many people seem to be becoming complacent; they are told that case numbers are rising throughout Europe but are wondering why hospital admissions and the death rate are not increasing.

To my mind there are a number of possible reasons for this:

One: The majority of these new cases are amongst the young. As a result the numbers of seriously ill cases requiring hospital care remain low. As far as we know, the risk of dying from COVID-19 if you are under 40 is estimated at below 0.2% if you test positive.

Two: The large number of deaths early on amongst the elderly and care home population have removed some of those most ‘at risk’ from the population.

Three: We are simply testing more people. We don’t really know what the true incidence of viral transmission was in the weeks before lockdown began. It is likely that there were many more cases than we supposed and so comparing absolute numbers of cases now with those in March is misleading. Subsequent analysis of samples from a 75 year old woman who died following admission to a Nottingham hospital on 21st February 2020 have revealed that she had COVID-19. This appears to be the earliest case of viral transmission amongst the UK population.

Four: The virus is less deadly. This idea appears to be gaining popularity. There is a theory that viruses become less virulent over time. This helps them to survive. An ‘ideal’ virus is one that is highly infectious but not fatal. Of course, the best examples of this are the viruses that cause the common cold (which include coronaviruses). There have been claims that some strains of the COVID-19 virus are less deadly than others but I’m not aware of any definite evidence to back this up. Whilst the cases that we were seeing in May and June did not appear to be as severe as those we saw back in March and April, the true fatality rate could simply be being adjusted by reasons 1-3 listed above. We are also more experienced at treating COVID patients than we were, and this may have led to a reduction in hospital mortality.

There is also now emerging evidence that it is possible to become re-infected with COVID-19. There have been three cases reported in the media to date, one in Hong Kong and two in Europe. All appear to have become infected again, some months after their initial confirmed infection. Gene sequencing has been used to confirm that the infection was with a new, different strain of the virus. My understanding is that the subsequent infections have all been asymptomatic or mild, suggesting that the immunity generated by the initial infection may still be conferring some degree of protection. That this has ultimately occurred is no real surprise. The medical community has been warning the public of the potential for immunity to wane after a few months and offering the opinion that, once an effective vaccine is discovered, repeated inoculations would be necessary to provide ongoing protection and prevent outbreaks.

So I would urge everyone to be cautious before allowing themselves to believe that they are any safer than they were a few months ago. The population of people that were ‘shielding’ during the initial surge of cases are still out there, and remain at risk. Just because we haven’t seen a rise in people admitted to hospital or an increase in the death rate doesn’t mean we won’t. I worry that we just haven’t allowed enough time for things to get going again yet.

This is my 100th post. It’s been a while since I’ve said this but here goes - stay safe everyone.