Reasons to be Fearful?

9th August 2021

UK COVID Deaths – Daily 37 / 7-Day average 88

Total UK COVID Deaths within 28 days – 130,357

Total UK Deaths with COVID-19 on the death certificate – 153,734 (up to 23 Jul)

James Cook Hospital – Total COVID deaths – 634

All COVID cases within South Tees Hospitals Trust – 77

James Cook Critical Care

COVID cases – 12 (9 ventilated)

Non-COVID cases – 46 (22 ventilated)

Three weeks have now passed since Freedom Day. The fall in cases that has been seen during this time looks to have stopped. Case numbers may even be starting to rise again but what we haven’t seen is the large rise in cases that many people were worried about. It would seem that people’s behaviour has not changed in quite the way that we might have feared. There is still plenty of mask-wearing and social-distancing going on; life has not yet returned to normal. Socialising outdoors and the closure of schools, colleges and universities has also helped. Finally, and most importantly, widespread vaccination has resulted in a high level of immunity within the UK population. As a result, things have not gotten out of hand and Boris’ big gamble looks to have paid off.

Locally, case numbers across Teesside have continued to fall. This is welcome news as, until recently, the North East had one of the highest levels of infection in the country. Nationally, the number of people being admitted to hospital has also started to fall. Middlesbrough seems to be lagging behind the rest of the nation but here too, there are signs that things are getting better.

The number of COVID wards at James Cook fell from four to three last week and, over the weekend, it has fallen further to two. Fewer patients on these wards need CPAP but we are still using two of our three General Intensive Care Units to treat COVID patients. It can take many weeks for COVID patients on the ICU to recover to the point where they can be discharged to the ward and so it’s not surprising that our ICU numbers have not yet fallen significantly.

This does mean that we are continuing to try to squeeze all our non-COVID patients into our single remaining ICU. Fortunately, we have had fewer of these than we had expected and so we had been coping relatively well. That is, until this weekend. Nicky has been on-call and, true to form, it has been busy. Most of the ICU admissions were non-COVID ones and were the result of many different illnesses. There were cancer patients, accidental and intentional drug overdoses, bleeding ulcers, assorted pneumonias and patients who were determined to prove that alcohol and diabetes is not a recipe for success. The usual collection of trauma cases added to the pot and the end result was more patients than we had beds for.

We created some capacity by transferring a couple of patients to nearby hospitals but it was soon clear that the only way to accommodate everyone was to turn the Female Surgical Admissions Unit back into a Surge ICU. To be honest, it’s surprising that we haven’t had to open it before now. We had been using a couple of beds in the Post-Anaesthetic Care Unit (PACU) and there had been a plan to occupy some beds on the Cardiac Intensive Care Unit (CICU) but, ultimately, the move into a temporary unit was inevitable as the number of critically ill non-COVID patients was never going to remain low forever.

Finding staff to open the Surge unit is never straightforward but we have managed over the weekend by stealing nurses from the wards again. However, unless things quieten down it will be an ongoing struggle to ensure we have enough pairs of hands. I’ve never come across a hospital that has a surplus of staff and so taking nurses from elsewhere inevitably ends up robbing Peter to pay Paul. Opening even a small number of temporary ICU beds will cause a major headache, especially given that the rest of the hospital is playing catch-up, trying to deal with the ever-growing backlog of routine work.

It’s worth pointing out that we are still seeing some very sick COVID patients who require ventilation. It will come as little surprise to discover that the overwhelming majority of these are unvaccinated. Whilst we are still ventilating a number of vaccinated patients, nearly all of these have a reason for their so-called ‘vaccine failure’. This is usually underlying chronic illness and/or drug treatment that causes immunosuppression.

We have far fewer very sick COVID patients than we have seen previously but there are enough of them to continually remind us just what a dreadful illness COVID-19 can be. We are still struggling to ventilate them adequately. They are still developing pulmonary emboli and multiple organ failure. They still require ventilating on their front and need chest drains for recurrent collapsed lungs. They are still dying.

Unfortunately, I get the impression that the general public are forgetting just how serious ‘proper’ COVID can be. This seems especially true amongst the unvaccinated patients. During the first and second waves nearly everyone was, understandably, terrified of ending up on a ventilator. They knew all too well that, should this happen, their chances of survival were around 50:50. They were desperate to do all they could to avoid ventilation and would tolerate CPAP for days on end in the hope that, with our help, they might turn the corner and start to improve. In contrast, some of our current unvaccinated patients don’t quite seem to appreciate how much danger they might be in. They are less willing to put up with CPAP and they just don’t seem as frightened of ventilation as they should be. Now admittedly, a lot of these sick patients are younger than they were during the first two waves and so are perhaps less aware of their own mortality but I wonder if this feeling of relative invulnerability is part of their decision to avoid vaccination? Simply put, have they lost their fear of COVID?

Let’s be honest, I have spent my entire career seeing critically ill patients who ‘never thought it would happen to them’. Ultimately, it’s human nature; none of us want to spend our lives worrying about the myriad of horrible things that potentially might happen to us. However, perhaps it might be time for those who remain unvaccinated to feel a little more like the country did during the first wave. Maybe a little bit of fear could be a good thing?