Turning Amber

4th March 2021

UK COVID Deaths – Daily 242 / 7-Day average 255

Total UK COVID Deaths within 28 days – 124,025

Total UK Deaths with COVID-19 on the death certificate – 140,062 (up to 19th Feb)

James Cook Hospital – Total COVID deaths – 593

All COVID cases within South Tees Hospitals Trust – 90

James Cook Critical Care

COVID cases – 11 (9 ventilated)

Non-COVID cases – 47 (25 ventilated)

I’ve been off work for the best part of a week now and I’ve come to realise how much I was in need of some time off. It had been anticipated that our situation would have improved much more by March and so we were encouraged to take some leave in order to allow a little recuperation. My shift pattern allowed for the best part of a week off but I had anticipated that after a few days I would feel guilty and end up volunteering for some extra shifts. But as the days passed I began to realise just how much I needed some time away from it all. It would be wrong to say that I am fully rested and raring to go again but a few days spent at home with the family, getting outside for walks, riding my bike and not ventilating anybody has done me the world of good. I’m even calmer about the swathes of people I see breaking the current lockdown restrictions – an obvious sign that I’m more chilled out, surely?

Of course, the more of us that are allowed time off, the busier our shifts become but there has to be a balance. I would rather be busier at work and have more time at home, than be less busy and at work more often. Everyone is exhausted and people are becoming increasingly grumpy and irritable. Of course, for some of my colleagues, grumpy and irritable is their default setting but it’s easy to look around and see how fatigued everyone is. One of the problems with being chronically tired is that you lack insight into how much fatigue is affecting you. It’s all too easy to believe that you are functioning fairly normally and behaving quiet rationally, even in the face of good evidence to the contrary. It’s the others who are being strange and irrational, not you. Of course you don’t need a rest, you always fall asleep mid-conversation…

Anyway, all good things have to come to an end and I’m back at work tomorrow. Luckily, it looks like the situation has improved when compared with when I was last at the hospital. Nicky has been at work for the past two days and reports that the total number of COVID patients within the hospital has begun to fall sharply again. After remaining fairly static for the past month, the number of COVID patients within Critical Care has also dropped. Regrettably, some of this reduction in numbers is due to the deaths of a number of our patients but many others have done well and have been discharged to the wards.

The reason that our overall numbers have begun to fall is that there are now consistently more patients recovering from COVID-19 and leaving the hospital than there are being admitted. Teesside has seen a sustained reduction in coronavirus infection rates and Middlesbrough can no longer be found amongst the country’s top five ‘areas of shame’. Indeed, across the whole country, the rate of new cases continues to fall across all age groups. Ultimately, fewer infections will result in fewer hospital admissions and subsequently fewer deaths. Vaccination also appears to be having an impact with far fewer infections in the over 80’s who have been vaccinated. The majority of the over 70’s who have been vaccinated should be achieving protection from their first vaccination any day now. This should drive the death rate down even further.

In other hospitals across the country, the pattern is similar, even if their numbers have fallen quicker than ours. In total, the number of people currently in hospital with COVID-19 in the UK is back to where it was at the beginning of November. As expected, the number of patients requiring ICU care is falling more slowly; the sickest patients in the ICU take longer to recover or die when compared to those on the wards. As a result, the total number of UK COVID patients currently requiring ventilation in an ICU is only back to where it was in late December.

Unfortunately, the fall in the number of our ICU COVID patients has been paralleled by a rise in the number of our ‘amber’, non-COVID patients. We now have an unprecedented number of ventilated patients with diagnoses other than COVID-19. We had been expecting something like this as we saw a similar rise in such admissions in the latter stages of the first wave but have been surprised by the sheer number of patients we are seeing. It’s a good job that we are not admitting many cases of pneumonia or influenza this year or we would have been overrun.

Just like the first wave, we are seeing many admissions due to alcohol-related problems, recreational and prescription drug overdoses and many patients who may have put off seeking medical help during the pandemic. Sometimes this is obvious; a delayed admission with a heart attack or a stroke is easy to spot. However, often it’s less straightforward to be able to attribute the severity of their illness to the effects of the pandemic. After all, even in more normal times, we frequently see people who delay seeking medical help until they are near death’s door. That said, I do believe that the perceived difficulty in obtaining medical care and a desire to avoid exposure to the coronavirus over the past year is an important underlying factor in many of our admissions.

For example, over the last few weeks we have had a number of cases of life-threatening septicaemia following teeth and mouth infections and it may be that reduced access to dental care is partly to blame. We have also seen a surprising number of cases of diabetic ketoacidosis and other diabetic emergencies. Some of these are easy to ascribe to the excess consumption of alcohol or recreational drugs in our younger patients or simply a delay in seeking appropriate help when they become unwell. However, in many of our older patients I suspect that a lack of rigorous medical review of their diabetic control may be contributory.

As a result of this increase in non-COVID patients, we are still very busy. Within the last 72 hours we have had to transfer five patients to other ICUs within our region in order to ensure beds are available for new admissions. It still seems that every other hospital nearby has far fewer patients than we do. We were also instructed to flip ICU3 back to a non-COVID unit yet again. Partition up, partition down, partition up… and repeat indefinitely…

The process involved emptying ICU3 yet again, cleaning it and smoking it out with a hydrogen peroxide fogging machine before bringing all the new, non-COVID patients in. There’s nothing we all like better than participating in this rigmarole every few weeks and I’m obviously devastated that I was at home and missed all the fun. I think the idea was to enable us to treat the increasing number of really sick non-COVID patients in a purpose-built ICU rather than one of the make-shift surge units. In reality, I suspect that having to repeatedly move patients back and forth is all part of some Kafkaesque plan which aims to grind us into submission. That way we might not complain too loudly about the measly 1% pay-rise that the Government is planning to give us.

To be fair, the upshot of all this tomfoolery was that we were able to close our third surge ICU. This should feel like a big step in the right direction except that we are now using part of the Cardiac High Dependency Unit instead and are still requiring the same 50 nurses every shift. This means it’s not quite as good news as it initially sounds.

Anyway, despite the fact that we are still ridiculously far away from anything approaching normality, the reduction in the number of COVID patients within ICU is encouraging. I am hopeful that we should see the situation continue to improve over the next month and life should begin to get easier for everyone. In the meantime, if you are unwell, please make sure you see a doctor sooner rather than later – you may end up helping both yourself and us.