Winter

28th April 2022

UK COVID Deaths –Daily average 232

Total UK COVID Deaths within 28 days – 174,696

Total UK Deaths with COVID-19 on the death certificate – 191,277 (up to 15 Apr)

James Cook Hospital – Total COVID deaths – 849

All COVID cases within South Tees Hospitals Trust – 184

James Cook Critical Care

COVID cases – 3 (3 ventilated)

Non-COVID cases – 48 (22 ventilated)

I feel like I should apologise for not having posted anything for over a month. The main reason for this is that I have been using up some annual leave that I haven’t taken over the past two years. I’ve been the mountain biking in the Peak District with friends, up to Edinburgh on a rugby tour with my son and then to the Lakes over the Easter Holidays with the rest of the family. I had intended to write something before we left, but things got busy and the last-minute packing frenzy conspired to keep me away from the laptop.

The other reason I didn’t write was that things at the time looked reasonably well under control. At least, that was the view from our Intensive Care window. Sure, local infections were on the rise, as was the number of COVID patients being admitted to the hospital. The A&E and Acute Medicine teams were very busy and the hospital had just opened a third COVID ward. ICU was busier than we would normally be at this time of year but we only had two COVID patients and neither was there as a consequence of their COVID infection. We had stopped wearing full PPE in the non-COVID areas, hospital visiting and social-distancing rules had been relaxed further and, on the ICU at least, things continued to feel relatively normal.

Increased socialisation, the end of restrictions and the increased transmissibility of the, now dominant, Omicron BA.2 variant have all led to a fairly impressive rise in the infection rate over the past month. By the beginning of April, just as free testing came to a halt, infection prevalence studies, such as the one conducted by the ONS, estimated that as many as 1 in 13 people in the UK were infected. Ironically, the final round of the REACT study recorded the highest level of COVID infection seen in England at any point in the pandemic. REACT will no longer operate as the Government has withdrawn their funding. Fortunately, plans to stop the ONS COVID Infection Survey have been postponed and this will continue for the time being.

It’s now clear that vaccination and/or previous infection with last year’s variants provide precious little protection against infection with Omicron. Fortunately, protection against severe illness remains very strong and Omicron is far less likely to cause pneumonitis. So, whilst we have seen an increase in the number of deaths directly caused by COVID, the overall death rate amongst the population has been lower than we would normally expect at this time of year.

About 40% of all COVID admissions are in hospital because the virus has made them unwell. The remainder have been admitted for other reasons but have an incidental COVID infection. Caring for such patients is obviously difficult because they need to be isolated in order to prevent them infecting other, more vulnerable patients.

As we all know, the symptoms of Omicron can be milder and/or different from those of previous variants. As a result, the NHS has finally added nine new COVID symptoms to the official symptom list. An Omicron infection may not result in the classic triad of cough, a fever or loss of sense of smell or taste. Instead, symptoms include ‘feeling tired’, a loss of appetite, headache, diarrhoea, a blocked nose, a runny nose, feeling sick and general aches and pains. This is not very helpful as there isn’t anything from Lassa fever to decapitation that won’t cause at least one of those. Of course, what they are trying to say is that, if you are feeling in any way unwell, consider that you may have a coronavirus infection. However, after listing these symptoms, the NHS website then tells you that you are no longer able to obtain a free NHS COVID test and instead advises that you should stay at home to avoid passing any potential infection on to others. Or go out and buy a COVID test.

Anyway, whilst I was away in the Lakes, discovering that I don’t hike as well as I used to and that my knees have seen better days, the NHS was experiencing its busiest ever Easter. Attendances at our A&E broke all previous records and, by the 22nd April the hospital contained a total of 197 COVID patients, the highest number since January 2021. The situation was made worse by the fact that the staff COVID absence rate, which had been falling, began to climb again and peaked over the holiday period.

Once again, Critical Care fared better than A&E and Acute Medicine, although at one point we had as many as seven COVID positive patients. This meant that we had to convert one of the ICUs back into a pure COVID ICU again for a week or so until numbers fell. Once again, despite these patients needing ICU, COVID had played little or no part in their illness. However, we did see one case of classic COVID pneumonitis in an older, at risk patient. This was the first case of COVID pneumonitis that we had treated since January. Unfortunately our patient did not survive.

The story has been the same in every hospital up and down the country. The Omicron wave continues to ensure that winter pressures are still being felt, even as we head rapidly toward the summer. Hospitals are being left to cope with little support from the Government. Everyone is feeling that Downing Street has all but abandoned a beleaguered NHS. It seems that the pandemic is one party that No.10 feels is well and truly over.

Fortunately, it looks like the Omicron wave is finally waning. Initial predictions that the whole population would have been infected by mid-February now seem woefully naïve. The ONS COVID Infection Survey reports that the number of people infected across the UK is falling and fewer than 1 in 15 people are currently infected. The ONS also reports that their data suggests that more than 70% of the English population have been infected with COVID-19 since April 2020. As well as cases falling across Teesside, we have seen the number of hospital admissions fall slowly over the last three weeks and the death rate is also decreasing. Hopefully things will begin to calm down and we can look forward to the end of ‘winter’ in a month or two.

My mountain bike trip to the Peaks was with a group of cycling buddies that included my friend Gary. Gary spent many weeks on a ventilator with COVID pneumonitis, way back at the start of the pandemic. This was the first time the group had seen each other and ridden together in over two and a half years. COVID has left Gary with long-term damage to his lungs although you would struggle to notice if you met him in the street. He was on his new e-bike which, given his reduced lung function, levelled the field and allowed us all to ride at the same pace. It was comforting to see that, as we climbed to the top of Mam Tor, everyone was just as breathless as each other. Back in April 2020, whilst Gary was doing his very best to die, none of us dared to imagine that he would ever cycle again, so it was quite something to be back on the top of a mountain together. It was one of those moments when you realise just how long it’s been since you last did something that felt ‘pre-pandemic’. We all vowed to have more of them this summer.

Mam Tor

Left to Right: Gary, Buzz, Me, James, MK