208 reasons for hope after patients discharged from the Royal Bolton Hospital

For the last few weeks the town has focussed its attention on the Royal Bolton Hospital as its heroic staff engage in a life and death battle to save the lives of local people stricken with coronavirus.

Only the sickest people out of the hundreds of people in the borough infected with Covid-19 are admitted to hospital and approximately four per cent end up needing intensive care to support their breathing.

But sadly, despite the superhuman efforts of medics and nurses, many of them do not survive.

Figures released by NHS England yesterday, Sunday, reveal 169 have died with the illness at the hospital and, as of last Thursday, out of the 469 people who have been admitted with the illness, 96 are still being treated but 208 have recovered enough to be discharged.

The Royal Bolton Hospital

Roughly one third of all people admitted to the hospital do not survive but each patient who recovers enough to go home is a victory which encourages those who have cared for them, says Bolton NHS Foundation Trust medical director Dr Francis Andrews.

“We have had survivors from intensive care and certainly that is very, very important for the staff – to show their efforts have not been in vain,” he said.

Despite this there have been some dark times mentally for staff in coping with the outbreak, not least of which was the death of colleague, health care worker Lourdes Campbell, from the illness last month.

“The staff have been absolutely fantastic looking after one another and also the Trust looking after the staff,” said Dr Andrews.

Dr Andrews stressed that many of the patients admitted to hospital with the illness are older or have other medical conditions.

“There is growing evidence that infection with Covid-19 gives a more serious illness in older people, in males and those with previous chronic illnesses, for example high blood pressure or diabetes or severe lung or heart problem,” he said.

“I can’t give the break down for Bolton I’m afraid, except to say that we are seeing that there are more males than females.

“The problem is, though, we just cannot predict who might get seriously ill. We know who is more at risk but there are certainly people who don’t have those risk factors who need to come into hospital and have ended up very, very seriously ill.”

The Royal Bolton Hospital does not have figures for the number of people from ethnic minority communities it has treated for Covid-19 and, while there is concern nationally, Dr Andrews says many factors may contribute to the appearance that they are disproportionately susceptible to becoming seriously ill with coronavirus and more research is needed before conclusions are reached.

Preparations for dealing with the pandemic locally swung into action as soon as it was realised that coronavirus was on its way.

Dr Andrews has experience of dealing with virus outbreaks as he was the consultant in intensive care medicine at Whiston Hospital, St Helens, the time of the H1N1 flu outbreak in 2009.

Dr Francis Andrews

“This is on a much bigger scale than that but lessons were learnt to get the planning right,” he said. “I am very happy that we did get the planning right in Bolton.”

The Royal Bolton Hospital normally has eight intensive care beds where patients can be put on ventilators, but extra capacity was created.

“If we needed to we could put up to 35 patients on a mechanical ventilator,” said Dr Andrews.

“We haven’t needed to do that but we have certainly ventilated more patients than we would normally do.”

Although there were 35 intensive care beds available, at it's busiest the maximum occupied were 25.

Increasing capacity to admit Covid-19 patients meant deferring some routine surgery and redeploying staff to ensure there were enough people to care for the sickest patients.

“The staff have been absolutely magnificent,” said Dr Andrews.

“He have redeployed staff into other areas. They have been trained to work in these new areas.

"Everyone has pulled together getting on very well and we have had some fantastic offers of help, “ he said.

“I am also really proud of out infection control team because we have been able to supply the correct PPE.

"Staff have been protected at all times in accordance with national guidance. We haven’t had instances where staff have had to look after patients without the right PPE.”

Dr Andrews

Dr Andrews emphasised that the hospital’s Accident and Emergency department remains fully functioning and safe for people seeking help with all other conditions.

“We still have the usual life saving range of treatments available,” he said.

And, in conjunction with the Beaumont Hospital and Christie Hospital, urgent cancer surgery has still been able to go ahead.

Unless they need additional specialist care all local people who have needed intensive care due to Covid- 19 have been accommodated at the hospital and, although the number of admissions is now falling, Dr Andrews stressed that it is only because people are generally adhering to the government advice to stay at home and away from other people.

“I would be extremely cautious. We are seeing, at the moment, a decrease in the number of patients needing intensive care and on the wards.

"Although the numbers are slowly decreasing the concern is, nationally, that if we stop doing all the important measures like isolation and only going to work if essential, the number of cases can creep up,” said Dr Andrews.

And with hopes that we may be over the worst of the pandemic, thoughts are tentatively beginning to turn to getting the hospital back to normal, enabling people to have their postponed treatments or operations in the not too distant future.

“We are starting to make plans on how we can increase services offered beyond what we have already,” said Dr Andrews.

“We will be guided by government advice on that.”

Figures from the Office for National Statistics show that 71 percent of people in Bolton who die from Covid-19 do so in hospital, whereas in Greater Manchester the figure is 74 percent and in England as a whole it is 75 percent.

No comparisons between Covid-19 death rates at the Royal Bolton and other hospitals is possible as it is not yet known how many patients they each admitted with the illness.