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The report published by the Academy of Medical Sciences (AMS) looks at what the biggest health challenges might be this winter, and how best to head them off.
This Roundup accompanied an SMC Briefing.
Dr Julian Tang, Honorary Associate Professor/Clinical Virologist, Respiratory Sciences, University of Leicester, said:
“With the lifting of COVID-19 restrictions, there is a concern amongst virologists that the usual seasonal winter respiratory viruses will return.
“This report does not really offer anything new on this aspect – clinical virologists and clinical teams just deal with this every season.
“But with the additional burden of COVID-19, expanding the seasonal flu vaccine coverage may be useful – if this is even possible – due to limited vaccine supplies that will be prioritised for the vulnerable first, as we do each year: https://www.nhs.uk/conditions/vaccinations/flu-influenza-vaccine/
“There is still no vaccine or specific licensed antiviral treatment for these traditional non-influenza seasonal respiratory viruses, and only paediatric RSV infections are cohort-nursed routinely.
“Multiplex PCR testing for respiratory viruses is the norm now in most hospitals – for both adults and children – but the actual clinical benefit of this is still hotly debated, since most infections are mild, when there is no specific antiviral treatment (except for flu), and except for RSV in hospitalised cases, there is no cohorting/segregation for the other respiratory viruses.
“Although lockdown has been unpopular globally, it has been very effective in reducing or completely suppressing the seasonal spread of these viruses – like influenza, parainfluenza, adenoviruses, RSV – all of which can cause viral pneumonitis leading to secondary bacterial pneumonia, as well as exacerbations of pre-existing chronic medical conditions, like diabetes, heart, lung, kidney disease, as well as croup and bronchiolitis in younger children: https://www.nature.com/articles/s41467-021-21157-9; https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.47.2001847?crawler=true; https://onlinelibrary.wiley.com/doi/10.1002/jmv.26964.
“But now with the lifting of all restrictions, and the surging numbers of COVID-19 cases, as people mix more freely, this will also facilitate the spread of these other seasonal respiratory viruses going into the colder autumn/winter months, and we are already starting to see some of this now in the UK – with ongoing rhinovirus but also parainfluenza and RSV cases increasing also: (page21) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1000373/Weekly_Flu_and_COVID-19_report_w27.pdf and influenza (page 20 in the same report).
“These numbers will just get worse going into autumn/winter – this happens each year and we just deal with it – but it just does not it make it into the media.
“All of this, along with the huge backlog of non-COVID-19 medical cases, may make this winter as bad or even worse than last year – and we will not (according to current government promises) be able to lockdown to curtail any of the virus spread.”
Dr Alexander Edwards, Associate Professor in Biomedical Technology, Reading School of Pharmacy, University of Reading, said:
“Regarding “triple tests” specifically:
“The technology is certainly available to detect panels of pathogens. This kind of approach has great appeal, with anyone who has respiratory symptoms being tested with a single swab, which is analysed in an instrument that can detect all the most important illnesses. Their treatment (and health advice, self-isolation rules etc) can then be tailored to the infection detected. It will help enormously to spot the more serious cases, and to ensure people get the best healthcare.
“Rapid instruments able to detect multiple pathogens are likely to be available in many hospitals, who will be particularly keen to separate highly infectious cases (e.g. COVID-19) from other patients and reduce the spread within hospitals. Whether there will be enough instruments and testing capacity available for this to be available widely in primary care remains to be seen.
“The central NHS covid-19 testing laboratory network are technically able to detect different pathogens, not just COVID-19, but I’m not sure if this will be done. There are significant practical considerations that may limit this, but in terms of the assays and workflow, it’s generally the same from swab through to RT-PCR detection of particular nucleic acids.
“Ideally, we would invest in local testing capacity, to make sure we have the testing available where it is needed, with local expertise to support this. The challenge of centralised testing is logistics – how to get samples from people, to the lab, fast enough to provide results in time to make a difference (e.g. treatment or contact tracing/isolating to prevent spread).”
Dr Doug Brown, Chief Executive of the British Society for Immunology, said:
“The last 18 months of the pandemic have been extremely difficult for us all but we must remember that we are not out of the woods yet. This comprehensive report from the Academy of Medical Sciences paints a concerning picture for the upcoming winter. An immediate and continued focus on research, healthcare and public health provision is needed to minimise the serious risks that our country faces as we head into the winter season.
“To maximise the effectiveness of the COVID vaccination programme and minimise health inequalities, we need to ensure very high uptake in all sectors of society. This means redoubling efforts to reach out to communities with lower vaccination rates to engage with them to understand their concerns and answer their questions as well as providing accessible vaccination services for all. Boosting local public health capacity to build long-term resilience into the system is a key tool needed to make this local approach a success. This same impetus needs to be given to the rollout of the winter flu vaccination campaign, which will require significant resources and the success of which will be critical to ensuring the most vulnerable are protected.
“It’s obvious that action is needed now to mitigate these serious risks ahead of winter. However, a longer-term focus is also important to tackle evolving health challenges such as viral variants and the number of people affected by long COVID. Scientific research has delivered us a way out of this pandemic through the development of effective vaccines but it’s crucial that significant investment in COVID research continues so that we can minimise loss of life and improve people’s health.”
Dr Zania Stamataki, Viral Immunologist, University of Birmingham, said:
“While many of us are getting ready for the school holidays and a much-needed break, the Academy for Medical Sciences has looked ahead into the challenges that we are likely to meet on our return. Beyond COVID, the NHS is set to face increased pressures from backlogs, other respiratory viruses and pandemic-fuelled pressures on healthcare staff and patients’ mental health. We would be wise to prepare now for the difficult winter to come.
“This report is a call to bolster our defences by injecting new resources into the health services, expanding our testing capacities to include influenza and RSV and extending clear guidelines for vaccination and infection prevention measures.
“A major strength of this report is that it contains a “People’s perspective” section contributed by a Patient and Carer Advisory group. Priorities were set following consultation with young persons and members of the public from across the UK, with ethnic minority groups represented. There is a strong focus on building resilience in our local communities by reducing inequalities and safeguarding the health and social care system, and better risk communication is highlighted as a key underpinning principle for success.”
‘COVID-19: Preparing the future: Looking ahead to winter 2021/22 and beyond’ was published by the Academy of Medical Sciences at 00:01 UK time on Thursday 15 July 2021.
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Dr Doug Brown: “Trustee of the Association of Medical Research Charities (AMRC).”
None others received.