What health experts say about the autumn COVID wave currently hitting the UK and what they think we should do next.
First published: Oct 2022.
President Joe Biden recently told CBS News’ 60 Minutes, “The pandemic is over. We still have a problem with COVID. We’re still doing a lot of work on it. But the pandemic is over. If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape, and so I think it’s changing.”
So, the pandemic is over... or is it?
Surge in cases as early as mid-October
“The coronavirus outlook is further complicated, potentially, by the twindemic.
“What is happening in Australia is a good predictor for what could happen in England.
“The modelling suggests that we will see an escalation or a surge in coronavirus cases around the end of November and early December.
“That increase could happen sooner, with case rates showing an upward trend towards mid-October.
“It is not a risk to overall health, except in certain vulnerable groups.
“The challenge is more staff resilience and business continuity, basically lots of people falling ill and staying at home as service suffers.”
Winter is coming, be prepared
“The increase in the R-value showing how much the virus is spreading is down from last week [in Israel]. We are keeping an eye on it. But according to what has occurred in the Southern Hemisphere that is finishing up its winter, a combination of COVID-19 and the flu can be deadly, especially for people at high risk such as the elderly and those with chronic diseases.
“We must celebrate holidays as we did before the pandemic, but we must protect ourselves and our relatives and friends. Personal responsibility is key to getting through this. We in the Health Ministry will continue to explain and provide what is needed.
“The more protected the public, the lower the risk of a new COVID-19 wave and the smaller the danger of hospitalization at death.”
Flu and COVID combination a serious risk to health
“Flu and COVID-19 are unpredictable but there are strong indications we could be facing the threat of widely circulating flu, lower levels of natural immunity due to less exposure over the last three winters and an increase in COVID-19 circulating with lots of variants that can evade the immune response.
“This combination poses a serious risk to our health, particularly those in high-risk groups.
“The H3N2 flu strain can cause particularly severe illness. If you are elderly or vulnerable because of other conditions you are at greater risk, so getting the flu jab is a sensible, potentially life-saving thing to do.
“We are extremely fortunate to have vaccines against these two diseases.
“Younger children are unlikely to have built up any natural immunity to flu and therefore it is particularly important they take the nasal spray vaccine this year.
“So, if you are offered a jab, please come forward to protect yourself and help reduce the burden on our health services.”
Start of anticipated COVID winter wave
“It is clear now that we are seeing an increase which could signal the start of the anticipated winter wave of COVID-19 – so the time to boost your protection with a vaccine if you’re eligible is now. Cases have started to climb and hospitalisations are increasing in the oldest age groups.
“In the coming weeks, we expect a double threat of low immunity and widely circulating flu and COVID-19, creating an unpredictable winter and additional pressure on health services. While COVID-19 and flu can be mild infections for many, we must not forget that they can cause severe illness or even death for those most vulnerable in our communities.
“If you are unwell this winter, please try to stay at home and avoid contact with vulnerable people – this will help stop infections spreading.”
Prepare now to prevent disruptions
“What should we expect from SARSCoV2 this autumn? I think it would be smart to prepare for both an increase in COVID-19 due to seasonal (behavioural) change and a new variant. As so many others have elegantly illustrated, new lineages are sparking interest.
“Since the dominance of BA.5 (22B), most of the world hasn't seen much else move in (though in some places BA.4/22A hangs on), with the exception of India and BA.2.75 (22D). However, in the background SARSCoV2 hasn’t stopped changing, and recently a spate of new variants have been identified that seem to have converged on similar sets of mutations.
“Why does this matter? Mutations themselves are random, but what ends up sticking around isn’t – things that give a fitness advantage. When we see something appear multiple times in a short period, it can be a sign that this is something that is working well for the virus now.
“The two variants under most discussion at the moment are BQ.1.1 (which comes from BA.5/22B) and BA.2.75.2 (which comes from 22D). Both have predicted growth advantages.
“Currently, we expect that selection pressure on the virus is largely to get around immunity, with so much of the world having a level of protection due to vaccination, infection, or both. This is a long-term game for many endemic viruses. So it is not surprising, but the big questions are when? and how much? WHEN might a new variant start to sweep through and dominate? HOW MUCH will it matter in terms of cases and clinical severity? And these are not easy questions to answer at the moment.
“So, question 3: What should we do? Given the time of year and what we are seeing in mutations and growth, I think we may well face a double-impact of autumn and a new variant in the next couple of months. We should prepare for this, and hope we don’t need those preparations. We don’t know and can’t currently predict ‘how bad’ such a wave might be. But, even if it is fairly ‘not bad’, we saw a notable impact of BA.5 (which was ‘not bad’) this summer due to absences, particularly in hospitals and airlines.
“While hospitalizations and deaths are obviously the most critical of outcomes, we do seem to be stuck in a bit of a black-and-white that if these are low, everything else is fine. I think we need to change that. Huge workplace absences can really impact our society.
“So, WHAT should we do?
- Start and encourage booster roll-out;
- Decide our ‘thresholds of action’;
- Make a plan for how to react;
- Publicise so people are prepared.
“No government is keen to encourage masks or home-office again, I know! But in my opinion, it is better to have these on the table to prevent disruptions to schools, transport, infrastructure, and deliveries, if cases and absences start to threaten those this autumn/winter.
“In a personal way, you can help too: when cases rise and/or you are in a crowded, ill-ventilated place, wear a mask! If you are sick (with anything at all!) stay home if at all possible. Even if not COVID, nobody wants your cold! (And those cause absences too!)
“We have got a lot of experience (and immunity!) under our belt now – we will never be back to those first pandemic times. But at the same time, it is smart to stay alert and prepared. This winter will be tough in many ways – let’s do what we can to stop COVID making it tougher!”
Ventilation, ventilation, ventilation
“I know it’s going colder, but COVID is on the way up again and pretty fast so please don’t abandon ventilation. It’s still important if you’re mixing indoors. There’s a few things you can do to improve indoor air without a massive energy bill
“When you’re interacting with others even just opening windows for short periods can help to refresh the air without making it too cold. Opening high level windows can enable ventilation but mitigate cold drafts.
“In workplaces, schools, etc, CO2 monitors can help manage ventilation and comfort. If you have a very low CO2 but it’s cold, your monitor can tell you when to close windows as well as when to open. Keeping Co2 around 800ppm is best, but even around 1000ppm is better than no ventilation.
“And if you’re regularly in shared spaces that are hard to ventilate, seriously look at adding an air cleaner. They can be really quite low energy (less than opening windows when it’s cold) and they do work.
“And on top of this, get your booster and fly jab when offered, try and stay home when sick, and when cases get high or if you think you may be infected and need to go out then don’t forget about masks – as a short term measure they can make a real difference.”
Worse than the last wave
“With cases already rising, it looks like we are in for a bad October and it’s likely to be worse than the last wave.
“COVID cases still rising and due to hit 200,000 daily new cases but colds are even more common now and rising even faster – maybe we lost some of our cold immunity?”
▫ Professor Tim Spector, Professor of Genetic Epidemiology, King’s College London. Head of Department, Department of Twin Research & Genetic Epidemiology.
Full effect of new variants still not felt
“BA.2.75.2 and BQ1.1 [variants] have mutations in their spike protein that help them to partly escape from BA.5-induced immunity.
“Combined with the fact that COVID hospitalisations have already started rising again in the UK, and that the full effect of these variants still isn’t felt, I would say this is not such great news.
“Most scientists believe that our high population immunity will cause the infection fatality rate to keep on declining. But any new infection wave will of course add to the toll of the pandemic.
“I can only recommend everyone that is offered a booster to go and get one: this is the best way to protect oneself from severe disease, and limit the impact of any new wave.”
New COVID wave: Combination of behaviour, waning immunity and variant soup
“Prevalence of COVID in the UK: going up steeply in Wales, less fast in England (BUT data only up to 17-Sep for England), Northern Ireland and Scotland less clear. Although less reliable data, the trend in ZOE symptom tracker is UP. In England, it is going up in all age groups and regions now.
“What’s behind it? A combination of behaviour, waning immunity and variant soup. New Omicron subvariants crop up every week, outperforming the previous ones: so the general soup is worse now than a few months ago even if none of them is dominant. The September batch is increasing (but low) – who knows how far they will get.
“[Hospital] admissions are increasing sharply in England in all regions, driven by the over 65s. Bigger increase in ‘in-hospital’ cases: it could be due to less testing picking up incidentals, but also less testing and masking making it more likely for patients, staff and visitors with COVID to infect others. It ‘shouldn’t’ be that high, that’s for sure. Nonetheless the number of patients where COVID is the primary reason for admission increase steeply as well (not just secondary and incidental patients).
“Deaths are flat (in all nations). It is too early to see anything from this wave yet. But note that over the last year COVID-19 deaths far exceed the average annual flu AND pneumonia deaths. Also, just this year we are already at ~26,000, on a par with an average full year of flu AND pneumonia.
“For mitigations, we are doing well with the autumn booster and the over 75s are well vaccine protected. But the under 50s have not been boosted for 9 months now and other protective behaviours are falling away a lot.
“Kids of course remain under-vaccinated, particularly the 5-11 year olds – which is a shame when such a safe and effective vaccine is available (although kids DO need boosting).
“Mitigations matter because people being able to lead their daily lives matters, even with much reduced deaths and admissions. Being sick two or three times a year from COVID is no fun (on top of colds, etc!). Nor is Long COVID.
“Ask your employer to sign the Independent SAGE pledge!”
▫ Professor Christina Pagel, Professor of Operational Research, Clinical Operational Research Unit, University College London. Member of Independent SAGE.
NHS staff: they cared for us then, why don’t we care about them now? | Unsplash/John Cameron
NHS system under-resourced
“Our system is under-resourced. We don’t have enough beds, and we don’t have the workforce for the demand that we’re being asked to deal with.
“COVID just makes everything that much harder and it’s entirely valid to link this with critical incidents being called around the country. All hospitals are feeling significant levels of pressure at the moment. COVID is a very heavy straw on the camel’s back.
“We need to use what beds we have as efficiently as possible. That means sorting out social care, so people aren’t kept in hospital waiting to leave.
“The spectre of a twindemic of flu and COVID means that winter could become very grim, like two playground bullies getting together and forming a gang.
“What’s happening with urgent and emergency care, particularly ambulance handovers and long waits in emergency departments – this needs to become a political priority. We need leadership and we need grip and investment.”
Acting now is crucial
“COVID is the sixth leading cause of death [in the UK], with more than 300 people dying each week. A stark reminder that this virus remains a threat for the foreseeable future.
“Although it is early days, this rise in cases is consistent with what’s been expected as winter approaches. Acting now to prevent further hospitalisations and deaths is crucial.
“People at higher risk of COVID should get vaccinated as soon as possible. This is especially important for people from deprived and ethnic minority communities, given the disproportionately brutal impact COVID-19 has had on them. Mask-wearing on public transport and in crowded places would also help.
“Since spring this year, overall deaths have been significantly higher than expected compared with previous years, in part due to COVID-19 deaths. There’s a real risk that the toll of excess deaths could mount.
“The NHS was over-stretched even during the summer months when demand for health care is normally lower, and winter will bring added pressures. We, therefore, urge the Government to address the longstanding staffing and funding deficits in NHS and social care services that pre-date the pandemic and continue to limit the ability to meet patients’ needs.”
— AUTHORS —
▫ PMP News reporting
- Text: This piece was originally published in PMP Magazine on 2 October 2022. | The experts write in a personal capacity.
- Cover: Unsplash/Gabriella Clare Marino. (Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)