Ambulance crews treat a patient with possible covid-19 symptoms
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A particularly “challenging” winter could bring a second wave of coronavirus infections that leads to around 120,000 deaths in UK hospitals, twice as many as the first wave, according to an estimate of a reasonable worst-case scenario.
Assuming people acted as though the coronavirus were no longer a threat, the average number of people one person with the virus goes on to infect – known as the R number – could rise from the current estimate of between 0.7 and 0.9 to 1.7 by September, say scientists behind the report, which was requested by the UK government’s chief scientific officer, Patrick Vallance. This would lead to a second wave of infections, peaking in January and February next year.
“A peak of coronavirus infection in the winter could be more serious than the one we’ve just been through,” report chair Stephen Holgate at the University of Southampton, UK, told a press briefing. “We’re anticipating the worst, which is the best we can do.”
Holgate is one of 37 scientists behind the Academy of Medical Sciences report. The group considered what might happen if people went back to a typical way of life, and didn’t factor in the use of new medicines, including dexamethasone, or a potential vaccine. But members also assumed that the UK government would step in to prevent the R number reaching 3, as it did back in March.
To build a picture of what might happen, the team considered the known impact of covid-19 on healthcare resources, combined with that of flu and other seasonal infections, during a time when health services are often overstretched. The researchers also looked to the experiences of other countries, particularly what happened to the R number in US states that have recently eased lockdown restrictions.
In any given year, deaths in the UK rise in the winter, due to the effects of cold weather and the impact of seasonal viruses like the one that causes flu. People tend to stay indoors and keep their windows closed during colder months, providing ideal conditions for the spread of infections.
A worst-case scenario would mean an unusually cold winter and a flu epidemic, on top of the backlog of routine care and elective surgery that has already been postponed as a result of the coronavirus outbreak.
If it were to happen, we could expect around 119,900 hospital deaths related to covid-19 to be recorded over the winter – more than double the number seen in the spring, warn the authors. The figure could lie somewhere between 24,500 and 251,000, they say. It also doesn’t include deaths that occur outside hospitals, such as care home deaths.
The authors caution that the figure is an estimate rather than a prediction, and that the UK has a crucial three-month window to avoid this scenario.
One important approach will be limiting the impact of seasonal flu. “We don’t know how covid-19 will interact with flu,” says report co-author Anne Johnson at University College London. An adequate supply of the flu vaccine will be vital in the autumn, says Johnson. Those who are considered vulnerable to flu, people working in healthcare settings and schoolchildren should all receive the vaccine, she says.
Test, trace and isolate programmes have been found to play a vital role in managing the spread of the coronavirus in countries around the world, and the UK needs to scale up this system to limit outbreaks of covid-19, according to the team. It is also recommending widespread flu testing, so that people will know which virus they have and so their care can be managed appropriately.
With this in place, the UK might also be able to start giving large swathes of the population antiviral drugs for flu infections. This hasn’t previously been possible due to a lack of testing, says Johnson.
There are other important steps the UK should already start taking, caution the researchers. The country should make use of facilities made available during the coronavirus outbreak – such as the new Nightingale hospitals – to clear the backlog of routine and elective procedures that have accumulated since the spring, for example.
Any attempts to limit the impact of coronavirus should prioritise those at greatest risk of severe illness and death, including people who are from black, Asian and minority ethnic groups, and those who live in crowded housing.
If measures successfully limited the R number to 1.1, the outcome would be very different, say the researchers. Infections could be expected to rise slightly over the winter period and would result in an estimated 1300 hospital deaths between September and June 2021.
“There’s a lot to do and we don’t have a lot of time to do it,” says Johnson. “The window for action is now.”
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