UK Dashboard July 14th - 42,302 New COVID Cases
#16,065
With the UK set to end nearly all legal restrictions on social contact 4 days from now - against the backdrop of continually rising COVID cases (see graphic above) - there are understandable concerns over what this fall and winter (and beyond) may look like.
We are already seeing increases in non-COVID respiratory diseases in some places where face mask requirements, and social distancing rules, have been relaxed.
SSI: Denmark Also Reporting A Summer Surge In RSV
ESCMID: When Respiratory VIruses Return & New Zealand's RSV Resurgence
CDC HAN: Increased RSV Reports Across The Southern United States
While seasonal influenza remains subdued around the globe, there are genuine concerns it could return this fall and winter - perhaps with a vengeance due to waning community immunity - significantly adding to the burden of pandemic-stretched health delivery systems.
While we've discussed the potential for seeing a `twindemic' of COVID and influenza a number of times over the past year (see June 2020's COVID-19, The Next Flu Season, And The Temporary Immunity Hypothesis) - so far, between `viral interference' and the public's use of NPIs - it hasn't come to pass.There are also early indications (see PHE Study: Co-Infection With COVID-19 & Seasonal Influenza) that being infected with both COVID and influenza greatly increases the risk of severe disease, and even death.
Overnight the UK Academy of Medical Sciences releases a lengthy (133 page PDF) report on what this fall and winter - and beyond - may look like with both COVID-19 and other respiratory illnesses concurrently spreading in the community.But with more people discarding their facemasks, and countries continuing to lower their non-pharmaceutical pandemic defenses - the risks of seeing a bad winter respiratory season on top of COVID this fall increases.
While no one has a completely reliable crystal ball, the report's overview lays out their goals:
In July 2020, the Academy of Medical Sciences published its report, ‘Preparing for a challenging winter 2020/21’.4 This year, at the request once again of the Government Chief Scientific Adviser, the Academy established an Expert Advisory Group chaired by Professor Sir Stephen Holgate CBE FMedSci to:
● Explore the health and social care challenges, including inequalities in health, that will be presented by winter 2021/22 in terms of COVID-19 and non-COVID-19 care.● Identify the priority areas for action and likely most effective interventions to manage these challenges, and stakeholders to address these.● Develop a range of scenarios for winter 2021/22 and, where possible, model health outcomes to inform planning.
● Explore the transition towards achieving lower circulation levels of SARS-CoV-2.● Determine outstanding uncertainties that will require further investigation, including research, ahead of winter.
Due to its length, I have only included a few excerpts from the Executive Summary. Follow the link to download and read the full report.
Executive summary
Immediate priorities
Despite a highly successful vaccination campaign in the UK, the coronavirus disease 2019 (COVID-19) pandemic is not over, and we are currently seeing rapidly rising infection rates. While there is an understandable and intense desire for ‘normality’ to return, we need to sustain our efforts to limit the transmission and impacts of the virus, particularly for the most vulnerable, for the longer term.To prepare for the winter period and beyond, the priorities over the summer period must be to:
● Maximise the speed and uptake of COVID-19 vaccination in all eligible age groups, and prepare for possible booster vaccines in priority groups and vaccination against influenza later in the year.● Increase the ability of people with COVID-19 to self-isolate through financial and other support, with a particular focus on those in areas of persistent transmission and in the lowest socio-economic groups.● Boost capacity in the NHS (staff and beds) to: build resilience against future outbreaks of COVID-19 and other infectious diseases, including through improving infection prevention and control (IPC), increasing vaccination and testing capacity for COVID-19 and influenza, adequately resourcing primary care, and reducing the backlog of non-COVID-19 care.● Provide clear guidance about environmental and behavioural precautions (such as the use of face coverings, ventilation and physical distancing) that individuals and organisations can take to protect themselves and others, especially those who are most vulnerable from infection.
Underpinning principles for success
In working to achieve these priorities and addressing the challenges ahead, the following key principles must be applied to ensure the most successful and equitable outcomes:
● Reduce inequalities. The pandemic has had a disproportionate impact on certain groups, including individuals from poorer and disadvantaged backgrounds, ethnic minority groups and deprived regions, who have shown greater COVID-19 mortality rate and poorer outcomes. The economic impact of the pandemic and repeated lockdowns is likely to have longer-term negative health impacts for groups already experiencing structural inequalities. All measures implemented to address the pandemic and the UK’s recovery must seek to halt and reverse the unequal impact of the pandemic on health and wellbeing. This will include prioritising those with the greatest need, ensuring that communication is appropriate and that access to prevention of infection and expert care is available to all.● Effective engagement and communication. Communication should focus on enabling people to understand the latest evidence on symptoms, transmission and effective mitigation. To maximise their effectiveness and to ensure they do not exacerbate inequalities, preparations for this winter, longer term adaptation plans and communications must be informed by engagement with and involvement of patients, carers, the public and healthcare professionals. We The Academy of Medical Sciences 5 support co-development where possible, which should be properly resourced, inclusive, transparent and recognise power inequalities.● Empower and resource local public health capacity. As we see greater variability in COVID-19 transmission and outbreaks at a local level, there needs to be a collaborative partnership between central government - who provide standards and consistency - and local authorities who should lead outbreak investigation and control. Local responses should be co-designed with local communities and delivered through local public health teams and primary care.
The challenges for winter 2021/22 and beyond In this report, we outline three key challenges that will be faced by the UK this winter and beyond:
● A resurgence of respiratory infectious diseases, including COVID-19, influenza and respiratory syncytial virus (RSV). Our modelling suggests that there will be a third peak of COVID-19 infections over the summer of 2021, although the timing and magnitude of the peak are uncertain. Mortality may be less severe than last winter but a rise in infections will put pressure on the health service and lead to higher levels of long COVID. The possibility of a further new variant is also of concern. Outbreaks of RSV in the autumn and influenza in the winter could be around twice the magnitude of a ‘normal’ year, and might overlap (at least partially) with a peak in COVID-19 infections.● Wider health and wellbeing impacts of the pandemic, including long COVID, mental and physical deconditioning, and the impact of delays in diagnosis and disease management during the pandemic. During the winter months, noncommunicable diseases (NCDs) such as asthma, chronic obstructive pulmonary disease (COPD), ischaemic heart disease, myocardial infarction and stroke are likely to be exacerbated.● Continued disruption to health and social care service delivery, including managing the backlog of treatment and diagnosis, incorporating IPC measures, and the financial precariousness of social care. By the winter, staff across the sectors will have been responding to a prolonged pandemic for over 18 months, with many directly affected by COVID-19, thereby compounding issues of staff capacity and vacancies.
Added to these, ongoing uncertainties remain over the: duration of post-vaccination immunity in different groups (and safety in children); likelihood of and impact of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, including the possibility of vaccine-resistant variants. This is in addition to the development and availability of treatments and prophylaxis for COVID-19; and prevalence, duration, severity and ability to treat, long COVID
Assuming we are lucky enough not to have to deal with another emerging pandemic threat (e.g. MERS-CoV, Avian Flu, Swine Flu, Virus X, etc.) in the near term, the path ahead is still strewn with pandemic perils, only a few of which we can anticipate.
- The impact of `Long COVID' - particularly among those with mild illness - remains largely unknown, but we've seen examples in history (see The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?) that post-viral infection sequelae can be be devastating on both an individual and societal level.
- Current vaccines appear to provide significant (albeit, reduced) protection against severe disease from known COVID variants, but as vaccine uptake increases, there will be increasing pressure on the virus to evolve to evade them.
- The role that non-human hosts may play in the preservation, and evolution, of SARS-CoV-2 remains a genuine concern (see SSI Study: Denmark's Cluster-5 mink Variant Had Increased Antibody Resistance).
- And the combined impact of co-circulating COVID and influenza has yet to be fully tested.
All of which suggests that it is far too early to start celebrating the imminent demise of the COVID pandemic, and that we risk seeing substantial setbacks if we abandon our pandemic protections (face masks, social distancing, hand hygiene, etc.) prematurely.
Lessons we somehow still seem inclined to learn the hard way.
