‘Very challenging’ time ahead from flu and Covid
CORONAVIRUS, a spike in respiratory viruses and an unpredictable flu season will lead to a “very challenging winter” for the NHS in Wales.
That’s according to Professor Kelechi Nnoaham, director of public health for Cwm Taf Morgannwg University Health Board, who said health and social care staff in Wales are in desperate need of a break.
He warned a rise in the number of Covid-19 cases in communities is translating into higher hospital admissions, albeit on a smaller scale than the first and second peaks.
Prof Nnoaham confirmed a higher proportion of younger patients had needed expert hospital treatment for coronavirus compared with earlier waves, with people in the 10 to 19 age bracket driving infection rates in Rhondda Cynon Taf and Bridgend over recent days.
However, in Merthyr Tydfil, which has seen a surge in infection rates over recent days, he said 20 to 50-year-olds – some of whom remain unvaccinated – were the biggest driver of cases.
The professor is urging young learners to take a lateral flow test the night before their first day of school to ensure they don’t bring Covid back into the classroom.
“With Covid infection rates higher than they’ve been for some time, especially among young people, it’s imperative that we take every possible step to stop the virus spreading in our schools and education settings,” he said.
“We’re asking learners to take a lateral flow test the night before they go back to school, and not to attend if they’re positive.
“Once they’re back in school, students should continue to take lateral flow tests twice a week to make sure they’re not spreading the virus unknowingly.
“Young people’s education has been hit hard by this virus, and it’s important we keep classrooms open as much as possible.”
We spoke to him to find out how he thinks the NHS will cope over the traditionally difficult autumn and winter period.
Q. Last time we spoke in July you said hospitals across Wales had “‘virtually no headroom” for another rise in Covid admissions. Clearly there has been another rise – and routine care is also ramping up. How concerned are you that hospitals will soon not be able to cope?
A. Yes, I am concerned. However, it is a measured concern based on what we have seen.
In the first and second waves we became quite used to a situation where the moment we get community cases rising, hospital admissions follow within about two weeks. A rise in deaths then follows within about five to 10 days from that point.
We’ve now had a number of weeks of sustained increase in community cases, but the trajectory that we were expecting in terms of hospital admissions has not materialised. In other words, hospital admissions have not risen at the same rates as we would have expected based on the experiences of the first and second waves.
Having said that, we know that hospital rates are increasing but not at the rates that we’ve come to be used to. That’s why there is reason for assurance and why I talk about a “measured concern” because we now have an effective vaccination programme.
Even when people are being admitted into hospital, they’re not as sick as they were during the first and second waves, and in fact the length of stay in hospital is now much shorter. So there are a number of things that are giving us reason to hope, but at the same time the general picture is that of an increase in hospital admissions – and that’s enough reason to worry. Q. The three local authorities in Cwm Taf Morgannwg UHB, and in particular Merthyr Tydfil, are seeing a surge in their seven-day infection rate. These are areas where people are typically older, have more chronic conditions and are more likely to become very ill with Covid. Are you expecting higher hospital admissions and deaths in these places?
A. Indeed. We have already seen a higher increase of hospital admissions in Prince Charles Hospital in Merthyr Tydfil when compared to our two other two district general hospitals. And interestingly, when you look at the epidemic in those three local authorities, in Bridgend and Rhondda Cynon Taf the increase we’re seeing is fundamentally driven by 10 to 19-year-olds, whereas in Merthyr it’s being driven more by people between the ages of 20 and 50.
It’s possibly to do with vaccination uptake in perhaps older individuals who are absolutely eligible but have not come forward to take the vaccine. Q. So in terms of people that are currently in hospital with Covid, surely we must be seeing a rise in younger people being admitted. Would that be a fair assumption?
A. This is an important point to get across. Across the first, second and current third wave, you are still more likely to go into hospital with Covid if you’re older than if you’re younger.
We did a quick analysis of a recent cohort of 58 patients, and what we saw was a greater proportion are still older people compared to younger folk. However, compared to wave one and wave two, with three we’re seeing more young people in hospital because most of the infection right
now is driven by people between the ages of 10 to 19. So compared to previous waves more young people are coming in the hospital. However, compared to other age groups, even this current wave you’re still more likely to get older people coming into hospital than younger people. Q. What is the latest research on the length of time the Covid vaccine protects people? Is its effectiveness likely to wane for people during the winter months, and does it make a difference what brand of vaccine they took?
A. It depends less on the kind of vaccine you take. I know there are reports that have said if you have a particular kind of vaccine it wanes faster than it does with another kind of vaccine. I think those are isolated research reports.
We need more evidence to be more clear about the relative rate of decay of protective immunity with different vaccines, so at this point we’re not making any sort of policy decisions based on those variables.
However, it is not unexpected that there will be some degree of waning of immunity over time, particularly when it comes to people’s individual personal characteristics – for example, if someone is immunosuppressed.
And that’s why the third vaccination announcement has been made. That’s why there’s also a plan for boosters. So the whole purpose of boosters is a recognition of the likelihood that immunity wanes. Q. How do you see the situation changing as we head into the autumn and winter period?
A. I think we are definitely going to have a very challenging winter in the
NHS. Last year there were a number of predictive modelling studies that pointed out that we would be exactly in the situation where we are right now. One example is the respiratory syncytial virus which is circulating now. It is out of season and doesn’t normally circulate this early, but that was predicted on the basis that lockdowns reduce social contacts.
We are also expecting a very busy flu season. Every year when we constitute flu vaccines it is based on the virus circulating in the previous season. Because of lockdown flu didn’t circulate the previous season, so we are constituting a vaccine around which there might be questions around how efficacious is it going to be. When you put all those factors together – Covid, respiratory syncytial virus in young people and flu circulating in the background – the NHS is braced for a very challenging autumn and winter. Q. What are staffing levels and morale like in the NHS at the moment? Does the health service have the resources and the workforce needed?
A. Workforce is one of our major concerns because a lot of our staff and across health and social care have been through a very challenging 18 months. They live in our communities, so some of them have suffered losses as a result of Covid in their families, some of them have been ill with Covid themselves, and they’ve had to maintain as much resilience as possible to enable us to mount a response to this pandemic.
So a lot of them are tired, and they would have valued a break from this pandemic more than anything else.
Yet no one is able to offer them a break. Instead, what we’re seeing is another challenging winter ahead. Q. And I guess some of the responsibility has to lie with the public this autumn and winter, with people only using the health services that are right for them?
A. I really want people to please think long and hard before showing up in A&E, using hospital services and primary care services.
GPs are also under the cosh, primary care is under a lot of pressure right now, so I urge people to consider whether they actually need to see their GP in the first place, think about whether a community pharmacy might solve your issue instead.