What has changed between the first and second waves?

ACCELERATING INFECTION RATE CAUSING CONCERN

WITH the whole country poised to enter lockdown on Thursday, numbers of coronavirus cases and hospital admissions in Nottinghamshire paint a sobering picture of the scale of the challenges ahead.

The county is classed as one of the highest-risk areas in the UK by the government and was placed under Tier 3 restrictions shortly before Prime Minister Boris Johnson announced the national lockdown.

With events beginning to mirror the first wave of coronavirus cases earlier this year, the government is hoping a second lockdown will produce a similar “flattening of the curve”, bringing down hospital admissions, infection rates and coronavirus cases before Christmas.

There are several differences in approach this time around. Schools and universities are remaining open, for example, and high-level sports, such as Premier League football, will continue.

So what differences are we seeing between the first wave and the second wave of coronavirus here in Nottinghamshire?

According to Dr Andrew Haynes, executive lead for the Integrated Care System in Nottingham and Nottinghamshire, one striking difference is the acceleration in the rates of infection and hospitalisation this time around.

He said: “This is partly speculation, but wave two does look slightly different in the way it’s arrived and manifested - certainly, it’s come very quickly.

“I think there’s something here about the speed with which it has spread across the community and the number of people who are infected, be they symptomatic or asymptomatic.”

One of the biggest differences in Nottinghamshire and nationally is the number of people being tested. On Monday, March 30, just after the

UK had been placed in lockdown, 23 daily cases were reported. In comparison, with much higher access to testing, in the 24 hours to October 30 there were 554 cases.

There has been a marked difference in hospitalisation rates, too, which is concerning for public health bosses. The number of coronavirus patients is currently 40 percent higher than in April.

But as Jonathan Gribbin, director of public health at Nottinghamshire County Council, explains, the rising hospital rates are a reflection of behaviour displayed about three weeks earlier.

He said: “We just need to reiterate that what we see happening in our hospitals is fuelled by the infection rates we are seeing in the community.

“Although it is rates in over-60s that have been the cause of such grave concern, because that is immediately driving up action in the hospitals, an infection anywhere in the community is a concern for us.

“What we see happening in the hospitals now is a result of what happened in the community about three weeks ago. Three weeks ago, roughly speaking, they (patient numbers) were about a third of what they are now.”

In the seven days to October 28, 49 deaths were recorded across all three hospital trusts. This remains far below levels seen earlier in the year during the first wave, however.

In the week ending May 1, 115 deaths were recorded across Nottinghamshire.

Another difference between the two waves is the way patients are being treated in our hospitals.

Dr Haynes says more patients are being treated with oxygen therapy, which means fewer are being treated in the intensive care unit so far.

But he expects to see “increased pressure” on ICU units across all three hospital trusts.

He said: “There is undoubtedly more testing, so we are finding more people who are attending, who aren’t known to have symptoms, but more than half of the patients in the hospital are on oxygen therapy.

“So it’s fortunate we’ve seen fewer patients in ICU so far, that seems to be the national picture and may reflect the learning we have had from wave one with better treatments both for patients who are sick but are not requiring intensive care and those in intensive care.

“So I think that’s a bonus, but, of course, that puts more pressure on our beds and we yet remain to know whether we are going to see increasing pressure in intensive care over the coming weeks – I think that’s quite likely.

“As to what the other factors are, I think it’s speculation and there’s not a great deal of difference in the characteristics of the patients who are coming in.

“The age range is as we would expect, but I think the speed this has happened in Nottinghamshire is quite striking and appears to be on a par with Liverpool.”

Before Nottinghamshire was placed into Tier 3, there was a huge spike in the infection rate in Nottingham - which eventually led to the city having the highest infection rate in the country.

A heat map released by the Department of Health and Social Care indicated how many young people had tested positive in the county compared with other age groups.

On October 8, for example, 1,609 16 to 29-year-olds tested positive, while 89 over-60s and 77 0 to 15-year-olds contracted the virus.

David Mellen, leader of Nottingham City Council, admitted the rise in cases in the city, and among young people, was partly down to the return of university students.

He said on October 7: “Quite a number of the new cases have been from people aged between 18 and 22 and universities have obviously gone back and that is a factor.

“I think it’s very difficult when you have 45,000 students in Nottingham, when those people return there is going to be an increase.

“We are working very closely with the universities. I think there is always a possibility that universities could have done more.”

The message from the government is now the same as it was during the first wave: stay at home, protect the NHS, save lives.

The hope is that, while case rates and hospitalisation rates are already beyond those seen in the first wave here in Nottinghamshire, the death rate does not rise to a similar level.