Winter warning that could be ‘similar, if

A SECOND peak of coronavirus this winter could be “similar, if not worse” than the first peak seen in March and April.

That’s the warning from NHS Wales chief executive Dr Andrew Goodall, who said the country is currently planning for the “worst-case scenario” in infection rates.

Speaking to the Senedd’s health, social care and sport committee yesterday, Dr Goodall warned that a winter peak could be “much more sustained” and at a higher rate.

He said it was likely that local outbreaks, and local lockdowns, would be required as the virus is known to spread more easily in darker, damper conditions and indoors where people are more likely to congregate as the nights draw in.

Wales’ chief medical officer Frank Atherton also expressed concern at yesterday’s coronavirus briefing that there will be significantly more social mixing going into the autumn, as lockdown is relaxed, than there is currently.

A new report by the Academy of Medical Science, which was commissioned by the UK Government’s chief scientific adviser Sir Patrick Vallance, has called for immediate efforts to prepare for a second wave.

Compiled by 37 experts, it warns that a resurgence of cases could “overwhelm” the NHS across the UK and claim as many as 120,000 lives of patients in hospital. The reasonable worst-case scenario assumes that the “R” value could roughly double to 1.7 across the UK in September. In Wales, it is thought to be at around 0.8 at present. However, the modelling excludes deaths in care homes and the community, assumes no government intervention to prevent transmission, and does not factor in the use of dexamethasone, a drug recently shown to save lives in intensive care units.

“Despite looking to reset normal activity quarter by quarter and into the winter, we absolutely need to assume that there will be a second peak, and that we should expect it to be similar, if not worse, than our experiences in March and April,” said Dr Goodall.

“We have done our own assessment of what we think we’ll need just in terms of providing capacity across the system in Wales. While we may not need as many beds through things like field hospital provision, as we were originally intending, we will still need to have that extra level of contingency in the system to respond.

“The peak is likely to be much more sustained through the winter period, at a higher level. In the winter the virus will act in a more difficult manner. [It will thrive] in cold, more contained surroundings with more people indoors – and the transmission is likely to be higher.

“We are going to have local lockdowns or local outbreaks. I think this will translate into something that will feel much more significant through the winter months, I’m afraid.”

Dr Goodall said he was “reflecting on international experience” when making these predictions, including most visibly in Melbourne where the population has gone into lockdown for a further six weeks.

He added: “We will professionally prepare. We have to make sure that we can respond to some of the assessment of the worst-case scenarios. But we have learnt an awful lot over the past 16 or 17 weeks to maintain as much as we can for as long as possible.”

Similarly, speaking during yesterday, Wales’s chief medical officer Dr Atherton warned that it was unclear how infection rates will evolve in the winter months, adding that Wales needed to “hope for the best and plan for the worst”.

“It might be that we are fortunate and continue to have low levels of the virus”, he said.

“We may also see flareups occur in some locations. In fact, we have already in places as such North Wales and been able to identify them through the Test, Trace, Protect programme and stamp them out.”

But he warned that the prospect of a second wave was “always there”.

“We just don’t know what will happen in the autumn when the circumstances for viral transmission is more favourable,” he said, adding that the more social mixing we have, the higher the risk is for viral resurgence.

He said the Welsh NHS is “working on the assumption” that there will be a second spike in viral transmission.

“We hope that may not be the case but we have to plan for that,” he said.

The ‘worst case scenario’ warning from the Academy of Medical Sciences comes to the following conclusion: “During a typical winter, the NHS and social care systems are normally at or close to full capacity.

“A colder winter also triggers even more illness, as well as more accidents leading to broken bones for older people, adding to the pressure.

“We have identified four serious challenges that will be faced this winter: ■ 1. Rising cases – Our models suggest that Covid-19 cases will rise again in the autumn and peak in January/february – the busiest time of year for the NHS. We estimate that in a worst-case scenario there could be 119,900 hospital deaths – at least double the number from the first wave. The figures are based on the assumption that it will not be possible to introduce a lockdown as effective as the one imposed in March 2020. Our models do not take into account the use of new drugs, treatments or potential vaccines. ■ 2. NHS disruption – The disruption caused by Covid-19 will make it harder for the NHS to deal with non-covid patients. The mass reorganisation of staff, beds and hospital services that took place in the first wave is unlikely to be possible at the same scale this winter because of other pressures, increased staff sickness and the need to treat patients whose care was delayed by the first wave. ■ 3. Backlog of routine care – The backlog of noncovid-19 care following the suspension of routine operations, consultations and tests in spring/summer 2020 will add to the pressure. NHS waiting lists could increase from 4.2 million before the pandemic, to 10 million by the end of the year. ■ 4. Seasonal flu - Another wave of Covid-19 this winter is likely to coincide with the flu season. It is impossible to predict how serious flu will be this winter, but the most recent serious epidemic in 2017/18 led to more than 17,000 excess deaths.”

Despite looking to reset normal activity quarter by quarter and into the winter, we absolutely need to assume that there will be a second peak, and that we should expect it to be similar, if not worse, than our experiences in March and April

- NHS Wales chief executive Dr Andrew Goodall