Urgent need for a UK Coronavirus integrated Plan for this winter

On Tuesday 14th July, the Academy of Medical Sciences published an 80 page report detailing how the UK must immediately prepare for a potential second wave of coronavirus infections this winter. The second wave could be more serious than the first with a worst case scenario of 120,000 deaths.The report was commissioned by Sir Patrick Vallance, Chief Scientific Officer.

This report should serve as a blueprint for developing a single integrated plan for the four Nations of the UK to prepare for this serious risk to public health. This is exacerbated by the disruption already created in the NHS by the first wave of Covid -19 , the significant backlog of patients already needing urgent assessment and treatment, and the possibility of a flu epidemic.

These new pressures are in addition to the challenge winter usually presents to the NHS, when other infectious diseases are more common and conditions such as asthma, heart attack, chronic obstructive pulmonary disease and stroke tend to worsen.  

The ‘Preparing for a challenging winter 2020/21’ report stresses that ‘intense preparation’ is urgently needed throughout the rest of July and August to reduce the risk of the health service being overwhelmed and to save lives this winter. This includes:

  • Minimising transmission of coronavirus in the community, with a public information campaign for all, as well as advice tailored to individuals and communities at high risk.
  • Reorganising health and social care staff and facilities to maintain COVID-19 and COVID-19-free zones, and ensure there is adequate PPE, testing and system-wide infection-control measures to minimise transmission in hospitals and care homes.
  • Increasing capacity of the test, trace and isolate programme to cope with the overlapping symptoms of COVID-19, flu and other winter infections.
  • Establishing a comprehensive, near-real-time, population-wide surveillance system to monitor and manage a winter wave.
  • Guarding against the worst effects of flu with a concerted effort to get people at risk, and health and care workers safely vaccinated.

The Academy has also released a ‘Peoples perspective’ report, written by patients and carers that calls for these actions to be developed through engagement with patients, carers and the public to ensure services, guidelines and communications work for people, rather than focusing plans on individual medical conditions.

Research suggests that COVID-19 is more likely to spread in winter with people spending more time indoors and the virus able to survive longer in colder, darker winter conditions. The report notes there is a high degree of uncertainty about how the COVID-19 epidemic will evolve in the UK over the coming months, but suggests a ‘reasonable worst-case scenario’ to prepare for is one where the average number of people that one infected person will pass the virus on to (Rt value) rises to 1.7 from September 2020 onwards.

Modelling of this scenario suggests there would be a peak in hospital admissions and deaths in January and February 2021 similar to or worse than the first wave in spring 2020, coinciding with a period of peak demand on the NHS. It estimates the number of COVID-19-related hospital deaths (excluding care homes) between September 2020 and June 2021 could be as high as 119,900. However, these figures do not take account of the fact that Government would act to reduce the transmission rate, or the recent results from a trial to treat patients in intensive care with the steroid dexamethasone, which could substantially reduce death rates.

Professor Stephen Holgate FMedSci, a respiratory specialist from University Hospital Southampton NHS Foundation Trust, who chaired the report, said: “This is not a prediction, but it is a possibility. The modelling suggests that deaths could be higher with a new wave of COVID-19 this winter, but the risk of this happening could be reduced if we take action immediately.”

“With relatively low numbers of COVID-19 cases at the moment, this is a critical window of opportunity to help us prepare for the worst that winter can throw at us.” Failure to cope with these winter pressures could create a burden of health problems which could last for decades.

The report highlights the backlog of patient needs created by halting non-urgent appointments and procedures during the first wave of the COVID-19 pandemic, with an overall waiting list that could stand at ten million by the end of this year. It also explains that the NHS is still severely disrupted by the pandemic, with staff and facilities redeployed to cope with the first wave, and notes that measures put in place to prevent the transmission of COVID-19 also reduced NHS capacity. The extra pressures of winter will mean a similar reorganisation will not be possible.

“Faced with these potential challenges, and after an already tough year, it would be easy to feel hopeless and powerless. But this report shows that we can act now to change things for the better. We need to minimise coronavirus and flu transmission everywhere, and especially in hospitals and care homes. We need to get our health and social care, and the track, trace and isolate programme ready for winter. This can be done, but it must be done now.”

Yesterday at Prime Minister’s questions, Sir Keith Starmer asked Boris Johnson if he had read the report….it was clear that he had not, but he “was aware of the report”. click here for savage satire of PMQ

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