Two years of lockdown measures and limited exposure to bugs seems to have disrupted the usual patterns of seasonal viruses, health experts have said.
As flu, Covid, infections with respiratory syncytial virus (RSV) and Strep A circulate among the population creating a massive strain on the NHS, it seems some are striking earlier than usual. According to Graham Brown, consultant in communicable disease control for Public Health Wales, Strep A has especially arrived earlier than it's usual peak in spring.
But we are also seeing a return to more normal "waves" of winter respiratory diseases after a near-three years of their spread being disrupted by lockdown measures, Dr Brown added. With all four arriving together, it's placed hospitals across the country under great strain and caused some to declare a major incident. On Monday, Betsi Cadwaladr health board in north Wales declared an internal critical incident as it struggled to cope with "prolonged, unprecedented demand across the health and social care system".
In the week ending December 19, Betsi Cadwaladr diagnosed 300 patients with flu, up 58% on the previous week. This was equivalent to 22% of available acute care beds. Most affected were aged over 60, or four and under.
We've seen stories of hospitals asking people to pick up sick loved ones and care for them at home, data showing that hundreds of people caught Covid in Welsh hospitals over the Christmas period and hospitals warning not to attend A&E due to "extreme pressure".
On Tuesday, a top NHS Wales consultant outlined just why the health care system is on verge of collapse on Twitter. While Swansea Bay Health Board has confirmed that nearly 280 patients in their hospitals are well enough to go home but currently can't, leading to concerns about "bed blocking" which is having a knock-on effect across the whole region.
Flu is "certainly on the rise" in Wales Dr Brown confirmed. The latest data indicates that hospital flu cases in the UK have nearly doubled in a week. But it's not particularly unusual when compared to previous years, before the pandemic, when we were more used to the usual merry-go-round of seasonal infections. For the past two years we've had lockdown and restrictions in place preventing the "normal public circulation" that typically happens over the festive period.
"There's been lots of parties and seeing families so lots of opportunities to have respiratory diseases spreading around," Dr Brown said. "Because of the restrictions in place during the pandemic we didn't see flu spread like we would normally. We've returned to what we would normally see in winter months. We've obviously got Covid still circulating and we've seen an increased number of Covid cases so the wave of that which has hit too."
On Tuesday, December 20, of the 538 patients in hospital with "confirmed" Covid, 72 of them were being actively treated for the virus - the most since July 22 (77 patients).
Strep A is a seasonal virus but this year "it's come early". Dr Brown continued: "We usually see it around early spring. So we've had that a bit earlier than usual. RSV has been on the increase too. All that together has increased pressure on the NHS."
Prof Kamila Hawthorne, the chair of the Royal College of GPs, told the Guardian on December 30: "Figures from the college’s research and surveillance centre show that rates of influenza-like illnesses, respiratory conditions and the common cold have been rising – and we are currently seeing cases of strep, tonsillitis and upper respiratory infections above the seasonal average."
With the number of patients in hospital with flu rising throughout the end of December, some experts have compared it to the winter of 2017-18 which was a really bad flu season, with the highest number of excess winter deaths recorded in England and Wales in more than 40 years – although below-average temperatures may also have contributed.
Dr Antonia Ho, a consultant in infectious diseases and clinical senior lecturer at the MRC-University of Glasgow Centre for Virus Research, told the Guardian: "Flu, in particular, predisposes to secondary bacterial infections. A lot of the group A strep that is currently circulating in children is probably linked to preceding respiratory virus infections.” Indeed, the UK also experienced higher than usual numbers of scarlet fever and invasive strep A infections after the 2017-18 flu season.
Dr Brown agreed: "Strep A is not something we would normally see so that's unusual," he said. "Flu is pretty standard - we always see a rise in December and January and we always get that peak around about now. That's why we recommend to get vaccinated in September and October ahead of the wave we would normally expect."
"Strep A - which can lead to scarlet fever - tends to affect younger children and cases peak in spring usually. We didn't see that last year because we weren't mixing. That's changed the pattern of how it's circulating and we've seen that peak happening in December instead."
At least 30 children have died in the UK from invasive strep A since September - which has triggered a run on hospitals and GP surgeries from concerned parents. Dr Brown reassured people that while the number of deaths being reported as headline figures are serious, they are "very small" compared to the number of cases. The "majority of people" will be fine, he added.
The main strain of influenza circulating in the UK is H3N2, which has been linked to more severe disease, particularly in vulnerable groups such as elderly people and young children. The current flu vaccine broadly covers this strain. Those eligible include children aged 2 and 3 on 31 August 2022, all primary school-aged children and some secondary school-aged children.
Looking ahead, we can use previous years to gauge how things will pan out in the coming weeks: "We know and expect a January peak of flu cases in January," Dr Brown explained. "We know Covid comes in waves and it's likely that over the next few weeks cases will start to fall. When it comes to RSV, early data suggests cases may have peaked but it's still too early to say that for definite."
The key is to understand "when you need to seek hospital care", Dr Brown added. He recommended that people use the NHS 111 service, and seek advice from their pharmacy or GP if their symptoms are "relatively mild". But there is "other stuff" that people can do, he continued. Primarily make sure they are up to date with their vaccinations.
"Vaccination is key to protect people from severe illness," he said. That and "basic respiratory hygiene" such as covering your mouth and washing your hands: "Those measures that were all drummed into us during the pandemic."
The Welsh Government advised people on Tuesday to wear masks in public if they have any signs of a respiratory infection. The new guidance came in response to the high levels of flu and Covid circulating and the "unprecedented demand" on the NHS this winter.
Powys, Aneurin Bevan, Cwm Taf Morgannwg and Betsi Cadwaladr health boards have all asked those with flu symptoms to stay away.
Symptoms of respiratory infections include:
- continuous cough
sore throat, stuffy or runny nose
unexplained tiredness, lack of energy
muscle aches or pains that are not due to exercise
- high temperature, fever or chills
- loss of, or change in, your normal sense of taste or smell
- shortness of breath
- not wanting to eat or not feeling hungry
- headache that is unusual or longer lasting than usual
- feeling sick or being sick.
If you are feeling unwell with these symptoms, the Welsh Government advises people to get plenty of rest and drink water to keep hydrated. Sufferers can use also medications such as paracetamol to help with symptoms. "Antibiotics are not recommended for viral respiratory infections because they will not relieve your symptoms or speed up your recovery," a spokesperson said.
"You should stay at home and avoid contact with others until you no longer have a high temperature or until you feel better. You could ask friends, family, or neighbours to get food and other essentials for you. If you feel well enough to work, you should work from home wherever possible. If you cannot work from home, talk to your employer about options."
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