Abstract
The UK has just three months to get ready for a covid-19 second wave that could be deadlier than the first, reports Jessica Hamzelou
A PARTICULARLY challenging winter in the UK could bring a second wave of coronavirus infections that results in around 120,000 hospital deaths – twice as many as the first wave – according to an estimate of a reasonable worst-case scenario.
Assuming lockdown restrictions continue to ease, the average number of people one person with the virus goes on to infect, known as the R number, could rise in the UK from the current estimate of between 0.7 and 0.9 to 1.7 by September, say the scientists behind a report. This would lead to a second wave peaking in January and February next year.
“A peak of coronavirus infection in the winter could be more serious than the one we've just been through,” report chair Stephen Holgate at the University of Southampton, UK, told a press briefing. “We're anticipating the worst, which is the best we can do.”
The report, requested by the UK government's chief scientific officer, was by the UK Academy of Medical Sciences. It considered what might happen if people went back to a typical way of life and didn't factor in the use of new medicines or a vaccine.
The team considered the known impact of covid-19 on healthcare resources, combined with that of flu and other seasonal infections.
In any given year, deaths in the UK rise in winter, due to the effects of cold weather and the impact of seasonal viruses like the one that causes flu. People tend to stay indoors with their windows closed, providing ideal conditions for infections to spread.
A worst-case scenario would involve an unusually cold winter and a flu epidemic, on top of the backlog of routine care and elective surgery that has already been postponed as a result of the coronavirus outbreak.
If it were to happen, around 119,900 hospital deaths related to covid-19 could be recorded in the UK over the winter – more than double the number seen in the spring, according to the report. The figure is an estimate, and could lie somewhere between 24,500 and 251,000, according to the authors. It also doesn't include deaths outside hospitals, such as in care homes.
The figure isn't a prediction and the UK has a crucial three-month window to avoid this scenario, the authors say.
One important approach will be limiting the impact of seasonal flu. “We don't know how covid-19 will interact with flu,” says report co-author Anne Johnson at University College London. An adequate supply of the flu vaccine will be vital in the autumn, she says. Those who are vulnerable to flu, people working in healthcare and schoolchildren should all have the vaccine, she says.
A peak of coronavirus infection in the winter could be more serious than the one we've just had
Test, trace and isolate schemes will need to be scaled up, according to the report, which also recommends widespread flu testing, so people know which virus they have.
With this in place, the UK might be able to treat many flu infections with antiviral drugs. This hasn't previously been possible due to a lack of testing, says Johnson.
The authors also advise using facilities set up to deal with the coronavirus outbreak, such as the Nightingale hospitals, to help clear the backlog of hospital procedures that have accumulated since the spring.
Any attempts to limit the impact of coronavirus should prioritise those at the greatest risk of severe illness and death, including people who are from black, Asian and minority ethnic groups, and those living in crowded housing, the authors say.
If measures successfully limited the R number to 1.1, the outcome would be very different. “There's a lot to do and we don't have a lot of time to do it,” says Johnson. “The window for action is now.”
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