A new report published by the Academy of Medical Sciences in The Lancet Respiratory Medicine on August 6th 2021 has warned that the UK could face exceptionally large outbreaks of a respiratory syncytial virus and influenza during the autumn and winter in 2021 and 2022.
The surge infections could overlap with the spike in cases of COVID-19 that is expected to follow the lifting of lockdown restrictions across the country.
The authors suggest that the healthcare systems must plan for a high burden of respiratory diseases. They urged the Government to roll out point of care joint testing for influenza, SARS-CoV-2 and RSE in order to ensure that the influenza vaccine is widely taken up by eligible populations.
The warning partly reflects the success of the precautions that are being deployed against SARS-CoV-2.
Mask wearing, social distancing and sharply constrained population movements have dramatically reduced the transmission of respiratory pathogens such as RSE and influenza.
Hospitals in Italy and France reported drops of more than 80% in the number of paediatric patients treated for acute bronchiolitis during the 2021 season, compared to previous years.
Australia, Chile and South Africa registered just 51 cases of influenza between them over the entire 2020 southern hemisphere winter. In the USA, the 2020/2021 influenza season was the mildest since at least 1997, the earliest year for which records are available.
The vast majority of children contract respiratory syncytial virus before the age of two years. The authors are concerned that there is a whole group of children who have not been exposed to the virus for 18 months to two years as the vast majority of children contract RSV before the age of two years old. The greater the risk of a sizable outbreak once the virus starts circulating.
England discontinued nearly all of its lockdown restrictions on July 19th 2021. Scotland and Wales are scheduled to do the same by mid-August. Even though there are several weeks of summer remaining, cases of RSV are on the rise (The USA is also seeing an out of season increase in RSV infections). Whether this will translate to an increased hospitalisation remains to be seen.
The Academy of Medical Sciences report recommends that children’s wards and paediatric intensive care units should be ready for a potential influx of patients with RSV, otherwise they could find themselves overwhelmed.
Modelling studies undertaken for the report suggested that a reasonable worst case scenario for an RSV outbreak somewhere in the region of 1.5 to 2 times greater than during a typical year, assuming the UK stays out of lockdown.
The results for the modelling studies for influenza were similar. The Academy warn there has been a waning of immunity to influenza and also there have not been enough cases elsewhere in the world to offer a strong idea of what needs to go into the vaccine. The mildness of the 2019/2020 influenza season in the UK might have further reduced population immunity.
Much is uncertain. We do not know what the influenza virus is going to look like when it returns argues Rachel Baker, Associate Research Scholar at the Department of Ecology and Evolutionary Biology at Princetown University.
She goes on to argue that it is not known how the virus evolved during the period of low case numbers. Will there be a strain that people have been exposed to or vaccinated against in the past. It is also unclear how the British will respond to the easing of lockdown restrictions.
Without a national mandate for mask wearing and distancing, much will come down to individual behaviour and no one really knows how people’s behaviour will change. They argue that vulnerable populations should still continue to wear masks in crowded public places.
Hospitals will have to quickly identify which patients have influenza and which ones have COVID-19 and ensure there are two sets of patients are kept separate from each other and from vulnerable patients who do not have any respiratory symptoms.
At the centre of the response will be the vaccines for COVID-19 and influenza. More than half of the UK population has already been vaccinated fully against COVID-19. All adults in the country are now eligible for the first dose of the vaccine.
In 2020/2021, take up of the influenza vaccines stood at 76.8% for frontline healthcare workers and 80.9% for individuals over the age of 65.
As it turned out, the healthcare system only had to deal with COVID-19 last winter. This year could be very different. The Academy argue that there could be RSV, influenza and SARS-CoV-2 circulating at the same time and they just do not know how the whole combination will pan out.
The London General Practice, the leading London doctors’ clinic in Harley Street advises all vulnerable patients to still wear masks in confined spaces and commends the Government on its vaccination programme. It encourages all those eligible to be vaccinated.
Dr Paul Ettlinger
BM, DRCOG, FRCGP, FRIPH, DOccMed