United Kingdom

Second Covid wave could see twice as many deaths and would require reorganisation of NHS hospitals

Stephen Holgate, Professor of Immunopharmacology and Honorary Consultant Physician at the University of Southampton, said: “The worst case scenario is a real possibility against which to peg out recommendations on. 

“In this scenario we see a new resurgence of Covid-19 and that a peak of coronavirus infection could be more serious than the one we’ve just been through. We are now in a period of relative calm and have the opportunity to prepare.

“Test and trace need to be upscaled in winter and we need to disentangle those that have flu from those that have true coronavirus. Our hospital will need to be reorganised to keep coronavirus and those without it apart. 

“We need to have a rapid system of monitoring in the UK so we can spot outbreaks when they occur.”

The R rate in Britain is currently between 0.7 and 0.9 but the experts said they were expecting it to rise as more restrictions are lifted. 

The risk of infection will also become higher in the winter as people spend more time indoors and keep windows and doors closed, stopping ventilation. Author Prof Azra Ghani, Chair in Infectious Disease Epidemiology, Imperial College London, said: “It’s also possible the virus could survive in colder conditions. Everybody needs to realise that Covid-19 hasn’t gone away.

“For a reasonable worst case scenario we have chosen an R value of 1.7. If we make this assumption then our modelling suggests the Covid 19 would rise from September peaking with cases in January and Feb next year. And this will coincide with peak demand on the health service.

"That would generate around 120,000 covid deaths from Sept to June.

“We do need to take this threat as a new wave of Covid very seriously, but we can prepare now and make sure this does not become a reality.”

Separate data seen by The Guardian, suggests that there is large regional variation in the death rates of patients in intensive care.

The overall death rate for ICU patients in England and Wales is currently 39 per cent but at one unnamed trust in the South West, eight in 10 patients had died, while just one in eight had died at the best performing London trust. 

Experts warned that the figures may be skewed because some trusts have very few numbers of patients needing intensive care. The demographics of areas may also be behind the disparity, with areas with older populations likely to fare worse, said doctors.

A second wave of coronavirus could bring twice as many deaths as the first, experts have warned, in a report commissioned by the Chief Scientific Advisor.

A group of 37 scientists, from the Academy of Medical Sciences, was asked by Sir Patrick Vallance to model a reasonable worst case scenario for the upcoming winter, and advise the government on how to prevent it.

The experts warn that 119,000 people may die in hospital if a second wave hits while the NHS is dealing with a bad winter flu season.

Under such a doomsday scenario, the reproduction ‘R’ rate would rise to 1.7 by September, with infections peaking in January and February. 

The overall number of deaths may even be higher, as the report does not factor in deaths in care homes.

The authors say it is critical to reorganise NHS and social care so that coronavirus patients are kept away from others. Many people caught the virus in hospital, or in care homes after patients were discharged without being tested.

Widespread testing, ramped up contact tracing and nationwide surveillance is also vital to stay on top of the disease, the experts say, and they have called for wider uptake of the flu vaccine to prevent the NHS from being overwhelmed.

“The window for action is now,” said report author Dame Anne Johnson Professor of Infectious Disease Epidemiology at University College London. 

“Infection rates are low and we’ve got time to think, breathe, and get on top of things. 

“Every winter we see an increase in the number of people admitted to hospital and in the number of people dying in the UK. 

“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.”

The team consisted of experts in infectious diseases, public health, statistics, meteorology and primary care.

The report warns that a new wave, combined with the NHS treatment backlog and the possibility of a flu epidemic, could pose a serious risk to health in the UK.

Winter is always difficult for the NHS, because infectious diseases are more common and conditions such as asthma, heart attack, chronic obstructive pulmonary disease and stroke tend to worsen.  

The worst case scenario assumes that the government will not respond to rising cases with another widespread lockdown.

However the new projections have not factored in recent results from the dexamethasone trial, which could substantially reduce mortality, the authors admit.

The team also modelled two other scenarios where the R number was held at 1.1 and 1.5 and found deaths would be between 1,300 and 74,800 respectively. 

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