Winter bugs and what we should do about it.

Winter looks like it could be bad one

Have you been unlucky enough to recently succumb to a nasty “cold-like” recently or do you know someone who has?  You won’t be on your own -as infections with “cold-like” symptoms are on the rise and it is not looking like a good winter for us.

So what is the current state of play?

Data from the UK-HSA data  dashboard was last refreshed on 4^th December and showed that there were a lot of viruses around with relatively high but falling levels of respiratory syncytial virus and rhinovirus. Both these viruses can cause cold like symptoms in healthy people. For more vulnerable people, however, RSV, can be very serious indeed. It is for this reason that a vaccine has been developed which has now been approved for people over the age of 75, babies and very young children.

More recently, data has been released from the  National Influenza (14^th December) and COVID-19 Report and the UK-HSA  Winter Coronavirus (COVID-19) infection study (21^st December). These studies show that flu is increasing and COVID-19 is rapidly rising as this excellent SubStack shows.  The rise in COVID-19 infections is largely accounted for by the so-called “Pirola” (BA2.86) variant which includes the JN.1 subvariant. These variants are a concern as they show enhanced immune evasion JN-1 is more infectious too. The WHO recently announced that JN-1 has become a variant of interest as it is rapidly spreading across the World.

The rapid increase in “pirola” infections has not, fortunately, caused a massive surge in NHS hospitalisations as yet. It is usually a few weeks before increased cases result in increased hospitalisations (if they will cause this to happen). However, frank questions need to be asked about how ready our NHS will be for this. Ambulance queues are exceptionally high suggesting the NHS is over-stretched and unable to cope with further strain. Waiting times for treatment remain high whilst bed capacity remains low- led in part by a struggling social services unable to support those who no longer need acute care.

Vaccinations remain one of the best ways to protect yourself against the severe impacts of COVID-19 or flu. However, the JCVI narrowed the eligibility criteria for autumn boosters in 2023. Of those eligible, uptake has been a little lower than the previous autumn. NHS England for example estimated that over 21 million people were eligible for the boosters in England however only 11.7 million vaccines have been administered. Frontline care workers are amongst the least vaccinated group (approximately 419,000 vaccines). It has been over a year since healthy people between 50-65 years old were last offered a vaccine and many people are over 2 years since their last booster.

What does this mean for our protection?

A recent study of data from >10.5 million people showed that the case fatality rate for COVID-19 was highest in unvaccinated people. This vulnerability was most stark in older people, showing the value of the vaccine for protection against severe disease.  Indeed, the protection was significantly increased up to 6 months post booster. However, protection did wane in those further from their booster strongly supporting that- until long term vaccines are available- booster campaigns are needed.

What about children?

The offer to vaccinate children in the UK was only offered as a non-urgent offer and then rescinded in Autumn 2022 for any child turning five after August 2022 (unless they are in higher risk group). This is in contrast to many other nations including the USA and much of Europe. Babies under the age of 6 months may get some protection from maternal antibodies if the mother was vaccinated against COVID-19. However, children under the age of 4 have consistently been shown to be exceptionally vulnerable to COVID-19. As such it was welcome news that the vaccines are now being offered to children up to the age of 4 in the UK-  although this is restricted to those who are clinically vulnerable. Again this puts us at odds with many other nations.

Boosters

Currently the decisions re vaccine eligibility in the UK have focused mostly on risk of severe disease and death from infection. Factors such as enhanced risk of cardiovascular disease post-infection or risk of developing or worsening long Covid have not been considered. Long Covid can be a devastating and life-altering condition. It is estimated that 65 million people worldwide have Long Covid-  a significant proportion of which report that long Covid affects their lives a lot. This is utterly devastating data to see. Protective links between the vaccine and likelihood of developing COVID-19 were established a few years ago. A new study just out shows the same for children. Children who were unvaccinated had a greater risk of developing COVID19 than those who were vaccinated. Data in adults has shown that boosters can protect  against worsening of long Covid. Such a study, has not yet to my knowledge, been published in children but it seems reasonable to assume the same for this age group.

Collectively all this data strongly states a case for vaccinating our children and wider availability for boosters. Reports have suggested that some of the current UK boosters are being reserved in case of a need for a surge vaccination campaign. I would suggest that given the volume of data showing the benefits of boosters, (not just for severe disease but also for post-infection conditions), coupled with the poor state of our NHS that the time is nigh for that campaign. We do not want our NHS to get overwhelmed and we do not more people affected with Long Covid.  

Currently, the booster appointments are not available in the UK for COVID-19, although they should start in the New Year. Flu vaccines can be purchased at many pharmacies so, if you can afford it, do get a flu vaccine!

What else can we do?

Vaccination is of course only part of the story- there are still things you can do to further reduce your risks of infection this winter. COVID-19 is primarily spread by aerosols. Wearing a well-fitting mask can dramatically reduce your risk of catching the infection especially in cramped quarters like busy trains, trams and buses or higher risk venues such as medical spaces. Better ventilated places are also safer for meet ups so do consider how airy the space is when you meet friends and family over this festive period. Last, but not least, tests can be purchased to check if you are infected- this is REALLY important if you will be visiting vulnerable loved ones. You really don’t want to leave a COVID-19 Christmas gift!

Please do take care and stay safe and I hope you have an enjoyable holiday break this Christmas.