As the days get shorter and the weather colder in the northern hemisphere, health officials have warned of a perfect storm of infectious respiratory diseases over the winter months.
Outbreaks of seasonal diseases like influenza and respiratory syncytial virus (RSV) are already putting pressure on the overburdened NHS. If surges of these illnesses collide with another large COVID wave, we could be facing a public health disaster. Some have called this threat a “tripledemic”.
But how can we realistically expect the winter to play out? To try to answer this question, we can look at the recent and current trends of some of the most common winter infections in the UK.
1. COVID-19
Let’s start with the most obvious one, SARS-CoV-2 (the virus that causes COVID-19). The UK has so far been through multiple COVID waves, fuelled by a combination of behavioural changes, emerging variants and waning immunity.
The trajectory of COVID cases in England over the past year. Adam Kleczkowski/UKHSA, Author provided
In contrast to the large epidemic last winter, more recent waves have been relatively small. And despite initial concerns about a significant winter surge this year, the number of COVID cases is currently decreasing. But the pandemic isn’t over yet, and what will happen next is highly uncertain.
So far, there’s mixed evidence as to whether COVID is worse in cold weather. But during winter, people tend to stay indoors more and reduce ventilation, giving viruses more opportunity to spread.
In an optimistic scenario, small-scale outbreaks might continue into the winter as COVID becomes “endemic”.
Previous COVID waves have largely been driven by single dominant variants – alpha and delta in 2020-21 and omicron in 2021-22. This time, the many “descendants” of omicron are multiplying worldwide, and the current spread is instead caused by a mixture of variants peaking in different countries at different times.
But it is possible that if a highly transmissible variant emerges this winter, it might cause another large wave of infections.
2. Influenza
Seasonal influenza is a respiratory infection caused by four types of viruses, two of which (A and B) are common and can cause severe illness, hospitalisation and death, particularly in vulnerable people.
Not unlike COVID, factors including waning immunity and the evolution of influenza viruses also drive repeated outbreaks.
Influenza infections in England over recent years, compared with the current season. Adam Kleczkowski/UKHSA, Author provided
Flu seasons usually start in November, with cases peaking from December to March. In some years, the outbreaks are particularly severe, as in the UK in 2018.
Flu responded the same way COVID did to non-pharmaceutical interventions, including lockdown restrictions and mask-wearing. The number of cases in the 2020-21 winter was very low. It came back the following season later in the year, but was still limited.
There is concern that the long period during which our bodies were not exposed to the flu might have created an “immunity gap” making us particularly vulnerable this year.
Australia saw the worst seasonal flu outbreak in five years during its recent winter, coinciding with a large COVID surge. While it’s still early to see what the 2022-23 winter will bring in the northern hemisphere, the current outbreak in England is early and large compared with pre-pandemic years.
Weekly hospital admissions for RSV in England over recent years, compared with the current season. Adam Kleczkowski/UKHSA, Author provided
In pre-pandemic years it followed a seasonal pattern, with most cases occurring in early winter. After a hiatus in 2020-21, many cases were registered out of season in the summer of 2021. This unusual pattern is again suspected to result from a loss of immunity.
Like flu, the onset of the more benign coronaviruses generally occurs in November, with the peak between January and March. Rhinoviruses and enteroviruses tend to peak in autumn rather than in winter.
Rhinovirus infections in England over recent years, compared with the current season. Adam Kleczkowski/UKHSA, Author provided
The 2021-22 rhinovirus season was similar to pre-pandemic trends, but we’re seeing higher numbers so far this year. The infection is usually mild, and most people quickly recover, but severe cases in vulnerable people can add to the pressure on hospitals.
Protecting ourselves
This winter, the UK will probably face high pressure from respiratory viruses. Cases of seasonal diseases are possibly higher due to the lack of exposure during the lockdowns. In addition, some research suggests COVID infections might affect people’s immunity, putting them at higher risk of infection with other viruses.
To reduce the spread of respiratory viruses, we can continue with measures like ventilation, mask-wearing and hand-washing.
And although we don’t have vaccines available for RSV or common cold viruses, COVID and flu vaccines are an important tool to prevent severe illness this winter.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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