Post by Nadica (She/Her) on Dec 6, 2024 3:36:14 GMT
NHS warns of potential 'quad-demic' as flu, norovirus, Covid and RSV cases on the rise - published Dec 5, 2024
Fears of a potential "quad-demic" are rising, with a 350% increase in flu cases and an 86% rise in norovirus cases in hospitals compared to the same week last year, the NHS England has said.
The health service has said it is "busier than it has ever been before" this winter, with cases of Covid-19 and RSV (respiratory syncytial virus) also increasing in hospital wards.
Those who are eligible, and NHS staff, are being urged to get their vaccinations without delay as virus levels rise, with pressure on hospitals expected to increase further over the coming weeks.
So, how bad are the difficulties faced by the NHS this winter? Here, ITV News takes a look at the latest figures.
What is a quad-demic?
A quad-demic is a way of describing the co-circulation of four "very common viruses" at this time of year – influenza virus, RSV, coronavirus and norovirus.
"The first three are respiratory viruses – they cause colds and more severe diseases of the lung; norovirus causes diarrhoea and vomiting," John Tregoning, a professor in vaccine immunology at Imperial College London, told ITV News.
"They are what are known as endemic viruses – there is low level circulation of them most of the time, as opposed to pandemics which are the massive outbreaks."
"Viral infections are more common in winter. They tend to peak in the last four weeks of one year and the first four weeks of the following one," he added.
How much are cases rising this winter?
New weekly figures, published for the first time this year, show a 350% increase in flu cases, and an 89% rise in norovirus cases in hospitals compared to the same week last year.
Rising Covid-19 and RSV levels are also a concern, with an average of 1,390 patients with Covid in hospital beds each day last week, and 142 children in hospital each day with RSV.
The NHS says the latest data shows it is going into winter under more pressure than ever before, with an average of 1,099 people in hospital with flu every day last week compared to 243 in the same week last year – the highest number of cases heading into winter for at least three years.
"We are still only at the start of December, so we expect pressure to increase and there is a long winter ahead of us," said NHS national medical director, Professor Sir Stephen Powis.
“For a while there have been warnings of a ‘tripledemic’ of Covid, flu and RSV this winter, but with rising cases of norovirus this could fast become a ‘quad-demic’ so it’s important that if you haven’t had your Covid or flu jab to follow the lead of millions of others and come forward and get protected as soon as possible," he added.
New figures from the UK Health Security Agency (UKHSA) also show tuberculosis (TB) levels in England increased by 11% last year, with 4,855 notifications of the disease in 2023, up from 4,380 in 2022.
How much pressure are ambulance services under?
Pressure on ambulance service is "incredibly high", the NHS said. The service transported 90,514 patients to hospitals in England last week, compared to 83,873 during the same period in 2023.
Meanwhile, 35,022 hours were lost to handover delays, up 87% from 18,703 this time last year. There were 413,426 calls to NHS 111 last week – with 73.1% answered within a minute, up 4.4% up on last year.
How crowded are hospitals?
An average of 96,587 adult general and acute hospital beds in England were occupied each day last week, the NHS has said, which is more than at this point in any other year.
The health service warns this could increase in the coming weeks, with problems discharging patients who no longer need to be in hospital continuing to have an impact on capacity.
An average of 11,969 beds each day last week were occupied by patients who were ready for discharge, taking up one in eight of all occupied adult beds.
Patricia Marquis, executive director for England for the Royal College of Nursing, said: “There is barely a spare bed in our NHS, with sky-high flu admissions and thousands stuck in hospital unable to be discharged due to a lack of capacity in social care.
“Before the cold weather hits, nursing staff and patients are desperately worried about what the coming weeks and months may bring.”
Saffron Cordery, interim chief executive of NHS Providers, said: “Services are already feeling the strain from a worrying spike in nasty winter bugs and bad weather.
"Flu, norovirus, RSV and Covid-19 are piling the pressure on already stretched services and staff, and this is likely to get worse as we head into the depths of winter."
In addition to high bed occupancy and a lag in hospital discharges, Ms Cordery warned social care and community services are "also under relentless pressure".
What are the NHS and government doing about this?
The NHS has put measures in place to manage extra demand during winter, including an upgrade of its 24-hour live data centres, strengthening same-day emergency care and offering more fall services for older people.
In September, an independent review by Lord Darzi warned years of underinvestment have left the NHS with an ageing estate and outdated tech, making it harder for staff to deliver the best possible care.
The government and NHS are now engaging the public, patients and staff in the biggest-ever conversation about the health service.
More than 1.1 million separate visits have been made to Change.nhs.uk, with almost 9,000 ideas now live as part of the 10 Year Health Plan, which aims to deliver an NHS fit for the future.
Professor Powis said services like urgent treatment centres – an alternative to A&E where people are treated for more minor injuries and illnesses that GPs cannot address – and same-day emergency care will be "important this winter" in order to relieve pressure on hospitals.
“As always, the public have an important part to play in helping NHS staff over winter by, as ever, calling 999 in an emergency and using the NHS 111 service through the NHS App, online or phone, for advice on how to access the right support for non-emergency health needs," he added.
Health and Social Care Secretary Wes Streeting said: “We inherited an NHS that is broken but not beaten, and staff are already working hard to tackle an increase in admissions this winter.
“We’re backing them with an extra £26 billion secured in the recent Budget and we’ve already resolved the industrial action to ensure A&Es will be strike-free for the first time in three years.
“For too long, an annual winter crisis has become the norm. We will deliver long-term reforms through our 10 Year Health Plan that will create a health service that will be there for all of us all year round."
Streeting also encouraged anyone who is eligible to join the 27 million people who have already come forward to receive their flu, RSV and Covid jabs, claiming this is the "best way to protect yourself this winter".
Why are people at a bigger risk of infection during the winter period?
“Infection is a complex mixture of factors a lot of which is down to good or bad luck," said Professor Tregoning. "There are a mixture of behavioural, immunological and virological reasons.
"The simplest, and probably main reason is that in the winter, people will be closer together in confined spaces – in summer you might meet friends for a picnic in winter its more likely to be in your house. This close proximity accelerates the spread of viruses.
"We also, in the UK, have less exposure to the sun in the winter, and there is some level of protection provided by vitamin D. Infections can also happen more when we are tired or run down, and the winter months being colder may in some way leave our bodies a bit more exhausted tipping the balance in the favour of the virus.
"The winter party season may also contribute some spread if people are more run down and also mixing more closely."
Professor Tregoning added that viruses tend to travel in droplets, which are coughed or sneezed up, which evaporate more quickly during the summer, meaning the virus dries out and becomes less infectious.
However, there is some debate over exactly what makes infections more common at the end of the year, according to Paul Hunter, professor of medicine at the University of East Anglia.
He expresses doubt over low vitamin D levels being a significant factor, and says research he has been carrying out with colleagues suggests increased contact between people "doesn't have a great impact" on R0 (the basic reproduction number) to make an infection seasonal.
The drying of nasal membranes due to drier winter air can make it "easier for the virus to infect the lining cells", Prof Hunter added.
What precautions can people take?
Professor Tregoning advised people to follow the same guidance as during the Covid-19 pandemic – hands, face, space.
"Hand washing – particularly for norovirus, but also for the respiratory viruses will slow spread. Wearing masks (properly and using a proper mask) can reduce spread of respiratory viruses," he said.
"If you are feeling ill, reduce contact with other people, where possible. But this is not to say don’t mix with people, being sociable is equally important for our health. Meet in well ventilated spaces if possible."
“And if you are at risk get vaccinated. There are vaccines available for three out of four of the quad-demic.
“One really exciting new innovation is that mothers can protect their children by getting an RSV vaccine during pregnancy. RSV is a really horrible disease in children, it leads to hospitalisation of tiny babies. You can give your baby the best possible start in life."
Professor Hunter added: “For most people, it would be very difficult to know whether you had flu, Covid or RSV. Norovirus is very distinct.
"In the early stages of illness it may not be clear how severe the illness may become, but it's best to stay at home, drink plenty and rest until you are feeling better. If needed take medicines like paracetamol or ibuprofen or throat lozenges. If I have a bad throat I tend to make a drink with hot water, lemon and honey and sometimes I add whisky."
Fears of a potential "quad-demic" are rising, with a 350% increase in flu cases and an 86% rise in norovirus cases in hospitals compared to the same week last year, the NHS England has said.
The health service has said it is "busier than it has ever been before" this winter, with cases of Covid-19 and RSV (respiratory syncytial virus) also increasing in hospital wards.
Those who are eligible, and NHS staff, are being urged to get their vaccinations without delay as virus levels rise, with pressure on hospitals expected to increase further over the coming weeks.
So, how bad are the difficulties faced by the NHS this winter? Here, ITV News takes a look at the latest figures.
What is a quad-demic?
A quad-demic is a way of describing the co-circulation of four "very common viruses" at this time of year – influenza virus, RSV, coronavirus and norovirus.
"The first three are respiratory viruses – they cause colds and more severe diseases of the lung; norovirus causes diarrhoea and vomiting," John Tregoning, a professor in vaccine immunology at Imperial College London, told ITV News.
"They are what are known as endemic viruses – there is low level circulation of them most of the time, as opposed to pandemics which are the massive outbreaks."
"Viral infections are more common in winter. They tend to peak in the last four weeks of one year and the first four weeks of the following one," he added.
How much are cases rising this winter?
New weekly figures, published for the first time this year, show a 350% increase in flu cases, and an 89% rise in norovirus cases in hospitals compared to the same week last year.
Rising Covid-19 and RSV levels are also a concern, with an average of 1,390 patients with Covid in hospital beds each day last week, and 142 children in hospital each day with RSV.
The NHS says the latest data shows it is going into winter under more pressure than ever before, with an average of 1,099 people in hospital with flu every day last week compared to 243 in the same week last year – the highest number of cases heading into winter for at least three years.
"We are still only at the start of December, so we expect pressure to increase and there is a long winter ahead of us," said NHS national medical director, Professor Sir Stephen Powis.
“For a while there have been warnings of a ‘tripledemic’ of Covid, flu and RSV this winter, but with rising cases of norovirus this could fast become a ‘quad-demic’ so it’s important that if you haven’t had your Covid or flu jab to follow the lead of millions of others and come forward and get protected as soon as possible," he added.
New figures from the UK Health Security Agency (UKHSA) also show tuberculosis (TB) levels in England increased by 11% last year, with 4,855 notifications of the disease in 2023, up from 4,380 in 2022.
How much pressure are ambulance services under?
Pressure on ambulance service is "incredibly high", the NHS said. The service transported 90,514 patients to hospitals in England last week, compared to 83,873 during the same period in 2023.
Meanwhile, 35,022 hours were lost to handover delays, up 87% from 18,703 this time last year. There were 413,426 calls to NHS 111 last week – with 73.1% answered within a minute, up 4.4% up on last year.
How crowded are hospitals?
An average of 96,587 adult general and acute hospital beds in England were occupied each day last week, the NHS has said, which is more than at this point in any other year.
The health service warns this could increase in the coming weeks, with problems discharging patients who no longer need to be in hospital continuing to have an impact on capacity.
An average of 11,969 beds each day last week were occupied by patients who were ready for discharge, taking up one in eight of all occupied adult beds.
Patricia Marquis, executive director for England for the Royal College of Nursing, said: “There is barely a spare bed in our NHS, with sky-high flu admissions and thousands stuck in hospital unable to be discharged due to a lack of capacity in social care.
“Before the cold weather hits, nursing staff and patients are desperately worried about what the coming weeks and months may bring.”
Saffron Cordery, interim chief executive of NHS Providers, said: “Services are already feeling the strain from a worrying spike in nasty winter bugs and bad weather.
"Flu, norovirus, RSV and Covid-19 are piling the pressure on already stretched services and staff, and this is likely to get worse as we head into the depths of winter."
In addition to high bed occupancy and a lag in hospital discharges, Ms Cordery warned social care and community services are "also under relentless pressure".
What are the NHS and government doing about this?
The NHS has put measures in place to manage extra demand during winter, including an upgrade of its 24-hour live data centres, strengthening same-day emergency care and offering more fall services for older people.
In September, an independent review by Lord Darzi warned years of underinvestment have left the NHS with an ageing estate and outdated tech, making it harder for staff to deliver the best possible care.
The government and NHS are now engaging the public, patients and staff in the biggest-ever conversation about the health service.
More than 1.1 million separate visits have been made to Change.nhs.uk, with almost 9,000 ideas now live as part of the 10 Year Health Plan, which aims to deliver an NHS fit for the future.
Professor Powis said services like urgent treatment centres – an alternative to A&E where people are treated for more minor injuries and illnesses that GPs cannot address – and same-day emergency care will be "important this winter" in order to relieve pressure on hospitals.
“As always, the public have an important part to play in helping NHS staff over winter by, as ever, calling 999 in an emergency and using the NHS 111 service through the NHS App, online or phone, for advice on how to access the right support for non-emergency health needs," he added.
Health and Social Care Secretary Wes Streeting said: “We inherited an NHS that is broken but not beaten, and staff are already working hard to tackle an increase in admissions this winter.
“We’re backing them with an extra £26 billion secured in the recent Budget and we’ve already resolved the industrial action to ensure A&Es will be strike-free for the first time in three years.
“For too long, an annual winter crisis has become the norm. We will deliver long-term reforms through our 10 Year Health Plan that will create a health service that will be there for all of us all year round."
Streeting also encouraged anyone who is eligible to join the 27 million people who have already come forward to receive their flu, RSV and Covid jabs, claiming this is the "best way to protect yourself this winter".
Why are people at a bigger risk of infection during the winter period?
“Infection is a complex mixture of factors a lot of which is down to good or bad luck," said Professor Tregoning. "There are a mixture of behavioural, immunological and virological reasons.
"The simplest, and probably main reason is that in the winter, people will be closer together in confined spaces – in summer you might meet friends for a picnic in winter its more likely to be in your house. This close proximity accelerates the spread of viruses.
"We also, in the UK, have less exposure to the sun in the winter, and there is some level of protection provided by vitamin D. Infections can also happen more when we are tired or run down, and the winter months being colder may in some way leave our bodies a bit more exhausted tipping the balance in the favour of the virus.
"The winter party season may also contribute some spread if people are more run down and also mixing more closely."
Professor Tregoning added that viruses tend to travel in droplets, which are coughed or sneezed up, which evaporate more quickly during the summer, meaning the virus dries out and becomes less infectious.
However, there is some debate over exactly what makes infections more common at the end of the year, according to Paul Hunter, professor of medicine at the University of East Anglia.
He expresses doubt over low vitamin D levels being a significant factor, and says research he has been carrying out with colleagues suggests increased contact between people "doesn't have a great impact" on R0 (the basic reproduction number) to make an infection seasonal.
The drying of nasal membranes due to drier winter air can make it "easier for the virus to infect the lining cells", Prof Hunter added.
What precautions can people take?
Professor Tregoning advised people to follow the same guidance as during the Covid-19 pandemic – hands, face, space.
"Hand washing – particularly for norovirus, but also for the respiratory viruses will slow spread. Wearing masks (properly and using a proper mask) can reduce spread of respiratory viruses," he said.
"If you are feeling ill, reduce contact with other people, where possible. But this is not to say don’t mix with people, being sociable is equally important for our health. Meet in well ventilated spaces if possible."
“And if you are at risk get vaccinated. There are vaccines available for three out of four of the quad-demic.
“One really exciting new innovation is that mothers can protect their children by getting an RSV vaccine during pregnancy. RSV is a really horrible disease in children, it leads to hospitalisation of tiny babies. You can give your baby the best possible start in life."
Professor Hunter added: “For most people, it would be very difficult to know whether you had flu, Covid or RSV. Norovirus is very distinct.
"In the early stages of illness it may not be clear how severe the illness may become, but it's best to stay at home, drink plenty and rest until you are feeling better. If needed take medicines like paracetamol or ibuprofen or throat lozenges. If I have a bad throat I tend to make a drink with hot water, lemon and honey and sometimes I add whisky."