Barely an hour goes by at the moment where we don’t hear of the wax and wane, or the resurgence of the novel coronavirus. Such is the enigma of modern news, we are bombarded with often contradictory statements from multiple sources. One thing is for certain though: coronavirus is not going away any time soon. With the relaxing of measures across Europe, there has been a somewhat slow, now near explosive increase in cases amongst our closest neighbours, with the UK about 3 weeks behind. This, amongst new research which suggests the impending flu season may also interact with the novel coronavirus and cause more mortality, has kicked into gear the mechanisms health leaders feel pertinent to prepare for winter.
At the beginning of the pandemic, much hope was whipped up around the seasonal nature of similar coronaviruses, with many predicting a suppression of viral transmission in hotter conditions, particularly in the northern hemisphere. However, with many sub-tropical locations around the globe seeing their own cases of COVID-19, it remains to be substantiated the effect climate and temperature can affect viral survival and transmission. Indeed, it appears a temperature of 4-5 degrees, the low availability of UV light (which damages viral particles) and the increase of use of indoor spaces are optimal catalysts for the infection to spread. Note, the virus appeared in Wuhan, China, when the climate at the time averaged right in the ballpark of 0-5 degrees centigrade.
With experts noting the 3rd week of September as the usual time for respiratory infection increases (with children back to school and mixing), the government must act now to secure PPE, funding and resources to provide a sense of trust and community amongst societal factions. On the 23rd August, the Chief Medical Officer reported the bleak and hard-hitting trope, ‘there will be real problems with COVID-19 this winter’. With vaccines still a long way off, the impetus must be around the ‘bottoms up’ approach to empower individuals to take responsibility of their own health and the safety of those around them. The NHS has embarked on inviting record numbers of patients into surgeries and hospital outpatient clinics to get vaccinations for yearly influenza, something offered to those particularly at risk of infection and mortality (those over 50, previous health conditions).
So how will we move forward? Many virologists agree a quick, efficient diagnostic test to distinguish between the 3 or 4 most common respiratory infections cause by viruses would be prudent. Quick diagnostics (under an hour) would allow a much wider opening of the economy and allow those infected to self-isolate much quicker. This method would also allow school testing on a weekly basis, preventing further spread and allowing exclusions to happen in a more timely manner. The UK is attempting to push the limits of testing to 500,000 tests a day, something which is extremely costly and intensive to do, but absolutely necessary if a semblance of normality is to be obtained before mid-winter. Another part of the strategy is to continue to categorise hospital wings and surgeries into ‘COVID-19’ and ‘COVID-19 free zones’, to protect other patients and staff. Continued messaging in public campaigns, as well as those targeted at individuals whose first language are not English, is imperative to ensue nationwide compliance to distancing and measures.
The test-and-trace system in place has been much scrutinised in the press amidst reports that not even a majority of contacts are traced of those who test positive. Organisational issues, alongside a landslide in public opinion around the integrity of government strategies and trust have certainly not helped the phenomena. Looking to the future, there are plans to build integrated tracking systems which relay news of admissions, positive tests and trends to allow a quicker enforcement of local lockdowns – like those seen in Manchester and Leicester – to prevent flare ups. It remains to be seen whether nationwide healthcare recruitment will increase in September and October, but it is imperative that trusts across the country have a bulk of nurses and specialist staff to deal with admissions and complex care, potentially signalling a leaning on bank nurses. Following the recall of retired healthcare staff by the government, one advocates a mass recruitment campaign to allow adequate ‘stocking’ of staff and resources in a flexible manner. Allowing individuals to work across trusts within an area allows a quick, elastic response to local lockdowns and any worrying trends in admission/complex cases.
With Chris Whitty stating bluntly, “we’ll be lucky to have a vaccine before winter 2021”, it seems the measures to be taken cannot be placed purely on the hope of a jab being widely available. The importance of face mask usage, PPE for those in hospitals and jobs to prevent higher viral load and mortality, are perhaps more stark given the devastation observed across society. Thus, one hopes complacency will not be the order of the day, when messages around face masks and coverings in March were openly discouraged by government, along with a lack of PPE for healthcare workers. Ultimately, one can only control those things they can achieve by personal agency, such as reducing social contact, working from home where possible, carrying out good sanitation and wearing face coverings where possible. It is not out of possibility that indoor gatherings and meetings may be reduced in the face of rising cases and winter pressure, and thus it is imperative individuals follow the advice that can change at a moments notice.