Outbreaks of influenza and respiratory syncytial virus (RSV) could lead to double the number of related hospital admissions this winter compared with a pre-pandemic year, a major new report has warned.
Primary care would experience particular pressure from an RSV outbreak, due to GPs seeing the majority of these patients, who are usually the under-fives, according to the review by the Academy of Medical Sciences.
The wide-ranging report, requested by the Government’s chief scientific advisor Patrick Vallance to review the biggest health risks this winter, said GP, hospital and NHS 111 services will need to help ‘prevent large numbers of children and older patients with breathing difficulties from being triaged with the outcome of an emergency ambulance’ during any potential RSV outbreak.
It said ‘many’ of these patients ‘do not need to be admitted and can be looked after in the community’.
However, the report noted face-to-face appointments in general practice will be best suited for deciding the most appropriate outcome for patients, ‘which would result in a large extra workload in primary care’.
According to new modelling for the report, between 15,000 and 60,000 people could die from influenza this winter – though the planned widespread flu vaccination should help to reduce this risk.
In addition, the expected RSV and influenza respiratory outbreaks this year – which were kept at bay last winter due to social distancing measures – ‘might overlap’ with a peak in Covid-19 infections, said the report.
A third Covid infection peak is currently projected for summer 2021 but the ‘timing and magnitude are uncertain’, it said.
Pressures on primary care are expected to ‘intensify’ this autumn/winter due to not only respiratory outbreaks but also more Covid-19 patients being treated in the community and delayed treatment causing chronic conditions to worsen, it added.
As a result, primary care must be ‘adequately resourced, particularly as new work is transferred from secondary care’ and ‘an increase may be needed’.
UK governments and NHS bodies should ‘consider additional measures to allow primary care to focus on the delivery of clinical care’, which could include the pausing of CQC inspections, it said.
The report also called for an expansion of Covid-19 testing to include influenza and RSV, wider use of antivirals to treat flu, increasing the speed and uptake of Covid-19 vaccination, and clearer Government guidance about the precautions the public can take against Covid-19, such as wearing face coverings in crowded indoor spaces.
The ‘Covid: Preparing for the future’ report, published today, said: ‘If Covid-19 infection rates and hospitalisations increase this autumn/winter, this could coincide with increased hospital admissions for influenza and respiratory syncytial virus (RSV).
‘As described….hospital admissions for influenza could reach 2.2 times that of a normal year, and 2 times that of a normal year for RSV.’
It later added: ‘Alongside these epidemics will sit the usual winter burden on the healthcare system from non-infectious conditions that increase in prevalence or are exacerbated in the winter months, such as asthma, chronic obstructive pulmonary disease (COPD), ischaemic heart disease and stroke.’
Professor Azra Ghani, an epidemiologist and expert advisory group member for the report, said it was difficult to predict the pandemic during the winter as it was dependent on factors including virus variants and how far people changed their behaviour as restrictions are lifted.
She said: ‘Our modelling suggests a summer peak of Covid-19 infections with subsequent local outbreaks over winter – though we can’t completely rule out another winter wave.
‘Whilst we expect the peak in deaths to be considerably lower than last winter, under some scenarios we could see hospital admission rise to similar levels. Furthermore, with a high level of virus circulating in the community there is a risk that the number of people living with long Covid could double.’
RCGP chair Professor Martin Marshall said: ‘GPs are seeing an increase in transmissible illnesses, particularly in young children, as restrictions ease and people begin to mix more freely, a trend likely to continue over the coming months.
‘With GPs and our teams already working under intense pressures, this means the rest of the summer and autumn are looking busy, ahead of a very difficult winter.’
As a result, mask-wearing and other infection control measures in general practice must continue for the foreseeable future, he added.
It followed advice from NHS England that GPs should ‘consider’ seeing all children under five with ‘respiratory symptoms’ face-to-face and referring them to secondary care.
On Monday the Government confirmed that legal Covid-19 restrictions will end in England next week (19 July), stating that it does not believe the current rise in infection rates will put unsustainable pressure on the NHS.