With new variants likely and an NHS already in crisis, there is no room for complacency about decreasing hospital admissions in England
Last week saw the first week-on-week fall in Covid hospitalisations in England since May. At the peak, in mid-July, an average of about 1,900 people were admitted to hospital with Covid each day in England. This is similar to the 2,100 admissions a day for the previous surge that topped out at the end of March, and the roughly 2,000 a day for the wave at the turn of the year.
The immunity acquired through high levels of infection in the previous two waves has proved insufficient to significantly reduce the burden of ill-health in this cycle: a reminder, if one were needed, that it makes no sense to get infected in order to prevent future infection.
So, while we may breathe a sigh of relief that this wave seems to be subsiding, we should be aware that “decreasing” prevalence is not synonymous with “low” prevalence. In climbing circles, there is an oft-quoted statistic that 80% of accidents happen on the descent – thanks, in large part, to fatigue and complacency about being over the summit. Peaks of Covid are not the same as mountains, yet there are similarities. We are all tired of Covid, and we can be happy that we are over the worst of yet another wave. The virus receding again is certainly good news, but if you were concerned about the prevalence levels on the way up, you should be equally concerned at the same juncture on the way down.
Looking to the longer term, this is unlikely to be the last wave we experience in the UK. Some scientists think the next variant of concern may be a descendant of an already existing subvariant of Omicron, such as BA.2 or BA.5 – responsible for the UK’s last two waves. The novel BA.2.75 subvariant, for example, is already spreading rapidly in India, and has been detected here in the UK. It has a range of mutations that have some scientists worried.
Others think the next wave will be the result of a variant that will be sufficiently different from the Omicron subvariants to be designated the next Greek letter, Pi. Irrespective of their views on origins, there is a consensus of opinion in the scientific community that there will be more concerning variants to come, and consequently more waves.
Experts have said they expect the next wave to hit us in the autumn. As the temperatures cool and the nights draw in, more people will understandably want to meet indoors more often. This will inevitably increase transmission levels leading to higher peaks – even with similarly transmissible variants. Inevitably, as cases turn into hospital admissions, this will pile further pressure on an NHS already facing an almost unprecedented summer crisis.
Currently, Covid is exacerbating existing healthcare difficulties caused by chronic underfunding. The latest figures suggest that one in nine people in England are waiting for treatment – not one in nine patients, one in nine people – 6.6 million of us.
Elsewhere in the health service, Covid is making it harder to discharge patients from hospital, meaning they occupy beds for longer. This in turn leads to difficulties in admitting patients, particularly from A&E. Ambulances then struggle to hand over their patients and end up queueing around the block, sometimes for hours. These same ambulances cannot then attend emergencies, causing them to miss response time targets by huge margins. At the acute end of the crisis, people are dying while waiting for ambulances.
At a time when the Conservative government is paralysed by its leadership contest, we desperately need to see leadership on health, and particularly on Covid. There is only so much we can do as individuals. We can wear masks indoors and ventilate our spaces to the best of our abilities. We can try to meet outside as much as possible. We of course should take up the latest booster jabs when available (although many of us have taken all those offered to us and are not being offered more).
But so much of our Covid risk is not in our own hands. We also need top-down solutions. Improving air quality in schools and other workplaces is something that many employers will not do voluntarily unless given the support and guidance from government to do so. Everyone protects everyone else by wearing a mask in shared indoor spaces such as public transport and shops, but without government mandates or strong public health messaging, we have seen that most people are not inclined to do this voluntarily.
The removal of free lateral flow testing has meant that many people are unable to afford to routinely determine whether they have Covid and to act accordingly. While self-isolation is advised, it is effectively voluntary. The onus from many employers is on their staff to come into work even when testing positive for Covid. Sick pay in the UK remains woefully inadequate.
Sadly, the short-termism that has characterised Boris Johnson’s government is being felt all the more acutely now as our lame-duck prime minister continues to limp on. My fear is that, even though the conclusion of the leadership race will spell the end for Johnson, it will only mark the beginning of yet another regime that continues to ignore the health crisis its predecessors have been so influential in creating.
Kit Yates is director of the Centre for Mathematical Biology at the University of Bath and author of The Maths of Life and Death