Prepare now for a winter COVID-19 peak, say UCL experts

The UK must prepare now for a potential new wave of coronavirus infections this winter that could be more serious than the first, says a new Academy of Medical Sciences report involving UCL.

An advisory group of 37 experts created the ’Preparing for a challenging winter 2020/21’ report following a request by the Government’s Chief Scientific Advisor.

Academics on the group included UCL’s Professor Dame Anne Johnson (UCL Institute for Global Health), Professor Andrew Hayward (UCL Institute of Epidemiology & Health), Professor Rosalind Smyth (UCL Great Ormond Street Institute of Child Health), Dr Nigel Field (UCL Institute for Global Health) and Dr Laura Shallcross (UCL Institute of Health Informatics).

Dr Heather Bailey (UCL Institute for Global Health), Dr Guy Harling (UCL Institute for Global Health) and Dr Reecha Sofat (UCL Institute of Health Informatics) also supported the report’s development by working closely with the advisory group and the Secretariat.

The report notes there is a high degree of uncertainty about how the COVID-19 epidemic will evolve in the UK over the coming months, but suggests a ’reasonable worst-case scenario’ to prepare for is one where the average number of people that one infected person will pass the virus on to (Rt value) rises to 1.7 from September 2020 onwards.

The group stresses that ’intense preparation’ is urgently needed throughout the rest of July and August to reduce the risk of the NHS being overwhelmed and to save lives this winter.

Modelling suggests there could be a peak in hospital admissions and deaths in January and February 2021 similar to or worse than the first wave in spring 2020, coinciding with a period of peak demand on the NHS. It estimates the number of COVID-19-related hospital deaths (excluding care homes) between September 2020 and June 2021 could be as high as 119,900.

The report highlights the backlog of patient needs created by halting non-urgent appointments and procedures during the first wave of the COVID-19 pandemic, with an overall waiting list that could stand at ten million by the end of this year.

The figures do not take account of Government action to reduce the transmission rate, or the recent results from a trial to treat patients in intensive care with the steroid dexamethasone, which could substantially reduce death rates.

Professor Dame Johnson, who is also the Academy of Medical Sciences’ Vice President (International), said: "Every winter we see an increase in the number of people admitted to hospital and in the number of people dying in the UK. This is due to a combination of seasonal infections such as flu, and the effects of colder weather, for example, on heart and lung conditions.

"This winter we have to factor in the likelihood of another wave of coronavirus infections and the ongoing impacts of the first wave. We have to be prepared that we might also experience a flu epidemic this year.

"Faced with these potential challenges, and after an already tough year, it would be easy to feel hopeless and powerless. But this report shows that we can act now to change things for the better. We need to minimise coronavirus and flu transmission everywhere, and especially in hospitals and care homes. We need to get our health and social care, and the track, trace and isolate programme ready for winter. This can be done, but it must be done now."

The report’s recommendations include:

Minimising transmission of coronavirus in the community, with a public information campaign for all, as well as advice tailored to individuals and communities at high risk

Reorganising health and social care staff and facilities to maintain COVID-19 and COVID-19-free zones, and ensure there is adequate PPE, testing and system-wide infection-control measures to minimise transmission in hospitals and care homes

Increasing capacity of the test, trace and isolate programme to cope with the overlapping symptoms of COVID-19, flu and other winter infections

Professor Stephen Holgate, a respiratory specialist from University Hospital Southampton NHS Foundation Trust, who chaired the report, said: "This is not a prediction, but it is a possibility. The modelling suggests that deaths could be higher with a new wave of COVID-19 this winter, but the risk of this happening could be reduced if we take action immediately."

"With relatively low numbers of COVID-19 cases at the moment, this is a critical window of opportunity to help us prepare for the worst that winter can throw at us."


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