Do we need a different strategy for the 3rd wave of COVID-19?

The proposed date for the end of lockdown is approaching, June 21st, and with ministers and official bodies questioning the plausibility and consequences of continuing to this schedule, it’s important to look at the current situation we’re in. With vaccination rates increasing and overall cases dropping, but with rapid growth of the Delta variant, are we prepared for the restrictions to be eased in the face of a possible third wave of the pandemic?

In this article, I will look at the statistics and facts as well as comments and suggestions from the experts commentating on COVID-19.

 

Pressure on the NHS and healthcare workers

As we know, the first two waves demonstrated how healthcare systems can be overwhelmed and how that had a significant impact on the health of patients and healthcare workers. Lessons must be learnt from the first two waves to tackle the issues that occurred and avoid them reoccurring in future waves, pandemics and outbreaks. We saw how overloading the NHS with COVID-19 patients lead to further complications for missed treatments and affected healthcare services, resulting in a backlog of more than four million patients waiting for their surgeries and treatments. Although elective surgeries resumed in the UK (and many other countries) in mid-2020, most hospitals are functioning at substantially reduced capacity, which translates to an ever-lengthening waitlist. As of September 2020, nearly 140,000 patients in England alone had been waiting for more than a year for their surgeries—100 times the number in 2019. Also, nearly 388,000 people were waiting more than a year for non-urgent surgery compared with just 1,600 before the pandemic began.

In addition, cancer figures for England show that the number of people starting treatment for the disease in February 2021 was 6% lower compared with the same time last year. Although there has been a slight improvement in the numbers referred to a cancer specialist by their GP since January, the total number over the past year is more than 370,000 down on normal, Macmillan Cancer Support said.

Furthermore, there has been a significant increase in A&E admissions the past couple of months. According to NHS England, the total number of attendances in April 2021 was 1,870,000, an increase of 104% on the same month last year; the smaller number of admissions likely affected by tighter lockdown restrictions. Of these, attendances at type 1 A&E departments were 82.7% higher when compared with April 2020 and at type 3 departments were 177.4% higher.

According to a recently published report by HSJ, dozens of hospitals have operated at very high levels of bed occupancy in the past month, as they deal with the surge in non-covid patients with thousands fewer beds than normal. At one point in May, 49 general acute trusts out of 145, the most since before covid, operated at an occupancy of 95 per cent or more in adult acute beds. A senior manager at one of the affected hospitals stated, “The big problem we have is we are as busy as we’ve ever been with non-covid activity…. Admissions are so high, even with escalation beds open, bed occupancy is virtually 100 percent,” he added, “With bed occupancy so very high, we are not in a resilient position should we have an outbreak or see a sudden increase in activity.”

Covid variants

As of the latest published figures, there are a total of 258,788 confirmed cases for the Alpha (B.1.1.7, or Kent) variant, and 12,431 for the new Delta variant (B.1.617.2 or Indian). The latest official figures overall, revealed 6,048 new infections over the previous 24-hour period, with 13 death cases, compared to 4261 cases and zero death cases on Tuesday 1st June. According to the scientific advisory group (SAGE), the now-dominant Delta strain is 40 per cent more transmissible than the Alpha variant and it would lead to more patients in hospital than previous Covid waves.

 

Vaccination roll-out

Matt Hancock has stated Covid restrictions will be lifted this month if hospital admissions remain low in the coming days, but he admitted it was “a tricky call”. The numbers are “broadly flat”, he pointed out, in growing evidence that the successful vaccination programme has “severed” the link between infections and serious illness where there has been a significant drop in number of cases and deaths.

68,800,879 vaccination doses have been given, of which 28,227,362 received both doses. However, the efficacy of COVID-19 vaccinations (Pfizer and Moderna) is no higher than 91-95%, which means there’s still a 5-9% possibility of having cases where people are admitted again to the hospital despite having both doses of the vaccine, something that cannot be ignored.

Education around the impacts of the vaccinations is still needed to ensure those vaccinated are aware that receiving the injection doesn’t make them completely immune to the effects and transmission of COVID-19.

Also, vulnerable and immunocompromised patients are always at risk of acquiring infections in different rooms and areas within a hospital, which can pose a risk for other patients as well as staff and visitors that can capture a hospital infection whether it is COVID-19 or other infections.

 

International travel

On the 17th of May, the ‘Stay in the UK’ regulation was ceased and international travel was allowed to restart, governed by a new traffic light system whereby countries on the green list being the safest for travel and posing the lowest risk. Passengers who have only visited or transited through a green list country will not be required to quarantine on arrival in England.

The risk posed by individual countries will be continuously monitored and assessed, and the green, amber and red lists will be updated every 3 weeks. The risk assessment considers certain factors such as testing rates per 100,000 population, weekly incidence rates per 100,000, and evidence of variant of concern cases in the country or territory. The green list contains countries that have very low number of cases and a high percentage of their populations are vaccinated. The list includes countries such as Iceland, New Zealand, Singapore and Israel – which all have shown great strategies to combat COVID-19.

International visitors who have visited or transited through any red list country in the previous 10 days will be refused entry into England. Only British and Irish citizens, or those with residence rights in the UK, will be allowed to enter and they must stay in a government approved quarantine facility for 10 days. Citizens are advised not to travel to red and amber listed countries, whereas official restrictions on this travel may be more beneficial in controlling the spread of the virus and variants.

 

Preventative measures

Despite the emergence of the new Delta variant and a higher possibility of a third wave, good hygiene practices should not be dropped and the NHS Trusts must continue to provide their services and implement more strategies to tackle the issues that were encountered previously.

A good example of that is the new government funding scheme to build surgical hubs that will provide more capacity for the NHS and tackle the backlog of the waiting list. In addition, other models can be proposed such as the provision of health spaces on the high street. This can support care in the community, allowing acute centres to improve discharge times and follow-up care. Pre-urgent care can be more accessible and the risk of patients ending up in hospital is reduced. Also, non-urgent treatment can be cut in order to release capacity. Long stays and admissions to secondary care are reduced as care is delivered in the community. Also, release time for clinicians to manage the most valuable and acute patients can be reduced. This model ensures that the healthcare fits around a patient’s life as the fear of visiting a hospital is removed and crowded waiting times are eliminated. Similar recommendations were provided by NHS England emphasising the importance of establishing new pathways for diagnosis in order to minimise acute hospital visits.

 

Final thoughts

Prof Gupta, a member of the government’s New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), said ending restrictions in June should be delayed “by a few weeks whilst we gather more intelligence”. Meanwhile, Dr Chaand Nagpaul, council chairman of the British Medical Association, said the UK was at a “pivotal moment” in its battle against the virus, and called on ministers to “act with maximum caution when considering whether to go ahead with lifting restrictions” on 21 June.

As outlined above, there are several lingering issues that can block NHS outputs and overload the healthcare service for a long time, eventually leading to a failed system that cannot cope with the increased workload. Our successful management of the health implications of COVID-19 is dependent on being supported by the NHS. Healthcare workers have endeavoured to provide care to the best of their ability in never-before-seen circumstances and must be commended. It’s vital that we learn from mistakes made from previous waves to ensure the impact of future waves are reduced and minimised, or completely avoided. While our health system struggles to recover, we cannot ignore the clear evidence around us and should do everything possible to reduce additional pressures from a third wave.

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