"Winter is coming," warn UK COVID-19 experts

By Dr. Ananya Mandal, MDJul 14 2020

The famous line from "Game of Thrones" about approaching dangers this winter may prove to be accurate, say, scientists in a new report. The researchers state that a second wave of infection could hit the United Kingdom this winter, and this would be worse than the first wave taking as many as 120,000 lives.

The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has gripped the world, and now experts warn that it is far from over. To date, the virus has infected 13.28 million individuals and taken over 577,00 lives across the world.

Novel Coronavirus SARS-CoV-2 This transmission electron microscope image shows SARS-CoV-2—also known as 2019-nCoV, the virus that causes COVID-19. isolated from a patient in the U.S., emerging from the surface of cells cultured in the lab.Image captured and colorized at NIAID's Rocky Mountain Laboratories (RML) in Hamilton, Montana. Credit: NIAID

Current status in the UK

To date, there have been 292,931 cases of SARS-CoV-2 detected in the UK, and the infection has led to 45,053 deaths in the country. Over time the rates of deaths and new cases have declined in the UK, and in July to date, there have been 1,100 deaths, the researchers say. There may be no scope for complacence they warn, however.

According to the nation's scientific advisors from the Academy of Medical Sciences, who were asked to predict using modeling analysis, the worst is yet to come.

Reasonable worst-case scenario for the winter COVID-19 epidemic in the UK. The model assumes that Rt rises to 1.7 from September 2020 through to July 2021. (A) daily infections, (B) COVID-19-attributable deaths in hospital (i.e. excluding care homes and excess deaths in the community), (C) general beds occupied and (D) critical care beds occupied. The solid line shows the median, dark band the interquartile range, and pale band the 95% credible interval (CrI).

Predictions and caveats

The 37 researchers on the team say that deaths during the winter could range between 24,500 and 251,000 in the hospitals across the UK. These would be related to the coronavirus infection. The deaths may peak between January and February 2021, they speculate.

These numbers are predicted in the scenarios where there are no lockdowns or available drugs to treat the infection or any vaccines to prevent COVID-19. At present, there are no specific drugs that can be used to treat COVID-19, and treatment is mainly supportive and symptomatic.

Around 120 vaccine candidates are undergoing clinical trials in various parts of the world, including one promising agent trialed by Oxford researchers. None of these are at present available for use in humans, though.

Lockdowns are a complete shutdown of offices, businesses, schools, and public transport to break the chain of transmission. The above numbers of deaths predicted do not take into consideration lockdowns, availability of effective drugs or vaccines during this winter.

The report

This report was requested by the UK's chief scientific adviser, Sir Patrick Vallance. The researchers wrote, "The risk... could be reduced if we take action immediately." The actual status of the pandemic during the winter is not yet certain. However, what is clear is that the virus may survive better during the cold winters and thus can spread easily among people who are cooped up indoors during the winter. The report states, "In cold, wet or windy weather people are reluctant to open windows as they create cold drafts and hence they often have lower ventilation rates in winter. This can be a particular challenge in modern airtight buildings which have very low infiltration rates for energy efficiency and for people on low incomes who are trying to keep heating costs down."

Burden on the healthcare system

As such, the COVID-19 has a high infectivity rate but a low risk of complications and deaths. Only a small percentage of individuals – mainly elderly and those with other diseases, are at risk of developing complications.

These individuals may need intensive care and ventilation and are more at risk of dying. However, a massive spread of the infection can also lead to an overwhelming of the healthcare system. This has been seen across Europe and in the United States over the past couple of months.

The NHS, too, has been under pressure to cater to the needs of thousands of patients. With waning numbers of COVID-19 cases, there has been a resurgence of flu cases and non-COVID-19 cases, the researchers explained.

A second wave of the coronavirus infections could stretch the system to its capacity, they speculated. They said that there is a waiting list of non-coronavirus cases and this could reach to the tune of 10 million by the end of this year if the situation with COVID-19 continues to worsen.

Expert speak

Prof Stephen Holgate, a respiratory specialist from University Hospital Southampton NHS Trust, was the chairperson of the report. He said in his statement, "This is not a prediction - but it is a possibility. The modeling 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."

He said that at present, the numbers are low, and this could be a "critical window of opportunity to help us prepare for the worst that winter can throw at us."

Co-author Prof Dame Anne Johnson, from the Academy of Medical Sciences, in her statement, said, "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." She said, "COVID-19 has not gone away. We need to do everything we can to stay healthy this winter."

Health Secretary Matt Hancock has assured that the government is already planning to deal with the second wave this winter. A government statement said, "We remain vigilant, and the government will ensure the necessary resources are in place to avoid a second peak that would overwhelm our NHS."

Recommendations for prevention of the second wave

The report authors have made certain recommendations to tackle the oncoming problem with the second wave of the pandemic.

• They urge for more testing for the infection and intensive tracing of all contacts of an infected person to prevent the spread of the infection.
• Broad campaigns to get more people vaccinated against seasonal flu to reduce the flu case burden this winter
• Prevent transmission of coronavirus infections to other patients by creating "corona free" areas in the hospitals.
• Availability of adequate personal protective equipment (PPE) for health care personnel to prevent infections and spread.

Window for action is now

The researchers added that at present, much of these predicted numbers are based on modeling systems, and if the parameters are altered even slightly, the number of deaths and hospitalizations could change significantly.

Researchers, however, urge the general public and the policymakers to brace for the worst-case scenario while hoping for the best. "There's a lot to do, and we don't have a lot of time to do it," said Johnson. "The window for action is now."