Hospitals told to brace for double wave of Covid and child infections

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An internal NHS email seen by Channel 4 News shows how hospitals are being told to prepare for a third Covid-19 wave at the same time as a spike in serious infections among very young children.

The email, sent by a London NHS trust to clinical staff, says “national guidance on planning” has been issued telling hospitals to expect 50 per cent of the Covid cases seen in the first wave of the pandemic.

At the same time the third wave of severe Covid cases is likely to peak in hospitals, in early August, NHS leaders are also predicting a national wave of Respiratory Syncytial Virus or RSV infections.

RSV is a common virus that usually causes mild symptoms but can lead to bronchiolitis and pneumonia, especially in infants.

The email begins: “We are preparing for a third wave of Covid.”

It goes on: “We are following national guidance on planning, which is to plan for 50 per cent of the first wave, with fewer patients needing (intensive care) and admitted patients being younger and less sick. This is the pattern we’re currently seeing across the trust.

“The peak is expected to be 1st August but that is likely to change as we get more information.

“At the same time as COVID, we are predicting a national wave of RSV infections in children, which will likely lead to more admissions, (non-invasive ventilation) and intubation among very young children.

“The size and duration of the wave is not yet known, but it’s likely to start in July or August.”

Paediatricians have been warning for months of the risk of a wave of RSV infections outside the normal winter season, as has been seen in Australia and other countries, though the timing remains unpredictable.

It follows a long period where many babies have not been exposed to normal childhood viruses due to social distancing measures.

‘Huge susceptible pool of children’

Professor Harish Nair, Chair of Paediatric Infections Diseases and Global Health at the University of Edinburgh, said: “Normally in the UK, RSV is a winter virus that causes a lot of hospitalisations. In fact, in winter, it is the most common cause of hospitalisation in children’s respiratory wards. Primarily, these are children younger than one year of age.

“You get annual epidemics. Generally, the peak in hospitalisations is around December or January. By the end of mid-February, the RSV epidemic is usually over in the UK. So by the time of Covid and the Covid-related lockdowns, RSV was already over in 2020.

“In the last 18 months or so, the infants that were born have not been exposed to RSV. We have a huge susceptible pool of children who have never been exposed to this virus.”

He added: “The real test for paediatricians is the paediatric emergency room. They are already quite full of children coming in complaining of coughs and difficulty breathing. These are not RSV cases and they are not Covid – they are other respiratory viruses that are circulating.

“Emergency rooms are under pressure. If an RSV wave starts, this does put pressure on the hospital’s paediatric systems. It will test the capacity and the resilience of the system severely.”

Third Covid wave

The internal email is an insight into the kind of planning NHS bosses are doing behind the scenes as hospitals brace for a third wave.

The UK is experiencing a sharp rise in Covid infections, driven by the increasing dominance of the more infectious B.1.617.2, also known as “Delta” or the “Indian variant”.

Public health authorities hope the UK’s high levels of vaccination will mean many fewer people die or are hospitalised with the disease than in the first and second waves.

The leaked email suggests the NHS is expecting the third wave to peak less than a fortnight after 19 July, the date lockdown restrictions are due to end in England.

The Department of Health and Social Care declined to comment directly on the leak or clarify whether the planning assumptions mentioned in the email take into account recent changes on lockdown easing.

A government spokesperson said: “We are easing restrictions across the country in a way that is cautious and prioritises data over dates as we strive to prevent further national lockdowns.

“The government paused step 4 of the roadmap to ensure we vaccinate as many people as possible with second doses in the coming four weeks and tackle the rising number of cases of the Delta variant.

“While we have been clear that the number of cases is expected to continue rising, due to the increased transmissibility of the Delta variant, the expansion of our phenomenal vaccination rollout should stabilise the number of people being hospitalised by the virus.”