The NHS enters the winter phase surrounded by the "perfect storm" with an unprecedented backlog of cases, the threats from Flu and RSV which may act synergistically with Covid 19 infection and cause infections of greater severity, an expected increase in wintertime hospitalisations from non-communicable diseases (eg Asthma, COPD, IHD), staff and equipment shortages and what is an already overburdened service seeing an unexpectedly high demand on its resources. The fact that > 75% of our population is double vaccinated is indeed a feat of science. Vaccine confidence nationally seems to be high. The risk however is "Vaccine Over-confidence", where all other preventative measures such as social distancing, wearing masks, well-ventilated workspaces, meeting people outdoor wherever possible is put aside for the sense of security that being vaccinated brings. Indeed there is data from Israel that antibody levels wean after 6 months or so. This may increase susceptibility to infection but the vaccines still continue to provide protection from developing a serious infection. There is also data that records a three-fold reduction in transmission in those vaccinated. 99.5% of the mortality in the last 6 months occurred in those who weren't double vaccinated at the time of infection. There is the risk of a "triple lethal combination" of Flu, RSV and Covid 19 working together to overwhelm an already outstretched health service. The Covid 19 causing virus may also experience a natural "selection pressure" when it will need to compete with the other winter prevalent respiratory viruses and this may also force a new mutation. 

What could the general public do to minimise their risks? The unidimensional approach of either focusing on any one intervention such as testing, lockdowns or mass vaccinations are bound to fail and a multidimensional approach will need to be adapted to keep ourselves safe and to safeguard the NHS. This means utilising any and all of the above options should they be deemed necessary along with basic pillars of managing respiratory infections such as face masks, social distancing, hand hygiene,  good ventilation etc. This will safeguard us from both Covid 19 and Flu/ RSV infections common in the winter season. Additionally, it is important for those who are vulnerable to self assess their risk and exercise greater caution. By exercising the above precautions the population could safeguard themselves and others dear to them. It is a fallacy to assume that the governments would need to walk a tight rope between securing the economy vs managing the covid pandemic as the data from other countries already shows that for the economies to be truly secured, the covid 19 threat needs to be managed first and foremost. 

The Government was given guidance around managing Covid 19 in Mid July with respect to the planning for the 2nd Winter with Covid-19. We start the winter with a higher number of cases as compared to the same time last year.  We hope that this guidance is heeded this time around and a more proactive approach is adopted by the policymakers. Our personal freedoms are important but when they interfere with the safety of others then it becomes a separate matter altogether and leadership needs to step in. Getting this timing right for such a government intervention will always be a difficult act to pull off for anyone in power. 

References 

1. https://blogs.bmj.com/bmj/2021/09/09/john-middleton-is-the-nhs-prepared-for-the-coming-winter/

2. https://www.bmj.com/content/374/bmj.n2270

3. https://acmedsci.ac.uk/file-download/4747802