Tuesday briefing: What will a third winter with the coronavirus bring?

In today’s newsletter: New variants, a struggling NHS and approaching flu season suggest a coronavirus surge is still a risk. A public health expert on preparing for what lies aheadSign up here for our daily newsletter, First Edition Continu…

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Good morning.

It’s 1 November, and despite unseasonably warm weather across many parts of the UK, winter is coming. However, unlike recent winters, mass testing, mandatory masks and social distancing are things of the past. Over the last 10 months, the medical and social spectre of Covid-19 has waned significantly, and many places have seen a return to pre-pandemic levels of activity. While infection rates have fallen since the summer, a combination of new variants, a struggling health service, and the approach of flu season has left scientists concerned that a new wave could be around the corner. A vaccination booster campaign is underway for vulnerable groups, but further government intervention seems unlikely. For today’s newsletter, I spoke with Prof Devi Sridhar, the chair of global public health at the University of Edinburgh, about where we are at with the pandemic now, what we might expect to see in the coming months and how we can keep ourselves safe. That’s right after the headlines.

Five big stories

In depth: Subvariant ‘soups’ and new vaccines – what’s on the horizon

In winter 2020, vaccines were just starting to be distributed, and everyone spent most of the season in lockdown. Last year, because of a highly effective vaccination rollout, immunity was far higher, but Omicron derailed plans to move out of the pandemic phase of this health crisis. This year, the country seems to be in a better position – but things are still changing. So, what will our third winter with Covid look like?

Where are we at?

The first thing to highlight is that we have come very far since 2020. “The good news is that, since two years ago, we’ve managed to bring down the fatality rate of Covid,” says Sridhar. “It’s still in the top 10 causes of death, but it’s no longer in the top spot that it held in the first and second waves, and that’s largely because of vaccines and therapeutics.” However, this is not to say that everything is fine, Sridhar notes. While the overall number of deaths from Covid this year were far below last year, during the summer twice as many deaths involving Covid occurred when compared with summer 2021, according to the ONS.

Around two million people are thought to have had Covid-19 in the UK in the last week, with estimated infections declining in Wales but increasing in Scotland and Northern Ireland – the trend for England remains unclear. There were 625 deaths in the week of 14 October, and data from 20 October shows that 12,406 people were in hospital with Covid-19, a similar level to the week before.

Scotland’s health secretary, Humza Yousaf, has warned that the coming months are likely to be the most challenging in the NHS’s history. “What we’re seeing now is an overloaded health service,” Sridhar says. “There’s not enough staff, not enough facilities, not enough investment. And that has accumulated over 12 years, where there has not been enough investment in the health service.” The NHS is operating with 130,000 staff vacancies, and the problem is exacerbated by a social care system that has been so severely cut that the health service cannot discharge patients easily. So, while there won’t be as many hospitalisations as we saw at the various heights of the pandemic, any kind of increase could overwhelm the NHS.

“The health service doesn’t collapse overnight,” Sridhar says, “it doesn’t break down in a visible, visceral way like in Brazil or India. It’s slow and it has been happening for a long time. It’s really unfortunate for those who might need it in the winter months.”

The effects of flu season

If you’re feeling congested, tired and a bit feverish, that might be because flu season has started early this year. Over the last two winters, flu levels have been at record lows in the UK because of lockdowns and mandatory self-isolation policies. This is the first winter since the beginning of the pandemic where many people are mixing without restriction. Children in particular are at risk.

The three respiratory diseases we should be looking out for this winter are: Covid, RSV (respiratory syncytial virus) and the flu. “RSV is largely seen in young children and the elderly. It causes wheezing and breathing problems, and in some cases it can lead to death,” Sridhar says. This could very well lead to employers shifting towards asking people to work from home again and people voluntarily wearing masks to avoid getting sick – whether it’s flu, Covid or another illness entirely.

New variants

A soup, a swarm, a subgroup – whatever they’re called, the latest offshoots of the Omicron variant are extremely diverse and complicated. “I think in the past what we saw was one dominant variant. What we’re seeing now is a more complex picture of a mix of what you might call subvariants,” Sridhar explains. The subvariants that are thought to be important for the UK are BQ.1.1 and BF.7. It’s unclear what all these new variants mean for immunity both against vaccines and each other but the UK Health Security Agency (UKHSA) is closely monitoring Covid to get a better understanding of how these subvariants work.

Vaccinations

The UK’s booster campaign is far more limited than previous rounds of vaccinations. It is now restricted to people over the age of 50, pregnant women, those with health conditions that put them at higher risk, those working in the NHS, social care or care homes, carers aged 16 to 49, and those who live with people who have weakened immune systems. The primary reason for this is cost and supply. “An important thing for people to be aware of is that the UK doesn’t vaccinate children against chickenpox,” Sridhar says, suggesting the reason why is down to cost. This same logic, many believe, has been used to cap the booster roll-out.

It’s a different story elsewhere. In the US, doses of the new boosters are available to everyone. “The new booster is also slightly different. It’s a bivalent booster, which means it’s tailored to the new variants of Covid, so it’s more tailored towards what is circulating now,” Sridhar explains.

A proportional response is very important, Sridhar says, but there are real consequences to not putting basic measures in place. In September, there were an estimated 2.3 million living with long Covid in the UK. (Read the excellent series on the illness and those who are living with it). “If you’re having people who should be in the workforce off sick for months, it’s very hard to build your economy and grow it,” Sridhar says.

There is hesitation to stoke alarm and cause fear, especially if little is being done to stop the problem from worsening, and with good reason. Ultimately, this winter will show us what living with Covid really means in a post-pandemic world.

What else we’ve been reading

Football | Twenty-eight clubs have written to the government urging it to move forward with plans to create an independent regulator, saying that inaction would lead to their clubs being wiped out.

Football | Hope Powell has stepped down as coach of Brighton Women following their 8-0 defeat by Tottenham on Sunday. Powell said it was “the right time to go” after five years in charge.

Tennis | Andy Murray was stunned and visibly frustrated after his first-round exit during the Paris Masters losing to Gilles Simon 4-6, 7-5, 6-3.

The front pages

The Guardian’s Tuesday splash is “Braverman increases the refugee rhetoric as pressure to quit grows”. The Mirror says “Braverman shambles” and “Inflammatory, irresponsible, incompetent … but still in a job”. The Times has “Alarm at Braverman’s immigration rhetoric” – senior Tories have condemned her “talk of Channel ‘invasion’”, the paper says. The Daily Mail is happy to join in though, repeating the invasion line and adding: “Suella: Channel migrant crisis out of control”. The i has “Cabinet anger as Braverman fights for her political life”. “Welcome to the UK” – the Metro shows children behind a wire link fence as a portrait of “migrants’ camp hell”. The Telegraph underlines a warning from the government: “Sweeping tax rises on ‘rough’ road ahead” while the Daily Express says “Dire warning! Higher tax on way to plug debt”. The Sun says “The Crown betrays Wills” – it’s angry at the recreation of her Panorama interview. The lead story in the Financial Times is “Dream of UK battery champion dims as Britishvolt teeters towards collapse”.

Today in Focus

Culture wars, abortion and conspiracy theories: what the midterms tell us about the US

Ahead of the US midterm elections, Oliver Laughland travelled around Florida to find out what really mattered to the people getting ready to vote.

Cartoon of the day | Ben Jennings

The Upside

A bit of good news to remind you that the world’s not all bad

Ahead of her 60th birthday, Cathy Loughead realised she was spending a lot of time working from home, as a project manager in the NHS, and wanted to socialise more. Her solution: join a punk band. Loughead signed up for the “66 Days to your Debut” challenge by Unglamorous Music, a project to help women form bands and perform on International Women’s Day. “I hadn’t realised it was about being in a rock band,” she says when she pitched up at a meeting in Leicester. But she stuck around and joined “the absolute beginners group” on the keyboard. The organiser played matchmaker, putting Loughead with a drummer and three guitarists. The band call themselves Velvet Crisis and they’ve played six shows in all. “We practise, we play, we sing,” says Loughead. “It gives me absolute freedom from anything else that’s going on in my life.”

Sign up here for a weekly roundup of The Upside, sent to you every Sunday

Bored at work?

And finally, the Guardian’s crosswords to keep you entertained throughout the day – with plenty more on the Guardian’s Puzzles app for iOS and Android. Until tomorrow.

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