We’re all very familiar with the term “pandemic”, but experts fear Britain could be facing a “quadremic” this winter – with a rise in cases of four winter viruses, each capable of putting us in bed – attacking all at the same time.
According to the UK Health Security Agency (UKHSA), rates of norovirus (also known as winter vomiting virus), which can cause violent vomiting and diarrhoea, have increased by 40 per cent in recent weeks.
But experts fear that the number of people infected by flu, Covid and respiratory syncytial virus (RSV), a virus that normally causes a mild cold or cough but can also cause severe pneumonia (inflammation of the lungs), will also increase. will skyrocket in the coming weeks as it progresses. Colder weather is forcing many of us to stay indoors, allowing viruses to spread more easily.
As well as making many people feel awful, it could put undue winter pressure on the NHS through extra workload and staff illness.
Meanwhile, older people and people with weakened immune systems (including cancer patients undergoing chemotherapy) could be at risk of infection after infection, which in some cases could be life-threatening. Every year in the UK, around 12,000 people, mostly elderly, are admitted to hospital due to the effects of norovirus symptoms, such as severe dehydration, which can sometimes be fatal.
Experts fear that the numbers of people infected with flu, Covid and respiratory syncytial virus (RSV) will skyrocket in the coming weeks
In January, at the peak of the winter bed bug season, there were 688 patients in hospital each day with severe norovirus, almost 4,000 with Covid and 2,226 with flu, according to NHS England figures. This winter there are fears that it could be even worse.
Not only has there been an unusual cold snap, but the pattern of illness in Australia’s recent winter – which runs from June to late August and tends to foreshadow what’s happening here – suggests the worst is yet to come in the future. United Kingdom.
Figures from Australia’s National Notifiable Diseases Surveillance System (a database of communicable diseases) show its winter insect season peaked later and lasted longer than in 2023, when flu infections, by For example, they peaked in May with around 220,000 cases for the month. This year they didn’t peak until July: they peaked at 316,000 for the month.
And the rise coincided with a rise in other winter infections, including Covid, RSV and an outbreak of whooping cough in children. This is a very contagious bacterial infection, also known as whooping cough or 100-day cough (because of the time it takes to recover).
The Royal Australian College of General Practitioners said many people spent the winter fighting one virus after another.
“RSV tends to affect the lower respiratory tract (deep lung tissue),” says Eleanor Riley, professor of immunology and infectious diseases at the University of Edinburgh.
Dr. Anju Aggarwal, vice president of the university, recently said, “It all starts with an infection and then the immune system gets a little compromised.” Then the second takes over and then the third. Then people get a little better and then they get worse again.’
The UKHSA has renewed its call for all those who are eligible for vaccinations against winter infections to receive them as soon as possible.
There is no NHS vaccine against norovirus (although an experimental one will soon be tested in a trial at London’s Royal Free Hospital), but there are vaccines available for flu, Covid and RSV (for the latter, only for pregnant women and those turning 75 years old on or after September 1, 2024, as older people are at greater risk of serious complications).
While norovirus symptoms are usually obvious, it is often less easy to tell which respiratory virus you have.
“RSV tends to affect the lower respiratory tract (deep lung tissue),” says Eleanor Riley, professor of immunology and infectious diseases at the University of Edinburgh. ‘Classic symptoms include cough and difficulty breathing. But flu and Covid tend to affect the upper respiratory tract, or the throat, nose and mouth, with symptoms that can include sneezing, coughing and sore throat.
Professor Riley says that if Covid vaccinated patients still get the infection, it usually appears as a mild upper respiratory tract infection, making it difficult to distinguish from the flu or a cold. “It can be very difficult to separate the three,” he says.
The chances of contracting all three respiratory viruses at the same time are incredibly slim, he adds. ‘That’s because we know that viruses tend to compete with each other when they try to enter the body to multiply.
«If, for example, you catch a cold, the immune system triggers an inflammatory response to try to eliminate the virus. It is this inflammation that gives you a little temperature and runny nose.
“That inflammation makes it much more difficult for a different virus to successfully invade the body; you would pretty much have to be exposed to all the viruses at exactly the same time, which is extremely unlikely.”
But there is a real risk of sequential infections (or one virus after another), as happened in Australia.
“Say, for example, you contract Covid and it causes temporary damage to your upper respiratory tract,” he says. ‘During the recovery period, the inflammation it caused gradually decreases.
‘If during that time you are exposed to a second virus, say, the flu, there is no inflammation in the airways to stop it and it is also more likely to infect your respiratory tract because you are still suffering damage there from the Covid infection.’
Professor Riley says this is why it’s so crucial to take it slow during recovery: overdoing it too soon is more likely to weaken the body’s immune response to a second or third attack.
And he adds: “It is important not to return to work too soon or start doing long runs.” Take it easy and you’ll recover more quickly.’
And for some people, it’s not just exposure to a second or third virus that threatens them when they get sick.
Wintering bugs can also trigger an abnormal response in bacteria that, when we are healthy, live harmlessly in or on our bodies.
This is often why viruses, such as the flu or even a bad cold, can, in some cases, cause a bacterial chest infection that needs treatment with antibiotics.
“It’s almost as if these bacteria, which normally cause no harm,
feeling that the body is being attacked by a virus and taking advantage of the opportunity to try to start growing and spreading,” says the professor
Riley. “That’s why, in patients with a history of respiratory infections, GPs often prescribe antibiotics, even though they know it is almost certainly a virus causing the primary infection – it’s called ‘antibiotic coverage’.”
How can you protect yourself?
- Wear a mask when traveling on planes, trains, and buses, or in crowded indoor areas; It may not offer complete protection, but it could reduce the risk of contracting mainly airborne viruses such as flu, Covid and RSV, the UKHSA says.
- Wash your hands thoroughly and with soap several times a day. Not only will it kill any norovirus that may be lurking on your skin, but it will also kill any flu or Covid particles that you might accidentally rub into your eyes or spread to your mouth or nose by touching them. Hand sanitizer is better than nothing if that’s all you have access to, but it won’t be as effective at removing bugs from your hands.
- At work, use alcohol wipes to periodically clean shared surfaces, such as doorknobs, light switches, and keyboards.
- Do the same thing at home if someone you live with has a respiratory or stomach infection, including the TV remote control. Kitchen counters should be cleaned with bleach-based products if someone you live with has norovirus.
- Do not share towels with anyone who has signs of flu, Covid, RSV or norovirus.
- Rinse all fruits and vegetables thoroughly, even before cooking, as they may harbor infected particles.
- If someone in your household is sick, wash all clothing and bedding on a 60-degree cycle.
- If you are the one who has a stomach virus, avoid cooking or preparing meals for others until at least 48 hours after all symptoms have gone away.
- Lock yourself in your room if you have an infectious virus, especially norovirus. Dr Marion Sloan, Sheffield GP and president of the Society of Primary Care Gastroenterology, says: “It is best to self-isolate until you feel better and ask someone else to bring your food and drink to your door.” .