'Worst-case' Scenario Outlined for COVID-19 This Winter

Peter Russell

July 14, 2020

The Government has been urged to use the next 2 months to make intense preparations for a potential second wave of COVID-19 this winter.

A report by the Academy of Medical Sciences (AMS) outlines modelling of a 'reasonable worst-case scenario' that could see as many as 119,000 excess hospital deaths between September this year and June 2021 (95% confidence level, 24,500 - 251,000).

The figure, which does not include deaths in care homes, assumes that the transmission rate (R value) will rise to 1.7 from this September, which would be just over half of the initial level of transmission experienced in early March 2020.

The authors of the report, Preparing for a challenging winter 2020/21, point out that they are not making a prediction, but warn that NHS disruption from the first wave of COVID-19, a backlog of patients needing treatment, and the possibility of a 'flu epidemic, pose a serious threat to public health.

"The peak of coronavirus infection in the winter could be more serious than the one we've just been through," said Prof Stephen Holgate, a respiratory specialist from University Hospital Southampton NHS Foundation Trust, who chaired the team.

Preparing for a 'Challenging Winter'

The AMS assembled 37 experts in response to a request from Sir Patrick Vallance, the Government's chief scientific adviser, to model expectations for a challenging winter.

Under the scenario, infections could be expected to rise gradually with a peak in hospital admissions and deaths, of a similar magnitude to the first wave, occurring in January and February next year and coinciding with a period of peak demand for NHS services.

"We are now in a period of relative calm and we have the opportunity to prepare for this scenario," Prof Holgate told a briefing convened by the Science Media Centre.

Less severe epidemic scenarios where the R rate was 1.1 or 1.5 from September to July 2021 were provided in an annex to the report.

An R rate of 1.1 could lead to 1300 excess deaths (95% confidence level, 200 - 14,000), while an R rate of 1.5 could lead to 74,800 excess deaths (95% confidence level, 2700 - 175,000).

Prof Azra Ghani, chair in infectious disease epidemiology at Imperial College London, and co-author of the report, said "some of the US states where we're currently seeing rises in infection cases currently have estimates of the reproduction number in the range 1.1 to 1.4", and if translated to the UK that would mean "the health service would still be stretched".

She pointed out that "if infections did start to rise, and we started to see more cases, we'd expect the Government to take action".

However, the modelling did not take into account recent positive trials of dexamethasone, which suggested it could substantially reduce mortality from COVID-19.


The report calls for several measures to save lives this winter and prevent the health system from being overwhelmed, including:

  • Minimising transmission of coronavirus in the community, with a public information campaign launched in the autumn

  • Reorganising health and social care staff and facilities to maintain separate COVID-19 and COVID-19-free zones to minimise nosocomial infection

  • Ensuring adequate testing and personal protective equipment (PPE)

  • Establishing a comprehensive, near-real-time, population-wide surveillance system to monitor COVID-19 levels

  • Guarding against the worst effects of 'flu with a concerted vaccination effort

"We don't have a vaccine yet for coronavirus, but we do have one for influenza," said Prof Holgate. "And we must help as many vulnerable people as possible, and as many health and care workers as possible, to get the 'flu vaccine."

He said upscaling test and trace programmes would be absolutely vital "because there's going to be a lot more people with infections that may actually resemble in some ways the coronavirus infection, and we need to disentangle those that have true coronavirus from those that have influenza and other respiratory viruses".

The Academy also commissioned Ipsos MORI to run online workshops with the general public, people who have been advised to 'shield', and those from Black, Asian and Minority Ethnic backgrounds, to understand how they think and feel about the problems expected this winter.

These revealed a limited level of understanding about what winter might mean in terms of a resurgence of COVID-19 and a lack of recognition that heightened risk could extend to the end of March next year.

"We're advocating for a powerful public information campaign," said Anne Johnson, professor of infectious disease epidemiology at University College London, and AMS vice president. "Everybody needs to realise that COVID-19 hasn't gone away. And therefore, everybody can help reduce transmission by social distancing, by the wearing of face coverings as a social norm, by good respiratory and hand hygiene, and the right level of heating and ventilation in our homes."


Responding to the report, Dr Simon Clark, vice president for policy at the Royal College of Paediatrics and Child Health, said: "Even without a second peak, restoring lost capacity and working through a massive backlog of cancelled procedures is an immense challenge. To go down this road a second time in 12 months would be a disaster for children and families. 

"We know a lot more about what we're facing than we did at the outset of the first wave. It's vital that we use the summer months to shore up our services so that we are better able to cope.

"It is likely to be a winter unlike any in recent memory. The commitment of NHS workers will not be enough on its own. The NHS needs emergency funding, extra capacity, and a plan to protect non-COVID focused services."


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