Last winter in retrospect: at the frontline against pathological respiratory bugs

Winter of 2022/23 warrants a retrospective reflection of how healthcare and social systems in the UK fared at the frontline. Dealing with cases related to pathological respiratory bugs. Unlike other winters in the recent past. The upsurge of cases may have hit an unprecedented peak with resultant pressure felt across various healthcare settings. Including primary care. In addition to a lingering burden from the Omicron variant of COVID-19. We also saw an increase in cases of infections from:

• respiratory syncytial virus (RSV),
• human metapneumovirus,
• influenza,
• streptococcus pneumonia
• variants of Group A streptococcus (GAS).

The prevalence of these infections was reported to have peaked earlier and higher than usual across the whole of the UK. With the Southwest amongst the worst affected.

An update from the UK Health & Security Agency (UKHSA) at the time revealed that, "scarlet fever cases remained higher than would typically be seen at the time of year with 851 cases reported in a particular week.” The trend appeared to be similar to invasive-GAS. According to several reports,” at one point 5 deaths were recorded within 7 days of an i-GAS infection diagnosis (from any cause) in children under the 10 years of age."

Surge in infections

This surge in infections meant that primary and secondary care had to manage a much higher number of patients with symptoms. This impacted services but in the face of it all, members of the various healthcare teams continued to work tirelessly to ensure that the overall situation did not deteriorate to unmanageable levels. There have been postulations that primary care in the Southwest may have dealt with as much as 25-50% more requests at the time compared to normal, but the reality is that even a 1% increase in the number of patients referred to hospital would have tripled the potential admission rate and put the whole system in grave danger.

We, on the frontline are familiar with the presentation of our patients. It reminded me personally of a very unpleasant acute exudative tonsilitis experience from the recent past. I was at the emergency department helping during one of the very busy winter shifts. One of my encounters was that of a child (from the overflowing paediatrics assessment unit). Who presented with a raging fever of 40 degrees Celsius. With all the accompanying red flag signs, despite appropriate administration of antipyretics by the mum. The throat swab later returned to be positive for RSV.

The child was admitted under the paediatrics team for appropriate care. I am not aware of the outcome, but my hope would certainly be for a full recovery and discharged back home to their family.

What lessons can be learnt?

What can the primary care setting learn from these lessons? Steve Holmes, current chair of the Severn Faculty board suggested that “if we can assess and reassure/manage our patients safely in primary care, we should do so. We should feel comfortable though referring people whose condition are more dangerous or for whom we consider for further investigation is appropriate. We do not have access to rapid chest x-ray in our surgeries nor CRP tests. We are not able to monitor people over several hours – hence these will need appropriate support from our hospital colleagues. The more confident we are with our assessment and safety netting, though tough, and I know we are all going the extra mile or ten – we will help to protect our overstretched hospital service and keep our population safe. I hope the population, politicians and senior colleagues recognise this too.”

Hardworking primary care teams

I believe that it would be quite appropriate to commend the hard work put in by various primary care teams across the West Country and the rest of the United Kingdom as the case may be.

In the words of Professor Kamila Hawthorne, the current chair of the RCGP, “we feel what it’s like facing the challenges in General Practice at the moment. So it’s vital to keep telling ourselves and those in a position of influence, why we do this rewarding job and the value of high-quality primary care.”

Even when faced with what appears to be enormous, non-ending workloads. We must endeavour to remain optimistic and continue to deliver the best possible standard of care we can to every patient we encounter. In the winter the respiratory bugs rear their ugly heads. In the spring, autumn, and summer, it might be something different. Seasons come and go, but no matter what, we stand strong. Look after ourselves and our patients and celebrate the silent satisfaction of being helpful to humankind.

About the writer

Dr Daniel Ogidigben is a GP Trainee from Somerset. AiT representative and Comms lead for the Severn Faculty Board.