Fears for post-summer wave of severe RSV and other respiratory illnesses

There are fears that the UK will be hit by an autumn wave of respiratory syncytial virus (RSV) similar to that already affecting hospitals in New Zealand and Australia due to the erosion of immunity in children as a result of successive lockdowns and social distancing.

It comes as the chief executive of NHS Western Isles warned that the Outer Hebrides “are seeing an increase in respiratory infections among children” which are not being caused by Covid-19.

Gordon Jamieson urged parents to keep children away from nurseries if they were experiencing symptoms such as fever.

“This is important to help stop the spread of infection,” he added.

A&E attendances for under-5s and five to 14s have been rising since March but still remain below pre-pandemic levels

A&E departments across the UK have been experiencing a rise in pre-school children presenting with non-Covid respiratory illnesses.

Dr Hendry, a member of the Royal College of Paediatrics and Child Health, the situation had “come full circle” from medics being worried that sick patients were avoiding the NHS to a spike in people seeking help.

“We’ve seen a gradual increase in our numbers of attendees here since March which has coincided with a gradual easing of restrictions and a return to normality.

“Children are back at school, back at nursery, in shared childcare, out playing with their pals again, doing sports, and that has coincided with the increase in numbers that we’ve been seeing.

“However, what we and other children’s emergency departments have picked up on is an extra increase in pre-school children, under the age of five, presenting with fever and respiratory symptoms that were not Covid. These were other viral infections.

“Between April and May into June, our numbers of attendees went up by 50%, and this was a common experience in other children’s emergency departments across the UK.

“A lot of it was felt to be displaced winter viral illnesses - it was a bit like winter in June.

“A lot of these children in December and January were locked down, so the normal sharing of the viruses over the winter months couldn’t happen, then we had things like increased handwashing and facemasks. So as we’ve opened up there’s been this increase in non-Covid respiratory illness.”

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Dr Hendry said they were mainly seeing mild cases of rhinovirus and parainfluenza rather than severe illness, but added that the major concern “on the radar” was a potential surge in RSV.

In New Zealand, the city of Wellington reportedly has 46 children in hospital with respiratory illnesses - particularly RSV - including infants on oxygen treatment. Other hospitals in the country are delaying surgeries or converting playrooms to cope with demand for beds.

The spread of the RSV in the Southern Hemisphere is expected to be mirrored here, with one leaked email from a London NHS trust telling clinicians this was “likely to start in July or August”.

The condition usually causes mild symptoms but can lead to bronchiolitis and pneumonia, especially in infants, sometimes requiring intensive care.

“There’s a spectrum of severity but a number of younger children can end up in hospital quite unwell with it,” said Dr Hendry.

“We normally see a single or dual peak of RSV in younger, pre-school children every winter, it’s a very seasonal infection. Often it’s November-December with a peak second later in winter, but we saw very little if any this past winter.

“There’s a lot of public health monitoring going on across the UK now looking for RSV, trying to get as early a warning as possible of whether numbers are going to increase.

“There is a degree of anxiety that we might get a peak of RSV and bronchiolitis in a part of the year where we wouldn’t normally see it and that it may be bigger in terms of numbers and severity than we might usually see, again because children haven’t been mixing.

"You've got a whole cohort of babies born over that time that haven't developed any immunity from previous exposure to viruses."

Dr Hendry added that over the past couple of weeks emergency departments in Scotland had seen a "dip" in the numbers of the young children presenting with respiratory illness, but that doctors were worried about the potential for a "worst-case scenario" of respiratory outbreaks when children returned to classrooms in August.

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"The Royal Colleges of Emergency Medicine and of Paediatric and Child Health are very anxious about what we did see in May and June, and what we might see in August," said Dr Hendry.

"It could be a perfect storm of a larger peak of RSV with more severe illness, and big surges in other non-Covid respiratory illness. We're battening down the hatches."

Epidemiologist and public health professor Michael Baker compared the surges in RSV sweeping New Zealand to forest brushfires: if a year or two have passed without fire, there is more fuel on the ground to feed the flames. When a fire finally comes, it burns much more fiercely, he said.

“What we’re seeing now is we’ve accumulated a whole lot of susceptible children that have missed out on exposure – so now they’re seeing it for the first time," said Prof Baker.

In New Zealand, lockdowns last winter led to a 99.9% reduction in flu cases and a 98% reduction in RSV, nearly eliminating the spike of excess deaths New Zealand usually experiences during winter.

Meanwhile, NHS Tayside's director of public health, Dr Emma Fletcher, warned that the region was facing an "exceptionally serious" situation as it was forced to ringfence a fourth ward at Ninewells hospital in Dundee to cope with an influx of Covid patients. The new ward has capacity for 30 patients.

Ninewells hospital had no Covid patients in April but now has 63, including five in intensive care, following weeks of soaring virus rates in the Dundee area which are now the worst in Europe.

In a video message, Dr Fletcher urged people aged 18 to 29 to get vaccinated, adding: "This is the highest number of patients we have had since 12 February and our rate per 100,000 population is more than 10 times what it was just a few weeks ago.

"Unfortunately there are young people right now with Covid in Ninewells - not only in our general wards, but also in our intensive care unit and our high dependency unit."

READ MORE: Why are infections still rising when 85% of Scots adults had antibodies by mid-June

It comes as the latest infection surveillance from the Office for National Statistics (ONS) indicates that around one in every 100 people in Scotland were infected with Covid in the week ending July 3, compared to one in 160 in England.

However, there were continued signs that the recent surge in cases could be slowing, with 20,386 cases confirmed by tests in the week to June 9 - down 14% on the 23,822 detected during the previous week.