Can the NHS handle ‘unprecedented’ super flu season?

0:02Sky News, the full story first.

0:08Thomas Moore:Coming up, a tsunami of super flu. The NHS warns that hospitals could soon be overwhelmed by a particularly virulent strain. As the day wraps up, get the scoop on what's been happening with Here's the Scoop, a new podcast from NBC News with me, your host, Yasmin Visugyan. We'll take a deep dive into the day's top stories with NBC News' trusted journalists. It's a fresh take that's sharp, thoughtful, and it's informative, bringing you closer to the headlines and conversations that are shaping our world. From the front page to the zeitgeist, here's The Scoop from NBC News. Listen daily wherever you get your podcasts.

0:51Thomas Moore:If you've been suffering from a particularly bad case of the pre-Christmas sniffles, believe me, you're certainly not alone. In fact, the latest data from the NHS shows that a new strain of influenza, the flu, is threatening to overwhelm our hospitals. Across England, the health service says there are enough flu patients to fill more than three entire hospital trusts. And there's no expectation the situation will get any better this side of the new year. All of which makes those doctor strikes planned for a few days' time a major cause for concern. In the studio we have Dr Raj Arora, a GP and health educator.

1:28Thomas Moore:Great to have you on the podcast. Thank you for having me. And coming back, of course, our resident science expert, Thomas Moore. We're going to start with you, Thomas. The data, how bad is it? I keep hearing about a tsunami of flu coming our way.

1:42Dr Raj Arora:The flunami, they're calling it, yeah. So we've had the latest stats from the NHS in England. There were an average of 2 ,660 patients a day in a hospital bed. last week that's a 55 percent rise on the week before 106 patients in a critical care bed so very seriously ill and that's a 24 percent rise on the year before and these are very very seriously ill people who need critical care so this is a really serious disease it's not the common cold this is influenza very distinct virus let's just run through the figures from scotland because we update on those too. So there's been a rise in the number of people in hospital from 860 to 986.

2:24Dr Raj Arora:So that's a 15 % rise. So it is a slower rise in Scotland. Seems perhaps slowing down there, but we wouldn't make predictions based on just one week's data.

2:32Thomas Moore:No, we certainly wouldn't. But Dr Raj, it's been called a super flu. What does that actually mean? Tell me about this strain. So the flu itself is not a nice thing to have. I can tell you that I've had it once and it's, you know, you've got it and you're very ill with it. But the super flu, I think, is indicating towards this strain that's mutated seven times over. So it's drifted away from what we normally see for mutations. And mutations are obviously common when you have the flu, but I think because it's mutated quite a bit, it's rendered the vaccine slightly less effective than we would like it to be.

2:59So it's now at 30 to 40 % for adults. For children, it's still at 70 to 75%. So it is still effective. It's just not a perfect match. And I think what we're seeing with the flu is that because that vaccine is not quite targeting that exact strain that's mutated, we're seeing those symptoms coming about and also causing more serious illness especially in those that are more vulnerable so the elderly those with comorbidities maybe pregnant people and even the fit and well because we're not quite capturing the same kind of immunity as we would from the vaccine you mentioned the symptoms there i mean how bad can it get so it's really clear to distinguish the common cold i think from the flukes as a doctor as a gp i do spend a lot of my time doing this and i think the common cold is more gradual onset so it's kind of like coughing sneezing upper congestion, you don't really get fevers or muscular aches or the other added symptoms.

3:42So with influenza, there's a clear, sudden influx of symptoms. And it comes on as a really high fever, for example. You will get aches and pains in the body. You may be getting a dry cough, a sore throat, a headache, feeling fatigued, loss of appetite, sometimes even tummy pain, diarrhea, vomiting, nausea. So it's a whole body illness. What actually happens is you genuinely cannot get out of bed. You're really, really, you feel you've been hit. And if you're somebody who's vulnerable now, already with a lung condition, for example, or immunocompromised, this can become serious. So the vaccine actually helps to prevent and reduce severe illness and hospitalisation.

4:20And that's why I think we rely on the vaccine for that.

4:23Thomas Moore:And yet, Thomas, we are being told that there are parallels in our hospitals right now with what happened not that long ago in terms of COVID. I mean, how accurate is that? I mean, the scale is presumably vastly different.

4:33Dr Raj Arora:Yeah, I mean, different viruses have spread in slightly different ways. And the R number, remember the R number? Yeah. Yeah, so, I mean, this is applicable to flu too, but the R number is slightly different. For those who don't remember, remind us what that means, Tom. Well, OK, so the R number is a measure of how easily these viruses spread from one person to another. So typically for seasonal flu, for every 100 people who get it, they'll spread it to another 120. Right. With this particular strain of flu that's going around at the moment, they spread it to 140. So that wall of immunity that we used to talk about in COVID, that's much lower this time around.

5:10Dr Raj Arora:Then people don't have that immunity built up from previous infections or from vaccination that will protect them against this strain. And that's why it's finding it easier to spread much earlier than normal in the season.

5:22Thomas Moore:What do we understand then has been the impact on our hospitals?

5:25Dr Raj Arora:It's bad, yeah. Yeah, this time of year is extremely bad. And they are worried because it's all coming together at the same time, of course, as the potential five-day strike from resident doctors, what we used to call junior doctors. And that is just before Christmas, when hospitals are really keen to get people home to discharge them from those beds because they want to give staff a break too. The number of people on shift over the Christmas period, they'd like to keep it much lower. And so they can't have too many people occupying beds.

5:53Thomas Moore:Dr Raj, we did, though, have a little bit of an early warning about this, didn't we? We saw what was happening in other parts of the world. Yeah, so we saw in Australia what was happening over the summer. Obviously, their flu season precedes ours here in Europe and the UK. So I think it's really interesting to see what's happening there, what happened there. So they kind of peaked in June, July, I believe, but it wasn't with the same viral strain that we're seeing here. And that's important to recognise. But I think what's really important to distinguish as well is that they did have a peak in the summer months of their flu.

6:22they had record numbers and hospitalized they had record rise in influenza cases but they also had lower vaccination rates whereas we have had the same if not more vaccination rate here in the UK so there was a slight difference there in what was happening.

6:35Thomas Moore:What is the vaccine uptake in the UK at the moment? Can we put a figure on it?

6:39Dr Raj Arora:It varies by group. Yes. So in the over 65s it tends to be very very good so I'm looking at last week's flu report here from the UK Health Security Agency updated every week but the latest figures we have show that in the over 65 71 percent had had the vaccine in the under 65s those with health conditions long-term conditions like lung and heart disease and so on is it drops to 36 percent 35 percent of pregnant women and quite low in children about 41 percent too so in the uptake could be a lot better so i think what you're seeing is where that drops come down to 30 to 40 percent for adults is still effective in reducing severe illness and hospitalisation, but it will not be as effective as it was previously because of the mutations that the virus has gone through.

7:23And we were not expecting that to happen seven times over with influenza, which has happened here.

7:27Thomas Moore:As you will probably have experienced in your own practice, there is a degree of vaccine scepticism around these days. And I'm wondering, just when it comes to this particular vaccine, are there side effects? Are there dangers? What reassurance can you provide people? So I think it's really important to recognise if there's contraindications, you will be made aware of them. So it's a very, very in-depth form you'll go through. A contraindication. So meaning that you can't have the vaccine. But I think it's important to recognise that there's a really comprehensive form you go through before you have the vaccine.

7:55I think it's also important to recognise that normally for most people, the majority of people having the vaccine, the side effects are very minimal. I had mine yesterday and I had a really painful left arm. And, you know, my arm was a bit sore, I didn't have to take any pain relief with that. I was just aware that it had the vaccine. Some people may find they get a few symptoms, mild flu-like symptoms but honestly most of my patients and most people who have it don't really have any other symptoms of it so that's really important to put out there but yeah other than that it's quite well you know received by most patients who have it and do take it but what you mentioned about vaccine skepticism I agree I think since Covid there has been a question mark around vaccines and the flu vaccines has been there for years and years and taken up quite well but I think there is also a little bit of fear around vaccines and because of all that we've seen the media and the public around Covid so I think as healthcare professionals we often have to have that conversation in clinic with patients and try to reassure them because if you're in a vulnerable group the best protection you can have really is through the vaccine.

8:45Dr Raj Arora:Yeah something like one and a half billion people a year have the flu vaccine though and it's broadly the same vaccine every year it's just updated with a particular strain so nobody should think that this is a new or experimental vaccine in any way it is a slight update on the one that we had the year before.

9:01Thomas Moore:And of course if you have any questions about this sort of thing go straight to your GP is always It was always the best advice. But, Thomas, are we at a point where if you can afford it, everyone should be getting the flu vaccine?

9:13Dr Raj Arora:Yeah, I did. So I paid, whatever it was,£18 for mine. You make your own decision on whether you want to do it, but I just felt that I didn't want to ruin Christmas. Cases were building up. I could see that three weeks ago, that we were heading for a crunch around a really important time of year when people tend to get together. Kids are the super spreaders of flu, right? Tell me about it. Exactly. Exactly. All those snotty noses. So they pass it around the classroom really, really quickly. And we've seen that. Some schools have actually had to close temporarily because it's just, you know, they can't actually staff it.

9:43Dr Raj Arora:It just goes around so quickly. The problem is that kids generally don't get that sick with food, do they? Yeah, they bounce back quite quickly. Yeah. It's Christmas time. When everybody gets together, they pass it on to elderly relatives, those who are more vulnerable. And that's when you see the big impact on the NHS. So the NHS will be extremely concerned that they could see admissions spiking at a time of year when people are off. And we're talking about 2 ,600 odd beds being filled at the moment. There are some predictions that could reach 5 ,000 to 8 ,000 by the end of this week. And that will continue rising.

10:18Dr Raj Arora:It's impossible to say where this is going to go next. But if you look at the trajectory at the moment, that steep upward curve, it doesn't look good.

10:25Thomas Moore:So vaccination, all important, Dr. Raj. But the vaccine doesn't start working on day one, does it? No, it takes about two weeks to get to its level where it's going to give you some protection. Have we still got time to sort this out before Christmas? You have, yeah. Go now, right now. Stop listening to the podcast. And actually it's available, really easily accessible and available as well, the vaccine. So you can go on the NHS website to get it. You can go to a local pharmacy to get it. You can pay for it if you're not in the eligibility criteria as well. And I think that's really important to say because I think oftentimes you don't want to ruin Christmas, as Thomas said.

10:53But if you've ever had the flu before, you are much more likely, if you're not in the legibility criteria, to go and pay for it, I think. I think a lot of my patients come in and say, I'm not going through that again, you know, and they go and buy it. So I think it's worth going through the legibility criteria. So for 65 years or over, if you're between 2 to 11 years, you'll be offered it at school. If you've got previous health conditions or comorbidities, you might be in legibility criteria as well. Pregnancy, if you're a carer and looking after somebody who's vulnerable or if you're in close contact with a carer or if you're a key worker.

11:20So there's all the legibility criteria on the NHS. But outside of that, you can go and pay for it, as Thomas said.

11:25Dr Raj Arora:I've had flu twice in my life and it is utterly horrific. I could not get out of bed. It is so painful, just the muscle pains. It is just really, really horrible. Just trying to get out of bed to go to the loo, not good. And so people tell you that they've had flu four times a year. That's not flu. It really isn't flu.

11:43Thomas Moore:We've talked about vaccine scepticism. What about mask scepticism? This week, we've seen that the chief executive of NHS providers urging people, if they have some sort of symptoms, to pop a mask on if they're out in public. What do we make of that? I think it's really important to recognise what mask it is that we're using. Every mask will provide some protection, I guess, because you're just preventing droplet infection from the influenza virus. It's like an aerosol coming out of your mouth and you cough, isn't it? Exactly. I think the masks that we're looking at, the really good quality sort of masks that we know work and have had some research and studies around them are the FFP2 and the N95 masks, which give you more protection because they sort of block out respiratory droplets.

12:20They are fluid resistant, as it were. You're likely to get more protection from those masks. So if you are vulnerable and you want an extra layer of protection, you're thinking of using a mask, go for one that's going to maybe give you more protection than a bog standard surgical mask.

12:31Thomas Moore:But is it for protection of yourself or is it for protection of other people? Because I think even during COVID, people were confused as to why they were being told, mandated to wear these masks.

12:42Dr Raj Arora:Yeah, no, I think you're right. I think if you want to protect yourself, you should try and wear those respirator type masks with very high levels of protection. If you want to do the decent thing, even if you're getting over flu or even the cold or any respiratory infection this time of year, if you want to help other people on the bus or the tube or train, wear those more surgical type face masks that we got used to during COVID because it will reduce the distance that these virus droplets are able to spread and that will help. I think the idea is around that reducing transmission. It's not either or.

13:12You can protect yourself and the other person. But look, if a mask is not for you and there are lots of questions around or masks might make patients feel like they are remembering the COVID era and they're worrying about that kind of connection or attachment. There are other things you can do, regular hand washing, disinfecting surfaces, ventilating your areas of rooms that you're in.

13:28Thomas Moore:How about something more fundamental? Why isn't the advice, if you are ill, stay at home? Yes, staying, not be in close contact with others if you're ill. And if you are coughing and sneezing into a tissue, into your elbow as a teacher at school, not openly on the tube or bus wherever wherever you are because you are going to transmit and like Thomas said one person to 140 that's a lot. So if you think you have the flu what should you do? You're just going to be tired you're going to be bunged up you're going to have this dry cough muscle aches you will be in bed a day or two even and sometimes three or four to be honest depending on how bad you get it but you'll be in bed you'll be resting sleeping you might have a fever and it might be quite high so you'll be you know trying to get that fever to come down with medication you can use things like paracetamol and myoprofen if you're able to use those safely always check with your doctor of course but it is normally self-limiting so it runs its course and then you're okay you know but there are certain things you must look out for in a doctor we call those red flags if you're struggling to breathe if you're getting chest pain if you're feeling dizzy if you're passing out if you are vomiting non-stop or aches and pains are not getting better with any kind of pain relief from medication bringing up copious amounts of sputum or blood in your sputum so there are things that you know you to look out for but generally most people feel rubbish for a day or two and then it'll start to feel a bit better keep your fluids up keep hydrated and try and eat small amounts but you

14:42Dr Raj Arora:might feel that you've got a lot of appetites don't rush back to work yes well that's don't

14:46Thomas Moore:give it to everybody else as if i ever do as if i ever do thomas but do we have an idea then through the modeling or just through the kind of the educated guesswork that we sometimes see when it comes to public health matters do we know when we might be coming out of it no you can't predict

14:58Dr Raj Arora:we were talking earlier about australia early on in the season they had this h1n1 virus going around that caused their peak in June July and it was only in August when you got this second wave of the H3N2 the the subclade K virus that we talk about it's very very difficult to predict you know at the moment there's very low immunity against this virus and so it will spread very very quickly it may be that Christmas in some ways puts the brake on the spread because the kids aren't at school but it could change so that it's more vulnerable people who get the infection and end up going into hospital.