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There are concerns the UK could be facing a “quad-demic” this winter — with levels of four common seasonal respiratory viruses currently being monitored by the UK Health and Security Agency (UKHSA).
While in previous years, COVID and flu viruses were the biggest concerns for peoples’ health, this year the UKHSA is also seeing an uptick in cases of respiratory syncytial virus (RSV) and norovirus. In fact, there has already been a 352% increase in the number of people hospitalised with flu compared with December 2023.
With normal winter pressures also affecting the NHS, patients may be concerned about access to GP appointments and hospital services if they do find themselves seriously affected by these viruses.
Why are we facing so many epidemics?
Respiratory viruses tend to affect people more in the winter for a variety of reasons.
The recent drop in temperature in the UK has encouraged people to spend more time indoors together or take public transport to work instead of walking. These environments make it easier for respiratory viruses to circulate and spread. Cold, dry air, too, can facilitate the survival and spread of viruses.
The flu virus also changes to present new strains, which we may lack immunity to. During winter months we also have lower levels of vitamin D due to the lack of sunlight, which can also lead to a weakened immune system.
Norovirus is highly infectious, which may explain why cases of this particular virus are so high during this time of year.
The legacy impact of the pandemic may also explain why people continue to be more affected by respiratory viruses. Some people may have less viral immunity than previously due to the lack of socialisation and exposure during the pandemic. Changes in the way we live and work since the pandemic may have led to differences in the way viruses spread – but more research is still needed to prove this hypothesis.
What can you do?
Getting vaccinated is one of the best ways to protect against these seasonal viruses. The NHS is urging eligible people to get vaccinated as cases and hospital admissions rise.
Flu, COVID and RSV vaccines are free to those who meet NHS eligibility criteria. Adults aged 65 and over, care home residents and people aged six months to 64 years with specific underlying health conditions are all eligible for flu and COVID-19 vaccinations on the NHS. Those not eligible for free vaccines can purchase one from their local pharmacy.
An RSV vaccination programme has recently been deployed by the NHS. As of November 2024, more than one million people have received an RSV vaccination. The vaccine is available to those considered most vulnerable: older adults aged 75 to 79 and pregnant women. Those not eligible can purchase a single dose of RSV vaccine from the pharmacy chain Boots for £245.
At this time there are no vaccines for norovirus – though some are in development. So the best way to protect yourself from norovirus is to properly sanitise your hands, cover your mouth and nose when you cough and sneeze, dispose of tissues, let fresh air circulate and stay home if you’re unwell.
Being able to pay for private vaccines can be challenging and raises questions about equity of access in our healthcare system. The varying eligibility criteria may also be confusing to patients. These factors may inadvertently act as barriers in people accessing vaccines.
Delays in the rollout of the RSV vaccine may also mean some vulnerable people received it too late this year to be protected.
How can you manage symptoms?
School children aged five to 14 have been identified as a group of concern, with positive cases of flu increasing by almost 12% in a week. Getting vaccinated remains the best way to reduce the risk of catching and spreading these illnesses. But if you or your child do get sick, symptoms can typically be managed at home with plenty of rest, fluids and (if needed) over-the-counter medicines to ease symptoms. Similar measures can also be taken to manage COVID symptoms.
The RSV vaccine is very effective in reducing hospital admissions – so patients should try to get vaccinated for this illness where possible. It’s important to note that while you can get the flu and COVID vaccine on the same day, it’s more effective for people to have the RSV vaccine on a different day than the others.
If you do catch RSV or norovirus, symptoms can usually be managed at home just as you would COVID or the flu. Norovirus symptoms usually only last a couple of days, while RSV infections tend to get better after five to ten days.
If your symptoms are more severe, your local pharmacy will be able to recommend non-prescription medicines that can help to ease and manage symptoms. Pharmacy teams are also trained to recognise cases that will need to be referred to a GP – for instance, high-risk cases of flu that may need to be treated with an antiviral medicine, which has temporarily been authorised this winter.
What next?
The NHS is already a strained system. Although plans have been made to meet seasonal demand, the current service demand already meets that expected in the peak winter months. Increased viral infections mean GP services will be faced with additional workload responding to serious cases of infection, especially for people who are more vulnerable. This may put further pressure on an already stretched service.
In addition to this, cases of mpox and avian flu have been reported – leading to the possibility the UK could experience a fifth and sixth epidemic if these aren’t carefully monitored.
The threat of potentially six epidemics hitting the UK at once is alarming. People are encouraged to be vaccinated where possible to protect both themselves and those around them – and to take measures to reduce the risk of getting ill.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
