Coronavirus column: A look at how virus rates are rising

In his penultimate column ahead of his retirement, our Director of Public Health Prof Dominic Harrison gives an update on the rise in Covid cases and hospitalisations, and reflects on the additional risks to people with preventable conditions such as heart disease, high blood pressure and diabetes.

It was always expected that Covid cases would rise again when all the wider controls on community transmission were lifted, but we did not expect the rise to be quite as sharp as it has turned out to be.

Epidemiologists are not sure how long the rise will continue, but some suggest it should plateau and fall soon. As of Monday this week, Covid case rates in England were at 780 per 100,000 – up 55% in seven days, and the North West regional case rate was at 642 per 100,000 – up 61%. The numbers of those testing positive were also up as a percentage of all those tested. Positivity rates are up 33% in England and 37% in the North West. Parts of Cheshire and Cumbria are seeing particularly high case rates again with the average rate for Cumbria on Monday at 948 per 100,000 – up 71% in the last seven days.

The average case rate for Lancashire is significantly lower at 624 per 100,000 – up 59%. Blackburn with Darwen, although it also has case rates rising, is maintaining the lower rates it has achieved since August 2021. The Blackburn with Darwen Covid case rate on Monday was 376 per 100,000 – up 74%, but still at only about half the English case rate.

Covid hospitalisations have risen across Lancashire with East Lancashire Hospitals Trust seeing a further jump to 68 Covid in-patients on Monday this week. As case rates rise across the whole community, staff absences for Covid in the NHS and social care system are rising again, putting continued pressure on an already strained system and workforce.

The better news is that conversion of hospitalised Covid cases into critical care beds is massively reduced compared to previous pandemic surges. It is estimated that of the identified hospitalised Covid cases, maybe only around 50% were admitted because of a Covid symptom or complication –  with the other 50% having Covid only identified on admission for other routine conditions.

The vast majority of the hospitalised Covid admissions are now for older people whose immunity since their booster jab may be waning. From this week, the immunocompromised and those over 75 will start to be invited by their GP for a fourth jab (or second booster). Over time, this should reduce the rate of Covid hospitalisations in more vulnerable groups and put a brake on these rising hospitalisations. This will help ease us out of the pandemic, but, for now, we will all still need to continue to take sensible infection control measures to limit the spread of the virus, particularly in high risk situations.

Various research papers are now being published on the effects of the last two years of the pandemic. One research paper looking at who was most likely to have died from Covid over the past two years found that, of all Covid deaths:

“Hypertension (high blood pressure), cardiovascular disease, and diabetes were the most common comorbidity in patients who died from COVID-19. More than half of the patients who died from Covid had two or more comorbidities.”

There is a very important message in this data. Well over 50% of all cases of hypertension, cardiovascular disease and type 2 diabetes are preventable. As we start the journey to a full exit from the pandemic, our focus needs to be on wider prevention of these diseases through public health measures. The NHS has an enormous backlog of treatment for these diseases which it will need proper funding to manage – but without more investment in prevention than is currently provided or planned for by the NHS, we will see a continued growth in hospital admissions from diseases that are avoidable.

As I retire at the end of this month, next week’s column with be my last. I will try to summarise what I think the experience of the last two years has told us, both about ourselves and about the health and care systems we all rely on.