Wales is dealing with a "tripledemic" which is causing widespread problems for staff in the health service, experts claim. Health boards across the country are currently contending with rising rates of Covid-19, record levels of strep A/scarlet fever cases and the typical winter flu season.
In Betsi Cadwaladr UHB in north Wales, all but the most urgent operations have had to be cancelled due, in part, to these three conditions. On Monday morning the health board declared a "critical incident" meaning it is "struggling to cope with the prolonged, significant demand on the health system". You can read more about that here.
Nesta Lloyd-Jones, assistant director of the Welsh NHS Confederation, described demand on the health and care system as "relentlessly high", while call volumes to the NHS Wales 111 helpline have increased by a whopping 300% - the highest on record. Here we look at all three health 'tripledemic' issues the NHS has to tackle and the threat they pose.
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Covid-19
On Friday, December 16 the Office for National Statistics released its latest weekly Covid infection survey. It found that infections were rising in most parts of the UK, including Wales, but were still well below levels reached earlier this year.
For the week ending December 5, 55,900 infections were recorded in Wales which equates to 1.84% of the population or one in 55 people - up from 43,400 or one in 70 the week before. Meanwhile the number of patients being actively treated from the virus in Welsh hospitals has almost trebled from 22 on December 7 to 59 on December 13.
There are currently 382 "confirmed" cases of Covid in hospitals in Wales as of December 13 - compared with 242 seven days earlier - but 85% of them are being treated for something that is unrelated to the virus. The number actively being treated for the virus has however leapt from a low of six on November 20 to 59 on December 13. Currently 10 people are in critical care beds being specifically treated for coronavirus.
The ONS said the total number of people in private households across the UK testing positive for coronavirus stood at an estimated 1.3 million in the week to December 5, according to the ONS. That is up 16% from 1.1 million the previous week. During the main waves of coronavirus earlier in 2022 the total peaked at nearly four million in July and just under five million in March.
The Covid-19 autumn booster programme is live and many people including everyone over 50 years old and those at risk of severe disease have been offered a Covid-19 booster to reduce their chances of getting seriously ill with Covid-19. Statistics published earlier this month show that over a million people in Wales have now received their Covid-19 booster vaccination this autumn.
Strep A/scarlet fever
Public Health Wales, which publishes a surveillance report each Monday, confirmed that 650 cases of scarlet fever were identified for week 50 between Monday, December 12 and Sunday, December 18. This was down from the record 857 reported the week before which was around 35 times higher than the average for this time of year.
The average number of scarlet fever cases for week 50 over the previous three years was around 25. Dr Chris Williams, consultant epidemiologist for Public Health Wales, said this data should be treated with caution as GPs and the public are being urged to look out for the condition.
The spike in scarlet fever reporting comes following a rise in Strep A cases which can cause a wide variety of infections, but most commonly scarlet fever. According to PHW, scarlet fever mainly affects children aged two to eight, with most having built up an immunity to it by the age of 10. Most cases of scarlet fever cause no complications, especially if the condition is properly treated with antibiotics.
Symptoms of scarlet fever include a sore throat, headache, fever, nausea and vomiting. This is followed by a fine red rash which typically first appears on the chest and stomach, rapidly spreading to other parts of the body. Older children may not have the rash. On more darkly pigmented skin, the scarlet rash may be harder to spot, but it should feel like 'sandpaper'. The face can be flushed red but pale around the mouth.
Influenza
Public Health Wales also publishes a weekly surveillance report on the prevalence of flu. Their experts claim that the flu season started much earlier this year which means the peak of activity is likely to be around Christmas. They are urging those who are eligible for a free flu vaccine to take up the offer now to help protect themselves and others from getting seriously ill with flu this festive season.
During week 49, ending December 11, there were 765 cases of influenza which was a rise of 15 on the previous week. In week 49 there were also 15.5 GP consultations for influenza-like illness per 100,000 practice population - almost double the 7.9 the previous week. It means flu is now circulating at above baseline levels and is now present at a 'low intensity' across Wales.
To put this into context, in 2019-20 flu was at 'medium' intensity (just below 40 GP consultations per 100,000) and in the record-breaking outbreak of 2010-11 there were in excess of 90 consultations - described as 'very high intensity'. Meanwhile the percentage of calls to NHS Direct Wales which were ‘influenza-related’ (cold/flu, cough, fever, headache and sore throat) during Week 49 increased to 40.1%.
Flu is a serious illness that can kill. Deaths and severe outcomes of flu infection are seen in every season. In the last season which saw very high levels of circulation (in 2017-18) the number of excess seasonal deaths estimated in Wales during the winter was 3,400, the highest in more than 20 years.
Dr Christopher Johnson, consultant epidemiologist and interim head of public health at Wales’ vaccine preventable disease programme said: "Flu can be serious, particularly for those who are older or have a health condition and are more vulnerable to complications as a result of the flu. We often socialise more at Christmas and are more likely to see vulnerable elderly relatives. Vaccinations are the best way to protect ourselves and loved ones from getting seriously ill this winter."
Similarly, confirmed cases of the respiratory syncytial virus (RSV) in children aged under five has increased compared to the previous week and remains at 'very high' intensity levels. In week 49 there were 134.5 confirmed cases per 100,000 in this age group.
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