Respiratory viruses pile the pressure on Cambridgeshire’s schools and hospitals
An increase in respiratory illnesses in children is placing increased pressure on health services and schools in Cambridgeshire.
The spread of seasonal illnesses is believed to be more acute this autumn because isolation during Covid-19 lockdowns has impacted on children’s immunity.
Cases of respiratory syncytial virus (RSV), in particular, are thought to be rising.
One parent, who attended the paediatric accident and emergency department at Addenbrooke’s Hospital, described it as being “filled with constant crying” with the “vast majority of children seeming to be suffering from chest infections, coughs and breathing difficulties”. Her full account is inside.
The hospital confirmed that the department was “very busy”, which had led to a second waiting room being opened in line with its standard escalation process.
Some patients were left queuing outside on Friday night due to the general demand on A&E.
Health services in Cambridgeshire said there is likely to be “more respiratory illnesses this year because children have not had exposure to the usual number of coughs and colds over the past 18 months”.
This means many will not have developed immunity and as a result there may be more cases this year than in a typical season. For the majority of children, these illnesses will not be serious and they will soon recover following rest and plenty of fluids.
Guidance from NHS England earlier this month warned that it anticipated an “earlier and greater than usual increase in respiratory syncytial virus and other respiratory illnesses in children”.
RSV is very contagious but usually leads to no more than cold-like symptoms and a cough for a week or two, although it can cause bronchiolitis – an inflammation of the small airways of the lungs.
Schools across Cambridgeshire say they are “seeing an increase in the challenges associated with managing student absence this term”.
Analysis of Covid-19 cases by the Cambridge Independent has shown that the highest number of infections are being seen among those aged 10 to 14 – some 592 of the 2,011 Covid cases in the county in the week to September 17 were in this age group. The next most commonly affected were those aged 15 to 19, with 239 cases, and children aged five to nine, with 232 cases. In total, these age groups made up more than half of all coronavirus cases in the county.
One challenge for parents and schools is that some symptoms of other respiratory viruses, such as coughs, are also symptoms of Covid, meaning PCR tests are required for diagnosis.
A parent in South Cambridgeshire, who did not wish to be named, said: “Our nine-year-old had what appeared to be a cold, but when he developed a terrible cough we took him for a PCR test and he had to be off school while we awaited the results, which thankfully were negative. A number of his friends were the same – and it all means they’re missing out on lessons, unfortunately.”
Nationally, acute respiratory, asthma and difficulty breathing increased particularly in children aged one to four and five to 14 years old following the return to school, with this rising further in the latest data covering September 13-19.
Public Health England data shows that respiratory attendances at hospitals are rising across all regions, including the East of England and are now above pre-Covid levels.
A spokesperson for Cambridgeshire Secondary Headteachers Group, said: “In common with the national picture, Cambridgeshire Secondary Headteachers are seeing an increase in the challenges associated with managing student absence this term.
“The continued pressure of Covid-19 infections alongside other seasonal illnesses remain significant for schools and families. Regular attendance at school is essential to ensure that children are supported to succeed in their learning.
“Although stricter control measures such as year group ‘bubbles’ or ‘zones’ have been relaxed this year, secondary schools still maintain careful procedures to monitor and limit the spread of infections. These measures remain under regular review, and headteachers are working closely with the local authority and Public Health England to help keep schools as safe as possible.”
A spokesperson for Cambridgeshire and Peterborough Clinical Commissioning Group, which is responsible for planning and buying local NHS services, added: “It’s likely there will be more respiratory illnesses this year because children have not had exposure to the usual number of coughs and colds over the past 18 months.
“Most colds and respiratory illnesses can be treated at home with plenty of fluids and rest, over-the-counter medication, and advice from your local pharmacist. If your child has a cold, encourage them to use a tissue to catch it, kill it, bin it and wash their hands regularly.”
Dr Yvonne Doyle, medical director at Public Health England, said: “This winter, we expect levels of common seasonal illnesses such as cold and flu to increase as people mix more and given that fewer people will have built up natural immunity during the pandemic.
“Children under two are at a particular risk of severe infections from common seasonal illnesses. If a child under two is suffering from a cold, keep a close eye on their symptoms and make sure to contact your doctor if they get a high temperature, become breathless or have difficulty feeding.
“It’s important that we carry on with good hygiene habits that we’ve become used to during the pandemic, in order to protect ourselves and those around us. This means washing your hands regularly, using a tissue to catch coughs or sneezes and washing your hands afterwards, and staying away from others if you feel unwell.”
The Cambridge Independent has also learned that some patients are turning up at A&E after struggling to get face-to-face appointments at GP surgeries.
But the CCG says practices are working “tirelessly to respond to a significant growth in demand”.
Dr Gary Howsam, chair of the CCG, said: “GP practices continue to work tirelessly to respond to a significant growth in demand for their services, whilst ensuring they provide care safely to protect both patients and their staff. Our practices are providing face-to-face appointments where requested or clinically appropriate, combined with telephone and online appointments to help make primary care services as accessible to everyone as possible.”
Many practices continue to offer patients a telephone or online triage appointment in the first instance, which can lead to a face-to-face appointment where requested or clinically appropriate.
GP practices in the area in July held 422,973 appointments, of which 234,446 (55 per cent) were face-to-face, with practices taking between 35,000 and 40,000 calls per day between them – more than one million a month.
Cambridgeshire County Council, which co-ordinates public health in the county, said it is working with the NHS, who are planning for these infections to increase this winter and promoting good respiratory – catch-it, bin it, kill it - and hand hygiene messages through schools and early years settings.
A spokesperson said: “The general public health measures we are recommending include good hygiene, ventilation, cleaning, stay at home if unwell and promoting the uptake of flu and Covid vaccinations to eligible children. This should reduce the number of non-covid viral infections as well.
“However, children have not had these infections last winter so immunity may have waned and we could see higher rates of other viral infections as restrictions are lifted and they mix more.”
The county said it was hosting regular meetings with the acute trusts, community services, the CCG and local authority children’s public health teams are in place.
Addenbrooke’s Hospital continues to see an extremely high demand with pictures circulating on social media of people sitting waiting on chairs outside the A&E department.
A CUH spokesperson said: “We apologise to patients who have had to wait longer than we would like for treatment. Our emergency department has been experiencing extremely high demand. In addition, because of Covid safety and social distancing, the emergency department has a reduced number of treatment spaces and seats in waiting areas.
“Any patients waiting to enter the department are reviewed by a registered nurse who will quickly prioritise those with the greatest need.”
The spokesperson added: “Please support your NHS by using the right service at the right time, so that our emergency departments can keep providing care for people who have a genuinely urgent or emergency healthcare need. If you are unsure where to go for help, visit 111 online or call NHS 111.”
NHS England began planning for the potential rise in paediatric respiratory infections in April 2021, with paediatric units bringing forward their usual winter planning, escalation and emergency processes which will support an increased capacity in terms of beds, workforce and ward supplies.
Meanwhile, a letter to parents from the county’s education director, Jonathan Lewis, this week warned that schools may have to “step up measures” to help tackle Covid-19 transmission.
“This may include reintroducing temporary measures that you will be familiar with, including the wearing of face coverings and individual classes being ringfenced from other groups within the school in shared spaces,” he wrote.
“Please do not be concerned if this happens at your child’s school, it is to reduce the spread of infection and for children to continue with their education.
“Where there are insufficient staff to safely operate the school, we will temporarily move children to remote learning. This will always be a last resort.”