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"The one thing that no one wants to be gifted this Christmas is a nasty bout of the flu. But with the number of hospital patients with the virus reaching levels not seen since 2010, this year’s winter flu crisis has plunged the NHS into a “worst-case scenario”.
"Cases have risen by more than 50 per cent in a week and health chiefs have warned that there is no peak in sight. An average of 2,660 patients per day were in a hospital bed with flu last week – the highest ever for this time of year. UK Health Security Agency data show that the infection rate is highest among children aged between five and 14, closely followed by those aged 15 to 24.
"Several schools have shut to combat outbreaks, while NHS bosses have encouraged people to wear masks in the office or on public transport, as they did during the Covid pandemic.
"Dr Nisa Aslam, an NHS GP and the chief medical officer at screening company Inuvi, says surgery waiting rooms are groaning with sick patients. “As an NHS doctor, working out of hours, I’m seeing a much higher than usual number of flu cases, and over the weekend we were struggling to keep up with patient demand.”
"Each winter we see a mix of flu viruses, she says, but this season the dominant strain circulating is Influenza A H3N2, a subtype of the usual flu which has “drifted”, meaning it has minor genetic changes compared with previous years. “These changes can allow it to partially evade immunity from past infections or vaccinations, so more people are getting infected.”
"The infectious form of flu spreading has been nicknamed “superflu” because it is thought to be a mutated version of the influenza A (H3N2) strain dubbed “subclade K”.
"Influenza
H3N2 appears less frequently than other versions of flu. Dr Simon
Clarke, an associate professor in cellular microbiology at the
University of Reading, explains that the “H” and “N” refer to two
proteins on the surface of the virus — haemagglutinin and neuraminidase.
“The numbers simply classify which versions of those proteins are
present,” says Dr Clarke. “It helps us categorise strains. H3N2 just
happens to be the variant dominating this year.”
“H3 subtypes are
relatively infrequent,” he explains. “That means the population doesn’t
have such a high level of immunity to it. There’s also evidence they’re
more transmissible and mutate more easily, which makes them harder to
pin down with vaccines.
“The result is what many are
experiencing: a sharp increase in cases early in the season, with
numbers likely to rise further as winter progresses.”
How does it differ from the usual variety?
"Generally there are three families of flu – A, B and C – according to Ed Hutchinson, a professor of molecular and cellular virology at the Glasgow Centre for Virus Research. “A and B are the ones that make people properly ill every winter. Influenza C is around too, but it doesn’t usually cause serious sickness. They’re all related but not similar enough that immunity to one protects you from the others,” he says.
"The problem isn’t that the virus has suddenly become dramatically more deadly – after all, many of us will have had it already and recovered well. “It’s more that a lot of people are getting infected. When a virus spreads widely, the small percentage of severe cases add up, so the overall impact feels worse for individuals and for the NHS,” says Hutchinson.
"There were 1,700 patients in hospital with flu last week, a rise of 63 per cent on the week before, and more than 50 per cent higher than this time last year. This is in part due to a particularly virulent subtype of the circulating H3N2 virus. “This subtype is circulating earlier and faster than usual, and immunity in the population is lower than expected for this time of year,” says Dr Aslam.
Why are vaccinated people still catching the flu?
"Flu
vaccines never give perfect protection from infection, and the amount
of protection they give you varies from year to year. “Because flu is a
winter virus, we always look at what’s happening in the southern
hemisphere to predict what will be going into the vaccines for our
winter here in the UK, because it takes about six months to make enough
doses to vaccinate an entire hemisphere’s worth of people,” explains
Hutchinson.
“So we’re guessing ahead which way the virus will go,
and sometimes those guesses are better than others. This time, right at
the end of a southern hemisphere’s flu season, the virus acquired seven
extra mutations, which is a lot, meaning that anyone who’s been exposed
to flu – effectively everyone – will have a bit less protection than
they normally would. And it’s spreading faster because of the
mutations.
“This year’s vaccine matches some flu types well, but
H3N2 threw scientists a curveball. The vaccine isn’t as good a shield
against catching H3N2 itself, although it still does a solid job at
preventing severe disease. In short: still absolutely worth getting.”
"Even though it’s a new variant, Dr Aslam says, H3N2 presents as typical flu: fever, cough, sore throat, muscle aches, fatigue, and sometimes gastrointestinal upset.
"You don’t need to see a GP or attend A&E if you’re otherwise well. “Red flags” to watch for, she says, include: difficulty breathing, chest pain, confusion, persistent high fever, severe dehydration, or symptoms that suddenly worsen.
"People most at risk are older adults, young children, pregnant women, and those with underlying health conditions, such as the immunosuppressed. And while children – largely because of how much they mix – are a major engine of transmission, parents shouldn’t panic.
“If children get flu, it’s usually not
severe. It’s adults who get the worst illness,” says Dr Clarke. “There’s
a school vaccine programme – the nasal spray – but that’s mainly to
reduce spread,” he adds.
"And there’s no clear sign that this
year’s flu will make you sicker for longer. “Flu is variable – some
people feel awful for a few days, others for a couple of weeks – but
nothing suggests this variant is prolonging symptoms,” insists
Hutchinson.
"There is no magic bullet, says Dr Clarke. But the basics do work: handwashing, avoiding crowded indoor gatherings, staying home when unwell, self-isolating within families where possible
“It’s
not inevitable that flu spreads through a household – though it’s
highly likely,” he adds. And, he notes, “If you’ve got proper flu,
you’re unlikely to be leaving the house anyway. It’s not the same as
just having a heavy cold.”
"Hutchinson advises that everything we learnt during Covid still helps. “Masking,
keeping some distance, working from home when you’re ill, and being
cautious around vulnerable people all reduce spread. In fact, during
Covid, when we were all so cautious, we were able to make one strain of
flu extinct.”
“Remember, people can actually spread the virus before they feel sick
– the fever and aches we associate with flu are our body’s immune
response, not the first sign of infection. Once symptoms begin, people
are typically infectious for about a week,” says Hutchinson. “So it’s
possible to pass flu on without realising you’ve got it yet.”
"Dr
Aslam says it’s sensible to avoid elderly relatives if you’re feeling
unwell this Christmas, and certainly to stay home while symptomatic;
typically four to seven days, depending on severity; until you’re no
longer contagious.
"All
the experts recommend getting the flu jab, which is safe, widely
available in pharmacies, and inexpensive (if you’re not eligible for a
free one). The flu jab is generally thought to achieve maximum
protection for an individual after 10-14 days.
"It remains a
valuable layer of protection even though some might be surprised to
catch flu, despite being vaccinated, but this is fully expected,
according to Dr Clarke.
“No vaccine is 100 per cent effective,”
he says. “Some people will have only just had their jab, so immunity
hasn’t developed fully, and in some individuals the vaccine simply
doesn’t work particularly well.”
"But he stresses it is still
absolutely worth having – noting that even he recently caught flu
despite being vaccinated six weeks earlier. “Yes, I caught it, but it
certainly took the edge off the symptoms,” he says. “In the past, the
one year I didn’t have the jab, I ended up in bed for a week.”
"Dr
Clarke wishes more of us would choose to be inoculated. The latest
National Flu and Covid-19 Surveillance Report shows that only 70.9 per
cent of over-65s have received their flu jab this season. Rates among
eligible under-65s are far lower, hovering around 35 per cent. “It
really would make a difference,” says Dr Clarke.
"Dr Aslam says that treatment hasn’t altered; treat this year’s slightly different strain as you would any other year.
“Plenty
of rest, fluids, and take fever and pain relief such as paracetamol
when required. Antiviral medications are reserved for higher-risk
groups, as most people can safely recover at home without visiting a
doctor.”
"Dr Clarke admits he recovered from his recent bout “in around 36 hours, helped along by a medicinal whisky”, he laughs.
"The
bottom line, he adds, is that we should brace ourselves for a tougher
winter. “Some years are gentler than others, but this year looks like it
may be a tougher one, and we haven’t yet reached the usual
January/February peak.
“But we’re going to see a flu outbreak every year – that’s normal,” he says. “The only time we didn’t was during the Covid lockdown.”
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