Ant 0.04
Winter is here. I know that because I've recently had a flu vaccination and my fourth Covid nineteen jab. But if I think back to the first lockdown in England that didn't happen until mid-March in 2020. That's practically springtime. So, what leads us to talk about a winter peak in infections? To answer that and talk more about the impacts that Covid and other respiratory infections can have I'm again joined by Claire Shooter, Public Health Manager at RSSB. Claire welcome back to the RSSB podcast. Let me get straight into the subject by asking why and when is there a peak in Winter Public Health issues
Claire 0.44
Hi Ant. Well, every winter we see that the rates of respiratory infections of all kinds go up. That includes flu rhinovirus, RSV, and now Covid nineteen as well. There's a few biological factors that we think make people more susceptible to infections in the winter. But the main reason is really just that everyone's indoors with the windows shut in those months. So viruses spread really readily in poorly ventilated areas. There's a bit of a misconception too that all these diseases peak around Christmas. People kind of think of Christmas as Midwinter. But, the coldest weather, which historically coincides with the peak of flu season is usually later, towards the end of January. And we think that's probably likely to be the case with Covid as that becomes a seasonal illness as well. So, this year and probably for many coming years, we still need to be conscious of Covid nineteen just like we've always been conscious and cautious about flu, which is more serious some years than others.
Booster vaccines have been offered for both flu and now for Covid nineteen to the most vulnerable people in the population and that's great. And those boosters now also target omicron variants of Covid nineteen which is fantastic; but the rest of us haven't been vaccinated in quite some time now. So our immunity coming into this peak for respiratory illness is quite a lot lower. This year as well, because widespread testing isn't happening anymore, we have less of an idea of what variants are out there and any new ones that are being beginning to emerge.
There's this common assumption around that new variants of a disease become less severe over time. But there's actually no guarantee that that will happen, and variants that cause serious illness could emerge at any time. A more dangerous variant could be creeping into the population and spreading, and we would be far less able to detect it now than we were last year. Also the rates of RSV are expected to be higher this winter. Although that's generally a mild illness, it can sometimes be severe in small children. And all of this we must remember is happening at a time when the NHS itself is under immense pressure. So we do need to be cautious about the potential for rising infections again this year.
Ant 2.43
Well, thank you for that less than comforting news for the general population. But for most of our audience I think the big questions lie around what it means for rail.
Claire 2.54
Yes. Well we don't know yet whether any industries need to respond in any specific way. That's of course up to the government to decide. But it's not inconceivable that some restrictions could be reintroduced in some industries if we get a new wave of Covid, and that could include impacts for public transport. If infections do go up again, we might also see changes in passenger demand, and we could also see more staff absence.
We know that for most people, especially if they're young and healthy, they recover just fine from Covid. But a small number go on to experience issues for sometimes several weeks, sometimes longer, after an infection which we've all collectively been calling long Covid. This often involves sleep disturbances, brain fog, and feeling run down, but the most common symptom is fatigue. We know fatigue is a really important issue for the rail industry where R S S B have ourselves done loads of research and produced guidance on this subject on our website. So, it's really important for people reporting into work to make sure that they're fit to do so. And if they're experiencing unusual levels of fatigue following a Covid infection, should be reporting that to their manager and those people should be making a plan together for how to move forward. There's a lot of reasons to continue being cautious about Covid this winter, so on top of that if you're sick stay home so you don't infect other people, and make sure you're registered with a G P. Be aware of what vaccines are available to you and more generally keep yourself in good health with diet and exercise as much as you are able, to make sure that you're just generally in good health.
Ant 4.23
Thank you Claire. That's all good advice at any time of the year but particularly now when we know there is a greater likelihood of people being infected. You mentioned the impact of fatigue on safety. To the best of my knowledge I haven't had Covid but my recent vaccines certainly floored me. I was hardly able to function for the next thirty six hours or so. Now that's a relatively short-term impact, but we know that there's a condition called long Covid which you've just mentioned where some of these symptoms can persist for a very long time. So what do we actually know about long Covid now?
Claire 4.59
So, first just to pick up on your point about feeling tired after the vaccine, that can certainly happen to some people and that's simply your body's healthy immune response to seeing something that's infectious, seeing something that's potentially dangerous, and fighting it off. But, yes, that can be difficult for some people; thankfully for a very short period of time.
With long Covid itself. We still know frustratingly little about the range of symptoms that some people can continue to experience after infection which, as you say, are collectively described as long Covid. There are quite a few clinical trials currently going on to find therapies for it. But without really understanding what the root causes are, or whether we're looking at just one condition with a lot of symptoms, or several different ones that are currently being grouped together erroneously, progress is going to be quite slow until we understand that.
There's a couple of front-running theories about what the possible causes of long Covid symptoms are. Some evidence suggests that in some people fragments of the virus remain in the body. And in those people, it keeps triggering their immune system and it's like your fatigue after getting vaccinated again. It causes inflammation and fatigue because your body is constantly in a state of attempting to fight off something, even though those bits of virus are inactive. Another school of thought is that Covid causes microscopic blood clots which obstruct some oxygen flow to some tissues. It could also be causing damage in the gut that we haven't been able to detect very well yet and each of these theories could be true. It could be that these are causing different subsets of the symptoms that we call long Covid and those may affect different people and they might need different drugs to treat them. So it's really challenging but the thinking is evolving, and research is moving forward. The good news is that most people do seem to get better over time.
But for now the best thing we can do is be informed about long Covid and how we can support people who are experiencing it.
Ant 6.49
Okay, so we're some time from fully understanding what long Covid actually is and being able to treat it. What things do we need to keep in mind until then?
Claire 7.00
What we need to keep in mind is that anyone can get long Covid. We tend to see it more in people who've experienced severe disease, and in people over 65, and in women. However, there are plenty of cases of long Covid among young healthy men as well. And even among people who've had asymptomatic infections which buck that trend, so it really is a disease that can impact anyone. If you think you're experiencing long Covid see a doctor who can advise you on how to proceed. They might be able to prescribe treatments that can alleviate some of the symptoms. And they can refer you to the brilliant N H S long Covid treatment plan app, which personalizes ways that you can help yourself recover as efficiently as possible.
The Health and Safety Executive, and also the Society for Occupational Medicine, have some back to work guidance for the use of employers and employees around long Covid. The H S E Guidance reaffirms the fact that, in these circumstances, continuing to work is generally quite helpful for the person experiencing long Covid symptoms. But for a while employers and employees may need to make some temporary adaptions to the work that that person is doing that are in line with that individual's capabilities. The really important thing is to have meaningful discussions with H R, with occupational health managers, and with staff to make sure that everyone understands one another, and understands what's expected of one another. Both those organizations, the H S E and the Society for Occupational Medicine, say that we need more research to get better at managing people returning to work with long Covid.
Ant 8.20
Thank you very much Claire. That's good information available from the N H S and H S E, but how can R S S B help our rail industry colleagues in particular?
Claire 8.30
Well R S S B can advise you on any public health questions that you have about dealing with respiratory viruses this winter, or any other public health issues that you're concerned about with your staff. We've got loads of great guidance on mitigating the risks of Covid nineteen, information on vaccines, and dealing with side issues of infectious diseases such as fatigue, and health and wellbeing issues.
One thing that I heard a lot during the pandemic from our members was that they were really struggling to find accurate sources for information, or they were dealing with staff who'd taken seemingly inaccurate information on board. So, because of that, we also recently produced a guide on how to identify good reliable sources of information and what the signs of misleading sources are, and that's available on our website. In light of how much the Covid 19 pandemic affected the industry, for the last year R S S B has been working on a G B Rail Pandemic Playbook which is there to help improve our resilience both to future waves of Covid and to any other disease that might arise and cause large scale infections that impact the way that transport operates. We've done this because sadly, even after what we've gone through in the last two years, the world hasn't really become more resilient to novel pandemic viruses. They could emerge at any time, and with people living in such densely packed populations, and so much global travel going on, it's still very possible for a disease to come into the human population, and spread really rapidly and lead to situations just like Covid again. You'll be able to find the brand new shiny pandemic playbook on our website.
The best time to prepare for a new pandemic is in advance. So do it now while you still remember what the last one was like; while you've still got staff who were there for it, and use this playbook to create a plan that is specific to your business and its needs. And one that doesn't make assumptions about what the disease will be like, which was the problem that we had in 2020; where we made plans for a flu pandemic when we weren't dealing with a flu pandemic. There's a big risk now that a new pandemic could come along, and we'll treat it like Covid when it's not Covid and behaves differently. So, that's what this pandemic playbook is for. It's to help you make a pandemic plan that makes sense for you, and your organization, and doesn't make assumptions about the disease. And we at R S S B can help you implement that and help you test it. That's what we at public health here are for.
Ant 10.43
Thank you very much indeed Claire you've talked a little bit about the Pandemic Playbook; I know it's quite a large document, but it is divided up neatly into useful sections. Could you explain a little bit more about how it's structured?
Claire a0.56
Yes, absolutely. So, the Playbook takes its structure from the way that the World Health Organisation, the W H O, structures the advice that it gives to governments for dealing with pandemics on a national level and international level. There's also different people dealing with different aspects of the pandemic, and in rail it's very similar. So, we've divided it into sections for planning and coordination around before, during, and after a pandemic for the same periods. How to assess information, how to monitor the situation; around communicating about it to your staff, to your customers, to the public; around maintaining staff health and wellbeing and other elements like that. So it divides into different, all the huge number of actions you may need to take into different realms of activity. Which will help people make their responses in a more structured way in the event of a pandemic happening.
Ant 11.50
Thank you, Claire. I've just mentioned it is quite a large document, do users have to read it from cover to cover?
Claire 11.57
No, absolutely not? Only people who are very interested in diseases, like me, or are very involved in strategic planning, might be interested in doing that. You might want to read the sections that are relevant to your area of organisation. So, if you're in operations. perhaps you want to read the sections that are about continuity of service if a disease is actually imminent. Then you might want to read the stuff that's about what to do in the situation where there's an outbreak of disease in other countries, but your country is, as yet, unaffected. You might want to read about what to do in a post pandemic period or in a pre pandemic period for future planning. Also it's got a load of resources in the back to help you understand the basics of dealing with infectious disease. The different tenets of transmission prevention and things like that. So, it should be a document where anyone who's dealing with, or planning for, pandemics in any way should find some information that's relevant to them; hopefully in a manner that's really easy to access and very clear. Just click around in it as much as you like, and find the bits that are relevant to your role.
Ant 12.58
Claire. Thank you very much for taking the time to deliver some sound and wise advice for us all over the coming months and perhaps years. There are links to the return to work guidance documents and to the Pandemic Playbook in the show notes for this episode. So, it just remains for me to thank you for listening and as always, say until the next time stay safe and stay healthy.
