Flu season is upon us and has so far been one of the worst in recent history, at a time when the NHS is struggling to cope with huge waiting lists and service demands. NHS England (2022) reported that the number of patients with flu in hospital had increased by two-thirds in one week in December. At the peak of the flu outbreak, there were 1939 flu cases in England's hospitals daily, up from 1162 cases a day in the previous week. Of those with flu, an increasing number were admitted to intensive care; with numbers up by more than 70% in a week to 149 admissions a day. NHS England (2022) also reported that when compared with the previous year, statistics showed a stark contrast in admission numbers – late 2021 had just two patients a day in critical care with flu, and 32 in general and acute beds in the week ending 19 December. GP surgeries were also affected, with increasing demand for appointments from those with respiratory symptoms. Reflecting this trend of increasing cases and service demands, are the data that also recorded a huge amount of calls to the 111 service. There were 721 301 calls a week, up by about 20 000 on the week before, and up by 60% when compared with the previous year, which saw 452 644 calls in the week ending 19 December (NHS England, 2022).
Partly contributing to this pressure on all services was the spike in Strep A cases in children at the end of 2022, as well as industrial action.
Staff sickness has been a long running problem, with the rising issue of burnout and other problems relating to working in a pressured and under-staffed environment. NHS England (2022) reported that there was an average of 60 583 absences because of staff sickness daily in December 2022, up by 20% on November, with the number of staff absent due to COVID-19 having risen from mid-November to December by a third, at 7218 absences a day.
Professor Sir Stephen Powis, NHS National Medical Director, commented: ‘The NHS has prepared for winter extensively with more beds, extra call handlers as well as the expansion of falls response services, control centres and respiratory hubs, but with flu hospitalisations and COVID cases on the rise, the best things you can do to protect yourself is to get vaccinated if you're eligible.’
The most recent statistics in January week 2 published by the UK Health Security Agency (2023) have shown that all cases of flu, hospitalisation and intensive care admissions due to flu, COVID-19 cases across all ethnic groups and areas, and service pressure have decreased, providing hope that the pressure may have peaked this winter.
NHS at crisis point
While the NHS faced, and continues to face, such pressures, it became clear that a number of trusts could not cope with increased demand, which was made worse by the shortage of social care services leading to medically fit patients taking up acute hospital beds and causing a backlog of acute cases waiting in ambulances outside hospital emergency departments. This of course also led to huge ambulance delays, and due to this, added pressure fell onto 111 and other primary care services due to the difficulties patients have been having in being seen. In December, three ambulance trusts in England declared critical incidents due to these pressures, made much worse by the mass outbreaks of coronavirus, norovirus and influenza during a particularly challenging winter (Mahase, 2022).
Flu complications and treatments
Flu can be a severe illness, although it has similar symptoms to the common cold, and can have a significant impact on vulnerable people, which is why it is crucial to protect the elderly and other at-risk groups by offering the flu jab.
Influenza is categorised as type A, B or C. Type A is more virulent and frequent, B involves milder disease but can still cause outbreaks, and C causes mild or no symptoms, which are similar to the common cold (British National Formulary (BNF), 2022). With flu, it is likely to observe more severe fatigue, chills, fever and myalgia, and there may be a dry cough and nasal congestion. Complications of flu include bronchitis, secondary bacterial pneumonia, and at times cardiac or neurological presentations, according to the BNF (2022). General practice nurses will be aware that at-risk groups of such complications of flu include children under 6 months, pregnant women and those up to 6 weeks’ post-partum, adults over 65 years, patients with long term conditions involving respiratory, renal, hepatic, neurological or cardiac disease, diabetes or morbid obesity (above 40 kg/m2 BMI), as well as patients who are severely immunocompromised (BNF, 2022). Antivirals are often the treatment for more severe cases of flu. Oseltamivir and zanamivir are commonly used; however, the BNF (2022) states there are risks that some strains of influenza can develop resistance to oseltamivir.
Even with the common cold there are complications to watch out for in at-risk groups. Complications from a cold include bacterial infections such as sinusitis, pneumonia or otitis media, and therefore antibiotics should be considered if appropriate, although these should not be given for a cold alone as these are ineffective for viral infections. However, someone may have both a viral and a bacterial infection, and in elderly patients we may see severe illness from this complication and therefore it is important to monitor the more vulnerable patients.
Vaccination remains the key method to prevent flu and its complications.
Nursing assessment
The patient presenting with flu symptoms should have their vital signs checked, and their lungs should be auscultated to check for wheezing and rales. Oxygen saturations and respiration rate are of course particularly important. There also is the ‘work’ involved in the patient's breathing – is it laboured by viscous secretions, and do they have a poor cough which has led to secretion buildup and greater difficulty in breathing (Boktor et al, 2022)?
Oxygen should be given where saturations are below 94%, although for COPD patients the threshold is lower. Other signs of poor oxygenation are cyanosis. As someone who is generally healthy, I experienced symptoms including blue lips for about 4 weeks while having the flu, and wheezing at night for a further 6 weeks. These symptoms are quite common even among people without contraindications. This season's flu has been noted by many people across the media as particularly bad and I would agree! The patient should be encouraged to hydrate throughout the course of their illness. On the subject of wheezing, it may be appropriate to give bronchodilators. More advice for the patient would be to perform deep breathing, which the clinician could go through with them, encourage coughing, teach the importance of handwashing, educate on the flu vaccine, encourage isolation while unwell, give health promotion advice regarding smoking cessation, and advise on plenty of rest (Boktor et al, 2022). Acute care or treatment would be required where the patient has a fever, loss of consciousness, dyspnoea, respiratory distress, low oxygen saturation or altered mental status (Boktor et al, 2022). The vaccine can help to reduce the intensity of symptoms in a person with flu and therefore should always be encouraged to be taken up, to avoid distressing severe symptoms that in some vulnerable people can prove fatal.