Third wave of COVID-19: what might happen and how nurses can prepare for it

The timing and size of a COVID-19 third wave in the UK are uncertain, but there are ways in which nurses can get ready

How likely is a third wave of COVID-19?

According to the most recent modelling by Imperial College London’s COVID-19 Response Team, published in May, the expectation is of a smaller third wave leading to hospitalisations and deaths.

This is most likely to happen in late summer to autumn. However, the timing and size remain highly uncertain and depend on the levels of transmission that occur from 17 May and 21 June onwards, as the route out of lockdown for England continues, and the other UK countries ease restrictions.

How serious could it be?

The team’s estimates for projected additional deaths are currently around 9,000 by June 2022, revised down from its previous reports suggesting around 15,000 deaths. This is because new data shows virus transmission from those vaccinated who still get infected is almost 50% lower than from unvaccinated cases.

Latest models suggest 72% of the population in England could be protected against severe disease – either through vaccination or recovery from previous infection – by the end of August.

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However, the team warns that variants of concern (VOCs) still have the potential to cause a much larger third wave, depending on how they spread and whether they can escape immunity.

Global collaborative efforts to control transmission abroad are vital in preventing the further emergence and importation of new VOCs, it says.

If a VOC emerges with similar transmissibility to the Kent variant, alongside a moderate ability to evade immunity, researchers predict that a third wave could be substantially larger than last winter. This would be both in numbers of people hospitalised and deaths. These figures do not allow for the potential mitigating impact of booster vaccines, they say.

What impact might the emerging Indian variant have?

Designated by Public Health England (PHE) as a VOC in May and now dominating new UK infections, the Indian variant or B.1.617.2 appears to be passed on at least as easily as the Kent variant.

It does not seem to be more harmful than others, and the latest research from PHE shows that the available vaccines are highly effective against symptomatic disease from the B.1.617.2 variant after two doses.

The Pfizer-BioNTech vaccine was 88% effective two weeks after the second dose and the AstraZeneca vaccine was 60% effective. Both vaccines were 33% effective against symptomatic disease from B.1.617.2, 3 weeks after the first dose.

As with other variants, even higher levels of effectiveness are expected against hospitalisation and death.

How have nursing staff coped so far?

Since the pandemic began, nursing staff have been involved in extremely stressful and traumatic situations, says the RCN. ‘The psychological impact of caring for increased volumes of very sick patients and distressed relatives must not be underestimated,’ the college says in a parliamentary briefing published earlier this year.

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During the first wave, 90% of RCN members reported being concerned about the well-being of colleagues, with 58% saying they were concerned about their own physical health and 52% worried about their mental health.

RCN professional lead for acute and emergency care Anna Crossley says: ‘Everyone has a limit, and we know that nursing staff are exhausted now, with many reaching rock bottom.’

How might winter pressures exacerbate a third wave?

Data released by the Scottish Government relating to April 2021 figures shows that attendances at emergency departments are already beginning to return to pre-pandemic levels. This has sparked fears of overcrowding and corridor care, putting patients at risk, according to the Royal College of Emergency Medicine (RCEM).

Some hospitals are already facing pressures, with patients delayed for hours, it says. The college is calling for a rapid assessment of resources, capacity and the way care is delivered in its campaign Summer to Recover: Winter-Proofing the Urgent and Emergency Care System for 2021.

In addition to emergency care, the most recent NHS data on waiting times shows that nearly 5 million people are waiting for planned hospital treatment in England alone – a level not seen for 14 years.

'Even if the NHS meets its challenging targets to increase activity in hospitals, waiting times for care will continue to rise for many months to come,' the King's Fund senior analyst David Maguire said last month.

What can nurses do to protect themselves and their colleagues?

Ensuring that you are vaccinated, alongside encouraging others to have the vaccine, is vital. The RCEM acknowledges historic mistrust about the vaccine among certain communities, highlighting the difference between being anti-vaccination or vaccine hesitant.

‘Vaccine hesitancy is not necessarily irrational – it is nervousness, anxiety and reasonable doubt that stems from a historic and well-evidenced reality that certain ethnic groups experience poorer outcomes when accessing healthcare,’ it says in a statement published in March.

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While it encourages members to speak to colleagues who may be worried or anxious, the RCEM says this must be done sensitively, avoiding blame.

Those who are uncertain should seek out information about the vaccine, its safety and effectiveness, it says.

What practical steps can staff and organisations take to prepare?

In May, the RCN published its UK-wide Nursing Workforce Standards, which are applicable to all sectors, highlighting several health, safety and well-being issues, including supporting nursing staff to look after themselves.

‘Both organisations and individuals will find these standards useful,’ says Ms Crossley. ‘When the pandemic recedes, we will need to address its far-reaching consequences.’

She adds: ‘The nursing workforce is key to the safe and effective restoration of healthcare services. There are lots of ways employers could recognise their contribution and raise the importance of health and well-being, including the possibility of time off for self-care.’

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Lynne Pearce is a health journalist

Find out more

• Imperial College London (2021) Evaluating the Roadmap Out of Lockdown
• Imperial College London (2021) Latest Models Suggest Smaller Third Wave In Late Summer but Variant Risk Remains
• New Scientist (2021) Indian Coronavirus Variant in the UK Seems to be More Transmissible
• Public Health England (2021) SARS-CoV-2 Variants of Concern and Variants Under Investigation
• RCN (2020) Passionate but Pushed to the Limit
• Royal College of Emergency Medicine (2021) Statement on Vaccine Hesitancy
• Royal College of Emergency Medicine (2021) Summer to Recover: Winter-Proofing the Urgent and Emergency Care System for 2021