Strep A concerns create ‘carnage’ and ‘eyewatering demand’ for the NHS

NHS 111, primary care and A&E services have suffered ‘carnage’ following the recent outbreak in Strep A cases, The Independent has been told.

Senior staff working across services in the NHS have warned that news about the outbreak of Strep A has pushed more parents to use services during a time when demand is already at record levels.

Leading epidemiologists speaking with The Independent have levied a warning that the outbreak, from which at least nine children have died, could be the beginning of the wave, with peaks usually expected closer to spring.

It comes amid rising reports of a shortage of liquid amoxicillin, most commonly used for children needing treatment for the illness. The Independent has been told that the Department of Health and Social Care’s medicines team is considering options for pharmacists and GPs in face of the shortage and demand.

Although Group A Strep is a common strain of bacteria, invasive Group A Strep, which causes the most severe infections, is rare.

The UK is currently experiencing an increase in cases of this infection which has been linked to the deaths of nine children.

Clinicians across the country have warned the news has triggered additional demand, after services now “inundated” that were already seeing high levels of attendances in children due to winter viruses.

One NHS source in London said their A&E had seen “eye-watering” levels of attendance with a record 200 children arriving at their trust’s A&E in a single day – this is double the number seen in 2019.

Another senior source in the south-west warned their GP services had seen a 40 per cent increase in patients within a week.

The crisis within the NHS 111 service, that has seen patients waiting half a day for a callback, has been worsened by the recent Strep A cases.

NHS 111 staff reported they were already struggling under the pressures of demand from callers, warning patient safety is at risk as people are left waiting hours for a clinician to call back.

Speaking with The Independent about the outbreak of Strep A, Dr Shamez Ladhani, a paediatric epidemiologist at St George’s said: “We are seeing the number of cases, the hospitalisations, and deaths are increasing, and that is the time to be concerned because we don’t know how high or how long this wave will be. So the right thing to do is to be concerned, is to raise awareness and try and find ways of reducing that risk as quickly as possible so that we does the cases don’t go too high.”

“We don’t know where this wave is going to end up. So we have to take it very seriously … and quickly.”

He explained the wave had come at an unusual time as was “completely off-season” as it is usually found when cases of chickenpox are circulating at high levels.

Dr Ladhani added currently there is “a sudden and rapid increase in cases and hospitalisation, which aren’t linked with chickenpox. It’s not the typical pattern that we would expect and that’s why it’s concerning. They’re clustered too quickly.

“So our concern is, is the first sign of worse things to come? And we don’t know that so the right thing to do is to raise awareness.”

The paediatric consultant said invasive Strep A, which is causing the acute cases and deaths, is very difficult to diagnose because it can be in children who have a virus and may be recovering then suddenly get very sick.

“I think one of the important things that I think people are missing is there a lot of viruses out there, we don’t always check all the viruses that can make children unwell. So this idea that you can look at one virus and say what’s going on is not so straightforward.”

Dr Simon Clarke, microbiologist for the University of Reading, said that it is not a new strain.

He explained there is a “reasonable” hypothesis that there is less population-wide immunity following the pandemic and should that lead to increased cases that would lead to increased deaths.

A second theory he said was “plausible” was other viruses such as flu or RSV, which are in higher circulation could be worsening the situation. Although he explained there is yet to be evidence for that.

He said: “we don’t know it’s not going to keep getting bigger, we’d expect the peak later in winter more towards the beginning of spring but we don’t know we’re not going to get that this time around and we’re not going to just get a bigger caseload over this space of 12 months.”

Dr Elizabeth Whittaker, paediatric infectious diseases consultant said: “Although we’re seeing more invasive group A Strep than usual at this time of year it’s still very rare if you take the whole population of England. I don’t think parents need to worry about their individual child, but be aware of what features should prompt seeking medical input.  We also need to make sure is that the health professionals who might see these children, whether that’s in primary care, or in A&E departments have the right information to make an assessment about who needs admission and/or antibiotics.

“If everybody runs to A&E because their child has a feverish illness, the children who are really sick will struggle to access care and that could be problematic very quickly. So we would say that there is no reason for parents to be more to attend any A&E more quickly than they would have before.”

She added: I know from talking to my colleagues in our emergency departments, both in London, but also across the country, they have been inundated with worried parents over the weekend, to the point where it is very difficult for the teams to see all the children in an appropriate time period. We would encourage parents to access online resources and information to make a risk assessment for their child first

Dr Whittaker said we are seeing fewer cases this week than in previous weeks and so this could mean we are over the worst and on the way down.

What parents have been advised to do if they have a child is unwell

Advice from UK Health Security Agency on Strep A