This article appears as part of the Inside the NHS newsletter.

How is the NHS preparing for its fourth winter with Covid?

The vaccine rollout has been accelerated, but the UK's approach has been criticised as "shambolic" amid concerns that excess stock is not being used in the 50-64 age group while frail and elderly adults look likely to miss out on an updated jag designed to maximise protection against new strains.

Meanwhile, there has been a recent wave of surprise and confusion over the decision to quietly abandon Covid testing for symptomatic frontline staff.

What's happening with vaccinations?

Frontline healthcare workers in patient-facing roles in the NHS, care homes, and in the community are being offered Covid boosters.

As of October 8 – roughly one month into the rollout – uptake was 17.4%. It is early days – many healthcare workers will still be waiting for their appointment – but last winter coverage topped out at 57.7%, suggesting a mix of apathy and inconvenience. Some social care workers reported difficulties getting time away from work to get vaccinated.

Over time, a combination of repeated boosters and repeated infections has understandably eroded people's fear of becoming seriously ill. The vaccines have also become gradually less protective against infection as the virus that causes Covid has mutated in ways that make it more transmissible and immune evasive. This has been seen again with the emergence of the BA.2.86 'Pirola' offshoot of Omicron, described as the "most immune evasive yet" due to its ability to escape antibodies.

This has prompted the UK Government to stock up on Pfizer's newest mRNA Covid vaccine, tweaked to provide a stronger line of defence against infections caused by the XBB Covid strains which have been dominant for most of this year.

The UK is due to switch to this batch later in the rollout and has bought up enough stock to include 50-64s in the rollout. Nonetheless, the Joint Committee on Vaccination and Immunisation (JCVI) – the body that advises ministers – says there are no plans to extend eligibility to the under-65s this winter.

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At the same time, the acceleration of the rollout in response to Pirola means that the higher risk groups – care home residents and over-75s – were re-prioritised and vaccinated earlier than originally planned. As a result, most have been given the older Omicron B4 and B5-based Covid vaccines which are likely to be less protective against infection from the currently circulating strains.

How much that impacts the NHS remains to be seen. The primary goal of Covid vaccination is to reduce, as far as possible, the number of people dying or requiring hospital treatment as a result of the disease and, so far, the older vaccines are still expected to provide strong protection on that front.

The Herald:

Testing

Frontline NHS workers are still being taken by surprise by Covid testing changes which were quietly introduced across the UK more than a month ago.

The issue came under focus after Stephen Griffin – a professor of cancer virology – shared a memo on Twitter/X from Shropshire Community NHS Trust which went viral last week.

In it, staff were told that "in line with national guidance", symptomatic staff should "not be testing for Covid-19" but simply staying home "if they feel unwell".

Underlining what many have interpreted to be the true impetus of this shift in guidance – minimising staff absence – the memo concluded: "Testing for Covid can result in having to remain at home for longer than their symptoms persist."

This prompted an outpouring of anger among those who feel that already too little is being done to curtail the spread of Covid in healthcare settings. People soon began sharing similar memos from their own NHS trusts across England and Wales.

There were some erroneous claims that such guidance had not been adopted in Scotland. In fact, as of August 30, symptomatic staff testing was also withdrawn here. This followed on from the removal of routine asymptomatic staff testing back in September 2022.

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As with the rest of the UK, some exceptions can be made for high risk wards – oncology and dialysis for example – but a circular distributed to NHS Scotland medical staff on September 5 – forwarded onto The Herald by a consultant – makes clear that staff "should not be testing for Covid 19".

It adds: "Staff who attend work with respiratory symptoms should wear a mask throughout their shift and will be allocated to the red side [to] avoid immuno-compromised patients for five days after the onset of symptoms. The same applies to staff who have undertaken an LFD which has come back positive."

Is that living with Covid, or giving up on Covid? It depends who you ask.