How to protect yourself against the winter virus QUAD-DEMIC (and the things you must NEVER do)

We are all too familiar with the term ‘pandemic’, but experts fear Britain could be facing a ‘quad-demic’ this winter – with a surge in cases of four winter bugs, each capable of leaving us bedbound – hitting all at once.

Already rates of norovirus (also known as the winter vomiting bug) – which can cause violent vomiting and diarrhoea – have jumped by 40 per cent in recent weeks, according to the UK Health Security Agency (UKHSA).

But experts fear the numbers infected with flu, Covid and respiratory syncytial virus (RSV), a bug which usually causes a mild cold or cough but can also lead to severe pneumonia (inflammation of the lungs), will also soar in the coming weeks as colder weather forces more of us indoors, allowing viruses to spread more easily.

As well as leaving many people feeling awful, it could result in excess winter pressure on the NHS from extra workload and staff sickness.

Meanwhile, the elderly and those with weakened immune systems (including cancer patients undergoing chemotherapy), could be at risk of one infection after another, which in some cases could be life-threatening. Every year around 12,000 mostly elderly people a year in the UK are admitted to hospital due to the effects of norovirus symptoms, such as severe dehydration, which can sometimes be fatal.

In January, at the peak of the winter bug season, there were 688 patients in hospital each day with severe norovirus, almost 4,000 with Covid and 2,226 with flu, according to NHS England figures. This winter the fear is it could be even worse.

Not only has there been an unseasonably cold snap, but the pattern of illness in Australia’s recent winter – which is from June to the end of August and tends to foreshadow what happens here – suggests the worst is yet to come in the UK.

Figures from Australia’s National Notifiable Disease Surveillance System – a database of contagious illness – show its winter bug season peaked later and lasted longer than in 2023, when flu infections, for example, peaked in May at around 220,000 cases for the month. This year they didn’t peak until July – hitting a high of 316,000 for the month.

And the surge coincided with a rise in other winter infections, including Covid, RSV and an outbreak of whooping cough in children. This is a highly contagious bacterial infection, also known as pertussis or the 100-day cough (because of how long it takes to recover from it).

The Royal Australian College of General Practitioners said many people there spent the winter battling one bug after another.

‘RSV tends to affect the lower respiratory tract [tissue deep within the lungs],’ says Eleanor Riley, a professor of immunology and infectious diseases at the University of Edinburgh

Dr Anju Aggarwal, deputy chair of the college, said recently: ‘It starts with one infection and then your immune system is a bit compromised. Then the second takes over – then the third. So people get a little bit better and then they get worse again.’

The UKHSA has renewed calls for all those eligible for vaccines against winter infections to have them as soon as possible.

There is no NHS jab against norovirus (though an experimental one is soon to be tested in a trial at the Royal Free Hospital in London), but vaccines are available for flu, Covid and RSV (for the latter, only for pregnant women and those turning 75 on or after September 1 2024, as older people are most at risk from serious complications).

While the symptoms of norovirus are normally obvious, it’s often less easy to tell which respiratory virus you have.

‘RSV tends to affect the lower respiratory tract [tissue deep within the lungs],’ says Eleanor Riley, a professor of immunology and infectious diseases at the University of Edinburgh. ‘Classic symptoms include a cough and shortness of breath. But flu and Covid tend to affect the upper respiratory tract, or the throat, nose and mouth, with symptoms that can include sneezing, coughing and a sore throat.’

Professor Riley says if patients vaccinated against Covid do still pick up the infection, it usually appears as a mild upper respiratory tract infection – making it hard to distinguish from flu or a cold. ‘It can be very difficult to separate out the three,’ she says.

The chances of catching all three respiratory bugs at the same time are incredibly slim, she adds. ‘That’s because we know viruses tend to compete with each other when trying to get into the body to multiply.

‘If, for example, you catch a cold, the immune system triggers an inflammatory response to try to flush out the virus. It’s this inflammation that gives you a bit of a temperature and a runny nose.

‘That inflammation then makes it much harder for a different virus to successfully invade the body – you would pretty much have to be exposed to all of the viruses at exactly the same time, which is extremely unlikely.’

But there is a real risk of sequential infections – or one bug straight after another – as happened in Australia.

‘Say, for example, you catch Covid and it does temporary damage to your upper respiratory tract,’ she says. ‘During the recovery period, the inflammation it triggered gradually dies down.

‘If during that time you get exposed to a second virus – let’s say, flu – there’s no inflammation in the airways to stop it and it’s also more likely to infect your respiratory tract because you’re still suffering damage there from the Covid infection.’

Professor Riley says this is why taking it slow during recovery is so crucial – overdoing it too soon is more likely to weaken the body’s immune response to second or third attacks.

She adds: ‘It’s important not to go back to work too soon or start doing long runs. Just take it slow and you will actually recover more quickly.’

And for some people, it’s not just exposure to second or third viruses that are the threat when they get ill.

Winter bugs can also trigger an abnormal response in bacteria that, when we are healthy, live harmlessly in, or on, our bodies.

This is often the reason why viral bugs, such as flu or even a bad cold can, in some cases, lead to a bacterial chest infection that needs treating with antibiotics.

‘It’s almost like these bacteria, which usually do no harm,

sense the body is under attack from a virus and seize the opportunity to try to start growing and spreading,’ says Professor

Riley. ‘That’s why, in patients who have a history of chest infections, GPs will often prescribe antibiotics, even though they know it’s almost certainly a virus causing the primary infection – it’s called ‘antibiotic cover’.’

How you can protect yourself

• Wear a face mask when travelling on planes, trains and buses, or in crowded indoor areas; it may not offer complete protection, but might reduce the risk of mostly airborne bugs such as flu, Covid and RSV, says the UKHSA.

• Wash your hands thoroughly and with soap several times a day. Not only will it get rid of any norovirus that might be lurking on your skin, but it banishes flu or Covid particles that you might accidentally then rub in your eye, or spread to your mouth or nose by touching them. Hand sanitiser is better than nothing if that’s all you have access to, but it won’t be as effective at ridding the hands of bugs.

• At work, use alcohol wipes to regularly clean shared surfaces, such as doorknobs, light switches and keyboards.

• Do the same at home if someone you live with has a respiratory or stomach infection – including the TV remote control. Kitchen worktops should be wiped down with bleach-based products if someone you live with has norovirus.

• Don’t share towels with anyone who has signs of flu, Covid, RSV or norovirus.

• Rinse all fruit and vegetables thoroughly, even before cooking them, as they may harbour infected particles.

• If someone in your household is ill, wash all clothing and bedding in a 60c degree cycle.

• If it’s you who’s sick with a tummy bug, avoid cooking or preparing meals for others until at least 48 hours after all symptoms have disappeared.

• Shut yourself away in your bedroom if you have an infectious bug, especially norovirus. Dr Marion Sloan, a GP in Sheffield and chair of the Primary Care Society for Gastroenterology, says: ‘It’s best to isolate yourself until you feel better and have someone else bring your food and drink to the door.’