The UK’s current method of recording covid-19 cases “is not a sensible approach to managing the spread of infection,” virologists have warned.
Latest data showed an uptick in the number of UK covid cases and hospital admissions that experts said was “worrying, so early in autumn.”
The latest surveillance report from the UK Health Security Agency (UKHSA) showed that in the week starting 15 September the overall weekly hospital admission rate for covid was 2.73 per 100 000 people. This was up by 60% from a month prior, when the rate was 1.71 per 100 000 in the week starting 18 August.1 And latest data from the following week show that covid cases rose 22%—from 2012 weekly cases to 2459—in the week to 24 September.2
“A combination of return to work and school after the summer holidays, cooler weather—more indoor mixing in poorly ventilated spaces—and waning immunity are contributing to the increased spread of the virus,” said Lawrence Young, virologist at Warwick University. “The increased trend in cases of infection and hospitalisations, although still low, are worrying so early in the autumn period.”
Amanda Doyle, NHS England’s primary care director, said, “It’s concerning to hear flu and covid-19 cases are already creeping up ahead of winter,” urging people who were eligible to come forward for vaccinations as soon as they could.3
But Young warned that reduced data now collected by the UK on the virus could mean that health officials were flying blind into the winter period. “The lack of routine [covid] testing means we have no idea about the spread of SARS-CoV-2 in the general population, making it difficult to predict any future waves of infection,” he said.
Current testing predominantly focuses on hospital patients rather than community or primary care, which Young said could make it “difficult to identify and monitor outbreaks.” He added, “Relying on hospitalisations as a measure of surges in infection is not a sensible approach to managing the spread of infection and planning for pressures on the NHS.”
Asked to comment on the current covid situation and concerns over the lack of surveillance, a Department of Health and Social Care spokesperson told The BMJ, “The government is committed to protecting those most vulnerable to covid-19 from serious disease and death, in line with the expert advice from the independent Joint Committee on Vaccination and Immunisation. This includes older adults—those aged 75 years and over and residents in a care home for older adults—and individuals who are immunosuppressed.
“The UK Health Security Agency continually monitors the prevalence of covid-19, with the most recent data suggesting circulation is currently low.”
Tightened eligibility criteria
Concern about levels of surveillance come as changes to UK covid policy mean that fewer people are eligible for vaccination this year.4 The NHS’s winter vaccination campaign covers people who will be over 75 on 31 January 2026 or are living in care homes for elderly people. This differs from last year, when over 65s were also eligible to receive the vaccine.
People aged 6 months to 74 years can obtain an NHS vaccination but only if they meet the criteria for specific risk factors (box).
Eligibility for covid vaccination in the UK
The vaccine is recommended and covered by the NHS for over 75s (on 31 January 2026), residents of elderly care homes, and people aged 6 months to 75 years who are immunosuppressed.
It is allowed but not covered for people without immunosuppression aged 6 months to 75 years and in practice is not sold to those under 12 years.
Categories of immunosuppression that grant eligibility to under 75s
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Organ, bone marrow, or stem cell transplantation patients
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Treatment with systemic steroids for more than a month
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HIV infection
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Treatment with immunosuppressive or immunomodulating biological therapy, including children who are about to receive therapy
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Undergoing chemotherapy or radiotherapy
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Long term treatment for immunosuppression
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History of haematological malignancy, including chronic leukaemia, lymphomas, and myeloma
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Genetic disorders that affect the immune system
Another change this year is that frontline health and social care workers (including care home staff) are no longer eligible for covid vaccination. This came after the government and NHS England accepted advice in June from the Joint Committee on Vaccination and Immunisation.5
Commenting on the eligibility criteria, Ian Jones, virologist at the University of Reading, told The BMJ, “Given that average life expectancy in the UK is about 80 years, the 75 cut-off seems late to me, although it is also the same for the new respiratory syncytial virus [RSV] vaccine. In Europe—with essentially the same demographics—the recommended age cut-off for the RSV vaccine is 60. The UK policies are a bit miserly and have more to do with saving money than improving health.”
In England, eligible patients have been able to receive their covid vaccination since 1 October. NHS England said this week that it had sent more than 12 million vaccination invites to people by email, with more to follow through the NHS app, text, and letters.
New strains
The rise in covid cases has also been exacerbated by new variants of the SARS-CoV-2 virus—including the now common XFG and NB.1.8.1, which are versions of the original omicron variant.
Young explained, “Virological studies show that NB.1.8.1 is more infectious than XFG, while the mutations in XFG’s spike protein help it partially evade the neutralising antibodies generated by previous covid infections and vaccinations. Both these features contribute to the increased spread of these variants.” But he added that there was no evidence that XFG or NB.1.8.1 resulted in more severe disease than previous variants.
Reflecting on the relevance for doctors, Jones told The BMJ, “The issue of variants is more of academic than clinical interest, as all the evidence to date is that the severity of infection is either not altered or is lessened in each variant that emerges. Importantly, the infection is now firmly upper respiratory, without the lower respiratory involvement that would be more serious.”
Meanwhile in the US, the health secretary, Robert F Kennedy Jr, recently dropped the country’s universal recommendation for covid vaccination.6 But health insurers7 have said that they will continue to follow the previous, higher coverage, recommendations and to take an “evidence based” approach.
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