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HomeResponsibilityRaising Public AwarenessBreathing Space Working together to reduce the burden of respiratory tract infections

COVID-19 is only one of the many causes of respiratory tract infection.

Other common causes of respiratory tract infections such as influenza, pneumococcus, and respiratory syncytial virus (RSV) are also major causes of respiratory hospitalisations in the UK.1,2,3,4 In 2017, before the emergence of SARS-CoV-2, these bacteria and viruses were responsible for over 88,000 hospital admissions in adults over 65 in England.4

In addition, a Pfizer-sponsored study conducted using hospitalisation data in 2020/2021 found that 55% of respiratory infections resulting in hospitalisations in Bristol during the pandemic’s peak were caused by non-COVID-19 infections.5

However, it is also true that non-pharmaceutical interventions intended to limit the spread of SARS-CoV-2 disrupted the transmission of many respiratory pathogens.6,7 A subsequent lack of exposure has potentially led to a lack of immunity in the population, leaving people more susceptible to infection.8,9

The co-circulation of RSV and influenza, as well as evolving SARS-CoV-2 variants, is expected to place additional pressures on an NHS which is already under significant stress.9

Find out more about some of the main* causes of respiratory tract infections that most commonly lead to hospitalisation below:

Table references: 1. CDC. Symptoms of COVID-19. 2. CDC. Respiratory Syncytial Virus Infection (RSV). 3. CDC. Key Facts About Influenza (Flu). 4. CDC. Pneumococcal Disease. 5. CDC. Respiratory Syncytial Virus Infection (RSV) – Symptoms and care. 6. CDC. Pneumococcal Disease Symptoms and Complications. 7. NHS. Who is at high risk from coronavirus (COVID-19). 8. CDC. People at High Risk for Severe RSV Infection. 9. CDC. RSV in Infants and Young Children. 10. CDC. Pneumococcal Disease Risk Factors.
*Other pathogens which can cause respiratory tract infections include human metapneumovirus, Group A streptococcal bacteria, and human parainfluenza viruses.4

Respiratory tract infections' impact on patients and society

Common respiratory tract infections such as pneumonia and bronchiolitis have the most impact on vulnerable populations such as babies, those with comorbidities, and the elderly.10,11,12

More hospital admissions and bed days are attributed to pneumonia than any other lung disease in the UK.11
Moreover, respiratory tract infections also result in lost productivity and increased absenteeism of parents and caregivers.13,14

1/6 of all paediatric hospital admissions in the UK during the winter months are due to bronchiolitis.10

In England, 82% of hospitalisations for bronchiolitis are due to RSV, in infants under 6 months.15

134,999 Emergency hospital admissions for pneumonia in England in 2020/2021.16

The burden of respiratory tract infections on the NHS

The NHS is currently under intense pressure and delivering key health services is increasingly difficult. The prevention of respiratory tract infections could play an important role in relieving some of these pressures by reducing patient footfall. 1,16,17,18

Respiratory tract infections are a major use of healthcare resources in the UK, through GP appointments, A&E attendances, and hospitalisations – with many patients being treated in hospital for long periods.1,16,17,18


of A&E clinical leads in the UK are not confident their organisation will safely manage winter pressures.19



hospital admissions in England for respiratory tract infections in 2020/2021.1



average hospital stay in England due to influenza and pneumonia in 2020/2021.1

The benefits of prevention for patients, the NHS and society

Common Public health protection interventions, which include healthy lifestyles and public health programmes, average a return on investment of around £14 for every £1 spent.20

Investing in the prevention of respiratory tract infections across a range of high-risk groups could help to alleviate the pressure on the NHS, as well as keep people healthy, and contributing to society independently.1,21,22,23,24

Additionally, the prevention of respiratory tract infections could improve the productivity of society by reducing the millions of sick days which are taken each year due to respiratory tract infections.25,26,27

The prevention of serious respiratory tract infections helps to meet the UK government's health priorities.


The NHS long-term plan has a clear focus on prevention.28


The UK’s five-year plan on tackling antimicrobial resistance, as well as the UK Health Security Agency’s strategic remit, state the need to minimise antimicrobial resistance as a priority.29.30 Preventing respiratory tract infections, which are often treated with antibiotics, could reduce the need for antibacterial prescribing in primary care and help the government meet this goal.31

Now is the time to act on the burden of respiratory tract infections, but currently only 5% of public funding for healthcare in the UK is spent on prevention, and 60% on cure and rehabilitation.20

We all have a collective responsibility to protect society from respiratory tract infections. Some simple steps which everyone can take include:20

  • Exercising good hand hygiene.23,24,32
  • Avoiding close contact with people who are unwell.32
  • Staying at home when you are unwell.32
  • Letting fresh air in when meeting others indoors.32

By working together to reduce the burden of respiratory tract infections, we can help to relieve some of the pressures on the NHS and enable people to remain healthy, independent, active and contributing to society.1,16,21,22,23,24,25,26,27
Together, let us give the NHS and society, breathing space.


  1. NHS Digital. Hospital Admitted Patient Care Activity 2020-21. Accessed Jan 2023
  2. Fleming et al. Modelling estimates of the burden of Respiratory Syncytial virus infection in adults and the elderly in the United Kingdom. BMC Infect Dis. 2015; 15: 443. Accessed Jan 2023
  3. Taylor, et al. Modelling estimates of the burden of respiratory syncytial virus infection in children in the UK. BMJ Open. 2016 Jun 2;6(6):e009337. Accessed Jan 2023
  4. Sharp, et al. Estimating the burden of adult hospital admissions due to RSV and other respiratory pathogens in England. Influenza Other Respi Viruses.2021;1–7. Accessed Jan 2023
  5. Hyams, et al. Incidence of community acquired lower respiratory tract disease in Bristol, UK during the COVID-19 pandemic: A prospective cohort study.  The Lancet Regional Health – Europe. Volume 21, November 2022, 100473. Aaccessed Jan 2023
  6. Koutsakos, et al. Influenza lineage extinction during the COVID-19 pandemic? Nature Reviews Microbiology. volume 19, pages 741–742 (2021). Accessed Jan 2023
  7. Huang, et al. Impact of the COVID-19 nonpharmaceutical interventions on influenza and other respiratory viral infections in New Zealand. Nat Commun. 2021 Feb 12;12(1):1001. Accessed Jan 2023
  8. UK Health Security Agency. Why we are preparing for a worst-case scenario winter season. Accessed Jan 2023
  9. The Academy of Medical Sciences. COVID-19: Preparing for the Future. Looking ahead to winter 2021/22 and beyond. Accessed Jan 2023
  10. University of Oxford Vaccine Knowledge Project. Respiratory Syncytial Virus (RSV). Accessed Jan 2023
  11. British Lung Foundation. The battle for breath: the impact of lung disease in the UK. Accessed Jan 2023
  12. Hianjo et al. Respiratory Viral Infections in Patients With Cancer or Undergoing Hematopoietic Cell Transplant. Front Microbiol. 2018 Dec 12;9:3097. Accessed Jan 2023
  13. Fendrick et al. The Economic Burden of Non–Influenza-Related Viral Respiratory Tract Infection in the United States. Arch Intern Med. 2003;163(4):487-494. Accessed Jan 2023
  14. Brassel et al. Realising the Broader Value of Vaccines in the UK. Accessed Jan 2023
  15. NIH, Table 2. Estimating the burden of respiratory syncytial virus (RSV) on respiratory hospital admissions in children less than five years of age in England, 2007‐2012 - PMC ( Accessed Nov 2022
  16. Public Health England. Public Health Profiles. Accessed Jan 2023
  17. Naser et al. Hospital admission trends due to respiratory diseases in England and Wales between 1999 and 2019: an ecologic study. BMC Pulmonary Medicine volume 21, Article number: 356 (2021). Accessed Jan 2023
  18. Moore et al. Alternative approaches to managing respiratory tract infections: a survey of public perceptions. BJGP Open 2021; 5 (2): BJGPO.2020.0124. Accessed Jan 2023
  19. Royal College of Emergency Care. Two-thirds of A&E clinical leads not confident their organisation will safely manage winter pressures, as new briefing shows UEC 10-point recovery plan ‘has failed’. Accessed Jan 2023
  20. Department of Health and Social Care. Prevention is better than cure. Accessed Jan 2023
  21. Nandi & Shet. Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Human Vaccines & Immunotherapeutics, 16:8, 1900-1904. Accessed Jan 2023
  22. World Health Organisation. Advancing the agenda, vaccines for older adults. Accessed Jan 2023
  23. Allison et al. Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis. American Journal of Public Health. August 2008, Vol 98, No. 8. Accessed Jan 2023
  24. Rabie & Curtis. Handwashing and risk of respiratory infections: a quantitative systematic review. Tropical Medicine and International Health. Volume 11 no 3 pp 258–267 Accessed Jan 2023
  25. Sinclair et al. Immune response, adult immunisation in the UK, improving access to vaccination for older people. Accessed Jan 2023
  26. ILC. Lost time Productivity and the flu. Accessed Jan 2023
  27. Lau et al. Hand hygiene instruction decreases illness-related absenteeism in elementary schools: a prospective cohort study. BMC Pediatrics 2012, 12:52
  28. NHS. The NHS Long Term Plan. Accessed Jan 2023
  29. Department of Health and Social Care. Letter from Maggie Throup to Professor Dame Jenny Harries, UKHSA chief executive. Accessed Jan 2023
  30. Department of Health and Social Care. Tackling antimicrobial resistance 2019 to 2024: the UK's 5-year national action plan. Accessed Jan 2023
  31. Andrews et al. Respiratory antibacterial prescribing in primary care and the COVID-19 pandemic in England, winter season 2020–2. Journal of Antimicrobial Chemotherapy, Volume 77, Issue 3, March 2022, Pages 799–802. Accessed Jan 2023
  32. GOV.UK. Living safely with respiratory infections, including COVID-19. Accessed Jan 2023
PP-UNP-GBR-3301 / January 2023
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