For many older adults, a severe chest infection still means an urgent hospital admission, long recovery, and a real risk to life. New UK research shows that this pressure on hospitals did not fade when the pandemic ended, but has continued at a steady and worrying level in the years since. The findings were published in The Lancet Regional Health.
A large study tracking adults admitted to hospital in Bristol between 2020 and 2024 found that community acquired lower respiratory tract disease remained common throughout and after Covid. This includes pneumonia and other serious lower respiratory infections that often require inpatient care, particularly among older people and those with long term health conditions.
Researchers examined more than 450,000 hospital admissions over four years, identifying nearly 45,000 cases linked to acute lower respiratory illness. Almost half of these admissions involved pneumonia, while over a third were non pneumonic lower respiratory infections, conditions that can still cause severe breathing problems despite lacking clear signs on scans.
The overall rate of hospitalisation rose sharply during the height of the pandemic, driven mainly by Covid-related pneumonia. While Covid cases later declined, the total burden of respiratory disease did not disappear. By 2023 and 2024, admission rates had stabilised at levels similar to those seen during the pandemic years, showing that non Covid infections continued at a consistent pace.
Older adults were disproportionately affected. People aged 65 and over accounted for the highest admission rates and the most severe outcomes. Patients aged 85 and above faced a far greater risk of dying within 30 days of admission compared with younger adults, highlighting the vulnerability of an ageing population to respiratory illness.
Outcomes varied depending on the type of infection. Pneumonia carried the greatest risk, with longer hospital stays, more intensive care admissions, and higher short term mortality. Non pneumonic infections were generally less severe but still placed a substantial demand on hospital services, especially during winter months when seasonal viruses circulate more widely.
The study also found that although Covid initially changed the pattern of respiratory disease, public health restrictions did not permanently reduce other infections. Once restrictions eased, non Covid respiratory illnesses returned to stable levels rather than remaining suppressed, suggesting a persistent underlying risk in the community.
Importantly, the researchers noted improvements in survival over time, reflecting better treatments, vaccination uptake, and clinical experience gained during the pandemic. However, these gains did not reduce the number of people needing hospital care, meaning the overall strain on the NHS has remained high.
The findings underline the importance of planning for respiratory illness beyond Covid alone. With pneumonia and related infections continuing to hospitalise thousands each year, especially among older adults and those with multiple conditions, health services face an ongoing challenge that extends well beyond emergency pandemic response.