Elected Members and Covid-19

www.hertfordshire.gov.ukwww.hertfordshire.gov.uk
COVID-19 Webinar
The role of Elected Members
28th October 2020
Jim McManus
Director of Public Health
Herts Covid Public Dashboard
https://hcc-phei.shinyapps.io/covid19_public_dashboard/

www.hertfordshire.gov.uk
• Cases in Hertfordshire have shown a definite increase from September to
October and surpassing cases for April,
• it must be noted that testing is vastly higher than in than April, which will
acount for the steady increase of positive cases EVEN THOUGH testing
has decreased compared to the last 7 days.
• Hertfordshire remains higher than the region but less than England.
• The age group reporting the highest increase remains 17-24 year olds.
• surveillance mechanisms include test and trace, the number of hospital
admissions and occupancy, and Covid-19 deaths in acute trusts have
increased but remain low. 111 calls remain stable. Symptomatic people in
care homes also remains fairly low.
Some Headlines

• understanding the key things to do
• advocating for compliance
• articulating the risks of non-compliance
• acting as the conduit between the responding
agencies and the public – especially the harder
to reach or harder to influence.
Key things for members

• “Behaviour Fatigue” masks multiple things
• Confidence in Leadership
• Clear, consistent messaging and comms
• Social Connectedness and compliance
• Pro Social Behaviour
• Fake News and Conspiracy Theory
• Articulate a Path out of COVID
• Balancing Encouragement with Enforcement
Reassurance, Compliance and the
Elected Member Role
https://www.who.int/news-room/spotlight/let-s-flatten-the-infodemic-curve

The Infodemic curve
1 9
15 24

The Infodemic Curve

National Contain Framework
www.hertfordshire.gov.uk/outbreakplan
June-Oct
• National Watch List
• 3 Tiers – Concern,
Support, Intervention
• Local Powers
• Outbreak Funds
• Outbreak Plans at Local
Level
• Joint Biosecurity Centre
October
• Enforcement monies and
guidance
• New Medium, High, Very
High
• Tranche 4 £1bn support
monies
00:01hours October 14th,

Where are we? Pandemic Milestones
May June July Augus
t
Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2020 2021
2
Some restrictions
eased May into June 2020
1a
Peak of cases.
Deaths
Lag cases by 2-3
week
Late April 2020
First
Peak
1b
Second
Peak??
Second peak of cases
sees restrictions
switched back on and
peak of cases and
deaths
Oct 2020
3
4
Recovery Focus
Efforts change to
focus on recovery
Q2 2021
Vaccine
Vaccine starts population roll
out (earliest) with frontline
workers and clinically vulnerable
Q2 2021
Full
Recovery
Full return to new Normal
Aug – Nov 2021
Apr
Phase 1 – First Two Peaks
Phase 2 - Control
Phase 3 - Exit
This is all provisional. The key drivers of these phases will be
levels of infection, recovery and immunity
Phase 4 - Recovery
Sep
4
Immunity

Not a Pandemic but a Syndemic
• Syndemic – two or more disease
states that adversely interact with each
other (Singer, 2009*)
• As we learned in HIV, Healthcare is
ONLY one aspect of response to a
Syndemic.
• Can we apply this learning post
COVID?
• The debate must not become focused
on healthcare and the NHS alone
• Look on Adverse Childhood
Experiences with a Syndemics Model
and we might get further.
*Singer,M (2009) Introduction to Syndemics: A Critical Systems Approach to Public and
Community Health.

Are we in a Second Peak or Not?

Eastern Districts
Broxbourne
North Herts
East Herts
WelHat
Stevenage

Western Districts
Hertsmere
Dacorum
Watford
St Albans

Western Districts
Three Rivers

www.hertfordshire.gov.uk15
OFFICIAL SENSITIVE
East of England 28 Sept
2020
28/46 (54%) LADs in the East of England were in epidemic phase based on 28/09/2020 data

Hospital Beds

Age Groups
0.0
100.0
200.0
300.0
400.0
500.0
600.0
700.0
800.0
27-Sep
28-Sep
29-Sep
30-Sep
1-Oct
2-Oct
3-Oct
4-Oct
5-Oct
6-Oct
7-Oct
8-Oct
9-Oct
10-Oct
11-Oct
12-Oct
13-Oct
14-Oct
15-Oct
16-Oct
17-Oct
18-Oct
19-Oct
20-Oct
Rateper100,000
Week ending
Weekly case rate by Age Group
0-17 18-22 23-39 40-59 60+

Age Groups
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
27-Sep
28-Sep
29-Sep
30-Sep
1-Oct
2-Oct
3-Oct
4-Oct
5-Oct
6-Oct
7-Oct
8-Oct
9-Oct
10-Oct
11-Oct
12-Oct
13-Oct
14-Oct
15-Oct
16-Oct
17-Oct
18-Oct
19-Oct
20-Oct
Rateper100,000
Week ending
Weekly case rate by Age Group
0-17 23-39 40-59 60+

Deaths

Testing
Antibody Test
Molecular Test

Testing
Antibody TestMolecular Test

Test Accuracy

The False News about False Positives
71-98% range (Watson et al 2020)
i.e. 2% - 29% false negatives
97% – 99% specificity

The False News about False Positives

• Combination Prevention
• Non Pharmaceutical Interventions work
– Face coverings can be effective
– Aerosol Spread
– Not everyone spreads the same
– Superspreading events do happen
– Social Interaction is core to spread
• Age difference of COVID exposure but it does
spread from
• younger to older
• Changes in Treatment (Survival)
• Covid is a multi-system infection not just
respiratory
• Herd Immunity is a false hope currently
Recent Science

Combination Prevention

Social interaction is key to increased
transmission
• Household transmission remains the most widely
recorded setting of transmission (by far).
• Outside the household, early analysis suggests:
– working in health and social care
– working in close personal services and hospitality
– frequenting entertainment venues e.g. bars,
restaurants.
• Opening schools, colleges and universities is likely to
increase transmission
www.hertfordshire.gov.uk/coronavirus

1. Non Pharmacological Interventions (NPIs)
1) Hygiene
2) Cleaning and disinfection
3) Physical Distancing (staying too far apart for virus droplets to spread)
4) Disruption of viral transmission opportunities (eg PPE, barriers, rota and
queue systems in workplaces and settings where people gather (eg
hospitals, gyms, public transport, shops)
5) Use of powers (quarantining people, closing premises)
2. Test, Isolate and Contact Trace
3. Case Finding (proactive and more intensive than Contact Tracing)
4. Vaccine (not yet available)
5. Antivirals (not yet available)
What works in stopping COVID-19?

1. Long COVID
2. Herd Immunity is NOT always possible and may not be with this
 Measles etc have not reached this without vaccines
 No confidence we will get immunity ever as a population yet
 Some do not produce antibodies
 Genetic vulnerability
3. Immunity Wanes over times
4. “Focused Protection” is misunderstood and already used
5. Impossible to fully identify and isolate vulnerable individuals
6. It is NOT what Sweden did
Six Reasons why the Great Barrington
Declaration is poor science…

1.Flu like symptoms,
no fever
1.5% need hospital
breathing support
2.Flu-like + Fever
As Group 1plus loss
of appetite and fever
3. + Gastrointestinal
Diarrhoea, anorexia,
headache chesy pain.
Usually no couch
4.+ Fatigue
8.6% require
breathing support
5. + Confusion (plus
fatigue etc)
10% require breathing
support
6. + Abdominal and
Respiratory
20% need breathing
support
6 “Clusters” of COVID Symptoms
Source: Covid Symptom Study

Long Term
Consequences
• “Long Covid”
• Individuals who continue to have
Covid-19 symptoms which disrupt
their health
• Outside of the two-week period in
which they are believed to be
infected. (i.e. after time virus should
have cleared)
• Estimates (rough) 1.5% to 10% of
those infected persist with symptoms
at 3 months
• Some reports suggest 80% of those
who have symptoms lasting >3wks
have long term symptoms
• Extreme fatigue
• Muscle weakness
• Hearing Loss
• Low grade fever
• Inability to concentrate Memory lapses
Changes in mood
• Sleep difficulties
• Headaches Needle pains in arms and
legs
• Diarrhea and bouts of vomiting
• Loss of taste and smell
• Sore throat and difficulties to swallow
• New onset of diabetes and
hypertension
• Skin rash
• Shortness of breath
• Chest pains Palpitations
• Heart Muscle Weakening
Source: Yelin D, Wirtheim E, Vetter P, et al. Long-term consequences of COVID-19:
research needs. Lancet Infect Dis 2020; published online September 1.
https://doi.org/10.1016/S1473-3099(20)30701-5.
Source: https://institute.global/policy/long-covid-reviewing-science-and-assessing-risk

Are UK BAME populations at increased
vulnerability from COVID-19?
#EvidenceCOVID
Abdul Razaq, Dominic Harrison, Sakthi Karunanithi
and others 05.05.20
Black, Asian and Minority Ethnic (BAME) groups are at markedly higher risk of
developing and dying from COVID-19. Causes appear to be multiple:
Overrepresentation of BAME populations in lower socio-economic groups,
multi-family and multi-generational households, disproportionate
employment in lower-band key worker roles, and co-morbidities (especially
cardiovascular, diabetes, renal and complex multi-morbidities).

PHE Report Infographic….

BAME COVID-19 Action Plan
Pillars
Prevent and Protect
• Risk Assess Staff and
situations
• Ensure preventive
messages and actions
• Ensure Outbreak Plan
fully considers BAME
populations
Communications and
Behavioural Science
• Behavioural Science
led communications
and engagement
• Community Language
resources and
information
High Risk Reduction “5
Point Plan”
• Taxi Drivers and High
Risk Settings infection
control support
• Ensure GPs run risk
registers on BAME
patients at high risk of
severe disease to
ensure good health -
URGENT
• Target BAME SMEs for
support
• Vitamin D in care
homes and for shielding
population
Co-Create Medium and
Longer Term Action
• Co-design and co
create engagement,
review and action on
Health Inequalities
• Co-produce community
lead Health Inequalities
Action?
• Co-create BAME
Network?

Outbreak levels
Level What does this look like? Recent Examples
1 Outbreaks within existing capacity, even if in
multiple settings simultaneously. The Health
Protection Board would manage these.
COVID 19 in care homes
and schools.
2 Outbreaks which would exceed existing
outbreak management capacity and need
additional resource or capacity. The Health
Protection Board and SCG would work
together to manage these.
Lookback exercises and
screening on over 1500
people (multi agency
response).
.
3 Outbreaks which would exceed existing
capacity and require the SCG and/or one or
more partners to declare a Major Incident.
‘Flu Season 2017
4 (Second
Wave)
A second wave of infection as bad or worse
than the first. This would require full scale
SCG co-ordination and a national response
and would result in many people needing
hospital treatment, and possibly many more
deaths.
COVID-19 first wave

Background
• Our current tactics on managing
outbreaks mean we seek to deliver
suppression of the virus
• The foundation of suppression is
effective testing, contact tracing and
isolation, and community wide
adoption of prevention measures
• The next layer is proactive plans for
settings and surveillance
• The next layer which builds on this is
rapid assessment and action on
outbreaks where surveillance identifies
these as issues
Reactive Plans
for Outbreaks
Proactive Plans
for Settings
Foundation

Our Current Health Protection Tactics
Keep the County as
safe as possible and
“open for business” as
much as possible
Suppress the
Virus
Multiple settings,
Multiple sources of
Infection, Multiple Foci
Engage and Persuade
First, Enforce if we have to
•If something can happen safely, work
to support that
•If it can’t work to get it safe
•If that doesn’t work, engage,
persuade or enforce
This strategy will work
provided English and
neighbouring area
transmissions is not
uncontrollable

Cycle of Health
Protection

4 Key Questions to Formulate
Action (sub steps in next slides)
1.What is driving the rise in cases - where/type of
location/community behaviour?
2. What has worked/could work to tackle this ?
3. What resources are needed and does mutual aid need
to be considered ?
4. Who will be the District lead assigned to manage and
report back any agreed actions ?

Escalation Plan
COUNTYWIDE
• Comms on Hygiene and Physical Distancing including “Treat everyone as infected message”
• Targeted Campaigning
• Widespread Campaigning
• Continue outbreak management in Key Settings (Care Homes and schools etc)
• Investigative Epidemiology
• Enforcement (police)
• Develop a menu of restrictions to support physical distancing
• Consider whether all out of school events should cease (Not at that stage yet)
DISTRICT BY DISTRICT
• Each District to provide a specific plan for their key issues of transmission
• Contact Tracing
• Enable self isolation
• Enforcement of physical distancing, face coverings etc including reminding all employers and
businesses
• Consider what physical restrictions and others to put in place
• Enforcement Patrols (Districts)
• Use of licensing powers

• Compliance grants to councils and Police
• £40k roughly per District/Borough council
• £400k constabulary
• Enforcement Strategy Group
• Events Group
• DPH Directions (No 3 Regulations)
Enforcement

• 7,600 testing capacity in Herts
• not including keyworker testing programme locally commissioned or
HUC outbreak/care home service locally commissioned
• Access to other testing sites across Hertfordshire, including 7 day
service open 8am-8pm in WGC and mobile testing units 2 days per
week in Stevenage, Watford, Hertford, Hemel, Hertsmere, Hatfield
as well as postal swab kits
• Additional locally commissioned capacity for testing in an outbreak
and preventative swabbing (e.g. testing patients moving care
settings in the community)
• In negotiation for direct supply of kits for education settings and for
additional walk-ins
Testing

• If person has a positive test result:
1. National track and trace try to contact them for 24 hours via phone
2. If this fails, details sent to HCC and local HCC call centre tries to
contact them for 4 attempts within 24hour period using local number
3. If the above fails, escalated to district council EHO team to knock on
doors
4. The back up plan to support this, is to have a contingent of central
pool of EHOs to help door knock across Hertfordshire, offering
resilience to staff / numbers and outbreak investigations
5. Advice will be given about importance of self isolation to cases and
also support available to them via Herts Help.
6. Any failed attempts will be sent back to the central system for
escalation (as per model)
Contact Tracing

Hertfordshire COVID -19 Contact and Trace
CENTRAL CALL HANDLER TEAM & LOCAL EHO APPROACH
with support of a new central contact tracer pool

Post COVID Health Impacts in Waves

Any questions?

Elected Members and Covid-19

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