COVID-19 Update Health and Wellbeing Board 2 nd October 2020 Jim McManus Director of Public Health www.hertfordshire.gov.uk www.hertfordshire.gov.uk
Are we in a Second Peak or Not? www.hertfordshire.gov.uk
Recent picture www.hertfordshire.gov.uk
Last 7 days (provisional) Last 7 days (excluding last 4 days) Incidence Testing Incidence Testing Prior* 7 day % Tests Exceedance Cases Rate Rate Rate* Rate Incidence Rate Flag Positive (last 14 days) Area or Workstream (per 100,000) (per 100,000) (per 100,000) (per 100,000) (per 100,000) Hertfordshire 221 18.66 615 24.49 837 2.93% NA 22.88 Watch R Broxbourne 22 22.71 668 37.16 921 4.04% 44.39 Watch A Dacorum 33 21.39 580 20.09 756 2.66% 11.67 Watch R East Hertfordshire 27 18.23 565 23.63 735 3.21% 12.15 Watch G Hertsmere 18 17.27 636 26.87 917 2.93% 43.18 Watch A North Hertfordshire 18 13.51 593 16.51 770 2.14% 16.51 No G St Albans 39 26.46 632 28.5 889 3.21% 34.61 Watch G Stevenage 6 6.84 544 12.54 790 1.59% 25.07 No A Three Rivers 23 24.72 733 35.47 969 3.66% 12.9 Flag Watford 21 21.7 688 27.9 941 2.96% A 26.87 Watch G www.hertfordshire.gov.uk 11.41 20.37 2.58% 11.41 Welwyn Hatfield 14 564 789 No
Key Lessons 1. When Rt>1 social interaction is key driver of increased transmission 2. There are principles of intervention when Rt>1 that work 3. The evidence on effective interventions is increasing www.hertfordshire.gov.uk
1. 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
2. Principles of effective intervention with R > 1 • Any measures implemented now will • R > 1 leads to exponential rise in only have effect in two weeks’ time – transmission with increase in there will continue to be a rise in hospitalisation and deaths admissions and deaths, cases in schools and fewer children in school, • Single interventions are unlikely to during this time. be able to reduce R below 1 – a • Some restrictions will be necessary for package of interventions needs to a considerable time – potentially to the be adopted spring • Intervention needs to be rapid for • All interventions have associated costs maximum impact and to reduce in health and wellbeing and many will the time needed for the affect the poorest in society to a greater extent. Measures will be interventions (ie before ongoing needed urgently to mitigate these exponential growth / doubling in effects. those infected) . Clear, consistent communications are essential and the interventions adopted should not appear to promote contradictory goals www.hertfordshire.gov.uk
What works in stopping COVID-19? 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) www.hertfordshire.gov.uk
Background • Our current tactics on managing outbreaks mean we seek to deliver suppression of the virus Reactive Plans • The foundation of suppression is for Outbreaks effective testing, contact tracing and isolation, and community wide adoption of prevention measures Proactive Plans • The next layer is proactive plans for for Settings settings and surveillance • The next layer which builds on this is rapid assessment and action on Foundation outbreaks where surveillance identifies these as issues www.hertfordshire.gov.uk
Our Current Health Protection Tactics Keep the County as Multiple settings, Suppress the safe as possible and Multiple sources of “open for business” as Virus Infection, Multiple Foci much as possible Engage and Persuade This strategy will work First, Enforce if we have to provided English and •If something can happen safely, work neighbouring area to support that transmissions is not •If it can’t work to get it safe •If that doesn’t work, engage, uncontrollable persuade or enforce www.hertfordshire.gov.uk
Standard Process to be followed 1. At the OTCG Meeting it 2. The OTCG Meeting, and may be determined that a any specific local meeting or particular district or outbreak IMT, needs to fully needs a detailed specific understand the dynamics of plan infection, and action. 4. The cycle has been 3. Each Meeting should run turned into four questions to through the steps in the facilitate development of a Cycle of Health Protection local plan www.hertfordshire.gov.uk
Cycle of Health Protection www.hertfordshire.gov.uk
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 ? www.hertfordshire.gov.uk
Where are we? Pandemic Milestones Phase 1 – First Two Peaks Phase 2 - Control Phase 3 - Exit Some restrictions Phase 4 - Recovery eased May into June 2020 Second Immunity? First Peak?? Recovery Focus 2 Peak Full Q2 2021 Second peak of cases 3 sees restrictions Efforts change to 4 Recovery Peak of cases. switched back on and focus on recovery 4 Deaths peak of cases and Full return to new Normal Lag cases by 2-3 deaths week Aug – Nov 2021 Oct 2020 Late April 2020 Vaccine Vaccine starts population roll out (earliest) with frontline workers and clinically vulnerable 1b 1b 1a 1a Q2 2021 Apr May June July Augus Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep t 2020 2021 This is all provisional. The key drivers of these phases will be levels of infection, recovery and immunity www.hertfordshire.gov.uk
Post COVID Health Impacts in Waves www.hertfordshire.gov.uk
Additive risks to system capability • Possible second wave of COVID-19 • Seasonal ‘Flu and Winter Pathogens (Enteric, Respiratory , ILI) (Flu could be milder in impact if Australia experience is salient but we should not rely on this) • Meningitis in Students Infection • Moving indoors and run up to Christmas may see abandonment of NPIs resulting in spike • Backlog of health issues untreated over Spring and Summer may make peoples’ health worse in Winter • Additional demand for social care from people who have deteriorated over spring/summer Demand • Homeless demand may rise • Staff absence from ILI and other winter diseases could compound absence • People symptomatic will need to self-isolate and in absence of testing for COVID-19 may increase workplace absence and reduce workplace resilience Infrastructure • Bad weather may worsen this www.hertfordshire.gov.uk/outbreakplan www.hertfordshire.gov.uk
Key Priorities to address Priority Key Outcomes Needed 1. Coping with demand for COVID and 1. System Capacity seasonal ‘flu peak from vaccine to beds and deaths 2. Workforce 2. Protecting workforce numbers 3. PPE and Infection Control through vaccination etc (see also 4) 4. Testing 3. Proper supply of PPE 4. Testing capacity to differentiate 5. Care Homes and Social Care seasonal ILI from COVID 6. Schools 5. Protecting Care Homes from outbreaks 7. Communications 6. Keeping schools running safely 7. Public continue to do what we need them to www.hertfordshire.gov.uk
Hertfordshire’s Outbreak Control What? Plan Themes Our Outbreak Plan covers all the themes set by Government • We also identify prevention as a key part of our work • We will work across a range of partners to deliver this • 2 3 4 5 1 Governance & Engagement & Testing and Contact Prevent & Respond Programme Co- Surveillance, Communication Tracing Ordination Intelligence and Data 1 2 3 4 5 6 7 High Risk Contract Data Care Homes & Places, Local Testing Tracing in Vulnerable Local Boards Integration Schools Capacity People Locations & Complex Communities Settings www.hertfordshire.gov.uk
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