COVID-19 Update Health and Wellbeing Board 2 nd October 2020 Jim - - PowerPoint PPT Presentation

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COVID-19 Update Health and Wellbeing Board 2nd October 2020

Jim McManus Director of Public Health

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Are we in a Second Peak or Not?

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Recent picture

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Area or Workstream Cases Incidence Rate

(per 100,000)

Testing Rate

(per 100,000)

Incidence Rate*

(per 100,000)

Testing Rate

(per 100,000)

% Tests Positive Exceedance

(last 14 days)

Prior* 7 day Incidence Rate

(per 100,000)

Flag Hertfordshire 221 18.66 615 24.49 837 2.93% NA 22.88 Watch Broxbourne 22 22.71 668 37.16 921 4.04% R 44.39 Watch Dacorum 33 21.39 580 20.09 756 2.66% A 11.67 Watch East Hertfordshire 27 18.23 565 23.63 735 3.21% R 12.15 Watch Hertsmere 18 17.27 636 26.87 917 2.93% G 43.18 Watch North Hertfordshire 18 13.51 593 16.51 770 2.14% A 16.51 No St Albans 39 26.46 632 28.5 889 3.21% G 34.61 Watch Stevenage 6 6.84 544 12.54 790 1.59% G 25.07 No Three Rivers 23 24.72 733 35.47 969 3.66% A 12.9 Flag Watford 21 21.7 688 27.9 941 2.96% A 26.87 Watch Welwyn Hatfield 14 11.41 564 20.37 789 2.58% G 11.41 No Last 7 days (provisional) Last 7 days (excluding last 4 days)

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• 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

Key Lessons

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• 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

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• 2. Principles of effective intervention with R > 1
• R > 1 leads to exponential rise in

transmission with increase in hospitalisation and deaths

• Single interventions are unlikely to

be able to reduce R below 1 – a package of interventions needs to be adopted

• Intervention needs to be rapid for

maximum impact and to reduce the time needed for the interventions (ie before ongoing exponential growth / doubling in those infected) .

• Any measures implemented now will
• nly have effect in two weeks’ time –

there will continue to be a rise in admissions and deaths, cases in schools and fewer children in school, during this time.

• Some restrictions will be necessary for

a considerable time – potentially to the spring

• All interventions have associated costs

in health and wellbeing and many will affect the poorest in society to a greater extent. Measures will be needed urgently to mitigate these effects.

Clear, consistent communications are essential and the interventions adopted should not appear to promote contradictory goals

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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?

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Background

• Our current tactics on managing
• utbreaks 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

• utbreaks where surveillance identifies

these as issues

Reactive Plans for Outbreaks Proactive Plans for Settings Foundation

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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

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Standard Process to be followed

• 1. At the OTCG Meeting it

may be determined that a particular district or outbreak needs a detailed specific plan

• 2. The OTCG Meeting, and

any specific local meeting or IMT, needs to fully understand the dynamics of infection, and action.

• 3. Each Meeting should run

through the steps in the Cycle of Health Protection

• 4. The cycle has been

turned into four questions to facilitate development of a local plan

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Cycle of Health Protection

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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 ?

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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 1a Peak of cases. Deaths Lag cases by 2-3 week Late April 2020

First Peak

1b 1b

Second Peak??

Second peak of cases sees restrictions switched back on and peak of cases and deaths Oct 2020

Immunity?

3 4

Recovery Focus

Efforts change to focus on recovery Q2 2021

Vaccine

Vaccine starts population roll

• ut (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

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Post COVID Health Impacts in Waves

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Infection

• 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
• Moving indoors and run up to Christmas may see abandonment of NPIs resulting in spike

Demand

• 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
• Homeless demand may rise

Infrastructure

• 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

• Bad weather may worsen this

Additive risks to system capability

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Key Priorities to address

Priority

• 1. System Capacity
• 2. Workforce
• 3. PPE and Infection Control
• 4. Testing
• 5. Care Homes and Social Care
• 6. Schools
• 7. Communications

Key Outcomes Needed

1.

Coping with demand for COVID and seasonal ‘flu peak from vaccine to beds and deaths

2.

Protecting workforce numbers through vaccination etc (see also 4)

3.

Proper supply of PPE

4.

Testing capacity to differentiate seasonal ILI from COVID

5.

Protecting Care Homes from

• utbreaks

6.

Keeping schools running safely

7.

Public continue to do what we need them to

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Hertfordshire’s Outbreak Control 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

1

Prevent & Respond

2

Testing and Contact Tracing

3

Surveillance, Intelligence and Data

4

Engagement & Communication

5

Governance & Programme Co- Ordination

Care Homes & Schools

1

High Risk Places, Locations & Communities

2

Local Testing Capacity

3

Contract Tracing in Complex Settings

4

Data Integration

5

Vulnerable People

6

Local Boards

7

What?

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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

• utbreak 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

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BAME Themes…(PHE)

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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?

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Example of Engagement

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

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Public information campaign launch

Campaign features Herts Residents four simple actions: 1. Washing hands 2. Socially distancing 3. Wearing face coverings where required 4. Isolating and getting tested if they develop symptoms

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Any questions?