Agenda item

Coronavirus (Covid-19) Update

The Director of Public Health to report, followed by questions from Members of the Council, to be answered by the Director.

 

(NOTE: The above item of business is scheduled to commence no earlier than 4.00 p.m.).

 

 

Minutes:

8.1

Greg Fell, the Director of Public Health, provided an update on the latest position in relation to the Coronavirus (Covid-19) pandemic. Mr Fell’s presentation was followed by an opportunity for Members of the Council to ask questions.

 

 

8.2

He outlined what could be ascertained about the Coronavirus from the epidemiology, key messages and areas of concern and the arrangements that were in place to manage the pandemic from a public health perspective.

 

 

8.3

He said that the weekly surveillance report, as published by Public Health England, was the key report in terms of what was happening in the country and he then summarised the national position, which was one of a rising number of Covid 19 cases. He also set out the position in Sheffield and South Yorkshire relative to other places, including West Yorkshire and Greater Manchester. The number of cases in Sheffield was relatively low and the spatial spread of cases more diffuse in the past 30 days. Household clusters are also more diffuse although these remained associated with more deprived areas. The age profile had changed, with the average age of people with positive tests for Covid 19 now being people in their mid-30s, rather than people in their 60s earlier in the pandemic. The ethnicity of people affected had also significantly changed.

 

 

8.4

Mr Fell explained that the strategy was owned by the Coronavirus Prevention and Management Board and based on four principles, namely: to keep people safe; protect the vulnerable; reopen Sheffield; and to follow government guidance, and the Council was trying to keep to those principles in relation to its decision making.

 

 

8.5

There was an operational plan which covered a range of issues including outbreak response arrangements, intelligence and epidemiology, contact tracing, support to those who were self-isolating, communications and engagement, different settings (including care homes, school and workplaces), high risk places and communities, local testing capacity and vulnerable people. An operational management board was established and the appropriate operational arrangements were in place to deliver the elements of the strategy to keep the level of virus as low as possible. 

 

 

8.6

Greg Fell said that looking ahead, he would contend that the broad strategy was right. There would be an increasing level of cases and a substantial impact from the opening of schools and universities, which needed to happen but meant that people mixed which would cause viral transmission and there was an increasing rate of cases nationally.

 

 

8.7

He said that, whilst there was not a need to change the Strategy, there was a need to intensify efforts around prevention, the management of individual outbreaks, communications, contact tracing and isolation.

 

 

8.8

However, he did not think there was a need to fundamentally change course. It was likely that there would be more localised contact tracing. The Council was working with NHS test and trace and at this time 74 percent of cases and contacts were completed and there was more that could be done subject to resources from the government. It was possible that shielding would be restarted and that would be a national policy decision and there was also significant activity relating to flu vaccinations. An increasing amount of activity inside during the winter months presented greater risk of viral transmission. The number of cases would rise in the autumn.

 

 

8.9

It was likely that a workable vaccine would not be available this calendar year. A response to Covid 19 would be in place for at least the next 18 months and at the same time it was necessary to also try to proceed with business as usual.

 

 

8.10

The city was seeking to avoid an imposed local lockdown and harmful social and economic effects.  At the moment, whilst there were cases of Covid 19, the related hospital activity was low.  Testing capacity was stretched and it was hoped that this was a transient and short term problem that was manageable. The emphasis was on testing those with symptoms and not those who were asymptomatic.

 

 

8.11

Greg Fell said that there was more that could be done to improve contact tracing and isolation and that was progressing. Whilst the return of schools and universities was concerning, that activity had to continue. It was very important to protect those who were vulnerable and whilst at present cases were apparent in young people who were well, it might be that there was transmission to older, more medically vulnerable, people and measures may need to be introduced again, including shielding care home residents and older people living at home who were vulnerable.

 

 

8.12

There was a concern about intervention fatigue and it was important to stick with the programme and look at the basic principles. There were also conspiracy theories relating to the Coronavirus and Mr Fell asked people to let him know if they became aware of such issues.

 

 

8.13

He said that the core messages were constant. These were, in order:-

 

-      if you have a symptom, get tested, stay home, isolate, give details of your contacts; seek help and advice if needed

-      stay at home if you are identified as a contact

-      wash your hands

-      keep your distance

-      wear face coverings where recommended

 

 

8.14

Members of the Council asked questions arising from the update from the Director of Public Health and responses were provided, as summarised below:-

 

 

8.15

Questions were asked firstly about testing capacity and concerns about the government’s narrative relating to testing and specifically, whether it was thought that 25 percent of people presenting for testing in Sheffield should not be; was it acceptable that, even with enhanced capacity, it would take six months to test everybody and was that helpful in the ability to fight the spread of the pandemic. Secondly, a question was asked concerning messages about whom people could meet, what venues were and were not allowed, such as swimming pools and as to whether there was guidance that could help make things clearer.

 

 

8.16

In response, Greg Fell stated that swimming facilities were still open. There were further changes being introduced from 14 September but he had not heard of a substantial shift in relation to the national rules around what people could or could not do in relation to sports or leisure centres.

 

 

8.17

He said that all social interaction from people outside of one’s family carried risk and people could minimise that risk.  In his opinion, the rules were overly complex and might be simplified. If someone was going swimming, for example, the risk was relatively low.

 

 

8.18

There were substantial numbers of people seeking tests who did not have symptoms and the reasons why there was a national lab capacity problem (with the mega labs in Glasgow, Milton Keynes and Manchester) were that, firstly, schools went back in Scotland before Sheffield, which had led to a large increase in testing, and which arguably could and may have been anticipated; secondly, significant numbers of people were seeking a test when they did not have symptoms.

 

 

8.19

Mr Fell explained that in terms of public health activity which would follow a test, asymptomatic testing was not considered particularly high value in the present circumstances. There were nonetheless substantial differences in the United States where they were advocating asymptomatic testing. However, in terms of value, he would start with those that were very ill in hospital, who definitely needed to be tested and then those that were ill but did not have serious symptoms. As to the testing of people with no symptoms, he knew there were a significant number but was unable to be certain of the exact proportion.

 

 

8.20

The third reason for the lab capacity problems was people coming back from holidays overseas and wanting to get a test to say that they did not have an illness and so they did not have to quarantine for the specified duration and that was affecting finite lab capacity and causing operational problems.

 

 

8.21

He said that he believed the Department of Health was working hard to address the problems relating to lab capacity. If this was a genuine short term problem, the city could probably cope, although it would cause problems. However, if it was a longer term issue, he would want to know immediately, because there would be a need to work on contingency plans.

 

 

8.22

Finally, there was probably a difference between surveillance and symptomatic testing. The Office of National Statistics did a weekly surveillance where they did both antibody and swab tests for a sample of one hundred thousand people nationally. That was one of the things included in the weekly Public Health England epidemiology report and it was helpful to give a sense of what was happening in respect of the epidemiology. That was very different to someone developing a symptom and then seeking a test and which should lead to a public health action. The surveillance was about the epidemiology and what was happening to the population nationally.  It did not provide much insight into what was happening at a particular place, such as Sheffield.

 

 

8.23

A question was asked in relation to support for cities with universities in respect of the additional pressures associated with an increased population and in particular, firstly whether there was additional funding or support and secondly how the Council would be working with the universities and to help communities with student populations which were often living in areas with other residential housing, so as to support community cohesion and given concerns expressed by some residents and the current relatively high number of Covid 19 cases in younger people.

 

 

8.24

Greg Fell said that both universities and the College had worked extensively with the public health team and others in the Council since the spring to plan for when the universities opened. He said that he was satisfied that both universities and the College took the matter very seriously and they had done a huge amount of operational planning for managing how they would reopen in a phased and as low risk a way as possible; and the right arrangements were in place for responding to cases and outbreaks as and when they occurred.

 

 

8.25

The universities and the College had established ‘gold’ groups and had planned how teaching and campus environments would work and this planning included the student unions. It was felt that the campus learning and teaching environments were as safe in relation to Covid-19 as they could be. A concern was what happened off campus, which was unregulated space, whereas student union bars were regulated space as were other licensed premises.

 

 

8.26

He said that a key concern was house parties and similar events. The recent changes relating to restrictions on groups of more than 6 people effectively ended large house parties. The universities were also involved in this issue and would be using their staff to undertake communications and messaging with student bodies regarding responsible behaviours to help prevent a spike in cases which eventually spread to the older population and a further lockdown which would be detrimental to everyone. There was also planning for harder edged enforcements with the police, the detail of which would require more work. In summary, Mr Fell said that he was as content as he could be that the universities and colleges were going to open safely but acknowledged that it could be difficult for a time.

 

 

8.27

Greg Fell stated that there was no additional resourcing for university cities. Whilst both universities had asked to establish a specific testing site for students, he said that he did not believe that was feasible or warranted and instead he wanted more accessible testing sites for the population as a whole, including students. Sites were being explored around Upperthorpe at the moment with the University of Sheffield and this was subject to technical and site feasibility activity. However, he did not think that special testing facilities would be established for the student population.

 

 

8.28

A question was asked about the messaging from the universities and whether this was clear enough and also about the location of testing facilities on campus, as other universities were planning to do as well as providing students with masks.

 

 

8.29

A further question was asked about the mental health support for students in Sheffield who might be living with others that they did not know and given the restrictions around meeting others.

 

 

8.30

Greg Fell was thanked for his recent quick response to correspondence regarding the wearing of masks on public transport and visual communications about the correct way to wear a mask.

 

 

8.31

Mr Fell said that the Council's communications team had and would continue to do work in relation to the wearing of masks and face coverings. Both universities had done a lot of communication but he could not say whether it was effective or clear and consistent enough and the same might also be said in relation to other communications and the messages were often difficult and complex. Communications relating to Coronavirus would need to continue. He said that he would ask the universities about feedback they had received from students.

 

 

8.32

Comments were made concerning the rising number of cases of Covid 19 and community transmission together with challenges for schools when students moved between classrooms. Questions were asked about plans for freshers’ week and in relation to students living in communities.

 

 

8.33

Greg Fell explained that the freshers' weeks had been extensively considered by both universities and the student unions and they were clear that freshers’ week would look very different this year and there would not be large student union organised parties.

 

 

8.34

What was of concern were advertised large scale raves, which the Council’s licensing team had investigated and he thought that events would not be happening.  There would be clubs and pubs that wished to organise events for freshers’ week and the Council would use its staffing resource and enforcement powers and work with the police and take action as appropriate, from education through to enforcement.

 

 

8.35

Both universities and student unions had been clear with regard to their communications that freshers’ week would be different and, although it was difficult to anticipate in advance what would happen in relation to the behaviour of students, the organisations were sighted on the issue and it was a concern.

 

 

8.36

A councillor shared their personal experience of the condition ‘long Covid’. This included the physical and mental health challenges and effects, cycles of relapse and recovery and significantly reduced capacity. Most people with ‘long Covid’ had a different profile to those who were subject to the NHS Covid Recovery programme. They were not hospitalised and many of them were young and previously healthy and were reliant upon their GP, her experience of which had been positive with necessary referrals for testing, including for neurological symptoms. There was also increasing research in relation to the long term health implications for people who had contracted Covid 19.

 

 

8.37

Questions were asked about whether, in Sheffield, data was being gathered about ‘long Covid’; what was being done to raise awareness in relation to ‘long Covid’ among GPs and in primary care as to the seriousness of the condition and given apparent disparities in the way people were being treated; and was anything being done to make sure that people were getting the correct referrals from their GP, such as referrals to cardiology or neurology.

 

 

8.38

Greg Fell extended his sympathy to the Councillor for her illness and responded that he was pleased that the Councillor’s experience as regards her GP was a relatively good one. He said that six months ago, nothing was known in relation to the virus and little was known about the epidemiology of ‘long Covid’ and a picture was slowly beginning to emerge. A member of the public health team had done a significant piece of work on the impact of Covid, which he believed was to be considered by the Health and Wellbeing Board and a recommendation of that work was for more structured and systematic surveillance epidemiology.

 

 

8.39

In relation to the response of primary care, he thought that it was an uneven picture, partly depending on GP experience of patients with ‘long Covid’ and therefore a lot of work was required to increase knowledge and skills in the clinical community and particularly GPs. At present, there was emerging intelligence in relation to ‘long Covid’ coming from different places and which was not as systematic as he would like it to be.

 

 

8.40

Questions were asked about areas of the City in relation to which there were concerns and what was being put in place based on learning from the pandemic; whether awareness was being raised in those areas and if intervention measures were being put in place.

 

 

8.41

A question was asked concerning mental health relating to the pandemic and as to what the Council could do and what partnerships there were with the NHS. 

 

 

8.42

A further question was asked about what was being done with schools, including academies in the context of some cases having been reported of Covid 19 in schools and how working parents might cope with their child being sent home and with regards to teachers who might be vulnerable.

 

 

8.43

A question was asked as to whether there would be a maximum capacity of 30 persons placed upon places of worship as a result of the recent government announcements.

 

 

8.44

Greg Fell responded that he had not heard the announcement from the Prime Minister which was happening at the same time as this meeting and so did not know the answer to the question concerning places of worship, although it was possible that there would be restrictions.

 

 

8.45

Mr Fell explained that all schools had worked extensively with the Council’s Director of Education, the Public Health team and Learn Sheffield to conduct comprehensive risk assessments and implement them in relation to how school buildings and staff would operate within the school and individual health and safety risk assessments for all staff. Significant changes had been made to the way that school buildings and school staff operate. Concerns relating to staff that were very medically vulnerable were addressed by either the national shielding guidance or school risk assessments. Where staff had expressed concerns, those matters would need to be taken up with the Headteacher concerned. 

 

 

8.46

In reference to mental health, Greg Fell explained that, whilst it would be preferable not to set up specific mental health services to deal with the impact of the Coronavirus, there should be improvements in mental health services more widely, including preventative and treatment services. This included the range of low level to specialist services commissioned by the Council, the Clinical Commissioning Group and NHS England and provided by the Health and Social Care Trust or other organisations. He said that there had been underinvestment in mental health services for decades and there were improvements that should be made to mental health services.

 

 

8.47

Mr Fell said that he was concerned about Sheffield as a whole, although previously, he had been worried about the suburbs to the east of the city centre, where cases were occurring at the time. Accordingly, in those areas, there was intervention, new testing sites were established and there was community oriented work in particular wards and this had been successful in keeping transmission of the virus relatively low. There was also a shift in the nature of the epidemiology from it being predominantly in the South Asian population to being about the population more generally. There was now a more diffuse but still relatively low level spread of cases across Sheffield as a whole.

 

 

8.48

A question was asked about the effectiveness of temporary lock downs in particular areas of the country.

 

 

8.49

A question was also asked concerning the enforcement of rules on public transport and responsibility for making sure that the rules were applied.

 

 

8.50

Greg Fell responded that he did not think that there was anywhere that had been in lockdown, and then taken out of lockdown and that was now in lockdown again. He said that in Leicester, which had been subject to a local lockdown, the action taken had achieved the desired results in reducing rates of Covid 19 and there had been a range of other associated interventions. The view of the Chief Medical Officer was that, where areas had gone into lockdown, and with the intensive interventions associated with lockdown, including enforcement and certain restrictions of people's liberties, the desired results of reducing rates of illness had been achieved with few exceptions. He said that there was a debate in relation to whether a whole place should be subject to lockdown or whether it might be restricted to the areas where transmission was much higher.

 

 

8.51

In relation to enforcement, he said that there might be a case for stronger enforcement. Use of face coverings was much higher now than it had been. However, he believed that on buses, nobody had the legal responsibility to enforce rules and there was a wish not to expect bus drivers to police this issue. On trains, the British Transport Police was able to enforce the rules. He believed that it was correct to say that bus companies did not have the same powers in that regard.

 

 

8.52

It was becoming apparent that the legal powers available under the Coronavirus Act were not as strong and clear as would be desirable and there was a grey area between guidance and what was enforceable under the law and further guidance was being sought from the government in relation to what the powers were.

 

 

8.53

A question was asked concerning whether there was data about the accuracy of the tests delivered locally. A separate issue was also raised concerning key workers and people working with vulnerable people and that had to be tested regularly by their employers and difficulty in access to testing kits; and whether those key workers could go to the local testing centres to be tested, if they were asymptomatic.

 

 

8.54

Greg Fell said that the accuracy of tests per day was measured in two metrics, namely sensitivity and specificity. The lab sensitivity was approximately 98 percent accurate. There was national data in this regard. Although the tests were not perfect, they were good enough for the purpose and there would always be some false negatives and occasionally false positives. Saliva tests were to become available, which were less accurate but would provide a faster result and wider coverage but at present, swab tests were the method used, which were as accurate as they could be and with reasonably good quality assurance.

 

 

8.55

He explained that, in relation to testing for asymptomatic key workers, care home residents should be tested every 28 days and care home staff should be tested every seven days. This was a Department of Health programme. It was correct to say that there were difficulties in relation to asymptomatic testing and care homes being able to obtain testing kits and Directors of Public Health were pressing the Department of Health on that issue in order that it was resolved with some urgency.

 

 

8.56

With regard to care home staff and others working with vulnerable people using test centres instead, Mr Fell said that his personal view was that this was not practical, because it would be very difficult to manage operationally and it was probably not operationally possible to link the test results to a particular care home. His preference would be to manage the process care home by care home and which was how the national system was set up. However, the problems outlined as regards testing kits did need to be resolved.

 

 

8.57

A question was asked concerning a Covid 19 vaccine becoming available and assuming the most vulnerable were immunised through their GP and that hospitals were able to deal with their staff, what plans could be put in place to immunise other groups identified as a key priority, such as people that worked in care homes and in domestic care settings and other key worker groups, when a vaccine became available.

 

 

8.58

Greg Fell explained that there was a national plan and NHS England would be responsible for it. It was possible that the existing mass vaccination and treatment plan for pandemic flu would be used or that the established primary care arrangements as for seasonal flu might be used instead. There was also activity to promote seasonal flu vaccinations this year.

 

 

8.59

A question was asked about the balance of the relationship between local areas and central government, including as Director of Public Health and more broadly in respect of other partners and the government. 

 

 

8.60

Greg Fell responded that the balance had shifted decisively both in respect of public health and more broadly. The early response to the pandemic was centrally driven. However, this was not optimal and the balance had moved from a national only response to a national and local response and both had to work in tandem and that was the case in relation to public health. More generally, there was acknowledgement of the importance of local government during the pandemic.

 

 

8.61

A question was asked about whether there was a standard approach in respect of care homes and it was observed that homes were operating in different ways in respect of visitors and residents taking exercise and arrangements in lockdown. 

 

 

8.62

Greg Fell said that there was a standard approach and this included working within the national guidance. The guidance stated that a Director of Public Health would need to agree that care homes could accept visitors. He had agreed that care homes could have visitors, subject to high quality infection prevention and control. That had to be risk-assessed. It was evident what could happen in care homes when there was infection and there had been too many deaths in care homes. There was an attempt to balance the epidemiology, the public health impact and the risk of introducing infections into care homes with the benefits of people being able to visit people in care homes.

 

 

8.63

Care homes had been told that they knew what would work in their particular setting and that they would need to take responsibility. Care homes could not be forced to accept visitors and they needed to each decide whether conditions would enable them to make arrangements work with respect to visitors. Those conditions would vary from place to place and there would be different attitudes to risk. This was a problematic issue and there were consequences both in respect of the risk of infection and the benefits of people visiting, which were difficult to quantify.  What could not be done was to force care homes to act in a certain way if they felt they were not prepared. However, they could be helped to try and achieve the right balance.

 

 

8.64

The Council noted the information reported and thanked the Director of Public Health for his update.

 

 

Supporting documents: