Agenda item

7.1

Greg Fell, the Director of Public Health, provided an update on the latest position in relation to the Coronavirus (Covid-19) pandemic, including the latest epidemiology and key metrics. Mr Fell described the epidemiology and indicated that lateral flow testing was now being done in Sheffield although not in great volumes. He said there was a significant rise in cases between mid-December and the end of December 2020. Lockdown 3 started at New Year, and there was a decline from then on until mid-January where the rate of decline levelled. Mr Fell stated that the numbers were still going down; however, they are now going down quite slowly. He said that the biggest risk continued to be households mixing, but that this should decrease with the lockdown although some people are still going into work. Mr Fell said that all age cases were falling steadily, although this might fluctuate and the fall is happening quite slowly. He said that the over-60s cases were also falling. He stated that the measure of reproduction was just below 1, but warned that this could change quite quickly. 20% of hospital beds now had a patient with Covid-19 in them. He said that the cohort is younger than might be expected, with Intensive Care Unit patients including a large number of 45 to 65-year-old patients.

7.2

Mr Fell gave an update on the Kent variant, and stated that 70% of all cases in Sheffield were the new variant. He said that this strain had now taken over the original virus, and reinforced that it was more transmissible and possibly more lethal. He said there has been a small increase in case mortality rates. Mr Fell said that the control measures were exactly the same, and the key things were vigilance and lapses in adherence. Mr Fell said that there were two more variants of concern, the South African variant and the variant from Brazil. Both were real concerns, both in relation to effectiveness of the vaccine and the possibility of people being re-infected who already had antibodies to the initial virus.

7.3

Mr Fell spoke briefly about vaccinations and noted that inequality in coverage was not proving to be an issue currently, but it could be in future. He said that a lot was being done to improve access to the vaccine and to address people’s concerns. Mr Fell stated that there are early signs that the vaccination process was working, and was beginning to reduce death and hospitalisation in the elderly. Mr Fell said that the effect of vaccination on transmission was not yet known. Mr Fell encouraged everyone to very cautious, even when they had received the vaccine, and to adhere to public health and hygiene methods.  Mr Fell stated that it would be foolish to allow unmitigated spread in an unvaccinated population as the virus would still cause harm to younger people and unmitigated transmission and  replication could lead to virus mutation. Mr Fell said the Council were pushing for full vaccination as soon as possible.

7.4

Mr Fell said he expected things to ease as we entered Spring. He said there will be seasonality in the virus, with people spending more time outside in Spring and this would have an impact. There was also some uncertainty about how the variants might progress. Mr Fell said he supposed the government might gently and slowly relax measures from mid to late Spring, in order to observe what happened as each of the individual measures was relaxed. He said that there remained some risk in the medium term, and that next winter will be problematic. However, getting to a very low level of the virus circulating was viable.

7.5

Mr Fell said that the criteria for review included when the R number was well below one, when the community transmission rate is similar to last summer and when there was a well vaccinated population. Mr Fell added that the basic strategy was unchanged.

7.6

Dr Zak McMurray (Medical Director at the Clinical Commissioning Group) spoke about the vaccination process in Sheffield. Dr McMurray said that the vaccination process was ‘the light at the end of the tunnel’, but there was still some way to go. He said that the vaccination process was led nationally and medical practices had to opt-in to an additional service to provide vaccinations. He said only one practice in Sheffield had chosen not to offer this service. He said that the supply of vaccines was the limiting factor. Around 90,000 people in Sheffield had been immunised so far. He said that all Sheffield residents in nursing homes had been offered a vaccination, and two thirds of the housebound population had been vaccinated, alongside the large majority of over 80-year-olds. Significant progress had also been made in vaccinating those over 75-yearsold and those over 70-years-old. Both the Pfizer and Astra Zeneca vaccines were being administered. T When the second doses were due, it would be necessary to administer the same volume of vaccines but with the second doses in addition and this was when the mass vaccination centres would come into use.

7.7

Dr Oliver Hart (Clinical Director for the local Primary Care Network) gave an overview of the differences between the two vaccine types. He said that the GP centres had engaged well with the voluntary sector and the local community. He said most of the Primary care Networks (PCNs) had delivered 500 vaccines per day, totalling 2500 vaccines per week for each PCN. He said that in most practices 80% to 90% of the vaccines offered had been taken up, with some10% declining to have the vaccine, and the remaining 10% being uncertain. Dr Hart asked for the Council’s help working with the community to assure people that the vaccines were safe.

7.8

The presentations were followed by an opportunity for Members of the Council to ask questions and a summary of the questions and responses was as follows:

A question was asked about the risk of health inequality and what was being done to ensure people could access the vaccine if they did not drive and did not want to take public transport during the pandemic. Dr Hart said that campaigning for a more consistent approach to the vaccine in terms availability was essential, as people needed notice of their vaccination in advance. He said that particularly with the Astra Zeneca vaccine, GPs were going to people’s home to administer the vaccine, and that pop up vaccine centres were being used in communities where the take up for the vaccine is lower. He said that most people were attending their vaccination appointment.

Questions were asked in relation to the numbers of people from the BAME communities that had been vaccinated, compared to the wider community in Sheffield and concerning the effectiveness of the vaccination with the gap between the first and second vaccination doses being longer than suggested by medical experts.

Dr McMurray responded that there currently did not appear to be a significant difference between the vaccination take up in BAME communities and the wider community in Sheffield, apart from a small difference in the African Caribbean community. He added that it was important to keep engaging with Elders in religious groups, and that there was some national communications due to be released in that regard. He said that so far, this has not been a major issue, but it may be as the process moved further down the cohorts.

A number of scientists had looked at the evidence and said that the gap between vaccinations was reasonable and only a minor reduction in effectiveness with an increased gap between the two vaccination had been seen. Mr Fell added that the data relating to BAME communities was limited and based on an old Census, but he added that the uptake in BAME communities was better than expected. Elderly Asian groups and the Black African population was a key concern, and work was being done to reassure people and improve access to the vaccination for these groups.

In response to a question about prioritisation of the vaccine, Greg Fell responded and said there were some nuances and difficulties in deciding who was high priority and what ‘front line work’ meant. He said that there was a national policy of age based vaccination and that on the basis of occupation alone, front line NHS and social care workers should be vaccinated.

A question was asked as to how data about reinfection rates in the new variants was being recorded and how this information would be shared with the public. A further question was raised about the gap extension with the Pfizer vaccine, and in reference to research from the University of Cambridge which suggested only 50% in the over-80s achieved neutralisation after one dose.

Greg Fell responded and said that based on the current data reinfection rates were very low. Whilst he had not seen any evidence to date of reinfection with the Kent/B117 variant, he said the Chief Medical Officer was concerned about reinfection with the Manaus variant, and that full vaccination was essential to minimise the effect of this variant and any others. The first vaccine jab did not lower the risk of getting the virus but lowered the risk of serious illness because of the virus. Mr Fell stated that information concerning reinfection rates was being collected, but this data had not been made available to him yet.

A question was asked concerning whether it was possible for front line workers, such as supermarket staff, to be tested daily to prevent the spread of the virus. Mr Fell said the evidence did not suggest that this lowered the rate of transmission significantly and it was logistically problematic to test large populations. There was a move toward home based lateral flow testing, although approval was required. He said that there were not at present, sufficient resources to test all ‘key workers’.

In response to a question concerning preparations in Sheffield for the South African and Brazilian variants of the virus, Greg Fell responded and stated that if these variants were linked to recent travel, then the process was to test everyone close to the person infected. If the case was not linked to recent travel then door to door testing was necessary.

A question was asked about the uptake of the vaccination in BAME communities and reference made to a pop-up vaccination centre in a local mosque and as to whether there was a plan to do more of these in future. Dr Hart responded and said that the importance of good relationships with communities was recognised. Dr McMurray added that GP Practices also had knowledge of the local population and links to their communities. It was important to encourage people with doubts about the vaccine to have conversations about it with their GP.

Questions were asked how the vaccination process would be affected once the second doses of the vaccines began, and if major changes would be needed during this time. Dr Hart responded that whilst this was a concern alongside GP’s day work, there was a capability to deliver many vaccines each week and he said he felt confident there would be the ability to manage the increase in volume, although this would depend on supply of the vaccine. Dr McMurray added that there was capacity to increase the number of vaccinations administered, with capacity currently running at approximately 20% and there was some flexibility around capacity and resources between the Primary Care Networks, Hospitals and Sheffield Arena.

Questions were asked relating to difficulty vaccinating care home staff; whether if somebody declined to have the vaccine, they were offered more information about how to come back should they change their minds; and whether it was possible to prioritise teachers for the vaccine, and if would that work as a process.

In response to question one Dr McMurray said there are some issues with uptake for vaccinations from care home staff, but there are fewer issues than expected. Greg Fell added that Dr McMurray and Dr Hart were doing what they can to increase uptake of the vaccine by care home staff. In response to question two, Dr McMurray said there was a process in place for providing information to a person initially declining to the vaccinated. In response to question three, he said that the priority for vaccination was decided nationally, and there is very little flexibility to deviate from this.

Questions were asked about the R rate in Sheffield; what could be done to keep the R rate below 1; and about the level of confidence of keeping the R rate below 1.

Greg Fell responded and said the R rate is not measured at city level, but the rate for Yorkshire and the North East is between 0.8 and 1.1. He said if the R rate was below 1, the epidemic would shrink. Mr Fell said the restrictions were having a downward impact on the R rate, and that he would predict a tier system after the current lockdown had ended.

A question was asked as to whether there was any research which looked at whether people who have had the vaccine still carry and pass on the virus. Greg Fell responded and said that his opinion was that being vaccinated would decrease the chance of transmission of the virus; however, it could still be passed on people’s hands. Mr Fell said he expected to have more information on this over the next few weeks.

Questions were asked about whether enough was being done to make it clear that vaccination does not necessarily make people immune to the virus and to passing it on; whether the variants were more concerning than suggested by the news reports; and whether the rules for lockdown were being enforced firmly enough, in particular in supermarkets.

Dr Hart responded and said that the messaging when giving the vaccine was very important and could be improved. Mr Fell said that there was concern about the variants and the possibility of them being resistant to the vaccines. He stated that global vaccination is important, adding: ‘nobody is safe until we’re all safe’.

In response to question three, Mr Fell said that the present lockdown was less strict than the lockdown in March 2020 and more activity had been allowed. He said there were places that were not following the rules and Environmental Health Officers carried out enforcement as and when needed. People could raise a concern about breaches of COVID-19 guidelines with the health protection service.

In response to a question about whether the UK would be taking vaccines from suppliers other than Astra Zeneca and Pfizer, Members were informed that different vaccines might be accepted. The infrastructure was in place, although specific training might be required for new vaccines. Examples of other vaccines were the Moderna vaccine and Sputnik vaccine.

A question was asked about people in the S6 postcode having been sent to the Arena for their vaccinations and as to whether alternative options were available to them. A further question was asked about the durability of the vaccinations, and as to whether top-up injections would be needed in the future. Dr McMurray responded that S6 was the area that didn’t have a Practice sign up. He said that by the end of the weekend, all those over 80-years-old will have been vaccinated. He added if somebody could not travel to the Arena then an alternative arrangement would be made.

Greg Fell said it was not yet known how durable the vaccination was. He said it might be the case that there needed to be a booster vaccine each year, similar to the administration of the flu jab.

The Council noted the information reported and thanked all of the presenters for attending the meeting and providing their updates and for answering Members’ questions.