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Local Outbreak Engagement Board (Health and Wellbeing Board sub-committee)

Monday 23 November 2020, 1.00pm

Present: Councillor Matthew Winnington (Chair), Councillor Judith Smyth, Cllr Jeanette Smith, Councillor Suzy Horton, Roger Batterbury (Healthwatch), Helen Atkinson (Director of Public Health), Dr Linda Collie (Portsmouth CCG), Steve Labedz (Portsmouth Education Partnership), Matthew Gummerson (Strategic Lead for Intelligence, PCC), Alison Jeffery (Director of Children, Families and Education, PCC), Richard Lee (Assistant Director- Regulatory Services, PCC), Natasha Edmunds (Director of Corporate Services, PCC), Kelly Nash (Strategy Unit, PCC),

Apologies: Stef Nientowalski (Shaping Portsmouth).

  1. Notes of last meeting (26th October 2020)

The notes were agreed as an accurate record of the meeting.

  1. Local Intelligence Summary

Matt Gummerson provided an overview of the latest data and key messages.

It was explained to the group that the data looks different this time because PHE are now assigning cases to local authorities based on the address given when booking a test (alternate address), rather than the address they registered with a GP at (primary address).

This means that the information is more accurate, but does increase the cumulative Portsmouth cases as we are a net importer of students, where the dataset is most affected by this issue, although the impact is less on the most recent data as the numbers had started to converge as GP registrations caught up. This means that the cumulative number of cases for the city is 4064.

Portsmouth recorded 568 cases over the last 7 days, with the rate per 100,000 over 7 days now at 264.3.  This compares with the wider south east region at 181.2, and the England figure of 251.5.  Noted that Slough is at 351.3, and that Liverpool is now 236.1.  Hull is currently the highest area t 652.1.

Age-specific data shows that the rate is now highest amongst 45-59 year olds, followed by the 30-44 age group.  Rates among children 0-14 remain lowest.  Noted that rates in 60+ are rising, and this is concerning because this age group is most closely correlated with hospital admissions due to the virus.

Covid related activity at QAH continues to increase, with a 17% increase in the previous week.  There have been 24 covid related deaths since beginning of October at QAH, but overall deaths are below average rates for the time of year.

It was noted that rates in the city continue to rise, and it would be 2-3 weeks into a lockdown situation before it would be expected that this would have any impact on the data.  It was noted that some areas that were placed in Tier 3 restrictions prior to lockdown are now seeing rates fall.

Initial analysis from SAGE on the impact of the tier system suggests that Tier 3 measures had a notable effect on transmission, but that there was a much smaller effect from Tiers 1&2.  It was not clear that even Tier 3 restrictions would be sufficient to reduce the R rate to below 1.

Louise Wilders asked if there was any breakdown of covid-29 related deaths compared to flu deaths in a normal year.  Matt explained that whilst this doesn’t exist specifically, flu deaths would be reflected in the rolling average for previous years.

The Chair thanked Matthew Gummerson for the presentation.

  1. Director of Public Health and Head of Regulatory Services Update

Helen Atkinson provided the following updates:

  • Testing sites – Two testing sites are now fully operational in the city, at the Eldon Building and Northarbour. DHSC had paused work on site identification, but this has now been resumed and we are looking to secure another local testing site for the city.
  • Contact tracing – Dominique Le Touze updated on the progress of the local contact tracing service which has been operational since 4th The local team are following up cases that have not uploaded details or where the national team have been unable to make contact within 24 hours.  They are receiving 12-15 cases a day, which is lower than expected looking at the prevalence rate, and the team are in conversation with PHE to determine the reasons for this.  The service are using locally-based data to enhance making contact.  Mostly, those contacted have been happy to be contacted and to co-operate. The service is operating mostly with staff redeployed from other roles.
  • Asymptomatic testing – Helen Atkinson explained that there is a lot of activity nationally around rolling out lateral flow testing. This type of testing is designed for use in outbreak situations and asymptomatic mass testing, and 66 local authorities have been identified for early rollout. A HIOW-LRF expression of interest has been prepared. Locally, there is a partnership with Southampton University to roll out a saliva testing programme, which should be piloted more widely in the area from next January.
  • Test and trace payments – Kelly Nash provided an update on the Test and trace payments, with a paper circulated separately setting out the whole policy. It was agreed that at the next meeting, a paper would come setting out the budget position.

Richard Lee reported that the regulatory services team have so far carried out 967 interventions related to the pandemic so far.  This includes routine checks and follow-ups to establish rapport and advise on the effectiveness of measures in place. Around 84% of businesses visited are fully compliant. Around 135 non-compliance incidents have been identified by the Red Snapper team, with a small number of penalties arising.  It was noted that there is very strong partnership working with the police, and the business support teams in PCC to ensure that all clarifications on regulations are circulated as swiftly as possible.  Richard reported that there is also close liaison with counterparts across the region to ensure that guidance is being interpreted consistently. There is variation in resources around the region but consistency of interpretation.

Richard noted that there are also new restrictions in place for vessels arriving in Port from Denmark, with string public health measures in place.  A notification has also been received of an outbreak of avian flu in the UK.  This is not a strand considered to be dangerous to human health, and has not been identified in the city yet, but is considered likely to emerge, so there is close contact with colleagues across agencies around bio-security.

Cllr Smith asked if PCC was taking steps to contact those who keep birds (such as chickens) and alert them to the risk.  Richard Lee responded that all those who are registered with the authority have been contacted, and there is information on the DEFRA website, but that he would raise this with the communications team.

  1. Vaccinations

Helen Atkinson provided an overview of what is currently known about the COVID vaccination programme.  For the HIOW LRF, a vaccination cell has been established to support this. The cell will lead on:

  • Service delivery model
  • Vaccination site selection and infrastructure
  • Workforce and training
  • Distribution, equipment and logistics
  • Oversight

NHS have been asked to have plans ready in all areas by 1st December (although, the vaccination programme won’t start that early).   Likely to start at end of December for priority groups:

  1. Care home residents and care home staff
  2. All over 80s and health and care workers

Then other groups in priority order.

The characteristics of some vaccines that pose distribution challenges are that it requires storage at an ultra-low temperature and drawing up before injection; and that two doses are required 21-28 days apart; and that there needs to be a period of time between receipt of the vaccine and the seasonal flu vaccine.  There are complex logistics around getting vaccines out to sites.

Delivery will be through a combination of:

  • Roving delivery
  • Community vaccination sites led by primary care networks
  • Mass vaccination sites

Key message is that we need to keep the focus on delivering the seasonal flu vaccine.  It must be stressed that the programme is NHS-led, with local authorities as a partner.  There is no expectation of local deviation from national guidance, and it is likely to take around 8 months to deliver the full programme.

Cllr Horton asked if teachers would be given priority.  Helen Atkinson reported that she is not aware of any national conversation re prioritising teachers as a group, as the focus is on the most vulnerable within our population and Health and Care staff.

Cllr Smith asked what is happening to communicate, and Helen stressed that the campaign will be NHS-led, but that she would be encouraging everyone to take up the vaccine.  Cllr Smyth asked if the vaccine was suitable for those who are immunocompromised  and Helen replied that there were no counter-indications and the expectation is that the immunocompromised- would be a high priority group.  In response to a further question about the ability to influence the prioritisation of teachers, Helen felt that this was unlikely, but also reminded the Board that the use of new testing regimes among professional groups including teachers would ease pressure for schools and support their business continuity.

  1. End of national lockdown – next steps

It was reported that an announcement is due later in the day about the new national tier system to replace the national lockdown, with announcements on the tiers for specific areas later in the week.  An extraordinary meeting of the Board has been scheduled for 1st December to enable the Board to look at the issue.  Richard Lee reminded the Board that the previous principles were around reducing households mixing and gatherings of people, with the highest restrictions for individuals and business at Tier 3.

  1. Assurance report

The Board received the report which covered:

  • Local context – updated with the information taken from the data reporting
  • Local activity – bringing together a range of information about what our work is telling us about our preparedness
  • Assurance to PHE
  • Key risks, which in this case were noted to relate to the increasing incidence of virus in the older age group.

Cllr Smyth noted that it would be useful to understand more about outbreaks in the city.  Helen Atkinson reported that Portsmouth had reported relatively few outbreaks, as opposed to exposures, although more are now emerging.  Care homes have been the focus of work locally, and it is worth noting that the city has been below regional numbers on the number of school outbreaks for some time. There have also been a number of nosocomial outbreaks in the hospital, which are assured  by NHSE/I.  It was agreed that consideration would be given to how outbreaks could be reflected in the assurance report in future.

  1. Any other business

There was no other business – it was noted that an extraordinary meeting had been convened for the next week.

The meeting concluded at 2.38pm.