The Director of Public Health will provide a verbal report on the Department of Public Health’s strategic Covid-19 plan and updates on testing, NHS Test and Trace and outbreak management.

A presentation will be provided and to enable Members to consider up-to-the-minute  information the slides to be used in that presentation will be uploaded  on to the Council’s website prior to the meeting.

The views of Members are requested.

(Sarah Muckle – 07816071701)

The Director of Public Health provided a verbal report on the Department of Public Health’s strategic Covid-19 plan and updated Members on testing, NHS Test and Trace and outbreak management.

A detailed PowerPoint presentation was provided and explained that there was a requirement for all Upper Tier Local Authoritiesto have an outbreak control plan with the purpose of reducing the spread of COVID-19 to prevent avoidable mortality and harm.

The presentation outlined the objectives of the plan produced in the Bradford District; to enable lockdown to be eased whilst minimising the spread of COVID-19 in Bradford; the launch of the NHS Test and Trace Service on 28 May 2020 and how local health protection expertise and capabilities were combined with the national response.

It was revealed that Bradford District Covid-19 Outbreak Control built on the existing outbreak plan, scaling up and enhancing existing arrangements and services to meet the needs of local communities.

The aims and objectives of the plan included reducing the health inequalities and health impact of COVID-19 for the people of the district and it was questioned how that would be achieved.   It was explained that reducing health inequalities was at the forefront of every thing which the Public Health Department undertook.  Postcode data of people who had died from COVID-19 was plotted and revealed a clear correlation between deprivation and dying from COVID-19.  Information had been tailored to people living in houses of multiple occupation; communications were provided in plain easy to read formats and were written in community languages.  As well as communications to the general population activities were focused on people who faced disadvantage.  Assurances were provided that information was also targeted at people with learning disabilities.

A Member raised concerns that, following recent and confusing government advice some people were appearing to act as though the threat of the virus had gone. The effectiveness of the messages communicated so far was acknowledged but it was questioned what action had been taken to counter confusing advice; to prevent a second spike of the disease and allay people’s fears.

Those concerns were acknowledged and assurances were provided that proactive communications were being conveyed.  The Road Safety team had provided signs advising of two metre social distances.  The signs would remain as it was known that two metres was best and one metre plus should be only when two metre distances could not be achieved.  

It was reiterated that communications had been conducted with 14 community anchor organisations.  That was a two way channel and it was hoped to get messages out right across communities.  The plan revealed investment had been made in ‘Support to Isolate’ which was to be carried out by Council Wardens. Wardens would continue to talk and engage with communities and residents were to be told to be alert and use common sense.  The district’s Gold Command group had heard the concerns that there was no law they could enforce so ‘softer’ channels would have to be utilised to influence people to understand what is being requested and required. 

Robust community engagement measures which had been developed to maintain trust and implement test and trace with consensus and local ownership were explained and the Chair stressed the importance of getting the appropriate communications to residents. 

Testing facilities including a national pilot to provide home testing kits and the provision of a city centre drop in centre were reported and data collection to understand the pandemic and to manage case were discussed.

In response to the plans to provide ‘walk in’ testing facilities in Centenary Square a Member expressed his concerns about the safety of that provision.  He believed that the centre could encourage people who were experiencing symptoms to travel on public transport and to visit a busy area of the city centre.  It was suggested that, with measures being employed to assist businesses to reopen there may be more appropriate sites for the testing centre to be located.

The Director of Public Health acknowledged those issues and agreed that people who were experiencing symptoms should not be encouraged to use public transport.  It was explained that residents were unable to walk into other testing facilities and could not always access personal tests.  It was hoped that the centre would encourage as many people as possible to be checked  and not to think it was too difficult and not bother.  If residents tested positive their contacts could be traced and the risk of an outbreak more easily controlled.  Assurances were provided that measures were in place to mitigate the risk.  The testing centre in Bradford would be positioned right against the City Hall building and away from the centre of Centenary Square.  Strong messages  would be conveyed to encourage visitors to use face covering and adhere to social distancing guidance.  An advantage of the testing centre being in a prominent city centre position would be the reminder to people of the threat of COVID 19 and that we are not back to a normal way of life.  It had previously been reported that taxi, train and bus drivers were being disproportionally affected by COVID 19 and it would be easy for them to access a city centre walk in site. 

Assurances were provided that the Department of Public Health had worked with officers from Emergency Planning and the company which managed the city centre site.  A strict criterion of suitability had been considered and no other site within the city centre had been suitable.  It was hoped that Members felt assured by the rationale for using that site and the measures in place to mitigate risk.

Members suggested that it may be prudent to conduct tests at local bus depots or other large centres of employment to develop testing regimes around employment patterns.   Whilst they acknowledged that drivers should not be at work if they were ill the benefits of testing asymptomatic drivers who could potentially infect high risk groups was agreed.

In response Members were advised there were a few options available and being considered to make it as easy as possible to get tested.  Self test kits were currently being delivered to large organisations in Calderdale and included care homes.  This allowed people to swab themselves and the kits were delivered back to a testing facility to be processed.  Commencing in July the Director of Public Health would have responsibility for the deployment of mobile testing units run by the army.  Following the recent outbreak in Kirklees a testing unit had been set up at the affected work place for three days and all employees were tested. The tests had been conduced at various times to ensure everyone was reached.  It was questioned if the unit was testing only symptomatic employees or extending that to their contacts and it was agreed to investigate and provide that information to Members.

The Chair questioned her belief that, to produce accurate results, testing should be carried out between the second and fifth days of illness.  The Director of Public Health confirmed that levels of the virus were more likely to be detected during that time period and that false negatives could be produced from people who were asymptomatic.  In some care homes where asymptomatic people who had been in contact with those infected were tested some of those people where found to be infected. 

Anti body testing was discussed and it was suggested that testing groups such as public transport drivers who had been identified as being at greater risk may reveal not only the current prevalence of the virus but historical information about the numbers who had previously been infected.

The Director of Public Health explained that there were no plans to conduct those checks locally and that would not be considered until the focus on NHS staff had concluded.  It was explained that Public Health England did conduct national prevalence tests and officers extrapolated that information to understand how much of the virus was circulating.  Whilst immunity testing may satisfy individual curiosity it may not be helpful as it was not yet known what level of immunity was provided following infection

The Strategic Director, Health and Wellbeing, reported that as there was a greater need for surveillance in care homes people were now being regularly re-tested on a three weekly basis. 

Following discussions about the collection of data to understand the pandemic and to manage outbreaks a Member questioned if there was any work underway to understand effects of COVID-19 and the risk to Black, Asian and Minority Ethnic (BAME) communities.  In response the Director of Public Health explained work undertaken with the Bradford Institute for Health  Research and the strategic advisory group C-SAG.  It was known that before COVID 19 death rates were higher among people of black and Asian origin and that those communities and other ethnicities had between 10 – 15% higher risks of death when compared to white British people who contracted COVID-19.   That research did not account for other possibilities other than ethnicity so things like co-morbidities, (existing conditions) obesity and occupation could have some implications for people who were experiencing COVID 19 worse than other groups.  Other evidence had shown that when co- morbidities like diabetes and hypertension were considered the difference in risk of death amongst hospital patients was greatly reduced.  Those statistics indicated that whilst there was definitely a greater risk for people from BAME communities from COVID-19 some of that could be due to other co morbidities that were known to be a risk in terms of their health and wellbeing.  Other research revealed that undiagnosed hypertension played a part in how people were affected by COVID 19.   The Department for Pubic Health were aware of those issues.

Work had been undertaken with the Council for Mosques to provide risk assessments in larger mosques and risk assessment templates had been provided so that all mosques could conduct risk assessments before they opened. The capacity of mosques had also been greatly reduced and the attendance at those facilities had been reduced to between 5% and 10 % of previous capacity.  The Council of Mosques had been very accommodating in ensuring they did everything that was needed to make those environments safe.  Communications with the Council of Mosques had included video Question and Answer sessions with a medical person; leaflets; specific information for multi generational households and those communications had been distributed through many different networks and in different languages to get to as many people as we possible.  It had been found that some of the Asian older generation were getting information from Pakistan from radio broadcasts and other methods which probably weren’t as evidence based as they needed to be.  Work would be continued to engage in a variety of different ways with the BAME population. 

In relation to the outbreak occurring in a meat processing factory in a neighbouring authority a Member referred to the substantial food processing industry in the Bradford district and that the industry was a major source of employment in the area.  He reported that he was aware of employees feeling they had to work whilst they were ill as they had no other income through the absence of sick pay.  It was feared that people in the least protected employment with other vulnerabilities like living in overcrowded accommodation and insecure employment were most at risk of any Covid-19.  The necessity for dialogue with trade unions, the Chamber of Commerce or others, who could influence employers, and assist those in insecure employment, was stressed.

Members were advised that, as soon the issues in Kirklees occurred communications had been increased to the communities that potentially were employed at that site.  At the moment the Department for Public Health did not have postcode data to be able to identify where those people were located and were using communication with communities to prevent further outbreaks.   Officers in Environmental Health had been asked to contact all large employers to remind them of their responsibilities to make sure work places were as safe as possible; that all the guidelines were followed and to make sure they understood what needed to happen when employees were unwell and unable to work.  Conversations had taken place with the trade unions and the Chamber of Commerce to make employers aware of their responsibilities.  Additional welfare advice provision was also being considered to provide essential advice that would be required after the lockdown.

The additional long term benefits of the dialogue being undertaken about employers responsibilities was acknowledged.   A Member who was also a general practitioner echoed his colleagues experience of employers who had a lack of knowledge about statutory sick pay provision. 

It was presumed that the proposed walk in centre would be for residents experiencing COVID-19 symptoms and was to kick start the test and trace process.  It was questioned what measures were in place to prevent that capacity being taken up by people without reason for concern. 

In response it was confirmed that the presumption was correct, however, national policy allowed for anyone to request to be tested.  All those attending the centre would be asked the reason for their visit.  It was agreed to contact the management company to ascertain how the testing capacity would be protected for those with legitimate concerns. 

In conclusion the Director of Public Health and her colleagues were thanked for the provision of a very informative report.  It was agreed that rather than ask for a progress report at a specified time the situation would be closely monitored and additional information would be requested as required.

No resolution was passed on this item.