As we all know, viruses have no respect for holidays. After almost two years of grinding away at the COVID coalface and with vaccine roll out well under way, in early November many of us were finalising light touch rotas for holiday cover which we hoped would give many of our COVID response teams a much needed and very well deserved break.
These days, ‘plan for the worst and hope for the best’ has almost become standard business practice for us. We’ve had seven day working as standard throughout the pandemic and the willingness of our teams to sign up for shifts even over the holiday period shows how willing to go the extra mile the public sector can be. As Omicron started to take hold and we watched case rates start to zoom up, it was clear that we’d need to go to our local ‘plan C’ – more local contact tracing, more testing capacity and more people on standby to support outbreaks. We’d been swapping notes in the run-up to Christmas with public health colleagues from UK Health Security Agency London who gave us some idea of how quickly Omicron moves and what impact this had on London’s COVID response. It’s always good to work with the benefit of someone else’s hindsight.
While directors of public health and their teams have been very much in the spotlight, the local council COVID ‘army’ is about as multi-disciplinary as you can get. As the vaccine booster programme was turbo-charged to get as many jabs in arms as possible, we worked with our local NHS to stand up a new pop-up vaccine site with one of our major employers Jaguar Land Rover which ran through to the afternoon of Christmas Eve. Transport planners sorted signage, emergency planners stood up a shuttle service to get people on site and our contact centre took calls from members of the public who needed help getting there. What would usually have taken several weeks to stand up happened in four days. One of the few benefits of COVID has been the cementing of very strong relationships with key partners: what would in the past have taken a couple of meetings, a proposal and at least a few weeks to stand up can now be done with a few quick phone calls. Throughout the holiday period – with two days off on the 25/26 December the whole health, social care and public health system continued to hold daily check-ins so we could monitor and react to a fast-moving situation.
In the period between Christmas and New Year rates really started to climb, jumping from around 150 new cases a day to over 400. On the 27 December we took the rapid decision to increase local contact tracing capacity, prioritising people who had practical support needs where the local team can really add value. Calm and capable, the team lead pulled in extra contact tracers despite being on leave – and managing a suspicious cough.
We also saw cases in care homes really starting to pick up, predominantly in staff. Although boosters and possibly Omicron’s slightly weaker fire power are providing good protection, and we thankfully are not seeing a repeat of the devastating picture in care homes that we saw in the first phase of the pandemic, the business continuity and systems flow impact are themselves major challenges. Like both Delta and Alpha before it, Omicron outbreaks look and feel different: very rapid and taking out large groups very quickly.
Joint working across public health, social care commissioner and local infection control teams has gone from strength to strength through the pandemic and the on-call team had the back up from a number of key people who said ‘I’m on leave but here’s my mobile if you need me’.
As the national testing system started feeling the strain of record case numbers, we realised that testing capacity could become an issue so we limited the number of boxes of kits people could pick up from two to one at our council run Community Collect sites. We also opened up our assisted testing facilities at 12 hours’ notice so that anyone who couldn’t get hold of a box of kits would be guaranteed a test in the all-important days leading up to New Year’s Eve, promoting a local message of ‘test before you go out’. In the Christmas and New Year week we issued record numbers of tests.
Two points stand out:
- First, the willingness of our troops to go over the top yet again. For many of these teams, there has been very little down time for almost two years. Many are driven by a strong commitment to ‘get the job done’ and to do the best they can for our local communities. We cannot thank them enough, even if they don’t always get the recognition of some of the front-line staff in more visible COVID roles. As leaders, we face difficult questions about resilience and recovery for ourselves and our teams. Working like this for so long takes its toll on staff and their families and it’s important that as a sector we recognise this.
- Second, let’s build on this passion for local. COVID has shown quite how agile local can be when there’s the right freedom and flexibility to act to deliver ‘last mile’ services. I may work in public health but sometimes it’s knowing the man with the road-signs that makes the real impact. Thinking big, we need to build alliances across central and local government to understand how we can understand and connect our worlds to improve both policy making and delivery. That would be a good Christmas present.
Ruth Tennant is director of public health at Solihull MBC