With further easing of lockdown due in England this weekend, local government faces a range of public health challenges. How can councils and their partners ensure they have the tools and data to ensure testing approaches match local needs and can quickly identify and manage localised COVID-19 outbreaks?
The third week figures for the NHS Test and Trace service show that of those who tested positive for coronavirus, just over 70% provided information about their recent contacts. But just 82% of close contacts were reached, down from 91% in the first two weeks. There has also been a time-consuming U-turn on a coronavirus contact-tracing app, with the NHS now switching to Apple and Google technology.
England's first local lockdown started in Leicester this week, after 866 COVID-19 cases were reported in last two weeks in the city. Non-essential retail shops closed on Tuesday, and schools in the area affected will close to most children from Thursday. Pubs and restaurants will stay shut this weekend.
Health secretary Matt Hancock said the number of positive coronavirus cases was ‘three times higher than the next highest city'.
Mayor of Leicester Sir Peter Soulsby has said the measures are ‘stricter than we anticipated, but we understand the need for firm action'.
‘I am detemined we will make this work, and to minimise the time these additional measures need to be in place in the city.'
The other English cities, counties and London boroughs which have seen coronavirus case rises in recent weeks are, in alphabetical order: Barking and Dagenham, Brent, Derbyshire, Doncaster, Ealing, Enfield, Gateshead, Gloucestershire, Hammersmith and Fulham, Haringey, Harrow, Havering, Hounslow, Isle of Wight, Kensington and Chelsea, Leicester, Medway, Milton Keynes, Plymouth, Portsmouth, Redbridge, Redcar and Cleveland, Richmond upon Thames, Sandwell, Slough, Suffolk, Sunderland, Tower Hamlets, Wakefield, Walsall, Wandsworth, Westminster, Wigan, Wiltshire, Windsor and Maidenhead, and York.
Councils have been calling on the Government for some time for access to COVID-19 postcode level data, and this is finally starting to be shared (see box below). Sir Peter said on Twitter that ‘after weeks of asking', last Thursday the council ‘finally got addresses of positive tests from Government'.
There's growing alarm about crowds gathering in situations where they're unable or unwilling to adhere to social distancing – bringing heightened risks of infection. Last week's hot weather led to a spate of illegal raves and an influx of crowds to some beaches. Bournemouth, Christchurch and Poole Council declared major incidents when beaches in Bournemouth and Poole were inundated with visitors. Leader Cllr Vikki Slade said the council did not have the power to close the beaches, and that ‘guidelines are useless, you need laws and powers'.
Care homes remain a significant concern. Cheshire West and Chester Council chief executive Andrew Lewis has written to the Government to highlight ‘unacceptable delays' in securing coronavirus test results for care homes. He said he believed the solution lay in ‘more local autonomy' – with councils allowed to prioritise test results.
Writing for The MJ, director of public health and wellbeing at Blackburn with Darwen Council Dominic Harrison, said the sector has ‘about five months to get all of us, but particularly vulnerable communities, ready for a second wave'.
He said low income and Black, Asian and minority ethnic (BAME) communities were likely to be ‘hit first, hard and universally' in any second wave.
He has called for a ‘COVID-19 Second Wave Ready Community Fund' to be allocated now to ‘manage down' the vulnerability in target communities.
The Department of Health and Social Care is working with a number of councils to explore more flexible testing approaches and how best to provide access to testing for vulnerable groups and those at risk of exclusion. Six new walk-through sites have opened in Newcastle, Rochdale, Leeds, Brent, Newham and Slough, enabling people without cars to get tested.
Brent has become the first place in the country to open a local COVID-19 testing site designed around the needs of the community.
Professor Kate Ardern is director of public health at Wigan MBC and lead director of public health for the Greater Manchester Combined Authority for health protection and emergency planning and response. She told The MJ data sharing with councils is ‘getting better', but that local areas need ‘much more control over the testing regime'.
Local control is needed ‘so that we can direct them in a way that actually helps us get ahead of the curve in the first and second wave'.
She added: ‘For example, can I deploy testing to help support the universities in October, so that they can reopen safely? If I don't have control over the testing regime, we can't deploy testing in that way.
‘You might actually have spare capacity, which is not being used, which could be used if we had control, and were able to direct it where it's needed.'
She added: ‘If you set up a system simply to develop capacity and not thinking about just how are we going to use the results and what are the consequences of that, then you won't have set it up in a way that gathers that intelligence. If we can influence that going forward, that will improve.'
Local areas ‘can't manage outbreaks unless we know who is being tested, and what the results are', she said. ‘The difference it makes, particularly if we have control over direct testing, is that we can target communications and engagement with particular localities or neighbourhoods or demographics.'
What Greater Manchester (GM) is trying to do ‘are the things at GM level that makes sense at that level', said Professor Ardern. ‘So that's data and analytics, training and development, and standard operating procedures and complex scenario development.'
She added: ‘What you have to do at the local level is consequence management with complex settings. That's all about relationships and trust. The gathering of soft intelligence which the system we're setting up in GM allows you to record is incredibly important.'
Greg Fell is director of public health at Sheffield City Council. He told The MJ that what most directors of public health (DPHs) have asked for is ‘person-level data in real time'.
He added: ‘It's often the ‘local detective work – the shoe-leather epidemiology, the putting together of all the pieces, including a whole bunch of soft intelligence – where you find that something is going off'. Giving the example of sex workers, he said: ‘I don't think the sex industry has respected lockdown at all. People will be very reluctant to "fess up" in those circumstances.' Person-level data ‘adds a lot to the picture', he continued.
He added: ‘I expect there's a lot of mechanics to do before making that material available to the DPHs, but it is the thing that's needed most. Often, it's the soft intelligence that is days ahead of the hard data.'
Local lockdowns are ‘a meaningless concept', he said. ‘We work within the powers that we've got – I don't have the legal authority to shut down Sheffield, and neither does the leader of the council. You take the lowest level of intervention needed to control the spread of an illness.'
He concluded: ‘In the meantime we continue to manage outbreaks when they happen, be very clear about how to prevent cases and outbreaks, and be really watchful about the surveillance, and what the hard and soft intelligence is telling us. That's the route to safely re-opening all the things we've shut down.'
Breakthrough for councils on access to COVID-19 postcode-level data
After lobbying from the sector, council directors of public health (DPHs) will now be able to receive postcode-level data of those who have tested positive from Public Health England (PHE) broken down by age, gender and ethnicity.
This will include the names and contact details of individuals to help support local efforts to tackle the spread of infection. A Data Sharing Agreement (DSA) will be needed between PHE and each council with social care responsibilities.
The Local Government Association (LGA) has made it clear that councils are ready to use their experience and expertise to work with the Government to help contact the third of people who tested positive for coronavirus but who can't be reached. Cllr Ian Hudspeth, chairman of the LGA's Community Wellbeing Board, said: ‘It's good that more data is being shared with councils' irectors of public health. With the right powers, flexibilities, data and long-term funding, councils can maximise their capabilities, skills and experience, to help ensure the programme is run effectively and is sustainable.'
But new survey data from Solace, the members' network for local government and public sector professionals in England, has highlighted fears about implementing local lockdowns and doubts about councils playing a role in testing and tracing.
Joanne Roney, Solace spokesperson for leadership and learning and chief executive of Manchester City Council, said: ‘If the next stage of the response to the coronavirus crisis is to be a national success then we cannot repeat the mistakes of the past – local government must be at the heart of it.'
Director of public health and wellbeing at Blackburn with Darwen Council, Dominic Harrison, said local authorities have been getting data from Pillar 1 testing – swab testing in PHE labs and NHS hospitals from those with a clinical need, and health and care workers – but that Pillar 2 data – commercial swab testing for the wider population – has been much slower at getting through to local authorities via PHE ‘but we are now getting better quality data from that source, which gives us a much fuller picture of who's diagnosed, who's tested and who has a confirmed case in each local authority area'.
He said one of the remaining challenges is the absence of a shared information system across every part of the test and trace system.
He added: ‘There's a national discussion, and certainly a regional one, going on about what shared information database we could buy into that would allow anyone in the test and trace system to look up a specific case or cases and to have a shared view of the same record.
‘That's not yet in place but there is a lot of discussion going on about it. That will improve the system immensely, and at the moment, the favourite for that is an existing Microsoft package , Microsoft dynamics 365, that would allow various people to access the same data source.'
