Agenda item

The Committee received a report of the Director of Public Health that provided Members with an update on the COVID-19 response and the updated COVID-19 Local Outbreak Control Plan (for copy of report, see file of minutes).

The Director of Public Health was in attendance to present the report and deliver a presentation that provided members with a summary of County Durham Cases; update on National Lockdown and Tier 4; update of the work of the Health Protection Assurance Board (HPAB) and the COVID-19 Vaccination Programme (for copy of presentation, see file of minutes).

The Director of Public Health explained that three development sessions had been held with elected members to explain the Durham Insight data dashboard for COVID-19 which was on the recommendation of Adults, Wellbeing and Health Overview and Scrutiny Committee that were helpful and had high attendance.

She updated Members on the County Durham 7-day rate that was currently 254.9 per 100,000 which was slightly lower than the England average and a reduction of 40.2 over the last week. There had been a rapid increase in rates up to and just beyond the Christmas period, the 29^th and 30^th December saw 500 cases per day in County Durham and again on the 4^th January. Since then the rates had started to decrease and colleagues in the NHS County Durham Foundation Trust were starting to see the Hospital admissions reduce including intensive care. The rapid increase was also against the backdrop of the new variant stream and based on projections from the health protection team in Public Health England, they thought around 70% of local cases were the new variant strain.

The Director of Public Health reported that out of 27,500 eighty plus year olds across County Durham they had almost 100% uptake of the vaccination. In terms of priority groups, other priority groups including health and social care staff, the hospital hub had vaccinated over 20,000 staff. The vaccination centre was set up very rapidly at County Hall for frontline health and social care workers and had seen around 500 vaccinations per day. The aim was to have the full vaccination of all four of the first priority groups by the 15 February 2021, the limiting factor was the supply as it was a push model. The mortality would reduce by 99% when all nine groups had been vaccinated.

The Chair on behalf of other members referred to the Minister for vaccinations indicating that the first four priority groups would be completed by next week and the next five by the end of March before they started looking at teachers and police and so on and asked how prepared were Durham to ensure that the remaining five priority groups hit this target. He then asked how Newcastle that had half the population of Durham had four mass vaccination centres and Darlington that had a fifth of the population of Durham had a mass vaccination when County Durham did not have a mass vaccination centre. He then indicated that 80-year olds and 90 years olds in some parts of the county were still waiting to have their vaccination whilst other parts of the County had had their second vaccination. This had raised concerns amongst the population.

The Director of Public Health responded in terms of those priority groups and the role out before the end of March then teachers and fire and that the second phase would consider other groups but was presently based on the clinical need which was predicated on age.

Michael Laing, Director of Integrated Community Services, County Durham Integrated Community Care Partnership responded to the concerns raised about rollout of the vaccination that was partly due to primary cares starting the vaccination at different times. Wave one was asked to mobilize at the end of November 2020 and started the week commencing the 14December 2020. The second wave started on the 16 December 2020 and the third wave was due to start on the 21 December 2020, but government asked them to push this back until the beginning of January 2021. This resulted in different people getting the vaccine at different time scales. This was linked to GPs ability to have premises where people could socially distance and get staff in place to administer the vaccine and also to store the vaccine at that time in line with clinical guidance. In terms of the mass vaccination centre seven centres had been put forward but the regional organisation have decided that they would have a vaccination centre in Durham and were looking for premises that they could use for a year and the announcement was imminent that would open on the 15 February 2021. The Minister had asked them to start on primary groups five and six which they had expected and would start planning for that and primary care networks were set up to carry out those mass vaccination programmes and if they had a mass vaccination centre this would help. They also had the option of using the facility at County Hall that was mobilised very quickly.

Joseph Chandy, Director of Commissioning Strategy and Delivery indicated that he was leading the general practice delivery of the vaccination campaign and indicated that the sites that got off the ground before Christmas were also administering the second dose of the vaccine within three weeks of the first. It was part way through the programme that the government nationally changed the guidance and extended to second vaccine to a 12-week gap. This resulted in the programmes that started later were able to quite quickly vaccinate more first dose patients while the original programmes were carrying out their second dose.

Councillor Jopling praised the vaccine rollout and indicated that she had received positive comments from her constituents. She referred to the lateral flow test and the publicity around this and how effective it was and how much they should rely on it and that it was being used quite widely. She asked if they had carried out any work to ascertain if the test was effective.

Councillor R Bell indicated that the rates were falling that was positive and if you looked at the interactive map they were all going in the right direction and the vaccine rollout was going well, he was also pleased to hear the Richardson Hospital was being utilised. His understanding of the lateral flow testing was that the benefit was to detect symptomless positive people. He then referred to the pilot carried out in Liverpool and asked what they had learnt from that pilot. It was not just test and trace as you needed to get people to isolate and that up to 40% of people contacted did not isolate. He asked how effective the mass testing on a lateral flow basis was going to be from the Liverpool experience.

Councillor L Brown wished to praise everyone involved in carrying out the vaccination rollout.

Councillor Reed echoed Councillors Brown and Jopling and wished to praise the NHS. She had been contacted by a number of constituents complimenting the staff at North House surgery in Crook who had indicated that it was very well organised and safety measures were adhered to and praised the staff. Her only negative was people from the Dales were having to travel to Crook for their vaccination and asked why this was the case. She then referred to funding and asked what types of vaccinations were being used and where they were manufactured and the associated costs, including the full cost of the programme.

The Director of Public Health responded in relation to the use of the lateral flow tests and indicated that they were using them as part of the overall programme of work. The test was particularly effective at detecting people who did not have any symptoms when they have a high viral load and was how they were aiming to use the tests locally. The work in the care home setting they were picking up on asymptomatic residents and staff. The targeted community programme that was the learning from Liverpool was a mass testing programme that mobilised test sites across Liverpool and what they found from that programme was that the people who were coming forward were the worried so it did not address inequalities and there was a high percentage of false positives. The local programme that they would be implementing builds on some learning from the university who had been using the lateral flow devices for their students when they returned home before Christmas. They were going to use the lateral flow and ensure they had a programme of tests and not just a one off, at both community sites and front-line workforces and supporting those to self-isolate. They raised issues nationally when there was no self-isolation payment as they knew people weren’t able to self-isolate, so they pushed for the payment. They would ensure in cases where people test positive both cases and contacts had access to information through the community hub. They know that there were some reservations with the lateral flow tests and were part of the overall programme and they would continue to evaluate.

The Director of Integrated Community Services indicated that he would pass on the Committee’s comments to North House Surgery who were doing a tremendous job. He then referred to the manufacture of the vaccine and that Pfizer was made in Belgium, Oxford vaccine was initially being made in Germany and the Netherlands but was now manufactured in the UK and the new vaccines that were currently going through registration process the Novavax would be manufactured in Stockton. In terms of cost there was a payment and cost framework for GP practices, the Trust were currently running two hospital hub sites, one in County Hall that had vaccinated about four thousand people but they had not talked about money as the priority was to get people vaccinated and making sure those priority groups were vaccinated by the 15 February 2021 and then move on to groups five and six. A reconciliation of costs would be undertaken and there were funding streams from the government to do that.

Councillor Crathorne wished to echo the comments from her colleagues in the fantastic work the NHS were doing and the volunteers. She then asked about care homes and how fare advanced they were with the vaccination in care homes and were there any current outbreaks of COVID in care homes.

Councillor Henderson referred to a letter he had received from the NHS inviting him to ring 119 to arrange a vaccination. Someone he knew contacted 119 and were offered Morecombe, Leeds, Bradford, and Newcastle and indicated that Morecombe was some distance from Teasdale and current advice was that you should not leave the County and stay at home. He was concerned that these areas were offered and that some people would travel and asked if this could be stopped.

Councillor Savoury commented that she had received nothing but praise from the residents from Weardale who had to travel to Crook for their vaccination and asked why a site had not been set up in Weardale as they had a limited bus service for those who had to travel on the bus.

The Director of Commissioning Strategy and Delivery indicated that NHS England had specifically asked each primary care network area to nominate one site as the Pfizer vaccine which was all they had at that time logistically could not be delivered to every practice. The requirements around mixing and constituting of the vaccine and the 15 minute wait meant that they were unable to administer like a influenza programme as this would make it very challenging for general practice as they were running day to day general practice at the same time. Each primary network was asked to use their local knowledge of residence and travel and capability of each of the practice sites. Sometimes a practice site was not the right place, and some had chosen community buildings and decided where that main site should be. North House was the chosen site and the Clinical Commissioning Group (CCG) took the decision to see if they could support transport and set aside money as a CCG to support transport and every patient who had been in contact with their GP surgery would have the option from their GP practice to be offered transport through the CCG transport booking service that was set up temporarily for this programme. With the introduction of the Oxford vaccine this gave the opportunity for primary care networks to rethink if they could deliver the vaccine closer to home from individual GP sites, there were still some inflexibilities as unlike the flu vaccination that got delivered to the surgery and put in the fridge, oxford vaccine under the national pharmacy guidance once if left the main vaccination site it had to be in someone’s arm within 24 hours and the moving of the vaccination was quite complex so some primary care networks have had the capability of taking the oxford vaccine if they have had a delivery and moving it to local GP surgeries. He would feed back the comments in relation to the119 helpline but they have had patients who had been offered the Nightingale at Sunderland and Bishop Auckland, so he did not know what algorithm they were using.

The Director of Public Health indicated that they were still managing a very small number of outbreaks in care homes. All their existing measures they encouraged and supported within all their settings still needed to be in place until guidance changed.

Sarah Burns, Head of Integrated Commissioning referred to the vaccinations in care homes and indicated that as of Wednesday all care homes had been vaccinated except those that had a current outbreak. They would be making arrangements once the outbreak had passed to go into the care home to vaccinate residents. In terms of staff as at Wednesday they had vaccinated over 4200 care home staff that was just over 71% and there was a push to get the rest vaccinated. They had also provided information sharing sessions for staff if they were concerned about the virus.

The Director of Integrated Community Services gave assurances that housebound patients they were going out to households to vaccinate patients. So far community nursing staff had vaccinated around 2500 housebound patients from a list of 3600 and were working with GP practices so ensure that they did take the vaccine out to patients. They were aiming to have all housebound patients in the County vaccinated by the 15 February 2021, if not before.

Resolved: That the updated COVID-19 Local Outbreak Control Plan be noted.