Agenda item

Coronavirus (Covid-19) Update

To receive updates on Covid-19 related matters affecting the city, including from the Director of Public Health, followed by questions from Members of the Council.

 

(NOTE: The above item of business is scheduled to be held from approximately 3.00 p.m. to no later than 4.30 p.m.).

 

 

Minutes:

8.1

Greg Fell, the Director of Public Health, provided an update on the latest position in relation to the Coronavirus (Covid-19) pandemic, including the latest epidemiology and key metrics.  He explained that, in the past year, mobility of the population had reduced and markedly so during periods of lockdown including walking, driving and public transport, although the disease continued to circulate.  The 7 day incidence of Covid-19 was high and rising.  Transmission of Covid-19 was still principally between households.  Incidence of Covid-19 was lowest in the younger population and growth was being driven by the working age population.  The rate of positivity of those tested was 9.7 percent.  A significant proportion of Sheffield Teaching Hospital beds had a patient with Covid-19 and the situation remined very difficult to manage.  The new variant of the disease was much more transmissible, although the mitigation measures were the same.  The fundamentals remained the same, namely people getting tested if they had symptoms, contact tracing and isolation, together with reducing social contact, hand washing, wearing face coverings and social distancing; and supporting individuals and businesses.

 

 

8.2

Mr Fell said that the effect of restrictions upon rates of infection depended on people’s behaviour and it was acknowledged that there were also harmful social and economic consequences associated with the actions taken to tackle the virus.  In regard to vaccinations, things were developing quickly and that many thousands of people had now received the first dose of the vaccine.

 

 

8.3

Greg Fell’s presentation was followed by an opportunity for Members of the Council to ask questions and a summary of the questions and responses was as follows:

 

 

8.4

Questions were asked about the decision to write to schools telling them to open and whether that was now considered to be the right decision; and as to whether teachers and other staff in schools should be vaccinated as a priority.  Mr Fell responded that there was very little in-school transmission associated with the way in which schools were run and he praised schools for the work they had done to manage risk.  However, any environment which brought people together carried a risk of transmission of the virus.  Importantly, children received an education in school.  He said that the case rate was lowest in school age children and there was local data to support that.

 

 

8.5

The decision regarding schools was a matter for the Department of Education and government. The City was very mindful of clusters, cases, and the importance of management of bubbles in schools and the schools had done a good job in relation to comprehensive risk assessments and working to a Covid-secure standard, although as in any context, this did not imply absolute safety.

 

 

8.6

He said that from an epidemiological perspective, there was a valid case that schools being open placed an upward pressure on the reproduction number (R).  Nonetheless, taking into account the negative effect of schools being closed, such as missed education, loss of life chances and life opportunities, his recommendations to the Council was that it should support schools to open.  Importantly, it was not the Council’s decision as to whether schools should open or not.  SAGE (Scientific Advisory Group for Emergencies) had never called for schools to close, although it had made the point that if schools were open, it would be difficult to keep the R number on or below 1.

 

 

8.7

Greg Fell explained that on Sunday 3 January, he advised the Cabinet that he believed the Council should support schools to be open.  However, he had not anticipated the change in government policy on Monday 4 January when the Prime Minister put the country into lockdown.  Schools were open for children of key workers and vulnerable children.  He said that it was a difficult, very complex and fast-moving situation and he would stand by the advice he provided to Cabinet.

 

 

8.8

He said that on the question of vaccinations, government policy was based largely on age and with one occupational category which was health and social care and care home care workers.  A change to that policy would be a national policy issue and people were vaccinated according to the Joint Committee on Vaccination and Immunisation priority list.  He would make available further information on the rationale relating to the order of vaccination.

 

 

8.9

In response to a question concerning the effect of poor air quality on Covid-19, including incidence, deaths and long-Covid and evidence in relation to Sheffield with regard to hospitalisation and death, there was national evidence that in areas of poor air quality, there was a higher instance of hospitalisation, admission to intensive care and early death.  Areas of poorer air quality also tended to be more deprived places and there may be other factors to consider.  There was however hypothetical and theoretical evidence to say that poor air quality, whilst it might not be a causal factor in Covid-19 outcomes, was not helpful and the City continued to do what it could to improve air quality.  However, local research had not been done on this issue.

 

 

8.10

Questions were asked about changes to the number of doses of the vaccine that people would receive, the lateness of the changes and that some people were receiving two doses whilst others had the appointment for their second dose cancelled, and with regard to concerns about whether a single dose was effective.

 

 

8.11

Greg Fell responded that two doses would be given of either the Pfizer-BioNTech vaccine or the Astra-Zeneca vaccine.  The change in policy was based on the Joint Committee on Vaccination and Immunisation recommendations to Chief Medical Officers and which was accepted and in turn recommended to the Government and it became policy.  The change concerned the space between the two doses and the recommendation now was for a 12 week period between doses.  Nonetheless, everyone should still receive two doses.  Mr Fell explained the rationale which was to provide more people with covering immunity in a limited period of time by providing them with a single dose.  The limiting factors included the availability of the vaccine and the availability of clinicians to administer it.  The original studies were done on the basis of the doses being given relatively close together.  He went on to explain the basis of the science behind the recommendation and policy and said that it was partly a matter of trust in the Joint Committee and the science.

 

 

8.12

He said that it was a difficult situation, because there were thousands of people who had received the first dose of the Pfizer vaccine and expected to receive a second dose and had consented to do so, whilst national policy was that those appointments should be cancelled to enable more people to receive a first dose.  It was also problematic for local GPs who were managing the situation as well as they could and making clinical judgments on a patient by patient basis.

 

 

8.13

He said that the vaccination programme was one delivered by the NHS.  There would be a citywide vaccination programme delivery board established, comprising the Council, principally for logistical support, and the clinical input of the NHS to achieve the shared aim of vaccinating people as quickly as possible.  Mr Fell remarked on the considerable effort by the NHS in terms of the roll out of the vaccination programme.

 

 

8.14

Questions were raised about balancing the effort required in respect of the vaccination programme with other interventions such as test, trace and isolate and as to how much control it was anticipated that Sheffield would have over how measures to tackle the virus were implemented.  A further question was asked about asymptomatic infections and lateral flow tests and as to whether there would be mass testing.  Thirdly, a question was put about NHS volunteer responders and registrations from people in Sheffield; how many requests had been taken up; and with regard to the number of people undertaking specific roles.

 

 

8.15

Greg Fell responded that he did not have information about volunteer responders and would endeavour to find that information out so that it could be published.  As regards asymptomatic infections and mass testing, there were several schemes using lateral flow devices.  However, there was not capacity to implement and coordinate such schemes into a coherent whole.  There was some lateral flow testing, for instance to enable care home visiting, and care homes had identified the difficulties in administering such schemes because of the resources required.  At the moment, he did not anticipate implementing mass testing in the way it was made operational in the Liverpool pilot, nor was he aware of evidence that such an approach made a difference, only that it was operationally possible.

 

 

8.16

Testing of those who had symptoms using a rapid test and then contact tracing and isolation made a significant difference.  Although asymptomatic testing might add some value, the cost in terms of necessary resources was high.  Liverpool had initially used 2,000 troops to implement the testing programme.

 

 

8.17

He explained that asymptomatic testing was an imperfect test and false negatives were a key concern and in the order of 40 percent of test results would be false negative.  That may have consequences for the way people behaved, having received a negative test and which was false.

 

 

8.18

In terms of current epidemiology, the COVID-19 prevalence was 2 percent.  Of those, 70 percent had symptoms and 30 percent were asymptomatic.  That 30 percent comprised a mix of truly asymptomatic; those with symptoms and who had not noticed the fact; or those who were pre-symptomatic.  The science regarding asymptomatic testing and lateral flow devices was valid in relation to very niche areas and very defined target cohorts, such as testing of contacts of cases and to minimise isolation periods which would be appropriate and would provide definite benefits.  However, the science did not support mass testing of whole populations.

 

 

8.19

In relation to the question concerning the balance of national and local control, Mr Fell said that the response was appropriately a national one as it was a national pandemic.  There had been some shift towards local control.  There were areas such as contact tracing, that he would wish were within local control.  The local contact tracing was performing well and the completion rates and the proportion of cases of contacts that were found, contacted, and given advice, was in the order of 80 percent, as compared to 50 percent for national test and trace.  He wanted to do that a lot quicker but required the resources to do so.

 

 

8.20

Questions were asked about the extent to which there might be further restrictions next winter, as indicated recently by the Chief Medical Officer; secondly, whether the vaccine would become an annual one akin to the flu vaccine; and thirdly, whether Covid-19 was just bad influenza.

 

 

8.21

Mr Fell responded that Covid-19 was definitely not a bad flu.  He explained that the case fatality rate i.e. the proportion of people that had flu and who then die, was in the order of 0.1, whereas it was a fatality rate of 1 percent for Covid-19, which was significant and particularly in the context of how easily the virus was spread.  Severe illness from Covid-19 was significantly worse than illness from flu and people were more likely to die.  There was also the cluster of syndromes known as long-Covid, which often had no bearing to the severity of the initial infection.  Covid was much more severe and more serious than flu.

 

 

8.21

Most Coronaviruses were seasonal and this was the case for Covid-19, which was a Coronavirus.  There may be other virological reasons but principally, people spent more time indoors during winter and the risk of transmission was higher indoors and particularly in places and touch points that were not cleaned regularly, such as in our homes.    People tended to be closer to each other indoors and not as Covid-secure and there was less ventilation.

 

 

8.22

Mr Fell said that as regards next winter, whilst it might be too far away to predict, it was likely and he hoped that, the population would be fairly well vaccinated by next winter.  Covid-19 would still exist and will not have been eradicated.  There might be some degree of measures in place, including handwashing, distancing, and wearing of face coverings.  He was not in a position to say whether there would be other restrictions.

 

 

8.23

Current thinking was that the Covid vaccine was a two dose and one off vaccine and not an annual measure.  However, it was not known how long immunity would last because the studies had not gone on for long enough and Coronaviruses may mutate.  Currently, the vaccine was effective against the identified mutated strain.

 

 

8.24

In response to a question about what the local authority could do to ensure that people were vaccinated as quickly as possible, Greg Fell stated that activity would include communications and myth-busting and the Council’s role in community leadership.  This was particularly as the AstraZeneca vaccine was implemented because it was much easier to handle so the vaccination programme could be accelerated.  The clinical element of the programme was the role of the NHS.  The Council had a role in relation to communications, building confidence and addressing people's legitimate concerns about safety.  It also had a role with regard to logistics support as well to enable the NHS to deliver the vaccination programme as quickly as possible.  For example, that might include the use of marquees outside primary care centres to enable people to queue under shelter.

 

 

8.25

A question was asked about the fatality rate, the age profile of those in hospital and vaccination priority for those people in hospital when they had recovered.  Mr Fell said that there were approximately 300 people in Sheffield hospitals with Covid-19 and they were mostly over 60.  The 1 percent fatality rate was referring to the proportion of all people who developed symptoms that would die.  The fatality rate was higher in hospitals.  However, the risk of death had significantly reduced because of two things.  Firstly, NHS intensive care clinical practice had changed so that intensive care clinicians used the prone position, turning patients on to their front to help their breathing and that had definitely had an impact on reducing hospital mortality.   Secondly, was the use of a drug Dexamethasone, which had massively reduced mortality.  Many people now in hospital would not have survived in the first wave but they were now surviving with complex illness for longer and they were in hospital for longer.

 

 

8.26

He said that he was fairly certain and would seek clarity on the point that, even if a person had had Covid-19, the recommendation was that they should still be vaccinated and that would be addressed at the point of the individual consenting for the vaccine.

 

 

8.27

A question was asked about plans and agreements and support that was in place with the City’s two universities in relation to students returning to Sheffield and how might they advise students in that regard.  Greg Fell explained that the Council provided regular input and advice to the two universities on interpreting national policy and in relation to Covid-secure campuses, teaching and learning environments and accommodation.  There was also support to help the universities manage cases and clusters as they occurred, as had been the case throughout the pandemic.  The universities were independent institutions with policy responsibilities to the Department of Education.  The Government Minister of State for Universities, Michelle Donelan MP, wrote to universities before the lockdown and advised them that they should not start routine face-to-face teaching other than for courses where it was very difficult to do otherwise, such as for nurses and doctors, health professionals and teacher training. He believed that both universities were offering online teaching as the default for most types of courses but with some exceptions.

 

 

8.28

He said that even in circumstances where students had travelled back to university, the vast majority of people did not have the illness, although it was critically important that when people developed symptoms they were managed appropriately and the individual concerned needed to get rapidly tested and to isolate.

 

 

8.29

Greg Fell said that both universities had managed the situation well.  There had been a big spike in cases in Sheffield at the start of the September university term, as occurred in all university cities and which was principally in 18 to 24 year olds but that had not bled into the general population as might have been feared.  If 18 to 24 year olds were removed from the data in Sheffield, its epidemic curve was the same as every other place in South Yorkshire.  Whilst he did have concerns, the reality was that some face-to-face teaching was necessary and the universities had practical systems to manage the situation.

 

 

8.30

Questions were asked about immunity following someone having had and recovered from Covid-19 and having received two vaccinations for the virus; and whether people that had received a vaccination could go out and mix with others.  Mr Fell said that people would be breaking the law if they mixed with others outside of the restrictions that were in place.  The recommendation would be that having had a vaccination, an individual should wait for 10 to 15 days whilst the antibody response developed.  However, even then people could carry the virus on their hands and it was not known whether or not being vaccinated reduced transmission.  It was known that it reduced the risk of death and people may have milder illness but could still be infectious to others.

 

 

8.31

Questions were asked about whether the universities were carrying out lateral flow tests with returning students and with regard to the provision of teaching and learning in the context of lockdown and restrictions.  Greg Fell said that, whilst he did not know the precise nature of the teaching offer at the two universities, both the universities and students placed a high value on face-to-face teaching and the Vice Chancellors had been clear that in terms of the mental well-being of students, face to face contact was really important.  However, at present that was not an option for significant numbers of courses.  His role and that of the Public Health team in relation to the universities concentrated on Public Health support, rather than the teaching and learning offer.

 

 

8.32

With regards lateral flow testing, it was notable that at the end of the last term, the two universities tested approximately ten thousand students and found about 12 cases of Covid-19 and there had been a similar ratio across the university sector.  Whilst lateral flow testing involved a large commitment of resources for what appeared to be little benefit, the universities would continue to undertake the tests and the Government had mandated them to do so.

 

 

8.33

A question was asked about early years provision and whether it was safe for early years providers to remain open to parents of non-key workers and non-vulnerable children and what was being done to support the early years sector.

 

 

8.34

Greg Fell said that not as much had been done in relation to the early years sector as it had in relation to schools and he had not been aware of concerns among early years professionals about a lack of guidance and he would address that issue.  He said that it might be the case that work had already been done in that regard.

 

 

8.35

Standard operating protocols had been developed for how cases of Covid-19 in the early years sector were managed, as they had been for schools.  He said that he would check the level of coverage of that guidance in the early years sector.  Regular updates had been provided to the sector, although there was probably more that could be done.  With regard to opening of early years provision and safety, the early years sector was likely to be no more or less safe than schools and this was subject to national policy decisions.  He said that he was not clear about why it was that early years provision remained open to all, whilst the schools did not.

 

 

8.36

A question was asked about the new variant and as to the adequacy of guidelines and measures which remained the same despite the new variant being significantly more transmissible.  Greg Fell explained that the mitigations and the behaviours of individuals required to reduce the risk of transmission were the same in relation to the new variant as for Covid-19 more generally (i.e. to wash hands, wear face coverings, keep distance and limit social contact).  He said that the problem was with implementation and adherence to the guidelines, rather than the guidelines themselves not being appropriate.  He could provide a recent paper that had been produced and that was relevant to this.  He was not aware of any fundamental change to the guidance and whilst he might accept that the approach should be toughened up, that would be in relation to implementation of measures and adherence to the measures.

 

 

8.37

A question was asked about the common areas in hospitals, such as accident and emergency and outpatient areas and as to work that had been done in relation to infections in hospital settings.  Mr Fell responded that he would request a written answer from the NHS to address the question.

 

 

8.38

A question was asked about the situation with regard the vaccine for patients that used an EpiPen and who had been turned away because they had allergies.

 

 

8.39

A further question was asked concerning the welfare of people who had been instructed to isolate or were shielding and remained in their homes and were having financial difficulty and whether any consideration had been given to provide a winter fuel allowance to those people on lower incomes.

 

 

8.40

Greg Fell responded that he would ask for an answer to the question concerning EpiPens as it was a detailed clinical policy question for the NHS.

 

 

8.41

He said that the Council had arrangements in place with regard to community hubs and the helpline to support people.  He did not know whether there had been discussion about additional winter-fuel payments for those who were shielding and he would provide a response to the question.

 

 

8.42

The Council noted the information reported and thanked Greg Fell for attending the meeting and providing the update and for answering Members’ questions.

 

 

 

 

 

Supporting documents: