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Gateshead COVID-19 Local Outbreak Control Plan

Our COVID-19 local outbreak control plan focuses on preventing further localised outbreaks and responding quickly if there are positive cases in a key location, like a school or care home.

It will support residents, care homes, schools and key locations to understand how they can play their part in preventing outbreaks by reinforcing social distancing, good hygiene and supporting vulnerable members of their community.

The plan outlines how Gateshead will ramp up national testing programmes, maximise localised and mobile testing and ensure residents understand the symptoms, how to get tested and how to isolate safely to protect their community.


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Contents

Introduction
Purpose and principles
Testing
Contact tracing
Supported isolation
Vaccination
Health Protection Action

- Data and intelligence
- Compliance and enforcement
- Vulnerable and under-served communities
- Governance
 -Communication and engagement
 -Resources

Appendix 1 - Surge testing (Operation Eagle)
Appendix 2 - Coordination and Response Centre (CRC) support
Appendix 3 
Appendix 4 - Gateshead COVID vaccine uptake and equality plan
Appendix 5 - North East Public Health system (LAs and PHE North East) arrangements for investigation multiple COVID-19 cases reported in premises / settings
Appendix 6 - Standard operating procedure for the joint local management of confirmed COVID 19 cases in schools and childcare settings
Appendix 7 - Standard operating procedure for the local management of outbreaks in care homes during 'test, trace, contain and enable'
Appendix 8 - Approach to preventing and managing outbreaks in workplaces (not schools or care homes)
Appendix 9 - Gateshead Health NHS Foundation Trust Covid-19 Infection Prevention Control: High level summary of standard operating procedures and outbreak plan
Appendix 10 - COVID-19 communication plan


Introduction: Covid-19 in Gateshead

The Council's vision is to make Gateshead a place where everyone thrives. This is based on a recognition that inequality is a common experience for many people and that this is bad for everyone. COVID-19 has not only shone a light on inequality, but also increased it for many, with BAME groups and more socially deprived communities disproportionately affected. We want to make sure that our COVID-19 response reflects this and provides help where it is needed, when it is needed.

As COVID-19 restrictions are eased in line with the Governments Contain Framework (Dec 2020) and COVID-19 Response ('roadmap' Feb 2021), it is important to maintain local vigilance to prevent and reduce the opportunities for the virus to spread within the community and key settings within Gateshead. Non-pharmaceutical interventions (NPIs) such as social and physical distancing, good hygiene and face coverings, remain important and reduce the likelihood of spread even from those cases without symptoms.

After 12 months of responding to the pandemic, now is the ideal time to take stock, learn lessons and tailor our local response to ensure there is a consistent test, trace and supported isolation programme in place and which links with the NHS vaccination programme. Our challenge is to find a balance that will allow lockdown restrictions to be lifted while preventing a resurgence of the virus.

This COVID-19 Outbreak Management Plan sets out the role of the Gateshead system in preventing and controlling COVID-19 with a focus on robust management of outbreaks and providing support for complex settings, communities, and individuals where required. It aims to protect the health of Gateshead's population from COVID-19 and assure stakeholders, and the public, that efficient and effective arrangements are in place.

The Plan remains a dynamic document which will be updated according to learning and experience in dealing with the COVID-19 response. The Public Health Team will keep the Plan under regular review and amend/update according to local, regional and national developments. It will, for instance, be aligned to the updated version of the Government's Contain Framework when that document is published. Likewise, the publication of the planned Outbreak Management Response Toolkit.

Purpose and principles

Purpose

Our purpose is to reduce transmission of COVID-19 in Gateshead, to protect the vulnerable, prevent increased demand on healthcare services and ensure provision of an effective and timely response as cases and outbreaks are identified.

We know that our most disadvantaged communities are those most impacted by this disease, for a range of complex reasons. We will work with our most vulnerable communities to minimise the impact of COVID-19 in Gateshead.

Principles

Public Health leadership: this plan is based upon a public health approach, under the leadership of the Director of Public Health. This means we will be concerned with:

  • Surveillance: so that action is informed by an understanding of the needs of the people of Gateshead
  • Evidence: our actions should be based on the evidence of what works
  • Policy and strategy development: through this COVID-19 Outbreak Management plan
  • Collaborative working for health and wellbeing
  • Public engagement to build confidence and trust in the arrangements

A whole system response: the capabilities of the whole system need to be mobilised in preventing and managing outbreaks.

An efficient and effective system: the need for clear communication and timely access and sharing of information, data and intelligence amongst local agencies and between local, regional and national systems to inform action, monitor outcomes and deliver rapid and proactive management of outbreaks.

A properly resourced response: each agency will have the necessary capability, both financial and in respect of skills and expertise, to carry out their responsibilities.

A graphic showing the national requirements of local outbreak control plans can be found in the downloadable version of this plan.

Testing

The purposes of testing can be described as follows:

  • Case finding - identifying positive cases of COVID19 within the population, and ensuring they self-isolate to reduce transmission to other people; this could include regular testing of the contacts of a case
  • Ensuring safety - discovering COVID19 status in the community to isolate and to ensure the ongoing safety of other individuals within the population.
  • Enabling return to normal activities, reducing the impact of the COVID-19 pandemic

Local testing capacity is essential not only for diagnosis for those who have symptoms but is also important in response to the management of a COVID-19 outbreak. The targeted deployment of local facilities alongside regional and national testing programmes will ensure that there is a swift response to outbreaks. Testing is also being used proactively to identify asymptomatic cases, who can then be supported to isolate to prevent on-going transmission.

Current testing arrangements

Pillar 1 (NHS Foundation Trusts)

Eligible groups:

  • NHS staff (via their employer)
  • GP's and Practice Nurses
  • Other Key workers
  • Symptomatic care home residents (via GP)
  • Asymptomatic care home residents who are transferring from community or other care home (via GP)
  • Patients being admitted overnight to hospital for overnight stay are tested

Pillar 2 (National Testing Programme)

Eligible groups:

  • Anyone who has symptoms of coronavirus, whatever their age
  • Essential workers who are self-isolating either because they or member(s) of their household have coronavirus symptoms
  • Whole care home asymptomatic testing

Testing can be accessed via the national testing portals or by dialling 119.

https://www.gov.uk/get-coronavirus-test

A crucial issue in relation to testing is the turnaround time of tests. The rapid turnaround for vulnerable populations and settings and fast return of results improves the effectiveness of the contact tracing and isolation system and prevents the spread of the virus.

Asymptomatic Testing

Targeted community testing (lateral flow testing) can be used to test people without symptoms. The results are available within half an hour without the need for laboratory processing. These tests are not as accurate as the tests available for people with symptoms and some people who have COVID-19 will receive a negative result in error. We know that up to one in four people who have coronavirus never show any symptoms but that does not mean they are not infectious. So, these tests are trying to find people who may have no symptoms but are carrying the virus. The Government is sending out supplies of lateral flow tests to care homes, staff in early years settings, staff in primary schools and staff and pupils in secondary schools. Businesses of over 50 employees can also register to deliver their own workforce testing at https://www.gov.uk/get-workplace-coronavirus-tests.

Via the Local Authority testing sites, Lateral flow testing is accessible to frontline staff working with vulnerable people in the community, and staff whose work means that they are at higher infection risk as they must travel together in vehicles for example Care Call, refuse services, home adaptations and repairs. Further expansion of the asymptomatic testing is planned to allow access for wider workforces to access testing to support their COVID-19 risk assessments.

A Community Collect model to enable home testing for the wider public, as lockdown restrictions are reduced, is currently being developed in Gateshead. Home testing kits for families where a household member is returning to primary or secondary school are available via online ordering or collection from test sites. It is anticipated that Community Collect target audience will widen in future months.

A sustainable model is planned to enable access to home testing kits across Gateshead and ensuring that all our communities have access to the resource. The development of community hubs in Gateshead locality provides an opportunity for access to home testing kits alongside a range of support right in the heart of our communities, utilising the engagement skills and relationships that are already in place.

Clear communications and messaging to support this roll out are being developed.

Testing kits are currently available via the main testing sites, but this resource will be phased out from April as our capacity to provide the kits in a more local way develops.

Surge Testing

Surge testing is increased testing together with enhanced contact tracing and commenced on 1 February in specified areas in England, in order to detect and assess the spread of a specific variant of SARS-CoV-2 known as VOC-202012/02 which originated in South Africa. Surge testing is intended to enable PHE, NHS Test & Trace and the Joint Biosecurity Centre to closely monitor any community spread of a new variant of concern (VOC), and then take steps with local partners to restrict further transmission.

Genomic sequencing is also included, analysing the virus samples to understand they compares with other cases. The current national programme of surge testing is known as Operation Eagle.

The process involves testing people who do not have any symptoms of coronavirus and identifying positive cases. Contact tracing then identifies people who have had close contact with the case while they were infectious and requires them to self-isolate, thereby breaking the chain of transmission. Enhanced contact tracing provides a retrospective focus on the 7-day period before the case is infectious in order to try to identify the likely source of infection. In this way additional cases can be identified from potential shared sources of infection.

In response to new VOCs being detected, Public Health England (PHE)/DHSC will provide the LA with stocks of Polymerase Chain Reaction (PCR) test kits and postcode details of where the new strain has been detected. It will be the LA's responsibility to distribute the kits in the target postcodes with the aim of reaching 10,000 test results. Once used the test kits will go to a designated laboratory for analysis including genomic sequencing to provide information about the spread of the strain in a community.

An Action card is in place within Gateshead detailing the process that would be undertaken if surge testing is required (appendix 1)

DHSC will inform the LA via agreed contact routes. The DPH and Public Health leads will be notified of the alert. There is an expectation that the surge testing will begin within 48 hours of the notification. The routes used to distribute the PCR kits into the community will be decided by the DPH, PHE and DHSC. Options may include

  • Collect/drop off points
  • Mobile testing units
  • Door to door

To enable these actions, relevant officers have been identified to support with communications, digital, vehicles, operating locations, staff, PPE, location information, and finance. All staff have been advised of the requirements of surge testing.

We recognise that where a dangerous VOC is identified and is likely to pose a significant risk to the vaccination programme or public health, the Government will take a highly precautionary approach, acting fast to address outbreaks. In such cases very close cooperation and engagement between local and national teams will be essential and we would ask that the local system is consulted to ensure a coordinated approach which reduces the need to re-impose economic and social restrictions at a local or even regional level.

Local contact tracing

The aims of contact tracing are

  • to identify people who have been exposed to cases of COVD-19 and ensure that they are given the correct advice about isolation;
  • to identify if an individual has any support needs that might enable them to isolate more effectively
  • to gather information which might identify the source of a case's infection.

This information is gathered through interviews with cases (via national the Test and Trace system or Local Tracing Partnerships) and includes information on:

  • where they have been prior to their infection (the possible source); and
  • where they have been whilst infectious (possible contacts).

In Gateshead, a case investigation call centre was set up in September 2020 to gather intelligence on the activities of COVID-19 cases and to develop the processes for eventually undertaking local contact tracing in Gateshead. Case investigation calls are made to cases after they have been contacted by the national contact tracing team. These "local voice" phone calls have been welcomed by cases and callers will follow up with wellbeing calls where there are concerns about vulnerable cases. We have developed data systems to pull out important intelligence from this activity, for instance, links with particular premises, locations or activities.

All positive cases of COVID-19 are entered into the national NHS Test and Trace service and individuals are emailed or texted an invite to fill in an online questionnaire to give details of the people who they have had close contact with and the places they have been around the time of their infection. After 8 hours, if the questionnaire has not been completed, the case will begin receiving calls from the national contact tracing team to conduct a contact tracing interview. All those who are identified as potentially infected through close contact with a case will receive calls from the national contact tracing team. Close contacts will be advised to isolate for 10 days and seek testing should the person develop symptoms. The identity of the original case will be protected.

We have an online reporting system, which was set up in October 2020, to enable schools and early years settings to report positive cases directly to us. There is a dedicated team who work directly with these settings and support them with contact tracing, isolation advice and any other advice that may be required.

Local tracing partnership processes

On 15 February 2021 Gateshead Council joined a "local tracing partnership" (LTP), where council employees would undertake contact tracing phone calls for cases classed by the national system as "hard to reach". Contact tracing phone calls are very similar to case investigation phone calls, with the addition of asking about people who may have been infected by the case, and the responsibility for providing self-isolation advice.

In the first stage of joining the local tracing partnership, Gateshead Council has been granted responsibility for cases that have not been reached by the national system in 32 hours from the test result. In the first 8 hours after a test result, the case is sent their result by SMS or e-mail and invited to fill in the contact tracing questionnaire online. In the following 24 hours, national contact tracers will make several attempts (maximum of 10) to reach the case. After 32 hours in the national system have elapsed, the team leads of our call centre receive and allocate out a real time list of these cases through a national contact tracing IT system. Our call handlers will manage these calls through the same system. We are running a 7-day service and will attempt to call cases 6 times over 3 days at different points in the day.

Doing contact tracing locally ensures that we can quickly give support to those who need it and to respond promptly to issues in the local area. We are looking at contacting "hard to reach cases" by getting details for people from local authority systems (e.g. housing, ASC, electoral roll) and by potentially using door-knocking teams. We are using the data from local contact tracing to understand how the virus is being spread in our area and what we can do to better control it.

Collaboration

We are working with the other 11 North East local authorities to use funding which has been granted to a regional COVID hub coordination and response centre (CRC) to improve the public's understanding of when they should be getting tested, to help individuals prepare should they need to isolate, to provide support to isolate, to work across boundaries, and to develop the use of the contact tracing data. The PHE Health Protection Team are closely involved with this as are colleagues from DHSC.

It is anticipated that collaboration with the CRC will provide capacity for mutual aid and opportunities to work across local authority boundaries. Innovations to come out of this work include upcoming pilots using enhanced local contact tracing approaches in areas of concern, to help individuals plan for self-isolation early and providing support to people self-isolating. We are currently planning our involvement in national and regional pilots which may see the Gateshead contact tracing model outlined above change quite substantially and rapidly, so that we may tailor our response for the needs of Gateshead and take responsibility for managing more cases in our residents.

With this in mind, we are exploring opportunities with the CRC and our adjacent local authority, Newcastle City Council. With strong regional partnerships across the North East, we aim to rapidly expand our local Test Trace and Isolate programme to have a sustainable model in place for the coming years. This approach is intended to optimise our contact tracing capacity as population rates of Covid cases decline and more targeted and comprehensive action of each chain of transmission can be pursued. Further information on CRC is included at appendix 2.

It is our aim that as the LTP develops, the team will start to contact people from the point of testing COVID-19 positive (Local '0'). As the number of cases reduce across the population, the team will then additionally contact all the 'close contacts' identified. To do this the team will need to grow and the intention is to recruit from local communities, cultures, and languages. This will be developed in combination with our wraparound teams, Community Champions programme and broader community engagement activities. Through this approach we are looking to reduce inequalities by facilitating contact tracing for every case and close contact in partnership with our local communities, from voluntary sector organisation to drug and alcohol services and community faith leaders.

A programme of work is being scoped to develop this approach shortly in preparation for lower population prevalence in partnership with Newcastle City Council, and includes specific workstreams in relation to:

  • Workforce planning and resilience
  • Communications and engagement strategy
  • Outbreak data and intelligence
  • Operational delivery

Further information on the scale of collaboration on COVID-19 initiatives is included in appendix 3.

Supported isolation

For many different reasons, it is not always easy for people to comply with COVID-19 guidance and supporting self-isolation will remain a key priority for Gateshead. It is likely that this will become more challenging as restrictions ease. We currently facilitate the Test and Trace Support Payment scheme (SIP) in which the Government funds £500 payments to people on low incomes who need to self-isolate. Targeted local communications, more timely payments, and more personalised non-financial support are key to continuing to improve the numbers of people who test positive for COVID-19 and go on to isolate. We remain committed to learn from examples of best practice in other areas. Where a household does not qualify for the SIP scheme, we have a range of options available to support people. These include:

  • Hardship grants distributed in 2020 and for 2021
  • Support via Community Hubs to include emergency food and help with utilities
  • DWP Winter Grant Scheme
  • Welfare Benefit maximisation and signposting to other support to include Citizens Advice
  • Discretionary Housing Payments
  • Crisis payments
  • Benefit processing as quickly as possible
  • Council Tax team supporting clients in arrears or in financial difficulties

In some areas of the country transmission rates have remained high and above the national average for long periods of time, resulting in 'enduring' transmission. It is likely this is caused by a range of factors, many of which will be linked to inequality. Along with testing, contact tracing, and vaccination, supported isolation will be important in reducing enduring transmission. It is also congruent with our aim to reduce the disproportionate impact of COVID-19 on our most under-served communities, that are already at greatest risk of the burden of ill health due to COVID-19.

An effective approach to ensuring high levels of adherence to self-isolation involves the following elements:

  • Communications to improve awareness of when people need to self-isolate, how long for, what this involves, its importance in stopping the spread of the virus, the support available and the consequences of breaking the rules
  • Practical, social and emotional support for those who need it, organised by Local Authorities and community groups
  • Financial support for people on low incomes who are unable to work from home and will lose income through self-isolating
  • Targeted enforcement of breaches of the legal requirement to self-isolate, as well as Local Authority enforcement against employers who pressure their employees to break self-isolation when they are required to do so

Vaccination

We know that the vaccine is effective at reducing the risk of mortality and hospitalisation from COVID-19. However, it is still possible for someone who has the vaccine to catch the virus, and have no or few symptoms, potentially infecting others who are not protected. For this reason, it is important that people who have been vaccinated continue to adhere to all guidance and restrictions.

The Gateshead vaccination plan is based on the four themes of the national COVID-19 Vaccine Uptake Plan (Feb 21) See: UK COVID-19 vaccine uptake plan - GOV.UK (www.gov.uk).

Working in Partnership

The oversight and implementation of the vaccine programme is led by the CCG, working with Primary Care Networks, GPs, the Gateshead Health NHS FT, other NHS bodies and the Council. A specific work programme has been established to achieve equitable uptake amongst the groups where low uptake is more likely.

Barriers to Access

We have established 5 vaccination sites in local premises in Gateshead, in addition to the QE Hospital and the mass vaccination sites at the Centre for Life in Newcastle and the Nightingale Hospital in Sunderland. Transport is available for certain groups, with the support of Age UK. All who are registered with GPs will be invited for vaccination in line with JCVI priorities, and subsequently recalled for a second dose. However, a one-size fits all approach will not be effective in ensuring take up in all our communities, so in addition to sound call/recall systems targeted work will be required to cover groups and communities including:

  • Deprived communities
  • Refugees and asylum seekers
  • People with severe mental health problems
  • People from black and minority ethnic communities (BAME)
  • Carers
  • Gateshead's Jewish community
  • People with learning disabilities
  • Gypsies and Travellers
  • Homeless people
  • People with a substance misuse issue

Data and Intelligence

Information is essential to enable us to understand progress, identify gaps and inequalities in uptake, inform the action we need to take to deliver the programme effectively, and provide assurance to system leaders and the local community.

Progress on this part of the plan will be dependent on the quality and timeliness of data made available to us.

Conversations and engagement

We will develop locally appropriate, tailored communications that foster and maintain a high level of vaccine confidence in the general public and increase confidence amongst the vaccine hesitant, and this will build on the established regional campaigns that we already support. This will make use of behavioural science approaches to motivate those not inclined to have the vaccine and support myth busting. We will use local insight, knowledge and expertise to understand community views and develop targeted and effective campaigns. We will identify and support a network of COVID Champions and engage directly with local communities. Our vaccine equity plan is included as appendix 4.

Health Protection Action

Outbreak management and contact tracing within it are part of a cycle of health protection action which starts from surveillance and epidemiology (reports of infection) through evidence of what is effective, the rapid formulation of actions, their implementation (requiring capabilities from many agencies in large outbreaks), assurance and evaluation and finally iteration as needed to prevent, suppress and reduce outbreaks of infection. This cycle remains the same regardless of setting. Each of these actions are necessary to manage outbreaks, even if they are extremely rapid in execution in practice.

Contact tracing can be both a part of surveillance/epidemiology on local outbreaks and a tool for implementing outbreak control.

In the context of COVID-19 this means:

  • Timely data flows from testing to be able to predict and intervene in outbreaks
  • Ongoing intelligence on the spread of infection and control measures
  • Implementation of a range of actions including testing, contact tracing, supported isolation and public communication, amongst others.

Outbreak Control Process

In order to avoid duplication and to enhance working at a local authority level during the management of COVID-19 outbreaks, detailed joint arrangements for the investigation of multiple COVID-19 cases reported in premises / settings have been developed for use across the North East Public Health System (see appendix 5).

Local public health teams (LAs and PHE) identify clusters or outbreaks of cases by using multiple strands of information. 'Enhanced Contact Tracing' (as described by the national Test & Trace programme) is the systematic use of the information gathered from case investigation to identify clusters of cases and activities / settings where transmission may have occurred. As outlined in Data and Intelligence sections, Common Exposure and Postcode Coincidence reports generated nationally will be crucial to this process.

An outbreak response may therefore be triggered via data and intelligence monitoring or in response to an alert from PHE/HPT via the council's COVID-19 Single Point of Contact (SPOC). The intelligence will be assessed by Public Health professionals who will make a professional judgement on the information received from NE PHE HPT and other non-clinical sources of information and determine the course of action required. As community prevalence decreases, the timely recognition of new cases / clusters of cases associated with a premises or activity becomes increasingly important, therefore timeliness of review of the 'Common Exposure' and 'Postcode Coincidence' reports become more important.

The SPOC mailbox will be monitored between 8am - 8pm, seven days per week.

From national briefings, it is expected that local authorities and / or HPTs will shortly have to report on action taken on the settings / activities flagged up on the 'Common Exposures' and 'Postcode Coincidence' reports. At present, it is not clear what metrics will be collected or which organisation(s) will be responsible for data collation and reporting. Gateshead will continue to collect information for each setting / activity via the SPOC Decision and Action Log (DAL) to record every contact from NE PHE PHT and the wider public queries including:

  • Summary of situation
  • Location
  • Whether this relates to a complex setting or community
  • Status assessment
  • Whether the case has been discussed with the DPH
  • Date / time of decision

The DAL will be updated and will be accessible only by named Public Health officers in line with data sharing governance and agreements. Public Health professionals will ultimately use their experience and judgement to decide on the most appropriate course of action required for a case.

Principles for local investigation and risk assessment

  • Settings are identified through a range of routes:
    • Postcode coincidence reports to the HPT
    • Common exposure reports on PowerBI
    • Reports from the settings about cases in staff / residents e.g. care homes, workplaces, food / drink venues
    • schools and early years online reporting system
  • In each situation, an initial assessment needs to be undertaken to verify information, including
    • Number of cases
    • Period over which cases have occurred
    • Dates of attendance at the setting
    • Likelihood of transmission having occurred between the cases in setting (or is it coincidence as large / busy venue)
    • Are cases being reported from backward contact tracing (setting is possible source) or forward contact tracing (possible risk of transmission to others in the setting)?
    • Has any action been taken to identify contacts within the setting?
    • What COVID secure measures are in place at the setting?
  • At the point of initial information gathering, advice should be given to the setting about
    • Case / contact definitions
    • Isolation advice for cases and contacts
    • COVID secure measures for the setting
  • Following the initial information gathering, an assessment will be made about
    • Likely transmission in the setting
    • Assessment of control measures - are they adequate?
    • The settings engagement with COVID secure practices
    • Further actions needed re identifying cases and contacts
    • Further control measures needed
  • In some situations, the 'lead' organisation / team will feel comfortable making this assessment
    • Where there are no concerns / no further actions are required, there is no need for wider multi-agency discussion
  • Where there are concerns, or an organisation / team wishes to discuss their assessment with colleagues, a multi-agency discussion will take place
    • In some situations, a simple call between LA and HPT to review information and agree that actions are appropriate will suffice
    • In others where a fuller discussion of concerns and agreeing actions is needed, a more structured OCT meeting will be convened The organisation / team who have undertaken the initial information gathering should make arrangements for the OCT and someone from that team chair the OCT, subject to agreement with PHE.

Our overall approach in Gateshead can be summarised as follows:

PreventCommunicateRespondDe-escalate
Public health advice on respiratory and hand hygiene

Coordinated communications strategy that conveys information on the situation, who is affected and provides clear public health advice and information

Testing of symptomatic individualsClosing and active outbreak and providing clear communication to all stakeholders on the closure of the outbreak and provides public health advice
Public health advice on social distancingIdentification of contactsWhere required ensure that there is a strategy to assist in reputational and financial recovery
Awareness of COVID-19 symptoms and when to self-isolate Exclusion and isolation advice for confirmed cases and contacts

Embedding IPC and social distancing to prevent the spread of coronavirus and further outbreaks

Access to symptomatic testingApplications of IPC measures and quality assuring that the right measures are being implemented 
Embedding Infection Prevention and Control (IPC) measuresTesting of contacts
Training on when and how to use PPEMutual aid and workforce capacity
Access to additional PPEEstablishing effective outbreak control teams
COVID-19 risk assessment and Covid secure placesSupporting vulnerable people and communities to self-isolate

Core principles to prevent, manage and recover from Covid-19 outbreaks

Data and intelligence

Risk Assessments

Scenario testing and risk management

Reflection and identifying lessons learnt to prevent further outbreaks

 

Schools and early year settings

It is vital that we ensure that these settings are supported to best prevent the transmission of COVID-19. The potential for the spread of the virus is higher in institutional settings due to the shared spaces and the frequent close contact between children and young people who often find social distancing much harder.

There is a diverse range of school and early year provision in Gateshead:

  • Early Years provision is split into childminders (99), day nurseries (32), out of school care (30 - note some of which are on the same site/under the same management as some of the day nursery provision), pre-school playgroups (22). We also have 2 Jewish independent nursery school provision and 4 private Jewish nurseries plus a small number of childminders. Early years settings in the borough are supported by the Councils Early Help Team who have excellent working relationships and regular contact with managers and settings.
  • There are 67 primary schools with a capacity of 15,299 places
  • 9 secondary schools with capacity of 11,870 places (8 of which are academies and one independent, 7 special/alternative provision and 1 FE college. Some of our primary schools offer nursery provision for children over the age of two during term time and within school hours.
  • 7 independent Jewish Schools and colleges with around 1250 students, providing education for children aged 5-16, plus colleges for older children and young people. These include boarding establishments.

State schools are supported by a School Improvement Service led by the Director of Education Schools and Inclusion and the Strategic Director of Children, Adults and Family Services with excellent working relationships and regular contact with schools headteachers and managers.

In line with the principles for local investigation and risk assessment above, Lead Officers from Public Health have been working closely with the Education Service and directly with schools to provide support on implementation of national regulations, COVID-19 secure measures, isolation and testing. This has led to dedicated email and telephone contact over seven days as schools build their confidence in dealing with the many changes they have faced since March 2020. Further information below and SOP in appendix 6.

Our approach to controlling outbreaks in schools and early years settings
PreventCommunicateRespondDe-escalate
Schools and early years settings have undertaken a risk assessment and are Covid secure

Clear communication with staff, students and parents that conveys information on the situation and provides public health advice and information

Testing of symptomatic staff and studentsClosing and active outbreak and providing clear communication to staff, students and parents that conveys information about the closure of the outbreak and provides public health advice
Application of IPC measuresIdentification of close contacts and exclusion and isolation advice for confirmed cases (both staff and pupils)Preparing staff and students to return to school (including deep clean)
Schools and early years settings employ nationally recommended measures such as social distancing and cohorting pupilsMutual aid and workforce capacity

Embedding IPC and social distancing to prevent the spread of coronavirus and further outbreaks.

Regular hand washing and access to hand sanitiserApplications of IPC measures and quality assuring that the right measures are being implemented 
Regular cleaning of surfaces and shared itemsTesting of contacts
Guidance and access to PPE where required for AGPs, personal care and symptomatic staff/pupils)Supporting vulnerable people and communities to self-isolate
Guidance on isolation when staff or pupils are symptomaticEstablishing effective outbreak control teams


Care homes

Care home residents are more at risk because of individual vulnerabilities to COVID-19 including age and underlying medical conditions, shared living space and frequent close contact with others who can unwittingly spread COVID-19 within and between settings. Protecting residents in care homes during the COVID-19 pandemic is an absolute key priority.
In Gateshead there are a total of 57 care homes. Gateshead council commission 28 elderly care residential homes with capacity for 1547 residents and 20 learning disability/mental health care homes with capacity for 241 residents.

The Adult Social Care Plan in England identified the additional support to be provided to care homes during the pandemic. In Gateshead our care homes are currently supported by staff working in Adult Social Care, the Commissioning Team and the Gateshead Community Partnership. There is regular phone contact, once a week, with each home, through which the Commissioning Team can identify new positive or suspected cases of COVID-19, collect soft intelligence about what is happening in the sector, target IPC resource and build an understanding of how to prevent outbreaks. When a home is in outbreak, the Commissioning Team have phone contact with the home daily. The Care Home completes a daily capacity tracker which includes COVID-19 related information and outbreak status. Information from the capacity tracker is collated by the Commissioning Team along with local intelligence and information received from the Health Protection Team. This is shared with key contacts once a week.

All homes are involved in the national testing programme and are aware that they should notify PHE and Local Authority Commissioners if they have any positive cases or symptomatic residents/staff.

The actions in this plan build on the work that has been in place since an early stage in the pandemic. In line with the principles for local investigation and risk assessment above, Lead Officers from Public Health were identified to play a key role in preventing and managing outbreaks in care homes.

ISL and Extra Care Settings

In addition to the Care Home settings there are a large and varied number of residential care settings in Gateshead. It is acknowledged that there are similar risks from COVID-19 due to the individual vulnerabilities of residents in these settings and the complexity of the settings. The approaches developed for Care Homes are now mirrored in these settings. A SOP is included as appendix 7.

Our approach to controlling outbreaks in care homes
PreventCommunicateRespondDe-escalate
Prevent and Protect team provide enhanced support to care homes to embed IPC measures (hand and respiratory hygiene, use of PPE)

Coordinated communication strategy that conveys information on the situation, who is affected, identifies stakeholders and provides clear public health advice and information

Application of IPC measures and quality assuring that the right measures are being implemented - enhanced cleaningUsing local intelligence and data to inform decision to close an outbreak
Adult Social Care and Commissioning Team monitor and support homes to prevent outbreaksCohorting residents (confirmed, suspected and contacts of a case)Embedding IPC and social distancing to prevent the spread of coronavirus and further outbreaks
Awareness of coronavirus symptoms (staff and residents) and the actions required to implement isolation proceduresFixed teams care for COVID-19 positive residentsDeep clean of care home
Staff are trained in use/disposal of PPE and have access to required levels of PPEIsolation advice for residents and staff and testing arranged for symptomatic residents and staff

Reflecting on outbreak and identifying lessons learnt and planning to prevent further outbreaks

Staff are adhering to social distancing guidance in and out of workData - monitoring (acknowledge that care homes may experience multiple outbreaks)
Only essential visitors are permitted to enter the care homeRestricting movement of staff between care homes
Care homes have tested out the impact of an outbreak on staffing and resident care and have a business continuity plan in place

Establishing effective outbreak control teams.

Supporting staff and their households to self-isolate

Community admissions are tested for COVID-19 prior to admission. Mutual aid and workforce capacityMaking provision for psychological support for staff and residents
Mutual aid and workforce capacity
 

 

Workplaces

The evidence about safety and transmission of the COVID-19 virus in the workplace indicates that the risk of transmission is most strongly associated with close and prolonged contact in indoor environments. The highest risks of transmission are in crowded spaces over extended periods. Emerging evidence suggests that other factors that could be implicated in workplace linked transmission include:

  • Failure to observe social distancing during refreshment, toilet and smoking breaks
  • Shared transport to and from work
  • Shared living accommodation for workers based away from their usual home

Physical distancing is an important mitigation measure (high confidence). Where a situation means that 2m face-to-face distancing cannot be achieved it is strongly recommended that additional mitigation measures including (but not limited to) face coverings and minimising duration of exposure are adopted.

In line with the principles for local investigation and risk assessment above, Lead Officers from Public Health have developed the process for responding to workplace issues in Gateshead. Where cases have been reported to the Local Authority SPOC, these have been followed up with the workplace to ensure that appropriate advice has been provided on isolation periods and contacts. Our Business Compliance Team has been instrumental in helping to provide advice on COVID-19 security measures and NPIs. They have also been vital in managing the demand for information as various iterations of national regulations have been released. Further information of this approach is included as appendix 8.

Other high risk locations and communities

There are many places, locations and communities in Gateshead that are at higher risk of outbreaks characterised due to factors, these might include:

  • Confined living spaces and multi occupancy housing
    Underlying vulnerabilities of individuals which include age, medical conditions, ethnicity
    Low understanding of individuals of the risks of infection and the risks of the disease
    Inability of individuals to keep to infection prevention measures
    Poor infection control measures

We are working with our partners to engage employers, community leaders, interest groups and individuals to identify and understand how to support our COVID-19 response in these settings. This is particularly important knowing what we do about COVID-19 and inequalities, and the likelihood of enduring transmission and lower vaccination/self-isolation in these groups. Likewise, the increased risk of transmission posed by VOCs or variants under investigation (VUI). In this case the need to work with communities to raise awareness of the threat and to seek cooperation with control measures will be important.

Healthcare settings

In some healthcare settings patients with COVID-19 contracted the disease over the course of the pandemic, while already being treated there for another illness. Action has been taken to reduce the risk of nosocomial infections and COVID-19 testing of health and care staff is now rigorously enforced.

Some of the infections were passed on by hospital staff who were unaware they had the virus and were displaying no symptoms, while patients with coronavirus were responsible for the others.

We are working very closely with the Gateshead Health NHS Foundation Trust in all or outbreak planning and delivery. A copy of the Trust COVID-19 Infection Prevention Control: High level summary of standard operating procedures and outbreak plan is attached as appendix 9.

Data integration

We have established a local surveillance system to monitor the on-going incidence and prevalence of COVID-19 in Gateshead. Data from national & local sources including PHE, DHSC, NHS and local stakeholder intelligence is analysed and interpreted to inform action in a timely and proportionate manner.

Local surveillance is under constant review, refinement and development. We aim to build upon strong relationships with partners and foster an unimpeded sharing of data to best support the Gateshead system. 

Core elements of the Gateshead local surveillance system encompass:

  1. Utilising patient identifiable information provided under a data sharing agreement with PHE, enabling a coherent strategic and operational intelligence viewpoint which is reported upon daily supporting internal stakeholders and external system wide strategic partners.
  2. Daily monitoring of a consolidated dashboard drawing upon PHE Common Exposure and Postcode Coincidence reporting, supplemented by locally gathered TTI intelligence, identifying emerging and potential outbreaks within community settings at the earliest possible time.  
  3. Consolidation and interpretation of local and national epidemiology data. 
  4. Bespoke reporting to interrogate data on emerging and potential outbreaks, high risk settings and inequalities for the purpose of control and prevention.
  5. In development, detailed evidence-based understanding of inequalities due to COVID-19, to better support all the communities across Gateshead 

This holistic approach provides a strong foundation to monitor, act and report upon as the need emerges. 

Compliance and enforcement

As the Local authority, we are responsible for ensuring businesses comply with measures outlined in COVID-19 regulations and guidance and taking enforcement action where a business is not complying with the regulations. We are also responsible for making sure that public spaces such as parks and green spaces are COVID secure. Increasing business compliance with COVID 19 guidance and regulations will help reduce transmission risk as sectors reopen and more social contact is permitted. 

We will continue to deploy resources according to our strategy of engaging, educating and building relationships with local and business communities to encourage compliance. Where businesses have not been complying with the regulations, we have used enforcement powers to take decisive action. 

Our Enforcement Liaison and Compliance group meets three times weekly in order to share information and intelligence about workplace outbreaks, reported issues of concern and upcoming events to have a coordinated plan of action to help reduce risk of COVID-19 transmission. This group consists of a range of partners including the Police. We have also deployed COVID-19 marshals and will continue to do so if necessary. 

The Business Compliance Team of the Council is responsible for providing advice and guidance to the business community in Gateshead concerning the rules and guidance on COVID-19 compliance. The team consists of a mix of enforcement officers and COVID-19 Support Officers who work together to ensure businesses of all types are complying with the legislation and have the best help and guidance available. The team attends the Enforcement Liaison and Tasking Meeting, which also has its own daily Data Screening Meeting. These meetings aim to coordinate activities and undertake some predicting of future issues.

The team investigates outbreaks of Coronavirus within the business environment and supports businesses to react and manage the outbreak to prevent the spread of the disease. This involves coordination with Public Health and PHE staff and attendance at OCT meetings as necessary. Notifications of outbreaks come from PHE, Public Health, businesses themselves and the general public via complaints. As well as providing advice and guidance the Business Compliance Team takes enforcement action in respect of those businesses who are not complying.

Vulnerable and under-served communities

NHS Test and Trace may identify individuals who will need additional support during isolation for example because of their social circumstances or clinical need. They may also identify individuals who may be unwilling or unable to comply with restrictions such as self-isolation. Some may not engage with the process of identifying their close contacts. In these circumstances the case could be escalated to the NE PHE HPT and then notified to the Local Authority for follow-up.

Social Support

Gateshead residents in need of help during this emergency (to include those who are self-isolating or described as clinically extremely vulnerable) can register online at www.gateshead.gov.uk/staysafe. If people need help to register this is available from schools, community leaders, employers and Council staff. For those who cannot access the website calls can be made to the Council's Customer Service Unit on 0191 433 7112 (Monday - Friday, 8am - 5pm.)

The Council can provide support, in partnership with local third sector organisations including:

  • emergency food parcels (free of charge)
  • help with routine shopping (for those who can pay and wish to choose their groceries)
  • collection of prescriptions and digital enablement for future needs
  • support if people want to talk to someone, befriending and reassurance
  • help and advice with money, benefits, employment or housing problems via Citizens Advice Gateshead
  • Referrals to mutual aid volunteers for things like dog walking or small household tasks

The Gateshead Council Call Centre continues to contact residents who have been registered as being Clinically Extremely Vulnerable (CEV) to provide welfare support, find out whether they have any support needs as a result of following the Governments advice regarding shielding and refer any residents who require additional support to the community hubs to follow up. The call centre is also contacting residents who have tested positive for Covid to ensure they are adhering to guidance requiring them to self-isolate whilst ensuring they have support in place to help as necessary.

Complex individuals

Where an individual is unwilling or unable to comply with restrictions such as self-isolation, the following process will be followed:

  • The duty consultant / SPOC will contact key services including the CCG, Social care, Housing, Substance Misuse and Police to determine whether the individual is already known to services.
  • Either the existing key worker or the CCG and duty consultant will convene a multi-disciplinary discussion with relevant services to put in place a risk-based action plan to ensure the individual's social, clinical and others needs are met. 

A detailed operating procedure will be developed, and the COVID=19 Control Board will agree arrangements for monitoring the delivery of these action plans.

Governance

Two new boards have been established to have oversight of the COVID-19 response in Gateshead. The Gateshead COVID Control Board is an operational or tactical level board which takes management responsibility for this plan and overall management of the local response. The group will be responsible for:

  • leading and co-ordinating our work to prevent the spread of COVID-19 in Gateshead
  • identifying local high-risk places, locations and communities and planning how outbreaks will be managed in each
  • reviewing data on outbreaks and cases to monitor epidemiological trends in Gateshead
  • managing local testing capacity with partners to ensure swift testing of those who have had contacts in local outbreaks
  • using local knowledge to help with contact tracing in these complex settings
  • supporting vulnerable local people to get help to self-isolate and ensuring services meet the needs of diverse communities
  • using our local Environmental Health enforcement powers in response to outbreaks if required
  • reporting to Council Members and partners including PHE
  • linking to the Local Resilience Forum
  • establishing governance structures

The COVID Control Board will be accountable to the Health and Wellbeing Board. It will also work with the Local Outbreak Engagement Board which will provide advice on how to ensure our messages on both prevention and dealing with outbreaks reach all our communities and settings. 

A graphic showing the governance of the Local Outbreak Engagement Board can be found in the downloadable version of this plan.

Risk management

A risk register has been prepared to assess the delivery of the seven key areas that this plan is expected to address, it will be monitored by the COVID-19 Control Board.

All outbreaks will be reported to the COVID-19 Control Board for assurance and oversight. Standard operating procedures are being developed for key settings such as Care Homes, workplaces and schools, but it is recognised that each outbreak will require a specific and probably individual response. A risk matrix for settings, people and places is shown in the downloadable version of this plan.

The Local Outbreak Engagement Board (LOEB) will provide political ownership and public-facing engagement and communication for outbreak response. Through this group, and Health and Wellbeing Board oversight of the COVID-19 Control Board, the key role of Elected Members in this work will be explored. Its role will be to provide strategic advice and support to the COVID Control Board and to further support its work.  

The LOEB will provide leadership on communication and engagement with affected communities, using established mechanisms and trusted relationships.  This will include the arrangements for supporting those who are self-isolating with food, essentials, errands and practical problem-solving around work, housing, benefits and education. The LOEB will also provide advice and support to the Health and Wellbeing Board on this.

The LOEB will be chaired by the Council's Deputy Leader and have a core membership including the Council Leader, Chair of the Health and Wellbeing Board, Cabinet member for Communities & Volunteering, the Director of Public Health and representatives of Social Care, Education, NHS partners, Emergency services, business, faith leaders and BAME leaders.  Others will be co-opted as necessary an on ad hoc basis.

Communication and engagement

As the Local Authority, we have an important role in community engagement to reinforce national messaging, encourage compliance, and understand the barriers to adherence to different NPIs. This includes using tailored local communications and messaging to bolster national communications and taking a leading role in joint communications at regional and sub-regional level. This will become increasingly important as restrictions are eased. Public perceptions of the threat of the virus are shifting, and this may lead to a reduction in compliance so we will ensure our communications are tailored appropriately to provide clear information. 

Communications is a key element in outbreak management. Providing accurate and timely information to residents, businesses and settings and having the ability to respond to any localised outbreaks quickly and efficiently is essential. We have recruited a dedicated communications professional, who will work as part of the Public Health Team to ensure that positive behavioural change messages are used and that we increase the understanding of all stakeholders, including residents, of how they can play their part in preventing further outbreaks. Our communications are based on the Prevent - Respond - De-escalate model:

Prevent will amplify and supplement the national campaigns with localised materials that make use of well-established channels and relationships. This will be communicated to a wide audience through social media, radio, TV and outdoor advertising and via the local press. We will continue to work with neighbouring local authorities (the LA7 group) and other LRF partners to ensure consistency of messaging across the region and address emerging issues. Language and tone will be persuasive, supportive, community focused and person centric. The EAST framework will be used to present all calls to action as Easy, Attractive, Social and Timely.

The LOEB will support the development of communications for different groups in our community. A social marketing approach will aim to ensure that the information is relevant and appropriate for different audiences. The prevention work will draw on positive relationships and communicate across all partner platforms and mediums. Verbal briefings, direct emails and engagement will be a key part of communication. A network of COVID-19 Community Champions has been established, whereby representatives from key partner organisations, stakeholder groups and communities are trained to disseminate relevant information. They will help to shape materials and provide feedback on where specific communications activity may be required - for example, common misconceptions or areas of concern.

Respond is quick, accurate and direct communications of any localised outbreak and relevant response level (Yellow - Amber - Red - Red Plus). Settings will be consulted on the best methods for communication and statements provided quickly to local press and via social media. The key element of this stream is the need for accurate and easily distributed information. Existing channels - such as school text systems to parents, business forums etc - will be mapped out and utilised in line with the outbreak scenario.

De-escalate as active outbreaks are managed, clear communication to the public, business owners and employees that conveys information on the outbreak and also when it is over is critical. This work will focus on managing public anxiety, communicating well about actions that have been taken and explaining why. 

The understanding, consent and compliance of the public is key to effective COVID-19 outbreak management. We need to be open and honest with our community to help to further build on existing relationships and trust. We expect people to be interested and concerned (we don't operate in a vacuum; our work is very visible) and so we will always take a collaborative approach and seek to learn and improve our communications over time. A communication strategy is included as appendix 10.

COVID-19 Community Champions

Gateshead Making Every Contact Count (MECC) organisations, represent 40 of the most marginalised and vulnerable communities across Gateshead (BAME, learning disabilities, carers, veterans, LGBTQ, grandparents, DV, refugees and asylum seekers, addictions, frail/elderly, deafened and visually impaired) and they formed the baseline for Gateshead's COVID-19 Community Champions (GCCC) in May 2020. They assisted to develop a Gateshead COVID-19 Community Champions (GCCC) concept, by trialling Covid related training, resources, key messages and contact methodologies that could be implemented in a variety of formats and suitable for local communities, services and businesses.

The GCCC approach has reached over 6900 local people via social media, involved over 300 local people in our training programme and created over 100 trained adult champions who highlight COVID based issues, problem solve together, cultivate ideas and nurture partnerships across all sectors. They help to ensure people across Gateshead hear correct and consistent information about Coronavirus developments. They assist Gateshead Public Health to gather insight about what's working well in our communities, services and business and what isn't. GCCCs tell us what questions people are asking, types of resources people need and what people think we can do better. They share some of the challenges and opportunities we are facing in providing services and support for those in need in a COVID-19 world.

The project is flexible and currently we are developing junior champions so they can be peer educators for their friends and families. We envisage our adult and junior GCCC's will continue to develop their knowledge, skills, confidence and competence to assist the people of Gateshead in their COVID-19 recovery journey for mental, social and physical wellbeing by using a MECC approach.

Resources - Test and Trace support grant / Contain Outbreak management fund

Local authorities in England are being provided with a Government grant to cover costs incurred in relation to the mitigation and management of local outbreaks of COVID-19. The grant for Gateshead is approximately £1.5m. The grant will be used to support 5 key areas of focus and aligned to the operational needs of the plan:

  • Surveillance:
    • rapid identification of clusters and outbreaks
    • decision making about local prevention actions
    • community buy in
  • Provision: Strengthen local capacity to provide robust Infection, Prevention and Control advice and support
  • Knowledge and skills: Equip local leaders to take local COVID-19 prevention action
  • Communication and engagement
  • Support for those who need to isolate

Subsequently, the Contain Outbreak Management Fund was set up to provide further financial support. To date Gateshead has received approximately £4m of this funding and is using to develop and refine our response to the pandemic. This includes, but is not limited to:

  • Building and maintaining testing capacity
  • Maintaining and training local contact tracing response
  • Supported isolation for identified cases and contacts
  • Compliance measures
  • Information and communication
  • Support for Clinically Extremely Vulnerable
  • Support for wider vulnerable groups
  • Targeted interventions for populations of interest
  • Support for educational outbreak response
  • Behavioural insight and COVID-19 experience in communities

Appendix 1 - Surge testing (Operation Eagle)

Background

In the event of a notified outbreak of a new strain of COVID19 and/or the invocation of Operation Eagle this action card should be used to assist in the planning of large-scale testing in a concentrated geographical area.

Operation Eagle is the response to a new strain of COVID19 being detected.  Public Health England (PHE) / Department Health & Social Care (DHSC) will provide the authority with stocks of Polymerase Chain Reaction (PCR) test kits and postcode detail of where a new strain has been detected.  These kits are to be distributed in the target postcode(s) with the aim to achieve 10,000 test results.  Once used, test kits will be analysed in a designated laboratory, including genomic sequencing to compare the sample with other cases.  This will allow PHE to better understand new variants and suppress the spread of coronavirus.

Initiation

DHSC or PHE will contact the authority via Care Call, duty Public Health officer or direct to Al Tose. If you are notified that Operation Eagle has been initiated ensure the following are made aware as soon as possible:

  • Director of Public Health (Alice Wiseman)
  • Public Health Consultants (Andy Graham, Gerald Tompkins)
  • Public Health Leads (Julia Sharp, Al Tose)

There is an expectation that testing will begin within 48 hours of notification, if not sooner.  It is unlikely, but possible, that notification will happen outside of normal working hours.

Immediate Actions

Distribution of the PCR test kits can be through 3 routes, any and all of these routes may be used to be decided by Director of Public Health and PHE/DHSC:

  • Collect / drop off points - residents of the targeted area attend a site established by the Council to collect PCR test kits, they take the kit home, test themselves and return the kits to the site.  Returned kits are transported to the designated Local Testing Site (LTS), these are Central Library carpark NE8 4LN, Leam Lane Wirralshir carpark NE10 8DX, or Blaydon Leisure Centre carpark NE21 5NW, from where they are transported to the laboratory for processing.
  • Mobile Testing Units (MTU's) - these van-based assets are deployed by DHSC to the locality, requiring a minimum carpark space of approximately 20 cars and deployed hygiene facilities (these 'welfare units' to be requested via Fleet Management, ext 7436).  This will provide a temporary testing facility for residents to use which may be by appointment only or on a walk-in basis.
  • Door-to-door - PCR test kits will be hand delivered to households in the target area with instructions on how to use them, to be collected later and transported to the designated Local Testing Site.  The delivery and collection of these test kits will be by local authority and/or volunteers.

To enable the above contact should be made with relevant officers to address the following needs:

  • Communications - Iain Burns for public communications and members.  Jo Carslake to keep Customer Services informed.  Ian Stevenson to engage with local community groups in the targeted postcode(s).
  • Digital - Roger Abbott to create an online postcode checker for residents to see if they are in the targeted postcode(s).
  • Vehicles - Martin Warriner to source any required vans for general transportation and welfare units to support deployed staff with washing and toilet facilities - these may need to be redeployed from construction activities.
  • Operating Locations - Zoe Sharratt and Michael Lamb to identify appropriate locations in the targeted postcode(s) for collect / drop off points to be established or MTU's to deploy to.
  • Staff - a team of approximately 20 will be initially required to operate at least 1 collect / drop off point and door-to-door distribution of testing kits.  These can be sourced from Hubs (Ian Stevenson), Covid Support Officers (Elaine Rudman/Peter Wright) and LFT Testing Sites (Al Tose / Peter McGhee).
  • PPE - Michael Greeves to supply staff deployed will require hi-viz weather appropriate clothing.  There is a stock of other PPE that may be required (gloves, masks and aprons) in a storage cupboard in Bewicks, Civic Centre - access to this is controlled by Peter McGhee and FM.  This stock will suffice for initial deployment and replenishment can be arranged through normal channels.
  • Information about the target postcode(s) - Simon Lewthwaite / Matthew Liddle can provide information such as total population and number of residential properties in the target postcode(s).
  • Finance - Gaynor Carle to provide guidance on accounting for additional expenditure.

All of the above have been advised of the possibility of Operation Eagle being invoked in Gateshead.

Collect / drop-off points Site Set Up

Whilst available infrastructure/equipment will dictate exact layouts, each site should consist of:

a. Queuing areas. Two separate entrances for subjects to collect test kits and drop off test kits. Each entrance consists of an appropriate queuing area in which barriers or markings will ensure social distancing between subjects.
 
b. Collection area reception desk. This will be the initial point of encounter with a subject when picking up a test kit. It will consist of a demarcated one-way system for subjects. It will include a 'check-in zone' at the reception desk. Subjects will receive the test kit and a leave via well demarcated exit route while socially distanced from new subjects arriving.
 
c. Drop off area desk. A second door will allow subjects to drop off their test kits which is separate from the collection only area. This will be clear through a distinct wall or physical barrier. Subjects will be assisted by operatives and a one-way walking system. A well demarcated exit route will allow subjects to socially distance from other subjects dropping off completed test kits. The drop off area is where subjects will place test kits in the delivery box.
 
d. Storage Area (for tests returned). Unused kits and completed kits handed back in by subjects must be stored in clearly marked different location to those in the collection area. Completed kits and unused kits that are returned must be stored in boxes marked clear as "Operation Eagle". Once the boxes are full (30 tests) or at the end of the day, the box is sealed with red (or similar) tape.

Further information on site operations, safety considerations and clinical governance can be sought from DHSC and from Resilience Direct

Supplemental Information - How the test works

  • Polymerase Chain Reaction (PCR) Tests. The test detects the presence of a protein (antigen) produced by the virus. The person's sample is sent to the LHL for processing to detect the presence of antigen. If the person's sample is positive, this test is then sequenced to understand if the positive sample is derived from the South African Variant. 
  • Timing. In general, it takes up to 72 hours for the person to receive their result. If the test is positive, it can then take a few weeks for the sample to be analysed and fully sequenced in a lab to determine if the sample is derived from the South African Variant.
  • Product Specifics. The Innova SARS-CoV-2 Antigen Test has undergone independent validation for NHS Test & Trace. These are CE certified and MHRA registered. The PCR tests need to be stored between 8 - 22 degrees Celsius i.e. a designated cool area away from direct sunlight. Completed kits should be stored at ambient temperature (2 - 30 degrees Celsius).  Completed test kits will need to be packaged appropriately to mitigate infection risk to members of staff and members of the public.

 

Appendix 2 - Coordination and Response Centre (CRC) support

The purpose of this document is to provide the North East Local Authorities with information on the regional support that CRC has provided to support the effective management of the consequences of Covid-19 and how CRC has been part of the North East approach to tackling Covid-19.

It also provides information on what future support CRC can offer and is designed to help the LAs revise their outbreak control plans.

Introduction

Local Authorities (LAs) and Public Health England (PHE) work closely in the North East with respect to health protection functions.  Close working with the national Test and Trace Service and with the NHS enables an integrated response to Covid-19

The over-riding purpose of CRC is to support these existing collaborations and augment their functions.

This document describes the current specific offer that CRC can make to its partners.

The purpose of the centre - the "Coordination and Response Centre" (CRC) - is to support the system to manage as effectively as possible - and reduce - the consequences of Covid 19.

  • CRC works at three levels - national (& international), the north (NHS region) and "the north east" (the population served by "LA12")
  • The primary aims are focused at LA12 level and will include direct support to the local systems, a service to help integrate, coordinate (with supporting analytics), respond and learn - and to devise better processes to respond to pandemic threats in the future. 
  • We work in partnership to create value.  What we do and learn will support all regional partners, the wider NHS and national policy

The CRC is one of three main components of the Integrated Covid Hub North East ICHNE:

  1. A new 'Lighthouse' Covid-19 testing lab (40k tests per day)
  2. An innovations lab. (linking science and business to innovated in testing)

The Coordination and Response Centre (CRC)

The CRC offer

The CRC offer includes:

  • Support, where requested, to implement the Local Trace Partnership (all 12 LAs are engaged in LTPs)
  • Coordination of and support to the further localisation of NHS Test and Trace through nationally agreed pilot processes.
  • Local T&T pilot schemes to support further localisation of Track, Trace & Isolate.  Our pilot offer currently includes:
  • Community champions (encouraging everyone who needs it to engage with testing)
  • Getting ready for your result (helping people, as they come forward for a test, to prepare for how to respond if the result is positive)
  • Support to isolate (helping to support people who need to isolate)
  • Support to the agreed LA12-wide engagement plans
  • Adding innovation to the local analytics associated with tracking Covid-19 testing and positive results
  • Providing extra capacity to support smaller authorities (and/or specific communities) to help ensure outcomes are equitable across the region
  • Providing surge capacity to support testing or trace activities as and when local demands exceed planned supply
  • Providing shared capacity - for example in call centre resource - if required
  • Supporting evaluation through methodological expertise, data collection and analysis and engaging specialist partners

Testing

What we can offer

  1. Train the trainer 
  2. Personal Protective Equipment
  3. Site set up 
  4. Mass testing sites 
  5. Micro testing sites
  6. Assurance visits 
  7. Continued point of contact 
  8. Resources 
  9. Staff self-testing

What we have provided already

  1. Trained over 320 staff face to face
  2. Worked across 12 different sites across the region
  3. Supported Blue Light Services with staff self-testing
  4. Provided assurance visits 
  5. Prevented an outbreak within Durham and Darlington Fire Service

We can offer future support with surge testing

  1. Providing training for PCR testing and LFT testing
  2. Train the trainer
  3. Training blue light services to support with "boots on the ground" for testing
  4. Offering 15-20 staff to support with training and testing
    Support with mobile testing units (set up and testing)
    Assurance visits 
    Offer continued support and guidance on testing 

Feedback received from survey

  1. We have received 165 survey responses, indicating a 55% response rate, with an average score of 4.59 out of 5 
  2. The most useful part of the training was the practical element of the training
  3. "Due to training we are able to ensure all testers are performing to a high standard and correctly, thus providing reliable results" 
    "The facilitators were knowledgeable and professional" received the highest average score of 4.70
  4. Contact tracing

What we can offer

The CRC have a team of staff fully trained in e-LfH, with full access to CTAS.
Benefitting from in house management of the Contact Centre, any requirement to add call handlers can be quickly accommodated.
 
Call handler training is also managed in house with the ability to test and silently monitor calls.
 
Agents are able to make calls from the office or from home, using their preferred device, the number presented to the case, will be consistent for all call handlers.

What we have provided already

  1. Support to mobilise Newcastle LA and Darlington LA with the local trace partnership
  2. Support with contact tracing for Newcastle LA, South Tyneside LA, Darlington LA and Stockton LA
  3. Weekend stand-by support for Stockton LA

Future support with the Local-0 Project

The CRC will be able to offer increased contact tracing support for any local authorities that require additional capacity to take on the Local-0 project.  This includes:

  • The ability to present numerous local dialling codes relevant to the Local Authority CRC are supporting.

CLI will be managed in house to allow the caller line identifier to be presented for several Local Authorities simultaneously, which will enable greater flexible support.

  • Call recording

Calls will be recorded and stored locally, in line with Information Governance and retention guidelines.

  • SMS bulk send

CRC will be able to upload a list onto an online messaging portal then initiate the SMS bulk send. There is no limit to the number of variations sent as multiple templates are permitted. Full reporting on the number of SMS sent.

  • Interpreter service

Nationally agreed North East Pilot Schemes

The current TT&I pilot offer specifically includes:

Community Champions:  

  • Improving recognition of symptoms
  • Support to understand the purpose of track and trace and why it's important to provide accurate data
  • Offering support to complete the T&T journey


Getting ready for your result and what you'll need to do if it's positive:

  • Provide more information at the test centre
  • Provide a telephone number for people to call if the test positive (opt in) and/or consent to being called by a local call handler if result is positive
  • Talk them through isolation support
  • Explain that they will be contacted by T&T and how to complete the T&T form and identify contacts
  • Explain the importance of everyone in the household isolating and if any other household members get symptoms they should be tested

Support to Isolate:

  • Can the links to support be offered at an earlier point in the T&T journey
  • Collate local approaches and impact of support models & develop best practice

Evaluation

CRC in partnership with the national behavioural insights team will support evaluation of the pilot schemes.

Engagement support

Engagement is an element of the CRC that runs across each of the work streams.  We can provide local authorities with communication and engagement materials in different forms relating to testing, contact tracing, the Local-0 project and the North East Pilot Schemes.

Directory of Resources:

The CRC has compiled a directory of resources for protected groups in the area along with nationwide multi-lingual resources for non-English speakers.  This covers different equality strands, e.g. BAME communities, people with learning disabilities and LGBT+ people and includes resources for British Sign Language information, Easy Read English and audio-visual information for people with autism.

Funding and Grants:

A resource of funding and Grants available for different groups across the region, together with the Resource Directory, the CRC can offer stakeholders signposting to relevant support groups / networks and guidance on what grants are available to different communities region wide where this is required.

 

Appendix 3

The seven local authorities of County Durham, Gateshead, Newcastle, North Tyneside, Northumberland, South Tyneside and Sunderland have been working as a collective LA7 since September 2020 focusing on a joint approach to covid-19. This has included political leadership to seek early intervention and restrictions, coupled with financial support, in September 2020 when infection rates were increasing rapidly across the area. 

The approach was based on a deep understanding of our local communities and informed by data and intelligence which centred around the inequalities that local communities have faced, either directly or indirectly due to COVID-19. The joint approach has centred around a small set of priorities, informed by Directors of Public Health:

  1. Engage our communities and work with them to address inequalities
  2. Localised, regionally coordinated Test, Trace and Isolate programme;
  3. Roll-out of targeted community testing
  4. Protection of vulnerable individuals in the community;
  5. Rapid implementation of a vaccine programme

 
It has included funding and delivery of a well evaluated public facing campaign Beat COVID-19 NE informed by insights from local people. This has given a joint message across the LA7 geography (link to campaign). A focus on health inequalities and taking our communities with us during the pandemic and representing the needs of those most affected by COVID-19 has been based on working with our communities. Community champions have been core to this work. 

The development of a more localised test and trace programme has centred on the Integrated North East Integrated COVID-19 Hub and the move towards a more regional and local focused test and trace programme, including local trace partnerships, support for testing and has drawn additional funding into the North East.

A joint approach to testing based on a set of principles has also been developed for the LA7 to ensure the roll out of targeted community testing is based on the protection of the most vulnerable, support for safe working arrangements and to contribute to action to reduce COVID-19 transmission and COVID-19-related health inequalities.

Dedicated work with our care homes and the production of materials to support guidance, quality assurance toolkit and support for testing arrangements within care homes have formed part of this work. More recently support for the implementation of the vaccination programme has been focused on support from local authorities, seeking a core data set, leadership into the oversight of the vaccination programme and insight work on vaccine hesitancy. A dedicated group to ensure high uptake of the vaccination programme is established.

Finally, the LA7 work is now also taking a joint approach to recovery, embedding health and wellbeing as a key outcome of economic recovery.

 

Appendix 4 - Gateshead COVID vaccine uptake and equality plan

Introduction

The successful development of vaccines for COVID-19 represents significant progress in the tools that are available to us in bringing the pandemic under control.  
 
Whilst vaccination is known to reduce the risk of serious illness or death from COVID, we do not yet fully understand its impact on its transmission. Vaccination therefore has to be only part of our strategy to tackle COVID in Gateshead; it does not obviate the need for continued focus on other elements of the strategy, including social distancing, hand hygiene, infection control, education, testing, contact tracing and support, treatment, etc.  
 
To secure high levels of uptake we need to ensure that any barriers to access are addressed, including overcoming vaccine hesitancy in sections of the population, through provision of information and education.  Failure to address these barriers risks creating a range of inequalities in uptake of and access to the vaccine, so specific action is required to ensure this is does not arise, and we have developed this plan in response.
 
Purpose: to ensure the COVID vaccination programme in Gateshead is delivered to all those eligible, across all the communities of Gateshead, as quickly and efficiently as possible

Desired Outcomes:

  • Maximum efficiency for the vaccine programme
  • Maximise uptake with the aspiration of herd immunity (this will require at least 80% take-up)
  • Optimise equitable uptake of vaccine across the population to reduce inequalities

Aims:

  • Addresses local health inequalities, tailoring and targeting interventions when necessary. 
  • Deliver the vaccine in culturally sensitive ways to meet the needs of diverse populations. 
  • Include procedures to identify and support those individuals considered vulnerable and hard to reach. 
  • Consider any specific needs for people with protected characteristics and follow equality guidance. 
  • Involve service users if possible, reflecting the local community and those with protected characteristics

 
Themes/enablers

The national COVID-19 Vaccine Uptake Plan (February 21) See: UK COVID-19 vaccine uptake plan - GOV.UK outlines four enabling themes:

  • working in partnership
  • removing barriers to access
  • data and information
  • conversations and engagement

This local plan is focussed on the additional work we need to do to ensure equitable uptake across all communities in Gateshead, rather than the basics of the establishment and delivery of the programme which are already in place.

Working In Partnership

Arrangements are already in place to oversee and manage the implementation of the vaccine programme, bringing together the CCG, Primary Care Networks, GPs, the Gateshead Health NHS FT, other NHS bodies and the Council.  This has enabled us to establish and staff vaccination centres in convenient and accessible locations across Gateshead and deliver the vaccine into care homes and to housebound people.  
 
Partnership work will be essential in achieving equitable uptake amongst the groups where low uptake is more likely, and to provide assurance to system leaders and to communities on progress.  
 
Actions: 

  • An inequality group with input from the PCN lead, Public Health, key Council services, commissioned organisations, and community groups will be convened to take forward the various actions required.  This group will report regularly to the COVID vaccination group, COVID Control and Local Outbreak Engagement Boards and the Health & Wellbeing Board Boards: Gerald Tompkins/Teresa Graham 

 
Barriers to Access

We have established 5 vaccination sites in local premises in Gateshead, in addition to the QE Hospital and the mass vaccination sites at the Centre For Life in Newcastle and the Nightingale Hospital in Sunderland.  Transport is available for certain groups, with the support of Age UK. All who are registered with GPs will be invited for vaccination in line with JCVI priorities, and subsequently recalled for a second dose.  However, a one-size fits all approach will not be effective in ensuring take up in all our communities, so targeted work will be required in addition to the basic, sound call/recall systems to cover the following communities:

  • Deprived communities
  • Homeless people
  • Carers
  • People with learning disabilities
  • People with severe mental health problems
  • People with a substance misuse issue
  • People from black and minority ethnic communities (BAME)
  • Refugees and asylum seekers
  • Jewish community
  • Gypsies and Travellers
  • Sex workers

Actions: 

  • PCNs and Public Health will develop action plans in respect of all the targeted communities - see Annex 1.  Teresa Graham/Gerald Tompkins 

Data and Intelligence

Information is essential to enable us to understand progress, identify gaps in uptake and inform the action we need to take to deliver the programme effectively.  
Actions: Public Health will

  • Develop a standard reporting framework to 
    • enable us to monitor progress in each Priority cohort, by dose;
    • Track attrition from dose 1 to dose 2
    • Support regular reporting to vaccine group, PCNs and COVID Control Board
  • Identify and report on inequalities in uptake - geography, deprivation, care homes, BAME groups, etc     
  • Provide information to the public on the levels of uptake via the Council's websites

Progress on this part of the plan will be dependent on the quality and timeliness of data made available to us.

Conversations and engagement

We will need to develop locally appropriate, tailored communications that foster and maintain a high level of vaccine confidence in the general public and increases confidence amongst the vaccine hesitant.  This will make use of behavioural science approaches to motivate those not inclined to have the vaccine and support myth busting 
 
Actions: This will include

  • Using local insight, knowledge and expertise to understand community views and develop targeted and effective campaigns, drawing on analysis of local uptake data 
  • Identifying and supporting a network of COVID Champions - trusted, culturally diverse voices to instil confidence in the vaccine across all communities, help increase understanding of the vaccine and reduce hesitancy
  • Community engagement to directly support harder to reach groups
  • Magnifying regional campaigns locally, 
  • Use of video presentations by clinical leaders and role models
  • Development of material in different formats and languages

This work will be led by the Public Health team

Target groups - rationale and intelligence

Target Group

Rationale

What we know

Deprived communities

Higher risk of COVID-19 infection, hospitalisation and ICU admissions due to COVID 19, and dying from COVID 19.

Evidence of lower vaccine uptake.

Overall, Gateshead is the 47th most deprived local authority in England, out of 317 local authorities. Around 32,700 (16%) people in Gateshead live in one of the 10% most deprived areas of England, and if we extend this nearly 62,600 (31%) live in the 20% most deprived areas. More than 50% of the population of Felling, Deckham and High Fell wards live in the 10% most deprived areas in England.

Homeless

May not registered with a GP, less likely to receive formal diagnoses or be identified as being in a priority group for vaccination, low vaccine uptake.

Poor existing health in particular for rough sleepers

There are 118 people currently engaged with Basis Gateshead. 25 of these people are considered clinically vulnerable. There are 26 people in their commissioned supported accommodation services;

Carers (nb: not care workers)

Carers are in frequent close contact with vulnerable people, who are at high risk of harm from COVID-19.  Carers may infect or be infected by the person they are caring for

Census data suggest as many as 22000 people in Gateshead may be carers, although the number on GP Carers registers is far fewer - around 7500.  There are numerous organisations working with carers, providing them support and guidance.

People with learning disabilities

Increased risk of dying from COVID-19.

Evidence that those with learning disabilities are under-vaccinated.

Approximately 1200 people are included in GP Practice Learning Disability registers, but these may well not include all those with a learning disability, with those with mild disability being less likely to be recognised and included. National estimates suggest there could be closer to 4000 people with a learning disability in Gateshead

Severe mental illness

Increased morbidity and mortality from COVID-19.

Vaccination may increase anxiety and distress.

GP records indicate that over 1,900 people have been diagnosed with a severe mental illness (schizophrenia, bipolar affective disorder and other psychoses)

BAME

People of Black ethnicity at higher risk of COVID-19 infection

People of Black and Asian ethnicity

People of Bangladeshi, Black Caribbean, Other Black, Chinese, Other Asian,

Pakistani and Indian ethnicity have an increased risk of dying from COVID

Evidence of low vaccine uptake and engagement with health services, mistrust

It is estimated that around 3.7% (7,500) of the population are from a black or minority ethnic (BME) group.  There have been significant increases in residents of Chinese (+690) and African (+695) origin, and 2% of households do not contain anyone who considers English to be their main language.  Bridges ward is home to the largest number of people from Black or Minority Ethnic groups at 1,281 or 14.2%, followed by Saltwell with 1,030 or 10.7%.

Refugees and asylum seekers

Vulnerable migrants may be less likely to receive formal diagnoses or be identified as being in a priority group for vaccination. May not be registered with GP. May not speak English

In recent years hundreds of refugees and asylum seekers have been housed in Gateshead, including many families from Syria.

Jewish community

Many live in large, multi-generational households; high level of digital exclusion

Resident population estimated to be ca 4000, excluding students from other parts of the UK (and Europe) attending the various colleges

Substance misuse

Some evidence to suggest that people who have substance misuse issues may be under vaccinated as and less likely to engage with healthcare services

In the year to March 2019 there were just under 1,000 opiate users and almost 300 non-opiate users in treatment

Gypsies and Travellers

Evidence of low vaccine uptake and engagement with health services, mistrust

Two permanent sites for Gypsies and Travellers in Gateshead, in Birtley and Felling

 

Target groups - action

Target Group

Action to date

What more we need to do

Leads

Deprived communities

Possible housing-linked locations identified.  Council mobile unit available to take out to key locations

Need better data on uptake at local (LSOA) level to identify any pattern of low uptake linked to deprivation.  Liaise with Edberts House and the Council's community hub leads to identify other vulnerable patients/ deprived areas

Further work to agree locations, tied to priority housing schemes and to low uptake (subject to data)

Public Health/

PCNs

Homeless

Basis Homelessness Resource Centre has a clinical room which can be used for a vaccination clinic, and will work with us to implement vaccination sessions.  Agreement in principle to provide dedicated vaccinations session(s) using mobile unit.

Agree timescale and confirm siting for mobile unit. Clinical vulnerability info on those in commissioned support services for homeless people is being gathered

Central/South PCN

Carers

Practices to invite those included on their Carers registers.  Practices being advised of those carers known to social care.

Engage with carers organisations to ensure communications distributed to encourage carers to come forward for vaccination

PCNs

Council commissioning team

People with learning disabilities

Practices to invite those included on their Learning Disability registers

Need to develop communications to promote uptake, including video walk-through of vaccination centres

Each PCN

Severe mental illness

Practices to invite those included on their severe mental illness registers Discussions underway on use of mobile.  Contact with Gateshead Clubhouse

Develop plans with CNTW, Gateshead Clubhouse and other local voluntary organisations working with  mental health clients. 

PCN lead

BAME

COVID Champions recruited from various BAME groups and have received basic training in respect of COVID including vaccination. Local Outbreak Engagement Board includes BME representatives and are used to support messaging. Practices will invite individuals as part of overall programme.

Develop appropriate communications and target social media routes to reach these communities

Public Health

Refugees and asylum seekers

Discussions begun with Mears and Home Office, and with Comfrey Project. RAS who are registered with GPs will be invited in line with JCVI priority groups. 

Second Street practice is a 'safe surgery' for RAS and can register RAS from anywhere in Gateshead

Further planning work required.  Need to register RAS with GPs. Possible use of mobile unit

Central/South PCN

Jewish community

Considerable work done with Jewish Community. South Central PCN already working with JCC to support Jewish patients to get vaccinated, eg offering earlier vaccination slots to ensure patients could avoid coming on Sabbath or close to it. Rawling Road site accommodated Hatzola and The Gateshead Hebrew Burial Society to get vaccinated.

Recruit COVID Champions? 

PH to agree programme of communications with JCC including action to promote vaccination and give assurance on safety.

Further discussions with JCC to plan vaccination event(s) for the community, (venue could be Bewick Centre, mobile unit or Rawling Rd) to ensure good uptake of the vaccine.  Issues include identification of members of Jewish community; culturally sensitive invitations and promotional material; marshalling by members of the community. 

 

Public Health / JCC

 

Teresa Graham; Central/South PCN

 

Substance misuse

Agreement with GRP to run a clinic in or close to Jackson St at same time as the hepatitis clinic and review clinics so that patients attending can also be vaccinated. GRP staff and recovery workers will support us in identifying clinically vulnerable patients and ensuring that we book the clinics and ensure patients can get into the centre.

Agree timescale and confirm siting for mobile unit

Central/South PCN


 

Appendix 5 - North East Public Health system (LAs and PHE North East) arrangements for investigation multiple COVID-19 cases reported in premises / settings

February 2021

Background

The aim of contact tracing is two-fold:

  • to identify people who have been exposed to cases of COVD-19 and ensure that they are given the correct advice about isolation; and
  • to gather information which might identify the source of a case's infection.

This information is gathered through interviews with cases (via national the Test & Trace system or Local Tracing Partnerships) and includes information on:

  • where they have been prior to their infection (the possible source); and
  •  they have been whilst infectious (possible contacts).

There are many other routes by which local teams receive information about possible sources / concerns about COVID-19 transmission including:

  • reports from premises / businesses reporting illness in their staff;
  • reports on cases in care homes (the Capacity Tracker); and
  • proactive work done by local teams working with businesses and other settings to encourage reporting.

'Enhanced Contact Tracing'

However, as described above, Local public health teams (LAs and PHE) identify clusters or outbreaks of cases by using multiple strands of information.  For each of these, a risk assessment is undertaken, and a judgment made about whether further investigation and / or action is required.

'Enhanced Contact Tracing' (as described by the national Test & Trace programme) is the systematic use of the information gathered from case interviews to identify clusters of cases and activities / settings where transmission may have occurred.

While there is a particular national focus on local use of this specific data set, it is important that local action continues to integrate all strands of information to ensure that as many clusters or outbreaks of COVID-19 are identified as possible, and that assessment and (where indicated) action is undertaken as quickly as possible. This is especially important given that other data sources often highlight issues for investigation more quickly than information gathered through contact tracing interviews. For example, workplaces will often telephone local authorities or the PHE Health Protection Team to report multiple COVID-19 cases in their setting before the Test & Trace contact tracing process has been completed.

'Enhanced Contact Tracing' reports and how they are used

The information gathered from case interviews is used to produce two types of report which are published on the PowerBI dashboard that local authorities and PHE Health Protection team use.

'Common Exposure' reports

  • use contact tracing data from the 'backwards' period to identify shared locations, settings and activities reported by two or more cases in a defined period
  • investigation of these settings
    • establishes whether there is an outbreak associated with the setting
    • establishing whether, even if no outbreak associated, there are measures that could be put in place to make the setting more COVID-secure

'Postcode Coincidence' reports

  • use contact tracing from the 'forwards' period to identify where the case has been while infectious - and so potentially cause risk of transmission to others
  • action may be taken if
    • any settings with vulnerable people identified
    • there are opportunities to review COVID secure measures in a setting and so mitigate the risk of any onward transmission is someone attended while infectious

North East approach

Following a workshop on 23 February 2021, the following approach was agreed across all North East local authorities and the PHE North East Health Protection Team

  1. Review of 'Common Exposure' and 'Postcode Coincidence' reports
    Local authorities will review the common exposure reports for their area on a regular basis
    See below how thresholds for review of information and for taking action may change as prevalence in the community changes.
  2. As per agreed arrangements for the initial investigation of cases linked to a setting (see below), the setting will either be 'managed' by the local authority team or passed to the Health Protection Team for review and investigation
  3. For any setting (managed by LA or HPT) the following steps will be followed
    a.      Review if setting already known / under investigation
    For known settings / exposures:
    i.      Review case numbers - often the numbers reported on common exposure reports do not match with local intelligence, but may be worth checking with premises depending on how 'active' the current investigation is
    ii.      Review timing of cases known locally with those reported on common exposure report
    b.      For 'new' settings / exposure, undertake a risk assessment as to whether further investigation +/- action is required:
    i.      Initial investigation may exclude some settings / exposures at an early stage (e.g. shopping at large supermarket)
    ii.      Review case numbers, background information about setting (e.g. size of workforce, type of setting - vulnerabilities) and timeline of cases to determine whether further investigation and / or action required
    c.       If action is required, lead organisation will be as per local agreements (below)
    d.      If a multi-agency OCT is required, the lead organisation will convene and chair the meeting
  4. NOTE: the same approach outlined for the use of the ECT reports will be followed for information received through any other routes
  5. NOTE: the national definition for outbreaks should be considered when assessing the information. It may be that a premise, which is known to the LA or HPT team, has cases which meet the definition of 'new outbreak'  https://www.gov.uk/government/publications/covid-19-epidemiological-definitions-of-outbreaks-and-clusters/covid-19-epidemiological-definitions-of-outbreaks-and-clusters-in-particular-settings

Changes to risk assessment as community prevalence changes

An important factor to note is that the thresholds for how frequently to review the reports and for when to initiate investigation / action will change as the prevalence of infection in the community changes.

As community prevalence decreases, the timely recognition of new cases / clusters of cases associated with a premises or activity becomes increasingly important, therefore timeliness of review of the 'Common Exposure' and 'Postcode Coincidence' reports becomes more important. At present, these are published daily.

While community prevalence is high, concerns about small numbers of cases in large workplaces may be low but as community prevalence falls these cases may be important early warning of a rise in community transmission and rapid, intensive investigation and control measures will be required.

In situations where community prevalence is low, a much lower threshold for an early multi-agency OCT should also be applied; it may be more appropriate for HPT staff to undertake the detailed contact tracing of cases in some situations - the decision about this will be agreed at between the local teams.

Recording actions taken

From national briefings, it is expected that local authorities and / or HPTs will shortly have to report on action taken on the settings / activities flagged up on the 'Common Exposures' and 'Postcode Coincidence' reports.

At present, it is not clear what metrics will be collected or which organisation(s) will be responsible for data collation and reporting. As an interim / preparedness measure it was agreed that each LA will consider processes for internally collecting the following information for each setting / activity reported on PowerBI, which we expect may be representative of the metrics requested nationally:

  • Was the setting /activity already known to local team 
    e.g. risk assessment been undertaken / control measures taken / OCT held 
    Records the date at which local action started
  • Was this a new outbreak that was flagged up through the Common exposures report? And if so, actions taken as a result
  • Other organisations that are involved (e.g. HSE, CCG etc.)
  • Comments field gives opportunity to explain why action taken / not taken (and capture settings where another organisation is leading - e.g. hospital outbreaks which are commonly flagged up)

As the HPT manages some situations, there may need to be a mechanism by which information about HPT-managed outbreaks is fed back to LAs if LAs are expected to report on all settings / activities flagged up; or vice-versa, if the HPT is expected to report. Suggested mechanisms for this information sharing include:

  • Existing mechanisms for information sharing about care home outbreaks (i.e. the information already sent from the HPT to LAs could be adapted to include any relevant metrics).
  • Some LA teams have weekly round-up meetings that are attended by a member of the HPT. These meetings could be used to check the lists of common exposures and update with information from HPT.
  • The weekly LA review meeting (hosted by the HPT) could be used to check any outstanding queries.

We also discussed an 'iCERT' tool currently under national development. This integrates both sets of Enhanced Contact Tracing reports and allows both the HPT and LA to update each identified setting or activity with the action taken. If this is developed in a timely manner and becomes the source of national metrics, the LA and HPT could simply update it for situation they are managing, negating the need for a single organisation to collate information about all settings / activities.

We will seek further agreement on the exact process for reporting actions taken as and when the national expectations become clearer.

Kirsty Foster & Simon Howard, on behalf of the HPT and DPH Network, February 2021

PREVIOUSLY AGREED NORTH EAST WAYS OF WORKING - NOVEMBER 2020

Principles for local investigation and risk assessment

  • Settings are identified through a range of routes including
    • Postcode coincidence reports to the HPT
    • Common exposure reports on PowerBI
    • Reports from the settings about cases in staff / residents  e.g. care homes, workplaces, food / drink venues
  • In each situation, an initial assessment needs to be undertaken to verify information, including
    • Number of cases
    • Period over which cases have occurred
    • Dates of attendance at the setting
    • Likelihood of transmission having occurred between the cases in setting (or is it coincidence as large / busy venue)
    • Are cases being reported from backward contact tracing (setting is possible source) or forward contact tracing (possible risk of transmission to others in the setting)?
    • Has any action been taken to identify contacts within the setting?
    • What COVID secure measures are in place at the setting?
    • At the point of initial information gathering, advice should be given to the setting about
      • Case / contact definitions
      • Isolation advice for cases and contacts
      • COVID secure measures for the setting
      • Following the initial information gathering, an assessment will be made about
      • Likely transmission in the setting
      • Assessment of control measures - are they adequate?
      • The settings engagement with COVID secure practices
      • Further actions needed re identifying cases and contacts
      • Further control measures needed
    • In some situations, the 'lead' organisation / team will feel comfortable making this assessment
      • Where there are no concerns / no further actions are required, there is no need for wider multi-agency discussion
    • Where there are concerns, or an organisation / team wishes to discuss their assessment with colleagues, a multi-agency discussion should take place
      • In some situations, a simple call between LA and HPT to review information and agree that actions are appropriate will suffice

In others where a fuller discussion of concerns and agreeing actions is needed, a more structured OCT meeting will be convened. The organisation / team who have undertaken the initial information gathering should make arrangements for the OCT and someone from that team chair the OCT.

Lead organisation / team:

The organisation / team which leads the initial investigation of a situation should be based on the typical type of support / advice needed.  Where another team is directly contacted in the first instance by the setting it may be helpful to gather information to complete an initial risk assessment and share with the lead organisation.

Cross-border working: It is highly likely that larger situations (cluster / outbreak) will involves cases and contacts from more than local authority area.   In line with 'normal' outbreak response, the area where a premise (e.g. a workplace) is located would take the lead for the overall investigation, but the responsibility for investigating cases / contacts may be delegated to their 'home' teams and that information reported back into an over-arching OCT.

Setting

Lead team / organisation*

Comments

Resources to support investigation

Care Homes

HPT

-          Advice is mainly infection control and arrangement of testing

-          HPT informs LA SPOC of details of each home where testing is being arranged

-          Daily line list to all SPOCs / DsPH re care home outbreaks (incl weekends)

-          Situations where there are specific concerns will be flagged directly to the commissioner

-          68 care homes were reported in the last week; initial risk assessment and documentation for each home takes between 1-3 hours

-          Note: there are ~220 ongoing COVID situations on our system - most of which are care homes. Not all require daily input but are 'active' in terms of ongoing / follow-up required, therefore capacity to provide detailed updates is extremely limited and will only be possible for situations where there are concerns.

-          Arrangements in LA teams (review meetings / level of contact with care homes) is very variable; further work to review this and rationalise the numbers of people contacting care homes / rationalise testing arrangements is being taken forward through the Regional Care Home Group

-          Care Home Pack and FAQs

-          Wrap-around team arrangements in place in each LA (exact arrangement vary between areas)

-          Ongoing IPC advice / support available through LA teams (although this is quite variable in terms of capacity and availability)

Children's Homes

LA

-          Can be complex issues relating to staffing/business continuity following identification of contacts, and commissioning arrangements, requiring multi-agency liaison

-          Advice is usually about infection control and COVID secure measures

-          Any complex situations can be discussed with the HPT via the ICC

 

-          Work being taken forward through CYP network regarding advice on PPE

-          Work through CYP network

Domiciliary Care providers / Supported living services

HPT

-          Advice is mainly IPC (and in some situations discussions about testing)

-          May require co-ordination of IPC support requiring liaison between LA and HPT.

-          Providers to not always fall within a single LA footprint

-          HPT informs LA SPOC about cases, enquiries / situations being managed as they arise.  - Options to include in daily care home line list for SPOCs / DsPH to considered via regional care homes group

-          Need discussion between HPT and LA/IPCNs as required.

 

-          Domiciliary care SOP in place. Outbreak/issue definition detailed within the SOP dependent on transmission within the setting.

-          Regional FAQs for domiciliary care

-          Ongoing IPC advice / support available through LA teams (although this is quite variable in terms of capacity and availability)

-          Testing to be made available to CQC registered Dom care providers

Primary Care / Dental practices

HPT

-          Advice is mainly IPC and staff isolation (and in some situations discussions about testing)

-          May require coordination between HPT / LA / CCG and NHSE

-          Primary Care and Dental SOPs in place

-          FAQs for primary care and dental settings

-          Dental PH team undertake initial risk assessment of staff cases and report any concerns to HPT (HPT manage dental patients)

 

Schools

LA

-          Reports of school cases/issues into the HPT (via the national helpline or direct report) are reported daily to SPOCs prior to any communication with the setting.

-          Main advice is about managing bubbles / identifying contacts and ensuring COVID secure measures in place

-          Careful assessment is needed to determine whether transmission is occurring in the school setting or whether positive results reflect community transmission

-          Business continuing issues may arise as a result of staff shortages

-          Schools are becoming increasingly confident in managing situations ins some areas

-          LA teams have been managing these since early October and have well-established relationships with school settings

-          Any complex situations can be discussed with the HPT via the ICC
 Thresholds for discussion will vary depending on setting but may include high numbers of cases / cases in several year groups or bubbles / reports of severe illness

-          Lower threshold for multi-agency discussion in SEN schools

-          Schools FAQs

-          Support through regional CYP network (further FAQs to be capture through this network)

-           

Universities

LA

-          Advice is mainly about ensuring COVID secure measures are in place and that contact tracing has been completed by the setting

-          LA teams have well established relationships and reporting arrangements in place with Universities

-          Universities are advised to report linked cases (on campus or in halls of residence) to the ICC

-          HPT liaise with LA and any complex situations can be discussed

-          Thresholds for discussion/requirement for and OCT will vary and may include high numbers of cases / reports of severe illness

-          FAQs for Universities

-          Initial risk assessment template

-          Template letters for contacts

Workplaces

LA

-          Advice in these settings is mainly about ensuring COVID secure measures (EHO / Public Protection Teams +/- HSE) are in place and that contact tracing has been completed by the setting

-          Careful assessment is needed to determine whether transmission is occurring in the workplace or whether positive results in staff members reflects community transmission (i.e. other plausible sources of infection)

-          A multi-agency meeting is often useful (may include the workplace) to reinforce messages about COVID secure practice and to offer support in settings where this may be more challenging

-          Any complex situations can be discussed with the HPT via the ICC

-          As part of the roll-out of mass testing with LFDs, there are workplace pilots - we may want to consider this for workplaces where COVID secure practice is more difficult

-          Workplace checklists (including re-vamped JBC action cards)

-          Standard email (with links to guidance and checklist for information to gather) for LA / HPT team to share with the workplace when they first report cases

-          Template letters for contacts and wider workforce

-          There are examples of asymptomatic testing in workplace - we (HPT) are gathering lessons learned

Emergency Services

HPT

-          Advice is mainly IPC and ensuring contact tracing has been completed by the setting

-          Settings do not always fall within a LA footprint

-          May be business continuity issues as a result staff shortage

 

Prisons (and secure children's facilities)

HPT

-          Advice is mainly IPC (and in some situations discussions about testing)

-          Careful assessment is needed to determine whether transmission is occurring in the prison setting or whether positive results in staff members/inmates reflects community transmission (i.e. other plausible sources of infection)

-          May be complex issues resulting from staffing issues or restrictions impose within the setting

 

-          National HMPPS guidance

Hostels

LA

-          Advice is mainly IPC and ensuring contact tracing has been completed by the setting

-          May be complexities and support required to access testing

-          Any complex situations can be discussed with the HPT via the ICC

 

 

 

Information sharing after initial investigation

Where a caller directly contacts an organisation that is not the lead for a particular situation, clarification should be sought about if/who they have spoken to in the lead organisation.

Where there have been previous discussions with the lead organisation, the caller should be re-directed to the individual who is managing the situation.

Where there has been no prior contact, initial information should be gathered and formally handed over to the relevant SPOC (ICC for the HPT) by e-mail notifying the caller that this is the process.

 

Appendix 6 - Standard operating procedure for the joint local management of confirmed COVID 19 cases in schools and childcare settings

Responsibilities

Directors of Public Heath (DPH) have a specific role in managing outbreaks in their Local Authority (LA) area, in particular advising on and implementing measures at geographic and sectoral level.

The DPH and the Local Authority have a pivotal role in the prevention of outbreaks through community leadership, management, supervision, support, statutory and enforcement roles. For COVID 19 this has included the development of the Gateshead COVID Local Outbreak Control Plan.

Local Health Protection Teams within Public Health England (PHE) have a lead role in supporting the LA to investigate and manage outbreaks, where required.  The North East Health Protection Team (NE HPT) is Tier 1 of the national Test and Trace system and will continue to manage cases in keeping with the published guidance.

Applicable settings

This document describes management in schools and childcare settings and applies to staff/pupils/children and young people in these settings.

Current situation

We are now in a situation of sustained community transmission and rising background prevalence of COVID-19 infection.  As such, it is not unexpected that we will see multiple cases of COVID associated with specific settings and it becomes increasingly difficult to disentangle potential sources of exposure and routes of transmission. 

Where multiple cases are linked to a setting, there is a collective responsibility for LA's and the NE HPT to respond collaboratively as a public health system, working with settings and communities to complete a risk assessment and implement control measures.

Local Authority actions for confirmed cases

In most instances the LA's PH Team will receive reports of confirmed cases in schools/childcare settings through their electronic reporting system.

However, in some instance cases may have been escalated to the NE HPT from NHS Test and Trace or the DfE helpline because they have reported attending a particular venue / setting (e.g. schools, childcare settings). This information will be shared with LA PH teams to ensure that there is awareness of the setting. The NE HPT will inform the single point of contact (SPOC) in the LA  about these cases via covidoutbreak@gateshead.gov.uk

Liaison with the NE HPT will be through the email address ICC.NorthEast@phe.gov.uk

The LA SPOC will liaise with the PH programme leads, who have responsibility for schools and childcare settings, to check if they are aware of the cases and are taking necessary action.

The PH programme leads will contact the school/childcare setting  and carry out a risk assessment to identify who has been in close contact with the case during the infectious period and advise that any pupil/staff member must isolate for 10 days following their last contact with the case. The close contacts will not be allowed to attend school for the 10 day isolation period.

Close contact in these settings means anyone who has had any of the following types of contact with someone who has tested positive for coronavirus (COVID-19) with a PCR or LFD test:

  1. face-to-face contact including being coughed on or having a face-to-face conversation within 1 metre
  2. been within 1 metre for 1 minute or longer without face-to-face contact
  3. sexual contacts
  4. been within 2 metres of someone for more than 15 minutes (either as a one-off contact, or added up together over one day)
  5. travelled in the same vehicle or a plane

Anyone who lives in the same household as someone with coronavirus symptoms or who has tested positive for coronavirus (e.g. sibling who attends the setting or partner of staff member who attends the setting) will be classed as a close contact and advised to isolate.

School/childcare settings have been provided with template text for inclusion in letters to those/the parents of those who need to isolate.

Arrangements for outbreak investigation and management

Either the LA Authority or the North East HPT can declare an outbreak of infection in accordance with national outbreak definitions, although, given the background prevalence in the region the threshold of '2 cases = outbreak' may no longer be appropriate.

At this stage in the pandemic it is no longer sustainable nor effective / necessary to hold a formal outbreak control team (OCT) meeting for every outbreak situation and situations may be managed in accordance with any emerging national guidance on settings in relation to COVID.

Key public health actions will be to ensure:

  1. Prompt identification and advice to cases to self-isolate
  2. Prompt and accurate identification of contacts (using national definitions)
  3. COVID secure measures are in place to limit any potential for ongoing transmission
  4. Prompt notification of any subsequent cases so that the situation and risk assessment can be reviewed

The PH programme leads, with responsibility for schools and childcare settings, will collate the information for the confirmed cases within the setting to enable the DPH and/or PH Consultant to consider any further action required.  This information may include, but is not limited to,  details of school or childcare  set up, total number of staff confirmed positive, total number of pupils confirmed positive, number of contacts, current measures in place and how these are implemented e.g. social distancing and infection prevention control, wider context e.g. external sources of transmission

In many situations in schools and childcare settings, a local discussion between the LA's PH team, the health and safety team and the setting will be sufficient to undertake a risk assessment and provide advice about isolation and control measures and a formal OCT may not be necessary. Advice will also be sought from the NE HPT, where considered necessary, by either the LA's DPH and/or PH Consultant.

The PH Consultant will brief the DPH to provide assurance that no additional support or action is required, or to discuss escalation as appropriate.

If it is decided a formal OCT is not required the management of the outbreak will be overseen/led by the PH Consultant with input from the PH programme leads, health and safety team and the school/childcare setting. 

However, in some situations the initial risk assessment and discussion may determine that a formal HPT or LA led OCT should be convened. Situations where a formal OCT meeting is most likely to be of value are:

  • Where there is not a clear link between cases or an alternative plausible explanation for the cases, resulting in a suspicion that something unexplained is happening in that setting
  • Where there are reports of severe illness e.g. multiple hospitalisations/deaths
  • Where there is significant media attention
  • Where there is a need for control measures that require multi-agency coordination.

Formal OCT convened

When the need for a formal OCT is agreed an initial meeting will be convened rapidly, chaired by a Registered PH Consultant and advised by the NE HPT.  Regional JBC officers and other national bodies may be involved depending on the outbreak/situation.

The following agencies may be represented, in addition to the school/childcare setting,  at the formal OCT: Education Gateshead, Early Help Team, Gateshead NHS FT Community Services, HDFT 0-19 Public Health Nursing Service, LA Facilities Services, LA Health and Safety, Communications and any other agencies as required. They will be required to assist in ensuring that control measures identified in response to the HPT risk assessment and through the initial response phase are put in place.

The formal OCT will meet to agree:

  • control actions to be delivered by the setting
  • the appropriate management approach for the outbreak
  • criteria for escalation and de-escalation (in line with guidance)
  • further meetings.

The NE HPT will also monitor the incident/outbreak and inform the DPH if further action is required in response to additional possible and/or confirmed cases in the school or childcare setting, or if the Headteacher/Manager of the setting is unwilling to comply with advice

An effective communications response is an essential part of the management of any incident/outbreak.  External communication and national reporting will be via the PH team.  If required the Local Outbreak Engagement Board will support public facing engagement and communication as part of any local outbreak response,  

Testing

In order to effectively manage incidents and outbreaks it is essential everyone is able to access a test when they need to and that they can receive their results in a timely manner.  The PH Consultant will support access to and appropriate use of testing during the outbreak, where required.  This could include:

  1. signposting to national testing routes for symptomatic pupils and staff
  2. utilisation of local testing capacity for symptomatic pupils and staff
  3. deployment of mobile testing units (where available)
  4. establishment of alternative testing arrangements

The NE HPT may wish to utilise their own testing arrangements dependent on the nature of the incident or outbreak, and the other tests that may be required in addition to the COVID 19 testing. This will be discussed and agreed as part of the formal OCT.

The LA with Gateshead NHS FT Community Services has developed an effective local response to the ongoing COVID-19 pandemic. Primarily this is targeted at care homes settings as detailed in the Care Home SOP.

However, if an incident or outbreak is identified at a school or childcare setting consideration will be given to any support with testing or infection prevention control advice that could be offered from Gateshead NHS FT Community Services. Where resources allow test swabs may be processed through the QE hospital which provides a fast turnaround of results.

Testing and infection prevention control advice may also include support from the Gateshead 0-19 PH Service School Nurses, under the remit/management of Gateshead NHS FT Community Services.

Each incident or outbreak would need to be discussed to determine the most appropriate approach for testing and support, considering the particular circumstances and advice from NE HPT.

Where appropriate the PH Consultant will identify and escalate the need for any additional resources to the Covid 19 Control Board.

Escalation

The NE HPT and DPH will escalate the incident, in keeping with the LA outbreak plan, if:

  1. Whole school closure is required
  2. Linked cases are identified in other schools
  3. increase in cases across several schools

Further action may be required such as closure of all schools in a given area. This will be led by the DPH/LA, advised by the NE HPT, in keeping with the LA outbreak plan.

The DPH or PH Consultant will de-escalate the outbreak in accordance with guidance and with the agreement of the formal OCT meeting.

 

Appendix 7 - Standard operating procedure for the local management of outbreaks in care homes during 'test, trace, contain and enable'

Responsibilities

1.      Directors of Public Health have a specific role in managing outbreaks in their local authority area, in particular advising on and implementing measures at geographic and sectoral level.

2.      The Director of Public Health and local authority have a pivotal role in the prevention of outbreaks through community leadership, management, supervision, support, statutory and enforcement roles. The local authority also has specific roles in terms of statutory accountability, commissioning or direct management of care homes, and prevention will be integral to these roles.  An enhanced local offer and team has been established to strengthen support. 

3.      Local Health Protection Teams within Public Health England have a lead role in investigating and managing outbreaks.  The North East Health Protection Team (HPT) is Tier 1 of the national Test and Trace system and will continue to manage cases in keeping with the published guidance.

Declaring and Ending an Outbreak

4.      If there is a single laboratory confirmed case, this would initiate further investigation and risk assessment.

5.      An outbreak in a residential setting is defined as two or more confirmed cases of COVID-19 OR clinically suspected cases of COVID-19 among individuals associated with a specific setting with onset dates within 14 days.

6.      The criteria to end an outbreak in a residential setting is no confirmed cases with onset dates in the last 28 days in that setting.

Health Protection Team Actions

7.      The HPT will receive electronic reports of confirmed cases twice daily (10:00 and 15:00 hours) from NHS Test and Trace.

8.      Cases may also be brought to the attention of the HPT through care homes or the local authority contacting directly to report confirmed cases among residents or staff, or to report multiple suspected cases.

9.      The HPT will undertake Risk Assessments whenever the care home makes contact with HPT.

10.  Following notification of exposure in a care home the HPT will undertake the following actions:

Suspected case: Resident

11.  The care home should notify the HPT of any possible cases in residents.

12.  Advice will be given in relation to the resident(s) who is a possible case. Residents with symptoms of COVID-19 should be isolated for 14 days from the onset of symptoms. If a resident has a negative COVID results they can come when they are clinically well and have been afebrile (not feverish) without medication for 48 hours.

13.  The HPT will conduct a risk assessment with the care home to gather information about whether there are other symptomatic or confirmed cases in the care home and whether this constitutes a new outbreak situation. Where there is no evidence of a new outbreak situation, HPT will arrange swabbing of symptomatic individuals.

14.  Where there is evidence of a new outbreak the HPT will arrange whole care home testing.

Confirmed Case: Resident

15.  The HPT will contact the care home to gather information on the onset of illness and test date to determine the infectious period. 

16.  Advice will be given in relation to the resident who is the confirmed case. This will include isolating the confirmed case for 14 days from the onset of symptoms (or date of the positive test if the case is asymptomatic).

17.  If the resident is a new admission to the care home, there may be household and community contacts who require self-isolation advice.  Any such contacts will be identified and managed appropriately through the national contact tracing system and the HPT will ensure adequate information has been provided to NHS Test and Trace to enable this to happen.

18.  If the resident was admitted from another care home or health care setting the HPT will contact that setting.

19.  Where individuals are identified as meeting the criteria for a significant contact, they will be advised to isolate for 14 days from the date of exposure. 

For residents in care homes, national guidance advises isolation for 14 days because of the risk of transmission to other residents in a vulnerable group, and because the average incubation period in this group tends to be longer.

Suspected case: Staff Member

20.  The care home should notify the HPT of any possible cases in staff.

21.   Advice will be given in relation to the member(s) of staff who is a possible case. Staff with symptoms of COVID-19 should be advised to access testing via Pillar 2. Staff who test negative for COVID-19 can return to work when they are clinically well and have been afebrile (not feverish) without medication for 48 Hours.

22.  The HPT will conduct a risk assessment with the care home to gather information about whether there are other symptomatic or confirmed cases in the care home and whether or not this constitutes a new outbreak situation.

23.   Where there is evidence of a new outbreak the HPT will arrange whole care home testing.

Confirmed Case: Staff Member

24.  The HPT will contact the confirmed case and establish the onset date of their illness, the date on which they were tested and their attendance at work during the infectious period.   The case will be advised to self-isolate until the latest of:

  • 10 days after the onset of symptoms (or 10 days after the test date if they are asymptomatic).
  • The time at which all of the following are no longer present: high temperature (without medication for 48hrs) and they are medically fit to return
  • no earlier than 10 days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
  • if a cough or a loss of or a change in normal sense of smell (anosmia) or taste is the only persistent symptom after 10 days (and they have been afebrile for 48 hours without medication), they can return to work if they are medically fit to return (these symptoms are known to persist for several weeks in some cases)

25.  The staff member will be encouraged to inform the care home of their result.

26.  If the staff member identifies contacts in the care home the HPT will contact the care home in order to provide the appropriate infection control advice.

27.  Any such contacts will be identified and managed appropriately through the national contact tracing system and the HPT will ensure adequate information has been provided to NHS Test and Trace to enable this to happen.

28.  Any household and non-household social contacts will be identified and managed appropriately through the national contact tracing system and the HPT will ensure adequate information has been provided to NHS Test and Trace to enable this to happen.

29.  All household contacts of the case will be advised to self-isolate for 10 days from the day the confirmed case's isolation period starts.  Where other individuals are identified as meeting the criteria for a significant contact with the case they will also be advised to isolate for 10 days from the date of exposure (or 14 days if the contact is a resident)

30.  If staff are symptomatic when tested

  • Symptomatic staff who test positive for SARS-CoV-2 or who have an inconclusive test result, and symptomatic staff who have not had a test, can:
  • return to work no earlier than 10 days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
  • if a cough or a loss of or a change in normal sense of smell (anosmia) or taste is the only persistent symptom after 10 days (and they have been afebrile for 48 hours without medication), they can return to work if they are medically fit to return (these symptoms are known to persist for several weeks in some cases)

31.  If staff are asymptomatic when tested

Staff who test positive for SARS-CoV-2 (either by PCR of LFD) and who were asymptomatic at the time of the test must self-isolate for 10 full days following the date of the test. If they remain well, they can return to work after their isolation period.

If, during the 10 days isolation, they develop symptoms, they must self-isolate for 10 days from the day of symptom onset. They can:

  • return to work no earlier than 10 days from symptom onset, provided clinical improvement has occurred and they have been afebrile (not feverish) without medication for 48 hours and they are medically fit to return
  • if a cough or a loss of or a change in normal sense of smell (anosmia) or taste is the only persistent symptom after 10 days (and they have been afebrile for 48 hours without medication), they can return to work if they are medically fit to return (these symptoms are known to persist for several weeks in some cases)

Significant Contact

32.  A significant contact is defined as any of the following:

  • Lives in the same unit or floor as a confirmed case (e.g. shares the same communal areas), unless the resident(s) (i.e. potential contacts) are effectively isolating in their rooms throughout the infectious period of the case(s) or vice versa.
  • Direct face-to-face contact with a confirmed case (within one metre);
  • Being within 1 metre of a confirmed case for 1 minute or more;
  • Being within 2 metres of a confirmed case for 15 minutes or more;
  • Travelled in a small vehicle with a case
  • Staff who have cleaned a personal or communal area of the home where a confirmed case has been located (note this only applies to the first time cleaning the personal or communal area)

Where appropriate PPE has been worn, then a contact is not classed as significant even if meeting any of the above criteria except for travelling in a small vehicle. PPE is only considered in workplace vehicles which have been fully risk-assessed and included in the workplace's COVID-safe plan. Where a person has travelled in a private car with a confirmed case, they are classed as having had significant contact even if PPE was worn.

33.  The timeframes in which significant contact occur are defined as 48 hours prior to the case's symptom onset OR date of test if asymptomatic.  Cases in staff members are considered infectious for 10 days from symptom onset OR date of test if asymptomatic.  Cases in care home residents are considered infectious for 14 days from symptom onset OR date of test if asymptomatic.

HPT Reporting to Director of Public Health / Local Authority

34.  The HPT will inform the DPH of the care home via an automated report which is sent daily (Monday-Friday) to the agreed single point of contact in the Local Authority.  This automated report includes all new care homes that the HPT has had contact with/in relation to one or more confirmed or suspected cases of COVID-19 infections in staff or residents since the last report was issued. 

35.  A new situation is declared in a care home if there is one new case (suspected or confirmed) of COVID-19 infection in a care home which has had no cases of COVID-19 infection for the preceding 28 days.  This means that some care homes may appear on the daily report multiple times.

36.  The HPT will advise on whole home testing in, and following on from, an outbreak situation using Pillar 2 tests.  In addition, Rapid Response daily LFD testing will be carried out by the Care Home until there have been 5 days with no additional positive tests for a minimum of 7 days.

37.  On declaring a situation, an email will be sent to the local authority SPOC which will detail name of care home; address; outbreak number; symptoms; date of onset; proportion of residents with symptoms; proportion of staff with symptoms; proportion of staff confirmed; proportion of residents confirmed; number of deaths; and number of hospitalisations.

38.  Once all results are available for a care home these will be communicated to the local authority SPOC via email.

39.  If the HPT has particular concerns about a care home, including (but not limited to) issues in adherence to control measures, staffing or resource concerns then additional contact will be made with the local authority through the nominated SPOC (including out of hours).

40.  Liaison will be through the HPT ICC email address.

41.  The HPT will inform the SPOC / DPH if further action is required.

Local Authority Actions

42.  The local authority will provide a SPOC for the HPT to report outbreaks to, available seven days a week between 08:00 and 20:00

43.  The designated duty Public Health Consultant will be responsible for reviewing the information provided by the HPT.  This could include any risk assessments undertaken, infection control advice given and any particular concerns shared about a care home, including (but not limited to) issues in adherence to control measures, staffing or resource concerns.

44.  As part of the initial response phase the duty Public Health Consultant will liaise with the Local Authority Commissioning team and Community Service IPC leads to ensure that there is engagement with the care home to:

  • understand the current position in relation to suspected or confirmed cases amongst residents and staff; agree the preferred channel of communication and confirm contact details; agree frequency of contact.
  • provide advice and guidance to support the care home to implement control measures and relevant national guidance.
  • assess areas including PPE requirements and usage, staffing, occupancy, training requirements and health and wellbeing checks for residents and staff.
  • highlight any particular concerns about a care home shared by the HPT and agree mitigating actions and timescales for implementation.
  • establish if resident cases are being supported in the home or are in hospital.
  • establish if staff cases are self-isolating at home and advise appropriately if this is not the case.
  • discuss risk assessments for residents and staff, including environmental issues such as the ability to isolate residents.
  • discuss business continuity arrangements and any emerging risk.
  • where appropriate identify and escalate the need for any additional resources.
  • agree monitoring arrangements to review progress in implementing control measures.

45.  If following the initial response it is necessary to establish a Local Outbreak Control Team this will be convened in accordance with agreed procedures for in hours and out of hours response, using an agreed key contact list.

Local Outbreak Control Team

46.  When the need for Local Outbreak Control Team (OCT) is indicated an initial meeting will be convened rapidly, chaired by a Registered Public Health Consultant and advised by the HPT.  Regional JBC officers and other national bodies may be involved depending on the outbreak/situation.

47.  Public Health, Adult Services, Commissioners, Community Services and Communications (other agencies as required) will be represented at Local OCT meeting to assist in ensuring that control measures identified in response to the HPT risk assessment and through the initial response phase are put in place.

48.  The Local OCT will meet to agree:

  • control actions to be delivered by the setting
  • the appropriate management approach for the outbreak
  • criteria for escalation and de-escalation (in line with guidance)
  • further meetings
  • how any learning from outbreak will be disseminated

49.  An effective communications response is an essential part of the management of any incident or outbreak.  External communication and national reporting will be Public Health.  The Local Outbreak Engagement Board will support public facing engagement and communication as part of any local outbreak response. 

50.  In order to effectively manage incidents and outbreaks it is essential everyone is able to access a test when they need to and that they receive their results in a timely manner.  Any issues identified in access to testing are to be escalated appropriate channels.

51.  Where appropriate the Public Health Consultant will identify and escalate the need for any additional resources to the Covid 19 Control Board.

52.  The Public Health Consultant will de-escalate the outbreak in accordance with guidance and with the agreement of the Health Protection Team.

Escalation

53.  The DPH will escalate the incident in accordance with the Covid Control Plan and with advice from the HPT if further action is required due to:

i.      Persistent evidence of ongoing transmission in the care home despite the additional support provided by the LA.
ii.      Other concerns about the quality of care in the care home
iii.      The care home failing to apply control measures.

54.  Further actions taken may have system-wide impacts such as closure of the care home or action across a group of care homes.

55.  If the management of the outbreak causes a significant test to the system's capacity and capability to respond and manage the issues, then consideration should be given to the declaration of an emergency or major incident, and activation of the Emergency Response Process.

Appendix

Description of Gateshead testing process

  • The Local Authority with Gateshead Community Services have developed an effective local response to the ongoing COVID-19 Pandemic.
  • Information is shared between partners as soon as there is an indication of a potential COVID-19 case (from Health Protection Team or direct reporting from the care home).
  • The Local Authority Commissioning team maintain daily / weekly contact with all care settings and record and action any reported infection, requests for PPE etc.
  • Community Services have developed strong working relationships with the Care Homes, providing IPC training and supporting with swabbing of residents if required.
  • A positive result is then followed up by IPC leads from the QE and LA commissioners, to offer support and guidance if required. The process for swabbing care home residents is documented below.

Care home testing guidance for residents and staff: PCR and rapid lateral flow (England) (publishing.service.gov.uk)

 

Appendix 8 - Approach to preventing and managing outbreaks in workplaces (not schools or care homes)

Background

As part of national measures to control the spread of COVID-19, the number of workplaces open for business is limited to those providing essential services. As the pandemic has continued, decisions were made nationally to progressively ease measures to allow businesses to re-open until the most recent lockdown in January 2021.

The evidence about safety and transmission of the COVID-19 virus in the workplace indicates that:

  • The risk of transmission is most strongly associated with close and prolonged contact in indoor environments. The highest risks of transmission are in crowded spaces over extended periods.
  • Emerging evidence suggests that other factors that could be implicated in workplace linked transmission include:
    • Failure to observe social distancing during refreshment, toilet and smoking breaks
    • Shared transport to and from work
    • Shared living accommodation for workers based away from their usual home
    • Poor ventilation
  • Physical distancing is an important mitigation measure (high confidence). Where a situation means that 2m face-to-face distancing cannot be achieved it is strongly recommended that additional mitigation measures including (but not limited to) face coverings and minimising duration of exposure are adopted

In summary, it is clear that there is an increased risk should workplaces operate with employees in close indoor contact for long periods and that reduction of social distancing has the potential to increase transmission of the virus within workplaces and therefore, in the community. For this reason, Gateshead Council has recommended that the 2-metre social distancing advice should be maintained.

General advice for workplace

Workplaces should be referred to the Working Safely During Coronavirus guidance that has practical steps to take. These should complement - not replace - steps already taken to adhere to health and safety requirements, working with Environmental Health Teams and Public Health Teams within Local Authorities, and Public Health England's Health Protection Team.

Carry out a COVID-19 risk assessment: refer to the HSE guidance and consult staff or trade unions

Review cleaning, handwashing and hygiene procedures: provide hand sanitiser around the workplace to complement hand washing facilities and frequently cleaning and disinfecting objects and surfaces that are touched regularly

Maintain 2-metre social distancing, where possible: put up signs to remind workforce of social distancing guidance and use tape to mark 2-metre distance between workspaces, reduce numbers of workers on site to maintain social distancing, cohort staff, limit car sharing and revisit shift patterns

Where people cannot be 2-metres apart, manage transmission risk: by using screens or barriers to separate people from each other and staggering arrival and departure times.

Managing cases and outbreaks in workplaces

Where symptomatic individuals are identified, workplaces should be advised to follow national guidance (link) and the individuals should self-isolate, not return to work and access testing in line with current advice (dial 119 for advice).

Responsibilities

Directors of Public Health (DPH) have a specific role in managing outbreaks in their local authority area, advising on and implementing measures at a geographic and sectoral level. This role is being developed as part of the work led by the Joint Biosecurity Committee. This includes the development of Local Authority level outbreak control plans (locally termed the COVID-19 Control Plan).

The HPT have a lead role in investigating and managing outbreaks and are designated as Tier 1 of the national NHS Test and Trace Service and will continue to manage cases in keeping with national guidance.

Identification

COVID-19 cases within workplaces will likely be identified in two ways.

  • Individual confirmed cases are reported to the NHS Test and Trace service who provide advice on self- and household isolation and undertake contact tracing (with contacts also being advised on isolation).  If the case is linked with a workplace the HPT is notified.
  • Cases will also come to light through workplaces directly contacting the HPT or Local Authority, for example to report any suspected or confirmed cases among staff as described above.

HPT actions

The HPT may contact confirmed cases escalated through the NHS Test and Trace Service and establish the onset date of their illness, the date on which they were tested, their attendance at work and contact details for the workplace. They may also refer the contact's details to the DPH for further investigation.

Cases may also come to light through workplaces directly contacting the HPT or Local Authority to report confirmed cases among staff or to report multiple suspected cases. The HPT, or LA at the request of the HPT, will provide advice.

The HPT, or the LA at the request of the HPT, will:

  • Contact the Workplace and disclose (in confidence) the name of the worker and undertake a joint risk assessment to identify close contacts who will require 14 days self-isolation from their last contact with the worker case.
  • Close contact is defined as any of the following (without PPE):
    • Direct face-to-face contact with a confirmed case;
    • Being within 1 metre of a confirmed case for 1 minute or more;
    • Being within 2 metres of a confirmed case for 15 minutes or more.
    • Travelling in a small vehicle with the confirmed case
  • Provide template text for inclusion in a letter from the workplace to those who need to be self-isolated.
  • Refer the workplace to the LA Business Compliance Team for advice on making the workplace COVID secure.
  • Provide advice to the workplace about escalation criteria and how the situation will be monitored (e.g. further cases linked to premises either reported through workplace or identified through Test & Trace)

The HPT will also inform the DPH of the incident, the initial risk assessment and the advice given to the workplace via email to the Council's single point of contact: CovidOutbreak@Gateshead.gov.uk.

The HPT will also monitor the incident and inform the DPH if further action has been required in response to further possible and/or confirmed cases in the workplace or if the Workplace appears unwilling/unable to comply with advice.

Gateshead Council actions

The local authority will:

  • Provide a single point of contact for the HPT to report outbreaks to. This will be monitored 7 days a week, between 8am and 8pm.
  • A Public Health (PH) Consultant will be responsible for reviewing the information provided by the HPT, including the initial risk assessment and advice given.
  •  At the request of the HPT
    • Contact the Workplace and disclose (in confidence) the name of the worker and undertake a joint risk assessment to identify close contacts who will require 10 days self-isolation from their last contact with the worker case.

Close contact is defined as any of the following (without PPE):

Direct face-to-face contact with a confirmed case;

  • Being within 1 metre of a confirmed case for 1 minute or more;
  • Being within 2 metres of a confirmed case for 15 minutes or more.
  • Travelling in a small vehicle with the confirmed case
  • Provide template text for inclusion in a letter from the workplace to those who need to be self-isolated.
  • Refer the workplace to the LA Business Compliance Team for advice on making the workplace COVID secure.
  • Provide advice to the workplace about escalation criteria and how the situation will be monitored (e.g. further cases linked to premises either reported through workplace or identified through Test & Trace)

Take further action at a local authority level if required, with PH being responsible for convening the appropriate outbreak response. The PH Consultant will contact local leads for support depending on the identified need and consider whether to convene a virtual outbreak coordination group.

Escalation

The DPH/HPT will escalate the incident if:

  • There are increasing numbers of cases in a workplace (2+)
  • There are linked cases in the community or supply chain
  • Media / political interest
  • If the business is not cooperating with advice and support

If an outbreak coordination group is required to manage local responses, members will include:

  • Public Health Consultant, Gateshead Council
  • Economic Development, Gateshead Council
  • Foundation Trust
  • Environmental Health, Gateshead Council
  • Others as required 

This group will consider and implement further measures to support the workplace in controlling the outbreak. The group will report weekly to the Gateshead COVID Control Board. The most likely escalation scenario in a workplace setting is if large numbers of staff are infected and pose an increased risk of community transmission away from the workplace. Where further escalation is required, the Council will work with the HPT and appropriate stakeholders to for a local Outbreak Control Team (OCT) to determine further action and support for the workplace, and potentially for the local community.  This may include the LA determining to close the workplace until satisfactory measures are in place. The OCT will continue to meet until the outbreak is under control, and will report to the Gateshead COVID Control Board

If the management of the outbreak causes a significant test to the system's capacity and capability to respond and manage the issues, then consideration should be given to the declaration of an emergency or major incident, and activation of the Emergency Response Process.

Testing

The Council PH Team will be able to provide advice on the importance of testing and how to arrange it.  The option of bringing in a mobile testing unit or access to asymptomatic testing sites will be considered.

Assurance

  1. Public Health Consultants will monitor progress on outbreaks in workplaces in order to assure the DPH that positive action is taken in all outbreaks.
  2. All outbreak activity will be reported to the Health Protection Board (COVID-19) on a weekly basis
  3. The duty Consultant will then brief the DPH to provide assurance that no additional support or action is required, or to discuss escalation as appropriate. 

Contact for workplace EHO

Peter Wright       PeterWright@Gateshead.Gov.UK

Stewart Sorrell    StewartSorrell@Gateshead.Gov.UK

Lorna Roberts     LornaRoberts@Gateshead.Gov.UK

Guidance Documents for Employers

This list of guidance documents pulls together national PHE, NHS and government guidance, and local resources.  Hyperlinks are displayed here for reference (click on the link to be taken to the relevant guidance/information online).

Social distancing and stay at home

Infection prevention and control

Business-specific guidance and policy

Cleaning and waste management

Testing and contact tracing

Staff well-being

 

Appendix 9

Gateshead Health NHS Foundation Trust COVID-19 Infection Prevention Control - High level summary of standard operating procedures and outbreak plan

Standard principles

The trust will do all it can to minimise the risk of patients and staff acquiring COVID-19 infection within the hospital and through its community services. This is a top organisational priority.

The Infection Prevention and Control team, Consultant Microbiologists and Directors of Infection Prevention and Control (DIPC'S) will play an integral role in the trusts response to COVID-19.

Strict application of national and local Infection Prevention and Control guidance will be applied at all times to minimise the risk of COVID-19 infection occurring in patients and staff.

We will work closely with colleagues in Public Health, the local council and the wider healthcare sector as well as within the wider community to ensure a joined up approach is established to prevent COVID-19 infection from occurring wherever possible.

All patients admitted to hospital will get a COVID-19 molecular test on admission (or in the 5 days preceding admission for certain surgical cases when shielding pre-op) regardless of symptomatology.

All patients will be nursed in single occupancy room accommodation until the result of their admission COVID-19 molecular test is known.

All patients with acute (infectious) COVID-19 infection will be nursed in either single occupancy accommodation or in specialised designated COVID-19 cohorted ward / area distinctly separated from non-COVID-19 patients.

All staff members have been strongly encouraged to ensure that they receive their Covid-19 vaccination at the earliest possible opportunity. To facilitate this the Trust has set up a Covid-19 vaccination service and continues to vaccinate staff at a rapid rate in line with national guidance.

Appropriate personal protective equipment (PPE) and all necessary training will be provided to ALL staff and visitors where required. 

ALL staff members have open access to a HR advisory line through which rapid COVID-19 molecular testing can be conducted in the event of any staff member developing symptoms compatible with COVID-19 infection. Staff members will be excluded from work as soon as symptoms develop. ALL staff members diagnosed with COVID-19 will remain off work until the end of the infectious period.

The trust will promptly identify (both patient and staff) contacts of active infections and put systems in place to break the chain of infection such as prompt isolation of patient contacts, mandating exclusion from work / self-isolation of significant staff contacts and arranging for additional environmental cleaning and such like to take place.

In addition to symptomatic testing, all staff members have been offered the opportunity to engage with the asymptomatic lateral flow Covid testing program. This involves twice weekly lateral flow testing with the intention of identifying asymptomatic Covid-19 infection in staff members. 

It is recognised that thorough and regular decontamination of the hospital environment is essential to prevent transmission of COVID-19 infection. Therefore, cleaning schedules are in place to minimise the risk of prolonged environmental contamination. We are now deploying hydrogen peroxide decontamination techniques in addition to conventional deep cleaning methodologies to any area where a high level of SARS-CoV-2 virus has been felt likely to have contaminated the environment.

Social distancing measures are in place throughout the organisation in line with government policies.

High quality and timely COVID-19 molecular testing will be performed in our own laboratory wherever possible.

The trust will proactively manage ALL COVID-19 cases both to optimise the management of the patient/staff member concerned and to do all we can to limit onward transmission of infection.

A consultant Microbiologist together with the IPCN team will actively and in real time investigate each positive COVID-19 result and assign the result into one of the following groups: Community acquired, Possible nosocomial, Definite nosocomial or known positive within 18 hours of the result being authorised. Each new result with be added to and cross referenced with a central IPC database to ensure that any clusters of cases or outbreaks are promptly identified.

Potential and confirmed COVID-19 outbreaks will be managed pro-actively with all necessary steps taken to reduce the risk of onward transmission at the earliest possible point. We will follow guidance set out in national documents and guidelines pertaining to outbreak management. 

As soon as an outbreak is identified immediate measures will be taken to contain the situation. For instance, the ward/ area will be closed to new admissions, all visiting will be suspended and internal movements restricted, all discharges to residential facilities or for patients going home with care packages will be put on hold and extra cleaning arranged for the area. 

All patients and staff in an area affected by an outbreak will undergo routine enhanced COVID-19 molecular (swab) testingdesigned to maximise the information available to the outbreak control team and identify all positive cases at the earliest opportunity. 

An outbreak control meeting will be called (to be held within 24 hours). Appendix 1 lists the core group of individuals that will make up the outbreak control team. The local health protection team and public health director will promptly be informed of any outbreak and invited to participate in the outbreak control meetings. Appendix 2 contains a template agenda for the first meeting.

A single point of contact for the local health protection team and local director of public health will be allocated - this will usually be the Consultant Microbiologist(s) nominated the outbreak lead role.

Regular outbreak meetings will take place until the outbreak is closed.

All outbreaks will be thoroughly investigated through established formal processes. A post infection / outbreak review will be conducted at the end of the outbreak and an outbreak report produced. A key part of this investigation process is to learn lessonsfrom what has happened and modify practice where requiredrecognising that this is a new virus and 'learning quickly from experience' is of paramount importance given the current limited understanding about many aspects of the virus. COVID-19 pathways and documents will be updated regularly as new evidence of learning from experience comes to light and national and local documents are updated.

The trust will be transparent in reporting all nosocomial COVID-19 cases and outbreaks through the appropriate national, regional and local reporting systems in a timely manner.

Outbreak control team (Gateshead Health NHS Foundation Trust):

  • Director of Infection Prevention and Control (Chair)
  • Infection control doctor / Consultant Microbiologist (Outbreak lead / Vice-chair)
  • Infection Prevention Control Nursing team
  • Admin team support (record minutes/action log)
  • Medical staff representative from affected ward / area
  • Matron covering ward/clinical area
  • Ward Sister for affected ward/ clinical area
  • Occupational Health / Human Resources team
  • Domestic supervisor
  • Patient flow lead
  • Communications team
  • Any other individual(s) deemed necessary for the particular area affected

In addition, if felt to be required and able to attend:

  • Health protection team representative
  • Local authority public health representative

Outbreak control meetings will be held remotely wherever possible using Microsoft Teams.

Outbreak control meeting - template for standard agenda

Outbreak Control Team Meeting Agenda

(Insert title of outbreak)

(Insert date, time and venue)

  1. Introductions
  2. Apologies
  3. Minutes of previous meeting (for subsequent meetings)
  4. Purpose of meeting

    At first meeting agree chair and terms of reference
  5. Review of evidence

    Epidemiological
    Microbiological
    Environmental
  6. Current risk assessment
  7. Control measures
  8. Further investigations

    Epidemiological
    Microbiological
    Environmental
  9. Communications

    Public
    Media
    Healthcare providers (for example GPs, A&E and so on)
    Others
  10. Agreed actions
  11. Any other business
  12. Date of next meeting

 

Appendix 10 - COVID-19 communication plan

Clear, accurate and timely communications is a key element in outbreak management. Providing accurate and timely information to residents, businesses and settings and having the ability to respond to any localised outbreaks quickly and efficiently is essential.

Using the OASIS framework as recommended by the Government Communications Service, this plan sets out our approach to communicating with Gateshead residents and other key stakeholders during the Covid-19 pandemic. It supplements the communications strategy set out within Gateshead Council's Local Outbreak Covid Control Plan, available at:

https://www.gateshead.gov.uk/article/16061/Gateshead-COVID-19-Local-Outbreak-Control-Plan

Objectives

To ensure all audiences remain:

  • Informed - including local / national restrictions and the reasons for these
  • Engaged - they need to understand the part they can play in preventing virus transmission, know what to do in certain situations and act accordingly
  • Reassured - although the situation remains serious, support is available

Audience

Key groups include:

  • Gateshead residents
  • Gateshead Council staff and members
  • Partners, including NHS bodies and emergency services
  • Schools and other education settings
  • Care homes
  • Business owners and employees
  • Community and voluntary organisations

Strategy and Implementation

The understanding, consent and compliance of the public is key to effective Covid-19 outbreak management. We need to be open and honest with our community to help to further build on existing relationships and trust. We will always promote a collaborative approach and seek to learn and improve our communications over time.

Our overarching communications strategy is based on a model of Prevent - Respond - De-escalate.

Prevent

We will amplify and supplement national campaigns with localised materials informed by audience insight. Key messages (see appendix 1) will be communicated to a wide audience through social and digital media, radio, TV and outdoor advertising and via the local press.

Language and tone will be persuasive, supportive, community focused and person centric. The EAST framework will be used to present all calls to action as Easy, Attractive, Social and Timely.

A regional campaign is currently underway, thanking North East residents for their efforts in slowing the spread and urging them to keep going with relevant behaviours. We will continue to work with neighbouring local authorities (the LA7 group) and other LRF partners to ensure consistency of messaging across the region and address emerging issues.

The Local Engagement Board will support the development of communications for different groups in our community. A social marketing approach will aim to ensure that the information is relevant and appropriate for different audiences.

The prevention work will draw on positive relationships and communicate across all partner platforms and mediums. Verbal briefings, direct emails and engagement will be a key part of communication. A network of COVID-19 Community Champions has been established, whereby representatives from key partner organisations, stakeholder groups and communities are trained to disseminate relevant information. They will help to shape materials and provide feedback on where specific communications activity may be required - for example, common misconceptions or areas of concern.

Respond

When localised outbreaks occur, we will deliver quick, accurate and direct communications and relevant response level (Yellow - Amber - Red - Red Plus) depending on the scale of the outbreak.

Settings will be consulted on the best methods for communication and where appropriate, statements provided quickly to local press and via social media. The key element of this stream is the need for accurate and easily distributed information. Existing channels - such as school text systems to parents, business forums etc - will be mapped out and utilised in line with the outbreak scenario.

De-escalate

As active outbreaks are managed, clear communication to the public, business owners and employees that conveys information on the outbreak and also when it is over is critical. This work will focus on managing public anxiety, communicating well about actions that have been taken and explaining why.

Scoring / evaluation

The effectiveness of communications activities will be continuously evaluated in terms of outputs, outtakes and outcomes.

These may include, but are not limited to:

Outputs (activities and their performance)

  • Social media reach and engagement metrics
  • Website analytics
  • Media coverage

Outtakes (how messages are received)

  • Surveys
  • Stakeholder feedback (e.g. Covid Community Champions and Local Engagement Board)
  • Comments on social media and online news articles

Outcomes (behaviour change)

  • Infection rates
  • Vaccine / testing uptake
  • Compliance with restrictions

Key prevention messages

Hands, face, space

To keep yourself, your family and your community safe:

  • Wash your hands regularly (or use sanitiser)
  • Wear a face covering where appropriate
  • Stay 2m away from people you don't live with wherever possible

It's also essential that we all respect any restrictions in place, locally or nationally, to prevent the spread of the virus.

Testing

If you start to experience coronavirus symptoms (a new continuous cough, a high temperature or a change in your normal sense of taste or smell), you should arrange a test straight away. You and everyone in your household or support bubble should stay at home until you get the results.

If you or someone you have been in close contact with tests positive, you must self-isolate in line with government guidance. Support is available if needed.

Regular lateral flow testing is encouraged to help identify people who could be spreading the virus without realising. It should not be used to bring self-isolation to an early end or if the individual is showing symptoms.

Vaccines

The Covid-19 vaccine is safe and effective. It has been rigorously tested.

We need as many people as possible to have the vaccine, to help keep everyone safe.

It is being delivered nationally by the NHS, using a priority group system. You will be contacted when it is your turn.

The vaccine will prevent you from illness caused by Covid-19, but it may not prevent you from spreading the virus. For this reason, you will need to continue to follow prevention guidance and observe any restrictions in place.

The first dose of the vaccine will give you a good level of protection, but it is important for you to have the second dose for longer lasting effects.


Published: 30 June 2020

Revised: 12 March 2021

Alice Wiseman, Director of Public Health

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