Lancashire on the brink of getting local Covid testing powers to help control virus

The programme has been designed to “identify cases earlier and enable effective contact tracing” and also aims to “remove barriers” to testing for some high-risk groups.

If it gets final approval from health bosses at a national level, it is hoped that the system will be in place by the end of the month.

The Local Democracy Reporting Service obtained the full details after publication this week of Lancashire County Council’s outbreak control plan, a document which all local authorities were ordered to produce to demonstrate how they intend to keep Covid-19 under control.

Lancashire’s testing priorities will be integrated with existing nationwide NHS plans, but the county will pay particular attention to targeted testing and getting results within 24 hours.

Lancashire County Council’s director of public health, Dr. Sakthi Karunanithi, said discussions about the more focused local programme are ongoing – but he hopes his previous call for flexibility has now been heard.

“We want to develop our own arrangements for getting the tests to the people who need them most. That might include community testing, [which would] go way beyond the mobile testing and drive-through units we currently have, where people with symptoms have to go online and book.

“It would put more capacity in our hands, so when we pick up any signals about high levels [of Covid-19], we can focus on that place and do as much testing as we possibly can to pick up anybody who is positive in that area,” Dr. Karunanithi explained.

He revealed that one of the county’s ambitions is to be able to declare every care home Covid-free and secure – and then use more targeted testing of staff, rather than entire facilities, to detect early problems and help care homes retain that cherished status. So far, 41 percent of care homes across the county council and Blackpool and Blackburn with Darwen council areas have reported a coronavirus outbreak.

The local scheme will also focus on vulnerable groups, such as those living in deprived areas, people from Black, Asian and minority ethnic (BAME) communities, the homeless and individuals dependent on drugs and alcohol.

According to the control plan, as well as being more likely to have the kind of underlying health conditions that put them in increased danger from contracting Covid, some members of these groups – particularly those from BAME and deprived backgrounds – also face other coronavirus risk factors as a result of their occupations and housing conditions.

“The people who have symptoms and can get to a testing centre tend to be from low-risk groups – not people in vulnerable categories, who don’t have access to cars or even mobile phones to get their results back. Our plan means we would be able to leave some swabs with, say, a housing estate manager or the warden of a hostel,” Dr. Karunanithi said.

Under Lancashire’s Covid outbreak plan, just two confirmed cases occurring in the same setting within a fortnight – or two suspected cases as a result of the display of relevant symptoms – will be deemed an outbreak. Amongst a range of other possible responses depending on an assessment of the risk, that could ultimately lead to the closure of a school or other setting.

“The actions that would result from an outbreak may or may not include shutting a building. If all of the linked cases were in one section of the building, we would do a deep clean of that area

“But if there is enough concern that warrants a whole building to be closed, we wouldn’t hesitate to do that – especially if, by doing so, we can prevent a wider closedown,” Dr. Karunanithi confirmed.

A surge in contact tracers could be deployed to help bring any outbreak under control, with a high-end estimate that as many as 5,200 people may need to be traced per day, based on symptomatic cases alone. That calculation is on the basis of each confirmed case having up to 14 contacts, of whom 12 can be tracked down on average.

Contact tracing in Lancashire will initially be carried out by a national team of call handlers and experts in the field.

However, the outbreak plan lists a series of the most complex scenarios in which that responsibility will be transferred to Lancashire-based staff, which could ultimately happen in 20 percent of cases.

These include cases where an individual has attended a school or childcare facility while infectious, cases identified in emergency service and healthcare staff and instances where individuals have tested positive for coronavirus, but are unable or unwilling to provide details about their contacts.

Outbreak control teams tailored to respond to flare-ups in particular settings will move to quell the spread of the disease via actions which “minimise viral transmission while mitigating social risks caused by control measures” – an apparent reference to the need to balance the risk posed by the threat from the outbreak and the response to it.

The control plan reveals that legal advice may have to be sought depending on the nature of the measures being considered.

An outbreak will only be deemed to be over when the individual responsible for dealing with it – known as the “single point of contact” – can declare that there is no longer a risk to public health that requires further investigation or management; no further cases have been identified for 14 days since the onset of the last symptomatic person or positive test; and a deep clean has taken place of the affected premises.

Meanwhile, the outbreak plan confirms that anybody asked to self-isolate after testing positive for coronavirus – or coming into contact with somebody who has – will receive support in obtaining food and medicine and also help with their finances, social isolation and even dog-walking.

TESTING TIMES

In spite of Lancashire’s plan to take a more roving approach to testing, seven new military-operated testing sites are also being set up to boost fixed-point capacity. These will be operational from 13th July at the latest at:

Blackburn – Old Bank Lane car park, Royal Blackburn Hospital

Blackpool – alternating between the Palatine Leisure Centre and Bispham College

Chorley – Woodlands Centre on Southport Road

Lancaster – Nelson Street car park

Nelson, Skelmersdale, Rossendale – locations not yet confirmed

The county’s regional drive through-test centre, which has been operating at Preston’s College since April, will remain open.

‘PROGRESS, BUT NOT ENOUGH’

It is nearly a month since Dr. Karunanithi told the Local Democracy Reporting Service that he was unable to see “basic information” about the results of Covid tests on Lancashire residents.

The ability of local authorities to access that data in full also ignited a row over this week’s local lockdown in Leicester.

Dr. Karunanithi said that the picture was now becoming clear for him, after he started to be supplied with so-called ‘pillar 2’ results – from tests carried out in the community – as well as ‘pillar 1′ data form NHS settings.

However, he said that details and delays were still a source of concern.

“We have now got some data by postcode – but we want that to be coming to us daily, not weekly. We also only receive details of the tests that are positive – we want the number of overall tests so that we can work out the percentage [case rate].

“It’s moving in the right direction, but is not yet sufficient,” Dr. Karunanithi said.

A spokesperson for the Department for Health and Social Care said: “All councils in England now have the ability to access testing data, right down to an individual and postcode level.

“Public Health England has already been providing this data to directors of public health in the event of an outbreak so that they can take all necessary action to curb the spread.”

SECTOR-SPECIFIC ACTION

Lancashire’s outbreak control plan focuses on several key settings in an attempt to stem the spread of coronavirus.

BUSINESSES

The county’s businesses are being warned that inspections will be taking place of their Covid-secure arrangements – particularly targeting environments deemed to be high risk or in response to specific complaints.

Firms are reminded that they must carry out a risk assessment and should also be implementing two-metre social distancing where this is possible. Only where it is deemed unfeasible should that distance be reduced – and “everything practical” should be done to manage transmission risk.

Businesses are still obliged to do all they can to help employees work from home where possible.

Lancashire’s outbreak control plan also provides a detailed checklist of actions to be undertaken if an outbreak is identified within a workplace.

The government has said that rules on creating Covid-secure working environments have indirect legal enforceability, because businesses can be issued with an improvement notice – and fined or prohibited from operating if they fail to act on it.

SCHOOLS

In the event of an outbreak in a school, standard infection control measures will be put in place –including “cough etiquette”, a stepping up of cleaning and the provision of personal protective equipment, which is not otherwise being encouraged in educational settings.

Affected pupils and staff will be excluded from the premises of and, in the worst case scenario, the school could be temporarily closed.

CARE HOMES

Similar measures to schools above, but any closure would be likely to be limited to new admissions rather than the whole building and symptomatic staff and visitors would be excluded, rather than residents.

A multi-agency response would be triggered in the event of an outbreak which the facility was struggling to control. This would include instances where the care home’s business continuity plan had been activated, but was failing, and also in the event of specialist support being required for settings caring for people with complex needs.