Bristol’s local response to the coronavirus pandemic has so far been “very successful”, but deaths are still expected to continue to rise over the next few weeks, according to the city’s director of public health.
Confirmed cases in Bristol have nearly doubled in the past week and deaths in the city’s main two hostpials now stand at 95, but the official data suggests the south west is currently faring better than elsewhere in England – in terms of cases and deaths.
Speaking to the Cable, a prominent public health expert has criticised the government’s response to the pandemic. The former regional director for Public Health England (PHE) in the south west said moving away from community testing and contact tracing went against “all principles of good public health practice”.
However, in an in-depth interview with the Cable, Bristol City Council’s director of public health Christina Gray shed new light on the local response and how Bristol and the south west are coping compared with the rest of the UK.
Gray announced that drive-through coronavirus testing for Bristol’s key workers will be introduced by the end of the week. The news comes amid intense scrutiny of the government’s promise to ramp up testing across the country, and concern about NHS and other frontline workers without access to a test being unsure whether to self-isolate or continue working.
The full details of the regional testing centre are yet to be confirmed, but it is understood that it will be similar to the testing for NHS staff set up in recent weeks at a carpark at Ashton Gate. The Cable will update as more information is announced.
“The great news is that it will be available to all key workers,” Gray said, adding testing would be available subject to certain criteria. She took the opportunity to pay tribute to Bristol’s care workers, describing them as “the absolute heroes of the hour”.
The announcement will be welcomed by frontline workers not employed by the NHS. The Cable spoke to one personal carer who recently made the difficult decision to self isolate because she was concerned about infecting the person she cares for, who has a number of health risks.
Bristol’s covid response
Gray said that so far the south west has been “very successful” in slowing the spread of the virus in order to prevent health services being overwhelmed. However, she also said she expected deaths in the south west to continue to rise in the next few weeks in line with national figures.
There are currently 333 confirmed cases in Bristol and 668 if you add South Gloucestershire and North Somerset. Both figures have almost doubled in the last week. Gray said these numbers were a reflection of people ill enough to need hospital care, and that we no longer have an accurate idea of how many cases there are in the community.
“It’s very useful to get the message across nationally and locally that people are making huge sacrifices but those sacrifices are making a difference,” she told the Cable.
Even though the data doesn’t give a full picture, the south west is currently the region with the fewest confirmed cases. “We’re last in a race that we don’t want to win in the south west, so keep up the good work, folks,” Gray said.
“It is likely that we might see a series of low curves rather than a single peak because the virus is still within the community,” she added.
Gray also stressed the importance of mental health and wellbeing, in terms of isolation but also people not being able to grieve in normal ways when they lose a loved one. “Keeping that human contact is so important,” she said. “Isolation is not good for our health. That’s why the voluntary effort has been so important. It’s been massive, Bristol has just been the best.”
Gray has been part of conversations about covid-19 since January, and said emergency Brexit planning had helped respond to the global pandemic. She is part of Avon and Somerset Local Resilience Forum, the multi-agency partnership coordinating responses across the region. The work by public health teams includes advising Bristol Mayor Marvin Rees, working with the local NHS on mental health, and supporting other affected council services. Gray said: “Our surveillance and national public health systems are absolutely second to none.”
A key part of public health work is managing local outbreaks of cases. Over the Easter weekend, it was reported that an outbreak at Edgemont View Nursing Home in Oldland Common on the outskirts of Bristol had led to the death of a number of residents. Gray said that authorities across the region have been working closely with the care sector to provide support in case of an outbreak, but that no outbreaks of this seriousness had yet occured in care homes in Bristol.
Tracing cases in the community?
A common criticism of the government’s response relates to the scaling back of community testing and contact tracing when the UK went from the contain to delay phase on 12 March.
The government was accused of missing an opportunity after not deploying about 5,000 environmental health workers from local councils to do contact tracing. Instead, Public Health England used its own local health protection teams – just under 300 staff – who managed to trace just 3,500 people, until tracing was scaled back.
Gray confirmed that environmental health workers had been doing other health protection work to free up PHE staff to do contact tracing.
“In the containment phase, we did lots of contact tracing, where you screen lots of people who are negative, you find your positive case and then you identify people who have had contact. It’s very time consuming. That’s what happened until the end of the containment phase and [that] was led by Public Health England.”
“Once they moved into the delay phase, it was decided that most people would get this virus and in the community, there wouldn’t be testing. Testing was reserved for the hospitals to support the clinical management of patients.”
Gabriel Scally, a public health and epidemiology expert, who was PHE’s regional director for the south west for 20 years, told the Cable this move was the “major sign that things were going seriously wrong”.
“It was entirely and absolutely contrary to all the principles and good public health practice not to seek out cases and not to do contact tracing and assist those people to self isolate,” he said.
“What should have happened, and what should happen from now, is that contact tracing and community testing should all be handled at a local level in a joint effort between local authorities and the NHS in a properly structured and organised fashion. What happened is PHE was responsible for it, but it didn’t have the capacity to do what was needed, which was a national effort – tracking down this virus and stopping its spread.”
“Testing is such a low level that it’s only identifying a tiny percentage of the cases in the community, but as we move towards to lifting lockdown, it’s really important that we restore community testing on a huge scale and make it more modern, base the contact tracing on the use of mobile phone apps, to try and clamp down on outbreaks as they occur. This is particularly important for care homes and nursing homes in the community because we know from elsewhere there are likely to be a lot of cases there.”
Did lockdown come too late?
There has also been much debate about the government’s decision not to introduce lockdown measures sooner than three weeks ago, as other countries did so when the number of cases and deaths remained very low.
Gray said this decision was about bringing in measures that people would follow at crucial times. “There was a lot of criticism of why Britain didn’t lock down earlier. We’ve been in lockdown for three weeks now, if we’d locked down three weeks earlier, which is what a lot of people were shouting for, we’d have broken ranks right at the time we wanted everyone to be social distancing.
“It’s about compliance. What has been remarkable is that it seems that people have been more compliant than the government thought. That’s great.
“These are fine judgement calls and it’s not easy to make. There are a lot of social and cultural contexts behind this.” She gave the example of Sweden, which hasn’t introduced a lockdown, because it was thought their population would social distance anyway. The scientists behind Sweden’s softer approach have said it’s based on the need for public acceptance, although now cases have risen to more than 10,000 cases and 887 deaths – more than all the other Nordic countries put together.
“If we get this wrong, what will happen is too many people will become very sick all at once,” Gray said. “We will get a big spike and we won’t have capacity, even with the field hospitals.”
“If we are being successful – and we have [been] to date – it’s to make sure when people become unwell there is capacity in the health system to treat them, and right across the UK we have been remarkably successful in achieving that. Certainly, in the south west we have been very successful.”