[The Director of Public Health will give a verbal update on Covid-19 vaccinations and testing in the City of Wolverhampton].
Minutes:
The Director of Public Health gave a presentation on the subject of Covid-19 vaccinations and testing in the City. Wolverhampton currently had a case rate of 854.4 per 100,000. This was a very high rate in both a regional and national context. The percentage case rate was down by a percentage of minus 17% from the previous week, which was a positive sign. The average case rate in England was exceptionally high at a level of over 500 per 100,000. The cases per day were extremely alarming and there had been one day when they hit 486 cases in one day. The new Covid-19 variant, it was thought was driving the high rate of infection. Working with Public Health England, it was thought that the new variant accounted for over 70% of new infections in the City.
The Director of Public Health commented that the Wolverhampton Covid-19 case rate heat map was showing that the confirmed cases were increasing in the over 65’s and in people aged under 15. They were targeting people most at risk to encourage them to keep themselves safe and to limit their movement within the population. The messaging had resulted in a lower than expected death rate during the pandemic compared to the City’s health burden pre-Covid. He wanted to be able to continue this going forward. He was however concerned with the unprecedented rates of infection in people aged over 65. This was worrying as the health risks of Covid-19 increased as you aged. The impact of the high cases had not yet been seen within the hospital setting to the extent to which it would be in the future.
The Director of Public Health stated that testing within the City was the highest rate within the West Midlands and it was currently the eighth highest rate in the country. 17,479 tests had been undertaken in the seven days leading up to the 11 January 2021. Testing was a core part of the strategy in fighting the pandemic in Wolverhampton. He described the testing approach as a “Hub and Spoke” approach with a hub at the Civic Centre and spokes in the community, run by the community. The first lateral flow test pilot had commenced in Sedgley Street Gurdwara. At the end of the pilot 67% of those who had attended were from the BAME (Black, Asian and Minority Ethnic Community). This had far outstripped other delivery modes previously in the City, which reinforced their approach to build on the model. As a consequence, there was now a testing site at Bilal Mosque, St Joseph’s Church and Pendeford Library for key workers and in particular Teachers. There were 4 additional community sites scheduled to open in the forthcoming weeks. They would also be rolling out a Schools offer and a Workplace offer, for people that had to leave their home to go to work. A regular testing programme for these people was the intention.
The Director of Public Health presented a slide on Covid-19 patients at the Royal Wolverhampton NHS Trust. There were more Covid patients in the Royal Wolverhampton NHS Trust than during the Spring peak, with ICU beds especially under pressure. The City needed to do everything it could to support them over the next month. If people followed the guidelines it would greatly help lower admissions into the NHS. He presented a slide on NHS admissions by age. Due to the high amount of cases in the City, there were now more young people being hospitalised.
The Director of Public Health displayed a slide on the Covid-19 vaccine roll-out. The responsibility for the roll out sat with the NHS, discharged to CCGs and ‘system footprints.’ There was currently a three linked approach. There were the mass NHS Vaccination Centres with the nearest to Wolverhampton being Millennium Point in Birmingham. There was also the Local GP delivery through the six Primary Care Networks. He hoped that when people were called for the vaccine that they would take up the offer. As a system they needed to continue to communicate with the people of Wolverhampton about the rollout of the vaccine. In the week commencing 11 January all 6 PCN vaccination sites were operational. All Care Home residents and staff would be completed that week, apart from where there was a current outbreak. The new variant was so infectious it could rapidly spread through a Care Home, which would have a huge impact on vulnerable people. The absolute priority was to vaccinate the residents in the Care Homes.
The Chair asked the following questions:-
1. How many Wolverhampton citizens have been vaccinated to date?
2. Do you have any specific local vaccination targets?
3. Can you comment on the effectiveness of the Pfizer vaccine and the Oxford-Astra Zeneca vaccine?
4. Can you comment on the fact that the Government has stipulated that they are happy for there to be a longer gap between the first and second doses of the Pfzer and Oxford-Astra Zeneca vaccines?
5. How is the progress on vaccinating Care Home residents and staff going and what is happening to make sure this is done as efficiently and effectively as possible?
The Chief Executive Officer of the Black Country and West Birmingham CCG Senior Management Team concurred with the Director of Public Health on the priority to vaccinate Care Homes. They had presently vaccinated staff and residents at 46 out of the 69 Care Homes in Wolverhampton. Across the population as a whole, he thought that over 12,000 people had received the vaccine across Wolverhampton. The Director of Public Health added that in every way it was important to drive as much as possible the Council working with the health system to make the vaccination programme as efficient as possible. It was welcome that the CCG were prioritising the Care Homes and that it was an area of key focus for the Chief Executive Officer of the Black Country and West Birmingham CCGs.
The Managing Director of Wolverhampton CCG stated they did not have numerical targets for the number of people to be vaccinated. The local targets were the same as the national targets, which were in the public domain. The national requirement was that all Care Homes should be vaccinated by the end of January, they were well on track and ahead of reaching this target. The other national milestone was to offer the vaccine to all eligible people over 70 by the 15 February 2021. Provided there was enough supply of the vaccine into the City, the milestone would be reached locally within Wolverhampton. The Director for Public Health commented that the CCG recognised that there was a need to work as quickly as possible to vaccinate people given the high case rate and the attack rate of the new variant in the Care Homes. It was a race against time against the new variant and the roll out of the vaccine. The local need outweighed any national target figures.
The Chief Executive of the Royal Wolverhampton NHS Trust stated that he was pleased that the Director of Public Health’s report had indicated that the cases were plateauing. The day’s infection rate reflected the amount of ICU beds that would be needed in two weeks’ time. He expected the peak of hospital admissions to be around the 27 January. Things had been worse in the last two to three weeks than in the first wave of the pandemic. In the last seven days there had been 51 deaths. There had been two days recently when the deaths had been more on any day than the peak of the first wave in April. There were now 323 Covid-19 positive inpatients, whereas the peak of the first wave, on 10 April, there had been 282. The stresses on the system were extreme. He praised the collaborative working of the Trust and Public Health and gave particular praise to the Director of Public Health.
The Chief Executive of the Royal Wolverhampton NHS Trust stressed that his main priority was to keep the maximum number of people alive as possible. It was however expected that the figure of over 500 Covid-19 deaths at the Trust would be reached by the end of the week. He had taken the decision, with NHS England, to allow the media into the Accident and Emergency Unit and the Intensive Care Unit. The decision was taken to do this to try and combat the fake news that was circulating. He did have several empty wards but that was because he had redeployed staff and was not conducting any elective surgery. He had doubled the level of ventilator capacity to cope with the Covid-19 admissions. It was an inaccuracy to say that the NHS wasn’t under pressure because there were empty wards. He regretted that the seriousness of the situation in hospitals was not publicised at an earlier stage. He agreed with the approach of the Director of Public Health to have intensive Covid-19 testing within the City.
A Member of the Panel commented that having reflected on the Chief Executive of the Royal Wolverhampton NHS Trust’s comments, the situation was deeply distressing and very serious. She acknowledged the impact on people working at the Trust who were having to care for people with Covid-19. She asked about the extent to which people would receive false negative tests at the walk-in lateral flow sites. She had a concern that people’s behaviour might change on the receipt of a negative test and on the general accuracy of the test.
The Director of Public Health responded that people who received a positive result having taken a lateral flow test were encouraged to have a PCN test for confirmation. Anyone receiving a positive lateral flow test received a phone call as a follow up regarding the advice to undertake a PCN test. A person using a negative lateral flow test as a reason to change their behaviour missed the point of having it in the first place. Everybody needed to follow the national guidance of “hands, face, space.” People needed to avoid going to other people’s houses. Irrespective of people having a lateral flow test they needed to follow the guidance. Human contact was how the virus was able to spread.
The Chief Executive Officer of the Black Country and West Birmingham CCGs on the question relating to the efficacy of Pfzer and Oxford-Astra Zeneca, advised that his Doctor had informed him that there was very little difference between the two. They were also very safe. He encouraged people to take the vaccine as soon as they had the opportunity. He reinforced the Director of Public Health’s comment about the need to press ahead with vaccinations as quickly as possible. It was important to note that vaccines did not work immediately and could take 12-14 days before they really started to take effect.
A Member of the Panel commented that there was no information on local hot spots in the Director of Public Health’s presentation. He asked if this information was available on a ward by ward basis. The Director of Public Health responded that he would send the link of the public domain dashboard which would show the data on a ward basis, to the Members of the Panel via the Scrutiny Officer. With the new variant and its higher transmissibility rate and 1 in 40 people in the City expected to have Covid-19 at the current time, he didn’t think there was much value in trying to identify specific hotspots at the present time.
A Member of the Panel asked about the next steps once tests had been completed. The Director of Public Health responded that if someone tested positive for Covid-19 they would be followed up by National Test and Trace. There was also a local offer where everybody who tested positive would receive a phone call from the Council and a letter. The letter checked on how the person was, offered support and reinforced the key actions the person needed to take having received a positive result.
A Panel Member stated that a friend’s mother had died of Covid-19 the previous evening at New Cross Hospital. It was very important to convey the message about the seriousness of the virus and counter the fake stories appearing on Social Media. She stressed the need for more promotion of the key messages. The Chief Executive of the Royal Wolverhampton NHS Trust commented there had been a recent change in strategy and that he had been asked by NHS England to appear in front of the media. He had since done interviews with the BBC on National Television and an interview with Piers Morgan on ITV. He would be at the WMCA Press conference with the Mayor of the West Midlands the following day. There were many months in the pandemic where it was not publicised how bad things could become; he was pleased that the media strategy had changed. He was very sorry about the people who had lost their lives who worked within the organisation. No one had attended Medical School or entered a nursing career to watch people die and not be able to do much to help them. It was not what they were equipped to do, which meant it was especially hard for them. There were anaesthetists at the hospital who had trouble sleeping at night because they could remember the faces of all the people they had told they were going to put to sleep and that they may never wake up.
The Vice Chair asked if there were enough people available in the City to help administer the vaccine. He also asked about the accuracy of the lateral flow tests and if there had been people attending a lateral flow testing site who were expressing symptoms. The Director of Public Health responded that they asked people when they attended at a lateral flow site if they had any symptoms and they also took their temperature. There were six PCR testing sites in the City for people who were expressing symptoms. The results for PCR tests were now turned around within 24 hours. On the accuracy of the lateral flow test, he thought it was good at a population level. The Managing Director of Wolverhampton CCG stated that they did have enough people to administer the vaccine. Some of the expectations on providing some services in General Practice had been relaxed at a national level so they could focus their resources on delivering the vaccine.