Agenda item

Mark Adams, Director of Public Heath (South Tees) and Craig Blair, Director Of Commissioning, Strategy and Delivery at Tees Valley Clinical Commissioning Group (CCG) will be in attendance to provide an update on Covid-19 and the local Public Health / NHS response.

Recommendation: Panel notes the information provided.

The Director of Public Health (South Tees) was in attendance at the meeting to provide an update to the panel in respect of COVID-19 cases in Middlesbrough.

In respect of the number of positive COVID-19 cases in Middlesbrough the panel was advised that there had been a significant reduction in cases during May. A low number of cases during June and July before an increase at the beginning of August when the first new outbreak had been reported. The numbers had then continued to increase during September. For cases tested during the last 7 day period (13 - 19 September) there had been 60 positive cases in Middlesbrough. A rate of 42.6 per 100,000 population. This compared to 55 cases the previous week (6 - 12 September), a rate of 39.0 per 100,000 population. Middlesbrough had seen in a 9.1 per cent increase in cases over the last 7 days.

It was noted that over the previous 21 days the rolling 3 day average showed daily cases had remained steady before decreasing over the previous 4 days. It was advised, however, that a lag in cases being added could be the cause of the drop in the last few days. With regard to the pillar 2 testing rates (those carried out in the community, as oppose to in a hospital setting) showed that Middlesbrough ranked 44th highest nationally for rate of positive Covid-19 tests. The rates of tests per 100,000 population showed Middlesbrough was ranked 34th highest nationally. Information in respect of ethnicity data was presented, which showed the number of positive cases by ethnic group over the previous 6 weeks. It was noted that the proportion of cases affecting Asian residents in Middlesbrough had been high during the first half of August but this had since changed and the virus was now mostly affecting White British residents. It was emphasised that it was not the case that the BAME community was more at risk of contracting or transmitting Covid-19. However, the community was more risk of having a poor outcome.

In terms of the ages of those affected it was noted that cases in the most recent 14 days had affected young people and those in the 30-49 age group, with much fewer cases in the older age groups. However, the numbers affected in the older, more vulnerable age groups (70+) were starting to increase. A heat map showing the 66 positive COVID cases in the previous 7 days by ward and the count by Local Super Output A rea (LSOA) across Middlesbrough was shared. It was noted that the positive cases were spread throughout the town and there had not been any particular clustering identified.

In relation to contact tracing it was advised that this was being undertaken by Council staff in an effort to build local intelligence and develop a better understanding of where people had been in the presymptomatic period. Most of the younger group had advised that they had been 'out and about' and 80 per cent of transmission had taken place within households, as had been experienced in other parts of the country including Bolton and Blackburn.

Following the presentation Members were afforded the opportunity to ask questions and the following points were raised:-

-        Concerns were expressed about the number of people not wearing face masks in town and what action was being taken to address this issue. It was explained that the Street Wardens were being used and a sensitive approach adopted. The temperature guns had been used to initiate over 13,500 conversations and there was a need to generate a longer term commitment from the community to wear a mask in public to help protect everyone.

-       In respect of the case tracing it was confirmed that a very proactive approach had been adopted and other local authorities in the region had followed suit. The Council's BME Network Co-ordinator had also been very proactive in distributing the message across the mosque and the Council's Communication Team were actively involved in emphasising the importance of social distancing. Targeted communications had been undertaken by VCS organisations to tailor the message to older people, BME and other groups to ensure these were delivered by trusted voices. COVID champions had also been recruited to challenge false stories and articulate the reality of what was happening.

-       Reference was made to the current testing locations and the possibility of hyper-local testing being developed. It was advised that the status of this was not clear at present although it was something the Council was pursuing. The Director of Public Health (South Tees) advised that he was hopeful there would be more testing made available locally and the Council was making all the representations it could to make this happen.

The Medical Director at Tees Valley Clinical Commissioning Group (CCG) was in attendance to advise the panel that Tees Valley CCG had been chosen by NHS England as one of only three areas in the country to take part in a clinical pilot to support patients with COVID-19, through the establishment of a virtual ward.

In terms of background information it was advised that the Tees Valley has seen some of the highest infection rates in the country; with Middlesbrough having one of the highest infection and death rates. Some patients were presenting late, some had 'silent hypoxia’ - low oxygen levels and were unaware of how unwell they were and those presenting late at hospital had a poorer prognosis. The aim of the 'virtual ward' was to implement home monitoring in order to detect deterioration of 'silent hypoxia' and enable earlier intervention, with a view to improving outcomes.

The COVID virtual ward, referred to as Covid Care @ Home enabled patients who had tested positive for COVID-19 to remain at home but be provided with a pulse oximeter that would be placed on their finger and measure the patient's oxygen saturation levels. It was explained that the patients would then be asked to submit their readings via a digital App for up to 14 days. Staff on the virtual ward would monitor the oximetry levels twice a day and proactively contact patients who showed signs of deterioration, to ensure appropriate clinical support was available.

It was highlighted that the App also had an inbuilt safety netting, so that if a patient entered deteriorating saturations it would automatically generate advice around action required, including calling 999 or 111 for in and out of hours assistance as needed in addition to telephone monitoring, and face to face assessments where appropriate.

It was advised that referrals to the virtual ward could be made by GP Hot Clinics, Urgent Treatment Centres, on discharge from hospital, via test and trace and from Care Homes. Currently there were 24 patients on the virtual ward. The point was made that if an individual did not have access to a smart phone their data could be added by staff on their behalf.

In response to a query from the panel it was advised that at present there was plenty of capacity within the service but the ultimate aim would be to focus on patients that would derive the most benefit from remote monitoring. It was anticipated that there would be an evaluation of the 'virtual ward' pilot by NHS England next week prior to any national roll out of the scheme.

The Chair thanked the Director of Public Health (South Tees) and the Medical Director (Tees Valley CCG) for their attendance at the meeting and the information provided.

AGREED that the information presented be noted and a further update be provided to the panel at the next meeting.