Agenda item

7.1  The Chair stated that there was one urgent item under AOB.  He had requested the Director of Public Health to provide another verbal update on the Covid-19 numbers and the test and trace situation in Hackney and he welcomed Dr Sandra Husbands (SH) (Director of Public Health) to the meeting. 

7.2  The Chair stated that he noted the progress on the new Covid-19 dashboard and noted that Hackney had more cases than anywhere else in London.  There had been 97 reported cases in the last two weeks and wanted to know if it had increased dramatically because of the additional mobile testing.  He also wanted to know the percentage infection level within the Charedi community, whether the community was fully aware it was high and what stress testing the local Public Health team were doing with PHE on what the next steps needed to be.

7.3  SH stated that she would give an overview on infection rates and numbers in Hackney and what was being done.  Members’ gave consideration to a tabled slide presentation and she took Members through it in detail.

7.4  SH stated that Hackney didn’t have the highest rate in London but rather had the highest rate of increase.  920 confirmed cases had been logged to date.  During each of the 14 day counting periods the numbers had fluctuated.  The reason for this was twofold.  With PHE they looked at the recent period and at the baseline period early on in pandemic and made a calculation as to whether the rate was more or less than they would have expected. The rate of increase has been far more than expected in the past two weeks. 

7.5  She explained that that day there had been 13 new cases reported which had been the highest increase in a number of weeks and most likely related to the Mobile Testing Unit work in Stamford Hill on the previous Sunday.  They’ve had the highest increase of any London borough in the previous fortnight.  But to put this in context however she compared Hackney to Tower Hamlets, Newham, Waltham Forest and Barnet but also nationally to Blackburn with Darwen, where they’ve had to take some extra measures, and with Leicester where three’s been a significant problem, but which is now on the way down.  She added that the London average was 400 cases.

7.6  She described the analysis being done from the national dashboard which counted rates per 100k population.  From 11 May when lockdown measures had eased cases locally had tended to be younger.  Also, a number of household clusters in N16 area had been identified.  From 11 May to 28 July 91 additional cases and 42% of those (i.e. 95) had been in the N16 area.  Of those 95 cases in Stamford Hill area a fair proportion were household clusters associated with c. 2 households.  A significant number were single cases not associated with any household or setting.

7.7  The Chair asked whether the analysis points to a higher proportion overall from this N16 area.  SH clarified that there was, but it wasn’t the majority borough wide.  She added that another trend they’d seen was that recent cases were not just in N16 area but tended to be younger than those seen earlier.  This could be as a result of the fact that they’d changed the testing regime and were now testing more young people rather than, predominantly,  older people in care homes etc.  She added that as younger people were out and about much more there was a reasonable expectation of greater transmission among them.  In last period since 11 May the wards most affected were: Cazenove, Hackney Down, Springfield and Stamford Hill West. She described PHE’s national ‘Exceedance Report’ which showed diagnoses by date with Pillar 1 testing results coming from health care settings and Pillar 2 from the community or home testing.

7.8  In relation to what is being done she described how 3 weeks previously they had noticed a couple of linked household clusters in Stamford Hill and were able to target information and support accordingly.  They instigated an immediate communications campaign with a direct leaflet drop and including additional information for Stamford Hill.  Letters were sent to schools, they worked with the Rabbinate, they alerted local GP practices who the sent out text messages.  Many in this community do not engage with technology and this presented a challenge.  They were working with GOPs on a communications toolkit.  They have a Covid-19 Incident Management Team for dealing with spikes which operated on the same basis as if handling a full  outbreak.  They looked at risks, at key settings, at potential sources for clusters of infections and what needed to be done to get the key messages out quickly.  They’ve got the Environmental Health Team involved in supporting Public Health and currently they are prioritising Stamford Hill and working with synagogues by ensuring they have proper risk assessments in place.  They’re also working with colleagues in Haringey because the Charedi community straddled both boroughs.  They had the second Incident Management Team that day. They were expecting to see the curve of cases flattening off.  They were putting more measures in place, monitoring it very closely, developing more communications and were working on future planning to support the Charedi community more during the upcoming religious festivals in September and October.

7.9  The Chair asked, for the last two weeks, what was the percentage infection rate within the Charedi community specifically and how this equated to rates in the rest of the country.  He also asked whether in meetings with PHE they had discussed the various layers e.g Hackney, North Hackney, Charedi community.  As there were only 27k Charedi population the infection rate within it must be very high in comparison with the spike areas nationally, he asked.  He commented that maybe the borough response currently was appropriate but once you burrowed down to the level within a specific risky community the rate was surely much higher.  SH replied that the Incident Management Team was looking almost exclusively at the clusters of cases in the Charedi community and they were very aware of numbers of cases and with support of PHE they could go beyond just postcode data and identify and focus on those specific clusters. 

7.10  The Chair asked whether we have to communicate more about specific clusters and whether Public Health was satisfied that people in these areas were aware of the extent of infection rate compared to other places.  SH replied that there was an important balance to be struck here between making people understand there is a risk and issuing them with information within their community and not putting so much focus on one single community so it seems that they are the issue.  She added that they worked with the community to make sure messages go out in ways that help the public engage with them.  They do this by engaging local community groups and making sure communications are sensitive and culturally appropriate.  They also work with the Behavioural Change team within Public Health to ensure the messaging is effective.  She added that it is not always most effective to talk numbers to people, there are a variety of approaches.

7.11  A Member asked whether there was a traffic light system so that when a certain level daily infections was reached, there was then a move to lockdown and it triggered various actions.  She also asked if it was likely to have a London or borough level lockdown.  SH replied that she couldn’t say there wouldn’t not be a London lockdown.  At a borough level however a lockdown would be very difficult to achieve and enforce.  She stated she is involved in discussions with PHE and the GLA on what local lockdowns would entail.  On the ‘traffic light’ issue she stated that it was not as straightforward as having daily infection rate thresholds. A number of factors would need to be taken into consideration.  She added that Hackney had a significant increase in the number of cases but starting from a low base and against a background of low circulation levels of the virus in London.  Our immediate current position might look terrible vis-à-vis London but compared to the rest of England it was not.  Outbreaks do need to be nipped in the bud and they were working on this.  There was a danger they might miss out on other clusters by focusing on one area for example.  She added that in terms of being concerned about the potential of going into another lockdown, Hackney was very far from that scenario.

She added that before more stringent measures would be imposed, we would have to be having high numbers and the mitigations would have to be having no impact. Also, other circumstances would have to be affecting us which would for example prevent us from taking specific actions – it’s a question of looking at the whole context.

She stated that we need to monitor our processes and we need a consistent approach in each borough given we can’t lock down individually.  We also need a consistent approach to closing a premisis, for example, which Public Health now has the power to do. If we had and outbreak in a factory, for example, an efficient way to get on top of that would be to close the premises down depending on the context and the nature of the factory and of the work force and where they all lived etc.  Different levels of compliance in different cohorts would also have to be taken into consideration.

7.12  The Chair asked what the next stage up would be if the rates don’t drop and what is the next tool in Public Health’s armoury.  SH replied that we would ask people to comply with special measures that they aren’t doing now like greater wearing of masks.  There were a number of intervention measures that could be taken with the consent of the community.  The message would be that people would have to recognise that by complying this would avoid a full lockdown, which is what is happening in Blackburn with Darwen.

7.13  SH stated that the things we are doing currently will work but it will take a bit time because people are not fully compliant with current guidelines.  We need to get people complaint with these existing measures before we try to instigate new ones.  We need to double down on getting people to focus on current measures and comply with social distancing, hand washing and respiratory hygiene.  She added that social distancing had appeared to have slipped.  The Government messaging had changed from 2m to 1m distance and had confused people. The key point was that if you cannot manage 2m you need to be 1m apart and the two of you then then need to have a “plus” i.e. an additional mitigation.  It wasn’t the distance alone.  She concluded that the virus was a parasite and it needed a host and to be able to pass from person to person so therefore social distancing measures were vital.

7.14  The Chair thanked SH for her update and asked if she and Cllr Kennedy could continue to keep the Commission updated on the two rolling 2 week figures.  Should that increase it would heighten Members’ concern and they would appreciate if the Commission could maintain this overview.