This week is critical for pressure on NHS
This coming week will be critical in terms of the number of people becoming seriously ill with Covid and the pressure on hospitals, LB Hounslow’s Director of Public Health Kelly O’Neill told the Chiswick Area Forum on Tuesday 12 January. Health officials were expecting a spike in Covid figures after Christmas, and there has been one.
The critical time period in which people who get it badly end up going into hospital is 11 – 18 days after they’ve been infected, she told the meeting. As Monday was 11 January, this week is the crunch week in which people who caught Covid around New Year might become seriously ill.
Image above: Graph showing progress of the pandemic in Hounslow
On 11 January the figure for the total number of cases in Hounslow reached 16,094 recorded cases. Currently 1,141 people per 100,000 in the Borough are infected. Kelly noted that at the beginning of the pandemic the only testing was taking place in hospitals, so the figures for the early part weren’t an accurate reflection of the spread of the disease, but now they have a much more accurate picture and they are able to spot clusters and outbreaks.
They hadn’t anticipated the massive escalation in cases in December, caused by the new strain of the virus, but they had anticipated that the second wave would coincide with the usual winter pressures.
“It would have been great if the lockdown had come before Christmas” she said. and in a brutally stark assessment she added:
“Clinicians are going to have to make some very tough decisions.” While at the moment there is no one who isn’t getting the care they need “that might change” if the hospitals are overwhelmed.
The latest figures showed that West Middlesex Hospital had well over 200 in patients with Covid, with around 26 patients in Intensive Care. All but two wards are for Covid patients. The hospitals in west London had daily meetings at 08.00am she said, to talk about bed capacity, so there was very clear oversight, ensuring hospitals are being used most effectively to deal with the most acute cases.
Chiswick is the least affected part of the Borough
Despite Chiswick having had around 300 cases a week reported since Christmas, Chiswick is the least affected part of the Borough of Hounslow in terms of positive cases of Covid. Chiswick Riverside ward has the lowest rate of infection of the whole Borough. The central part of the Borough is the most affected, with the highest rates seen in Hounslow West, Hounslow Central and Heston West.
The majority of people who catch it are in the working age population. In Chiswick 67% cases have occurred in the 20 – 59 age range. 16% in over 60s. Women have been more affected than men – 53% cases in women; 45% in men. The infection occurs evenly in residential areas, not just in one particular area.
The reason rates are higher in the centre of the Borough has to do with the demographics, Kelly said: age, deprivation and exposure. The Black, Asian and Minority Ethnic (BAME) communities are more likely to be hospitalised and therefore at risk of dying. This was the position in the first wave and this has not changed. They are also the most likely to have high exposure jobs, working as carers, taxi drivers and security guards for example. Dense community living is a factor. Where they have seen clusters of cases, this is often in multigeneration households living in a confined space.
Lack of airport screening may have contributed to LB Hounslow Covid rate
Kelly also gave the meeting her personal view that Hounslow suffered from being near Heathrow airport. “Proximity to the airport has probably contributed to this” she said.
“I think we’ve missed a trick nationally with airport entry and we are still in a position where airport screening is not as robust as it needs to be”.
Image above: Queue for vaccinations at Chsiwick Health Centre; photograph Joanna Raikes
Praise for Chiswick Health Centre
Vaccinations are now being given at three centres in Hounslow – Chiswick Health Centre, Heart of Hounslow and Thornbury. A fourth centre in Feltham is being considered and also a mass vaccination site in Brentford willbe part of the programme.
“I have to applaud my colleagues in Chiswick Health Centre” she said. “They have vaccinated roughly 2,500 people in a few days because they got an extra batch of vaccine they weren’t expecting. This is an incredible feat”.
The Primary Care Networks are organising the vaccination programme at a local level. GPs have organised the location and the workforce. Asked when community pharmacies would also be brought in to deliver vaccinations, she said there were plans for this but, to be clear, there weren’t a lot of people spare to deliver the programme faster, nor is there the availability of the vaccine at the moment.
“There is not enough vaccine available at the pace it needs to be rolled out” she said, but that would not be the case in a few weeks’ time, as more production of the vaccines comes onstream.
Nationally 25% people who had been vaccinated had already had their second dose, she said.
“The view clinically is that these vaccines are interchangeable” ie. you could have a first dose of one vaccine and the second dose of another, though she said the NHS was trying to continue delivering two jabs of the same vaccine.
She also said that in her view it was better that 100 people received one dose than that 50 received two, this protected population health. One dose of Pfizer-BioNTech vaccine gives 90% protection. One dose of Oxford AstraZeneca –gives 70% with high protection against severe disease.
In response to a question from a member of the public asking if there could be information published so the public had some idea how far along vaccinations were progressing locally, she said LB Hounslow Chief Executive Niall Bolger had suggested the same thing and they were working on producing an accumulator so people in lower age brackets could see steady progress through the population and gauge progress, and when they were likely to get their jab.
You will be contacted by your GP
In answer to a question about elderly people who have not yet been contacted for a vaccination, Kelly said because of the logistics of getting the vaccination to the right place and the short turn around time to use it, people were getting their vaccination appointments at short notice.
Rest assured, she said “we do know about you and you will be contacted by your GP”. There are very few elderly or vulnerable people who are not known to a a local GP and if elderly people don’t have a mobile phone, don’t pick up the message, don’t open their post or otherwise get the message, they won’t be left out, they will be followed up.
“If people aren’t vaccinated it won’t be our fault. It will be because the vaccine isn’t available”.
Image above: Staff at Chiswick School delivering Rapid Covid tests
Delivering vaccinations and testing at the same time
Vaccinations are also being delivered to residents of care homes, at their homes, and to hospital and social care staff, at hospitals.
During the first lockdown the number of outbreaks in care homes was “small” and the number of deaths “minimal”. LB Hounslow acted early and made a £1 million investment in PPE and, said Kelly, had “done a lot of work on managing outbreaks”.
“Now we’re seeing increases because of the incredible transmissibility of the new strain and Council staff were doing a lot of work visiting and checking care homes, managing outbreaks at the same time as rolling out the vaccination programme.
Schools had done “a fantastic job” she said. Schools are not hermetically sealed environments. They have the infection brought in from the community. Quite a few schools had had to isolate children but there have been very few clusters in schools, which is a big achievement.
She said over the course of the pandemic there have been outbreaks of Covid at the hospital and at the Young Offenders institution. LB Hounslow has supported the Track & Trace programme, following up people they couldn’t track or trace with phone calls and knocking on doors.
New Covid testing centre planned for Stamford Brook for people showing symptoms
There are plans for a new testing centre for people who are showing Covid symptoms at Stamford Brook. Whether or not the site is suitable for PCR testing will be assessed on Friday 15 January, and if it is considered suitable, testing will go live in the next two weeks.
Currently there are PCR testing sites at Feltham, Hounslow Central, Heston, Heathrow and Twickenham. Central government is in charge of the delivery of Covid testing for people who are showing symptoms, through the Department for Health and Social Care.LB Hounslow is responsible for asymptomatic testing.
Asymptomatic testing is available at two sites in Hounslow at the moment, the nearest to Chsiwick being Hounslow House, the Borough’s headquarters in Hounslow town centre. There are plans to open two more sites in the Borough next week.
The schools are also carrying out testing on their staff and pupils. Chiswick School started Rapid Covid testing last week and Head Teacher Laura Ellener told the meeting they were pleased to have found several people testing positive, who were showing no symptoms. Given that they have the children of medical staff in school, that’s extremely useful information for the school to have. They are now testing all staff and children who are in school once a week.
Director of Public Health thanked for her outstanding work
The nine Hounslow councillors who represent Chiswick on Hounslow Council all thanked Kelly for her presentation and hard work. Leader of the Conservative group of councillors Gerald McGregor thanked her for her outstanding work. They have seen her give presentations on many occasions, but this was an opportunity for any member of the public who wanted to dial in to hear her address the Covid crisis as it affects the Borough of Hounslow and Chiswick in particular.
Laura Ellener, Head Teacher of Chiswick School, thanked her for her unfailing support, saying that even if she had a query at midnight she would get a response. Indeed Tuesday was Kelly’s birthday and she stayed till almost 10.00pm answering questions.
One question put to her was whether she felt she had had sufficient support from central government. She said there were times during the first lockdown when she was frustrated in the way organisation of the Covid response was so centralised, when she wondered what was the point of having Directors of Public Health in local councils.
“I’ve been working in public health protection for 17 years and I’m good at it!”
She also said she finds it frustrating that she finds out what Government policy is when everyone else does, from the press conferences. “It would be nice to get a couple of days warning” she said, so they could plan for 180 degree turns in policy.
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