Message from Julia Burrows, Director of Public Health, Barnsley - 2 June 2020

It's nearly three months since my first update stating that we were awaiting confirmation about a presumed positive case of Coronavirus (COVID-19) in Barnsley. So much has happened in such a short space in time and so many lives have been changed by the virus.

I wanted to use this update to talk about:

  • Coronavirus (COVID-19) figures in Barnsley
  • Schools opening to more children
  • Social distancing measures
  • Care homes and testing
  • Test and Trace
  • Hidden Harms

Thank you and stay safe,

Julia Burrows, Director of Public Health, Barnsley.


Coronavirus (COVID-19) figures in Barnsley

High figures of cases reported in the media

We do not have access to the scientific evidence, modelling, data and information which Scientific Advisory Group for Emergencies (SAGE) are using to inform the decisions being taken at a national level.

We do know numbers of cases are reducing across the country and in South Yorkshire.

I understand that people may find the recently reported number of positive Coronavirus (COVID-19) tests in Barnsley worrying. Whenever we see a change in pattern, we thoroughly investigate to understand the reasons why. We believe the recent variation we've seen has been associated with increased testing activity in care homes.

There is no basis for thinking there is more chance of being infected here than other parts of Yorkshire. We continue to review our local data and intelligence daily to make sure we aren't missing anything important locally. Although we see a natural variation in our figures, we have not picked up any significant differences between Barnsley and other areas so far.

Our local health care system

The NHS in Barnsley has responded exceptionally well to the challenge it's facing, and, to date, the local health system has not been overwhelmed. Critical care and specialist treatment are being provided to those who have needed it.

People who have recovered from the virus

It's important to talk about the people who are recovering from Coronavirus (COVID-19). Over the period from the 21 March 2020 to 28 May 2020, Barnsley had 335 new hospital Coronavirus (COVID-19) cases. In the same period, 245 hospital Coronavirus (COVID-19) hospital cases were discharged.

People who have sadly lost their lives to the virus

Sadly, as of 28 May 2020, there have been 208 deaths registered in Barnsley with a mention of Coronavirus (COVID-19) on the death certificate. 119 of these were in hospital, and 89 were outside hospital. Locally we reached the peak of the pandemic in April 2020, and death rates have been falling. No children or young people in Barnsley have died having been diagnosed with Coronavirus (COVID-19).


Please keep following social distancing guidance

The R number (the estimated number of people that one person will pass on the virus to on average) has come down across every part of the UK since the start of the pandemic. As of 29 May 2020, the R number in the UK is thought to be between 0.7 and 0.9. There's concern that the number is nearer 1 than we would like it to be.

R is a retrospective measure, and its calculation is extremely complicated and has to be based on very large sets of data, some of which is still not available, such as the true level of Coronavirus (COVID-19) infection in the population (we only know numbers of positive results, not the number of those who have been infected but were not tested). Although approximations of R across the country are often cited, attempting to calculate it on a place by place basis is not reliable.

Locally, we continue to analyse and review the impact of the virus. We do this through robust analysis of a range of different data. This informs our local response.

On 16 April 2020, the Government presented five tests for easing measures.  Test five (Be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelms the NHS), is the one I think we have to be especially careful about as we see the easing of a variety of restrictions. 

 I'm concerned about the risks of increased transmission of the virus through what we're currently seeing across the community of over-relaxation of social distancing, going well beyond recent guidance. This worries me far more than children slowly returning to school in carefully managed and controlled environments.

It is why, as a council, we're urging you to be more alert and more careful than ever about observing the now-familiar measures to reduce transmission in the community. These include regular handwashing; social distancing, staying at home and self-isolating if symptomatic, and we're keen to encourage you to wear face coverings in enclosed public spaces to protect others.

We must double our efforts as a whole community in Barnsley to adhere firmly to guidance to protect ourselves and each other. This must be in addition to the extra measures we have put in place to protect our most vulnerable residents; the elderly and those with underlying health conditions and those living in care homes.

Schools opening to more children

Schools in Barnsley have remained open for some children, including those of key workers over the past nine weeks.

Public health advice to inform the council's decision about gradually extending this to a wider group of children from 1 June 2020 has involved carefully balancing a variety of important considerations. It has been additionally complex due to the different approaches taken by other local authorities in South Yorkshire. Although I acknowledge this will seem confusing to people, it demonstrates what a finely balanced position it is.

We know that research is underway across the world to help us understand Coronavirus (COVID-19) better. As these studies continue and findings emerge, the evidence will increase. The one thing we do know is that we will have to deal with a level of risk resulting from coronavirus for the foreseeable future. In a world of uncertainty, all of us are having to learn to deal with risk and make balanced decisions based on imperfect evidence and knowledge. Our approach in Barnsley is to base our decisions on the best evidence available at the time, to follow national guidance and to consider our approach in the wider context of harms to the health and wellbeing of our residents, through both the direct and indirect consequences of Coronavirus (COVID-19).

We must weigh the risks of a potential increase in transmission of the virus from slowly and carefully extending school opening against the risk of not opening schools more widely. The current state of knowledge is:

  • The chance of children becoming seriously unwell from coronavirus is extremely small.
  • Children probably have the same, or possibly a lower, chance than adults of catching the virus.
  • Evidence from a number of settings suggests that, while it's possible for children to pass on the infection, it's rare.

We know there's a risk to children from missing out on education and socialisation. We're seeing worrying signs of harmful impact on the mental health of children and young people from the isolation they are experiencing. We know there are safeguarding risks for a small number of children and young people that may be made worse by not going to school. As in so many areas, those who lose out the most from not receiving face to face contact in an educational setting will be those from the most disadvantaged sections of our society. I'm worried that the long-term educational attainment gap that may result from Coronavirus (COVID-19) will be one of the many long-lasting tragedies of the pandemic.

I have seen impressive examples of how schools are risk assessing, planning and managing the creation of a safe environment as possible for children and staff. Conversely, if instead of being in school in a well-managed environment, children mix with wider and changing groups of family or friends outside home or school, the risk of virus transmission will be higher.

We're as confident as we can be that the decision to allow the gradual and careful further opening of schools from 1 June 2020 is the right one. We'll keep it under continuous review, and our decisions will always put the wellbeing of Barnsley people first.

 

Test and Trace

The national Contact Tracing Programme, NHS Test and Trace, has been launched. Contact tracing is important as it's about breaking the chain of virus transmission and viral spread. It's not directly about protecting individuals and keeping people safe, though it does have that effect indirectly by limiting transmission of the virus and keeping the number of cases low.

While NHS Test and Trace is not yet as well established as we would have hoped, we're working intensively on how we can provide additional local support to the national programme as soon as possible. In the meantime, Barnsley's public health team has local outbreak management plans for schools. We have tried and tested measures in place to support Public Health England in helping schools and early years settings with contact tracing, based on our approach to working with schools on other infectious diseases.

Locally, we have a testing offer which is continually increasing its capacity. All adults and children can access testing if they become symptomatic. Access to data from test results from wherever they are taken is not yet perfect, but it is improving.


Testing in Care Homes

Public Health England is providing testing for Care Homes, and in Barnsley, we also have a local Care Home Plan for testing to help keep care homes safe and shielded from the virus and to effectively support and manage outbreaks early.

In May, our local health partner, South West Yorkshire Partnership NHS Foundation Trust (SWYPFT), started the process of testing all care homes staff and residents, including those who may be asymptomatic. Although the vast majority of our care homes appear to be COVID free, we have unfortunately seen a number of cases in some homes, and this has contributed to the recently reported number of positive Coronavirus (COVID-19) tests.


Hidden harm

I don't think anyone really knows what the total impact of Coronavirus (COVID-19) will be on our local communities, but we do know that people are struggling. Our residents already at a disadvantage or those who already had vulnerabilities have been the most affected by Coronavirus (COVID-19), but we know that more and more people across the borough are finding things such as social distancing measures and financial pressures difficult to deal with. Some of that is visible, but most of it is invisible.

Identifying and responding to hidden harm is a crucial element of our recovery strategy, and everyone has a role to play.

There are many definitions of hidden harm, but the three suggestions here may help you to consider what it means for you and your families:

  1. The first is harm by permission and is due to services being diverted to support the Coronavirus (COVID-19) response. An example of this harm is a person who has a late diagnosis and treatment of heart disease owing to a longer wait during the pandemic and consequently has a higher level of lifelong disability.
  1. The second is harm by suppression and is due to unplanned or unanticipated consequences of Coronavirus (COVID-19) and social distancing. This is largely the effect of social isolation and anxieties about the virus combined with a reduction in available services. These effects mean people's health and social needs increase, but people don't or are unable to, access services and support. An example of this harm is someone who suffers from more severe mental illness due to social isolation, reduced access to support services and more serious financial difficulty, and consequently suffers severe mental illness.
  1. The third is harm by oppression which is probably the most difficult to identify. This is due to the exploitation of the circumstances brought about by Coronavirus (COVID-19 and social distancing. This is where people use the situation to harm others or unduly benefit themselves. This is the most hidden type of harm, the hardest to monitor and address, and it is the most vulnerable people in our population who are at greatest risk. Examples of this harm could include someone suffering abuse at home that's not identified because of lesser visibility during social distancing, or someone living alone who's the victim of a fraudulent call offering support.

We all have a responsibility to turn over every stone and continuously look for those who need the most help. You can report any concerns to us via our website or by calling:

  • Concerns about a child: (01226) 772423 
  • Concerns about an adult: (01226) 773300

You can also find lots of information and support specifically about Coronavirus (COVID-19) on our website.

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