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Knowsley COVID-19 Outbreak Prevention,

Management and Support Plan

30 June 2020

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Contents Page

Section 1 - Introduction, Aim, Objectives and Scope of the Plan 4 Section 2 - Prevention of COVID-19 in Community Settings 14 Section 3 - Identification and Notification of an Outbreak 20 Section 4 - Outbreak Management 23 Section 5 - Declaring the End of an Outbreak 29 Section 6 - Support to Vulnerable People 31 Section 7 - Data Management 32 Section 8 - Governance 33 Section 9 - Communication 38 Section 10 - Joint Operational Learning / Sharing Best Practice 39

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List of Appendices Page

Appendix 1 COVID-19 40 Appendix 2 Key National Guidance 41 Appendix 3 Key Definitions 42 Appendix 4 Outbreak Control Team Terms of Reference 45 Appendix 5 Outbreak Control Team Template Agenda 46 Appendix 6 Enforcement Approach 47 Appendix 7 Local Testing Pathways (in development) 51 Appendix 8 COVID-19 Equality Impact Assessment 52 Appendix 9 Outbreak Management Board Terms of Reference 59 Appendix 10 Outbreak Management Board Template Agenda 63

Disclaimers: This draft Plan has been developed by drawing upon work by the Cheshire and Merseyside Public Health Collaborative.

This draft Plan has been signed off in principle by the Leader of Knowsley Council, the Chief Executive of Knowsley Council, and Knowsley Council’s Director of Public Health to guide local work to contain outbreaks and will be submitted for formal approval by Knowsley Council’s Cabinet on 29 July 2020.

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1. Introduction

COVID-19 is an infectious disease caused by a newly discovered Coronavirus.

Most people infected with the COVID 19 virus will experience a mild to moderate self-limiting illness. Some will not experience symptoms at all.

However, some people who are infected will suffer more severe symptoms. More severe illness is associated with a number of risk factors, such as

older age and pre-existing long-term conditions.

The main symptoms of COVID-19 are:-

A new continuous cough;

A fever (a temperature of 37.8°C or higher); and/or,

A loss of or change in normal sense of taste or smell (anosmia).

COVID-19 is passed from person to person mainly by large respiratory droplets and direct contact. It can also be transmitted by indirect contact -

droplets can land on surfaces which another person may touch and this can lead to infection if that person then touches his/her nose, mouth and/or

eyes.

The virus has caused a global pandemic. Nationally, a steep peak in cases in early 2020 led to unprecedented restrictions on the lives of citizens in order

to control the virus. Following the introduction of national social distancing measures, cases decreased. However, as these restrictions are relaxed, there is

an urgent need to establish mechanisms to identify viral transmission within the community and settings, and then to put in place public health measures rapidly to control

such transmission.

The best way for people to prevent and slow down transmission is by them washing their hands and/or using an alcohol based rub frequently, and by

not touching their faces. Respiratory hygiene is also vital, when a person coughs or sneezes (“Catch it, Bin it, Kill it”). People are also still

recommended, where possible, to limit their contact with other people outside of their households. People who develop symptoms of COVID-19 should

self-isolate at home, and get a test as soon as possible. Their household members should self-isolate for 14 days or until the suspected case has a

negative test.

Section 1: Introduction, Aim, Objectives and Scope of the Plan

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Contact tracing is an effective public health measure for the control of COVID-19. It requires the prompt identification and management of the contacts

of cases in order to disrupt onward transmission. Identified contacts are then required to self-isolate for 14 days from the day when they were last in

contact with the infected person.

Outbreak management ensures that, if transmission does occur in a setting, action is taken in a timely manner to mitigate the impact of any outbreak

and get it under control as soon as possible.

1.1 Aim

The Knowsley Outbreak Management Plan describes local coordinated arrangements to prevent outbreaks of COVID-19 and to support the national Test

and Trace programme and the Cheshire and Merseyside Test and Trace Hub to ensure the effective and co-ordinated detection and management of

COVID-19 outbreaks within Knowsley.

1.2 Objectives

Prevention of cases, clusters and outbreaks by providing targeted advice and support to identified settings, workplaces and communities

Reduction of onward transmission, morbidity and mortality through the rapid identification and isolation of cases, and by identifying, alerting and

supporting contacts of cases

Early identification of outbreaks through the use of hard and soft intelligence

Prevention of future cases by identifying potential sources of exposure, risk factors for infection, and implementation of appropriate prevention

and control measures

Provision of continued support to vulnerable local people

Provision of a framework to support rapid decision-making in support of preventative action

Work at the most appropriate footprint to deliver effective, efficient services and actions whilst ensuring local understanding of communities

and needs

Capture of joint operational learning in order to develop and share best practice

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1.3 Principles

The prevention and management of the transmission of COVID-19 in Knowsley is:-

1. Rooted in Public Health Systems and Methodology

Knowsley Council’s Director of Public Health has a statutory duty to be assured that arrangements to protect the health of the Knowsley

community are robust and implemented. The Director of Public Health provides local expertise to enable an effective community-led response to

outbreaks of any disease or illness. Well-established public health systems rely on tried and tested methods with Public Health, Infection Control

and Environmental Health at the heart of such arrangements, working with communities, and local leadership. The expertise and the delivery of

specialist health protection functions by Public Health England is a central part of the prevention and management of COVID-19. A local hub model

ensures that this expertise is close to Knowsley and supports the development and maintenance of working relationships between partner

agencies.

Public Health England is mandated to fulfil the Secretary of State for Health’s duty to protect the public’s health from infectious diseases, working

with the NHS, local government and other partner agencies. This includes providing surveillance, specialist services (such as diagnostic and

reference microbiology), investigation and management of outbreaks of infectious diseases, and ensuring effective emergency preparedness,

resilience and response for health emergencies. At a local level, Public Health England’s Health Protection teams and field services work in

partnership with Directors of Public Health, playing strategic and operational leadership roles both in the development and implementation of

Outbreak Control Plans and in the identification and management of outbreaks.

A national Public Health England Outbreak Control Plan describes the formation of Outbreak Control Teams, which will assess the risk to the

public’s health, and ensure that the causes of outbreaks are investigated and that control measures are implemented as soon as possible.

This Plan builds on existing systems of working, and local roles and responsibilities.

The Plan is rooted in prevention, infection control and health protection, and utilises intelligence to enable targeted action, including testing, if

required.

The Plan relies on work undertaken by the Association of Directors of Public Health (https://www.adph.org.uk/2020/06/guiding-principles-for-

effective-management-of-covid-19-at-a-local-level/).

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2. Supported by Effective and Transparent Leadership

Relying on professional, technical and legal advice, the Outbreak Management Plan will be led by those responsible for the leadership of the place

and the local community. The Outbreak Management Board will be led by Elected Members from Knowsley Council and will also include

leadership from the public agencies who form the Knowsley Better Together Partnership. The Board’s responsibilities are set out in section 8.2.1.

3. Based on a Whole System Approach

A wide range of Knowsley Council services and partner agencies beyond the Council work together to prevent and mitigate the impact of COVID-19

as described in the Plan. Escalation, where required, to the Merseyside Local Resilience Forum will support whole system action. Local

engagement will be key to the success of the Plan, from consultation to communication on the ground to support behaviour change.

4. Delivered through an Efficient and Locally Effective Responsive System

Intelligence will be at the heart of decision-making and action. The Plan sets out the detail of when a multi-agency response may be required and

supports the principles of mutual aid across the system. The governance system will ensure the timely collation and analysis of data to inform local

actions and to monitor outcomes. Local leadership will be the default position, while remaining sufficiently flexible to deal with larger cross-border

issues. Clear outbreak plans, including site-specific plans with clear roles and responsibilities, will support effective responses.

5. Sufficiently Resourced

The unprecedented nature of COVID-19 means that anticipating outbreaks is difficult at this point and the response model therefore needs to be

flexible and react to surges in demand. A partnership approach to the prevention and management of COVID-19 both at Cheshire and Merseyside

level but also among Knowsley Better Together partner agencies will enable a reactive system to develop a flexible response to what remains a very

uncertain situation. The development of longer term mutual aid across Merseyside will supply additional surge capacity for times of increased

outbreak activity. Investment in prevention, awareness raising, support and advice to (for example) schools, care settings and workplaces will result

in less demand for management of the consequences of poor infection control.

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1.4 Scope

This Plan will be used for the prevention, investigation, management and containment of community outbreaks of COVID-19 in complex settings within

Knowsley which are not already covered by the existing outbreak control processes detailed below:-

Outbreaks within care homes will be managed according to the North West Care Home Outbreak Control Plan, adapted for Knowsley and in line

with national guidance.

Outbreaks within schools and early years settings will be managed in accordance with the Knowsley Educational and Child Care Settings Outbreak

Management Plan, and in line with national and local guidance, including the Public Health England North West COVID-19 Template Resource Pack

for Schools, and Knowsley Supplementary Schools Guidance.

Outbreaks within specific NHS Trust premises (whether acute, community or mental health trust) will usually be led by the relevant NHS Trust in

accordance with the associated local operational plan., alongside national guidance on the mitigation of risk of transmission between acute and

community settings.

Local guidance for the above sectors is available for reference. Any revisions of this guidance will be communicated directly with the relevant sector.

The Knowsley Outbreak Management Plan sits within a national system which aims to identify COVID-19 cases and use contact tracing and outbreak

management to control the transmission of the disease. The key stakeholders are described below:-

Body Role

National Contact Tracing Advisory Service Identifies and gets in touch with close contacts of individuals with confirmed COVID-19. Advises

such contacts on self-isolation. Identifies complex cases for escalation to Public Health England.

Public Health England North West Working within the Cheshire and Merseyside Contact Tracing Hub, provides expertise to

support contact tracing of complex COVID-19 cases and escalates to the Knowsley Council

Single Point of Contact cases of concern, or outbreaks. A Memorandum of Understanding will

underpin the work of the Hub which is jointly resourced by the Cheshire and Merseyside Public

Health Network, Cheshire and Merseyside local authorities, and Public Health England. The

Hub is hosted by Wirral Council.

Knowsley Council Single Point of Contact Receives referrals from the Cheshire and Merseyside Contact Tracing Hub, takes initial

information and identifies key actions before referral to the Knowsley COVID-19 Management

Team.

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Knowsley COVID-19 Management Team Responsible for the management of cases and outbreaks as escalated to the Team. Includes

Public Health Consultant, Public Health Programme Managers, Environmental Health Officers,

Northwest Boroughs Hospital Community Infection Control Team, and data analysis and

communications resources.

Outbreak Control Teams Will be formed when outbreaks are causing concern. A multi-agency team of experts in

infection control, as stakeholders involved in the outbreak setting. The Teams will manage

outbreaks and implement control measures, including making recommendations to the

Outbreak Management Board. The Teams will be responsible for declaring the end of each

outbreak.

Knowsley Outbreak Management Board Will oversee and review all activity within Borough in respect of reported COVID-19 outbreaks,

including ensuring that appropriate actions are being taken at the right time and by the right

agencies, that the vulnerable are receiving support, and that effective and clear communication

with the public is being maintained. In respect of the most significant outbreaks, the Board will

itself make recommendations to the appropriate organisations or bodies. The Outbreak

Management Board will be supported by the Knowsley Health Protection Forum and the

Merseyside Local Resilience Forum meeting structures, as well as being accountable to the

Government in respect of outbreaks of COVID-19 occurring within Knowsley.

Knowsley Health Protection Forum Ensures that the Knowsley Outbreak Plan is protecting the population from threats to health.

Examines the available intelligence on COVID-19 activity and the actions being undertaken to

prevent and mitigate its impact. Supports the Outbreak Management Board in providing

assurance that appropriate actions are being taken.

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The Cheshire and Merseyside COVID-19 Test and Trace Hub will receive complex cases identified from the National Contact Tracing Advisory Service, for

example:-

Cases living or working in care homes/long-term care facilities or other care facilities for those with complex needs

Cases in healthcare workers or emergency service workers

Cases who attended healthcare for reasons other than COVID-19, whilst in the infectious period

Cases amongst those living in homeless hostels or shelters or refuges and similar residential settings

Cases amongst those attending or working in special schools

Cases amongst those attending day care centres for older/vulnerable people

Cases or employers unwilling to provide information

Cases where contacts cannot be identified without disclosure of names to employers or third parties.

The Hub will, where appropriate, refer cases to Knowsley Council - for example, a referral will be received by the Council’s Single Point of Contact (who

will then refer it as appropriate to the COVID-19 Management Team) when:-

• A large number of contacts are likely to meet the proximity or direct contact definition

• High numbers of vulnerable people are identified as potential contacts within the setting

• There is potential significant impact on service delivery if staff are excluded for 14 days from exposure

• There are significant consequence management concerns

• There are concerns around the support needs of a potentially vulnerable individual or household

• An Outbreak has been declared

• There is a case in a healthcare setting

• Death or severe illness has been reported in the case or contacts

• There is likelihood of significant public interest in the situation

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• There is the potential for cross-border outbreaks

This approach is described further in section 3.2.

A Merseyside Team will be formed within a Hub model, providing efficiencies for shared functions (such as contact tracing), and where appropriate for

surge capacity and mutual aid. The Hub will allow for the development of common working procedures and allow faster system learning. The

development of the Hub will be led by ongoing learning of what is working well, as well as exploring demand. This approach will also be reflected within

Knowsley’s operational planning.

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1.5 The Hub Model

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1.6 Overview of COVID-19 Outbreak Management Process within Knowsley

COVID-19 Data Protection Impact Assessment will be undertaken in parallel to the development of this Plan.

A COVID-19 Equality Impact Assessment has been undertaken and is attached at Appendix 8 to this Plan.

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2.1 The Role of Prevention

Prevention is the most effective method of stopping transmission and outbreaks of COVID-19. Stringent attention to social distancing advice, regular

hand washing, respiratory hygiene, use of appropriate Personal Protective Equipment and face coverings (as directed by national guidance), and

effective cleaning should be in place in all settings during the COVID-19 pandemic.

2.2 Preventative Action undertaken by Knowsley Council

Knowsley Council will:-

Continue to ensure that any national, regional and/or local sector-specific guidance is disseminated appropriately

Continue to work with partner agencies (including in the care sector, Knowsley Clinical Commissioning Group, Primary Care, Acute and

Community Trusts) to support the care sector and ensure that there are robust procedures in place within high risk care settings to mitigate

the risk of COVID-19 infections

Continue to work with educational settings to ensure that there are robust plans and procedures in place to mitigate the impact of COVID-19

and reduce the risk of outbreaks

Identify and contact a range of settings, groups and places to help to ensure that they are COVID-secure (i.e. that they have a COVID-19 risk

assessment, and safe operational systems for employees, volunteers and visitors relevant to the function of the place, setting or group,

activity and business continuity measures in place)

Identify those in the community who are more vulnerable to the severe effects of COVID-19 in order to provide and facilitate targeted advice

Provide advice and specific guidance relevant to employers to ensure safe systems of work (see section 2.3)

Provide advice and signposting to support complex settings and communities as appropriate

Develop a workforce development programme for front-line staff (Council and non-Council) and volunteers with a focus on infection, prevention

and control, and outbreak management

Work with partner agencies to develop an effective testing strategy to enable the early identification of COVID-19 and mitigate the risk of

Section 2: Prevention of COVID-19

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outbreaks

Support a widespread communication strategy which promotes test and trace and self-isolation where necessary

Support vulnerable people to self-isolate

Establish governance structures and a new Elected Member-led Board to develop and maintain oversight of Knowsley’s Outbreak

Management Plan; provide regular update reports to Knowsley’s Scrutiny Committees to support their oversight and scrutiny

responsibilities in respect of the COVID-19 pandemic and communicate with the general public, supported by the expertise of the COVID-19

Health Protection Forum in conjunction with local NHS and supported by existing Gold Command forums

Proactively support national communications through a local COVID-19 Communications Plan

Keep this Plan under regular review in order to ensure that it captures joint operational learning and shares best practice

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2.3 Mapping High Risk Settings

Knowsley Council and partner agencies have mapped out possible high risk settings in order to inform more targeted prevention advice and activity.

These settings are described (in category terms) in the table below:-

Complex Settings High Risk Communities High Risk Places and Locations

Hotels housing homeless residents

Hotels housing refugees and asylum

seekers

Homeless hostels

Learning disability supported living

Extra Care housing

Care homes

Mental Health residential settings

Secure residential facilities

Youth housing

Probation Centres

Primary Care (GP Surgeries, dental,

optometry, pharmacies)

Gypsies and Travellers

Homeless

Substance users

Refugees and asylum seekers

Migrant workers

BAME communities

Domestic abuse victims

Sex workers

Older people

Early years / childcare settings (not

covered by guidance for schools)

Public / shared transport

Workplaces

Other well-defined settings and

gatherings, such as places of worship /

private social events

Houses of Multiple Occupation

Sports and recreation places – indoor or

outdoor

Day care (including community clubs)

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2.4 Preventative Action undertaken by Employers

It is important for employers to continue to protect the health and safety both of their workers and of other people who may be affected by their

business, including agency workers, contractors, volunteers, customers, suppliers and other visitors. To help employers and the self-employed, national

guidance has been developed on the five steps for working safely along with sector-specific guidance:-

Five steps for working safely: https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/5-steps-to-working-safely

Sector-specific guidance: https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19

There is also guidance available for education and childcare settings, residential care and nursing homes, and public transport operators:-

Guidance for education and childcare settings: https://www.gov.uk/government/publications/coronavirus-covid-19-implementing- protective-

measures-in-education-and-childcare-settings

Guidance for children’s services, including foster carers and children’s homes: https://www.gov.uk/government/publications/coronavirus-covid-

19-guidance-for-childrens-social-care-services

Guidance for residential care and nursing homes: https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-

people-in-care-homes

Guidance for transport operators: https://www.gov.uk/government/publications/coronavirus-covid-19-safer-transport-guidance-for-

operators/coronavirus-covid-19-safer-transport-guidance-for-operators

It is important to follow national guidance to help to reduce the risk of a spread of infection in the workplace. Employers must continue to follow

the relevant health and safety workplace guidance for their sectors, including:-

making every reasonable effort to enable working from home as a first option

where working from home is not possible, identifying sensible measures to control the risks in the workplace

keeping the workplace clean, maintaining safe working separation, and preventing transmission through unnecessary touching of potentially

contaminated surfaces

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The measures which employers put in place to maintain social distancing will depend on their individual business circumstances, including their

working environment, the size of a site, and the number of workers involved. The available guidance will support employers to make an informed

decision in each case.

Employers also have a key role in supporting the National Test and Trace Service and should where possible put into place systems which are able to

capture staff who have possible COVID-19 and recommend that they access testing in order to enable the national system to instigate contact tracing.

The definition of a close contact involves requesting people who have been within two metres of a confirmed case when they were infectious for 15

minutes or more to self-isolate for 14 days. Good social distancing within a workplace setting will reduce the impact on the employer of a confirmed

case in a workplace setting.

If workplaces requires advice on prevention measures and or suspects an outbreak or cluster within their settings, it is essential that they contact the

Council’s Environmental Health service (see section 3 for key contacts).

2.5 COVID-19 Risk Assessment

COVID-19 is a new risk which must be incorporated into workplace risk assessments. Employers must therefore carry out a new COVID-19 risk

assessment if they have not already done so. The Health and Safety Executive has published guidance to help businesses to conduct COVID-19 risk

assessments: https://www.hse.gov.uk/news/working-safely-during-coronavirus-outbreak.htm

Employers have a duty to consult their workers, and unions where applicable, as part of their risk assessment. Involving workers in this way will help

to build trust and confidence that all reasonably practicable steps are being taken to reduce the risks of COVID-19, so that people can return to work

safely.

Employers should share the risk assessment with workers and consider publishing the risk assessments on their websites. Examples of measures

which businesses can implement include:-

Adhering to COVID-19 guidance for the particular setting

Proactively maintaining a risk assessment approach to preventing COVID-19 in the setting

Limiting visitors

Using social distancing floor markings and barriers

Shift and service managers proactively asking staff and any volunteers if they are symptomatic at the beginning of each shift

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Ensuring that staff follow social distancing measures to the best of their ability, including in staff spaces such as break rooms

Where premises are part of a group, trying to limit staff movement between facilities

Consideration of limiting staff movements within facilities, e.g. individual staff only working on one floor of a facility

Increasing the frequency and intensity of cleaning for all areas, and focusing on shared spaces and high touch points

Maintaining an accurate daily list of all staff and visitors to premises (with in and out times)

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3.1 Identifying a COVID-19 Outbreak

An outbreak is defined as two or more cases who have tested positive for COVID-19 within the same 14-day period, amongst people who either

work at or have visited a specific setting. Local surveillance data may also identify multiple cases within specific communities or clusters of

outbreaks with localities, thereby requiring a co-ordinated response. In residential care homes, an outbreak is defined as two or more

symptomatic cases (or laboratory confirmed case) within the same 14-day period.

3.2 The NHS National Contact Tracing Advisory Service (Test and Trace Service)

If an employee, client/service user, resident or visitor tests positive for COVID-19, the NHS Test and Trace service or the Cheshire and Merseyside

Test and Trace Hub will help to identify people at high risk of having been exposed to the virus through recent close contact with that individual.

The service or the Hub will alert those contacts who meet defined risk criteria, based on the proximity and duration of the contact which they have

had, and provide advice on the steps which need to be taken. This will include individuals being informed to self-isolate and in certain circumstances

may require contacts to be tested.

If contact tracing and subsequent testing identifies two or more cases of COVID-19 from a specific workplace or setting, the NHS Test and Trace

service will activate the outbreak notification process. An assessment will be made by Public Health England (see escalation criteria in section 3.3)

who will escalate for information or for action. Details of the outbreak will be forwarded to Knowsley Council’s Environmental Health team via a

Single Point of Contact (SPOC).

3.3 Criteria for Escalation

In certain circumstances, Public Health England (in consultation with the Director of Public Health) may decide to convene a multi-disciplinary

Outbreak Control Team. In making an assessment, the following criteria for escalation will be taken into consideration:-

A large number of contacts are likely to meet the proximity or direct contact definition

High numbers of vulnerable people are identified as potential contacts within the setting

The potential impact on service delivery if staff are excluded for 14 days from exposure

Section 3: Identification and Notification of an Outbreak

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Significant consequence management concerns

Concerns around the support needs of a potentially vulnerable individual or household

An Outbreak has been declared

Case in a healthcare setting

Death or severe illness reported in the case or contacts

Significant likelihood of public interest in situation

Potential for cross-border outbreaks

This consideration will be applied in all instances, whether escalation is “for action” or “for information”. The Knowsley Outbreak Management Board

will be informed of these situations and whether such escalation is for action or information.

3.4 Outbreaks requiring Multi-Agency Co-ordination

For outbreaks which require multi-agency command and control in place across Merseyside or regionally, action will be taken via the following

mechanisms:-

During day to day business via the Merseyside Local Resilience Forum Secretariat using current COVID-19 structures and the establishment of an

extraordinary Tactical Co-ordinating Group or Strategic Co-ordinating Group

Out of normal business hours, activation of the Tactical Co-ordinating Group or Strategic Co-ordinating Group through Merseyside Police (via the

Force Duty Officer) in accordance with the Merseyside Emergency Response Manual

A Major Incident has already been declared in response to COVID-19 - should this be downscaled, consideration would also need to be given to the

declaration of a Major Incident.

The requirement for this should be determined by the Outbreak Management Board, as advised by the Director of Public Health in consultation with

Public Health England.

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3.4 Identification and Escalation of an Outbreak by Other Means

COVID-19 Outbreaks may also be recognised by a setting, service provider, Microbiology or Virology service, Infection Prevention and Control Team,

Environmental Health or other Council service area, voluntary organisation, Public Health England, Cheshire and Merseyside Test and Trace Hub or

through local surveillance data.

As soon as they suspect an outbreak, residential care homes should notify Knowsley’s Infection Prevention and Control Team during working

hours or Public Health England out of hours following normal practice for any infectious disease outbreak. Knowsley’s Infection Prevention

and Control Team would notify the Environmental Health Single Point of Contact of any such notification.

All complex settings identified in section 2.3 are required to notify Knowsley Council’s Environmental Health Single Point of Contact as soon

as possible where they suspect an outbreak or cluster (i.e. where they have two or more symptomatic or confirmed cases within a 14-day

period linked with their setting and have not yet received telephone advice or support).

To report a suspected outbreak or cluster, contact:-

Environmental Health Single Point of Contact for COVID-19 Telephone: (0151)-443 4712

Email: environmentalhealth@knowsley.gov.uk

9.00 a.m. to 5.00 p.m.

After 5.00pm or at weekends or on Bank Holidays, contact:-

Public Health England North West Health Protection Team

(0151)-434 4819

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4.1 Outbreak Management

If multiple cases of COVID-19 appear in a defined setting, group or place, an Outbreak Control Team from either Knowsley Council or Public Health

England will, if necessary, be assigned to work with the relevant setting lead to manage the outbreak. The setting, group or place lead or manager

should seek advice from Knowsley Council’s Environmental Health team Single Point of Contact in the first instance:-

Section 4: Outbreak Management

For advice on managing an outbreak contact:

Environmental Health Single Point of Contact for COVID-19 Telephone: (0151)-443 4712

Email: environmentalhealth@knowsley.gov.uk

9.00 a.m. to 5.00 p.m.

After 5.00pm or at weekends or on Bank Holidays, contact:-

Public Health England North West Health Protection Team

(0151)-434 4819

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4.2 Contact Tracing – Symptomatic Person

When someone first develops symptoms and orders a test, he/she will be encouraged to alert the people with whom they have had close contact

in the 48 hours before symptom onset. If any of those close contacts are co-workers, the person who has developed symptoms may wish to (but is

not obliged to) ask his/her employer to alert those co-workers.

At this stage, those close contacts should not self-isolate, but they:-

must avoid individuals who are at high-risk of severe complications of COVID-19, for example because they have pre-existing medical

conditions, such as respiratory issues

must take extra care in practising social distancing and good hygiene and in watching out for symptoms

should prepare for the possibility of having to self-isolate for 14 days if the person who has symptoms has a positive test result and if they (the

contact) receive a notification from the NHS Test and Trace service.

4.3 Contact Tracing – Confirmed Case

If the person who has symptoms has a positive test result for COVID-19, the NHS Test and Trace service will ask him/her to share information

about close recent contacts. If he/she works in or has recently visited or attended one of the following settings, the contact tracing process will

be escalated to the Cheshire and Merseyside Test and Trace Team which will liaise as necessary with the manager or link person of the relevant

setting:-

a health or social care setting (e.g. a hospital or care home, or day care)

a prison or other secure establishment

a school for children with special needs

any setting where there is a risk of a local outbreak

In other cases, any non-household contacts who need to self-isolate will be contacted by the NHS Test and Trace service. Such individuals will

receive a formal notification (either a phone call, letter, email or text message) setting out how long they need to self-isolate for.

The period of self-isolation will be for 14 days from the point of most recent contact with the person who has tested positive for COVID-19.

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4.4 Actions to be taken by Cheshire and Merseyside Test and Trace Team working with Knowsley COVID-19 Management Team

The criteria to declare a cluster/outbreak and the criteria to end such a declaration vary according to the setting. In order to establish key facts

and inform the decision to declare/end an outbreak, the following steps may be undertaken:-

An initial investigation to clarify the nature of the outbreak should begin within 24 hours of receiving the initial report

Confirmation of the validity of the initial information upon which the potential outbreak is based (including ascertainment bias, the possibility

of false positives etc.)

Assignment of an individual to liaise directly with the setting/service or convene a local multi-disciplinary Outbreak Control Team to lead the

investigation, management and containment of the Outbreak

Work with the setting to identify all persons who could be a contact of the case/cases (NB In a setting where Personal Protective Equipment

is routinely used, any person who wore appropriate Personal Protective Equipment or maintained appropriate social distancing (over two

metres) would not be classed as a contact

Identification of all people who have had contact with the confirmed case/cases from 48 hours before onset of symptoms to 7 days after the

onset of symptoms (NB If the case was asymptomatic, identification of all people who have had contact 48 hours before the test to 7 days

after the date of the test)

Provision of advice on how to care safely for someone who becomes unwell on site with COVID-19 symptoms and any cleaning as

appropriate

Ensuring that the setting has robust systems in place to identify contacts and record anyone who has been in the setting who has COVID-19

symptoms and/or is a confirmed case

Conduct of preliminary interviews with initial cases to gather basic information, including any common factors (this can be carried out by

Public Health England or local contact tracers)

Where appropriate, arrangements for testing of contacts using local pathways as required or signposting to the national testing website

Formation of a preliminary hypothesis

Consideration of the likelihood of a continuing public health risk

Conduct of an initial risk assessment to guide the decision-making process

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Initiation of vulnerable people support processes

4.5 Actions to be taken by the Setting

Immediate control measures should be implemented - it is not necessary to wait for the outcome of a test result in order to act

As soon as it becomes apparent that an outbreak may exist, immediate communication between the setting and Knowsley Council’s

Environmental Health Single Point of Contact is essential. After 5.00pm, at weekends or on Bank Holidays, such contact should be with

Public Health England North West, which is linked to the Cheshire and Merseyside Test and Trace Hub

Identification of an Infection Control Lead in the setting (suggested experience includes occupational health, health and safety, risk

manager, business management)

Workers should be encouraged to heed any notifications to self-isolate and support should be provided to these individuals when in self-isolation

Employers/managers should continue to communicate with workers/clients in self-isolation and provide support

Agreement of the content of advice to be provided to the rest of the workforce, visitors or residents

4.6 Other Actions to assist Employees, Volunteers, Visitors

Employers should support people to work from home if they remain well and they can do so

If people cannot work from home, employers must ensure that any self-isolating employee is receiving sick pay and/or using paid leave days

Employees in self-isolation are entitled to Statutory Sick Pay for every day in isolation, as long as they meet the eligibility conditions.

Information for employers on reclaiming Statutory Sick Pay can be found in this guidance: https://www.gov.uk/guidance/claim-back-

statutory-sick-pay-paid-to-your-employees-due-to-coronavirus-covid-19

The NHS Test and Trace Service will provide a notification which can be used as evidence that someone has been told to self-isolate

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4.7 Arranging Testing: Cases and Contacts

Test and trace guidance for businesses and employers is available via the following link:-

https://www.gov.uk/guidance/nhs-test-and-trace-workplace- guidance#about-the-nhs-test-and-trace-service

Appendix 7 provides information on local testing pathways.

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4.8 Managing the Deployment of Broader Resourcing and Local Testing Capacity

As part of both outbreak management and prevention, Knowsley Council may need to arrange for the rapid deployment of testing utilising capacity

from both local (“Pillar 1”) and national managed (“Pillar 2”) provision. To prevent and manage outbreaks effectively within complex settings and

vulnerable groups, flexible access to testing will be key, and pathways are in place for Knowsley to utilise the local testing capacity provided by the

North West Boroughs Trust testing team. In the event of an outbreak, the Outbreak Control Team will work with NWBH to deploy testing based on

needs. The Council will continue to work closely with the Cheshire and Merseyside Testing Cell to influence and implement prioritisation of testing

based on needs.

Knowsley Council will also work closely with the National Joint Biosecurity Centre, which has the role of bringing together data from testing and

contact tracing alongside other NHS and public data in order to provide insight into local and national patterns of transmission and potential high-

risk locations and to identify early potential outbreaks so that appropriate action can be taken.

The National Joint Biosecurity Centre will shortly be issuing further information about how local movement restrictions may need to be increased if

infections increase again.

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5.1 Declaring the End of an Outbreak

It is important that there is continued vigilance for new potential cases as well as adherence to infection prevention and control principles once any

outbreak is over as such actions will reduce the chance of a further outbreak. The North West Boroughs Trust’s Community Infection Control Team, or

Knowsley Council’s Environmental Health team may monitor the outbreak until it is declared over by the Outbreak Control Team.

The Outbreak Control Team will decide when the outbreak can be considered over and will make a statement to this effect. The decision to

declare the outbreak over should be informed by ongoing risk assessment and considered when:-

a. there is no longer a public health risk which requires an Outbreak Control Team to conduct further investigation or to manage control measures;

and,

b. the number of new cases has declined to an acceptable level.

The outbreak will be declared over when there have been no new cases of confirmed or suspected COVID-19 within a continuous 14-day period (28

days in the event of a residential care home). The criteria to declare a cluster/outbreak and the end of such a cluster/outbreak varies according to

the setting.

5.2 Communication

The Outbreak Control Team’s Chairperson (usually the Public Health England Consultant in Communicable Disease) should ensure that minutes are

taken at all meetings of the Outbreak Control Team and circulated to participating agencies in a timely fashion. All key decisions should be recorded

and the minute-taker is accountable to the Chairperson for this function.

To ensure the appropriate dissemination of critical information within relevant organisations, usual organisational communications protocols should

be followed.

A communications strategy for informing the public and key stakeholders should be discussed and agreed at the Outbreak Control Team. Key

information needs to be agreed with and shared with the setting or geographical place where the outbreak has occurred and any relevant services or

groups associated with the setting or place.

Section 5: Declaring the End of an Outbreak

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This includes:-

Advice on cleaning

Agreeing the content of a daily email to be returned on staff sickness

Advice for staff, volunteers, service users or visitors who have been contacts

Advice for staff volunteers, service users or visitors who have not been contacts

A Warning Notice if non-compliance is an issue

Advice on financial issues including Statutory Sick Pay

Advice on communications in relation to the outbreak

Recommendations and lessons learned from the outbreak in order to improve practices to prevent further outbreaks

5.3 Legal Issues

Public Health England is the national public health agency which fulfils the Secretary of State for Health’s statutory duty to protect health and

address inequalities, and executes the Secretary of State’s power to promote the health and wellbeing of the nation.

All organisations represented on an Outbreak Control Team have different legal powers and duties. Any discussions regarding legal issues in

response to an outbreak should be discussed with relevant legal representatives of the organisations involved where required.

A summary of the legal powers available and the enforcement approach which Knowsley Council will take is available in Appendix 6.

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6.1 Provision of Support for Vulnerable People who are required to self-isolate

It is anticipated that most people will be able to self-isolate for the maximum two-week period with support from their family and friends.

However, where a person who has been advised to self-isolate needs practical or social support (either for themselves or for someone who they

care for), they will be directed to the Knowsley COVID-19 Volunteer Hub for help and support for the provision of household provisions (e.g. food

and toiletries) and social connections (e.g. safe and well checks), and other reasonable requests (such as dog walking). Prescription deliveries will

be provided by the Merseyside Fire and Rescue Service (who have confirmed that they will continue to provide such support as they have done

from the start of the pandemic).

It is anticipated that majority of people who require help will be identified via the national NHS Test and Trace Service and referred to the Council.

There may also be circumstances whereby an individual’s needs are identified through local contact tracing. For practical non-medical or social

support needs, members of the public will be able to access the Knowsley COVID-19 Volunteer and Community support line:-

Section 6: Support to Vulnerable People

If you are vulnerable and need help, telephone 0800 073 0043

Monday - Friday 9.00am – 5.00pm and Saturday and Sunday 10.00am – 2.00pm

The Deafness Support Network is providing a relay service to people who cannot use the telephone. Contact 07786 200547 (text only) or email: dsn@dsnonline.co.uk

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7.1 Data Management

Development of a local case management solution is being considered in order to facilitate the flow of key data relating to the response to track

and trace escalations. The COVID-19 Management Team and the Infection Prevention and Control Team will be primary users of this system. The

data will be used to track and monitor delivery of key activities and inform local and regional reporting (details of which are yet to be determined).

Work is being undertaken to explore possible wider footprint systems. In the meantime, existing case management systems will be utilised.

7.2 Data Flow

High level processes around data flow have been developed which will now start to shape the required solution highlighted at 7.1 above.

7.3 Data Protection Impact Assessment

A Data Protection Impact Assessment has been drafted in parallel to this Plan. The Assessment will identify and inform additional requirements to

ensure data protection legislation compliance and will be kept under regular review.

Section 7: Data Management

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8.1 Governance Arrangements

The response to COVID-19 in Knowsley will build upon existing health protection governance responses, and will strengthen these in order to ensure a

coordinated and joined up response to COVID-19 is delivered in a timely manner. A dedicated COVID 19 Outbreak Management Board will be

developed to oversee and review all activity within the Borough in respect of reported COVID-19 outbreaks, ensuring that appropriate actions are being

taken at the right time by the right agencies, that the vulnerable are receiving support, and that effective communication with the public is being

maintained. The COVID-19 Outbreak Management Board will be supported by the Knowsley Health Protection Forum and the Merseyside Local

Resilience Forum meeting structures, as well as being accountable to the Government in respect of outbreaks of COVID-19 occurring within Knowsley.

8.2 Decision-Making

It is recognised that the response to reported or possible COVID outbreaks needs to be as dynamic as possible in order to ensure that decisions are

made swiftly and appropriately, in order to protect the public and contain the infection. The Knowsley Outbreak Management Plan seeks to ensure

that decision making is sufficiently flexible to support swift decisions at a variety of levels:

8.2.1 Knowsley COVID 19 Outbreak Management Board

The Knowsley Outbreak Management Board is an Elected Member-led Board with responsibility for:-

Developing and maintaining oversight of Knowsley’s Outbreak Management Plan;

Considering local outbreak information;

Providing recommendations to relevant organisations as to the discharge of duties or support arrangements relating to COVID-19 and supporting

those organisations to implement such decisions in accordance with their organisations’ decision-making processes;

Coordinating support for the local public health response to COVID-19;

Supporting and promoting the NHS Test and Trace Service;

Developing risk management plans and support arrangements for local outbreaks;

Section 8: Governance

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Reviewing incidents and the deployment of resources in order to identify lessons learned;

Ensuring an appropriate level and style of communications to keep the residents of Knowsley safe, protect the NHS, and promote recovery from

COVID-19;

Leading on communication with the public in respect of COVID-19 engagement plans;

Leading on collaboration with neighbouring authorities, if advised by the Director of Public Health that it would be advisable to do so (for

example in the case of a local outbreak that crossed the Borough’s border);

Facilitating Merseyside-wide discussion and decision-making by recommending agreed actions to relevant bodies or individual local authorities

where appropriate.

The Board’s core membership will be:

The Leader of Knowsley Council (Chairperson)

Health and Social Care Cabinet Member (Vice-Chairperson)

Knowsley Council Resources Cabinet Member

Knowsley Council Chief Executive

Knowsley Council Director of Public Health

Merseyside Police Representative

Merseyside Fire and Rescue Service Representative

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The Outbreak Management Board will be further supported by an invited Membership which will be determined by the nature of any reported

incidents or business items to be considered by the Board, this will include but is not limited to:-

Knowsley Council Children’s Services Cabinet Member

Knowsley Council Regeneration and Economic Development Cabinet Member

Knowsley Council Executive Director (Health and Social Care)

Knowsley Council Assistant Executive Director (Education and Early Help)

Knowsley Schools Representative

Knowsley Care Homes Representative (provider – adult/children’s/specialist)

Knowsley Housing Representative (registered provider/hostel/temporary accommodation/Housing Options)

Primary Care Representative (Primary Care Network/CCG)

Other Non-Acute Health Representative (CCG)

Geographical Hot Spot Representatives (Knowsley Council Ward Members)

High Risk Workplaces Representative (Knowsley Chamber of Commerce/business representative)

Knowsley COVID-19 Volunteer Hub

Other relevant individual deemed necessary by the Chairperson/Vice-Chairperson

Operational Arrangements:-

The Knowsley Outbreak Management Board will meet not less than monthly with meeting frequency being determined by emerging need and

infection levels within Borough

Dates and times of meetings will be determined in consultation with the Chairperson

The agenda and papers will be circulated to Board Members in advance of each meeting

Meetings of the Knowsley Outbreak Management Board will be held remotely utilising Cisco Webex and will be facilitated by Knowsley Council

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Decision-Making:-

The Knowsley Outbreak Management Board will provide recommendations to organisations in respect of the coordination and discharge of their

statutory powers or responsibilities in respect any response to an outbreak of COVID-19. Decisions will then be formally implemented locally following

the respective organisational decision-making processes.

Reporting:-

The Knowsley Outbreak Management Board is not a public meeting. The decisions of the Board will be published in accordance with local decision-

making processes and will be reported via Knowsley Council’s Scrutiny Committees, which maintain oversight of the Knowsley Better Together

Partnership’s response to COVID-19 within Knowsley.

Communication:-

In accordance with its duties and responsibilities, the Board will lead on communication with the public in respect of the response to COVID-19 within

the Borough.

8.3 Knowsley COVID-19 Health Protection Forum

Knowsley Health Protection Board has a remit to assure health protection arrangements and plans to protect the health of Knowsley population. The

Terms of Reference of this group have been reviewed in order to provide assurance on prevention, surveillance, planning and response with regard to

COVID-19. The Forum will meet as a Health Protection COVID-19 Forum on a minimum monthly basis to undertake this role. This meeting will report to

the quarterly Health Protection Forum and will operate under the established governance structure for the Health Protection Forum. The duties of the

COVID-19 Forum will be to:-

Scrutinise and ensure that plans are in place to prevent and respond to COVID-19 outbreaks

Review COVID-19 intelligence, including monitoring the incidence of COVID-19 cases and outbreaks by setting, location and groups where

appropriate

Monitor response to outbreaks and ensure learning from incidents/outbreaks has been established into future working practices

Scrutinise testing strategy and monitor local testing capacity and demand

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When and if available, monitor the uptake of immunisations/treatment of COVID-19

Ensure robust two-way information from and to the Outbreak Management Board

Make recommendations to the Outbreak Management Board

Operational Arrangements:-

The Health Protection COVID-19 Forum will meet not less than monthly

The agenda will cover key responsibilities (as listed above) as part of a rolling programme of work

Conflicts of interest must be declared by any member of the group

8.4 Officer Decision-Making

Recognising the emergent and unpredictable nature of COVID-19, it is important to ensure that all organisations have capacity and expertise and have

made appropriate arrangements to delegate authority in order to be able to provide a swift and appropriate response to an anticipated COVID 19

outbreak, and to provide assistance and support to organisations and the public where this is required. Any decisions made by individual officers in the

discharge of these functions will be reported to the Knowsley Outbreak Management Board.

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9.1 Knowsley Council Communications

The Knowsley Outbreak Management Board will lead on communications.

Knowsley Council will continue to actively support the national COVID-19 prevention campaign.

A comprehensive communications strategy has been developed to ensure that accurate, timely and consistent messages are shared with a view to make

sure that people who experience symptoms of COVID-19 are tested and comply with the advice given. It is important that people understand why

testing, contact tracing and isolation are important in protecting themselves and others, helping the economy to get moving again, helping everyone “to

get back to normal”, and preventing a second wave of the infection.

This includes promotion of the NHS Test and Trace programme, and emphasising the importance of that programme in helping to reduce the spread of

infection, as well as explaining what people need to do if displaying symptoms and when testing positive and the support available for people who are

asked to self-isolate.

Prevention messages will also continue to be shared in terms of the maintenance of good hygiene (hand washing, and “Catch it, Bin it, Kill it”), adhering

to social distancing, working from home where possible, limiting social interactions, and wearing a face covering when on public transport and in

hospital settings.

Targeted messages will be shared with key groups including businesses, schools, and care homes to provide preventative advice and advice on next

steps should an outbreak be reported.

In the event of a localised outbreak within a specific setting, Knowsley Council will co-ordinate local communications and engagement with the

setting and wider community as part of the management of that outbreak and in order to protect and inform the community.

The Council will share communications and best practice with local health partner agencies and other local authorities in the collaborative effort to

work together to tackle the virus.

Section 9: Communication

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10.1 Joint Organisational Learning

Joint organisational learning provides responder agencies with a consistent and accountable mechanism to ensure that identified lessons are acted on

and become lessons learned. It is essential that joint organisational learning is accepted as the standard for multi-agency learning and is adopted by all

response agencies to ensure interoperability is continually improved. Joint organisational learning can also be used to share notable practice, where

services have found a solution to an interoperability issue and wish to share it so that others can benefit from their learning. The joint operation

learning will be submitted nationally into a portal in order to share best practice across the country.

The Cheshire and Merseyside Public Health Network now operates an explicit sector-led improvement approach to accelerate improvements in quality

and outcomes - the approach is based on:-

a culture of openness, learning, testing and sharing across the collaborative.

a variety of tested methods and approaches.

Outbreak Management Plans and learning will the focus of sector-led improvement work moving forward providing a framework for developing good

practice.

Sector-led improvement methods include:-

Benchmarking performance

Reviewing the latest evidence and guidance

Analysing data (including economic analysis) and developing common data-sets

Planning and evaluating projects

Focusing on learning including (continuing professional development)

Providing opportunities for expert panels to peer review and challenge

Sharing best practice of “what works” through newsletters, workshops, conferences, website and social media

Bringing in national and international experts

Section 10: Joint Operational Learning / Best Practice

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Appendix 1 - COVID-19

Coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus, and spreads from person-to-person through large droplets and contact transmission. It is a new disease that is distinct from other SARS, MERS, and influenza. Although coronavirus and influenza infections may present with similar symptoms, the virus responsible for COVID-19 is different with respect to community spread and severity. There is still much to discover about the disease and its impact in different contexts. Preparedness, readiness, and response actions will continue to be driven by rapidly accumulating scientific and public health knowledge.

The most common symptoms of COVID-19 are fever, dry cough, loss of sense of taste or smell, and tiredness. Other symptoms that are less common and may affect some patients include aches and pains, nasal congestion, headache, conjunctivitis, sore throat, diarrhoea, or a rash on skin or discoloration of fingers or toes. These symptoms are usually mild and begin gradually. Some people become infected but only have very mild symptoms. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness.

The average incubation period for COVID-19 is five days, with a range of between one and 14 days. An infected person can start transmitting the virus up to 48 hours before the onset of symptoms (pre-symptomatic) and for up to two weeks. In the early stages of the disease, there is a particularly high concentration of the virus in secretions and therefore risk of transmission. The disease is mainly spread from person to person through inhalation of respiratory droplets from an infected individual (cough, sneeze). Transmission can also occur if a person touches their eyes, nose, or mouth after touching a surface contaminated with virus-containing droplets, which can remain viable for up to several days. Some people are infected without developing symptoms at any point and, although the risk of transmission is lower, they are still able to transmit the infection.

Currently there are no specific vaccines or treatments for COVID-19, however there are many ongoing clinical trials. Preventative measures include regular hand washing, avoidance of touching face, nose, mouth eyes etc., social distancing, effective cleaning and the effective use of PPE in roles requiring direct care in addition to a range of government policy measures.

Appendices

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Appendix 2 – Key National Guidance

Information on coronavirus, including guidance, support and announcements.

https://www.gov.uk/coronavirus

Guidance for health professionals.

https://www.gov.uk/government/collections/wuhan-novel-coronavirus

Guidance for settings / workplaces.

https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19

https://www.nhsemployers.org/covid19

Guidance for schools/educational settings. https://www.gov.uk/government/collections/guidance-for-schools-coronavirus-covid-19

Coronavirus Resources.

https://coronavirusresources.phe.gov.uk/

COVID-19: putting on and removing PPE – a guide for care homes (video)

5 moments for hand hygiene: with how to hand rub and how to hand wash. Posters: https://www.who.int/infection- prevention/campaigns/clean-

hands/5moments/en/

Catch it. Bin it. Kill it. Poster: https://campaignresources.phe.gov.uk/resources/campaigns/34/resources/2665

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Appendix 3 – Key Definitions

Term Description

Close contact (GOV.UK definition) Close contact means:

having face-to-face contact with someone (less than 1 metre away)

spending more than 15 minutes within 2 metres of someone

travelling in a car or other small vehicle with someone (even on a short journey) or close to them on a plane

within 48 hours before developing symptoms and the 7 days’ time since developing symptoms.

Cluster Two or more confirmed cases of COVID-19 among individuals associated with a specific setting with onset dates within 14 days

(In the absence of available information about exposure between the index case and other cases)

Complex settings

(Adapted from WHO Health Promotion Glossary)

A place (indoor or outdoor) or social context in which vulnerable people or communities engage in daily activities in which environmental, organizational and personal factors interact to affect health and wellbeing. Settings can normally be identified as having physical boundaries, a range of people with defined roles, and an organizational structure.

Community transmission Larger outbreaks of local transmission defined through an assessment of factors including, but not limited to: - Large numbers of cases not linkable to transmission chains - Large numbers of cases from sentinel lab surveillance Multiple unrelated clusters in several areas of the country/territory/area

Confirmed case A person that has received a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Contact (WHO definition) A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case: 1. Face-to-face contact with a probable or confirmed case within 1 metre and for more than 15 minutes; 2. Direct physical contact with a probable or confirmed case;

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3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper personal protective equipment; or

4. Other situations as indicated by local risk assessments.

NB for confirmed asymptomatic cases, the period of contact is measured as the 2 days before through the 14 days after the date on which the sample was taken which led to confirmation.

Contact Direct contact without PPE: Face to face contact with a case for any length of time, within 1m, including being coughed on, a face to face conversation, unprotected physical contact (skin to skin) or travel in a small vehicle with a case. This includes exposure within 1 metre for 1 minute or longer Proximity contact without PPE: Extended close contact (between 1 and 2 metres for more than 15 minutes) with a case.

Household contact: A person who lives with or spends significant time in the same household as a possible or confirmed case of coronavirus (COVID-19). This includes living and sleeping in the same home, anyone sharing kitchen or bathroom facilities, or sexual partners.

Person who has had contact (see below) at any time from 48 hours before onset of symptoms (or test if asymptomatic) to 7 days after onset of symptoms (or test). A person who wore appropriate PPE or maintained appropriate social distancing (over 2 meters) would not be classed as a contact.

Exposure period 48 hours prior to and 7 days after the possible or confirmed case’s symptom onset or specimen collection date (if the case is asymptomatic).

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High risk communities (Adapted from WHO Health Promotion Glossary)

A specific group of people who share a common culture, values and norms, are arranged in a social structure according to relationships which the community has developed over a period of time. They exhibit some awareness of their identity as a group, and share common needs.

High-risk places and locations Settings or locations whereby people or communities engage in daily activities in which environmental, organizational and personal factors interact to affect health and wellbeing. Places and locations may be considered high risk due to number, age or vulnerability of people interacting.

Probable case A person experiencing the following symptoms:

fever over 37.8; or

new, continuous cough; or A. loss or change of sense of smell or taste

Sporadic case A single confirmed case.

Vulnerable people Clinically extremely vulnerable people – People defined on medical grounds a clinically extremely vulnerable, meaning they are at the greatest risk of severe illness. This group includes solid organ transplant recipients, people receiving chemotherapy, renal dialysis patients and others.

Clinically vulnerable people - Clinically vulnerable people include the following: people aged 70 or older, people with liver disease, people with diabetes, pregnant women and others. Ethnicity, age and types of employment are also emerging as risks for severe disease. Vulnerable people (non-clinical) - There are a range of people who can be classified as ‘vulnerable’ due to non-clinical factors, such as children at risk of violence or with special education needs, victims of domestic abuse, rough sleepers and others.

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Appendix 4- Outbreak Control Team Terms of Reference and Template Agenda

The terms of reference should be agreed upon at the first meeting and recorded accordingly.

Outbreak Control Team - Terms of Reference

a. To verify an outbreak is occurring. b. To regularly conduct a full risk assessment whilst the outbreak is ongoing. c. To work with the setting to develop a strategy to deal with the outbreak and allocate responsibilities to members of the OCT based on the risk assessment. d. To agree appropriate further investigations. e. To ensure that appropriate control measures are implemented to prevent further primary and secondary cases. f. To communicate as required with other professionals, the media and the public providing an accurate, timely and informative source of information. g. To make recommendations regarding the development of systems and procedures to prevent a future occurrence of similar incidents and where feasible enact these. h. To determine when the outbreak can be considered over. i. To produce a report or reports, containing lessons learned and recommendations.

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Appendix 5 - Outbreak Control Team Meeting Template Agenda

Outbreak Control Team Meeting Agenda

(Title)

(Date, time and venue)

1. Introductions 2. Apologies 3. Minutes of previous meeting (for subsequent meetings) 4. Purpose of meeting

At first meeting agree chair and terms of reference 5. Review of evidence

Epidemiological

Microbiological

6. Current risk assessment 7. Control measures 8. Further investigations required 9. Communications

Public

Media

Healthcare providers

Others

10. Agreed actions 11. Any other business 12. Date of next meeting

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Appendix 6 - Enforcement Approach

Knowsley Borough Council Regulatory Services

Guidance Note: COVID 19: Containing the spread of infection and managing outbreaks in a workplace or community setting.

1. Purpose:

It is not possible to provide detailed guidance to cover all scenarios. Each incident will need to be managed on a case by case basis. The purpose of this document is to outline the range of guidance documents and formal enforcement powers that can be considered when managing such incidents.

2. Scope:

The guidance is applicable to all workplaces and community settings such as schools and care homes – these are collectively referred to as settings for the purpose of this document. However responsibility for enforcement of Health and Safety at work legislation is shared with the Health and Safety Executive. Local authorities are responsible for enforcement in the following sectors; retail, catering (restaurants / takeaways leisure / entertainment venues, warehousing / distribution, offices and call centres, residential care homes. The HSE are responsible for all other sectors including manufacturing, construction, education, hospitals, nursing care and local authority activities.

The Council will not be able to use Health and Safety at Work Act powers in premises that are not allocated to the local authority for enforcement.

Currently a number of businesses are required by law to remain closed. This guidance does not deal with enforcement of business closures. This guidance deals with health and safety and public health arrangements in businesses and community settings that are permitted to remain open.

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3. Legal powers and enforcement approach:

In keeping with the Government’s approach to enforcement of Coronavirus restriction and social distancing guidelines the Council’s approach will be guided by the “4 E’s:”

Engage

Explain

Encourage

Enforce

Therefore enforcement powers will be used as a last resort but must be considered as an option where necessary to protect public health.

4. Overarching principles

All settings will need to adapt their operations to manage the routine risk of infection. Settings may need to take further additional steps in the event of an outbreak associated with that setting. Public health interventions or enforcement actions may be required to effectively manage an incident.

Whether a setting is managing the routine risk of infection or an outbreak amongst staff, customers or service users the principal control measures are;

Exclusion of suspected cases and household contacts of suspected cases from the setting. Those individuals should self-isolate at home. This exclusion may be extended to all contacts of suspected cases once the national Test, Track, Trace and Isolate system is introduced. Employers should ensure all suspected cases are excluded from the setting. (Note this is not applicable to residential care)

Encourage employees / service users to work at home where possible

Hand Hygiene – employees/ service users should be encouraged to regularly wash their hands for 20 seconds with soap and water or hand sanitizer if soap and water are not readily available.

Increased environmental cleaning and disinfection. Shared facilities such as toilets, changing rooms, restrooms and canteens should be regularly cleaned and disinfected. Surfaces that are regularly touched by hands such as switches, door handles and taps should also be regularly cleaned and disinfected.

Implementation of social distancing measures to ensure staff and customers keep 2 meters apart. Where this is not practical additional measures should be put in place.

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5. Available guidance

The above principals underpin the Governments COVID Secure guidance for workplaces and other settings.

https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19

In addition the HSE have provided guidance for employees on undertaking a Corona Virus risk assessment.

https://www.hse.gov.uk/simple-health-safety/risk/index.htm

The Chartered Trading Standards Institute (CTSI) and Chartered Institute of Environmental Health have also compiled guidance for businesses;

https://www.businesscompanion.info/focus/coronavirus-covid-19#utm_source=TSO&utm_medium=email&utm_campaign=Covid- 19%20buisness%20guidance

https://www.cieh.org/policy/coronavirus-covid-19/resources/

6. Enforcement

The majority of interventions to secure routine compliance with hygiene and social distancing measures and in response to an outbreak will be based on the application of the above principles and associated guidance.

However where necessary to protect public health and safety formal enforcement action may be required.

This action may have the effect of closing a business or it may target certain activities within that business.

There are 3 broad strands of legislation that could potentially be utilised to secure health and safety objectives. These are:

Health and Safety at Work Act 1974 and associated regulations

Specific Corona Virus legislation

Public Health (Control of Diseases) Act 1984 and associated legislation.

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7. Legislation

a. Public Health (Control of Disease) Act 1984 as amended by the Health and Social Care Act 2008

i. Three sets of regulations complement the amended Act:

b. Health Protection (Notification) Regulations 2010 updated the system of notification

c. Health Protection (Local Authority Powers) Regulations 2010 updated the powers and duties of local authorities in relation to protecting the

public from infection or contamination

d. Health Protection (Part 2A Orders) Regulations 2010 allow local authorities to obtain an order (Part 2A Order) from a Justice of the Peace that

impose restrictions or requirements to protect the health of the public.

e. The Coronavirus Act 2020

f. The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020 (as amended)

g. Health Protection (Coronavirus, Business Closure) (England) Regulations 2020 (as amended)

h. Health and Safety at Work etc. Act 1974

i. Management of Health and Safety at Work Regulations 1999

j. Personal Protective Equipment at Work Regulations 1

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Appendix 7- Local testing pathways (in development)

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Appendix 8: COVID-19 Equality Impact Assessment

Service: Public Health

Responsible Officer: Sarah McNulty

Completed by: Richard Holford

Date: 24/06/2020

Name and give brief description of Policy/Decision/Function/Project/Service to be reviewed:- Knowsley COVID-19 Outbreak Prevention, Management and Support Plan - The Knowsley Outbreak Management Plan describes local arrangements to prevent outbreaks of COVID-19 and to support the national Test and Trace programme, and Cheshire and Merseyside Test and Trace Hub to ensure the effective and co-ordinated detection and management of COVID-19 outbreaks within Knowsley.

(1) Does the Policy/Decision/Function/Project/Service have a direct impact on people?

In considering this question, you should give special consideration to the following (this list is not intended to be exhaustive):-

Accessibility

Community Cohesion

Delivery of contracts

Human Rights Act

Positive action

Procurement

Reasonable adjustments

Yes

(2) If the answer to (1) above is ‘yes’, complete the Equality Impact Assessment Template over the page. If the answer is ‘no’, please consider whether or not an Equality Impact Assessment is necessary. If you think that it is not, please state why and include this text within the relevant section of your report (see 6.1 of the report template).

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(3) Have you conducted a consultation? No

(4) If the answer to (3) above is ‘yes’, please complete the columns across and attach evidence/include a hyperlink:-

Who did you consult with? How and when did you consult?

What was the feedback?

Equality Impact Assessment Template

NB There is a general duty to:- (i) eliminate discrimination, harassment and victimisation; (ii) advance equality of opportunity between people who share protected characteristics and those who don’t share it; and (iii) foster good relations between people who share a protected characteristic and those who don’t. You should give details below, with evidence, of the impact of the policy/decision/function/project/service on each of the protected characteristics taking into account (i)-(iii) above.

Protected characteristic

Is there any potential positive impact?

Is there any potential negative impact?

What evidence do you have? (E.g. complaints, statistics, surveys etc.

disaggregated by equality groups.)

What action will you take to mitigate negative impact?

Please state if negative impact is intended due to positive

action.

How will you monitor and review the actions that you have taken to mitigate the

impact?

Age Yes Yes PHE disparities report on COVID-19 identifies age as the largest disparity in the

risk and outcomes of COVID-19. Among people

already diagnosed with COVID-19, people who were 80 or older were

seventy times more likely to die than those under

40. PHE report highlights

The plan includes actions to prevent/ reduce the risk of outbreaks and infections in vulnerable groups including

older people. It also includes an escalation process to PHE

and identifies support for vulnerable people having to

self-isolate as a result of infection or contact with

infected person.

The outbreak management plan has a robust partnership

governance structure to manage its delivery. This includes a

Knowsley Outbreak Management Board, Health

Protection Board and a COVID-19 Test, Track and Trace

management Hub. There is also Cheshire and Merseyside and national structures linked to

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specific risks and poor outcomes for residents in care homes. Nationally deaths in care homes accounted for 27% of

deaths from COVID-19 up to 8 May 2020.

Extra care residential units and

care homes are identified as complex settings and potential

high risk place/location in outbreak plan and thus

identified as initial priorities.

these for escalation.

The plan includes framework and processes for managing

outbreaks in different cohorts and settings and data

management processes are to be established to monitor

outbreaks.

Carer’s status

Yes Yes No direct evidence of specific negative impacts

on carers, however due to the increased risks of

infection and poor health outcomes for the cohorts

identified in the PHS disparities report carers may be more anxious in

regards to health and wellbeing of the individual they are caring for. Also

many carers will fall in the at risk category due to

own personal characteristics such as age

and health status.

The plan includes actions to prevent/ reduce the risk of outbreaks and infections in vulnerable groups including

older people. It also includes an escalation process to PHE

and identifies support for vulnerable people having to

self-isolate as a result of infection or contact with

infected person.

Specific guidance on caring for someone who is ill with

COVID-19 is included in the plan.

Same as above

Disability

Yes Yes PHE disparities report on COVID-19 identified people with long term health problems are at a higher risk of experiencing negative

The plan includes actions to prevent/ reduce the risk of outbreaks and infections in vulnerable groups including

older people. It also includes an escalation process to PHE

Same as above

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outcomes of COVID-19. This is particularly the case for individuals with following health issues - diabetes, hypertensive diseases, chronic kidney disease, chronic obstructive pulmonary disease, dementia and obesity.

The CQC and ONS have completed analysis on the impact of COVID-19 on people with a learning disabilities. The findings provide evidence that there was a 134% increase in the number of death notifications this year compared to same period last year.

and identifies support for vulnerable people having to

self-isolate as a result of infection or contact with

infected person.

Learning disability supported living, Extra care residential units and mental health residential settings are identified as complex settings and potential high risk place/location in outbreak plan and thus identified as initial priorities.

Gender

Yes Yes PHE disparities report on COVID-19 risks and

outcomes identifies men as being at greater risk of death and poor outcomes

from COVID-19 than women. In particular for

men in low skilled occupations.

The outbreak management plan does not include gender

specific actions. The plan includes actions to prevent/ reduce the risk of outbreaks and infections in vulnerable groups which will take into

consideration individual risks. It also includes an escalation

Same as above

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process to PHE and identifies support for vulnerable people

having to self-isolate as a result of infection or contact

with infected person.

Gender identity

Yes No No evidence of specific negative impacts.

N/A N/A

Offending past

Yes No direct evidence of increased risk or

disproportionate impacts. However for those

recently released from prison there may be

increased risks due to housing arrangements,

especially if in temporary or shared settings such as

hostels.

Probation Centres, hostels and housing of multiple occupation

as complex settings and potential high risk

place/location in outbreak plan and thus identified as initial priorities. Outbreak

management plan for prisons and other secure units is

referenced.

Same as above

Sexual orientation

Yes No No evidence of specific negative impacts.

N/A N/A

Race (including gypsies and travellers)

Yes Yes The PHE disparities report highlights that people in Black, Asian and Minority Ethnic (BAME) groups are more likely to experience a diagnosis or death from

COVID-19 compared to people in White ethnic

groups. PHE also found a particularly high increase

High risks groups including BAME individuals/

communities, migrant workers, refugees and asylum seekers, gypsies and travellers identified as priority groups in

the plan.

Same as above

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in all cause deaths among those born outside the UK

and Ireland.

Although no direct evidence of negative

impacts on gypsies and travellers it is likely given their living arrangements

and access to routine health services that

COVID-19 outbreaks will potentially have a

significant impact on such communities.

Religion or belief

Yes Maybe No evidence of specific negative impacts.

However, as a setting should places of worship

open may potentially become an outbreak

management risk.

Places of worship identified as a potential high risk

place/location in outbreak plan and thus identified as an

initial priority.

Same as above

Social economic status

PHE disparities report on COVID-19 risks and

outcomes identifies that people who live in

deprived areas have higher diagnosis rates and

death rates than those living in less deprived areas. For example,

The outbreak management plan identifies priority groups

which will be particularly vulnerable to outbreaks and

poor COVID-19 outcomes. The plan clearly identifies initial

priorities in relation to complex settings, high risk communities and high risk

Same as above

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mortality rates from COVID-19 in the most

deprived areas were more than double the least deprived areas. The

findings from the report suggest that high

diagnosis rates may be due to geographic

proximity to infections or a high proportion of

workers in occupations that are more likely to be

exposed. Health and social care workers increased

risk of infections and Men working in low skilled occupations had the highest rate of death

involving COVID-19 up to 20 April. Jobs included

security guards, taxi drivers and chauffeurs, bus and coach drivers, chefs, sales and retail

assistants, lower skilled workers in construction and processing plants.

places and locations. This will be used as part of the risk and outbreak management process

to respond effectively taking into consideration

vulnerabilities of cohorts affected.

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Appendix 9 Outbreak Management Board Terms of Reference

Knowsley Outbreak Management Board Membership

Core Membership

The Leader of Knowsley Council (Chairperson)

Health and Social Care Cabinet Member (Vice-Chairperson)

Knowsley Council Resources Cabinet Member

Knowsley Council Chief Executive

Knowsley Council Director of Public Health

Merseyside Police Representative

Merseyside Fire and Rescue Service Representative

Invited Members

Knowsley Council Children’s Services Cabinet Member

Knowsley Council Regeneration and Economic Development Cabinet Member

Knowsley Council Executive Director (Health and Social Care)

Knowsley Council Assistant Executive Director (Education and Early Help)

Knowsley Schools Representative

Knowsley Care Homes Representative (provider – adult/children’s/specialist)

Knowsley Housing Representative (registered provider/hostel/temporary accommodation/Housing Options)

Primary Care Representative (Primary Care Network/CCG)

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Other Non-Acute Health Representative (CCG)

Geographical Hot Spot Representatives (Knowsley Council Ward Members)

High Risk Workplaces Representative (Knowsley Chamber of Commerce/business representative)

Knowsley COVID-19 Volunteer Hub

Other relevant individual deemed necessary by the Chairperson/Vice-Chairperson

Supporting Officers:

Communications

Legal

Health and Safety

Business Administration

Environmental Health

Quorum

The Knowsley Outbreak Management Board will be quorate where a third of the core membership are in attendance which must include:-

A member of Knowsley Council’s Cabinet.

AND

The Director of Public Health (of their representative).

Meeting Frequency

The Knowsley Outbreak Management Board will meet not less than monthly with meeting frequency being determined by emerging need and infection levels within Borough. Dates and times of meetings will be determined in consultation with the chair. Meetings of the Knowsley Outbreak Management Board will be held remotely utilising Cisco Webex and will be facilitated by Knowsley Council.

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Meeting Reporting / Accountability

Locally: The Knowsley Outbreak Management Board will provide regular update reports to Knowsley’s Scrutiny Boards to support their oversight and scrutiny responsibilities in respect of the COVID-19 pandemic. Regionally: The Knowsley Outbreak Management Board will provide periodic updates to the Merseyside Outbreak Management Board. [Regional oversight arrangements to be confirmed] Nationally: The Knowsley Outbreak Management Board will provide such reports to Government as are required.

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Terms of Reference

The Knowsley Outbreak Management Board will be responsible for:

1) Developing and maintaining oversight of Knowsley’s Local Outbreak Control Plan;

2) Considering local outbreak information;

3) Providing recommendations to relevant organisations as to the discharge of duties or support arrangements relating to covid-19;

4) Coordinating support for the local public health response to covid-19;

5) Supporting and promoting the NHS Test and Trace Service;

6) Developing risk management plans and support arrangements for local outbreaks;

7) Reviewing incidents and the deployment of resources in order to identify lessons learnt.

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Appendix 10: Template Agenda

Knowsley Outbreak Management Board Date/Time/Venue

Agenda

1. Introductions

2. Apologies and Declarations of Interest

3. Minutes of Previous Meeting

4. Review of Evidence

5. Current Risk Assessment

6. Review Knowsley Local Outbreak Control Plan

7. Communications

a. Public

b. Media

c. Healthcare

d. Others

8. Agreed Actions

9. Any Other Business