Thurrock COVID-19 Outbreak Control

Plan

30 June 2020

v 1.5

Author: Ian Wake, Director of Public Health, Thurrock Council

The following members of Thurrock Council’s Public Health Team have contributed to the production of this COVID-19 Outbreak Control Plan

• Beth Capps, Senior Public Health Programme Manager

• Helen Forster, Strategic Lead Public Health – Health Improvement

• Helen Horrocks, Strategic Lead Public Health – Place, Environment and Community

• Maria Payne, Strategic Lead – Public Mental Health and Mental Health Transformation

• Teresa Salami-Oru, Assistant Director and Consultant in Public Health

• Emma Sanford, Strategic Lead Health and Social Care Public Health

Acknowledgements

2

1. Introduction and Background

1.1 Purpose of an Outbreak Control Plan

2. Aims, Objectives and Principles

2.1 Aims, Objectives and Purpose

2.2 Underlying Principles of the Thurrock Approach

3. Partnership Relationships

3.1 National, Regional and Local Architecture

3.2 Essex Strategic Control Group for COVID-19

3.3 Overview of Roles and Responsibilities of Key Partners

4. Thurrock COVID-19 Prevention and Management Architecture and Governance

4.1 Thurrock COVID-19 Prevention and Control System Architecture

4.2 Thurrock COVID-19 Governance

4.3 Thurrock COVID-19 Summary of Functions of System Architecture

5. Capabilities

5.1 Prevention

5.2 Communications and Engagement

5.3 Surveillance and Intelligence

5.4 Testing

Contents

6 . NHS Test and Trace

6.1 Test and Trace Standard Protocol

6.2 Test and Trace Architecture

6.3 Escalation to Tier 1 and Data Flows

7. Thurrock Operating Model

7.1 Overview

7.2 Capacity and Functions

7.3 Demand and Staff Capacity

7.4 Staff structure: TLOCC and Surveillance Cell

7.5 Process for Outbreak Management

7.6 Supporting Vulnerable Communities to Self-Isolate

7.7 Process Flow Diagram – Supporting Vulnerable Communities to Self-Isolate

7.8 Risks and Mitigation – Supporting Vulnerable Communities to Self-Isolate

8. Supporting High Risk and Complex Settings and Communities

8.1 What determines COVID-19 risk?

8.2 Prevention and Outbreak Management Hubs

8.3 Preventing and Managing Outbreaks in Businesses, Workplaces and Public Venues

8.4 Preventing and Managing Outbreaks in Care Homes and Similar Settings

8.5 Preventing and Managing Outbreaks in High Risk Communities

8.6 Preventing and Managing Outbreaks in Schools and Early Years Settings

9. Finance3

Introduction

This Outbreak Control Plan sets out a local strategy prevent and control COVID-19 in Thurrock

moving forward.

We believe that the epidemic curve of COVID-19 in Thurrock peaked at the end of March 2020 and

has declined steadily since early April 2020. However COVID-19 presents a serious an ongoing risk

to the public health of the residents of Thurrock and a second peak cannot be ruled out.

Conversely ‘lockdown’ itself presents a risk to public health. We have already witnessed a

significant number of ‘excess deaths’ over and above the five year average in Thurrock where

COVID-19 was not recorded on the death certificate. The underlying cause of these are unclear at

present but they may have been as a result of our residents being too fearful or unable to access

health and care services for other serious health conditions. It is vital for the health of our

population that we are able to relax the current lock down restrictions to allow as many essential

health, care and wider wellbeing services such as education and early years services currently

restricted to resume operation.

A prolonged period of lockdown risks long term economic damage and a resulting reduction in

taxation base. Both of these factors present a significant long term risk to health and wellbeing and

of widening existing health inequalities.

As we have learnt more about COVID-19 during the last six months it is becoming clearer that not

everyone within the population is equally susceptible, equally at risk or has an equal risk of

transmitting the virus if they do become infected. For example, there is now clear evidence that

children and young people are at significantly lower risk of complications from COVID-19 and may

be less likely than adults to transmit the virus if infected. Similarly, we believe that 80% of new

infections result from only 10% of infected cases. As such, moving forward we are likely to see

more localised outbreaks in specific high risk settings, and prevention, early detection and control

of these will be critical.

1. Introduction and Background

Background

On 22 May 2020, the UK Government announced its expectation that every top tier local authority

would create a Local Outbreak Control Plan by the end of June 2020.

Local Outbreak Control Plans are required set out measures across seven key themes:

1. Planning for local outbreaks in care homes

2. Identifying and managing outbreaks in high risk places, locations and communities

3. Identifying methods for local testing capacity

4. Contact tracing in complex settings

5. National and local data integration including local surveillance and monitoring of outbreaks

6. Supporting vulnerable local people to self-isolate

7. Establishing governance structures including a local DPH led Health Protection Board and

elected member led Engagement Board

Thurrock Council has been awarded a central government grant to develop and implement its plan,

including local testing and contact tracing arrangements.

At time of producing this plan, national decisions are yet to be taken regarding surveillance, testing

and contact tracing data flows between national system architecture and local contact tracing

teams, roles and responsibilities of different elements of the national, regional and local NHS Test

and Trace programme and devolution of additional statutory powers to local authorities on

outbreak control and management. As further clarity is provided, we envisage this document

evolving to reflect this. 4

Test

Contain

TraceEnable

An integrated and world-class Covid-19 Test and Trace service, designed to control the virus and enable people to live a safer and more normal life

Underpinned by a huge public engagement exercise to build trust and participation

Rapid testing, at scale, to identify and treat those with the virus

Integrated tracing to identify, alert and support those who need to self isolate

Identify outbreaks using testing and other data and contain locally and minimize spread

Use knowledge of the virus to inform decisions on social and economic restrictions

Te

st

Tra

ce

Con

tain

En

ab

le

Continuous data capture and information loop at each stage that flows through Joint Biosecurity Centre to recommend actions

The UK Government has set out four key strands to the national approach in England to controlling COVID-19: Test, trace, contain, and enable. The intention is for this to form a continuous data capture and information loop at each stage, with intelligence following through a new arms length government body - the Joint Biosecurity Centre, that will recommend further actions. Local planning and response will be key to the success of the system, with local government having a key role to play in the identification and management of COVID-19 to contain its spread and infection. This plan outlines how Thurrock Council in collaboration with wider stakeholders and our residents will deliver this.

1.1 Purpose of an Outbreak Control Plan

5

Section 2:

Aims, Objectives and Principles

AIM:

• To prevent and control the spread of COVID-19 in Thurrock, minimising the number of deaths whilst reopening as much of the economy as possible to mitigate public health harms caused by lockdown

OBJECTIVES:1. Receive, review and analyse surveillance data to build an on-going picture of the

local epidemic and identify new outbreaks in settings or localities

2. Prevent outbreaks from occurring by providing setting specific advice and high quality communication to our residents to reduce risk of transmission

3. Where outbreaks do occur, provide a rapid and coordinated response to contain the outbreak, test suspected cases, isolate contacts and prevent wider transmission

.1 Aim and Objectives of this COVID-19 Outbreak Control Plan

PURPOSE OF THIS PLAN• Define the local governance structures for the identification and management of COVID-19

outbreaks in Thurrock and how these interface with wider structures across Essex and the East of England.

• Define the roles and responsibilities of different stakeholder organisations in the prevention and management of COVID-19 in Thurrock

• Describe local surveillance functions in Thurrock to map local epidemiology and how we will identify new outbreaks

• Specify local arrangements to ensure timely testing of COVID-19 to support efforts to arrest the spread of COVID-19

• Specify outbreak management protocols for preventing and COVID-19 outbreaks in different settings and other high risk places

• Describe local contact tracing capability and procedures and how these interface with NHS Test and Trace

• Describe arrangements for supporting vulnerable people who need to quarantine because they are a contact of a case

• Outline the communication and engagement work needed to ensure that this plan is successful

• Identify the resources needed to deliver our COVID-19 outbreak control response

• Summarise key risks, planning assumptions and considerations that underpin planning and response arrangements to COVID-19 in Thurrock.

2.1 Aims and Objectives of this Outbreak Control Plan

7

8

1• We will provide regular communication on COVID-19 to

our residents to help them minimise the risk of becoming infected

• We will deliver setting-specific communication and advice to different settings to allow them to reopen safely including support to develop risk assessments

• We will provide setting-specific advice and guidance on Infection Prevention and Control

PREVENT OUTBREAKS

BEFORE THEY OCCUR

3

• We will develop and review dedicated outbreak control protocols for specific high risk settings

• We will provide multi-agency setting based outbreak support and management

• We will ensure enhanced and on-going testing in outbreak situations to identify and support management of outbreak and know when it is contained

• We will seek to identify all contacts of confirmed COVID-19 cases and provide advice and support to allow them to self-isolate to prevent further spread

MANAGE OUTBREAKS EFFECTIVELY

6• We will implement a high quality surveillance function

that triangulates a wide range of different metrics to describe and map the local epidemic, identify local outbreaks and describes, reviews and responds to risk

• Will regular cross reference and adapt our plan in line with the emerging COVID-19 evidence base

• We will ensure that all protocols and advice is based on the best published evidence and local intelligence

INTELLIGENCE AND EVIDENCE

DRIVEN

4

• We recognize that some communities and individuals are at higher risk of infection and at increased risk of serious health consequences if they become infected

• We will deliver a system of proportional universalism to ensure that all individuals get the right level of support required to help them stay well and where necessary to quarantine rather than a ‘one size fits all’ approach

ADDRESS INEQUALITY

2DETECT CASES

AND OUTBREAKS

EARLY

• We will ensure a rapid response to suspected outbreaks

• We will ensure rapid access to testing and results in outbreak situations

• We will use proactive surveillance to identify clusters of cases and ensure swift follow up

• We will ensure clear and straight forward reporting mechanisms to allow every to report suspected cases easily

5WHOLE SYSTEM & PARTNERSHIP

WORKING

• Prevention and management of COVID-19 is the responsibility of everyone, not simply a “Public Health” function

• We will coordinate whole systems action across a wide range of stakeholders

• We will work in collaboration with communities and the third sector to deliver this plan

7MITIGATE RISKS OF

LOCKDOWN

• We recognise that lock down itself presents a serious risk to public health due to social isolation, withdrawal or reduction of critical public services, damage to the economy, and from a reduced taxation base that can be used to fund future public services.

• We will seek to mitigate and balance this risk against the risk of COVID-19 by regularly reviewing restrictions and seeking to find ways to re-open as much of economy as possible where it is safe to do so.

2.2 Underlying Principles of the Thurrock Approach

9

Section 3:

Partnership Relationships and Responsibilities

9

103.1 National, Regional and Local Organisational Architecture

Figure 2 shows the organisational architecture of Outbreak Control and NHS Test and Trace at a national, regional and local level. Nationally, a new government arms length body - the Joint Biosecurity Centre, together with a PHE Incident Coordinating Centre is responsible for NHS Test and Trace. Regionally, a PHE regional Incident Coordinating Centre and Regional Hub/Oversight Group is responsible for the programme.

At Thurrock level Test and Trace responsibilities are shared jointly between PHE Health Protection Teams and Thurrock Council. Responsibility for the programme sits with a DPH led Thurrock COVID-19 Health Protection Board and member led Engagement Board.

Figure 2

11

LEVEL 3

ABILITY

REINFORCEMENT

3.2 Partnership Relationships: Essex Strategic Control Group

The Outbreak Control response needs to be a multi-agency response rather than something that is “public health” narrowly defined. Stakeholders from across all sectors will need to be involved in the surveillance, prevention and management of outbreaks.

The involvement of stakeholders will depend on the setting or geography of the outbreak and its extent and severity. Outbreaks in specific settings or localised outbreaks can be managed at Thurrock level. However should these spill out into wider spread community transmission over a wider geography or where increased transmission translates into demand that threatens to overwhelm the capacity of critical public sector infrastructure like hospitals, outbreak management may need to take place on a Mid and South Essex or Essex footprint, with coordination via the Essex COVID-19 Strategic Response.

The Surveillance Section of this plan sets out how we will manage these issues and defines different levels of outbreak and how we will communicate these to the Strategic Control Group (SCG) through the Health Protection Board and COP. Outbreaks that are wider than Thurrock will be escalated to the SCG who will be responsible for management.

Figure 3 shows how the Thurrock Health Protection and member-led Engagement Board and wider Thurrock Test, Track, Contain and Enable programme interfaces with the Essex Resilience Forum, tactical groups and recovery arrangements.

Figure 3

Strategic Coordination Group (SCG)

PUBLIC HEALTH ENGLAND:

• Has responsibility for protecting the health of the population and providing an integrated approach to protecting public health through close working with the NHS, Thurrock Council, emergency services, and government agencies. This includes specialist advice and support related to management of outbreaks and incidents of infectious diseases.

• Will ensure adequate granularity of surveillance data is provided to Thurrock Council in order for it to fulfil its obligation to monitor outbreaks and track the epidemic. This will include case and individual test level data at post code level.

• Will fulfil its statutory duty by receiving notification of COVID-19 cases, clusters or possible outbreaks (directly, or through testing data/local intelligence), undertaking the risk assessment and providing public health advice in accordance with national guidance or local setting based protocols

• Will ensure that Thurrock Council has access to case and contact data via CTAS (national case/contact tracing database) where settings based protocols require Thurrock Council to undertake outbreak management and contact tracing under the settings based protocols

• As per setting specific arrangements set out in this OCP and the protocols that sit beneath it, conduct follow up of these settings as a shared responsibility with NHS partners and/or Thurrock Council Public Health Team and fulfil their statutory duty for safeguarding and protecting the health of their population.

• Will advise on swabbing and testing for symptomatic individuals when first aware of an outbreak in line with local arrangements and settings based protocols

• Undertake a risk assessment and give advice to the setting and the local system on the management of the outbreak.

• Provide advice on complex situations on request from local partners including advice on closing and opening care homes to new admissions.

3.3 Overview of Roles and Responsibilities of Key Partners

THURROCK COUNCIL :

• Under the Health and Social Care Act 2012, Directors of Public Health in upper tier and unitary local authorities have a duty to prepare for and lead the local authority (LA) public health response to incidents that present a threat to the public’s health.

• Under mutual aid arrangements, this collaborative arrangement creates a shared responsibility between the Thurrock Council through the Director of Public Health, and PHE East of England and Essex Health Protection Team to manage with COVID-19 outbreaks.

• Through the DPH, continue with wider proactive and preventative work with particular settings and communities in order to minimise the risk of outbreaks/clusters of cases including leading communication to residents and settings on COVID-19 including support in reviewing and advising on COVID-19 risk assessments.

• Through the DPH, work with PHE to support complex cases and outbreak management (in a range of settings/communities), looking to mobilise/re-purpose existing capacity within public health, environmental health, trading standards, infection control, education, as well as wider professional workforces as appropriate (school nursing, health visiting, TB nursing and sexual health services, academia).

• Through the DPH, provide a single point of access for communication with the Council on matters relating to the reactive outbreak management response, as well as out of hours contact.

• Through the DPH, establish regular proactive meetings with ‘link’ PHE colleagues to discuss complex outbreaks, local intelligence, alongside enquiries being managed by local authorities, alongside wider issues/opportunities. This may be at both local and sub-regional footprints.

• Underpinning this work will be a need to rapidly work jointly with PHE on a workforce plan to ensure capacity in the system for delivery of the above.

• Under the Care Act 2014 have responsibilities to safeguard adults in Thurrock including provision of support and personal care (as opposed to treatment) to meet needs arising from illness, disability or old age 12

SHARED RESPONSIBILITIES (continued)

It is feasible that there will be outbreaks/incidents where the setting is located in one local authority area, with cases or contacts in different one(s). In such situations the overall management responsibilities will reside with the relevant HPT and lead local authority where the setting or majority of cases are located. Other local authorities should:

• be informed of any associated cases or contacts

• invited to participate in any IMT

• take responsibility for local actions, when and if appropriate.

HEALTH AND CARE PROVIDERS:

• Medical practitioners have a statutory duty to notify suspected and confirmed cases of notifiable diseases to PHE under the Health Protection (Notification) Regulations 2010 and the Health Protection (Notification) Regulations 2020.

• Care Home providers have a duty to cooperate with Thurrock Council and PHE to fulfil their responsibilities under the Care Homes Settings Based protocol and in line with terms through which additional funding has been made available to them by Thurrock Council to manage COVID-19.

• Responsibility for decisions to move COVID-19+ residents to isolation units in other locations ultimately remains with care homes, with advice from General Practice and Public Health. The needs of the COVID+ resident and consequences to their health and wellbeing must be considered before any transfer takes place.

• MSE Hospital Group, NELFT and EPUT are responsible for preventing and managing COVID-19 outbreaks that occur in their respective organisations including contact tracing in conjunction with Public Health England

• Primary Care Providers are responsible for cooperating with support and advice provided by PHE, Thurrock CCG and Thurrock Council Public Health Team to preventing and managing outbreaks as set out in the Primary Care protocol

3.2 Overview of Roles and Responsibilities of Key Partners (continued)

NHS THURROCK CLINICAL COMMISSIONING GROUP:

• Under the Health and Social Care Act (2012), CCGs have responsibility to provide services to reasonably meet health needs and power to provide services for prevention, diagnosis and treatment of illness.

• Provide infection control support to health and care settings as outlined in the protocols that sit under this OCP

• Support outbreak management arrangements where outbreaks occur in Primary Care and Care Homes settings in line with arrangements set out in the setting specific protocols that sit under this OCP including participation in the Primary Care and Care Home setting specific hubs.

• Support prevention and communications activity where this relates to healthcare settings

SHARED RESPONSIBILITIES:

• The NHS, PHE and Local Authority system has a shared responsibility for the management of outbreaks of COVID-19 in Thurrock.

• The Essex Strategic Control Group, its tactical cells and all partner agencies has over all responsibility for responding to the COVID-19 epidemic including any ‘second wave’

• Infection Control support for each setting will be provided in line with current arrangements.

• The following Settings Based Protocols will be developed that set out in detail the process of preventing and managing outbreaks and of contact tracing and will specify shared responsibilities between partner organisations:

• Care Homes• Domiciliary Care• Primary Care• Workplaces• Early Years settings• Schools• Vulnerable populations in residential settings• Community settings

3.3 Overview of Roles and Responsibilities of Key Partners

13

Section 4:

Thurrock COVID-19 Governance and

Architecture

4.1 Thurrock COVID-19 Outbreak Prevention and Control Architecture

Surveillance Data

Case/Contact Data from other elements of Test and Trace Programme

NHS T&T

Tier 3 /

2

Tier 1

PHE

Essex

HPT

De-escalation

PHE

National

Surveillance

Specialist advice and guidance

SETTING

S IN W

HIC

H

OU

TBR

EAK

S OC

CU

RC

ASES /

CO

NTA

CTS

Locally

Commissioned

Testing

Capacity

Intelligence and advice

Direction / test results

Thurrock Health Protection Board• Strategic oversight of Tier 1 T&T• Strategic oversight of COVID-19 epidemic in Thurrock

Intelligence and

Surveillance Cell• Monitoring/analysis of

surveillance and testing data

to ascertain outbreak

patterns/risk

Member Local

Engagement Board

Thurrock Local Operations Control Centre (TLOCC)• Data processing

• Case/contact/outbreak management system

• Operational Management and coordination of all testing/contact tracing/outbreak management

Local Contact Tracing Capacity

SETTINGS BASED HUBS

Health and

Social Care

Settings Cell

Schools &

Education

Settings Cell

Communities

and high risk

places and

people cell

Businesses and

Public Venues

/Settings Cell

Other Local Authority / Thurrock

Stakeholder Functions including TCCA

National Outbreak Control

Plans Advisory board

Joint Bio-security

centre

Essex Resilience

Forum/SCG

Directors Board

Reporting

Thurrock Joint Health & Wellbeing BoardThurrock COVID-19 TCG

Communications

Cell

Residents, businesses and settings

Information

1

6

Chair• DPH

Frequency:• Fortnightly or as often as is

required

Membership:• Public Health COVID-19

response Leadership Team• Corporate Directors AHH and

Children’s Services• Emergency Planning Manager• Strat Lead Environmental

Health• Chairs of the Settings Based

Outbreak Control/Prevention Cells

• Thurrock PHE CCDC• CCG Chief/Deputy Chief Nurse• Essex Police Lead• Emergency Planning Mgr, TBC• Comms Lead• Finance Lead

Operational and clinical oversight of, and operational focus on the implementation of COVID-19 epidemic in Thurrock and on implementation of

prevention and outbreak management and control

REINFORCEMENT

Funct ions of Programme Boards

Thurrock Health Protection Board

• Receives and reviews intelligence on:

• Overall epidemic in Thurrock including the epidemic curve

• COVID-19 outbreaks including nature, progress with control measures, input from local partners

• Performance on national Test and Trace relating to Thurrock

• Performance on local test

• Assess risk and determines the local ‘threat level’ (see section 5.3) and escalates to the Essex SCG where wider support of county wide coordination is necessary

• Oversees the operational implementation of Thurrock Outbreak Control Plan

• Identifies areas of risk, areas where there are blockages and over arching issues in order to either resolve or escalate these

• Approves alterations to settings based protocols in line with emerging evidence base

• Provides update and make recommendations to the Oversight and Engagement

• Links and provides advice and recommendations to the Thurrock COVID-19 TCG and recovery architecture

• Sets communication strategy

• Ensures the programme is adequately resourced

Member Local Engagement Board (subgroup of H&WBB)

The main function of the Board is to main strategic oversight and assurance that plans are in place and being delivered to:

- KNOW what is happening in our communities

- PREVENT COVID-19 from spreading within the community

- RESPOND to and manage outbreaks when they do occur including tracing and isolation of contacts

• Receives and reviews performance and surveillance information from the Health Protection Board

• Maintains strategic oversight of the COVID-19 epidemic in Thurrock and assurance of the implementation of the Outbreak Control Plan

• Acts as the mechanism through which recommendations to Cabinet on COVID-19 are make

• Ensures effective engagement with communities and groups on COVID-19, particularly in settings where outbreaks occur or are more likely

Strategic and political oversight of the COVID-19 epidemic in Thurrock and Outbreak Control Plan

Chair• CPH Social Care

Frequency:• Six weekly

Membership:• Leader of Thurrock

Council• Chair of Health

Overview and Scrutiny Committee

• CPH Social Care• CPH Public Health &

Air Quality

In attendance:• CEX• Corporate Director

AHH• DPH• Deputy AO, NHS

Thurrock CCG• AD Law & Governance

& Monitoring Officer

4.2 Thurrock Governance

Prevention and Control of COVID-19 Outbreaks in specific high risk settings

• Dedicated specialist ‘hubs’ with relevant stakeholders that provide oversight of the settings based prevention and outbreak management protocols

• Health Care and Social Care

• Education and School based

• Communities and high risk places settings or with high risk individuals

• Businesses/workplaces/public buildings/spaces

• Supports development and oversees implementation of settings based T&T protocols

• Provides setting specific advice and guidance on prevention of outbreaks

• Assesses and mitigates risk of operational viability due to contact quarantine

LEADS / MEMBERSHIP: See section 8.2 on specific settings

Settings Based Outbreak Control / Prevention Cells

Responsible for identifying contacts of cases and providing appropriate response

• Identifies/verifies the contacts of cases and provides appropriate advice in the following settings:

• Schools

• Care Homes

• Primary Care

• Workplaces

• High risk communities

• Assesses vulnerability of contacts and identifies additional support needs for follow up by TCCA

• Provides advice to contacts including infection/prevention/control in line with national guidance and local protocols

• Updates CTAS/Case-Contact database

• Communicates with contacts to provide advice to self-isolate to prevent onward transmission

Local Contact Tracing Cell

Intelligence and Surveillance Cell

Mapping and monitoring of COVID-19 epidemic in Thurrock

• Receives and analyses epidemiological and testing

data from PHE/JBC

• Receives data on cases from PHE Health Protection

Team and from within settings within the

community

• Surveillance of measures which could indicate early

signs of outbreak/increased community

transmissions and further investigate and alert

Operations Centre where appropriate

• Maps epidemic curve and outbreaks locally,

working with wider system to ensure demand

planning is timely and appropriate

LEAD:

• Strategic Lead Health Care Public Health

MEMBERSHIP:

• Senior PH Programme Mgr: Health Intelligence

• PH Programme Mgr: Health Intelligence

• PH Informatics staff

Overall coordination and management of day to day Operations of Thurrock Test and

Trace Programme

• Coordinates and day to day oversight of all operational details of the OCP

• Data processing escalated cases from Tier 2 and 3 and de-escalation of cases back to tier 2/3

• Liaison between Thurrock service and PHE HPT team for joint management of cases/settings

• Acts on surveillance data to initiate new outbreak investigations

• Manages implementation of Settings Based Protocols including case/contact/management outbreaks and prevention in settings/high risk communities

• Maintains Case/Contact database / CTAS

• Liaison with Settings Based Hubs

• Management of Contact Tracing Cell

• Procures of additional local testing and receives results

• Escalates issues / provides monitoring intelligence to Health Protection Board

LEAD: Assistant Director of Public Health

MEMBERSHIP: See section 7.4

Thurrock LocalOperations Control

Centre (TLOCC)

4.3 Summary of Functions of System Architecture

17

Section 5:

CapabilitiesPrevention

Communications and EngagementSurveillance and Intelligence

Testing

Preventing Outbreaks from occurring in the first place is clearly more desirable than trying to manage and control them once they do occur. Effective prevention is dependent on our residents complying with government guidelines and on individual settings such as workplaces, shops, restaurants, bars, schools and health and care settings undertaking effective risk assessments and implementing safe working procedures that reduce the risk of transmission of COVID-19.

The more that our residents comply with behaviours that reduce the risk of COVID-19, and more settings that we are able to open in a way that operates safely with minimal risk of COVID-19 transmission, the better we can balance the two risks of direct threat of COVID-19 and the impact of lockdown itself on the health and wellbeing of our residents, and therefore meet the overall aim of this Outbreak Control Plan.

Evidence based interventions/behaviours that prevent the spread of COVID-19 that can be implemented by all residents include:

• Limiting the number of people they have contact with

• Working from home whenever this is possible and conducting meetings virtually through use of technology.

• Avoiding public transport where possible and where not, avoiding rush hour

• Frequently washing hands for at least 20 seconds with warm water and soap

• Maintaining at least 2m distance from other people at all time

• Self-isolating at home for seven or 14 days if they or their household contacts show symptoms of COVID-19 including fever, a continuous cough or a loss of taste/smell

• Participating in NHS Test and Trace by getting tested for COVID-19 if they show symptoms and providing contact information to the best of their ability

• Sneezing or coughing into a tissue, handkerchief or arm

• Wearing a face mask where maintaining a 2m distance is not possible (evidence on the effectiveness of face masks is weaker than the above measures but there is some evidence that they may help reduce the risk that those already infected with COVID-19 from spreading the disease to others.

Evidence based interventions/policies/procedures that employers can take to help prevent the spread of COVID-19 include but are not limited to:

• Allowing all employees who can work at home to do so and conducting meetings virtually.

• Staggering start and leave times of employees who must access a workplace

• Conducting a thorough risk assessment of each workplace and its procedures to ensure that it is ‘COVID-19 safe’

• Limiting the numbers of employees/customers/clients who can access a space at a given time

• Ensuring that employees/customers/clients maintain a minimum distance of 2m from each other at all times

• Following infection prevention/control advice recommended for the setting including regular disinfection of surfaces, especially high volume surfaces

• Where employees/customers/clients cannot maintain a minimum distance of 2m from each other, ensuring that appropriate additional measures are in place including appropriate PPE, Perspex screens, contactless payment methods

• Keeping a record of employee/customer/client contact details that can be used by NHS Test and Trace

Government Guidance

Government guidance on lockdown restrictions is changing from 4 July 2020 to allow for more settings to re-open, relaxation of the 2m distance rule in some circumstances and with many caveats and more flexibility in terms of members from different households meeting in doors and relaxation of some restrictions for people in the highest risk ‘shielding’ (CAT A) category. Full details of the guidance and changes can be accessed at: https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance

5.1 Capabilities: Prevention5.1 Prevention

19

Relaxation of lockdown measures presents an opportunity for more sectors to open and life to become more normalised and will begin to mitigate some of the risks to health and wellbeing and the wider economy of prolonged lockdown. However, COVID-19 presents an on-going public health threat to the residents of Thurrock and with lockdown relaxation, the guidance becomes more complex, nuanced and difficult to understand for our residents and risks a lower level of compliance that could result in new COVID-19 outbreaks.

In order to mitigate these risks we will undertake the following actions on prevention:

• We will develop an on-going communications campaign for our residents with up to date advice on what is and is not allowed under lockdown. This will be the responsibility of the Thurrock Council Communications Team with advice and support from the council’s Public Health Team

• Prevention strategy in specific settings will be the responsibility of the Settings Based Hubs and prevention strategy will be set out in the Settings Based Protocols

• We will develop settings specific communication materials/campaigns

• We will map all guidance available to specific settings and communicate this to providers via the settings based hubs to allow safe opening

• We will ensure evidence based infection control and prevention advice is provided to specific settings through the settings hub

• We will support individual settings providers with advice on risk assessments

• We will highlight the risk of ignoring the 2m rule to providers in the context of increased risk of staff becoming identified as ‘contacts’ in the event of a ‘case’ and the negative impact of operational viability on the setting should this occur.

5.1 Capabilities: Prevention (continued)5.1 Capabilities: Prevention5.1 Prevention (continued)

20

Communications and engagement with our residents, businesses and stakeholders will be key in positively influencing behaviour and ensuring maximum compliance with guidance to prevent and reduce the risk of transmission of COVID-19. As lockdown guidance has relaxed, it has become more nuanced and complex and this presents a challenge in terms of communications to our residents, staff, businesses and stakeholders.

Communications will be both proactive in terms of regular positive messages and reactive in the sense that we may wish to target additional or specific messages to different population cohorts or localities in response to intelligence and local surveillance information that shows early signs of outbreaks or risk of outbreaks.

We have set up a Communications Cell comprising of senior public health and communications staff from Thurrock Council. The communications cell will manage all proactive communication to residents, businesses and other settings related to COVID-19 and receive local intelligence from the surveillance cell through the Thurrock Local Operations Centre to tailor messages and distinct settings or geographies in the event of outbreak or increased risk of outbreak.

The Communications Cell will develop a detailed COVID-19 communications strategy to support the Local Outbreak Plan and ongoing management of the epidemic in Thurrock. The cell will also work with the Settings Based Prevention/Outbreak Management Hubs to develop setting specific messages and products for employees, customers, residents and service users in that specific setting, including explaining the Settings Based Protocols and stakeholder responsibilities under then.

The Cell will also investigate mechanisms to better target specific and relevant communications messages at different population cohorts using and triangulating intelligence held in existing data sets such as Xantura and TCCA.

The Cell will liaise with other key stakeholders including the third sector and local NHS partners to coordinate communications messages such that there is a coordinated and consistent message to residents, businesses and employees across the borough.

5.1 Capabilities: Prevention5.2 Communications and Engagement

OVERARCHING AIM

• Positively influence the behaviour of the population of Thurrock, employers

and other stakeholders, such that risk of COVID-19 transmission is reduced

whilst allowing as much of the economy and public services to operate

KNOWLEDGE

• Produce and implement a COVID-19 communications strategy to support the Thurrock COVID-19 Outbreak Control Plan

• Coordinate communications strategy on COVID-19 within the Council and across other key stakeholders to ensure consistent messages to residents and employers

• Communicate proactive messages on the risk of COVID-19 to residents and employers to encourage behaviour that is complaint with government guidance and reduces risk

• Develop specific relevant communications messages and products to different sectors and settings clear explanation of requirements and responsibilities of different stakeholders, as specified in the Settings Based Protocols

• Use existing data sets and products such as Xantura to segment the population into different risk cohorts, and develop a targeted and nuanced messages at different population cohorts

• Increase the proportion of residents who become tested for COVID-19 when they develop symptoms

• Ensure maximum compliance with the Test and Trace pathway including self-isolation of contacts 21

2

2

TACTICS COMMUNICATION CHANNELS

Will include:

• Thurrock Council social media channels: Facebook, Twitter, Instagram, YouTube and LinkedIn

• E-newsletters: Thurrock News, Housing News and Business Buzz

• Thurrock council website

• Economic development channels: Business Buzz, Love Grays, Thurrock Business, Thurrock Opportunities website

• Direct marketing: Letters and call to relevant businesses and residents in the borough

• Print/digital resources: Posters (A4/A3 outdoor), social media graphics

• Press updates

The Communications Strategy will make good use of national assets and locally focused materials. There will be several strands:

• Widely targeted information highlighting what is expected of people generally and explaining Government guidance

• Specifically targeted information facilitated through stakeholders for specific population cohorts at differing risks, for example those with additional needs or underlying health conditions

• Setting specific communications and products that seek to promote safe working practices/operation to allow the economy to reopen safely

• Setting protocol specific products explaining the responsibilities of stakeholders under the protocols and what to do in outbreak situations

• Dedicated campaigns on Test and Trace

Initial products will include:• A digital campaign across existing council channels will reach a wide audience across the

borough including Thurrock News e-newsletter, social media accounts (Facebook, Twitter and Instagram) and thurrock.gov.uk website.

• A locally produced video using trusted voices to explain what test and trace is, why it is important and exactly what residents will need to do.

• More bespoke information can be delivered to specific groups using mail-outs and digital e-newsletters through contact information obtained through previous contact made as part of shielding or Thurrock Coronavirus Community Care and through data analysis on risk factors facilitated by Xantura.

• Additionally street signs can be put up in areas likely to see higher concentrations of people. This will also allow this campaign to work in conjunction with the exiting ‘reopening non-essential shops and transport communications strategy’.

5.1 Capabilities: Prevention5.2 Communications and Engagement (continued)

Who: Businesses and workplaces

How:Facilitated by the Business, finance and economic recovery group.

A series of actions to ensure effective communications.

• Tailored postal and digital communications supporting and guiding to national resources and guidance and explaining the Test and Trace programme.

• Mapping existing communications and linking in with multiple stakeholders regarding their current and existing communications e.g. Trade association, chamber of commerce, HSE to prevent duplication

Impact: Businesses and workplaces are linked into the

outbreak control planning & test and trace and have effective risk assessments.

Businesses know how to access test and trace and have confidence in the system..

There is clarity within businesses and workplaces as to what is required of them and they communicate effectively with their staff as a result.

5.1 Capabilities: Prevention5.2 Communications and Engagement (continued)

Who: Schools and Educational settings

How:Facilitated by Brighter Futures partners, Schools Recovery Group. A series of actions to ensure effectives communications.

• Easy read versions to distil key points of the schools MOU and protocol for managing outbreaks

• Video communications to support infection control and vulnerable children in the shielded group produced by partners is shared with schools.

• Phone support to schools and settings from Public Health Programme Managers to support with implementing guidance around outbreaks and test and trace.

• Digital communications shared through head teachers briefings from the corporate director weekly.

Impact: School staff have a clear understanding of their

responsibilities around outbreak management and test and trace allowing them to respond effectively to any cases that are confirmed or suspected.

Increased confidence in families following clear communications from schools and settings reinforcing local and national messaging.

Who:Care Homes

How:Facilitated by the Care homes hub, Adult social care contracting and compliance team for care homes. A series of actions to ensure effective communications.

• Digital communications to care homes to share protocols and guidance to support national directives and changes in guidance in relation to the Care Home Protocol, Prevention of COVID-19 in Care Homes, Managing outbreaks and Test and trace arrangements locally

• Easy read versions of the guidance and the outbreak control protocols are produced to aid staff understanding of responsibilities and necessary actions.

• Phone support to homes to support outbreak management.

Impact: Care Homes staff and residents have a clear

understanding of test and trace allowing them to fulfil their responsibilities effectively for any cases that are confirmed or suspected.

Increased confidence in staff and residents to respond to advice in relation to test and trace.

Who: Vulnerable groups and the shielded

How:Facilitated by TCCA, Xantura and Stronger Together. A series of actions to ensure effective communications.

• Postal and email communications to those in the shielded group, those with known Covid-19 vulnerabilities and/ known to a service to support with accessing guidance, explaining the local plans to control outbreaks and details of the test and trace service and accessing short term emergency support to allow them to isolate if advised.

• Easy read versions of guidance produced.

• Video communications from trusted local voices.

• A guide produced to support stakeholders with sharing key points with vulnerable groups.

Impact: Confidence in test & trace and a willingness to

follow advice from those that are most vulnerable.

A collective understanding of support available and a system response to sharing information and supporting those most vulnerable with communications and understanding. 23

The Surveillance and Intelligence cell will bring together all available data, from national and local sources in order to provide intelligence to the operations cell, outbreak control cells, and communication cell as well as alerting local providers of any local changes to the epidemic. The surveillance and Intelligence cell will provide an overview of the local situations to the Health Protection board. The cell is lead by the Strategic Lead for Health and Social Care who is responsible for ensuring that the messages that go out from the cell are appropriate, alerts are proportionate and go to the right people to action. Other key people in the cell are the Public Health Intelligence lead who will be responsible for ensuring all data is analysed in a robust and timely way, and members of the Public Health Intelligence team who will support with the production of analyses.

The main functions will be: mapping the epidemic; raising alerts; identifying clusters of cases and potential outbreaks that have not been identified elsewhere; researching the impacts of COVID-19 and lockdown on our population (particularly those with vulnerabilities) in order that these can be balanced or mitigated against where possible.

Two alert systems are in the process of being designed for the direct management of COVID-19. The first of these pertains to the monitoring of outbreaks and community spread of the virus and the second to increasing demands and demand management in the event that the first set of alerts are showing an expected increase in demand. Alerts will go through the strategic lead and/or DPH to the health protection and health and well being boards, other appropriate system leaders (eg. Hospital, Director of ASC, Providers of community beds) and to the SGC in the event that an outbreak either crosses borders or it is evident that drastic measures need to be in place to prevent this from happening.

The risk rating for the community spread is mainly dependent upon whether we have small pockets of setting outbreaks, or whether these have spilled in to community spread and how well contained this is.

The risk rating for demand management is dependent upon the systems ability to meet observed or predicted demand. Although the cell will constantly be monitoring this anyway they will start to monitor more regularly an report into the health protection board when the community spread alerts are 2 or higher.

5.2 Capabilities: Surveillance and Intelligence

Community spread/

prevalence

Demand Management

Health Protection Board

Essex SCG COP SCG

Local Partners and Providers

Communications Cell

5.1 Capabilities: Prevention5.3 Surveillance and Intelligence

Indirect harm

In addition to informing direct responses for COVID-19 the cell will have an additional responsibility to research the indirect impacts of COVID-19, namely lockdown measures on the health and wellbeing of the residents of Thurrock with a view to making strategic and policy recommendations about how these can be mitigated. While more questions will rise over time some initial areas of focus are:

• Primary Care, namely patients with Long Term Conditions. For example, what are the short and long term impacts that COVID-19 and how can services be reopened safely?

• Mental Health including monitoring referral trends into services, the impact of lockdown on the mental health of our residents and how we can continue to protect mental health and deliver critical services.

• Children's health and Wellbeing and educational attainment.

• Economic impacts, namely number of people claiming job seekers allowance and universal credit.

• Crime and domestic/sexual violence

• While these will not generate alerts, they will be RAG rated depending on what is happening to mitigate and reported to Health Protection and Health and Well Being boards.

24

Ongoing monitoring of localised setting outbreaks and Community Transmission

We will create and maintain a Community Transmission dashboard for Thurrock. In this dashboard we aim to create alerts based on the amount of community spread that there is in the population. Generally speaking level 0 means that we only have localised setting specific outbreaks that are under control; level 1 that we suspect that there has been some additional community spread; level 2 that community spread is extending / confirmed and options need to be considered to arrest this, and; level 3 where there is a considerable amount of community spread and demand on services is expected to rise imminently. At level 3 we can say we are in a “second wave” and concentrations need to be on supressing that wave and ensuring that local health care systems can cope with demand.

During level 0, brief weekly updates are given to the health protection board, at level 1 these shift to twice weekly, and then daily from level 2 onwards. At Level 2 we also start monitoring capacity. Level 3 would suggest resumed action by the SCG in terms of a major incident.

5.3 Capabilities: Surveillance and Intelligence

Outbreak and Community

Transmission Dashboard.

We will bring together data on: testing; contact tracing; local service use;

and local outbreak intelligence to determine a level of risk of entering

a “second wave”.

Manage Individual Outbreaks Locallythrough outbreak control cells

Level 0Individual Setting Outbreaks which are managed according to setting outbreak control plans and have not spread into community transmission.No evidence of geographical outbreaks or hotspots.No evidence that Prevalence and/or Community Transmission is Increasing.

Alert COVID-19 response partners (hospital, ASC), as well as Health Protection board.

Consider available setting closure options and relevant communications.

Level 1Individual setting outbreak which is not under control and/or is suspected to have spilled into community transmission.OR some evidence of Geographical Outbreaks or Hotspots.OR some evidence of increased prevalence or community transmission (test and trace evidence)(Can be escalated to level 2 if multiple indications)

Alert COVID-19 response partners (hospital, ASC),as well as Health Protection board.

Consider available local lockdown options (SCG) and relevant communications (at risk groups).

Level 2Individual setting outbreak which is confirmed to have spilled into community transmission.OR increasing evidence of Geographical Outbreaks or Hotspots.OR increasing evidence of increased prevalence or community transmission (eg. early indications of bed occupancy trends increasing / continued test and trace increasing trends with no explanation)(Can be escalated to level 3 by DPH if multiple indications)

Begin implementation of capacity plans.Use all available powers to try to control spread

and mitigate risks.(back into response mode – SCG lead)

Level 3Evidence of large Geographical Outbreaks or Hotspots.Definitive evidence of increased prevalence or community transmission (eg. continued bed occupancy trends / exponential rises in test and trace activity with no explanation)Any other indication that causes alarm - Director of Public Health concern

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5.1 Capabilities: Prevention5.3 Surveillance and Intelligence (continued)

25

System Demand Modelling and Capacity alerts

It is important to ensure sufficient health and care capacity continues to be available should increased community transmission of COVID-19 result in increased demand for health and care services. Demand and capacity of health and care services is monitored by MSE group modelling cell as a matter of course. The designated lead of the Thurrock surveillance cell is also part of the MSE modelling cell and so is cited and will monitor health and care demand and capacity on a daily basis. It will only be reported by exception during lower levels. Reports to the MSE modelling cell will be by exception where we remain at level 0. At level 1, we will commence further modelling work through the MSE cell. Once the outbreak and community transmission alerts are at 2 or higher this will start to be reported to the health protection board. Initially weekly but will shift to twice weekly in level 2 and daily in level 3.

Actions pertain to bringing online capacity plans which may have been moth-balled since the first wave.

5.3 Capabilities: Surveillance and Intelligence

Sitrep report that looks at demand and

capacity across the entire

system. MSE modelling cell

to model projected capacity.

No Action required – continue monitoring

Level 0No evidence of increased community transmission AND no increasing demand levels in any part of systemAND demand can be met by current capacity in all parts of the system

System needs to start planning for increaseddemands. Modelling of projected demand

to commence as soon as possible.

Level 1Evidence of large setting outbreaks that may have spilled into the communityOR Evidence of Increased community transmissionOR Evidence of increasing COVID-19 related demand in hospitalAND current demand and expected imminent demand can be met by current capacity in all parts of the system

No immediate action required, continue monitoring the Demand and capacity status. Have plans ready to come

Online should they be needed.

Level 2Demand on parts of the system has risen but is currently and projected to be met by current capacity plans.

Implement stretch capacity plans where necessary. Use neighbouring facilities, request for any

centralised support available.

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5.1 Capabilities: Prevention5.3 Surveillance and Intelligence (continued)

26

Mitigating harms caused by lockdown

5.3 Capabilities: Surveillance and Intelligence

Series of analyses/reports

that looks at potential harm to

Long Term Condition Patients,

Mental Health, Increasing

Vulnerabilities and domestic abuse.

(Due to potential time – lags in data sets this is a long

term research work stream. The work plan will evolve

over time as more questions are highlighted and need to

be answered.)

No Action required – continue monitoring

No Evidence of:Serious harm to specific individualsHarm to large groups of individualsHarm that may have large financial implications if left unchecked.

No Action required – continue monitoring

Evidence of:Harm to specific individualsHarm to large groups of individualsHarm that may have large financial implications if left unchecked.

All harm identified is currently being mitigated against.

Employ a Population Health Management Approach:Who, what, where, when, how?

Engage with relevant teams / organisations.Implement

Evidence of:Serious harm to specific individualsSerious harm to large groups of individualsHarm that may have large financial implications if left unchecked.

One or more aspect of harm identified is not currently being mitigated against.

Urgent action that is proportional and relevant to the Identified harm

Lockdown harm is having a potentially permanent impact on groups of our population.

Evaluate the harm on children’s health and wellbeing.This is a longer term piece of analyses due to time lags on data. We will use the brighter futures survey to ascertain how the wellbeing of children has changed during the academic year of the COVID-19 pandemic and lockdown combined with data on educational attainment in the following years and school attendance rates going forward. It is important that we identify any issues and put support and processes in place to give our children the best chance of recovering, both in terms of health and wellbeing but also in terms of missed education. A sustainable economy for the future is dependent on this.

While there is no formal alert system for the potential indirect harm caused by COVID-19 it is important to investigate and mitigate against this for two reasons:

1) To ensure that indirect harm is not of greater significance than direct harm avoided by actions taken to suppress virus transmission.

2) The impacts of lockdown are likely to affect different cohorts of people to differing extents with the greatest burden falling on more deprived communities. As such lockdown risks potentially increasing health inequalities.

Moving forward we will continue to monitor and investigate the impact of lockdown and seek to find ways to mitigate risk. Findings will be RAG rated according to actions being taken to mitigate and reported to the health protection and health and well-being boards.

5.1 Capabilities: Prevention5.3 Surveillance and Intelligence (continued)

27

Rapid access to testing and results of the test are key to being able to prevent and control COVID-19 outbreaks. Two tests are available:

The national approach to COVID-19 testing includes five separate pillars through which testing is delivered. The testing pillars cover a number of pathways. Each pathway, irrespective of location includes the same steps of: requesting a test; testing; test analysis and; reporting.

5.4 Capabilities: Testing• Testing of individuals who have developed COVID-19 symptoms to determine whether they have

active COVID-19 symptoms and need to self-isolate and provide details of their contacts

• Testing of all individuals in a particular setting like a school or care home when an d confirm when it is over.

Proactive Screening

Proactive screening aims to detect COVID-19 before symptoms occur, allowing those who are infected to self-isolate before they pass the virus on. We believe about 20% of individuals infected with COVID-19 never develop symptoms, and that the majority of individuals are highly infectious for a time period of up to three days before they develop symptoms. Proactive screening at population level requires a huge number of tests to be undertaken on a regular basis and if offered to everyone, would quickly overwhelm finite testing and laboratory resources. It therefore has to be targeted at settings where it is most beneficial; namely at front line workers who interact with residents in very high risk settings and who are at high risk of COVID-19 complications or hospitalisation if they become infected.

• At present Thurrock Council operates a proactive screening protocol of offering weekly testing to all front line staff in care homes as a mechanism for early detection and self-isolation of staff. The service is provided by Commisceo and accesses the NHS Pillar 1 lab capacity at AddenbrookesHospital. Details are set out in the Care Home Outbreak Prevention and Management Protocol.

• MSE Hospital group tests all patients on admission and all patients prior to discharge to care homes to confirm their COVID-19 status. COVID-19 positive patients are never discharged directly into care homes.

• NHS Partners have begun to also test front line staff asymptomatically. It is important that this continues for staff offering clinical services to vulnerable residents such as CAT A/B ‘at risk’ groups and in high risk settings such as clinical in-reach into care homes.

• At present all PCR tests have to be sent to a lab for analysis with results usually within 24 hours. We will seek to procure specialist equipment able to deliver instant test results (within 20 minutes) when this becomes more widely available as this would enable more frequent testing of all staff in high risk settings such as care homes.

There are two tests available:

• PCR (antigen) test which seeks to detect active infection

• Antibody test, which seeks to detect antibodies to determine whether or not a person has been

infected with COVID-19 in the past.

Overall responsibility for ensuring adequate day to day testing capacity that responds effectively and

rapidly to current level of outbreak threat in Thurrock rests with the Health Protection Board, with

strategic oversight through the Health and Wellbeing Board.

COVID-19 PCR (antigen) testing can be used in three broad scenarios:

• Proactive screening of individuals without COVID-19 symptoms to confirm that they are not infected

with COVID-19

5.1 Capabilities: Prevention5.4 Testing

28

Testing of Residents with Symptoms

A combination of national, regional and local testing infrastructure operates within Thurrock.

Residents can call 119 or book/order tests through www.nhs.uk/coronavirus.

Drive through centres operate seven days a week at Stanstead Airport and Greenwich in south

London. A mobile testing centre operates on some days of the week in Thurrock at Blackshots

Leisure Centre. Residents can also order a postal testing kit on-line. The postal kits service

operates through Pillar 2.

A Community Testing TCG reporting to the SCG operates to monitor community testing capacity

and includes representation from the Thurrock DPH.

Mobile Testing Units (MTUs) are available and fall into three categories:

• Regionally Allocated MTUs (includes current provision in Grays) scheduled by the Regional

Control Group

• Regional Reserve MTUs – kept in reserve to meet additional demand caused by local outbreaks

and immediate resilience in the case of an Allocated MTU failure e.g. breakdown

• Strategic Reserve MTUs – circa 30 MTUs, regionally dispersed but scheduled by the Department

of Health and Social Care. These can be deployed in support of local outbreaks when requested

to provide surge capacity.

Testing staff and their household contacts with symptoms

NHS, care home (including private sector care home) and Thurrock Council staff and their

household contacts can access drive through testing provided by the Mid and South Essex Hospital

Group. The nearest test centre to Thurrock operates at Phoenix Court in Basildon. NHS staff can

book through a dedicated NHS testing hub and council and care home staff through a council

provided hub. The council hub directs all staff reporting COVID-19 symptoms to testing facilities

and provides follow up on return to work.

5.4 Capabilities: TestingNo COVID-19 test is 100% accurate and a risk of a ‘false negative’ (a negative test result where the

individual is actually infectious) presents a serious outbreak risk, where a test result is used to

allow a symptomatic worker to return to work in settings with people at high risk of COVID-19

symptoms such as care homes. Thurrock has developed a local strengthened protocol for return

to work arrangements for staff working in care homes and other high risk settings, requiring staff

who test positive to self isolate for 14 days and symptomatic staff who test negative to continue

to isolate for seven days to reduce the risk of a false negative result.

Testing in Outbreak Situations

The settings based protocols that sit below this Outbreak Control Plan or are in development

specify detailed testing arrangements for managing and controlling outbreaks including criteria for

determining when an outbreak has commenced and is outbreak is over. For example the

Thurrock Care Home protocol requires weekly testing of all residents and staff during an outbreak

as a mechanism to identify new cases that need to be isolated. The council already has a contract

in place with Commisceo who provide on-site testing of all residents and asymptomatic staff. We

would envisage extending this contract to cover dedicated on-site testing in other settings or with

high risk individuals who may not engage with standard testing capacity available. In these

circumstances it will be the responsibility of the Operations Control Centre to organise enhanced

on-site testing in conjunction with the setting in question and in consultation with the Settings

Based Outbreak Control/Prevention cell.

Where our surveillance cell identifies clusters of community cases within a small geography or

locality or within a large setting such as a major factor or logistics centre, we will consider

deploying a mobile unit (MTU) to that locality to support with testing. The decision will be taken

by the Health Protection Board and request made through the Community Testing TCG

5.1 Capabilities: Prevention5.4 Testing (continued)

29

The national protocol on contact tracing does not provide for testing of contacts of positive cases unless they become symptomatic. In situations where the number of contacts in a setting required to quarantine presents a risk to the operational viability of that setting or where backfill staff arrangements such as agency staff present an additional risk (for example in care homes), we will consider extending testing to contacts to allow them to return to work early where this is clinically safe to do so. Further details will be set out in the relevant settings based protocol where appropriate and can be discussed on a case by case basis by the relevant Settings Based Outbreak Control/Prevention Cell.

Antibody Testing

Antibody testing forms Pillar 3 of the national strategy. Antibody tests seek to identify Immunoglobulin M and G (IgM and IgG) made in response to COVID-19 infection. It is thought that the best chance of detecting IgM is from 14 days after COVID-19 symptom onset to 21 days after symptom onset, and the best chance of detecting IgG if from 18 days after symptom onset, with levels declining slowly week by week after this time (Figure 5).

Antibody tests cannot be used to confirm active infection or infectiousness due to the time delay between active infection and antibodies being produced.

At present we are unclear what level of immunity different concentrations of IgM or IgG provide against future COVID-19 infection or for how long, although it is reasonable to assume that testing positive for antibodies may provide some level of short term immunity. However, until further research is available, a positive antibody test result should not be used to assume that an individual has long term immunity to COVID-19 or cannot be re-infected or be infected. As such a positive antibody test can show whether or not a person has been infected with COVID-19 in the past, but never be used as a reason to ignore infection control and prevention advice or dispense with PPE.

Antibody tests are currently available to NHS staff in Mid and South Essex and will be available to adult social care staff in the near future. However their practical application at present is limited to a surveillance tool to ascertain the percentage of the population who have already been infected with COVID-19.

5.4 Capabilities: Testing

Figure 5

5.1 Capabilities: Prevention5.4 Testing (continued)

30

3 1

Section 6:

NHS Test and Trace

32

NHS Test and Trace seeks to quickly identify contacts of residents who test positive for COVID-19 and isolate them, hence disrupting onward transmission of the virus.

Figure 6 shows the high-level standard protocol for NHS Test and Trace.

When a resident develops COVID-19 related symptoms they start self-isolating for 7 days and book a test.

If the test result is positive, the resident if defined as a case and shares their contacts with NHS Test and Trace. This information will be gathered in one of four ways:• Online by the case completing a template• Dedicated contact tracing staff employed by PHE• Local public health experts employed by PHE or a Local Authority• The new NHS COVID-19 app (when this becomes available).

A contact is defined as anyone with whom the case has been in close contact (2m or fewer for 15 minutes or more) within the 48 hours prior to symptoms developing.

NHS Test and Trace then contact all contacts and instruct them to also self-isolate for 14 days from the date of close contact with the case. At this stage, household members of contacts do not need to self-isolate.

Asymptomatic contacts are not tested under the standard protocol. Contacts can only book a test if they subsequently develop symptoms of COVID-19. If this happens, all household members have to start a period of self isolation of 14 days from the date of onset of first symptoms of the contact.

If the contact’s test result comes back negative, all household contacts can immediately stop self-isolating, BUT the contact must complete their initial period of 14 days self-isolation from date of their last social contact with the case.

If the contact’s test result is positive they must begin a new period of 7 days self-isolation and their household members must complete their period of 14 days self isolation from the date of onset of first symptoms of the contact.

Figure 6

We know that individuals infected with COVID-19 remain infectious for up to 72 hours before they develop symptoms and for several days after symptoms occur. As such ensuring rapid access to test results and contact tracing immediately after a positive results is vital if the programme is going to be effective in controlling the spread of COVID-19.

5.1 Capabilities: Prevention6.1 NHS Test and Trace

3 36.1 Test and Trace: National, Regional and Local Architecture

CONTACTS

TIER 3

TIER 2

TIER 1

NATIONAL: SERCO – 18,000 +

call handlers

CASES

REGIONAL: PHE – 3000 trained

clinical staff

LOCAL: PHE LOCAL HEALTH PROTECTION

TEAM + LOCAL AUTHORITY

In the vast majority of cases, details of contacts will be collected from

the case by the case completing an on-line form when they receive a

positive test result. Call handlers at Tier 3 will then telephone contacts

and cases and provide advice on self-isolation where the case has

been able to provide contact telephone details. Tier 3 call handlers will

work to a dedicated script. Tier 3 will do this for all routine cases where

this information has been provided.

TIER 3

TIER 2 Where a case has failed to or is unable to provide contact details of all

contacts, their details are escalated to Tier 2. Tier 2 staff are employed

regionally by PHE, generally have some clinical training and have

received further training from PHE. Their main role will be telephone

cases and interview them to collect as much information on contacts as

possible. They will then communicate with contacts and instruct them

to self isolate. Tier 2 staff will also be responsible for contact tracing in

inpatient settings.

TIER 1Tier 1 staff will be a mixture of specialist Public Health staff and other

staff with relevant experience e.g. EHOs employed through PHE Health

Protection Teams, and within other agencies at local authority level.

Their primary function will be to contact trace and manage outbreaks

in complex or local settings

5.1 Capabilities: Prevention6.2 NHS Test and Trace: National, Regional and Local Arhitecture

3 4

NATIONAL: SERCO – 15,000

call handlers

REGIONAL: PH – 3000 trained

clinical staff

A database called CTAS as been developed by national government to manage the records of cases and contacts in Tiers 3 and 2. It includes a web based resident facing offer to collect contact information. There are four ways of escalating a record in CTAS

Direct allocation.

Records that when entering the system are automatically allocated to tier one due to their status, for example a record identified as a care home resident is automatically assigned to tier 1 follow up in the system without progressing through the CTAS questionnaire

Automatic escalation.

When a case provides certain responses to questions, e.g. “working in a health or care setting” the record is automatically assigned to tier one follow up upon completion of the questionnaire

Call handler

escalation

Following successful phone-based contact, if a person provides contextual information not directly captured by CTAS questions that suggest a Tier 1 response is required or where the case is unwilling to provide information

Central escalation

CTAS team will identify any records or events that need escalation and have not been captured from the other three escalation mechanisms, for example a cluster of cases in particular post code or small geography

• Has attended healthcare for non-COVID reasons• Works in a prison or other place of detention• Works in a special school• Lives in a homeless hostel/shelter/refuge or similar residential setting• Leads the call handler to believe the case has other risks not adequately disclosed• Cannot identify all contacts without disclosure of name to employer/third party• Is unwilling to provide all information required

3. Consequence management• Identified impact on local public sector service or critical national infrastructure due to a high

proportion of contacts needing to quarantine e.g. school/care home• Cases or contacts unable to comply with quarantine restrictions, e.g. homeless, other complex

social issues.• Likely high profile media / political concerns/interest

4. Increased disease frequency or severity that warrants local investigation• 2+ case in schools• High workplace absenteeism• Reported high numbers of hospitalisations

Interface between Tier 1 Essex Health Protection Team and Tier 1 Local Authority Contact Tracing

At time of producing this plan, data flows between the Test and Trace architecture remains unclear.

• It is assumed that cases escalated to Tier 1 from Tiers 2 and 3 initially will be directly to the Essex Health Protection Team

• Local Authority Tier 1 case/contact tracing capability requires access to accurate and timely data flow of case information and a database to manage case and contact information. It is assumed that Thurrock Council will be given access to CTAS (national case/contact database system) if required to undertake case/contact tracing in specific or complex settings

Specifics of how data will flow between Tier 1 Health Protection Team and Tier 1 Local Authority functions will be set out within the Settings Based Protocols

The following criteria will be used to decide which cases are escalated to Tier 1:

1. Cases where liaison with an educational/childcare setting or employer is required• Case has attended an educational setting whilst infectious• Case has attended work whilst infectious and is unable to identify all of their contacts

2. Complex and high risk settings. The case:• Lives or works in a care home/long term care facility• Is a healthcare worker who has been in contact with patients• Is an emergency services/border force worker who has been in contact with residents

5.1 Capabilities: Prevention6.3 Criteria for Tier 1 Escalation and Data Flows

3 5

Section 7:

Thurrock’s Operating Model

35

Overview

The Thurrock Local Operation Control Centre (TLOCC) acts as the nucleus of the outbreak management in Thurrock including test and trace. It provides a co-ordination function to ensure the right information is shared with the right people at the right time. It serves to process data and facilitate the management of outbreaks and the investigation of cases warranting further investigation. The service will operate Monday to Friday 9am – 5pm with out of hour on-call arrangements provided by the Director of Public Health, Assistant Director of Public Health, Strategic Leads for Public Health and Public Health registrars.

Data is received from three key sources:

• Directly from other architecture in the Test and Trace structure, either via CTAS (if/when operational within the local authority) or directly from the Public Health England Health Protection Team where a joint local authority/PHE tier 1 response is required and this has been escalated from Tier 2/3 under the escalation criteria set out in section 6.3

• Directly from providers or settings, for example if a care home or school reports a case to the Council.

• As an alert from the Surveillance Cell where clusters of cases have been identified locally from local surveillance mapping activity.

The centre will be led by the Assistant Director for Public Health and comprise of EHOs, Public Health Protection Programme Managers, redeployed Public Health staff and contact tracers. The TLOC has a central email address publichealthsi@thurrock.gov.uk and is monitored by administrators and Public Health staff 7 days a week.

The main objectives of the TLOC are:

• To receive, understand and interpret national PHE guidance and other published evidence base on best practice to prevent and manage COVID-19

• To receive and respond to local surveillance intelligence from the surveillance cell including investigation of possible local outbreaks

7.1 Operating Model: Overview5.1 Capabilities: Prevention7.1 Operating Model Overview

• To develop settings based protocols that set out prevention, risk assessment, outbreak management procedures including enhanced testing where appropriate, contact tracing and quarantine arrangements and determining when an outbreak is over in consultation with the four settings hubs and PHE.

• To provide expert public health advice to the four settings based hubs including developing and updating settings based protocols in consultation with the hubs in light of local intelligence, national guidance and evidence of best practice and oversee their implementation including safe operating of individual settings.

• To provide central operational co-ordination of all outbreak prevention and management activity including maintenance of the CTAS database (if/when available)

• To support PHE in initial settings based risk assessments (where required), and formation and management of outbreak control teams where necessary

• To investigate setting based outbreaks in conjunction with PHE and setting based hub members and drawing on expert resources as required including but not limited to infection/prevention/control advice and EHOs and to oversee the implementation of the settings based protocols. Where necessary forming an Outbreak Control team, collecting contact information, ensuring contacts are followed up (subject to access to CTAS), arranging enhanced testing arrangements, placing in additional controls to manage outbreaks and determining when an outbreak is over.

• To develop and implement a communications plan including setting specific communications and general advice to residents in conjunction with Thurrock Council Communications Team and settings based hubs.

• Provides governance, leadership and strategic coordination for the local (T1) Contact Tracing function

• The governance for the TLOC sits with the Health Protection Board. TLOC will provide regular updates to the Health Protection Board on the COVID-19 epidemic in Thurrock and measures to control it.

36

REINFORCEMENT

Contact Tracing Cell

• Assess initial contacts list and determine risk

• Follow up contacts and provide appropriate quarantine advice

• Provides results of tests to contacts were appropriate

• Manages case/contact CTAS database

• Assesses additional support needs and passes contacts’ details to TCCA for follow up

• Cross references COVID-19+ cases against CAT A database and calls all CAT-A cases to offer support. Informs GP where permission given by resident

7.2 Operating Model: Capacity and Functions

Contact tracing task delegation

Information flow to manage outbreaks

Surveillance/direct reportsOngoing management

Escalation from Tier 2/3Initial risk assessmentOngoing managementAdvice and guidance

5.1 Capabilities: Prevention7.2 Operating Model: Capacity and Functions

Thurrock Outbreak Control Centre

• Receives intelligence data once a week from intelligence cell/ more frequently as required to investigate cases

• Single point of contact for reports from settings

• Informs PHE HPT of initial reports

• Receives escalation from Tier 3/2 to Tier 1 from PHE HPT Team

• Form OCT and agrees plan with PHE where appropriate

• Undertakes detailed settings based risk assessment conducted with setting

• EHOs will risk assess workplaces only, provide an enforcement function and on the ground liaison.

• Liaison with settings based prevention/outbreak management hubs

• Initiates the establishment of contacts list

• Public Health Advice, IPC advice to setting to manage outbreak in line with Setting Based Protocol or Outbreak Control Plan

• Liaison with expert resource for further information to inform the risk assessment.

• Identifies services used by case & alerts

• Provides quarantine/isolation advice dependent on local protocol for setting

Public Health England Essex Health Protection Team

• Receives escalation from Tier 2/3 and informs TOCC

• Receives surveillance data and direct reports from TOCC of new incidents

• Undertakes initial risk assessment

• Joint management of complex outbreaks as per settings based protocols or Outbreak Control Team/Plan

• Expert advice and guidance

• Management of outbreaks/situations not responsibility of LA

• Contact tracing

7.3 Operating Model: Demand and Staff Capacity

Understanding potential demand on Tier 1 is important in both planning for both the short term and longer term capacity that may be needed and in deciding at which geography to operate Tier 1, i.e. Thurrock only arrangements or collaboration over a wider geographical footprint. However it is also extremely difficult for a number of reasons:

• We are unclear what the total number of daily cases handled by CTAS will be at Tier 3. This will be is a function of a number of variables that are subject to change as the epidemic progresses including:• The total number of new daily infections of COVID-19 in the community (daily

community incidence). • Daily numbers of new cases who become symptomatic• The proportion of symptomatic cases who decide to get tested• Asymptomatic cases who consent to be tested through screening• Overall testing capacity and responsiveness at national and local level

• We are unclear what impact further future government policy changes to lockdown will have an the R value and how many additional cases this will generate. An R value above 1 rapidly leads to growth in the number of daily cases and thus increased demand on the system

• We are unclear of the extent to which NHS Test and Trace will mitigate against a rise in R in the early stages of lockdown measures being lifted and so keep cases over a longer time period at a level which is manageable

• We are unclear what proportion of cases initially at Tiers 3 and 2 will be escalated to Tier 1 in the future and this is likely to vary from week to week at Thurrock level

• Detailed protocols specifying how tasks will be shared between PHE and Thurrock Council are yet to be developed for some settings.

What is likely is that capacity required to meet demand is likely to need to flex. Initial capacity required to meet current demand is relatively low but capacity needs could increase significantly if the R value moves above 1 or current behavioural response to lock down restrictions causes a significant number of localised outbreaks

Recruiting to new specialist public health contact tracing or health protection roles may also be challenging at a time when many other local authorities and PHE are attempting to do the same thing.

We have designed our staffing operating model to provide capacity that is flexible by identifying roles within the existing Thurrock Public Health Team with health protection skills that can be redeployed or take on additional COVID-19 responsibilities in the new structure, whilst commencing recruitment into interim posts. We will use some of central government grant provided for Local Authority Tier 1 response to fund back-fill for redeployed staff where necessary, as we believe that recruitment of interim non-health protection public health expertise may be easier in the current climate of very high demand for health protection staff.

We are however seeking to also compliment the structure with interim EHO roles that have particular outbreak management expertise in workplace settings.

The proposed structure for both the Thurrock Local Operating Control Centre and Surveillance Cell are shown on the next page. The ADPH will oversee TLOCC and the Strategic Lead for Healthcare Public Health will oversee the surveillance cell. The DPH will oversee the entire programme.

We have aligned outbreak control and health protection staff to the four hub settings as we believe that this will allow stronger level of focus, setting based expertise and relationship building. However the overall structure allows flexibility to move staff between settings where operational demands require.

We have based overall capacity requirements on working assumptions used by other local authorities, aggregated to Thurrock overall population size.

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7.3 Operating Model: Demand and Staff Capacity (continued)

StaffingA proposed staffing structure is set out on the next page which will be filled through a mixture of redeploying existing Public Health staff and backfilling their current responsibilities, and through recruitment of new temporary staff. The ADPH will manage TLOCC and Contact Tracing. The DPH will oversee implementation of this plan and COVID-19 Outbreak Control.

Settings Based Strategic Lead for Public HealthEach of the four setting areas is overseen by a Strategic Lead who will sit on their respective Settings Based Hub meeting and provide expert public health advice to the settings hub. Their role will include:• Developing the respective settings based protocols that the hub is responsible for overseeing in

conjunction with Public Health England and other hub members. Each protocol will set out roles and responsibilities of different stakeholders in terms of preventing COVID-19 in specific settings including safe operating within the setting, managing positive cases and outbreaks, contact tracing and appropriate quarantine advice for cases and contacts, enhanced testing (where appropriate) and criteria by which the outbreak will be determined to be over.

• Providing advice to the hub based on the latest Public Health Guidance• Overseeing the development of a settings specific communications campaign with support from the

communications cell• Providing strategic oversight of public health activity to the setting• Line managing Protocol Managers

Protocol / Outbreak ManagerEach setting will also have a Protocol Manager. In the case of the Workplace setting, this will be an Environmental Health Officer. Protocol Managers/EHOs will be responsible for ensuring that actions set out in the Settings Based Protocols for preventing and managing outbreaks are implemented including:• Direct liaison with providers/communities within the setting to ensure that advice/activity/operating

procedures reflect best practice in preventing COVID-19 for example through excellent infection/prevention and control

• Providing settings based communications resources directly to providers/communities within the setting

• Risk assessment in the case of outbreaks in conjunction with PHE as set out in the protocol• Identifying the contact details of all contacts where the setting receives a positive case based on the

risk assessment and ensuring that the setting manages positive cases and contacts in line with the protocol

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Protocol / Outbreak Manager (cont.)• Arranging settings based enhanced testing where appropriate and coordinating the results• Direct liaison with the setting in an outbreak situation to advise of further controls to contain the

outbreak and prevent its spread in line with the protocol• Determining when the criteria set out in the protocol for when an outbreak is over have been met

Contact Tracing CellContact tracing will be undertaken by the contact tracing cell who will receive details of contacts from the Protocol/Outbreak Manager through the risk assessment.

Contact Tracers will also be responsible for determining if cases/contacts are vulnerable and where necessary brokering additional support via TCCA and other stakeholders to allow them to quarantine

The Contact Tracing Cell will be led by a Programme Manager who will be responsible for all data flows in and out of the Thurrock Local Operations Control Centre (TLOCC) and all administration to settings/cases and contacts. He/she will also be responsible for ensuring CTAS is maintained.

Major OutbreaksWhere the initial risk assessment, or as a result of subsequent test results it is determined that the setting or community is experiencing a major or high risk outbreak, an Outbreak Control Team will be formed. The decision to form an Outbreak Control Team will be made by the ADPH/DPH in conjunction with PHE and in consultation with the Settings Based Hub members. In such circumstances, a dedicated Outbreak Control Plan will be devised and the Outbreak managed in line with this plan.

Surveillance and Intelligence CellThe Surveillance and Intelligence Cell will monitor the local epidemiology and alert TLOCC to any potential outbreak situations including clusters of cases that warrant further investigation. The functions of the Surveillance and Intelligence Cell are set out in section 5.3

Communications CellThe Communications Cell will develop overarching and settings specific communications materials both proactively and in response to local intelligence. It will comprise of a dedicated COVID-19 post working closely with the DPH and Thurrock Council Communications Team, as set out in section 5.2.

40

ADPH – TLOCC Lead (BF)

HE ALTH AND ADULT

SOCIAL CAREE DUCATION & E ARLY

YE ARSWORKPLACES

COMMUNITIES AND VULNE RABLE

GROUPS / SE TT INGS

Manages implementation of protocol:• Prevention• Outbreak Risk

Assessment• Outbreak

controls• Testing• ID contact info

PR

OT

OC

OL

IMP

LEM

EN

TA

TIO

N

SU

RG

E

CA

PA

CIT

Y

EHO (NTP)1.0WTE

Contact Tracer (NTP)

1.0WTE

Information Analyst

0.5WTE (BF)

7.4 OPERATING MODEL: Staff Structure, TLOCC and Surveillance Cell5.1 Capabilities: Prevention7.4 Operating Model: Staff Structure – TLOCC and Surveillance Cell

BF = Deploy from existing resource and back fillNTP = New temporary postWTE = Whole Time Equivalence

Strategic Lead PH –Lifestyles

(BF)(also outbreak

lead)

ADPHStrategic Lead PH –

MH

Strategic Lead PH

PEC

Protocol/ Outbreak Mgr (BF)0.2WTE

Protocol / OutbreakMgr (BF)1.0WTE

EHO (NTP)

1.0WTE

Protocol/Outbreak Mg6 (BF)0.6WTE

Protocol/ OutbreakMgr (BF)0.4WTE

Protocol/ Outbreak Mgr (BF)1.0WTE

ST

RA

TEG

IC O

VER

SIG

HT

AN

D S

ET

TIN

GS

LEA

D • Strategic Oversight of Setting

• PH Lead to Hub• Develop Setting

Protocols• Risk Assessment

to Setting

SpR0.2WTE

Contact Tracer (NTP)

1.0WTE

Programme Manager1.0WTE

Contact Tracer (NTP)

1.0WTE

Contact Tracer (NTP)

1.0WTE

Contact Tracer (NTP)

1.0WTE

CONTACT TRACING & DATA PROCESSING CELL

• Manages data flows / CTAS• Email/letters to settings• Follows up cases/contacts to assess

vulnerability• Provides advice to cases/contacts

on appropriate quarantine

Strategic Lead HCPH

0.5 WTE (BF)

Snr PH MgrIntelligence

0.5WTE (BF)

HCPH / Intelligence

Mgr 0.5 WTE (BF)

Info Analyst0.5 WTE

(BF)

SURVEILLANCE & INTELLIGENCE CELL

• Receives and analyses

epidemiological case and testing

data from PHE/JBC

• Local surveillance of epidemic

• Alerts TLOCC /wider system of

potential outbreak clusters

COMMUNICATIONS CELL• Develops and implements comms

plan• Setting specific comms on protocols• Proactive comms to residents• Reactive comms in outbreak

situations• Targeted comms to at risk groups

DPH – Outbreak Control Plan Lead

COVID-19 Comms

Lead

Thurrock Council Comms

Team Rep

Strategic Lead Communications

415.1 Capabilities: Prevention7.5 Operating Model: High Level Process Diagram for Outbreak Management

The diagram below sets out the high level process through which cases, contacts and outbreaks will be managed. Detailed processes and responsibilities are set out in the Settings Based Protocols that sit below this plan.

Test and Trace presents additional challenges to some individuals to self-isolate for seven or 14 days if they or a household contact tests positive for COVID-19 or if they are contacted by NHS Test and Trace because they have been identified as a contact of a case.

Thurrock Council in partnership with Thurrock Council for Voluntary Services set up Thurrock COVID-19 Community Action (TCCA) early in the epidemic to support vulnerable individuals to cope during the epidemic. This includes:

• Residents on the government’s ‘Shielding’ list who are at very high clinical risk of COVID-19 who have been asked to self-isolate (known as Category A, circa 10,000 residents)

• Residents with underlying health conditions that place them at increased risk of COVID-19 but who are not on the Government’s ‘shielding list’ (known as Category B, circa 40,000 residents)

• Residents with other vulnerabilities for example those with mental health problems of who are at risk of domestic violence (known as Category C)

Thurrock TCCA has operated a dedicated telephone support service throughout the epidemic. Outbound calls were made to every new resident on the shielding list and the service maintained a master database of the needs and individual characteristics of shielding residents in order to ensure that there needs were met. Initial food boxes were provided to category A residents who required them when they are first added to the shielding list

The service provides a range of support services that can be accessed via the telephone to all risk categories through a network of volunteers including:

• Help to access essential supplies like food and household products

• Medicines collection and delivery

• Practical help like gardening, cleaning and dog walking

• Befriending

The service operates 9am-5pm Monday to Friday, and 10am-12pm Saturday to Sunday.

7.6 Supporting Vulnerable Communities to Self-Isolate

We will link TCCA to our operating model for Test and Trace in order to assess and target support

at residents who may need it proactively.

The process by which this will be done is set out on the next page.

Contact tracers will ask all contacts whether or not they are vulnerable and/or need additional

support using an agreed script. Where potential vulnerability or support needs are available,

contact tracers will explain the support offer of TCCA and ask whether or not the contact consents

to pass their contact details to TCCA. Where consent is obtained, TCCA will follow up with the

contact and either arrange support through the volunteer network or broker support through

other council or wider stakeholder services.

If/when the council gets access to the CTAS information, TLOCC will also have access to patient

identifiable COVID-19 positive case information. In these circumstances we will cross reference

positive cases with our CAT A data base. Where a positive case is also recorded on our data base

as a CAT A resident, we will arrange a proactive phone call to make the same support offer that

we make to all contacts, and where required, refer details of the case the TCCA.

CAT A residents who test positive of COVID-19 are at significantly increased risk of complications

from COVID-19. In these circumstances we will also ask the resident’s permission to share their

positive test result with their GP practice, and if given, alert the GP surgery and request clinical

following up and monitoring of their patient.

7.6 Operating Model: Supporting Vulnerable Residents to Self-Isolate

42

Contact Details Obtained by Contact

Tracer

TLOC obtains case identification via CTAS

On CAT A database?

End

Contact tracer asks contact if they

require additional support to self-isolate

Additional support

required?

Contact tracer informs individual of

TCCA support available

TCCA support required

Consent gained to pass details to TCCA

Contact tracer passes name, telephone

number, address and type of support required

to TCCA

TCCA call handler records details on

4me including specific code ID’ing

interaction as T&T

TCCA Triage function informs other Council services if requested /

applicable

TCCA call handler makes contact with resident to

arrange support as required including external referral if

appropriate

Contact tracer calls case to ascertain if they require additional

support to self-isolate & request permission to

inform case’s GP

Contact tracer cross references case ID

with CAT A database

Wider support brokered / provided

End

NO

YES YES

NO

YES

NO

Contact tracer informs case’s GP that they have a CAT A patient who has

tested positive for COVID-19 to ensure

clinical follow up

7.7 Flow diagram: Supporting Vulnerable Communities to Self-Isolate (continued)7.7 Operating Model: Supporting Vulnerable Residents to Self-Isolate - Process

Contact tracer calls case to ascertain if they require additional

support to self-isolate

43

Risk/Issue National / local risk Possible mitigation measure

TCCA contact centre has reduced in capacity (incoming function absorbed with central Council contact centre and outgoing function solely for shielding patients up to end of July). If demand increases, contact centre might not be able to cope.

Local Need to develop approach to record whether a support request has come following contact from T&T for intelligence purposes & to inform any future changes to structure of TCCA.Continued communications encouraging use of webform compared to telephone number.

It is unknown what sort of demand for support there will be due to T&T, given that we do not have data from pilot sites on how many of those contacted have required added support.

Local – what is known is that demand for support from shielded patients has been decreasing since government guidance changed on 1st June.

Need to establish clear data flows between contact tracing cell and TCCA to enable clear recording of needs for intelligence purposes.

Food storage function at High House has also reduced following reduction in need for emergency boxes. If demand increases, this may require a rethink on the food box programme.

Local – 520 emergency food boxes have been distributed in total, and more of those were at the start of the program.

It is thought unlikely that this will have a large impact in terms of space requirements.

Emergency food boxes not to be offered in first instance – offer of volunteer getting shopping for them and using CVS payment reimbursement system to be promoted.

The number of volunteers available to support TCCA has been decreasing as more return to work.

Local Communications to reiterate that people ask family/friends for help before approaching TCCA, and that shielded patients can continue to access priority slots for online shopping. . This to be written in script of call handlers as well.

Continued roll out of Our Road programme to encourage community networking and resilience

7.8 Risks and Mitigation: Supporting Vulnerable Residents to Self-Isolate.7.8 Risks and Mitigation: Supporting Vulnerable Residents to Self-Isolate

44

Section 8:

Prevention and Management of COVID-19 in High Risk Settings

and Communities

8.1 Variation in Risk

As the COVID-19 epidemic has progressed we have learnt more about the risk that the virus poses. There is now clear evidence that the risk of both contracting the virus and the risk to an individual’s health once infected with COVID-19 is not the same across the population. Certain communities and population groups are at increased overall risk of COVID-19 by nature of variation in risk of becoming infected in the first place, and variation in health outcome once infected.

Overall risk of COVID-19 to different communities and population groups can be thought of as a function of both likelihood of exposure and consequence to health of exposure.

Some settings, both residential and workplace increase the likelihood of exposure to COVID-19 and hence infection: This can be because there is a higher chance that a COVID-19+ person will access the setting, because the setting’s environment facilitates COVID-19 transmission, or because of behaviours or tasks undertaken within the setting.

Equally, the risk to health from becoming infected varies from group to group dependent on a range of factors including age, ethnicity, number of underlying health conditions and lifestyle factors like weight and smoking status

Figure 7 suggests where on average, different cohorts of residents may fall on these two dimensions of risk (exposure and consequence). For example, children and young people in schools settings have the lowest risk as there is some research evidence that suggests that they are less likely to contract COVID-19 and may be less effective at transmitting COVID-19 and strong evidence that they are highly unlikely to suffer significant adverse health consequences if they do become infected.

Conversely nursing home residents spend all of their time in a high risk setting and are at significantly increased risk of adverse health consequences from COVID-19 when compared to other population groups.

Human behaviour and risk mitigation practices such as infection control and PPE are not factored into the diagram but can have a significant impact on where an individual lies on the ‘risk of exposure’ access. Additionally there is likely to be variation between different individuals within a population cohort in terms of where they lie on the ‘consequence’ (y) axis depending on their individual health status in terms of lifestyle and numbers of underlying health conditions

8.1 What determines risk from COVID-19?

Figure 7

46

In recognition of the differing risks of COVID-19 faced by different cohorts of our residents, we will develop specific protocols setting out how we will prevent and manage COVID-19 outbreaks in different settings and communities managed by setting specific ‘hubs’

Thurrock formed a Care Home Hub and agreed outbreak management protocol earlier in the epidemic and have been proactively preventing and managing outbreaks in care homes using the protocol since May 2020. We will develop similar protocols covering prevention, outbreak management and test and trace for the following additional settings, managed by four Outbreak Prevention and Control Hubs:

• Domiciliary Care

• Primary Care

• Workplaces (currently in draft form)

• Schools and Early Years (currently in draft form)

• Vulnerable populations in residential settings

• Community settings

Cases, contacts and outbreaks in specific settings will be managed in line with the protocols.

Existing relevant structures that form part of the COVID-19 response and recovery structure of Thurrock will be used as the Outbreak Prevention and Control Hubs as these meetings already have all of required stakeholders around the table. Where protocols are yet to be developed, the hub will be used as a reference group for protocol development. Once developed, the hubs will review the protocols regularly to ensure they remain fit for purpose as the epidemic develops. The hubs will also be used by the Communications Cell as a consultation mechanism for specific communications messages/products aimed at specific settings.

These are shown in figure 8.

8.1 Supporting High Risk and Complex Settings and Communities: Prevention and Outbreak Management Hubs

BUSINESSES, WORKPLACE & PUBLIC

VENUES HUBStructure used: Finance, Business and

Economic Cell (TCG sub-group)

Frequency: Weekly

Chair: Director of Place, TBC

PH Lead: Strategic Lead PH – PEC

Protocols: Businesses, Workplaces and Public Venues

PRIMARY CARE & ADULT SOCIAL CARE

Structure used: Existing Care Home Hub (to be expanded)

Frequency: 3 x a week

Chair: Deputy Chief Nurse, TCCG

PH Lead: Strategic Lead PH – Health Improvement

Protocol(s): - Care Homes

- Primary Care

- Domiciliary Care

COMMUNITIES HUB

Structure used: Stronger Together Board

Frequency: Fortnightly

Chair: Strategic Lead – Communities and Equalities, TBC

PH Lead: Strategic Lead PH – MH

Protocol(s) - Vulnerable populations in residential settings

- Community settings

SCHOOLS AND EARLY YEARS HUB

Structure used: Schools & Early Years Cell (TCG sub-group)

Frequency: Weekly

Chair: AD Education & Skills, TBC

PH Lead: AD Public Health

Protocol(s) - Schools- Early Years

8.2 Prevention and Outbreak Management Hubs

Figure 8

47

Scope• Businesses and workplaces in Thurrock. Three major ports, food/drink processing companies employing 10+ staff. • Public Venues.• High risk considerations: Workplaces where there are large numbers of people in close proximity; High volumes of employees living or travelling together (car sharing /

minibus sharing); Impact of self-isolation on viability of (parts of) a business (High consequence environments should be a factor in this consideration). Catering/hospitality settings serving large numbers of public making contact tracing challenging. Large number of visitors for public venues/events e.g. theatres, concerts and sports stadiums.Workplaces where there might be language barriers. Workplaces where vulnerable employees have not been identified. Less mechanised settings. Settings where there is lack of awareness of, understanding of or engagement with infection prevention/control measures on the part of employers/employees.

AIM: • To reduce the risk of and prevent the transmission of COVID-19 within business, workplaces and public venue settings and limiting the spread of infection between these settings and the community. This

may include people residing in and travelling in and out of the Borough.• To assist in managing the subsequent impacts on local businesses, workforces and the public attending public venues. OBJECTIVES:• To identify and work with the high-risk businesses, workplaces and public venues for preventative and outbreak management measures.• To promote prevention by ensuring that businesses have access to relevant information, advice and support. • Rapidly identifying and confirming a COVID-19 outbreak when it occurs and providing a coordinated response to reduce the threat of transmission to local workforces and the community.• Supporting businesses and workplaces to interpret Public Health guidance and prevention and control measures to allow settings remain open and continue to operate, where possible. • Outbreak management and contact tracing if required, including specialist guidance to high risk businesses experiencing an outbreak (and to trace contacts that have attended public events).

Existing infrastructure/assets• Many national and local organisations already provide information, advice and

guidance to businesses (see stakeholder list). • Stakeholders, Partnerships and existing groups:

• Business, Finance and Economic Recovery cell• Thurrock Business Board• SELEP• Economic Development and Skills Partnership• Health and Safety Executive• Unions• Essex Chambers of Commerce• Federation of Small Business• Trade associations• Food Standards Agency

• National Test and Trace programme. • PHE Health Protection Team outbreak management function.

Current processes/responsibilities

• Multiple organisations provide information, advice and guidance to businesses.

• PHE Health Protection Team lead on outbreak risk assessment and management.

• Priority testing is available for key workers. Others can access testing via the national system including mobile testing units.

• Contact tracing – only as carried out through PHE / national Test and Trace currently.

- Awaiting release of SOPs and MOU with PHE for Businesses and Workplaces

- Awaiting formal release of PHE action cards to communicate out and guide discussions with stakeholders.

8.3 Preventing & Managing Outbreaks in Businesses, Workplaces and Public Venues

48

8.3 Preventing & Managing Outbreaks in Businesses, Workplaces and Public Venues, Risks and Mitigation

49

Risk/Issue National / local risk

Possible mitigation measure

Unclear roles and responsibilities in relation to the roles of HSE, FSA and Port Health Authorities.

National and local Issue escalated at regional level on the MOU for business and workplaces between PHE and LAs. This needs to include the appropriate enforcement authorities.

Too many businesses locally to fully keep track of developments on an individual basis.

National and local Mapping of which organisations provide what level of information, advice, guidance and support to which types of businesses. Identify high risk businesses and workplace settings for prevention.A regular online survey of local businesses to be considered undertaken on a weekly basis to identify any emerging issues?

Business/organisational trust in the Local Operating Centre/Outbreak Management and impact on business viability.

National and local Proactive communications and engagement on notifying early to mitigate and minimise risk on operations of business.Businesses will be keen to ensure a good reputation.

Potential difficulties in obtaining all required information –e.g. all details of contacts etc.Business/Employer willingness to share information or send letters.

National and local Develop targeted communications, standardised messaging to roll out which stipulate importance and benefit of providing required information if contacted by T&T.Protocols for escalation where businesses or workplaces do not engage?

Governance and oversight of workplaces and businesses outbreak management protocol to be confirmed.

Local Business, Finance and Economic Recovery Cell. Interface with Local Operating Centre.

No defined pathway from initial business contact through to outbreak management. Currently this would only be escalated through positive case contact tracing from the national team and local HPT.

National and local Awaiting final SOPs and MOU from HPT.Detailed model under development.

Unknown capacity/resource requirements for outbreak management – large numbers of businesses and workplaces, not all of equal risk.

National and local High risk settings and employee numbers to be identified.Resource allocation on Outbreak Management to be considered.

Scope• The scope of this work will be focused on CQC registered care homes and other care providers

including working age adult homes, domiciliary care, supported living services, nursing homes, housing with care schemes

• The PHE/LA standard operating procedure (Care Home COVID-19 Protocol) provides a framework for the joint management of COVID-19 outbreaks in care homes and similar settings including extra care housing and supported housing. This includes the four key objectives of:

• Preventing Outbreaks before they occur including IPC advice/training proactive weekly screening for COVID-19 in all asymptomatic staff

• Rapid and proactive management of outbreaks including enhanced weekly testing of all residents and staff during an outbreak and strengthened definition of outbreak as one confirmed case in resident or staff member

• Support to care for COVID-19+ residents including option of step up to isolation unit

• Enhanced ongoing support to staff to provide care for residents during COVID-19 epidemic including GP LES, individual care planning, community geriatrician and additional equipment.

• Contact Tracing

• Further protocols under development to cover Primary Care and Domiciliary Care settings

Aim: To minimize the COVID-19 infections and related deaths in care homes in Thurrock reducing transmission, protecting the vulnerable and preventing increased demand on healthcare.

• Plan and prepare with Care homes and other care providers, ASC and CCG a comprehensive COVID19 testing approach for staff and residents• To provide facts, information and guidance to care homes on the latest approach to preparing for and managing COVID19 outbreaks in care settings• Guide the Care providers during an outbreak and provide access to specialist PH advice• Record and monitor all relevant outbreak data for reporting

Existing infrastructure/assets• PHE provided Line list (contact records from tracing activity)

• Outbreak management and prevention approach (Proactive and Preventative Management of COVID19 outbreaks in care homes – Thurrock Model)

• SOP – PHE-LA Joint Management of Care Home Covid-19 Outbreaks in EoE

• Outbreak Tracker (detail records of outbreaks in older age and adult working age care homes)

• SitRep

• Care home staff exposure template (PHE provided approach to T & T)

• https://www.gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings

• Capacity Tracker (filled in by Care homes for MSE)

Current processes/responsibilities

• Documented service engagement with Commescio for testing proactive and outbreak management testing

• Care home hub (bi weekly oversight meeting to co ordinate responses for care homes in outbreak)

• MDT weekly call regarding COVID19 positive cases

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Risk / Issue Local/national Possible mitigation measure

1. Other care providers or settings may be missed as part of the scope Local Additional protocols under development for Primary Care and Domiciliary Care.

2. Very high risk setting in terms of both transmission and consequence of infection

Local Protocol sets out detailed actions to address these risks including IPC and enhanced testing of staff and residents and step up facilities for COVID+ residents

3. A danger of competing priorities / lack of capacity within care home staff which will detract from outbreak management

Local Care Homes have signed up to Protocol and additional funding provided by TBC conditional on adherenceA range of on-going support is available from TBC, TCCG, GPs (via LES) and NELFT.Daily calls between Care Home Hub staff and Care Home ManagersDedicated communications products on protocol under development

4. Non-compliance of staff with self-isolation due to low pay Local Additional funding provided via TBC to provide for care home staff sick pay

5. Staff present on-going risk of bringing COVID-19 into home from the community or cross infecting homes where working across multiple sites

Local 7 day testing of all asymptomatic staffEnhanced self-isolation protocol of 14 rather than 7 days for staff who test COVID-19+ and a requirement to self isolate for 7 days for any COVID-19 symptomatic staff even after single negative test resultProtocol prohibits use of staff across multiple sites

6. Risk of operational viability of home if multiple staff members become contacts of an infected case and need to self-isolate at the same time

National Specific dedicated communication products for care homes on Test and Trace under development to stress the need to remain 2m apart at all times when PPE not wornExploring if self-isolation period for contacts could be reduced through further enhanced testing including antibody testing

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ScopeThe individuals covered are likely to be amongst those we have locally determined in Thurrock to be in categories B (clinically vulnerable to COVID but not shielding), or C (heightened vulnerability to the impacts of COVID). These include:

• Rough sleepers and those at risk of homelessness

• Those known to drug & alcohol services

• Those in Sheltered Housing

• Residents of HMOs

• Those living on traveller sites

• Those experiencing domestic or sexual violence

• Those with mental ill-health, LD and autism

• Those known to Probation

• Those in faith communities accessing places of worship

• BAME communities

• Unaccompanied Asylum Seeking Children

Aims & Objectives

- To bring together various forms of intelligence to better profile our high risk communities

- To use this intelligence to ensure those at high risk are supported to access testing and with identification of contacts

- To use this intelligence in order to support preventative & control measures in high risk settings

Existing infrastructure/assets• Communities Team – extensive knowledge of at risk groups

• Strong relationship with CVS & third sector including Stronger Together Partnership

• Partnerships such as Housing First, Essex Resilience Forum, Safeguarding Boards

• Xantura data system – customising reports to identify vulnerable groups

• Homelessness Prevention Strategy

• Rough sleepers have been housed and using new vulnerabilities form to gather more information on their needs

• Travellers team

Current processes/responsibilities

- EPUT outbreak control procedures (awaiting from NL)

- Awaiting formal release of PHE action cards to communicate out and guide discussions with stakeholders

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Risk/Issue National / local risk Possible mitigation measure

Difficult to fully identify all in this group if not all are known to services

National and local Vulnerability mapping to better estimate high risk groups and key settings

It could be difficult to make contact with some of these individuals – transient populations, lack of current contact details etc

National and local Strong partnership links with officers most likely to have alternate contact details or other insight – e.g. Housing Solutions team etc, and link into teams with existing outreach functions (e.g. rough sleepers).

Potential difficulties in obtaining all required information – e.g. all details of contacts etc

National and local Develop targeted communications, standardised messaging to roll out across wider teams which stipulate importance of providing required information if contacted by T&T.

Council only manages 3 of the traveller sites, and in particular does not manage the largest one (Buckles Lane) where over 1,000 residents live.

Local Communications on T&T to be factored into the existing wider work programme around Buckles Lane (Louise Vallance leading).

Each ‘contact’ could take longer than average, given the complexities of some of these individuals.

National This should be factored in to contact tracing capacity plans – allow more than the average 30 minutes given in the national guidance.Data to be captured on average length of time for contact to be traced, in order to inform any future need to change capacity.

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Settings : Schools & Early Years

Aim : To provide a collaborative and coordinated approach to preventing and managing COVID-19 single cases, clusters and outbreaks in

Education & Early Years Settings

ContextThere were 29,926* 3- 18 year olds attending school in Thurrock in 2019/20 (Source: School Census)

:

Structures/assets

• Education and Children’s (includes early years) Recovery Group ( Thurrock TCG Sub group).

• School Leads Forum• Early Year Managers Forum• SEND Improvement Board• Brighter Futures Annual Survey• CYP & Families COVID -19 support line led by the Schools Wellbeing Service (SWS) &

Educational Psychology Team• Research Proposal in situ: understanding of the impact of COVID-19 on young people’s

mental wellbeing and health behaviours. This will further influence the scope of the SWS service

Current process/responsibilities

• PHE- LA MOU for the management of COVID19 outbreaks in schools and early years settings.• The Thurrock Proactive Prevention and Management protocol for COVID-19 outbreaks in

Schools and Early Years Settings. • NELFT have their own separate organisation protocol

8.5 Preventing & Managing Outbreaks in Schools and Early Years

Risk/Issue Local/national Possible mitigation measure

1. Difficulty in applying social distancing rules on school transport. (transmission)

Local Discussions ongoing – risk assessment being compliedPublic Health Support available to schools on risk assessment via the Schools and Early Years Hub

2 Parents not feeling confident about sending children back to school (risk to development, socialisation, quality of education )

Schools unsure of their role in CV19 management ( risk to programme & transmission risk)

Accuracy in compiling contact lists.(transmission risk)

Local & national • Animated video aimed at parents of young children on safe school opening and attendance produced and distributed

• Local Communications Campaign.• Proactive calls to schools• Collaborative approach in developing CV19

protocol with head teachers

3. Operational viability of school if large numbers of staff become contacts of a case and need to self-isolated

Local & national • Pupil teacher ‘social bubble’ system to limit contacts in outbreak situation

• Additional dedicated communication materials planned communicate risk to head teachers and stress importance of 2m+ social distancing in staff room

• Will be addressed through school risk assessment

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Section 9:

Finance

Thurrock Council has received a grant from Central Government to implement Outbreak Management Plans.

Figure 9 shows a high level budget which funds backfill arrangements, new interim posts, enhanced testing in care homes and other settings (where necessary) and communications.

We have assumed that the structure is in place for 12 months only and that capacity as set out in this structure is adequate to meet future demand.

Day to day budget monitoring will be the responsibility of the DPH/ADPH. Resource issues will be escalated to the Health Protection Board

9. Finance

Item Amount (£s)

Backfill TLOCC 395,281

Backfill Surveillance and Intelligence Cell 107,195

New Temporary Posts 320,000

Communications 20,000

Enhanced Testing Contract 260,000

Total Spend 1,102,476

Government Grant (1,052,000)

Met from within PH resources 50,476

Figure 9

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For up to date information on COVID-19 in Thurrock please visit

www.thurrock.gov.uk/coronavirus