Ask Tracey – 15 Jan 2021

 

Ask Tracey-Jan2021 from Public Health Wales on Vimeo.

Blwyddyn Newydd Dda! It was a weird Christmas period – utterly bizzare for everybody. I hope you all managed some downtime, although many of our amazing people were working through the festive period.
So an enormous thanks to everybody – we’re all really tired. I’m very mindful that we need to move into 2021 and get back to where we were pre-pandemic and create more sustainability and resilience.
It is a challenge right now, especially with schools closed, but I don’t want people to think they’ve got to extend the working day to work into the evenings. That’s not the way to do this. We have to all adjust and adapt. We’ve got to look after ourselves, and we need to give people slack and flexibility.
I’ve joined a lot of meetings and everybody is working flat out. Just because you can’t see colleagues, doesn’t mean they’re not working hard. 2021 has to be the time we look after one another. Many of you are working in whole or in part on the response, as well as keeping previous jobs going. And our screening teams are keeping our screening programmes going.
As I always say, Wales is so lucky to have every single person working in Public Health Wales. I don’t know where we would be in the pandemic without you. The advice we give, the services we support, everyone supporting the response in any role, as well as the broader activity … just a really big thank you.

As of today (15 January) in Wales, we are reporting a total of 177,864 cases, and very sadly are reporting a total of 4,171 deaths. To give you some perspective as to how it feels now, by the end of November we reported 2,560 deaths in Wales since the start of the pandemic. But in the month of December alone there had very sadly been 931 deaths – 22% of all deaths reported in the pandemic. That shows why the actions were taken before Christmas.
The current 7 day rolling incidence per 100,000 cases is currently 366 and the positivity rate is 18.8%. Compared to before Christmas, numbers have settled down, but our teams are cautious in how we interpret those numbers. For example, testing numbers are lower.

You’ve all heard about the new UK variant, which is 50% more transmissible than the original strain. We’re still evaluating whether it’s more harmful. The general view is that it isn’t but there’s continually building evidence on that.
With testing, whatever the variant, you’ll be identified as positive if you’ve got it, but not every test will show which variant you have. So we bought some additional test kits in to Wales that are selected for that variant for South Wales. In North Wales, the majority of tests go to a Lighthouse Lab that has the platform that detects the new variant.
The Genomics team is also looking at sampling of tests across Wales, testing specifically hospital cases that are positive, to give some prevalence.
So we believe the new variant in Wales is now the dominant strain. With around 70% of cases in Wales, and probably around 30 – 50 % prevalence across Wales. Week by week it’s growing. So while the original strain is starting to settle down, the new variant is starting to kick in. Our view is that we’ll probably see a more sustained peak for the next few weeks.
There is another variant – coming out of South Africa. Similarly, we think it’s 50% more transmissible. You’ll have seen there’s a whole process in closing off various countries and anyone coming in we are contacting and they are expected to have a test.
A third variant has emerged from Brazil. Along with England, we are among the top three / four countries doing sequencing of Covid around the world. We’re doing about 2,000 a week.
The key question on these new variants is how they respond to a vaccine at any given time and the view is that the UK and South African variants are sensitive to the vaccine but it’s early days with sequencing of the Brazil variant.

Over the last couple of months we have submitted various pieces of advice to the CMO and Welsh Government, such as what restrictions to bring in and when. Fair to say, pretty much all advice submitted has been actioned in whole or in part. The respect for the advice is exceptionally high.

State of vaccination in Wales
VPDP team full on since June, advising Government and planning for implementation. Richard Roberts and his team, and all others involved, have been working hard. Our role isn’t to administer the vaccine but tailor guidance, provide advice, but not involved in logistics or prioritisation. Welsh Government published a vaccination strategy. It’s worth reading, and includes prioritisation for the NHS.

Staff vaccination programme
Pfizer vaccine is more challenging logistically, meaning we need health boards to vaccinate our staff. Oxford vaccine is easier to store. We’ve trained vaccinators to use the Oxford vaccine in-house from next week (w/c 18 January).
We’ve identified 967 of our staff, based on NHS categorisation of frontline staff. For us, those are service user facing, and staff handling specimens. We’ve had a struggle getting access to capacity from health boards. 345 of our staff have been vaccinated by health boards to date. This access will continue, alongside our own vaccination programme, delivered in CQ2, Matrix House and a North Wales venue TBC.
We’re able to track numbers of staff vaccinated through the Welsh Immunisation System (WIS) and will be publishing those numbers internally.
I’ve heard anecdotally of some non-frontline staff receiving the vaccine before our own eligible staff. Probably in situations where they don’t want to waste vaccines. Please be assured that we are pushing so that staff prioritised in the first phase of can get access as quickly as possible.

 

A lot of discussion about how we create sustainability. We’ve submitted a health protection business case into Welsh Government, and having ongoing discussions to secure additional funding to bring more staff in. To take the pressure off our people, and to reactivate our core functions over the coming months. We’re also doing work we shouldn’t be doing! For example, our National Contact Centre receives a lot of queries that should be dealt with by the Test Trace Protect Teams.
This year we’ve got to rapidly increase our response to the population health impacts of Covid. The broader impacts of mental wellbeing, unemployment, early years, vulnerable people will have a much greater impact than the infection in its own right. We’ve put a lot of investment into this, including the WHO. We have to progress our focus around leading Wales out of the pandemic, not just from a health protection point of view.
This year we’ve got to be on the front foot. To safely transition more resource into health protection from outside, and enable us to reactivate our core functions as the year progresses. How do we re-induct people back into roles they were in before? We also need to remind people what we do, in terms of broader population health.
On wellbeing and welfare of staff. Our People and OD team and our staff networks are providing a lot of resource on wellbeing. But we know there’s more we can do. How do we shift the organisation to resume normal working hours? We’ve got to get stricter about saying no, and we’ve got to keep an eye on each other. We’re going to connect with all of you about ways of working, to help us carry forward the bits we want to, and leave behind the bits we don’t want to.

Staff member in North Wales asking when they will get the vaccine? They’ve also heard of non-frontline staff getting vaccinated in health boards before our own microbiology staff. What influence do we have in changing that?

I raised this with the Minister in a discussion on NHS Wales staff vaccination. He acknowledged that our health protection and microbiology staff are key. I reminded him that if lab staff aren’t able to attend work, as well as the welfare element, that will have an impact on turnaround times and the provision of results. They are key frontline services, similarly to screening. The team here is also pushing this and I hope, as far as BCU is concerned, that we will start to pick up speed. In addition we’re finalising arrangements to begin vaccinating our own staff in PHW venues next week. I’d urge people, wherever they are offered vaccination, please take the offer.
Will we be running vaccination clinics like flu clinics? And will we vaccinate staff outside of the first couple of priority groups?
As mentioned, our own clinics start next week. We’ll use an online booking system and all of those identified in phase 1 will be emailed with a link to book. An internal dashboard will tell us how many people have been vaccinated and where.
For all other staff, we’ll be following JCVI prioritisation. First for vaccination, are those frontline staff, and clinically extremely vulnerable members of staff.  When we’ve exhausted that, hopefully in the next couple of weeks, I’d hope we’d be able to progress to the next phase, but it’s likely we’ll follow the same prioritised approach. That said, as we’ve got our own internal vaccinators, if we can fast track to the next phase for other members of non-frontline staff, then we’ll have that conversation. What we won’t do is waste vaccinations. At the moment we’re due to receive 100 doses a week, which is why it’s important to continue working with health boards.
Susan (on internal comms) we’ve created an intranet page with the latest information – and things are changing all the time. We’re committed to telling staff what we know when we know it. Emails have been sent direct to those 967 staff. And for the wider staff group, we’ve held, for example, a Q&A session with Richard Roberts and Rhiannon, plus signposting to the Covid-19 vaccine microsite. We’ll be sharing more information on our staff vaccination clinics next week, once everything is in place.

If a member of staff receives the first vaccine from a health board, do they have to let PHW know?

All our member staff are on WIS. We should be able to identify Public Health Wales staff from that. The reason we’ll have our own internal dashboard, we need to know by area, by locality, by team, so that if we’ve got a problem in a particular area, it can be addressed.

How were priority groups identified?

There has to be some consistency around prioritisation. We’re following JCVI prioritisation, which is based on risk – risk of multiple contacts, high risk areas, and risk where we know certain age groups may need more support. JCVI defines frontline as those in a patient facing role, but we also include those who handle specimens. For us this is our screening staff, some health protection and all lab staff handling samples.

Many of us have been fully deployed for almost a year in a role completely different to my usual one. Because operational response vs developmental work is totally different, there’s hope I’ll return to my role later in the year. Is there a plan to help staff safely transition back into their own roles? It could potentially be as stressful to redeploy staff into old roles, as it was to deploy them in the first place.

 

We have to be in a position where we reactivate services, but we have to do it safely. It’s been a strange year for everybody. It’s felt like two years in one, with the volume of work, the change in mind-set, in requirements and knowledge. Even if you’re in your usual role, you’re doing at a pace we’ve never had to deal with in a sustained way.
Our People and OD team have already started thinking about how we support people. We used the term repatriation at the beginning, people moving roles, and it almost feels similar. Whether going back means exactly the same or slightly different.
We’ll be looking at role transition in a way that can be timed and planned, with clarity about what they’re being inducted back into, what’s the nature of that work, what additional support will people need? What are people being inducting back into? There will need to be orientation into whatever that role is. As well as pace – the pace will be different too. It will be a change.
To reassure you, People and OD are looking at what that repatriation, returning to pre-Covid roles, looks like. We’ll ask the team for an update on that.

One final question. When this is all over please can we have a bit Public Health Wales Party?

Yes! All in one room, not socially distanced. We’ll need to do something, definitely.