South Tyneside Outbreak Management Plan

Published 1st July 2020 An accessible plan from southtyneside.gov.uk

Report compiled by the COVID-19 Contact Tracing Working Group:

Tom Hall
Chair, Director of Public Health
Rachel Perry
Lead Author, Public Health, STC
Paula Phillips
Public Health, STC
Anna Christie
Public Health, STC
Samantha Start
Public Health, STC
Stuart Wright
Development Services - STC
Joanne Chastney
Environmental Health – STC
Natalie Johnson
Communications – STC
Jeanette Scott
South Tyneside CCG
Kirstie Hesketh
South Tyneside CCG

This plan is subject to continuous review and may be updated accordingly.

1st July 2020
Published on
24th June 2020
Plan approved by COVID-19 Leadership Board on

Introduction

What is the NHS Test and Trace service?

NHS Test and Trace service forms a central part of the government’s coronavirus (COVID-19) recovery strategy.

Specifically, the NHS test and trace service:

  • ensures that anyone who develops COVID-19 can quickly be tested to find out if they have the virus, and also includes targeted asymptomatic testing of NHS and social care staff and care home residents
  • helps trace close recent contacts of anyone who tests positive for coronavirus and, if necessary, notifies them that they must self-isolate at home to help stop the spread of the virus

The service aims to help return life more to normal, in a way that is safe and protects the NHS and social care. It will allow us to trace the spread of the virus, isolate new infections and give us early warning if the virus is increasing again, locally or nationally.

National testing strategy

The government’s testing strategy is framed around five pillars:

Pillar 1
NHS swab testing for those with a medical need and, where possible, the most critical key workers
Pillar 2
Mass-swab testing for critical key workers in the NHS, Social Care and other sectors (including symptomatic children of critical key workers)
Pillar 3
Mass antibody testing to help determine if people have immunity to coronavirus
Pillar 4
Surveillance testing to learn more about the disease and help develop new tests and treatments
Pillar 5
Spearheading a Diagnostic National Effort to build a mass testing capacity at a completely new scale

National contact tracing system

Anyone who tests positive for coronavirus will be contacted by NHS test and trace service and will need to share information about their recent interactions. This could include household members, people with whom they have been in direct contact, or within 2 metres for more than 15 minutes.

People identified as having been in close contact with someone who has a positive test will be contacted by NHS test and trace. They will be advised that they must self-isolate for 14 days, even if they do not have symptoms, to stop unknowingly spreading the virus.

The national contact tracing team is expected to operate at four broad levels:

  • Automatic: an app-based platform that automatically alerts people to possible contact with a positive case and directs them to testing (the NHS coronavirus app is currently in development and when rolled out will complement rather than replace the other aspects of the Test and Trace service).
  • Tier 1: Led by Public Health England (PHE) this tier will deal with complex cases and outbreaks in high-risk settings such as care homes, schools and workplaces. Local authorities will have a key role in supporting this tier of the Test and Trace service to support and manage complex cases and outbreaks at a local level.
  • Tier 2: Centralised contact centre of health professionals who will contact and interview confirmed cases and collect details of anyone they have come into close contact with in their infectious period (classed as 48 hours prior to symptom onset through to day 7 of symptoms). Tier 2 call handlers will escalate any complex cases (or contacts they are notified of via Tier 3) to Tier 1.
  • Tier 3: Centralised contact centre of call handlers without a clinical background who will contact those individuals identified as a contact through Tier 2 providing advice on symptoms, testing and instructions to self-isolate at home.

Purpose of the South Tyneside Outbreak Management Plan

The purpose of the South Tyneside Outbreak Management Plan is to clearly outline how we intend to prevent and control outbreaks of COVID-19 in South Tyneside to support local recovery. It will cover the guiding principles of how we will operate and highlight the key activities we will undertake to prevent outbreaks. It will then outline how we intend to address the seven key national themes identified for outbreak planning, including managing outbreaks in high-risk settings (eg care homes and schools); ensuring we have sufficient local testing capacity, high-quality integrated data to support decision making and strong local governance to oversee plans.

It is important to highlight that this is a working plan that needs to remain responsive to the evolving nature of the COVID-19 pandemic. This means that the plan may be adapted as we learn more about COVID-19 in the region, in the UK and across the world.

General principles of the outbreak plan

Guiding principles

Be rooted in public health leadership

Adopting a public health approach, this “system within a system” will be able to receive, share and process data from a range of sources in a timely way to prevent and control the transmission of COVID-19. At a local level, the Director of Public Health will provide strategic local leadership and the delivery of specialist health protection functions will be provided by the PHE North East Centre. The Director of Public Health will be supported by a range of specialist functions within the public health system, including, for example environmental health and specialist infection prevention and control teams.

A whole system response

The capabilities of the whole system will be crucial in both preventing and controlling outbreaks of COVID-19. The strong connections across the South Tyneside Alliance provide firm foundations on which to develop and deliver our Outbreak Management Plan. Drawing on the expertise and input from key partners will be a fundamental part of our approach.

Delivered through an efficient and locally effective and responsive system

The many agencies involved in recovery from COVID-19 are already operating at extreme pressure and it is important that our local system runs efficiently to harness their valuable input without creating unnecessary burden. The system also needs to be efficient in order to provide a rapid, responsive approach to preventing and controlling outbreaks. This includes timely access to and sharing of information, data and intelligence to inform action and monitor outcomes.

Be sufficiently resourced

The system requires resource and capability, in terms of both financial and skills/expertise. South Tyneside have been allocated £1.2m from Government to support the delivery of this plan.

Definitions

Public Health England has provided an overview of the definitions they would use as part of their submission to the Joint Biosecurity Centre and their ongoing monitoring of COVID-19 in different settings. It focuses on outbreak definitions in key settings, prioritising those that are critical for local and national infrastructure and areas with significant public and press interest. Applied to surveillance data shared with the Joint Biosecurity Centre, these definitions will inform local alerts and action and provide consistency with how areas manage outbreaks.

Table 1: Declaring and ending an outbreak and cluster in a non-residential setting (eg a workplace, local settings such as schools and national infrastructure)
Criteria to declare Criteria to end
Cluster Two or more confirmed cases of COVID-19 among individuals associated with a specific setting with onset dates within 14 days

(In the absence of available information about exposure between the index case and other cases)
No confirmed cases with onset dates in the last 14 days
Outbreak Two or more confirmed cases of COVID-19 among individuals associated with a specific setting with onset dates within 14 days

AND ONE OF:

Identified direct exposure between at least two of the confirmed cases in that setting (eg within 2 metres for >15 minutes) during the infectious period of the putative index case

OR

(when there is no sustained community transmission or equivalent JBC risk level) - absence of alternative source of infection outside the setting for initially identified cases
No confirmed cases with onset dates in the last 28 days in that setting (higher threshold for outbreaks compared to clusters)

Table 2 provides a broader definition of an outbreak in residential settings. This definition differs from the definition for non-residential settings because SARS CoV2 is known to spread more readily in residential settings, such as care homes and places of detention, therefore a cluster definition is not required.

Table 2: Declaring and ending an outbreak and cluster in an institutional or residential setting, such as a care home or place of detention
Criteria to declare Criteria to end
Outbreak Two or more confirmed cases of COVID-19 OR clinically suspected cases of COVID-19 among individuals associated with a specific setting with onset dates within 14 days

NB. If there is a single laboratory confirmed case, this would initiate further investigation and risk assessment.
No confirmed cases with onset dates in the last 28 days in that setting
Table 3: Declaring and ending an outbreak and cluster in an inpatient setting such as a hospital ward or ambulatory healthcare services, including primary care
Criteria to declare Criteria to end
Outbreak in an inpatient setting Two or more confirmed cases of COVID-19 OR clinically suspected cases of COVID-19 among individuals associated with a specific setting with onset dates 8-14 days after admissions within the same ward or wing of a hospital.

NB. If there is a single laboratory confirmed case, this would initiate further investigation and risk assessment.
No confirmed cases with onset dates in the last 28 days in that setting (higher threshold for outbreaks compared to clusters
Outbreak in an outpatient setting Two or more confirmed cases of COVID-19 among individuals associated with a specific setting with onset dates within 14 days

AND ONE OF:

Identified direct exposure between at least two of the confirmed cases in that setting (eg within 2 metres for >15 minutes) during the infectious period of the putative index case

OR

(when there is no sustained community transmission or equivalent JBC risk level) - absence of alternative source of infection outside the setting for initially identified cases
No confirmed cases with onset dates in the last 28 days in that setting

Governance Arrangements

To support the delivery of an effective response to outbreaks, strong coordination and local oversight will be key. The implementation of the Local Outbreak Control plan will be supported by the establishment of new governing arrangements as well as by aligning with existing oversight bodies such as the Local Resilience Forum (LRF) and Strategic (Gold) Command.

A COVID-19 Leadership Board will be established to provide strategic oversight and assurance on the delivery of the Outbreak plan, chaired by Cllr Iain Malcolm (Vice Chair Dr Mathew Walmsley).

A COVID-19 Health Protection Board will be established to provide oversight to the delivery of the Outbreak Control Plan. This group will bring together expertise from public health, environmental health, communications, clinical commissioning group and PHE.

Setting-based Outbreak Control Management Teams (OCTs) will be mobilised as appropriate to provide an operational response to individual outbreaks in complex settings. A decision on whether to convene an OCT will be made by the Consultant in Communicable Disease Control (CCDC) in the Health Protection Team (HPT) at Public Health England (PHE), who will chair any OCTs which are established. Membership of these teams will be specific to the setting with specialist teams established for schools, care homes, business and wider community outbreaks.

The Director of Public Health will act as the liaison officer between the local Health Protection Board and the National Outbreak Control Advisory Board as well as the PHE North East Centre.

Key decisions taken by each of these groups will be logged to ensure transparency.

Terms of reference and membership for governing structures can be found in Appendix 2.

Legal and policy context

The legal context for managing outbreaks of communicable disease which present a risk to the health of the public requiring urgent investigation and management sits:

  • With Public Health England under the Health and Social Care Act 2012
  • With Directors of Public Health under the Health and Social Care Act 2012
  • With Chief Environmental Health Officers under the Public Health (Control of Disease) Act 1984
  • With NHS Clinical Commissioning Groups1 to collaborate with Directors of Public Health and Public Health England to take local action (eg testing and treating) to assist the management of outbreaks under the Health and Social Care Act 2012
  • With other responders specific responsibilities to respond to major incidents as part of the Civil Contingencies Act 2004
  • In the context of COVID-19 there is also the Coronavirus Act 2020
  • In the context of potential outbreaks in workplace settings the Health and Safety at Work Act 1974 which place a statutory requirement on employers to control risks in the workplace through the process of risk assessment

This underpinning context gives Local Authorities (Public Health and Environmental Health) and Public Health England the primary responsibility for the delivery and management of public health actions to be taken in relation to outbreaks of communicable disease through the local Health Protection Partnerships (sometimes these are Local Health Resilience Partnerships) and local Memoranda of Understanding. These arrangements are clarified in the 2013 guidance Health Protection in Local Government2.

PHE is mandated to fulfil the Secretary of State’s duty to protect the public’s health from infectious diseases, working with the NHS, local government and other partners. This includes providing surveillance; specialist services, such as diagnostic and reference microbiology; investigation and management of outbreaks of infectious diseases; ensuring effective emergency preparedness, resilience and response for health emergencies. At a local level PHE’s health protection teams and field services work in partnership with DsPH, playing strategic and operational leadership roles both in the development and implementation of outbreak control plans and in the identification and management of outbreaks.

The Director of Public Health has and retains primary responsibility for the health of their communities. This includes being assured that the arrangements to protect the health of the communities that they serve are robust and are implemented. The primary foundation of developing and deploying local outbreak management plans is the public health expertise of the local Director of Public Health.

This legal context for Health Protection is designed to underpin the foundational leadership of the local Director of Public Health in a local area, working closely with other professionals and sectors.

Enforcement powers are seen as a last resort and we will first seek a strategy of engagement with the public, businesses and other key partners. It is important to explain the reasons behind the actions we are taking in managing outbreaks and we will seek to do this through a detailed communications plan.

  1. And NHS England in the case of Prisons and custodial institutions
  2. Protecting the health of the local population: the new health protection duty of local authorities under the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013

Prevention

While this document is titled an Outbreak Management Plan, our ultimate aim is to prevent an outbreak from happening in the first place to support recovery from COVID-19 and prevent future waves of disease. A key strand of this plan is therefore focussed on Prevention which will include:

Effective use of public health intelligence to identify outbreaks and provide surveillance of disease patterns

It is crucial to monitor local infection rates to anticipate any resurgence of disease. Timely local clinical and laboratory data will be used alongside regional national data sources, eg national test and trace service, Public Health England.

Testing

Making sure people who develop COVID-19 symptoms are tested is vital to ensure we have comprehensive intelligence data to monitor disease patterns. We will continue to liaise with the relevant local, regional and national partners involved in delivering the five pillars of the national testing programme. There may also be instances, for example during outbreaks in a specific setting or locality where testing resources need to be deployed to quickly and effectively test possible cases.

Media and communications

A proactive approach to communications forms a key component in supporting the delivery of our outbreak management plan. We need to continue to engage with the public to continue promotion of key messages around COVID-19 prevention (eg hand hygiene, social distancing) as well as specific messages relevant to test and trace, for example positive messages related to the part that an individual plays when self-isolating as a contact to prevent spread of disease and protect the most vulnerable in South Tyneside. We will also focus communications on workplaces, supporting them to stay COVID-19 secure to prevent any outbreaks in their setting.

Working with community (including the most vulnerable)

Successful outbreak management will help to keep our communities safe and help life return more to normal. In order to achieve this we must work with our local communities to make sure public advice is clear and to keep residents and businesses informed of local development. Those who are more vulnerable may need support if they need to self-isolate, for example with food, medication and financial assistance. It is also important to ensure communities that are at greater risk of COVID-19 (in terms of both risk of infection and complications from disease), eg BAME communities, have the advice and support they need to stay safe.

Specialist support and advice

We will review the specialist advice available to high-risk settings (eg care homes and schools) to ensure they are confident in preventing outbreaks in their setting. This may include, for example, specialist infection prevention and control advice. Where appropriate, we will draw on the financial resources allocated to deliver outbreak management plans to support the provision of specialist advice.

Key Themes

The outbreak plan is centred around seven key themes:

  • Care Homes and Schools
  • High risk places, locations and communities
  • Local testing capacity
  • Contact tracing in complex settings
  • Data integration
  • Vulnerable people
  • Governance and local boards

A summary of each of these seven key themes are provided in this plan. Where further, specific actions are identified by theme these will be developed into an action plan which will be monitored and evaluated by the COVID-19 Health Protection Board.

Outbreak Management framework

A big focus of our efforts will be on settings where reducing transmission risk is more difficult, such as care homes, schools and other high-risk settings, such as transport hubs. The HPT at PHE will continue to lead the process for the detection and declaration of outbreaks in South Tyneside.

There are some key principles of outbreak management that will apply across all of these settings and these will be outlined first for information, followed by specific issues for each setting in line with the Key Themes of the outbreak plan.

Identification of outbreak

Outbreaks may be recognised by PHE, Local Authorities or NHS Microbiologists. Each organisation has its own procedure for surveillance, detection and control and as soon as it becomes apparent that an outbreak may exist, immediate contact between these parties is essential.

All outbreaks should be notified to the local authority via an alert system from the Health Protection Team at Public Health England via a single point of contact (SPOC) email address: covid@southtyneside.gov.uk and notification to the Director of Public Health.

Outbreaks may also be notified via informal routes, for example direct contact from a setting (eg school). Notifications in these circumstances will be routed through the SPOC email address for consistency. Settings should also notify the HPT at PHE if they have not done so already to ensure a risk assessment can be carried out.

Initial response/investigation

Initial investigation to clarify the nature of the outbreak should begin within 24 hours of receiving the initial report. This will include, for example, reviewing local clinical and microbiological data and carrying out an initial risk assessment to guide the decision-making process.

Declaration of outbreak

It is usual that locally confined outbreaks will be recognised and declared by a PHE Consultant in Communicable Disease Control (CCDC) in the Health Protection Team at the PHE North East Centre. Where an incident occurs in a NHS Trust premises then the Medical Director or Director of Infection Prevention and Control (DIPC) may declare an outbreak.

Following the recognition and declaration of the outbreak, a decision regarding the need and urgency to convene an Outbreak Control Team (OCT) is required. This decision should be guided by the risk assessment.

Establishment of Outbreak Control Team (OCT)

The purpose of an OCT is to agree and coordinate the activities of the agencies involved in the investigation and control of the outbreak. The OCT will be a multi-agency group who will confirm and assess any outbreak, establish appropriate control measures to minimise the spread of disease (eg infection control) and mobilise the people and resources required to maximise outbreak control.

OCTs will be chaired by the CCDC and membership will be specific to the outbreak setting (eg care homes, schools, businesses) to provide a specialised response. The Terms of Reference for Setting-Specific OCTs, including roles and responsibilities can be found in Appendix 2. In the context of OCTs, it is possible that local authorities may have a role in chairing these where an incident is escalated, for example if the outbreak is not contained or if wider action is required at a sectoral/geographical level. A joint management document between PHE and Directors of Public Health is being finalised and will provide further confirmation on this issue.

It is acknowledged there will be a different approach for outbreaks detected within acute healthcare settings (STSFT) where the decision to declare an outbreak will be made by the Trust’s Director of Infection Prevention and Control (DIPC). OCTs in this setting will be led by the DIPC or a designated member of their team.

Standard incident action and decision logs will be completed to record key decisions, a copy of the template is included in Appendix 3.

Escalation of outbreak

Escalation to an emergency situation or major incident

Outbreak planning and response is locally managed by each individual Local Authority Director of Public Health and Public Health Teams, in partnership with the PHE HPT. If the management of the outbreak causes a significant test to the council’s capacity and capability to respond and manage the issues, then consideration should be given to the declaration of an emergency situation or major incident, and activation of the existing Emergency Response Process.

Northumbria Local Resilience Forum (LRF)

Some outbreaks may require a multi-agency response at the strategic level in order to provide a resolution. In such incidents, the LRF will convene a Strategic Co-ordinating Group (SCG) to determine policy between the lead organisation, the emergency services and other organisations involved directly in the incident and ensure there is that wider collaboration and coordination where required.

End of outbreak

The OCT will decide when the outbreak can be considered over and will make a statement to this effect. The decision to declare the outbreak over should be informed by ongoing risk assessment and considered when:

  • there is no longer a risk to the health of the public that requires an OCT to conduct further investigation or to manage control measures;
  • the number of cases has declined or;
  • the OCT is satisfied that the chain of infection has been broken with the identification and isolation of cases

A written report will be prepared at the conclusion of the outbreak to identify lessons learned and disseminate to relevant stakeholders a set of recommendations to prevent future outbreaks.

Accessing data in an outbreak

The OCT will review the latest laboratory and epidemiological data as part of the investigation. Other intelligence sources, for example, testing data will also be relevant.

Public communications in an outbreak

A communications lead will form part of the membership of an OCT. The OCT will discuss and agree an appropriate communications plan which may include proactive and reactive messaging.

Care homes and schools

Care homes

Care homes remain a very high-risk setting for COVID-19 outbreaks as they accommodate and care for people who are particularly vulnerable to the virus by virtue of age and frailty.

At a regional level a joint management document has been developed to agree a consistent set of principles for preventing and managing outbreaks at a regional level between PHE and local authorities. This includes, for example, a consistent approach to testing asymptomatic staff and residents, eg agreeing frequency of asymptomatic testing.

In South Tyneside, there has been a strong network of support available for care homes to prevent and manage outbreaks and this network will continue as we move into the next phase of recovery. Care homes have been supported by a range of partners in the system through a Core Team, including representatives from the Joint Commissioning Unit, Public Health, Infection Prevention and Control and the Clinical Commissioning Group. It will be crucial to maintain clear lines of communication to make sure care homes have the advice and support they need to maintain a safe environment for their residents and staff.

If an outbreak is declared within a care home, a setting-specific OCT will be established to assess the outbreak, implement any control measures in conjunction with the care home and review lessons learned. Members of the Care Home Core Team will be involved in individual OCTs as required. Terms of Reference for OCTs can be found in Appendix 2.

Schools, early years and other educational settings

Schools represent another high-risk area for transmission of COVID-19. In England, education and childcare settings have been open to priority groups (vulnerable children and children of key workers) and are welcoming back a limited number of pupils from certain year groups. Plans to welcome back all primary school children for four weeks prior to the summer holidays have been cancelled with a plan that they will return at the beginning of the new school year in September.

A joint management document between PHE and local authorities has been agreed to support the management of outbreaks in schools and will be referred to in the event of an outbreak.

Schools are currently operating in ‘bubbles’, defined groups of staff and pupils who can only interact with each other. If a positive case is confirmed in a school then the whole ‘bubble’ needs to be excluded (staff and pupils) and to follow self-isolation advice. As part of the risk assessment it will be assessed whether anyone else in the school may have come within 2m of the case and a communications plan will be agreed. PHE have developed a standard letter template which can be shared with schools to communicate with parents in the event of an outbreak.

In complex situations where cases occur across bubbles a risk assessment will be done in conjunction with the Director of Public Health and if there appears to be sustained transmission across bubbles within a school then there may be a decision to close school however this will usually not be necessary.

As part of the outbreak management plan we will also engage with early-years settings, special schools and further education (South Tyneside College). It is particularly important to engage with South Tyneside College as this is attended by a substantial proportion of students from BAME communities. This is important given it has been established that COVID-19 is having a disproportionate impact on BAME communities compared to people who are White British.

High-risk places, locations and communities

Outbreaks may also occur in other settings where it will be more difficult to reduce transmission and where people may be more vulnerable if they are infected by COVID-19. Work is currently underway to identify those locations and communities in South Tyneside which will include, but not be restricted to:

  1. Residential and supported living accommodation
  2. Sheltered accommodation
  3. Special schools
  4. Local authority children’s homes
  5. Healthcare settings
  6. Transport hubs, eg Port of Tyne
  7. Workplaces, eg large factories
  8. BAME communities
  9. Religious congregations – eg mosques
  10. Hostels (which support people who are homeless)
  11. Substance misuse treatment services

As part of the outbreak management plan we will proactively engage with identified high-risk settings and communities, providing advice and support to prevent outbreaks. If outbreaks are confirmed in any identified high-risk setting then an OCT will be established with appropriate membership.

Local testing capacity

In order to effectively respond to local outbreaks it is important that testing capacity is available to provide vital intelligence. A timely and responsive testing system has been established in South Tyneside during the initial phase of the COVID-19 pandemic which we will continue to depend on going forward.

South Tyneside local testing arrangements for care homes offer symptomatic testing to any care home resident in line with the local Standard Operating Procedure. The test is requested by the care home via the single point of contact for the Community Nursing team. The Community nursing team support the care homes to undertake the swab taking, providing the relevant equipment, advice and collection of completed swabs. The tests are sent to the local lab within the QE Hospital. The results are pushed to the individuals GP via ICE. The GP is then required to share the result with the care home Manager. For any care home wishing to test whole home residents and staff asymptomatically they can access the online portal and request the swabs, and all care homes in South Tyneside have completed this at least once (June 2020).

For residents who require asymptomatic testing within the community to support admission to a care home, this is currently being discussed as an extension of the symptomatic testing SOP provided by the Community Nursing team, and the local lab. This is likely to come online in July 2020.

For symptomatic staff who are registered with a South Tyneside GP they can access a test at Stanhope parade, supported by the GP federation and the CCG. This service has supported many key workers to access a test locally, again utilising the local lab arrangements within the QE and results texted to the individual. In addition to the local testing key workers can access a test via the Government national portal and a regional testing centre is offered as a drive through appointment.

Anti-body testing is currently available in primary care and NHS Trust. This will be extended to cover all health and social care workers in the future.

As the situation evolves there may be occasions where additional testing capacity is required, and in these scenarios the Director of Public Health may seek the deployment of mobile testing units (MTUs) in identified locations. Work is currently underway at a regional level to seek consensus on how testing resources could be safely and effectively deployed to support local outbreaks. The outcome of this work will inform our plans at a local level.

The Department for Health and Social Care have established an Ops Line 24/7 in order to request MTUs: 07814 785028 or 07821 801611.

Contact tracing in complex settings

In the initial stages of the NHS Test and Trace service, PHE are conducting contact tracing in complex settings. It is anticipated that there will only be a role for local authorities in rare circumstances, for example, if there is a complex outbreak in a high-risk setting where the local authority has established local relationships then there may be a role to facilitate contact tracing in this setting. In these circumstances we would look to use staff with existing skills in contact tracing (eg environmental health, public health).

Data integration

Public health intelligence is vital in helping to develop a local picture of new cases and outbreaks. Data on COVID-19 comes from many sources and these will be integrated to provide routine, timely reports for the COVID-19 Leadership Board, COVID-19 Health Protection Board and operational teams.

This includes data and intelligence from Public Health England and NHS Digital on confirmed cases and exceedance reports for South Tyneside and across the North East. We will proactively gather local intelligence from across the council, care homes, schools and elsewhere to identify potential cases and areas concerns.

Vulnerable people

Support to self-isolate

Self-isolation for COVID-19 cases and their contacts is a big ask, and some people will need additional support to be able to do this in the event of further outbreaks. We will build on the arrangements developed in the South Tyneside COVID-19 Shielding Support Hub, which was established in the early stages of the pandemic, to support those who are clinically extremely vulnerable who have no other means of support, for example providing wellbeing checks and deliveries of food and essential medication. From 1 August 2020, a ‘stand-up’ COVID-19 Shielding Support Hub function and action plan will remain in place to respond to clinically extremely vulnerable clients and those self-isolating with no other forms of support, in the event of any future second wave or local outbreak.

It is recognised that some individuals may encounter financial hardship as a result of self-isolation which risks non-compliance with isolation measures. We will signpost individuals to relevant sources of support through our communications plan.

Supporting high-risk and diverse communities

Plans are currently being developed to proactively engage with communities who are more vulnerable to contracting COVID-19 and are at greater risk if they do. Community engagement forms a key part of our outbreak management action plan to provide clear advice and support to our whole community. We will also link in with regional best practice, for example engaging with plans to develop a regional approach to supporting people who are experiencing homelessness.

Governance and local boards

The development and delivery of local outbreak management plans is complex involving many partners across the system, including the public. Robust governance arrangements and timely and clear communications will be key.

The establishment of governance structures to oversee local outbreak management plans is outlined in Guiding Principles.

Communicating effectively with internal and external stakeholders, including the public, will play a crucial role in the success of our outbreak management plan. A detailed communications plan will be developed, considering what needs to be communicated at an operational and strategic level and where we will share proactive as well as reactive messaging to prevent outbreaks in high-risk settings.

Continuous reflection and learning

There are many challenges ahead as we try to return life more to normal while keeping our local community safe and well. It is important that as we move forward in this fast-paced environment that we remain pragmatic but reflective to ensure we take lessons on board and adapt our plans accordingly. This plan should be seen as a “live” document that is adapted in line with the circumstances in which we find ourselves to ensure it is fit-for-purpose. As a starting point we will be running desktop discussion exercises to test our plan in its current format and lessons learned will be reflected into this plan.

Appendices

Appendix 1: Local, regional and national leadership roles

Local, regional and national leadership roles (adapted from Guiding Principles for Outbreak Management Arrangements, 2020)
Level Place-based leadership Public health leadership
Local

LA CE, in partnership with DPH and PHE HPT to:

  1. Sign off the Outbreak Management Plan led by the DPH
  2. Bring in wider statutory duties of the LA (eg DASS, DCS, CEHO) and multi-agency intelligence as needed
  3. Hold the Member-Led Covid-19 Engagement Board (or other chosen local structure)

DPH with the PHE HPT together to:

  1. Produce and update the Outbreak Management Plan and engage partners (DPH Lead)
  2. Review the daily data on testing and tracing
  3. Manage specific outbreaks through the outbreak management teams including rapid deployment of testing
  4. Provide local intelligence to and from LA and PHE to inform tracing activity
  5. DPH Convenes DPH-Led Covid-19 Health Protection Board (a regular meeting that looks at the outbreak management and epidemiological trends in the place)
  6. Ensure links to LRF/SCG
Regional

Regional Lead CE in partnership with national support team lead, PHE RD and ADPH lead

  1. Support localities when required when there is an adverse trend or substantial orcross-boundary outbreak
  2. Engage NHS Regional Director and ICSs
  3. Link with Combined Authorities and LRF/SCGs
  4. Have an overview of issues and pressures across the region especially cross-boundary issues

PHE Regional Director with the ADPH Regional lead together

  1. Oversight of the tracing activity, epidemiology and Health Protection issues across the region
  2. Prioritisation decisions on focus for PHE resource with LAs
  3. Sector-led improvement to share improvement and learning
  4. Liaison with the national level
National

Contain SRO and PHE/JBC Director of Health Protection

  1. National oversight for wider place
  2. Link into Joint Biosecurity Centre especially on the wider intelligence and data sources

PHE/JBC Director of Health Protection (including engagement with CMO)

  1. National oversight identifying sector specific and cross-regional issues that need to be considered
  2. Specialist scientific issues eg Genome Sequencing
  3. Epidemiological data feed and specialist advice into Joint Biosecurity Centre

Appendix 3: Incident action and decision log