Team Doncaster have been continuously planning a framework for our response to localised outbreaks of COVID-19 in Doncaster and an outline of our response to regional and national systems and guidance.
Team Doncaster's COVID-19 outbreak management plans are are centred around 7 themes:
- Planning for local outbreaks in care homes and schools (e.g. defining monitoring arrangements, identifying potential scenarios and planning the required response)
- Identifying and planning how to manage other high-risk places, locations and communities of interest including sheltered housing, dormitories for migrant workers, transport access points (e.g. ports, airports), detained settings, rough sleepers (e.g. defining preventative measures and outbreak management strategies)
- Identifying methods for local testing to ensure a swift response that is accessible to the entire population. This could include delivering tests to isolated individuals, establishing local pop-up sites or hosting mobile testing units at high-risk locations (e.g. defining how to prioritise and manage deployment)
- Assessing local and regional contact tracing and infection control capability in complex settings (e.g. Tier 1b) and the need for mutual aid (e.g. identifying specific local complex communities of interest and settings, developing assumptions to estimate demand, developing options to scale capacity if needed)
- Integrating national and local data and scenario planning through the Joint Biosecurity Centre Playbook (e.g. data management planning including data security, data requirements including NHS linkages)
- Supporting vulnerable local people to get help to self-isolate (e.g. encouraging neighbours to offer support, identifying relevant community groups, planning how to co-ordinate and deploy) and ensuring services meet the needs of diverse communities
- Establishing governance structures led by existing COVID-19 Health Protections Boards and supported by existing Gold command forums and a new member-led Board to communicate with the general public.
The aims of this plan are
- To prevent the occurrence and spread of COVID-19
- To identify any new cases of COVID-19
- To respond promptly to any new cases of COVID-19
- To reduce the impact of any new cases, clusters or outbreaks of COVID-19
- To build public confidence in the local approach to COVID-19 control
The key objectives of this plan are:
- To summarise the key risks, planning assumptions and considerations that underpin the planning and response arrangements to local outbreaks of COVID-19;
- To define the roles and responsibilities of responding organisations and professionals;
- To outline the procedure for managing and responding to COVID-19 outbreaks in single settings and/or institutions e.g. schools and care homes;
- To outline the procedures for identifying and managing COVID-19 outbreaks in high risk places, locations and communities of interest;
- To outline the local and regional contact tracing capability and process in complex settings, and interfaces with national systems and programmes;
- To summarise the process and coordination of support for vulnerable people needing help to self-isolate;
- To outline local methods and access routes to timely testing and interfaces with national systems;
- To provide an overview of national and local data, intelligence and surveillance flows and role of the Joint Biosecurity Centre;
- To summarise the governance structures for the management and response to localised outbreaks of COVID-19 in Doncaster.
Covid-19 Response Team and Outbreak Management
The COVID-19 Task Force will drive the coordination and management of outbreaks of COVID-19 in Doncaster, along with key elements of prevention, risk management, data and intelligence and wider local response.
This will include a number of central, dedicated teams ensure a timely and coordinated response to outbreaks of COVID-19 in Doncaster including:
- Public health (health protection and EPRR) Core Team
- Contact Tracing central team
- Data cell/dedicated team
- Specialist Infection Prevention and Control resource (through Testing and IPC cell
- Localities leads
- Outbreak planning and development team
The governance and reporting structure for COVID-19 outbreak management in summarised below.
Public Health and The Health Cell
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 public health response to incidents that present a threat to the public’s health.
In relation to local outbreaks of COVID-19, this includes:
- Lead the local multi-agency IMT and ensure effective co-ordination of actions, resources and response
- Ensure the provision of expert advice from both the public health team and Team Doncaster partners such as Doncaster CCG. This will include amongst other specialisms infection prevention and control support and advice
- Mobilise plans to increase access to local COVID-19 testing arrangements
- Mobilise resources for local contact tracing in complex settings, including increasing capacity and bespoke training
- Ensure the follow-up and support settings to continue to operate whilst managing the outbreak, including support with infection prevention and control (through the IPC task and finish group)
- Provide regular and timely updates to Council leadership, Team Doncaster Gold, Cabinet and elected members amongst others.
The COVID-19 health cell will continue to provide expert leadership across the local health system and will closely support and link to the COVID control board and IMTs through the designated representatives from NHS Doncaster Clinical Commissioning Group.
This may include:
- Develop solutions across Health Providers in relation to Local, Regional and National expectations for the management of COVID-19 within Doncaster with clear actions
- Provide Coordination and leadership in relation to Health response
- Provide single point of appropriate updates and communication through to relevant stakeholders
- Provide a strategic point of escalation for Health Providers
- Identify key risks and escalate risks as appropriate
- Identify appropriate and proportionate data collation and reporting
- Prepare updates and information for the covid control board and daily IMTs
- Support reporting arrangements
- Maintain oversight of the arrangements for the management of outbreaks in commissioned and clinical settings such as primary care settings and provision
Infection, Prevention and Control
The infection prevention and control and testing task and finish group will provide specialist advice and guidance on infection prevention and control and assure local arrangements for testing, including access, increasing capacity and data sharing as appropriate.
This may include:
- Ensure clear IPC guidance and information to staff in high-risk settings, including care homes
- Ensure additional capacity for the provision of lower level IPC advice through a “train the trainer” approach
- Ensure additional support for quality assured routine deep cleaning
- Provide information and advice on PPE guidance when this is required
- Provide advice and guidance on the routes for accessing testing in localised COVID-19 outbreaks, including on risk assessment and prioritisation of testing to where it will be a more effective tool in understanding and managing an outbreak and protecting life.
The data cell team will be central to the response to local COVID-19 outbreaks by collating, analysing and triangulating all available data to provide a situation overview upon which decisions on prevention work and outbreak control measures are required can be made.
This may include:
- To receive, share and process data to and from a range of sources in a timely way to deliver all local Covid-19 outbreak management functions including contact tracing.
- To integrate test, track and trace data from all sources to enable: contact tracing, infection mapping and surveillance, epidemiological analysis to enable decisions and monitor effectiveness and impact.
- To analyse data in near real-time, using time series and trend/forecasting analyses with the aim of:
- Identifying local outbreaks and hotspots through data analysis and mapping;
- Providing evidence to aid decision makers about local response measures;
- Providing evidence to aid decision makers looking to redistribute resources;
- Provision of support (where required) to people self-isolating; and
- Where possible, undertake forecasting and predictive analytics.
- Support the preparation of national situation reporting as required.
This plan has been developed for use by organisations involved in the management of localised COVID-19 outbreaks in Doncaster. It will assist responding staff and organisations to understand the risk and management of COVID-19 outbreaks and incidents in the Borough. The plan will also refer to actions and arrangements in place to respond to future outbreaks and incidents. Plan holders will receive updated copies following any changes and reviews.
A number of organisations may be involved in the management of a communicable disease incident or outbreak in Doncaster. Depending on the nature and scale of the outbreak, these may include, amongst others:
- Doncaster Council;
- Public Health England;
- St Leger Homes of Doncaster;
- Doncaster Children’s Services Trust (DCST);
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH);
- Doncaster and Bassetlaw Teaching Hospitals Foundation Trust (DBTHFT);
- NHS Doncaster Clinical Commissioning Group (DCCG);
- Yorkshire Ambulance Service (YAS);
- Primary care services;
- Voluntary sector and community groups;
- South Yorkshire Police;
- NHS England.
A range of interventions are available in planning the response and controlling the identified risks. These include:
- Public information:
Ensuring advice and information is available to the public is a core function of public health. Key messages related to the control of outbreaks of COVID-19 include:
- Physical distancing of 2m or more
- Self-isolation if symptomatic
- Self-isolation if have been in close contact with a symptomatic individual
- Practice good hygiene e.g. washing your hands for 20s or more, keeping your hands below your shoulders etc.
- Social Distancing:
Much of the guidance to help reduce the spread of covid-19 as focussed on physical distancing principles such as:
- Maintaining a distance of at least 2m or more from those not in the same household or same social bubble;
- Maintaining a distance of at least 1m where 2m is not possible, with additional protective measures in place;
- Adaptations to the public realm such as increase signage, distance markers and queuing systems amongst others.
- Enhanced hygiene including deep cleaning:
Much of the public and professional messaging and guidance to help reduce the spread of COVID-19 has been associated with enhanced hygiene practices. These include:
- Washing hands with soap and water for 20 seconds or more. Where soap and water/hand washing facilities are not available, hand gel can be used;
- Increasing access to handwashing and sanitisation facilities and hand gel dispensing facilities at entrance and exit points;
- Enhanced cleaning and more frequent cleaning routines of common touch points such as door handles, hand rails etc.
- Infection prevention and control
- Restriction of movement:
Restriction of an individual’s movements for the prevention of transmission of infections may be necessary for severe infections. Health Protection legislation (Department of Health, 2010) provides a number of options for restricting the movements of individuals in this way:
- Requests to cooperate for health protection reasons/infection prevention and control;
- Part 2A orders which can be used to isolate cases and effectively quarantine contacts;
- Coronavirus act.
- Restriction of access:
In contrast to the restriction of the movements of individuals, restrictions can also be placed on the access to certain premises, or things, under the health protection regulations. Specifically these include:
- Requirements to keep infectious children away from school;
- Request to control/manage the number of visitors to health and/or social care premises;
- Requests for cooperation for health protection purposes where employees are asked to refrain from attending work;
- Part 2A orders which can be made in relation to premises or things to prevent or limit access and therefore exposure to health hazards.
A number of these have already been in place at various points throughout this pandemic.
The Health Protection (Local Authority Powers) Regulations 2010 allow Local Authorities to make arrangements to disinfect a thing or premises upon the request made by the owner or custodian of the thing or premises.
Public Health nurses/ infection prevention and control nurses will advise of the most appropriate method of decontamination. This should also be taken through the COVID-19 Infection Prevention and Control task and finish group and the core COVID-19 Incident Management Team and task force.
Vaccination is an important means of primary prevention, providing a level of acquired immunity in the individual. Through community (herd) immunity, vaccination also protects susceptible individuals within a population once a minimum level of coverage has been achieved.
Identification and Support for Vulnerable People
Throughout the pandemic, significant work has been undertaken to ensure that vulnerable people are identified and supported when this is required through the community hub and the communities cell. Arrangements are now in place through localities cells, locality MDTs and the local voluntary, community and faith sector groups to ensure that support remains accessible for vulnerable residents and those needing to self-isolate that cannot get support elsewhere.
This includes establishing, supporting and signposting to wider support networks.
Communities and multi-agency locality teams have reviewed communities in relation those more vulnerable to the impacts of covid and have prioritised the higher-risk people, settings or places for monitoring, visibility and action/support. Individuals identified as requiring support through local contact tracing or welfare calls will be referred for support to the relevant locality team single point of contact emails.
Preventative Measures for those that are Vulnerable include (but are not limited to):
· Ongoing humanitarian support to enable shielding for those requiring it
· Targeted up to date guidance and information for shielded and vulnerable populations
· Targeted education/ social distance measures for vulnerable people in areas of concentration, including hygiene, routines, training regarding PPE.
· Targeted education for wider community and networks/facilities in these locations about the vulnerability
· Specific support for Carers and service providers for vulnerable people
· Localise targeted messaging in affected areas to alert people to heightened risks of community transmission (to vulnerable people, carers and wider community).
There is also a Support Page for those that have been identified as Clinically Extremely Vulnerable.
Financial support for self-isolation may be available subject to eligibility criteria. Those requiring further information will be directed to call 01302 735336 (option 1).
Response and Outbreak Management
A borough wide vaccination programme is currently taking place, you can find more information on the Covid-19 Vaccination Programme via the Doncaster CCG website.
National Action Cards
A number of nationally developed action cards for a range of sectors, settings and venues are available online for sector/setting/venue use. These outlined initial outbreak management actions that should be undertaken to contain any potential outbreaks including symptoms and testing, initial contact tracing, key guidance links and when to inform their PHE Health Protection Team. Local information has been circulated on how to inform the most appropriate local authority team for advice and support.
The national action cards available are outlined in the following sections, including direct links to download these resources.
Contact tracing is the process of identifying the contacts of people who have confirmed or suspected infection. These contacts are then required to take certain actions, such as self-isolation, with the aim of interrupting the onward transmission of Covid-19.
Government guidance defines a contact as a person who has been close to someone who has tested positive for Covid-19 anytime from 2 days before the person was symptomatic and up to 7 days from the onset of symptoms. Specifically this includes:
- People who spend significant time in the same household as a person who has tested positive for COVID-19;
- Sexual partners;
- A person who has had face-to-face contact (within 1 metre) with someone who has tested positive for COVID-19;
- A person who has been within 2 metres of someone who has tested positive for COVID-19 for more than 15 minutes;
- A person who has travelled in a small vehicle with someone who has tested positive for COVID-19 or in a large vehicle or plan near someone who has tested positive for COVID-19.
Contacts only require follow up if the exposure occurred during the infectious period, which is deemed to begin 48 hours before onset of symptoms or 48 hours before the time of the test is the person is asymptomatic.
National NHS Test and Trace Programme
The national NHS test and trace service has been set up to:
- Ensure that anyone who develops symptoms of coronavirus (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
- Help 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.
Local Contact Tracing
A core team of staff have been trained and are undertaking contact tracing on a rota basis. A dedicated database system has been set up to monitor cases and contacts and quality assurance is in place. In some cases, other teams and colleagues may undertake and facilitate contact tracing activity, including in settings where an existing relationship and trust with those being contact traced is beneficial.
Cases are passed to us for “Local Follow up” from the National Test & Trace Team if:
- Case has not engaged after 24 hours
- Case has provided incorrect contact details
- PHE would like us to follow up locally for more information on cases escalated tier 1 relating to Doncaster
Effectiveness of contact tracing will be reviewed on a regular basis through the daily Incident Management Team meetings and reviews of incidents and/or outbreaks. Regular contact, training updates and support is provided to the contract tracing team through the Track and Trace MS teams channel process which is subject to quality assurance and supervision support from the contact tracing lead.
Contacts who are health and care staff
A staff member who has been caring for a person who has tested positive for COVID-19 or who has symptoms of COVID-19 while the staff member was wearing appropriate PPE will not automatically be asked to self-isolate
There are however some circumstances that the member of staff will need to isolate for 14 days in line with advice to the general population. These are:
- A staff member who has been caring for a person who has tested positive for COVID-19 or who has symptoms of COVID-19 whilst wearing PPE, but the PPE has been breached;
- A staff member who has been in contact with anybody else who has tested positive for COVID-19 whether at work or in the community.
An overarching Doncaster COVID Testing Strategy is also in place which aligns to the objectives of this outbreak control plan.
There are a wide range of testing approaches outlined in the figure below. However, the simplest split is between testing in those who have one of the 3 clinical symptoms of COVID-19 (new and continuous cough, high temperature and a change of/or loss of sense of taste or smell) so called symptomatic testing and testing in people who don’t display one of the 3 clinical symptoms known as asymptomatic testing.
There are 5 core objectives for testing in Doncaster:
- Control transmission
- Monitor incidence and Trends and assess severity over time
- Mitigate the impact of COVID-19 in health care and social care settings
- Rapidly identify all clusters or outbreaks in specific settings
- Prevent (re-)introduction into Doncaster where sustained control has been achieved
Testing for those with symptoms:
Covid-19 swab testing is now routinely available to all members of the public with coronavirus symptoms by visiting https://www.nhs.uk/conditions/coronavirus-covid-19/testing-and-tracing/ask-for-a-test-to-check-if-you-have-coronavirus/ or by calling 119.
Work is also progressing on the requests for 2 urban located Local Testing Sites designed for those arriving on foot or by bike, making testing more accessible to local communities in the borough.
We also have plans in place to be able to deploy testing to specific locations in the event of larger outbreaks to support management and response.
Testing for those without symptoms (rapid testing):
Regular rapid testing is currently being offered to some frontline staff groups in Doncaster and will shortly be opened up to more key worker groups. We are working hard to improve access to testing for local communities and will be able to provide more information on this soon.
Incident Management Team
Incident Management Team
The partnership Incident Management Team meets daily to review incidents, clusters and outbreaks of covid-19 across a range of settings and communities including schools and early years settings, care homes, health settings, vulnerable communities and more. It aims to:
- Understand outbreaks/incidents across the borough
- Ensure effective incident management of those outbreaks/incidents
- Assess what preventative action we might take.
The team considers the latest data and intelligence and determines key areas for further investigation, specialist support, prevention activity or outbreak management actions.