Health bosses warn ‘fear of further deprivation’ makes self-isolation difficult

Health bosses today warned that a “fear of further deprivation” is making it difficult for people from low-income households to self-isolate and is a barrier to bringing down the capital’s rising Covid infection rates.

According to Town Hall health lead Cllr Chris Kennedy, who met with health secretary Matt Hancock and London council chiefs earlier in the week, there is a “universal determination shared by government and all London leaders” to try and keep the capital out of more restrictive Tier 3 measures.

However, public health director Dr Sandra Husbands and clinical commisioning group (CCG) managing director David Maher, analysing the rising rates in north-east London as a “map of deprivation”, have both called for more action to support people to take the proper measures to keep themselves and others safe as winter sets in.

Husbands said: “Clearly there are some underlying factors that are going to take a bit longer to deal with than we have to break the chain of transmission.

“But, understanding that at the root of it is deprivation, people in low wage jobs and insecure employment, unstable living environments, that make all of the things like being able to self-isolate from work and within your home that make all of those things difficult.

“If we understand that, it gives us some insight into how we can support people better.”

Maher added: “It is clearly correct that East London has a long history of deprivation, but knowing what we know about that social geography and parts of East London with car refitting outlets, some heavy plant, factories, I wonder whether we need to with north-east London partners recommunicate to those businesses or have a bespoke local offering that allows them to take measures to move people onto furlough or other support.

“Deprivation is surely the root cause, but it is the fear of further deprivation that impedes people taking action to isolate and keep themselves safe and well. It is the fear of further deprivation that is keeping north-east London in the current picture that it is in.”

The Town Hall’s public health director, who yesterday released advice on how to have a Covid-safe Christmas, added that locals remain worred about being potentially unemployed from having to take time off despite the £500 payment that can be claimed when told to self-isolate.

Husbands pointed to a City of London scheme whereby environmental health certify businesses as Covid-secure, which she suggested being extended across high-risk businesses across the entirety of north-east London.

The council is understood to have brought up with national government the insecurity that people feel around being forced to self-isolate, rather than simply its immediate financial burden, and that while it has been raised with central government that assurance must be given to people that they will not be made unemployed, the Town Hall has yet to hear anything back.

According to public health data, Hackney’s incidence of the virus increased by around a third between 26 November and 2 December, from 125 to 164 per 100,000 residents respectively.

Testing rates in Hackney remain lower compared to London and England averages, with roughly 2,000 tests per 100,000 population carried out between 26 November and 2 December in Hackney, compared to an average of 2,300 in London and 3,000 in England.

Positivity rates remain “in the red” according to public health, though have declined since last week, above 7.5 per cent.

While the most recent cases continue to be diagnosed among working ages for both genders, the distribution between age groups has become more equal recently, with most cases in Hackney now being diagnosed among those aged 20 to 40.

In a key indicator of the virus’ increasing pressure on the NHS during the second wave, Covid-19 bed occupancy at the Homerton hospital has continued to increase since mid-October, with acute care bed occupancy increasing by 43 per cent within the past week and critical care bed occupancy rising by 17 per cent, in line with rises across NE London. Covid related staff absences also spiked by 82 per cent to 93 absences.

When asked by CCG chair Dr Mark Rickets if in the population there is a “false sense of security” or if people are not not coming forward because they don’t want to be found to be positive, Husbands responded: “Yes, in short, there is a bit of that going on.

“It is a more variable a picture than that. It’s not as if there is one area with low testing uptake, but we do know both from the data and soft intelligence that there are parts of the borough where people are reluctant to get tested.

“Across the borough we’ve had much lower uptake of testing than other parts of London all the way through and we also know from Public Health England intelligence we have been getting back and direct from the community that there is a combination of a low level of understanding of the need to get tested and of trust in the system.”

The Town Hall continues to work on direct communications and through community champions to enable greater uptake of testing, but concerns continue to be raised about trust in the health system, with Kennedy voicing alarm at recent statistics showing that only one in five of local care home staff have chosen to take the flu vaccine this year.

Husbands said: “That is worrying. It is not an uncommon picture that you see health and care staff refusing flu vaccination for a number of reasons, and in my previous job we spent a lot of our energy on trying to motivate staff to get the vaccine and to get them to understand the benefits to themselves as well as to patients and clients.

“You can have asymptomatic flu and bring it into a care home, which could be devastating for some of the older people or those with underlying conditions that you are looking after, or you could bring it into the workforce and devastate the workforce.

“Some see it as an issue of their individual choice and their rights, and they are right about that. But you have to balance rights and responsibilities. I hope it is not a harbinger for the Covid vaccine, but there is still some more work to do to get the flu vaccine uptake to where it needs to be as well.”

Planning is now underway to roll out asymptomatic testing using lateral flow devices, despite concerns having been raised as to their reliability, with the original plan locally to undertake a small pilot area in care settings, Hackney special needs schools and homeless hostels in the City of London.

Sensitivity for lateral flow tests have been found to reduce from 80 per cent to under 60 per cent if not carried out by somebody trained and experienced, though Husbands has pointed out that these figures were ascertained under laboratory conditions using trained scientists, making the actual reliability potentially much lower.

Due to the high rates of Covid in north-east London, however, mass community testing in areas with the highest prevalence is now the plan, with the council’s team currently working on plans to roll it out, with a new local booking system also developed and designed to be easier to use than the national system, in order to ensure every slot at local test centres is used.

Primary care sites for the delivery Pfizer/BionTech vaccine are also being set up from next Monday. A batch is expected on Tuesday at Elsdale Street Surgery. Other sites to be stood up still awaiting final confirmation as the local health system works to ensure not a single vaccine dose is wasted, with the batches able to be kept under refrigerated conditions for around three days before they degrade.

Rickets also revealed other difficulties in logistics planning, not just in the conditions in which the vaccine must be kept but in light of new regulations around its deployment brought in by the Medicines and Healthcare Products Regulatory Agency (MHRA) following cases of people experiencing allergic reactions to it.

People with a history of anaphylaxis are now not to receive the dose, and conditions have also been tightened to make sure that all who receive it will be observed for 15 minutes, a condition previously intended only for drivers to make sure that their arm did not become painful as they travelled home in control of a car.

According to Rickets, this has had implications over finding spaces sufficient to socially distance people as they flow through vaccination centres as that 15-minute observation is undertaken, with his team currently working through the subsequently altered plans.