Responding to Covid-19: a perspective from Barnet
Dr Tamara Djuretic, Barnet Council Director of Public Health
London was the first part of the country to see a surge in coronavirus cases – and as Director of Public Health in the capital’s most populous borough, Barnet’s Dr Tamara Djuretic was at the heart of things.
“When we saw what was happening in the early days, we quickly realised this could have major implications. We reviewed our flu pandemic preparedness plans and held a one-day exercise in early March to test them out.”
More than 70 people attended the event from a variety of different organisations, including the NHS, council, police, fire service and local voluntary and community sector.
“It was a really valuable exercise. We went through various aspects – communication, excess death planning and NHS capacity. It meant we were in a position to respond well as the system, when needed. For example, when the policy on supporting those shielding was announced, we were in a position to know what the voluntary and community sector could do and what they needed to make it work.”
‘We’ve worked well with PHE’
Like many areas Barnet saw only a handful in the early stages. By early March most of the cases could be traced back to trips made in the February half-term, but then, like the rest of London, cases started rocketing.
Dr Djuretic said: “It was overwhelming. We’ve been consistently in the top three or four places for infections in London. That has obviously caused a lot of concern locally. Fortunately, we have a very integrated and close working relationship with the London Public Health England team.
“There is a London Corona Response Cell. At the start, they did all the contact tracing and were sharing all information relevant for further local actions. We now get a daily download of cases by postcode and some demographics. This data allows us to respond quickly to cases, especially those in care homes settings, and able to answer questions from the MPs and counsellors.
“We had local dentist who tested positive in early days and was well established in the community, so we were able to respond appropriately. I understand from my colleagues that outside of London, information is not always shared promptly, and that has been very frustrating. But in London we are fortunate that we have very good relationship between the regional Public Health England team and local government.”
Schools ‘will be the next challenge’
The rising rates prompted Barnet to set up a seven-day on-call rota for the public health consultants.
“First we were answering lots of questions from schools before they closed. Then it was from care settings. Getting hold of PPE was a major issue and logistics of its distribution has not always worked. It was confusing as we knew we had central stocks. Our local suppliers helped to fill that gap until the national, regional and sub-regional system improved.
“Now it is beginning to swing back to schools again. We are talking to unions and head teachers. It is about understanding some of the scientific research in this area – we know risk of serious illness in children is low, but we still don’t fully understand to what extent they spread it.
“It is about communicating risk – and that is not easy when evidence is still emerging about this virus. When schools start opening again it will be crucial to keep on a top of it and communicate regularly with parents and wider community. There’s also the issue of when children test positive whether you need to isolate the whole class. Things like that have been worked through as we speak.”
Alongside the advice and support, Barnet has also been doing a lot in terms of engaging with residents about social distancing measures, including producing banners and material explaining why it was important not to be gathering in parks and working with the local faith groups – Barnet is very diverse borough with a significant Jewish, Muslim and Asian populations.
Dr Djuretic said there has also been an emphasis on health and safety in the workplace. The council runs a workplace wellbeing initiative for council staff as well as wider support to local business about mental health and wellbeing, the safety of home-working and adjusting workplace procedures post lockdown.
Councils and track and trace
Developing and then evolving the track and trace system will be a priority in the coming weeks, Dr Djuretic believes. “I know some of my colleagues have been arguing for local government to be given a major role, but I think the system that is emerging looks to have the right balance.
“Having the Public Health England and 3,000 health professionals employed to do some of the complex work, while the call handlers deal with the simpler cases is right.
“I think our role will then be to get involved with those complex cases, when needed. In London, we are well prepared to work with the regional Public Health England team on that. It will be things such as dealing with ongoing outbreaks in schools, care settings, prisons or among homeless people.”
Decision-making is getting more difficult
As the pandemic has gone on, Dr Djuretic believes the complexity of decision-making has become even more difficult. “I’m trained in communicable diseases, so I’ve done a lot on outbreaks globally before, but this is very different. It feels very different. In the early stages it was somewhat easier in that we were following the scientific advice, but as the scale of the economic and social impact has become clearer, it has added a different dimension to it.
“Consequences of prolonged lockdown such as mental ill-health, unemployment and schools being closed can all have significant impacts in their own right, so one needs to get the balance right. People seem to criticise all aspects of pandemic response, but I think we need to be more patient - this is a first time we all had to deal with something like this on the scale.”