In-depth interview with Rochdale’s director of public health on testing, regional restrictions and the local response to Covid-19
Date published: 11 August 2020
Andrea Fallon, Director of Public Health
Back in mid-July Rochdale had the highest coronavirus infection rate in Greater Manchester and officials were concerned it could follow Leicester into a local lockdown.
Officials ramped up their messaging and urged residents to take extra precautions - such as wearing masks in shops before it became compulsory.
The infection rate came down sharply and the borough was overtaken by Oldham, Trafford and Manchester as the areas with the highest concentration of positive tests.
However, Rochdale was then placed in a Greater Manchester-wide lockdown and, with rates slowly creeping back up, again finds itself as the second worst-hit borough in the city region.
But what has Rochdale learned over the last six months and what will be its next move in the fight against the spread of coronavirus?
Local democracy reporter Nick Statham spoke to Andrea Fallon, the council’s director of public health, for an in-depth look at the borough’s experience of the pandemic.
Rochdale’s infection dropped quite significantly after you brought targeted measures in - but what were the main challenges in the borough as rates began to spike?
“The main challenges were the same for everybody in a lot of areas that had higher infection rates or did at that time,” says Mrs Fallon.
“We are a borough with a lot of challenges in terms of deprivation and that brings with it a whole host of things. And we also have a higher population in the south Asian communities, so there are communities there who have language barriers and some cultural barriers.
“But predominantly what we found was that lots of issues at the beginning (of the pandemic) were around deprivation. It goes back to if you are poor, or you come from a poorer background, you get by based on mutuality.
“Your networks are really, really important to you. You can borrow food and bits of money, but it’s not just about that - it’s about the sharing of problems.
“You may not exchange money like rich people do, but you support people much more and you back that by social interaction, so that is a factor.
“Obviously, there’s a whole host of other things around more people being in the house and, in those communities that are poorer, the main breadwinner tends to be a key worker.
“We have a very tight knit community, which is a massive strength with non-communicable diseases - if one of your family has a stroke or heart attack, you have a much stronger support network.
“But for infectious diseases it’s less good. There are strengths and weaknesses in different communities and how they live. Unfortunately, where there are more people in the house you have more chance of getting it and more chance of passing it on.”
And, as in boroughs such as Trafford and Stockport, rising cases among younger adults are providing significant cause for concern in Rochdale.
“More latterly we have seen a reduction in the age (of people testing positive for the virus). About 60% are under the age of 40, which is a real change to that working age adult population,” says Ms Fallon.
Was this a result of the easing of lockdown - the reopening of non-essential retail followed by bars, pubs, restaurants?
“It’s got to be, hasn’t it? It would be hard to say what else it would be. We always knew this was going to happen in many ways.
“When national easing came in, the North West was already in a worse position than nationally - we were flagging that up as a concern for us across the North West.
“It’s no surprise that the whole North West has the highest infection rate - we started from not a great position.”
However, Ms Fallon is keen for people to enjoy as much freedom as possible.
“What we really want is for young people to be able to get out there and live their lives - and all of us really,” she says.
“Some of those measures affect different parts of our society differently, they are not all affecting the same age group or same people. It’s a bundle and it’s a kind of mixture - you’re trying all the time to find the right combination of measures to give people reasonable freedoms.
“There are the freedoms we have just given to some of our shielding population. You want people to be able to when the infection rate is relatively low - as it is nationally, compared to where we were.
“Because, when we get to winter, if we get to a position where we have to put more measures back in place - nationally and maybe even regionally - you want people not to be totally in measures fatigue, or lockdown fatigue.
“We need people to come with us, it’s really important we don’t crush everyone’s lives by the measures. But they are carefully considered and based on the epidemiology.”
Rochdale had the highest infection rate in Greater Manchester in mid-July.
However, after ramping up efforts ahead of the Greater Manchester-wide lockdown, the borough saw its longest continuous fall in cases since May - dropping from 46.8 to as low as 25.6 infections per 100,000 people.
How worried are you that the rate is now creeping back up (33.3 for the week ending 5 August and 39.6 for week ending 7 August)
“We’re keeping a watchful eye on it,” says Ms Fallon.
“It could be testing - our testing strategy has become more focused, especially in the last week, so it could be that.
“It could be the easing (of lockdown restrictions), but it’s not a massive spike. We don’t have any massive outbreaks - that’s a big thing. We are doing more testing now - we are the third highest in Greater Manchester - and are among the highest in the country. We seriously were sucking in all the testing.”
During mid-July, Milkstone and Deeplish, central Rochdale, Kingsway - and also Middleton - were reported as the areas causing the most concern. How were you able to identify those areas; what steps did you take to get on top of the issues they were experiencing?
“As soon as we started seeing cases and started getting the postcode data, we could start building a picture of where the cases were emerging,” says Mrs Fallon.
“But it is important to say that, just because it might not be in your area, it doesn’t mean you will be okay.
“What we don’t want people to think is they are okay, there’s no need to worry because it’s down the road. That’s really not right and we’ve seen that in Trafford.”
She adds that the resilience and indiscriminating nature of the virus should not be underestimated.
“There’s a real risk of people thinking ‘it’s not me that’s going to be affected’. This is a virus that’s really clever; it doesn’t care who you are, it’s looking to move on, survive and replicate. It’s not bothered where you live or how much money you have, or what culture or background you have.
“We really don’t want people to think if it’s not in their area they are not at risk, that’s really important.”
However, she says that access to postcode data from the test and trace system has been really, really helpful.
Ms Fallon adds that the input of everyone from central government and Public Health England to the combined authority and local intelligence and public teams is vital for bringing data together to ‘create a whole rich picture’.
“It took some doing to start this up but now we have got it, it’s not perfect, but it’s really, really helpful. We can start to see now where our cases are coming from, so we can actually go into those neighbourhoods and talk to the people who live there,” she says.
“I’ve got to say the neighbourhoods we have got that have high numbers of cases – at the minute Smallbridge and Firgrove and central Rochdale – those communities have been absolutely fantastic. The work they have done has been absolutely phenomenal. I’ve been blown away by the volunteers that have come forward and the community leaders, it’s been amazing.”
However, she is aware there are ‘huge challenges’ in Rochdale.
“For someone to test positive, it means they are not going to get paid and their families are going to go without, potentially,” says Ms Fallon.
“It’s tough but we have seen an absolute commitment. It’s been fabulous, the communities want to sort this out.”
She adds that the council strives to give communities the means to do just that – distributing thousands of free masks and leafleting all the borough’s 90,000 households.
Meanwhile councillors - such as multi-linguist Councillor Sameena Zaheer - have also recorded videos in different languages to help get key messages across to as many people as possible.
There has obviously seen a big increase in testing in Rochdale. But to what extent has increased testing account for the increase in the number of cases?
“The more you test the more your positivity rate goes down - the number of positive cases as a proportion of tests you have done,” says Ms Fallon.
But she adds that it is important to ‘cast the net’ across the borough - not just areas Covid is known to exist - to make sure no outbreaks are missed.
“We know there will be asymptomatics, I think we tested all the staff at JD Sports warehouse and found not very many cases, but some were asymptomatic. It’s reflective of what you find in the general population,” she says.
“We know from the testing we’ve been doing, and from encouraging asymptomatics to come forward, we will find a few people who have got the virus who haven’t got a clue they’ve got it.
“And they are taking it in the house and passing it on to the people they live with potentially.
“We need to get as many as we can and help people to isolate as soon as they can, which is tricky.”
False stories about the nature of testing have also proven an obstacle to halting the spread of the virus in Rochdale.
“There’s quite a lot of misinformation out there. There are people who are afraid the test involves an injection, or it is a DNA test, we have had all kinds of things come back to us,” says Ms Fallon.
“It is what it says on the tin - a swab of the back of your throat and your nose that gets popped in a little tube and then off it goes. It’s pretty easy to do. I’ve had two now and it’s pretty straight-forward.”
Council leader Allen Brett has indicated Rochdale will set up its own tracing system due to continuing problems getting all the necessary data from the government.
How much of a hindrance has this been in Rochdale and how are plans for the council to set up its own test and trace system progressing?
“Some of the positive cases are uncontactables, the national contact tracing service, for whatever reason doesn’t manage to get to them, or they don’t pick up, or they’re not bothered, or don’t get the message,” says Mrs Fallon.
“What we wanted to do was get hold of that list of people who are positive who, for whatever reason, have not managed to speak to the national contact tracing service, so we can follow them up locally.
“Because we know everybody, we know our community really, really well. We know where all the roads are - we can door-knock if we need to. But the national contact tracing system just doesn’t have it. It’s telephone operated basically.
“So instead of waiting, we have asked for this to come to us after 48 hours. So, after 48 hours, if they’ve not managed to get hold of someone, we want that information to come to us locally.
“We can then do the contact tracing, we can find those people, we can get hold of them ourselves.”
She adds that the council could be particularly effective where there are complex cases - such as engaging people with mental health issues and other difficulties.
Ultimately, the council would like access to the contacts list of people who have tested positive for Covid-19, as well as the cases themselves.
However, the first stage will be tracking and tracing positive cases - and the council will be making an announcement about this on Wednesday.
What are the main lessons the council has learned since March and how much better equipped do you think it is to deal with any further waves of coronavirus - bearing in mind we are heading into winter when seasonal flu could put additional pressure on the health system?
Mrs Fallon says that in pre-covid times the council mainly had an ‘assurance role’ when it came to infectious diseases - checking their own and other systems were working as they should. But ‘the bulk of responsibility’ lay with Public Health England.
However, things have now changed radically.
“This is just a massive shift, what the council and all the partners have realised is, when you get something as significant as this, no one agency can do it on its own,” says Ms Fallon.
“You need the experts - Public Health England, experts in communicable diseases, statisticians, virologists, epidemiologists - but you can’t do it without local authority boots on the ground - people who are right at that interface with local people.
“Working in isolation is never going to work for a pandemic. Expect every single part of the system and service to be affected - there’s no part of our service that hasn’t been affected by this - and that recovery takes a long time.
“We started looking at recovery two months ago, expecting we would have to move to that. Recovery is going to take years not months.”
Ms Fallon adds that the mental health and economic consequences of lockdown will begin stacking up - as well as the impact of delayed treatment for other conditions.
“The answers lie not necessarily in services,” she says. “It’s about services and organisations supporting local people to the things they identify needs to happen. There’s no point doing two (approaches) when you have a situation like this, it’s about everybody working together.
“That strength of local community we have got, I have been absolutely gobsmacked by the sheer will of the people. You are always going to get some unsavoury elements but, on the whole, people have been amazing.
“We need to keep people going on that. It’s going to be tough; the economic impact is going to hit - it already has - and people are going to lose jobs and be without money.
“We need to try to keep people safe and help people to live their lives, because that’s what it’s about.”
Ms Fallon also says that people are having to adjust to testing being a routine part of their healthcare.
“We need as far as possible to control the virus and live our lives. In the past if you had some of these symptoms services - doctors and nurses - would be sending you away to take some paracetamol and spend a few days on the sofa.
“This is not like that. What we are asking people to do is add an extra step into their treatment and self-care - which is go and get tested, because we know people can get very ill.
“Testing has become a normal part of how you manage these particular sets of symptoms. They are vague, as well, so if you don’t feel right, go and get tested. That’s the bottom line.”
What preparations has the council made for all pupils returning to school and college in September - and could it yet change its mind if the situation in Greater Manchester doesn’t improve? Would the council support schools if they chose not to open on safety grounds?
A council spokesman answered this question.
He said: “The health and safety of pupils and school staff has been placed at the forefront of school recovery plans.
“Schools have completed thorough risk assessments informed by infection control and health and safety guidance which enabled them to increase pupil numbers in June safely and successfully.
“We will be continuing to work in partnership with schools to ensure that plans to return enable a safe full-time return to school for children and young people and will clearly be monitoring the situation closely.”
Rochdale Council’s current advice to residents is as follows:
- Wear face coverings in shops and all public places, as much as possible
- Keep 2 metres apart at all times
- Avoid physical contact with anyone outside your own household, including shaking hands or hugging
- Get tested even if you don’t have symptoms and isolate if you are told to do so
The full set of restrictions for Greater Manchester, East Lancashire and parts of West Yorkshire can be found at:
Nick Statham, Local Democracy Reporter
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