Northamptonshire COVID-19 Outbreak Prevention and Control Plan

This headline summary outlines our objectives as a Northamptonshire system in preventing and controlling COVID-19 outbreaks.

• It provides an overview of the roles and responsibilities of key partners, identifying where there are interfaces with key stakeholders and the flow of information.

• The plan will address both prevention as well as identification and management of outbreaks.

• It also outlines the route for identification of cases via the NHS “test and trace system” and key processes to be followed as part of this outbreak response.

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COVID-19 Health Protection Board• Provides health protection expertise.• Leads development of the Outbreak

Prevention and Control Plan.• Assures system of delivery of the plan.• Makes strategic decisions about the outbreak

response.

Local Oversight and Engagement Board• Provides political oversight of the plan.• Engages with the public on elements of the

plan.

Strategic Coordination Group (SCG) • Mobilises the multi-agency resources required

to deliver the plan.

GovernanceCOVID-19

Health Protection

Board

Local Oversight and Engagement

Board

Strategic Coordination Group (LRF)

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Engagement

• We will speak with, listen to and understand the concerns of local communities.

• We will ensure vulnerable groups and marginalised communities are heard.

• We will use existing channels as well as digital and social media to reach out and engage.

Proactive Communications

• We will build on the LRF’s existing #NorthantsTogetherbranding.

• We will use local intelligence alongside published literature on behavioural insights to shape local messaging.

Reactive Communications

• We will work closely with the Public Health England regional communications team as well as key local stakeholders to keep residents informed.

Communication and Engagement

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Dimensions of primary prevention measures

1. Environmental and structural measuresSupporting physical measures in place to supportsocial distancing in public spaces and workplaces.

2. Advice, guidance and trainingSupporting measures through tailored advice and guidance and local training support.

3. Resources and staffing measuresTo ensure that settings (particularly high risk settings including care homes) have sufficient resources to implement infection control measures.

Population-level measures

Targeted prevention in settings

Targeted prevention – vulnerable individuals

Rapid testing and contact

tracing

Outbreak management

Tiered Prevention

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• Logistics and distribution hub – both rail freight (at the Daventry International Rail Freight Terminal DIRFT) and road distribution with the M1 traversing the county.

• Large rural areas with dispersed pockets of employment and large manufacturing and industrial centres primarily in Northampton and Corby with still some shoe industry including in Rushden/Kettering.

• Though we have no abattoirs in the county there are a number of meat cutting plants and cold stores.

• Silverstone is a significant sporting venue with Northampton Town Football Club currently playing ‘closed doors’ and The Saints Rugby and County Cricket Club planning a similar approach.

• The county also has a number of country houses, country parks and a small theme park.

Northamptonshire Context

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Understanding and Managing Risk

Why identify high risk settings?1. To be able to target proactive prevention activity including advice and guidance.2. For surveillance/mapping – so that we can identify patterns early and act quickly. 3. To have access to contact details out of hours to be able to gather information if any reports of

possible/suspected cases or outbreak.

What support is given to high-risk settings around prevention?1. Care homes – offered infection control training and regular guidance updates.2. Schools – offered advice and guidance updates via the NCC Education Cell.3. Businesses and workplaces – offered guidance and advice from Northamptonshire Environmental

Health Officers and the local Safer Public Spaces Taskforce.

The plan identifies a number of potentially high-risk settings and vulnerable populations. Settings are considered high risk if outbreaks are highly likely to occur or if the consequences of an outbreak in the setting would be significant.

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Carehomes

Schools Sharedaccommodation

Prisons and otherdetention

Healthcare

settings

Industrial and office settings

Public open spaces

240 with an additional 29

supported living facilities

326 mainstream,

15 special schools, 10

independent schools plus 5 boarding

schools

Homeless shelters largely closed but 2

hotels running. Multiple HMOs

(houses of multiple occupancy).

University Halls of Residence

3 detention facilities at border of

county

2 districtgeneral

hospitals,14 other hospital

settings, 69 GP practices

54 food processing and meat packing

10 train stations, bus

and coach stations. List of

tourist attractions

being compiled

High Risk Settings

Access to Testing

Rapid testing is accessible

for all, including vulnerable

groups.

Targeted Prevention

Appropriate advice on

infection prevention is

accessible to all.

Outbreak Management

Outbreak response

recognises specific needs and

context of vulnerable groups.

We can consider ‘vulnerability’ in terms of:• People who are clinically at higher risk of more serious illness and poor health outcomes e.g.

black and minority ethnic communities, people with long term conditions, people who are “shielding”.

• People who are socially isolated or excluded and marginalised e.g. deprived communities,people for whom English is not their first language, traveller communities, people who are homeless, carers, etc. * to note that there is significant overlap in these categories

We want to ensure:

Vulnerable Communities

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The Safer Public Spaces Task Force aims to

promote COVID-secure workplaces and public

places as well as additional walking and cycling

infrastructure across Northamptonshire. This

will be delivered via six work streams led by

multi agency partners:

1. Public Transport2. Active Travel3. Retail and Town Centres4. Schools and educational facilities5. COVID-Secure Workplaces6. Communications

Targeted PreventionThe Care Home Resilience Plan outlines

actions that will be taken across the tiers of

prevention to support care homes in their

resilience including support around:

1. Workforce Capacity

2. Access to personal protective equipment

(PPE)

3. Access to IPC training and advice

4. Access to clinical support

This action will be supported financially by the

National Care Home Support Package

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The UK Government Testing Strategy has 5 pillars, of

which two are particularly relevant to the local

contact tracing and outbreak control plan, namely:

Pillar 1. NHS swab testing – this focuses primarily on

antigen testing for key workers and outbreak

response and in Northamptonshire is coordinated

via Northampton General Hospital and their

partnership with commercial laboratories

Pillar 2. Nationally coordinated commercial swab

testing (antigen testing) at Regional Test Centres

(RTCs), Mobile Testing Units (MTUs) and home self-

test kits) – this provision is for all members of the

public including those in the Pillar 1 category.

Coordination of Capacity

As well as laboratory capacity, swabbing staff

capacity will be expanded in wider workforce to

support setting-specific swabbing e.g. NASS staff

swabbing care home admissions.

Prioritisation

National blanket-testing capacity in care hone will

be prioritised according to local risk assessment.

Escalation

Thresholds for escalating to request additional

capacity (both from within and outside of the local

system) will be clarified.

The above will be coordinated by the Outbreak

Prevention and Control Hub

Testing

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LOCAL Current staffing capacity Current lab capacity

In-hospital testing N/A

NGH Lab 700 swabs/day

NGH/KGH drive-through

Max 500 tests/day(KGH max capacity 200 NGH max capacity 300)

Infection Prevention and Control swabbing team

2 core team (RNs: registerednurses) with 3 short term RNsupport and 10 volunteers

Mobile Testing Units Max 300 tests/day N/A

REGIONAL/NATIONAL Capacity

Regional Testing Centres Not limited by local factors

Home Testing Kits Not limited by local factors

How we scale up additional capacity in response to an outbreak/incident will be dependent on the setting and population:• Care homes/children will be

managed by mobilising community Infection Prevention Control support staff (as well as potentially other nursing staff e.g. 0-19 team)

• Other settings can be managed with self-swabbing via established drive-through sites or Mobile Testing Units

Testing Capacity

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We will amplify messaging

on accessing rapid testing

for anyone with symptoms

of COVID-19.

People who have

symptoms will be

encouraged to choose from

a range of testing options

with a strong emphasis on

good communication with

employers on test results.

Individual Testing

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Initial focus on testing of

symptomatic individuals only

has shifted towards whole-

home testing. This has been

supported by the availability of

Pillar 2 home testing kits

available on request via the

Care Home Portal.

The care home cell and

Infection Prevention and

Control team work with national

colleagues to prioritise blanket-

testing of care homes according

to local risk assessment and

known needs.

Care Home Testing

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• The 3-Tiered National Test and Trace System will support contact tracing for all positive cases identified –regardless of the testing route.

• Any cases associated with contact in a high risk setting or community will be escalated to Tier 1 of the system coordinated by Public Heath England (PHE) regional Health Protection Team.

• In complex cases with multiple contacts in a high risk setting, or in a context where local insight is required, the Northamptonshire local Health Protection Team will work together with PHE, or if a hospital-related case, with the NHS Trust Infection Control Team.

• This arrangement is underpinned by the East Midlands Contact Tracing Standard Operating Procedure (SOP).

Contact Tracing

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• Outbreaks are defined as two or more laboratory-confirmed cases of COVID-19 connected by time and place.

• In all outbreaks, the initial risk assessment will be led by PHE.

• The interface between the regional PHE Health Protection Team and the local NCC Health Protection Team will be by:• Daily briefings/situational reports (sitreps)

• Weekly detailed teleconference between the local team and PHE EM

• Notification of new outbreaks to nccg.intelligence.covid19@nhs.netand nccg.communityipc.covid19@nhs.net

Operational Delivery/ Command and Control Structure

COVID-19 Outbreak Prevention

and Control Hub

Daily OPCH strategic lead

SCC IPC Team

Intelligence Capacity -

STAC

Logistics and testing

cell

Outbreak Management

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Care Home Outbreaks - Overview

While all outbreaks will follow the same core processes and procedures, actions required from certain parts of the local outbreak response will vary according to setting.

For example in care homes the SCC Community Infection Prevention and Control Team will lead on swabbing, rather than require staff to swab residents –allowing both rapid testing and risk assessment of the setting.

The weekly Care Home Cell meeting will cover both prioritisation of proactive support as well as reviewing current outbreaks and any trends in settings declaring outbreaks.

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School Outbreaks - Overview

While all outbreaks will follow the same core processes and procedures, actions required from certain parts of the local outbreak response will vary according to setting.

For example in schools the NCC Education Cell are likely to be involved early on as they are notified of suspected single cases.

Testing in these settings is likely to be organised by staff and parents themselves but in cases of mass wider testing the IPC team may support.

There also may be a role for the IPC Team in reviewing infection prevention and control procedures.

While developing detailed protocols for local response to all categories of high risk setting is not practical, there are a number of key specific situations that will need consideration, namely:

NHS SettingsNHS Trust outbreaks will primarily be managed by Trust Infection Prevention and Control (IPC) Teams and Directors of Infection Prevention and Control (DIPCs) with support if required from the Community IPC Team and oversight from local health protection team.

Prisons/Detention CentresResponse in these settings is being led by the relevant healthcare provider.

Businesses and other workplacesProtocols for local response are a collaboration between the local health protection team, environmental health officers and regional HSE and FSA colleagues.

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Outbreak and complex contact tracing notifications

Midlands testing SitRep and contact tracing data overview

Exceedance Reports

Pillar 1 testing data

Local soft intelligence

Outbreak Prevention and Control

Hub – Intelligence Cell

Joint

Biosecurity

Centre

(JBC)

East Midlands

Health Protection

Team

National and Regional Local

Proactive

risk-assessments

Health Protection

Board Intelligence

Pack

Outbreak LogSituation and

case mapping

Information Governance• Personal Identifiable Information only shared securely

between NHS email for purposes of care/outbreak management

• All other information shared anonymised

Data Flow

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