Healt Matters - By Matt Ashton

BLOG: Looking back on a year since lockdown

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It has been a year since Liverpool entered lockdown for the first time – Director of Public Health Matthew Ashton reflects on 12 months of dealing with the worst pandemic in a century.

If we have to start anywhere when writing about the last 12 months, it has to be thinking about the 1,300 people in Liverpool who have lost their lives as a result of Covid-19, and their families and friends, along with everyone else across the country and indeed the world.

It is also easy to forget that many others – up to one in five people – suffer some form of what has been dubbed long-Covid, suffering symptoms many weeks, months and even a year after contracting the virus.

This will undoubtedly be one of the biggest challenges for the health service as we emerge from the pandemic, particularly as little is still known about the long term effects on the body.

Staff inside the ICU at the Royal Liverpool University Hospital caring for Covid patients

In addition, every single one of us has been affected by Covid, even if we have not had it ourselves.

Not being able to see our family and friends.

Social distancing and wearing face coverings.

Working from home.

Home schooling.

Businesses and livelihoods lost.

Impact on our personal mental health and resilience levels.

There is a substantial amount of recovery needed for the city, both economically and from a health and wellbeing perspective.

Director of Public Health, Matthew Ashton

As Director of Public Health, my work is usually largely taken up with trying to increase life expectancy by getting people to give up smoking, drinking less, taking more exercise and attending health screening programmes.

Although a pandemic is something we had carried out emergency planning exercises for, in the public consciousness it wasn’t an issue because there hadn’t been one in living memory.

If you had polled people before the pandemic, terrorism and the consequences of Brexit would have been far further up the things they were worried about. Even though the consequences, as we have seen, are more wide ranging and far reaching.

But amongst the negatives of the last year, there have been huge positives – particularly in the leadership I have seen in this city.

Everybody has downed tools and turned their attention to supporting the fight against Covid.

And this includes our brilliant citizens – from following the guidance to looking out for fellow residents.

LIVERPOOL, ENGLAND. Liverpool City Council’s Licensing Enforcement Officers make sure pubs, bars and restaurants on Smithdown Road are doing everything they can to prevent the spread of coronavirus on 12 September 2020. Liverpool and Merseyside have been placed on the central government watchlist for 7 days as Covid-19 numbers continue to rise in the region. Picture: Jennifer Bruce/Liverpool City Council.

I need to pay particular tribute to my public health team – I started in post on 1st April and their response has been nothing short of amazing.

Many have worked 15 hour days for most of the last year – as have many others across the council and in other sectors dealing with the challenges of Covid.

But this is very much a team effort.

Everything we have done in the city has been through the organised efforts of society, the definition of public health in practice itself.

There are too many to mention, but our environmental health, communities, adult social care and children’s services departments, schools, cultural partners, our incredible NHS, the business and hospitality sector, the voluntary and community sector, our world-class football clubs, the emergency services and the military have all played a part in our response. And many more.

I was particularly proud of our response to the outbreak in Princes Park last summer, taking a hyperlocal approach to managing an outbreak in a specific part of Liverpool. We closed down the outbreak in under three weeks, supported and led by councillors, community champions and faith leaders. It was old fashioned public health work at its best – going door by door, street by street to spread the word and reduce the spread.

Ice Cream Man Paul
The response to the Princes Park outbreak included getting an ice cream man to spread the word about testing

The summer brought new challenges, the exit from the first national lockdown with people mixing in much greater numbers and initiatives such as Eat Out to Help Out contributing to infection rates rising again, particularly in our area where we were one of the last areas to come out of the first wave and had not quite reduced the spread of the virus sufficiently. The embers were still burning, so to speak.

The smart testing programme in November was an incredible experience. The military rolled into the city, supporting us with the setup of almost 50 symptom-free testing locations, and helping us to actively test over a third of our population in a month, helping us to become the only area of the country to exit the second lockdown in a lower tier than the one we had gone into lockdown in. We still miss Brigadier Joe Fossey and his incredible team of troops.

From this point on, it became much harder. Despite retaining a community Covid testing offer, a combination of factors made life very difficult. Other areas of the north west had tighter restrictions such as shop closures, but that meant there was a temptation for some of their residents to come to Liverpool, shop, eat, drink, and in some incidences stay overnight.

We were also battling Covid fatigue – adherence to social distancing started to wane as we got closer to Christmas. Then the b117 Kent variant meant cases escalated quickly to over 1000 per 100,000, our highest ever rate. This resulted in more deaths, more illness and inevitably, a third lockdown.

Covid vaccine centre in Liverpool

Thankfully, a year after we started, we are now on the road to recovery, supported by the successful rollout of the vaccination programme, where we are now seeing over 90% uptake in our top priority groups, which is a brilliant achievement. Let us not forget that our own Liverpool School of Tropical Medicine was instrumental in the trials which led to the Astra Zeneca vaccine being approved.

So, after an exhausting year, what does the future hold?

I think it’s clear that Covid isn’t going away – it is something we have to learn to live with, like many other diseases.

We are likely to have community transmisssion for some time to come, and unfortunately we are going to have to live our lives in a slightly different way for the foreseeable future.

The best tools we have at our disposal are the vaccine (and my message to everyone is that you should have it when it is offered) and regular testing.

In addition, I recommend we take a precautionary principle approach to what I call the 3 c’s – crowded places, close contact and closed spaces. If you are ever unsure, it is best to avoid.

This doesn’t mean staying indoors though and hopefully we can start to move into reopening the city in the safest way possible, allowing us to start to recover our physical, emotional and economic health.

Liverpool Waterfront
Life in Liverpool should start to return to normal as restrictions are eased

Once again, Liverpool is leading the way by piloting some events, including at a comedy club and a nightclub, which will help with research into how far we can in enabling people to gather in close proximity in large numbers.

We don’t yet know what next winter will bring. We are likely to need a vaccination booster at some point, to help us deal with the new Covid variants that are emerging. We may well see another wave – and although it is likely to be smaller than previous waves, it will still affect some people badly and there will always be a number of deaths, similar to flu. Ultimately we will find a way to live with Covid, and heal together.

Until that time, thank you for everything. Stay Covid safe, and I am looking forward to a big party when this is finally over. Heaven knows, we all deserve it.

You can read the annual report of Liverpool City Council’s Public Health Team here: https://phar2020.liverpool.gov.uk/

Liverpool Waterfront