Lancashire's public health boss wants walk-in vaccine centres for ALL over-18s
Walk-in clinics where anybody over the age of 18 could turn up to get their Covid vaccine without an appointment should be opened across Lancashire, the county’s director of public health has said.
The call was the latest push from Dr. Sakthi Karunanithi for Lancashire to be granted government permission for a faster rollout of the jabs than current national eligibility criteria allows.
He says that if previous requests for local flexibility had been heeded, then we “wouldn’t be in his situation now” - referring to increasing case rates in every part of the county. That includes Central Lancashire where infections per 100,000 people doubled in Chorley, more than trebled in Preston and shot up by five times in South Ribble in the week to 29th May compared to seven days earlier.
Elsewhere, there were only marginal rises in Blackpool, Lancaster, West Lancashire and Wyre, but far more significant jumps in other corners of the county over the same period. Confirmed infections more than doubled in Burnley and Pendle, more than tripled in Blackburn with Darwen, were ten times up in Rossendale and eleven times higher in Ribble Valley.
A one-off open access vaccination clinic at Twickenham Stadium in London gained national attention when younger people not currently eligible for the vaccine were amongst those who flocked for 15,000 jabs made available on Bank Holiday Monday. At the moment, broadly only the over 30s are entitled to a vaccine - other than those working or living with people who are particularly vulnerable to Covid or who have such a vulnerability themselves, as well as health and social workers and people with a learning disability.
Dr. Karunanithi says walk-in clinics should be a permanent part of Lancashire's armoury in the ongoing fight against Covid.
“The case is very simple - if you look at a map of the country, parts of Lancashire have always been more affected with severe disease and hospital admissions [than elsewhere]. Vaccines prevent hospital admissions and deaths and if we had been allowed to go faster with [administering both] doses of the vaccine, then we would have done the whole thing by now and not face the prospect of issues escalating and a third wave - or rather what would be a fourth wave in Lancashire.
“There is probably still time to act if we had [access to] more vaccines quicker. We would not only reduce [any] pressure on the NHS, but it’s very likely to reduce the level of infections and the emergence of new strains.
“Infection levels are quite high in our patch - so there is a biosecurity case, an NHS case and an economic case as well, [because] the more the transmission goes up, the more disruption for workplaces and schools with people having to self-isolate."
Dr. Karunanithi says it is “too soon to tell” whether the vaccine rollout has succeeded in breaking the link between cases and the number of people who become seriously ill and require hospitalisation.
The latest figures show that there were four Covid patients at the trust that runs the Royal Preston and Chorley and South Ribble Hospital on 1st June - and none at Blackpool Teaching Hospitals NHS Foundation Trust. However, any impact on hospitalisations from the current spike in infections would be unlikely to be felt just yet.
The Scientific Advisory Group for Emergencies (SAGE), which advises the government, concluded at a meeting last month that if the Indian variant were to be between 40 and 50 percent more transmissible than the so-called Kent strain that had dominated in the UK since late last year - with the higher figure deemed a "realistic possibility" - then proceeding with stages three and four on the government's roadmap out of lockdown on the planned dates could lead to a "much larger peak" in hospitalisations than during previous waves.
Stage three - which permitted indoor mixing between groups of up to six people or two households and saw indoor hospitality and some entertainment venues reopen - went ahead as intended on 17th May. The government has said it will decide by 14th June whether stage four - which would remove all legal restrictions - should proceed as proposed on 21st June.
Dr. Karunanithi says that while the progress of the vaccination programme in Lancashire is positive, it should be remembered that a “significant proportion” of the population has yet to receive two doses. In the Greater Preston clinical commissioning group (CCG) area, 54.8 percent of 50-54-year-olds and 59.4 percent of 55-59-year-olds have had their second jab, while the respective figures are 60.4 and 67.8 percent for those age groups in the Chorley and South Ribble CCG patch.
He also stressed recent data showing that effectiveness of the vaccines against severe disease caused by the variant of Covid first identified in India - and which is now dominant in the UK - is only 33 percent after one shot and up to 88 percent after a second.
He says that while takes some comfort from the fact that very few cases are currently being identified in the over 60s - single figures in total over the week to 28th May in each of Central Lancashire's three districts - that is not a reason to be complacent.
“If eight out of 10 people are protected, two out of 10 [who might not be] is still quite high.”
Dr. Karunanithi is also calling for the entire county to be declared an enhanced response area, which would give access to the kind of surge testing - using lab-analysed PCR tests - that was announced in Burnley, Pendle, Hyndburn and Rossendale last week.
However, at that point, Chorley had seen more confirmed cases of the Indian - or Delta - Covid variant than any of those eastern districts, while Preston had an equal number to Burnley. In the latest data, Chorley and Preston have registered a cumulative 91 cases each - more than in every eastern borough but Burnley, which has now recorded 95. South Ribble has had 32 confirmed Delta infections.
In a candid assessment, Dr. Karunanithi describes a “gaping hole” in the national system’s support for areas which “have always been vulnerable during this pandemic”.
“Preston hasn't been identified as an enhanced response area. I’m hoping that will change very soon - but if not, and the [admission] rates go up in the hospital, it would be as though with the first wave we had a chance to develop insight, with the second wave we had a chance to have hindsight and if there is now a third wave, it would show that we didn't have foresight.
“We're working on having much more accessible locations and making it easier for people to receive the vaccine. We are working with community champions and getting people through to, say, the St. John’s Shopping Centre [vaccine hub] in Preston, providing facilitated access [using] hyper-local community engagement for people who have refused their vaccines.
“However, walk-in centres and vaccine buses that go round to village halls - we could really do that if it was controlled by us locally. But it isn't and that’s the issue at the moment.”
In spite of his concerns about what he says are the three highest-risk activities when it comes to virus spread - “indoor mixing, international travel and big events - the county’s public health boss is not calling for the likes of Preston, Chorley and South Ribble to be left under local limitations if the final stage of the government’s roadmap out of lockdown does go ahead on 21st June.
“What we need is more support, not sanctions. One thing that might change [whether any part of Lancashire remains subject to restrictions] is hospitalisation levels.
“I don't know what the government’s thinking is [about] a return of the tiers. If it happens, it will be disappointing, because it is not for the want of [them] being warned by local directors of public health [about] how to prevent that.
“I think it will create a huge uproar if that happens,” Dr. Karunanithi added.
In the meantime, he said everybody should pull together to get "the basics done beautifully - by which I mean continuing handwashing, [social] distancing, mask-wearing and regular testing".
WHAT THE GOVERNMENT SAYS
The Lancashire Post asked the government why all over-18s had been permitted to receive a jab at the pop-up vaccination centre in Twickenham earlier this week - and about similar activity in places like Rochdale - when requests for that flexibility had not been granted to the directors of public health in Lancashire and Blackburn with Darwen.
A spokesperson for the Department of Health and Social Care did not comment on whether areas offering vaccines to all adults had been given special permission, but said:
“We are making phenomenal progress through our vaccination programme, including increasing the number of centres and extending opening hours and capacity in Blackburn.
“On top of enhanced vaccine deployment, the government is reducing the spread of variants in the region with a huge number of preventative measures including whole genome sequencing, surge PCR testing and enhanced contact tracing.
“We are on track to offer a jab to all adults by the end of July and continue to follow the advice of the independent JCVI [Joint Committee on Vaccination and Immunisation] who recommend people in cohorts one to nine come forward for their second dose after eight weeks rather than twelve, as they are at most risk of death and serious illness.”
CONFIRMED CASES OF DELTA/INDIAN VARIANT IN LANCASHIRE
Data as at 3rd June - national ranking and number of cases:
No. 2 Blackburn with Darwen - 724
No. 23 Burnley - 95
No. 24 = Chorley - 91
No. 24= Preston - 91
No. 25= Rossendale - 85
No. 34 Hyndburn - 60
No. 39 Pendle - 51
No. 68 South Ribble - 32
No. 91= Ribble Valley - 20
No. 91= Wyre - 20
No. 95 West Lancashire - 19
No. 111 Fylde - 14
No. 123 Lancaster - 11
No. 146 Blackpool - 8
= denotes joint ranking
Source: Public Health England