How health bosses are preparing for a second wave of coronavirus in Manchester - and what it means for Mancunians

Manchester's director of public health, David Regan, explains the measures being put in place for the city's new normal

Hundreds of people have lost their lives to coronavirus in Manchester alone.

While lockdown measures are gradually being eased, health bosses say the fight against COVID-19 is far from over.

Though the death - and infection rate - has been steadily falling, a second wave is likely. There could be more peaks after that.

David Regan, director of public health in Manchesteer, says plans are already in place to ensure the city can cope with the disease in the long-term.

Here, he shares what has worked, what hasn't - and preparations for the next stage of the pandemic.

Was Manchester prepared for COVID-10 and how has it coped?

We were really fortunate to have Wuhan as our sister city.

We were notified as to what was happening in January and had meetings with our infectious diseases consultants at North Manchester General. We were alerted early to what was happening and established a Covid planning group in February.

One of the lessons we have learned is that this isn’t like pandemic flu; there was a treatment option with Swine Flu and we haven’t had that.

We have had to accept that this is life with a pandemic the world has never seen.

One of the positives steps was establishing our own community testing service early with a community swabbing team.

We tested all care home residents who were in hospital prior to discharge. We introduced that on March 13, well in advance of the national peak.

The only way we could ensure the NHS was not overwhelmed was by freeing up as many beds as possible so it had the capacity and capability to cope with the peak of the pandemic.

When care homes were saying they couldn’t take residents back unless they knew they were free of the virus, having our own discharge policy helped free up hospital capacity.

That protected the NHS in Manchester. We also set up the Nightingale in record time, the North West facility.

These are all things we as a city we should be proud of. We also managed to set up the two drive -through testing facilities at Manchester Airport and the Etihad in a very short space of time.

This means that key workers and residents now have access to those drive-through facilities.

What have been the biggest challenges in tackling the outbreak?

The flip side is that we've had challenges with the flow of information back into the city from our testing facilities.

We don’t have the accurate data of how many key workers have been tested. It’s recognised nationally that this has to improve because local authorities need the data to enable us to plan our services based on the transmission rate and the number of cases.

That’s been a real challenge. We recognise that we’ll have to reflect more as we progress through this.

I think locally, given the national constraints we have faced, I’m really proud of what we’ve achieved and how we’ve worked collaboratively across Greater Mancester.

What lessons have been learned in the last five months?

In the early days of the outbreak we were able to do contact tracing.

But as the number of cases started to increase, we lacked the diagnostic capacity, the lab capacity and the staff capacity to do contact tracing, testing and diagnosis.

We looked to Germany and South Korea and that was a lesson for the country.

Now that we have the lab capacity in place, access to testing and the national ‘test and trace’ service we can enhance that locally to make sure that as we come out of lockdown phase we can start in increase confidence in the city.

That's among staff in the workplace, among schools, amongst residents; we want them to have confidence in our testing capacity and an effective contact tracing service.

Without a vaccine or effective treatment that will be crucial going forward.

We have done contact tracing with infectious diseases for years. We have done it around sexual health services and our environmental health teams.

We’ve got expertise that we can use and engage with residents. We have all sacrificed a lot over the last 10 weeks of lockdown. What we’re trying to do with test and trace is be more flexible with our response and nip things in the bud at an early stage. We'll be asking people to self-isolate for 14 days -  14 days will go a lot quicker than 10 weeks.

We’ve all got to see things differently. It’s still going to be tough but we are going to be able to manage this more flexibly, if we do it well.

Do you have concerns about the easing of lockdown?

We will need to monitor the data extremely closely. Currently from our daily data there were only seven positive test results, and that’s good news

The rate per 100,000 people for Manchester is the lowest in Greater Manchester and we'll continue to watch that closely.

The new biosecurity centre, JBC, through the test and trace service will be getting postcode data where they can spot trends and hotspots within local areas.

Things are being put in place to make sure we have intelligence and data to look at the changes in the lockdown measures and what impact that would have.

We all know from the national news coverage that the R-number is just below 1. There is a recognition that as we ease some of the lockdown measures that could increase slightly.

As long as that number doesn’t go right up to 1.5 or 2 then we will have to look at similar approaches to those of South Korea and Japan where they have responded to second outbreaks.

The mayor, Andy Burnham, is right. We need to be cautious, look at things very closely and be prepared to respond to that data.

If that R number gets above 1 and starts to get out of control again, we’ll be looking at a second peak.

Will contact tracing work?

The contact tracing is designed to provide bespoke advice to individuals: it’s not an enforcement service.

When we contact people, we’ll have an honest discussion with them in confidence.

There are no sanctions on this, it’s about getting advice to individuals.

Those images of Italy during the peak of the virus, they fade in the memory very quickly.

If don’t respond to the advice in the contact tracing service, we could end back in that situation.

We all have friends and family who are in the shielded group, our vulnerable groups and our elderly relatives. They are still at the greatest risk.

Will there be a second wave of cases?

In Public Health, we are always planning for the ‘what if?'.

With any planning we’re looking at the worst case scenario. It’s about ensuring that if we have a second wave the NHS and care homes are prepared.

The whole plan is to avoid a big second wave but there may be waves, I’m being very honest here. You might get smaller increases in different parts of the country and it’s being able to deal with those.

Even in countries like South Korea where they’ve done a great job in suppressing the virus, it can still rear its head again.

It’s about having your plans ready to respond to that in a pragmatic and proportionate way.

We’re planning for all those scenarios.  We want to suppress the virus as much as we can, especially during the winter months when we’ll have flu to deal with as well.

What does a 'recovery phase' mean for Manchester?

We’re very aware of the health and wellbeing impact of the last 10 weeks. It’s not just about test and trace, it’s our wellbeing services and our mental health services.

We want to make sure the early detection and prevention of disease isn’t lost.

It’s important that people who are concerned about their health who perhaps haven’t been to the doctors in the last 10 weeks access their GP or primary care service.

We want to make sure the programmes around heart disease, cancer and our work with early years in giving children the best start in life get back on track. We’ve lost time and we need to make sure those services are back up and running.

Are you confident that care homes and social care teams have the resources and support they need to cope with COVID-19 going forward?

Our infection control team have a relationship with all the care homes. Throughout the year they deal with flu, norovirus and all the different outbreaks.

We have brought in three extra nurses to support that team because we know care homes were facing real challenges.

I think the care homes have rightly been frustrated with the confusion around the testing.

Care home managers and others have almost felt overwhelmed with the daily changes in guidance. I think we’ve all learned from that and we’ll reflect on that.

We now have a care homes board for Manchester chaired by the director of adult social services. That’s bringing together the learning from the last few months, and making sure that sector is as stable as it can be for the next stage, so if we do get a second wave or mini-waves we’ll be in a better position.