Local authorities can fully engage with local communities to combat covid-19
New and better ways to manage covid-19 must be adopted in the UK as soon as possible, and may well be needed for several years to come. Lockdowns are a blunt instrument, whether local or national, short term circuit breakers, or longer term lasting months. Their use is essential sometimes, but has severe implications for the economy and a negative effect on the wellbeing of local populations. Effective contact tracing is a much finer instrument enabling index cases to isolate and contacts to quarantine while those not affected can carry on working, attending school and socialising. The latest Independent SAGE report clearly outlines how a Find, Test, Trace, Isolate and Support (FTTIS) service could be resourced and run by local authorities.
The UK government’s response to the threat of covid relies on a privatised national call centre-based contact-tracing service and smart phone apps. More tried and tested ways of dealing with infectious diseases, such as working with primary care and established local authority public health systems, have been side lined. It is welcomed that central government has acknowledged the importance of involving local government, but rhetoric must be followed by urgent action.
The evaluation of a pilot study and work with local communities in Sheffield have found that for local initiatives to be effective and sustainable there has to be meaningful community involvement. “Ear to the ground” organisations can help identify community needs with regards to testing, contact-tracing and the practical and financial support measures required for self-isolation. It is crucial to recognise that communities have different needs. For example, communities with a high concentration of people from ethnic minority groups, will have very different resources and different requirements from neighbourhoods where there is a high concentration of university students.
Sheffield Community Contact Tracers (SCCT) worked successfully with Heeley Trust, a community organisation, to demonstrate the effectiveness of a local contact-tracing scheme run by volunteers and a group of retired public health doctors and GPs. Community organisations, including those specifically for ethnic minority groups and other seldom heard communities, should be able to expect a realistic allocation of financial support to undertake this work in a sustainable way. In Sheffield, SCCT has delivered a rolling programme of “Covid Confidence” sessions to communities that would previously have been labelled “hard to reach.” “Covid Confidence” will enable trusted people to counter the misinformation and conspiracy theories which are increasingly prevalent. Building community level confidence could enable “Covid Street Champions” to be embedded in every community. These are the locally trusted people who can work alongside local contact tracers providing a Find Test Trace Isolate Support service.
Local authorities and community organisations have the ability to identify high-risk areas such as places with high density housing or where employment requirements might pose a specific risk. Their knowledge can also help detect localised outbreaks early before significant spread has occurred. Holistic support for communities is critical in maintaining morale and ensuring that the measures required to control infection are sustainable in the long term. Moral support and encouragement cannot easily be delivered by smart phone app or remote call centres. People, perhaps older people and those whose first language may not be English, may need help accessing support services and navigating their way through digitally-based systems. These very local initiatives need funding and training to build up capacity. Local authorities need to work closely with voluntary sector organisations.
Although we have made the argument that local authorities and community organisations play a critical role in infection control, working alongside national support measures is equally important. For example, national legislation and appropriate allocation of funding is required for cash-payments for workers who have to self-isolate. Furlough measures that protect employment need to be instigated nationally. Community organisations however, can play an important role in monitoring the implementation of these measures by local employers.
Threats of £10,000 fines and police gaining information from the national track and trace service is giving the wrong messages from government and are likely to lead to less community engagement with managing covid. As the numbers of covid infections continue to rise again, especially in the poorest sectors of society, the need to get this right is more important than ever. The signs are that covid will be with us for many months and possibly several years. Gearing up local authorities to provide a FTTIS service will never be too late, but should happen as soon as possible.
Paulina Ramirez, Researcher and Lecturer Birmingham University, Sheffield resident
Jack Czauderna, former GP Sheffield
Tom Heller, former GP Sheffield
Tim Woolliscroft, Research Fellow, Sheffield Hallam University.
Janet Harris, Honorary Senior Lecturer, ScHARR University of Sheffield.
Paul Redgrave, former Director of Public Health
Andy Jackson, manager Heeley Trust Sheffield
Ian Drayton, CEO SOAR Community Trust Sheffield
Lucy Melleney, CEO Darnall Wellbeing Sheffield
Maddy Desforges, CEO Voluntary Action Sheffield
Competing interests: No competing interests