By: Hon David Ashford MHK, Minister for Health and Social Care
Thank you Mr President,
Honourable Members, Mr Speaker, I stand before this Court in support of an Island’s response to the Coronavirus or COVID-19 public health threat which we must all play our part to protect each other, our families and our Island’s Community.
I am delighted with the commitment and support from Honourable Members to stand firm and ensure our position is agreed and we use our time effectively to manage risks to our population.
My Department has been preparing the Isle of Man response for a number of months now in relation to COVID-19, and will continue to be at the heart of our cross government response for many months to come, not least right at the forefront of care delivery as we move into the critical phases of this unprecedented situation.
As a department we have until the last few days followed PHE advice throughout, and this position will continue to be the basis of our future approach. Working with our clinical and managerial operational leaders we have then enacted a suite of decisions, and future options in order to best prepare the Isle of Man for the inevitable coronavirus spread in the Isle of Man.
By way of background we will all be aware that coronavirus is a type of virus common across the world. Most are like a common cold, some types are more severe, for e.g. SARS/MERS.
New virus causing Covid-19 emerged in Wuhan, China in December 2019. Now more than 142,000 people infected and 5,300 deaths across 100 countries.
Symptoms include fever and a cough that may progress to a severe pneumonia causing shortness of breath and breathing difficulties.
The current evidence is that most cases of COVID-19 type appear to be mild.
Severe symptoms more likely in people with weakened immune systems, older people, and those with long term conditions like diabetes, cancer and chronic lung disease.
The response to Coronavirus is in four phases:
- Contain: detect early cases, follow up close contacts, prevent disease taking hold on Island as long as reasonably possible
- Delay: slow the spread on Island. If it does take hold, lower the peak impact and push it away from winter season (when NHS is already stretched)
- Research: incorporate new developments into our response as they become available. Could include new diagnostics, drugs and vaccines.
- Mitigate: provide best possible care and support to people who become ill, support Nobles to maintain essential services, work across government to minimise overall impact on society, public services and the economy.
Throughout the now pandemic situation, the main approach has and will continue to be to support respiratory hygiene, hand washing and social distancing. This will continue to be important and ultimately aiming to slow transmission to reduce impact on NHS, public services, the economy and wider society.
Early DHSC preparedness was the following:
- Public information in place advising on how to receive advice (via GPs/MEDs/ED)
- Clinical triaging based on Public Health England guidelines
- Microbiologist on call 24/7 to take further information, liaise with UK specialist labs and remains the key patient contact
- Community based sampling rota in place to ensure continued self-isolation
- Robust transportation of samples in place to UK – to include Air Ambulance transit in place if needed
- Triage point in place outside hospital for patients who attend ED on foot and require advice
- Isolation room preparations – ED, ICU, Ward 8 and 9
- Extensive Personal Protective Equipment (PPE) training for all front facing staff
- Business continuity testing for hospital processes successfully completed in early February.
Current planning is as follows:-
- Development of NHS 111 with workforce clinical model now the key requirement prior to launch if possible by 20 March 2020
- Services are being prioritised and electives have been cancelled with effect from 16 March 2020 in order to allow time for staff to be trained to meet the expected demands
- Changes are being made in the Emergency Department to create the relevant isolation areas and patients will be asked to move to Ramsey for lower level treatment (with effect from 18 March 2020)
- Estates work are underway or in the process of planning in order to create additional isolation, side-bays, or decant spaces
- Patients who are medically fit are being prioritised for discharge (approx. 50 patients with many who have long length of stays)
- Delivery of virtual clinics across all services are being developed as quickly as possible – off the Isle of Man, Outpatients and in Primary Care
- Plans to support the most vulnerable who are living alone or in nursing/care homes alongside the voluntary sector and repurposing staff in non-emergency areas.
- Workforce modelling is being undertaken, in line with the changes being made around clinical service prioritisation, but also to create the relevant contingency planning around nursing establishment.
- Building a network of external support, volunteers and recently retired personnel.
As a department there are a significant number of risks to manage, which will continue to be the case over the forth coming months.
On Thursday 12th March, UK made decision to move to delay phase whilst maintaining many of the contain phase actions. The Isle of Man continued to follow PHE advice and also moved to the delay phase although will contain to operate many containment approaches.
There currently remain no confirmed cases in the Isle of Man, and despite the UK’s decision to halt testing outside hospitals, we will continue to test in the community until such time that the community position has no impact on our management of later admissions.
Advice is changing rapidly, with the main change on Friday 13 March 2020 in relation to self-isolation for 7 days for symptomatic and 14 days for non-symptomatic. This has changed again as at Monday 16 March 2020 with an alignment around 14 days for all self-isolation. Clarity around families self-isolating at the same time has also been changed, all of which help improve the simplicity of messages for the general population and we have moved to the same position here on the Isle of Man immediately thereafter. The Isle of Man also mirrored the advice around school trips abroad.
It has been as a result of DHSC’s strongest recommendation for the need for a significant number of other policy decisions in order to manage the risk to residents, predominately attempting to reduce the challenge on health and social care services, and ultimately improve likely mortality rates.
For COVID-19, the number of secondary infections generated from one infected individual – is understood to be between 2 and 2.5, higher than that for influenza. The impact on a high exponential growth in the virus following the first cases, is a high admission rate and unmanageable need for ventilated support for many weeks for each patient. Within a number of weeks the health system would be at maximum critical care capacity with no contingency, due to the specialist workforce need. Isolation, social distancing and significant national measures were our recommendation. We are confident that tight controls now, at the start of the outbreak, are the only prospect the Isle of Man has to keep the trajectory of the curve under control. The controls can then be eased and tightened as needed.
DHSC will manage the patients and do everything it can to reduce transmission, but public control measures are the only way to make some difference in managing the impact of the virus.
This led to the announcements made by the Chief Minister on Monday 16 March 2020. I would like to applaud the Council of Ministers for listening to our scientific, clinical and leadership advice in making these essential decisions. The actions clearly affect all of our daily lives, but will ultimately save lives.