Your questions answered by Calderdale Council's Director of Public Health Deborah Harkins

1. From Neill Bustin, via email: Infection rate figures are going down, is this because it’s almost impossible to get a test? I had to lie on the booking form to get a test.

The second wave of COVID-19 in Calderdale appeared to peak at just under 500 per 100,000 on November 14. Since then the infection rate has steadily fallen as the impact of the second national lockdown takes effect. The number of Calderdale residents being tested remains high at around 900 Calderdale residents being tested each day. We also look at the proportion of people tested who get a positive test result. This indicates how widespread the virus is in the community. This measure can help us gauge whether availability of testing is influencing the case rate. For example, if the case rate is falling while the proportion of people with a positive test result is increasing, it suggests that availability of testing is affecting our case numbers. This is not the case in Calderdale according to our latest data. The figure peaked in the 7 days prior to November 14 when 16.8% of people tested got a positive test result. On the latest data this has reduced to 10.8%. This compares to a national figure of 8.2%. During the second wave (since September) there have been times the demand for tests out-strips the laboratory capacity needed to process them, leading to difficulties booking tests. If that happens, please do keep trying as more test slots become available throughout the day.

2. Also from Neill Bustin, via email: Supermarkets are busy and people shopping and staff flaunt the PPE rules, what can you do to enforce the rules?

The Council works in partnership with West Yorkshire Police to take a robust but fair and proportionate approach to enforcing breaches of government legislation. The Council is responsible for enforcing non-compliance with regulations by businesses and the Police are responsible for non-compliance among individuals. Since March, the Council with its partners has carried out thousands of visits to business premises across Calderdale offering ‘COVID-19 Secure’ advice and enforcing the regulations with fines and closures. On the vast majority of these visits the businesses have been complying with the law and enforcement action has only been necessary in 2% of visits. The Council cannot enforce the wearing of face coverings in supermarkets, pubs and restaurants or small businesses, although throughout the pandemic we have been working with businesses to advise on COVID-19 safe practices.

3. From Greg Watson via email: How many people in Calderdale under the age of 60 and with no pre-existing conditions have died of COVID-19 since the pandemic started?

Sadly 165 Calderdale residents have died of COVID-19 so far in the pandemic. Six of these people were aged under 60 and 3 of these had no pre-existing health condition.

4. From Edwin Gordon Halliday via email: For both coronavirus cases and deaths in Calderdale since the pandemic started, could you say how many had pre-existing underlying health problems? For the nation as a whole the Government for some reason seems very reluctant to publish these figures.

Of the 165 Calderdale residents who have died of COVID-19, 75% had a pre-existing health condition. Information is not available about the proportion of people who test positive for COVID-19 that have a pre-existing underlying health condition.

5. From Stephen Jarvis via email: Why is A&E any safer than seeing a GP face to face? Have nurses less chance of catching COVID-19 than GPs as I saw one in A&E and another did my flu jab at the doctors? How many face-to-face appointments have GPs at Rosegarth/Siddal done since the start of the pandemic?

People with symptoms of COVID-19 must not attend their GP practice because they could put other people at risk from the virus. If people are struggling to cope with COVID-19 symptoms it is important to call NHS 111 for advice and you may be asked to visit the Emergency Department at the hospital. Accessing all health care services appropriately is safest for patients, their families and the health care workers they come into contact with. This means that attendance at the Emergency Department should be limited to emergencies. If you aren’t sure where to go for a health problem telephone NHS 111 and they will advise you on the most appropriate place to go. Emergency Departments and GP practices have safety precautions in place to reduce the risk of staff and patients contracting COVID-19 when providing care, such as flu vaccination. I spoke to my colleagues at the CCG about face-to-face appointments. They explained that do not hold information relating to the number of face-to-face appointments provide since the start of the pandemic at a GP practice level. GP practices have been required to offer face to face appointments since 1 October at all sites.

6. From @Leefly12F on Twitter: I would love to know how the people of Halifax have nothing better to do than wait dangerously for their McDonalds.

If you have concerns about businesses operating in COVID-19-secure ways, you can report them to the Council through our community protection email address: [email protected].

7. From Sarah Januszczyk via Facebook: Is this lockdown pointless with the schools still open?

We know from both the first and second national lockdowns that limiting contact between people reduces the infection rate. The need to reduce contact between people must be balanced against the long-term public health impacts of further time away from school for children that have already missed significant time at school this year. We know that time away from school can have a real impact on children’s development and current and future health and wellbeing, and that these impacts are disproportionally experienced by vulnerable children and those in

low income families. We are now starting to see the positive impact of the most recent lockdown on infection rates in Calderdale which have almost halved in 11 days from a peak of just under 500 per 100,000 for the week ending November 14 to 255 for the week ending November 25. If we all continue to make the efforts we have during the lockdown, I hope the rate will continue to reduce without negatively affecting children’s education and wellbeing.

8. From Leanne Plunkett-Clegg via Facebook: Why are our children not able to attend their physio and podiatry appointments unless it's an absolute emergency? My son hasn't had his appointments at all this year and I have had to ask for new equipment and to just go off shoe sizes rather than be seen and measured.

The hospital trust provides these services so I am unable to answer this question

9. Also from Leanne Plunkett-Clegg via Facebook: When can our asthma reviews take place? Mine was due last December and I keep getting put back and when I asked about it when I had my flu jab I was told after COVID-19?

GPs and their teams aim to provide care that best serves the needs of their patient population, in a way that adds most clinical value and keeps patients, clinicians and staff safe from the risk of contracting COVID-19. The review of the need to undertake an asthma review will be based on clinical judgement and informed by experience gained during the first wave of this pandemic. That said if you feel the need to seek clinical advice, your GP practice remains open and you should contact them to arrange an appointment. It is important to be aware that appointments may be carried out in different ways than we are used to.

10. From Sheila Church via Facebook: Could you please tell me where are all our surgery GPs? You've more chance of winning the lottery than actually seeing a doctor. Health wise I've never had such a miserable time with unaddressed health issues.

GPs and their teams aim to provide care that best serves the needs of their patient population, in a way that adds most clinical value and keeps patients, clinicians and staff safe from the risk of contracting COVID-19. The need to see and or contact patients will be based on clinical judgement and informed by experience gained during the first wave of this pandemic. That said if you feel the need to seek clinical advice general practice remains open and patients will be seen face to face where it is clinically appropriate.

11. From Diane Pickles Hartley via Facebook: Do you think that putting us in local lockdown after the national lockdown kept COVID-19 cases down in Calderdale and Kirklees? Bearing in mind, you have said we are 19th or 23rd in the country with the highest rates.

The situation in Calderdale has changed throughout the pandemic. During the first national lockdown we had some of the lowest rates in the county. When the first national lockdown was relaxed in May, too many restrictions were lifted too quickly for Calderdale. Our rising infection rates in June and July meant that we were placed under local restrictions and Calderdale has been under some form or restriction or other since then. It's my view that restrictions are only part of the solution to tackling COVID-19. We learnt from reducing infection rates during August that a combination of action is required. These include:

1. Engaging with communities, businesses, schools and workplaces to understand the issues they face and support them to play their part. We have a wonderful team of Community COVID-19 champions who talk and listen to people in communities.

2. Working hard to prevent COVID-19 taking hold in care homes

3. Using data to identify groups that are at higher risk of being exposed to the virus and support them to reduce their risk

4. Making testing easy to access, deliver local contact tracing and supporting people with COVID-19 to self-isolate

5. Communicating clear and simple messages to the public about what we can all do to tackle the virus

6. Undertake a programme of enforcement of COVID-19 regulations and restrictions

7. Be ready to deliver the COVID-19 vaccine when it is available

The infection rates in Calderdale are improving and we are currently 44th highest of all of the English local authorities. However, the rates are still too high and we need to keep working hard to keep the virus under control.

12. From Rob Baker via Facebook: Why is the town centre being run into the ground, with high rent and ridiculous parking charges? Do you have a recovery plan for small humble shops, or is everything going to be piled into the Piece Hall?

Prior to the pandemic a significant amount of investment into Halifax town centre, including major works to the train station and improvements to the road infrastructure into and around the town were already planned. Our partners, West Yorkshire Combined Authority, are also progressing the development of a new bus station. We have recently completed a sixth-form college which has brought over 500 students into town, using local businesses at lunchtime. The next phase of the Northgate development will bring further significant daily visitors and workers into the heart of the town centre, again driving footfall to businesses, particularly hospitality. We are also hopeful that our bid to central government for Future High Streets Funding will enable further investment, into the Borough Market in particular, where many small and independent traders operate, and into other schemes improving spaces for shoppers and tourists alike, to support a vibrant town where businesses can thrive. All of this development continues, with the same purpose but with the added focus on the impact that the pandemic has had on businesses in the district and how these developments can most support economic regrowth.

13. From Mark Powell via Facebook: Ask about false positive PCR tests and what effect deaths within 28 days of a positive COVID-19 test is having on the stats. Also, compared to other years when the NHS is overwhelmed at winter how are we doing?

No test gives a 100% accurate result. The laboratory analysed PCR test is more likely to produce false negative results than false positive results. This means that less than 5% of people who do not in fact have the virus will be told they do have it with this test. Up to 30% of people that really do have the virus will be told they do not have it with this test. This means that it is important that people who have symptoms of COVID-19 continue to self-isolate even if they get a negative test result. When we look at data on COVID-19 deaths, we look at the cause of death recorded on the death certificate rather than deaths within 28 days of a positive COVID-19 test. In Calderdale there have been 196 excess deaths compared to the 5-year average since March 20 and 162 (83%) of these were caused by COVID-19. In the 2 weeks up to November 13 there were 16 excess deaths in Calderdale residents and all of these extra deaths were caused by COVID-19. I don’t have data on the pressure on the NHS this year compared to previous years. We can ask for information from CHFT to see if they can provide this in next week’s responses

14. From Craig Hodgson via email: We’re in ‘lockdown 2’ which is having no impact on COVID-19 infection rates in Calderdale - the figures are still increasing. This is partly because this lockdown isn’t as strict as the first lockdown (more shops and services remain open), but mainly because a significant enough proportion of people are ignoring the rules. How is Deborah going to ensure enforcement and drive the rates downwards? Otherwise, post lockdown 2, we’ll remain in tier 3 for a very long time.

We have started to see the impact of the second national lockdown and rates have been reducing steadily since the peak on November 14 indicating that the lockdown has had some impact. I covered our approach to enforcement in my response to question 2. I covered my view of the combination of actions needed to drive the rates down in my response to Q11.