(SOP) High Risk Places, Locations and Communities

Staffordshire COVID-19 Local Outbreak Control Standard Operating Procedure (SOP)

High Risk Places, Locations and Communities - Staffordshire

Version 1.2 7/7/2020

Summary of changes Version 1.2 - Draft for consultation

Contents Contents ...... 1 Review ...... 1 Purpose: ...... 2 Definitions ...... 2 Scope ...... 2 Risk Assessment ...... 6 Appendix 1: Process Chart ...... 20 Appendix 2 Outbreak Risk Matrix ...... 26

Review This Standard Operating Procedure will be reviewed monthly or more frequently if required

Purpose:

1. The purpose of this SOP is to set out the local process required to ensure an effective response to Incidents and Outbreaks of Covid-19 in high risk places, locations and communities.

2. The SOP should be read in conjunction with the Staffordshire Covid-19 Local Outbreak Control Plan and the Staffordshire County Council (SCC) Public Health England West Midlands Health Protection Team (PHE) Covid-19 Joint Standard Operating Procedure.

3. This SOP has been agreed by Public Health England (PHE), and local partners: Staffordshire County Council (the Council), NHSE, Prison healthcare providers and health and justice commissioners.

4. Where urgent action is required to protect life then that must take precedence over following the SOP.

Definitions

5. Definitions of cases and contacts are included in the Staffordshire County Council (SCC) Public Health England West Midlands Health Protection Team (PHE) Covid-19 Joint Standard Operating Procedure

Scope

Settings

District/Borough Council (DBC) Environmental Health Response Teams subject to this SOP

• Cannock Chase District Council • East Staffordshire Borough Council • Lichfield District Council • Newcastle-under-Lyme Borough Council • South Staffordshire District Council • Stafford Borough Council • Staffordshire Moorlands District Council • Stoke-on-Trent City Council (SOTCC)

• Tamworth Borough Council

The local outbreak Central Co-ordinating Function is managed by: • Staffordshire County Council; & Stoke City Council/

The following workplaces/settings could be considered at a high-risk of Covid-19 transmission due to the type of setting and proximity of persons working or living together.

• Homeless shelters / hostels • Fruit pickers • Hand car washes • Warehouse with transient / temporary workforce • Domestic violence refuges • Abattoirs • Migrant workers – employment or residential setting • Any other setting with temporary or low skilled labour • B&B Accommodation for vulnerable persons • Housing of Multiple Occupancy (HMO’s) - Licensed & Unlicensed • Certain Take Away’s assessed as being high risk e.g. history of groups of workers living together on/off-site or travelling together to and from work. • Traveller communities • Religious settings – where there is risk of groups congregating in one area and/or an older demographic • Food processing/manufacturing • Taxi drivers and operators • Any other case/location identified at the Risk Assessment stage by PHE/the ‘Local Authority Response Team’/Environmental Health Response teams.

This list is not exhaustive and will flex in response to the outbreak being dealt with. If an ‘outbreak’ or ‘trigger’ is identified in one of these settings the response will be led by the local EH Response Team at the local District/Borough Council (DBC) within Staffordshire or SOTCC. There will be close liaison with colleagues in SOTCC to ensure that the SOP is aligned and consistently applied across each EH Response Team.

Incidents

The scope of this SOP is:

a) Settings with a suspected or confirmed ‘Case’ of Covid-19 among users and/or staff.

b) Settings with a ‘Cluster’, defined as two or more suspected and/or confirmed cases among users and/or staff in the same setting with onset during a 14-day period - or an increase in the background rate of absence due to suspected or confirmed cases of Covid-19.

c) Settings with an ‘Outbreak’, defined as two or more epidemiologically linked suspected and/or confirmed cases among users and/or staff in the same setting with onset during a 14-day period - i.e. the cases have had contact.

6. The remainder of this SOP will refer to ‘Incidents’ and this includes single cases, clusters and outbreaks where intervention is required to prevent and control an outbreak.

Where there are other reports and enquiries that do not fit the definition of an Incident then these will be recorded separately as ‘Advisory’ in case information becomes relevant later. These will not be logged in the Covid-19 Local Outbreak Control database.

Identification of incidents

This SOP does not replace the need for the workplace or setting at the centre of the outbreak to submit a RIDDOR report to the Health and Safety Executive where this is required e.g. a Covid-19 infection confirmed as being contracted in the workplace. Further guidance on this can be found at: https://www.hse.gov.uk/news/riddor- reporting-coronavirus.htm Please note there is no legal requirement for a Workplace or ‘High Risk Place, Locations or Community’ to report a Covid-19 Outbreak or Incident to PHE so if an outbreak is identified in the community outside of the Master Tracker database, EH Response Team colleagues will need to report this directly to PHE and the Public Health LA Response Team. This will ensure they are recorded, and risk assessed in line with this SOP. A COVID-19 (coronavirus) case/outbreak/trigger should be reported to the Health Protection Team in Public Health England using the online reporting system available here: https://surveys.phe.org.uk/TakeSurvey.aspx?SurveyID=n4KL97m2I

Or by telephone to 0344 225 3560 (opt 0 opt 2) Email: [email protected] On receipt of this report, PHE will carry out an initial risk assessment and decision on whether there needs to be an escalation to the Public Health ‘Local Authority Response Team’. Where PHE refers an ‘Outbreak’ to the Public Health ‘Local Authority Response Team’ this will then be risk assessed and a decision made on whether an ‘Incident Management Team’ is called.

NB When dealing with a surge in cases PHE may forward details of outbreaks to the Public Health LA Response Team and/or the EH Response Team and other individual Cell leads ‘For Information’ as an early heads up that can be risk assessed locally.

Where the EH Response team or ‘Duty Holder’ report an outbreak to PHE they must also copy in the Co-ordinating function at the Public Health LA Response team: [email protected] or Use the web form: www.staffordshire.gov.uk/Coronavirus/Professional- Referral/Professional-referral-form.aspx

Staffordshire County Council - Central Report Line [email protected] The Public Health LA Response Team is available Monday – Friday 0800 – 2000 hrs and Saturday-Sunday from 1000 – 1600 hrs.

Reduced capacity is available out of hours and will concentrate on any emergency needs and actions.

Stoke-on-Trent City Council - Central report Line For incidents/outbreaks within the City of Stoke-on-Trent, these should be referred to colleagues using the following contact details:

Stoke on Trent Report Line Tracecovid19@stoke,gov.uk Telephone number 01782 231222

Tracecovid19 cell available in hours 9:00 am 5 pm Mon- Friday Saturday & Sunday 10:00am - 4pm

The EH Response Team at the DBC/SOTCC where the Outbreak/Cluster or Incident occurs will lead the investigation and will be responsible for the initial actions agreed at the IMT. If any visits are required, this should be arranged with colleagues in the relevant EH Response Team for that area. The DBC’s and Stoke City Council EH Response Teams also have the option of requesting ‘mutual aid’ to obtain assistance from other DBC’s as and when necessary. Any new local outbreaks/incidents not received from national alert or PHE will be reported through to PHE and the Public Health Local Authority Response Team/Trace Covid-19 Cell l so that both agencies have overall Master Tracker lists of all local outbreaks.

PHE Contact Information to be used

West Midlands 2019 nCoV Cell Tel: 0344 225 3560 option 2 Email: [email protected]

Out of Hours Arrangements/Rota for Environmental Health Response Teams All DBCs/SOTCC have in place a rota to provide Out of Hours cover as follows: Monday to Friday: 08:00 to 20:00 hours Weekends and Bank Holidays: 10:00 to 16:00 Low and medium risk incidents will be reported to the relevant Council through the Outbreak@ mailbox and does not require a response until the next working day. High risk incidents will be reported by telephone by the PHLRT to the relevant Council through the on-call arrangements established by the Council and contained within the shared SCC Teams site. The relevant Council will provide a member of staff sufficiently competent and trained to be able to accept the call; dial into or attend a local or PHE initiated IMT; agree, act upon and implement the decisions of the IMT.

Risk Assessment

Local EH Response Teams may be involved in initial Risk assessment and decision on whether IMT needed. An Outbreak Risk Assessment of the setting, will normally

be carried out within 2 working days and this will determine the risk rating. If the outbreak is via referral from the PHE then PHE may have carried out the initial risk assessment. The Local EH response Team will be responsible for keeping the Risk Assessment updated throughout the outbreak.

Following completion of the risk assessment a risk rating is assigned and actions determined. Follow up calls and support are based on the risk rating and information provided.

Duty Holders at the High-Risk Place, Location or Community are responsible for informing the EH Response Team of any changes in circumstances and new outbreak information such as new confirmed or suspected cases.

The following risk ratings will not remain static and settings are likely to move around the risk ratings dependent on how the outbreak progresses and the effectiveness of the controls implemented at the setting. The Initial Risk Assessment will be determined by the EH Response Team at the DBC/SOTCC and where necessary this may be in conjunction with the Public Health LA Response Team and/or PHE at an initial IMT.

High Risk – An outbreak/setting that is classified as High Risk will be brought to the attention of PHE for further consideration:

An outbreak will be classified as High Risk if one or more of the following criteria are identified:

(1) High attack rate. (2) Inadequate understanding of risk. (3) Non-adherence to setting guidance. (4) Management concerns such as staffing issues or lack of PPE. (5) Significant media / political interest. (6) Any other significant implication.

The EH Response Team will immediately notify the Public Health LA Response Team where they identify a ‘High-Risk’ outbreak and arrange for this to be communicated with PHE. The EH Response Team will co-ordinate the initial Risk Assessment with support from the Public Health LA Response Team and PHE as necessary.

The Duty Holder at the ‘High Risk Place, Location or Community’ will not be invited to IMT meetings as there may be an enforcement conflict of interest.

However supplementary meetings can be scheduled with Duty Holders separately as agreed at the IMT. The Communications Teams from the County Council and relevant District/Borough Council will be involved at all stages.

EH Response Team at the DBC/SOTCC will continue to follow up with the ‘Duty Holder’ setting every 48 hours whilst this risk rating remains.

Medium Risk – Outbreaks classified as Medium Risk will be monitored by the EH Response Team to establish if there is any ongoing transmission or increase in cases. This will continue until the situation is confirmed as stabilising/decreasing.

The EH Response Team will convene regular meetings to agree key actions and arrangements for ongoing monitoring. These meetings may also involve the Public Health LA Response Team and PHE as necessary. The ‘Duty Holder’ will not be invited to these meetings to avoid a ‘conflict in interest’ but will be communicated with separately (unless members unanimously agree their attendance is required). These meetings (where required) will be completed within 3 working days.

All initial reported outbreaks are at least rated Medium Risk until monitoring of actions and attack rate can be understood.

Public Health LA Response Team will continue to follow up with the EH Response Team at the DBC/SSOTCC every 48 Hours until initial interventions are implemented and then every 5 working days whilst this risk rating remains.

Low Risk – As an Outbreak comes under control it will be designated as ‘Low Risk’. The following criteria will be used to determine when an outbreak becomes ‘Low Risk’:

1. EH Response Team are satisfied there has been a decrease in Incident trend and no other concerns are identified or: 2. No Risk Identified’ –A Service with no incident identified (symptomatic or confirmed) in the last 28 days, as a minimum.

The EH Response Team at DBC/SOTCC will continue to follow up with the ‘Duty Holder’ setting weekly until the case is deemed closed and all actions completed.

Outbreak Closed The outbreak can be declared over, and the case formally closed 28 days after the last case of COVID-19 infection.

Incident Management Team (IMT)

Where deemed necessary an IMT should be convened as soon as practically possible as set out in the Staffordshire County Council Public Health England West Midlands Health Protection Team Covid-19 Joint Standard Operating Procedure.

Management of Incidents

Management of Incidents may include a range of control measures, which will be determined following the Risk Assessment and/or by the IMT. Potential control measures include the following, and arrangements for these are described in the Staffordshire Covid-19 Local Outbreak Control Plan: a) Infection prevention and control measures – including isolation and cohorting; closure of settings – either full or partial; ‘Deep cleaning’; additional Personal Protective Equipment. b) Support for business continuity including management and staffing. c) Addressing quality and safeguarding concerns. d) Testing. e) Contact tracing. f) Support for self-isolation. g) Enforcement.

On receiving a report of an outbreak at ‘High Risk Place, Location or Community’ an IMT may be called to agree actions and direct the EH Response Team. The type of actions required will be deployed as soon as is reasonably practicable to do so, including but not limited to:

• Preliminary contact with duty holder/location to collect further information. • Identification of potential ‘Contacts’ to a confirmed ‘Case’ and whether they are deemed High Risk and need to self-isolate. • Swabbing – confirmation of which ‘contacts’ may need swabbing and whether this will be done via the national swabbing arrangements or through local provision (Bet365 Stadium in Stoke-on-Trent and Stafford Education and Enterprise Park Beaconside are regional testing sites). • Infection Prevention & Control: Practical support and guidance – to be agreed and delegated during each IMT (EH Response Teams to be supported by Infection Control Nurses/PHE as required). • Review building layout, advice to improve social distancing – Environmental Health Response Team at DBC or SOTCC.

• Assessment of Covid-19 Risk Assessment procedures at the Duty Holder location and whether there are adequate arrangements for social distancing, hand washing and exclusion of staff from work duties where Covid symptoms identified etc. • Additional Contact Tracing, see Appendix ? However if a high number of contact tracing is required SCC will provide additional support • Guidance / Checklists for setting to carry out regular self assessments • Formal enforcement action, including the use of Part 2A Orders

In cases where an ‘outbreak’ at a High Risk Place, Location or Community is classified as ‘High Risk’, as detailed in Risk Rating section below, PHE/Public Health LA Response Team and EH Response Team will determine and direct the required interventions.

Classifications

Case definition

Confirmed case: laboratory positive case of COVID-19 with or without symptoms Suspected case: new continuous cough or high temperature or a loss of, or change in, normal sense of taste or smell Any confirmed individual case should be reported, so that you get appropriate advice and early support.

Outbreak definition

Two or more epidemiologically linked suspected and/or confirmed cases in the same setting with onset during a 14-day period - i.e. the cases have had contact and there has likely been transmission within the setting.

Cluster Definition

Two or more suspected and/or confirmed cases in the same setting with onset during a 14-day period - or an increase in the background rate of absence due to suspected or confirmed cases of Covid-19.

Incident Definition

Settings with a suspected or confirmed ‘Case’ of Covid-19.

Contact definition 1. A ‘contact’ is a person who has been close to someone who has tested positive for coronavirus whilst they were infectious (see ‘Infectious Period’ below). The following criteria should be used when defining a contact of a case: 2. Direct close contacts: Direct face to face to face contact with a case for any length of time, including being coughed on or talked to. This will also include exposure within 1 metre for 1 minute or longer 3. Proximity contacts: Extended close contact (within 1-2m for more than 15 minutes) with a case 4. Travelled in a small vehicle with a case

Infectious period 5. For symptomatic cases, the infectious period is from 48 hours prior to symptom onset to 7 days after the date of onset of symptoms. 6. For asymptomatic cases, the infectious period is classed as the time from 48 hours before the person tested positive up to 7 days after the date of the test.

1. Reporting

Other reporting Intelligence

PHE will distribute daily a list of Settings with ‘On-going Issues / Outbreaks (COVID- 19) via email to the Public Health LA Response Team who will keep EH Response teams updated.

Within Staffordshire the Public Health Local Authority Response Team will complete a daily review to ensure that the Master Tracker Database holds all current local incidents and outbreaks. Within Stoke-on-Trent City Council this function will be completed by the tracecovid19 cell.

This process will refer to the following information sources:

• PHE daily ‘On-going Issues / Outbreaks (COVID-19)’ list; • Email alerts from national system coming into SCC/ SOTCC from the central email system for testing and trace; • PHE direct email; • Information gained from settings; • Any other information / intelligence shared by a partners and other key- stakeholders.

Direct interventions to Manage Local Outbreak

Actions for ‘Duty Holder’

During the Risk Assessment Process and completion of Outbreak meetings actions will be identified for the ‘Duty Holder’ at the ‘High Risk Place, Location or Community’ to carry out. These actions will be recorded, communicated to the setting and monitored by the EH Response Team. The ‘Duty Holder’ is expected to confirm completion of any local actions to the EH Response Team. This will all be logged on the ‘Outbreak Control Tracker’ database.

Risk Assessments will be monitored and reviewed if situation escalated to include any new information/cases.

Record Keeping

The records for each outbreak case will be stored securely on the EH Response Team’s existing database and key information will be updated on the ‘Outbreak Master Tracker’ database that is stored on the secure ‘Microsoft Teams Channel’. The ‘checklist’, ‘Risk Assessment’ and correspondence with the ‘Duty Holder’ will all be stored on the EH Response Team’s own secure database.

The 'Outbreak Master Tracker’ database will be kept updated by the EH Response Team ‘Cell’ who will confirm the current status and record any new information after each interaction with the ‘duty holder’ or change of risk rating. The content of the ‘Outbreak Master Tracker’ database will be reported to the ‘Health Protection Board’ meeting every Monday/Wednesday/Friday who will provide the Central Co-ordinating function.

All new outbreaks/clusters need to be reported to the Public Health LA Response Team and Public Health England as outlined in section 5.

Site Visits

A Site Visit maybe required at a ‘High Risk Place, Location or Community’ if contact via telephone has not been successful or where a site visit is needed to:

• Obtain contact details; • Speak to the ‘Duty Holder’; • Review social distancing controls; • Review Infection Prevention & Control procedures;

• Assess the suitability and implementation of the Covid-19 Risk Assessment.

The ‘Duty Holder’ at the ‘High Risk Place, Location or Community’ is expected to support such visits when identified in timely manner.

The EH Response Team will use their powers of entry under Health Protection or Health and Safety at Work powers wherever necessary. Police support may also be required in certain situations.

In those workplaces where the HSE are the enforcing authority for health and safety matters the EH Response Team will:

• Send details of the outbreak to the HSE via [email protected] or via the Enforcement Liaison Officer. • Invite a representative from HSE to the IMT or other management meeting as above. • Attend the site (where necessary) and enter using powers contained within public health legislation. The EH Response Team must be mindful that they will not deal with any issues relating to health and safety as they do not have the powers to do so and may compromise any HSE investigation. • Any further information gathered during the visit must be shared with the HSE as above.

Visiting officers must have regard to any local risk assessments and controls required by the duty holder and their own employer.

Powers to direct actions/intervention.

It is hoped that in all outbreak situations there will be mutual agreement between the EH Response Team and the ‘Duty Holder’ on the actions needed to manage the outbreak and reduce transmission.

The Director of Public Health within Staffordshire County Council and Stoke on Trent City Council has powers to direct actions necessary to manage a local outbreak and reduce transmission risks. This includes but is not limited to the following:

1. Partial or full closure of the site for a determined period. 2. Requirement for Training in Infection Prevention and Control 3. Deep Clean of an affected area. 4. Site visit by EH Response Team or MPFT Infection Control Team 5. Communication with setting to offer Swabbing/Testing

6. Requirement of individual not to attend the setting if symptomatic or been a contact with confirmed case.

The EH Response teams at the District/Borough Councils and SOTCC have powers under the following legislation to deal with contaminated premises, equipment and infected persons:

• Public Health (Control of Disease) Act 1984 (as amended by the Health & Social Care Act 2008) • Health Protection (Local Authority Powers) Regulations 2010 • Health Protection (Part 2A Orders) Regulations 2010

If there is intelligence that a premises, equipment or person are potentially infected then the Public Health LA Response Team will lead. Once a confirmed laboratory sample has been received this will be passed to EH Response Team for action.

Incident Management Team Meetings

These meetings will consider the following:

• The Risk Assessment. • Infection Prevention and Control intelligence. • Public Health England intelligence. • Environmental Health intelligence. • Other relevant information.

When an IMT is held it will include (subject to need) representatives from: 1. PHE 2. MPFT Infection Control/CCG 3. Public Health LA Response Team 4. EH response Team from DBC/SOTCC 5. Communication Team Support PHE/LA

When a EH Response Team Meeting is held it will include (subject to need) representatives from:

1. Public Health LA Response Team 2. EH Response Team from DBC/SOTCC 3. MPFT Infection Control – swabbing/testing support 4. Communications Team Support (LA)

These meetings will build upon the detail contained in the Risk Assessment and determine the actions required to mitigate any emerging risks. This will include consideration of issues as per the standard agenda in Appendix 9 and the frequency of communication by the EH Response Team at the relevant DBC/SOTCC during this period.

Actions identified will have a target date assigned which will normally not be more than 7 days and may well be much sooner. The actions identified will be tracked as part of the risk assessment and settings asked to report updates and reviewed at follow up calls.

Non completion of actions is likely to affect risk ratings and may mean that the outbreak needs to have increased risk rating and more formal actions taken.

The EH Response Team dealing with the outbreak will record their actions on their own internal IT systems and on the ‘Master Tracker’ hosted by the Public Health LA Response Team and the Coordinating Group.

Follow up of existing Incidents

1. Follow up includes monitoring for significant new information about the Incident – for example an increasing number of cases and/or deaths – as well as checking that control measures required to minimise the spread of infection and mitigate the wider consequences of the Incident have been implemented.

2. Services should be encouraged to provide any significant new information in relation to the Incident to PHE and/or SCC immediately.

3. Follow up should include regular proactive contact with the Service to check for significant new information and/or progress on implementation of control measures.

4. High Risk – follow up by PHE:

5. Medium Risk – follow up by Care Commissioning (Covid-19 outbreak management) Team: a) Repeat Risk Assessment: at least weekly or more often if there is significant new information and/or as implementation of control measures is confirmed. b) Revise Risk Rating using the criteria in the Staffordshire County Council Public Health England West Midlands Health Protection Team Covid-19 Joint Standard Operating Procedure Appendix 2. c) Escalation:

• if there is a lack of progress with implementing individual control measures – raise with relevant organisation; • if there are additional new suspected or confirmed cases and/or little progress is being made with implementing control measures - call IMT; • if repeat Risk Assessment changes Risk Rating to High Risk – notify PHE immediately; d) De-escalation: if repeat Risk Assessment changes Risk Rating to Low Risk – manage accordingly. e) Reporting: PHE to be notified if follow up reveals significant new information and to be kept informed about progress, including through the weekly review.

6. Low Risk – follow up by Care Commissioning (Covid-19 outbreak management) Team: a) Repeat Risk Assessment: at least weekly or more often if there is significant new information and/or as implementation of control measures is confirmed. b) Revise Risk Rating using the criteria in the Staffordshire County Council Public Health England West Midlands Health Protection Team Covid-19 Joint Standard Operating Procedure Appendix 2. c) Escalation: - if there is a lack of progress with implementing individual control measures – raise with relevant organisation; - if repeat Risk Assessment changes Risk Rating to Medium Risk – call IMT; - if repeat Risk Assessment changes Risk Rating to High Risk – notify PHE immediately; - De-escalation: close Incident once criteria met – see Staffordshire County Council Public Health England West Midlands Health Protection Team Covid-19 Joint Standard Operating Procedure

The Environmental Health Response Team at the District/Borough or SOT CC will contact all settings in line with their risk rating. The team will use a standard script to determine if there are any escalating concerns about Incidents and/or concerns about infection prevention / control more generally. This information will be fed back to the Public Health LA Response Team at SCC and the Trace Covid 19 Cell at SOTCC. This will include, as a minimum:

• Incident details • Media/social media coverage • Staffing Levels; • Management control – social distancing

• Setting Guidance compliance • Infection Prevention and Control • Cleaning Management • Personal Protective Equipment; • Supply and availability of consumables; • Capacity of the Setting; • Management of any restrictions applied • Progress with actions.

Where there are escalating concerns about an Incident and/or the management of Infection prevention and control, any practicable direct interventions will be deployed, and the Risk Assessment will be reviewed, and risk rating altered as needed.

When the ‘High Risk Place, Location or Community’ Setting has been categorised as ‘Low Risk’ and there have been no incidents identified for a minimum of 14 days, the EH Response Team will contact the ‘Duty Holder’ on day 28 and if no further actions or risks are outstanding then the Outbreak/Cluster/Incident will be formally closed and this will be recorded on the Outbreak Master Tracker Database on Microsoft Teams.

New Outbreaks

If a Duty Holder has another outbreak after a previous outbreak is formally closed, then a new outbreak will be created. The process should commence as a separate case and with a new risk assessment. The LA Response Team and PHE may choose to consider previous outbreak actions in determining any response requirements for the new outbreak.

Information sharing & storage

Information relating to each Outbreak/Cluster/Incident will stored on the secure database of each SOP owner. Information will be shared via the secure Outbreak Tracker Database and associated Microsoft Teams platform. Data will be shared between partners in accordance with the ‘Acceptable Use Policy’ and existing Data Sharing protocols.

Information relating to Outbreaks will be kept for 7 years.

The Public Health LA Response Team will alert partners about new Outbreak/Clusters/Incidents via the designated email boxes below (although sensitive information will not be included in these communications).

The Council: Central Report Line [email protected] Stoke City Council Contact – [email protected]; Tel: 01782 231222

EH Response Team at each DBC

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

CCGs: [email protected] & [email protected]

Infection Control: [email protected] & [email protected]

PHE: Local PHE team related to existing outbreaks: [email protected]

Other Partners By dedicated emails for the Partner.

Partners will assume responsibility to ensure this information is securely stored and distributed to relevant officers within their respective organisations.

Standard Templates

The following standard templates are available • Risk Assessment form (Appendix 3) • Workplace Covid checklist (Appendix 4) • Letter to Duty Holder (Appendix 5) • Enforcement Pack: Public Health (Control of Diseases) Act 1984 (Appendix 6) • Letter to Homeless Shelters/HMOs (Appendix 7) • Contact Tracing Script/ Questionnaire (Appendix 8)

• Standard Agenda for IMT response meeting (Appendix 9

2. SOP Owners • Cannock Chase District Council • East Staffordshire Borough Council • Lichfield District Council • Newcastle-under-Lyme Borough Council • South Staffordshire District Council • Stafford Borough Council • Staffordshire Moorlands District Council • Stoke-on-Trent City Council (SOTCC) • Tamworth Borough Council • Staffordshire County Council; & • Stoke City Council

Appendix 1: Process Chart

1 Proactive additional support • SCC provided Guidance and templated COVID -19 Secure Risk Assessment Templates. • SLN and External Web Page information with useful documents and guidance • Regular setting communications. • Access to advice and Support through Environmental Health Response Team at District/Borough and Stoke City Councils. • FAQ’s • Meetings with Premises/Business Settings

COVID-19 Incident Management Standard Operating Procedure (SOP) Workplace and other ‘high risk’ settings

Owner Xxxxxxxx (name, job title, email/tel)

Version 1 09.06.2020 Draft for consultation 2 Initial notification to PHE

Review This Standard Operating Procedure will be reviewed monthly or more frequently if required.

• Initial notification comes to PHE via the Setting, EHLA Response Team Information, Lab reports, WMAS etc.

3 PHE outbreak management (supported by local partners)

• An outbreak is defined as two or more symptomatic cases linked to a setting (in either residents, employees or visitors etc.) ) • PHE/PHLA • PHE /PHLA carries out Public Health risk PHE/EHLA provides advice and toolkits and other supportive materials Response Team assessment setting not already aware of. carries out • PHE/PHLA contacts IPC team for swabbing Infection Control: [email protected] / 07977 208783 investigation of • If only a single case is reported from the setting PPE Emergency PPE Email Box contacted for supplies/Setting Directed to transmission, attack (i.e., no other symptomatic individuals inked to Fire Station.

rates, morbidity and same setting), this is recorded by PHE/PHLA as mortality - and a Case only. PHE/PHLA emails guidance/IPC associated risks advice - and what to do if situation escalates / further issues identified. PHLA Response team provide advice and guidance. • PHE/PHLA confirms • For IPC priority visit, PHE/LA requests urgent • PHE/EHLA send any relevant guidance and support tools to assist the direct/immediate IPC support directly: setting interventions and [email protected] • Actions identified are recorded. controls, and • For urgent PPE supply issues, Emergency PPE assistance in tracking inbox emailed or directed to fire station. incidence/transmissio • Quality or urgent concerns about management n patterns or leadership capacity in the setting then relevant employer is contacted by EHLA Response Team. • For urgent access to clinical support or pathways, PHE contacts CCG’s directly: covid- [email protected] • PHE/PHLA identifies • PHE distributes daily On-going Issues / • PHLA Response Team ensures reconciliation with list of outbreaks and setting as “red Outbreaks (COVID-19) in the West Midlands’ – incidents tracked and managed daily (Monday – Friday) flagged” outbreak including Red Flag Services • PHLA Response Team inform PHE if risk assessment identified Red Flag. • PHE/PHLA assesses • PHLA speaks to PHE if they identify need • The PHLA Response team, CCGs and MPFT ensure that agreed need for IMT • PHE calls IMT, agrees and minutes actions and actions by any of these three agencies are completed in the specified sends these to all relevant partners; and timescales. confirms that actions have been concluded • The PHLA response Team, CCGs and MPFT log the infection/outbreak risk at the setting as High Risk “Red” • PHE follows up • This period of follow up by PHE/LA is variable – • If local partners (The Council EHLA Response Team, CCGs or closely for next few applicable to the presenting situation MPFT Infection Control Team identify a Setting they believe is at days. Timescale • LA Response teams follow ups will follow the high risk (red), they inform PHE by phoning depends on uptake of risk rating of the setting. New Outbreaks: interventions and • Once any urgent direct interventions have been Survey (preferred): attack rate - arranged, The EHLA Response Team https://surveys.phe.org.uk/TakeSurvey.aspx?SurveyID=n4KL97m2I

decrease in triangulates intelligence on the Service with Email: [email protected] incidence of CCGs and MPFT Infection Control Team or Phone: 0344-2253560 Option 0, Option 2 cases/symptomatic). other agency/employer. PHE will inform PHLA Response Team • PHE Hand case to • The EHLA Completed Risk Assessment to be Existing Outbreaks: PHLA Response recorded and shared with PHE/other partners as Phone (preferred): 0344 225 3560 Option 0, Option 2 Team to follow up as needed. Email: [email protected] needed. • The EHLA Response Team co-ordinates regular contact with the Setting – unless the Service is Settings where the Risk Assessment is Rated Amber or Green will be Red Flagged by PHE, who will subsequently co- monitored by the PHLA Response Team and all information will be co- ordinate and specify the required support and ordinated by them. contact for the period of ‘escalation’. Partners to keep team informed of any concerns:

Staffordshire - [email protected]

Stoke – [email protected]

PHLA Response Team will escalate any worsening conditions or information with PHE and IMT arranged.

PHLA Response Team will set up meeting with setting to assist in management od amber cases and to determined interventions and actions required.

Regular follow up call will be made to monitor actions and situation and continued support to setting.

PHLA Response Team will request support from PHE, CCG and MPFT as required by the situation.

4 SCC and partners follow up outbreaks closed by PHE • PHE closes outbreaks • Once stable PHE, closes situation on HPZ - and • The LA Response Team notes cessation on HPZ via reconciliation for routine follow up by advises setting regarding LA Response team with daily report from PHE. local authority follow up • LA Response Team plus, CCGS and MPFT Infection Control Team where involved with the setting de-escalated from Red flagged as Amber. • LA Response Team continue with follow up and LA Response Team Meetings with Setting as required. • LA Response Team maintain effective log of all setting outbreaks and keep PHE informed on status. • The Environmental • The LA Response Team maintains a tracker of • Any Setting locally rated as Medium (LA Response Team Meeting Health Response Team settings which continue to be supported, on behalf or Monitor Trend) by the Council, CCGS and MPFT only becomes co-ordinates support of The Council, CCGs and MPFT Incident Control rated as Green risk when all local partners agree and criterial in from CCG and MPFT Team. SOP reached. where necessary until • The LA Response Team, CCGs and MPFT Infection Control Team the Incident is closed continue agreed support (including contact) to the Setting until the Incident is over. • The LA Response Team maintains 7 day a week response from to urgent issues and need for emergency advice and support by the setting.

• If The LA Response • Criteria for re-notification to PHE include the • Any immediate actions that can be taken by any local partners are Team, CCGs, MPFT number of new cases continues /appears to be carried out (such as safeguarding, quality assurance, IP&C Infection Control Team increasing; the number of deaths is visit/advice, deep cleaning, full or partial closure, site visit by LR or the setting identify a consistently increasing; the staffing levels are Response Team or other intensive support input). deterioration in the identified by the setting (or other relevant • If the deterioration in the Setting amounts to a high risk in the view settings level of agency/employer) to be unsafe; or the PPE of The LA Response Team, CCGs or MPFT, then PHE are notified infections, PHE and supply is causing concerns and cannot be via phone: 0344 225 3560 Option 0, Option 2 the LA Response Team rectified by arrangements under the LA • If not high risk, then PHE are notified via email: are notified Response Team. [email protected] • On receipt of this notification, PHE & LA Response Team review outbreak management and process recommences at stage 3 and

review of Risk assessment and controls. PHE/LA Response Team notify setting and local partners of the outcome.

Appendix 2 Outbreak Risk Matrix

Risk Assesment recorded on standard template and reviewed as needed based on follow up calls and any IMT/LA Response Team Meeting with the setting.

Risk Matrix

The LA Response Team and will apply the following Risk Matrix to assess the intelligence and information gathered by the Risk Assessment and/LA Response Meeting. This can also be found within the Risk assessment template

Low Medium High: 1. A. High Attack Rates of Decreasing number Stable/Consistent Increasing number of suspected or of suspected or number of suspected suspected/confirmed confirmed COVID- confirmed cases or confirmed cases cases (last fortnight) 19 cases and/or (last fortnight) (last fortnight)

high numbers of

associate deaths

2. Whether there is an adequate Setting has some link understanding and Setting has strong with PHE but has not Setting has not reported recognition of the links with PHE and followed required to PHE public health risk provides regular reporting in all cases associated with updates the situation

3. Whether the national guidance for control of the Some concern raised outbreak is being Fundamental concerns Confidence the regarding the followed, and local raised regarding the setting is applying understanding and advice is understanding and guidance effectively application of some consistent and well application of guidance elements of guidance understood and implemented.

4. Where the internal Some concerns Fundamental concerns Effective Internal management of raised regarding regarding management management the setting, management control control and support demonstrated including social and support from available from

distancing employer/other key employer/other key management, t, partners partners staffing levels and provision of PPE, are causing concern

5. Significant media and/or political No media / political Active local media / Regional/National Active interest interest political interest media interest

6. Other No other significant Minor other concerns Significant other risk identified identified concerns identified

Appendix 3 – Risk Assessment Template (insert link)

Appendix 4 – Workplace Covid Checklist (insert link

Appendix 5 – Letter to Duty Holder (insert link)

Appendix 6 – Enforcement Pack: Public Health (Control of Diseases) Act 1984

Appendix 7 – Letter to Homeless Shelters/HMOs

Appendix 8 – Contract Tracing Script/Questionnaire

Appendix 9: Standard Agenda for IMT/LA Reponse Meeting

Standard Agenda for IMT/ LA Response Team Meetings with settings.

Agenda

COVID-19 Meeting: XX Setting Date - xx Time - xx Teleconference: dial in details are on the calendar invite

1.0 Introduction and apologies Notes

Record Attendance 2.0 Purpose of the Meeting Help setting to manage outbreak/suspected outbreak, provide reassure, review infection prevention and control arrangements, provide professional advice and determine actions/interventions required.

3.0 Previous Meeting Minutes & Actions

Record if anything Changed since last contact or urgent issue to be considered.

4.0 Review of the Evidence Summary of outbreak Nose & throat swabs (testing – confirmed/symptomatic) Environmental- Social Distancing and setting guidance compliance (isolate/cohort/exclude/restrict/close)

5.0 Control measures/ assurance sought Management of symptomatic - self isolation Infection Control – hygiene, cleaning, PPE, training etc Prevention – aim to prevent spread and provide advice Management of higher risk staff

6.0 Further Issues

High risk setting/business Concerns Media Interest Social Media

7.0 Attendance

Review those in the setting

8.0 Communications

Media Support BusinessLetters Need for testing

9.0 Any other business

AOB – check staffing levels and PPE Does the setting aware and understand the latest setting government guidance and latest PHE/Infection Control guidance

10.0 Actions Agree Date/Owner List Actions

11.0 Future meeting dates/follow up