Agenda Item 7 The Impact on Health and Wellbeing in Sheffield of the Covid-19 pandemic and subsequent societal response to it. A report for the Health and Wellbeing Board 24th September 2020 1 Page 1 Contents Chapter 1 Introduction Page 3 Chapter 2 Active Travel Page 7 Chapter 3 Employment Page 22 Chapter 4 Health behaviours Diet and weight management Page 44 Physical activity Page 59 Tobacco Page 68 Alcohol Page 77 Breastfeeding Page 85 Gambling Page 89 Chapter 5 Education Page 99 Chapter 6 Income and Poverty Page 106 Chapter 7 Loneliness and Social Isolation Page 125 Chapter 8 Domestic and Sexual Abuse Page 150 Chapter 9 Access to care and support Chapter 9a Healthcare Page 169 Chapter 9b Social Care Page 199 Chapter 10 Housing and Homelessness Page 221 Chapter 11 End of life Page 246 Chapter 12 ‘Long-Covid’ Page 277 Chapter 13 Mental Health Page 287 Chapter 14 Black, Asian and Minority Ethnic Page 365 Communities Chapter 15 Crosscutting Themes Page 386 Chapter 16 Tabulated Theme Recommendations Page 389 Appendix 1 Framework and Guidance for Page 400 Contributors 2 Page 2 Chapter 1 Introduction The Covid-19 pandemic began as a cluster of cases of ’viral pneumonia of unknown cause’ in Wuhan, China in December 2019. On the 9th January 2020, the cause became established as a novel (new) coronavirus1 later named SARS-CoV-22. The virus rapidly spread internationally, with the first case outside of China confirmed in Thailand on 13th January 2020 and on the 23rd January, Wuhan was placed under quarantine1,3. Shortly afterwards, on the 24th January, the first European cases were identified in France1. By the 31st January, SARS-CoV-2 had reached the United Kingdom4. 34 days later, the first official death within the UK was reported5. Sheffield experienced its first confirmed case on 29th February and first death on 17th March. On the 16th March, the Prime Minister announced social distancing measures, advising against all but essential travel and social contact. Those who could work from home were advised to do so and shielding was introduced for vulnerable individuals6. These interventions were shortly followed by the closing of schools (to all except the most vulnerable children and those of key workers)7, and multiple businesses, particularly in the hospitality sector8. On the 23rd March 2020, the UK entered lockdown, permitting only key workers to work and only essential journeys for food, medical need and exercise9. These full measures stayed in place for approximately 7 weeks until the 10th May 2020, when it was announced that restrictions would gradually begin to ease10. Since April, 9.6 million jobs have been furloughed as workplaces were forced to close11,12. As of the 7th September 2020, the UK has documented 350,100 cases and 41,554 deaths of people who had tested positive for SARS-CoV-2 in the 28 days prior to their deaths13. Covid-19, the clinical syndrome caused by SARS-CoV-2, is typified by cough, fever and loss of sense of taste and smell14. It is believed to spread primarily via respiratory aerosols or droplets, or from contaminated surfaces15. Precise figures for mortality are difficult to assess due to the fast evolution of the situation and varied approaches to testing internationally and over time. Therefore, case fatality rates range widely from <1% to 19%16,17. Deaths from Covid-19 are disproportionately higher amongst older people, people with known long term conditions, people from deprived areas, men and within the black and minority ethic (BAME) population18. The potential longer-term consequences for patients surviving initial infection are still not clearly understood19. Sheffield has a population of approximately 583,000. Whilst broadly similar in age demographics to England as a whole, it is notable for a higher than average number of 20 to 24 year olds, due to a large student population of around 60,000 people20. 3 Page 3 As of the 2011 census, Sheffield was 81% white British with a growing BAME population. After white British, Pakistani is the second most prevalent ethnic group in Sheffield (4%), followed by mixed (2%), white other (2%), other (2%) and African (2%)21. Sheffield is a city of wide variations in wealth, ethnicity and health across the city’s 28 wards. More than 40% of households in the wards of Darnall and Burngreave are in poverty, compared to fewer than 14% in areas such as Fulwood and Dore and Totley22. In 2011, Darnall and Burngreave were also home to a larger proportion of BAME residents – 49% and 62%, respectively21. Overall 38% of Sheffield’s BAME community live in areas amongst the 10% most deprived in the country and 15% live in overcrowded housing23. This is reflected in the pronounced health inequalities in the city, with a difference in life expectancy of over 10 years between Burngreave and Ecclesall24 and a 20 year difference in healthy life expectancy between the best and worst in the city25. As of the 7th September 2020, 4,862 positive tests for Covid-19 have been reported in Sheffield and 412 deaths have occurred within 28 days of a positive test13. This Rapid Health Impact Assessment (RHIA) examines the impact on health and wellbeing in Sheffield of the Covid-19 pandemic and the social measures put in place to slow its spread. It can be viewed as 12 ‘mini’ RHIAs examining key areas of concern identified by leaders citywide, from which it is hoped learning can be taken to mitigate against second and subsequent waves of the pandemic and used as an evidence-base for recovery activities. (Guidance for theme authors is included at appendix 1). Taken in its entirety it tells a story of resilient people and communities and agile services but sheds a light on historic inequalities which have been made only worse by the double impact of Covid-19 and then lockdown. By highlighting the experiences of some of Sheffield’s most vulnerable communities, this report delivers an opportunity for system-leaders to consider what they want the Sheffield of the future to look like and how to get there. References: 1. World Health Organisation. Timeline of WHO’s response to COVID-19. World Health Organisation (2020). Available at: https://www.who.int/news-room/detail/29-06-2020- covidtimeline. (Accessed: 11 August 2020) 2. World Health Organisation. Naming the coronavirus disease (COVID-19) and the virus that causes it. World Health Organisation (2020). Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical- guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it. (Accessed: 13 August 2020) 3. Johns Hopkins University and Medicine Coronavirus Resource Centre. Hubei Timeline - Johns Hopkins Coronavirus Resource Center. coronavirus.jhu.edu (2020). Available at: https://coronavirus.jhu.edu/data/hubei-timeline. (Accessed: 13 August 2020) 4 Page 4 4. Johns Hopkins University and Medicine Coronavirus Resource Centre. New Cases of COVID-19 In World Countries - Johns Hopkins Coronavirus Resource Center. coronavirus.jhu.edu (2020). Available at: https://coronavirus.jhu.edu/data/new-cases. (Accessed: 13 August 2020) 5. Department of Health and Social Care. CMO for England announces first death of patient with COVID-19. gov.uk (2020). 6. Prime Minister's Office 10 Downing Street. Prime Minister's statement on coronavirus (COVID-19): 16 March 2020. gov.uk (2020). 7. Prime Minister's Office 10 Downing Street. Prime Minister's statement on coronavirus (COVID-19): 18 March 2020. gov.uk (2020). 8. Prime Minister's Office 10 Downing Street. Prime Minister's statement on coronavirus (COVID-19): 20 March 2020. gov.uk (2020). 9. Prime Minister's Office 10 Downing Street. Prime Minister's statement on coronavirus (COVID-19): 23 March 2020. gov.uk (2020). Available at: https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-23- march-2020. (Accessed: 14 August 2020) 10. Prime Minister's Office 10 Downing Street. Prime Minister's statement on coronavirus (COVID-19): 10 May 2020. gov.uk (2020). Available at: https://www.gov.uk/government/speeches/pm-address-to-the-nation-on-coronavirus-10- may-2020. (Accessed: 14 August 2020) 11. Office for National Statistics. Early insights of how the coronavirus (COVID-19) pandemic impacted the labour market: July 2020. ons.gov.uk (2020). Available at: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandempl oyeetypes/articles/earlyinsightsofhowthecoronaviruscovid19pandemicimpactedthelabourma rket/july2020. (Accessed: 14 August 2020) 12. HM Revenue & Customs. HMRC coronavirus (COVID-19) statistics. gov.uk (2020). Available at: https://www.gov.uk/government/collections/hmrc-coronavirus-Covid-19-statistics. (Accessed: 13 August 2020) 13. Gov. UK. Coronavirus (COVID-19) in the UK. gov.uk (2020). Available at: https://coronavirus.data.gov.uk. (Accessed: 8 September 2020) 14. National Health Service. Check if you or your child has coronavirus (COVID-19) symptoms. nhs.uk (2020). Available at: https://www.nhs.uk/conditions/coronavirus-Covid- 19/symptoms/. (Accessed: 13 August 2020) 15. Public Health England. Transmission characteristics and principles of infection prevention and control. gov.uk (2020). Available at: https://www.gov.uk/government/publications/wuhan- novel-coronavirus-infection-prevention-and-control/transmission-characteristics-and- principles-of-infection-prevention-and- control#:~:text=The%20transmission%20of%20COVID%2D,be%20droplet%20and%20contact. (Accessed: 14 August 2020) 16. Oke, J. & Heneghan, C. Global Covid-19 Case Fatality Rates - CEBM. cebm.net (2020). doi:10.1101/2020.03.09.20033357v1 17. Rajgor, D. D., Lee, M. H., Archuleta, S., Bagdasarian, N. & Quek, S. C. The many estimates of the COVID-19 case fatality rate. Lancet Infect Dis 20, 776–777 (2020). 18. Public Health England. Disparities in the risk and outcomes of COVID-19. gov.uk (2020).