Reading the runes on Covid and close contact services.

Since writing this on the 14^th the Northern Ireland Assembly moved today (15^th) to shut Close Contact services for the next four weeks – so this is very much a changing feast and I write this knowing it may be out of date very quickly.

We have been trying to keep you updated with the ever changing regulations around Close Contact work and Covid and for this edition of the newsletter I was asked to say what I thought might happen over winter. “Reading the Runes” is described as ‘trying to understand what will happen in the future by looking at what is happening now’. This is my best guess having followed the Government positions and that of SAGE for some time now. 

We know that Boris Johnson is keen to avoid a second national lockdown although the mood music on this has started to change – the language that this would ‘not happen again’ has been replaced by him ‘not wanting it to happen’. Instead we have the three tiers of both concern and restrictions – but these are highly politicised. In my area (Lancashire) we were not placed in tier 3, not because the numbers indicated that, but because negotiations about how to do it had broken down.

To look ahead we need to look at the advice by SAGE, when they met on 21^st September to advise the Government on what to do next with regard to the developing numbers they suggested:

“A package of interventions will need to be adopted to reverse this exponential rise in cases. Single interventions by themselves are unlikely to bring R below 1. The shortlist of non-pharmaceutical interventions that should be considered for immediate introduction includes:

1. A circuit-breaker (short period of lockdown) to return incidence to low levels.
2. Advice to work from home for those that can
3. Banning all contact within the home with members of other households (except members of a support bubble)
4. Closure of all bars, restaurants, cafes, indoor gyms and personal services (eg hairdressers)
5. All University and college teaching to be online unless face to face teaching is absolutely essential”

(58^th SAGE Committee Notes)

Clearly the package of three tiers does not incorporate all of these, on 12th October, when they were announced, Chris Whitty followed up with the comment that the measures introduced even for tier 3 were base measures and lots more will need to be added if the rise in cases is to be curbed.

I am often asked, do I think close contact services will close again and my reading of the scientific advice is ‘not yet’, but I do think it will come. Do I think we are a big spreader of the virus? No, not when we are using the correct PPE, when our clients are wearing face coverings for the full treatment (they should only be removed if absolutely essential) keeping our clinics well ventilated and keeping face-up work to an absolute minimum. Will this make a difference to if we are closed again – probably not.

My biggest concern about all of this is the unevenness with which measures are introduced, we could well find ourselves in a position where we are instructed to close, but the clinic 2 miles away on a different LA, even within the same tier of risk, may not be asked to do so – this is one of the key things that the government need to address, parity. I don’t think we will be the first thing to be closed, or even the next, but I do suspect it will be coming.

I hope my reading of the runes is incorrect but we need to be ready for the possibility that another closure could be on the way, at ThinkTree we will, as we have been, be lobbying hard for our sector. We have always had a good eye on hygiene and infection control and certainly I am spending almost as long cleaning and washing as I am treating.

Let’s hope I am wrong.

Maureen Abson

ThinkTree Managing Consultant