The main public health technique for controlling epidemics returns to England tomorrow with the start of the NHS Test and Trace service. ..... Anyone with corona virus symptoms will be asked to self-idolate and book a test. If the test delivers a negative result, the self-isolation ceases but if it is positive the service will contact them and try to work out all their contacts - people who have been within 2 metres of them for more than 15 minutes in the last few days. These contacts will be asked to self-isolate for 14 days or 7 days after they develop symptoms, whichever is shorter. If they have a negative test result they must still carry on with this. In this way the spread of Covid-19 can be reduced. Success depends on prompt action at all stages, booking a test, taking it, getting results back, tracing contacts. This is because the virus can develop in a contact within a few days so that they become infectious. COVID-19 is best understood as a pattern of local outbreaks, rather than a national pandemic with a similar impact in every community, which is why councils as local leaders have a fundamental role to play in the test and trace service. It is good government has recognised the importance of directors of public health within councils, who need to have the necessary powers and authority to lead the response locally and tackle outbreaks early and aggressively. The success of the programme will also depend on the continued support and co-operation of the general public. We believe they would be reassured and encouraged if the roll-out of the service is underpinned by the leadership of their local council. Environmental health, emergency planners, trading standards, public health including sexual health services and infection control nurses are just some of the council services which can use their considerable expertise and unparalleled experience, to help in stopping the spread of coronavirus. As we move into the next phase, it is important that councils have the capacity and necessary data to play their full part in this national programme, so they can understand where the outbreaks are happening and be able to act quickly to contain them. Local government and local public health departments will have a central role. The Local Government Association said: "COVID-19 is best understood as a pattern of local outbreaks, rather than a national pandemic with a similar impact in every community, which is why councils as local leaders have a fundamental role to play in the test and trace service. It is good government has recognised the importance of directors of public health within councils, who need to have the necessary powers and authority to lead the response locally and tackle outbreaks early and aggressively. The success of the programme will also depend on the continued support and co-operation of the general public. We believe they would be reassured and encouraged if the roll-out of the service is underpinned by the leadership of their local council. Environmental health, emergency planners, trading standards, public health including sexual health services and infection control nurses are just some of the council services which can use their considerable expertise and unparalleled experience, to help in stopping the spread of coronavirus. As we move into the next phase, it is important that councils have the capacity and necessary data to play their full part in this national programme, so they can understand where the outbreaks are happening and be able to act quickly to contain them.

The Independent SAGE commission, chaired by former Government Chief Scientific Adviser, Sir David King, has issued a report on the integrated Find, Test, Trace, Isolate and Support system that is necessary to control the Covid-19 epidemic as the crude lockdown is eased.

The Government has announced 300 million funding for local authorities to take a central role in the national test, track and isolate programme. ..... Pro-rata funding for Reading would be 870,000. The national Joint Biosecurity Centre will act the supplier of data to local authorities to use in suppressing local outbreaks of Covid-19. Each local authority must develop a plan to do this in its area. Their plans will focus on identifying and containing potential outbreaks in places such as workplaces, housing complexes, care homes and schools. Local authorities will also be responsible for ensuring that testing for the virus is directed to the highest risk settings, working with local NHS and other partners. They will operate in close partnership with local hospitals, GP practices, businesses, religious groups, schools and charities. National Test and Trace Adviser and Chief Executive of Leeds City Council, Tom Riordan, said: "It is essential that communities and local authorities are at the heart of our plans to roll out test and trace. Their work to respond to the virus has been exemplary, demonstrating how people across the country have come together to respond to the virus. As we move forward with our plans to trace every case of the virus, and contact those at risk, we will need to continue to work together and tailor support at a local level. This joint endeavour between local government, the NHS and local partners will help those in self-isolation, and reduce the risk of widespread outbreaks in our schools, businesses, hospitals and communities. A new National Local Government Advisory Board will be established to work with the test and trace service. This will include sharing best practice between communities across the country." 11 local authorities have been selected to share lessons learned (although any authority could do this). They are Tameside, Warwickshire, Leeds, London (Camden lead in collaboration with Hackney, Barnet and Newham), Devon with Cornwall, Newcastle with Northumberland and North Tyneside, Middlesbrough with Redcar and Cleveland, Surrey, Norfolk, Leicestershire, Cheshire West and Chester. It might be wondered why this did not happen in February rather than at the end of May.

Health Service Journal reports today that the Department of Health and Social Care's PPE Portal is so far reaching only a tiny proportion of its intended users. ..... After starting development on March 27th the site went live in a pilot service to 1000 users in Devon and Cornwall on 27th April. There are now 1400 out of the intended 58,000 users able to make use of the site.

 CEO Steve McManus has explained that the Royal Berkshire Hospital has created separate areas for suspected coronavirus patients and all others ...... Patients are advised not to hold back from attending A&E or their urgent cancer appointments as the hospital is taking great care to separate out susected coronavirus patients. The number of patients coming in with suspected heart attack, stroke or cancer has reduced strongly since the start of the epidemic and this could well be at significant risk to the health of those patients who have not come forward. In separate news the hospital has announced that it is taking part in the UK's RECOVERY clinical trials of treatments for patients with Covid-19.

Reading university has lent 3 of its best PCR machines to expand Public Health England's live virus testing capacity. It has also supported the national effort in a number of another ways: .... 

• Researchers in relevant disciplines are contributing to understanding of the behaviour and characteristics of the SARS-COV-2 virus.
• The University is answering many media and public questions about the virus and epidemic.
• The University's car parks are available to NHS staff 24 hours a day, some accommodation has been made available and the Royal Berks Hospital runs a shuttle past the main car park.
• 100 high quality webcams, which were intended for use in online teaching, have been donated to the Royal Berkshire Hospital and the Royal Brompton Hospital for use in remotely observing patients without having to enter the Covid-19 contaminated area. These also let patients talk to their families.
• The University has contributed expertise in 3D printing to develop new types of PPE for the NHS and have transferred this to local production.
• The University's technical services department have user their laser cutting experience to help deliver face visors to the NHS.
• A method of testing the face-fit of PPE has been developed for the NHS.
• The University has helped in the procurement of Oxygen for the NHS.
• Researchers have provided tools to help children cope with anxiety and social distancing and others have provided home schooling advice.
• Surplus food has been donated to NHS staff, to the Whitley Community Development Association and to Foodshare.

The Financial Times has today published an article in which it gives the results of its analysis of deaths in care homes and states that nearly 11,000 more deaths have occurred in care homes than would have done in previous years. ..... While it is not clear that this can be taken as the best indication of the number of deaths in care homes, it is a component of the overall excess deaths which does add to the already 20,000 deaths in hospital attributed to Covid-19, showing the gravity of the present epidemic. As the descent from peak cases is slower than the ascent so the number of mortalities is greater on the way down unless treatment is radically improved.

 In March 2020 the Care Quality Commission awarded Berkshire Healthcare NHS Foundation Trust the Outstanding rating. See the summary report here. The trust delivers community nursing and community health services, community hospitals, mental health in-patient and community services throughout Berkshire. It was praised for its high quality, strong leadership and continued quality improvement.

Progress or decline of the Covid-19 epidemic is assessed by the R0 value, the average number of people infected by one infected person. Values known so far are: China (Wuhan) 0.1, Germany 0.7, Italy 0.8. A new generation of infected people according to the R0 value will appear roughly every week. The very small value from Wuhan indicates a rapid extinction of the virus to the point at which containment can be reasserted and any sporadic outbreaks suppressed. With its R0 around 0.8 Italy has only managed to halve the number of disease cases in the four weeks after the peak of infections. So to reduce the disease to a point at which sporadic outbreaks can be suppressed. say 100 cases a day, will take a further 11 weeks. And if the lockdown is loosened then things may go even slower. The figure from Wuhan was revealed by Harvard Professor Xihong Lin to the Science and Technology Select Committee on 16 April 2020 (starts about 15.45). She had made a detailed study of the patient data from Wuhan. The figure of 0.1 was achieved by interrupting the transmission of the virus within households as well as between households. This was done by placing all persons confirmed to have Covid-19 or showing symptoms of Covid-19 (there was a lack of testing at the time) in field hospitals while all other traced contacts were placed in hotels rooms (common air conditioning disabled) or other special accommodation where cross-infection was less likely. Children went with parents. In China this approach was mandatory, but it is possible that it could be quite effective as a voluntary measure in the UK. The suppression of disease was rapid; the field hospitals were only open from the beginning of February to the 5th March. The values for Italy and Germany are taken from an interview with Franco Locatelli, president of the health advisory council of Italy, in Corriere della Sera of 18th April. At present we are closely following Italy in the numbers of cases. So we may also be looking at a 15 week descent from the peak to a manageable state unless we can do better than the Italians in our interruption of disease.

The Governing Body of Berkshire West CCG will meet in public at 9.30-12.30 on Tuesday, 10th March 2020 at 57-59, Bath Road, Reading RG30 2BA. You can register online to attend here. Registration closes at 12 noon the day before the meeting. You are invited to submit questions relating to the agenda before a meeting takes place. To allow time to respond, we would ask that questions are submitted, no later than three working days in advance. In most cases, a response will be provided by email before the meeting. Questions that arrive after this time, or require a more detailed response, will be responded to by email after the meeting. To enable members of the public attending the opportunity to put forward an agenda related question to the Governing Body, all questions that have been submitted in advance of the meeting will not be discussed. The agenda includes an allotted time slot for public questions, and will be limited to one question per person. This will be subject to time available on the day and at the discretion of the CCG Chair. To submit a question please email: bwccg.enquiries@nhs.net or telephone 0118 982 2958. Please note: questions must relate to the agenda and are limited to a maximum of three per person.