Interview with Dr Louise Smith, Director of Public Health, Norfolk County Council
This is part of a series of interviews with public health directors, published on 23 October 2020.
Norfolk, like much of the country, had seen relatively low levels of coronavirus over the summer. So when reports of someone testing positive after arriving at A&E emerged, it immediately rang alarm bells for Director of Public Health Dr Louise Smith.
“It was late August and our infection rates were low. That was a Thursday. Within a few days we had a major outbreak on our hands.”
The person who tested positive was a worker at Barnham Poultry factory. The factory, on an industrial estate on the outskirts of the market down of Attleborough, is one of the biggest suppliers of chicken products in the UK. It accounts for around 7 per cent of chicken processing in the country.
“When we realised it was a worker from the factory we immediately contacted the employer. They had already started testing some of their staff. Within four days the number of positive cases was in the triple figures.”
‘We ran into problems testing and tracing’
What happened next was, Dr Smith said, a perfect case example of the challenges councils face containing outbreaks.
“At first we were using our local pillar one testing capacity, but within a few days a mobile unit had been deployed under pillar two. That made it easier to get workers tested, but we did not get immediate access to the data. That slows down the contact-tracing process.
“And when we did chase up workers to speak to them we were faced with more challenges. The workforce was dispersed across a large area, involving four of our district councils. There were even some workers in neighbouring authorities.
“The staff were mainly migrant workers – not all of whom had great English. We translated materials into 10 different languages. Some staff did not want to engage. They would put the phone down and even when they did engage the language issues were a real barrier – there was confusion about what we were asking them to do.
“We found some of the contact details the employer had were out of date or not accurate. We would turn up at addresses and the person who was meant to be living there wasn’t.
“In the end we engaged the help of the HR team. Staff were much more likely to be responsive to them – and that helped us to explain what we were asking them to do in terms of getting tested and when to isolate.”
The wider consequences of the outbreak
But as well as containing the spread, Dr Smith said the outbreak had much wider consequences. “There were animal welfare issues – we could not simply stop production as the birds needed to be slaughtered. A skeleton staff were brought in from outside to keep things running. We had Defra and the Food Standards Agency involved.
“In the end we had four different cells – one concentrating on the outbreak, one focussed on community outreach, another on animal welfare and a final one on the financial viability of the business. There was a point when we also had to consider the threat of public disorder – there was talk of protests from Animal Rebellion.”
The highest number of positive cases were traced back to the factory cutting room although there were positive cases in most factory areas – and in the almost 800 staff who worked there were asked to self-isolate.
Dr Smith said the need to provide financial support also became apparent very early on as the workers were on low incomes with minimal sick pay.
“As a council we spent around £37,000 of our own money on providing welfare support so workers could self-isolate. That is why the announcement by the government that people on low incomes will be entitled to £500 payments is so important. Councils need that help when we are trying to contain outbreaks.”
Could the outbreak have been prevented?
Dr Smith said a review of infection prevention procedures taken by the factory was carried out. It led to the installation of more screens between workers and a reception area where staff gathered before work was closed.
But she said: “Hand-on-heart I cannot say these changes would have stopped the outbreak. The environment these staff work in is the perfect breeding ground for the virus. It is cold, staff are in one area all day and there are lots of hard, metal surfaces.
“You also need to consider the environment outside of work. We found many of these workers lived together, often in our most deprived areas in houses of multiple occupancy.
“It is easy to criticise the fact they shared cars together or had a smoke together – I have heard that said – but you have to remember these are people who may be in the same household and we live in a rural area where people need to drive to go to work. It is too easy to judge people’s behaviour in the pandemic.”
‘The next six months will be long and hard’
It is now six weeks on from the start of the factory outbreak and nationally as well as locally the picture has changed. Norfolk has started seeing cases rise in the community and hospital admissions start creeping up again.
“I think we are at a real tipping point in Norfolk. Our background numbers are rising, and we are seeing rapidly increasing numbers of outbreaks.
“For a large rural and mixed county like Norfolk the challenge will be to get the right balance of interventions. We need a simple message on the rules that everyone can follow and that is easiest with a Norfolk-wide approach.
“But when we look at the data there are large differences in the numbers in different areas and so we will need to implement control measures in communities where the additional restrictions can be clearly justified.
“We are, though, in a much stronger position now than we were in March. As directors of public health, we have learnt much more what works and how this virus spreads. The testing data helps us to track what is happening with disease activity in the community
“The support from government has improved and we need to remember by next March we will be in an even better position still. We will be closer to a vaccine, there will be better treatments, the weather will improve, and we will have learnt even more. It will be a long six months – but we can get through it.”