How Guernsey Together took on Covid-19

‘When Nikki emailed me on 14 January to tell me there’s a virus in China and we’re worried about it, then I was worried about it,’ says Deputy Heidi Soulsby of the email from Dr Nicola Brink, the director of Public Health.

‘Nikki doesn’t say things like that just to stir things up,’ adds Heidi, who headed up the Health & Social Care committee at the time and is now vice-president of the Policy & Resources Committee.

An ‘unusual situation’

Nikki picks up the story from those early days of the pandemic. ‘There was a cluster of unexplained pneumonias at the end of December 2019 and that caught our attention. We heard about it through the international reporting system, which we were part of. By early January they’d identified that this was a novel coronavirus. They released the full genetic sequence of the virus very soon afterwards. So, it was very clear that this was a new coronavirus.

‘What caused concern for me was firstly how this cluster of pneumonias had occurred but secondly how it appeared to be transmitting from person to person quite efficiently. That’s what highlighted to us it was a concern. That’s when we alerted the Committee for Health & Social Care that we thought we were dealing with an unusual situation.’

As the outbreak in China was traced to a market in the city of Wuhan, concerns grew about its global impact. ‘We felt from the end of January 2020 that this virus had pandemic potential,’ explains the director of Public Health.

‘Ready and waiting’

There was already what Nikki describes as a ‘very close and responsive’ relationship with her team and HSC committee – which proved hugely beneficial. Another vital ingredient was the planning and preparation for a pandemic well before anyone had heard of Covid-19.

Take November 2019. A ‘table top’ exercise considered both influenza and a novel respiratory virus pandemic. There’d been resistance from some quarters to the exercise on the basis it could ‘get in the way’ of Brexit planning. But Heidi navigated those concerns and it took place. ‘A pandemic won’t come around just at the right time when you’re not doing anything,’ she notes.

Key parties took part in the exercise, which Nikki says helped when it came to Covid-19. Consideration was given for examples of clusters of cases spreading and lockdown. ‘We mapped the scenario of a pandemic and how it would occur, and what our responses should be at each stage,’ says Nikki.

Guernsey’s Civil Contingencies Authority (CCA) – established to deal with emergencies – had also identified a pandemic as a high risk. Senior politicians, civil servants and the authorities more widely were therefore alert to a pandemic.

It was to this backdrop that the 14 January email landed in Heidi’s inbox – with action ramped up as those key relationships, plans and preparations showed their worth. Key figures were quickly assembled to plot the route ahead. They included people such as Deputy Gavin St Pier, chair of the CCA and then the island’s most senior politician, and top civil servants such as Paul Whitfield and Mark de Garis.

The first CCA update was on 10 February due to the scale of the threat and impact. But there was no panic as Nikki and her team were allowed to get on with their work, with the politicians taking their cues from them.

‘It was a very measured approach,’ says Nikki. ‘From the beginning we said we needed to have a community-based test, track and isolate programme. During February, we trained up contact tracers because if we were going to underpin our test, track and isolate strategy we had to have the appropriately trained contact tracers. By the time we had our first case on 9 March, we were ready and waiting.’

Testing times

A major challenge, however, was testing capacity. Initially, samples had to be sent to the UK. Results could take up to five days and only 35 tests daily were allocated to Guernsey. ‘The third thing is that the UK changed in the first wave to a hospital-based testing programme, not a community-based programme,’ says Nikki.

‘We wanted to run ours as a community-based programme. So, we then went back to the Committee for Health & Social Care and asked for permission to develop our own on-island testing capacity.’

That was approved and capacity has been ramping up since then. Some 2,000 ‘reliable’ PCR tests can now be done on-island a day, with contact tracing under way within an hour of results. Nikki says this bodes well for the future with local expertise on the ground.

Building relationships with potential positive people has been key to the test, track and isolate programme, which the pair explain requires some information being kept confidential to ensure full disclosure. A small cluster of cases in November was handled on this basis with about 300 people tested.

Mass testing remains an option, says Nikki, if there were multiple clusters of unexplained cases. But, at time of writing, there was no evidence of any community seeding with more focused testing judged to be a more effective approach.

Back in March, though, there was concern about whether the limited testing capacity would sufficiently pick up the actual number of cases. The island saw its first case of unidentified ‘community seeding’ on 20 March as opposed to trackable travel-related cases or contacts of known positive cases. There were also probably more unconfirmed cases, suspects Nikki, with GPs reporting patients with coughs and fevers. The island could not see the horrendous scenes from Italy where many lives were being lost and hospitals overloaded happening here, adds Heidi.

Lockdown – ‘what have I done?’

To control the virus, a historic decision was made. Lockdown was imposed on 25 March 2020. ‘One of the fundamental reasons why we had lockdown when we did was because we could not get the test results fast enough,’ says Heidi.

She recalls the run-up to the CCA briefing on 24 March when the decision to lockdown was announced. ‘I felt in a different zone. It felt completely surreal. The last thing you want to do is restrict people’s freedoms, that’s not what you go into the States for.’

Later she went home to her husband, and said to him: ‘What have I done?’

‘I had to give him a big hug. But we absolutely knew it was the right thing to do – the information absolutely tells us that if we don’t do this, based on where we are, it will run rampant. We knew the impact that would have. At that time we didn’t know all about what Covid was like, and we could see ventilators being used everywhere and the death trajectory going up.’

And the result of lockdown? Within 10 days, Nikki explains the rate of infection was flattening in Guernsey. But while the number of deaths could have been higher, the virus still claimed just over a dozen victims – devastating for the team.

‘I remember where I was standing’

The director of Public Health remembers vividly 30 March 2020. ‘There were some days which were very difficult and I go back to the day we had our first death. I remember what I was wearing and where I was standing. On that day someone also sent us a nice message. It was a day that we were sitting there feeling really devastated. Just getting some messages of support was really, really helpful.’

On a personal level, the director of Public Health’s home was divided into three – her, her husband who works at the hospital, and her 86-year-old mother – to avoid any risk of giving each other the virus.

Heidi also reflects on some of the hardest moments of 2020. Decisions such as closing the care homes to visitors and pregnant women unable to have partners or loved ones with them in hospital immediately come to her mind.

Travel

Tough self-isolating requirements for inbound travellers have been another feature of 2020 as a means of controlling the pandemic. It has been set at 14 days self-isolation for much of the year as part of an adaptive system, which could reduce that period depending on the number of cases from countries and regions that travellers were arriving from.

But in a glimpse of how we could live with the virus, on-arrival testing at the harbour and airport was introduced in November with countries split into four categories depending on their prevalence rates. Category one, for example, covered countries and regions where there was no requirement for any travel restrictions or testing.

Category two countries were those with a Covid prevalence rate of fewer than 30 cases per 100,000 for seven days. Anyone arriving from those would be tested on arrival, but required to self-isolate only until the result of that test comes back, providing it is negative, Once a negative test is received, a traveller will be subject to ‘enhanced follow up’ until a test on day seven. Following a second negative result, ‘passive follow-up’ restrictions are in place until day 14.

At the time, it had little practical implications because travellers were arriving from jurisdictions where the number of Covid-19 cases required 14 days of self-isolation. That said, Heidi says the fact that a number of positive cases were picked up at the border showed the system worked.

With an eye on the future, Nikki adds a ‘fully formed and mature’ community test, track and isolate programme sits behind the border testing. Understanding of Covid-19 and treatment has ‘vastly improved’ and the island’s hospital is well-prepared. Public Health is also preparing to roll out a vaccination programme as soon as possible.

Overall, the Public Health director highlights how it is a framework to mitigate the potential for more positive cases as the situation changes over time.

Communications

Another key pillar for the two leaders has been communications. Nikki says the decision was taken early to be as transparent and human as possible. This meant sometimes, when asked a question, acknowledging they didn’t have the answer immediately. The approach was to be clear but reassuring, as Deputy Gavin St Pier put it: ‘We’ve got this’. The media role in relaying critical information to the community is praised too.

Nikki and Heidi became international media stars, along with Gavin, as people from around the world saw Guernsey’s apparent success as cases fell to zero for an extended period. The States of Guernsey communications team’s efforts were central as a community effort to take on Covid-19 became known as Guernsey Together.

Guernsey Together lifesavers

Indeed, one of the most heartening aspects has been Guernsey’s community. Nikki and Heidi repeatedly stress how important it has been in taking on Covid-19. That includes unsung heroes from cleaners to the procurement team sourcing PPE (personal protective equipment) in a ‘Wild West’ situation where nations around the world were racing to source it, public health colleagues, essential workers and teachers.

Rainbows and signs thanking essential workers in windows, clapping on Thursdays and rock towers on the coast were physical manifestations of what became known as Guernsey Together. So too was sticking with the rules and observing recommendations such as staying home when unwell, regular hand-washing and hygiene measures or working from home when needed. It allowed Guernsey to come out of lockdown restrictions sooner than elsewhere.

For Nikki, she is particularly proud of children returning to school on 8 June. ‘We were the only place in the British Isles, other than the Isle of Man, who had their children back to school completely unrestricted. It was very important because we value our children and their education.’

When the scales are weighed, Nikki and Heidi are unequivocal about the impact of Guernsey Together. It saved lives – and for that we can be glad.