Covid and Family Stress

www.hertfordshire.gov.ukwww.hertfordshire.gov.uk
COVID-19 Impact
Herts Family Justice
Conference
14th October 2020
Jim McManus
Director of Public Health, Hertfordshire County Council
Visiting Professor, University of Hertfordshire
Vice-President, Association of Directors of Public Health

www.hertfordshire.gov.uk
Where are we? Pandemic Milestones
May June July Augus
t
Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
2020 2021
2
Some restrictions
eased May into June 2020
1a
Peak of cases.
Deaths
Lag cases by 2-3
week
Late April 2020
First
Peak
1b
Second
Peak??
Second peak of cases
sees restrictions
switched back on and
peak of cases and
deaths
Oct 2020
3
4
Recovery Focus
Efforts change to
focus on recovery
Q2 2021
Vaccine
Vaccine starts population roll
out (earliest) with frontline
workers and clinically vulnerable
Q2 2021
Full
Recovery
Full return to new Normal
Aug – Nov 2021
Apr
Phase 1 – First Two Peaks
Phase 2 - Control
Phase 3 - Exit
This is all provisional. The key drivers of these phases will be
levels of infection, recovery and immunity
Phase 4 - Recovery
Sep
4
Immunity

Not a Pandemic but a Syndemic
• Syndemic – two or more disease
states that adversely interact with each
other (Singer, 2009*)
• As we learned in HIV, Healthcare is
ONLY one aspect of response to a
Syndemic.
• Can we apply this learning post
COVID?
• The debate must not become focused
on healthcare and the NHS alone
• Look on Adverse Childhood
Experiences with a Syndemics Model
and we might get further.
*Singer,M (2009) Introduction to Syndemics: A Critical Systems Approach to Public and
Community Health.

Are we in a Second Peak or Not?

www.hertfordshire.gov.uk5
OFFICIAL SENSITIVE
East of England 28 Sept
2020
28/46 (54%) LADs in the East of England were in epidemic phase based on 28/09/2020 data

Largest rise in younger ages

Syndemic Impacts not Pandemic

1.Flu like symptoms,
no fever
1.5% need hospital
breathing support
2.Flu-like + Fever
As Group 1plus loss
of appetite and fever
3. + Gastrointestinal
Diarrhoea, anorexia,
headache chesy pain.
Usually no couch
4.+ Fatigue
8.6% require
breathing support
5. + Confusion (plus
fatigue etc)
10% require breathing
support
6. + Abdominal and
Respiratory
20% need breathing
support
6 “Clusters” of COVID Symptoms
Source: Covid Symptom Study

Long Term
Consequences
• “Long Covid”
• Individuals who continue to have
Covid-19 symptoms which disrupt
their health
• Outside of the two-week period in
which they are believed to be
infected. (i.e. after time virus
should have cleared)
• Estimates (rough) 1.5% of those
infected persist with symptoms at
3 months
• Extreme fatigue
• Muscle weakness
• Hearing Loss
• Low grade fever
• Inability to concentrate Memory lapses
Changes in mood
• Sleep difficulties
• Headaches Needle pains in arms and
legs
• Diarrhoea and bouts of vomiting
• Loss of taste and smell
• Sore throat and difficulties to swallow
• New onset of diabetes and
hypertension
• Skin rash
• Shortness of breath
• Chest pains Palpitations
• Heart Muscle Weakening
Source: Yelin D, Wirtheim E, Vetter P, et al. Long-term consequences of COVID-19:
research needs. Lancet Infect Dis 2020; published online September 1.
https://doi.org/10.1016/S1473-3099(20)30701-5.
Source: https://institute.global/policy/long-covid-reviewing-science-and-assessing-risk

Are UK BAME populations at increased
vulnerability from COVID-19?
#EvidenceCOVID
Abdul Razaq, Dominic Harrison, Sakthi Karunanithi
and others 05.05.20
Black, Asian and Minority Ethnic (BAME) groups are at markedly higher risk of
developing and dying from COVID-19. Causes appear to be multiple:
Overrepresentation of BAME populations in lower socio-economic groups,
multi-family and multi-generational households, disproportionate
employment in lower-band key worker roles, and co-morbidities (especially
cardiovascular, diabetes, renal and complex multi-morbidities).
www.hertfordshire.gov.uk/coronavirus

PHE Report Infographic….

Impact of COVID-19
population groups at particular risk :
• Children from asylum seeking families
• Refugee and migrant children and young people
• Young People who are vulnerable
• Looked After Children
• Young Carers
• Children experiencing neglect and abuse
• Children in Need/those who have a Child Protection Plan
• Children missing
• Children at risk of sexual and criminal exploitation
• Children with SEND

Impacts
• Family Stress
• Obesity
• Cognitive Milestones
• Confidence
• Financial Impacts
• Attachment Issues
• Increase in
Developmental Delay
• Decrease in School
Readiness
• Decline in Vaccine
Uptake

Mental Health
Predicted MH
Impact: CYP MH
Factors
Disrupted
social
development,
social
support,
routine,
education
Isolation,
Loneliness,
Exclusion
(inc. digital) &
< Structured
Activity
> Worry /
Anxiety,
Stress, Low
Mood
(?PTSD?)
Increased
vulnerabilities
& increased
exposure e.g.
ACEs, Socio-
EcReduced
access to MH
& pastoral
support. >
escalation of
MH diffs
Direct impact
of COVID-19
Unexpected
Bereavement
/ Complex
Grief
Vicarious
Anxiety.
[Parent/Carer
s;
School/Colleg
e; Media (inc.
Social Media)
Family
discord /
stress
Hopelessne
ss / Fear of
Future
Consequenc
es

Priorities for Exiting
Recovery of essential
milestones for children
Identification of
Inequalities in
outcomes and stratified
action for those with
worst outcomes
Collective response to
major enduring Trauma
System Wide response
to issues
Short, Medium and
Long Term Strategies
A four to five year haul

Any questions?

Supplementary Slides
(Not for using during
presentation but for
participants to use
afterwards)

What are young people telling us about
their mental health ?

www.hertfordshire.gov.ukwww.hertfordshire.gov.uk
Impact of COVID-19/lockdown
• Family stress
• Families usual support networks disrupted/removed (both in terms
of services and personal support)
• Children and young people missing their friends, many missing
school
• Economic family hardship including loss of jobs
• Food insecurity (provision of free school meals, healthy meals,
sufficient food)
• Risk of homelessness
• Families worried about future (work, health of immediate and
extended family, their children’s future)
• For some families inability to access internet and sufficient laptops
for learning and family contact - increased digital exclusion
• Children and young people not being in early years and school
provision will have widened the attainment gap

Impact of COVID-19/lockdown
• The number of families accessing health services such has
decreased
• Reduced capacity and changes to delivery of healthcare services
• Likely increase in families’ poor health, illness, health inequalities
• Drop in number of safeguarding referrals
• Increase in domestic abuse and families accessing refuges
• Services may struggle to catch up on addressing missed
appointments
• A lack of capacity to address emerging need whilst trying to
meeting existing need

What might we expect in terms of impact on health?
• Increase in poor perinatal health
• Poor attachment
• Decrease in breastfeeding
• Increase in developmental delay
• May see outbreaks of infectious disease due to
disruption of childhood vaccinations
• Decrease in school readiness
• Increase in safeguarding – all ages

What might we expect in terms of impact on health?
• Increase in obesity (and maybe underweight children)
• Poor oral health
• Reduction in healthy behaviours
• Increase in risk taking - alcohol and substance misuse
(including smoking)
• Increase in STIs, unplanned pregnancies
• Increase need for counselling for sexual assault
trauma for young and vulnerable person
• Increase in poor emotional well being and mental
illness in children and young people

Covid and Family Stress

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