The document summarizes key points from a public health COVID briefing in Hertfordshire, England. It discusses the challenges of eliminating SARS-CoV-2 given its ability to produce variants. It frames COVID response as a staged, multi-pronged process. It also outlines short and medium term public health goals, including managing COVID as an infection and suppressing outbreaks as much as possible over two years. Finally, it discusses lessons learned from the pandemic response so far.

1. Public Health Covid Briefings
Prof Jim McManus
Visiting Professor
Director of Public Health, Hertfordshire
Jim.McManus@hertfordshire.gov.uk
COVID: The next step to health and wellbeing
7th July 2021, University of Hertfordshire Masterclass
www.hertfordshire.gov.uk/OutbreakPlan
Hertfordshire Health Protection Board

2. Public Health Covid Briefings
Hertfordshire Health Protection Board
1307 (?) 1321, Ravenna;
Nel mezzo del cammin di nostra vita
Mi ritrovai per una selva oscura
che la diritta via era smarrita
Inferno, Canto 1.I.1
In the midst of our journey of life.
I came around and found myself now
searching through a dark wood.
The right way blurred and lost

3. Public Health Covid Briefings
Hertfordshire Health Protection Board
Epidemiological Lens – is there an Endgame?
We cannot alter the virus. SARS-CoV-2 is extremely good at producing variants which are “fit”
(very transmissibile)
Elimination – permanent reduction to zero not feasible right now
Eradication – effectively suppression to very low levels may be
Will need to reach this in stages – there is no other way
There is NO silver bullet, no single thing – an accumulation of small steps each of which is
imperfect but add up in combination to prevent and suppress
So what does that look like? A staged and combination process

4. Public Health Covid Briefings
Hertfordshire Health Protection Board
The Syndemic Lense of Coronavirus Impact
 Singer, 2009
 1st Wave: Immediate mortality and morbidity
of COVID-19.
 1st Wave Tail: Post-ICU and admission
recovery for many patients.
 2nd Wave: Impact of resource restrictions on
non-COVID conditions – all the usual urgent
things that people need immediate treatment
for – acute.
 3rd Wave: The impact of interrupted care of
chronic conditions (people stayed home).
 4th Wave: Psychic trauma, mental illness,
PTSD, economic injury, burnout, and more.

5. Public Health Covid Briefings
Hertfordshire Health Protection Board
The System Lens: Our medium term goals
 Creating epidemiological conditions for huge
work – economic, psychosocial - of recovery
 We have to reach an eradication of Covid or
render it of little public health significance
and live work and study as safely as possible
while Covid is, for now, endemic.
Vaccination is one key plank
 Low Covid makes sense if it’s part of the
journey to No Covid or no [more significance
than ‘flu] Covid - even if that feels hopelessly
ambitious
 Build back fairer – inequalities
Collective Major Trauma must not be
underestimated
 Tasks for every bit of every local system here

6. Public Health Covid Briefings
Hertfordshire Health Protection Board
Short Term Public Health Goals
1.Covid as a manageable infection – reduce infection, reduce disease
severity, increase survival rates, seek to reduce long covid. Vaccines
plus therapeutics
2. As Low As Possible Covid –suppress infections and outbreaks as
much as possible especially intra and inter household networking into
work and school settings. Combination Prevention plus test trace isolate
3. Respond, Recover, Refresh, Rethink

7. Public Health Covid Briefings
Hertfordshire Health Protection Board
Two Year Game Plan
Exit the Pandemic
Phase
Manage Covid as part
of an ongoing health
protection approach
Recover,
Build Back
Fairer
Ensure every single person recovered,
refreshed, renewed
Manage Manage Covid, its variants and syndemic
impacts as part of an ongoing approach
Exit
Plan for running Covid Exit alongside non
covid work for 2021-22

8. Public Health Covid Briefings
Hertfordshire Health Protection Board
Key Tasks and Context for Organisations
Make your community, organisation and events covid safe
• Learn to live with covid as a community
Learn to
Live
Help people build confidence in managing risk
Confidence
Your organization’s capabilities and role in recovery across multiple impacts
Articulate
Help people grieve, make sense of what happened and be alert to mental
health issues
Care and
Connect
Help people vision the next two years – i.e. life a year after the pandemic
hopefully.
Hope

9. Public Health Covid Briefings
Hertfordshire Health Protection Board
What have we learned?
ADPH Rapid National Review of Learning
 “Team of Teams” works. THE game in town
‒ We need each other.
‒ LAs and Vol Orgs have competencies NHS doesn’t and vice versa.
‒ Mutual appreciation of competencies is the key. respect and appreciation for
different skills and roles of different organisations is an absolute must
 Those areas with a systems and systemic approach fully embraced by all partners have
fared better through challenges especially NHS Supply chain issues
 The Big 4 – Access, Hesitancy, Data, Misinformation
 System Leadership delivers better results

10. Public Health Covid Briefings
Hertfordshire Health Protection Board
Lessons in Heraldry

11. Public Health Covid Briefings
Hertfordshire Health Protection Board
The Bard…
Questa montagna è tale,
Che sempre al cominciar di sotto è
grave;
E quant’ uom più va su, e men fa
male.
Dante Alighieri
Purgatorio’ canto 4, l. 88
This mountain is by nature such
that, down below, the start is
always hard
Yet hurts far less the more one
rises up