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Duncan Selbie's Friday Message - 24 July 2020

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Dear everyone

Getting ready for flu

The annual flu vaccination programme is critical to our winter planning and we are working with DHSC and NHS England to roll out the biggest campaign in UK history to protect more people than ever this coming season.  For the first time, the programme is being expanded to include all Year 7 children, people aged 50 – 64 and household contacts of people that have been on the shielding list, in addition to the annual push to vaccinate as many health and social care staff as possible.

Key to reducing community transmission of flu is our school vaccination programme and uptake has increased every year amongst school children since the beginning of the programme in 2013. We have published a briefing for headteachers to explain the programme to them and ask for their help in supporting the vaccination sessions in school, especially as they adapt to challenges posed by the COVID-19 pandemic.

Obesity and COVID-19

PHE has produced a summary of the insights and evidence from what we know so far about the effects of being overweight and COVID-19 positive. One study found that for people with a BMI of 30-35, risk of death from COVID-19 increases by 40% and with a BMI over 40 by 90%, compared to those who were a healthier weight. Other data found that in intensive care units 7.9% of critically ill patients with COVID-19 had a BMI over 40 compared with 2.9% of the general population. The Prime Minister has been clear in recent weeks about his personal commitment to addressing this including launching a new PHE campaign and a strong evidence-based policy agenda. Actions will be focused on both helping prevent excess weight gain and supporting people living with obesity to make healthier food and healthier activity the easiest choice. Government action on this is a great example of public health professionals never giving up, gathering the evidence, making the case and ultimately winning the argument.

Reporting COVID-19 mortality

How we measure deaths that are COVID-19 related is important. The World Health Organization advises against a fixed time limit between testing positive and death when deciding whether a death is likely to be due to COVID-19.  Countries have adopted different approaches to counting such deaths for statistical purposes, including across the nations of the UK.  As the pandemic goes on, assessing the cause of death following a positive test becomes more complex.  We aim to capture as many COVID-19 associated deaths as possible, but also recognise that as time passes following a positive test other underlying causes of death become progressively more likely.  The method used in England was agreed in April when the bigger concern was that only hospital related deaths were being reported.  We always planned to review the approach in July, have now done so, and will be publishing a revised method very shortly.

Death certification identifies deaths for which clinical judgement at the time of death was that the death was due to COVID-19. The Office of National Statistics (ONS) have been publishing these numbers weekly for some time and they have been consistently higher than numbers of deaths following a positive test, published by PHE.  This is because ONS numbers include deaths judged to be due to COVID-19 but without a positive test.  Another approach is to estimate excess mortality. The ONS has done this for England and Wales and PHE is now also publishing weekly a report of excess mortality for England for all causes and for all persons, but also separately by age group, sex, cause, region, place of death, ethnic group and deprivation quintiles. You can find that here.

Intelligence-led testing

It has been great to hear about the work across South Yorkshire to drive down rates of COVID-19. The PHE North East and Yorkshire team, working with the South Yorkshire Directors of Public Health, revised their testing strategy to adapt to a small but persistent rise in cases. Taking a targeted approach, they ensured that more testing opportunities were available in areas where there had been a limited take-up of testing despite the prevalence of cases. Intelligence-led testing and agile decision making has enabled a reduction in cases across South Yorkshire overall, thanks to the exceptional work from our colleagues and the Directors of Public Health: Greg Fell (Sheffield), Julia Burrows (Barnsley), Rupert Suckling (Doncaster), Teresa Roche (Rotherham) and their teams, the South Yorkshire Local Resilience Forum and the Integrated Care System.

Eid al-Adha

And finally, Eid al-Adha, the Muslim festival marking the culmination of the annual pilgrimage to Mecca and commemorating the sacrifice of Abraham, starts next Thursday after sunset for three days and is a special celebration that brings families, friends and communities together. Despite restrictions on the numbers of people who can safely congregate in places of worship and a two-household limit on indoor gatherings, religious festivals can still be observed. Thank you to everyone who is doing their best to adapt and be flexible at this difficult time and faith leaders will be able to advise on the best approach locally. Colleagues will be able to access a toolkit, which will be available later today, containing print-ready and digital assets to help promote a safe Eid, and we have also published this blog. For those celebrating I wish you an Eid Mubarak.

Best wishes



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