The Safe Exit Revised: A Review
Suppress, contain and
shield
The Government of Jersey is pursuing a suppress, contain and
shield strategy to ensure the continued control and suppression of the virus in
a safe and sustainable way that protects Islanders by causing the least overall
harm.
It should be noted that a 'suppress, contain, and shield'
strategy, is a significant move away from the 'delay, contain, and shield'
strategy pursued since March.
As can be seen from my earlier post, key government thinking
was for some variant on “herd immunity”
"To date, there is a view that the virus will have to
go through the island in some shape or form, at some point", John Le Fondre
“The aim has been to
allow the virus to move through the island at a slow safe rate, without putting
pressure on the health services.” (Jersey Medical Director, Patrick Armstrong)
Deputy Richard Renouf, the Minister for Health and Social
Services, has said Jersey's new plan will ‘mean more people in hospital’ and
‘an increase in the number of deaths’.
But now with the change from delay to suppress, the messages
have changed:
John le Fondre now says:
“We must continue to suppress and contain the virus and
shield the most vulnerable in our community.
And Richard Renouf now says:
“With the support of the community we have controlled the
spread of the virus. Now, as we ease the restrictions, more people will meet
others from outside their households. There may be sporadic cases, and some
people may need hospital care. So we are taking a phased, gradual and
controlled approach to lifting restrictions, accompanied by increased testing and
tracing.”
“There are currently no active cases of COVID-19 in Jersey
care homes and measures are in place to pro-actively screen staff and
residents, to ensure good infection control practices and environmental
hygiene.”
So we can draw a line under the previous strategy. This is
the dawn of an improved one.
Rewriting History
While “suppress” is not quite what Jess Perchard wanted in
the wording – she wanted “eliminate” – it does much the same job, and is a
change of direction and policy, even if it may be pretended by politicians that this was the strategy all
along!
It was clear from the building of the Nightingale Hospital (on
which I’d still support the government as an insurance policy) that the policy
of delay did not involve near complete elimination of the virus.
And history is already being rewritten. For example, the new
document itself says:
“Having successfully achieved the primary goal of delaying
spread, the focus now shifts to maintaining very low case numbers in Jersey.
The term ‘delay’ has therefore now been replaced by the term ‘suppress’”
Whereas in reality, a more honest approach would read:
“Having successfully achieved the primary goal of delaying
spread, and being surprised that strategy
has also almost eliminated the virus in the community, the focus now shifts
to maintaining very low case numbers in Jersey. The term ‘delay’ has therefore
now been replaced by the term ‘suppress’”
It was an unintended
consequence of the original strategy and the lockdown, and clearly was not
planned!
Overview
Suppress the spread
Contain the virus quickly where cases or clusters of infection
arise
Shield the most vulnerable
1. Active monitoring, providing daily public health
intelligence regarding testing and screening results, active cases,
hospitalisation, recovered cases and deaths
2. Clear communications, helping Islanders to understand and
apply public health guidelines
3. A Community Taskforce to connect community and voluntary
action
4. Legislation to enable Government to act where necessary
5. Expert advice from the Scientific and Technical Advisory
Cell (STAC)
Points of Interest
Our progress through the levels must be balanced and
conditional to avoid triggering a spike in new cases. When we move down a
level, or phase changes within each level, depends on how quickly and how far
our monitoring tells us COVID-19 is spreading, and how much pressure key health
and care services are under.
As social contact increases, there is a risk of an increase
in transmission of COVID-19. A key pillar of our strategy is to be pro-active
and agile, to find people that are infectious and ensure they isolate quickly,
to suppress the rate at which COVID-19 spreads. We are now testing hundreds of
people each day and our expanded contact tracing team are responding in detail
to every positive case.
Throughout the levels of the Safe Exit Framework, we will
continue to focus on:
• Testing, contact tracing, and isolating confirmed and
suspected cases of COVID-19
• Preventing individual cases becoming clusters –
particularly in institutional settings such as care homes, and
• Responding quickly to stop any early clusters from becoming
outbreaks
Communication Strategy
In order to reach as many Islanders as possible, multiple
channels are chosen to promote the advice and to provide context and
understanding. This means that an Islander may hear the same advice, explained
differently, on the radio, in the print media, social media and via a press
conference. The information is the same, but the method of delivering it
changes in order to expand the context and provide more underpinning detail.
Further, subtitles have been added to all videos, including
live press conferences; agespecific content has been developed for children and
young people; all key messages have been translated into British Sign Language
and key announcements have been translated into Portuguese, Polish and
Romanian.
And to make sure advice reaches Islanders who do not use
digital technology, several solutions will continue to be used. Three adverts
have been created for TV; advertising within the newspaper and community magazines
will continue; radio adverts in English, Polish, Portuguese and Romanian will
continue; roadside banners, posters, pull up banners and vinyl stickers will be
updated as we progress through the levels, and all printed material, including
translated leaflets and posters, will be updated on gov.je so that they are accessible
for businesses to print their own as they begin to open for trade.
Better Statistics on the Way
For a mathematician such as myself, this will be a major
step forward, although other countries have been publishing the extra data for
some time.
“We have also completed two rounds of our community antibody
survey, which later in June will provide us with further evidence of the
prevalence of COVID-19 in Jersey. Our Essential Worker Antibody Survey will
similarly afford extra insights into the prevalence across those groups that
were working during the stay home period.”
Future monitoring metrics for publication will include:
• Report on screening programme for essential workers
• Phase 2 antibody testing programme
• Care Home positive cases and their outcomes
• Age bands of recovered cases
• Breakdowns of infection history of any new positive cases
(eg. travel, existing previous positive case)
Unfortunately it doesn’t say when the “future monitoring
metrics” will come into play, but I hope and would expect by the end of June at
the latest.
In Conclusion
This is a much improved strategy, and signifies a
considerable change in direction, and one for the better. The “Mapping” which
shows the sources for the new direction are also welcome (see below) and shows
how even when a backbencher fails to achieve all they set out to do, they can
make a significant different to us all.
“This strategy contains well-recognised measures used to
control, suppress and ultimately eliminate infectious diseases across many
jurisdictions. To illustrate, the table below maps the key measures in Jersey’s
COVID-19 strategy to (i) five essential elements of an elimination strategy,
sourced from Baker et al (2020), and (ii) key World Health Organisation advice.”
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