An interview with David Regan, Director of Public Health, Manchester City Council
This is part of a series of interviews with public health directors, published on 8 December 2020.
Wuhan’s sister city in the UK is Manchester – the two were twinned in 1985 when a Chinese consulate opened in the city. It meant Director of Public Health David Regan was aware of what was happening with coronavirus before many.
“I started seeing the reports right at the start of January. Towards the end of January, we were in touch with our colleagues in Wuhan. We then had our first meeting at North Manchester General Hospital on January 23rd with the hospital staff and Public Health England (PHE) – it is one of the designated high consequence infectious disease units in the country.
“We discussed the situation – although of course we little idea of the scale of what was going to happen next”
‘We are doing better on care homes’
Within two months, the UK was in lockdown with public health teams battling outbreaks across the country. “Like everywhere we had real problems in care homes. The lack of PPE and testing made it really difficult.
“I’ve worked in the city for 30 years and we have some really strong relationships. One of the things we were able to do was to organise testing prior to discharge from hospital to care homes. We used the hospital testing system – at one of PHE’s regional labs. It helped, but we still saw a lot of deaths.
“In the second wave it has been a totally different situation. We understand the virus much more. We have plenty of PPE and testing in place, but we – like everywhere – still have outbreaks. It shows how difficult it is to contain the spread.
“But the scale of the outbreaks we are seeing is between a quarter to a third of what happened in the spring. It is progress, but we still have to remain vigilant. My biggest concern is how mentally exhausted everyone is.”
How university outbreak hit the headlines
One of the most challenging periods for Mr Regan was the return of universities in the autumn. The outbreak at Manchester Metropolitan University thrust the public health team in the national spotlight when 1,700 students were told to self-isolate after a major outbreak. It led to media headlines of students saying they “felt like prisoners” and resulted in the majority of learning for that university and the University of Manchester to move online.
Mr Regan said it was difficult, but he does not regret the decisions that were made. “These are fine judgement calls. But we know it is best to go hard and go early – that has been a key lesson during the pandemic. That’s what we did. “
“But we did it in collaboration with PHE and the university. We were in full agreement and it meant we were united and confident in the approach we took. There were more than 200 asymptomatic cases in the end – and it is clear the action we took helped contain the spread. But it is certainly not easy being in a situation like that.”
The move to tier three
Shortly after the university challenges, Greater Manchester (GM) was in the spotlight over the discussions about the move into tier three. This involved all ten local authorities in the City Region and saw the GM Mayor Andy Burnham battling to secure a fair deal from central government if the area was to be moved into tier three.
The dispute was mainly focused on the financial support for hard hit businesses and employees, rather than the value of the tighter restrictions on public health grounds. Mr Regan said that in such situations you must remain focused on protecting the health of the public as that is the core element of your role.
“I was involved in some of the meetings, but really I was busy getting on with my job. There was lots to do – we were just in the process of trying to get local contact tracing going.”
Now, with lockdown ended, Greater Manchester and much of the surrounding region has once again found itself in tier three. This time cases are coming down.
Mr Regan said: “We are probably just 10 days behind Liverpool. Cases are now over 60% lower than they were at the beginning of October and although there is still a lot of pressure on hospitals, the rise in admissions we were seeing have plateaued.”
Tough months ahead – but 2021 will be better
Mr Regan said it will be a difficult call on when it will be right to move into tier two and the decision should be based on transparent and fair criteria. “The review is in mid December – that will be just before Christmas. We have to be careful. But we also need to recognise the importance of the hospitality industry. It is a vitally important sector for the city and is a big employer of young people.
“Staff working in the sector are often on low incomes and many rely on the tips they get. The longer the sector is affected, the wider the income inequalities and, therefore, health inequalities become.”
The Christmas relaxation is also something that is weighing heavily on Mr Regan. “I can see the logic – people naturally want to meet up and there is a strong argument to work with them to encourage them to do it safely. But there are risks – and we need to ensure we don’t see a third wave in the new year.
“Public health directors do not want to be harbingers of doom – we all want to see family too. We need to be clear with people about the risks and help them make informed decisions. It is going to be a difficult few months no doubt – but let’s also look forward to 2021. We can be optimistic now we have three vaccines in the pipeline. It is going to be better than 2020 I am sure."