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Thursday 18 June 2020

c-19 sensemaking

Out of step

Could places like Grimsby and Cleethorpes have been safely spared the economic pain of lockdown if they had more power?

By Tom Goulding and Xavier Greenwood

When Prime Minister Boris Johnson sat in Downing Street and ordered the country into lockdown in late March, the infection hotspot was moving from London to the West Midlands. By mid-April it was in Lancashire, and then in May a cluster formed between Sunderland and Middlesbrough. But throughout this whole period, one local authority has consistently had one of the lowest number of cases: North East Lincolnshire, with the towns of Grimsby and its conjoined twin, Cleethorpes, sitting at its heart.

The two towns lie together across a deceptively large area along the eastern coast, just where Lincolnshire curves north into the Humber Estuary. They are the last stops at the end of the TransPennine train line that bisects the North of England. While Sheffield, an hour’s drive away, has over 2,500 cases at the time of writing, there are 164 registered cases in North East Lincolnshire, more than 19 weeks after the UK’s first case. The area has consistently had the lowest Covid-19 rate of any local authority in the UK, except for the tiny county of Rutland.

“We’ve got water on two sides,” says Dr Stephen Pintus, the Director of Public Health for North East Lincolnshire, referring to the North Sea to the east and the Humber Estuary to the north, as the coast curves round into Hull. “The population is not very transient, not many people move in and out of the area,” he says. “And there’s only one major route in.”

Grimsby is neither a through route (except, naturally, to Cleethorpes) nor a destination. It doesn’t have a direct train to the closest city, Hull, let alone Sheffield or London. This isolation has in recent times been the town’s economic downfall. But in a pandemic, it becomes the ideal protection.

So by the time Boris Johnson announced a nationwide lockdown on 23 March, North East Lincolnshire had only three confirmed cases, and zero deaths. Local businesses were nonetheless brought to a standstill, hitting the tourist-driven, seaside economy of Cleethorpes especially hard.

Is Grimsby the story that shows how a pandemic response dreamt up in London, at the epicentre of the early peak, was hideously out of step with other economically vulnerable and all but virus-free areas of the country?

The town of Grimsby epitomises two interwoven narratives at the heart of British society over the last five years: the left-behind, often coastal, small or medium-sized town, and the Northern, historically Labour, constituency, that has staked its future on Brexit.

In December of last year, after ten years during which the local North East Lincolnshire council’s budget was cut by 40 per cent, Great Grimsby voted for the Tories – the architects of this unprecedented austerity – for the first time since 1935. “Get Brexit Done” seemed to cut through for the 71 per cent Leave-voting constituency.

Freeman Street, Grimsby

But in our reporting from Grimsby over the last year within our Tortoise Local network, we have unsurprisingly found that the story of such a coastal town is much more layered than these two headline narratives. The fish industry, though a shadow of its former self, still dominates the local job market, with the Young’s and Seachill factories each employing several thousand factory workers in Grimsby, sending fish to supermarkets and restaurants across the country. Since lockdown began, Young’s have let go of all agency staff, and negotiations for pay rises were immediately put on hold.

Many of the factory workers live in East Marsh, a neighbourhood in the 0.1 per cent most deprived wards in the whole of England. The land was a marsh drained of water in the 19th century to clear space for homes for dock workers. The houses were built in a rush, and suffer constant structural problems. More than 40 per cent of children in East Marsh grow up in poverty.

“People round here have been abandoned,” says Billy Dasein, founder of a local community group. Three years ago, a county lines drug network controlled the street corners in plain sight. “The street I grew up in was like living in an episode of The Wire.”

Billy Dasein

Billy led a group of neighbours to raise the issue at council meetings, but didn’t feel the national or local government was able – or willing – to help. So they formed East Marsh United, and read up on the ‘Broken Windows’ theory of community safety. By cleaning up small acts of littering and vandalism, a positive chain of events was set in motion. The drug trade left the street, youth violence dropped, and the area is gradually on the mend.

But when Covid-19 arrived in the UK, East Marsh and the local public health team had reasons to be worried. North East Lincolnshire has one of the highest rates of people on disability benefit due to chronic illnesses, as well as one of the highest rates of people with diabetes. Along with medical susceptibilities to Covid-19, the danger of economic lockdown is high in a local authority with the highest number of young people not in employment, education or training (NEET) in the country, at 5.8 per cent. If the virus didn’t get you, the economic whiplash triggered by lockdown might.

As the lockdown was introduced (when, again, there were only three confirmed cases in the whole of North East Lincolnshire) the area’s unemployment surged to 6.8 per cent, one of the highest rates in the country. The food bank run out of the hall of St Andrew’s Church in East Marsh, which might serve 50 people on a typical week, doubled in users in the first week of April, serving 120 people.“The community spirit is all some people have here,” says Reverend Kay Jones, the parish priest for East Marsh. Mental health was the biggest challenge, she said, with local poverty inextricably linked to physical and mental illnesses. “People here usually wander from house to house, kids play in the street. Isolation is overwhelming for many.”

Social distancing took a little while to be widely observed across Grimsby, as Luke Green, a student and supermarket cashier, observed. “Some people think it’s a conspiracy theory and think it will all blow over,” Luke told us in the first week of lockdown. “People are very good at doing what they’re told until they want something for themselves… and then you’re not going to change their mind.”

But, as cases got into local schools in both Grimsby and Cleethorpes, scepticism died down. Three days after lockdown, the first death came in Grimsby’s Diana, Princess of Wales Hospital.

Revd Jones was tasked with organising that first funeral. The elderly gentleman who died was one of East Marsh’s most well-known characters. “The funeral would have been packed to the rafters, but only nine family members were allowed,” she says. The family broadcast the funeral through speakers to friends and family waiting outside the cemetery, who could then pay their respects at the coffin, one-by-one, once the family had left. “It was bleak. That’s the best word I can come up with.”

Reverend Kay Jones

Through April, as the number of local cases rose to 20, then 30, Cleethorpes seafront became a ghost town. Wild deer were spotted running on Cleethorpes beach, which is normally heaving (with humans) over Easter weekend. Thorpe Park, the caravan site a few miles down the coast which usually brings in 6,000 tourists to Cleethorpes over the summer, announced it would shut until July.

Consumer spending dropped by 46 per cent in the first week of lockdown across Grimsby and the surrounding areas, according to exclusive data from Social Investment Business, shared with Tortoise. This was in line with the national average drop, but Cleethorpes, like many other coastal towns reliant on tourists, was much worse hit than other towns in the area. In Cleethorpes North and Haverstowe Ward, there was a 72 per cent reduction in spending. Cleethorpes, relatively Covid-free, is at the sharp end of the economic impact of lockdown. Grimsby and the rest of the area have been hit hard, too. Did it have to be this way?

The role of councils in combating the virus has been contested from the start. Every public health director and local authority has a pandemic plan. Most plans are for a flu (such as swine flu), rather than a coronavirus, but one of the core questions at the heart of any plan is the same: do we have the personnel locally to trace the disease?

For most councils, the answer is yes – local health workers contact trace regularly for sexually transmitted diseases, or other environmental diseases from food. These workers have local knowledge of which GPs, community centres and food banks will be able to track the relevant people in a chain, which communities are harder to reach and why. Tracking down the contacts of a new patient requires trust and local knowledge: knowing the local points of contact, and how a community will respond to a call to self-isolate.

East Marsh area of Grimsby

However, in the first few weeks of March, the task of contact tracing was given to Public Health England, the national body within the Department for Health, which has 290 employees. That’s about one employee for every confirmed Covid-19 patient on 5 March, when there were 271 cases. A week later, there were 1,577 cases. “They were overwhelmed very early on,” says Donna Hall, chair of the New Local Government Network and a senior NHS adviser. Public Health England were stood down from doing any more contact tracing on 12 March. “It should never have been given to them in isolation from local government and local NHS expertise,” she says.

The new plan was for the Government to build a centralised tracing operation through an NHS app, and national call centres run by a private company Serco, employing staff without public health training or experience. Local public health teams, such as Grimsby’s, were bypassed.

When discussing this over a video call, Grimsby’s local director of public health, Dr Stephen Pintus, talks in a measured, understated tone, typical of the quiet professionalism of local government and civic society. After years as a nurse in the 1980s, Pintus has worked in public health for several decades in Sheffield, Derby and now Grimsby. His frustration about the biggest public health challenge of our lifetimes only comes out in statements concerning life and death. “We didn’t get a case for a few weeks,” he says. “Contact tracing could have worked for us in those early days.”

Other countries show the power of locally coordinated tracing: in Germany, Bavarian authorities traced one of the earliest community transmissions to a single salt shaker in a car parts company’s canteen in the town of Stockdorf. The salt shaker was carrying the virus to all workers who touched it, originally from a Chinese employee who worked there. Locating the salt shaker and enforcing local lockdowns bought Germany crucial time in stopping the spread of the virus, scientists said. Similarly, devolved contact tracing teams were all part of the response of Canada, Ireland and Iceland – countries with successful records of controlling local outbreaks.

The town centre shopping area around Freshney Place and Victoria Street

North East Lincolnshire’s agility in contact tracing was shown in their management of Covid-19 in care homes across Grimsby and Cleethorpes. The public health team’s close relationship with homes have enabled them to conduct a small, informal trace and isolate plan for them. Where places like Tewkesbury, near Cheltenham, have seen deaths in care homes linked to Covid-19 occur at a rate of 10 per cent of total care home bed capacity, the number of care homes with any cases in Grimsby can be counted on one hand, with no serious outbreaks.

This is only possible if test results are delivered quickly. With a wait of 48 hours or longer, the task of finding every person a patient has come into contact with recently becomes all but impossible. Key workers who have been receiving tests at the local facility at the Humber Bridge, run by private contractors G4S, have had to wait up to nine days for their result.

“We just worry about nipping it in the bud as quickly as possible,” says Pintus. “Ideally the national system would be responsive and quick to react, but if it isn’t, we have to be able to respond immediately on a local level.” Hall says it more directly: “If contact tracing had been given to local government from the off, we would have had a lot fewer cases and a lot fewer deaths.”

Without a vaccine on the horizon, contact tracing to locate outbreaks is the only way to come out and stay out of nationwide lockdown. In the middle of May, after an unsuccessful trial on the Isle of Wight, the government’s flagship contact tracing app was not ready. Tracing would have to rely solely on patient interviews, and persistent lobbying from councils to involve them and their public health teams eventually cut through. The Government announced £300m for a new partnership for contact tracing with councils, led by Tom Riordan, the chief executive of Leeds City Council.

Whilst the new tracing operation launched on May 28, local teams like the one in North East Lincolnshire won’t be integrated until the end of June, and exactly how they will work with the national, Serco-run, call centre is yet to be ironed out. “It’s too late,” says Hall. “It should have happened on day one when we got the first case in England.”

In Grimsby and Cleethorpes, despite the low levels of virus infection, people are nervous about what the easing of lockdown might bring. After government messaging changed from “stay at home” to “stay alert” in mid-May, people started returning to Cleethorpes on weekends. The seafront has been pedestrianised to encourage visitors to social distance.

Chris Stanland and Nikki Gibson

Chris Stanland, who works in the Young’s factory in Grimsby, suggests that the area might have gotten off lightly so far. On the factory floor of one of Grimsby’s biggest employers, Chris claims that social distancing is an impossibility. “Social distancing doesn’t actually exist.” When he is on the lines, he says, “people are just walking up to you chatting away, as if [the virus] is in its own little bubble.”

And so for Chris, who suffers from diabetes and high blood pressure, and whose partner Nikki is a care worker, the easing of lockdown socially only compounds the fear of infection. “We’ve got the beach 20 minutes from our house,” he says. “Everyone’s going to come visit the beach. It’s just going to bring that second wave of cases here to Grimsby. Unfortunately, it’s economics versus safety. You have to make a tough decision somewhere.”

Pintus sets out the risks: “You only need a Cleethorpes care worker to touch a surface touched by someone [infected] from Yorkshire and then they go into a care home here. That would be the way it would be reintroduced back.” The public health team are closely following the cases of towns further up the coast, with comparable demographic profiles to Grimsby, such as Hartlepool and Sunderland, which had a similarly low rate until a recent huge surge of cases, to see if lessons of prevention can be learned.

In East Marsh, as restrictions lift, there is confusion over what is and isn’t allowed. The worst may yet be to come, and people want measures that respond locally and quickly.

“We know physical contact is how it spreads,” says Revd Jones, “and we know when we go outside, we can touch things that can spread it. But now we’re set free, and people are coming in from Doncaster and Sheffield, where there are higher rates.”

“People are asking: why now?”

All photographs Steve Morgan for Tortoise

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