This is a very rough and unverified transcript of the Isle of Man Government produced COVID Question & Answer Session on Wednesday 27th January 2021. In particular, for any legal guidance, you should seek advice from official sources.

You should not rely heavily upon it — it is transcribed by an automated speech recognition service, and I cannot guarantee its accuracy. Any local Manx words (especially in Gaelic) are more likely to be inaccurate. Also, the automated speech recognition service often converts proper nouns incorrectly (especially the spoken words “Isle of Man” to “Ireland” or “all of man”).

Before relying or quoting anything contained here, you should verify it against the underlying audio recorded here. Time Stamps and automatically-generated speaker names should help in the verification.

James Davis 0:00
Well, Hello, good afternoon welcome. I suppose this is what they call a bonus briefing really, one way you the great Manx public are asking the questions to the health officials of the day, and hopefully an opportunity where we can explore and dig deep into some of the issues and the areas of the day and drill down into some of the specific concerns and queries that you have. My name is James Davis from Isle of Man Advertising and PR and my job is to literally put the questions from you on your behalf to our guests who will introduce it in a moment and hopefully have a chance to look ahead into the long run. After next week when potentially Fingers crossed, the island may well be in a position to come out of lockdown. Without further ado, let us welcome our guests. I’m delighted to be joined by the Chief Executive of the department of health and social care, Kathryn Magson. And the Director of Public Health Dr. Henrietta Ewart. Thank you, both of you, for your time are no strangers to this forum. Of course, our panellists are literally here to answer everything, and anything within reason as long as it’s relevant from you this afternoon, so no problem. Now I’m told her Brexit, the HS two network and Liverpool’s FA Cup run are out of the equation, but anything other than that is absolutely fine. I’ve not long seen them there is an element of some repetition in some of the questions. So in a few of those, I will double up rather than ask virtually the identical question twice. But that aside, let us let us get going. And we’ll start with it with a net if we may. She’s been in touch. There’s a vaccination query from her. And I’ll put this to Dr. us to begin with, if I may. She says why is the Isle of man’s vaccine rollout in her words, so much slower than guernseys? An island nation with a with a smaller population than ours?

Henrietta Ewart 1:50
Actually, I think that’s more one for Catherine because this is an operational issue that she’ll be able to speak to

James Davis 1:56
I do apologise, Catherine.

Kathryn Magson 1:59
Thank you. Thank you, James. Yeah. So in fact, we don’t we don’t believe that actually, our programme is behind. And there is a there’s a recognition that we started effectively an operational week later than Guernsey, which may be driving some of the viewers thinking and findings behind that the way that they’re viewing the numbers. But we do we absolutely and starting this programme on the fourth of January, and that was the difference effectively of a week, I think we’re really referring to and the minister has been really clear so that we we will catch up for want of a better word. And I actually do think that catch up probably within the next and then next week is that we actually went through a very, very stringent process to ensure that all the paperwork was correct. And your listeners will be aware of the fact that actually, we are reliant on the UK indemnity in relation to this vaccination is on the Isle of Man. And in doing so we didn’t have all the paperwork in place in relation to starting this just before Christmas. So we did take the right decision to get that right to finish that off to finish it off completely, to ensure that not only is we do this, in the right way clinically, and using the right prioritisation, but we do this well. We do this in a very structured, clammed careful way that residents feel safe. And it’s equally our responsibility that this is not about a race, it’s about doing it well. And it’s about doing it best. And it’s getting all of those processes and procedures in place. So I just want to stress a little bit. And I’m hoping some of the listeners may well have seen some of the dashboard stats that we’ve now started to publish, which we promised to do. And I’m a big believer in transparency and openness around where we are. And the dashboard went live yesterday, it’s been through quite considerable quality assurance. And I know there’s been some views and thoughts already around how we might improve that and how we might produce more information. Absolutely welcome that and welcome for some thoughts and views, again, from people if they want to contribute that. So for example, we’ve been asked to supply you know how many deliveries we’ve had on Ireland, how many vaccinations we’ve got to set aside we will do that that’s not an issue comfortable, we can do that. But just to give some feedback, and these are updated every 90 minutes. So I am only going to give you stats as it were as of last night actually. But even if I look at the live dashboard, now they are different. So recognise that this is last night. You know, we have done 4678 vaccinations, 4049 of those were firsts. And 629 of those are second doses. And to give you some idea of the scale, which we’ve always said we’re going to be doing and ramping up in line with the deliveries that we receive. And we’ve got 3000 individuals booked over the next seven days. So bear in mind we’ve been here since the fourth of January we’ve done 4678 in total, which is now actually a high number as I speak now but and then a 3000 in the next seven days. It gives you a real feel for how quickly this programme is developing and accelerating. There are actually 6500 vaccinations booked beyond seven days. So, so a lot underway and actually by my reckoning over the next seven days we will be will have done 7000 vaccinations, which is more than 8% of the population. And so I’m just in relation to people often asked me also how many vaccinations we have in Ireland, that’s a common question perfectly valid. And our aim is to vaccinate as quickly as we receive we are dependent on the UK deliveries they come once a week, although it can change. And even only yesterday, we received a vaccination tray of Pfizer vaccinations, that’s 970, although we do actually get six vaccinations out of each vial, so that will be for 1170 people. And so just to get a feel for where we are, we have one Pfizer tray in stock. So assuming 1170, to be booked, and for set aside for their second dose, that they’re in the deep freeze the hell out of that minus 70. And put aside in line with our policy around a second dosage. So that changes all the time. And it is a very Moveable Feast, the delivery schedule does definitely move, including the volumes, although Pfizer is is certainly generally more standard every week, we tend to receive a tray,

Kathryn Magson 6:25
and AstraZeneca, which is the second vaccination that we’re currently using. Now, when we started in the residential care homes last week, and we’re starting in the airport tomorrow. We have 2400 vaccinations on Ireland for the first dose, and 2800. On the second dose, there’s a difference between the two because I said this is live information. And actually some of those first doses are underway in relation to the care home and the residential home. So we’ve got enough set aside for those that we’re getting the first days through to the second. So the second dose we’re going to use and again, filling that hopper and that funnel of what we’re receiving on Ireland, nearly 2000 of those that are about 1700 next week, this week from tomorrow at the airport, just over 400 a day. And the rest of those trays are satisfied for the residential care homes, which your listeners will know is absolutely one of if not is the first priority group to receive their vaccination. So it’s really important to this and I no matter what sport This is that in line with our policy position around jcvi. And find those protocols, that we do ensure that we’ve vaccinated in order to protect those that are most vulnerable. And those top priority groups first. So hopefully that gives you some feel for the numbers that we’re holding, and numbers that are coming through. And I do I am due to get another delivery today. And that will be a Pfizer tray, and then an AstraZeneca tray. And we will in line with those delivery schedules and booking. And just to get a feel for how fluid This is, and how fast we are working. We didn’t expect to tray from Pfizer yesterday. But we’ve over the next couple of days where we’re going to bring forward because we now have one. And all of those that were booked in on the 15th of February week to next week. And the one on one team are on the way with that. So lots going on. And we’ll continue to share that information. And as I’ve talked about, would encourage people to look at the dashboard. If they cannot have access online to do so.

James Davis 8:24
Thank you very much indeed. You’ve actually answered Katherine there about three of the next questions as well in that, so I do appreciate that. So if I don’t bring your question to the panel, please understand it’s because that they have been answered in in that in that fairly articulate lengthy answer. And Leslie, just on top of that, really moving on slightly, is just queering. He says considering the vaccine doesn’t prevent individuals from catching the virus or indeed passing it on. He’s just questioning what the advantages are advantages are of having it. I know this has been answered before, but just for Leslie’s purposes and anyone else interested? If you would give an answer to that, please? Yes. So

Kathryn Magson 9:05
again, between the two of us, I think Henrietta would be best to answer that from a public health perspective, and that’s okay.

Henrietta Ewart 9:11
Yes, I think there’s some confusion in the question because it confuses what we know, with what we don’t know. And what we know is the results that had been published from the phase three trials that were done on these vaccines, and they measured certain things and they got results about those certain things. So that is what we know. And that is the both these vaccines very significantly prevent people becoming ill and more specifically, seriously ill with COVID-19. What we don’t know is whether it stops them being infected. These are vaccines, they do stimulate an immune response, so they do stimulate the recipient to produce both an antibody and a cellular immunity response. which targets the spike protein on the virus, and clearly makes it much, much, much, much less likely to cause you to be ill, to any extent with COVID-19. Over the coming months, as more and more people are vaccinated, and more and more long term follow up is available, we will begin to understand whether it stops people transmitting the virus to other people, and whether it stops them becoming infected. But we don’t know that yet.

James Davis 10:31
Thank you. Moving on, john is trying to understand, aren’t we hold john, John’s trying to understand where we go once the population of the island man is vaccinated in terms of he says it appears inevitable that annual vaccination may well become the norm for many, with the attendant pressure on the health service. Of course, however, he says even if it transpires that the vaccines do suppress transmission, and achieve the principal objective of saving lives, they’ll still be a small percentage, he wonders a vaccinated people who remain vulnerable for whom the jab is not effective. So his question is, will the number of people who remain vulnerable will be low enough so as to not overwhelm our health service?

Henrietta Ewart 11:16
The best case scenario is that we can get about 80% of the population vaccinated and protected. So in the 20%, you’ll have the people that have said they don’t want a vaccine for whatever reason, but non clinical reasons. And also the people who either can’t have it for a clinical reason, or because of their clinical condition, do not make a good response to the vaccine. And typically, that would be people who are immunosuppressed, they their immune immune system is not able to make that response to the vaccine. So that’s what we’re trying to aim for 80% really of coverage of people who can be protected, and that we will hope, but obviously, we have to wait until we see what happens will enable us to reach a sort of an equilibrium where the levels of the virus, the severity of the illness, it causes and the pressure on the health service will all be violent civil.

James Davis 12:15
Thank you very much. Indeed, just as a supplementary to that, john, is that is asking will the opening of the borders ultimately to all allowing potential new and harmful strains of the virus to enter the island, negate all that’s been achieved and is going to be achieved.

Henrietta Ewart 12:32
That is another unknown. Obviously, there are three variants of concern that are being talked about at the moment. One of those emerged in the UK, it looks as if it’s more transmissible, there is some emerging evidence evidence, which is not yet certain that it may cause more serious illness. At the minute, it looks as if the vaccines we have are still effective against it. Then we have the other two variants. One is a South African variant, which has been detected in the UK. And that also looks as if there may be issues with immunity there that the vaccines may not entirely work against it. And then the third one is a Brazilian variant. There have been two Brazilian variants. In fact, the second the most recent, that has not yet been detected in the UK, but it has been detected in people who travelled from Brazil to Japan. And again, early early work indicates that there may be an issue there about immunity. But all of that is currently being studied in depth by the vaccine manufacturers, and also in other studies to look at whether people who have natural immunity because they were infected by other strains, whether that cross covers for these new strains or not. So all of that is working progress. And we don’t know the answers to it yet. But it is something that is obviously of concern.

James Davis 14:08
I appreciate it. In some cases, it’s like being asked to where to predict the lottery numbers for tonight, for example, I know it’s not definitive, but is there is there a point where enough of the island’s population will have been vaccinated where health chiefs and by that I mean yourselves and others can will recommend to government that border restrictions be used?

Henrietta Ewart 14:32
Yes, I mean, as always, decisions about the border are political decisions, obviously. And they are driven not only by what’s happening here, but what’s happening elsewhere. And in our context, the most important elsewhere is the UK because that’s obviously where where most of our cross border travel originates. So there are all manner of issues there. Obviously back in the summer, when rates of viral infection COVID infection across with very low or compared to where they are now, actually, we did relax the borders a bit, we brought in the seven day test as a way that people could come in and have shorter self isolation, because the risks per per traveller of being infected were very much lower. The risks per traveller now are obviously unacceptably high. So we have a much tighter policy. So even without the vaccine, there are policy drivers that we follow anyway, in terms of the levels of infection across. And now added to that we have, you know, monitoring the situation regarding new variants and what we’re learning about them. And also the situation regarding vaccine uptake, coverage and effectiveness.

James Davis 15:48
And thank you. And just Further to that, is there a known some form of scientific modelling or known percentage or benchmark by which you will use that to assess the infection rates in the UK and beyond and make that decision or certainly advise recommend to the politicians?

Henrietta Ewart 16:05
Well, that’s simply based on the infection rate 100,000 across and then pro rata, muttering that to the number of people that come across the border. And obviously, that would change depending on border policy, whether we’ve opened up the borders or whether we haven’t, and then from that the number of infected persons that we would expect to come across based on the prevalent infection rate at the time.

James Davis 16:32
Thank you very much. That’s that’s very helpful. Thank you. And Solomon has a point here just moving slightly off topic. He wants to know, how can we stop what has happened in Guernsey this last few days happening here?

Henrietta Ewart 16:45
simple answer, we can’t. We were almost like Guernsey just into the new year, as people will remember when we had a really quite significant cluster, we’re still doing the final analysis on it to really understand where it came from. But at the moment, we’re pretty confident it came from a travel episode. So we know how it got in Guernsey are one step further down the line of uncertainty if you like in that at the moment, they can’t link back kuster to a travel event. And that means that whereas for us, we were lucky because by the time we managed to identify the issue we’d got if you like one line of transmission, and we just had to follow that through with rigorous contact tracing and testing for them, they potentially got, you know, a whole range of different lines of transmission that could be going all over the place in the community. And I think probably the the kind of the illustration for that is something like a Moreland fire, where you don’t maybe even know it started because it started you didn’t spotted it got in under the peat layers. And it’s actually burning its way along under the peat layers. And then every so often it will find a thin bit and it’ll pop up and cause a little Blaze. And when you’ve got the widespread community transmission, and you can’t link it back to one chain and one travel event, then that’s effectively what you’ve got. And that’s a very difficult one to deal with. So Guernsey are doing absolutely what they should be doing. They’re doing very, very widespread testing at huge levels to try and find out everywhere where this could be and then close it down through contact tracing self isolation. And so but yes, there but for the grace of God is what we have to say on that.

James Davis 18:44
Any views on another point that’s been raised on travel passports, I suppose this is a political one, really, it looks increasingly that that most countries will require some sort of proof ultimately for for being negative for COVID before entries permitted. So could travel passports become the norm, especially if you want travel insurance? It is a political one in in a way, but it’s being asked so I thought I’d put it to you.

Henrietta Ewart 19:11
Okay, let’s put in another one that I can pick up. I’m not sure there whether you’re talking about a passport based on a certificate of vaccination, or a certificate that says you’ve just had a negative COVID test. I suspect

James Davis 19:25
they mean the latter.

Henrietta Ewart 19:27
The negative COVID test. Okay, the problem with that is its snapshot. All it means is that at the moment that you had that test, you were not shedding virus, you could already have been infected and be incubating. And the test won’t prove you’re not. So I think the issue with those tests insofar as they’re useful, they are useful as a red light test. So if you test positive, you don’t travel. But if you’re negative Have you travelled, but it’s not a guarantee to the place you’re going, that you aren’t incubating and aren’t going to proceed to be infectious and infect people once you’ve got there. Now, if you are talking about travel between countries, which both have circulating COVID at quite high levels, then actually, that’s quite a benefit, you may be grateful not to get a few extra positive cases. And if you still get a few cases that weren’t positive, when they tested, you don’t really mind. Because it will make a huge difference to your overall situation. For us going through elimination, it would make a huge difference, we’ve only got to get one person across the border, who goes about their business without any self isolation, and they could spread it everywhere. You know, we could be in a very bad position very quickly. So that that’s the issue with those tests, really, they don’t guarantee that you are negative, they will tell you if you’re positive, then you don’t travel. But for elimination, somebody who just might be incubating. We don’t, we can’t take that risk, we would still have to do the self isolation and the testing regime here. And the passport or certificate wouldn’t get the personality of that.

James Davis 21:16
Very helpful. Thank you. Very, thank you very much. Just back to the vaccine slightly a question from john here. His question relates to the current vaccination numbers and and simply ask, Are you going to achieve your target the island’s target to have everyone on the island vaccinated? By September? I think he’s questioning at the current rate. Is it really achievable? Yeah.

Kathryn Magson 21:36
So just to reaffirm, yes, absolutely. We believe that we can meet that vaccination schedule, subject to, to those vaccination numbers of the entire population in line with the timescales that we’ve set. It is absolutely subject to delivery of the vaccination schedules that are expected to receive on Ireland. And you know, we are dependent on those supplies and will continue to be so it does change, as I’ve talked about earlier, but we we believe that we can meet that requirement. Yeah.

James Davis 22:02
Thank you. Interestingly, as I see the UK is missed its targets on successive days, actually, as well, if we’re outside the UK vaccine programme, Robert asked what it what is stopping that the government from trying to source vaccines from from other suppliers, ie, Russia, India, for example.

Kathryn Magson 22:23
Yeah, so that we’re not in that position, we do source them entirely in line, we as a government, we need to be indemnified for these vaccinations. They are licenced under emergency regulations, which we mirror the UK position. And we’re directly related to how the UK sources vaccinations, clearly as a very small island, we don’t have the ability, the scale to be able to do that, and the indemnity and everything that sits behind it all features through that chain. So our source will be through the UK, we have been given those assurances in line with our percentage of the population, which is naught point, one 3%. We are receiving those supplies as expected. And again, we had a surprise supply this week. And it may fluctuate. We’re monitoring it carefully. But we will resource up according to what we receive in line with the predicted delivery schedules.

James Davis 23:15
Thank you. Let’s move on to Eileen, because thanks for your question. Ireland. Simply she wants to know how you reach the decision to decide the order of call up for vaccine. She’s asking, Is it by date of birth? Is it by month? Is it alphabetically from a list compiled from where I’m sure there is a foundation and a structure behind it?

Kathryn Magson 23:35
Yes, that’s really support transfer. Yeah, so we do, we’ve been using the jcvi protocols, which I think have been widely publicised. They are UK priorities that are set to gain as a huge infrastructure behind clinicians, medic scientists and professionals that have determined these priority groups. And we remember those, that’s a policy decision of the department. And we’ll continue to do so in line with the size of the evidence that’s coming through. So if they change them, we’ll continue to review that and make those changes accordingly. So we follow those to the letter. And in doing so, you’ll have heard that their key priority is to vaccinate the top two priority groups first. So ultimately, the first group is those from residential and care homes. And we weren’t able to start those first because the Pfizer vaccine itself was was it was impossible under our legislation to be able to pack down Scotland were able to do that, but not England and other parts of the UK and the dependencies. So we have started using Pfizer with the second group. But as soon as AstraZeneca arrived, and those documentation was ready then we started with the AstraZeneca vaccine in the residential care home. So those are the top priority groups residential care homes and those that work in those settings. The second one then is the over eight ism frontline health care workers. We are working on invited we’ve invited all of you We’re working on completing those. And then actually, as we’ve completed those who have come forward, we then start filling that hopper of the next group through. So we are about to issue the over 75 letters and towards the end of this week, and they go out in batches the same way as the over eight is do. That’s not for any particular reason other than allowing my mum, to cope with the volume of calls, there are more than 4000 people in each of those groups. And I know we do is the post office to issue them for us. They’re called from the GP registered list and then sent to the post office and they issued them in batches of 500, it takes about 10 days to issue those letters. And the over 80 of them will take a similar number over the over 75. But we continue to say to people, when you have that that is the time to call, when you’re invited to come forward for registration, that’s the time to call one on one. And we ask people to wait until they’ve received those letters.

James Davis 25:57
Just on testing a question from Michael about the various COVID-19 testing processes. He’s wanting to know how many false positives how many false negatives? Does each different testing process on the island man generate? I don’t know if you’ll actually have that information to handle you. Yes, I

Kathryn Magson 26:15
can. Absolutely So and Henrietta may also want to come in as well on this and FDA logical perspective. So our main platform and has been throughout. And we do believe that that’s been fundamental in their success in managing our strategy is what we call the real real time PCR platform. It has an absolute sensitivity of 98.9 to 99.1%. And we, if we do pick up any false positives, then what we do is we recheck those and they tend to be due to inadequate swabbing in all honesty, but they are less than naught point 2%. And the way that the team have worked here and established, has been phenomenal. They’re doing a considerable number on a daily basis are able to scale up. And not only the pathology team, but also the swabbing team. And actually, in reality, we’ve been really pleased with the the array of platforms that we now have, that creates resilience in the system by constantly evaluating those methods and confident that we’re providing a comprehensive service for the residents. The Isle of Man, I don’t know how many of you want to come in around the epistemological?

Henrietta Ewart 27:23
Yes, I mean, really just to say that the test is only just shy of 100% in terms of both specificity and sensitivity. So it really is the gold standard test. And that’s universally acknowledged globally. In terms of the false positives and the false negatives, false negative is most likely to happen either because the swab wasn’t done properly didn’t get enough cells to process or because the person was tested very early in infection. And although they were infected with COVID, they weren’t yet shedding cells with the virus in. So that’s the main reason for false negatives, and false positives. That would generally be you know, an issue like a mix up of swabs, or something of that sort. But that’s not an issue that we have had any issues with here at all. Fortunately, it’s a very well managed process.

James Davis 28:21
Interesting question from Brian, he’s asking in order to determine whether or not the community is free or otherwise, is free or otherwise of COVID viruses. He’s asking his testing of sewage being undertaken? Who would like to take that one?

Henrietta Ewart 28:36
I’ll take that one. Because actually, it’s an absolutely fascinating topic. This is wastewater testing. I’ll answer the precise question first, and then just talk a little bit more about it. Would we do wastewater water testing to confirm that an outbreak had gone had been completed and closed? No, we wouldn’t. And this is the reason wastewater testing is designed to pick up virus that’s been shed from the body in a number of ways. But the main way obviously, given the nature of it is in faeces. could also be in urine could also be skin cells that have gone into the wastewater system as part of how all the waste gets generated. But those sources all of them are likely to continue shedding bits of dead cell and dead virus that would still be detectable quite a long time after active infection and the risk of active infection had gone. So it wouldn’t really help us to say had we close down our outbreak because we might go on seeing that for a long, long time. We don’t actually do any wastewater testing on the island at the moment. And there are a number of reasons for that. Firstly, it’s technically quite complex. That may change because there is a lot work going on to develop sort of automated platforms for doing this, which will make it a whole lot more straightforward. And also, there are some unanswered issues about where in the wastewater system is the best place to do your routine monitoring and testing. There are also things that we don’t know in terms of what are what are the questions that this kind of additional surveillance would help us to answer. Now, it may be that actually, wastewater surveillance is a good early warning system. So possibly it might begin to show us early signs of infection before that actually translates into symptomatic cases that presented for testing. We don’t know that yet. It could be. The other thing it could be is really just an adjunct to understanding what’s going on in terms of a symptomatic outbreak, potentially using geographical results from wastewater testing, to say, actually, hey, you need to get over to that area and do some extra surveillance, extra testing there, because we’re seeing quite a lot in the water here. But it’s not coming forward in the test results. So those are the ways it may be useful, but how it will be useful and how it’s best to do that, how it can be cost effective to do that. We’re not clear on yet. And actually, there are a lot of pilots going on across the UK to try and answer some of those questions. And some other countries are also doing similar work Australia is one. And so we’re looking at the results as they come from those places to see whether it would be a useful and cost effective adjunct for us here.

James Davis 31:43
It’s something I’m sure the majority of the public wouldn’t have even considered. So thank you for that. The answer? Thank you for the question. From testing to shield and Keith is asking, given the the virulence of the new variant, and how easily it could reappear in the community, would you advise the elderly and the vulnerable to continue shielding for at least two weeks following the first COVID jab, to allow time for our level of immunity to be built up?

Henrietta Ewart 32:12
I think to an extent that depends on the overall context. If we’re confident that we have returned to a locally COVID, free situation, the strength of any advice for people in the clinic give me a very vulnerable group to continue shielding, the strength of that advice comes down because effectively we are not concerned there is much that they have to shield from this is really where we get into how people feel about things themselves, how they assess the risks to themselves and what they’re going to feel comfortable with. You the questioner is absolutely right. But it takes about two weeks to develop the immunity following the first vaccination. So if people feel that they would be more comfortable to you know, continue shielding or partially shielding until that time regardless of the level of risk on Island, then that’s a decision for them to make.

James Davis 33:09
Just a general point of its being raised here. Before we we move on. It’s not a medical question. It’s not a political question either. But rightly or wrongly, Do either of you sense a less tolerant, more critical, aggressive approach or mood amongst the public this time, and I appreciate a lot of comments on social media far from reflects all of the public but in some areas we see in here. We it seems to be we’re hearing so much less of the the wonderful community spirit and collective effort we had last spring, just just a thought and observation from from a listener or viewer. But I just want to share that with you. Because obviously you both hear and read a lot. You get a lot of feedback.

Kathryn Magson 33:58
I’m happy to take that first day because that would help. Yeah, I, at the end of the day, we concentrate on receiving feedback from a variety of different sources, they I don’t think we’d be in a position where we were, unless there was a great deal of tolerance and understanding and support for the strategies that have been in place, we wouldn’t have been able to be in that position where we’ve effectively that’s in no community transmission. If If behaviours, especially one of the better word and tolerances you’re describing, we’re not we’re not excellent. You only have to look across to see differences there and ultimately what it could look like differently. And I pay credit as a new member, a number of the ministers during council of ministers in a way that the Isle of Man, residents have behaved and have been tolerant of what they ask is and undoubtedly they are the key difference that’s made the difference in where we are now and that’s how I would answer it.

James Davis 34:48
Not to you know,

Henrietta Ewart 34:49
yeah, but absolutely agree. I personally keep off social media, but obviously I do get emails from members of the public, often giving their views about what they think we should or shouldn’t be doing to manage the situation. And I think the key thing is that the people who email generally have a strong view of one or other end of the spectrum. So I think one has to interpret one’s one’s postbag or email bag in that light. But I think Katherine’s absolutely right, we wouldn’t be where we are now without, you know, a major buy in from the vast majority of the people on the line. And

James Davis 35:27
you’ll be glad to know both of you neither of you a trending but but it’s very interested to hear your answer. So thank thank you very much for that. The pandemic plan, Muriel says how far along the lines, are we following the department’s pandemic plan, as referenced in the islands major incident response plan from just over a year ago now, and when was it last updated?

Henrietta Ewart 35:47
Okay, that actually is interesting, because the pandemic response plan is actually designed to be a pandemic influenza response plan. And it was last updated in February 2020. It’s actually held by the Department of Home Affairs, rather than by public health Cabinet Office or the dhsc. And because it’s an a pandemic influenza response plan, a lot of it was not relevant to COVID. Because obviously, in response to influenza, you expect two things that were not present at the beginning, but COVID. And those two things are a vaccine against the pandemic strain strains, which if you don’t have it, initially, you expect to have pretty soon into things. And secondly, the need to distribute and use antivirals as treatment for the pandemic influenza. So the pandemic influenza plan has a lot that is built on those interventions, and therefore does not major so much on the non pharmaceutical interventions, the things like social distancing, gathering restrictions, face coverings and so on, that we’ve had to use with COVID. Because at the beginning, certainly neither vaccines nor effective treatments were an option at all. So you know, there was some some elements where there was transferable learning transferable approaches, but others were there weren’t. But it was actually February 2020, as luck would have it, just before all of this kicked off, that that plan was last updated

James Davis 37:31
just before it all began. Thank you, doctor. I’d be interested in your viewpoint as well. Katherine Maxim. Yeah,

Kathryn Magson 37:38
thank you, James. Yeah. So just to add to what Henrietta said, clearly as a department, in our part in playing that, and clearly, one of the lead departments in doing so and we sit under this command structure that is part of that that planning, is just referred to. And clearly we as dhsc, have had to have extensive plans prepared. So we’ve taken it even one step further. So we, you know, we we’ve talked about how we, in the past how we developed, and the first lockdown or the planning that went without what we had to do to shut down services. And actually, we then spent, because it’s incredibly difficult and time consuming them to pull back and reopen all those services. So it did take us quite a number of months to do so. And we prepared those back to health care documents. But as a consequence of all the work that we have done, in relation to this lockdown that we’ve had, we’ve had, clearly a lot of the suite of those documents that would sit within those that escalation planning and pandemic planning from a COVID perspective that we’ve been able to enact. So P P is one of those personal protective equipment that we use in health and care settings. So we will quite easily able to as soon as the next lockdown was announced to roll back into those. So all the plans that we’ve had have been developed, they’re obviously clearly developed a pace and we had to change the laws as we went along. But we’ve been able to use those and we’ll continue to be able to use those. So we in effect in healthcare, we have a lot of escalation now de escalation plans that will form part of future planning, and ultimately response plans for the future.

James Davis 39:10
That’s great. Thanks very much. Indeed. Alice has been in touch she has long COVID. You may have heard or or read about her difficulties in the local media, a three pronged approach hear from her. She’s asking what the department’s doing to treat people with long COVID symptoms to prevent them from becoming effectively long term disabled. Has there been any training for GPS and medical staff here on diagnosing and treating lung COVID? And are people with severe lung COVID being classified as vulnerable for the vaccine rollout? I don’t expect you to remember all three of those but just start with that the first one, what’s the department doing to treat people with the lung COVID symptoms.

Kathryn Magson 39:49
So as a department we’re very, very aware of these issues have been cases that have been flagged to as you would expect, we’re managing them Catholic the moment with guidance and advice. It’s coming from the UK, there is some nice guidance that exists as well. And we’re developing and started to think about what these pathways might look like. We have appointed Li cognition within the HSE to start to develop those, and the diagnostics that go with it referral pathways, and then that will come through and do and be agreed by the department. So it’s early days yet. And that’ll be a piece of it as a piece of work that’s already underway. At the moment, individuals are being managed in relation to diagnostic tests and referral pathways in line with some of the symptoms that they may be feeling.

James Davis 40:37
I’m sorry, we’ve lost Katherine for a moment, I don’t know if from a clinical perspective, if I can bring you in at this point. And hopefully, then we’ll we’ll go back to Katherine Maxim.

Henrietta Ewart 40:46
We don’t know about long COVID, because we’ve only been able to study it over the number of months that it’s been around. It may be not just one diagnostic category, but several, depending on different symptoms, whether there is organ damage, whether there isn’t and so on and so forth. So it’s not easy. And it’s not something where one can just set up a long COVID service. The best we can do really at the moment is to keep very cognizant of the work that nice is constantly doing to keep on top of the emerging evidence base. And the recommendations for interventions or support and rehabilitation, that flow from that. Obviously, some of the general principles for person centred rehabilitation will apply to this as they apply to anything else. And as we learn more, we will be able to, you know, fine tune responses for different patients accordingly.

James Davis 41:44
Thank you and back to hopefully by cyberspace back to Catherine. Yeah, thank

Kathryn Magson 41:49
you, James. So yeah, we have agreed, similar to what then Hermes was just talking about was trying to get across was is that we have a legal issue and appointed to start to look at those and developer look at the evidence, look at the nice guidance and determine how we might manage this in the future. So I agree entirely with him yet. And

James Davis 42:05
that’s our approach. And and just just on the last point. And if you did answer it, we when it cuts out, we didn’t hear there are people with with severe, long, long COVID being classified as vulnerable for the for the rollout process for the vaccine

Kathryn Magson 42:19
agenda under this under the jcvi. There are strict conditions and priorities.

James Davis 42:26
Let’s try again. Sorry, shall we? Sorry, Catherine. In here again, we got you got you. But not for long, it would it would seem so MIT perhaps we’ll come back to that question when the links a bit clearer. I have got a question, which while we try and sort those difficulties out, I’ve got a question from Chris about mask wearing, which I’ll I’ll put to you, Dr. us if I may. wanting to know what health conditions are exempt from wearing a mask, he can’t find any guidelines on it. And he’s asking to people with respiratory failure meet the criteria.

Henrietta Ewart 43:01
Okay, the reason there aren’t any guidelines on it is because there are actually no conditions that would be a complete contraindication to Mars squaring respiratory conditions. If you have a respiratory condition, you are at greater risk of serious illness if you catch COVID. So you really should use a mask if you can. The British lung foundation actually has some very good guidance on this. If you Google British Heart, British lung Foundation, face coverings, you will get an excellent set of resources, it’s very clear the way they set it out, they make it very clear that wearing a face covering or mask of any type does not deprive you of oxygen, neither does it cause a buildup of carbon dioxide. So if you possibly can wear a face covering you should, and if you’ve got an underlying condition like a respiratory condition, or heart condition, diabetes, or any of the other things that make you clinically vulnerable, you really should if you can wear a face covering and British lung foundations pages will actually give you guidance to help you do that. Some people however, find it actually very anxiety provoking to have a face covering that may be because as they perceive it, it affects the way they can breathe. Or it may be because they have something else going on like a post traumatic stress disorder, where anything on their face is actually a trigger for very, very severe anxiety. And that sort of thing is an absolutely bonafide reason for not wearing a face covering. So I think the issue there is it’s not possible to say there is a definitive list of conditions that mean if you have that condition, you should not wear a face covering that is not the case. The general rule is if you possibly can wear a face covering insurance if you have an underlying condition, if you possibly can. You definitely should. The British lung foundation and I think probably British Heart Foundation, and others have very good guidance that will give you tips and you know, things that you can do to help you feel more comfortable with a face covering. But at the end of the day, if you feel you absolutely can’t, and the distress it’s causing you is just too great, then you do not need to wear one. The British lung foundation does actually have some sort of resources online that you can download, for example, onto your phone, which will say, you know, I do not wear a face covering because, you know, I can’t I forget exactly what the wording is. So if anybody feels, you know, uncomfortable risk of being challenged, then if you want to download something like that onto your phone and just show it to people, that’s absolutely fine. I think minister Ashford has actually done a very good job of repeatedly saying, Please don’t stigmatise people who don’t wear face coverings, because they probably have a very good reason for not doing so. So that that’s it really, there is no hard and fast list of conditions. But some people for a variety of reasons, may just find it impossible to use a face covering.

James Davis 46:10
Interestingly, if no one has studied the effects of long term mask wearing and the risk of the mean any studies which show whether social distancing actually works or how effective it is, do you know just out of interest,

Henrietta Ewart 46:22
yes. Now this is very, very interesting, because if you try and do single intervention studies, it’s damn difficult. It’s difficult enough to try and do randomised control trials where the intervention is swallow one tablet, once a day, even when you’re trying to get people to do that they don’t do it, they forget to take it, they take two on one day, and then no more for a week. And that’s under trial conditions, when people are really, really motivated, and they really, really want to do it, you can imagine that trying to set up trial conditions to investigate a behavioural intervention is virtually impossible. However, there are studies and lots of them. And as with any studies, actually, some will show it’s the best thing since sliced bread, and other will show it’s absolute rubbish. And then there’ll be loads of others that cluster in the middle of that. So you have to do what we call systematic review and meta analysis to actually get an overview and an analysis of the whole pooled data if you like, rather than doing what a lot of people do. And I get these in my email box, or at least every week, if not every day, people cherry picking a particular study and saying this study shows x is rubbish, you shouldn’t be doing it, you shouldn’t be recommending it. And actually, you know, you cannot draw conclusions from one study. Even if it appears to be a gold standard quality study, there will still be limitations to it. And as I say, when you’re looking at anything that is a behavioural intervention, the issues about getting a quality study are even greater. And in fact, when you’re looking at transmission of a virus, you’re not only looking at behaviour, you’re looking at behaviours, against the context of the background level of virus that was there in the first place. I think what we do know is that respiratory viruses overwhelmingly pass by droplet spread from person to person. So the bottom line is, if you do not mix with anybody else, you will neither catch nor transmit the virus. But obviously, we can’t live like that. We do know that there is no single silver bullet intervention. Rather, we’ve got what is usually described as a Swiss cheese model, which is lots of slices of cheese. each slice represents a different interventions. So one slice would be social distancing, one slice would be face coverings, one slice would be reduced numbers at gatherings, etc, etc. And all of those, if you line them up, you get the Swiss cheese thing where there is no straight line through that the virus can go through, there are bits where the virus is going to fall off each time. So we need to be doing all of those things all of the time. And that is difficult when it comes down to behaviour. But that is really the bottom line on this if we want to reduce the transmission of a respiratory virus virus.

James Davis 49:33
Thank you. I do like the Swiss cheese analogy. Very, very, very helpful. Thank you. Um, third time lucky Fingers crossed. Yeah, about to have a maxon people severe lung COVID. Are they being classified as vulnerable for vaccine rollout?

Kathryn Magson 49:46
They get a quick answer so we don’t lose signal. So effectively, we’re starting the over 75 at the end of this week inviting those as we said, Please wait till you have your letter before calling. And the next week after that will be those that are under the jcvi priorities. vulnerable, there is a distinct list and the GP will decide we’re asking them to start gathering that information at the moment, then they will advise as a militia those letters accordingly.

James Davis 50:09
Thank you. And we are virtually out of time. But I just want to put one more point to you, Miss max. And if I may, quite rightly, we’ve been COVID focus for many months now. But Rob says this has been at the expense of particularly cancer testing treatment, it will sadly result of course, it has already in cases not being identified quickly enough. And poor outcomes for those who missed treatments. He’s asking, how is the department addressing what is, is clearly part of the hidden costs of this pandemic?

Kathryn Magson 50:40
Excellent question. And one, I’m sure that we’ll be down to many studies around the world in reality of the impact of COVID and long term impact of the COVID. I think we should start from the concept of we’re extremely lucky on the island. And we’ve talked about earlier on in this session actually about where we are, that has allowed us, in effect to keep the majority of our services open for pretty much now for over six months since the first lockdown. We were we’ve continued throughout the second lockdown to keep as much business as usual as we can, there’s been a slight reduction of footfall. But our main change actually in this last lockdown, which we’re very conscious, obviously, elective programme, and that’s the inpatient elective programme, we did continue to keep de cases open. And it really was to protect that capacity that I think you referred to earlier in case that we did spike and we had practice on the health care system. I’m pleased to say that we’re actually reopening the elected trustee this week, and the impatient elected capacity. And our focus, even behind the scenes, despite everything else with COVID is start to me to think about how do we continue to do that work that we wanted to do almost 12 months ago, to re transform and transform and deliver new pathways, the shift of care and the community and everything out of this Jonathan Michaels report was about the fourth is very, very firmly on the gas there. There’s some really exciting times ahead. And we’re going to learn from some of the things that come out of COVID. So technology is a really good example. How do we continue to keep for those that it suits and where it’s clinically appropriate virtual consultations alive and maximise the use of what is scarce resource, but at the same time, transform many of those pathways and delivery mechanisms that we’re trying to get the right for, for patients and putting care at the centre. And at the heart of everything that we do. So yes, absolutely recognise it, we have got a huge programme and agenda here to follow you around transformation. It’s not forgotten. It’s absolutely been behind the scenes. And we’re working on rolling out as much as we can as fast as we can. But we should recognise that this is a long term journey. This is going to take a considerable number of years to make the changes that are described in that report. There are 26 recommendations, and some of them are imminent in relation to the establishment of Medicare. Some of them are more longer term and will be a gradual process, for example, the digital strategy informatics strategy, but if we if we take particular areas of concern, so cancer that was raised in your question, we’ve seen a huge growth in referrals into the breast service. So we’ve put on extra clinics over these weekends to try and catch up. And we’ll continue to be three to four to move in that way as best as we can to make sure that we’re keeping residents as safe as we can, as we develop these future pathways as we move forward.

James Davis 53:21
Listen, that thank you both, we are out of time. But I really appreciate a real insight into some some areas here and perhaps areas where we’d normally not have the opportunity to drill down into some specific points and issues. So so thank you for that. And hopefully we’ve had a chance to explore some of those today. I say there may be another chance in many ways. I hope there isn’t because that means hopefully we’re we’re on the right path. But certainly if we do do one of these again, there’s other issues to follow up already. I know that we’ve got to most of the questions. So thank you for submitting the questions. It very much is appreciated a real insight into those areas, as I’m sure you agree. A James has been in touch, asking and this isn’t a question for either of you panellists By the way, presumably the car park charges will be waived at the airport and Chester street so people can receive their jobs. Well, it’s out here now. I’m sure the the politicians will. In fact, Katherine Maxim is nodding here. So Catherine.

Kathryn Magson 54:14
That is correct. They will be waiting for your vaccination appointments. Yes.

James Davis 54:17
Lovely. Excellent. Thank you both. The chief executive of the department of health and social care Catherine Magnuson, the Director of Public Health, Dr. Henry Ford, and all of you who have submitted questions, thank you for your time in doing so thank you for your expertise this afternoon. And I think until next time, goodbye.