Interview with Professor Ivan Browne, Director of Public Health, Leicester City Council
This is part of a series of interviews with public health directors, published on 21 October 2020.
Leicester City Council Director of Public Health Professor, Ivan Browne found himself in the middle of perhaps one of the biggest media storms of the pandemic so far – the lockdown of Leicester.
With restrictions easing across the country, the city went into reverse in late June when the government announced non-essential shops would have to close and the imminent re-opening of pubs and restaurants could not go ahead.
For Professor Browne, it was a situation that had been brewing for a number of weeks – although the extent of the lockdown came as a surprise.
“It was more draconian than we thought it would be. We had been expecting that the continued relaxing of restrictions that had been set out nationally would be paused, but in the end the government went further than that. We essentially went back into lockdown – as you can imagine that had major implications.
“Locally businesses that had just opened had to close, while those that were planning on opening had their hopes dashed. It was difficult, but the attitude and response of the residents of Leicester was amazing.
The level of compliance was amazing. We had had good compliance during the national lockdown – and we saw it again. The streets were completely empty. People responded really well.”
The difficulty interpreting the early warning signs
Professor Browne said the first signs that something maybe wrong started emerging in early June.
“At the start of month, we began to get the pillar two data. It was just the raw number of cases so it was hard to interpret it. Hospital admissions were low and we were not getting the granular detail down to a local level that we do now.
“But within a week it looked like our figures were going up, not down. We had recently had a regional testing centre open up in the area so I though it could be a consequence of that. But on June 9 I alerted the regional Public Health England (PHE) team and they agreed to have a look at it.”
Within a week, they had reported back and confirmed Professor Browne’s concerns that Leicester’s rates were indeed out of kilter with what was happening elsewhere. Talks began with government and later in the month the city was placed in lockdown.
“Looking back now, it is clear we experienced what other areas started to see later – rising rates among young people. That is why it had not translated through to hospital admissions and that is what caused some of the initial confusion. Looking back you naturally think perhaps we could have done something sooner – but you make decisions based on the information you have at the time.”
The positives and negatives to lockdown
Professor Browne said there were “positives and negatives” to finding the city back in lockdown.
“We were able to pull down a lot of resource quickly. We had mobile testing units deployed and started to quickly identify which neighbourhoods had the highest rates.
“The council threw all its resources at it – it was not just a public health problem. We had the director of finance working on shielding and the head of property services focussing on testing.
“But you have to remember a lot of what we did – from setting up the walk-in centres in buildings to offering door-to-door testing – was the first time it had been done. We were learning as we went and that was challenging. It consumed every waking moment for quite a while.
“The one thing that became clear was the importance of that neighbourhood-level data – that is a point we were making to government at the time and is something we have now got and I hope, has been of benefit to others.”
The lockdown soon started to have an effect with rates beginning to fall by mid July. “We are now outside the top 50 local authorities when it comes to infections per 100,000 people. We have made great strides. I do wonder now if our rates would have come down without a lockdown. Perhaps not as quickly, but there were already some signs they may have peaked.”
‘I worry about fatigue setting in’
But even as progress began to be made, the challenges did not stop. “The rest of the country was opening up – I remember August 1 being seen as some kind of liberation moment. But it was different in Leicester – we were a long way behind that trajectory and we had to make sure we got the communication right locally.
“We had to create clear blue water between what was happening nationally. We were very mindful of the fact we did not want to undo the progress made on social cohesion so we really stressed the Leicester Together theme – that it was a collective effort.
We have focussed on providing two clear voices – myself and the mayor. It helped build trust.” But as summer has turned to autumn and cases have started to rise again, Professor Browne said he does worry about whether the people of Leicester can sustain their efforts.
“I worry about fatigue setting in. While the rest of the country has had a bit of a summer, in Leicester they haven’t. People have not been able to see their loved ones as household mixing is still not allowed.
I do worry about people’s wellbeing. It is very tough. We are now seeing other areas with rates that are higher than ours which are not facing any sort of restrictions.
“I do wish sometimes we had the power locally to decide if people could meet up in their gardens or just have a little bit of contact in as safe a way as possible.
We are asking a lot of people and we are relying on their good will. There is only so much you can ask. It is now coming up to a year since we first heard of coronavirus. I never expected to be in this position – no one did. But we all have to keep going.