Responding to COVID-19 Abroad: Health Protection in the European Epicentre of the Pandemic

There is no question the COVID-19 pandemic is one of the greatest public health challenges of our time, but it has also provided those of us working in public health with one of the greatest learning opportunities of our time. It has tested our strengths, exposed our weaknesses, and forced us to figure out how to improve together as a system. And on a personal level, it has given me a once-in-a-lifetime opportunity to gain real-life pandemic response experience.

Since 2017 I have been working at Public Health England (PHE) as a Healthcare Public Health Practitioner, working to incorporate public health principles and practice into the more clinically-focussed health services within our region. When COVID-19 hit, all of that changed: it was all hands on deck.

PHE is the equivalent of PHAC in England. We perform a wide variety of public health services from surveillance to health improvement. The Health Protection Team (HPT) in particular is responsible for protecting the population from dangerous hazards and diseases, of which COVID-19 is clearly one. Throughout January and February 2020, the team was working overtime to contact-trace all confirmed cases of COVID-19 in the country, which at that time were mostly people returning home from trips to the continent (not much skiing to be had in England!). They completed a year’s worth of contact tracing in just one month. By early March, they were struggling to cope and a huge number of us from other PHE functions were hurriedly trained and redeployed to support the team full-time. By mid-March, it was obvious that Europe was the epicentre of the global pandemic, with the UK recognised as one of the worst-hit countries in the region. I was working 6 days a week on extended hours with the HPT’s Coronavirus Response Cell (CRC). It was exhausting, challenging, and dare I say it – exhilarating – to be so deeply involved in the country’s response.

While PHE has responded to the pandemic in several ways, the CRC is where the Executive Agency’s rubber really hits the road. At first, we were contact tracing, which was a huge undertaking given the rising number of cases. When it became apparent there was sustained transmission within the community, we focussed our energies on containing the most high-risk and complex outbreaks of the virus, such as those in care homes, and responding to enquiries from both local partner agencies and the public. The number of enquiries were increasing, and the number of outbreaks were skyrocketing. 

By the end of April, I was exhausted. Never in my life had I worked this hard. Never in my life had I experienced so many difficult, distressing, and just plain sad conversations in a day. Never in my life had I been thrown so abruptly into such deep, unfamiliar water. None of my public health training nor previous jobs had quite prepared me for this. 

On any given day, I can be managing a caseload - providing public health advice to individual cases and trying to minimise the risk of onward transmission - or I can be responding to enquiries from the public and from our local partners, such as local government. Alternately, I can be managing what we call ‘situations’. Situations refer to single cases, clusters, and outbreaks of the virus in high-risk or complex settings which require a dedicated public health response. Most of our situations involve care homes, healthcare providers, schools, or large workplaces such as distribution centres and factories. This often involves a bit of detective work to try to determine the extent of the outbreak and the possible means of transmission within the setting, as well as undertaking risk assessments and providing appropriate public health advice to mitigate those risks. Depending on the nature of the situation, we often liaise directly with local government to ensure that, between us, we are providing the best possible support to these settings. 

As we start to move out of lock-down, we’ve implemented a Test and Trace programme aimed at identifying, isolating, and contact-tracing confirmed cases. We now work hand-in-glove with this team, which has been a great learning experience for both sides as we try to come to grips with how best to work together. I’ve been spending a lot of time lately training these new recruits in how we respond to outbreaks, which has been a useful experience for me and made me realise just how second nature this all is to me now. Who would have thought it six months ago! Certainly not I. 

As people are allowed out and about in the community and businesses reopen, our work has become more varied. The situations we find ourselves responding to are much more complex and often involve greater multidisciplinary collaboration For instance, we’ve worked with local authorities, environmental health officers, border authorities, international military bases, and many others to respond to situations in schools, food factories, hotels, ships, and even oil rigs, to name just a few. 

To add a little more flavour to my role, in my spare time (Ha! Wishful thinking…) myself and some of my pre-COVID colleagues from both PHE and the National Health Service have worked together to undertake a systematic evidence review of the impacts of epidemics and disasters on child and adolescent mental health. The review has already been used by those in higher places than I to inform policy decisions and we’re now working on getting it ready for publication. 

While I felt like a fish out of water at first, and still do sometimes, I have learned so much from this experience, and I have been blown away by the incredible determination and resilience of the public health community. People from across the system and across the world are finding ways to come together to protect their populations, and I could not be more proud of my public health colleagues everywhere. If this pandemic has taught us anything, it’s that we’re stronger when we work together.