COVID: THE GREAT DIVIDE
A community that has been ravaged by hardship and deprivation – and now faces the worst virus death rates anywhere in Scotland...
YESTERDAY morning, in the shadow of the town’s leisure centre, soldiers from the British Army arrived for duty in Greenock. In a place usually populated by swimmers and gym-goers, the military has now set up a testing centre in the latest attempt to combat the epicentre of Scotland’s Covid-19 outbreak. It may be too late.
Inverclyde is the undisputed coronavirus capital of Scotland. Recent figures show that for every 10,000 people who live in Inverclyde 13 are dying, giving it a death rate three times higher than the national average.
The dead include the elderly, many with underlying health conditions, as well as health and care workers.
As of Wednesday, 106 lives have been lost in a population of just 78,000.
For Stephen McCabe, leader of Inverclyde Council, watching his home become Scotland’s ground zero has been a shock.
‘I wouldn’t have been surprised if Inverclyde had been one of the areas with a higher death rate because we’re seeing that Covid-19 has the hardest impact on places with high poverty and deprivation,’ he says.
‘But when the figures were actually published, to see us way out in front of everyone else, three times the national average, ahead of West Dunbartonshire just across the Clyde, well that was a surprise. It really was a shock.’
Why Inverclyde and not Glasgow, where the death rate is nine per 100,000? Or West Dunbartonshire, as cited by Mr McCabe, which has the second highest rate at 12? It is a difficult question to answer.
So much so that the council has commissioned a report, due to be published by Public Health Scotland two weeks from now, that will try to answer why this cluster of towns on the Firth of Clyde, which takes in Port Glasgow, Greenock, Gourock, Wemyss Bay and Kilmacolm, has proved more deadly than any other part of Scotland.
Certainly, if there is evidence that deprivation is tied to higher death rates in Covid-19, you will find it here.
The Scottish Index of Multiple Deprivation earlier this year found that some of Scotland’s most deprived neighbourhoods were in Inverclyde.
MuCH of the area is depressed. All but one of its shipyards has closed. The computer giant IBM, which built PCs there from the early 1980s and provided a much needed economic shot in the arm, has shut down. A sugar refinery which also provided jobs has closed, too.
Then there are the health problems that go with deprivation, from smoking to obesity, and the many serious conditions that can develop, including diabetes (the most lethal underlying condition when it comes to Covid-19), high blood pressure and lung disease.
Inverclyde also has a higher than average elderly population. ‘Health is definitely a factor,’ Mr McCabe told the Mail. ‘We have an older population in comparison to many other areas and we have high density housing. urban areas have been hardest hit and that’s what Inverclyde mostly consists of, urban areas with largely dense populations.’
Lack of ‘lockdown discipline’ may also be another issue.
On Saturday March 21, riot police swooped after an assault was reported at a pub called Cheers in Greenock, which had opened its doors despite government advice issued the previous day to shut all bars and restaurants.
As one resident later groaned on Twitter: ‘So ashamed, embarrassed and angry at this.
As a community, we’re doing so much to help each other.
‘This isn’t a reflection of the town.’
Mr McCabe, however, who suggests most in Inverclyde have obeyed the lockdown, has his own theories.
‘The fact that we are so much of an outlier would suggest there are other factors in play,’ he says.
‘Looking at the Inverclyde curve, it would suggest it peaked earlier than elsewhere in Scotland, so it could be that we had outbreaks earlier than other parts of the country.
‘It’s not beyond the realms of possibility that somebody in Inverclyde came back from holiday in northern Italy and infected widely within the community, which meant we got that earlier spike.’
The community reaction has certainly been impressive as Inverclyde fights Covid.
The Belville Community Garden Trust, more used to growing food and running small community projects based around mental health and climate change, has changed tack and is providing a crucial food delivery service for the vulnerable, sending out weekly food boxes.
‘We’ve done over 2,000 boxes so far,’ manager Laura Reilly says. ‘We’re dealing with a lot of people who are suffering from Covid and are not able to go out and get shopping, people who are particularly vulnerable and in need of a bit of help.’
She estimates that around 70 per cent of the boxes they have distributed have been to those suffering from the virus.
However, being on this secondary front line takes its toll.
‘We hear about people we know,’ she says. ‘We have one volunteer who is a home care assistant who has lost a lot of clients.
‘Each morning she’s getting awful news about someone who has passed away.’
A lack of testing may also be a factor for the area. While there has been a drive-through testing centre in Port Glasgow for several weeks, it is available only to healthcare staff.
The military testing site which got up and running in Greenock yesterday, however, will be available for symptomatic key workers, those aged 65 and over, and people who have to leave home to go to work, as well as their households.
It is hoped that the increased testing may help to lower the death rate in this corner of the Clyde coast.
But there is a sense, too, that the damage has already been done.
‘You can see the effect on the whole area, the anxiety and stress, the sense of loss,’ says Mr McCabe. ‘We have a tight-knit, relatively small community here.
‘To lose 106 people to this virus – that’s a huge impact.’
If there is a story that sums up Tayside’s experience of coronavirus, it just might be that of Daphne Shah. The 98-year-old was taken to hospital in early April from her home in St Madoes, Perthshire.
Given her advanced age, her son Wesley said that when she left in the ambulance: ‘I honestly never thought I’d see her again.’
And yet five days later Mrs Shah was discharged from Ninewells Hospital in Dundee with medication, and has been recovering at home ever since. Tayside, too, is recovering in a way which few would have initially predicted. Until the recent revelation of the Nike conference outbreak in Edinburgh in late february, it was believed that Scotland’s first coronavirus case occurred in Tayside, involving an individual who had returned to the area after travelling in northern Italy.
Since that first positive diagnosis on March 2, Tayside has waged a battle against Covid-19 which has focused, primarily, on testing.
While areas such as the Highlands, Shetland, Dumfries and Galloway, and the Borders – rural areas with low populations – have all seen fewer cases, Tayside’s response to coronavirus, now ahead of the rest of the country, has made it something of a model.
Some have even likened it to South Korea which, despite a high number of cases early on, used an aggressive testing system in order to control the virus.
Tayside was the first health board in Scotland to start testing health and social care staff for coronavirus, with a drive-through test centre up and running by March 17. It proved so successful that by early April the region was testing more healthcare workers than the whole of England.
In late April, Dundee was recorded as having the highest number of coronavirus cases in Scotland, more than 404 confirmed per 100,000 people.
But while eyebrows were initially raised, it was quickly attributed to the fact that more people were being tested here than anywhere else in the country.
Dr Daniel Chandler, a consultant in public health medicine at NHS Tayside, says: ‘The higher rate of positive results in the health board area is very easily explained by the fact that other data will show NHS Tayside has tested many, many more frontline workers and household members from NHS, social work, care homes and first responders and other key workers.
‘NHS Tayside made a very early decision to proactively begin staff testing. We would expect to see similar rates of positive tests in other board areas if they were testing staff at the same level as NHS Tayside.’
Tayside covers a large swathe of Scotland and has a wide demographic, from Dundee, parts of which are economically deprived, to affluent corners of Perthshire.
The population numbers more than 400,000, and yet as of this week there are no patients in intensive care, and the number of new cases per week continues to fall. Last week there were only 22.
Altogether, 257 people have died, with the rate now at six deaths per 10,000 people.
More than 50 per cent of those who tested positive were residents of Dundee.
Unlike other urban areas of the country such as Glasgow, Edinburgh and Inverclyde, however, cases have remained relatively low. The evidence seems clear: testing works.
There have undoubtedly been dark moments. Like every region of Scotland, Tayside has had outbreaks at care homes, including the deaths of ten residents and one nurse at Pitkerro care home in Dundee, which has now been reported to the Care Inspectorate after one member of staff resigned in disgust at the conditions under which she was forced to work.
Meanwhile, the University of Dundee has been at the forefront of drug trials in the fight against coronavirus, in particular a clinical trial led by James Chalmers, a consultant respiratory physician at Ninewells Hospital who is also British Lung foundation professor of respiratory research at the university.
He has juggled treating patients on the front line with working on clinical trials, and can often be found in his laboratory at two in the morning.
‘We are finishing our shifts and going to work on these trials to find a cure,’ Professor Chalmers says. ‘It is so important, the only exit strategy is to do research and find a treatment.
‘This trial is trying to intervene early on before the inflammation develops to stop so many Covid-19 patients going into ICU.’
BUT the testing has clearly been key, with even the first Minister praising Tayside’s lead. ‘I would absolutely say NHS Tayside has been an exemplar in this and other health boards have been able to learn from the methods that they have been using,’ said Nicola Sturgeon in a recent briefing.
‘So I would absolutely give them the credit that they deserve.’
Now, the next challenge will be contact tracing. The pilot software is being tested initially in fife, Lanarkshire and Highland, and will be rolled out across the country by the end of the month.
In the meantime, doctors such as Dr Tom fardon, a respiratory consultant at Ninewells who has had the illness himself and gone on to recover, have been attempting to keep the local population informed on the best way to fight Covid-19.
His popular facebook page is not only a source of information and discussion, but has also raised thousands for charities including the British Lung foundation and Chest Heart and Stroke Scotland.
‘Test, isolate, trace, support, when the infrastructure is in place,’ he wrote in a recent post.
Back in St Madoes, Mrs Shah will turn 99 in July, and her son now hopes that having survived Covid19, she will live to see her 100th birthday.
‘I thought it would be a shame if Covid took her life before then, because she was doing so well,’ he said. ‘I’m so happy to have her back.’
Experts will be hoping that Tayside, much like Mrs Shah, continues its slow and steady recovery.