Covid five years on – reflections from environmental health professionals

The role of the environmental health profession transformed overnight five years ago as the first Covid lockdown came into force, and it had to step up in incredibly challenging circumstances going above and beyond to protect communities from a whole new threat.

To mark the fifth anniversary of the first Covid-19 lockdown we spoke with a wide range of environmental health professionals to get their insights and reflections on that time.

Here they look back on how they dealt with an unthinkable situation, discuss how the profession has changed as a result and contemplate how prepared we are for the next pandemic.

Dr Rob Couch, an EHO working within a public health department during the pandemic

Dr Rob Couch, an EHP who has worked in various sectors both in the UK and internationally, was part of the Covid response for a public health team in the East of England and his role gave him a deep and lasting insight, both good and bad, into how we tackled this challenging and devastating time.

He said: “There was a lot of thinking on your feet, particularly in those early days – you had to adapt so quickly, and we were doing that day in, day out, week in, week out. We got better at it but in the early days we worked 24/7, it was quite brutal and frightening sometimes.

“It was like running a marathon with no end in sight in those early days, we really weren’t sure what was going to happen, whether there would be a vaccine, how effective it would be, all that kind of stuff. And that was quite hard, physically, psychologically, but you would just bury yourself in the work.

“One fascinating thing for me was overnight people were talking the language of our day jobs - everyone became a public health expert, over the garden fence you were having a discussion about PPE, or hand washing, or being physically separate from somebody, whether one-and-a-half or two metres.

“One particularly upsetting aspect was having discussions with people who were really quite ill, struggling to breathe, you just didn’t know what happened to them as you had to go on to the next person - we were quite literally working through a list.”

Rob contributed to a book which documents first-hand experiences and reflections of EHPs work across the world during the pandemic and recognises the significant contributions they made to protecting lives and livelihoods alongside recommendations to inform future policy and practice – the book is still available here: https://www.routledge.com/COVID-19-The-Global-Environmental-Health-Experience/Day/p/book/9780367743314?srsltid=AfmBOopIm6gKOujMnWFG8iJBm7aY4ItQMK81DZEoBvhM_cw29Zinb5c1 

“Part of the reason for writing the book was that we feared that what we did as a profession would become a little footnote in history, a lot of the value that we brought to the pandemic response would get lost amongst the bigger picture,” Rob explained.

“In terms of our knowledge and skills what for me came through was our local knowledge, our knowledge of place, of businesses, of communities, of homes became critical.

“Then you combine that with our practical epidemiology experience, or the shoe leather epidemiology as we call it, so looking into cases, whether they’re becoming outbreaks, putting in place control measures, that’s our bread and butter.

“A lot of the interventions, particularly around PPE, ventilation, hygiene, isolation, these were quite familiar to us though the scale was very different!

“So, we brought all those types of practical skills, and then you add our knowledge of how the council and wider health services work. We’re just a small part of a very large and complex public health system, but in the day job in environmental health you know who does what, that systems knowledge was absolutely critical to our pandemic response.

“Then in terms of the frontline work as well, our knowledge of public health law and guidance and the ability to make decisions when you have limited knowledge, or there’s a great deal of uncertainty there, which was often the case during the pandemic, was also critical.

“We’re used to being in very difficult situations and having to make a decision and I think as a profession these skills stood us in a very good stead.”

Rob has worked internationally during his career and has developed strong links with environmental health professionals across the globe so was able to get a sense of how other areas were dealing with the unfolding crisis.

“I’m incredibly proud of how our profession rediscovered and asserted our public health credentials on a global scale,” he said. “During the pandemic, in the few moments of rest, colleagues from across Africa would get in touch with me and ask how it was going, are you experiencing what we are etc.

“It quickly became clear that EHOs around the world were mobilising around this, doing incredibly important local frontline work, particularly around prevention, detection and control measures.

“And in those places which got the vaccines a lot later, the work of EHPs was absolutely critical for a lot longer and we tried to capture this in the book.

“I think sometimes we get lost in our regulatory worlds, our silos and forget why we do what we do, but here we were re-asserting our relevance for 21st century public health, within a pandemic context, which is as extreme and valuable as it gets. I hope we won’t miss this opportunity to remind politicians and policy makers of the difference we can make and why environmental health services are a sound investment.”

Suzanne Whittaker, Regulatory Services Manager (Environmental Health) at Trafford Council

The onset of Covid saw environmental health professionals up and down the country face almost unrelenting pressure working long hours trying to keep their communities safe and well.

Five years on from that initial lockdown, Suzanne Whittaker at Trafford Council has spoken with us about the challenges her and her team faced both personally and professionally during that time, and how she reflects on the experience.

“It was obviously a huge impact on us - almost overnight our job changed,” she said.

“It was very chaotic at times with the ever-changing regulations, the fact they were constantly released at the same time that we got to find out about them and then members of the public and businesses expected us to be the experts and give them guidance.

“There were so many grey areas in the guidance and with some of it, it was hard to know where the Government were coming from. It was hard to be the face of that, for sure, because the officers particularly came across a lot more aggressive behaviour from businesses.

“And just the sheer volume of work that was coming through was overwhelming and in terms of myself and the team leader for environmental health we certainly shouldered a lot of it as we felt like we had to, to try and shield the team to a certain extent.

“It was a time of real high stress and high anxiety, so I did suffer personally throughout that time because I was literally logging in at 7am and working flat out until the evening.

“It’s funny when you see other people reflecting back and saying, “the weather was amazing, the sun was out” and some people were obviously furloughed and were bored at home and that just wasn’t my experience!

“But on the flip side of that, obviously I am proud that we did have such a significant input into the response and hopefully were seen as having a positive impact. As much as we’re always seen as the bad guys that are doing the enforcement, there are pockets of the public out there who recognise that we do it to ultimately benefit them.

“It was definitely a break from the norm and an experience to look back on, but hopefully not something I have to deal with in my career again!”

Despite the clear challenges and strain placed on her and her team, Suzanne said there were positives that came out of those times.

She said: “We work better in partnership now, even with teams like trading standards who worked within our service before, they were there when we needed them to support us during that time so that has helped us to deliver more coordinated approaches going forward. We do days of action that we didn’t do before.

“During Covid we were having meetings daily with public health to go through lists of businesses where there were outbreaks and then we would attend virtually with public health to discuss with the business how they could minimise spread of the virus and keep their staff safe.

“We hadn’t worked that closely with public health in the past so that was a positive in terms of us coming together, and that is something that has stuck since the pandemic, we have a lot closer working relationship with public health.

“Another positive was developing closer working with our community safety team and the police – we forged relationships with them that before had been quite weak and moving forward we have developed that to work more closely with them.

“They understand more about what we do and how we can assist.

“There’s definitely been lessons learned for us as a team and as a council. I think we’ve strengthened in terms of our resilience and our ability to adapt to changing regulations.

“We knew something was coming but to what extent and how much we were expected to react we couldn’t know, so I think we would be far better prepared for it now than we were. We’ve certainly built up our Business Continuity Plans over the last few years!”

Rachel Flowers - EHP and Director of Public Health in Croydon at start of the pandemic

Rachel Flowers has her professional roots in environmental health, however for nearly 20 years she has also been a registered public health specialist and when the Covid pandemic came around she was Director of Public Health in Croydon.

Rachel spoke about how “relentless” it felt during those early months of the pandemic working in public health.

“Time does odd things when you’re working in a major incident,” she said. “So, at the beginning of the pandemic, when we went into lockdown, there was some weeks that I only knew it was Sunday because Michael Ball was on the radio, and he was only on the radio on Sunday.

“It was just relentless. From March, with the exception of a few days, most directors of public health were working as standard, 12–13 hour days, pretty much every day of the week, however I know others were working that hard too including EHPs, we all wanted to make sure we were doing the right thing for the people that we were representing, to make sure the vulnerable were safe.”

Rachel believes the pandemic shone a light on the work the environmental health profession and the work that they do every day as a matter of course, perhaps something that not everyone realised. Being out in the community being the “boots on the ground” EHPs just go out and get things done.

“I think that the multiple skill sets EHPs have and knowing their communities, was absolutely critical for many local responses,” she said.

“Particularly at a time when local businesses were finding it a challenge – I certainly had regular conversations with business leaders who talked about how valuable they found EHPs providing them with advice and guidance.

“I think that the light that was shone on the profession highlighted that there’s a whole load of talented, able people who are actually already doing this role in their communities.

“At the end of the pandemic when we did a bit of a wash up about the work that we did within London, I insisted that we have a dedicated EH workshop which allowed the London Association of Directors of Public Health to actively acknowledge and celebrate the work that had been done by EHPs across London.”

Talking about preparedness for the next pandemic, Rachel was clear it was a case of if and not when- a fairly common response from public health specialists, and said she was fully confident in the environmental health profession being able to step up once again – if the support for it is there.

She explained: “There is always something – we’re currently in the midst of a measle pandemic, my first pandemic was HIV and AIDS, which has killed millions around the world, we’ve had Swine Flu, SARS, MERS Covid, so anybody who’s been involved in public health or environmental health, will know it’s just a case of when, not if.

“If you look through history it seems inevitable. The thing that perhaps we hadn’t prepared as well as we might have, was that Covid was a novel disease - unknown in humans before - so there is definitely learning from that.

“Many of us have had to develop specific outbreak plans, and part of those had very specific, clear roles, where environmental health could be. In terms of the profession, have we learnt lessons – time will tell.

“Often, and perhaps understandably after any major incident, most people want to forget it and get on with their lives, except for those who have been significantly impacted by it and that is always the challenge around this in future preparation.

“Throughout my career I’ve been a big advocate around the role of environmental health practitioners because often EHPs are seemingly invisible as they just get on and do their work and rarely communicate about it.

“So, when the next pandemic happens, do I think EHPs will step up to the plate? If we have the funding within local authorities to make sure we have EHPs, absolutely they will, working closely with Directors of Public Health, because that’s what they’re trained to do. If you look back at history that’s what they’ve always done around communicable disease.”

Carol Archibald, a Chartered EHP, CIEH fellow and Food and Safety Manager

The onset of the first Covid lockdown five years ago saw the job of the environmental health professional change dramatically, as well as the landscape in which we worked.

Carol Archibald, a Chartered EHP and Food and Safety Manager was leading a team at Tendring District Council in Essex at the time. She has reflected on the impact on their work and how they how to adapt how they worked in those early days.

She said: “I remember sending my team home when they were talking about a lockdown, and we thankfully had a good IT set up and were ready and able to work from home and the authority was proactively encouraging it.

“I carried on working from the office for a couple of days extra just to sort some things out and I just remember a feeling that things were never going to be the same again.

“We managed to develop our digital capability and found a solution where we could remotely see inside a food business very quickly using a desktop computer and then a mobile phone.

“The product that was developed was ‘Inspector ShowMe’. We trialled it and it was a huge step forward and helped the team stay safe. We were instantaneously able to look in many, many businesses at a time when it was really getting to be not a good idea to go out and we couldn’t travel either.

“We developed it, we wrote protocols for it, so we had our own sets of rules and everything. We also did a newsletter that kept the businesses up to date which also gave us an idea of who’s closed and who’s not as we had stuff delivered back to us.

“So that’s how we proceeded. We did have to go out to businesses to deal with Covid situations. That was quite tense – PPE conversations were quite fraught at times about what you needed and what you wanted – what they didn’t want to give you basically.”

Carol spoke about some of the challenges her and her team faced at the time, and also how Covid changed their work going forward.

She said: “Going into food businesses we quite quickly noticed that they were changing a lot of things, cleaning basics that they’d always done were going down the pan and everyone was swapping hand washing for sanitiser - we were awash with hand sanitiser!

“We spent years getting people out of the habit of constantly using hand sanitiser and then hey presto there it was, back just being used in place of hand washing. So, all the hard work we’d been doing had just swept away and it felt like we were going to be starting from scratch when things got back to normal.

“Food businesses and other businesses have changed dramatically. We’ve seen a massive upsurge in delivery services and they’re causing issues now. Food businesses come and go like days of the week, much more than before.

“And of course, we had masses of home caterers start up during lockdown, cake bakers, all sorts - that kept us very busy. The number of people who started to do that and register was off the scale really – I think it was about 250 or something like that that registered in one month in the first lockdown. In a small place that’s pretty significant.

“Overall, we all worked very hard, and I am very proud of what the team achieved against the odds and the profession was very strong throughout and has overall managed their way out of a difficult environment that was left behind.

“However, I do feel there could have been better learning from Covid and taking that forward as we get back to the 'norm'. There has been no Covid review for our profession which I think is a shame.”

Oliver Nelson, Chartered EHP and Environmental Health Manager at Epsom & Ewell Borough Council when lockdown hit

Lockdown saw EH professionals quickly faced a range of challenges including how to explain the ever-changing guidance to businesses and the public and this challenge continued through the rest of the year.

In late 2020 the small EH team at Epsom & Ewell Borough Council wanted to help get important messages out in response to the impending reopening of close contact services and decided a video was the best solution.

Chartered EHP Oliver Nelson was the Environmental Health Manager at the council at the time. He explained: “The idea for the video came from my concern of how to get the message out to close contact workers in good time for the reopening, with current reliable advice and whilst a great many of them were furloughed.

“It was conceived, written, shot and edited in three weeks employing a local, otherwise out of work videographer and with the cooperation of a nearby temporarily closed hair salon.

“The talent was entirely drawn from the environmental health team including an EHO as presenter and voiceover actor, the Environmental Health Enforcement Officer in the hairdresser's chair and myself and another EHO pretending to be barber and client.

“We had a wonderful response from the trade who we had publicised it to and who were able to view the video at home in readiness for their return to work. We also had contact from colleagues in different parts of the country wanting to use it in their area.

“The video stands out as being one of the rare occasions during the pandemic where I felt we were properly on the front foot, being able to think ahead, and help business reopen in contrast to earlier in the year where we had the unpleasant task of reacting to events to ensure those same businesses were closed.

“Much of the public view of the pandemic understandably focussed on national concerns around how the NHS was coping, the limitations of the early test and trace system and the unprecedented restrictions on everyday life.

“What was achieved locally by hard pressed environmental health professionals went undocumented back then and as time marches on, is at risk of being forgotten.

“However, most who were working in Environmental Health during the pandemic will recall where they were and what they did to support their community during those difficult months.”

You can still view the video here: https://youtu.be/TB3nP8tRCFc?si=BCOJlyV3pSfdB1t9