Public health bosses in Liverpool are 'extremely nervous' about the prospect of a second peak of coronavirus in the city.
Hundreds of people have died in the first devastating wave of Covid-19 in the city, with Liverpool experiencing one of the worst death rates in the entire country.
As lockdown measures are eased and with new modelling suggesting the R rate of infections has risen above one in the North West, there are real fears that more misery could be on the way.
Liverpool Council's new Director of Public Health Matt Ashton, came into his new job in the most difficult of circumstances – at the outset of the pandemic.
He and the council's cabinet member for health Cllr Paul Brant are seriously concerned that a second spike could bring even more pain to the city.
We asked both figures about these concerns, about how the city is preparing for another wave and what lessons have been learnt so far.
How concerned are you that we could be hit by a second wave – how bad could this be for our city?
Matt Ashton: "We have seen the number of infections falling and the number of deaths falling, which is really welcome, and we are therefore definitely on the other side of the peak.
"The latest news about the R number shows we cannot be complacent and we are definitely not out of the woods yet, it is so important for people to maintain social distancing and keep washing their hands.
"We continue to see new infections every day, and our best estimates of the reproduction value at a local level show that there is a real risk that a small increase in infection could lead to a second peak quite quickly.
"I am therefore extremely nervous about the potential for a second peak, and we have already seen the huge adverse impact the virus has had on our communities due to long standing levels of deprivation and poor health.
"Any increase in infections could have a massive impact on individual and population level health & wellbeing, and a big knock on impact on our economic recovery."
Cllr Paul Brant: "This is certainly no time for complacency. We know in the Spanish flu pandemic in 1918 the second wave happened after the authorities dropped their guard. There are lessons from history here."
How concerned are you about the decision to ease lockdown measures?
Matt Ashton: "I am massively concerned that the message received by our communities is that lockdown is over.
"It isn’t, we need to be taking a precautionary approach to exiting lockdown, moving slowly and safely to get life back as close to normal as possible, but all of us still being incredibly aware of social distancing and hand hygiene measures, and with people not leaving the house when they are not well.
"The impact on us all has been considerable, and we are all desperate to get back to normal, but we need to the support of the whole of the city to help us reduce the potential for any second spike. This is not over yet, my plea is for everybody to work with us to help keep our city safe."
Cllr Paul Brant: "We mustn’t underestimate the sacrifices that people have made.
"They have not seen friends and relatives in the normal sense for months. And we are grateful to everyone for their support.
"I think there is no doubt whatsoever that what Dominic Cummings did has made life harder for all of us across the country in public health in terms of people following the advice.
"But anyone who knows anyone who has had a bad bout of COVID-19 knows how dangerous it is, so we need people to be cautious and follow the advice we are issuing locally – it is there to save lives."
Was Liverpool prepared for Covid-19, how has the city coped with the crisis so far?
Cllr Paul Brant: "Like all cities, we prepare for major incidents, and emergency planning exercises for the likes of a flu pandemic take place regularly.
"But I don’t think any type of planning could prepare you for the scale of what we have seen and the way in which it has impacted on each and every area of all of our lives.
"It is not just the impact on the health service, but the limitations on how we interact with each other and go about our daily business.
"That has had a massive impact on people’s health and wellbeing and I think we will be seeing the ramifications of that for years to come.
"What has impressed me most has been the way in which everyone has stepped up to deal with a public health emergency.
"Not just the health service, but our workforce, care staff and the rest of the public sector, including the emergency services.
"We had 50 childcare hubs staffed by teachers making sure key workers could go to their jobs.
"We made sure that parents of children on free school meals got vouchers so they wouldn’t be out of pocket while schools were closed.
"And we had 3,000 people who came forward and volunteered to help others. So many individuals have played a part and we are so grateful. We also must not forget that huge sacrifices were made by the vast majority of people who heeded the message to stay home and stay safe."
What lessons has the city learnt that it may be able to use if a second wave does come?
Matt Ashton: "There are massive challenges around the impact of COVID-19 on populations that already have high levels of inequalities and long standing poor health conditions.
"But, there are massive positives in the way the city has worked together to respond to COVID-19, right the way across the public sector, the NHS, the council, the academic sector, and also with the voluntary/community and private sectors.
"We should be really proud of our collective effort in responding to a really challenging situation."
Cllr Paul Brant: "I think organisationally we have been tested in a way we haven’t been before, and we have come through it.
"But we need to remember that we have a lot of staff who are absolutely exhausted, so a second wave would definitely cause fatigue, particularly for those on the frontline.
"So we need to be mindful of that and I know there is a lot of work going on in the council to make sure that staff are supported, particularly given that they have had to adapt to new ways of working overnight."
Can you help us keep Merseyside covered?
Care homes have obviously been hugely impacted, could homes in the city cope with a second wave?
Matt Ashton: "Public health and adult social care have worked incredibly closely with the care home sector and our infection prevention control services to protect our most vulnerable residents.
" As a result we are confident that we have strong preventative measures in place to help protect residents and staff the best we can.
"However, the potential for further outbreaks is always there, and the impact of outbreaks on our most vulnerable people can be significant. Clearly it is essential we continue to support care homes, and all our vulnerable communities going forward, and we continue to put plans into place to help this to happen.
Cllr Paul Brant: "We are committed to doing all we can to support the sector.
"The advances that have belatedly been made by the government in terms of testing and tracing will help care homes. Their residents are very vulnerable so we need them and staff to be treated as an absolute priority to prevent the spread of the infection.
"I think we are already seeing irrefutable evidence that government did not act fast enough in terms of locking down care homes with the first wave, so they must ensure that is not repeated. Tragically, it is too late for those who have already lost relatives and friends."