By Professor Dominic Harrison Director of Public Health, Blackburn with Darwen Council

This week marks a critical tipping point for Lancashire in the Covid-19 pandemic.

The North-West Region of England is seeing rapidly rising rates of confirmed cases along with the North-East of England.

The first wave of the UK pandemic was caused by ‘seeding’ of multiple local outbreaks as wealthy travellers returned from winter holidays in Europe. Rates rose first in bigger urban centres - but the spread was national.

In France, Spain and Italy the first wave of the virus was much more uneven than in the UK with very different rates in some regions. It is possible that the second wave of the virus in the UK could follow this pattern with the North of England, led by the North-West, being, impacted at a very different rate than the UK as a whole.

Four weeks ago, in response to continued rising local rates, Blackburn with Darwen introduced further control measures in eight wards and relaxed measures in nine wards.

The criteria for inclusion in the ‘intervention wards’ was a rate of 60 confirmed Covid-19 cases or above. This week the intervention wards have a rate of over 300 per 100,000 and the non-intervention wards have risen to 120.

Does that mean the control measures were entirely ineffective? Not necessarily.

All areas in Lancashire have risen over that time - and many faster than Blackburn with Darwen which was third worst in the UK a month ago and is now 10th. This week the North-West rate has shot up to 150 per 100,000.

Burnley is worst in the UK with 306 per 100,000 and even Ribble Valley which has enjoyed amongst the lowest rates in the north of England throughout the pandemic, is now at 83 per 100,000.

There are probably three levels of explanation as to why Lancashire is so much more vulnerable to the virus.

Firstly, Lancashire exited the lockdown with higher case rates and less people with immunity from previous exposure than the rest of the UK. As the lockdown lifting generated more social contacts the embers of community transmission re-ignited faster here.

Secondly, Lancashire has more front line workers than the national average and a higher BAME population. BAME populations are more vulnerable to infection along with many front line key workers as many cannot work from home and are therefore more likely to be risk exposed.

Thirdly Lancashire has more clinically vulnerable residents with long term conditions and compromised immune systems than UK average – which makes us more susceptible to the virus and its effects.

National government has few ‘next steps’ options available.

Much stricter compliance by us all to current legal rules and guidance will help, but some kind of ‘circuit break’ lockdown at regional or national level seems increasingly likely if rates continue to rise rapidly.