This week, Blog Preston teamed up with LancsLive for an hour long question and answer session with Dr Sakthi Karunanithi, Lancashire County Council’s Director of Public Health.

From facts and figures, to masks and alcohol misuse, here are the questions you asked us to put to him, and what he had to say…

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Lancashire County Council is ranked as one of the most deprived county council areas in England – what is being done to tackle the situation during the pandemic?

What we’re seeing is a challenge to our health and wellbeing where the Covid-19 pandemic is coming in to a community that was already facing some challenges in terms of health and wellbeing.

So what we’re doing now in this current context is – while we are doing everything we can to prevent the spread of the virus in the community through lockdown and isolating people and leeping the most vulnerable people shielded – we are also having to make sure that there are no other unintended consequences of being locked inside.

Mental health is a big issue for us. We know that is already an issue and there is a quite a lot happening in terms of people’s mental health and wellbeing.

We’ve also know that finances are an issue so that contributes to our health and wellbeing fundamentally.

So while we’re working on the coronavirus pandemic in Lancashire we’re also making sure that some of our more vulnerable – but I call them more valuable people – are looked after and protected from not just the virus but also the wider impact of what’s happening during the pandemic.

Particularly protecting groups such as the homeless, children living in households with families working or families facing challenges. There’s quite a lot going on in terms of the welfare of our society while we’re fighting the virus at the same .

Read more: Director of public health warns of fragile time in fight against coronavirus

How have services been impacted by coronavirus?

Demand is going down and that’s been one of our concerns because while it is important for the services to create the capacity for ‘surge’ – when people are becoming poorly or need to be taken care of because of the Covid outbreak – we have prioritises services.

We prioritised more high-risk groups and created the capacity for other things that are important as well as Covid.

But what we’re seeing is in the NHS particularly there’s a huge capacity being made to be ready for the Covid surge but we’re seeing people not come forward, with chest pain, strokes, cancer.

So while we need to stay away from each other in social distancing it’s also important to seek help when we need it when you get symptoms for heart attacks and cancers.

“The overall message is let’s prevent the coronavirus spread by staying at home, protecting the NHS, and saving lives. But what we’re also saying is when you need help, the NHS is still open, our services are still there for people when they need it.

Although we’re operating in the coronavirus pandemic environment, so not every service is open.”

Can I catch coronavirus by visiting hospital for something not related to Covid-19?

When people turn up to A&E they are effectively triaged, or screened. If you’re showing symptoms – a fever, cough – they go a separate way and if you’ve a broken leg, you obviously go a separate way.

But there are so many other online options which is great in one sense because it is something we never thought would suddenly have to come in to play.

People are using services in different ways. Overall it’s pretty challenging with Covid, but there are certain things that have happened which is positive in being able to support people in different ways.

There is enough protection in place for people that need to be seen for key things like broken legs, heart attacks, and strokes. So we’re encouraging not putting off seeking help when people really need it. Our services that are critical and essential are still there.

I’d really like your support in getting that message across because people are scared of coming to hospital because they’re scared of catching the virus.

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Absolutely there is a risk, but the virus isn’t in the air. It’s on the surfaces. It’s in the air when you’re in close contact with someone who is coughing but otherwise it isn’t.

But still, the overarching message is stay home, only come out if it’s essential for work, food, medicines, health or exercise – which is really important.

Have you planned for emergency situations like Covid-19?

We plan for so many emergencies, so we’ve gone through this drill in lots of different ways.

But the scale of it…no one has planned for this long. It’s not like a ‘big bang’ like a fire. Or flooding which can be weeks.

This is in a completely different scale and I’m ever so grateful for the public – us Lancastrians – we have stuck to the message.

And that’s the only way that we could have seen cases flattening. We are seeing the curve flattening in Lancashire.

And thumbs up to everyone – but we’re not out of the woods yet and that’s my worry in terms of looking forward. There’s a very, very fragile few weeks ahead.

Lancashire Constabluary are reporting people breaching lockdown and relaxing a bit more. What is the outcome of that?

We have been in lockdown for five, six weeks.

From someone catching the virus, becoming ill, ill enough to then go to hospital, and recovering or sadly passing away, there is a also a five to six week time period.

Right now is the most surpressed state right now for the virus.

If we let our guards down and go out – yes it is frustrating to be indoors for most of the day – if we do break the rules and start mingling between the households, especially now we know there’s a likelihood people are carrying it but without symptoms, the danger is we will see the cases rising and more people ending up in hospital which we don’t want to happen.

The virus is still dangerous; it’s not like a simple flu.

I can understand the frustration – but it is worth obeying.

Even if you don’t catch it yourselves, its our grandma, people that we look after that we more vulnerable. Particular the shielded population we need to protect.

How important is it that people exercise outside of their homes, as allowed by the Government?

Social distancing is important but its also incredibly important that we exercise and get some fresh air.

Even if it’s just a walk. At least you’re on the block because the benefits of exercise to mental health and exercise…this is going to be a long haul and it’s important to look after our emotional wellbeing.

I would recommend everyone take advantage.

What provisions are being made to deal with mental health issues in adults and children?

As well as exercising every day, it can also be frustrating for those who stay inside following the advice.

I have a couple of kids and they are incredibly bubbly and it’s very difficult as a parent to support the children without taking them out, especially with the good weather.

On the other side, I am seeing Zoom and virtual ways of meeting friends and relatives. It has become more prevalent and I have spoken to people I’ve not spoken to in months.

But that doesn’t really take away from meeting face-to-face and having a party. But if you look at why we are doing this, this is the most serious thing to happen to our health in 100 years since the Spanish Flu.

There are services if there is a need. It’s actually improved over the last three to four months.

There’s a lot of groups providing support remotely. Support for parents, for carers particularly.

I want to pay tribute to carers, especially unpaid carers. You’re locked in for such a long time, so I really want to recognise and pay tribute to them.

When people need help they must not hesitate. Whether that is mental health, financial help. There’s never going to be enough but there’s quite a lot that’s happened to support people when they need it the most.

Are care homes in Lancashire getting a proper supply of PPE?

I’m very proud to say we have taken a proactive step in Lancashire and I include the public and providers in care as well.

On that it’s already a very fragile care system up and down the country, not just here.

What has happened now is the council is stepping in to support the care sector and care homes. We have weekly webinars with the providers.

We have invested ourselves along with other councils in the area to buy our own PPE for council staff and rpivate providers in the county.

There is a system in place that they can email if there are any concerns and we have a system to provide the supply of PPE.

We have also started recruiting care workers on behalf of the sector.

We’ve got support to manage any failure – if any organisation goes under – there are mechanisms in place where the county council comes in and supports the residents being cared for during that period.

We’re not waiting for the national supplies to land.

We’ve got millions and millions of pairs of gloves and aprons. We’ve sourced our own from China.

There is enough for the next four to six weeks and there is another consignment coming. We’re also looking at sourcing locally with local manufacturers and suppliers.

It’s one thing that we will look back on and say that’s well worht it. We got stuck in and din’t wait for government supplies to land.

For how long that will last? It’s difficult because we’re using more than we used to use. And people are scared working on the front line. They have to be protected and that’s our priority.

We’re doing everything we can. For now, we’re on top of that. We’re working together like never before with councils in Lancashire with the support from the police and military planners. There’s some top notch people working with us.

Read more: Personal protective equipment on its way to care homes in Lancashire

What onuses are on care home’s to make sure that staff are being protected?

Every employer is responsible for the health and safety for their employees. They are responsible for doing all the risk assessments and protecting employees with PPE.

I’m not aware of anywhere putting their employees at risk by putting them in places where they shouldn’t be.

If anyone has an issue in terms of PPE or concerns about agencies, we have the contacts. I’m very confident we have mechanisms in place to pick up issues like that.

Ultimately we all should be aware of how to protect ourselves, especially if you work in a care setting.

Takeaways are booming – how can we ensure good public health is being undertaken by businesses?

It’s a mixture of many things. Essentially they need to comply by law on safety and food hygiene.

They have quite a lot of support on information on how to conduct their business in that sector. Even if it’s a takeaway you don’t let people in and you maintain physical distancing.

In terms of policing – it’s very hard. But our businesses generally use their common sense. They don’t want to harm people. And we need a live economy and successful businesses in the county.

We do have trading standards and environmental health officers are still around. There are still stringent measures and advice in place, particularly with takeaways.

Should people be wearing a mask when not at home?

This is a real hot potato at the moment because the signs only take you so far on this and the opinion is divided after that, even among scientists.

In the UK, masks have a really important role to prevent people catching the virus.

That’s why front line workers are wearing a mask dealing with people coughing and spluttering.

However it is common sense if you cover your face when out and about we don’t cough whatever we might have into the environment.

But there is a balance. If you and I, who don’t have any symptoms and aren’t working on the front line, stockpile masks, then our healthcare workers wont be getting masks.

I can already see some people wearing masks in shops and you can’t control that. But our science says the added value of wearing a mask – from the point of view of preventing the virus circulating – on balance, isn’t needed in public.

But it’s a very fast moving field. I wouldn’t be surprised in the next couple of months it becomes normal for people to cover faces without surgical masks. But we have to be careful over the false sense of security it brings.

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Fly-tipping and waste burning is increasing in Lancashire with waste centres closed – what is your message to those disposing in the environment?

Let’s look after our environment during this pandemic. Let’s be responsible.

Burning waste is harmful and fly-tipping isn’t good too. Let’s be patient.

I’ve cut my lawn and hedges and I can’t take them to the tip. But is it worth taking the risk by burning it and harming myself and family?

There’s a reason why recycling centres aren’t open and that’s to maintain physical distancing an protecting ourselves and family members from the virus.

We are generally good at looking after our environment.

If social distancing can be enforced, should tips reopen?

At some point yes but not right now.

It is really, really important we don’t give the virus a chance and that’s the reason we’re in this lockdown with distancing.

There is a number called ‘R below 1’ [where each existing infection causes less than one new infection]. And the best and only thing we have is to spread ourselves out and we avoid non-essential movement.

This is all part of that strategy for suppression. Schools, public transport, pubs, cinemas. All of that is aimed to suppress the transmission of the virus.

If we have suppressed R below 1 enough, we will start to see the lifting in various guises. But it will still be important to protect the shielded group. And if you’re symptomatic, to stay at home for seven days. And maintain social distancing.

There’s no vaccine, no antivirus, no treatment yet for this.

Is there a link between Kawasaki disease and coronavirus in children?

It is scientifically plausible that coronavirus can present like Kawasaki.

I’m not picking up it is a significant pattern in Lancashire. I have read the recent reports.

I’m not aware of any specific issue in Lancashire. I would be if there is.

Some people are drinking more due to being at home for most of their time – is an increase in alcohol and obesity support expected after Covid-19?

It is quite easy to drink more especially if you can’t go out. There is a risk of every one of us picking up a new habit with one glass becoming two glasses.

What I am concerned about is this could become an issue in the next phase of the pandemic.

We are already seeing mental health, as we have discussed, is a key issue during this.

The problem is people might not seek help when they need it and then there’s a pile of people waiting when there is some kind of lifting of the lockdown. It’s a possible risk, we’re just monitoring it at the moment.

If you have an issue, services are still open. There might be a delay but it is important to remain healthy and not get into the slippery path of drinking every day and drinking over the limit.

When will normal services be resumed at GP surgeries?

I don’t know what normal with be, that’s the honest answer.

I don’t think for the foreseeable future that normal will be what it was.

GP surgeries are open. There may be a delay due to prioritising more serious conditions. But people can still access the services.

I don’t see how we will ever go back to what was before. In both positive and negative.

It will be a prolonged battle at least for the next few weeks but there are positives in the sense that people are doing different things to support people.

People will get injections, prescriptions. But at the moment there is a lot of precaution in spreading the virus, which is why there is a delay in the normal service.

What advice would you give to those expecting a child if lockdown is soon relaxed by the government?

Whatever happens we need to protect ourselves during this pandemic. I would be advising the usually steps to take in terms of infection protection and social distancing.

People who are pregnant should be expected to get their normal services. There might be a change in where it is located.

But I just want to wish everyone the best if they are expecting a baby. It is the best thing that can happen in someone’s life.

What happens if someone in a care home tests positive for Covid-19?

It depends on the state of the care home and if they can isolate people. Are they are people with dementia?

There are lots of things happening in cafe homes from preventing new cases to testing and isolating people.

We will be doing even more to make sure care homes without cases of coronavirus stay like this.

There’s quite a lot of capacity now for testing so we are really getting on top of that. But it is still important to wash your hands and wear PPE.

Why does Lancashire have one of the highest confirmed cases of coronavirus in the UK?

It comes down to a range of factors. Yes, we have underlying [reasons]. If you look at pre-Covid times, Lancashire is one of the places where we have some health challenges because of underlying issues of deprivation, lifestyles, access, and so on and so forth.

So it’s not surprising on one level that we are one of the areas with higher levels of the virus.

But it is also down to the number of tests. We really don’t know per 100 tests how many have returned positive. We just know the numbers. This will all be analysed and there is various pieces of work doing on nationally.

And also it is down to how well we have followed the advice.

But I can report that what we are starting to see is plateauing, so whatever we are doing seems to be working, so therefore it is important to continue at level until we find a cure or a vaccine, or we are sure that people who have had the virus are really immune for a longer period of time.

Is Lancashire behind London by around two weeks? Should we be looking at the capital for a sign of things to come?

It is a reasonable one to do because what we have found there is a rough time lag of a week, week and a half, two weeks.

It doesn’t always happen at the same time in every part of the county and there is a time lag between some of the southern areas and the Midlands.

But what we’ve done across the country is create a common timeline with the lockdown. It’s important to understand where there are hot spots.

When we go out of this phase it will be about managing mini outbreaks and containing.

That’s why testing and contact-tracing is going to be very important in the next stage.

How will children will complex medical needs be protected if they return to schools when they open?

There is no other additional thing to protect people from the virus apart from social distancing.

It is too premature to say when the schools will reopen.

We may have a vaccine but it is not likely in the next month or two.

We will also know more about the virus and if it is particularly affecting certain groups of people. So when things are open they may still need to be protected.

Are a new persistent cough and high fever still the symptoms to look out for?

There are some atypical symptoms but the most common are cough and temperature. That’s shared commonly.

If you are feeling unwell, you should take rest. And if you have a cough or temperature, it is wise to get tested.

As we know more going forward, we will know more about the different symptoms.

One final message to our readers?

I want to thank everyone for keeping ourselves and our family members and Lancashire safe by following the advice.

It is still dangerous, we need to stay home and protect the NHS.

If you have symptoms and are struggling to cope, services are still open so you shouldn’t hesitate to seek help especially with mental health.

There’s quite a lot of fake news out there and quite a lot of armchair experts. We need to take the public with us with the right information and be as transparent as we possibly can.