'We have become like army generals for public health'

An interview with Dr Sakthi Karunanithi, Lancashire County Council.

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As the Director of Public Health for Lancashire, Dr Sakthi Karunanithi oversees one of the largest, most populated areas of any director of public health. 

There are 1.2 million people, 12 districts and five hospitals – and he believes all corners of the county have played a role in the pandemic. 

It has been a whole societal effort. Everyone has come together for the common-good. That collaboration has been wonderful.

“It is the text book definition of public health and to see it all come together has been both amazing and humbling. I could not have done my job without them. 

“It happened from the very start. We all came together to help the care sector when there was the shortage of PPE. We bought PPE and distributed it. Then there was the community hubs to support people when they were isolating. It was just meant to be for clinically extremely vulnerable, but went miles beyond what was needed. We provided so much support to so many people.  

“We were also one of the first local authority areas to set up community testing facilities. It was early summer 2020. We redeployed on our own staff, we had members volunteering and lots of support from the public, people who were on furlough, wanting to make a contribution. We saw the same with the vaccination programme. 

“The organised efforts of society made a real difference. I would not have been able to do my job without them. The Lancashire Volunteer Partnership, BME networks, faith leaders - we worked with them all.” 

Difficult decisions have had to be taken 

The pandemic has still, of course, proved incredibly challenging, said Dr Karunanithi. “Working in a fast-changing environment where there is a huge deal of uncertainty has made decision-making very difficult. Sometimes you have to make decisions when you don’t have all the knowledge. I think we have got more confident with that as we have gone along.  

“As directors of public health we know our local areas, we understand the weakness and vulnerabilities and our strengths. We can foresee problems. We have that intuition. I really thing we should have been trusted more by the government. 

“We took difficult steps in Lancashire. For example, we did not reopen schools in September 2020 when we could see NHS Test and Trace was constrained. We issued advice about local sports event when we could see COVID-19 was spreading at them. We also advised faith settings about the risks of congregating for prayers. We had to be brave, but I think it helped protect our local people. 

As public health professionals our skills have expanded massively. We have become more confident. We have learnt a lot about logistics, setting up testing centre and vaccination centres.

Media engagement is another area, Dr Karunanithi believes, that has been a major area of learning. “We have worked closely with the media. I have done weekly appearances on radio, question and answer sessions, asking the public what they wanted to know. They have been really open, the message has been that there is never a question too silly to ask.  

“But I have also engaged with the national media more than I ever have done before. I have appeared on BBC Radio 4’s Today programme. It is very powerful. I have had national bodies contact me afterwards to pick up on points I was making. It has been a huge learning curve.” 

Dr Karunanithi said he and his team has also gained a lot working alongside the armed forces on the testing and vaccination programmes. ‘They are trained to be deployed into unfamiliar environments. They quickly orientate themselves to their surroundings and identify what needs to be achieved. In a way as directors of public health have become public health majors - the planning, the logistics and having problems thrown at us all the time.  

‘I can see a tsunami of infections coming’ 

Those skills look like they will once again be tested to their limits with the rise of the Omicron variant. “It is going to be difficult,” said Dr Karunanithi. “We still don’t know the impact in terms of serious illness. Our message is simple. We keep stressing five things – vaccination, ventilation, face coverings, testing and limit social contacts. 

“I am concerned though, things are changing very quickly. We are worried about the economic situation. We have a lot of businesses which are vulnerable. We need to protect them.  

“I would hope what we are doing is enough. It might be if we see milder illness, but we can see tsunami of infections coming. There may come a time soon when we have to do more.” 

And if that happens Dr Karunanithi will draw on the experiences of the past 20 months to give him strength.  

“I have learnt a lot about personal resilience. I have two children – my son is taking his GCSEs this year – and the last two years have gone by and I have not been there as much as I would have wanted to be.  

“My duty as a director of public health has taken over. It is hard, but when I look at the sacrifices others have made and how people have come together I have had to adjust to that.”