The number of Covid cases in Moray soared rapidly - but what happened, and how did health chiefs stop the spread so quickly?
In the space of just one week, the number of Covid cases in Moray tripled.
But with the first use of vaccinations to curb an outbreak, health chiefs were able to stem the spread in a matter of weeks.
We have been given exclusive access and interviews with NHS Grampian’s deputy director of public health and the head of their Covid testing programme, to help tell the story of how the tide was turned so quickly.
Health chiefs’ concerns began to grow during the last week of April when a number of cases sprung up around Elgin Academy.
Moray had “traditionally” had low Covid-19 rates through the pandemic, and had moved down to Level 3 restrictions with schools and many businesses reopening.
But Chris Littlejohn, NHS Grampian’s deputy director of public health, said: “It was the speed at which it rapidly developed that really struck us.
“It’s always been the case, right through the pandemic, that you get high transmission rates in the cities and, as you move away from them, the transmission rates are lower.
“That makes sense as people live more on top of one another in a city.”
Deputy Director of Public Health Chris Littlejohn.
He added: “We were beginning to see cases in schools but, with Elgin Academy, the assessment at the time was they had really good measures in place.
“They’d done everything they needed to do – everything asked of them and more.
“But it was to do with the kids’ contact with one another outside of school.
“You can’t control events like walking into school, lunchtime, leaving and after school.
“It wasn’t an unprecedented situation to have cases within a school, but that’s where it began.”
A specific Incident Management Team (IMT) was set up to monitor Elgin Academy, with the “exceptional” surveillance system already identifying linked cases in the wider community.
By the end of that first week, health chiefs had spoken out in a bid to stem the surge of Covid infections.
The case rate was continuing to rise, soaring well above the levels seen in neighbouring Aberdeenshire.
Additionally, around one-third of the new cases could not be linked to the existing cluster.
Fears were growing that the upcoming May Day weekend would lead to a “perfect storm” with coronavirus spreading even faster – potentially spelling longer-term disaster amid national plans to move to Level 2 Covid restrictions.
Health bosses quickly broadened the testing regime in the region to try and get a handle on the surge.
They also expanded the list of possible Covid symptoms to include sore throats, headaches and diarrhoea, urging anyone with these to get themselves tested.
Susan Webb, NHS Grampian director of public health. Picture by Jason Hedges
“We really are on a worrying trajectory in Moray and it’s vital everyone ensure they are sticking to the rules.
“There is a real fear, that with unlocking and the May Day weekend, if individuals don’t act responsibly and stick with the guidelines they could create the perfect storm in the area.”
– Susan Webb, NHS Grampian director of public health, April 29
Prof Shantini Paranjothy, NHS Grampian’s clinical lead for Covid testing, had been keeping a close eye on the ever-rising figures.
“Testing is really crucial – it forms a critical part of the epidemiology, and understanding of the pandemic,” she said.
“If you have a high testing rate and you’re starting to see numbers going down, you can be pretty certain they are really going down.
“But if nobody’s testing, you’re not going to pick up infections so you’re never really sure.”
Friday, April 30
Case rate: 61.57 per 100,000
Positive tests: 14
The Covid rate in Moray rises to the highest level of all Scottish council areas – and is almost 10 times greater than neighbouring Aberdeenshire.
The figures continued creeping up, however. The number of cases linked to Elgin Academy almost doubled in just a few days, rising from 28 on the Friday to 46 by Monday.
Part 3: ‘We have a situation here’
By May 6, there were of 210 Covid cases throughout Moray – with the total number having tripled within just one week.
While links to the school appeared to account for many of the infections, health bosses were left scratching their heads for the remainder.
Mr Littlejohn said: “Even at that point, Elgin was a clear focal point for this growing cluster.
“But there were others in the surrounding towns, and we couldn’t see where the links were.
“We knew there was something big going on.
“We’d just come out of lockdown and we were seeing this rapid and sudden increase of cases, which was so unusual for this part of the world.”
The region’s assessment group was escalated into an IMT of its own to help clamp down on the surge.
An all-star cast from across the worlds of health, local and national government assembled to discuss the issue, with attendees including infection control experts, immunisation specialists and environmental health reps.
Mr Littlejohn said: “We brought in additional mobile testing for extra capacity and put the word out – ‘We’ve got a situation here, people’.
“We said we needed to find all the cases, asking people to get tested, even if they didn’t have symptoms. so we could track the connections of it.”
All of the test results were logged in a central database, giving NHS Grampian’s analysts “almost real-time” data about how the virus was spreading.
“We had excellent surveillance,” Mr Littlejohn added.
“Our data analytics are all interrelated – you get a test, it’s digitally captured.
“We’ve got great analysts who draw these network maps to see where the connections are between cases, so we can see how it spread.”
Jamie Hogg, Dr Gray’s clinical director. Picture by Jason Hedges.
“Our message is simple: Self-isolate or Moray will become isolated.
“The area will see further increases potentially leading to hospitalisations and possibly deaths.”
– Jamie Hogg, Dr Gray’s clinical director, May 5
This information allowed the team to target resources where they were needed most.
They called on the Scottish Government for help and rolled out additional mobile testing units at Elgin Academy and Keith Primary, helping pupils during the week and the wider community on weekends.
An external Covid-19 testing centre was set up at Linkwood Medical Centre. Picture by Jason Hedges
Prof Paranjothy added: “It was about making sure the right messages about testing were there and making it as easy as possible.
“And then ensuring the access to testing was there, that there was sufficient capacity.
“When we looked at the data, you could see that, as soon as the number of tests started to go up, it coincided with a drop in the number of infections.
“It suggested we were finding cases early – and because of that we were able to stop the transmission.”
Mr Littlejohn described the public’s reaction to their call as “phenomenal”.
“We put on extra testing, and we could see who’d had more than one test, and the number coming forward for their first test,” he said.
“There was a massive spike – people really took this onboard.
“It made the cases visible – while we had all these unconnected clusters or outbreaks, everybody rolling up to get tested made it more visible in terms of the folks who had no symptoms or minor symptoms, and shrugged it off.
“All of a sudden it became clear as to the extent of it, and we were able to ask them to isolate and identify their contacts.”
Vivienne Cross, Moray Council head of education. Picture by Darrell Benns
“These have been some of the toughest weeks of the pandemic for our school staff and families.
“We’re reassured by public health that our strong Covid protection measures mean that transmission is not happening within our schools, and ask our residents to make the most of the expansion of testing.”
– Vivienne Cross, Moray Council head of education, May 5
Part 4: Vaccine breakthrough
On May 7, vaccine chiefs said concerns over blood clots meant the under-40s should not be given the Oxford/ AstraZeneca jab where possible.
And as stocks of the jabs were reorganised throughout Grampian, they were able to capitalise on the breakthrough.
“There had been some shifting around and suddenly we had an excess supply of vaccine,” Mr Littlejohn explained.
“We didn’t anticipate it but we had it – and it was really important for how we got this under control.
“All of a sudden there was a real opportunity.
“We weren’t going to be able to control an outbreak using the vaccine but, at least, two weeks down the line more people would be protected than otherwise.”
The health board was able to roll-out first doses of the vaccines to all 18-to-39-year-olds in Moray, well ahead of schedule.
Large queues formed at drop-in clinics, while appointment letters and emails were swiftly scheduled out.
Mr Littlejohn said: “The people who actually administered the vaccines greatly increased their hours and worked additional shifts and we opened additional places.
“It meant we could do this without detriment – we weren’t taking vaccines away from anyone.
“We put in extra effort to deploy the vaccine and staff bent over backwards to do extra time, and I think they helped our partnership with the public.
“They were saying ‘We can see NHS Grampian is doing its absolute best to help us, so we’ll join them in getting on top of this’.
“It all led to a ‘we’re all in this together’ feeling.”
Press and Journal reporter David Mackay
“Just when the region was coming to terms with the fact it would be left behind the rest of the country as Scotland moved to Level 2, a ray of light came that brighter days will be on the way again soon.
“I’m a 34-year-old man with no health problems other than a genetic disposition to my body hoarding iron.
“I estimated it would still be a month before I got my first jab.
“Then I got a call on Saturday afternoon while having lunch and was being vaccinated by about 9pm on Monday.”
– David Mackay, P&J reporter, May 11
Part 5: A further blow
With Covid cases still the highest in Scotland, First Minister Nicola Sturgeon said Moray would be temporarily left behind.
The whole country was due to move to Level 2 restrictions on May 17, which would allow larger groups to socialise and the reopening of cinemas, bingo halls and other entertainment venues.
But Ms Sturgeon said it was “prudent” the move was delayed amid the high case of numbers in the area.
It meant Moray remained in Level 3, rather than having a local lockdown enforced as other areas, such as Aberdeen, had experienced in the past.
Mr Littlejohn said: “With Aberdeen we didn’t get a chance to get onto it.
“It was the first outbreak after the lockdown and I dare say the Scottish Government wasn’t taking any chances.
“Lockdowns are a crude measure, with all the consequent harms that come with them, but we know they do work as they stop people being able to mix.
“But going into Moray, the strategic picture was changing and we were pretty sure there wouldn’t be a further lockdown.
“That’s part of the reason we took it so seriously.”
In the days which followed, the case rate per 100,000 began to decline rapidly. More people were receiving Covid jabs, and the increase in testing had managed to halt the spread of coronavirus in certain areas.
While there was still work to do, the positive signs allowed Moray to join the rest of the country in Level 2 by the end of the week.
Moray Council chief executive, Roddy Burns. Picture by Jason Hedges
“There’s reassurance that Moray is doing well, we’re just not there yet.
“So we’re optimistic that extended restrictions will only be for a short time, and we’ll soon be joining the rest of mainland Scotland in Level 2 and enjoying more of the freedoms that come with this relaxation.”
– Roddy Burns, Moray Council chief executive, May 14
Proprietor Gordon Brailsford of the Mosset Tavern in Forres. Picture by Jason Hedges
“The restrictions getting eased at midnight came as a big surprise.
“We were confident we were going to be moving down a level but didn’t see that one coming – although it’s hugely welcome and we’re ready for it.
“The Mosset has done well through the lockdown through the phenomenal support of our customers, but it’s great that Moray is going to be open for business for people to able to enjoy a dram indoors.”
– Gordon Brailsford, owner of The Mosset Tavern, May 21
Part 7: Aligning ‘like Swiss cheese’
Just a few days later, the outbreak was declared over and incident management team was disbanded.
Mr Littlejohn said this was due to several factors lining up in just the right way – as though they were holes in a block of Swiss cheese.
The timing of the JCVI’s Vaxzevria decision, the community response and the fact the Delta variant had not yet spread to Moray were all crucial elements, he said.
“This was only a couple of months ago – but it feels like a lifetime.
“I do think it’s a testament to the people of Moray and the community response.
“They heeded our concerns and basically did what we asked them.
“People stepped up to the mark more than we could ever have hoped.
“It’s remarkable we had a community outbreak go right up, then came right back down and stayed right down.
“It’s the first time that’s happened in Scotland, if not the UK.”
Health chiefs are warning the success of these measures cannot lead to complacency.
Prof Paranjothy said: “I think we’re going to have to do a bit of work encouraging people to continue to report when they’ve tested.
“When you’re testing frequently, if you’re doing as we say you should – twice a week – you can see how people can get tired of it quite quickly.
“But it remains important for us to understand what is going on in terms of the pandemic in our area.
“And unless we do that and understand that, we can’t really protect the health of the population.”
‘We have a situation here’: A behind-the-scenes look at how health bosses tackled Moray’s Covid surge
