The lowest level we can expect Covid-19 infection levels to fall to may be more than 10 times as high as Derbyshire saw last summer, largely due to new variants.

Dean Wallace, director of public health for Derbyshire County Council, said that getting cases to a low of 500 per week would be a feat in itself, especially with schools going back and lockdown due to ease.

He said the county area, minus Derby, was recording around 650 cases per week – minus the recent outbreak at Sudbury Prison.

Mr Wallace said it would be ideal to get cases below 500 and definitely to keep them below 1,000 per week, particularly to maintain effective contact tracing.

He said that getting cases back to a low of under 50 a week, which the county managed last August, would be highly unlikely due to the new variants.

This would leave Derbyshire with infection levels 10 times that of last summer, with the new normal and "acceptable" levels of Covid-19 set to remain far higher.

'Tsunamis' of public health issues

He also said that he and his team were aware of the "tsunamis" of public health issues which would dominate the county once Covid-19 takes a back seat, issues which have been put on the backburner for the past year.

This includes mental health, obesity and health inequalities, he told the Local Democracy Reporting Service.

He also said that other diseases such as measles could crop-up again due to lower uptake of vaccines nationally during the pandemic, with measles far more infectious than Covid-19.

This alongside other public health issues will remain a significant pressure for the next few years, he said.

For these reasons he said "We can't go back to a world where we have cut public health budgets like we did from 2015, surely".

Vaccination roll out

Mr Wallace also warned of the need to roll out the vaccination programme as fast as possible and for residents to override fatigue and continue to follow hands, face, space guidance – including at school pick-up and drop-off.

This need was now greater than ever, he said, due to the risk of creating vaccine-resistant Covid variants.

Mr Wallace said: "We have had a downward trend, but have not fallen as fast as the national average.

"We won't see the rates drop as low as they did in the summer and that is linked to the new variant, people's fatigue and the season.

"It is what becomes the new acceptable level of background rate while we get the vaccination programme rolled out and you have schools and potentially other parts of society or the economy opened up."

He suggested that if specific regions have much higher rates this could see them having extra measures reintroduced, but said local level lockdowns – such as by district – were too problematic.

Mr Wallace continued: "With the new variant, we are not going to be able to get down to the level we saw in August.

"In one week in August we had 36 cases in a week with a rolling rate of something like 3.6 (per 100,000 people).

"We have probably hit the lowest point we are going to hit (86.5 cases per 100,00 in the week to March 5, totalling 694 in the Derbyshire county area, excluding Derby) because with schools going back I am not sure we are going to see rates fall any lower.

"If we are lucky we will see a slight up-tick and then try to hold the plateau.

Increase in cases?

Dr Jenny Harries, the nation's deputy chief medical director recently suggested the country will see an increase in cases for the next two weeks as schools return, but hoped that this would then flatten or return to normal.

Mr Wallace said: "Ideally I'd like to get to 500 cases (in a week) and that would feel more manageable, but we have definitely got to keep it under 1,000.

"Anywhere around 500 we can cope and mitigate onward spread and can bring in additional contact tracing when we see outbreaks and contact every contact ourselves to do enhanced tracing."

Mr Wallace said: "I realise people are fatigued, but those measures need to be done in a much more stringent way than we could have got away with before, especially in terms of the new variant

"Also, because we are vaccinating at quite a rate people feel "oh, job's done" well, the vaccine is not fully effective until we have two doses, for people who have a single dose it takes up to 21 days to have the full immune response, so we still need people who have had the vaccine to continue to do all of those things.

Lateral flow testing

"It is really important that anyone with children access lateral flow testing to try and make that safer and that in and out of school gates, bubbles are maintained, there is social distancing and face coverings.

"It is doing that all the time, religiously. We need people to still treat it as if everybody outside of your household has Covid, until we get the vaccine out to the whole population.

"At the moment it is focussed on the most vulnerable, which is the right thing to do, to protect people at greatest risk of the worst outcome, but the biggest group spreading the virus are the 19 to 50 year old age group, the age group which is still going out to work and who provide care.

"That's where the virus is really spreading and that group has not really been touched yet for vaccination, so vaccination will not have much of an impact on the spread for some months yet, until that roll-out goes further.

"It is reinforcing that when people are so fed up with it all, and understandably so.

"The risk is, if we have higher case rates while we have the vaccination programme in place, and because the virus likes to mutate, you create a space for more and more new variants to arise.

"When that happens, while vaccination is available, there is a greater chance of a new variant becoming vaccine-resistant or making the vaccine less effective and you end up taking one step forward to take two steps back.

"That is why it is so important to get the vaccines out as fast as possible and that people still do all those other measures to protect themselves and their families and equally for the greater good and getting back to something like normal by summer."

Next phase of pandemic

On the next phase of the pandemic, after lockdown has been eased and the country aims to return to a new normal, Mr Wallace said: "There is the impact of Covid and the indirect impact of Covid.

"I think we will see a whole new set of the population who will have issues around anxiety.

"Lots of this pandemic has played out on the impact on adults, but we shouldn't underplay the impact that this is going to have on children and particularly younger people who have missed out on all those experiences.

"I think we are going to have the burden of mental health issues that have been stored up, we know we have got other health impacts such as obesity and we already had issues with that going into this.

"The big one is health inequalities, the impact of Covid is not going to be equal across the community, some communities are going to bear the brunt of that and they may be more vulnerable from a social and economic standpoint and have more unstable employment and they are the individuals who will potentially suffer more.

"If we are not careful we will end up with an endemic new virus in specific communities which could create a space where variants could develop.

"There is the potential for waves or tsunamis of issues, including one for public health, which will create issues for a long time to come.

"Measles and MR (measles, mumps and rubella) uptake has fallen further and what we don't want to do is see other diseases we got on op of, start to get reintroduced.

"There are certain diseases that have been around for a long time that people don't think are an issue any more and if we do get large unvaccinated portions of the population it will very much be an issue again.

"There is going to be more pressure. The stuff we have just tried to keep bubbling along we will have to step back up, for example sexual health services, school nursing, substance abuse services.

"While those services have been operating they have not seen as much demand as they normally would, due to lockdown, so there will be greater demand there. It is going to be really tough for the next few years."