By Prof Dominic Harrison, director of public health for Blackburn with Darwen

The NHS and social care system across Lancashire is now under significant pressure and today I am asking all residents of Blackburn with Darwen to step-up their efforts to control the spread of Covid and other winter viruses.

There are five things we now need to do to remain well over winter and protect the NHS:

1. Washing our hands regularly and carrying hand sanitiser when we go out

2. Taking regular rapid tests, particularly before mixing with others

3. Getting fully vaccinated against Covid-including the booster dose which is available to over 40s from next Monday, 22 November

4. Keeping rooms well-ventilated, particularly when spending time indoors with people we don’t live with

5. Returning to regular mask wearing in shared public spaces including in communal areas in schools and colleges.

These measures are preventive measures. Blackburn with Darwen is doing well in controlling its Covid case rate and we want to keep it that way. On November 16, the borough's rate was 294.6 per 100,000. This meant that we were 52nd lowest of 315 English local authority areas.

These measures will protect the health and care system from further avoidable demand over the coming winter months. Our local system is fragile and already experiencing very high demand. Covid hospital admissions have almost doubled in the last few weeks, with 82 Covid inpatients in East Lancashire Hospitals Trust (ELHT) on Monday November 15.

Long waiting lists and lower than average local GP numbers mean that the hospital had more than three times the usual A&E attendances one day last week. But the risk is not only Covid. A real cold snap, with ice on pavements, will generate both a rise in falls and respiratory admissions to ELHT. This could really put pressure on the hospitals' capacity to provide more urgent life-saving treatments. The cumulative risk of hospitals being overwhelmed is that delays to life-saving treatment may generate a rise in avoidable excess winter mortality.

It is now evident that a winter surge in Covid cases is spreading across Europe, despite our collectively high European vaccination rates. This week, the Netherlands, Austria and Ireland, all of whom have similar or higher vaccination rates than the UK, have had recent Covid surges. These have required them to move rapidly into various lockdown-type measures. Mask wearing will reduce this risk.

There can be no doubt that if we implement more widespread infection control measures earlier we may avoid the risks of having to escalate into any further Covid controls so abruptly.

Widespread mask wearing alone will not stop any winter surge in Covid infections – but it will slow it down – especially if adopted as part of the wider winter wellbeing actions listed above.

If we all act together, we can keep the NHS and social care system safe and available for those who need it most. Those who need the health and care system most are not ‘others’. Anyone at any-time can need urgent and emergency life-saving treatment from the NHS. If the NHS is overwhelmed, we are all at risk.