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Volume 801: debated on Monday 3 February 2020


My Lords, with permission, I will now repeat a Statement made by my right honourable friend the Health Secretary regarding the ongoing situation with the Wuhan coronavirus:

“On Friday, the Chief Medical Officer announced that two patients in England who are members of the same family tested positive for coronavirus. They were transferred to a specialist unit in Newcastle, where they are being cared for by expert staff. Public Health England is now contacting people who had close contact with these two confirmed cases. Close contacts will be given health advice about symptoms and emergency contact details to use, should they become unwell in the next 14 days. These tried and tested methods of infection control will ensure that we minimise the risk to the public.

On Friday, a Foreign Office-chartered aircraft carrying 83 British nationals left Wuhan for the United Kingdom, and I thank all those involved in this operation, including staff at my own department, the Foreign Office, Border Force, the Ministry of Defence and military medics, as well as all the NHS staff, officials at Public Health England and many more who have worked 24/7 on our response so far.

Yesterday, we brought back a further 11 people via France, and returned UK nationals have been transferred to off-site accommodation within the NHS at Arrowe Park Hospital on the Wirral, where they will spend 14 days in supported quarantine as a precautionary measure. I thank all the staff there who have done so much to make this possible. There, they will have access to a specialist medical team who will regularly assess their symptoms. In addition, one British national has been taken to a separate NHS facility for testing.

We will take a belt-and-braces approach that puts public protection as the absolute top priority for a virus that is increasingly spreading across the world. As of today, there are more than 17,000 diagnosed cases in mainland China, with a further 185 in other countries, including France, Germany and the United States. There have been 362 fatalities so far. The World Health Organization has now declared the situation a public health emergency of international concern, and the UK Chief Medical Officers have raised the risk in the UK from low to moderate. We are working closely with the WHO and international partners to ensure that we are ready for all eventualities.

Health Ministers from G7 countries spoke this afternoon, and we agreed to co-ordinate our evidence and response wherever possible. The number of cases is currently doubling around every five days, and it is clear that the virus will be with us for at least some months to come; this is a marathon, not a sprint. On existing evidence, most cases are mild and most people recover. Nevertheless, anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel, and should stay indoors and avoid contact with other people, just as they would with flu, even if there are no symptoms. Anyone who has travelled to the UK from mainland China in the last 14 days and is experiencing a cough, fever or shortness of breath should self-isolate and call NHS 111, even if symptoms are mild.

We will do all we can to tackle this virus. We are one of the first countries in the world to develop a new test for the virus. Testing worldwide is being done on equipment designed right here in the UK, in Oxford, and today I am making £20 million available to the Coalition for Epidemic Preparedness Innovations to speed up development of a vaccine. I can also announce that Public Health England has sequenced the viral genome from the first two positive cases in the UK and is today making that sequence available to the scientific community. Its findings suggest that the virus has not evolved in the last month. We have also launched a public information campaign, setting out how every member of the public, including Members of this House, can help by taking simple steps to minimise the risk to themselves and their families: washing hands and using tissues when they sneeze, just as they would with flu. That goes for all of us.

We remain vigilant and determined to tackle this virus, with well-developed plans in place. I commend this Statement to the House.”

My Lords, I thank the Minister for repeating the Statement and once again pay tribute to the medical, public health and NHS staff who are working so hard to deal with this crisis, both in the UK and internationally. Last week, the Minister underlined the importance of all public health authorities and the NHS working closely together to ensure clear co-ordination. Now that the World Health Organization has declared the virus a public health emergency of international concern, this is more important than ever.

As we have heard, 93 British nationals have now been repatriated to the UK and transferred to a dedicated NHS facility in the Wirral as a precautionary measure. Can the Minister update us on the health and well-being of those people in quarantine? There have also been reports that 15 health workers have been diagnosed in China. We know that the virus mainly spreads through contact with an infected person. Can the Minister outline what protections are in place for health workers, particularly for those in the Wirral and in Newcastle, who are in close contact with those in incubation?

One of the disturbing findings from the early stages of the virus so far has been reports that a number of the people who have sadly died had pre-existing conditions. Does the Minister have any further information on this, including on the particular types of pre-existing conditions and what steps will be taken here to advise and support these very vulnerable people in the UK?

On vaccine development, there have been suggestions that human trials of a vaccine could start soon and be progressed with unprecedented speed. I welcome the reference to this in the Statement. The Times today reports that the head of the Coalition for Epidemic Preparedness Innovations has mentioned that an investigational vaccine from gene sequencing of the pathogen through to clinical testing could happen in 16 weeks, with the earliest stages of clinical trials taking two to four months. We welcome the Government’s £20 million contribution to the coalition’s research to speed up development of a vaccine. Has the Minister any specific further information on how quickly they expect the vaccine to be available and ready to distribute?

The Minister will be aware that many east Asian people living in the UK have reported being the target of racist abuse linked to the outbreak, while Chinese businesses are suffering from bogus claims that Chinese culture is to blame for the coronavirus. Their community leaders have expressed concern about repercussions, as Chinese students, workers and tourists in Europe become a focus of fear and confusion about the virus. What steps are the Government taking to combat racism, stereotyping and making assumptions during the outbreak of the virus?

Finally, we fully support the Government’s public information campaign centred on simple preventive measures to minimise the risk of the virus spreading, such as by washing hands and using tissues when you sneeze. Can the Minister reassure the House that the campaign will be proportionate to the risk currently faced by the general UK population? While we need to alert the public, we all want to avoid causing unnecessary stress or creating a panic.

I echo the thanks to medics, staff involved in logistics and especially the scientists working so rapidly to sequence the genome of the coronavirus. I support many of the points made by the noble Baroness, Lady Wheeler.

Our concerns are more about some of the very practical arrangements and the fact that the UK seems to be responding 24 or 48 hours behind some other countries. I note the Statement says that

“anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel.”

It also says:

“Anyone who has travelled to the UK from mainland China in the past 14 days and is experiencing a cough, fever or shortness of breath should self-isolate”.

It is interesting that the Philippines, New Zealand, the USA, Singapore and Australia are now barring all foreign nationals from mainland China from entering their countries at all. I know that the World Health Organization is not yet saying that we should follow that, but I noticed that a report at the weekend said that about 340-odd people had come in from Wuhan just before the arrangements were put in place and that the Department of Health was now trying to track these people. Given that we now know that the disease can infect people prior to symptoms emerging, has the Department of Health been able to identify those people who arrived prior to the Government’s arrangements being put in place? Do the Government now have absolutely clear procedures to identify people coming not just from Wuhan and Hubei province but from mainland China so that they can contact them urgently if there are issues? Is everyone travelling in from China getting specific advice about who to contact and what to do?

Finally, what are the numbers of cases in regions outside Hubei? The press is reporting that at least 24 provinces, municipalities and regions in China have now told businesses not to resume work before 10 February at the very earliest. These account for 90% of exports from China. Given that many of our businesses rely on just-in-time manufacturing, I wondered whether the Government were assessing what the impact on our businesses would be if there was a gap in production and exports from China.

I thank the noble Baronesses for their comments and very relevant questions. The UK is of course very well prepared for these types of outbreaks. We have responded extremely well on previous occasions, so we should have confidence not only in the capability of Public Health England and the NHS to respond, but in the ability of our chief medical officers to assess the level of risk, which speaks to the point the noble Baroness, Lady Brinton, made about the pace and types of responses being put in place. This is clear medical advice based on the evidence and data available.

The advice available for travellers is obviously being kept under constant review and it has changed. Currently, there is advice against all travel to Hubei province and all but essential travel to mainland China. Essential monitoring has been put in place for all incoming flights from Hubei province, and for wider travel too. Public health officials are meeting all those flights and advice is being given as outlined in the Statement.

Rightly, a question was raised about the risk to the health workers who respond, as this is a virus that is spread by contact. Obviously, this speaks to the capabilities of NHS expert teams, who are accustomed to responding to any risk. As well as the expertise they already have, advice is being communicated from the CMO and others. The NHS expert teams are with every ambulance service and are in a number of specialist hospital units, where equipment and highly trained staff are ready to receive and care for patients with any highly infectious diseases. We have also provided an extra service on NHS 111, for public health advisers to triage people with specific queries or symptoms who have travelled from the region, so that they get to the right point. I hope that answers the question.

On the question of information to NHS staff across the system, a tripartite letter has been issued by the CMO, the NHS medical director and the director for the National Infection Service and PHE to all front-line clinical staff, so that they are aware how to respond and what steps to take when encountering patients arrived from overseas with respiratory infections. This was updated on 31 January in the light of the WHO’s declaration of PHEIC. I think we can be reassured on that point.

It is absolutely right that the evidence shows that the mortality rate of between 2% and 3% is mostly for older patients and those with pre-existing conditions. That is part of the data and the evidence which has been given to the NHS so that it knows how to provide appropriate care.

I would like to respond to the questions raised regarding the care provided for the confirmed cases. Public Health England is making good progress in identifying and contacting anyone who has been in close contact with those two confirmed cases. Thorough investigations will continue, to ensure that we take all possible actions to identify anyone who has come into close contact with them. They will be given health advice about symptoms, and emergency contact details to use if they become unwell within the 14 days. This is based on the CMO’s advice about tried and tested methods. Additionally, we are pursuing wider contact tracing across the country for all who have come in from Wuhan. We are confident in the progress that we are making.

Finally, I turn to the questions regarding vaccines. As I noted in the Statement, the Government have pledged £20 million to develop new vaccines to help to combat the world’s deadliest diseases. This will support work developing new vaccines for epidemics and includes three new programmes to develop vaccines against novel coronavirus. The project aims to advance vaccine candidates into clinical testing as quickly as possible. I cannot give an exact timeline to the noble Baroness today, but I shall endeavour to get her as much information as possible. I am sure that we shall have more discussion on these issues as we go through this, but I hope that I have answered her main questions. If I have missed anything, I will be very happy to write.

My Lords, the Minister said that we were well prepared for this outbreak, but quite honestly it does not altogether appear so. We saw reports in the media of the first flights arriving from Wuhan. The passengers reported that there was no medical intervention and no advice offered of the kind that is in the Minister’s Statement. We are now asking people who have arrived in the last 14 days to contact the NHS immediately to inform them of recent travel, to stay indoors and to avoid contact. That advice was not offered to the first people who arrived. The delayed FCO chartered flight this week has quarantined people for 14 days, as we all know. These actions appear inconsistent. Can the Minister assure us that they are consistent and that there is some coherence and rationale behind them? There does not appear to be.

There is indeed. The first Urgent Question I replied to a few days ago was when we introduced the enhanced monitoring on planes, meeting each flight coming into Heathrow from Wuhan; they come in three times a week. That information and advice was given to individuals on those flights and public health officials met them from that day. If individuals came in before that day, they would not have received advice; contact tracing has been under way for those people. Subsequently, British nationals wishing to return home have been in contact with the Foreign Office and flights have been arranged to bring them home. I think that is the flight which the noble Lord is referring to. As a precautionary measure, quarantine has been arranged for those individuals for 14 days, to ensure that we manage any potential risk as effectively as possible. This is based on the advice of the Chief Medical Officer, from the data which has subsequently become available, since evidence is evolving regarding the risks associated with the Wuhan coronavirus.

It may seem rather indelicate at this stage to talk about the wider economic impact within China and on Chinese trade with the rest of the world, but, as was mentioned in Questions earlier, might it be useful if that dimension was included in future reports? A lot of businesspeople will be putting off trips and so on. There may need to be new lines of credit, especially at the present juncture. Of course, in China everything is coming to a halt in terms of internal transport and so forth. To show our interest in what we might call the economic and social developments in China, would it be useful to have some reporting on how the rest of the world is dealing with all these other non-medical dimensions? I think the Chinese and a lot of our businesspeople would appreciate that so that we do not jump the gun. People will be desperate to get back to business, which is not yet timely.

The noble Lord will not be surprised to hear that it is important to put the public health response first and foremost when it comes to a risk of this kind, and that is exactly what is happening in this case. The actions that the UK has taken in this regard have been appropriate, proportionate and commensurate with the data and evidence that have come forward, and they are based on clinical evidence. Having said that, he is absolutely right that an economic impact as a result of quarantine measures taken by China and others cannot be avoided, and it is right that we should consider the impact for UK businesses. I am sure that consideration will be given to what can be done about that.

My Lords, can the Minister define what she means by mainland China? I asked a question about Hong Kong last week and I note from the Foreign Office website that the Hong Kong Government have announced that all border crossings with mainline China will close at midnight tonight, Hong Kong time, which is an excellent idea in terms of containment. I am also aware that people who work for international companies in Hong Kong have been told to work from home for a minimum of two weeks from last Friday—three days ago. What will we do about people coming to our borders from Hong Kong in the immediate future?

The noble Baroness asked that question last time and I did not forget. At the moment, Foreign Office travel advice is that anyone who has travelled to the UK from anywhere in China other than Wuhan or Hubei province, but not including Macau and Hong Kong, in the past 14 days and has developed symptoms should immediately self-isolate, even if symptoms are minor, and call NHS 111. Macau and Hong Kong are not included because those territories do not have evidence of sustained community transmission, as has been observed in mainland China, to date. They are therefore not currently included in the same travel advice as mainland China. However, the epidemiological situation in Hong Kong and Macau, as indeed in the rest of the region, is kept under constant review and will be considered in travel advice as we go forward, and reported to this House accordingly.

My Lords, I am most grateful, as is everybody, to the Minister for updating us. She spoke about person-to-person transmission not having occurred in Hong Kong and those other areas. Will she confirm that to date there has been no evidence of person-to-person transmission outside China? That is, it has come from contact within China and people who have the virus leaving China. Do we have that information?

Also, in modelling for the worst-case scenario that might occur, how many negative pressure room beds do we have across the whole of the UK for those patients who develop severe acute respiratory infection and therefore have to be hospitalised and possibly ventilated in the event of this becoming severe? What evidence is there about the length of time that the virus survives on different surfaces outside the body? Because of the incubation and asymptomatic periods, when it appears that people are still infectious, there is a concern that the virus has quite a long survival time on surfaces, particularly those that may be warm and damp.

There were a few questions there. With regard to transmission, this is an evolving picture, so the best thing would be for me to send the most up-to-date information to the noble Baroness and put a copy in the Library, as I am sure it will be of interest to the whole House.

On ECMO beds, since April 2013, NHS England has commissioned a total of 15 adult respiratory ECMO beds from five providers in England. There is further provision in Scotland. But in periods of high demand, the capacity can be increased. For example, in the winter of 2018-19, when there was a significant risk associated with flu, the capacity was increased to over 30 beds and similar arrangements are in place for paediatric services. In addition, there are eight commissioned high-consequence infectious disease beds and around 500 infectious disease beds, and at the moment NHS England is confident that it has enough capacity, which I hope is reassuring for the noble Baroness. Obviously, we are keeping that under constant review as the situation evolves.

On the question about surfaces, that is one of the specific reasons why advice has been given regarding personal hygiene—washing hands and using tissues when sneezing—to avoid any forms of transmission that may create the kind of risks referred to by the noble Baroness.

My Lords, when the Minister repeated the Statement, she referred to the precautionary measures that people are being invited to remember when trying not to pass on infection. If I recall, the Statement said something to the effect of “as you would normally do with flu”. But does the Minister agree that that is not what people normally do with flu? People often do not take the symptoms seriously and transmit it before they have even decided to give into it themselves. I have one germane example in this context. A member of my family contracted flu a couple of months ago which became pneumonia, although fortunately not a serious case. He was advised to go to his GP and the GP referred him to A&E where he waited a long time with a lot of other people in what was clearly a highly infectious state.

Given the stringency of the measures taken to contain coronavirus, can the Minister say what wider public health lessons we might take from this in giving consistent messages to prevent people imagining that flu is a minor illness and it does not matter if you continue going to work or pass it on to other people? It does matter, and the mortality rate among vulnerable groups with flu can be quite high, as the Minister will know.

The noble Baroness has rightly raised this issue with me before. She is quite right that flu can and should be managed much more effectively in the community and by individuals. I think we have had an effective flu campaign this year. The flu vaccine has been offered to 25 million people. We have also extended the flu programme this year to children in year 6 to improve herd immunity and drive up its impact. We are seeing the number of those with flu declining, so we are starting to see some improvement. However, I completely recognise the noble Baroness’s point about public health lessons and improving public education on the management of infectious conditions, which we live with every winter, not just when we have an infectious situation such as this. I thank the noble Baroness for an important question.

My Lords, in my view the measures the Government have taken are balanced so as not to cause a panic and unnecessary alarm. The important thing, though, is that the Government remain on top of developments. If the virus mutates and spreads rapidly from human to human, it will require much more draconian measures to be taken.

It has been reported that the virus transmits from human to human and to people who have not been in China, although the numbers are small. An index or measure of human-to-human transfer is known as R0. It currently stands at about 1 to 2. If it increases, that means the virus is spreading faster. Sequencing of all the known cases so far suggests that the virus has not mutated. It remains 99.98% the same sequence, including in the two patients known in the United Kingdom. I hope the Government have a strategy in place to keep on top of developments and that they will take the steps required to stop the spread.

I thank the noble Lord. He is right that there is a global effort to keep on top of the sequencing of the virus to track any evolution of it. As he said, the indications are that the virus has not evolved in the past month, which is encouraging. The rate of transmission is as reported. That means that the infection control measures in place, which are based on clinical evidence and the data, are proportionate and appropriate. Combined with the public health advice that has come out and the contributions each of us can make as individuals to manage the spread of infection, we believe that this is the responsible and appropriate route. However, as the noble Lord said, we will keep the developing situation under a close eye so that we can respond quickly and nimbly as the situation goes forward.