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Wuhan Coronavirus

Volume 801: debated on Tuesday 11 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. The Statement is as follows:

“I have laid an instrument before the House to confirm the power that we have taken to isolate those at risk of spreading the virus, and if necessary to keep them isolated as part of our belt-and-braces approach to protecting the public. The powers are proportionate and will help us slow down transmission of the virus and make it easier for NHS and public health staff to do their jobs.

The clinical advice about risks to the public has not changed and remains moderate. As of today, eight people in England have tested positive for coronavirus. All are receiving expert care from the NHS, which is well prepared and equipped to deal with this situation. Contact tracing of the first four cases has been undertaken rapidly and is now complete, while tracing for the latest four cases is ongoing. This contact tracing itself identified five of the cases—a tribute to the skill and tenacity of Public Health England staff—as well as finding five further British nationals in France who also tested positive for the virus. They are now receiving treatment, and the Foreign Office is following up with consular support.

On Sunday, 105 more British nationals and dependants from Hubei province landed safely at Brize Norton. They are now in isolation facilities at Kents Hill Park in Milton Keynes and receiving all the necessary medical attention. I pay tribute to the Foreign Office and the MoD, as well as Milton Keynes Council, Milton Keynes hospital and my own team, for their hard work and efficiency in ensuring that this all went smoothly. This is, of course, in addition to those now reaching the end of their isolation on the Wirral.

I turn to the efforts to contain the outbreak in China. The Foreign Office is advising against all travel to Hubei province and all but essential travel to mainland China. Last week we issued new advice to all travellers returning to the UK from China, Hong Kong, Macau, Malaysia, South Korea, Singapore, Taiwan and Thailand. That advice is clear: if you develop symptoms of cough, fever or shortness of breath, you should call NHS 111 and immediately self-isolate for 14 days, even if the symptoms are minor. If you have returned from Hubei, you should self-isolate and contact NHS 111, even if you have no symptoms.

My officials discussed the incubation period with the World Health Organization this morning. The current evidence shows that a 14-day incubation period remains appropriate. We will continue to monitor emerging evidence closely with our international partners.

As I said last week, dealing with this disease is a marathon, not a sprint. The situation will get worse before it gets better. We will be guided by the science. Be in no doubt: we will do everything that is effective to tackle this virus and keep people safe. We are investing £40 million in vaccine research and working with international efforts on therapeutics. Today I can announce to the House the immediate launch of a capital facility to support any urgent works the NHS needs for coronavirus response, such as the creation of further isolation areas and other necessary facilities.

Finally, there are actions that each and every one of us can take—simple but effective steps such as washing hands and using tissues. We will take all necessary precautions to keep the public safe. I commend this Statement to the House.”

I thank the Minister for repeating the Statement. Of course, our thoughts are with those who have been diagnosed with coronavirus and are in quarantine. I place on record these Benches’ thanks to our NHS and public health staff.

On the specific issues of quarantine arrangements, we understand the approach the Government have taken, particularly to deal with anyone who seeks to break the quarantine. We understand why the Secretary of State has invoked the regulations; he is entitled to do so under the Public Health Act, and we offer our support for that. Quarantine arrangements must be seen to be necessary, proportionate and in accordance with the law. Their enforcement, including with powers of restraint where necessary, must be fully transparent. The rights and freedoms of the quarantined evacuees must be fully understood to ensure that they are treated with dignity and respect. The media coverage so far certainly suggests that that is exactly the case.

To maintain public confidence in these arrangements, the framework must be understood and scrutinised by Parliament. With that in mind, I ask the Minister when we in this Chamber will deal with the regulations laid. The progress of this virus is rapid; there seems to be rapid change from day to day. We are due to break next week and it seems that 24 February may be too late, because it is moving so quickly. What arrangements are the Government making for us to deal with the regulations in this Chamber?

I feel that I need to declare an interest in the register: I am a member of a local clinical commissioning group. Perhaps the Minister could tell the House what clinical commissioning groups and trusts are being asked to do in terms of making plans in the coming months if this turns into a pandemic. Can she assure the House that local plans are robust and fully resourced? Are we confident that the 111 helpline has sufficient capacity to deal with increased calls? Will the community health trusts that are tasked with visiting suspected patients, and will have to visit people’s homes to carry out swab tests, be given extra resources to build up the capacity to be able to carry that out properly?

Finally, will the Minister update the House on international efforts to share research intelligence and attempts to find a vaccine, as well as the likely timescale? I understand that there is a summit of the World Health Organization today. On behalf of the Official Opposition, I thank all our NHS staff and reiterate our hope that the Secretary of State will continue to keep the House fully informed.

My Lords, I begin my remarks from the Liberal Democrat Benches by echoing those thanks to all staff who are involved, not just on the front line but in the large amount of planning that is going on. We would also like to thank the patients who have self-isolated in calmness, accepting what has happened and moving a long way from home, and those who after flying back from abroad have quite contentedly gone on elsewhere. The advantage of social media, television and radio is that we can hear how they are managing.

I note that the Secretary of State has declared that transmission of coronavirus is a serious and imminent threat to public health, despite the fact that the current situation remains moderate. The regulations for England only—to isolate and hold those at risk of spreading the virus—is, I hope, a last resort. So far, that has not been necessary, but we on these Benches understand that there may be occasions when it is. Will the Minister confirm that the devolved states will follow suit? We would not want Gretna Green suddenly to have a reputation for the wrong reasons, with people trying to remove themselves to somewhere that the regulations do not apply. It seems sensible in the United Kingdom to make sure that there is consistency among the four states.

What safeguards are in place for those conducting the quarantines and isolation to ensure that they are kept safe, along with the patients, and to prevent them contracting the virus?

I note also the regulation that came into force at the end of January, ensuring that no charge is to be made or recovered from overseas visitors who may have to be diagnosed with, or treated for, coronavirus. We believe that that is right, but how is this information being disseminated to healthcare bodies? I see nothing at all about it on the department’s website. The regulation appears for parliamentarians via Hansard, but I can see nothing else anywhere that might help inform hospitals and other bodies.

Today’s Statement from the Secretary of State, the department’s daily 2 pm statement, and the report from the Chief Medical Officer all talk only about those travelling from a number of Asian countries—which the Minister read out in her repeat of the Statement—and who have come from those countries in the last 14 days. This is echoed in the department’s advice to healthcare professionals. So, despite being updated daily—and the number of patients was up to date as at 2 pm today—these Statements do not reflect the fact that some of the eight UK-based cases contracted coronavirus in France, or possibly even in the UK.

Today on radio and television, we have heard a number of experts from China, from John Hopkins University and from UK universities all talking about the possibility of substantial transmission. Indeed, the department has confirmed that this is a high-consequence infectious disease, with all the concerns and constraints that go with it, which include being

“often difficult to recognise and detect rapidly … ability to spread in the community and within healthcare settings … requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely”.

We now have cases in York, in Brighton and its area, and in the specialist receiving hospitals in London and Newcastle, in addition to two GP surgeries in Brighton that have been closed for cleaning. There are local concerns in Brighton about a community centre, and some schools appear to be making the decision to allow children not to come in, after two people were told to self-isolate. But there does not appear to be any formal advice being offered to councils, councillors, schools, prisons and other public bodies. Can the Minister explain why the Statement seems to take no account of what is happening in the UK at the moment? What advice is being given to local councillors, schools and other bodies about early planning for their area, what they should do if a person may have coronavirus, and what happens once they are diagnosed, so that they are ready in the event that there are cases in their area?

I specifically want to mention the role of councillors here. Elected members are often at the heart of their communities, and an informed councillor can calm worries, particularly at the school gate, if they can say that they have been briefed. These days, briefings do not have to happen face to face; there are mechanisms through technology for people to be brought up to date.

Finally, in Brighton, it has been reported in the local media that a number of people with cancer and other long-term conditions are understandably worried about what they should do. They are asked to make sure that they have their annual flu jab, but at the moment there seems to be no specific advice for people regarded as vulnerable patients. Public Health England’s very helpful flow chart on the management of a suspected case runs through very sensibly what to do with the patient, but nowhere does it suggest to ask the patient whether they have any vulnerable people in their family or their contact, nor can I find any advice, anywhere at all, about what primary care doctors should be saying to vulnerable patients in their area—I am thinking particularly of Brighton, at the moment—to make sure that they feel comfortable about this.

These are concerns that could, I suspect, be resolved with effective planning. However, it seems that, at the moment, there is a bit of a lacuna, and I hope that the Minister will be able to help fill the space.

I thank the noble Baronesses for those important questions and, like them, I thank NHS and PHE staff for their extraordinary work over recent days, and those patients who have acted so responsibly in self-isolating. In doing so, they have slowed the transmission of coronavirus in the UK and protected many, including those who are particularly vulnerable. I also thank both Benches for their support of these regulations, which hopefully will not be needed, but should they be needed, could play a crucial role going forward.

I wish to clarify that these regulations will apply only to coronavirus. They will be in force for two years and will be triggered only in the instance of a serious or imminent threat to public health by a person not complying with public heath advice and therefore putting themselves and/or others at risk.

The noble Baroness, Lady Brinton, asked about the devolved Administrations. These regulations apply only to England, but we are in touch with the devolved Administrations, and they will consider this. Obviously, CMOs are acting in concert, and we think that the devolved Administrations will want to take this forward. The question of the scrutiny by Parliament is one for duty managers, but we have come back to the House with this issue on a number of occasions and we are very committed to keeping the House updated on this and will continue to do so.

On the point about how the NHS is being kept updated and prepared, we have announced the capital arrangements today to ensure that the NHS can be prepared for different isolation measures, but the NHS is always ready to provide world-class care, with expert teams in every ambulance service and a number of specialist hospital units that can respond to this. I am pleased to report that the latest data from PHE indicates that, in the past week, flu activity has once again decreased, against all indicators, the rate of GP consultations remains below baseline levels and the rate of ICU and HDU admissions and hospitalisations remains low, which is an encouraging background for us.

The noble Baroness, Lady Brinton, also asked about those who are vulnerable. This is factored into the NHS 111 algorithm, where we advise individuals to call should they have any concerns, as part of the public health advice. I take on board her point about those individuals who may be useful for community communications with councils, schools and others. Obviously, the first place for advice is Public Health England, but there may be activity which I do not have in my brief, so I will come back to her on this.

We have cascaded very detailed information through the NHS about coronavirus—what to look out and what actions to take—which has come from the Chief Medical Officer and those leading the response, to ensure not only immediate response and preparedness, but also on what actions can be taken by healthcare professionals to protect themselves.

The noble Baroness, Lady Thornton, asked about vaccines. She will know that we have pledged £20 million for the new vaccines to combat this. Every day that we slow down sustained transmission is a day closer to development of that vaccine. Developing a new vaccine is not necessarily a quick process; I think it will be in months rather than weeks, but we will put every effort into making sure that we can take part in that.

Finally, the noble Baroness, Lady Brinton, asked about the differential advice regarding travel from Wuhan and travel from other Asian states and about where that stands at present. The Scientific Advisory Group for Emergencies and UK Chief Medical Officers have given that advice, on those who have travelled from mainland China and the other nations that I stated versus those who have travelled from Wuhan, based on evidence now available on sustainable transmission. Should there be person-to-person transmission at a different rate, it would be kept under review and the advice would change.

I hope that I have responded to most of the questions. Should there be further questions, I am happy to respond in writing.

My Lords, I do not want to overreact, but this is a very dangerous condition, and prevention starts at home. The average age in this House is 70. We therefore form part of the most vulnerable group, the group most susceptible to viral infections. Bearing in mind the pressures on Members to attend, should not the House authorities be preparing advice for us on what action should be taken to avoid cross-infection within the House, including, in the event of an infection breakout in London, the wearing of face masks on these premises, not only for self-protection but also for the protection of other people in the House?

The noble Lord is quite right that each of us has a role to play in preventing the spread of infection. At this point, the advice is that, if you have travelled from any of the infected areas or have been part of the contact tracing, you should self-isolate. Should you have any of the symptoms associated with coronavirus—a cough, fever or shortness of breath—you should stay indoors and call 111, even if the symptoms are mild. Outside the question of whether you have had any contact or travelled to the affected areas, the advice from the Chief Medical Officer is that effective handwashing and the “Catch It, Bin It, Kill It” concept—to use tissues when you sneeze or cough and to throw those tissues away—is the most effective way of limiting the passing on of infection, and each and every one of us has a role to play in doing that. However, I am happy to pass on to the House authorities the point the noble Lord has made and ask for communications to be sent from Public Health England with the most up-to-date information.

My Lords, I thank the Minister for bringing the update to the House. Among all those people to whom we owe a debt, we should particularly single out the chief medical officers, led by Chris Whitty, who is an epidemiologist and therefore has an in-depth understanding of the science. We should also thank the owners and crew of, and all those on board, the “Diamond Princess”—a British-owned vessel—who are working with the Japanese authorities and doing all they can to contain the outbreak that has occurred there.

One of the difficulties—this was alluded to by the noble Baroness, Lady McIntosh, who is not in her place at the moment—is that in the early stages this is like the common manifestation of any other viral disease. Therefore, self-isolation and being responsible by staying away from people is everyone’s responsibility with all such infections. Unfortunately, some turn out to be coronavirus. Are the diagnostic kits for Covid-19, which I think is now its official name, available to adequate numbers of hospital laboratories which are under public health supervision? Are those diagnostic kits available across all four nations of the United Kingdom? Are they linked to Colindale so that there is good co-ordination of the way in which the diagnostic procedures are undertaken?

The noble Baroness is quite right. We are aware that there are British nationals on board the “Diamond Princess” in Japan and that six more people have tested positive for coronavirus, none of whom is a British national. We have offered consular assistance to those British nationals—we have been in touch with the “Diamond Princess”—including one who is in hospital. We obviously pay tribute to the work being done in trying to contain the situation there. I identify myself with the thanks and tribute paid to the work of the CMOs, who are doing an extraordinary job right now to make sure that the UK is prepared.

We are one of the first countries in the world to have an effective test; it is working well. Now that the protocols have been sent to the devolved Administrations, testing centres in Glasgow, Edinburgh, Cardiff and Belfast have started testing already. Labs in Cambridge, Bristol and Manchester have started testing today and Birmingham, Newcastle and Southampton will come online shortly. I hope that reassures the House about the capability already available within the NHS.

My noble friend’s appreciation of what is being done in contact tracing and the urgency that has been invested in that and other aspects of containment of the disease is welcome. I share the appreciation that there is across the House for that.

I am sure my noble friend agrees that the effort put in now to try to contain the virus is not disproportionate, even if it includes the powers under the new regulation, because it buys us time. She referred to buying time for research into a potential vaccine. I have not seen any reference to other antiviral treatments that might be identified and be of use. For example, if a new flu-like virus was circulating we could use our stockpiles of Tamiflu. Have any viral treatments been explored for this particular virus?

As ever, my noble friend is astute on this issue. Contact tracing has been hugely effective, particularly for the 1,466 passengers and 95 staff who arrived in the UK on direct flights from Wuhan between 10 and 24 January. All those have now passed through the incubation period and none of them was a confirmed case. Of the remaining cases that we have found, a number are linked to contact tracing. We should be very proud of the effectiveness of our system.

On the question of antivirals, work and research is ongoing in regard to a particular HIV retroviral which has been used in this measure. That is being considered. There are three projects which aim to advance the vaccine candidates into clinical testing as quickly as possible. We are also looking at some correspondence from both diagnostic kit manufacturers and potential end users, and we are considering whether we can also improve the diagnostic kit.

My Lords, it is always a pleasure to correct the former Secretary of State for Health. This virus is RNA in its genetic makeup. H1N1—the previous pandemic that we were worried about when we stockpiled the antivirals—had a DNA genetic make-up. Some antivirals work better with DNA than RNA, although the Minister was correct to say that there are several antivirals currently being tested to see whether they will work against the coronavirus. As far as a vaccine is concerned, it takes a long time to develop a vaccine; when you develop one, it takes even longer to see whether it is effective.

Last time we discussed this, I said that the Government were taking a proportionate action to contain the virus in the United Kingdom. I believe that to be so even today. However, we might be on the knife edge of a pandemic. If a pandemic is declared, the whole attitude to how we contain this changes. It becomes much more draconian, to stop the movement of people, isolate the index cases and identify the contacts. Currently, asking the Members of this House to wear masks would only make the public panic and ask why we are protecting ourselves when they are not being protected. It can be a good measure, but we have to wait to see how things develop. I would like to hear reassurance from the Minister that there are plans in place, so that if this becomes pandemic, the Government will take the draconian action that is required.

We are fortunate that, apart from the Chief Medical Officer Chris Whitty, who is a first-rate epidemiologist, we have Professor Piot, who discovered the Ebola virus, and Jeremy Farrar, chief executive of the Wellcome Trust. They have better knowledge on containing pandemics than anyone else in the world; I hope the Government will use their expertise.

The noble Lord has demonstrated, far more eloquently than me, why we have more expertise in public health, and in particular in infectious diseases, than many other nations; we of course share our expertise through the WHO with Professor Piot, Professor Jeremy Farrar and our own Chief Medical Officer Chris Whitty. We operate using the best scientific evidence and advice from SAGE, which is currently advising the risk level of moderate. We keep that under constant review and are not complacent in any way. Through the preparations that we are putting through the NHS and all other parts of the system, we will be prepared for whatever situations might emerge should there be more sustained transmission in the UK. We will take the measures necessary to protect public health. The steps that we have taken so far have been proportionate and appropriate; they also demonstrate that the Government will act as necessary to make sure that we protect public health.

My Lords, these are indeed worrying times, with self-isolation a necessary measure to control transmission. In the spirit of informing government, in the context of borders, is the Minister aware that mandatory forced isolation is contrary to provisions in the Portuguese constitution? This might become relevant when protecting our shores in future risk management efforts, to which she referred.

I believe there are some legal specialists in the Chamber. I note the noble and learned Lord, Lord Judge, sitting at the front on his Bench, who may be able to answer more effectively than I can. However, I believe that the regulations as they have been drawn up are legally appropriate and proportionate. As I have said, they apply only to coronavirus, are in force for only two years and are triggered only by a serious and imminent threat to public health and where a person has not complied, or will not comply, with public health advice and is therefore putting themselves and others at risk. This is well in line with other legal measures.

My Lords, will the Minister give more information on people, including parliamentarians, attending conferences and functions in various parts of the world? Is there a risk of picking up coronavirus at airports and on long-haul flights? Many of your Lordships attend conferences and one noble Lord has asked me to relay this question.

The travel advice, as it stands, is against travel to Hubei province, and against all but essential travel to China. There is no advice against other travel. People should be reassured that there is no problem there.

My Lords, perhaps I could follow up on that very subject. This afternoon the set of barristers’ chambers to which I belong advised any of its members who had returned from any of the named countries to self-isolate, irrespective of whether they were showing symptoms. I think that is because it is so difficult, at the beginning, for the symptoms to emerge to a point at which somebody realises that they have reached the stage of being able to transmit the disease. This set of chambers has taken rather an extreme measure; maybe others are doing the same. Do I gather that that is not yet the CMO’s advice? On the other hand, would the CMO be considering whether the advice should be not just to self-isolate if symptoms develop, but for people returning from such places to self-isolate anyway as a precaution?

I am sorry that I had not noticed the noble and learned Lord, Lord Hope—who is of course also an excellent legal mind— sitting right behind the noble and learned Lord, Lord Judge. We are very grateful for the precautionary measures being taken by a number of individuals and organisations. However, the advice from the Chief Medical Officer and SAGE is proportionate. At the moment, the available evidence is that transmission while asymptomatic is very unlikely. That is why the advice stands as it is: where the risk is highest and where transmission is sustained, people should self-isolate immediately on return—which means on return from Wuhan and the rest of Hubei province. On return from other areas where transmission is less sustained, people should self-isolate on the arrival of symptoms.