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Wuhan Coronavirus

Volume 802: debated on Wednesday 26 February 2020


My Lords, with the leave of the House, I shall now repeat a Statement made today by my right honourable friend Matt Hancock, the Secretary of State for the Department of Health and Social Care. The Statement is as follows:

“Mr Speaker, with your permission, I would like to update the House on the Covid-19 coronavirus. As of this morning, 7,132 people in the UK have been tested for the virus. So far, 13 people in the UK have tested positive, of whom eight are now discharged from hospital. We expect more cases here.

As planned, 115 people left supported isolation at Kents Hill Park in Milton Keynes on 23 February. All tested negative for Covid-19. On Saturday, 32 people from the ‘Diamond Princess’ cruise ship were repatriated and taken to Arrowe Park, where they will remain in supported isolation. Four of those have tested positive and been transferred to specialist centres. British tourists are currently being quarantined in a hotel in Tenerife and the Foreign Office is in contact with them.

We have a clear, four-part plan to respond to the outbreak of this disease: contain, delay, research and mitigate. We are taking all necessary measures to minimise the risk to the public. We have put in place enhanced monitoring measures at UK airports and health information is available at all international airports, ports and international train stations. We have established a supported isolation facility at Heathrow to cater for international passengers who are tested, and to maximise infection control and free up NHS resources. The NHS is testing a very large number of people who have travelled back from affected countries, the vast majority of whom test negative.

In the past few days, we have published guidance for schools, employers, first responders, social care and the travel industry on how to handle suspected cases. If anyone has been in contact with a suspected case in a childcare or educational setting, no special measures are required while test results are awaited. There is no need to close the school or send other students or staff home. Once the results arrive, those who test negative will be advised individually about returning to education. In most cases, closure of the childcare or education setting will be unnecessary, but this will be a local decision based on various factors, including professional advice. Schools should be guided by the advice on GOV.UK and contact their regional school commissioner in case of queries.

In the coming days, we will roll out a wider public information campaign. While the Government and the NHS have plans in place for all eventualities, everyone can play their part. To reiterate, our advice is for everyone to take sensible precautions such as using tissues and washing their hands more.

Yesterday, we updated our advice to returning travellers from northern Italy, defined as anywhere north of, but not including, Pisa and Florence, as well as Vietnam, Cambodia, Laos and Myanmar. Those returning from Iran, the lockdown areas in northern Italy and special care zones in South Korea should self-isolate and call NHS 111, even if they have no symptoms.

We are working closely with the World Health Organization, the G7 and the wider international community to ensure that we are ready for all eventualities. We are co-ordinating research efforts with international partners. Our approach has at all times been guided by the Chief Medical Officer, working on the basis of the best possible scientific advice. The public can be assured that we have a clear plan to contain, delay, research and mitigate and that we are working methodically through each step to keep the public safe. I commend this Statement to the House.”

My Lords, that concludes the Statement.

My Lords, I thank the noble Lord for repeating the Statement. The challenge the Government face—as we all do—is that this is a very fast-moving situation. If noble Lords look at their BBC newsfeed, they will find that coronavirus is now spreading faster outside China, according to the World Health Organization—that was reported literally 15 or 20 minutes ago. Our thoughts are with those who have been diagnosed with the virus in the UK, across Europe and elsewhere, and those in quarantine. I place on record our thanks to the NHS and public health service staff.

I understand the approach the that the Government have taken to the quarantine arrangements. There has been a significant spread of the virus across the continent, including cases in Austria, Croatia and Switzerland. As the noble Lord said, a hotel in Tenerife is in lockdown after a guest tested positive. What support is being offered to British nationals in this hotel? Will flights from northern Italy be stopped? Will there be any additional screening of flights from other European cities with confirmed outbreaks? Can the Minister clarify the travel advice for passengers to and from these areas? I know of several people who intended to fly to Italy and have now cancelled their flights.

Several schools in England and Northern Ireland seem to have shut down completely for a week to carry out a “deep clean” after students and teachers returned from skiing trips in northern Italy over the half term. The Minister has given us some information about the advice to schools. How will it be enforced, or are we leaving it to local organisations, councils and school and academy boards to take those decisions?

I am sure that noble Lords will already have noticed that the oil company, Chevron, has asked 300 traders at its Canary Wharf headquarters to stay at home after an unwell employee was tested for the virus, having reported flu-like symptoms. They are awaiting results.

I want to ask a question about capacity. We have just had a debate in which many noble Lords talked about that issue. According to the NHS’s weekly winter statistics, bed occupancy in England is at 94.8%—way above the target considered to be safe. If this virus was to spread rapidly in the UK, how would the Government free up bed space in hospitals, which are currently mostly full?

Public Health England has announced today that tests for the virus are being increased, to include people displaying flu-like symptoms, at 11 hospitals and 100 GP surgeries across the UK. Up to now, people were tested only if they displayed symptoms having recently returned from one of the countries where there has been an outbreak, including China, South Korea and northern Italy. This action seems contrary to previous advice given to patients, which was not to go to GPs or A&Es but to self-isolate. I would like some further clarity on that issue.

On behalf of the Official Opposition, we thank all our NHS staff. We also thank the Government and hope that they will continue to keep us fully informed, as they have done hitherto.

From the Liberal Democrat Benches, I start by echoing the Labour Party’s thanks to the NHS, staff at the Department of Health and Social Care and other public bodies, and all the staff, clinical and non-clinical, working around the clock both in the UK and abroad in the FCO in countries where there are cases and UK citizens. I think that we all accept that this is a major continuing crisis. It is one thing for something to happen for two or three weeks, but we are now two months into this, and it is clearly continuing to increase.

I emailed the noble Lord, Lord Bethel, with some questions on the basis that we were all working here for some hours immediately before the Statement, and I hope that advance notice of them was helpful. Dr David Nabarro from the World Health Organization spoke on the “Today” programme this morning about the WHO’s overnight warning that the world must prepare for a potential coronavirus pandemic and that the WHO is beginning to be concerned that the outbreak could be “Disease X”, for which they have been preparing for many years. I also thank the World Health Organization and its staff, who are doing a brilliant job that is invisible to most countries—I shall return to that in one of my questions.

In previous Statements on coronavirus, I have asked other Ministers to explain why UK health advice always seems to be one step behind that of a couple of other countries—I refer specifically to CDC. I will give a personal illustration. I am due to go to Naples at the tail end of next week. I suffer from a long-term condition for which I take medication that suppresses my immune system. As a result, I come into that category of vulnerable people who need to think carefully, yet when I look at the World Health Organization website, the government website and the NHS website, I can find very little of clarity about what I should do as somebody in that condition. However, the CDC website is very clear.

So I ask again, as I have done repeatedly: what advice are the Government and the NHS giving to people regarded as being in a vulnerable position? My previous comment was about people so described who might live in and around Brighton when the cases surfaced there—what should they do and where would they get their advice from? Perhaps I am “asking for a friend”, but what is the position for people going to a country defined by the CDC at alert level 2? I think the UK is at that level, but we do not call it that. The CDC’s advice, in its key points box at the top, is very clear:

“Older adults and those with chronic medical conditions should consider postponing non-essential travel.”

I have seen it, and that is fine. I am sure that other professional travellers will be looking at it, but many people planning holidays will not know where to turn. They would normally go to the FCO website or the NHS website, and it is just not clear on those. In the Statement, the Minister referred to a public communications plan. Are there plans to set out exactly what people need to do? Will part of this communications plan be to make clearer, as the CDC website does, all the different stages and what ordinary people need to do to think about things?

Picking up the point about the Tenerife hotel, have lessons been learned from the cruise ship in Japan about keeping a lot of people in close quarters? Can we be reassured that UK and other citizens who are going to be in this hotel for two weeks will not end up in the same position as the many hundreds on the cruise ship who have now been diagnosed with coronavirus?

Talking of updates, Ireland has just postponed the Ireland v Italy Six Nations rugby match that was due to be played in Dublin, because of the coronavirus virus outbreak. So the Irish Government are already beginning to think that travel plans ought to be reconsidered.

My final question arose from noticing, when using the toilets in this place, that there are now very helpful posters reminding us about the 12 steps of hand washing. Suddenly, in the last two days, hand sanitisers have appeared. That is great; it is wonderful. But what will the Government’s advice be to the general public about personal hygiene such as hand washing and using alcohol hand sanitisers? The World Health Organization’s frequently asked questions and myth-busters pages are very good. I struggle to find anything as accessible in the UK. Most of the BBC report referred to by the noble Baroness, Lady Thornton, was taken from the WHO pages. So let us not reinvent the wheel but talk to people to ensure that they understand where we are.

I want to end on the same note as the noble Baroness. I thank the many hundreds, if not thousands, of people working to keep our country safe.

My Lords, I too express my profound thanks to NHS staff and the ancillary workers who support our clinical efforts: the bus drivers, the hotel staff and the deep-cleaning staff, who all have done so much already to help contain this virus in the UK. I especially thank the Chief Medical Officer, whose excellent advice has guided all our decision-making to date and will continue to be the most important guidance we can have.

There were two questions about the Tenerife hotel. I start by thanking the Spanish authorities. The practicalities are that the Foreign Office is in charge of handling arrangements for British citizens overseas, so questions about managing flights and cancelled services are questions for the Foreign Office. I understand that the Spanish authorities are flying specialist medical staff to Tenerife, because Tenerife has relatively limited health arrangements. A considerable effort is being made to ensure that all nationalities, including British holidaymakers who are in the hotel, have the best possible health provision.

On changing travel advice, we are going to be living through a period over the next few months when travel advice is fluid and changes on a week-by-week basis. The Foreign and Commonwealth Office issues travel advice—it is not for the Department of Health to do that—but my advice is to keep close to the advice. The travel advice of all countries will not always be aligned, but the World Health Organization has, to date, played an important, positive and constructive role in seeking to co-ordinate a response to the pandemic. We in Britain will move from a situation where containment is the priority to one where that is no longer practical, and the advice we give on travel will reflect that transition when it happens.

The noble Baroness, Lady Thornton, asked about the advice given to schools and, with characteristic thoughtfulness, she answered her own question. The current arrangement is that local schools, governors and authorities should make arrangements for themselves. As the epidemic progresses, that decision may need to be reviewed but, at present, it seems reasonable, proportionate and what parents want.

The noble Baroness also asked about capacity within the NHS, and it must be on everyone’s mind that the NHS does not have infinite capacity and it will not be possible to find a hospital bed for everyone affected by the virus. There will be considerable pressure put on the system, but I reassure the House that, over the years, considerable planning has already gone into making arrangements for this pressure and that the safety of the workforce and patients is paramount.

There are considerable measures that individuals can take to support themselves, and Ministers will be emphasising until they are blue in the face the importance of hand washing and self-isolation. These are important behavioural changes that we will seek to communicate to the British people over the next few weeks. In answer to the noble Baroness, Lady Brinton, we are planning and developing a massive communications campaign on how to protect people, particularly vulnerable people, in our population. At present, we are ensuring that people know how to protect themselves, highlighting the importance of staying at home if you feel unwell, and of regular hand hygiene. The needs and special arrangements of those with immune issues, which the noble Baroness rightly pointed out, will also be an important part of that campaign, and plans are well developed for launching it shortly.

A question was asked on the arrangements for travellers to China and, if I understood the question correctly, there is a distinction between those who travel to high-risk areas and those who travel to risk areas. If you travel to a high-risk area such as Wuhan, or one of the sanctioned areas in north Italy, on your return you are asked to immediately self-isolate. However, if you travel to China or Italy more broadly, you are asked to self-isolate if you start to display symptoms of a virus. That is the distinction noble Lords can have in their minds, and which will be communicated to the public more widely.

The noble Baroness, Lady Brinton, asked some detailed questions. I am grateful to her for forwarding them, and I will answer them in detail. She asked about the World Health Organization and its preparation for declaring a potential pandemic. The UK is prepared, and delivering plans for, a potential coronavirus pandemic. The plans are advanced and in place. Any new disease could be considered a “Disease X”. Current information and planning is based on what we call a “reasonable worst-case scenario”.

The noble Baroness asked about advice to travellers and rightly brought up the excellent CDC website. She mentioned CDC category 2 countries, particularly Iran and Italy, whose approaches seem to be different to that of the UK. The Foreign and Commonwealth Office already advises against all but essential travel to Iran. There are 10 small towns in Lombardy and one in Veneto which have been isolated by the Italian authorities. The health page on the Foreign and Commonwealth Office travel advice website has been updated with information on the coronavirus outbreak.

Lastly, the noble Baroness, Lady Brinton, asked about advice to the general population on personal hygiene and noted, quite rightly, the spread of hand-washing advertising and sanitisers in this House. There is very comprehensive advice on this on the NHS website. It can be accessed directly from the NHS homepage by searching for “Covid-19”. There are also answers to common questions, such as: are face masks useful for preventing coronavirus?

We are also aware of the dangers of fake news and a team is working on combating the misleading and wrongful advice that might stem from that.

My Lords, I have half a lung following surgery for a tumour and COPD on the residual lobes. I am over 70 and therefore form part of the group of thousands—potentially hundreds of thousands—who are at particular risk from this virus. When the virus reaches London in conditions of a pandemic, and perhaps even before, I am likely to withdraw from the House for a period of time. For vulnerable groups, advice to wash hands, use tissues and self-isolate is totally and utterly inadequate. Those in vulnerable groups risk loss of life and are entitled to far more detailed information. With that in mind, will Ministers reply individually and in detail to each of the many questions that I, following consultation, shall be asking either in the House or by way of correspondence? There are a large number of questions that vulnerable groups will want answered. Could the answers be distributed more widely? Be of no doubt: in the absence of detailed advice, lives will be lost.

The noble Lord, Lord Campbell-Savours, makes his point extremely well. I cannot believe that there is anyone in this House who does not have a relative, friend or loved one who is in the same situation. When we look closely at this virus, it causes enormous anxiety. It is part of the Government’s role to ensure not only that information is provided and distributed effectively and energetically, in the way he described, but that this is done in a reasonable, paced way that does not create panic and alarm. The Government lean towards early action on the virus, pre-empting issues and having the right information, data and measures in place. That has been the philosophy of our response from the very beginning. The communications that he described, as did the noble Baroness, Lady Brinton, are exactly the kind of materials that we are working on right now. They will be distributed with the energy and determination that he described.

My Lords, we know that there are adequate quarantine facilities in the Wirral and Milton Keynes, but can my noble friend assure the House that the Government have provisional plans in many other parts of the country, in case we have a repeat of having to fly back large numbers of people and put them together for a fortnight or thereabouts? There is real concern on this issue and I would be grateful for reassurance.

My noble friend is quite right that the quarantine arrangements at Arrowe Park have worked extremely well. This has meant that Britain has been one of the more advanced countries in handling this period of containment. I pay tribute to those involved at Arrowe Park and at Heathrow and Gatwick for handling those flights. It would be misleading of me to stand at the Dispatch Box and suggest that quarantine arrangements are going to be possible ad infinitum for everyone returning from an at-risk area. There will be a moment—as has already happened in Italy—where the containment of the virus in this country will no longer be possible and we will move on to a new phase. Quarantine has worked well so far but it is not, on its own, going to be the solution to this problem.

My Lords, I add a note of congratulations to all the public health people, to Public Health England, Public Health Wales, staff across the UK and health board staff at every level. They have rapidly changed the way that they are working in order to undertake close planning. Can the Minister confirm that we are producing enough testing kits to be able to roll out more testing in the community across the whole of the UK? Has additional budget been put aside to ensure that health service personnel have all they need and to allow additional isolation facilities to be used, if necessary, for very sick patients who would be taken in isolation to NHS units?

I reassure the House that there is an enormously energetic effort being put into testing kits. The testing arrangements to date have worked well. There is a 24 to 48-hour turnaround for testing. Work is being put into a dramatic increase in the number of tests necessary. Energetic work is being conducted by commercial organisations into smaller, portable testing kits—the size of this Dispatch Box—that could be put in wards to have an immediate turnaround for testing. This will greatly facilitate the management of this epidemic. I salute those involved in the 24/7 race to produce new technology and large numbers of these testing kits. Like the noble Baroness, Lady Finlay, I have warm words for Public Health England, which has done a fantastic job. I cannot remember the third thing that she asked.

My Lords, I beg the House’s indulgence because I know the convention is that a Back-Bencher should ask a quick question and sit down but in this case I cannot do that.

I have absolute confidence in our ability to try to contain this virus but, having said that, it will depend on how the virus behaves. As yet, we do not know its behaviour. Most of the cases hitherto reported are from areas where there have already been cases and are not new cases. A pandemic has not been declared yet but we may be at the knife edge. If it is declared, the advice will change, as will the way of screening people.

In this situation, containment is the first phase of stopping the virus spreading. It is like a fire, which can last only as long as there is kindling available. It will infect as many people as it possibly can. Possibly four out of five people in our country will be infected and maybe 2% will die. The noble Baroness, Lady Brinton, is right. The Government need to provide clear guidance for those who are high risk. Hitherto, the deaths reported throughout the world have been of older, vulnerable immunocompromised people, not children or young, healthy adults.

I hope the Government have a strategy. I have absolute confidence in our advisers Professor Chris Whitty —the CMO—Professor Sir Jeremy Farrar and Professor Peter Piot, who I know are the world experts in containment of pandemics. However, the Government need to be more stringent in the advice they are giving to the general public on the value of things such as handwashing, using tissues and, importantly, self-isolating. When the numbers involved get bigger, that is when the risk is that people will not self-isolate and take that advice. The Government need to be more stringent about that.

The noble Lord, Lord Patel, has expressed it all very well and with infinitely more authority and knowledge than I could have done. He has described very well the dilemma facing policymakers, because we simply do not know the behaviours of the virus. We do not know exactly how infectious it will be; we do not know which demographics it will target; and we do not necessarily know how mortal it will be. We hope for the best but are planning for the absolute worst. The noble Lord is right: the clear guidance for high-risk groups is critical. As I have already mentioned, there is a plan for a substantial awareness campaign, but its effectiveness will rely on the saliency of the subject matter. At this stage of the cycle, the British public are not necessarily tuned into the risk or at the point where they are seeking to address their behaviours, although I suspect that that moment is approaching very quickly. I reassure the House that all the preparations have been put in place. The creative is incredibly impressive and the detail is being thought through, and I believe that the impact will be profound.

One hypothesis on which people are working is that this disease started with bats. Is there a possibility that other species of mammal or perhaps birds could be infected or could be carriers, possibly including domestic or farm animals, or are our veterinary authorities confident that that cannot be the case?

The noble Lord asks a perfectly fair question but I am not a qualified virologist. Certainly, I do not know the answer to that and I am not sure that even the virologists are certain about it at the moment, but it will be investigated.

The reason I suggested that it came from bats is that there is an 85% genomic match in the sequencing of the viruses affecting humans and bats. On the other hand, the sequencing of the virus in pangolins is showing virtually a 100% match. However, it will not come to farm animals—they are not bothered by this virus—so chickens and sheep will not be affected.

It is unusual to have that kind of interruption. Perhaps I may ask that Peers ask short questions to allow more Back-Benchers to intervene.

My Lords, perhaps I may follow up the points about both capacity and testing. Noble Lords might have heard Nick Robinson on the “Today” programme this morning describe his experience. Having come back from abroad, he contacted 111 and was advised to go to his local hospital, where, as he described it, he was extremely well treated. However, it involved huge resources. A nurse, booted and suited, as it were, came out to him in the car park and escorted him through the hospital and so on. As he commented, that simply cannot be replicated many times. Can the Minister reassure the House about the capacity for testing of that type? Happily, Nick Robinson was okay.

The noble Baroness, Lady Hamwee, has put it very well. Testing is absolutely critical to the correct treatment of this virus. There is a race on to find cheap, easily applied and speedy testing arrangements. That will help us avoid the kinds of complex arrangements that Nick Robinson vividly described. The NHS is proceeding incredibly energetically. Financial arrangements are not holding back any of the work that is being done, and resources are being thrown at that in a very big way.

My Lords, my noble friend has spoken a lot about the tests. Can he give us an estimate of their accuracy? Is there a large number of false negatives or false positives in the test results?

My noble friend asks a very reasonable question. It raises the issue of heat tests at airports—which I know that he did not ask about—which is a subject of concern. Certainly, temperature tests provide a large number of false positives, and that is why they have not been applied at British airports. However, the saliva tests being used in clinical conditions at the moment are thought to be very reliable indeed, and the number of false positives is very low.

My Lords, I echo the thanks from all sides of the House to the medical and administrative staff. We need to acknowledge that at the moment, most of them are not, of course, at risk; but it is very stressful just thinking that you might be, and that stress needs to be acknowledged. The Statement referred to working closely with the WHO, the G7 and the wider international community. There was no specific reference to working closely with the EU regime of communicable disease control, which is co-ordinated by the European Centre for Disease Prevention and Control in Stockholm. That oversees the early warning and response system and the emergency mechanism for the approval of pandemic medicines by the European Medicines Agency.

My understanding is that we are still part of the EWRS system, but we do not have any say in the decision-making. At the end of this year, when the transition period ends, we will fall out of that system unless special arrangements are made. I understand that Switzerland, which is not part of the medical countermeasures rapid approval procedure for testing, treatment and vaccines, has applied for special access to that system. Have we also applied for special access to it? How are we working with our EU neighbours, who have a very sophisticated system? What will the situation be in less than a year’s time?

The noble Baroness asks a detailed question on an important part of our response. British scientists have done an enormous amount to investigate an antidote to the virus; £20 million has been put into research into those arrangements. We are absolutely at the forefront of trying to find some kind of antidote. The regulatory arrangements for that are not in my brief, so I cannot answer her question directly. I reassure the House that British scientists are absolutely working hard; they are well resourced, and any regulatory arrangements that are needed to find the right medicines for this virus will be put into place.

My Lords, I thank my noble friend for the authoritative way he has given this Statement and provided reassurance to the House. I join other noble Lords in recognising the efforts of many health and non-health staff in dealing with this, not just in the UK but abroad.

I want to ask a specific question about the advice being given to schools. The Statement said that schools should refer, if they are unsure, to regional schools commissioners. He will know that such commissioners were not set up to provide public health advice but to supervise the structure of the school system. What access are they getting to advice from Public Health England and its equivalents across the UK to make sure that they are getting the right advice, and not closing when they should not close or opening when they should not open? I declare my interest in and involvement in schools as a concerned parent.

My noble friend asks a characteristically detailed question. There has been a huge hunger on the part of schools over the last few days for more accurate information about how to respond. As a result, the Department for Education has put in place a regular email directly to the schools themselves—to headmasters and governors. This is currently planned to happen weekly, but that will change as events progress. The email refers to the provision of further information on the DfE website. Arrangements for hotlines and follow-up information are being put in place.

My Lords, I draw attention to my entry in the register of interests. The Minister, in repeating the Statement, identified the four-part plan, of which the third part is research and co-ordination with international partners. Can he reassure the House that mechanisms are in place for the early adoption, at pace and scale, throughout the NHS of any innovations in diagnosis, prevention and treatment that could have a profound impact in reducing the overall burden of this disease?

The noble Lord is right to emphasise this point. The clinical treatment of the virus is in part through the medicine itself. We have to be realistic about whether a medical solution to the virus will be found before the peak epidemic. One is instinctively optimistic that such a thing can happen, but it cannot be guaranteed. However, there are also the procedures and arrangements for nursing and looking after patients as they go through the cycle of the virus, and such best practice is absolutely the priority of the Chief Medical Officer. Arrangements have been put in place to spread that best practice through the trusts and CCGs that provide front-line care.

My Lords, I was listening closely to the noble Lord, Lord Patel, when he was asking his question earlier. If I heard him rightly, he said that if this becomes a pandemic, four out of five people in this country might become infected. That is a very alarming number, not just because four out of five people will get ill but because of the impact on all kinds of social and other activities, including economic ones. Do the Government themselves recognise that figure as a likely outcome in a pandemic situation? Is any information currently available about the immunity, either short-term or long-term, that may or may not be conferred on those who have already succumbed to the virus?

The noble Lady is correct, inasmuch as we should be prepared for and able to envisage the possibility that the virus may spread through a large proportion of the country. The Government are looking at all possible scenarios. However, I do not recognise the numbers that the noble Lord, Lord Patel, has provided, and the Government are not yet providing forecasts for the virus. Certainly the worst-case situation could be of the order that she describes, but that estimate is not based on scientific forecasting.

On the question of our arrangements for the possible impact, that is difficult to predict because we do not know the speed with which it would spread through the population. Creating some kind of herd immunity, whereby a large proportion of the population has had the virus and is therefore inoculated, is clearly the objective—well, not the objective; rather, it is one of the results of the virus passing through, as flu viruses do regularly. It is expected that it will be a one-off experience, so herd immunity will actually provide resistance to future visits by the virus.