United Kingdom COVID-19 Briefing Transcript April 5

Alex Thomson: (00:08)
What exactly does that mean? So if people continued to ignore your social distancing rule, what does tightening up the measures actually in practical terms mean?

Matt Hancock: (00:17)
Well, we’re not planning any changes to those rules imminently, but we do absolutely require people to follow them. And we have had these questions about the boundaries of the rules and people pushing the boundaries. But as Jenny just set out, there’s very clear reasons that we set the rules as they are and we want people to follow those rules. And of course there’s now the police enforce against them. They’re not rules that anybody would want to have in place, but they’re rules that need to be in place and everybody must follow them and stay at home wherever possible unless for those four reasons. And we’re crystal clear about that. And we’ve set those rules, we’re enforcing against those rules and we reiterate those rules because that is the best way to be able to bend the curve down and stop the spread of the virus. Alex Thomson from Channel 4.

Well, good afternoon to you both. You’ll both be aware that in the last few hours an urgent directive has gone out to NHS ICU doctors to the effect that if hospitals are using a lot of oxygen machines, the entire oxygen supplied to the hospital can fail from C-PAP face mask ventilators right through to operating theaters. So what has been done to address that critical problem and more widely, we understand three hospitals in the past few days have come close and these are running out of oxygen. What’s being done to increase supplies to ensure that doesn’t happen in the coming days and weeks when clearly the number of patients will increase?

Yes, this is a very important operational question. We have adequate supplies of the oxygen that’s needed in hospitals. We need to of course, make sure that each hospital has that available. We have had an equipment failure as I think you referenced and we therefore had to divert some ambulances, but this is the normal operation of the NHS when there are things like equipment failures. Of course interest in it is heightened because of the nature of coronavirus but the supply, the quantity of oxygen and supply of oxygen is something that we’ve been working very hard on and we have a very high degree of confidence in the supply of oxygen.

Jenny Harries: (02:45)
So I was just going to add actually some comments that I think Professor Steve Paris made a few days ago, which is actually to signal that this is a positive sign in most cases. If you have a whole system where it’s unusual in the UK where we have a national health service, it means that we have a system of flagging where there are potential risks or problems before they actually become a significant problem. It is a strength of our system that we have these flags going off at regular intervals. And I think his comment back to the questions at the time was, “This is a positive thing. We flag them, we deal with them as they arise.” But to reinforce what the secretary state has said is there is no insufficiency of oxygen and I think the public should not be concerned that if they become ill and need a hospital admission, that care is available to them.

Okay, great. Charlotte Ivers from talkRADIO.

Charlotte Ivers: (03:41)
Thank you Mr. Hancock. You changed and updated the rules on PPE a few days ago and I was being to a doctor who said before these changes, he was moving between treating COVID patients and cancer patients who were… had compromised immune systems and he was terrified that he would be deadly to them because he didn’t feel it was adequate. So can I ask you firstly, was he correct to be scared and if he wasn’t correct to be scared, why has something had to change?

Well, we’ve changed the upgraded the guidance. So now in all instances it’s at or above the levels of protective equipment recommended by the World Health Organization. But we’ve also upgraded it following more being known about the virus. As we learned about the science of coronavirus over the last few months. So we will keep upgrading and improving guidance as we learn more about it. So that was the main reason for the changes to make sure that we reflected the latest that we know about the virus and I think that the new guidance set out on Thursday has been very widely welcomed and provides clarity about what protective equipment is needed in which circumstance. And then of course we have to deliver and make sure that that protective equipment that is needed according to the guidance gets to the frontline. Jenny?

Yeah. So I think just to support that, I don’t know the individual case that you are describing, but clearly it wouldn’t matter whether you were a cancer patient or a patient in another setting. We want to maintain good infection prevention control procedures and the bedrock of that in the UK and throughout the NHS is actually systematic practice. It’s one reason why this country is very good. We don’t get a lot of nosocomial infection as an onward spread in healthcare settings because it is the basics, which we are also obviously been teaching the public around a good hand and respiratory hygiene in a systematic approach and using PPE carefully, which keeps that at bay. But I think the new guidance there, what it has done is it’s reinforced the fact that our guidance previously was actually inconsistent with WHO guidance. It was endorsed, it was a report, I think back on the 27th by WHO and recognized.

But what we’re seeing now is a slightly different prevalence of disease and we’ve adapted our guidance to manage that. So there’s a level of uncertainty and there’s a level of protection which is higher in some high-risk procedures. So the areas we’re very concerned about from a clinical perspective are what we call aerosol generating procedures under pressure. So this is where somebody, where you get a potential airborne spread and we want to make sure people have absolutely adequate protection there. And then the other issue is recognizing the settings in which people are working. So the most obvious one would be if we went back say four months, very unlikely anybody in the emergency department would see anybody with COVID-19. Actually now in some of those settings where it’s uncertain for professionals in when they’re first seeing patients and understanding them, it’s important that they have COVID in anticipation of what might be a different prevalence of disease. So that’s basically, I can give you more detail of the actual equipment, but that’s as effectively what we’re trying to do is covering the changing circumstances.

Did you have a follow-up? You put your hand up?

Charlotte Ivers: (07:25)
Yes. I was just going to ask you talks about us now knowing more about the disease. So knowing what we know now, should we have had these higher levels of protection from the beginning? Were people at risk?

Well the thing is that you can only make decisions based on the information that you have at the time. And we’re constantly looking for new information about this disease so that we can improve the guidance that we have and the response that we have to it. The question that we have in government and that I ask myself every day is, are we doing the right thing now and what can we change to improve our response for the future? And so you can have a debate about the past but you have to take decisions on the information that’s available at the time. And I think the previous guidance was the best guidance possible on the information that was available at the time. And then we’ve upgraded it.

So I think to support that, it’s not so much we are obviously learning all the time about the disease, but the basic guidance was entirely appropriate and as I say, endorsed by WHO despite I think some media reporting about differences. But the important thing is we are now operating in a slightly different environment. So it’s the uncertainty that some clinicians, not all clinicians find themselves in that we have reviewed where that is to ensure that they feel safer in those environments.

I think there are other opportunities we’re learning from. So for example, where we are finding that you can reuse masks safely, for example, with appropriate cleaning and technology. That’s very helpful because of course we need to keep in mind that regardless of supplies and advice, the whole world wants personal protective equipment and it’s really important that we all use it appropriately and judiciously, exactly have it in the right places where it’s needed but not be wasting it so that the people who are working on the front line, whether it be in care homes, domiciliary care, or in the front line of an emergency department, they have the right PPE at the right time for the right clinical risk and that’s what our whole basis of the guidance is based upon.

Thanks very much Jane Merrick at the i.

Jane Merrick: (09:46)
Thank you. How do you square what the queen says today about the nation’s attributes of self-discipline with your warning about having to toughen the restrictions of people, don’t stop gathering and parks? That’s to the health secretary and to the chief, the deputy chief medical officer. What is the testing strategy for care homes and prisons given that these are emerging as a major hotspots for cases and sadly deaths? Are prisons and care homes going to be next in line for mass testing after NHS workers?

Well, I think we’re all looking forward to seeing what the queen has to say and watching her address and listening very carefully to it. I think the message from all of those of us in it across the board is very clear, which is that we need perseverance in the face of some great challenges and that also means the perseverance in following the rules. And I couldn’t be clearer about my emphatic requirement of people, which is backed up by law to follow the rules that we’ve set out and to make sure that people stay at home. That is the number one thing that you can do. And we’ve set out those four exemptions and people should stay at home unless they’re going out for one of those four reasons and those four reasons alone. Jenny.

Thank you. So absolutely. You’ve highlighted two very critical and domains if you like, for public health surveillance and intervention. That’s been recognized right from the start of this incident and in fact is recognized before COVID-19. We always keep a close eye on care homes and prisons because the setting in which people live is potentially problematic. So the care homes, clearly you tend to have a collection in the nicest possible use of the word of potentially elderly or more vulnerable individuals. That’s one issue. And then certainly in prisons you are intentionally through a prison operation holding people together. So both of those environments are very well recognized. In fact, Public Health England hosts the WHO Collaborating Centre for healthy prisons. So we have a lot of experience and actually advise other parts of the world. And I know that the key consultants there have been working with ministry of justice and with the prime minister on establishing and looking at what have those environments should be treated.

You asked specifically about testing and testing in both prisons and care homes has always been on the priority list. So once we moved from containment to delay, if you remember the categories of testing that we have our clinical care of patients in hospitals as an absolute category because that’s how we manage the safety and the benefit of that health intervention, but what we then do is test in care homes and prisons. What we do do though is we wouldn’t necessarily test everybody because you want to test whether it’s going to be a positive advantage to doing the testing. I’ll stop in a moment and we usually test up to about five people to establish… It can vary depending on the setting but to be sure that we have established what the issue is. It’s usually quite possible in a setting like that to understand then on a clinical basis whether there is a case, it may not be laboratory confirmed but it would be a presumed clinical case.

Jim: (13:22)
Thanks very much. Jim at the FT.

Sorry.

Oh sorry. You wanted to come back Jane, sorry.

Wanted to come back on the question on testing that you said that they are next in line, but when will that testing take place? Given that there are probably lots of people who are very concerned about their relatives and care homes and also the people who work in care homes and people who work in prisons.

Yeah, so sorry to perhaps I didn’t explain myself clearly enough. So for any care home outbreaks, whether it relates to a worker or an individual resident or a prisoner or somebody supporting him or her, those tests happen now they are in the prioritized list already. So the groups of people who are routinely tested and have been ever since we have started responding to this incident include potential outbreaks in care homes and prisons. That’s been going on right from the start. In terms of other workers there as we go forward for NHS workers and front-line care workers and responders, clearly those are in the priority group because we recognize that those workers, we need to think of the care sector almost like the other arm. We talk a lot about the acute hospital sector, but we often forget that it’s the care sector who are operating in the community, community nurses and domiciliary care workers who are equally important in our drive to manage this incident. So they will come within prioritized key workers.

Does that answer the question Jane?

I think it was just to get clarity on when that testing would take place for those workers. If there’s no specific timing.

So the outbreaks happen already and the other workers will be falling into the expanding program which has been ramping up as you’ve heard and I think has been reported on a daily basis this week.

Thanks Jim from the FT.

Jim: (15:17)
Secretary of state could you please tell us yes or no, whether the government is preparing to take equity stakes on taxpayer’s behalf and some of the large companies which have found themselves in major crisis because of the pandemic. And if so, do you think that Richard Branson’s Virgin Atlantic is a worthy recipient of that kind of assistance given that in 2017 Virgin Care sued your beloved NHS after losing the contracts and given that, so Richard lives as a tax exile on Necker Island. And the question for Jenny Harris, I know you might say it’s too early to speculate about how the lockdown might end. The new focus seems to suggest this morning that there could be a kind of staggered way of doing it in terms of different age groups and different regions coming out to the lockdown before others. Is that-

Jim: (16:03)
… and different regions coming out of the lockdown before others. Is that possible?

Well, I’m going to not answer the first question and then Jenny can answer the second one. My response to the first question is this is an area in which Rishi Sunak has been doing unbelievable work. He’s recognized around the world for the first class economic response that we’ve got here in the UK. And overall, from the protection of workers, the protection of self employed right across the board they’ve taken the right steps and I think done it with remarkable speed. Of course there’s enormous economic consequences for businesses of all sectors. Of the decisions that we’ve had to take. And no, these decisions on social distancing aren’t the sorts of decisions anybody would want to take.

But, I think the way that the prime minister and chancellor have responded on the economic front has been absolutely first rate and I’ll leave it to them to answer questions about the details of what might or might not happen. Which their best place to do rather than me. Jenny on the second point.

Dr. Jenny Harries: (17:14)
Thank you, yes. I think the brief answer is all things are possible. It’s important because right from the start, we’ve driven the response from science and we have modeled. Neil clearly has been one of the key contributors to that modeling group and in us understanding what interventions we need to put in at what time. I know there’s a huge amount of work ongoing at the moment looking at both the individual packets of intervention that have gone in. So we’ve staggered them in. Some of them had significantly more impact on the way in and those are the ones that we put in at the time to give the maximum benefit.

But clearly what we don’t yet know, and I think this is critical. I didn’t hear Neil’s interview this morning, I apologize. But what we don’t yet know is how the disease on a whole population basis has affected our immunity, how many of us have had it and how many haven’t. And that is important. If we can find that information because it will give us an understanding then, as he has obviously described, by region for example. So London has had a lot of cases here. If it was found that a large number of people would immune them, it may be that different interventions could come off sooner or later.

Equally, if we find that there are areas where there have been less cases prevalent, then we need to be very mindful what would happen if the social interaction levels increased in those particular areas, and what the impact might be. As you will have heard many people say before, the very last thing we want to do is have put in all of this effort with everybody trying to do the right thing, almost everybody, across the country, and then find we lift the lid too early and we have a second spike. It will waste the effort that we’ve put in and we still need to get over that very first hump really of the epidemic curve, and then look at detail. But I can assure you, there is a huge amount of work involved in that and Neil clearly has contributing to it.

Thanks Jim. The next question from Harriet at the PA. Hi.

Harriet: (19:30)
Hi, to the [inaudible 00:19:31] first, many people here have spent the last couple of weeks obeying [inaudible 00:19:34] and socially distancing themselves. We’re wondering if it’s safe for them to see family if they’ve also been following the guidance over the Easter weekend. Are they safe to do that? And if not, can you explain why not given that surely the chances of them having Corona virus are now very small?

Harriet: (19:51)
And to Dr. Harrie, as we know that the testing isn’t showing the true picture of the current spread of the virus. How many people do you estimate have had or currently have the Corona virus in the UK?

Well thanks Harriet. The answer to the first question is really clear which is that this virus can spread in all sorts of different ways. Both from directly respiratory and also through objects and through touching objects that others then touch. The uncertainty over who has it, especially before they have symptoms, means that the only effective way of bending the curve down is to reduce that social contact. And that’s why we came to the conclusions that we did, the difficult conclusions, that we have to have such extraordinary social distancing policies in place. And why we took the decision more than a week ago now to flip the basis of those rules from saying you can’t do certain things to saying you must stay at home unless you’re doing one of a small number of things, four things. Which we’ve been absolutely crystal clear about those rules and the evidence shows that a very high proportion of the public understand those rules and a very high proportion of the public are following those rules. We need everybody to be following those rules. And that’s why we talk about them so much and the importance of following them. On the other question.

So I might just add to the Secretary of State’s comments actually on that. Because I think sometimes people get slightly confu-… Their inter mixing if you like the phrase family with household. That’s quite an important difference. So in infection control or public health terms, it is a household which is really important. So for example, if you’re a group of students and you probably will be home with your family in one household now. But previously you might have had five students living in a flat. Under one roof, sharing cooking, bathrooms, all sorts of things. That in infection control terms is a household. So the important thing here is we know that households tend to have the same risk exposures. So they tend to have the same opportunity to become infected from one another. And it’s one of the reasons why we have the stay at home family isolation policy. It’s a household isolation policy.

So if your family is with you, the likelihood that one of you have had it, particularly after you’ve all waited 14 days, then probably your risk is low. It’s possible that one of you may have had it, not noticed any symptoms particularly. But if your family lives in a different town, they are an entirely different household. And mixing those two is not what we want to do generally. So I think the difference between family and household. So it’s stay with the people that you live under the same roof with and keep doing that for as long as you can and safely. So that really just answered to that from an infection control perspective.

And I can’t answer your second question and I’m not going to try. Because that is exactly why we need to understand the immune picture across the population. Obviously some countries are a bit ahead of us. So somewhere like China, other countries, we learn where we can from reports that they do and we’re looking. But there is no country in the world currently which has good population based serology testing for immunity to be able to say with confidence how many of the population have had the disease and which layers. Which ages, which sexes or which people with different characteristics. We just need to understand that in the future. So I won’t hesitate a guess at this point.

Does that answer your question, Harriet? Or at least explain why we’re not able to answer it?

Harriet: (24:01)
Yeah, just to clarify so people who have only been going to the shops or only going out for exerciser are still at risk of having Corona virus, having picked it up and those sorts of things you’re saying. And therefor aren’t safe to travel even by car and see family or friends.

That’s right. I have a particular interest in this having had Corona virus and having come through it. Obviously I’ve asked all these questions for myself and as well as Secretary of State. The rules are there for a reason, even for those of us who’ve had it. Where the science predicts it’s likely that our immunity is higher and our ability to transmit the virus is lower, we are not yet confident enough in how much higher the immunity is and how much lower the likelihood of those of us who’ve had the disease transmitting it is, to be able to change the rules. So there is clarity on the social distancing rules for people whether they’ve had Corona virus or not. And the rules are the same for everyone and will be until the science an give us confidence that we can say something different to those who have been through it.

Final question. Paris from the Scotsman.

Paris: (25:22)
Thank you Secretary of State. In the past few hours we’ve learned that the chief medical officer of Scotland, Dr. Catherine Calderwood for the past two weekends has driven over 40 miles to a holiday home taking with her on one occasion, her entire family and on the other occasion her husband. How damaging is that to your efforts to convince the public to stay home and save lives? If Dr. Calderwood worked for you Mr. Hancock, would you have asked her for her resignation?

Paris: (25:50)
And can I ask Dr. Harries, is she still an effective spokes person for the public information campaign and do you have a second home that you’ve visited since movement restrictions came into place?

Well thanks very much, Paris. This is a matter for the Scottish government. They I know are addressing the questions that have been asked in Scotland. These rules are there for everyone. We couldn’t be clearer the social distancing rules are there for everyone to follow. I understand that the Scottish CMO has apologized and as far as I see it, that is a matter for the Scottish government to address. Thanks very much everybody. That is it for today. I hope that you, like me, will tune in to see the address from Her Majesty at 8:00 this evening. Thank you all very much indeed.

(silence)

Good afternoon and welcome back to Downing Street for today’s Corona virus press conference. I’m joined today by our deputy Chief Medical Officer Dr. Jenny Harries. The government is working through out action plan which aims to save as many lives as possible by slowing the spread of the virus. Protecting the NHS and preventing it from being overwhelmed. Our response is built upon the bedrock of the best possible scientific and medical advice so that we can take the right steps at the right time.

First by slowing the spread of the virus across our society. And second, by boosting the capacity of the NHS so that we can always care for those who’ve fall sick. Sadly Corona virus continues to spread. I can report that through the government’s ongoing monitoring and testing program according to the latest figures, 195,524 people have now been tested for the virus. And 47,806 have been tested positive. Across the UK the number of people admitted to hospital with Corona virus symptoms is now at 16,702. And of those who’ve contracted the virus, 4,934 have sadly died. We mourn their passing and we offer our profound sympathy.

We mourn their passing, and we offer our profound sympathies to their families and friends. I’ve lost two people that I was fond of, so I understand what a difficult time this is for the country.

This evening, Her Majesty the Queen will give a rare formal address to the nation. I know that we’ll all be watching and listening to see and hear what she has to say on behalf of us all. I understand that people are yearning to know how long this will all last, and the answer is entirely dependent on how much people follow the rules on social distancing. Following these rules is mission critical if we’re to protect the NHS, slow the spread, and give the NHS time to expand capacity, and so to save lives. The more people follow the rules, then the faster we will all be through it.

So I say this to the small minority of people who are breaking the rules or pushing the boundaries. You’re risking your own life and the lives of others, and you’re making it harder for us all.

We’ve included exercise as one of the things that you can leave your house to do, because exercise is good for our physical and our mental health; but please do not bend or break this rule. We can’t rule out further steps, but I don’t want anyone to think that any changes to the social distancing rules are imminent, because the vast majority are following the rules.

To you, to all those at home, to all those who are following the rules, I want to say thank you on behalf of us all and especially on behalf of the doctors, nurses, and other colleagues who put their lives on the line to care for you in the NHS.

As well as working to slow the spread, of course, we are increasing the capacity of the NHS. Last week, we saw the completion of the Nightingale Hospital in East London. It was planned and constructed and fully staffed within nine days. It was humbling to see the NHS, the military, and everyone involved in its construction pulling together in this time of need. There are many more Nightingales to come across our entire United Kingdom, including Harrogate, Birmingham, Manchester, Glasgow, Belfast, and Cardiff. These new hospitals are on top of the expansion in critical care across the NHS.

There are currently over 2,336 spare critical care beds for the NHS in England and over 9,000 ventilators are now available to NHS coronavirus patients across the country thanks to the national effort to ramp up capacity. 300 new ventilators arrived this weekend from China, and we’ve seen UK manufacturers working at pace to develop new ones.

Of course, hospitals and ventilators are critical, but our NHS is nothing without the people who work there. It’s been so encouraging to see over 27,000 former healthcare professionals signing up to return to the NHS frontline. I want to say a great big thank you to each and every one of you. Welcome back, and I hope that many more will sign up in the weeks ahead.

This weekend, we also have launched our latest technology, a new coronavirus status checker. It asks people who currently have coronavirus symptoms to share their experiences to help us in our fight against the virus. It’ll help make use of this information, which will in turn help us to understand the disease, so we can, for instance, allocate resources like oxygen and ventilators and additional staff to where they’re needed most. Please do your bit if you currently have symptoms by going to www.nhs.uk/statuschecker. Because the more people who use it, then the better informed our response will be. The smart use of data like this and digital technologies is one of the strongest bulwarks that we have against coronavirus, because new technologies can help us to meet these new threats and allow us to gain the understanding and the insight that we need to defeat this virus once and for all.

Technology is one piece of the jigsaw and an important piece; but ultimately, the strongest weapon in our arsenal is if we join together in tough times and follow the rules that have been put in place. I, like many of you, have young children at home. So I know what a challenge this can be for families. I really understand how much everyone wants to enjoy the sunny weather, but the cruel thing about coronavirus is that it thrives on social contact and the human bonds that brings so much to life.

So we must show our resolve. All the things that we miss right now, going to the pub for a pint with friends or sitting in the park with a book or hugging a grandchild, we will have these moments again, and they’ll mean even more to us. But until then, the only way to protect yourselves, your loved ones, and your community is to stay at home, protect the NHS, and save lives.

I’ll now handover to Jenny to take us through the daily statistics charts.

Thank you,. Thank you.

Could I have the first slide please? So what we have here, I think we’ve just got four slides to show what’s happening over the last few days. I think it’s really important that people can see the data and what is happening from our interventions. The first slide probably hasn’t changed very much, but that is really good news. What it shows is that our transport use is down and remains down since early March, beginning back in February as well. We’re managing to sustain that. As the Secretary of State has said, it is really important that we continue to do that despite the good weather. So thank you to the members of the public for observing that and please ensure that we keep moving in that direction. Next slide please.

So the second slide shows the number of new cases. Now, these are lab test reported cases. You’ll be aware that our capacity is increasing all the time on laboratory tests. So we need to interpret this with a little bit of caution. We are following to a degree an epidemic curve. We can see the rise, and we will of course in due course be looking to see that level off. But you will notice that over the last 24 hours or so, there is an apparent big surge there. We just need to keep in mind that we need to watch this for a trend over time; because as our testing capacity increases, inevitably we will find more cases. Thank you. Next slide please.

Again, England hospital admissions for COVID-19. I think the critical thing here is, again, looking at the data as it flows across. Think of the trend across the points on the graph, not on an individual day-to-day basis. But nevertheless, it gives an indication of how hard our different parts of the country are working. Here it’s hospital admissions, so it’s the NHS. But there will be comparative streams of health and care staff working in the care sector as well as the number of cases rise. So clearly London, we all know, has been working super-hard on the front line, and those cases continue to rise now with an increase over the last 24 hours in the northwest.

We still, as the Secretary of State has said, have capacity in all of our hospitals to manage these cases, and we’re hoping in due course if everybody continues to practice social distancing, that those cases will start to fall. Clearly, there is a delay in the number of hospital admissions from when people often contract the disease and then become more ill and need more intensive care. So there will be a lag on some of this data compared with our social distancing measures. The last slide please.

Again, this gives an indication of the global death comparison. Now again, as many of my colleagues have said before, this tries to give a direct comparison, even though some of the international comparative data is difficult to interpret. But I think it’s important that we continue to look and where necessary and where possible to learn from other countries. The UK in this slide is in blue in the center of that grouping. These are the deaths which have all been calculated from a zero day. They’ve been brought back to when the first 50 deaths were reported in the country.

Now for the UK, these are COVID-associated deaths. They are all sad events. They will not all be a death as a result of COVID, but certainly we need to be sure that we are counting everything appropriately and being very clear and transparent on that. So we will continue to track and monitor this and learn from other countries where we can.

Thanks very much. If we now go to questions. First question, Hugh Pym from the BBC.

Hugh Pym: (41:51)
Thank you very much. Secretary of State, you’ve said there are just over 9,000 ventilators in the system; and in due course, 18, 000 should be in place. How many will there be there next week at a time when experts say the NHS will be close to or at the peak of demand?

Thanks, Hugh. As I said, we have over 9,000 ventilators now across the NHS, and we are ramping that up. The production from the domestic manufacturer is starting to come on stream, and the key goal is to always keep the amount of critical care beds, which nearly all need ventilators, above the demand. I haven’t got an exact figure for how many extra we will deliver next week, not least because when we bring them in from abroad, there are risks to the timing there and challenges to the timing. But I would expect many more over the next week. The goal continues to be to keep ramping it up to the 18,000 target that we’ve set. We don’t expect on the central expectation to need 18,000, but I want to keep the ramp up going, because I always want to keep the supply ahead of the need. So I’m sorry I don’t have any more detail than that which we’ve put out today, but that is because of the inherently uncertain dates of arrival of kit, especially from our international sources.

Shehab Khan from ITV.

Shehab Khan: (43:37)
Health Secretary, there will be plenty of people, some of whom have no access to open spaces who do not understand why they cannot briefly sit in a park if they listen to the government’s guidance and stay two meters away from the nearest person. Can you explain exactly why you shouldn’t be doing that? Also, if I may, you just said you are not ruling out further measures if people ignore the social distancing measures. Can you clarify with practical examples what exactly you are considering and in what circumstances they’ll be used?

No, we’re not planning any changes to the rules imminently, so we’re not looking at any specifics in that space. But what we are doing is being absolutely clear that the current rules must be followed. Of course, I understand why people ask the question of why have the rules been set as they have. The reason is that exercise helps your physical health, your mental health, is incredibly important. That’s why we’ve kept it in the rules and the reason that sitting and not exercising doesn’t give you the advantage that exercise does. I don’t know whether from a medical point of view, Jenny, you want to say anything more in addition to that?

Really just to add to that, I think we have always said right from the start of managing this incident that it’s really important that we balance physical and mental health needs as the Secretary of State has described. But I think one of the issues, and we’ve taken that into account through scientific advice, is around behaviors as well. It’s not just the what are you doing, it’s the how that you do it. So if you’re sitting on a park bench, people tend to accumulate. It’s very difficult to prevent that. I think actually having rules where we are getting all of the benefits and minimizing the risks of the harms is an important approach to maintain.

Thanks very much. Does that answer your question? Would you like a …

Shehab Khan: (45:44)
Yeah. You mentioned that you were considering tightening up the measures. What exactly does that mean? So if people continued to ignore your social distancing rule, what does tightening up the measures actually in practical terms mean?

Well, we’re not planning any changes to those rules imminently, but we do absolutely require people to follow them. We have had these questions about the boundaries of the rules and people pushing the boundaries. But as Jenny just set out, there’s very clear reasons that we set the rules as they are, and we want people to follow those rules. Of course, there’s now the police in force against them. They’re not rules that anybody would want to have in place, but they’re rules that need to be in place, and everybody must follow them and stay at home wherever possible unless for those four reasons. We’re crystal clear about that. We’ve set those rules, we’re enforcing against those rules, and we reiterate those rules, because that is best way to be able to bend the curve down and stop the spread of the virus.

Alex Thomson from Channel four.

Good afternoon to you both. You’ll both be aware that in the last few hours, an urgent directive has gone out to NHS ICU doctors to the effect that if hospitals are using a lot of oxygen machines, the entire oxygen supply to the hospital can fail, from C-PAP face mask ventilators right through to operating theaters. So what has been done to address that critical problem? More widely, we understand three hospitals in the past few days have come close indeed to running out of oxygen. What’s being done to increase supplies to ensure that doesn’t happen in the coming days and weeks, when clearly the number of patients will increase?

Yes, this is a very important operational question. We have adequate supplies of the oxygen that’s needed in hospitals. We need to, of course, make sure that each hospital has that available. We have had an equipment failure, as I think you referenced. We therefore had to divert some ambulances, but this is the normal-

He therefore had to divert some ambulances, but this is the normal operation of the NHS when there are things like equipment failures. Of course, interest in it is heightened because of the nature of coronavirus, but the supply, the quantity of oxygen and supply of oxygen is something that we’ve been working very hard on and we have a very high degree of confidence in the supply of oxygen. Is there anything else?

I was just going to add actually some comments that I think Professor Steve Parris made a few days ago, which is actually to signal that this is a positive sign in most cases. If you have a whole system where, it’s unusual in the UK where we have a National Health Service, it means that we have a system of flagging where there are potential risks or problems before they actually become a significant problem. It is a strength of our system that we have these flags going off at regular intervals, and I think his comment back to the questions at the time was this is a positive thing. We flag them, we deal with them as they arise, and but to reinforce what the secretary state has said, is there is no insufficiency of oxygen and I think the public should not be concerned that if they become ill and need a hospital admission, that care is available to them.

Okay, great. Charlotte Ives from talk radio.

Charlotte I.: (49:21)
Thank you Mr. Hancock. You changed and updated the rules on PPE a few days ago. And I was speaking to a doctor who said before these changes he was moving between treating COVID patients and cancer patients who had compromised immune systems and he was terrified that he would be deadly to them because he didn’t feel it was adequate. So can I ask you firstly, was he correct to be scared and if he wasn’t correct to be scared, why has something had to change?

Well, we’ve changed the upgraded the guidance. So now in all instances it’s at or above the levels of protective equipment recommended by the World Health Organization. But we’ve also upgraded it following more, being known about the virus. As we’ve learned about the science of coronavirus over the last few months. So we will keep upgrading and improving guidance as we learn more about it. So that was the main reason for the changes to make sure that we reflected the latest that we know about the virus. And I think that the new guidance set out on Thursday has been very widely welcomed and provides clarity about what protective equipment is needed, in which circumstance. And then of course we have to deliver and make sure that protective equipment that is needed according to the guidance gets to the frontline. Jenny.

Yeah. So I think just to support that, I don’t know the individual case that you are describing, but clearly it wouldn’t matter whether you were a cancer patient or a patient in another setting. We want to maintain good infection prevention and control procedures. And the bedrock of that in the UK and throughout the NHS is actually systematic practice. It’s one reason why this country is very good. We don’t get a lot of nosocomial infection as an onward spread in healthcare settings because it is the basics, which we are also obviously been teaching the public around a good hand and respiratory hygiene in a systematic approach and using PP carefully, which keeps that at bay. But I think the new guidance there, what it has done is it’s reinforced the fact that our guidance previously was actually inconsistent with WHO guidance, it was endorsed, it was a, I think back on the 27th by WHO and recognized.

But what we’re seeing now is a slightly different prevalence of disease and we’ve adapted our guidance to manage that. So there’s a level of uncertainty and there’s a level of protection which is higher in some high risk procedures. So the areas we’re very concerned about from a clinical perspective are what we call aerosol generating procedures under pressure. So this is where somebody, where you get a potential airborne spread and we want to make sure people have absolutely adequate protection there. And then the other issue is recognizing the settings in which people are working. So the most obvious one would be if we went back say four months, very unlikely anybody in the emergency department would see anybody with COVID-19. Actually now, in some of those settings where it’s uncertain for professionals when they’re first seeing patients and understanding them, it’s important that they have covered in anticipation of what might be a different prevalence of disease. So that’s basically, I can give you more detail of the actual equipment, but that’s as effectively what we’re trying to do is covering the changing circumstances.

Did you have a follow up? You put your hand up?

Charlotte I.: (53:06)
Yes. I was just going to ask, you talked about us now knowing more about the disease. So knowing what we know now, should we have had these higher levels of protection from the beginning were people at risk?

Well the thing is that you can only make decisions based on the information that you have at the time. And we’re constantly looking for new information about this disease so that we can improve the guidance that we have and the response that we have to it. So, the question that we have in government and that I ask myself every day is, are we doing the right thing now? And what can we change to improve our response for the future? And so you can have a debate about the past, but you have to take decisions on the information that’s available at the time. And I think the previous guidance was the best guidance possible on the information that was available at the time and then we’ve upgraded it.

So I think to support that, it’s not so much, we are obviously learning all the time about the disease, but the basic guidance was entirely appropriate. And as I say, endorsed by WHO, despite I think some media reporting about differences. But the important thing is we are now operating in a slightly different environment. So it’s the uncertainty that some clinicians, not all clinicians find themselves in that we have reviewed where that is to ensure that they feel safer in those environments.

I think there are other opportunities we’re learning from. So for example, where we are finding that you can reuse masks safely, for example, with appropriate cleaning and technology. That’s very helpful because of course we need to keep in mind that regardless of supplies and advice, the whole world wants personal protective equipment and it’s really important that we all use it appropriately and judiciously. Exactly have it in the right places where it’s needed but not be wasting it so that the people who are working on the front line, whether it be in care homes, domiciliary care, or in the front line of an emergency department, they have the right PPE at the right time for the right clinical risk and that’s what our whole basis of the guidance is based upon.

Thanks very much. Jane Merrick at the i.

Jane M: (55:26)
Thank you. How do you square what the Queen says today about the nation’s attributes of self discipline with your warning about having to toughen the restrictions of people, don’t stop gathering at parks? That’s to the health secretary and to the deputy chief medical officer. What is the testing strategy for care homes and prisons? Given that these are emerging as a major hotspots for cases and sadly deaths, are prisons and care homes going to be next in line for mass testing after NHS workers?

Well, I think we’re all looking forward to seeing what the Queen has to say and watching her address and listening very carefully to it. I think the message from all of those of us in across the board is very clear, which is that we need perseverance in the face of some great challenges and that also means the perseverance in following the rules. And I couldn’t be clearer about my emphatic requirement of people, which is backed up by law to follow the rules that we’ve set out and to make sure that the people stay at home. That is the number one thing that you can do. And we’ve set out those four exemptions and people should stay at home unless they are going out for one of those four reasons and those four reasons alone. Jenny.

Thank you. So, absolutely you’ve highlighted two very critical and domains if you like, for public health surveillance and intervention. That’s been recognized right from the start of this incident and in fact is recognized before COVID-19 we always keep a close eye on care homes in prisons because the setting in which people live is potentially problematic. So the care homes, clearly you tend to have a collection in the nicest possible use of the word of potentially elderly or more vulnerable individuals. That’s one issue. And then certainly in prisons you are intentionally through a prison operation holding people together. So both of those environments are very well recognized. In fact, Public Health England hosts the WHO collaborating center for healthy prisons. So we have a lot of experience and actually advise other parts of the world. And I know that the key consultants there have been working with Ministry of Justice and with the Prime Minister on establishing and looking at what have those environments should be treated. You are specifically about testing and testing in both prisons and care homes has always been on the priority list, so once we moved from containment to delay, if you remember the categories of testing that we have our clinical care of patients in hospitals as an absolute category because that’s how we manage the safety and the benefit of that health intervention. But what we then do is test in care homes and prisons. What we do do though is we wouldn’t necessarily test everybody because you want to test whether it’s going to be a positive advantage to doing the testing. I’ll stop in a moment, and we’ll usually test up to about five people to establish vary depending on the setting, but to be sure that we have established what the issue is. It’s usually quite possible in a setting like that to understand then on a clinical basis, whether there is a case, it may not be laboratory confirmed, but it would be a presumed clinical case.

Thanks very much Jim at the FT.

Jane M: (59:05)
Sorry.

Oh sorry. You wanted to come back Jane, sorry.

Jane M: (59:08)
Want to come back on the question on testing that you said that they are next in line, but when will that testing take place? Given that there are probably lots of people who are very concerned about their relatives in care homes and also the people who work in care homes and people who work in prisons.

So sorry, perhaps didn’t explain myself clearly enough. So for any care home outbreaks, whether it relates to a worker or an individual resident or a prisoner or somebody supporting him or her, those tests happen now they are in the prioritized list already. So the groups of people who are routinely tested and have been ever since we have started responding to this incident include potential outbreaks in care homes and prisons. That’s been going on right from the start. In terms of other workers there as we go forward for NHS workers and front line care workers and responders, clearly those are in the priority group because we recognize that those workers, we need to think of the care sector almost like the other arm. We talk a lot about the acute hospital sector, but we often forget that it’s the care sector who are operating in the community, community nurses and domiciliary care workers who are equally important in our drive to to manage this incident so they will come within prioritize key workers.

Matt Hancock: (01:00:30)
Does that answer the question, Jane?

Jane M: (01:00:34)
I think it was just to get clarity on when that testing would take place for those workers. There’s no specific timing.

Jenny Harries: (01:00:41)
The outbreaks happen already and the other workers will be falling into the expanding program, which has been ramping up as you’ve heard and I think has been reported on a daily basis this week.

Thanks. Jim from the FT.

Jim: (01:00:57)
Secretary of State, could you please tell us yes or no, whether the government is preparing to take equity stakes of taxpayer’s behalf and some of the large companies which had found themselves in major crisis because of the pandemic and if so choosing that Richard Branson’s Virgin Atlantic is a worthy recipient of that kind of assistance given that in 2017 Virgin Care sued your beloved NHS after losing a contract. And given that, so Richard lives as a tax exile on Necker Island. And the question for Jenny Harries, I know you might say it’s too early to speculate about how the lockdown might end, but Neil Ferguson seemed to suggest this morning that there could be a kind of staggered way of doing it in terms of different age groups and different regions coming out of the lockdown before others. Is that possible?

Well, I’m going to not answer the first question and then Jenny can answer the second one. My response to the first question is, this is an area in which Rishi Sunak has been doing unbelievable work. He’s recognized around the world for the first class response, economic response that we’ve got here in the UK, and overall from the protection of workers, the protection of self employed right across the board. They’ve taken the right steps and I think done it with remark.

United Kingdom COVID-19 Briefing Transcript April 5

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