UK Prime Minister Boris Johnson Coronavirus Press Conference Transcript October 20

Boris Johnson: (05:20) Good afternoon. I'm joined by Steve Price of NHS England and Jonathan Van-Tam, Deputy Chief Medical Officer. Across the world, the countries that are waging the most successful fights against coronavirus are adopting regional and local measures to protect their populations. And that's why last week we launched the three local COVID alert levels for England, with interventions based on the prevalence of the virus in local areas. Since then, we've been undertaking discussions with local leaders in those parts of the country which are currently bearing the brunt of the second wave of this epidemic. And before I update you on those discussions, I will ask Jonathan Van-Tam to brief us on the latest data nationally and in greater Manchester. Thank you. Jonathan. Jonathan Van-Tam: (06:10) Thank you, prime minister. First slide please. So I'm beginning today's data briefing with a slide which I showed on the 12th of October, and I'm doing that on purpose. First of all, to remind you that there are two maps of England here. The one on the left in purple shows the weekly case rates per 100,000, and the one on the right in brown shows the rate of change per 100,000 population, all by local authority area level. And the darker colors indicate higher rates of disease or higher rates of change. And you'll see that these geographic maps are current for the week 30th of September to the 6th of October. And if you quickly look at those shadings, we'll now turn to the second slide, which is the 8th of October to the 14th of October. And you can clearly see that that dark purple confluent problem area has extended from coast to coast now and extends quite a long way down the country. Jonathan Van-Tam: (07:22) In contrast, the rate of change is more variable, and there are more patches of green indicating a negative rate of change as much as there are new patches of dark brown, such as in Lincolnshire. Next slide, please. And there's a similar picture for those age 60 and above. Again, these are the old geographic maps that I showed you eight days ago. And changing to the new graph now, you can see that the purple areas have increased and there are some new areas of increased rate of change in the over 60s. And I really want to emphasize that it is the over 60s that really worries us most because these are the people who become severely ill with COVID-19. They are more likely to be admitted to hospital. If they are admitted to hospital, they stay in hospital for longer. And sadly, they are more difficult to save. Jonathan Van-Tam: (08:24) Next slide, please. So, here are the data broken down by age band and by English region, beginning with the Northeast, the Northwest, Yorkshire and Humber. And really, each of these subplots is a contrasting game of two halves in as much that the 10 to 19 and 20 to 29 age group, you can see that the weekly case rate has declined on all of those traces. Now, this may be partly ascertainment. It may relate to the rate at which people are coming forwards for testing, which is now flat, because the rate of swab positivity continues to increase. But the other half of the coin, if you like, are the older age groups from 30 to 39 through to 80 plus. And here you can see over time this continuing increase in case rates. And this really shows us now that the infections which have seeded in the younger age groups are now penetrating those older age groups as we go forwards in time. And these are cases. This means that the hospital admissions and the deaths sadly that are linked to those cases are now baked in for the next two to three weeks. Jonathan Van-Tam: (09:55) Next slide, please. These are the same graphs again, but this time for the East Midlands, for London and the West Midlands. You can again see particularly in the East Midlands and related to Nottingham particularly that drop in the 10 to 19s and 20 to 29s, but the continuing increase in case rates in the other ages. Next slide, please. And the same is true of East of England, Southeast and Southwest, but at much, much lower overall levels of disease than we are currently seeing in the North of England. Next slide, please. Now again, I'm referring back to the heat maps that I showed you on the 12th of October, showing that gradual warming up of disease rates in the 16 to 29s, that then creeps through into the older age groups with a few weeks lag as we move through the age bands, as we go up each of the blocks. That's the visual snapshot from the 12th of October. I'll now move to the new snapshot. Jonathan Van-Tam: (11:05) And I think it's pretty stark. I think you can see very clearly now from these data that are just a week on how those heat maps have increased very markedly, not just in the Northeast, not just in the Northwest, but also in the East Midlands, top left, and in Yorkshire and Humber, bottom right. This is most concerning because it's the penetration of disease into the older age groups that gives the NHS significant problems. Next slide, please. And indeed, here are the weekly COVID-19 hospital admission rates in England by age group. And you can see very, very marked and very steep increases for 85 plus, 75 to 84 and 65 to 74. And some of you, the eagle-eyed amongst you will say, "Well, these data extend up until the 11th of October." I will show you some data that go further than that. Though, they are not segregated by age, but the pattern is the same. Jonathan Van-Tam: (12:13) Next slide, please. Before I do so, these are the ICU and HDU admission rates. You can see that same very sharp rise in 75 to 84s, 65 to 74s and 45 to 64s, but less so in aged 85 plus, consistent with the fact that fewer patients in that age group are appropriate clinical candidates for intensive care. Next slide, please. And I did say I would bring those data from the 11th of October right up to date for you. So, these are up to the 17th of October, and they show daily COVID-19 patients admitted by English region. You can see that the burden at the moment is in the Northwest, Northeast- Jonathan Van-Tam: (13:03) You can see that the burden at the moment is in the northwest, northeastern Yorkshire, but with an increasing burden in the Midlands. And the little red arrows that are on each of the X axes show you where the level was one week ago, which shows you once this gets started in an area, how quickly it then builds. Next slide, please. These are total numbers of patients in hospital with COVID- 19, as opposed to new admissions. But again, you can see that that trend of increasing burden in the NHS continues with some dramatic increases in the last week. Next slide please. Jonathan Van-Tam: (13:46) And Prime Minister asked me to focus a little on greater Manchester. These are the heat maps for greater Manchester, up to date on the October the 15th, and the data extending from early September through to that date. And you can see across the sub regions of greater Manchester, there are really very significant areas of heat across pretty much all of the ages and really extending to some deep purple zones in the older age groups. Next slide, please. This is the rate of new COVID hospital patients in England by NHS region. You can see that the North is running ahead of the rest of the country at the moment. Next slide, please. Drilling down a little bit into the Northwest, you can see Cheshire, Greater Manchester and Lancashire's STP partnership areas, and all of those increases in the number of patients being hospitalized with COVID-19 now. Next slide, please. Thank you, Prime Minister. Boris Johnson: (15:00) Oh, thank you, thank you very much JV Team. And the presentation that you've just seen shows clearly why we must act. And as we act, I don't want anybody to think that your actions, our actions are in vain, or the effort's in vain. Because, our collective action across the country has brought the R number well below its natural rate of about three. As a result, the virus is not spreading as quickly as it did in February and March. However, while the R is below its natural level, it does remain above one. Meaning, that the virus continues to spread. So we need to take action to reduce the R, control the virus, especially in those parts of the country as you've just seen where the virus is most prevalent. Boris Johnson: (15:51) And this evening, informed by the data that we've just seen, I can announce that Greater Manchester will move to the very high alert level. That means that pubs and bars must close unless they're serving substantial meals. Households can't mix indoors or in most outdoor settings. In some public outdoor spaces, groups must be limited to the rule of six, and we strongly advise against travel into and out of the area. In line with the additional measurements taken in Lancashire, casinos, bingo halls, betting shops, adult gaming centers and soft play areas must also close. Regulations will be laid in Parliament on Thursday, and come into force just after midnight. Boris Johnson: (16:36) I know that these restrictions are tough, both on businesses and individuals. And believe me, no one wants to be putting these things into effect. But that's why we're also enacting a comprehensive package of support. The job support scheme ensures those affected by business closures are still paid, those affected by business closures are still paid. And once you top that up with universal credit, those on low incomes will receive at least 80% of their normal income. Boris Johnson: (17:08) We've made available up to 465 million pounds to help local authorities implement and enforce restrictions. Greater Manchester will receive 22 million pounds of this and that's on top of the extra one billion pounds we're providing in funding for local authorities across the whole country. We will work with local authorities, including Greater Manchester to allocate testing and introduce local contact tracing. Over the last 10 days, we tried to get an approach with local leaders in Greater Manchester, a joint approach. Unfortunately, agreement wasn't reached. And I do regret this. As I said last week, it would have been better and we would have a better chance of defeating the virus if we work together. In addition, I must say to the support outlined above, we made a generous and extensive offer to support Manchester's business. I want to stress, this offer was proportionate to the support we've given Merseyside and Lancashire. The mayor didn't accept this unfortunately, and given the public health situation, I must now proceed with moving Greater Manchester as I say to the very high alert level. Because not to act would put Manchester's NHS and the lives of many of Manchester's residents at risk. Despite the failure to reach an agreement, I hope the mayor and council leaders in greater Manchester will now work with us to implement these measures. Elsewhere, discussions are moving to the very high alert level, continue with local leaders in South Yorkshire, West Yorkshire Nottinghamshire and the Northeast. Boris Johnson: (19:01) I hope and expect central and local government will continue to work closely together as we're seeing in Merseyside, in London and Lancashire and in many other parts of the country. Because ultimately, all of us want to protect the NHS, and in doing so to save lives. Thank you, I'm not going to go to questions from the public. Can we have our first question please? Jake Chester: (19:28) How many places under tier three restrictions would be needed before implementing a national lockdown? Boris Johnson: (19:35) Well, I think what we're trying to avoid is a national lockdown talk, and that... that's Jake. I'm sorry, I should have said Jake from Chester on the video. We don't rule anything out Jake, but the difficulty is that the distribution of the virus this time around is very uneven by comparison with March and April. And so the right responses many other countries are doing is to go for this local and regional approach. That's what we're going for. Let's go next to Vicki from Lancashire. Vicki from Lancashire asks, my grandmother has dementia, lives in a care home and has been in and out of hospital over recent months. Due to restrictions on visiting and local lockdowns, I've only been allowed to visit her once since March. Is there an opportunity for the restrictions on visiting care homes to be reviewed, which may enable an individual to visit their loved ones? Boris Johnson: (20:38) Well, I'm going to ask JVT, Jonathan Van Tam to comment on that in a second. But I just wanted to say Vicky that everybody sympathizes deeply with you and your family, and this is a situation that tragically is being replicated up and down the country. We do have to prevent the spread of the virus in care homes. You remember what happened in the early part of the year, so we have had to take some steps to protect elderly residents from the possibility of infection by visitors. But we are certainly looking at what we can do to review the circumstances that might allow people to visit their elderly relatives in extreme circumstances and on compassionate grounds. Because you know, I can see how absolutely wretched it is, and I think many, many people across the country have not had the experience of this problem. Jamie, did you want to add anything? Jonathan Van-Tam: (21:39) Yeah, thank you Prime Minister. This is really extremely distressing, and I know it's extremely distressing for relatives and for people who live in care homes. But the unfortunate and horrible truth about this virus is that when it gets into care homes, it can inflict really massive mortality very quickly. And the staff that go into care homes are being regularly tested. We can't get them to live in the care home as well, so they are in contact with the community, and there is this constant tension between wanting to see relatives and not wanting to witness catastrophic mortality in these care homes. I am hoping that some of the pilots with rapid and novel testing methods will eventually lead to a breakthrough so that we can be more relaxed about visiting residents and our families in care homes in a much safer way. But for now, I acknowledge openly a very difficult situation indeed. Boris Johnson: (22:54) And thanks for mentioning that point, JBT about the new types of testing systems that we were hoping to bring in. And as I said in the press conference on Friday, we will be prioritizing care homes for those tests, because it is a truly tragic and very difficult situation for many people. Let's go to Vicky Young of the BBC, please. Vicky? Vicky Young: (23:20) Prime Minister, in the last few hours, thousands and thousands of businesses in Greater Manchester have been told that they are going to have to close very soon. You've talked about 22 million pounds of help for the Greater Manchester area. Can you now clear up? Because many of your own MPs in the area do not know, what are you offering to the area beyond that? Are you withdrawing the extra, what you called generous offer? Is that now off the table? And what do you say to the mayor of Greater Manchester, who has accused you of grinding down communities through these negotiations? And then to professor Van Tam if I could, Northern Ireland and Wales have both now announced what they're calling a fire break, a short period of severe restrictions. Do you think that now should be the approach that England as well? Boris Johnson: (24:09) Well thank you, thank you very much Vicky. Look, I bitterly regret any restrictions that lead to damage to businesses and to people's lives, of course I do. And nobody wants to be putting people in Greater Manchester or anywhere through the experience that they've been through. And frankly, Andy Burnham is right what he says about the length of the endurance that Greater Manchester has shown. And I've simply got to look at the data, alas, the number of deaths, the hospital admissions, and we to act. And of course, the package that I just read, the 22 million that I described? That's additional to other support. We're always happy to continue to consider that. Boris Johnson: (25:08) But then don't forget Vicky, that this is a government that has put 190 billion pounds already in supporting businesses and jobs, livelihoods across the country. We are investing huge sums to support local authorities and another billion pounds as I said. And greater Manchester will have access to all kinds of funds, particularly to help with testing, and tracing, and of course with enforcement. So the funds are there, they're massive. And what we couldn't do, I hope people understand was do a deal with Greater Manchester that really would have been out of kilter with the- Boris Johnson: (26:02) ... been out of kilter with the agreements we'd already reached with Merseyside and with Lancashire. That was the problem. But, I'm very, very grateful to Andy and to his teams for going ahead now, as they have said they will, and implementing these measures. The most important thing now is that people comply and that we get a higher level of compliance in Greater Manchester and in all the areas that are currently in the upper tiers, because that's the way to drive the R down, Vicky. Jonathan Van-Tam: (26:45) So I'll continue and answer my question. Thank you for it. The answer's kind of in four parts. First of all, I hope my opening slides were very clear that pretty much everywhere in England is now heating up to some extent. And we are trying to walk a very fine line between getting the virus under control in areas where it is out of control and incurring the minimal amount of economic damage in doing so. Jonathan Van-Tam: (27:21) And it is clear that in the areas where it is out of control, and I focused on those in the presentation, hard measures are needed. But do I think right now it is appropriate to insist on those similar hard measures in, for example, the Southwest of England or Kent, where levels of disease are really very, very much lower than in the North of England, in other words, the national firebreak you talk about? No, I don't think that's right. And I don't think that's consistent with the epidemiological picture we're seeing, or indeed consistent with the pressures that are being seen in different parts of the health service across the country, which again are very different. And maybe Professor Powis might comment on that point. Steve Powis: (28:13) Yes. Thank you, JVT. So as JVT has shown with the epidemiology, there is variation around the country. And indeed that is also reflected in the number of patients that we see in hospitals. So if I give you an example of that, there are more patients in hospitals in Greater Manchester alone at the moment than there are in hospitals in the entire Southeast and Southwest of the country. So we are seeing variability in infection rates. Those infection rates inevitably lead to unfortunately, more deaths. They lead to more hospital admissions and more people in hospitals. They actually lead to more longterm symptoms because we now also know that COVID can affect you beyond the initial acute illness in what's becoming known as long COVID. And that's a condition that affects all ages. So it's not just the elderly. But it is variable throughout the country. Steve Powis: (29:06) So the key to this, as the prime minister and Jonathan have said, is to reduce infection rates. And that requires measures to be put in place that will do that, but also crucially, for people to comply with those measures. The British public did that in April and May, and we saw what happened. All came below one, death rates and hospital rates began to fall. So we know these measures work and really we can all play a part here. It's for everybody in the public to comply with the measures, to reduce the spread of the virus. And that will then reduce hospital admissions. It will benefit, obviously people with COVID, but it will also benefit other patients who don't have COVID because the last thing we want to do is to eat into the capacity that we have in hospitals that we use to treat other conditions. Boris Johnson: (29:54) Thank you very much, Steve. Thank you. Thank you, Vicky. Let's go to Kyle of ITV. Kyle: (30:00) Thank you, Prime Minister. Will businesses in Manchester, like the pub where I'm sitting now, have to close without any of the extra support that you were talking to Andy Burnham about earlier today and is Manchester being made an example of? Kyle: (30:16) And if I could ask Jonathan Van-Tam as well, two quick questions. Are these tier three measures with the added restrictions that come with them enough to make a difference in Greater Manchester and how damaging has the 10 days or so of delay been? Boris Johnson: (30:33) Listen, Kyle, thank you very much. Clearly we wanted a deal, as I said, that was the best way forward. We've had to take action just because of the urgency of the situation. I've described some of the funds that are already on the table. Other discussions undoubtedly will continue, but just for your viewers, for our viewers, we've already, in Greater Manchester, provided 196 million pounds of additional COVID funding to local authorities in Greater Manchester. 663 million pounds to the Greater Manchester local enterprise partnership through the local growth fund to help them, and 81 million pounds of shovel-ready projects to support business and growth in Manchester. We don't want to do this in the way that we've had to. Obviously we're going to keep talking to Andy Berman and his teams, but I'm grateful to them. I'm grateful to the leadership of the councils in Manchester now for getting behind the measures that we're putting in place, because that's our best chance of getting the virus down. Jonathan Van-Tam: (31:54) So to your question, Kyle, about tier three measures, the nationally published tier three measures are the minimum national standard for hard measures, but there are other things that local authorities can consider on top. And I hope some do. What is really important is compliance. Everybody needs to accept that this is not a good place to be if you're in tier three, but to get behind it and try and get the rate of disease falling so that R in that area is falling so that the pressure comes off the health service, particularly in those 60 plus age groups. Jonathan Van-Tam: (32:41) And to your point about what's 10 days delay look like? Well, I've got some data in front of me and I'll just pick out three local areas. I'll first of all, give you the case rate per 100,000 in the age 60 plus between the 1st and the 7th of October and then I'll fast forward to the 8th to the 14th of October. So that's not quite your 10 days, but I hope it will give you some idea. Jonathan Van-Tam: (33:17) So Manchester, initial figure 302 per 100,000. Later figure, 326. Salford 164, later figure 287. Wigan, 207. Later figure, 399. So I hope that gives you some kind of understanding of what we talk about when we talk about the doubling time. And when we talk about the rapid rate of progress of health service amenable problems in the elderly, once this disease gets out of control in an area, and I hope that gives you some flavor of what that kind of time period produces at the moment. Boris Johnson: (34:10) Thanks very much, JVT. Steve, anything you want to add to that? Steve Powis: (34:14) I think it's worth saying that, as JVT has said in terms of doubling rates of infection, that also plays directly into the effects on hospital admissions and patients in hospital. So, we have made this point many times and you alluded to it, that any measures that are introduced now, people comply with them. It will be up to two weeks before we see that having an effect on the NHS, because there is an incubation period for the virus of about five days. Then there's five to seven days of symptoms before typically people present and have to be admitted to hospital for the small proportion that do. Steve Powis: (34:52) So to give you an example in Greater Manchester, which illustrates that. So my colleagues in the NHS in Greater Manchester are doing a great job at the moment. They are managing, they are working together as a health care system to ensure they can manage the rising number of patients with COVID, but also keep services going for everybody who hasn't got COVID. And it's really important that people continue to access those services. Steve Powis: (35:15) But two weeks ago, there were just over 330 patients in hospitals in Greater Manchester. Two weeks further on, i.e, yesterday, there were just over 620. So that's a doubling. Another two weeks, if that doubles again, then we're into 1,200 or so. Now at the very peak in Manchester and Greater Manchester, on the 18th of April, there were 1,277 patients in their hospitals. So in two weeks time, we could well be seeing, at the current rate of rise, the sorts of numbers of patients in hospitals in Greater Manchester that we saw at the peak in April. And that's why it's really important that measures are taken at the right time and it's really important why everybody complies with them to get infection rates down. Boris Johnson: (36:03) Thanks, Steve, and thanks Kyle. Let's go to Tom down at Times Radio. Tom: (36:09) Good afternoon, Prime Minister. Thank you very much. Whales and Northern Ireland both have lower infection rates than England, sometimes considerably lower, yet both have voluntarily put themselves into regional lock downs. Pretty much have been closed apart from schools. Why have you decided to take a different course? Why are you not looking at regional or local lock downs at the moment? Tom: (36:31) And a question to Jonathan Van-Tam and Steven Powis, please. John Van-Tam, you just eloquently explained why national lock downs, national circuit breakers, may not be such a clever idea with varying infection rates, but can you confirm you are actively looking at local circuit breakers for these hotspot areas and how long are you going to give tier three to work to reduce the R rate in Manchester, Liverpool, et cetera, before you then advise the prime minister to move on to local circuit breakers? Boris Johnson: (37:02) Well, Tom, thank you very much. First of all, obviously in the areas which are experiencing a particular surge of the virus, that are now in tier three or going into tier three, we rule nothing out. If we have to take tougher measures, then of course, we will. We think that that local regional approach is right, but I just want to go back to the points that both Steve and JVT have been making, that the way to make this work with tier three is for everybody to comply. And I think the package of measures that we have in tier three, in these hotspot areas, if they are implemented, if they are implemented, will do the trick in those areas. And that can make a huge difference to the overall spread of the virus in the country. Jonathan Van-Tam: (38:00) So thank you for the question. My retort is rather simple, really. We just can't afford just to let our elderly die, and we can't afford to allow our NHS to be completely consumed by looking after COVID so it can't do its other businesses usual work. So we'll have to take as tough measures are necessary to stop that. And the typical lead time, the lag time between doing something and beginning to see a discernible effect in terms of first case rates, and then maybe delayed by another week, hospital admissions, is two to three weeks. And just to make a point that again, that the prime minister made, we're running now with the brakes partially on and the R is 1.3 to 1.5, according- Jonathan Van-Tam: (39:02) And the R is 1.3 to 1.5 according to the latest SPI-M estimates. So we can't take the brake off on this. And we may have to push on the pedal a little harder to get it back under control. Boris Johnson: (39:16) Thanks very much. Thank you, Tom. Jason Groves of the Daily Mail. Tom: (39:22) Thanks, Prime Minister. First of all, can you clear up once and for all whether Manchester is going to get this 60 million pounds that you offered earlier in the day? And more broadly, you seem to be facing a kind of northern revolt. This isn't just Andy Burnham. Your own ally, Graham Brady, says there's no evidence these measures will work and lots of evidence they'll wreck jobs. The leader of Middlesbrough Council says you're using bad data. The leader of Hartlepool Council says the government can sod off if it wants to impose more restrictions. Why can't you convince northern leaders of all stripes that you're doing the right thing? And does it matter if you can't? Can the country go forward together if you can't? And Professor Van-Tam, can ask you very quickly, today's death toll is shockingly high, 241 people. Is that a blip? Or you talked about things being baked in, is that what we're going to be seeing regularly over the next few weeks? Boris Johnson: (40:20) Well, Jason, first of all, let me just say, in respect to funding of Greater Manchester, obviously we want to do more, we want to, as we said earlier on today. But for the sake of fairness, the deal has to be in line with the agreements we've reached with Lancashire and, and Merseyside, for instance, where we have made progress. And I just remind you that, in terms of business support, 46,700 business premises in Greater Manchester have received local authority grant payments of 546 million pounds. 96,100 people in Greater Manchester have received support under the Self-Employed Income Support Scheme, and the [inaudible 00:02:13], the furlough scheme has looked after 407,900 jobs so far in Manchester. And I think it's just worth repeating because all that's already gone in, but we're now offering more. But as I say, we have to act today because of the surge in cases that you've just rightly alluded to in order to protect health and save lives. Jonathan Van-Tam: (41:41) Yeah. So thank you, Jason. Yes, 241 new deaths today. That's up 161 compared with yesterday. But on a Monday or Tuesday, we always get something of a catch-up due to the delay in reporting deaths over the weekend. So part of that surge in deaths is related to the weekly pattern of slightly lower figures at the weekend, and then a kind of catch-up early in the week. But overall, is the trend upwards? Yes. Do I expect the trend in deaths to continue upwards? Yes, unfortunately, I do. Boris Johnson: (42:24) Thanks very much, JVT. Let's go to Dominic Yeatman of Metro. Dominic Yeatman: (42:31) Hello, prime minister. You said what we couldn't do is a deal with Greater Manchester that's out of kilter with deals struck with Merseyside and Lancashire. But given that the 22 million pounds on offers is exactly half that offered to Liverpool, should local authorities be penalized if they do not agree with the settlements offered? And one to Professor Van-Tam, if I may. Is the argument for short national circuit break now stronger or weaker than when SAGE recommended it on September the 21st? Boris Johnson: (43:14) Well, listen, thank you very much, Dominic. And first of all, the 22 million that you mentioned, that's separate and additional to any other support that we were trying to agree with Manchester for business support. I mentioned the figures, the support that's already gone in to support business in Manchester. Our door is open to continue that particular conversation. But for the sake of fairness, we have to keep it in line, as I said, with what we agreed with Lancashire and Merseyside and so forth. Jonathan Van-Tam: (43:55) Yeah. Could you remind me of the question please? Dominic Yeatman: (43:59) Yes. Is the argument for short national circuit break lockdown now stronger or weaker than when SAGE recommended it on September 21st? Jonathan Van-Tam: (44:10) Thank you. So I've already articulated the reasons why I think a national lockdown at the moment would be inappropriate for communities in Cornwall and East Anglia, for example. But it is a kind of scientific feature of the effect of a lockdown that if disease levels are higher when you affect the lockdown, the effect will be less overall than if the lockdown is inflicted at a point when disease levels are much lower. So I suppose what I'm saying is that I wouldn't expect the same magnitude of effect if one were done now as if it were done early in September or mid- September. But I repeat the point that the epidemiology is so varied across England that I think it would be very difficult to justify for some communities. Boris Johnson: (45:12) Thank you. Thank you very much, JVT. Last question is to Jen Williams of the Manchester Evening News. Jen Williams: (45:21) Thank you. Prime minister, Greater Manchester has been under constantly changing lockdown measures since the start of August, sometimes announced with just a few hours notice, sometimes emerging late at night on social media. At one point, Bolton was under four different sets of restrictions in the space of a few days. Have you visited the region at any point to speak to people about what this has been like for them? Do you think we are owed an apology? And do you think there's any connection between that approach and our current high infraction rate? And secondly, you still haven't said exactly how much business support Greater Manchester is getting. Given that you're saying that it needs to be aligned with Lancashire, does that mean it will be no more than 60 million pounds? And to the deputy chief medical officer, do you think that a more localized approach to contact tracing before now would have helped to keep some of these current infection rates down? Boris Johnson: (46:04) Well, Jen, let me just say to all those businesses, you asked me to apologize. And I am deeply sorry that it is necessary to put these measures in place and to everybody who's endured the privations and the difficulties of this period. Of course, I'm deeply, deeply sorry for what's been necessary, Jen. But nobody wants to enact measures like this. I do think that there's been some simplification thanks to the tiering system. That's a good thing. And of course, we want to give Manchester, give businesses, people in Greater Manchester, the proper levels of support, as I've said. Our door remains open to Andy to discuss that. Though we've got to keep it in line, obviously, with deals already done. And I just want to repeat my gratitude to the people of Greater Manchester for their willingness to help everybody in the country to follow the guidance, follow the rules, and get this virus down. I mean, it's in all of our hands. Jonathan Van-Tam: (47:21) So on the question about contact tracing, I believe a blended approach of national contact tracing to kind of deal with the high volume, low complexity contact tracing is a good thing, but I think the local backup to deal with complex and difficult and hard to reach cases is a really good idea. I think you need both, to be truthful. Boris Johnson: (47:50) Right. Steve Powis: (47:50) So I know how difficult it is at the moment in the Northwest. And of course, from the NHS, I'm particularly grateful to all the NHS staff in the Northwest who I know are dealing day by day with increasing number of patients with COVID, and at the same time are ensuring that all other patients, our cancer patients, patients with heart attacks or strokes, whole range of things, are also being looked after and managed appropriately. But as I've said, the key to keeping doing that is to get infection rates under control. I expect that Liverpool University Hospitals will have as many patients or more patients by tomorrow with COVID in their hospitals than they had at the peak in April. And I think that shows just how fast we can see infection rates and hospital admissions rise if we don't get this under control. So it's really critical. And as the prime minister has said, we're all grateful for everybody to comply with these measures to maintain social distancing and to ensure, quite simply, that the virus doesn't have a chance to spread. Boris Johnson: (48:59) Thank you very much, Steve. Thank you. Thank you, JVT. And thank you, everybody, for watching. I guess I just want to repeat the central point that we're walking a narrow path here today because we don't want to go back into a national lockdown with all the damage, social and economic, that can do, unless we absolutely have to. We think that the local approach is the reasonable one, given the way the virus is dispersed. And that's what we're going to do. And just to sort of give everybody some hope, if you look at what is actually happening with the universities, for instance, they have done a great job, I think, in getting their virus under control. You saw how some of those lines are starting to come down. Boris Johnson: (49:48) And I repeat the point that we made earlier, both JVT and I, that the R is currently above one, but it's not that much above one. And so if we all follow the guidance together and everybody gets together and complies with the rules for the tiers that have been set out on the website, then I've no doubt that we can drive it down, particularly in those badly affected areas. Thanks very much, everybody.