United Kingdom Coronavirus Briefing Transcript April 29

Dominic Raab: (00:02) Good afternoon and welcome to today's Downing Street press conference. I'm pleased to be joined by Professor Jonathan Van-Tam, deputy chief medical officer, and also professor Yvonne Doyle, medical director at Public Health England. Let me just start by saying I think, on behalf of us all, a huge congratulations to the prime minister and to Carrie on the wonderful news of the birth of their baby boy. I have spoken to the PM and I can tell you that both mum and son are doing really well. Now, next, let me give an update on the latest data on coronavirus from our Cobra data file. And I can report that, through the government's ongoing monitoring and testing program, as of today, there have now been 818,539 tests for the virus across the U.K., including 52,429 tests that took place yesterday. 165,221 people have tested positive. And that's an increase of 4,076 cases on yesterday's number. Dominic Raab: (01:06) Now, as the health sector announced yesterday, from today, we're moving to an improved daily reporting system for deaths so that that's in all settings are included wherever the individual has tested positive for COVID-19, rather than just those in hospitals. And those figures show that, up to yesterday on the new measure, we have recorded an additional 3, 811 deaths in total. And I think it's just important to say that those additional deaths were spread over the period from the 2nd of March to the 28th of April. So, they don't represent a sudden surge in the number of deaths. Dominic Raab: (01:47) Sadly, today's figures show an additional 765 deaths compared to yesterday. I'll let professor Doyle talk us through the data in detail in a little while. But I think we must never lose sight of the fact that behind every statistic there are many human lives that have been tragically lost before their time. We also pay tribute, of course, to those caring for the sick. And yesterday at 11 o'clock in the morning, the whole country observed a minute silence, a moment to reflect on the sacrifice of all of our frontline workers who have died whilst dedicated themselves to caring for and serving others. Dominic Raab: (02:28) Now, on the 16th of April, I set out five principles that would guide our approach to the transition away from the current set of social distancing measures in place and into a second phase. We continue to see evidence in the data of a flattening of the peak of the virus. And that is only happening because we delivered on the two central pillars of our strategic approach to defeating coronavirus. The first one was that we reinforced our NHS capacity through the Nightingale Hospitals, the extra critical care capacity, more ventilator beds, and extra doctors and nurses on the front line. And the second is that we introduced the social distancing measures at the right time, guided by the scientific and medical evidence. And the public's overwhelming support for those rules has helped save lives and protect the NHS from becoming overwhelmed. Dominic Raab: (03:18) Now, we're still coming through the peak. And this is, as I've said before, a delicate and dangerous moment in this crisis. So, I know that a lot of people have made a lot of sacrifices, which is why it's so important that we don't let up now and risk undoing all of that hard work. Dominic Raab: (03:38) So, as we look to the future, our five tests remain absolutely key. First, we must continue to boost NHS capacity, preventing it from being overwhelmed. Second, we need to see a sustained and consistent fall in the number of deaths. Thirdly, we need to see further reductions in the rate of infection to manageable levels across all the relevant areas and settings. And fourth, we must be confident the NHS will be able to cope with future demands. And that includes as a result of any changes to existing measures or new measures that we may need to take. Dominic Raab: (04:17) Fifth, and I think this is probably the most critical of the five principles, we need to be confident that any adjustments to the current measures will not risk a second peak of infections that could overwhelm the NHS. A second spike will be harmful to public health. And it would result in many more deaths from COVID-19. That itself would lead to a second lockdown, inflicting further prolonged economic pain on the country. And, as the governor of the Bank of England, Andrew Bailey, said last week, that wouldn't just be economically dangerous. It would inflict a serious blow to public confidence. Dominic Raab: (04:56) So, this issue of a second spike and the need to avoid it, it's not a theoretical risk. And it's not something that's just confined to the United Kingdom. Having relaxed restrictions in Germany over the last week, they've seen a rise in the transmission rate of Coronavirus. Chancellor Merkel has said publicly, and she's made it clear that they might need a second lockdown in Germany if the infection rate continues to rise. So, this is a very real risk. And it's vital we proceed carefully guided by the scientific advice so that our next step through this crisis is a sure footed one. We mustn't gamble away the sacrifices and the progress that we've made. We must continue to follow the scientific evidence. And we must continue to take the right decisions at the right moment in time. Dominic Raab: (05:45) Now, we are working on all of the potential options for a second phase. There is light at the end of the tunnel, whether you're an NHS worker on the frontline working tirelessly shift after shift, or a parent at home with young children. But we do need to be patient and we need to be careful as we come through what is a moment of maximum risk. So, we'll wait for Sages next review of the data in early May. We're ramping up the testing with capacity now at over 73,000 per day and 52,429 tests carried out per day. And eligibility for those tests is now being expanded again further to include anyone who needs to go to work and can't work remotely and who has symptoms. It also includes anyone over 65 with symptoms and all care home residents, as well as care home staff. And, at the same time, as we ramp up the testing capacity, we'll keep working on our tracking and tracing capability, which is going to be a key component in the next phase of this crisis. Dominic Raab: (06:52) We'll continue to source ventilators and personal protective equipment both at home and abroad. Paul Dayton is leading the national effort to increase domestic production and supply. We continue to source PPE from abroad. We're setting ourselves out as the international buyer of choice in the international marketplace. And I can tell you that, in the last ten days, we've secured over five million masks from China. We've had three flights with gowns from Turkey. Because we know that every single one of those items of PPE is needed by those working so hard on the front line, both in NHS and also in our care homes. Dominic Raab: (07:31) And our international effort isn't confined to procurement. I can tell you we've also made enormous progress in returning British nationals who otherwise would have been at risk of being stranded abroad. And it's worth just noting that, since the outbreak in Wu Han, we've helped an estimated 1.3 million British nationals return on commercial flights. And we've done that by working with the airlines and with those governments to make sure that the flights can run and that the airspace is left open. And we brought back over 200,000 British nationals from Spain, 50,000 from Australia, and over 11,000 from Pakistan, to name but just three countries. Dominic Raab: (08:12) As well as those commercial flights, we've also chartered flights where commercial options were not possible. And we've now reached the stage where we've brought back over 20,000 British nationals on 21 flights. And that includes 9,000 British nationals who had been brought back from India, 2,000 from South Africa, and 1,200 from Peru. Dominic Raab: (08:34) So, it's also, just in terms of repatriations, worth bearing in mind that on the 17th of March when we changed our travel advice for those traveling on cruise ships, there were something like 19,000 British passengers on 60 cruise ships sailing around the world. And, as the border restrictions were put in place by country after country, we faced a daunting task in getting our people home. But we stuck at it. And six weeks later, we've now got all 19,000 British passengers back home, safe and sound. Dominic Raab: (09:11) So, that was an enormous effort. And we recognize that the job isn't yet done. We'll continue with this unprecedented effort with further charter flights coming back from New Zealand, Pakistan, and Bangladesh, amongst others, over the next week or so. So, I must pay tribute, at this point, to all of the outstanding work our conciliar teams working night and day at the FCO in London, but also at our embassies and our high commissioners around the world have been putting in. Dominic Raab: (09:40) Finally, the Health Secretary announced last week that U.K. trials have started as we draw on the incredible scientific talent that we've got in this country to pursue a vaccine. And that effort too has an international dimension to it. So, today we announced that the U.K. will provide GAVI, which is the International Vaccine Alliance, with the equivalent of 330 million pounds each year over the next five years as we seek to come up with a vaccine, both to protect the British people, but also to help immunize millions of the poorest and most vulnerable people right around the world, combining the depth of our innovative knowhow with the big hearted determination that has characterized our national effort to defeat the Coronavirus. And having said that, I'm now going to ask Yvonne to talk us through the latest data slides. Yvonne, over to you. Yvonne Doyle: (10:31) Thank you, Secretary of State. We have a selection of measures and slides here today to show. And the first one is just to remind us of the five tests for adjusting the lockdown. As the Secretary of State has said, this is about capacity, it's about a fall in the daily deaths, it's about reliable data, and also that we have good supplies of material for our NHS and care staff and that we're confident that the adjustments to the current measures will not risk a second peak. Yvonne Doyle: (11:05) But moving to the actual slides, and the next slide, please, shows what is going on out in society at the moment. This is a transport slide which shows the use of various forms of transport. As we've seen up to now, very dramatic falls in most modes, but there has been an uptick in motor vehicles. And the message here really is that we are still passing through this peak. And this use of motor vehicles, it's the highest working day use since the 23rd of March. And we really have to be vigilant that most people are making huge efforts to stay at home and save lives. And this is slightly worrying. So, please do stay at home, protect the NHS, save lives, and go out for the necessities. And the transport data will reflect that. Yvonne Doyle: (12:02) And the next slide, please, is about new cases in the NHS and in the country at the moment, in the UK. And we can see here the increasing amount of testing that's going on through the orange bars. But basically, the cases have remained broadly stable over the last weeks. And that is good news. But I want to move on really to show you a little more about that. Yvonne Doyle: (12:27) The next slide, please, does show this. So, now we have a slide about people in hospital. And this is broadly good news because the numbers in hospital have decreased from over 18,000 to over 15,000. That's a 16% decrease. And it's manifest in all regions. You can see how London had an early peak. But now, London is declining in its use of hospital facilities. But, of course, other regions may overtake that. So, we do have to be careful. As I say, we are passing through this peak. We're not through this yet. And the next slide, thank you. Yvonne: (13:03) ... To speak. We're not through this yet. And the next slide, thank you is about critical care bed use in the UK and this means all beds, both high dependency and intensive care wards use, and this is good news because we can see here that 40% of the beds are being used. That means there is critical care capacity, and that is a credit to the NHS for how it has got us through this crisis to this stage, and there is capacity and room for patients who need it. The next slide please is about the cumulative daily COVID deaths. Now this is an interesting slide where we'll begin to get into a little bit more into what is going on with deaths. So the deaths in hospital is the blue line, and that is what has been measured very reliably up to now. Yvonne: (13:52) But now public health England, with support from the NHS, has been in a position to congregate deaths in all settings based on confirmed tests that we see coming through our labs. So what we can see here is first of all that the deaths on the orange line are confirmed deaths from coronavirus, that tells us what exactly is going on in all settings. And when I say all settings, I mean hospitals, health protection team, the local outbreak teams in the community broadly and in care homes. So now we see that there is a divergence. It's not a huge, it's about a 20% divergence, but it's good news in the main in terms of what it is showing because what it's showing is we are getting a comprehensive picture and this is most important for control. So could I move on to the next slide please? Yvonne: (14:46) Which is about the daily deaths, which is excluding deaths outside of hospital. So these are hospital deaths, which is what we were looking at in the previous slide in the blue side. It shows this declining trend of deaths in hospitals, which the trend started to increase at the end of March and we can see it declining. But to restress, we're still coming through the peak because of course this doesn't represent all deaths, but it is good news about deaths in hospital and that is also a credit to the good treatment in hospital. The next slide looks at COVID deaths in all settings and you can see there it's a cumulative line there, the orange line. And it's good to do it that way because otherwise you get swings and ups and downs when weekends occur and people are not sure what has happened with deaths. Yvonne: (15:42) But with the line you can see the trend and the trend is quite flat actually. And it may begin to decline, but we're not convinced of that yet. But it's good to show that. And the reason it starts at the 30th of March is because this is about all settings. That was the time when we were able to start measuring that from then on. And so this is a seven day rolling average and it clearly ... And it's very important, we know what's happening daily. Now on to global. So global death comparisons are two slides here. The first one is actually just crude numbers. And you can see here a portion that looks like the United States has a very high number of deaths and other countries perhaps are aligning with each other. But the point on this slide, the slide says a number of things. Yvonne: (16:33) First of all, and these measures may not be comprehensive measures of death ... And we're very keen to do here and are doing now comprehensively. So for instance in Spain, we're not absolutely clear whether the deaths in Spain include all care home deaths. And this is understandable because it's very complex and difficult to get these measures, particularly on a daily basis, which is why the news today about being able to do this on a daily basis is very good news. Although of course the news about numbers of deaths is not good news and, again, stresses how dangerous this virus is, how sad it is for those individuals, and how we have to be ever vigilant about how we look after each other and how we adhere to the requests to stay at home, protect the NHS, and particularly to save lives. Now the last slide is also interesting because this now shows the cumulative death number per million population, and this shows a very different pattern where we can see two measures for the UK, the hospital deaths and the comprehensive deaths. They're not hugely different on this scale, but you can see where we are now tracking much more along our European neighbors and also, and we've seen Italy and Spain there and France, but the US of course has dropped because we're now measuring rates per a million. Other countries have increased. The important thing here is that it is ... Our measures are comprehensive, they're daily and they're taken in all care settings. So I thought you would wish to see the two contrasts. Thank you [inaudible 00:18:22]. Dominic Raab: (18:22) Thank you very much indeed. I think we'll now turn to questions from the media and I think first up we've got Hugh Pin from the BBC. Hugh, you there? Hugh Pin: (18:34) Foreign secretary, question about testing. What support will you give care homes in administering and organizing tests and helping them keep residents and staff safe? Dominic Raab: (18:49) Well, I'm happy to let either Yvonne or Jonathan come in, but just to be clear, we've expanded the eligibility. Eligibility now includes anyone in a care home where they're resident or staff and we have obviously had a distribution issue. There's no sugarcoating the challenge we've had with that, we've helped deliver them through the local resilience forum. We are getting the clipper service up and running and the military have also done an exceptional job. So whether it's the supply, and which we're ramping up in the way I described and the health secretary has explained, or the delivery, are we doing everything that we possibly can? Yvonne, I don't know whether you or Jonathan want to add anything. Yvonne: (19:33) Well and thanks. Yes indeed Hugh. So there are a number of ways that testing is and will continue to happen at scale in care homes since this epidemic in care homes, which still continues and there has been a huge local effort both through local government, our directors of public health, our health protection teams, but increasingly with support from national endeavors to get the tests to the home to make sure staff get the testing they need. This will continue for some considerable time until we are convinced that we have got under this epidemic in the care homes, which is of course utmost concern. Dominic Raab: (20:11) Anything else you'd like to ask on that? Hugh Pin: (20:14) Couldn't testing really have started sooner than that? Yvonne: (20:18) Well, Hugh, testing has always occurred during outbreaks and that has never been given up at a local level. Our health protection team supported by others, the NHS locally, have been into and going into care homes throughout the country. But the scale and the speed of this epidemic is really in the last couple of weeks, and there is a huge national and local endeavor to both not just test, which is very important, but to also understand the measures that would make a difference in care homes. And to look at that in a very rapid way looking at the evidence so that we can put in place measures that protect people. People are absolutely passionate about getting this right, but it is the most complex sector to get to 16,000 homes, a lot of places to go under ... Critical to use local intelligence as to where the risks are highest. Dominic Raab: (21:11) Also Hugh it's just worth saying that of course you'd have to have an enormous testing capacity to deliver what I think you're suggesting we could have or should have. One of the big challenges we've had is asymptomatic people coming to and in and out of care homes, whether it's other care home workers who work in more than one place and it just staff coming in or indeed members of a family and there's an onset, it's obviously a very decentralized system, but the social distancing and the control over transmission in and out of care homes, it's probably the single biggest factor and obviously we're doing everything we can to give the guidance and give the support to care homes to achieve that. Dan Hughet, ITV. Dan Hughet: (21:55) Thank you secretary of state. And we've discovered that hospices are being denied access to government managed supplies of PPE, of personal protective equipment. Unlike hospitals and care homes, they are not being included in the main NHS supply chain managed by the government through supply chain coordination limited. Instead, hospice are still relying on donations of PPE and they're having to buy their own largely on the open market at hugely inflated prices. It means the hospices have told us that they could run out of PPE within a matter of days. Why is it the hospices are being treated differently to hospitals and care homes when it comes to accessing PPA? Dominic Raab: (22:32) Well, again, I'll defer to Jonathan and Yvonne, but basically, and I don't know of course the hospices that you've talked to, but we've been guided throughout by the NHS about, A, where the shortfalls have been and, B, what's the priority? And we've always said that the priority is being on the frontline and the NHS and care homes. But obviously we want to make sure we've got enough PPE. That's why we're doing all of these flights from abroad, that's why Paul Dayton's ramping up the domestic capacity to get to anyone that may need it. And obviously hospice is a very important area as well. Yvonne: (23:09) Yeah, secretary of state. It's very important we ascertain where these problems are and that's why local intelligence is very important. The guidance covers all places where people are at risk. So that's very important to say. There is no differentiation here in where people are at risk and what they might need. What may often be lacking is the knowledge of where there are pockets of problems, and we've had this throughout. So it is welcome to know this and there are ways in which hospices can actually make known what they need through helplines. But if that isn't happening then it's very important that we do hear this. Dominic Raab: (23:45) Thank you. Do you want to supplement anything you want to come back on? Dan Hughet: (23:49) Yeah. Thank you so secretary of state. On that, Hospice UK, the main charity, I understand they've been coordinating and speaking to the relevant bodies within government to explain and have provided evidence that shows they need this PPE. So you're absolutely right to say must go where it needs to, but they have made a very strong case to say they need it. They're treating three times as many terminally ill patients now than they were this time last year. They're treating people with coronavirus, so they definitely do need this PPE. I think the assurance they want is when they'll be included in the NHS supply chain because they say they are caring for very second vulnerable people as well. Dominic Raab: (24:26) Oh absolutely. And my heart goes out to all of those working in hospices, those that have been cared for and their family and we'll do everything we can in the way Yvonne described to make sure that we get PPPE to them as soon as we physically can. Beth Rippe from Sky. Beth Rippe: (24:44) Thank you. First, secretary of state, on Sunday you said you were, and I quote you, reasonably confident that deaths in care homes are coming down at about the same rate more broadly as captured by the NHS figures. What does this new data tell you? Are we actually approaching a peak in care homes, if not overall? And Professor Van Tom, extra deaths today show the situation even worse than we knew. But it's true too that these numbers could be underreported still in part because of low testing levels. Should we be braced for a farther upward revision of these figures in the future? Dominic Raab: (25:25) So Beth, look. In the way that Yvonne described the importance of getting these measures refined is that we've got a clearer picture and of course what we'd like is a perfect picture and we're constantly looking to see whether we can modify and glean a more granular picture. The reality is, and I think when Sage gave its evidence on its review of the social distancing measures around the 16th of April, I think it was the press conference, so it was shortly before then. They were very clear that the R level was coming down. It was below one in the community, but there were challenges in hospital settings. We're getting to grips with that, but also in- Dominic Raab: (26:03) There were challenges in hospital settings. We're getting to grips with that, but also in care homes. So we've known about this challenge, and we're doing everything we can to meet it. PPE is one of the aspects of it, testing is another, but probably the single biggest thing, and this is tough in a decentralized, localized set of care homes, is making sure that we control the ebb and flow of people into those care homes that may risk transmitting the virus. So alongside all of those other practical measures, disseminating that guidance, refining that guidance, supporting those care homes as best we can is the surest way that we will really get a grip and then drive down those infection levels in the care home scenario. Yvonne, is there anything you'd like to add, or Jonathan? Yvonne Doyle: (26:47) I might just add, but Jonathan can supplement this. So Beth, the question is opposite to what CQC also measures. So CQC will also put out deaths in care homes, and they will not always be confirmed by testing. So in due course, those deaths sadly may occur on death certificates. So we may expect more than we're seeing at the moment. Yes. Sorry, Jonathan, that was just my [crosstalk 00:27:18]. Dominic Raab: (27:17) And it's worth just bearing in mind, as Yvonne said earlier in relation to the slides, what we're trying to do is get the most granular picture. I think when it comes to the international comparisons, certainly not all of the countries are recording even to the level that we've got to now, which is why some of those international comparisons, but we're just committed to maximum transparency. One because people should know the full picture and secondly, when you know more about the data, you've got a better chance of gripping it in the way that we're absolutely committed to doing. Jonathan? Jonathan Van-Tam: (27:45) Yes. So thank you, Beth. I'll answer your question in a slightly different way and say that clearly we have moved to a system of recording deaths that is better and more granular because it covers more than just the hospital setting, but in epidemiology terms, eventually we will be able to compute a different estimate of deaths called excess deaths and that is really accepting that across the year deaths go up in the winter and down in the summer in a broadly oscillating wave and one can work out what the average is over multiple years and then work out what in this particular coronavirus pandemic our departure has been from that in terms of total number of deaths. And that will give us an excess death figure and that will be highly comparable when other excess death figures come out across the world, including many parts of Europe. Jonathan Van-Tam: (28:46) In fact, there's a standardized methodology that the Europeans use for calculating excess mortality. So to your point, will there be more? I think I'd kind of turn that question slightly or turn the answer and say in time we'll have a much better answer when we start to look at excess mortality as a total, which will take into account both deaths related to COVID-19 and deaths that may have occurred, not due to COVID-19 at all, but as a consequence of the crisis. And some of those will take time to come through and I'm afraid that is a phenomenon that we will face right across the world with this awful crisis that we're in. Dominic Raab: (29:34) Beth, do you want to pick up on any of that? Beth: (29:36) Yeah, just quickly. Just to follow up, it's been really encouraging that although the death toll has been horrific, but it has been falling in hospitals. Now you have the care home data, is it falling in hospitals, but that death tally going up still in care homes? Dominic Raab: (29:52) I'm not sure we have the data, but I'll- Yvonne Doyle: (29:54) I don't think we can say that quite yet, Beth. I wouldn't make any predictions about what will happen in care homes, but we should know that soon because the hospital curve has declined. Bearing in mind that still the majority of deaths do occur in hospital, including those who are resident in care homes. Dominic Raab: (30:17) Beth, thanks very much. Andy Bell from Channel 5. Andy Bell: (30:21) Thanks very much. You have your five tests that you say have to be met before we can move on in terms of lockdown. Right now, how many of those tests do you think you're passing? Dominic Raab: (30:35) Well, as I said, when I set them out, we will need the advice from SAGE, which was going to be three weeks after, I think the 16th of April, so it will come early May. So we don't know yet. There is some positive signs in the data, but as Yvonne has said and as we've been at pains to say we're at a delicate and dangerous moment in this challenge. We're coming through the peak, but we're not there yet, which is why keeping on focusing on the social distancing measures, which has been one of the great successes of the approach taken because of the support of the British people is so important. So people sitting at home watching this have saved lives by following that guidance. And until we're out of the woods, if I can put it like that, they need to keep doing that. And we won't know that we've reached that point until SAGE give us that review of the evidence. Andy Bell: (31:24) I can I come back in on that? Dominic Raab: (31:24) Sure, of course. Andy Bell: (31:26) But the government has said several times that the NHS is not being overwhelmed, is not being overtopped. Are you saying you're not even satisfied at this stage that you can say you've passed test number one? Dominic Raab: (31:37) Well, then it just quite clearly hasn't been overwhelmed. That's been the second key critical bit of the strategy which we delivered successfully. It's a great credit to those in the front line, but we have also got the ventilator beds, the critical care capacity up, the military have done a great job in supporting the new Nightingale hospitals. So we're confident at this stage, but of course if you look at the five tests, Andy, and I know you're taking this very seriously, we've also said that we need to make sure that we can see to the future that that will still be the case, and also with any changes we might make and what that would do, not just to the coronavirus infection rate as we've seen in Germany, but also to the non-COVID cases. We need to be confident the NHS will be able to cope. So you're right, absolutely to point to the five tests, and I've just got to say at this moment in time, we're waiting for SAGE's evidence on all five aspects, which we're expecting in early May. Dominic Raab: (32:35) Can I bring in Jason Groves from the Daily Mail? Jason Groves: (32:40) Thanks. Foreign Secretary, you may have seen overnight the new mail force charity has brought in a million pounds with the PPE from China. You know how difficult that is. You've got your own challenges with PPE. I wondered how helpful that sort of private sector initiative is and to Professor Van-Tam, we've heard a little bit about this idea that the virus perhaps fades more slowly outdoors than it does indoors. I wonder if you could tell us a little bit more about that and what the implications of that might be. Dominic Raab: (33:13) Well, Jason, fantastic mail force campaign, a hundred thousand miles, 50,000 overalls, all going to those frontline workers in the NHS in care homes. I've just got to pay tribute, the Daily Mail has really contributed to that national effort that we were talking about and it all counts. So a huge thanks, I think from the government side. Jonathan Van-Tam: (33:37) Jonathan. Okay, so thank you for the question about how the virus spreads and to what extent it spreads and if I can just replay the question back to you to be sure I heard it right. You were asking about the difference between indoors and outdoors? Jason Groves: (33:54) Yeah, that's right. Jonathan Van-Tam: (33:56) Thank you. Okay, so we have learned a great deal over the years from studying influenza and patterns of transmission of influenza, and I accept that the coronavirus is a new virus, it is not entirely the same as influenza and we are getting more and more data on transmission of COVID-19 as the days and weeks roll by. But nevertheless there is a definite truism across all of the science literature that ventilation is the most critical part of reducing transmission from respiratory viruses. And if you think about being outdoors, first of all, by and large distancing between human beings is greater anyway, but if you just stand still for a moment and experience just normal breezes and air currents around you, you absolutely get a sense that any kind of plumes of anything are going to be very rapidly dispersed. And from that perspective it is absolutely categorically clear that outdoor spaces with higher degrees of ventilation are less problematic environments for transmission than indoor spaces. Jonathan Van-Tam: (35:17) And of course you only have to go as far as thinking about flu and summer, winter and the way we live our lives. In the winter, we live indoors, in conditions of relatively low ventilation with the windows closed. In the summer, we go outdoors, we leave the doors and the windows open when we're at home. Dominic Raab: (35:38) Jason, do you want to come back on any of that? Jason Groves: (35:39) Yeah. Well, thanks for your comments and I was going to come back on that latter point. People are obviously thinking about what's going to happen in this next phase. Given that difference, might it mean that there is some hope for things like garden centers, outdoor events, like park runs, going to the beach, maybe even beer gardens before people sort of give up hope? Jonathan Van-Tam: (36:04) Thank you for the question and I completely get it and understand why you're asking the question. SAGE absolutely is keeping all of that evidence under very considerably detailed review and that evidence has been formulated into guidance that we are putting forwards to ministers on a periodic basis. Jonathan Van-Tam: (36:28) Now in terms of any of the settings that you mentioned, I just want to take us through the journey a little and say that these are complex and at various different points they might involve the congregation of individuals and one has to be very painstaking and very careful about thinking through some of these before we make the wrong move to relax measures. And so from that perspective, I think all of your comments are valid, but I think we have to be extremely surefooted and extremely painstaking about this. Jonathan Van-Tam: (37:12) This virus will absolutely come back. You've seen Secretary of State refer to the resurgence in Germany and the difficult considerations that are going on there. This is with us for quite some time, potentially for as long as until we get a vaccine. So from that perspective we have to be really careful and really surefooted, and I'm just not going to suggest for a moment that any of this should be rushed. Dominic Raab: (37:40) Thanks, Jason. Dan Bloom from the Daily Mirror. Dan Bloom: (37:43) Hello. I'd like to ask if we had been able to access better testing and screening earlier than we did for care home residents. So for example, were testing those discharged from hospital before mid-April and some of the other things the government has introduced, might some of the deaths that have been published today been avoided? Dominic Raab: (38:03) I think there's always learning in a unprecedented unique crisis like this that we'll want to feed back in to make sure that we can refine and fine tune the measures we're taking. You'll know, Dan, we take the actions and the steps that we take on the best scientific evidence we've got at the time. I think in relation to care homes, and as I mentioned before, the key thing above all is to manage the transmission, of the ebb and flow of people into those care homes that might carry the virus. And that of course includes family members and friends, it includes people that are working in more than one care home setting, it includes NHS staff. So on top of testing and BP and all the things I understand you want to raise, I think that's probably the single most important aspect. Do you want to come back on anything else there, Dan? Dan Bloom: (38:53) I'd quite like to ask the medical experts, what they think of the same question because they may have an opinion on it. Dominic Raab: (39:00) Of course. Yvonne. Yvonne Doyle: (39:02) Yeah. Thank you, Dan- Dominic Raab: (39:02) Of course. Yvonne? Yvonne: (39:02) Yeah. Thank you Dan. So it's a very good question and it's also a learning one, but I put it this way, where there have been outbreaks in care homes, there has always been intervention throughout this. That would be no different to normal practice. What we have learned a lot about is how the virus is behaving in different populations. And one of the various other things that we have found is that the virus, when older people get this virus, it is affecting predominantly older people, particularly people over 75, and one of the reasons that the deaths are high there is that actually their demise quite quickly if they get the dose of this virus that perhaps a younger person might be able to put over their shoulder because of the way their immune system works. So that's one feature. So it may not even be possible to have got to the test by the time the event happens. Yvonne: (39:54) Second, we've now learned from looking at the literature that we've asked and asked what is it that would make a difference to stop this epidemic in a home? And the movement of staff is an absolutely critical one and how the virus actually moves within a home. And that has really only begun to become evident since we've been able to look at new techniques like genomics. And that has given us a huge insight into the dynamics of what is happening within a home. And not every home will be the same in the way that people, residents and the staff interact, the use of bank staff. But there are some very interesting learning that we've come across quite recently. Now whether testing makes would have made a huge difference or not, it's impossible to see at the moment. And that's one thing we wanted learn but there has been testing but I think there are possibly more fundamental and structural issues about how care homes are run in an epidemic that we are now looking to implement. Dominic Raab: (40:56) Thanks Dan. Matt Foster from Politics Home. Matt Foster: (41:00) Hi for secretary of state. Your colleagues have spoken about us all being in this together, but there are a sizable number of people in the UK who despite paying taxes are barred from claiming universal credit, housing benefit, or free school meals for their kids because the home office has deemed that they have no recourse to public funds. Some of those people are working in key frontline jobs right now in the NHS, social care, and its delivery drivers. Will the government consider at least temporarily causing an RPS status during the outbreak and if not, what reassurance can you give people that they're not going to be shut out the same help we all may need to rely on during an economic crisis? Dominic Raab: (41:41) Look, I absolutely understand the point and obviously we feel for anyone who's going through the challenges, whether professionally or in their home. I know the home secretary has been looking at this very carefully, she keeps these issues under constant review. I think she went before the home affairs committee today and said that we'll always at new measures and what more can be done, particularly in relation, I think, to frontline workers from overseas who are working within care homes or the NHS, so I can't give a commitment, but I can tell you that the home secretary is very carefully looking at that and the government wants to make sure we're as sensitive and as flexible in our approach as we possibly can be. Do you want to come back with another one there, Matt? Matt Foster: (42:24) That's fine. Thanks. Dominic Raab: (42:24) Very good. And then finally Peter Madly from The Express and Star. Peter Madly: (42:31) Thank you, secretary of state. A question for the medical experts schools across the Westman and just starting to consider how things might look once they're up and running again. The education secretary said today that schools will reopen in phases and clearly some form of social distancing will be required. Can you give us an idea of how you think social distancing will work in a school setting and do you envisage home education continuing for some pupils into next year? Peter Madly: (42:58) Secondly, a question for you, secretary of state. You mentioned repatriation flights before. There's still thousands of British citizens stranded in India, particularly in the Punjab region, a lot from West Midlands and that area of the country in fact. The CTM charter team has said this week that more than 20,000 people have registered for flights from an Amritsar in the North, there's only one flight every couple of days with a maximum capacity of 300 so people who are running out of money and medicine have been told it's not possible to confirm when they'll be able to get back. Now, do you have an idea of how many Brits are stuck in India, and are you planning to increase the number of repatriation flights from Northern cities so these people can return home? Dominic Raab: (43:41) Well, thanks very much. And look, can I first of all say the incredible effort from the West Midlands where you're reporting both the NHS care homes and frankly the people following the social distancing guidance, it's made a massive difference. We follow the regional impact of all the measures that we're putting in place and NHS capacity. And I know the West Midlands are putting an incredible shift. On repatriation flights, and just to give you a sense, we've already charted, so separate from the commercial flights, 58 returning more than 12,000 people from across South Asia. Dominic Raab: (44:14) I can tell you that in recent days we've announced 28 more charter flights with the capacity to get around 77,000 more Brits back home. They'll return home, that scheduling would be up until about May the seventh, they include 14 flights from India another nine from Pakistan, and five from Bangladesh. So we're doing everything we can to get stranded Brits from the West Midlands and right across the country home. And as I've said in my earlier remarks, I think the foreign office and the department of transport and our missions abroad put in a heroic shift. But look, the jobs not yet done and as long as there are people that are in a predicament, we want to see what more we can do. I don't know whether Jonathan or Yvonne wants to come back? Jonathon: (45:01) Schools? Dominic Raab: (45:02) Schools. Yes, please Jonathan. Jonathon: (45:04) So I've got two sons, Alex and Theo at home, 11 and 12, and I know exactly how difficult it is for them wanting to go to school and the stress and strain that this is placing on people. But I'm absolutely clear that it was the right thing to do to close schools when we did and equally we now have to be very careful indeed about how we relax social distancing measures and when we do it and clearly there are multiple combinations of how one might think about that. I'm not going to go into those in detail because the scientific thinking is not yet complete or settled on those. It is still a matter of detailed daily and deliberation and study, and clearly as part of that relaxing schools is in the mix. Precisely how one would do that, I'm not going to comment further because I think there are multiple permutations that you can think of and we have to work through those carefully, one by one scientifically and get the best and the most optimized answer we can. So I wouldn't want to make any premature comments about exactly how and to what extent schools are going to being involved in how we relax social distancing carefully, painstakingly and as and when we can with safety. Dominic Raab: (46:34) Peter, is there anything else you'd like to come back on? Peter Madly: (46:37) Yes, Mr. Van Tam. If I can be a bit more direct with my question in that case, do you think it's possible for groups of young people to stay two meters apart all day long in a school? Jonathon: (46:48) I think that will be very difficult with a classroom of four year olds, five year olds. I think that will be really tricky. I think we have to think through all of those measures and how that might work. Dominic Raab: (47:00) Thanks very much Peter. I think we've now got a couple of questions from members of the public. We've got Matthew from Surrey who's asking what has been done to ensure that visitors or returning citizens coming through British ports and airports are going into a 14 day quarantine and why hasn't this been implemented before? I'll turn to Yvonne to answer this, but we've looked at this regularly. I've asked this question actually quite a few times, and so far the advice has come back that actually it wouldn't make any significant material difference to stopping the spread. It may become more relevant as we progress through this crisis and as we bear down on the transmission rates within the UK. But Yvonne, I don't know if there's anything you'd add. Yvonne: (47:50) Secretary of state, not very much. So Matthew, thank you. It's a really interesting question and obviously as we move into a new phase over the coming months, it's one that will come back again and the scientific advisory committee is looking at all of the measures that ports could and should perhaps do implement that would make a difference. That's the important thing because otherwise we're just disrupting everything for no particular gain and we have had some experience of it of course during the contained fees when we worked intensively with all the ports in Britain to ensure that we kept our citizens as safe as possible. And we've learned quite a bit from that. But there are a number of measures of which quarantine is one and it is being looked at. Dominic Raab: (48:33) And of course as we keep the ports and the airports open for vital supply chains, that's a consideration as well, but we'll continue to keep that under review. I think there's a second question which is coming up on the screen. Bob: (48:51) As there has been success so far in not overwhelming the NHS and there seems to be plenty of space in the Nightingale Hospitals, why can't we remove some residents from care homes for their immediate safety? If this takes place immediately and perhaps with military assistance, this could save some lives. Is it feasible in any way? Dominic Raab: (49:14) Well, I'll let Yvonne talk to the current situation. What I can say, it's something that has been under constant discussion. Of course we want to make sure, and the Nightingale's have been amazing and the military's done a great job in supporting the NHS teams. We've got to make sure we've got the NHS capacities as we set out in our five principles for how we might move forward to the next phase that it's not just there to deal with the current cases, but to deal with the future demands that may be put on the NHS, both in relation to the virus but also other health needs. But we're looking at that, not least in the context of some of the cohorting that may need to be done, which hasn't been done in some areas, some areas it has. So it's certainly something that, again, remains under review. Yvonne, do you want to say a bit more on that? Yvonne: (50:00) Thank you secretary of state and thank you Bob. So it is, and the Nightingale Hospitals, they operate on a number of different models and we're looking at the difference between those models and whether they are adaptable to circumstances that may arise as we go forward, of which this would be one. And the issue about the home residence is that this has to be a humane solution for people and that it isn't more damaging or harmful to have people move, particularly people who are already frail, vulnerable, maybe suffer from dementia. So it has to be looked at as a judgment in terms of what is the best thing to do for those people and what is the most humane intervention given the risk they may face. But it is certainly ... It is something that is looked at and will be continued. Dominic Raab: (50:46) It's worth also just saying, Bob, that one of the pieces of learning that the cabinet office had from 2016, we looked at the lessons learned from the flu epidemic we had was that the shift of people out of the NHS and into the community, including care homes, was something that was important, which should be taken forward. But I understand your question. We've got to make sure all of these things are done safely, and that doesn't mean that certain NHS facilities couldn't be used in the way that you've described. So we're looking at all of that. Thank you very much, Bob. Thanks everyone for all of your questions. And that brings to a close today's Downing Street press conference. Thank you very much. (silence).