United Kingdom Coronavirus Briefing Transcript May 18 with Dominic Raab

Dominic Raab: (00:04) Good afternoon and welcome to today's Downing Street Press Conference. I'm pleased to be joined by Professor Jonathan Van-Tam, our Deputy Chief Medical Officer. Dominic Raab: (00:13) I'll start with the daily update on the latest data on coronavirus. 2,682,716 tests for coronavirus have now been carried out in the UK, and that includes 100,678 tests carried out yesterday. 246,406 people have tested positive, and that's an increase of 2684 cases since yesterday. 9408 people are currently in hospital with coronavirus, which is down 13% from this time last week. And I'm very sad to report that of those who have tested positive for COVID-19 across all settings, 34,796 have now died. That's an increase of 160 deaths on yesterday. It goes without saying, we offer our condolences to the friends and family of every individual who's passed away during this coronavirus pandemic. Dominic Raab: (01:15) This is a challenging time, and as we chart the right course over the weeks and months ahead, our overriding priority remains to save lives, whilst also at the same time, preserving livelihoods and allowing people to return, over time, and as and when it's safe, to something resembling more normal way of living. So on the 11th of May, we set out a roadmap to provide the information, the advice, and the reassurance, to businesses, to public services, to other organizations, and to employees and citizens up and down the country. I want to thank everyone who is making the adjustments and engaging with us in government to forge a path ahead in a sure-footed and sustainable way. Now of course, we recognize that people have concerns, they have questions, and we want to work together with them and with everyone involved to provide the necessary confidence and reassurance in the next steps that we're poised to make. That approach is summarized in the slides, which if we could now have them up on the screen, please. Dominic Raab: (02:20) And you'll see from slide one, as people will be aware, we've established a new COVID Alert System with five levels, each relating to the current level of threat posed by the virus. The alert level is focused on the rate of infection known as the R-value, as well as the total number of coronavirus cases overall. That alert level helps us to determine the social-distancing measures that we need to fight the virus. So the lower the level, the fewer, or the less restrictive, the measures that we will need at any given time. Dominic Raab: (02:54) Since the lockdown began at the end of March, we've been at Level Four, as on the slide. And thanks to the hard work and the huge sacrifices across the UK, and the progress that we've made as a result of that, particularly in relation to compliance with the social-distancing measures, we're in the process of moving from Level Four to Level Three on the slide. We will do that through a number of very careful and deliberate steps. Dominic Raab: (03:22) Slide two, please. Dominic Raab: (03:25) So you'll see that last week, the prime minister set out the first of three steps designed to carefully modify the measures that had been put in place. And by gradually easing certain measures, we can begin to allow people to return to something resembling a more normal way of life. The choices we make, what we're asking the public to do, and what we're asking them not to do, are designed to avoid the very real risk of a second peak that would overwhelm the NHS, and of course, risk turning a temporary economic painful moment for the country into permanent damage to the UK economy. At every step, we will closely monitor the impact of easing restrictions, and in particular, the impact on the spread of the virus. It's only by collecting and monitoring the data that we will be able to take the next step, which is indicated as step two on the slides, and that will be no earlier than June 1st. Now, I understand it's natural for people to question why they can't do one or the other thing now, why certain distinctions have be made, but in reality, you have to look at the package of measures as a whole, mindful of the risk of the R-level, and taking into account the various different economic and social effects combined. So we've adopted a balanced approach guided at all times by the science, and as I said, the overriding need to avoid a second peak that could overwhelm the NHS. Dominic Raab: (04:52) Of course, it's true to say that making any changes inherently comes with some risk of spreading the virus, compared to simply staying at home. But it's also true that staying in permanent lockdown is itself not sustainable on health grounds or economic grounds. That's why we've only used measures where it can be done with the lowest risk possible. And that's also why we are watching the impact of every change that we make very closely. I know the last couple of months have been really tough for families, for businesses, for everyone up and down the UK, but it's only by keeping to the plan, sticking to the rules, even including when those rules change, that we'll beat coronavirus for good. Dominic Raab: (05:36) Slide three, please. Dominic Raab: (05:39) That's why we've asked people to stay alert, to control the virus, to save lives, as we make changes to the measures in place in England, and adjust the government's advice accordingly. Now, for the vast majority of people, that still means staying at home as much as possible, but those that can't work from home, they should return to work with the arrangements in place to ensure that it can be safely and responsibly done. We've also adjusted, as you can see from the slides, the advice to allow people to exercise more, to visit public outdoor spaces, but staying two meters apart from those outside their own household. Dominic Raab: (06:19) And as ever, people need to keep washing their hands regularly and carrying out the hygiene measures that we've advertised before. Our advice is to wear a face covering when you're outside the home, in enclosed spaces and where it's difficult to socially distance. For example, if going to the shops or traveling on public transport. If you or anyone in your household develop symptoms, then you still all need to self-isolate. Now, while we're asking the public to do these things, we in government will keep ramping up the effort that we need to see to get the UK back to a more normal way of living. Dominic Raab: (06:56) And with that in mind, today the health secretary announced that anyone in the UK with COVID-19 symptoms can now get a test by booking online. I can also report that we've recruited now over 21,000 contact tracers and call-handlers in England with the implementation of our test and trace program. That program is absolutely key in the next steps that we need to take as a country to come through this pandemic safely and responsibly. Dominic Raab: (07:24) Jonathan, if you'd like to run us through the latest data? Jonathan Van-Tam: (07:27) Thank you, Secretary of State. Good afternoon, everybody. I've just got a few data slides to show you in the normal fashion, beginning with this one, which shows you Apple Maps searches for directions. So it is confined to Apple users, and it shows the beginning of the period of lockdown on the left, on the 23rd of March, and what has happened to searches for walking instructions, driving instructions and public transport from that point until the very recent past. You can see that there has been a gradual, but only gradual, upward trend in searches related to walking and driving. But for public transport, this trend is essentially flat. This is very much in line with the guidance that the government has issued about avoiding public transport wherever possible, saving it for key workers. And clearly, this is a trend that the public are following. Jonathan Van-Tam: (08:32) I've shown you the two data points on the right of the slide before, now. That's compared with last year, 44% of adults are working at home in the period 24th of April to the 3rd of May, compared with 12% at the same time last year. And that 80% of adults report they have either left the home for permitted reasons or not at all in that period. Jonathan Van-Tam: (08:59) Next slide, please. Jonathan Van-Tam: (09:03) Moving on now to testing. These data are correct as at 0900 hours this morning, and they relate to tests processed and sent out. The broad message is that we are continuing to test at the rate of around 100,000 tests per day, and that in total, almost 2.7 million tests have been used since the crisis began. In terms of confirmed cases, the data as of this morning, were overnight for 2684 new cases, out of a grand total of diagnosed cases of just under a quarter of a million. But what you can see, if you look to the bottom right hand corner of the slide, the green bars, you can now see a definite and sustained decline in new confirmed cases, which continues to be encouraging. Jonathan Van-Tam: (10:06) Next slide, please. Jonathan Van-Tam: (10:10) So these are data I showed to you last week, updated of course, data from hospitals. The top curve relates to estimated admissions with COVID-19 in England. 678 is the latest figure, down from 701 on the 9th of May. So again, steady declines, and you can see that in the top blue curve. Turning at the bottom of the slide to the percentage of critical care beds currently occupied by COVID-19 patients, this trend is also consistently down across the four nations, and currently the figure runs at 19%. Jonathan Van-Tam: (10:55) Next slide, please. Jonathan Van-Tam: (10:59) And then this slide also relates to hospitals. It relates to all of the UK, and it relates to the total number of people in hospital with COVID-19 over time, updated as of the 17th of May. What you can see here is that everywhere the numbers of patients in hospital with COVID-19 is now in sustained decline. Again, very good news. Jonathan Van-Tam: (11:27) And the final slide, please. This is the daily deaths data. These are deaths confirmed with a positive test in the UK. As of the 18th of May, we are reporting 160 deaths and a total of 34,796 with a positive test. What you can see, and again, it remains the most important thing to look for, is the overall longterm trend, as illustrated by the orange line- Jonathan Van-Tam: (12:03) ... which is showing a consistent and solid decline as the days and weeks roll by. Thank you, Secretary of State. Dominic Raab: (12:12) Jonathan, thanks very much. We'll open it up to questions. And I think there's one from David from Barry. David: (12:20) Good afternoon. As we take the first tentative steps towards releasing the lockdown, when will the government outline the roadmap ahead beyond the pandemic to ensure a swift fiscal health and wellbeing recovery? And what has already been discussed and decided? Dominic Raab: (12:42) Well, thank you very much. It's Danny from Barry. I'm terribly sorry. I had David here. Danny, we've already published over 50 page roadmap to how we rebuild after coronavirus. And that includes the three steps that I set out on the slides. The key thing, and there are different measures at different stages relating to no earlier than the 1st of June, the phasing of reopening of primary schools, different issues for businesses at different times. So non-essential retail will be dealt with at that point. But whether it's the 1st of June or the 4th of July or any subsequent steps, we will only take those decisions and take those measures based on the scientific advice that tells us we can responsibly do so. And I think the worst of all worlds will be to trip up now and to stumble when we've made the progress that the Deputy Chief Medical Officer has set out very clearly. Dominic Raab: (13:39) So we'll be guided. We set a roadmap, but it's a conditional roadmap. And we will monitor very carefully based on the changes that we've made over the last week and see what impact that has. And we will assess where the R rate is and the other coronavirus data is before taking any subsequent steps no earlier than the 1st of June. Jonathan, would you add anything to that? Jonathan Van-Tam: (13:59) No. Dominic Raab: (14:01) Danny, thanks very much. I think there's one from James from Wittering. James asked by text, is the government preparing for a second wave on PPE, ventilators, testing, et cetera, so all the issues of the first wave won't happen again? I'll let the Deputy Chief Medical Officer comment, but one of the key things we've said all along is first of all, that we're going to be very mindful to avoid a second wave. We want to keep the R level down, the rate of transmission down to avoid that. And we do not want and we will not sanction measures where we fear, well, there's a risk that they would take us above R1. Dominic Raab: (14:43) At the same time, when we set out our five tests for easing the lockdown, and they still in large part apply, one of the key things that we wouldn't take measures until we're absolutely confident that we got all of the capacity we need in the NHS. One of the things that we've done and it has been effective is we've made sure that at every step, the NHS has not been overwhelmed. And in particular, the critical care capacity that Jonathan showed on the slides has not been overwhelmed. And it's not just good enough to do that day by day. We want to make sure that with any steps we take in the future, that that remains the case. Jonathan, what would you add to that? Jonathan Van-Tam: (15:22) Thank you, Secretary of State. So I would add that we're absolutely hoping not to have a second wave. And that is one of the reasons why we are being so careful about unlocking social distancing one piece at a time, because we absolutely don't want this to get out of control again. However, is it right and proper to prepare for emergencies? Is it right and proper to put ourselves in a good position to be able to deal with an upsurge of cases? Absolutely. And let me emphasize a couple of things here. One is that maybe people are just hoping and praying that this virus will just go away as indeed I hope and pray it will. But the reality is that certainly until we get a vaccine and only if we get a vaccine that is really capable of suppressing disease levels will we ever be what we would call kind of out of this. Jonathan Van-Tam: (16:27) And so from that perspective, we may have to live and learn to live with this virus in the long term. And certainly for many months to come, if not several years. A vaccine may change that, but we can't be sure we will get a vaccine. The other thing to say is that this virus is a new virus. We don't fully understand it. We don't understand something called seasonality. And one of the things that's very clear, for example, with flu viruses, is that they come in our cold winters and the levels of transmission and circulation decline over the summer months. Now, the data we have on other coronaviruses, we've looked at very carefully, and it is not clear that these coronaviruses are as seasonal as influenza, but there may be an element of seasonality and it may well be that the autumn and winter conditions provide a better environment for the virus to then do its work again. So we have to be very cautious about that and plan for these kind of healthcare surges that we hope we don't need, but we want to be ready for them if they happen. Thank you. Dominic Raab: (17:45) Very good. And thank you, James, for your question. We'll open it up to the media now, and I think we've got Fergus Walsh first from the BBC. Fergus, over to you. Fergus Walsh: (17:53) Thank you. You've just added loss of taste and smell as a key symptom for coronavirus. France advised people back in March that if they lost taste or smell that they should self isolate. Hasn't the UK been very slow to act? Dominic Raab: (18:11) Jonathan, I think that's probably one for you. Jonathan Van-Tam: (18:13) Yes, thank you, Fergus. We've been very careful about looking at the data on anosmia and looking to see if adding it to the case definition would change something in terms of what we could practically do. Now I do understand, and you're absolutely right, that anosmia has been recognized for some time now as a possible symptom of COVID-19. But if you unpick that a bit further, one of the first questions is how often does anosmia come really early in the illness? That's the first question. Versus coming later on in the illness, when there are many other symptoms that are evident, particularly cough and fever, which are absolutely the most prominent. Jonathan Van-Tam: (19:11) The next point is how often does anosmia occur on its own in the absence of other symptoms? And the answer seems to be very rarely indeed. And so from that perspective, what we've had to do is go through all of the possible symptoms of COVID-19. And other than fever and cough, the WHO list includes tiredness, aches and pains, sore throat, diarrhea, conjunctivitis, headache, skin rash, even loss of speech or movement is something that the WHO put on there. So what we have had to do is do some very careful analysis behind the scenes to try and work out when looking at the whole range of symptoms again, which of those it might be useful or important to add in terms of picking patients up and improving the very simple and easy to remember symptom cluster we had already of cough and fever. Jonathan Van-Tam: (20:22) And that's why we have taken our time in this country because we wanted to do that, again, painstaking and very careful analysis before we jumped to any conclusions. And even if it was [inaudible 00:20:34] obvious that anosmia was part of this, we wanted to be sure that adding it to cough and fever, as opposed to just listing it, adding it in formerly into our definition, was the right thing to do. And based on advice from NERVTAG, we have made that decision. Dominic Raab: (20:54) Fergus, did you want to come back on anything? Fergus Walsh: (20:58) Professor Tim Spector estimates that between 100,000 and 200,000 cases of COVID-19 may be missed by the failure to include this earlier. How many cases of COVID-19 do you think have been missed as a result of not including this earlier on? Jonathan Van-Tam: (21:17) I don't have those figures to my fingertips. I'm not sure anyone's, other than Professor Spector, is trying to make those kind of estimates. What I can tell you is that from the Public Health England data set called the FF100, the first few hundred cases, there are actually 229 cases in there, all laboratory confirmed COVID, all of whom have been studied in considerable detail and 0.44% reported anosmia on its own as a symptom. So the point about anosmia is that it doesn't always come as the first symptom. And even if it does, it is followed by the cough, the fever, and many of the other symptoms that I've talked about referring to the WHO definition. So you don't miss those cases. And the important thing was to work out if this would add any sensitivity to the diagnostic cluster we were using. And the answer is it makes a small, very small difference, and we have therefore decided to do it. Dominic Raab: (22:29) Thanks, Fergus. Next up, Beth Rigby from Sky. Beth Rigby: (22:33) Thank you. First, Secretary of State, you're asking people to use their common sense as we come out of lockdown. And you're also asking many people to go back to work or soon send their children back to school. But isn't it common sense for people to wait until you have that track and trace program properly in place before they go back to work or before they send their kids to school? Otherwise, aren't you asking people to make something of a leap of faith? And Professor Van-Tam, the R rate last week was said to be 0.7 to one. Parents and teachers are obviously anxious about transmission in primary schools. Do you expect there to be some level of COVID-19 transmission in schools once children return? And how do you expect that to impact the R number? Dominic Raab: (23:24) Thanks, Beth. Well, first of all, we're making good progress with the test, track, and tracing regime. As the health sector has announced today, we've got 21,000 traces. The level of testing is above 100,000. We've got 60,000 downloads of the app on the Isle of Wight pilot. So we're making good progress on that. In terms of the measures we've taken right at this stage, as you will know, at step one, we've been pretty cautious. And that is precisely because we want to make sure footed and sustainable steps. Dominic Raab: (24:03) When we come to the later steps and as and when the testing capacity and the tracing capacity is up and running, we'll be able to. It'll give us more room for maneuver, more flexibility. We are making very sure that we're taking the right steps at the right moment. Obviously, the testing and the tracing is going to be a key component, particularly medium to longer term as we come through the coronavirus. Dominic Raab: (24:24) Jonathan? Jonathan Van-Tam: (24:25) Yes. Thank you, Beth. I'm going to chop your question into four bits and answers in bits, if that's all right? Jonathan Van-Tam: (24:34) The first point is about disease in children. We are absolutely aware of a small number of cases in children associated with a disease that looks a bit like Kawasaki Syndrome, looks a bit like toxic shock syndrome, but these are very, very, very small numbers compared with the vast majority of confirmed infections in children, which are really extremely mild compared to the illness suffered by adults. We do think, to conclude, we think children experience mild disease. Jonathan Van-Tam: (25:11) The next question is, do children have a higher infection rate or a lower infection rate than adults? You can gain those data from serology studies, studies of the blood to look for antibodies. The emerging data from around the world, on the whole, suggests that the rate of infection in children is about the same as in adults, possibly a little lower in the younger aged children, but they get this much more mild disease on the whole. Jonathan Van-Tam: (25:47) The next question then is, can children transmit the virus to adults? Here we have to acknowledge that we're working with a new virus where the data are pretty sparse at the moment. But the experts have already had a look at this and formed a conclusion that unlike influenza, like flu, where we are very clear that children drive transmission in the community to adults, it really does not seem to be the same kind of signal with COVID-19, that children are not these kind of big, high-output transmitters as they are with flu. Jonathan Van-Tam: (26:29) Then to your final point about getting children back to school and is that safe in terms of the R naught, all of the measures that are being considered always are run against the test case of can we keep control of R naught? If the answer is yes, then it will be considered. If the answer is it's going to risk pushing the R naught higher than one, then our science advice to ministers will always be no. We advise against it. As simple as that. Jonathan Van-Tam: (27:08) Of course, this is a difficult balancing act, you're absolutely right, because there are significant welfare and wellbeing issues for children who are out of school for months and months on end. It's delicate and difficult and I accept that. Dominic Raab: (27:25) Beth, do you want to come back on any of that? Beth Rigby: (27:26) Just quickly. You've done a great job in recruiting people to track and trace, but in terms of the app, just to be fixed parents out there, will the app be ready by June the 1st, when you ask some of us to send their kids back to school? Because parents might want that reassurance. Dominic Raab: (27:46) Again, all of these steps are a balanced assessment, not just of one or other element, but particularly the R level and the prevalence of coronavirus. Dominic Raab: (27:55) In terms of the app, it's still our attention to roll it out across the country for everyone to use in the weeks ahead. I can't be any more precise at this stage. But as I said before, we're making pretty good progress with it. Dominic Raab: (28:08) Beth, thanks very much. I'll go to Gary Gibbon next, Channel Four. Gary Gibbon: (28:12) Thank you very much. It sounds a bit as though the progress on the app has slipped a bit. We were told to expect it to be rolled out in the middle of May. You're saying you can't say any more than that it'll be in the weeks ahead. Given that the app and the testing are two key ingredients to giving people reassurance about going back to work and going to school and the rest of it, are you're worried by that and also by the fact that some of these tests seem to be coming back really rather late, like sometimes five days or something like that, you've missed the opportunity potentially to quarantine someone, haven't you? Dominic Raab: (28:46) Well, look, we're learning as is perfectly reasonable to point out. We're learning all the way as we go through this pandemic and not just on the scientific side but on the innovation that we need to get a grip on it and control the virus. We are making good progress on the testing and on the tracing and on the pilot in the Isle of Wight, in relation to the app. We're going to make sure, and we've always said, of course, that the steps that we might take at what is step two on the slides that I just showed, will only be taken at the earliest on the 1st of June. We've not committed ourselves to anything at this point in time. What we're doing is giving a roadmap with maximum conditionality to make sure both in terms of the measures that we've taken at step one and any subsequent measures, we're confident that we can take further sure-footed steps. Dominic Raab: (29:37) Feel free. Come back. Gary Gibbon: (29:39) May I quickly? Dominic Raab: (29:42) Please. Gary Gibbon: (29:43) Could you guide us, maybe the professor can, to what extent was the modeling on which the easing is based, based on a fully-functioning app and the testing process that was bringing back results before 48 hours? Dominic Raab: (29:56) [crosstalk 00:29:58]. Jonathan Van-Tam: (29:57) [crosstalk 00:00:29:58]. Jonathan Van-Tam: (29:59) Yes. I want to be clear that the app is one part of the test and trace system. The rest of it is much more of the tried and tested methodology used by Public Health England for this, and for many other diseases. The mainstay will always be the Public Health England system, as evidenced by the 21,500 recruits, one third of whom are doctors or nurses to help with that. That's the mainstay of it. Jonathan Van-Tam: (30:36) Testing is very much testing for action. We don't do it for the hell of it. It informs action for people either to be reassured that they have a negative result and they don't need to go into self-isolation, or that they absolutely must, and it will inform contact tracing as part of test and trace. It absolutely will. Jonathan Van-Tam: (31:00) From that perspective, you are absolutely right that we need to do it bigger and faster, and as fast as we can. We are sending a clear message as scientists that it needs to be fast, and we have to work as hard as we can to improve the timeliness of the testing system as we go along. Dominic Raab: (31:23) Thanks, Gary. Of course, the reality is the further along it is, the more expanded it is, the more flexibility we'll have. It's not a binary choice, but it's proceeding at pace. Dominic Raab: (31:33) Tom Newton Dunn from The Sun. Tom Newton Dunn: (31:35) [inaudible 00:07:35], thank you very much. May I ask you about the authorization resolution taken today which Britain is a signatore too? It calls for a review into the international community's response to the pandemic. It doesn't mention anything about getting to the bottom of the origin of it. It doesn't mention China by name at all. Are you letting China off the hook here, or do you, A, want an independent inquiry after like Australia does and, B, want this inquiry to get to the bottom of the origin of the pandemic? Tom Newton Dunn: (32:05) A question from Mr. Van-Tam as well, please. Jonathan, in your incredibly honest way as usual, can you update us on how far Sage has got investigating the double-bubble, co-joining of two households? In particular for the over seventies, should they hold out any hope they'll be able to co-join them with their children or grandchildren, or is that unrealistic at this stage? Perhaps now would be a good time to manage their expectations, because they're running pretty high. Dominic Raab: (32:34) Tom, thanks very much. Well, certainly at the international level, we've been very clear and we work with all of our partners, including Australia and many others because we want this review to come on the strongest support because it's more likely to be effective if it does. It's got to be. Obviously, it's going to be international. It's got to be credible, which means it's independent and impartial, and it's got to able to get to the bottom of how it happened, how the outbreak happened and spread and critically the lessons that we can learn for future pandemics. Dominic Raab: (33:06) Jon? Jonathan Van-Tam: (33:06) Yes. Thank you for the question. My mum lives on her own. She hasn't seen her grandchildren for many months, so I appreciate how difficult and stressful this really is for the kind of categories of people that you mentioned out there. It is hurting and it is difficult. Sage is looking at this at the moment. The matter is under review. It would not be right and proper for me to comment further at this stage. Therefore, with respect, I won't. Dominic Raab: (33:45) Tom, do you want to come back on any of that? Tom Newton Dunn: (33:48) Just a quick follow-up for Mr. Van-Tam. I completely understand your reasoning there. Perhaps you could offer a bit more in regards to camping, which you did kindly offer to look into last week. If Brits can't go on holiday anytime soon, maybe can they go camping outdoors not co-joining with anybody safely? Jonathan Van-Tam: (34:05) Yes. I've had quite a lot of correspondence about that since my appearances last week, as you'd imagine. I stand ready to give advice to the government on all of those complex issues as and when it asks for it. Dominic Raab: (34:21) Right. Good. Thanks, Tom. Kate Proctor from The Guardian. Kate Proctor: (34:25) Hi, thank you. For the foreign secretary, thousands of care workers from outside the European economic area are risking their lives working in Britain, in care homes in the coronavirus pandemic. These same carers are being asked to pay 625 pounds to use the NHS. In many cases, this is the same service in which they work for. Will the government exempt migrant care workers from this NHS charge or will they scrap it altogether? Kate Proctor: (34:55) For Jonathan Van-Tam, I wanted to ask what you thought the scientific justification is for introducing a quarantine period now, as opposed to doing it earlier on in March or April, particularly considering the infection rates for other countries in Europe is particularly low? Dominic Raab: (35:14) Thanks very much. Well, the there's no current plans to make the change that you described. What we do want however, home secretary's very keen to make sure we got a sensitive immigration system for all those exceptional frontline workers, whether it's in care homes or in the NHS. We recognize that there are a lot of people who come from abroad that do those jobs and make a huge, invaluable, and valued contribution to this country. Dominic Raab: (35:39) Jonathan? Jonathan Van-Tam: (35:40) Yeah. On the question of quarantine, why didn't we do it previously and we're talking subject to ministerial announcements about maybe doing it now? Jonathan Van-Tam: (35:55) Well, my recollection is we did do it before, that on the 29th of February and then I think on the 30th of February- Jonathan Van Tam: (36:01) ... we announced that travelers returning from the hotspot of Wuhan and then Hubei province respectively, when they arrived in the UK, must self isolate at home for 14 days. And then I believe, and you've caught me on the hop here, I'm afraid. I think it was about four weeks later, we had made further advice that people returning from Northern Italy, initially it was Lombardy province, then it became Northern Italy and South Korea and Iran I think, we asked them also on arrival in the UK to go home and quarantine, self isolate at home for 14 days. That being the potential maximum incubation period of this virus. Jonathan Van Tam: (36:53) So I think we have done it before. We did it for at a time when the virus activity was concentrated into international hotspots, such as Hubei province, South Korea, Northern Italy, we're now in a very different world where this virus has spread completely internationally. And we are lucky in that we are driving down our case rate to the point where we are becoming an area of low incidence of COVID-19. And at that point, then it becomes more sensible to think about what the contribution of travelers from abroad might be. So that's, I hope, knits it all together for you, but I haven't got the precise dates on some of the previous quarantines, but we did it. Dominic Raab: (37:45) Okay. Would you like to follow up on any of that? Kate Proctor: (37:48) Oh yeah. Thank you for that explanation, that was very helpful. But to the Foreign Secretary again, you said that you want to have a sympathetic immigration system. I don't understand what's sympathetic about a 625 pound NHS charge for carers and you have made it exempt for other health workers. So why not carers? Dominic Raab: (38:06) Well, we keep these things constantly under review, but that's a provision that applies to all workers, subject to the definitions coming into this country. We're doing lots of other things to support the care sector, including the action plan for the sector that was launched a few weeks ago. And if your concern is having the people to work in the care sector, of course, we put extra money in an extra recruitment program to make sure we're able to do that. So we'll keep it under review and I understand the point, Kate, you're making. And it's absolutely right to pay tribute to the incredible work that so many do. And in fairness, it's not just in the NHS, it's in so many other ways, but we also do have a set of immigration controls in place and how they apply in the COVID pandemic is something we keep carefully under review. Dominic Raab: (38:54) Thank you very much, Kate. And lastly, I think we've got Jez Hemming from the North Wales Daily Post and BBC Wales. Jez Hemming: (39:02) Good evening. What do you say to claims the decision to relax lockdown in England is undermining efforts to contain the virus in North Wales where a full lockdown remains, cases are increasing, but tourists are still heading over the border in large numbers. I'd be interested to know what Mr. Van Tam thinks about the divergence between the English and Welsh scientific approaches. Dominic Raab: (39:25) Well Jez, to start with, we've actually done a pretty good job, all nations in the UK of adhering to the social distancing measures and getting the incidents and the R level down. That was one of the successful elements of the strategy. We've had, I have to say very good collaboration with the devolved administrations. I've sat in on COBRA meetings where the, notwithstanding the different either perspectives or slightly different considerations, which will apply in different nations of the UK, we've actually had a UK wide approach. Equally, we've recognized that given the devolved competencies and given the level of coronavirus in different parts of the UK, there may be different speeds at which the different nations proceed or even at regional level. And in answer to your question about people from England going to Wales. We've be very clear. Anyone that wants to travel say from England to Wales or any other part of the United Kingdom needs to be very mindful of the regulations that the relevant devolved administration will have in place. Jonathan, would you like to add anything? Jonathan Van Tam: (40:28) Yes. So I'll answer my bit of the question. So decisions that are made are always a complex blend of science, politics and practicality. And I think we have to recognize the right of different parts of the UK to make their own decisions. What I would be far more worried about is if there was a separate stream of science driving decisions in Wales, Scotland, Northern Ireland from England, but SAGE absolutely is a committee that advises the whole of the nation in that sense. One of the difficulties with all of these data and working out what's happening is that as you chop the UK into smaller and smaller regions, you don't have as much region specific data to work with and the granularity of the picture down at regional level starts to fade. So I think some differences in timing and so forth are to be understood. Dominic Raab: (41:38) Jez, would you like to come back on any of that? Jez Hemming: (41:39) Yeah, I would. Going back to what you're saying about cooperation with the nations. Wales First Minister Mark Drakeford recently complained that Welsh government hadn't had a conversation with the UK government for a week. Is the UK government simply leaving devolved nations to their own fate? And if not, what assistance is being provided? Dominic Raab: (41:58) Well, I don't think that's right at all. If you look at the funding that's been provided to all the devolved administrations, including the Welsh executive, I don't think it's true. If you look at the amount of PPE that we've helped deliver for nurses and others on the front line. I don't know the last time that any one of the UK government spoke to the Welsh executive, but what I would say is that this challenge of as far as we possibly can, steering a UK wide approach whilst also recognizing the devolved competencies and the fact that judgments and the state of the virus will be different in different geographic parts of the UK is not unique to the UK. Dominic Raab: (42:38) If you look at Italy that they've experienced that, if you look at the, I spoke to my German opposite number recently, and he was explaining the different approaches taken in the different Lander states of Germany. It's been true in France, they've got different geographic variations and variables at play. So, but we'll work the best and certainly the best as we can, and certainly there is a huge repository of good will, I think that has been built up on both sides, and certainly from the UK government's point of view, we want to continue that going forward. Please, Jonathan. Jonathan Van Tam: (43:10) Could I add something? On the medical side, and I'm only talking about the medical side. I don't recognize the position that you've outlined. My last conversation with the Welsh Medical Director in teleconference was late last week and my first one with him will I expect be this evening. And I know that our Chief Medical Officer for England is in pretty much daily contact with all of the devolved administration chief medical officers and that on very many things, they act as the four CMOs together. Dominic Raab: (43:49) Jez, thanks very much for that. Thanks everyone. That brings to a close today's Downing Street press conference. Thank you very much, Jonathan. Thank you.