United Kingdom Coronavirus Briefing Transcript April 16

Dominic Raab: (00:00) ... and lets defeat the coronavirus for good. Now, Patrick, I don't know whether you're going to give us some more detail on both the state of the coronavirus but also SAGE's advice today. Patrick Vallance: (00:10) I'll do that, yes. Can I have the first slide please? This is one you've seen before. It's the transport use showing the reduction that's maintained down. It is these sorts of changes, the fact that we've managed, all of us, to keep our social-distancing going that's meant that the transmission of the virus in the community has reduced. And SAGE looked very carefully at all of the evidence and is of the opinion that it is highly likely that the R is below one. Patrick Vallance: (00:39) The transmission force of the virus is below one, meaning as the first secretary has said, that one person will, on average, be infecting fewer than one other person. That's an important change. It means in the community, it's likely that the virus and the epidemic is now shrinking. There are areas such as hospitals and social care settings where there may be growth in some places, but overall, the R is below one, but we can't say by how much. Patrick Vallance: (01:11) Next slide, please. This shows the new cases. Of course, as I've said before, this is just the cases that are tested in hospitals, so it's not the totality. The blue bars are the people who were tested in hospital, and there is a flattening and possibly signs of decrease. The orange bars show that the testing has now been expanded to critical workers in the NHS, social care and other sectors, and of course, cases are being picked up amongst that population too. But the overall message is that cases are at least flattening and may be decreasing. Patrick Vallance: (01:53) Next slide, please. This is probably the critical slide. This shows people in hospital beds with COVID infection. Here you can see, across many regions the numbers are decreasing. In some, they're flat, so there is some regional variation. But again, this is consistent with the idea that the R is below one, somewhere between 0.5 and one. The closer it is to one, the more likely it is that even small changes in the measures that are in place could lead to the R going above one. Patrick Vallance: (02:36) If the R above one, this starts to grow again, fast, it may be quite difficult to predict and detect that growth, and then we run the risk of a second peak with all of the damage that that will cause to health and to the economy. So at the moment, this is looking in a good place. It's beginning to come down, beginning to stabilize in some places. And it's important that all the measures that we're taking stay in place in order to allow us to maintain this level of control and to see the epidemic begin to decrease. Patrick Vallance: (03:13) Final slide, please. Sadly, of course, there are people who have died from this awful virus. I expect the deaths to reach a plateau and to stay up a bit for a little while and then to decrease thereafter. And what you can see on this slide, is both the deaths in hospital, and in the all settings, from the Office for National Statistics data, so the total picture can be seen. So SAGE's view is that R is below one, that the changes that we've all made to our lives has made a difference and will continue to make a difference. It's important that we continue with those in order to drive the numbers down and to get ourselves into a position where we can see that this is really now decreasing as an epidemic. Dominic Raab: (04:11) Patrick, thank you very much. Dominic Raab: (04:13) So we'll take some questions from the media. Is Laura Kuenssberg there for the BBC? Laura Kuenssberg: (04:19) Yeah. Thank you, Foreign Secretary. You've been very clear about why, in your view and SAGE's view, now is not the time, but can you give the public any hope of when the restrictions might start to lift? As you said yourself, in other countries, people have been told when and what to expect. From what you know now, is it more likely that we're looking at another three weeks or maybe another three months? Dominic Raab: (04:42) Well, the prime minister had said at the outset that it would take three months to come through the peak, and I think that broadly is still the the outline. But what we set out today is our approach, which will be step-by-step guided by the evidence. It will be reviewed by SAGE at the end of the month. We've set out five points of principle, if you like, that will guide us. Dominic Raab: (05:02) So we can't give a definitive timeframe, that would be to prejudge the evidence. That wouldn't be a responsible thing to do. But our message to the British public, is there is light at the end of the tunnel, we are making progress, but at the same time, we must keep up the social-distancing measures. And there've been all sorts of challenges, Laura, as you'll know, with this coronavirus crisis. But one of the things that we've seen is the country pull together, follow pretty consistently the guidance, and that is one of the reasons that we've made the progress that we have, not withstanding the significant, huge losses that I've described. Dominic Raab: (05:34) Do you want to come back? Laura Kuenssberg: (05:35) Yeah, I mean as you say, people have overwhelmingly listened to the government's guidance and followed it. Why do you think then you can't share with the public anything about what might be next? Dominic Raab: (05:48) We can. I've come and done these press conferences multiple times. We do them on a daily basis. The problem is not being willing to talk to the public about the detail of this, it's that if we prejudice the data and the evidence that SAGE is getting, both on the spread of the virus and the extent to which we get it down, well below the level R one, we'd be prejudging the decision that we need to take. And likewise, the evidence SAGE is getting is constantly informing, it's an iterative process, the options that we've got. Dominic Raab: (06:23) So what I've tried to do is be as upfront as possible and set out the principles, if you like, the five principles that can give, I think, a bit of hope to the country and also to say, "Come on, we've got to keep this up. What you're doing is working." I think we can see the signs of that, not withstanding the death toll, which is a huge tragedy for so many people. But we must stay the course and if we let up now it would be, as Sir Patrick has explained, damaging for public health but also damaging for the economy. Dominic Raab: (06:51) It's not a trade off here. If we get a second peak, it's not just damaging for peoples' health and for public safety, we'll also end up back in a second lockdown, which would prolong the economic risks. So we're taking the right decision at the right time, as we've always said. And the truth is, if I start giving you artificial and arbitrary timeframes, it would be the irresponsible thing to do and I can't do that. Dominic Raab: (07:15) Tom Clarke from ITV. Tom Clarke: (07:18) Thank you very much, Foreign Secretary. In yesterday's press briefing, Professor Whitty, when asked about how we should manage this next phase of the outbreak, that data that SAGE needs, [inaudible 00:07:30] talking about, he said one bit of information that would be really useful is serology data. Namely, this is the survey data of blood supplies from the country to get a sense of how much of the population has been infected with the virus, and therefore how many may be immune to it. Tom Clarke: (07:46) The PHE labs in Porton Down have tested more than 3000 samples from that survey, but the results have yet to be published. Is that because, as I understand it from scientists who are familiar with the work going on there, that these tests are not delivering reliable results? Either because of the tests themselves or because of what's going on in the immune systems of people who are being infected. And where does that leave us, in terms of figuring out how big a potential second peak or how long we have to stay in a lockdown situation is? Are we currently flying blind? Dominic Raab: (08:18) Thank you, Tom. I'll let Chris address that. Chris Whitty: (08:21) Thank you. So serology data is going to be absolutely critical for a whole lot of reasons. The most important of which, at this point of the epidemic, is to work out what proportion of people look as if they have been infected. We have a kind of crude estimate, but that's a way of measuring it directly. It will, in the longer term, also probably be important in understanding our options. For example, getting a vaccine. And it may also be useful in very longer term to provide evidence that someone has actually had an infection and they remain immune if the tests are reliable. Chris Whitty: (08:55) Now, that's why it's important. You're absolutely right. There is a lot of work, not just going on in Porton Down, to be clear, there are now substantial bodies of work in the academic sector, in Public Health England, and in many commercial areas, because everybody wants to have an accurate serology. There are several different ways of approaching this and different people are going down different groups. Chris Whitty: (09:21) Broadly, there are three things that have slowed us down to date. The first of which is we don't yet have a serological test which we can put a lot of reliance on, although it can give us a ranging shot. We do expect to have really quite crude early data, but that definitely needs to be improved on. The second thing, is that we don't yet have a good sampling, what's called a sampling frame in epidemiological terms, and what we're trying to do is get that set up across the country so that we have a wide view about what's happened in this infection in various areas. Chris Whitty: (09:58) But the third thing, which is just a fact of biology, is that it takes probably at least 21 days for the test to be reliable. So you're always looking back in time on this, and early data will therefore be ... Because looking back in time, 21 days, the epidemic was as at a much earlier stage before we've reached the evidence of the beginning of the peak, which Sir Patrick talked about. That is a very different stage of the infection, and we will get, the data will become more useful over time. But we're moving very fast in this area scientifically, but we are definitely not there in either of the issues or getting a serology or getting the sampling frame. But we probably will have a crude ranging shot fairly soon, and that's the consensus of the scientists involved. Dominic Raab: (10:48) Tom, I think that gives you a pretty detailed answer. Is there anything you wanted to come back on? Tom Clarke: (10:52) That was a very detailed answer. Can I just have one follow-up though? An interesting addition today to the data, we've got this all cases addition to the number of cases, so- Tom Clarke: (11:03) ... that's outside of the hospital setting. How, it looks like that's going to be very important. Is it going to change SAGE's predictions of how the peak is manifesting itself and what is happening with R, specifically, are we seeing faster transmission for example in the care home setting at the moment and that's something you're now going to have to factor in to any next phase response. Dominic Raab: (11:30) Patrick, I'll let you address that one. Patrick Vallance: (11:32) Well as I said before, I think it's very important to have the hospital death rate and the total death rate. It's worth remembering again that the ONS rates are people who've got COVID on their death certificate. It doesn't necessarily mean they were infected because many of them haven't been tested. So we just need to understand the difference. In terms of the SAGE view, the SAGE view is looking at the R of the transmission in the community and I don't think any of those data change that opinion as to where the R is. As I've said, it's not true that the R is necessarily below one in every hospital or in every care home, and that's the important area that we now need to look at and make sure that the appropriate measures are in place to try and reduce the R there but it doesn't change the overall view that I've described, that the R overall is below one and therefore we expect to see the slowing and the turn of the epidemic. Dominic Raab: (12:34) I think Chris wanted to just add something. Chris Whitty: (12:36) So just on top of what Sir Patrick said, the ONS data of course tells us not only the people who are diagnosed as having COVID on the death certificate with a diagnosis, some of which is on a basis of tests, some on the basis of the fact that doctor thought it was likely but not definite, but it also gives an indication of what's called excess mortality. The difference between the normal death rate, sadly at this time of year and what we've got at the moment and that's been changing over time and there are some additional deaths on top of the ones that you would expect for this time of year. So in the last week for which we have data from ONS, 3,475 people were diagnosed as having COVID, some of them from in hospital, some of them from out of hospital, but the excess mortality was, in terms of the period as a whole for that week, was depending on whether you compare it to the week before or the same week last year, somewhere between five and 6,000 people. Chris Whitty: (13:36) Now that there's a gap between those. Now that could be just random variation, but one of the things that we've said from the beginning is that people die for many reasons in epidemics. They include the direct cause of death, but they can also include people who died, for example, if they stayed at home because they were worried that going into hospital was dangerous for them and actually they have a heart attack or a stroke or something important like that. Chris Whitty: (14:02) And the reason I'm making this point, other than just to clarify the data, is it is really critical for people to realize if they're having a medical emergency, we really appreciate people taking pressure off the NHS for the less urgent things. But if they're having a medical emergency, a heart attack, a stroke, a really bad a flare up of asthma, things like that, which could be life threatening. One of the things that the British public have done by taking the pressure off the NHS by staying at home and my remarkable colleagues in the NHS have done by building up NHS capacity is we've always maintained the ability to handle emergencies, whether COVID or not. Chris Whitty: (14:37) And I really want to encourage people that if they have other medical emergencies, the NHS is open for business, and we really must encourage people who are having these life threatening or life changing things to go to hospital, contact NHS 111 where that's necessary, because we would be very sad to have a situation where people's activities and the NHS had managed to preserve the ability to do emergencies and people were not coming forward. Dominic Raab: (15:07) Tom, thanks very much. Sam Coates from Sky News. Sam Coates: (15:12) Dominic Raab, Sky analysis has found that 70% of frontline health and social care staff who've died from coronavirus were from a non white and [inaudible 00:15:22] backgrounds. Now people in that community are very worried. They know you're having a review because you've announced it, but what specifically can you say to help them? Is the government on their side? What is your message to that community? To Patrick Vallance and Chris Whitty, Dominic Raab just said that we could eventually relax in some areas and strengthen the lockdown in others, but every time older people hear things like that, they get worried seeing everybody else is the priority. There's a perhaps justified fear that they might be kept indoors until there's a vaccine, which might be 18 months. They are worried that they might never see their grandkids for at least another year. What's your message to them at this anxious time? Dominic Raab: (16:03) Well, Sam, first of all, on your first question on the BME or any other demographic breakdown of the data, I think I'm going to defer to Patrick in terms of the analysis of that, but absolutely we're on the side of anyone. Frankly, this coronavirus doesn't discriminate, but we will want to follow very carefully any of the analysis of the data and the way you described. On your second point, and I'll certainly let Patrick and Chris comment. What I said was measures could involve various different permutations, some getting stronger, some easing off. We haven't made up our mind on any of that, but our priority has been to safeguard life. One of the things that the British public have been very effective in doing is denying coronavirus the means to spread, and of course we know that the, and the data shows very clearly, that those who are older or have a preexisting condition are particularly vulnerable. Dominic Raab: (16:57) So far from wanting to take measures which disproportionately prejudice them, we want to take measures which safeguard them and that's been the guiding principle in relation to anyone who's particularly vulnerable to the coronavirus throughout this crisis. I don't know whether Chris or Patrick. Patrick Vallance: (17:12) I'll take the second question, then Chris, I think you might take the one on ethnicity. On the second one, our aim is very clear, which is to get the numbers down now and that means the social distancing measures that are in place need to stay in place in order to reduce the numbers of people with the infection in the community. That allows the, I mean that's because the R comes down, but it's also the absolute number that needs to come down. So we've got fewer people carrying the infection. Once we're at that stage, then you can start to think about which are the measures that make most sense to release in order to not have another growth and put the R above one and in doing so, the aim there is to try and do that in a way that allows everything to start moving more towards normal, not to segregate on certain groups and so on and say that there is a differential approach to this. Patrick Vallance: (18:07) Now it may be necessary when you look at different jobs and different things to think about how you do that in a way that's safe. But the aim certainly in terms of how we're viewing it from the scientific angle is to try to understand the basic principles that reduce transmission and allow the policymakers to take those basic principles and apply them in a number of different settings. Dominic Raab: (18:30) Chris, would you like to add on the ethnicity point? Chris Whitty: (18:32) So it's absolutely critical that we find out which groups are most at risk so that we can help to protect them, and obviously there are three things which are really clear and ethnicity is less clear. The three things that are very clear are age, and that's one of the reasons it's so critical to protect older citizens. People who've got co-morbidities, people we've got more than one other disease. Things like cardiovascular disease, and if you look at the ONS data on this, over 90% of people who have sadly died of this had at least one other disease. Many of them had more than one, and actually male sex is a very clear risk factor for reasons that are not absolutely clear. Chris Whitty: (19:13) Ethnic, being a member of an ethnic minority group is less clear and we both looked and I've had discussions with scientists about this in terms of trying to tease this apart today. Also, looking very specifically at healthcare workers with leaders at the NHS and across the medical and nursing professionals. Because this is something we are very keen to get extremely clear. We've asked Public Health England to look at this in some detail, and then what we really want is if we see any signal at all, we want to then know what next we can do about it to minimize risk. But at this point in time whilst the age, co-morbidity, and gender is clear, this is not yet clear in terms of I think minorities and we need to look at this more carefully and get this right. Dominic Raab: (20:00) Sam, would you like to come back on any of that? Sam Coates: (20:03) Just one thing. It sometimes feels like ministers, Number 10, are trying to pretend that there isn't a debate about what happens next, but you only have to pick up a paper or look at a TV broadcast to see plenty of people speculating about the what next and the easing of the lockdown. Is it really wise and sensible for ministers to almost absent themselves from the field in this debate given that it's happening anyway? Dominic Raab: (20:27) Well, I don't think we can be accused of absenting ourselves from the debate. We turn up to these Downing Street press conferences. I've set out the five principles. I've also explained why I know the media will always want to tease out what the next question is that needs to be answered, but it would be irresponsible for us to set out in either more detail the measures that are being considered as potential options, or indeed the timeframe because we don't have the data yet from SAGE. So we'll continue to be guided by the principles we started with. That is, follow the scientific evidence, take the right decisions at the right moment in time, and I think I addressed that fully in my remarks. Ben Kentish from LBC. Ben Kentish: (21:08) Thank you. First Secretary, you've said today that the spread of the virus in the community is because of the sacrifices people are making on the way down, but in care homes and hospitals, it's on the way up. Whether that's because of a lack of protective equipment, a lack of testing, or another reason. Would you accept that the measures in place in those settings have proved inadequate, and what would you do to make sure that some of the most vulnerable people in the country aren't put a further risk in places where they ought to feel safe? And if I could just ask Professor Whitty, you talk very openly there about the indirect cost, the indirect deaths that arise effectively as a result of the lockdown. I'm really interested to know whether you've modeled that, whether you're able to put a number on what would be expected, and some scientists have warned that in time, those deaths will outweigh the deaths from the virus itself. Are you confident that we're a long way from that point, and are you able to say when it might come? Ben Kentish: (22:03) Thank you. Dominic Raab: (22:05) Thanks. Well, so first of all, the coronavirus doesn't apply, doesn't spread in a uniform, consistent way and so your absolutely right, we've made progress. I think Patrick and Chris have set that out, but in terms of care homes, we're absolutely gripping this. Dominic Raab: (22:21) The Home Health Secretary on Wednesday set out a plan and you asked, in particular, "What's the detail of what we're doing?" That the plan was to make sure that all care home residents and staff with symptoms will be tested, that all patients discharged from hospital will be tested before going into care homes. Dominic Raab: (22:38) Care homes are being supported with different mechanisms to order PPE quickly. We had a local resilience forum drop, to deal with distribution to care homes. Obviously dispersed more widely than hospitals. We've had one last week. We've got another one this week. We're working up the clipper service which will regularize and expedite the distribution more generally. Dominic Raab: (23:01) We've got the plan to expand the workforce in care homes to 20,000 through a new recruitment campaign and new guidance to minimize the spread of the infection. So we recognize that the virus hasn't spread uniformly. We're absolutely committed to making sure wherever it's reared, it is being tackled in as targeted and as concrete way as we possibly can. Dominic Raab: (23:25) I think Patrick were you... Did you get the second one? Or, was that Chris? Patrick Vallance: (23:28) I think- Chris Whitty: (23:29) Me first, but Patrick might want to add to that. I've said from the early on, you're absolutely right, that indirect deaths, we need to think about, and indirect other illness. Death is not the only thing. If someone has had, for example, a major operation postponed, that also is something that we need to remember and take account of. Chris Whitty: (23:49) So just to remind people, the four things I've laid out are direct deaths from the coronavirus, indirect deaths because the NHS emergency services are overwhelmed, and because of what the British public have done and because of the fantastic work of my NHS colleagues, we have not come close to that, and we do not intend to come close to that. Chris Whitty: (24:08) But the two other forms are indirect deaths because the NHS is reoriented towards COVID-19 and therefore less able to do other things that are not necessarily so urgent, but are very important. Chris Whitty: (24:22) And then finally, we know that anything that increases deprivation can, in the long run, cause issues. And we are absolutely looking at how these work and how they interact. Because in coming to the next phase of this, we need to take account of all of those, rather than just think about the direct COVID deaths. Chris Whitty: (24:42) Because if we just thought about those, we could end up having a much less targeted approach and one that didn't allow the NHS to respond properly to all these other indirect causes. And this is actually something which SAGE, which Patrick chairs, has looked at in some detail and will continue to do. Patrick, you want to add to that? Patrick Vallance: (25:01) Yeah, we look at it and just to reiterate the point I made earlier on, at the moment, this is not a tension between the economy and health. It's very clear what we need to do now, which is to keep this down, stop this from coming back again, stop a second wave which would need a second lockdown if that occurs and make sure that we get things down to a level where this is manageable. Patrick Vallance: (25:21) So those two things are not in conflict at the moment, but yes, we do absolutely look at those longterm consequences and modeling maps and thinking about what the implications of that is. Dominic Raab: (25:31) And would you like to come back on any of that? Ben Kentish: (25:34) Yes. If I may, just on the care home point First Secretary, it would seem the new measures that were introduced this week were a recognition that there wasn't enough in place to protect people in cares hospitals. Are you confident there now is? And that those measures will be enough to protect people in those settings? Dominic Raab: (25:50) Well, I noted that Care England, which represents the independent providers in the care sectors said, "It was heartening to know the government is listening and it's really important." And we are continuing to listen and as I said, this virus, the way it has spread is not being uniform or predictable, and we want to make sure that wherever it spreads as we try and get it down overall, that we're there to make sure we've got the measures in place, the testing in place, the equipment in place to deal with it as soon as and as rapidly as possible. Thanks Ben. Dominic Yeatman from Metro. Dominic Yeatman: (26:23) Hello, First Secretary. Professor Ferguson said this morning that we will need to keep a significant level of social distancing until we have a vaccine, which we understand may take 18 months. Are you scared about discussing an exit strategy because there will be no real exit? And secondly, can I ask you, do you agree with the World Health Organization's assessment this morning, which puts us in the same camp as Russia and Bella Russ with regard to our success in controlling the outbreak? Dominic Raab: (26:57) Well, I don't think the data internationally and Patrick talked through some of it, which shows the international comparisons would bear that out. But I haven't heard and seen the direct comment, so I'll pass judgment for the moment on that. Dominic Raab: (27:10) And in relation to your question about Neil, I mean I'll ask Patrick to comment on it, but we've been very clear that we'll take the right decisions at the right moments based on the evidence. And they may well involve a transition out of the current measures. And of course they could be calibrated in different ways. Dominic Raab: (27:28) And the reason that we need to do that is based on the five principles that I set out. How do we do this in a reliable way, which protects the NHS at the same time as allowing us to ease up on the economy and engage more in the kind of social activities that people want to? Patrick Vallance: (27:48) So I completely agree that the way out of this is vaccines and therapeutics. Those are going to be critically important. There are vaccine programs across the world, over 80 around the world, probably four of those are in the clinic now. There are also therapeutic programs, both old drugs and people making new drugs and those are going to be critically important in terms of reducing the effects of this disease and potentially reducing transmission. Patrick Vallance: (28:15) So vaccines and therapeutics, critically important, no question about it. And the UK of course, is somewhere where a lot of that work is going on. Now, where we are now, as I've said, is that the social distancing measures are needed to reduce the levels right down to a low level. At that point there may be decisions about which ones to relax and which ones not to relax. It's important to keep the R below one, and this is all about trying to reduce contacts, particularly between households, reduce transmission and keep the levels low across the community. Patrick Vallance: (28:51) So there may be a number of measures that need to continue in order to allow that to be suppressed and controlled whilst vaccines and therapeutics come along. But that's very different from saying that the measures that are in place now are the ones that need to be in place longterm. So yes, there will be some changes, I think, that needs to take place that have already taken place around things like homeworking, that are going to be important to maintain that ability to break transmission. Patrick Vallance: (29:20) But vaccines and therapeutics are now being very actively looked at right the way across the world, including in the UK. Dominic Raab: (29:28) Dominic, would you like to follow- up on that? Dominic Yeatman: (29:31) Thank you. And just in terms of lifting the lockdown, can you give us some idea of how many daily tests will have to be available before community testing can begin? Dominic Raab: (29:44) Well, we've got the initial target of getting to 100,000 and then after that we want to keep ramping it up beyond that. And I think one of the crucial things that SAGE will do over the next couple of weeks until the end of the month, is then feed back on us on the evidence of how the evidence on the impact that the measures we've taken have had on the virus, what we need to consider in relation to that evidence in relation to measures, and how that interacts with testing and tracing? Dominic Raab: (30:12) Chris, I don't know whether you want to say anything further? Chris Whitty: (30:13) No. I think that's exactly the right thing to say. Dominic Raab: (30:16) Joe Murphy from the Evening Standard. Joe Murphy: (30:19) Thank you First Secretary. Can I ask Sir Patrick, following up on what you said earlier, you gave us the very good news that R is less than one in the community, and presumably well below one in hospital settings, but you still seemed concerned about other settings, and the position that the elderly population is obviously the one that springs to mind. Are you tacitly warning us to prepare for a lot more deaths to come despite today's good news, more deaths to come in old people's homes? Patrick Vallance: (30:51) What I said was R is below one in the community. There may be where it's not below one. That might include certain hospitals. It might include certain care settings and that's a very important thing to tackle. Those numbers need to come down. There needs to be a control of the infection in those sorts of settings. Patrick Vallance: (31:11) Currently the proportion that they contribute to the overall picture is not entirely clear. There are measures being taken and Chris could speak to this better than I can, to try to get on top of these issues and they're important ones that we do need to tackle if we're going to drive the R down below one, right the way across every setting. Dominic Raab: (31:32) Joe, would you like to come back on that? Joe Murphy: (31:36) No, I'll ask something else to Chris Whitty, if I may. On the question of masks, if you could illuminate how you reached the government's line that masks are no help outside a care setting, because it's being challenged by experts like Jeremy Howard and Jeremy Hunt, who says they may reduce the spread on London Underground, when people get back to work after lockdown. Joe Murphy: (31:57) Specifically, can we ask, when the government came to that conclusion, did it consider only the medical evidence about transmission or was it also taking into account the obvious fact that they're aren't at the moment, enough masks to go round to the public? Chris Whitty: (32:12) Well, it's certainly the case that if there was ever a competition between healthcare workers and care workers in the front line, and people are using them in situations where the risk is incredibly low, I don't think it takes a scientist or a doctor to work out that would be a very bad thing to happen. Chris Whitty: (32:32) And that's one of the reasons why the World Health Organization reiterated its advice that in most settings, masks should be for healthcare workers. However, this is a very live issue that we are re-examining and SAGE, which Patrick chairs, re-looked at that this morning. Chris Whitty: (32:49) Other scientific groups are re-looking at the evidence. I think my summary to date would be the evidence is weak, but the evidence of a small effect is there under certain circumstances. And what we're really trying to do is work out under what circumstances, if... Chris Whitty: (33:03) ... any, should we extend the advice, and under what circumstances should we not change that advice. But the point about scientific advice is it evolves and that is one of the things that we have to do the whole time is re-examine evidence as it comes in and that's the reason SAGE has looked at it and why we've looked at it in other scientific settings. Dominic Raab: (33:21) Kitty Donaldson from Bloomberg. Kitty Donaldson: (33:24) Thank you. To Patrick Vallance and Chris Whitty, your slides today show that the UK is still tracking Italy in terms of deaths from the outbreak. Given we were four weeks behind Italy at the beginning of the outbreak, can you talk us through why we're not making better progress lowering the death rate? And to the First Secretary of State, there's been a lot of talk this week from your colleagues in the Tory Party about a reckoning with China. Do you think it will be business as usual with China when this is all over? Dominic Raab: (33:53) Patrick, do you want to address the first one? Patrick Vallance: (33:54) Yes, I think I've been clear that the R has come down, cases look as though they've come down in hospital, there's a lag time before that translates into reduction in deaths. You can see there's a flattening off of ICU cases. There's a potential flattening off of deaths and I've said that that probably will reach a plateau and then come down. That's very much the curve that's been followed in other countries, so I repeat what I said, I think right at the beginning that I thought we were probably three or four weeks behind Italy. Dominic Raab: (34:30) On the question in relation to China. Look, I think there absolutely needs to be a very, very deep dive after the event, review of the lessons including the outbreak of the virus and I don't think we can flinch from that at all and it needs to be driven by the science. At the same time, I think the one thing that coronavirus has taught us is the value and the importance of international cooperation. I've just been standing in for the PM on the G7 meeting where we've been going through all of the areas where the UK is providing a leading role and working very closely with all of our international colleagues on. And I have to say, there are all of these questions about the outbreak, but also we had very good cooperation with the Chinese in relation to the return of UK nationals the outset from Wuhan, and we have on procurement the things that we need. So we ought to look at all sides of this and do it in a balanced way, but there's no doubt week we can't have business as usual after this crisis and we'll have to ask the hard questions that how it came about and how it couldn't have been stopped earlier. Dominic Raab: (35:35) Kitty, do you want to come back on any of that? Kitty Donaldson: (35:38) Yes, just First Secretary, what does that mean in practice? Does that mean tariffs? Or does it mean greater restrictions on Chinese investment in the UK? How do you see that playing out? Dominic Raab: (35:50) Well, what I just said was that we'd looked very carefully and with all of the other international partners and indeed with the WHO and the other international organizations as to how this outbreak and what can be done to prevent it happening in the future. I think before you get those answers, you can't really track a way forward. Dominic Raab: (36:07) Bill Jacobs from The Lancashire Telegraph. Bill Jacobs: (36:10) Gentlemen, the number of COVID-19 cases and deaths in the Northwest is one of the worst in the country as your slide showed. Do you have any reasons for why this is, such as deprivation or widespread longterm ill health? And are you taking special measures in the region to tackle these tragically high figures? Chris Whitty: (36:40) They're pointing at me so I'll give an answer to that. I mean, I think on both sides of the equation. So until quite recently, the Northwest was tracking several other bits of the country, including the Southeast and the West Midlands, but below London. And actually in the data that Sir Patrick showed at the beginning, what you can see is actually COVID cases in the Northwest have actually started to trend downwards recently, having previously been trending upwards. But it's quite a short time period so I don't want to over read on that issue. Chris Whitty: (37:16) The two areas where I think we need to look particularly carefully, but I think they're ones which is true across the country, we need to look quite carefully at all cause mortality, so not just the COVID related mortality and that tends to be linked together. And we do need to look at care homes because if you look at care homes where there have been outbreaks, quite a few of them have been in the Northwest and this is why the the measures that were announced yesterday really to look at the care home issue are so important. Dominic Raab: (37:46) Bill, would you like to come back with the last one? Bill Jacobs: (37:49) Yes. It's the number of cases in the Northwest remains stubbornly high, could this mean a slower release from a lockdown in the region than elsewhere in the country? And what steps is the government taking to tackle mental health problems as a result of the pandemic? Dominic Raab: (38:07) Well, there's all sorts... I'll let Chris address the mental health issue, but there's all sorts of fluidity in the data. What we need to do is make sure that we continue to monitor it very carefully. We want to get it down across all regions. We want to get the R level down as consistently as we possibly can, and also in terms of measures that might be taken, them be informed by the evidence that we get back. The critical thing is to wait until SAGE has done that analysis. They're talking about being it by the end of the month. We'll look at it very carefully. And I don't think we can jump ahead as to what the measures might be or any of the variations of it at this point. Patrick Vallance: (38:43) Shall I just answer about variation as well. Dominic Raab: (38:46) Yeah. Patrick Vallance: (38:46) There isn't really a huge variation in timing across the country for most of this. There's a little bit. Most things are following the same sort of trajectory and actually most of us right the way across country have adhered to the measures of social distancing in the same way. So there's much more similarity than difference actually in terms of the time course and trajectory of the epidemic across the country. Chris Whitty: (39:09) I agree with Patrick's point. But just on mental health. And it's an absolutely key point and one that we've been from the beginning concerned about and there are several different aspects to it, which include the risk of people increasing loneliness and include issues about delivery of mental health services across the whole country and indeed around the world in this new era of COVID-19. At the moment, we've set up quite a large number of things to try and look at how we can improve on mental health services. But you're absolutely right, it's an area where everybody who's looked at this is concerned, and there's recently been a serious look by our academic colleagues to try and work out what are the things we need to do differently as a result of this COVID epidemic for mental health than we would do under normal circumstances. Dominic Raab: (39:59) Thanks, Bill. Thanks everyone. And that brings to a close today's press conference. Thank you very much.