United Kingdom Coronavirus Briefing Transcript April 22

Dominic Raab: (00:00) ... and that whole MOD led by defense secretary Ben Wallace, they have been there every step of the way, helping us to build the new NHS Nightingale Hospitals, to reinforce our critical care capacity, supporting our local resilience forums in delivering personal protective equipment where it's needed most, and helping also to deliver the mobile labs, which are critical to ramping up our testing capacity right across the country. And as a result of those efforts and that teamwork, hospitals have been able to treat more patients. As a result, they've saved more lives, and we've ensured that the peak of this virus has not overwhelmed the NHS. Dominic Raab: (00:42) And today our armed forces are, again, part of that team is we announce two new deployments to the NHS Nightingale facilities in Harrogate and Bristol. And across the UK, this extra hospital capacity, which itself comes on top of the 33,000 additional beds we've managed to free up across the NHS. That's the equivalent of building an extra 50 district general hospitals, and as I said, that has safeguarded the capacity in our hospitals both to care for coronavirus patients, but also to make sure other people get the urgent care or the emergency treatment they need. People used to joke in this country that you could never build a hospital that quickly. Well, we didn't just build one. We built seven, and we thank our armed forces for helping to make that happen. And you know, for many countries around the world, including modern democracies, the site of their military on the streets in a national emergency could be a cause for concern or even trepidation. But for the British people, the site of our armed forces working side by side with our brilliant NHS staff offers a calm reassurance that the task is at hand and that we will come through this crisis. Dominic Raab: (01:58) Now, I make no bones about it. There have been challenges. There still are challenges. We're not there yet. We continue to ramp up the testing capacity, which will play a really important role in the next phase of the crisis. Amidst a global shortage in personal protective equipment, we've distributed over a billion items to the front line, where it's needed most. We've just brought in Lord Deighton, who helped organize the London Olympics, to boost our domestic supply even further, and I'm on the phone every day pursuing the next batch of deliveries from abroad with the support of our tireless diplomatic service, and the first of several new deliveries landed from Turkey in the early hours this morning. Dominic Raab: (02:40) We will only come through this global pandemic if we come together as a nation, and if we bring other countries around the world together so that we can rise to this international challenge. And as we work with our partners abroad to get the PPE we need. To get the ventilators we need to pursue a vaccine for this terrible virus, we're also working night and day to return stranded British nationals from all four corners of the world. We kept airports open and airlines running to bring over a million Brits home on commercial flights, a massive endeavor. And on top of that, at the FCA, we set up a 75 million pound special charter arrangement with the airlines, and that's already brought home over 13,000 people on 63 flights from more than a dozen countries, and we're organizing more charter flights in the days ahead from India, Pakistan, Bangladesh, New Zealand, Nigeria, and Sierra Leone. So at home and abroad we're meeting the whole range of challenges that coronavirus presents, and if we stick together and if we stay the course, we will defeat this virus for good. Dominic Raab: (03:47) And I think I'll now turn over to Sir Nick to brief us on the latest military involvement in the effort. Nick Carter: (03:53) First Secretary, thank you very much. The First Secretary has asked me today to give you an update on what the armed forces and defense as a whole is doing in support of the government's response to the virus. Upfront, I would say that our role has been entirely in support of the heroic healthcare workers on the front line, that's both the NHS and social care, with humility very much being our watchword in the way that we give that support. We've done it in a variety of ways. We've supported first and foremost the Ministry of Housing, Community, and Local Government, and the devolved administrations through the national spine of local regional fora that the first secretary referred to, and we have dozens of liaison officers embedded into each of those fora. Nick Carter: (04:35) It's a tried and tested system that's been used many times in the past, whether for delivering military aid to the civil authorities through for the foot and mouth, or for flooding, or for wildfires. It's frequently exercised, and there are very close relationships which give great confidence between all of those who are working on those teams at the lower level. And I think it's important, this, because of course it's that delegated sense at that level which works, because it makes them much more responsive and much more flexible to local demand, whether it's for ambulance drivers, or for testing, or for whatever else.With decentralization being so much of the key to the way some of this is done, and the Defense Secretary delegated authorities to this level early in the crisis, which has proved to be extraordinary successful. We've also been giving support to the Department for Health and Social Care, and of course the NHS. Nick Carter: (05:25) First and foremost, this has been a logistic task, and I would say that I think in all of my more than 40 years of service, this is the single greatest logistic challenge that I've come across. I'll just give you a scale of the problem. In 25 days since we started working together with the NHS, they've gone from some 240 customers they deliver to normally to nearly 50,000 customers. This has involved creating 260,000 square feet of distribution warehousing. That's nearly four football fields worth, and some 38 additional delivery routes per day. That's the equivalent to driving three times around the world. That is a major logistic challenge. Nick Carter: (06:07) We've of course been involved in the Nightingales, which the First Secretary referred to, but we've also been involved in planning, and what we call command and control, providing additional resilience to hard pressed staff, and we've got dozens of people embedded both in Skipton House, but also in Victoria House, where the DHSC headquarters is. We're involved in testing both in terms of playing a role in helping design the system but also in manning some of the regional test centers and adopting some innovative approaches, like mobile pop-up centers, which will make it possible to get to the decentralized areas that I described earlier. Nick Carter: (06:44) And a brigade commander we have there, Brigadier Lizzie Faithfull-Davies and her team, have been very imaginative in the way that they've taken this forward. And of course we've provided an Aviation Task Force that's been able to support the communities from Scotland down to the Channel Islands, in Northern Ireland, and from Wales to the east coast of England. We've been involved in helping the Foreign Office with repatriations and supporting our overseas territories, where we have security advisory teams deployed now in several of them, and of course we've deployed ships, HMS Argus, to do just that. And we've been involved with the Cabinet Office Rapid Response Unit, with our 77 Brigade helping to quash rumors from misinformation, but also to counter disinformation. Nick Carter: (07:27) Between 3,000 and 4,000 of our people have been involved with around 20,000 available the whole time at high readiness. We probably have at the moment some 73 ongoing tasks, and we've probably completed about 30. What's interesting is it's been very much a whole force, not just of regular military from all the three services, but reservists as well. Some 15% of the force has been reservists. It's involved defense civilians, defense contractors, scientists from [inaudible 00:07:57], and something called the Engineer and Logistic Staff Corps, where we bring in people from industry who work inside the military in times of crisis and provide expert support for how we might link into the civilian community to bring forward skills, and indeed industrial support. Nick Carter: (08:14) The skills have been about planning, logisticians, medics, engineers, and CIS or IT-based people, and the road has been very much about catalyzing, designing, and supporting, and I'll just single out one individual to give you an example of the sorts of backgrounds that we're talking about. A young Major called Major Eb Mukhtar has been mobilized from the Reserve. He's really stepped up to the plate. His daytime job is as a logistics expert who runs Google's transport network across Europe, North Africa, and the Middle East. He has been part of the supply team that's been working on how we distribute PPE. He's designed an e-portal in partnership with eBay, which will in due course manage individual customers, and he designed a bulk supply chain for distribution of PPE to all of the NHS regions and trusts. Nick Carter: (09:05) Now, despite all of this, we are still involved of course in protecting the country, and there are essential operations that must continue, whether that's defending the homeland with the nuclear deterrent, or protecting British and UK airspace more generally. Whether it's overseas operations in Afghanistan, the Middle East, Africa and further afield, or whether it's about fielding essential operational capability. And what we do as we do this is to take great care not to endanger the population. Nick Carter: (09:34) All of this is a truly national endeavor. We've even mobilized 99 year old veterans, and I think everyone would agree that Captain Tom Moore embodies the sense of service and duty ingrained in our armed forces. Our armed forces are drawn from every part of the United Kingdom and much of the Commonwealth, and they take great pride in serving the communities that they are part of. Everyone is experiencing real challenges at the moment, and it makes me feel immensely proud of our collective national effort in pulling together behind those on the frontline to combat this unprecedented challenge, which I firmly believe we will defeat together. Thank you. Dominic Raab: (10:20) Brilliant. Thank you very much, Sir Nick. Chris, would you talk us through some of the latest data please? Chris Whitty: (10:24) Thank you very much, First Secretary, and before I do, can I just on behalf of my colleagues in the NHS thank the armed forces enormously for the assistance they've given us, which has been absolutely terrific? These slides are, I think, familiar to most people who watch this. The first is a look at transport usage in the country, and it's really as a proxy for, "Are people continuing to stay at home except for essential business?" And as you can see, although there is some bumping along, it has broadly remained very stable, despite the fact that people have had to do this for a considerable now period of time, and there is further time we're going to have to do this if we wish to pull the peak of this right down. Next slide please. Chris Whitty: (11:13) Looking at new cases in the UK, these are tests positive, whether they're in hospital or out of hospital. As you can see, this is broadly flat with a slight trend downwards over the last several days, really back to about the 8th of April, but not a steep descent at this point. Next slide please. Chris Whitty: (11:35) And if you look at people in hospital with COVID-19, looking across the country, the situation is either improving, and I think it's particularly improving, for example, in London, or broadly flat across all four nations. Next slide please. Chris Whitty: (11:53) If you look at people who have sadly died in hospital, this is not all deaths, but this is probably the majority of those who have sadly died with COVID. What you can see again is that the very steep upward climb that there was up to the earlier part of this month has now flattened off over the last week and a half. Next slide please. Chris Whitty: (12:19) And this is a slide we use just really to track the trajectory between different countries. I should be clear that trying to compare different countries using these kind of data is notoriously difficult, but it does show the trajectories between the different countries with the UK using hospital data, which is our most steady source of data over that time. Next slide please. Chris Whitty: (12:45) This is just one slide we thought we would add in in addition, because I think it makes a point which I think is important for people fully to understand, and what you can see here, this is the seven day rolling average for deaths, sadly, in several countries, including the UK. And the reason I thought it was sensible to put this in was for people to see that even in those countries which started their epidemic curve earlier than the UK and which are still ahead, the downward slope from the point where we change is a relatively slow one, and we should anticipate the same situation in the UK. We should not expect this to be a sudden fall away of cases. Thank you very much. Dominic Raab: (13:32) Thank you very much, Chris. Let's turn to the media. Have we got Alison Holt there from the BBC? Alison Holt: (13:38) Yes. First Secretary, worrying figures today suggested doubling in care home deaths in England. In a virus that targets the elderly and the vulnerable, do you see that as inevitable? Dominic Raab: (13:53) I didn't catch the last bit of it. I'll let Chris Whitty talk about, I think, the CQC. Alison Holt: (13:59) Let me just repeat it. Dominic Raab: (14:00) Why don't you? Please. Thanks. Alison Holt: (14:03) Okay. So we've seen a- Alison Holt: (14:03) ... doubling in care home deaths in England. In a virus that targets the elderly and the vulnerable, do you see that as inevitable? Dominic Raab: (14:17) No, I don't think anything is inevitable. We're fighting tooth and nail striving every senior to make sure we minimize the life lost in all contexts. I'll let Chris Whitty say a little bit more about the CQC data, which I think is going to be published, but obviously in care homes, whether it's on PPE, testing, PPE deliveries, whether it's on testing across the whole range of things that we're looking at, we are doing everything we can to make sure we provide the support to them to protect the care homes, to protect the workers there, and obviously to protect the residents as well. Of course, it is a vulnerable part of our community if you like, and we are targeting all of our efforts to make sure that we protect and safeguard as best we can the most vulnerable in our society. Chris, do you want say anything on the CQC? Chris Whitty: (15:06) Well [inaudible 00:15:07] hasn't yet published its report. But I think in terms of care home deaths, sadly your starting position is of course correct. In care homes, what we have is a large number of people of the most vulnerable age for this virus. This is a virus which is particularly a virus of people who are older, and particularly a virus which causes severe disease and death in a minority, but an increasing minority as you go up in age, and in those who have coexisting medical problems. And many people in care homes of course, and nursing homes in particular have coexisting medical problems. So they are a very vulnerable group. You're absolutely right. The numbers that have been ascribed to COVID directly in ONS statistics are still relatively modest. But I've said repeatedly in data, the fact that the ONS said in their last weekly report, 826 deaths, every one of them a tragedy. Chris Whitty: (16:09) But I think that will be an underestimate, and what we need to look at in these data and other data if we want to get a true picture is, and I've said this right from the beginning, the all cause seasonally adjusted mortality over time. And that is because as I've said again before, deaths from COVID will be a combination of direct deaths from the virus, and also indirect deaths if for example people are nervous about going into hospital. And I think one of the things we've been trying to make really clear is it is absolutely critical that if people have heart attacks, strokes, children have asthma, severe asthma attacks, any of the things that have severity and this would include people in social care settings that the NHS remains absolutely able to manage emergencies as it always been able to manage emergencies. Chris Whitty: (17:01) But when we look back over this epidemic, and I want to be really clear, we are not anywhere near being able to say, "Right, that's done. We can now look back." When we are at that stage, I'm sure we will see a high mortality rate to sadly in care homes because this is a very, very vulnerable group, and people are coming in and out of care homes, and that cannot to some extent be prevented. Dominic Raab: (17:25) Alison, did you want to follow up on any of that? Alison Holt: (17:28) Just a quick follow up. I mean families and staff in care homes have heard lots of promises about protective equipment, about testing, but what I'm being told is they're just still not seeing that on the ground. So what reassurance would you give them that they are being made a priority in this? Dominic Raab: (17:46) Look, we are conscious that there's a challenge with care homes. I'd said that in my early remarks, but we are doing everything we can. The situation is improving. We are getting the PPE to those places that need it. We are working with the military in relation to some of the mobile testing labs because we know that it's difficult for some people in care homes to access the testing. We've revised the guidance or the NHS revised the guidance to make sure on discharge the ... We're actually being very careful with those that go into care homes. We are doing everything we can. We understand their concerns or anxiety. I feel for those who are living in care homes and are nervous about this, all their loved ones, and we're doing absolutely everything we can to protect them. Robert Peston from ITV. Robert Peston: (18:35) Good afternoon. Representatives of the TSSA transport union have been told to prepare for a possible increase in a phased way of the railway service between the 11th and 18th of May. Now we're obviously not looking at an exit from lockdown, but is that a timetable for modifications of the lockdown, and secondly, overseas doctors and nurses working in the NHS pay a surcharge of hundreds of pounds a year, thousands if they've got families to use the NHS. Given that they are putting their lives on the line to protect us, is there a case for waving that surcharge? Dominic Raab: (19:24) Well, first of all, the dates that you described, I don't know where they come from. It's not something I recognize, and as Chris Whitty has rightly said and as the Governor of the Bank of England has said, so you've got it from the public health, but also the economic perspective, it would be a mistake to take our eye off the ball right now. The focus is still delivering us through the peak, and we're obviously reliant as I said last Thursday on the data that we get back from Sage and a couple of weeks time in order to even think about the next phase. And in relation to people here from overseas working in our NHS, the Home Secretary has already outlined some measures to make sure that their interests are safeguarded. We pay tribute to the incredible job they do, and of course we want to look after them in every way possible. Robert did you want to come back on any of that? Robert Peston: (20:12) Well, I just want to ... You didn't really say whether the surcharge would be waived. And just on these union representatives, is it just that their managers have just got it wrong? Dominic Raab: (20:22) Well, I don't know on the unions what information they've got, but I'm telling you that that is not a government timetable. We've had lots of attempts to put that to us, and I understand why people would try and do that. That is absolutely not a timetable that we're working to that I recognize, or that is under consideration right now. And I'll defer to the Home Secretary on and the Health Secretary on issues around the surcharge. But I think the point I would want to make really loudly and really clearly is we pay tribute to all those from overseas who are doing a heroic job in our NHS on the front line. Beth Rigby from Sky. Beth Rigby: (20:59) Thank you. A question first to Professor Whitty please. We've talked a lot about PPE shortages and trying to plug the gaps, but NHS workers just want to know they have the equipment they need when they turn up at work. Can you tell me when you expect the shortages to be resolved? Is it three days? Is it a week, or can't you answer that question? And to the First Secretary please, the Health Secretary said today we've reached the peak of the crisis, and he said it was time to reopen the NHS for routine care. Is this the light at the end of the tunnel that we have been talking about and waiting for, and might we all look forward to some modest easing of restrictions on May the seventh when you review the lockdown? Dominic Raab: (21:48) So there's certainly light at the end of the tunnel. There is a glimmer, but we're not there yet. I think the way I would describe it, but I'll defer to Chris on where we are, we're coming through the peak, but we're not there yet. And I think the health sector is repeating what CMO has already said, which is one of the positives, one of the successes amidst all the challenges which I'm open to and accept has been that we've kept NHS capacity with the headroom not just to deal with COVID-19 patients, but to deal with all of those other people who have got ailments, injuries or who need treatment. I've heard Chris Whitty said it before, the NHS is still there for them, and I think he wanted to echo that point. Chris Whitty: (22:30) In terms of PPE, so I'm not a international procurement expert, so in a sense, I'm going to say what I'm told rather than pretend any expertise in this area. But it is very clear that at the moment, we are tight at different times for different items of PPE. It's not everything at all times, but different things at different points have been very, very close to the line. And of course when you are close to the line, inefficiencies in any kind of part of the system tend to lead to local stockouts. So if you're very, very heavily overstocked, that's less true. And this is why the support from the armed forces and so on has been so critical to trying to reduce this. So at this point in time, we are still close to the line, but at a national level, we're not underwater on anything that I'm aware of. Chris Whitty: (23:20) And I keep quite a close eye on this because I care very deeply about this as do all members of my profession. But of course, there may be local issues, and I'm aware of them from my colleagues along the way. And all of us want to be in a position where there is a sufficient excess over a long period of time that this can all be balanced out. But because of a combination of excellent work from the armed forces and mutual aid where different hospitals and care homes and others are sharing what they have, we have broadly, and this is a tribute to the services involved, managed a very difficult situation without yet getting to the point where that we're no longer able to cope with it. But I think to promise now that in two or three days this is all going to be sorted in the context of the credibly difficult according to my colleagues, and I see absolutely no reason to disbelieve them having read the international press, credibly difficult situation where everybody, every country wants these, and the suppliers are very limited I think would be a mistake. Chris Whitty: (24:22) I think what we need to do is we need to manage it as best it is possible to be managed. And I'm very aware that my expert colleagues in this area are working the whole time on this. And I care about it, and I check on this the whole time. And they assure me that they are and I can see that they are. And that is why we've managed to keep just ahead at a national level with some significant local pressures from time to time. Dominic Raab: (24:46) Beth did you want to come back? Beth Rigby: (24:47) Yeah. Yeah just quickly in terms of the lockdown, I understand that you don't want to spell out exactly what you intend, but the Irish Prime Minister has told the Irish people he will at least give them a roadmap by May the fifth to give them a sense of how they might begin to work through this. Germany is allowing some smaller shops to reopen. I understand that you might want to flex the model, but the British people aren't silly. I mean they understand what's facing them. Can't you at least give them some idea of what might be coming down the road? Dominic Raab: (25:24) Well that's why on Thursday I set out these five principles, but key to that is recognizing that we don't want to risk a second spike in the virus. And the challenge that we've got is that as the transmission rate comes down, we need to get more data as to precisely where it is in order to inform the measures that we could actively consider. So I think the responsible thing to do if I may say at least on the data that we've got is to make sure we've got that evidence before we start touting around ideas at the risk of there not being either us not being able to deliver them, or taking them and then risking a second spike. And I do think again, it's something Chris has highlighted, but also Andrew Bailey, the Governor of the Bank of England, we must avoid a second spike. And so whilst I know people will be wanting us to give them more information, and the minute we can responsibly do so based on the evidence we will. Dominic Raab: (26:15) At the moment right now and I think the vast majority of people in this country recognize it, we've got to keep our eye on the ball because we're coming through the peak, but we're not done yet. Laura Makin-Isherwood from British Forces News. Laura Makin-Isherwood: (26:29) Good evening. First Secretary of State, you've praised the work of the military today, but there are 20,000 personnel on standby to help in this crisis, and fewer than 3000 have actually been deployed. So are you under utilizing a [inaudible 00:26:41] of very skilled people that could essentially take the strain off the NHS further perhaps be deployed to all NHS Nightingale Hospitals? To the Chief of the Defense Staff, the government still says it hopes to reach 100,000 COVID-19 tests a day by the end of the month. Will you be helping to ensure that that target is met? Will you be taking over drive through test sites, for example? And to Professor Whitty if I may, scientists at Porton Down Laboratories are trying to work out what percentage or proportion of the population might've been infected with COVID-19. How are those figures looking? Dominic Raab: (27:16) Well, just on the question you asked me, of course we want to make sure we use all of our resources in the right way that complements and supplements the brilliant work of the NHS, and we're always talking and considering what more can be done. I talked about the deployment to the new Nightingale Hospitals, and I've been talking with the Defense Secretary about the mobile testing labs and how we can deploy them in the future. But of course, those are difficult decisions. We've got to make sure that we deploy our resources where they add the greatest value and in the right way. So, Nick, I don't know whether you want to go back on the second question. Nick Carter: (27:47) I might have a go at the first part of your question as well. I mean, the answer is that we have deployed all that we have needed to deploy at this stage in support of the organizations that we're working for. There is more there if people need it, but the sorts of skills and capabilities that are in the remaining 20,000 are not necessarily the ones that people need at this- Nick Carter: (28:03) ... point in time. And to your question about testing, yes, we're working very closely with the DHSC and with the NHS and more broadly through the local [inaudible 00:00:28:13], that I described in my opening remarks. Because what we're trying to do, is to help design the right system with the team in DHSC that can provide the sort of testing that customers need, so that you match demand to supply in the right way. And that's why the innovative idea of popups unlike mobile libraries, we think will be a very useful way of going. And what we're trying to do at the moment, is to upscale that idea so that we've got enough capacity to be able to get out into those areas which are harder to reach. So, it's an overall system that's been put together at the moment. It will be very sophisticated once it's completed. And there's some very really good people designing it and we're working with those people to make it as good as it possibly can be. Dominic Raab: (28:55) Chris, on the last point. Chris Whitty: (28:56) On the last one. So, you're absolutely right, that [inaudible 00:28:58] has some of the best capacity to do what's called, serological testing. This is the testing, the antibody testing, where you can tell whether someone in the past has had an infection including COVID-19. The problem we have had, is that we do not yet have a test that is as good as we would want even with the expertise of the academic sector, [inaudible 00:29:21] and their expertise, Public Health England and their expertise, and industry. And many different people are trying to work on an improved test, there are fairly good tests at the moment on this, but there are not very good tests. Chris Whitty: (29:33) This is one of the critical bits of information we need to make decisions. And I'm hoping... But I've been hoping for a while, so I don't want to over promise on this, that we will shortly have tests that are good enough to get at least a ranging shot as to what proportion of people in different age groups, in different parts of the country, have had this virus. But we're not yet at the point, I think, where we have a test we can say that reliably, but I'm hoping we will be able to do so in the pretty near future. Dominic Raab: (30:04) Or, would you like a follow up there? Laura: (30:05) Yeah, if that's all right. Dominic Raab: (30:07) Sure. Laura: (30:07) We obviously have heard from so many places now that there's a real shortage of PPE, are the military themselves going to be protected enough when they're helping in these incidents and when they're deployed? And also, is there any update on what's happened with the arrival of that PPE from Turkey? Is that on the front line with those medical staff that need it now or is it still being checked? Dominic Raab: (30:29) Well, we obviously very carefully check all the consignments that we get. We've had reports in other countries of PPE that's then distributed to the frontline, it isn't effective. Not only does it have to be withdrawn, but then you have to isolate or send into self isolation the care workers. So, we do check that very carefully. The consignment has landed and we are expecting further consignments in the future. But as Chris mentioned earlier, it's an incredibly competitive market and it just shows you that Turkish challenge that we had. How you need to have excellent cooperation with the Turkish government, and I had conversations over the weekend with my Turkish opposite number, and also how the MOD and the SCO have worked hand in glove together and it's a team effort, to get all of the supplies we possibly can, and we'll continue to do it. We obviously don't want, and will take every step we can to avoid for all of those reasons, any risk to anyone on the frontline in terms of the quality of the PPE. I don't know, Nick, whether you want to say anything more about that in relation to the military. Nick Carter: (31:28) Yes. Laura, those military personnel who were deployed alongside healthcare workers and the like, are equipped in the same way that they are for the function that they're performing. Dominic Raab: (31:39) Tom Newton, down from The Sun. Tom Newton: (31:43) Foreign secretary, thank you very much. Question to you and the chief medical officer, if I may. We understand that Sage, having looked again at the issue of wearing masks, and they decided to advise you that it would be a good idea to wear some sort of [inaudible 00:03:58], fluff or otherwise, for people who are asymptomatic but able to transmit the disease themselves. When are you going to meet to decide on that? And it doesn't [inaudible 00:32:10] today, what's your advice to people tomorrow morning going to work? Should they or should they not be wearing face masks to protect people? And to the chief medical officer, can you say a little bit about the work you're doing at the moment for the end of the month on restrictions? What sort of shape is that taking? And in particular on the first secretary's fifth and most important test, as he says, on avoiding a second peak and being sure you can do that. [inaudible 00:32:37] can you ever get yourself in a position that you are sure? Almost seems an [inaudible 00:00:32:40]. or, are you calm that you can design some sort of new metric for that? Dominic Raab: (32:46) I'll let Chris answer that one. On [inaudible 00:32:48] Sage, as always the case, we'll look at the evolving evidence as we learn lessons through this crisis. They have been asked to look at the mask issue again, we haven't had the advice back yet, so nothing will change until we've had that and considered it Chris Whitty: (33:02) In terms of what we're looking to the future, and of course you're absolutely right, this is a critical question, not just for the UK but for other countries and we share our experiences. The... There is an upper and a lower bound, of what is possible. The upper bound of this is, we cannot allow the R, the force of transmission, to go above 1, for any extended period at any point. Because if it does, exponential growth of this will continue. It will resume and we will get back to a situation where the NHS could have its emergency services overwhelmed, which we've managed to avoid due to the remarkable work of the NHS itself in expanding its activities, the British public in heeding advice to stay home, and some significant help, of course, from the armed forces. Chris Whitty: (33:50) So... But, if it goes back up and you get exponential growth where you've got a doubling time of a few days, or to say, it does not take very long before you move from bad numbers to really bad numbers over quite a short period of time, and at one... At some point... To the point where the NHS would really find it very difficult. So we cannot allow that to happen. At the bottom end of the... In a sense, the other end of the bracket of what's possible, is this disease is not going to be eradicated, it is not going to disappear. So we have to accept that we are working with a disease that we are going to be with globally, this is a global problem, for the foreseeable future. Chris Whitty: (34:31) And what we're trying to work out is, what are the things which actually add up to an R of less than 1? And there are lots of different options which ministers will then have to consider. But that narrows our options quite significantly. If you're having to keep the R below 1... And I think we have to be very realistic that, if people are hoping that it's suddenly going to move from where we are now in lockdown suddenly into everything is gone, that is a wholly unrealistic expectation. We are going to have to do a lot of things for really quite a long period of time. The question is, what is the best package? And this is what we're trying to work out. But if you release more of one area, you have to keep on board more of another area. So, there is actually a proper trade off, and this is what ministers will... Are having to consider. Dominic Raab: (35:19) Tom, would you like to follow up on any of that? Tom Newton: (35:20) Just a quick one. I think some people are going to be some doubt whether to wear face masks tomorrow morning after your question, but I don't think I can get much more... Can I just quickly follow up with, Professor Whitty? Very interesting on what you're saying about the R, is establishing R below 1 enough for you on easing these particular restrictions, whatever effect that has? Or, would you be wanting to go down to 0.5, 0.25, or whatever? Is it just a case of simply a tiny percentage below? Or, can you calculate [inaudible 00:35:56] that you'll be extremely comfortable with? Chris Whitty: (36:00) Well, R going below... Not going above one, is a minimum ask, that absolutely has to happen. There are then a number of, from a purely health point of view... And this goes back to something I've said before, but I will repeat myself because obviously it may be a different audience. There are multiple different ways in which this epidemic is going to kill people or cause ill health. The direct causes of deaths from the COVID... The potential of the indirect causes of death if the NHS gets overwhelmed, which we have absolutely been determined should not happen, it has not happened, we are determined it does not happen. But the third area is, people who die indirectly because the health service has had to be reoriented towards COVID, and therefore you can't do other things, elective things, screening, a number of other things that the NHS normally would do. Chris Whitty: (36:48) But there is also a final group which is, if the interventions we have extend deprivation among people, that is also a risk to their long-term health. And all of these, are going to have to be taken into account from a health point of view. And they don't all lead to exactly... If you're optimizing it for one, you may not be optimizing it for another. So what we have to do, is think very seriously about this, what is the best balance of measures that gives us the best public health outcome? Which is... Does absolutely include, people who die, sadly, directly of COVID, but also has to include all these other factors. Dominic Raab: (37:25) Thanks, Tom. Can we go next to Gordon Rayner, from The Telegraph? Gordon Rayner: (37:30) Thank you, first secretary. Can I ask a question for yourself and the CMO, first? Can you guarantee the public that if the Oxford or Imperial vaccine trials proved successful, British people who paid for those trials will be the first to get the vaccines? How else has the CMO... Just following on Tom's question, is it possible for us to ease the lockdown measures before we have a contact tracing system in place, which the health secretary has been talking about quite a lot today? And... So just lastly, one question for the first secretary, specifically. In October, 2016, the government run a pandemic drill called, Exercise Cygnus, as you all know. It involved all nature government departments, and simulated an epidemic similar to the one we're facing today. Tens of thousands of people died in the simulation, but its findings have never been published. Can you today commit to making those documents publicly available? Dominic Raab: (38:35) No, I can't. I think if they were conducted in the circumstances that you described, I'd have to look very carefully at the rules around it. But, I'm happy to take that away and have a look at it. Chris, on the other points. Chris Whitty: (38:48) Vaccines... Well, I mean that... In a sense, that's a commercial question as much as it is a scientific question. We... Obviously, the UK is going to want to get early or very... Or... As fast as we possibly can, access to any effective vaccine, in a sense, whether it's developed in the UK or developed somewhere else. But a lot of work has been put into at the moment, both trying to support the science so that an initial vaccine can be done and we support this directly in the UK and indirectly elsewhere through other routes. But even once you've got a vaccine, this is the point Sir Patrick Vallance has made several times to the government [inaudible 00:39:24] advisor, you then have to go into big trials. Chris Whitty: (39:26) And then also, and this is a bit people often forget, into manufacturing and scaling up and all the way along that path. We're going to want to keep track of this and make sure that the UK has access. But I mean, this is not a straightforward position. In terms of the lockdown question, essentially there are quite a large number of possible combinations of things you can do. You're certainly right that contact tracing is one of those. But I think... What I think we need to do, is put to ministers all the various things that are possible. And at that point, they will decide what the right combination is that achieves the best public health and wider social goals. Dominic Raab: (40:09) I mean, Gordon just on that. Let's be clear about this, the vaccine is not going to come in anytime, particularly soon, to allow us to ease out of the current social distancing measures into a transition. I think it would, and I'll be corrected if I'm inaccurate about this, it'd be more likely to be of particular value in stopping a second global wave down the track if we don't eliminate coronavirus for good. Chris Whitty: (40:34) So, should I just add to that? So I think, in the long run, the exit from this is going to be one of two things, ideally. One of which is, a highly effective vaccine, and there are a variety of ways vaccines can be deployed. They can be deployed for... Damping down epidemics that can be deployed to protect vulnerable people. And, or, highly effective drugs so that people stop dying of this disease even if they catch it, or which can prevent this disease in vulnerable people. Until we have those, and the probability of having those anytime in the next calendar year, are incredibly small, and I think we should be realistic about that, we're going to have to rely on other social measures. Which of course are very socially disruptive as everyone is finding out the moment. But until that point, that is what we will have to do. And it will have to be the best combination that maximizes the outlooks, but it's going to take a long time and I think we need to be aware of that. Dominic Raab: (41:32) Gordon, do you want to come back on any of that? Gordon Rayner: (41:36) Well, just briefly. On... To Professor Whitty, if you're saying that you don't expect a vaccine to be available in the next calendar year, are you effectively saying that we're going to have very socially disruptive measures for probably the next calendar year? And... Sorry, just to come back first secretary on Exercise Cygnus very quickly. Could I just ask, have you personally read the document and has it been made available- Gordon Rayner: (42:02) ... available to all of your key scientific advisors? Dominic Raab: (42:02) I would have to go and check, I'm afraid. A huge volume over recent weeks, but it's not something that immediately springs to mind. Chris, on the- Chris Whitty: (42:13) On the vaccines, I am very hopeful that we will have vaccines which have proof of concept much earlier than a year, to be clear. There are very large numbers of people around the world, very good groups, excellent ones in the UK, first vaccine tomorrow in demand here. But there is a long path between having a vaccine that's proof of concept. And until we have either a vaccine or a drug... I mean, we have managed other epidemics without a vaccine. HIV is an example where it's managed with a drug or combinations of drugs. But until we have those solutions, yes, what we have available to us are social measures, and that's obviously what we're using and it's what's the optimal combination of those. Dominic Raab: (42:59) And Gordon, the one thing I'd just add, and it's really important to reinforce this message. The lower we get the R-level, the transmission rate, the more options we have, which is why our message right now has been just to focus on keeping up the adherence to the social distancing measures. It is making a big difference. And of course, the more we get the transmission level down, the wider the range of options that we would have in place. Dominic Raab: (43:20) David Hughes, from PA. David Hughes: (43:27) All right. As we're looking for a way out of this, is one of the plans you're considering a mass population testing program? And if so, how would that be administered? When it comes to contact tracing, are you planning to rely on this new app that's being developed or are you thinking there's going to be a huge amount of manpower needed. If so, is it something that General Carter and the military would be involved in? Dominic Raab: (43:45) I'll let talk about the wider mapping. Look, we're boosting the testing capacity. We are looking at the functionality and the way the app would work. The more options, the two big factors in it, I think it leans into the question that Gordon Rayner was asking. The two factors that will help give us a greater range as we transition to the next phase when the evidence suggests that we can, will be getting the transmission level down and the level of testing and the functionality of the app in order to allow us to look at the various different options and control any potential resurgence of the virus, because we will want to be mitigating, keeping it as low as possible. Dominic Raab: (44:26) So that's why we're putting so much effort into not just the testing, but also the wider tracking and tracing that could be put around that. As the weeks proceed, that could have a significant impact on our ability to ease out of the current social distancing measures. Dominic Raab: (44:44) Chris, anything? Chris Whitty: (44:44) There's a lot of things that you can do with testing. Obviously, patient management. Obviously, allowing people who are in lockdown and they've got a relative in the house and that's the reason they're there and they're key workers, to see if they're able to go to work. Chris Whitty: (44:59) Obviously though, and this is an area in which we will be doing a lot more of, testing across the community to find out at the earliest possible stage if we're starting to see a resurgence of this virus. Because at the moment, we're relying on a situation when people get as far as hospital. If they do that, they'll have had five days in which they don't have any symptoms. They might have had up to a week when things are getting worse, and so you're behind the curve if you rely on that. Chris Whitty: (45:25) So we're going to certainly be doing a lot more population testing and we'll go into details of that once we've got this going very shortly to find that the earliest point, is the R below one, are we still going down... or is there some part of the country where the R is beginning to go up, in which case we then need to act. That is going to be part of a wider range of things we need to do with the tests. Dominic Raab: (45:49) That's why we set those tests out, the five principles, out last Thursday, because all of those factors inform the proposals and any future decisions we might make. Dominic Raab: (45:57) David, would you like to follow up there? David Hughes: (46:00) Yeah. On the contact tracing app, do you think the British public would be willing to install this on their smartphones given the necessary invasion of privacy it would entail? What's about the proportion of the population that don't have a smartphone or wouldn't feel confident using it? Dominic Raab: (46:18) Well, both good points. I think overwhelmingly, what the public expects of us right now is to innovate as best we can to try and ease our way out to the next phase of this virus in a way that protects public health, but also allows us to go back to the kind of economic social life that is as close to normal as possible. So we'll innovate in those areas. And if we come up with something which is effective, we'll have to look at those decisions. But I think people do understand that we're in an exceptional crisis and we need to take measures that we probably wouldn't think about doing if we weren't in this crisis. Dominic Raab: (46:50) Kate Wilson, from The Bristol Post. Kate Wilson: (46:52) Good evening. Firstly, to the Chief Medical Officer. As we've already heard the Health Secretary said this afternoon, the UK have now reached the peak of the coronavirus outbreak. Does that peak extend to places like the Bristol area, where the numbers of cases and deaths are much lower than in other parts of the country or could they peak later? And therefore, will Bristol's Nightingale Hospital, which is going to be ready to take its first patients from this weekend, still be needed? Kate Wilson: (47:20) And secondly for the First Secretary, we know that two-thirds of SMEs in Bristol have stopped trading since lockdown began. If Bristol's figures have indeed peaked at a lower level, would you consider an earlier exit from lockdown in order to restart the economy here? Dominic Raab: (47:35) Chris, do you want... Thank you very much, Kate. Do you want to go first, Chris? Chris Whitty: (47:39) I'll go obviously, on the issue about the numbers. You're of course right that the Southwest has had probably the least impact from Covid so far. I mean, Bristol itself has had under 500 cases, from memory. It's also true in the social care settings. There's a smaller proportion of care homes, have been affected by Covid outbreaks in the Southwest than they have in other parts of the country. So of course, that is absolutely right. Chris Whitty: (48:14) The thing about the peak we are going through at the moment however, is that it's not in a sense the natural peak of an epidemic without us doing anything. It's a peak brought about by the British people staying at home and actually not giving the virus the opportunity to spread. And therefore, the actual peak of it is likely to occur in most parts of the country at really a very similar time. There is a little bit of evidence that there is a slightly earlier effect in London. Chris Whitty: (48:44) But really elsewhere, there is a little bit of regional variation. But there's much less, because basically this is an artificial peak brought about by our activity than there might have been had this been running unmitigated, which clearly was absolutely what we are trying to avoid. Chris Whitty: (49:01) In terms of the Nightingale in Bristol and this would be true of all the Nightingales, it firstly gave us the ability if the British people had not heeded quite to the fantastic extent they had and there had been more pressure on the NHS, it gave us capacity to deal with emergencies. It still will give us and the other Nightingales will give us flexibility. Because if you think about the two forms of concern that I was talking about earlier, the direct deaths, but also the indirect deaths... having the Nightingale capacity enormous help from the armed forces in setting up so fast does actually mean that when we're planning forward, this does give us a number of options we would not have had if those were not there. Now we shall see how they are properly used. Chris Whitty: (49:51) I am absolutely delighted that the Nightingales have really not had to be used in great numbers for Covid because that is in a sense, a sign of success. We have been able to cope with this within the emergency environment of the NHS already. But the NHS is going to be under pressure from Covid for really quite a long time, and having that flexibility is an additional thing we can work through in terms of how best to deploy NHS resources for the next several months. Dominic Raab: (50:24) Kate, look, small businesses are the lifeblood of our economy. They are going through a really tough time right now. SMEs create the lion's share of jobs in this country, they have done over a sustained period. So we absolutely want to see them through this crisis, and they'll be part of Britain bouncing back in due course. Dominic Raab: (50:41) But the risk right now not just for public health, but for all of those small businesses is that if we move too early to ease up in the way that your question suggested, not only would we get a second spike in the virus, we would need to then have a second lockdown. That protract the economic pain and all of the uncertainty that goes with it. Dominic Raab: (50:59) I can tell you that in terms of the support given to Bristol City Council, they've been allocated more than 88 million pounds as part of the government's business support package. We've identified 8,000 business properties which may be eligible for grants. More than 4,000 grant payments would be made. And on top of that we've got the loan guarantees, the coronavirus job retention scheme, deferral of VAT payments, tax relief, and other cash grants. Dominic Raab: (51:27) I take your point that they're the heart and soul of this country, small businesses. We'll do everything we can. But I think it will be counterproductive if not dangerous if we eased up too early. Not just for public health, but also for entrepreneurs. Dominic Raab: (51:40) Would you like to come back on any of that, get the last word? Kate Wilson: (51:44) The only thing I wanted, just a little bit more detail if you could on the army as part of the Nightingale Hospital in Bristol. I know you said they had been helped helpful in setting it up. Are they also going to be helping to staff it as well once it's up and running? Dominic Raab: (51:57) Well, the way that the military have tended to work with all the Nightingale hospitals, but I'll pass on to CDS to supplement, is to support what the NHS workers are doing. And so it will depend on the specifications for each Nightingale hospital, but they're there to support the NHS staff. Sir Nick, is there anything you'd add to that for Bristol? Nick Carter: (52:18) Yes. I mean, in Bristol, we have allocated some combat medics to act as nurses and the like, and some sort of general duties personnel to help support it as well. Dominic Raab: (52:28) Thanks very much, Kate. That's all, I think, for this press conference. Thank you all.