United Kingdom Coronavirus Briefing Transcript April 27

Matt Hancock: (00:00) Today's briefing will follow a bit of a new format following significant demand as well as questions from the media. We'll take our first question from a member of the public. This is going to become a regular feature of these briefings. The questions are selected by an independent polling organization and just like the journalist questions, we don't see the questions in advance, but we'll give them the very best answers that we can. In the past few hours, since we announced this new approach, we've had over 15,000 questions submitted and you can ask a question yourself by going to gov.uk\ask. And today I'm joined by Professor Chris Whitty and Professor Steve Powis, the medical director of the NHS. The government is working through our action plan and at its core the objective is to protect life and to protect the NHS both by slowing the spread of the virus so that we flatten the curve and by ensuring that the NHS always has more than enough capacity to provide critical care for all those who need it. Matt Hancock: (01:18) According to the most recent figures, there have been 719,910 tests for coronavirus so far in the UK, including 37,024 yesterday. 157,149 people have tested positive. That's an increase of 4,310 cases since yesterday. 15,051 people are currently in hospital with coronavirus, down from 15,239 yesterday and sadly of those hospitalized with the virus, 21,092 have now died. That's an increase of 360 fatalities. And we must never lose sight of the human cost of coronavirus and the pain and the grief that it causes. And each death serves as a reminder that we must stand firm in our resolve. Sadly, these deaths figures include 82 NHS colleagues and 16 colleagues who work in social care. They dedicated their lives to caring for others and I feel a deep personal sense of duty that we must care for their loved ones. Today, I'm able to announce that the government is setting up a life assurance scheme for NHS and social care frontline colleagues. Matt Hancock: (02:54) Families of staff who die from coronavirus in the course of their essential frontline work will receive a 60,000 pound payment. Of course, nothing replaces the loss of a loved one, but we want to do everything that we can to support families who are dealing with this grief. And as a government, we're looking closely at other professions that work on the frontline against coronavirus who also do not have access to such schemes to see where this may be required. This gross crisis has shown this country values so much our health and social care workers and I want to pay tribute to the perseverance of the British public who, even this warm spring weekend, in the vast majority did the right thing and stayed at home to protect the NHS. Thus far in this crisis at every single hour of every single day the NHS has always had the capacity to treat the people who need that treatment. Matt Hancock: (04:09) I'm glad to be able to report that there are now 3,190 spare critical care beds. Indeed, 42% of oxygen supported beds in the NHS now lie empty. And in most parts of the country, the number of people in hospital with coronavirus is beginning to fall. One of the reasons NHS capacity has always exceeded need is because of our amazing program of NHS Nightingale Hospitals. Today, I was proud to attend virtually the opening of the eighth of our 10 Nightingale Hospitals across the UK. Again, built in a matter of weeks. This Nightingale Hospital Project stands as a monument to the nation's ability to get things done when it matters. This is one of the most ambitious projects this country has ever seen in peace time and I'd like to thank the NHS, the armed forces, and all the companies that have worked side by side to make these plans of reality. Matt Hancock: (05:12) The Nightingale Project is just one of the measures that's boosted capacity all across the NHS. By reenlisting thousands of former staff, former clinicians, and enrolling early thousands of students. We've boosted the workforce of the NHS and we've changed forever the digital capability of the NHS. I think many people who've now used online GP consultations and online outpatient visits won't ever go back. And I pay tribute to the staff who've worked in different ways to how they would ever have imagined and who've been more flexible and open to change when it was really needed. So where there have been advances amongst these huge challenges of this crisis, we must not lose them. However, we also know that fewer people are coming to the NHS when they need to and the attendances have dropped to 221,000 emergency department attendances in the last week compared to 477,000 in the same week last year. Matt Hancock: (06:20) That's more than 50%. Now some of this drop is due to lower road traffic and people following the social distancing rules. Some of it will be due to people accessing the NHS in ways that work better for them, like online or through pharmacies. And that's a good thing. But in some cases we know that the drop is due to people not coming forward and using the NHS for critical things that matter. Our message is that the NHS is open. Help us to help you. So if you're worried about chest pains, for instance, maybe you might be having a heart attack or a stroke, or you feel a lump and you're worried about cancer or you're a parent concerned about your child, please come forward and seek help as you always would. It is so important that everybody uses the NHS responsibly and the NHS will always be there for you when you need it just as it's been there for us all throughout this crisis and throughout our lives. Matt Hancock: (07:27) And as the number of hospitalizations from coronavirus begins to fall, I can announce that starting tomorrow we'll begin the restoration of other NHS services starting with the most urgent, like cancer care and mental health support. The exact pace of the restoration will be determined by local circumstances on the ground according to local need and according to the amount of a coronavirus cases that that hospital is having to deal with. Having written off 13.4 billion pounds worth of historic NHS debt, I want to ensure that the NHS is always there in a way that doesn't just help us recover from coronavirus as a country, but also puts us in a stronger position for the future. We're coming through this peak. We'll honor those who've dedicated their lives to caring for others, but it will count for nothing if we let things slip now and risk a second peak. I know that lockdown is hard for so many people, but let us all have the resolve to see this through. So please stay at home, protect the NHS, and save lives. We're now going to go to Professor Chris Whitty, the chief medical officer for the daily data charts, and then we're going to take questions from the public. Professor Chris Whitty: (08:56) Thank you very much, Secretary of State. So just the first slide is just a reminder to people of the five tests for adjusting the lockdown. The first three of which are about the epidemic that the NHS has capacity to provide critical care across the UK, a sustained and consistent fall in the daily deaths overall from coronavirus, and the rate of infection decreased to manageable levels across the board. Then there's an operational point about operational challenges including testing and PPE in hand with supply, able to meet future demand, and then finally and importantly confident that the adjustments to current measures will not risk a second peak of infections. Next slide please. Professor Chris Whitty: (09:44) The next two slides are really ways of looking at whether people are continuing as they have been consistently throughout this crisis to heed the guidance in terms of keeping pressure off the NHS by staying at home unless they have to go out for necessary things. And as you can see, after a very remarkable fall, initially, broadly, this has been flat, very slight trending up in terms of motor vehicles, but otherwise really the data remain largely unchanged on these transport metrics. Professor Chris Whitty: (10:18) Next slide please. And then looking at other forms, the driving we've talked about before. A very slight increase in walking. Public transport remains largely flat. So evidence, I think, that the great majority of people are continuing to honor the lockdown, which is helping us to drive the number of cases down and therefore take pressure off the NHS. Next slide please. Professor Chris Whitty: (10:44) The next few slides are really ones that people who watch these briefings will be very familiar with. It's just the most recent data. So new cases in the UK. As you can see, obviously one thing we have to bear in mind is the number of tests is going up overall, but despite that the trend is flat or slightly down in terms of positive cases. Next slide please. But when we actually look at people in hospital, I think the trends that demonstrate that over the country as a whole, we're going through the peak are reasonably clear to see. Obviously a bigger fall in London, but the rest of the country in different areas are either flat or decreasing over time. Next slide please. And then when we turn to one of the most important questions, which is critical care capacity, if you look at these trends across England, Scotland, Wales, and Northern Ireland, these are the percentage of all critical care beds being used for covid patients and both in absolute and in relative terms this is gradually trending down. Professor Chris Whitty: (11:55) But importantly, and I talked about this last time I was here, this is a very gradual peak. We're not seeing a dramatic falloff and nor do we expect to in the next short while. Next slide please. And finally, sadly, people are continuing to die as we have said. Every time just after a weekend, there's an artificial drop because there's less notification over weekends. So the number of cases who sadly were reported as having died yesterday with 360 I do actually expect there will be a bit of an uptick again later in the week as we catch up from the weekend drop. Nevertheless, the trend overall, as you can see from the seven day rolling average at the top, which smooths out these weekend effects, is a gradual decline. But we are definitely not consistently past the peak across the whole country at this point in time. Finally, a slide which compares different countries, and again I would be really clear that we should not over-interpret the absolute numbers. The way these are actually measured in different countries is different, but the trend lines I think are reasonably clear from this. Thank you very much. Matt Hancock: (13:14) Thank you very much Chris. Now we're going to go to the first question, which is from Lynn in Skipton. And I'm going to read out the question, and I'm reading it for the first time, and then we will endeavor to answer it. I'm missing my grandchildren so much. Please can you let me know if after the five criteria are met, is being able to hug our closest family one of the first steps out of lockdown. Well, thank you Lynn for that question. An incredibly important one and brings home the emotional impact of the lockdown measures. I think why don't we take the direct medical evidence from the chief medical officer? Professor Chris Whitty: (13:59) Well very clearly for most people, the ability to actually interact with families in a way that they have not been able to during this period is absolutely essential. In terms of the direct answer to this lady's question, it depends, if I'm honest, on the situation that she finds herself in. So if she is someone who has a significant medical problem in a way that means that she would have to be shielding that is, and she's an older person. Some grandparents are younger grandparents, some obviously are older. If she's in a group which is vulnerable, then the answer is that it might well be prudent, and this will be depend entirely on individual circumstances, for her not to get into a situation where she is putting herself at risk. Obviously if she's healthy and younger, that may well not be true, but the overall view that actually one of the things that clearly is important to everybody is the ability to get together with families remotely, but also physically everyone fully accepts. Nevertheless, it is important that people who are vulnerable continue to be protected even after whatever the next steps are occur. Matt Hancock: (15:16) Thank you. And the thing I'd say to Lynn directly is that we understand the impact of not being able to hug your closest family. It affects all of us too, as well as the direct health impacts of the lockdown, bringing down the curve and trying to stop this terrible disease. And also the economic impacts, which are clearly very significant. There are also the direct emotional bonds because it's one of the most natural things in the world to want to hug a member of a family. And we just hope we can get back to that as soon as possible. And the best way we can get there fastest is for people to follow the rules so we can get those five... Matt Hancock: (16:03) ... is for people to follow the rules so we can get those five criteria met as soon as possible. I don't know if you wanted to add anything. Speaker 2: (16:07) I have only to add that we all know how hard this is. My own mother lives hundreds of miles away and I know she's wondering when she will be seeing me and her grandchildren again. This is really tough, but as the Secretary of State have said, it is bearing fruit in that we are seeing reduction in the number of hospital admissions. We're seeing a reduction in the number of deaths, and it's only by the British public continuing to comply with that guidance until the time is right that we will all continue to see a reduction in deaths, which I know has touched so many people around the country in terms of loved ones. Matt Hancock: (16:43) Thank you very much, Lynn, for your question and for submitting it. And I hope that, I think that's shown that the questions from the members of the public can be just as informative and can be just as difficult to answer as questions from journalists who are trained to ask them. Talking of which Hugh Pym from the BBC. Hugh Pym: (17:11) Thank you very much. Question for the Secretary of State. It's about testing particularly important in the short term, at least for up to 10 million key workers and their families. We're hearing varying reports on how easy it might be or not to book tests online. What do you say to that and do you think you will hit your target of a hundred thousand tests a day by the end of this month? That's later this week. Matt Hancock: (17:35) Well, thank you. I think we are on track to the hundred thousand target. We're broadly where we expected to be. You've seen a big increase over the weekend to 37,000 tests yesterday. Now we are also enhancing and making it easier to access how you get a hold of tests. The home tests have been particularly popular. We delivered 5,681 of those yesterday. And that is all about being able to make the testing as easy for people who, if you've got symptoms you're by the nature of the thing you are already ill, and so we want to make it as easy as possible to get hold of those tests, alongside it still we're opening more and more drive through centers. So we're broadly where we expected to be and we've got a lot of work the rest of this week to keep continuing the ramp up to the goal that I so clearly set up. Thanks, Hugh. Hugh Pym: (18:43) Can I ask a follow up? Matt Hancock: (18:44) Yes, of course. Hugh Pym: (18:45) Beyond this it's very important to escalate testing capacity significantly to prevent or help prevent a second spike. Where do you want to be with capacity and testing ability in a few months time? How many hundred of thousands a day? Matt Hancock: (19:01) So this is a really important question and of course the reason that I set the goal and that we're working so hard towards it is because testing is an important part of how we keep the spread of the virus down, especially once we've got the number of new cases down through the social distancing measures. So we want testing to continue to increase. As you'll know, the Prime Minister set a goal of 250,000 sometime ago, especially for when the antibody tests come on stream. But so far there isn't one of those that is clinically valid. So we'll keep on increasing. It's important to note that we've already gone past the number of tests per day, for instance, that they carry out in South Korea. We're approaching the levels that Germany undertakes. So, it's a project to keep increasing. Matt Hancock: (20:06) Also, we need to think very hard and take the clinical advice on how to use those tests. For instance, we're putting far more into care homes. We're making sure that now NHS staff get tested, including when they're asymptomatic, to make sure that we understand where the people who are working in hospitals have got the virus and using the tests for surveys. The Office for National Statistics have got a survey for instance in the field right now and with people being tested this week to find out how many people have got the virus, how many have had the virus, the critical questions that we need to know the answers to. So I don't know if you want to add anything Chris, but the point is, it's a really important question because testing is a critical part of controlling the virus once we get the number of new cases down. Chris Whitty: (21:07) Only thing to add is that the more testing capacity you've got them, the more flexibility you have to do different things, with both the patients and in terms of things like care homes as the Secretary of State was saying. Matt Hancock: (21:19) Thanks, Hugh. Robert Peston ITV. Robert Peston: (21:23) Good afternoon. On the life insurance scheme, will overseas healthcare workers working in the NHS and those who come back to the NHS temporarily, will they qualify for this life insurance? Right now they don't for example, qualify for normal death in service benefits. And the question I think largely for Chris Whitty, more or less the most important test you've set is the transmission rate, the so called R has to fall to a 0.5 so in language you can all understand on average it will take two infected people to infect one other person. What's the magic of that 0.5? Why does it give you comfort? And also since we still don't know how many people are walking around with funny symptoms or no symptoms at all who have the virus, how can you be remotely confident that you will get there. Neil Ferguson said he thinks that the number is currently O.6 to O.7, but how can we possibly be confident of that? Matt Hancock: (22:24) I'll take first question, Robert. The answer is yes. This is for frontline staff working in the NHS and in social care, who die and are employees within the NHS and social care. And as I say, we're also looking at which other groups of key workers that applies to and who don't have a scheme already in place. Chris? Chris Whitty: (22:52) 0.5, can I just correct? I don't recall ever saying that the target was 0.5. What I have said is that it's in the range 0.5 to one at the present time, probably somewhere in the middle of that range. And the second thing which I have said is that it is really important we do not go above one. That one is an absolute target. And the reason for that is that once it goes above one for any prolonged period of time, I mean it might just flick up for a short period, then you go back to exponential growth and then a short sooner or later, depending on how much above one it is, you get back to the situation, the NHS is threatened to be overwhelmed because exponential growth goes from very small numbers to very large numbers very fast. Chris Whitty: (23:33) So I would like to clarify that it's not going above one is the longterm target. Clearly the lower we can get it at the moment the better. But as I say, it's probably in the middle of the range 0.5 to one at the present and that is bringing down the R, which is what you're actually seeing when you look at the critical care and other metrics we looked at in the slides. Matt Hancock: (23:56) Thanks very much. Yeah, or course. Robert Peston: (23:59) Could I? One extra thing, actually just on the life insurance, and just to be clear, there's nothing in this life insurance scheme that would waive the rights of the families of individuals who get COVID and either die or are seriously injured from suing the NHS in the traditional way if they feel they haven't been properly protected, particularly in the absence, they might feel appropriate PPE, there's no waiving of their standard employment rights involved in any of this? Matt Hancock: (24:31) No. Beth Rigby from SKY. Beth Rigby: (24:36) Thank you. Professor Whitty, at the beginning of the lockdown. Sir Patrick suggested a death toll below 20,000 was a good outcome. Now hospital deaths are suddenly above 21,000, and that doesn't even include care home or community deaths. How have you had to change your expectations as the disease has progressed? And can you provide an updated expectation of what you think a more realistic number is now? And Secretary of State, you've promised a hundred thousand tests by Thursday and last week you said trace and track was key to ease in social distancing measures. What level of testing do you need to get track and trace up and running and what's your timeframe for that? Matt Hancock: (25:24) Yeah, go ahead. Chris Whitty: (25:27) So on the first one, the number will definitely see 20,000. So even with hospital deaths, as you say, sadly it has gone above that. Once we look into direct and indirect and I constantly make this point, it is really important direct and indirect deaths all cause mortality. We definitely sadly do expect it to exceed that. Chris Whitty: (25:51) I think that my view actually is we need to view this epidemic over the long run. And this has got a very long way to run. And I'm really cautious about putting out, and I've said this again repeatedly, these kinds of absolute numbers because this could go in a lot of different ways over the next many months until such time as we have a clear exit that has a vaccine or drugs or some other route that allows us to be able to say, "Look, we now couldn't stop people dying from this." And this is going to be true, to be clear, in every country around the world. So I'm really cautious about putting these absolute numbers, but I am absolutely clear also that the 20,000 number is not where we will be once we add in the direct and indirect causes both in and out of hospital. Matt Hancock: (26:39) And on the question on test, track and trace, it's all a matter of degree and the lower the number of new cases, the more effective a system of test, track and trace of any scale is. And therefore a hundred thousand tests a day is a big enough testing system to start test, track and trace. But if it's bigger, then the system can work on a higher number of cases and be more effective. South Korea is a really good example where they peaked in terms of tests today just over 20,000 and they've now brought that down because their number of new cases is so much lower. They can test everywhere they want and they still don't need to use up all of the tests that they have the capacity for. Matt Hancock: (27:31) And we've seen over the last few weeks that the gaps between capacity and the number of tests done in this country as well, and on Sunday the new German Ambassador to the UK was explaining that the test capacity in Germany is 800,000 a week. And they used 450,000 of that capacity each week. So we have a similar pattern of the capacity being higher than tests use all around the world. And the capacity that we're building is big enough to get started on test, track and trace. Matt Hancock: (28:12) We need to get the track and the trace part of that up and running so that they can be effective as we bring the number of new cases down. Beth Rigby: (28:25) Can I just follow up just on one thing. Professor Whitty, what explains the mismatch between where you thought the death toll would be at the beginning of the lockdown and where we are ending up a month in? What changed over the course of the past few weeks? Chris Whitty: (28:43) I've never put an absolute number into the public domain. I've been asked this lots of times. My aim has always been to try and get the number to be the minimum we can manage, but to be clear this has got a very long way to run. And I think just thinking about the first peak, which due to the fantastic work the whole nation has done and the work of the NHS, we have actually managed to go through, we still got some way before it's falling right off, but there is a long, long way to go beyond that. And I think it's a big mistake in my view just to consider just the first phase. We need to look at the epidemic as a whole. Matt Hancock: (29:18) Thanks very much, Beth. Gary Gibbon from Channel 4. Gary Gibbon: (29:23) Professor Whitty, can I follow up on what Robert Peston was asking about on the infection rates? If we're in the middle of the 0.5 to one range, will that do? Is that good enough, or is it actually the rate that you need to get clearance to a relaxation of the rules is lower than that, is perhaps around 0.5? Chris Whitty: (29:49) Well, clearly the lower the R just to remind people who don't watch this program the whole time. This is if R is one, one person gives it to one person and the disease is stable, if R is 0.5, 10 people give it to five and so on, it's going down and if it's two, one person gives it to two give it to four and so on. That was just a clarification for people watching. The further away the R is from one and on the downside, so the closer it is, the lower it is the better, for two reasons. The first of which is that it will mean that the peak will fall away faster and we'll get down to small numbers at a quicker rate. That's a good thing, clearly. Chris Whitty: (30:33) But the second thing is the larger the gap between where the R is, the current force of the transmission and one, the greater room for maneuverabilities in terms of trying to think through when ministers have to look at things in terms of what could be reintroduced without threatening the risk that we could go back above one and start going back to exponential growth. Chris Whitty: (30:55) So we know what we've currently measured indirectly, but I think that there's a reasonable degree of confidence that it's in that broader range 0.5 to one and I think it's probably in a rather narrower range in the middle of that. Obviously if it was lower that would give us more room for maneuver, but it gives some room for maneuver, but it doesn't give a huge amount of room for maneuver. And that's one of the things that we ministers are going to have to consider is how to actually make sure we keep the R below one given where we are at the moment, thanks to what everybody is doing. But you know there isn't a magic number here. Lower is better, but it's not that there is a specific number that has to be the right number. Gary Gibbon: (31:33) May I ask a quick second? What's your current estimate of what R naught is measuring in hospitals and care homes? Chris Whitty: (31:42) I think at the moment it's quite difficult to separate those two out. It is very clear it is falling in hospitals. Where it is in terms of care homes I think is less easy to work out at this point. We've got ONS data coming out tomorrow, which may help a bit, but we're not measuring that directly, I have to say and- Chris Whitty: (32:03) Which may help a bit, but we're not measuring that directly I have to say. And what I think we're seeing across the country is some care homes, weather significant outbreaks and other care homes which are unaffected, it's not like the community are, which is much more heavily influenced by the whole of the population. It's much more local to particular areas and particular care homes. Matt Hancock: (32:22) And maybe Steve could answer on the NHS point. Speaker 4: (32:24) Yeah, so in hospitals it's clear that the number of people who are tasting positive in hospitals is falling and therefore infection rates are falling. We would expect that because we're now in a position where the community spread of the virus is less and therefore that will translate into lower spread in people coming into hospital and therefore in hospitals as well. As Chris said, I think care homes think differently in terms of approach to that, but in hospitals it's clear that the infection rate is falling. Matt Hancock: (32:55) Thanks very much Garry. Sebastian Payne of the FT. Sebastian Payne: (33:00) Thank you very much Mr. Hancock. There were reports over the weekend that in the second phase of fighting the coronavirus the government is planning to quarantine people arriving in the UK for 14 days. I was wondering what changed your mind about tighter border restrictions and does that mean you're going to be encouraging British families to holiday at home this year? And if I can ask a question for professor Witty, could you give us an update on antibody testing please and whether the government has seen any breakthrough in its assessments for those tests? Matt Hancock: (33:30) Thanks so much. On the borders, we've been very clear that we follow the science and given the current level of infections, level of new cases in the UK and the very low amounts of international travel that's going on right now, it is clear that the impact on the epidemic as a whole of the number of people coming through the borders as a proportion is very low. But as we bring the number of new cases down in the UK, that proportion coming from those who are traveling internationally will rise and that means that the judgment on the measures that you need at the border changes. And we've seen a number of countries go through this process and we'll have more to say about it in due course. Matt Hancock: (34:26) On the testing point I don't know whether you want to go into that? But the antibody tests is still something that we work on. We have now lab based antibody tests in fact in the field now the office for national statistics survey is based on lab based antibody tests. But we're yet to find what's called a lateral flow, which means a test you can take, you don't need to send a sample to a lab because it gives you the result on the stick. We're yet to find one that has a clinical level of results that we're confident in. Chris Whitty: (35:06) I mean, my view is it sounds very seldom moves forward by breakthroughs. It moves forward by small incremental changes that over time significantly improve things. That is what I think will happen with this antibody test. We currently have tests that are good enough to give us a first pass at arranging shot on surveys to give us a feel for how many people in the community overall may have been infected. Some of them without knowing it because there's certainly some transmission without people actually getting symptoms. But an antibody test that is good enough actually to be able to say to an individual we're confident either yes you've had it or we're confident no you have not, we have not yet got to that stage and I think it's unlikely to happen in a single leap. It's likely to happen in a series of small improvements that get us to a point where we feel sufficient confidence we can do that. Sebastian Payne: (35:56) Thank you. Mr. Hancock, could I just ask a follow up please? Matt Hancock: (35:58) Sure. Sebastian Payne: (35:59) You mentioned earlier you were encouraging people that if they've got heart pains or worried about serious illness to go to hospital. Has the government done any work to measure some of the health side effects of the lockdowns such as its impact on mental health or domestic violence and will that play any part in your decision on how to ease the lockdown measures? Thank you. Matt Hancock: (36:20) Yes we have and one of the striking things around the world is that far fewer people are coming forward to use health services including here far fewer people are coming forward to use non-covid services in the NHS. I'll ask professor Powers to elaborate because he's been doing a lot of the work on this. Speaker 4: (36:46) Yes. So secretary of state said and as Chris said earlier, one of the things that we have concerns around are the indirect deaths I.e Deaths at home that is not related specifically to infection with COVID-19. And that's why for some weeks now we've all been reminding everybody that if you do have a condition which might be a heart attack, chest pain, symptoms that might be a stroke, then don't forget that the NHS is still there for you. The emergency services are there and always have been there throughout this. And also these are conditions where it's important not to wait because treatment and diagnosis and treatment speed is of the essence and we can do many things for those conditions now, but we need to do it quickly. So the message to the public is come forward, the NHS is working if you have a sick child, if you have those symptoms. I think in the longterm we will only be able to tease this out as we start to look at excess deaths overall. Speaker 4: (37:47) Chris has mentioned that I think earlier today and of course comparisons between countries in terms of excess deaths will be important as well. But we do know that attendance [inaudible 00:37:57] departments are done. There's reasons that that might be the case, but there are reasons why we want to encourage people to come forward if they have emergency symptoms that might need emergency treatment. So I think it will become clearer over time. But the key message for the public is the NHS is there for you come forward as you always would if you've got symptoms or one of your loved ones has got symptoms that might need emergency treatment. Matt Hancock: (38:26) Thanks very much. So Gordon Rayner from The Telegraph. Gordon Rayner: (38:31) Thank you secretary of state. Professor Witty, you said in March that children only got mild symptoms of coronavirus, which you said was a silver lining. While Sir Patrick [inaudible 00:38:43] said closing schools would have a minimal effect on the spread of the virus so it was safe to keep them open and there was zero chance of children avoiding contact with each other anyway. To what extent has your advice on sending children to school changed? Have you worked out the effect on the R value of sending children back to school? And also do you believe that children can spread coronavirus to other children following reports at the weekend that perhaps they couldn't and just very quickly, secretary of state, you've just announced good news for a lot of people that hospitals are going to start taking in cancer patients and doing other non-emergency work. Can you give us more detail on that and would people be watching this be wrong to interpret that as the start of an easing of the lockdown? Matt Hancock: (39:27) Great, do you want to take the first one and then I'll ask Steve to comment on it. Chris Whitty: (39:32) So it remains the case that the great majority of children either don't get coronavirus or if they do the symptoms are minor. That doesn't mean sadly that that is absolutely true. There are still a small number of cases including some very severe cases, but they are relative to adults they're much less than adults. So that remains absolutely the case. So the first reason for not sending children to school, which is it's particularly dangerous for them, that wouldn't be true in the case of coronavirus. Secondly, there is no doubt that they contribute. If you have schools open, it does contribute to increasing the R, so if you close schools the R goes down. It's part of the collection of things that were done in March to try and pull the R from where it was near three to where it is now below one. Chris Whitty: (40:28) It's only one off, if you did it just on its own, it wouldn't be enough. But if you stopped doing it, you would actually lose some of the benefits that we've currently got. Now, there is quite a debate at the moment around the world in science what contribution do children make to the actual spread of this virus between families around the country, wherever we're talking about. And is it different, for example, between young children and older children? Which it may be. But unfortunately we do not yet have direct data that really helps us remembering that this is a new disease so we can give a reasonably accurate answer for disease like flu. We really understand how children help drive flu. We're still really learning on this one. And so whilst I think it remains the case that we think that the contribution of children at school to the spread of this virus is probably less than, for example, for flu. Chris Whitty: (41:25) We do think it certainly contributes and what we're trying to work out is what proportion of the R it contributes and therefore if children went back to school how much closer to one and that's in a bad way, would we be? And could it even tip us above one and what can we do if so to try and minimize that? So it's a very good question to which there is unfortunately not a really clear answer. But we are getting closer I think to having a slightly narrower range of uncertainty around this. Matt Hancock: (41:55) Thanks Chris. On the restoration of the NHS, we've always said throughout that people should come forward for medical treatment. So people's access to the NHS, access to medical treatment has never been locked down. Indeed it's one of the four reasons that you should leave your house if you need to. And what we can do though is because we now have the capacity in the NHS to be able to start reopening some services we can do that. And I'll ask Steve to answer the question about with more detail, but it will be locally determined according to what capacity there is locally. But our message to people watching this and reading the Daily Telegraph is that the NHS is open and there to help you as it always is. And so people, if they think they need medical treatment from the NHS, then they should come forward in the first instance by phoning up their GP or going to their GP online calling one on one. Speaker 4: (43:02) Yeah so as the secretary of state says we are now in a position to start undertaking some of the services that we may have had to have stepped down to manage the surging coronaviruses or occasionally where services have become disrupted. So for instance, I know cancer patients there may be good clinical reasons why treatment might be delayed during a time when there is a lot of circulating virus in the community. And again as we've both said, emergency services have been there all along and it's really important that people access them. But I think to answer your question directly, it's not at all a sign that the lockdown is about to be relaxed. In fact, I think it's the reverse. It's a sign that the lockdown and the measures that have been taken and the fact that everybody's following them has meant that we are now seeing a decline in patients in hospital with COVID-19 and it's exactly that that is providing the capacity once again, that means that we can get back to restarting services such as elective surgery. Speaker 4: (44:09) So I think the message shouldn't be now is the time to relax. The message should be that by continuing to comply with these instructions, it will continue to help the NHS as we start to get over the peak and the plateaus to a point where we can get much more back to the services that unfortunately we've had to delay over the last few weeks as we've managed this surge. Gordon Rayner: (44:33) And can I just ask you a quick follow up? Matt Hancock: (44:34) Of course yeah. Gordon Rayner: (44:36) Just on the school's question, I mean listening to that answer that professor Witty gave a lot of people I think listening to this would interpret that as being in that there still isn't really a plan in place for how schools are going to go back. Would it be wrong to infer that from what you're saying? Matt Hancock: (44:55) Well Chris, what I'd say it's still as we've said over and over again too early to make decisions on this and people should follow the social distancing rules of staying at home to protect the NHS and save lives. And in a way, what we've been saying today about the restarting of hospital treatments, NHS treatments and the encouragement of many people to come forward when they haven't been coming forward with non-covid health problems is all part of protecting the NHS, which has been made possible by the fact that we've flattened the curve thanks to the social distancing measures. So it should be seen in that light, in that context. But on the school specifically Chris, do you want to answer? Chris Whitty: (45:47) So I think starting with the obvious point that obviously the final decisions will be for ministers and this is not a scientific decision. But what we can contribute from the science side is to say well look we've got this room for maneuver between where the R is now and one. And there's a lot of things to contributing which everyone's doing to pulling that down. Schools are contributing some of that and it may be different between different bits of schools and what we're trying to do in very, very short order is try and give a kind of feel for what are the combinations of different things which actually still keep the R below one, which is an absolutely critical thing but allow opening up different bits of society and different bits of which schools is one. Chris Whitty: (46:35) But I think the decision about how the different combinations go together, that finally is one for ministers. And I know the secretary of state would completely agree with that. What we can do is help provide some data to help say, here are some combinations of things we can do. But, and I really want to be clear about this, there is no perfect solution where we are going to end up being able to do all the things that people want and at the same time keep R below one. So there are going to have to be some very difficult choices between different things, all of which ideally all of us would love to open up, but we can't do them all. And therefore there will have to be some difficult choices and choices around schools clearly will be one of those. Matt Hancock: (47:15) Is that okay, Gordon? Gordon Rayner: (47:17) Yes thank you. Matt Hancock: (47:19) Great. We've got David Walsh from the Sheffield Star David Walsh: (47:23) Hello secretary of state. The raise the bar campaign wants to increase the threshold over 25,000 pounds retail hospitality unless you're a grant from 51,000 pounds reasonable value, to 150,000. In Sheffield city center this would mean a further 157 businesses can benefit from additional 3.9 million pounds of support. This could save businesses and jobs unless [inaudible 00:47:55]. A second one for the secretary of state please, Sheffield is famous for its independent breweries... David: (48:02) Sheffield is famous for its independent breweries. It has more per capita than anywhere in the country and was enjoying a golden age prior to the crisis. The government's supporting them in time, but with no opening date yet for pubs and bars, their very existence is under threat. To get them back on their feet, will the government council [inaudible 00:48:22] the six months when they're allowed to restart operations. Matt Hancock: (48:28) Well, thanks David. I understand, especially coming from a small business background myself, just how important these questions are to the businesses in the Central Sheffield and the breweries, which have, as you say, been flourishing right across the country over the past few years and have obviously been very hard hit by social distancing, by its nature, which takes away the ability to go for a pint with friends. So I will take these away and talk to the chancellor about them. What I would say is his announcement today of 100% guaranteed loans for smaller businesses is another important step in supporting businesses to get through this. We recognize the importance of supporting businesses right across the board, whether they're in the town center breweries or others who are badly hit by this. Supporting businesses through it is critical because both the health impact of the measures and the economic impact are both best served by people staying at home because that saves lives but will also get the rate of transmission down as fast as possible, which will then allow us to get through this as soon as possible. Matt Hancock: (49:56) So we want to get through it as soon as possible and we want to support businesses on the way through and those two specific ideas, it's tempting to say yes to as health secretary, but I think that I need to talk to the chancellor. Thanks very much. Dave West from the HSJ. Dave West: (50:17) Hi. Thank you. First question for Mr. Hancock. Could you tell us a bit more about the restoration of general planned services in the NHS? And there are millions people on the waiting list for general operations or appointments, hip replacements or cataracts and things. What sort of timeframe would you expect that kind of general activity to be getting back to normal? Might it be region by region and what role do those Nightingale hospitals have to play in that which you mentioned? And second question if I can for Chris or Steven. This morning, HSJ revealed the warning to doctors about the small numbers of children who are becoming seriously ill with an unusual set of symptoms which the experts believe may be an emerging symptom linked to coronavirus. Do you think this may be a new feature of the outbreak or are you pretty confident that these are simply cases of the very small number of serious cases of coronavirus which we do see in children? Matt Hancock: (51:20) Thank you. I'm very worried about the latter and we are looking into it closely. I'll ask Steve to answer on that. On the restoration, this will be a locally driven approach system by system. Of course the principles are that the most urgent treatment should be brought back first and also that it needs to be according to the local demands on the system. There's parts of the country where their number of COVID patients as a proportion is much lower than in other parts. And so it has to be locally driven. Unfortunately, I can't give you a sort of concrete single number answer to when and it is gradually over weeks but starting from tomorrow. Steve? Steve: (52:10) Yes, thanks Dave. Yeah, so as you've referred to, we have become aware in the last few days of reports of severe illness in children, which might be a Kawasaki like disease. So Kawasaki diseases is a very rare inflammatory condition that occurs in children. The cause is not often known, can be related to a number of things. So it's only in the last few days as I say that we've seen those reports and I know you reported that in the Health Service Journal this morning. So both Chris and I are aware of that. We have asked our experts, I've asked the National Clinical Director for Children, Young People to look into this as a matter of urgency. I know the secretary of state is concerned as he said, I know public health England, they're also looking into this. Steve: (52:55) So it's obviously important that when clinicians see these cases and worry that there might be a cluster, they alert other clinicians so that we can make sure that they are identified if they're occurring elsewhere and then quite rightly, we ask our experts to look into them and to see whether they can establish any link. Steve: (53:16) We're not sure at the moment. It's really too early to say whether there is a link, but what I should say as we said already this afternoon is our advice to parents is that these are the sort of diseases, very, very rare. If you are worried about a child who is becoming sick and not recovering, then do remember to contact 111, talk to GP or an emergency contact 999 because the emergency services in the NHS are there for sick children and it's important for this and other conditions. Although very rare, I must emphasize rare, that you come forward to seek treatment and diagnosis as quickly as possible. Matt Hancock: (53:55) Thanks Steve. Chris Whitty. Chris Whitty: (53:57) Just really to reinforce what Steve said, this is a very rare situation but I think it is entirely plausible that this is caused by this virus at least in some cases because we know that in adults who of course have much more disease than children do, the big problems are caused by an inflammatory process and this looks rather like an inflammatory process, a rather different one, but therefore given that we've got a new presentation of this at a time with a new disease, the possibility, it's not definite, we need to look for other causes as well. But the possibility that there is a link is certainly plausible. But back to Steve's overriding point, numbers are very small. Key thing is if parents are worried then phone up and get advice. Very rare. Speaker 6: (54:40) Ask a very quick follow up on the restoration. Matt Hancock: (54:42) Yes. Speaker 6: (54:44) The NHS needed to free up about 30,000 beds to ensure it was ready to deal with the first peak and has been able to do so but has he used a lot of capacity and that's rearranged a lot of things. How many is it going to need to keep open in case of a second peak or other returns of the virus because that's clearly going to be a big constraining factor along with the staff who staff the beds on what it can get through back to normal. Matt Hancock: (55:09) Well, one of the principles of the tests we've sat before we make any adjustments to the social distancing measures is that we shouldn't risk a second peak for many, many reasons. The direct impact of course, but also because a second peak would mean that we would have to halt the restoration of the NHS for non COVID treatments and that has an impact itself on the health of the nation as Chris Whitty first set out several weeks ago in terms of the indirect death rate. So we've got to make sure that we don't have that second peak. Therefore, the NHS is of course making sure that it can reopen where that locally is appropriate given the local amount of pressure on the system and also take into account the Nightingale hospitals. Matt Hancock: (56:08) In fact, I'm going to answer a question that was asked previously by Beth Rigby I think, but I didn't answer, which is that the Nightingale's are not going to be used for non coronavirus purposes because they are precisely set up and designed to deal with people who are intubated and are sedated. But the fact that they're there does help us to restore more of the core NHS and get that going as much as possible. Were you coming in again? Speaker 6: (56:46) I was just going to say very funnily would you see them all the Nightingale hospitals, all seven or I think it's seven or eight now to be used in that way? Matt Hancock: (56:55) In the first instance, yes, but as we go through this we always keep things like this open to review to work out what's the best way to use the resources at the nation's disposal. Steve. Steve: (57:08) Yeah, so I think the Nightingale's in specifically have been a very important part of the flexibility that the NHS has put in place to manage the surge. Remember, it's only a few weeks ago that we were really concerned that we would see a surge in patients, particularly those that needed critical care that would go beyond even the surge capacity we could put in place in our existing critical care facilities by surging into theaters and recovery areas. So the Nightingale's I think are real proof that the NHS can be agile and flexible and can change its model of care in a very short period of time. Clearly, we want to keep them there because although the peak is reducing, we still feel that we need to have them there as the insurance policy for COVID patients. Steve: (57:55) But as we go forward, we will be keeping them under review as the secretary of state has said and of course we're only into the first week or so of coming off a plateau and a peak. And as you would expect all that work, again, as the secretary of state has indicated is being done at the moment to plan capacity going forward. And the restoration of services is a really important part of that, which I'm absolutely sure will occur hospital by hospital and region by region because infection rates are a bit different everywhere and because different organizations have stacked up to manage the surge in slightly different ways. But the key point is that we are now in a position to bring those services increasingly back on stream. Matt Hancock: (58:38) If you'd asked me a month ago, Dave, whether we would be having this discussion now about the restoration of those parts of the NHS that we had to pause in order to put capacity towards treating coronavirus. And the question is, how much NHS capacity do we need to keep in hand in case there's a second outbreak, which we don't want to risk. And that the NHS had not in the meantime, been at all overtopped by demand in any instance, then I think we'd be ... If you told me that a month ago, I would be very pleased with where we've come to on the NHS capacity because that is absolutely core to the principles of this country is that if you need NHS treatment, then you get it. And we've managed to keep that principle throughout this vast crisis. Okay. Thank you very much indeed. That concludes our Downing street briefing for today.