United Kingdom Coronavirus Briefing Transcript May 15 with Matt Hancock

Matt Hancock: (00:04) Good afternoon, and welcome to Downing Street for the daily Coronavirus briefing. I'm joined by the deputy chief medical officer, Jenny Harries, and by NHS England's medical director for primary care doctor Nikki Kanani. First, I want to take this chance to update you on the latest Coronavirus data. 2,353,078 tests for Coronavirus have now been carried out in the UK, including 133,784 tests yesterday. 236,711 people have tested positive for the virus, an increase of 3,560 since yesterday. 10,024 people are currently in hospital with Coronavirus. This is a 13% fall from the same time last week, and very sadly of those who've tested positive across all settings 33,998 people have now died. That's an increase of 384 since yesterday, and we mourn each one. Matt Hancock: (01:17) The number of deaths is falling each day in all settings, thankfully, and we are past the peak of this virus, and I just want to take a moment to remind everyone about our plans for this second phase. If we have slide one please. We've set up the new COVID Alert Level system, that's the five levels of threat based on the R value and the number of new cases. The alert level intern guides the social distancing rules, which are vital in our efforts to control the virus. A higher alert level means stricter rules. Throughout the lockdown we've been at level four, which means that COVID-19 is in general circulation, and transmission is high, or rising exponentially, but thanks to your shared sacrifice, we've brought R down cautiously, and carefully, and responsibly. We're now in a position to start moving to level three. Matt Hancock: (02:20) If we could get to the next slide, please. We've set out the first of the three steps that we'll take carefully to modify the social distancing rules, and start to restore freedom to this country, all the while avoiding a disastrous second peak that could overwhelm the NHS. At each step we'll closely monitor the impact on R, on the number of new infections, and on, of course, all available data, and we'll only move to the next step when we judge it's safe to do so. In the first step as of this week, if you work, but can't work from home, you should speak to your employer about going back in. People can now spend time outdoors and exercise as often as you like, and you can meet one other person from outside your household in an outdoor public place, but please keep two meters apart. Matt Hancock: (03:16) This weekend with the good weather, and the new rules I hope people can enjoy being outside, but please stick with the rules. Keep an eye on your family, and don't take risks. Next slide please. We've also updated what we're asking people to do, which is to stay alert, control the virus, and save lives. For the vast majority of people staying alert still means staying at home as much as is possible, working from home when you can, limiting contact with people, keeping your distance if you go out, two meters, wherever possible, washing your hands regularly. This is still the single most effective thing that you can do to keep yourself safe, and of course, self isolating, if you or anyone in your household has Coronavirus symptoms. Matt Hancock: (04:08) By staying alert and following the rules, you can play a part in the national effort, getting R down and keeping R down, controlling the virus so that we can save lives, rebuild livelihoods, and start to recover our freedom as a nation. From the start of this crisis across the world, because this disease has a bigger impact on the elderly, there's been a huge need to protect people in care homes. We've worked to do this in this country right from the start of the crisis. This morning's information from the ONS once again reminds us that care homes do so much to look after our most vulnerable people in their frailty towards the end of their life. Many of you watching this will have a loved one in a care home as I do, and I know how worrying it's been. Matt Hancock: (05:06) I want to tell you what we've been doing to protect people in care homes throughout the crisis. If we start with the data, in April 31,203 people died in care homes, of whom 11,560 died with Coronavirus. I'm grateful to the ONS for having responded to the requests to put extra resources into understanding, and measuring all this. Right from the start it's been clear that this horrible virus affects older people most. Right from the start, we've tried to throw a protective ring around our care homes. We set out our first advice in February, and as the virus grew, we strengthened it throughout. We've made sure that care homes have the resources they need to control the spread of infection. Social care is a devolved matter of course, and this week we've made a further 600 million pounds available to care homes in England. This comes on top of the 3.2 billion we made available in March, and April, and the 712 million pounds we've made available to the devolved authorities, that's 369 million extra for Scotland, 223 million extra for Wales, and 124 million for Northern Ireland. Matt Hancock: (06:28) We've put extra infection control procedures in place, and prioritized testing in care homes. We test any resident returning to a care home from hospital, and all residents with symptoms, and all social care colleagues, and members of their households if they have symptoms. Together, these measures have saved lives, and protected 64% of care homes, almost two thirds from having any Coronavirus cases at all, and where there are cases we've taken extra measures to protect residents and staff with local public health officials playing such a critical role. Now we have capacity for well over a hundred thousand tests a day. We're extending testing coverage still further. All care home residents, and staff in England, both of those with symptoms, and those without are now being tested. Matt Hancock: (07:22) In fact, we'll test every resident, and every member of staff in our elderly care homes in England between now and early June. To get those tests to where they need to be, we've set up an easy to use digital service on gov.uk, allowing care home managers to apply online for the testing kids. Next, we've strengthened the NHS support available to colleagues in social care, and this is what Nikki is here to talk about today. Throughout the NHS has been supporting care homes with infection control training, and advice, and support on, for instance, PPE usage. We're putting in place a named clinical lead for every care home in England. These leads are already connected, and we'll check in regularly to assess residents and support care home staff with clinical advice. This is the most intense support and scrutiny that care homes have ever received. Matt Hancock: (08:19) In some cases for residents who need to see a GP, a video consultation may be safer and just as effective, so the NHS is also supporting care homes to introduce the right technology. This same technology can, and is being used to be able to help residents stay connected to their loved ones, something I know is important, both for their wellbeing and for ours. Third, we're making sure local authorities play their part. We're now requiring councils to conduct daily reviews of the situation on the ground in local care homes. These reviews ensure that every care home gets the support they need every single day, and we're requiring care homes to ensure the flow of timely and accurate care home data, so local and national government can support, and where necessary challenge, and act if that's what's needed. Matt Hancock: (09:12) As a result of all this, and the work of so many people across the social care system, and across the NHS, and across local government, two thirds of England's care homes have had no outbreak at all. The number of care homes reporting their first case each day has fallen from a peak of 219 to 59. I'm glad to report that since the peak, the number of COVID-19 deaths of people in care homes has halved, but whilst this is progress, there is so much more to do, and this crisis has also demonstrated the imperative for reform. It's shown the importance of long standing calls for closer working between health and social care. It's acted as a catalyst for integration and shown the benefits of it on the ground. Information support mutual understanding between health and social care are flowing better than ever before, helping to break down some historic barriers despite the system, not because of it, and my view is that health and social care have a common mission to care for people, but too often in the past bureaucracy has held them apart. From the start, we've worked incredibly hard to throw that protective ring around our care homes. Yes, it has been difficult. These viruses reserve their full cruelty for those who are physically weakest, the elderly, the frail, and the already sick. All those who most rely on human contact. People who live in care homes are amongst our most vulnerable citizens. Matt Hancock: (10:53) We'll do everything humanly possible to protect them for as long as they are threatened by this virus, and thanks to the collective efforts of everyone watching we have passed through the peak, but there is still a long road ahead, so stay alert, control the virus, and save lives. If Jenny can now take us through the rest of the daily data. Jenny Harries: (11:18) Next line please, thank you. Today we are hearing a lot about the R number. It's important that the public can see that. For the first time this afternoon we're publishing the R number. We want to keep this below one, and as you can see R is the average number of additional people infected, so while it's one pandemic and epidemic in this country will stay flat. If it goes above that number, we will start to see an increasing number of cases, and we may experience the second peak. It's really important that we keep monitoring it. Having said that you can see that there's quite a range there, an 0.7 to one in the estimate of R, and this is for a number of reasons, partly because a number of different models are used to model this data, and it's important that they challenge each other, and that we get the consistency of that. Jenny Harries: (12:12) Partly the data comes from historic data. We obviously can't predict precisely, so we're estimating it on different sources of information, so things like hospital admissions that have happened historically, and then, I think, thirdly, importantly, we know that we have slightly different R values relating to some areas of risk. Obviously, in recent weeks care homes have been heightened interest, hospitals also, and we keep an eye on those. This is very much a national average, but it's quite likely in the community across the country that where people have been working really hard on the social distancing measures, that our value will be lower. This is an average across the country, and on the left hand side you can see it's important that we take the R value in the context of... Jenny Harries: (13:03) ... the case numbers that we're seeing across the country and from the ONS survey, which is a community survey conducted in people's homes on the longitudinal basis. So sequentially, the average proportion of the community in England that had COVID was 0.27%, upper limit of that, about 0.4. So a maximum of about one in 400 people. And then right across the country, therefore in England, a broad estimate of around 148,000 people with COVID at any time. So that's coming down. Next slide, please. So the data on the left is from Google mobility data. Obviously, there's a little bit, we can't control exactly who's uploading that, but it gives us a pretty good indication of people's movements. Jenny Harries: (13:55) And you can see that early March, people were moving as normal and we've seen a significant drop off as social distancing measures have come in. That's continued to be maintained so people are only going out in the main for permitted activities. So some people going to work as permitted, but many staying at home. Going out for grocery and pharmacy, which are essential visits, and then a rise in the use of parks coming forward now. And we anticipate that within social distancing measures, that will increase. And on the right hand side, you can see the ONS opinion's in lifestyle survey. And that shows that 44% of employed adults are actually working from home compared to 12% last year. This is a change in habit, and we're expecting that people will maintain that and advising that they should. Jenny Harries: (14:48) And it's probably going to be a successful way forward for us to control many of the social distancing measures over the next few months. 80% of adults only left home for those permitted reasons that we can see on the left and 91% of adults have avoided contact with vulnerable people. So everybody is trying to keep each other and our vulnerable people safe. Next slide, please. Here we can see the slide which represents current situation with testing. So 133,784 tests were completed up to nine o'clock on the 15th of May. So this includes lab tests, those were posted out under satellite testing, and you can see the rise there going forward on the top chart at the right. So we're heading towards two and a half million tests in total now, and we've had 3,560 cases confirmed over the last 24 hours, which brings the UK total to 236,711. Jenny Harries: (15:51) And the graph on the bottom left, despite that increasing testing and therefore the likelihood of finding new cases is continuing to come down. Next slide, please. This shows our data from hospitals. So the estimated emissions with COVID in hospital is now down to 910, on the 13th of May. So that's down from over 1,000 the week before. And the graph obviously on the right is showing that clearly, the downward trend on the graph is down, but it's slow and careful, and therefore we need to maintain our social distancing measures. But the biggest concern or one of the big concerns right at the start of the epidemic in the country was about critical care bed capacity. And in fact, only 19% of our critical care beds are occupied now with COVID-19 patients. And that pattern is replicated across all critical care usage in the UK. Next slide, please. Jenny Harries: (16:54) Here, we can see people in hospital and the geographical distribution. And I think on the bottom right hand side, where London has had a severe and sharper rise in the number of cases in a highly densely populated area, that has come down now. Other parts of the country are seeing a slightly different shape to their epidemic... Which for us, these are across all our settings, not just the hospital settings. But again, you can see that the rolling average, which is a better measure as the deaths are reported at different times shows that those deaths are steadily decreasing, which is obviously good news and we need to keep our social distancing going. Matt Hancock: (18:18) Thank you very much, indeed. Questions. Firstly, from the public, we have Susanna from Oxford. Susanna: (18:28) The government's COVID alert level one is eradication in the UK. Is this a realistic policy target? Matt Hancock: (18:37) Well, that is a great question. And Jenny, as the scientist and epidemiologist, you're best place to answer it, I think. Jenny Harries: (18:45) Thank you. So it's an ambitious target, I think, but then I think if we're dealing with something as serious as COVID, we want to be ambitious. You may be referring to the WHO announcements over the last few days where I think the reality of COVID, in global terms, not just in the UK, was put forward. And I think it's fair to say, there isn't an immediate easy outcome to this to get us to level one. Smallpox is the only infectious disease where we have actually eradicated a disease. But of course, there is an example there. So I think having that ambition is good. The key things, obviously, that we need to drive this forward in the longterm are understanding the immunities, and not just understanding our antibody response, but what that means in terms of maintaining immunity in a population over time. Jenny Harries: (19:39) And obviously treatments in the short term for treating people, but to eradicate it, we really need vaccine as well. So all of those programs are ongoing, but clearly the immediate effort is to reduce the number of cases that we have and to ensure that we dampen down the epidemic in the UK, and that's what we're doing at the moment. Matt Hancock: (20:00) Thank you very much, indeed. Next question, which has been sent in by Anna from Worthing. Anna from Worthing asks, "After many years of waiting for a pay rise, nurses are frustrated and feel very devalued due to a neverending unrecognized financial pay they deserve. Would this crisis be a strong evidence for the government to finally recognize that nursing is a highly skilled profession and it deserves decent pay?" Well, I think I'm best placed to answer this one, Anna, and I agree very strongly that nursing is a highly skilled profession and deserves decent pay. And we put up nurses' pay last month and in fact, last year, we had the fastest rise, the biggest rise in the pay, especially for nurses when they're starting their career and the lowest paid nurses who got a pay rise very significant of over 15%. So there has been a significant pay rise for nurses and I think one of the things the crisis has shown is just how much the nation values our staff across the health and care system, including nurses, and when it comes to how we reward people for their efforts in this crisis, what I can tell you is that as the health secretary, I will be making sure that we fight to have that fair reward. But I think it's worth noting the increases that have been put through in the last couple of years, and it is worth all of us coming together to show the value with which we hold nurses and everybody else who works across health and social care. Thank you for your question, Anna. Next question is from Allison Holt of the BBC. Allison Holt: (22:03) Secretary of State, today's official figures show the very high number of deaths in care homes, and also in hospitals of care home residents. The measures you've introduced today, aren't they too little too late? Matt Hancock: (22:18) Well, what I set out today are the things that we've been doing throughout this crisis to support people in care homes. And in the last couple of weeks, we have, as you say, added further measures. I've set them all out today. They've in fact, been put in place over the period of the crisis. And making sure that we give that support that's needed, the extra money building on the money that we put in right at the start, the infection control processes, building on the infection control processes that we put in right at the start and have built throughout. It's all part of doing everything we can to support people in care homes. And the good news is that the number of cases, the number of new cases is coming right down, but there is clearly a long way to go. And I'm also going to ask Nikki to comment on this strengthening of the link between the NHS and in particular, GPs and care homes, to make sure that we get that clinical support in every care home. Dr. Nikki Kanani: (23:26) Yeah. Thank you. Thank you, Matt. Look, it's a GP. I know that it's really important to offer care to all of our residents, whether you're in a care home or you live at home, you live in a big house, small house, whatever it is, that's what your GP practice is there to do. And around the country, the vast majority of practices look after their care homes in a way that you'd want your family member to be looked after. As a GP, if I talk a little bit about what happens in practice. So often, GP practices, or working with other GP practices come together to build what's called a multidisciplinary team. So members from the practice, members from pharmacy, our allied health professionals, social care colleagues, community services colleagues, come together to offer support into care homes. And it's really important that we recognize that it's a multidisciplinary team that actually is needed to make sure that our care home residents stay safe. Dr. Nikki Kanani: (24:22) Importantly though, we've really ramped up that support over the last few weeks and months to make sure care home residents get the care that they need. Making sure that our care home managers are able to have a regular check in, whether that is with the GP or the lead professional in the team. And that might be an advanced nurse practitioner, it might be a geriatrician. It has to be the right person for the job. And we've got some incredible examples in Dorset and Frimley where this is happening really, really well. We're doing a range of other measures to sure that care and residents are well supported. So that is a working with our clinical commissioning groups to make sure that medications provision is really optimized into care homes. And we have a suite of digital innovations there to back our care homes as well. Dr. Nikki Kanani: (25:07) So you've mentioned a few of them, Secretary of States, but making sure that care homes have NHS, good internet access, the digital tablets are absolutely revolutionary because it means that we can keep our residents and staff safe while we look after our care home residents through remote monitoring, and we can use those portals for residents to connect with their family and their loved ones as well. I think it's really worth mentioning as well that we've asked every part of the country to offer infection prevention control trading to care homes. So that's how to use PPE, how to don and doff safely, how to manage social distancing in what can be quite busy areas. And we've got 100% coverage around the country of these super trainers who are going out to look after our care homes. So it will take the whole system to look after our care home residents, but absolutely something the NHS has committed to doing. Matt Hancock: (26:00) Thanks very much. Sam Coats from Sky. Allison Holt: (26:02) Can I just do a followup, please? Matt Hancock: (26:03) Sure, yes. Allison Holt: (26:06) Yeah, if I may. If the R number has increased, are you rethinking the easing of the lockdown? Matt Hancock: (26:14) Well, we're constantly keeping the R under review, and it is one of our five tests, is for R to be below one. The latest evidence that Dr. Harries has presented, is that the R is between 0.7 and one. So we don't think that it's above one, we think that it is in a range of between 0.7 and one. So that still meets that test. But of course, we're constantly looking at and updating all of the information that we see. Sam Coates from Sky. Sam Coates: (26:55) Secretaries, thank you. Given our lives are determined by the R rate, why do you collectively appear quite relaxed that the R rate is up today? And the latest R rate suggests that transmission of the disease might not be reducing in the wider community, because your range includes one, flat. Is it because despite its presentation by the prime minister, it's actually not the best measure to use for making decisions for the whole country? Because it's skewed by hospitals and care homes and the tragic situations there. Or should we reconsider England's lifting lockdown timetable, and does it help that the data is two or three weeks out of date? Matt Hancock: (27:33) Well, those are really, really good questions, Sam. And if I'll answer a couple, and then hand over to Dr. Harries. The first thing I'll tell you on is on the timing. This is based on data from a couple of weeks ago, because of the way that it's measured, but also from the survey data that the ONS have published. And as that survey grows, the measure of R will become more timely, but even in countries that have had large scale survey testing for some time, like Germany, there is still something of a lag. It is an incredibly important figure for policymakers, but it's one data point to look at, alongside also the level of new cases, as well as the R, which is the rate at which they're changing. Matt Hancock: (28:27) But I think a change in the range of R, that still encompasses most of the values that we think R could be, is very important to look at. But overall, this report from the scientists says that the R is not likely to be above one. Jenny Harries: (28:50) Sure. So, reinforcing those comments really, I mean, R is a very standard way of looking and comparing what's happening, and it's a really important measure. But the real outcome that we're looking for is a reduction in number of cases, and getting rid of the epidemic in the UK. So that is our focus, not R, R is a representation of what is happening in that fight. So it is very important, but I think picking up some of the statistics around this, the R that you see presented has confidence intervals around it, how confident we are in it. As the Secretary of State has said, as we go forward, the ONS survey will give us key points of infection across the country, which will become increasingly important. The more points we have, the narrower our confidence concerns are, and the clearer we are that we know exactly how many cases there are in the UK. Jenny Harries: (29:45) So it's not just the R value, it's the triangulation of all of the evidence that we have. And I think the final point about the R value is, when it's created it's really important that different models and different estimates are put together. And so you will find published on the web now, slightly different variations. And that's really important, because it challenges. If there are different outputs from different models, it's an opportunity for us to look and say why is it different, either across the country, in a locality, or because the makeup of the model, the data streams which are going in, are slightly different. So it's an important measure, but it definitely isn't the only one. Matt Hancock: (30:29) Thank you very much. Sam Coates: (30:31) Some acknowledgement, that it does look strange, that on the day that the R rate is published and is going up, you're about to heading to a weekend where in England, at least, lots of people are going to go out on long journeys and enjoy the countryside. Are you absolutely confident that that's the right decision? Matt Hancock: (30:49) Well, we set out the five tests in advance. And one of the tests is that R isn't above one. And in fact, so the data that has been published actually confirms that test rather than the opposite. But everybody can play their part in keeping R below one, and pushing R down. And you can do that by following the social distancing rules. So if you do go outdoors, do it only with members of your household, and keep two meters away from others who aren't in your household. And those social distancing rules are incredibly clear, and they will help to keep us safe. Ayshah Tull from Channel Four. Ayshah Tull : (31:38) Thank you, Secretary of State. There have been concerns raised to us about care homes that can't apply for these tests on the portal. They say that it only applies to people with dementia and over 65's. But that leaves out a very vulnerable group of people under 65 with multiple health conditions and problems, and also those with learning disabilities. Why have these people been left out? Matt Hancock: (32:02) Well, those who are in care homes for working age people, as opposed to the elderly care homes, of course also need support, and often also are clinically vulnerable. It is true that age is the biggest factor in terms of your risk towards Coronavirus, but absolutely we need to make sure that care homes for people of working age also have access to tests. And we're rolling that out too. Jenny Harries: (32:36) If I could add to that. Shall I answer first? And I can see you're trying to offer another question. I was just going to add to that, because I think as the Secretary of State has said, prioritization at the start was clearly we need to manage risk, that's how we approach clinical risk. And different elements of risk were there, so care homes in particular, very, very stark variation in risk for the elderly, particularly 70, 80, 90. So it's really quite stark in comparison to all of the variables. Jenny Harries: (33:11) But in relation, I actually had an email yesterday from somebody with a unit in Nottinghamshire, trying to implement some very careful, really good work with his residents and staff. And I've actually put them in touch with the Director of Public Health. Now, I wouldn't suggest everybody does that immediately, but the point I wanted to raise is, if there are concerns about particular practices or prioritization that's needed, there are local oversight of that. And directors of public health are working with the local NHS, and local authority Director of Adult Social Care, to make sure that where there are priorities, that particularly if there is an outbreak or something like that in a non elderly care home, that they can access tests. Matt Hancock: (34:01) You had a follow up? Ayshah Tull : (34:03) I did have a follow up. I just wondered, a lot of people that I've spoken to say that they feel like they've been forgotten. And I wonder, do you think that you're putting the people with learning disabilities at the back of the queue? Matt Hancock: (34:13) No. I don't think that's the case, because we've been throughout this, ensuring that the guidance that goes out is to all care homes, of course. And one of the things that I've been very worried about as Secretary of State throughout my time in this job, is to ensure that we get the support to people in care homes, for those of working age as well as elderly care homes. It is so important that we do that, and we have done that through this crisis too, but we've got to make sure also that we follow the clinical advice in terms of the different risks that people face. And so if there is an individual care home that thinks they're not getting what is clinically needed, then of course they should get in contact, and they should, starting with the local Director of Public Health, but ultimately they should raise that. But we've got to follow the clinical advice in terms of how we apply the testing capability that we have. Jenny Harries: (35:22) And just to add onto that, there's some very good resources in terms of specific advice and guidance written for learning disabled as well. So I think it's not just about carers and parents and guardians or care managers, it's very much for individuals themselves. Matt Hancock: (35:39) Thank you, Ayshah. Michael Smith from the Daily Mirror. Michael Smith: (35:46) Good afternoon. I've got two quick questions, firstly to the scientists: With the government hoping to start reopening schools in the next couple of weeks, you've no doubt carried out some quite complex modeling of the risks of taking that action. Could you give me an idea of what the government considers to be an acceptable level of risk to teachers and parents, in terms of increased infections and potentially deaths? Michael Smith: (36:15) And also to the Secretary of State, for years, schools have been telling the Daily Mirror that they struggle to afford basic equipment, like pens and pencils for children to use in the classroom. Social distancing is going to be hard work in schools. It's hard to get kids to wash their hands in the best of times. And before the lockdown, teachers were telling us they didn't have enough soap and hand sanitizer to go around. If a teacher looks at all, this looks at their own school and decides the risk to their staff and to their community is too great to reopen their school, what consequences would they face? Matt Hancock: (36:58) Well, on the second point, and then if I ask Nikki and Jenny to comment on the first question. We think it's really important that this is a team effort. It is an incredible challenge that we face with the reopening of schools. I think everybody understands that trying to get schools open in a way that is safe, and only in a way that is safe, that is really important for children's education. But we've got to do it in a way that that keeps the control of the virus. Matt Hancock: (37:32) Now, the good news is, in the same way that it's terrible news that this virus impacts on the elderly so much, the good news is that it seems to spare children in almost every case. Not quite every case, but almost every case. And so the risk to children is much, much lower than to anybody else in society, to any other age group. Unless, certainly if you don't have underlying health conditions. And that means that we are able to propose going down this route of reopening schools. I wouldn't support a proposal to start to reopen schools unless it was safe to do so, and it is safe to do so. And as you say, Mike, there's an awful lot of work to do in each individual school, to make sure that that is done in a way that's safe. Dr. Kanani: (38:35) Thank you. So, I'm a mom of two school aged children, and can I just thank the teaching staff actually, for responding so quickly in such an unusual situation. It's not something that they would have ever had to deal with before, and they've been really quite phenomenal. But risk is relative, isn't it? And we have to think about the wider risks to children and families as well. So as you said, we wouldn't send children back if it wasn't safe to do so. But we're doing that in a careful, phased way, and monitoring the whole time- Dr. Nikki Kanani: (39:03) ... o make sure that children and families are well. But actually, some of our children who are more vulnerable, who need more support, need to be back in school to get the benefit of both the social environments, but also the physical space as well. So it's really important that we carefully get our children back to school because actually, that is what's going to be good for them in the long run. Speaker 4: (39:24) Thank you. [crosstalk 00:39:24]. Jenny Harries: (39:24) Should I add to that? So I think, just sort of trying to put the risk in perspective, if currently we have say two or three in a thousand of our population with infection, in the proposed timeframe coming forward in the next couple of weeks, that's likely to halve. So I think there's a lot of anxiety, I think, around this, but people need to think through, in an average, I don't know, infant school with a hundred children, the likelihood of anybody having this disease is very small and diminishing with time. So I think we just need to keep that in perspective. Jenny Harries: (39:57) The other thing is, picking up Nikki's point, on a public health perspective, there are all sorts of risks. And children who have been invited back to school are at key points of their education, and their longer term health risks of not getting good basic education, which then takes them into work employment in adult life, and gives them the prevention opportunity from longterm conditions is really very important. Jenny Harries: (40:21) But I think the concerns that you're particularly referring to are around teachers and children in enclosed environments, if you like. And there is very good advice has come out from Public Health England, lots of input from pediatricians, as well, in a hierarchy of controls to manage that risk. It's not simply about a bit of kit. It's actually about how you manage groups. So in many ways, managing them more as if you were a family, where you wouldn't think about putting on PPE or handling it different ways, but you keep in those groups, you can distance within the school. And in fact, school environments for the reasons which Nikki has said, which are teachers are brilliant. I know, as a parent, they're often much more productive than I was at trying to get my children to wash their hands consistently and practice good hygiene. So there's some really strong guidance out there to try and support this. And the background risk of disease is diminishing all the time. Speaker 4: (41:21) Thank you, Andy McCaskill from Writers. Andy McCaskill: (41:23) Good. This is a question from the Secretary of State. The prime minister said in Parliament this week that the government ordered a lock down of care homes before the national lockdown on March the 23rd. But the guidance to care homes before then was issued on March the 13th, which suggested a restriction only on people infected with COVID and those feeling sick. And your own department told us that the only directive on a ban on care homes came on April the 2nd. That's 10 days after the national lockdown. So based on the words of your own department, do you think the prime minister should correct what you said in Parliament? Speaker 4: (42:03) No. On the 13th of March, we did introduce this extra guidance. And on the basis of that guidance, many of the care home providers, for instance, KUK, at that point stopped visitors. Now the challenge with much of the management of care homes from a national level is that their accountabilities are local, and it is a first and foremost responsibility of local government. So we did bring in that guidance on the 13th. As a result of that, many care homes did stop visitors. As I said in my opening remarks, we strengthened that guidance all along. And the point that I think I tried to articulate in my opening comments, is that we've tried to build infection control and the support and the protective ring around care homes, right from the start. Speaker 4: (43:05) And Alison Morris, from the Irish News. Andy McCaskill: (43:09) Just something on the point of transparency, a lot of relatives have told us that a lot of care homes are resisting telling them the number of infections or even the number of deaths from coronavirus in care homes. I'm just wondering whether that information should be made public to the families and the general public. Speaker 4: (43:29) Yes. I didn't know about that. And it's certainly something that I'd like to look into. And because our overall approach in this is that transparency is the best way forward. We've asked the CQC and now the ONS to come in and do more, to be transparent about the impact of coronavirus. Unlike many countries, we put deaths of people, whether they die in a care home or in the wider community or in hospital, into our overall figures. We've taken an approach of maximum transparency. And so I can understand why people have been in contact with you about that. And it's certainly something that we will take away. Speaker 4: (44:13) Jenny? Jenny Harries: (44:14) I was just going to add, I think we just need to think really carefully about what a care home is. Because as we've heard earlier in this, it might be a learning disabled care home. They're not all big care homes. Some of them are really quite small, and we need to be careful about individual clinical information and families as well. Jenny Harries: (44:32) And I was just going to support this. So there's an ONS survey, which you may well have seen, out today. There are reports coming through from CQC. So there is a lot of work, trying to make the deaths information much more understandable, I think, because it's clearly quite difficult, with individuals who have multiple diseases, for example. When a death is registered, it's not always easy to pinpoint, as a doctor actually, what the overriding cause of death is. I think it's quite likely that there are more deaths associated with COVID-19 in older people because we know that the risk, the age is a very, very significant risk. But they will have many other illnesses, as well. So it doesn't necessarily mean that's what they have died from. It's quite right, that there is interest in this, and there is additional work currently ongoing, to look to see how older people and individuals from care homes have been using hospital services, for example, along with how the rest of the population have. Some of that usage has dropped, and it's important we understand that that was appropriate in those individuals. Speaker 4: (45:45) Thanks. Andy, is that... I didn't realize you wanted to come in again. I hope that's answered your question. Andy McCaskill: (45:48) Thank you. Speaker 4: (45:51) Okay. Thanks very much, indeed. So finally, we'll go to Alison Morris from the Irish News. Alison. Alison Morris: (45:58) Aye, Secretary of State, as you will be aware, businesses impacted by the lockdown measures are expecting a very slow recovery. This week, members of the devolved executive were braced by government. The [inaudible 00:46:09] border posts will be required within Northern Ireland for goods destined for the EU market, after the prime minister previously insisted that no such checks would be necessary. What do government intend to put in place to mitigate this double pressure on businesses in Northern Ireland, to have both the COVID lockdown measures and pending [inaudible 00:46:27] border checks to contend with? And can I also ask the deputy chief medical officer, given that the devolved regions are now leading up, dying at a different pace, and with varying R rates, will she be advising COVID risk assessments, temperature checks, and advice to self isolate, et cetera, at ports in our ports for those traveling either in or out of Northern Ireland to other parts of the UK? Speaker 4: (46:51) Well, thank you very much indeed. On the first subject, I know that the prime minister spoke to the [inaudible 00:46:58] this afternoon, a very positive discussion, and we fully intend to meet all the commitments that we've made, in terms of delivering on the result of the referendum. Jenny, do you want to answer the- Jenny Harries: (47:14) Yes, well, clearly it will be for Secretary of State and political colleagues to decide on the policy at borders. But I think from a scientific perspective, as a scientist, as UK CMO teams, we work very closely in understanding the science. And there may well be times, whether it be within England or across the UK countries, where potentially, differential policies will apply as we look in more detail and get more granular insight, as we dampen down the epidemic right across the UK. So I think that is all entirely appropriate. I don't think, actually, although you're hearing site differences in timing or announcement, actually the science that's underlying it, I'm sure the public can see coming through just the same. So things like the risk of being outside is minimal in managing that potential change in an R value, for example. Jenny Harries: (48:08) And I think nearly all the UK countries are recognizing that there are slightly different epidemic curves as we showed in the slides earlier. So I think those conversations will keep going, the science and depending it is the same. And we do need to respond to our different populations, taking account of all of the things like density of population and travel patterns, as well. Jenny Harries: (48:30) On temperature, I've spoken about this before. The evidence around temperature checks, whether it be on borders, or whether it be going into work, and particularly for COVID, is not a very valid intervention in terms of scientific prevention. If you have an incubation period up to 14 days, the chances of you finding somebody with that temperature on the minute that they walk through a border or the doorway to work is very small. And in fact, we know that quite a large proportion of people who have symptoms for COVID actually do not have a temperature, at least in the early symptomatic phase. So much more important, I think, that we focus on people taking themselves out of their work and social environments, as soon as they feel that they have any symptoms at all. Speaker 4: (49:14) Fantastic. Thank you very much, indeed. And that ends today's coronavirus daily briefing. Speaker 5: (49:26) See the headlines as they happen, and watch BBC News live in the app, and get the full story with bbc.co.uk/news. Follow the story for all the latest with BBC News.