Wednesday 22 July

 

1. PMQs

Johnson/Starmer exchange

 

Today's exchange focussed predominantly on the Russia report and also on the persecution of the Uighur people in China.

 

Health related questions

 

Tom Randall MP (Con): will true numbers of COVID-19 deaths help improve confidence and isn’t the distinction of those dying with or of COVID-19 important to understanding this disease? PM says it is important for a proper statistical assessment at the conclusion of the epidemic.

 

Ben Lake MP (PC): will the PM remove VAT on non-medical face masks? PM says those which meet the PHE guidance will have zero VAT.

Caroline Nokes MP (Con): COVID-19 disproportionately affects BME people, men, elderly and overweight. What steps are being taken to move people away from fat-shaming and BMI? PM says obesity needs to be addressed.

 

Layla Moran (LD): 900 submissions to our inquiry by the APPG on coronavirus, including BMA and NHS Confed. Will the PM take the recommendations seriously? PM says he is happy to see whatever is produced.

 

Other topics

 

• Digital connectivity
• Brexit
• Scottish independence/devolution
• Education
• Economy
• Levelling up
• Families
• Housing

 

Tuesday 21 July

1. Health and Social Care Committee oral evidence: Management of the Coronavirus outbreak
2. Science and Technology Committee oral evidence: UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks

 

 

1. Health and Social Care Committee oral evidence: Management of the Coronavirus Outbreak

 

The Health Select Committee heard from the following witnesses in its first session – below is a summary.

 

Professor Sir John Bell, Regius Professor, University of Oxford

Professor Sir Paul Nurse, Director, Francis Crick Institute

Professor Devi Sridhar, Professor of Global Public Health, University of Edinburgh

Professor Sir Jeremy Farrar, Director, Wellcome Trust

 

• There was agreement that public health has been neglected and that the UK let down its guard. Jeremy Farrar said that it was clear in January that this virus was not like SARS 1, it was spreading quickly and asymptomatically. There were no diagnostics, no immunity, no vaccine, no treatments and it was v infectious.
• Other countries in Asia have learnt from previous pandemics. Test and isolate structure were in place in Jan/Feb but they weren’t ramped up. Testing capacity was nowhere near enough. The UK was slow to put testing and PPE in place and this led to the virus taking off in a different way than in some other countries. There wasn’t enough urgency in the UK and its regrettable that SAGE wasn’t more blunt in its advice.
• Paul Nurse said that there was not good governance in place – not clear who is responsible for what. He said the Crick had done some research which should that up to 45% of health workers were infected at the height of the pandemic – they were not being tested systematically.  
• He didn’t think that false positive tests are much of a problem – their research shows that they have 1 false positive for every 5000.
• John Bell said that the failure to aggressively approach testing was a major oversight. PHE was out of its depth. There was a failure to test staff/patients in hospitals.
• There was a discussion about the flu vaccine and whether this is being ramped up enough for this winter – there is a need to get more people vaccinated, the confluence of flu with COVID will be a nightmare.
• Professor Devi Sridhar said the decision to shift from contain in March was a disaster. We could have put robust measures in place (eg travel restrictions, masks, distancing). She was asked if she agreed with the PM about avoiding a second lockdown; she said that it is no good promising this, you don’t know. Only place this might work is NZ. There is a need to supress the virus to zero – then we can get the economy going. Lockdowns are effective but blunt.
• Witnesses were asked about the successes and failures in the UK: we responded too slowly; we were asleep to the concept that we were going to have a pandemic; but we have done well in evaluating new therapies, eliminating those that don’t work and hunting for a vaccine. Testing is now impressive.
• Critical phase is now June, July and August – use this time wisely. If we get complacent we will be in the same situation again. It’s just as infectious as it has been. We will face a difficult winter.
• On herd immunity, there was agreement that the idea had never been to let it spread rampantly through the population. There is an argument that it can only be controlled by herd immunity but nobody thinks that there was scientific decision to allow herd immunity to happen.
• Public messaging: Devi Sridhar said that messaging is essential – people will follow rules they understand. People didn’t understand stay alert. Communication in Scotland was better.
• Jeremy Farrar said lockdown came in too late – it led to the epidemic expanding faster. He agreed that messaging is critical and trust is vital. Need info in all languages. And blanket testing of staff.
• Things won’t be done by Christmas – the virus isn’t going away, it will be here for years to come.
• On shielding – on whether there is confidence that pausing shielding is safe – there is never zero risk but there is also risk to people of mental health issues of isolation. Measure to mitigate the spread should be taken.
• There were a few questions on social care: lessons need to be learnt and more routine testing of vulnerable people needed as well as clear lines of accountability.
• They all agreed using excess deaths data is the best metric for measuring mortality.
• Vaccines: it will take a long time to eradicate this virus; it’s going to come and go and likely that a vaccine won’t be long lasting so would need to get it done every few years.
• Public Health – there is a need to invest in this for the future; when looking at govt/PHE there has been lots of fragmentation.

 

The second session heard from Dr Jenny Harries, Deputy Chief Medical Officer for England, Department for Health and Social Care; Professor Chris Whitty, Chief Medical Adviser and Chief Scientific Adviser, Department of Health and Social Care; and Professor Jonathan Van-Tam, Deputy Chief Medical Officer for England, Department for Health and Social Care.

 

• Initially believed COVID would be similar to SARS/MERS – small number of cases to be isolated.
• Incorrect to assume that test, trace and isolate could be simply ‘switched on’ – current system is after months of work and substantial funding.
• Advice to stop community testing ‘given the capacity’ was correct advice.
• Why have all healthcare staff not been recommended for routine testing?
  Initially did not have the capacity – even now there are capacity constraints, although this is easing
  Symptomatic testing of healthcare workers is essential
  Not against routine testing of healthcare workers but do not know what the correct rate of doing this is – currently recommended for outbreak situations in healthcare settings, 
  Using this period of relative quiescence of infection to use data to achieve a better idea of best way for routine testing
  Winter surge is a serious concern – will need asymptomatic testing of healthcare staff, questions of who, how often, under what circumstances
• Why taking so long to reach regular mass testing in healthcare system?
  Need to know more about frequency of testing healthcare workers
  In favour of routine testing if there is a big surge – current circumstances favour surveillance and systematic approach
• How do you think Public Health England has performed?
  Challenges in a fast moving situation
  Deaths are actually recorded in very precise ways but translation has not been good in the media
  Public health has not had significant investment
• Science on face masks changed during the course of the pandemic – advice is clear and consistent: masks should be used where social distancing cannot be maintained.
• UK has had the highest number of healthcare deaths bar Russia. Was guidance on PPE downgraded on guidance from SAGE?
  High proportion of healthcare workers will have caught COVID in the community
  Grading of PPE is less important than whether people used it at all
  Healthcare workers continue to take risks when caring for people with infectious diseases
  Confident that current PPE advice is effective – need  to keep on top of this during the difficult winter period.
  Reasonable data shows that healthcare workers are more likely to be infected from staff to staff transmission.
• SAGE is for science, other groups advise and feed into SAGE including people from social care sector - criticism should be that it is too big rather than too small.
  Challenge of social care is that it is a disparate grouping – difficult context to gain good information. There is now a social care working group.
• Clear that every country with a social care sector has not handled this well – including the UK. Had not recognised risks including workers across multiple homes, not being paid sick leave etc.
• Excess mortality is the more important measure – direct and indirect COVID deaths e.g. includes people dying indirectly due to health service not running properly.
• PHE did not put a timeline on measuring COVID deaths as some people die from COVID after 28 days – clinicians make a judgement. Misreported in the media.
• Whitty: chances of a vaccine before Christmas is very low. JVT: cautiously optimistic for a vaccine by Christmas.

 

 

2. Science and Technology Committee oral evidence: UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks

 

Matt Hancock's session with the Science and Tech Committee. Much focus on the future of PHE (see below). Other key points:

 

Testing

Hancock clarified that there had been a 'clear logic' re the 100,000 target: a decision was made to ramp up testing at scale and setting a demanding target was deemed to be the right way to achieve this.

 

PHE  

Hancock initially set out a defence of PHE, stating that it had been set up to be a scientific organisation, rather than an organisation which was designed to move to scale very quickly. When politicians realised that PHE wasn’t equipped to roll out the testing policy, responsibility was shifted over to the DHSC on 17^th March. Hancock was pressed on the need to have standing capability, and specifically on whether PHE would be reformed in anticipation of future waves, Hancock's defence of PHE ebbed, saying 'the time will come for that': the focus now was on controlling the spread of the virus and preparing for winter’.

 

Vaccinations

Asked about the roll out of a COVID-19 vaccine and the role PHE would play in this, Hancock confirmed that the Government was taking public health advice from orgs/ individuals, including PHE. However, the DHSC was leading this policy and administration would be carried out by the NHS. Hancock also confirmed that the Govt was seeking to change the law to increase the list of professionals who could administer vaccination in expectation of a mass COVID-19 vaccination programme later.

 

Death rates

Hancock was challenged by MPs over excess deaths and asked why beds in hospitals remained vacant while people were dying. Hancock focused on the NHS restart plan and the efforts that had been made to keep services going as much as possible during the pandemic. He confirmed more money was being invested in diagnostics given the bottleneck here.

Monday 20 July

1. Matt Hancock Statement to the House of Commons
2. Public Accounts Committee Session: Nursing Workforce
3. Joint Human Rights Committee oral evidence session as part of their inquiry into Black people, racism and human rights.

 

1. Matt Hancock Statement to the House of Commons

 

Matt Hancock delivered a statement to the House of Commons on coronavirus, including an update on NHS Test and Trace. Full transcript here - https://hansard.parliament.uk/commons/2020-07-20/debates/CEB1C545-2E55-4CD7-84D4-5CDC09C5F357/CoronavirusResponse

 

He summarised the PM’s announcement from Friday.

 

On the vaccine trial – he says the preliminary results of the SNG001 trial are encouraging, but the data needs to be peer reviewed and the government will support a large-scale trial.

Government has secured early access to vaccines if successful.

 

Jon Ashworth,  shadow health secretary:

• He asks Hancock to confirm that the chief nursing officer was dropped from the No 10 press conference because criticised Dominic Cummings.
• Asks to ensure equal access to vaccine when developed and says he will support the SofS in getting vaccine delivered to everyone
• Asks what scenario planning is happening if no vaccine is successful
• Asks about working from home after CSA said there was no reason to not continue home working
• On NHS funding – he welcomed it but asked about extra resources for social care
• Called for support for businesses forced into local lockdowns
• On test and trace – he quotes Director of Public Health in Blackburn who said test and trace is failing.

 

Hancock responds to Ashworth (but doesn’t respond to the comments about the Chief Nurse)

• If there is no vaccine, then the next best thing is treatments, and are putting efforts behind finding treatments
• On local lockdowns he said all data available is used. More data has been provided to local authorities, with the department now providing details of individuals who have tested positive provided data protection agreements have been signed.

 

 

Other questions:

• Jeremy Hunt, the chair of the Commons health select committee, says on about ¼ of people infected are being tested and asks what can be done to get more people tested.

Hancock says they are monitoring the data, but the main cause of the gap is people that are asymptomatic, who aren’t being tested, and he says he wants people with even mild symptoms to request a test.

 

• Hancock says he wants every person in the NHS to get a flu vaccine this winter, unless there is a very good reason why they should not have to have one.

 

 

2. Public Accounts Committee session: Nursing Workforce

The Public Accounts Committee held an oral evidence session into the nursing workforce. It was a lengthy session which took evidence from:

Sir Chris Wormald, Permanent Secretary, Department for Health and Social Care; Ruth May, Chief Nursing Officer for England, NHS England and NHS Improvement; Mark Radford, Chief Nurse, Health Education England; Lee McDonough, Director General, NHS and Workforce, Department for Health and Social Care; Prerana Issar, Chief People Officer, NHS England and NHS Improvement.

 

• The opening question (and most interesting part of the session) was to Ruth May regarding her presence at the number 10 briefings. Meg Hillier asked why she was dropped – she said this happens all the time, but she had prepared for it. She claimed she didn’t know why she was dropped but said that she was asked her views about the rules of lockdown and had said that the rules were clear and apply to everybody – then she was dropped.
• Cheryl Gillan asked about numbers of retired/nurses not working in the NHS who have come to help on the crisis – she was told that 10,000 nurses have stepped forward as well as 20,000 student nurses and 2000 overseas nurses. Ruth May said she didn’t know how many want to stay on but directors of nursing are having those direct conversations with people – they could end up as bank staff or work in other areas eg. Online consultations or NHS 111.
• There was an acknowledgement that over 80% of the nursing workforce is female and questions were asked about how to attract more men to the profession. There was agreement that more flexibility was needed for all genders in nursing.
• Questions were asked around burn out and pay rises – Ruth May said that a lack of pay rises over a number of years have had an impact on retention and that she wants to see nurses being properly rewarded.
• Flexible working – there were positive aspects from the COVID-19 outbreak, which had allowed some of the nursing profession to work more flexibly.
• People plan – there was a series of questions about why social care nursing will not be included in the People Plan. Various panellists explained that the People Plan has come from the Long Term Plan which is a plan for the NHS.
• Prerana Issar said that the People Plan would come in two parts: the first which would come “before the autumn” would focus on culture and support that staff need. The second part would come when the comprehensive spending review comes, and this will focus more on numbers. Need for multi year arrangements comes hand in hand with multi year budget.
• There was some discussion about the 50,000 nurses target, with Lee McDonagh setting out some background to it.
• Generally, there were lots of questions about social care and the nursing workforce – why can’t the department get a grip on this?
• They discussed differences in the vacancy rates – it was explained that some of these are geographical and some are to do with specialties.
• There were questions about leadership across the NHS, as well as questions about how much funding goes into recruitment and retention.
• Issar acknowledged that bullying and harassment is still an issue and some of things to increase retention don’t need extra funding – they need leadership support.
• There were further questions about the mental health workforce, ensuring staff get time to recover between the COVID-19 outbreak and winter.
• There were also questions about international recruitment. There was agreement that increasing the domestic workforce will help sustain supply but that recruiting from abroad is really important and the NHS is doing this responsibly. There was also a question about whether there should be a rule to say that nurses who have been trained here should be tied to the NHS for a certain period of time – witnesses said that they want people to stay for the right reason and that they were pleased to see CPD money last year, which helps to attract people and help them to stay.
• They touched on the Health and Care vis – Lee McDonagh explained how it works, with a 50% discount for health and care workers, and an exemption from the IHS.
• There was a recognition that more needs to be done on the apprenticeship levy, and the committee heard that the NHS is trying to promote the levy via comms etc.  
• There were some questions on the impact on BAME workers specifically regarding their support and progression and long term impact on their career. Issar explained that they are helping employers with risk assessments and that they are being done right now. They don’t have feedback re the redeployment of people. Not all BAME staff are being redeployed, some are being protected with control measures/PPE and training etc. There was an agreement that COVID needs to be the time that we take a step forward with equal and inclusive treatment.
• Finally Meg Hillier asked Chris Wormald when the annual accounts will be filed. He said that they are probably going to be done after the summer – but would check for a more precise date.

 

3. Joint Human Rights Committee oral evidence session as part of their inquiry into Black people, racism and human rights.

 

The first session heard from Professor Jacqueline Dunkley-Bent OBE, Chief Midwifery Officer, NHS England and NHS Improvement:

 

• Why is it the case that the death rate for black women is five times higher than for white women during maternity or childbirth?
• Working to reduce mortality and morbidity of BAME patients and the socially economically disadvantaged.
• Certain diseases, such as heart disease, are more common in some communities – need to be responsive to the needs of these communities.
• Looking for continuity of carer to improve outcomes for babies and mothers – target for 75% of black women will receive continuity of carer.
• Anecdotal evidence suggests some pregnant women, especially black women, are scared to seek help in hospitals due to COVID-19.
• Four point plan published to support maternity providers

1. Reducing threshold for BAME women using maternity services – more sensitive to timely referral
2. Encouraging change in communications by maternity providers
3. Ensure ethnicity is recorded in an appropriate way including comorbidities – will ensure good surveillance
4. Ensuring appropriate nutrition – specifically Vitamin D

• Will COVID worsen the disparity between black and non-black women?
• Still birth rate is reducing for black mums.
• Maternal date is not as common as data sounds – in real terms it means 70 women out of 600,000 annual births which is tragic but working actively to ensure messaging is heard and relevant to be acted on.
• Long term plan is a universal offer but also offers a targeted offer for BAME mothers
• Some interventions are creating improvements – percentage of women who reported feeling listened to was higher in black women
• Is the disparately due to individual behaviour of black women or due to how the service treats black women?
• Multifactorial
• Urging maternity care that is safe and care for each group – e.g. setting up clinics for women experiencing FGM.
• Work to be done on stereotyping and unconscious bias – WRES standards
• Should there be a target to reduce racial disparity? Yes

 

Friday 17 July

1.COVID-19 infection survey pilot: England (17 July 2020)

The latest COVID-19 infection survey findings show that the proportion of people in England who have tested positive for the virus has remained stable compared to the previous two-week period.

Key headlines:

• The current estimate of people in England with COVID-19 is 24,000 or 0.04% of the population in England.
• There were an estimated two new COVID-19 infections for every 10,000 people per week in the community in England (1,700 new cases per day), the same as the previous two-week period.
• Between 26 April – 8 July, 6.3% of those who gave blood samples tested positive for COVID-19 antibodies.

 

Analysis

• During 6 July to 12 July 2020, an estimated average of 24,000 people within the community in England had COVID-19 (1 in 2,300 individuals or 0.04% of the England population). This is up from 15,000 in the previous two-week period (estimates are now based on exploratory modelling figures which explain the higher figures). 
• There were an estimated two new COVID-19 infections for every 10,000 people per week in the community in England. This equates to an estimated 1,700 new cases per day, the same as the previous two-week period.
• The decrease in the rate of people testing positive for COVID-19 seen since mid-May has levelled off.
• Between 26 April – 8 July, 6.3% of those who gave blood samples tested positive for COVID-19 antibodies.
• There is not enough evidence of a difference in the proportion of people testing positive for COVID-19 between regions.

 

Source: Gov.UK

 

2. The latest reproduction number (R) and growth rate of coronavirus (COVID-19) in the UK 17 July 2020

The latest R rate has just been published and remains the same for the seventh week running. The R number range for the UK is 0.7-0.9 and the growth rate range is -5% to -1% as of 17 July 2020.

There is some local variation. For example, in London the growth rate has changed from -5 to +1 last week to -3 to +2 which shows a change in direction of the growth rate - towards it speeding up (but I think this is extremely minor). However, it is also worth flagging that at the select committee yesterday Vallance said that R is no longer a good indication of infection. His words:

Asked about R, Vallance says it “becomes a blunt and lagging tool” as the number of infections go down. It was the right thing to measure early in the epidemic but “it’s not the right thing to be using now”. He says indications as to a second wave will come from a higher proportion of positive tests.

 

What is R?

The reproduction number (R) is the average number of secondary infections produced by a single infected person. An R number of 1 means that on average every person who is infected will infect 1 other person, meaning the total number of infections is stable. If R is 2, on average, each infected person infects 2 more people. If R is 0.5 then on average for each 2 infected people, there will be only 1 new infection. If R is greater than 1 the epidemic is growing, if R is less than 1 the epidemic is shrinking. R can change over time. For example, it falls when there is a reduction in the number of contacts between people, which reduces transmission.

 

What is a growth rate?

The growth rate reflects how quickly the number of infections are changing day by day. It is an approximation of the percentage change in the number infections each day. If the growth rate is greater than zero (+ positive), then the epidemic is growing. If the growth rate is less than zero (- negative) then the epidemic is shrinking. The size of the growth rate indicates the speed of change. A growth rate of +5% indicates the epidemic is growing faster than a growth rate of +1%. Likewise, a growth rate of -4% indicates the epidemic is shrinking faster than a growth rate of -1%. Further technical information on growth rate can be found on Plus magazine.

 

Source: Gov.UK

 

Thursday 16 July

1. Secretary of state statement to the house of commons 
2. Care home data 
3. NHS test and trace statistics (England)
4. Science and technology committee

 

1. Secretary of State statement to the House of Commons

Matt Hancock delivered an urgent statement to the House of Commons on the actions in Leicester. Full transcript here - https://hansard.parliament.uk/commons/2020-07-16/debates/CDE998DA-08F7-4528-9945-CD59C418D0E3/Covid-19Update

 

2. Care home data

The PHE social care outbreak data was published today. Full analysis is below.

 

Take away: the number of outbreaks in care homes has increased very marginally since the week before but the number remains stable and low with 47 outbreaks across the country (compared to 1,002 at the peak for care homes). We are down to just a handful of outbreaks in some regions, with no outbreaks in the North East last week - good news! The East Midlands (which is where Leciester falls I think!) is also reporting a low number of 3.

 

Findings:

• There are 15,476 care homes in England (interestingly but maybe not surprisingly this figure has fallen by around 31 in the past month) . This week there were 47 confirmed or suspected outbreaks in care homes (a slight increase from the low of 43 last week).  The cumulative data shows there has been 6,676 outbreaks in care homes - this means that 43% of all care homes have had a suspected or confirmed COVID outbreak.
• There is variation by region. Below are the cumulative figures:

 

Region	Weekly outbreak number	Total outbreaks	Coverage of total outbreaks in area (%)
East of England	7	827	47.9%
East Midlands	3	552	36%
London	9	690	49.8%
North East	0	404	54%
North West	9	945	49.3%
South East	9	1,249	42.5%
South West	6	612	30%
West Midlands	2	690	40.8%
Yorkshire and Humber	2	707	47.4%

 

Source: https://www.gov.uk/government/statistical-data-sets/covid-19-number-of-outbreaks-in-care-homes-management-information

 

3. NHS test and trace statistics (England): Week 5 (2 July – 8 July 2020)

 

Overall:

This week there was a further drop in the number of positive cases transferred to the system (to be expected as the number of cases declines across the country), but there was only a marginal improvement in the proportion  of these reached at the beginning of the test and trace process. The subsequent number of close contacts identified continues to fall, but there have been no improvements in the proportion of these reached or the amount of time it takes to reach them. In the testing data, fewer Pillar 2 test results were returned within 24 hours this week.

 

Key test and trace data from week five:

• 3,579 people who tested positive had their case transferred to the contact tracing system (768 less than last week).
• Of these, 2,815 (79%) were reached by the track and trace system and asked to self-isolate and to provide details of recent contacts. This is a marginally higher proportion than last week (78%) (figure 1).
• Of these, 2,201 responded with details of their close contacts. This is 78% of the 2,815 who were reached, or 61% of the 3,579 positive cases transferred to the system this week.These are both slightly higher proportions than last week (75%, 59%).
• This week, 74% of positive cases reached were contacted within 24 hours (up from 70% last week)
• 13,807 close contacts were identified, slightly lower than last week (15,272). This equates to an average of 6.3 close contacts per positive case who responded. Compared to week 1, the total number identified and average per positive case are much lower (52,815 close contacts identified, 14.9 per positive case).
• This week, 9,811 close contacts (71%) were reached and advised to self-isolate. This is the same proportion as last week (figure 2).
• The time taken to reach close contacts is only reported for non-complex cases. This week, 83% were contacted within 24 hours, the same proportion as last week.

 

In total, since 28 May 2020:

• 34,990 positive cases were transferred to the contact tracing system, of whom 76% (26,742 positive cases) were reached and asked to provide details of their recent close contacts.
• 185,401 close contacts were identified, of whom 84% (155,889 close contacts) were reached and asked to self-isolate.

 

Testing data

• This week, there were a total of 320,124 people tested for coronavirus, which is 11,791 more than last week (4% more).
• 124,884 of these tests were carried out in Pillar 1 (39%) and 195,240 in Pillar 2 (61%).
• The time it takes to receive Pillar 2 test results had improved in recent weeks, and by last week 55% of Pillar 2 test results were returned within 24 hours. However, this week the figure fell slightly and only 51% were returned within 24 hours.
• Turnaround times for Pillar 1 testing are not yet available.

 

Note:

Pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers

Pillar 2: swab testing for the wider population, as set out in government guidance

 

Source:

https://www.gov.uk/government/publications/nhs-test-and-trace-statistics-england-2-july-to-8-july-2020

 

4. Science and Technology Committee

 

Sir Patrick Vallance, Government Chief Scientific Adviser gave evidence to the Science and Technology Committee as part of their inquiry into UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks.

 

• Clear outcome has not been good in the UK
• Many factors to consider when comparing why some countries did worse than others e.g. population, international connectivity etc.
• Would have been preferable to have much greater testing capacity earlier on, but not just testing – issues included data flows from hospitals, rates of admission, rates of death, ICU rates etc.
• Even though it is a national healthcare system, no centralised data flows on all information needed – need improved data flows.
• SAGE advised on the need for greater testing capacity as far back as February
• Care homes were flagged by SAGE back in February – policymakers made decisions
• Face masks are of marginal positive value when used in enclosed spaces where crowding may occur and social distancing is not possible – same as WHO advice
• Science on face masks has not changed dramatically and studies vary
• Vast majority of people who get COVID-19 have an antibody response but may not be long lasting – this does not mean immunity is not long lasting, there is still a lot unknown
• Made very clear that economic downsides would have significant health effects
• SPY-M (modelling group) would have liked to have seen the hospital data but difficult to obtain
• Discussions of a ‘second wave’ really mean the re-emergence of the suppressed first wave – a second wave is the return of the virus once the virus has been reduced to low levels, usually the next year. Likely that we will see this virus return several times over a next few years
• Highly likely there will be an increase in cases in winter
• A well designed app could help – modelling suggests 30% of use increases detection rate by 9%
• Still at a time where social distancing measures are important and working from home is still a good option
• Need a public engagement campaign in autumn to prepare for winter
• Flu vaccination this year is particularly important
• Study suggests 350,000 daily testing capacity is needed for winter
• A properly funded public health system is vital for dealing with pandemic

 

 

Tuesday 14 July 

1. Matt Hancock's statement to the House of Commons
2. Deaths registered weekly in England and Wales week ending 3 July week 27

 

1. Matt Hancock's statement to the House of Commons

Matt Hancock confirmed reports that the wearing of face coverings in shops and supermarkets in England is to become mandatory from 24 July. The full transcript of his statement is available to read here.

• Hancock said that as progress has been made, some freedoms can be restored but that we can’t let progress lead to complacency.
• He said that sale and retail assistants have higher deaths rates – we need to make sure staff are safe and we want shoppers to go back to the high street – that’s why the government are saying that wearing face coverings will be mandatory in shops and supermarkets. People who don’t wear them will be fined £100.
• There are exemptions for children under 11 and some people with certain conditions.
• He stressed that it does not mean we can ignore the other measures that have been important (e.g. hand washing and social distancing).
• Ashworth responded – he said that the virus exploits ambiguity. Mixed messaging is dangerous – there has been a lot of confusion over the last few days.
• This was avoidable. Why has it taken so long and why is it going to be 11 days until the measures come in.
• He asked questions regarding Leicester and the local lockdown there – when will it be eased, when will an announcement be made and what metrics will be used to assess this.
• He also said that LAs need specific person identifiable data. He mentioned the report published today regarding the potential impact of a second waves and flagged that extra revenue funding for winter was missing from last week’s announcement from the Chancellor – he said we need to get winter funding in place.
• Hancock said that evidence on face coverings is being followed and criticised Ashworth for using it as a political football. He addressed some questions regarding Leicester, saying that a decision is due to be made later this week.
• Hunt mentioned winter and asked if the govt would be ramping up test and trace to deal with cases this winter – Hancock said that they are involved in ramping things up and that it will be sufficient to deal with the numbers mentioned in the report.
• There were a range of other questions – why was it announced to the media yesterday; are measures being put in place to help those who have to self-isolate so that they can get sick pay; when will more data be available at a more local level.

 

2. Deaths registered weekly in England and Wales week ending 3 July week 27

This week's data continues to show positive signs that total death numbers are returning to average levels seen in previous years and that the impact of COVID-19 is lessening. The total number of deaths is below the five-year average for the third consecutive week and the number of COVID-19 deaths is the lowest since week 12. Despite the total number of deaths now being below the average, deaths in private home continue to be excessive and well above the average.

 

Key findings

• The total number of deaths registered in England and Wales was below the five-year average for the third consecutive week (9,140 deaths, 0.5% below average).
• There were 532 COVID-19 deaths in the week ending 3 July, down by 11.9% last week and the lowest number of COVID-19 deaths witnessed since week 12.
• Private homes continue to be the only setting where deaths are well above the average (33.3% higher than the average).
• The North West continues to be the English region with the highest percentage (8.2%) and the highest number of COVID-19 deaths (100 deaths).

 

Total deaths registered remain below the five-year average for the third consecutive week

• The total number of deaths registered in England and Wales in the week ending 3 July 2020 (Week 27) was 9,140, this was 161 deaths more than the week before (2% more deaths). Although deaths registered were slightly higher than the week before, they remain below the five-year average for the third consecutive week (0.5% or 43 deaths below the average).
• 532 registered deaths mentioned “novel coronavirus (COVID-19)”, the lowest number of deaths involving the virus since week 12 (week ending 20 March) and accounting for 5.8% of all deaths in England and Wales (down from 6.7% last week).
• Between 28 December 2019 and 3 July 2020, 50,548 deaths involving COVID-19 were registered in England and Wales.

 

Location – The North West has the largest proportion and largest number of COVID-19 deaths

• In most regions (except for the East of England and London which saw an increase), the number of COVID-19 deaths continued to decrease or was similar to the week before. Five of the nine regions in week 27 had total deaths below the five-year average (compared to six regions in week 26).
• The North West continues to have the largest number of COVID-19 deaths (100 deaths, although down from 120 deaths last week) and the highest proportion of deaths involving COVID-19, accounting for 8.2% of all deaths in the region.
• The North West (7.1%) and East Midlands (7%) had the highest percentage of deaths above the five-year average. The South West had the lowest percentage of deaths below the five-year average at 6.1%.
• The South East had the highest number of total deaths at 1,454 (3.3% higher than the five-year average).

 

Setting – Total deaths in private homes continue to be well above the average

• The number of deaths in care homes and hospitals continues to be lower than the five-year average. However, the number of deaths in private homes still remain higher than the five-year average at 33.3% higher (755 more deaths than the average, up from 32.4% last week). Despite deaths in private homes being well above the average, only 1.1% were due to COVID-19 in week 27. Care home deaths are 4.6% lower than the five-year average (88 fewer deaths, down from 5.4% fewer deaths last week) whilst hospital deaths are 15.1% below the five-year average (634 deaths fewer and down from 19.1% last week).
• The proportion of care home deaths that involved COVID-19 decreased from 10.5% in week 26 to 9.2% in week 27.
• Of the 532 COVID-19 deaths that occurred in week 27, 58.1% occurred in hospitals (309 deaths and down from 62.2% last week), 31.8% occurred in care homes (169 deaths and up slightly from 31.5% last week) and 6.4% occurred at home (34 deaths and up from 4.8% last week).
• Year-to-date figures show that 63.5% of COVID-19 deaths occurred in hospital whilst 29.7% occurred in care homes, 4.6% occurred in private homes and 1.4% in hospices.

 

Deaths by age and gender remain similar to previous weeks

• As in previous weeks, the age group which had the highest proportion of COVID-19 deaths were those aged 80 to 84 years, accounting for 7.9% of registered deaths in the age group (down from 8.2% last week).
• More females aged 85 years and over have died (11,559) than males of the same age (9,806) from the virus. This could be because there are more females aged 85 years and over (939,000) than males (564,000) in England and Wales.

 

Source:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/comparisonofweeklydeathoccurrencesinenglandandwales/latest

 

Monday 13 July

Daily testing figures

• Total number of lab-confirmed UK cases: 290,133
• Total number of COVID-19 associated UK deaths: 44,830
• Daily number of lab-confirmed UK cases: 530
• Daily number of COVID-19 associated UK deaths: 11

 

Home Office questions

Questions on the NHS visa and IHS were both asked, with the minister saying that they expect the new visa to be in place by October.

 

• There were a couple of questions from Tory MPs, welcoming the PBS. The Minister said that we need to boost the domestic workforce, immigration is part of the solution but is not an alternative.  He said that the UK will be open to the right talent but should recruit domestically where possible – terms and conditions for domestic workers need to be attractive.

• Several Labour MPs asked a question on the implementation of the Immigration Health surcharge for NHs and care workers. The minister said that they are working to implement the exemption and to identify those of tier two who will be eligible for a refund. The new Health and Care visa means that they won’t have to pay it in future. There were specific questions about how many have already had the exemption and how many are left to receive it. The Minister didn’t provide numbers but said that refund payments have already started. He stressed that the IHS is about creating resources for the NHS.

• On the surcharge, there was concern that NHS staff currently have to pay for their families and there was a question about when paying the surcharge will end for social care workers.

• The Minister said that they are expecting the new visa to be in place for the 1^st October.

• Nick Thomas-Symonds (Shadow Home Sec) focussed on today’s announcement that care workers won’t be included in the visa. He asked what the govt have against care workers.

• The minister responded saying that senior care workers would qualify under the PBS and that we need to prioritise jobs in this country.

• Yvette Cooper asked about the decision to exclude care workers from the visa and asked if they will need to pay the surcharge up front – the minister said that the visa would include various people in the care sector.

 

Friday 10 July

 

R rate published:

The latest R rate remains the same for the sixth week running. The R number range for the UK is 0.7-0.9 and the growth rate range is -5% to -2% as of 10 July 2020.

There is some local variation. For example, in London the growth rate has changed from -4 to +2 last week to -5 to +1, this is the rate moving in the right direction as we want to see more negative numbers and fewer positive numbers as it shows the growth of the infection is slower. An explanation of the growth rate is below.

 

What is R?

The reproduction number (R) is the average number of secondary infections produced by a single infected person. An R number of 1 means that on average every person who is infected will infect 1 other person, meaning the total number of infections is stable. If R is 2, on average, each infected person infects 2 more people. If R is 0.5 then on average for each 2 infected people, there will be only 1 new infection. If R is greater than 1 the epidemic is growing, if R is less than 1 the epidemic is shrinking. R can change over time. For example, it falls when there is a reduction in the number of contacts between people, which reduces transmission.

 

What is a growth rate?

The growth rate reflects how quickly the number of infections are changing day by day. It is an approximation of the percentage change in the number infections each day. If the growth rate is greater than zero (+ positive), then the epidemic is growing. If the growth rate is less than zero (- negative) then the epidemic is shrinking. The size of the growth rate indicates the speed of change. A growth rate of +5% indicates the epidemic is growing faster than a growth rate of +1%. Likewise, a growth rate of -4% indicates the epidemic is shrinking faster than a growth rate of -1%. Further technical information on growth rate can be found on Plus magazine.

 

Source: Gov.UK

 

Thursday 9 July

 

Roundup from yesterday:

 

1. Oral statement - Publication of independent medicines and medical devices safety review (Cumberlege Review) – DHSC Minister Nadine Dorries
2. NHS test and trace statistics (England): Week 5 (25 June – 1 July 2020)

 

1. Oral statement

Full transcript here.

 

2. NHS test and trace 

Overall:

This week there was a further drop in the number of positive cases transferred to the system (to be expected as the number of cases declines across the country), but we continue to see only three quarters of the people reached at the beginning of the test and trace process. The subsequent number of close contacts identified continues to fall sharply – this week there were only a quarter as many as those identified in week 1 – and we now see considerably fewer identified per positive case. As the system beds in the methodology has been adjusted, but serious questions remain about how complete the coverage of the system actually is.

 

Key test and trace data from week five:

• 4,347 people who tested positive had their case transferred to the contact tracing system (1,836 less than last week).
• Of these, 3,336 (77%) were reached by the track and trace system and asked to self-isolate and to provide details of recent contacts. This is a marginally higher proportion than last week (75%) (figure 1).
• Of these, 2,552 responded with details of their close contacts. This is 76% of the 3,336 who were reached, or 59% of the 4,347 positive cases transferred to the system this week. These are both slightly higher proportions than last week (75%, 56%).
• This week, 70% of positive cases reached were contacted within 24 hours (up from 66% last week)
• 14,892 close contacts were identified, much lower than last week (23,028). This equates to an average of 5.8 close contacts per positive case who responded. Compared to week 1, the total number identified and average per positive case are much lower (52,815 close contacts identified, 14.9 per positive case).
• This week, 10,547 close contacts (71%) were reached and advised to self-isolate. This is down from 74% last week (figure 2).
• The time taken to reach close contacts is only reported for non-complex cases. This week, 83% were contacted within 24 hours (up slightly from 82% last week).

 

In total, since 28 May 2020:

• 31,421 positive cases were transferred to the contact tracing system, of whom 76% (23,796 positive cases) were reached and asked to provide details of their recent close contacts.
• 169,863 close contacts were identified, of whom 85% (144,501 close contacts) were reached and asked to self-isolate.

 

Testing data

• This week, there were a total of 303,409 people tested for coronavirus, which is 16,710 more than last week (6% more).
• 119,585 of these tests were carried out in Pillar 1 (39%) and 183,824 in Pillar 2 (61%).
• The time it takes to receive Pillar 2 test results has improved in recent weeks - this week, 55% of Pillar 2 tests had results returned within 24 hours, compared with 41% last week and only 7% in week 1.
• Turnaround times for Pillar 1 testing are expected to be released in a future publication.

Wednesday 8 July

1. PMQs
2. Chancellor’s summer economic update
3. Lords question on the publication of Government White Paper on Social Care

 

Johnson/Starmer exchange

 

Starmer began by asking PM to apologise for huge offense caused by his statement that ‘too many care homes didn’t follow procedures as they should have done’.

 

PM responds

• It was not his intention to blame
• He takes full responsibility as to what has happened
• Knowledge on asymptomatic transmission has changed (therefore guidance changed)
• Pays tribute to care workers

Starmer makes clear how ‘raw’ issue is for care workers. Pushes for apology. States gov did not put protective ring around care homes.

 

PM responds

• Reality is we know more about disease now
• Appreciates work done by care workers
• Gov will continue to invest in care homes
• Wants cross part consensus on care home reform

Starmer claims government have been in power for 10 years. Sad reality that over 19,000 have died in care homes, asks PM to accept government got it wrong.

 

PM responds

• The government does take responsibility
• The action plan for care homes has now helped to reduce Covid-19 rates
• Monthly testing for every resident and weekly testing for staff

Starmer states no apology is insulting to front line workers. Government must accept decision to discharge people to care homes without testing was a huge mistake.

 

PM responds

• Understanding of the disease changed throughout
• Government stuck to plan which enabled country to get through epidemic
• Hits back at Starmer asking if he is for or against action plans that government produce
• Hails government ‘steady and stable’ approach

Starmer moves onto removal of free hospital parking. Claims it could cost hundreds of pounds for staff and that we owe NHS workers more. PM must know this is wrong. Would he reconsider?

 

PM responds

• Car parks are free for staff now
• Gov want to make them free for patients who need them
• No such plans under labour gov
• Hits back at Starmer suggesting he is “consistent in opportunism” whereas government want to “build, build, build for jobs, jobs, jobs”

 

Other topics

• Thank you to Hospices throughout the past few months
• SNP urge to remove parking fund
• Will PM commit to extending furlough scheme?
• Free port in Derry
• Young people face mass unemployment, needs to be plan in place
• Doncaster in need of new hospital
• Luton council need funding
• Tidal barrage in Cumbria leading to creation of clean energy jobs
• Violence against shop workers
• Demand for timetable for industries not yet able to open
• Tribute to Beckford care homes
• Demand for power for communities
• Questions over future of homelessness plans
• NI protocols limiting tariffs after Brexit
  
  

 2. Chancellor’s summer economic update

 

Chancellor Rishi Sunak delivered a summer economic update today, in which he outlined a series of new measures to support individuals and the UK economy in light of the ongoing COVID-19 pandemic.

 

What does this announcement mean for the NHS?

 

In the Policy Paper, A Plan for Jobs 2020, which accompanied the Chancellor’s statement, HM Treasury refers to the following investment in the NHS, which builds on the Prime Minister’s announcement on 30 June for £1.5bn of additional capital spend across the NHS in 2020/21:

 

• NHS maintenance and A&E capacity: the government will provide £1.05 billion in 2020-21 to invest in NHS critical maintenance and A&E capacity across England.
• Modernising the NHS mental health estate: the government will provide up to £250 million in 2020-21 to make progress on replacing outdated mental health dormitories with 1,300 single bedrooms across 25 mental health providers in England.
• Health Infrastructure Plan: the government will provide a further £200 million for the Health Infrastructure Plan to accelerate a number of the 40 new hospital building projects across England.

 

In his ‘Plan for Jobs’ to find, create and protect employment in the UK, the Chancellor also announced:

 

• A Job Retention Bonus to help firms keep furloughed workers: Employers who bring back furloughed staff and keep them in employment until at least 31 January 2021 will receive a one-off bonus £1000 per employee. Funding will be made available for each six-month job placement, which will cover 100% of the National Minimum Wage for 25 hours a week.
• A flexible and gradual wind down of the Job Retention Scheme in October 2020.
• Kickstart scheme: The Government will cover six months of wages plus overheads for employers who create new jobs for 16-25 year olds. Individuals who are claiming Universal Credit and at risk of long-term unemployment will be eligible. There will be no cap on places.
• Additional support for creating apprenticeships: Businesses will be given £2,000 for each new apprentice they hire under the age of 25.
• Green Job Plan: The introduction of a £2 billion “green homes grant” in which homeowners will be given vouchers to make improvements to their homes. This proposal is expected to support approximately 140,000 jobs.
• A £1 billion public sector decarbonisation scheme to make public buildings, including schools and hospitals, greener.
• An increase in the stamp duty threshold from £125,000 to £500,000. This measure, which comes into effect immediately, will remain in place until 31^st March 2021.  
• A cut in VAT from 20% to 5% on food, accommodation, and attractions from today until January 2021.
• Eat out to help out voucher: Throughout August, individuals eating meals at any participating business will receive 50% off their meals, up to a maximum of £10 off.

 

Responding to the chancellor’s summer economic update the deputy chief executive of NHS Providers, Saffron Cordery, said:

 

“We are pleased the chancellor confirmed plans to speed up capital investment in the NHS, including the very welcome but long overdue replacement of mental health dormitories with single bedrooms,

“Our recent #RebuildOurNHS campaign highlighted the way capital spending on vital infrastructure including buildings, scanners, and community rehabilitation facilities has slipped back year after year.

“It also showed the positive impact that a properly funded and well designed system of capital funding would have.

“The coronavirus pandemic has underlined the urgency of updating and modernising the NHS estate to provide clean safe therapeutic environments for patients and for staff.

“The chancellor is also right to prioritise funding for testing and PPE which have proved so problematic during the pandemic and remain serious concerns despite recent progress.

“We also welcome the additional spending on health services including private sector capacity which will be vital as the NHS restores routine services while maintaining preparedness to deal with a second surge of Covid-19 cases.

“The funding will also help trusts and their local partners extend their collaboration to ensure patients can be discharged safely from hospital without delay when they’re ready to leave”

 

 3. Lords question on the publication of Government White Paper on Social Care (Lord Dubs, Lab)

 

Full transcript here.

Tuesday 7 July

1. Urgent question to Matt Hancock
2. Latest weekly deaths registered data for England and Wales
3. ONS published data on infections in the community

1. Urgent question to Matt Hancock

There was an Urgent Question to Matt Hancock. Jon Ashworth asked for an update on COVID-19.

Matt Hancock:

 

• 352 new cases yesterday, lowest since lockdown began.
• 209 patients on mechanical ventilator beds.
• 16 deaths
• Number of deaths for all causes has been lower for the past two weeks than the same period last year.

 

Jon Ashworth:

 

• What is the exit strategy for Leicester?
• Complaints about incomplete data from Directors of Public Health. Will the Secretary look into this?
• Will the Secretary look again at sick pay entitlement?
• Can the Secretary explain why NHS staff are not being routinely tested?
• Can the Secretary understand why people are unhappy with the PM’s comments on care homes?

 

Matt Hancock:

 

• Next announcement on Leicester will be on 14 July due to need for 14 days’ worth of data.
• Have been with clinicians to agree regular testing of NHS staff, scheme is now in place.
• Pay tribute to care homes.

 

Jeremy Hunt asked if the Secretary will commit to regular testing of NHS Staff? Hancock said procedures are in place for regular NHS staff testing. Prevalence is higher in care homes but will keep situation under review.

2. Latest weekly deaths registered data for England and Wales for the week ending 26 June 2020 (week 26) 

Key findings

• The total number of deaths registered in England and Wales was below the five-year average for the second week in a row (8,979 deaths, 3.4% below average).
• There were 606 COVID-19 deaths this week, down by 23% from the week before.
• Total deaths in hospitals and care homes remain below their five-year averages, while deaths in private homes continues to be well above the average.
• The North West continues to be the English region with the highest number of COVID-19 deaths at 120 deaths (down from 134 last week) and now has the highest percentage of total deaths above the five-year average at 7.4%.

Setting – Total deaths in hospitals and care homes below five-year averages, but remain well above average in private homes.

• The total number of deaths in all settings decreased, and hospitals and care homes continued to see a lower number of deaths than their five-year averages. Hospitals witnessed 19.1% fewer deaths than the average this week (815 deaths below the average), which is even fewer than last week when deaths were 17.9% below average.  Similarly, care homes witnessed 5.4% fewer deaths than the average (103 deaths lower than the average), which is also fewer than last week where deaths were 2.5% below average.
• Deaths in private homes remain 32.4% higher than the five-year average (745 more deaths than the average), although this is a slight improvement from 36.9% above the average last week. Only 1% of deaths in private homes were due to COVID-19 (down from 1.7% last week), which may indicate that people who are seriously unwell are reluctant to visit hospitals because they fear they might catch the virus.
• Of the 606 COVID-19 deaths this week, 377 occurred in hospitals (62.2%), 191 in care homes (31.5%), and 29 were in private homes (4.8%).
• In care homes, the proportion of deaths due to COVID-19 has decreased from 12.9% in week 25 to 10.5% in week 26.
• Year-to-date figures show that of all COVID-19 deaths, 63.5% occurred in hospital, 29.7% in care homes, 4.6% in private homes and 1.4% in hospices.
  
  

 3. ONS published data on infections in the community

This refers to the number of coronavirus infections within the community population in England between 26 April and 27 June. Community in this instance refers to private residential households, and it excludes those in hospitals, care homes or other institutional settings.

Source

Key findings:

• Individuals working outside the home show higher rates of positive swab tests than those who work from home.
• Rates of positive tests appear higher for people exhibiting symptoms of COVID-19 at the time of the swab test compared with those reporting no symptoms.
• There is evidence to suggest that infection rates are higher among people who have reported coming into recent contact with a known case of coronavirus than those who have had no reported contact with potential cases.
• One-third of individuals testing positive for COVID-19 reported having symptoms. But this analysis is only based on 115 individuals in the sample who tested positive.

 

Analysis:

• It is too early to say whether there are differences in infection rates among different ethnic groups over the study period as the number of people testing positive in this survey in groups other than the White ethnic group are very small.
• An estimated 0.56% of individuals who reported working outside of the home tested positive for COVID-19 in comparison to 0.15% of individuals who reported working from home.
• Those working in patient-facing healthcare or resident-facing social care roles are more likely to be infected by COVID-19 (1.58%) than those not working in these roles (0.27%). This includes NHS professionals, such as nurses and doctors, and those working in social care (e.g. those working in care or nursing homes and social workers).
• There is some evidence to suggest that household size affects the proportion of individuals testing positive for COVID-19. There is evidence to suggest that infection rates among those living in households with two people are lower than infection rates among those living in larger households.
• Only one-third of individuals testing positive for COVID-19 reported having symptoms. The remaining positive cases either did not report having any of the specific or general symptoms on the day of their positive swab test, preceding swab test or subsequent swab test. It is important to note that symptoms were self-reported rather than clinically diagnosed and this analysis is only based on 115 individuals in the sample who tested positive.
• 10.3% of those reporting symptoms of a cough or fever, or loss of taste or smell on the day of testing, tested positive for COVID-19. This is in comparison to 0.28% of those who did not report having these specific symptoms on the day of their positive test.
• An estimated 2.62% of individuals who have reported coming into contact with people suspected of having COVID-19 were more likely to test positive, in comparison to only 0.19% of those who had no reported contact with a suspected COVID-19 case.

Monday 6 July 

1. Lords Science and Technology Committee 
2. Lords Oral Question

 

1. Lords Science and Technology Committee

The Lords Science and Technology Committee held an oral evidence session as part of their inquiry into The science of COVID-19. The committee heard from Baroness Harding of Winscombe, Chair, NHS Improvement; Simon Thompson, Managing Director of the NHS COVID-19 App, NHS Test and Trace, Department of Health and Social Care.

 

• How did the government decide on the strategy on test and trace? How are local doctors and local health professionals involved in this strategy? Contact tracing has been used for many years. Test and Trace has four components:

1. Scale testing – increasing availability and speed
2. Trace – quickly identify close contacts and break chain of transmission
3. Contain – cut chains of infection at a local level
4. Enable – learning about the virus and enabling individuals to manage own risk (app is particularly important for this)

• Building backward tracing capability and trialling in Leicester
• Figures for the first month:
  • 27,125 people have had positive test results transferred to the system, 73.9% have been reached and asked to provide contacts
  • 153,442 contacts were provided – 86.5% have been reached, over 80% contacted within 24 hours
  • Each person is contacted up to 10 times in a 36 hour period
  • SAGE target for a mature system is 80% – doing well for a new system

• Testing capacity of almost 300,000 tests per day
• People working in ‘complex clinical settings’ (e.g. health settings, schools) have their case escalated to local public health groups.
• Less than half the population in England is aware they are eligible for a test if they have symptoms.
• 98% of people being tested do not have COVID-19.
• Estimate that 70% of people with COVID-19 don’t have symptoms.
• Need better targeted testing – need to focus in high risk environments (e.g. if someone tests positive in a hospital ward, aim to test everyone who has been in the ward in the previous 14 days) and vulnerable communities
• Concern that testing contacts will reinforce view that isolation is not needed if tested negative despite possibility for virus to show within 14 days
• Completed first complete testing regime of care home residents and staff. Announced next stage.
• SAGE target is to isolate 80% of contacts within 48-72 hours.
• Mandating self-isolation and monitoring is likely to discourage people from coming forward for tests and providing contacts – currently seen high levels of support.
• If app can work accurately enough, would be a huge benefit. App needs speed, precision, reach
• Isle of Wight had about 40% uptake (60% of smart phone users) – findings show good levels of adoption.
• Plan to routinely test all NHS workers? Driven by advice from SAGE, CMO, CSO – currently regular testing of asymptomatic social care staff and residents where transmission is higher than in NHS. Advice from CMO is not to regularly test all NHS staff at this stage but to focus on outbreaks – approach may change if prevalence increases.
• Customer survey show only 3% are dissatisfied with the Test and Trace service.

 

 

2. Lords oral question 

 

Lords oral question on an 'Increase in COVID-19 restrictions as a result of lifting restrictions'.

 

Lords criticised the government's handling of the lifting the lockdown. Issues raised included

• The government's blaming of the public for ignoring mixed messages
• Failure to admit incompetence and accept responsibility
• Questions over the advice given to managers of meat processing plants where infection levels are high
• What lessons have been learnt from large scale events such as Liverpool vs. Atletico Madrid football match taking place
• Questions over the level of data sharing taking place between government and local councils
• Questions over the power that local councils have over lockdowns
• The criteria the government use to implement local lockdowns
• Higher fines for those who break social distancing

Lord True (minister of state) responded

• The government continue to be guided by the science at all stages
• Assurance that the safety of workers in all sectors is government priority
• The lord will undertake steps to peruse specific matter of Liverpool football match
• Stressed that the role of local council was extremely important, and they had been granted additional powers/money
• The government is trying to make data as transparent as possible
• Data sharing is occurring between government and local councils
• Majority of people act with dignity and do follow guidelines

 

Friday 2 July

Today's round up includes:

1. No.10 press briefing
2. Daily testing figures
3. R number in the UK
4. ONS care home data

 

 

1. No.10 press briefing

 

Boris Johnson:

• Regularly, fewer than 1,000 new cases are being reported each day
• Sage assess that the R rate remains between 0.7 and 0.9 across the UK.
• In England, the number of new infections is shrinking by 2-5% every day
• There is now substantial testing capacity nationwide and the ability to target testing to get on top of localised outbreaks
• Targeted measures will be put in place going forward
• With each local outbreak, five principles will guide the approach:
• Monitoring, engagement, testing, targeted restrictions and finally, as a last resort, lockdown
• He urged people to act responsibly over the weekend and said don’t gather in groups of more than six outside or two household in any settings, keep your distance from others and wash hands

 

Q&A:

Contingency plans for a second wave:

Whitty: Possibility of second wave will be with us for some time. Evidence of second waves elsewhere in the world. Planning is underway. Essential that people continue to follow social distancing and other mitigations

Vallance: Key to make sure we stick with rules as there will be an increase in local outbreaks and need to be able to monitor and manage those. As winter comes, that we are prepared to be able to deal with it. Virus hasn’t gone away, it’s been supressed.

PM: two tools that we didn’t have in February – the therapeutics in reducing mortality, and NHS test and trace which will assist in local lockdowns.

 

BBC: To the scientists, are you comfortable with the pace of the unlocking?

Whitty: risks either side of the path we are on. Trying to get the balance right. No perfect way of doing it, but trying to balance the multiple risks for society to be as close as possible to normal. Virus is a long way from gone, but it wont be gone for a long time, so this is a reasonable time to take these measures. But none of us believe this is a risk free next step.

Vallance: Key is that people get tested if they have symptoms.

 

Chris Smyth, Times: How concerned are you about what’s going to happen tomorrow and what sort of surveillance measures to control infection, given that Sage papers identified pubs and bars as among the principle sources of ‘super-spreading events?

Vallance:  indoor, cramped environments which connect different households need to be adjusted so people can properly socially distance to reduce the risk of spreading.

 

Face coverings:

PM: in crowded spaces with people you wouldn’t normally come into contact with, you should wear a face covering, but stopped short of saying they should be mandatory in shops.

 

Other topics:

• Events and arts industry
• Cricket
• Quarantine policy

 

2. Daily testing figures

As of 9am 3 July, there have been 10,120,276 tests, with 205,673 tests on 2 July. 284,276 people have tested positive. As of 5pm on 2 July, of those tested positive for coronavirus, across all settings, 44,131 have died - an increase of 137.

 

3. The R number in the UK

 

Key headlines:

• Latest estimate for R in the UK remains between 0.7 to 0.9 (no change from last week).
• The growth rate range for the UK is -6% to 0% per day
• The R estimate for England is slightly higher than the UK (0.8 to 0.9).
• By region, London (0.8-1.1) is higher than the overall R estimate for the country, and also has a higher estimated growth rate (-4% to +2%). The South West also has a higher estimated growth rate (-7% to +2%) than the country overall.

 

Region	R	Growth rate % per day
England	0.8-0.9	-5 to -2
East of England	0.7-0.9	-5 to 0
London	0.8-1.1	-4 to +2
Midlands	0.8-1.0	-4 to 0
North East and Yorkshire	0.8-1.0	-5 to 0
North West	0.7-0.9	-4 to 0
South East	0.7-1.0	-5 to 0
South West	0.7-1.0	-7 to +2

 

Source:

https://www.gov.uk/guidance/the-r-number-in-the-uk

 

4. ONS care home data

 

ONS have today published a distinct data set on the deaths in the care sector. This is in addition to their usual data set and is focused solely on the care sector. It covers all deaths up until 12 June and registered up until 20 June.

 

There isn’t anything new in here compared to other data but provides us with the latest data. Key figure is that 29% of all deaths from March - 12 June in care homes this year were a result of COVID.

 

More detail below.

 

Source:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/deathsinvolvingcovid19inthecaresectorenglandandwales/latest

 

• Since the beginning of the coronavirus (COVID-19) pandemic (between the period 2 March to 12 June 2020, registered up to 20 June 2020), there were 66,112 deaths of care home residents (wherever the death occurred); of these, 19,394 involved COVID-19, which is 29.3% of all deaths of care home residents.
• Since mid-April 2020, we have seen a slowdown in both the total number of deaths and deaths involving COVID-19 in care home residents.
• England had a statistically significantly higher age-standardised mortality rate for deaths involving COVID-19 (1,182.9 deaths per 100,000 care home residents) compared with Wales (822.3 deaths per 100,000 care home residents).
• Of deaths involving COVID-19 among care home residents, 74.9% (14,519 deaths) occurred within a care home and 24.8% (4,810 deaths) occurred within a hospital. From 2 March 2020, of all deaths in hospital involving COVID-19, 15.5% could be accounted for by care home residents. Between the period 2 March to 12 June 2020, registered up to 20 June 2020, COVID-19 was the leading cause of death in male care home residents, accounting for 33.5% of all deaths, and the second leading cause of death in female care home residents, after Dementia and Alzheimer disease, accounting for 26.6% of all deaths.
• Dementia and Alzheimer disease was the most common main pre-existing condition found among deaths involving COVID-19 and was involved in 49.5% of all deaths of care home residents involving COVID-19.
• The Care Quality Commission (CQC) collects information on recipients of domiciliary care in England and between 10 April and 19 June 2020, there were 6,523 deaths of recipients of domiciliary care; this was 3,628 deaths higher than the three-year average (2,895 deaths).

 

Thursday 2 July

 

1. No.10 press briefing

Education Secretary Gavin Williamson announced plans for full school reopening in England from September. The new guidance set out plans for year-group 'bubbles' and staggered start times‌. By the autumn term, all schools will be provided with a small number of home testing kits that they can give directly to parents or carers collecting a child who has developed symptoms at school, or staff who have developed symptoms at school.

 

2. ONS data round up

This includes the weekly infection survey findings as well as the weekly outbreaks in care homes data (R estimate has not been released yet).

 

From the infection survey, the estimate of the number of COVID-19 cases in the community appears to have levelled off. While it is positive that total number of cases does not appear to be increasing, an estimate of 25,000 new cases each week remains concerning. From the care homes data, there were significantly fewer outbreaks this week, hopefully indicating better infection control measures in place.

 

 

COVID-19 infection survey pilot: England (2 July 2020)

 

Key headlines:

• Current estimate of people in England with COVID-19 is 25,000, down from 51,000 in the previous two-week period.
• It is estimated that 25,000 new COVID-19 infections occurred per week in England, up from 22,000 in the previous period.
• The number of people testing positive decreased between mid-May and early June 2020, but it has now levelled off.
• We know there are regional differences, but the small number of cases in this survey does not allow definitive comparison.

 

Analysis

• At any given time between 14 June to 27 June 2020, an average of 25,000 people in England had the coronavirus (COVID-19), or 0.04% of the community population in England.
• There were an estimated 25,000 new COVID-19 infections per week in England, or 3,500 per day.
• The decrease in the proportion of people testing positive for COVID-19 seen in previous weeks has now levelled off.
• Differences by region are currently in the spotlight, but from this survey there is not enough evidence to be sure about infection rates between regions. The low numbers of positive cases picked up by the survey within each region means there is high uncertainty in the regional estimates, as indicated by the large intervals across most regions.

Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/2july2020

 

 

Outbreaks in care homes (22 - 28 June)

 

Key headlines:

• There were 58 outbreaks in care homes this week, down from 112 the previous week (a decrease of 48%).
• The cumulative data shows there have now been 6,608 outbreaks in care homes since the start of the pandemic (9 March – 28 June) – this means that 43% of the 15,507 care homes in England have had a suspected or confirmed COVID-19 outbreak.

 

Regional analysis:

• This week, the North West has outbreaks in almost a quarter of its care homes.
• Interestingly, there are currently no reported outbreaks in care homes in the East Midlands. While this might just demonstrate the lag between outbreaks in the community being transferred into care homes, it could also be a sign of better infection control measures in place.

 

Region	All outbreaks in current week	Percentage of care homes that have reported an outbreak
East Midlands	0	0%
East of England	11	19%
London	3	5%
North East	4	7%
North West	14	24%
South East	8	14%
South West	2	3%
West Midlands	4	7%
Yorkshire and Humber	12	21%

 

 

NHS test and trace statistics (England): Week 4 (18-24 June 2020)

 

Overall

This week the data has improved slightly on some measures, but still falls some way short of what most would call good performance. There were fewer positive cases transferred to the system, and the proportion of positive cases reached picked up after the dip last week. However, the methodology for reporting close contacts identified and reached has changed, which makes comparison difficult for this downstream part of the statistics. There remain serious doubts that the right contacts are being identified and then reached, and the proportions reached within 24 hours showed no improvement this week (both for positive cases transferred to the system, and close contacts identified).

 

Key data headlines from week three

• 6,183 people who tested positive had their case transferred to the contact tracing system (740 less than last week).
• Of these, 4,639 (75%) were reached by the track and trace system and asked to self-isolateand to provide details of recent contacts. This is a higher proportion than last week (70%).
• Of these, 3,497 responded with details of their close contacts. This is 75% of the 4,639 who were reached, or 56% of the 6,183 positive cases transferred to the system) this week. These are both slightly higher proportions than last week (75%, 52%).
• This week, 65% of positive cases reached were contacted within 24 hours (down from 70% last week)
• 23,028 close contacts were identified, much lower than last week (31,623). This is partly because of the evolving way complex and non-complex cases are counted (non-complex are more likely to not have contacts/be uncontactable).
• This week, the data for the number of contacts reached is only presented for non-complex cases. Of the 9,238 close contacts of non-complex cases identified, 6,348 (69%) were reached and advised to self-isolate. (This is down from 70% last week).
• 82% of the close contacts of non-complex cases reached were contacted within 24 hours (the same as last week)

 

In total, since 28 May 2020:

• 27,125 positive cases were transferred to the contact tracing system, of whom 74% (20,039 positive cases) were reached and asked to provide details of their recent close contacts.
• 153,442 close contacts were identified, of whom 86% (132,525 close contacts) were reached and asked to self-isolate.

 

Source:

https://www.gov.uk/government/publications/nhs-test-and-trace-statistics-england-18-june-to-24-june-2020

 

Daily testing figures

 

As of 9am 2 July, there have been 9,914,663 tests, with 252,084 tests on 1 July. 283,757 people have tested positive. As of 5pm on 1 July, of those tested positive for coronavirus, across all settings, 43,995 have sadly died an increase of 89.

 

Wednesday 1 July

1. PMQs:

Johnson/Starmer

Johnson begins by commending the Together initiative for organising the biggest ever thank you for the NHS on Sunday. He says key workers, as well as NHS workers, will be thanked. Starmer also says he celebrates the birthday of the NHS

Starmer asks why was the government so slow to act on Leicester, 11 days after Matt Hancock acknowledged there was a problem there? Johnson says the government took action on 8^th June and engaged with authorities. Unfortunately, they could not get results so took the decision to lockdown Leicester.

Starmer says he supports Monday’s action on Leicester. He says the local authority only had half the data and did not have the pillar 2 testing data of wider community tests meaning they thought the number of cases was 80 when it was in fact 944. Can the PM give a cast iron guarantee that no other local authority will be put in that position again? Johnson says Starmer is wrong and that both pillar 1 and 2 data has been shared with all authorities across the country.

Starmer asks if the PM regrets being so flippant about reopening beaches? Johnson says it is important that seaside communities be welcoming but vital that people must behave responsibly. The scenes in Bournemouth were completely unacceptable.

Starmer says 2/3 of people with COVID-19 were not being reached. Updated figures show things have got worse. Now 3/4 of people with COVID-19 are not being reached. How can the PM explain that? Johnson says the system has reached 113,000 contacts and the number of new infections has come down to below 1000 – a great achievement on behalf of the entire population.

The exchange also covered Johnson’s speech yesterday on a ‘New Deal’

Other topics

• Economy/’New Deal’
• Scottish border
• Barnett consequentials
• Arts sector
• Brexit
• Hong Kong
• Universal basic income
• Local government procurement fraud
• IT inequalities
• Benefits
• DBS scheme
• Buses

 

 2. Lords question:

On the action being taken by the government to to address the impact of the COVID-19 pandemic on mental health. Source