Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
My Lords, I beg to move that the Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) (Amendment) (No. 6) Regulations 2021 be approved and shall also be moving the Health Protection (Coronavirus, Wearing of Face Coverings) (England) (Amendment) Regulations 2021 and the Health Protection (Coronavirus, Restrictions) (Entry to Venues and Events) (England) Regulations 2021.
Despite our progress so far and our investment in treatments, the omicron variant has been designated a variant of concern and so we must act now, as quickly as possible, to slow its spread. The UK Health Security Agency predicts that omicron will become the dominant strain within one to two weeks across the whole country. In response, the UK’s four Chief Medical Officers have raised the Covid alert level to 4, its second-highest level.
Although we do not yet have a complete picture of omicron’s severity, it has become increasingly clear that omicron is growing much faster than the previous delta variant and is spreading rapidly all around the world, so its higher transmissibility means it still threatens to overwhelm the NHS. We are seeing increased transmission rates reflected currently in case rates, and the current doubling time for omicron cases is now between two and three days. We need to act now to help slow the spread of the variant and reduce the chances of the NHS coming under unsustainable pressure, while buying time to deliver more boosters.
On 8 December, the Government announced that it was now necessary to implement plan B measures in England in response to the risks of the omicron variant. This includes: extending regulations on face coverings to make them mandatory in most indoor public settings from 10 December; asking those who can work from home to do so from 13 December; and making vaccine or test certification mandatory for entry to certain venues and events from this morning.
Today, we are debating the regulations that bring about the legal requirements for face coverings and certification. These regulations are sunsetted or due to expire on 26 January 2022, but they will be reviewed by the Government in early January. We are also debating regulations that bring important changes to self-isolation requirements to enable fully vaccinated contacts to take part in daily contact testing.
From 10 December, face coverings have been mandatory in most indoor public spaces in England. However, they are not required in hospitality settings such as cafés, restaurants and pubs, or in nightclubs. Exemptions apply—including for children aged under 11 and for those unable to wear a face covering for health or disability reasons. Evidence from the UK Health Security Agency respiratory evidence panel suggests that all types of face covering are, to some extent, effective in reducing transmission.
From today, showing the NHS Covid pass is mandatory as a condition of entry to certain settings in England. This is not a vaccination passport, and people will have different ways to show that they are eligible. Negative test results provide some assurance that an individual is not infectious when the test is taken and for a short time afterwards.
There is evidence to suggest that vaccination reduces the likelihood of infection or transmission to a small degree with delta, which continues to circulate. Early evidence suggests that vaccine effectiveness against symptomatic infection after two doses is significantly lower against omicron than against delta. Nevertheless, a moderate to high vaccine effectiveness is seen in the early period after a booster dose. Vaccine effectiveness is also likely to be higher in preventing severe, rather than mild, disease, and it continues to be vital in response to the high levels of delta cases that continue to circulate.
Covid status can also be shown through proof of a negative test taken in the previous 48 hours, which demonstrates that you are less likely to be infectious, as well as proof of medical exemption or evidence of participation in a clinical trial.
Certification will apply in a limited number of settings, including venues acting like nightclubs; indoor events with 500 or more attendees likely to stand and move around; outdoor events with 4,000 or more attendees likely to stand and move around; and all events with more than 10,000 attendees. Vaccine or test certification will not eliminate the possibility of infectious people attending or transmitting the virus in these settings, but it will help to reduce the risks.
The test, trace and self-isolate system continues to be one of the key ways to control the virus and to protect our nation. Yesterday, the Government introduced a policy of daily testing for all fully vaccinated contacts of people who have tested positive for Covid-19. This will identify—or help to identify—the virus quickly and help to break chains of transmission without requiring large numbers of people to self-isolate. To support this, we have removed the requirement in the self-isolation regulations for all close contacts of suspected or confirmed omicron cases to self-isolate, regardless of their age or vaccination status. This was introduced as a temporary measure on 30 November. Unvaccinated adult contacts will continue to be legally required to self-isolate, unless they are participating in an approved workplace daily contact testing scheme. We will constantly monitor and review the data.
Lastly, let us all urge everyone who can have the vaccine to get boosted now. More than 24 million booster or third doses have already been administered across the UK. Our target is to offer this to every eligible adult in England by the end of December.
I thank everyone involved in the vaccination programme for their continued efforts to maintain this tremendous progress over the important weeks ahead. I understand that there are concerns among noble Lords across the House about these regulations. It is always a difficult balance and we hope we have got the balance right. I look forward to continued scrutiny by noble Lords and to their valuable contributions to this debate.
Lord Robathan (Con)
My Lords, I will start with a quote:
“It always suits Governments … to scarify the population.”
This was specifically about the ID cards Bill in 2005, when
“only a handful of principled Tories stuck up for liberty, and they were duly overwhelmed by the Government.”
The same person promised to “eat” his ID card if asked to show it to an official—so I expect that noble Lords will recognise the author of the quotes, who was then the Member of Parliament for Henley and editor of the Spectator.
Roosevelt famously said in his 1933 inaugural speech during the Depression—others had said it before—that
“the only thing we have to fear is fear itself”.
So what is going on? Why are the Government scarifying the population and stoking fear?
Medical Schools: Training Places
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Lord Robathan
To ask Her Majesty’s Government how many training places for new doctors there were in medical schools and other institutions in (1) 2000–01, and (2) 2021–22; and what plans they have, if any, to increase the number of places for 2022–23.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
In the 2000-01 academic year in England, there were 4,300 government-funded medical school places. Initial data shows that, in 2021-22, 8,460 places have been taken up, including additional places for students who completed A-levels in 2021 and had an offer from a university in England to study medicine subject to their grades. The Government continue to monitor the number of medical school places that they fund to ensure that it is in line with NHS workforce requirements.
Lord Robathan (Con)
My Lords, the Answer is quite encouraging, but doctors and other medical staff are working flat out on our behalf, and we are told that there are not enough doctors. That is because we are not training enough. Some 21 years ago, Gordon Brown confected a row over a girl called Laura Spence, who was well qualified but was not able to get into Oxford to read medicine because there were not enough training places. We have had all three major parties in government in those 21 years, and there are still not enough training places. Rather than taking doctors from the poorest countries in the world, where they are needed, and bringing them here, does not my noble friend think that it is time to make sure that we train enough doctors in this country and that there are enough training places for them so we can actually service our own needs?
Lord Kamall (Con)
I thank my noble friend for the question, but there are record numbers of medical students in training. There are currently more than 35,000 doctors in undergraduate training and 60,000 doctors in foundation and speciality postgraduate medical training. On the international market, we follow strict ethical guidelines, in line with the World Health Organization guidelines.
Health Protection (Coronavirus, Wearing of Face Coverings) (England) Regulations 2021
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Baroness Noakes (Con)
My Lords, I first support what my noble friend Lady Neville-Rolfe said about impact assessments. In fact, I have tabled a Motion on a later coronavirus order regretting the lack of impact statements, which I look forward to debating with the Minister in due course.
I start by recording what Reuters reported today from a World Health Organization official. He said that, to date, most omicron cases have been “mild” and that there is no evidence yet of reduced vaccine effectiveness. On that basis, we may find that these orders have been overhasty and that we do not see an extension of them.
I will concentrate my remarks on the mask-wearing order, because I continue to believe that there is insufficient scientific evidence on which to base requirements for people to wear masks. Much attention was paid, a week or so ago, to a meta-analysis that was published in the British Medical Journal. Its headline was that masks showed a 53% cut in the transmission of infection. When one looks at the detail of that meta-analysis, the case falls apart. Of the large number of studies included, only six related to mask wearing, of which two had a critical and four had a moderate element of bias. Of those four, only one was a properly randomised trial and its results were inconclusive. There is no evidence that scientifically supports the wearing of masks.
I will not oppose this order and I hope it runs out in a few weeks’ time, but I hope that the Minister ensures that the right messaging is put out. I have heard that the noble Baronesses, Lady Thornton and Lady Brinton, want it extended, including to theatres. They may like to know that this is already happening. I reveal one of my hobbies by saying that, yesterday, I received emails from both the English National Opera and the Royal Opera House telling me that, as of yesterday, they were mandating masks. I have to put up with a mask for the sake of listening to Wagner, this weekend, but the messaging that this order relates only to shops, transport and the close personal services that were referred to earlier is not out there.
In addition, when I got back to my apartment block last night, the management company had splattered the place with “Masks now required”. I challenged that today and of course there is no legal basis for that prohibition, so I have asked it to remove or alter the messaging. Unless the Government give clear messages to the public at large that this is a very limited measure for very good reason, and there is no need for it to be extended further, it will carry on spreading like some kind of virus throughout all social activity. We must not let that happen.
Lord Robathan (Con)
My Lords, I would like to add to the words of my noble friends Lady Noakes and Lady Neville-Rolfe. I am afraid the Government have got themselves in a muddle over this. This is a “worrying new variant”, as the Minister rightly said, and I think he quotes from the WHO. But while sitting here, I got an alert from the news that said exactly as my noble friend Lady Noakes just said:
“Most Omicron cases are ‘mild’ and there's no evidence to suggest vaccines may be less effective against the variant, says WHO official”,
speaking on behalf of the organisation. He specifically said that people should
“apply an evidence-informed and risk-based approach”
to travel measures and that
“Blanket travel bans will not prevent the … spread”
of the new omicron Covid variant.
We should look at the evidence, not opinions. What is the number of deaths that this or Covid are causing? I am going to yet another memorial service tomorrow for a Member of this House who died of cancer, not Covid. I think I have been to six memorial services so far this year of people who have died from cancer—nobody from Covid. All Peers should ask themselves how many people they know who have died from Covid under the age of 85.
We need to show some understanding of risk and should not be scaring people. As my noble friend Lady Noakes said, we are just scaring people into running around like headless chickens, worried about what on earth this variant means. I regret to say that I think the Government are trying to look decisive after what has not been an extremely good month or so for them. They are responding to the accusations of the Opposition that they must be more decisive and take firm action. We are keeping people scared, not keeping them safe. We are damaging children’s education and hugely damaging the economy, and cancer waiting lists are stretching. I heard today that waiting lists for hospital treatment may extend to 12 million by the end of next year. This is shocking.
My noble friend Lady Noakes asked to see the proof about face coverings, because we do not actually know if they work. Of course surgical masks work, but these flimsy paper or cardboard things we are all wearing are not effective. Since, according to the noble Baroness, Lady Brinton, we have to wait for the scientific advice, let us listen to the advice that Jenny Harries gave us in March last year that, in fact, if you wear a face mask you are more likely to increase the severity of any Covid you have, because you would trap all the germs and keep them there. As late as August last year, she was saying that she did not think there was any point in us wearing face masks.
Lord Kamall (Con)
I apologise to noble Lords— I was looking forward to so many more contributions. I hope noble Lords will forgive me for enjoying the debate rather too much. I apologise to my noble friend Lord Greenhalgh, who has been waiting for ages, and to my noble friend behind me who says he has to go to the theatre. I hope he will wear his mask when he goes to the theatre.
I thank all noble Lords for their contributions to today’s debate. What is really important and what it shows is that we are still debating issues and contesting the science. Clearly there is a range of views across the House on the issues raised. There is no consensus on this. That is really interesting in the way it shows that we can debate these issues and question the statistics. I will turn to some of the points noble Lords made, particularly about some of the statistics but also on the regulations.
I hope noble Lords will forgive me if I do not answer every single question and refer to every single noble Lord who asked them—unless noble Lords want to stay here a bit longer and my noble friend Lord Greenhalgh can go and have another teacake or something while he is waiting.
Lord Kamall (Con)
Sorry, was that offensive? I apologise for any offence caused to my noble friend. I just assumed that because I like teacakes, my noble friend also does.
I will start with some of the questions. On the question of how many people have been helped by some of these financial services, as of 17 November 2021, local authorities have reported 362,573 successful claims since the start of the scheme, totalling £181 million in test and trace support systems.
Despite the easing of the restrictions at step 4 of the road map, the Government have continued to recommend that face coverings are worn in crowded and enclosed spaces. We accept that there is wide support for reintroducing mandatory face coverings, but we have always tried to balance these issues. As I said in previous debates, we look at a number of factors, not only medical but economic and social. Also, within health itself, many mental health experts are very concerned that we might go for more lockdowns and about some of the measures that a number of noble Lords have mentioned.
As we saw in the debate, there are noble Lords who believe that we have gone too far and noble Lords who feel that we have not gone far enough unless we effectively enter a second lockdown. That shows the range of views here and the difficulty, as my noble friend, Lady Altmann, said, that the Government are damned if they do, damned if they do not, but we accept that.
So, do face masks actually work? This is where there is still a debate. I thank my noble friend Lady Noakes for pointing out the article by Professor Simon Wood, who is professor of statistics at the University of Edinburgh, in which he analysed the BMJ paper. It is in effect a meta-analysis. A number of newspapers have taken a line saying that wearing a mask cuts Covid by 53%. I encourage noble Lords to read the article, in which he takes apart the statistics as a statistician and looks at, as those who have done statistics will understand, whether we have a significant number of samples to make it statistically sound. In addition, Professor Naismith of Oxford University has been quoted as saying that
“the Scottish and English approach to masking, although formally different since July, has made no meaningful difference to delta.”
Once again we see that there is a whole range of views, but we have listened to those views. Because we do not yet know enough about this variant, we will continue to review the data. For example, some say that it is very mild in South Africa so we should not be overly concerned about it, but we also have to remember that South Africa has a different demographic in terms of younger people. We know that when the virus first struck it disproportionately affected older people—as my noble friend Lord Robathan said, people aged over 85. On the balance of the data at the moment, we believe that wearing face masks works but we have always been very careful to make sure that it is proportionate where we do it.
On the expiry of some of these measures, as the Prime Minister said on Saturday, all the provisions that have been voted on will be reviewed in three weeks. They are necessary and proportionate while we learn more. I refer to the economics Nobel laureate Friedrich Hayek, who talked about humans having limited knowledge. He talked about the conceit of knowledge. The way to understand a lot of complex problems is to allow the discovery process to take hold and to look at what we can learn from that process. We should be very careful not to imagine that we have total knowledge. What we have to do is assess it proportionately.
It is our hope that these regulations will no longer be necessary in three weeks’ time and that we can return to the system that we lived under last week, but in the event that we need more time to understand the effect of the variant, or that the data shows that we need to take a different approach that requires new regulations, the House will return to Parliament ahead of the Christmas Recess for a debate and vote on the regulations ahead of their coming into force.
On regulations expiring, the international travel regulations will expire at the end of 16 May 2022. The face covering regulations will expire, unless extended, at the end of 20 December 2021. The self-isolation regulations at the moment expire at the end of 24 March 2022, but we will continue to review the data. Almost daily the data is being reviewed and conversations are going on. We will also continue to review the data on the new variant and we hope to update Parliament on the review in the week commencing 13 December.
A number of noble Lords asked about facilities. We are told that setting up dedicated testing facilities at border entry points such as airports is logistically difficult at the moment, and risks delays to passenger journeys and operations. Given the turnaround for a PCR test, passengers would still have to travel to their home or the place they are staying and isolate there before receiving a result. The Government are taking a measured and proportionate response. We want to try to protect the UK from omicron while allowing continued safe travel.
A number of references were made to points made by Dr Jenny Harries. As the Prime Minster said, the guidance remains the same as the measures that were in place to fight delta. We have now brought in tougher measures, but we continue to take advice from a number of experts. Individual experts are free to give their viewpoint but we look at the balance—some of it medical, some of it clinical, but also economic and social factors—and getting that proportionate.
Covid-19 Update
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Lord Kamall (Con)
The important thing for us is to make sure that PCR tests are available and that there is sufficient supply and capacity to deliver them. Frankly, as much as we want to make sure there are enough PCR tests, we want to make sure that supplies come to the market. But, as the noble Baroness will be aware, my right honourable friend the Secretary of State has raised concerns about the cost of some of the PCR tests and has been quite public about that.
Lord Robathan (Con)
My Lords, first, did the Minister see the interview with Dr Coetzee, the South African doctor who first identified the omicron variant, on “The Andrew Marr Show” yesterday? She said that the British Government were overreacting and, when asked, specifically agreed that they were panicking. Secondly, could he identify and publish for the benefit of everyone the studies that have shown that wearing these flimsy, non-surgical face masks is effective in preventing transmission? I refer to the excellent research which my noble friend Lord Ridley detailed in the Grand Committee on 26 October, which is in column 123 of Hansard. So far, no proper study has shown that wearing a face mask is effective.
Lord Kamall (Con)
I thank my noble friend for those points. On the comments made by the South African expert, I raised these issues with officials and experts today; one of the points made was that there are different demographics of who has been affected. We want to make sure that we are being cautious and proportionate. Therefore, we have taken these measures as a precaution. On the efficacy of face masks, the point my noble friend makes shows that there is a debate, but we have decided to err on the side of caution to make sure that we are prepared.
Cancer Drugs: Licensing and Approval
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Lord Kamall (Con)
Both NICE and MHRA are aware of the concerns, particularly regarding the delay between approval and licensing. That is why they are having conversations with NHS England and NHS Improvement to make sure, as far as possible, that they can discuss co-operation to ensure the speedy approval of drugs.
Lord Robathan (Con)
My Lords, regarding the efficacy of cancer treatment, so far this year, six friends of mine have died from cancer; all were under 80 and three were younger than me. I know of many more who have terminal cancer, regrettably. I also knew one person who died from coronavirus aged 55. She had leukaemia, or blood cancer, which destroyed her immune system, and she caught the virus while she was being treated in hospital. To put cancer in perspective, how many people under the age of 80 have died this year from cancer and how many people under the age of 80 have died in this terrible pandemic, which has shut down society, damaged our children’s education and mortgaged their future for decades to come?
Lord Kamall (Con)
I thank my noble friend for his question. The focus was on fighting Covid and making sure that people were vaccinated as quickly as possible. As noble Lords know, economics is about the allocation of scarce resources and there are always trade-offs. Sometimes there are unintended consequences of focusing on one condition rather than another. I will write to my noble friend with an answer to his specific question.
Coronavirus Act 2020
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Lord Robathan (Con)
My Lords, I certainly do not oppose these measures since I believe them to be going the right way. I am pleased with that.
I want to concentrate on face masks. The noble Lord, Lord Scriven, mentioned them quite a lot because he believes that everybody wearing them would save lives; they were mentioned in the Minister’s final words as well. They have become a bit of a totem for both sides of the argument on coronavirus restrictions. They divide society, actually. On the one hand—I find myself on this side—I do not believe them to be effective so I do not wear one. It is an act of individuality, if you like; you might even call it an act of rebellion against being told what to do. On the other side of the argument, where the noble Lord, Lord Scriven, is, believers in further restrictions believe that wearing a mask shows virtue and solidarity and provides reassurance to others. That is a perfectly reasonable position, I suppose.
Whatever the opinion polls say, I reckon that about 40% of people on the Tube do not wear a mask now—not 13%, as the noble Lord suggested. That 40% has given up, basically. Children are not required to wear them, of course, but they obviously cannot pass on the virus; I will come back to that later.
In the Chamber of the House of Commons, there is a great political divide between the Government on the one hand, wearing hardly any face masks, and the Opposition on the other, where practically everyone wears one. Last month, I went to a packed memorial service in the Brompton Oratory. It is a huge church—perhaps not the biggest Catholic church in London, but huge. One person was wearing a face mask. None of the clergy was. However, last week, I went to David Amess’s memorial service, where probably about 20 masks were being worn in the congregation. All the bishops and clergy, as they processed behind the unmasked choir, were wearing them. We almost have a Reformation divide now, with Catholics versus Anglicans.
My question for the Minister is simple. Are masks effective? We have, I fear, had some mixed messaging from the Government over the past 18 months. Either masks work or they do not. I am certainly not an expert; I do not pretend that they will or will not do good because, unlike the noble Lord, Lord Scriven, I do not know whether they work.
However, full surgical masks worn in operations presumably work. All the doctors and nurses wear them and have done so for some time—but they are proper surgical masks. Flimsy paper masks are being worn by several people in this Committee, and by the general public. I do not know whether those masks do any good, but I suspect that they do not. What I do know is that Jenny Harries, who is now the chief executive of the UK Health Security Agency and was the Deputy CMO previously, said in March last year that it was “not a good idea” for the general public to wear them. She also said that they “trap the virus” and cause people to start breathing it in.
I have a series of quotes, if the Committee will bear with me, that show the confusion in this matter. I am not saying that I am right. Professor Jonathan Van-Tam, who noble Lords will know, said on April 4 last year that the wearing of face masks by those who are not sick was not recommended by the British Government. He said that there was
“no evidence that the general wearing of face masks by the public who are well affects the spread of the disease in our society.”
That is his view—or it was in April last year. I do not know. Sir Patrick Vallance, who, again, we have got to know well over the past 18 months and is the Chief Scientific Adviser to the Government, told MPs last May:
“The situation with masks … is that the data and the evidence are not straightforward”.
In this House, the then Minister, the noble Lord, Lord Bethell, said on 21 April last year that
“the British Government have been sceptical about the efficacy of face masks. We do not want to be in a position of misleading or providing false reassurance for the public when there is not sufficient scientific evidence for the relevance of face masks.”—[Official Report, 21/4/20; col. 22.]
The following month, on 19 May, he said:
“There is an instinctive human belief that face masks make a difference, but the scientific proof that they do so is not crystal clear.”—[Official Report, 19/5/20; col. 1096.]
Then on 11 June he quoted the World Health Organization and said that
“‘the widespread use of masks by healthy people … is not yet supported by high quality or direct scientific evidence’”.—[Official Report, 11/6/20; col. 1908.]
On 22 June, 11 days later, he said that the mandatory of wearing of face masks was not recommended by the Government.
Now I genuinely do not know, but the situation is certainly confusing; I think everybody can agree on that. I am willing to accept that I am a bit confused. At the Labour Party conference, everybody wore face masks in the hall—we saw them all on television—but they did not wear them at the karaoke parties or receptions. The Liberal Democrat conference was of course virtual, so that was fine. However, they would not have had to wear them because it would not have been very crowded.
So what is the evidence now? Can the Government publish the evidence that made them change their position of last year, with the quotes I have given, to encouraging people to wear face masks? Perhaps there are studies. If they are conclusive, I will wear a mask. That is a promise—but I warn the noble Lord, Lord Scriven, who has just spoken, that one should not rely and base one’s policies on opinion polls.
All the calls that we hear for a return to restrictions should, again, be based on evidence. Are things getting worse? The vaccines certainly seem to work. Indeed, I had a message today to get my booster jab. Deaths are actually right down on what they were a year ago. Can the Minister tell us the percentage of deaths from the virus among those who are over 85? I understand that the average age of death is 85, which is actually higher than average life expectancy.
The Office for National Statistics shows that about half of all new infections are among school-age children—in other words, the unvaccinated young—with few lasting ill-effects. Is that true? Perhaps the Minister can enlighten us on that. Is it the case that there are now studies predicting that cases are likely to fall sharply in the winter? That was in a study from the London School of Hygiene & Tropical Medicine, which was covered in the press yesterday. Is that the case?
We have now heard one or two doctors panicking about flu and calling for the wearing of face masks because there will be flu around. Wear face masks for ever. Every year, on average—it varies dramatically—about 11,000 people die from flu. That is about the same number who are dying every week. So will the Minister reassure me that the Government will not be panicked into reintroducing any dramatic restrictions, or plan B, without basing the decision on very serious evidence?
The Deputy Chairman of Committees (Baroness Pitkeathley) (Lab)
The noble Baroness, Lady Wheatcroft, is not with us, so I call the noble Baroness, Lady Foster.
Viscount Ridley (Con)
My Lords, whether we approve of these restrictions or not, and despite the relaxations of last summer, we should be honest with ourselves and admit that, as the noble Lord, Lord Hunt, said, this remains one of the most illiberal pieces of legislation the House has had to consider since the days of Oliver Cromwell. Actually, Oliver Cromwell abolished this House, so that might not be true.
That it will extend into 2022, two years after the rules first came into force, is alarming. It surely reminds us that the Government made a mistake when they declared an emergency under health legislation rather than the Civil Contingencies Act. Under that Act, we would be able to revisit these regulations much more frequently—monthly rather than six-monthly. When he winds up, will my noble friend express the strongest possible commitment—and hopefully promise—that this is the last time we will extend these regulations?
I am the first to admit that we are not out of the woods. Infections, hospitalisations and deaths remain higher than we would like, although far lower than even the most optimistic of SPI-M-O’s models published in early September—yet another failure of modelling, I am afraid. Already, the recent mini-wave, which is mainly happening among children, seems to have peaked. I urge the Government to resist the increasingly noisy calls for another mandatory lockdown, vaccine passports and mandatory mask-wearing. We can get through this winter with faster vaccinations, especially boosters, and sensible voluntary measures. Remember that, thanks to vaccines, the overall mortality rate for people who get Covid-19 is now down to about 0.1%, as low as flu.
Of all the measures taken, by far the most effective has been vaccination. Lockdowns have undoubtedly also helped but at a brutally painful cost. All other interventions have, as far as I can read from the evidence, proved either surprisingly ineffective, such as handwashing, or ambiguous at best, such as face masks. I want to focus on face masks and the argument for making them mandatory.
I am completely open-minded as to whether face masks help; they might or they might not. I have been willing to wear them. I favour them on precautionary grounds and if anybody can present me with a decent study on their effectiveness, I will read it and shout it from the rooftops. However, in preparing for today’s debate, I read a lot of scientific papers and I came up empty. The papers that purport to vindicate masks tend to be flimsy or flawed: they ignore the effect of other measures; they confuse correlation with causation; they compare apples with oranges; they rely on modelling rather than data.
For example, a meta-analysis commissioned by the WHO claimed that masks could lead to a reduction in the risk of infection, but the studies considered mainly N95 respirators in a hospital setting and not cloth masks in a community setting. Another study in the PNAS claimed that the correlation between declining infections and mask mandates was due to causation, ignoring similar declines elsewhere, and 40 scientists recommended that the study be withdrawn. Early in the pandemic, the advocacy group, #Masks4All, argued that Czechia had fewer infections thanks to the early use of masks. In reality, the pandemic simply had not reached eastern Europe by that stage. A few months later, Czechia had one of the highest infection rates in the world despite an early and strong mask mandate. A study in the US and another in Bangladesh were eventually withdrawn; a German study claiming to vindicate masks actually found no net change overall; a Canadian study claimed that countries with mandated masks had fewer deaths, but it compared very different countries and only the first few weeks of the pandemic. A review by Oxford University claimed that face masks are effective, but it looked at healthcare settings and not community settings—and so on and so on.
Meanwhile, the studies that are well designed and carefully executed have all reached the opposite conclusion: that they cannot find evidence that masks help. An April 2020 review by the University of Illinois, a May 2020 article in the New England Journal of Medicine, a May 2020 US CDC meta-study on pandemic influenza, a July 2020 review by the Oxford Centre for Evidence-Based Medicine, an October 2020 randomised control trial with close to 8,000 participants, a November 2020 Danish randomised control trial with 6,000 participants, a November 2020 gold standard Cochrane review—sorry about this; I am nearly at the end—
Viscount Ridley (Con)
A February 2021 review by the European CDC, a July 2021 experimental study published by the American Institute of Physics and an August 2021 study published by the International Research Journal of Public Health all failed to find causation. It might be there; they are not saying it is impossible, but they have not found it. If somebody can produce a study showing a strong and significant effect of masks on transmission then I will change my mind, but it has to be a decent bit of work.
Talking of experts, Gary Lineker said of mask wearing on Twitter that
“the evidence is clear that it reduces your chances of catching Covid”.
Well, which studies is he referring to? He did not cite a particular study.
Yet surely it is common sense that covering your face must help. To some extent, I am convinced myself that it probably does. It certainly stops large droplets. However, one thing that we have learned in this pandemic is that decades of advice about how such a virus is spread has turned out to be wrong. We now know that the way that this kind of virus spreads is generally not through droplets, which masks stop, but through much smaller aerosols, which are essentially evaporated droplets. They go straight through or out the side of most masks. Catching aerosols with masks is like catching midges with a tennis net.
Masks can give false reassurance. Like my noble friend Lord Robathan, I went to a memorial service yesterday, albeit a different one. There were hundreds of people in the church. The organisers suggested taking a lateral flow test before coming, which was a good idea, and I did. They also said that mask wearing was a condition of coming and I did that too. So did anybody else. But did that give me and the others there just slightly too much reassurance? Risk compensation behaviour is a real phenomenon: motorcyclists drive faster with helmets on. Do people take slightly more social risks when wearing masks? I fear it is possible that they do, so it is not necessarily the right policy.
Masks signal that you care and that you are being careful. That is worth something, I admit, but is it enough to justify making them compulsory? I do not think it is. Again, I say this not because I want masks to be ineffective—I would much rather they were useful; I do not find them particularly enjoyable to wear, but I do not particularly mind wearing them—but I try to think with my head and not my gut. It is data that should guide us, not feelings.
I have one final point. I declare an interest in that I am about to publish a book about the origin of Covid—I might have mentioned it before. The fact we still do not know and that we most certainly cannot rule out that it was a lab accident, as my noble friend Lady Foster said, at the Wuhan Institute of Virology means that another such pandemic is possible and could happen any day. That fact alone will have encouraged rogue states and terrorist organisations to investigate the possibility of deliberately causing a pandemic. The UK Government have shown surprisingly little interest in this issue so far, leaving it to the American Government, the Chinese Government and the WHO, but as one of the leaders in scientific research in the world the UK Government should give it their attention. I ask my noble friend to put it in his no doubt very thick in-tray.
COVID-19: Type 2 Diabetes
Lord Robathan Excerpts(2 years, 6 months ago)
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Lord Kamall (Con)
In response to the increases in weight due to Covid-19, but also before, which led to more type 2 diabetes, the Government, the DHSC and the NHS have been looking in detail at how to respond. Further details will be made available.
Lord Robathan (Con)
My Lords, I am glad that the Government recognise that this is a huge problem, and the dangers that being overweight brings, especially during Covid. However, does my noble friend not recognise that the strategy, good as it may be, is not working? Is it not time to revert to the situation when I was young, when it was not socially acceptable to be grossly overweight, and to push individual responsibility? Government policy should tell people that they must not eat so much.
Lord Kamall (Con)
I am beginning to wish I had eaten a full breakfast. With any strategy or programme, we always have to be careful about unintended consequences. As we focus more on obesity and make more people aware of healthy living and healthy eating, it is important to have the right balance and to be aware of the impact this can have, so that we are not creating more problems, concerns and anxieties for those who suffer from eating disorders.
Covid-19: Plan B
Lord Robathan Excerpts(2 years, 6 months ago)
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Lord Kamall (Con)
I thank the noble Baroness for her question and, while I have the opportunity, for all her advice, as a new boy in the role. We will continue to look at a number of different factors, including both economic and health indicators, before we judge whether it is necessary to move to plan B. Plan B does not actually involve complete lockdown. It involves introducing mandatory vaccine-only Covid status certification in certain riskier settings; legally mandating face coverings in certain settings, such as public transport; and communicating clearly and urgently to the public if the risk level increases.
Lord Robathan (Con)
My Lords, could my noble friend tell us, following the amazing success of the vaccine rollout, what proportion of hospital beds are occupied by Covid patients? Because it seems to me that some people—some doomsayers—are trying to create panic where there is no need for it.
Lord Kamall (Con)
I thank my noble friend for his question. I do not have the detailed data and I will write to him. But in terms of the link between cases, hospitalisations and deaths, it is quite clear that the vaccine has been working to break the link between the number of cases, hospitalisations and deaths.
Covid-19 Update
Lord Robathan Excerpts(2 years, 10 months ago)
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Lord Bethell (Con)
My Lords, I did not quite say that I did not know how many people use the app; I said that we do not know who is using it. We keep an eye on it and, to date, its use has not dropped, but we are naturally concerned that trust in the app will deteriorate and that is why we are looking carefully at the advice that comes out of being pinged. Some 19 million people have the app. It is an enormously valuable resource, and one that we believe has made a big impact.
Predicting long Covid and infections is extremely difficult because we do not know what the infection rate is going to be. We are in a race against the virus. I hope that very soon the impact of the vaccine will bring R below one and the disease will start going down instead of up. But I cannot tell the noble Baroness, exactly when that date will be.
Lord Robathan (Con)
My Lords, last month the Minister made some highly critical comments about my having had the temerity to question the wisdom of government restrictions. Yet we now know that the last Secretary of State did not believe in their value either. Given the small risk to children and teachers from the virus, can my noble friend explain what the value has been—backed by evidence—of severely disrupting the education of hundreds of thousands of children by enforced isolation? Or should we be similarly sceptical about that policy?
Lord Bethell (Con)
My Lords, I know that my noble friend is sceptical of almost everything to do with the Government, and I am not quite sure how to address that question—but I will take it seriously. The bottom line is that children are a vector of infection, and, during the tough days before the vaccine, they were the ones who spread the disease around, accounting for a very large proportion of the numbers. As a father of four, I can tell you that it was extremely frustrating to have our children sent home, but, none the less, it was an important and impactful aspect of our fight against Covid.
Health Protection (Coronavirus, Restrictions) (Steps and Other Provisions) (England) (Amendment) (No. 2) Regulations 2021
Lord Robathan Excerpts(2 years, 10 months ago)
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Lord Robathan
To leave out all the words after “that” and insert “this House declines to approve the Regulations laid before the House on 15 June because (1) the measures are disproportionate, and (2) no impact assessment has been prepared for them.”
Lord Robathan (Con)
My Lords, we are told it is “one last heave”, “a teeny bit longer”, “just a little longer” and “we only rely on the data, not the dates”. “Freedom day”, which was meant to be next Monday, has now been replaced by “terminus day”, 19 July. I hope we all believe in freedom. It is no business of the Government to tell us whether we can, for instance, hug people. They can advise perhaps, but not order us. People should be free to make their own decisions and their own assessment of risk.
We have been told since this started 15 months ago so many contradictory things. I shall start at the beginning: “Stay at home, protect the NHS, save lives”. I understand—the Minister can correct me if I am wrong—that 1% of hospital patients are now in for Covid-related issues. Are the hospitals overwhelmed? Is the NHS protected? It is not like Italy last March. On “save lives”, according to the Times, yesterday there were three Covid deaths. The average number of daily deaths over the past four weeks has been in single figures. We know that more than 75% of deaths are among the over-80s; we know that underlying health conditions—obesity, diabetes, respiratory problems or infections—are normally contributory factors to fatalities. The Prime Minister said that the extension to these regulations would save “thousands of lives”. I am not sure that is right.
This is a very serious and unpleasant virus that is killing people, but it is not the Black Death, the Great Plague or the Spanish flu. I ask every Peer in the Chamber or listening how many people they know—not know of, but know: friends or family—who have died of Covid. Most people will say none. I know two. One was an 89 year-old relation with severe dementia in a care home—where, by the way, he caught the virus; the second was a charming, really nice 55 year-old who had been working in the Commons tea room ever since I got there, Julia Clifford. It was a tragic death and I am so sorry. She had leukaemia, for which she was being successfully treated by the NHS with chemotherapy. Her immune system was damaged, and she caught the virus in hospital.
Other advice included, “It’s pointless to wear face masks”—we were told that until August last year. I can see some wisdom in wearing them, but we are now told that droplets of breath escape from the sides—I really do not know, but I deprecate the litter they have brought. We were told “wash your hands”—very good hygiene—and “clean surfaces”. Now a study shows—I do not know whether it is true—that one in 10,000 cases are contracted from surfaces, and many fewer than 10,000 cases were reported yesterday. Can my noble friend tell me whether that study is correct?
The Government say that “we are following the data”, but we are not; we are being spooked by the possibilities of risk. The only huge success story is vaccinations. I congratulate the Government, all those involved, Kate Bingham—who was criticised by some members of the Opposition for being, first, successful and, secondly, married to a Conservative Minister—and the Minister, Nadhim Zahawi. Is it not the case that 95% of vulnerable people—those most at risk of death or severe consequences—have now been vaccinated? So who are we protecting and from what risk?
If I might digress, mandatory testing for travellers is a completely pointless racket and hugely expensive. I went to Lisbon a couple of weeks ago. I had three tests to go on a long weekend. Two were in the UK. There was a special deal; the price was reduced by 50% to £120, but while I was away it went down to £86, so that is a huge profit for the company. As two vaccinated people, we paid a total of about £450 for tests.
We are literally mortgaging our children’s future. They will be paying off the national debt for decades. We are deliberately harming our country; this is deliberate self-harm. Even Tony Blair, with whom I disagree about most things, says that some 6 million jobs may be lost offshore, and the data shows me that this is unnecessary. Airlines, the travel industry, hospitality—all are hugely harmed. Hotels, pubs and restaurants have closed and will never open again. The impact on education and our children’s development is horrendous, and what is it for? The data says that there was an average of fewer than 10 deaths daily post the vaccination success, but in the summer something like 1,300 people die daily in the UK, and there is an average of some 1,700 deaths each day over the year.
It gives me no pleasure to move this fatal amendment to the Motion, but I fear that the Government’s policy is foolish and harmful, and I know a great many people agree with me. The Government admit that they do not know the impact. I shall quote from page 4 of the regulations:
“No impact assessment has been prepared for these Regulations.”
The front page says that this is a
“serious and imminent threat to public health”.
Is it really, if the vulnerable have all been vaccinated? Is it proportionate to close businesses and put people out of work for very little? To repeat my noble friend Lord Hannan in the last debate, to what problem is this SI the answer? We need to live with the virus, as the Chancellor and, I think, the Prime Minister have said, and we need to live with risk. Parliament is responsible for legislation, especially of course the House of Commons, rather than here. We are being asked, as parliamentarians, to suspend our critical faculties. This measure does not deserve to be nodded through. It impacts adversely on too many lives and on our country’s future. I shall, with regret, divide the House today, in the hope that many who agree with me will wish to be counted.
Lord Robathan (Con)
My Lords, by his last rant my noble friend Lord Bethell really knows how not to get me to withdraw an amendment. I point out that, yes 127,000 people have died from or with Covid, at the same time as somewhere between 700,000 and 800,000 people have died altogether. Of those 127,000 people—and they are all tragic—three-quarters have been over 80. I am older than him—let me tell him: mortality is on the horizon.
I thank the noble Lord, Lord Winston, very much for the advice on military tactics. I always thought it was about judgment, risks and balancing risks. I agree with Clemenceau who said that war is too important to be left to the generals. In this case, this crisis is too important to be left to Neil Ferguson and his risk-averse colleagues. We are asked to suspend our critical faculties and called to make a judgment as parliamentarians on the evidence. I am sceptical, as the noble Lord, Lord Bethell, said.
It is the responsibility of the other place to determine this policy, notwithstanding what has not been good treatment by the Prime Minister. I have found this debate and the feel of this House rather disappointing and pusillanimous. As far as possible, I have taken the mood of the House; it is pretty difficult at the moment. I am very happy to go over the top at any time to certain defeat, to continue the military analogy of the noble Lord, Lord Winston, but on this occasion—notwithstanding the support of various colleagues who have urged me to force a Division—I can see that certain defeat is going to be rather overwhelming, so I beg leave to withdraw the amendment.