Covid-19 Update

Baroness Brinton Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for the Statement today, which takes us further into the discussion that we were having on Tuesday and allows him to address some of the questions that perhaps he was not able to on Tuesday.

We all want our economy to open and get back to normal. The question is whether we do it in a controlled way or a chaotic way. The Health Secretary told the Commons on Tuesday that, under the Government’s plan, infections could go to as high as 100,000 a day. There are some huge issues that the Minister and the Government have failed to address with information and clarity about the massive change in policy contained in the announcements on Monday and Tuesday. The first of these is surely the potential 100,000 infections a day in a few weeks’ time. When I asked on Tuesday about the scientific advice, the Minister gave me what can be described only as a pick-and-mix answer, one in which he said SAGE’s advice was “interesting”. I am sure that SAGE’s advice is always interesting, but is it being taken into account in decision-making as it used to be? I specifically refer him to the most recent SAGE papers, which made it clear that with high infection rates there would be a greater chance of new variants emerging and greater pressure on the NHS. More people will get long Covid and test and trace will be less effective. As NHS Providers said today,

“current pressures on the NHS mean that the predicted rising infection rates for COVID-19 will inevitably affect the speed at which trusts can recover care backlogs.”

I quote Chris Hopson:

“Trust leaders can see the strong logic of ‘if not now, when?’ and they recognise that, as a nation, we must learn to live with COVID-19. But they want the Government to be clear about the risks of relaxing restrictions. This includes the inevitability of higher hospitalisations and mortality, albeit at lower levels than previous waves and the risk of new and more dangerous variants emerging. They are also worried about the impact of long COVID. It’s important these trade offs are clearly set out, including the impact on the NHS’s ability to bear down on the backlog.”


Indeed, a letter from 100 experts in the BMJ today raises the same issues. That is why the impact assessment is so crucial. The Prime Minister seemed to find this impossible to address yesterday, so I would like to see if the Minister with his much greater and closer knowledge of these issues could be more enlightening to the House today. Have the Government undertaken an impact assessment of the projected rate of infection? Yes or no would probably suffice. If it is yes, when will it be shared with Parliament and the public? If it is no, the Minister must explain why this has not happened and tell the House when it might. We need to know what is the number of hospitalisations and deaths; what is the number of people with long Covid, which will be the outcome of 100,000 infections a day; and what is the impact on the NHS, will it slow down the catch-up for diagnostics and treatment and by how much? I am very happy if the Minister wants to email the details of the answers to me, if he does not have them to hand–although he ought and they need to be in the public domain.

We know that the link between infection rates and deaths has been weakened, but it has not been broken. All the experts seem to agree on that. Let us be clear why infection rates are so high: it is because the Prime Minister let in the delta variant. I agree with my right honourable friend Keir Starmer that we might now change its name to the “Johnson variant”. Let us be clear why the number of cases will surge so quickly: it is because the Government are taking all protections off in one go. As my right honourable friends Sir Keir Starmer and Jonathan Ashworth have said, this is reckless.

The next obvious question is the one about the dreaded ping and the huge number of people who will be asked to isolate. If there are 100,000 infections a day, that means hundreds of thousands—perhaps millions —of people are going to be pinged to isolate. The Financial Times estimates that it could be 2 million people and the Daily Mail says it could be 3.5 million people. Either way, it is a massive number. How many people do the Government expect will be asked to isolate if infection rates continue to rise at this rate? Again, this question was asked of the Prime Minister yesterday and he clearly did not know the answer or refused to say, so I will repeat it again: how many people are going to be asked to self-isolate if there are 100,000 or more infections a day?

Does the Minister appreciate that those who are immunocompromised or for whom the vaccine is less effective will have their freedoms curtailed by ditching masks on public transport? Blood Cancer UK warned yesterday that people with blood cancer will feel that their freedoms have been taken away from them. It is quite possible that the 19th will not be freedom day. It might be the day when a record number of people will switch off their NHS app, because they will see coming down the track isolating and cancelling holidays. It is already beginning to happen. Has the Minister seen those stories? We on these Benches do not support that course of action, but does he realise that this could seriously undermine the expensive track and trace system, on which so much depends?

I have to repeat again that the biggest barrier to an effective isolation policy has been not the inconvenience but the lack of financial incentive to stay at home. If we are to live with this virus, the days of people soldiering on when unwell are over. Sick pay is vital to infection control. Will the Government please now fix it?

Business leaders are expressing very serious concerns about the loss of staff and customers. There are now 700,000 children off school per week. At my grand- daughter’s school this morning, two classes were sent home due to two teachers being pinged. After-school sports were cancelled and she is very disappointed. It is happening everywhere, as our amazing head teachers and school staff limp towards the end of term doing everything they can to deliver teaching, joy and normality to our children under the most difficult and often underappreciated circumstances.

The question I want to ask for clarity from the Minister is about the ubiquitous ping. Is the ping advisory for self-isolation or mandatory? If you get an email or phone call, does that trigger mandatory self-isolation? Finally, I ask about data in the last 24 hours or so from Israel’s Ministry of Health, which points to the Pfizer vaccine being just 64% effective at stopping symptomatic and asymptomatic transmission of the delta variant. Can the Minister tell the House about this?

[Baroness Brinton (LD) [V]]

My Lords, one year ago when lockdown was lifted, we had around 1,000 new cases a day. Yesterday it was 32,000 new cases. Equally concerning, cases are doubling every nine days; hospitalisations are going up; ventilation bed occupation is going up; NHS Providers, as the noble Baroness, Lady Thornton, has said, is talking about hospitals moving back into created-Covid wards and managing safe areas. GPs and hospitals are all reporting a worrying large increase in young people with long Covid, putting further pressure on their services, let alone the worries of an epidemic of long-term illness in the working population. Anecdotal evidence suggests that some hospitals are now considering cancelling some staff summer leave. Wonderful as yesterday’s England victory was, the sight of 60,000 fans walking down Wembley Way in very close proximity with hardly a mask in sight was concerning. As with the England-Scotland match, we must expect a surge in cases. Yesterday, the BBC asked Dr Mike Ryan of the World Health Organization about the UK proposals to lift all restrictions on 19 July. He replied:

“The logic of more people being infected is better is, I think, logic that has proven its moral emptiness and epidemiological stupidity”.


The letter in today’s Lancet from 100 senior medics and scientists echoes the WHO view. What are the Government doing to explain to the experts why their strategy is safe?

I will return to the substance of the Statement later, but I start by thanking the Minister for the meeting yesterday with other Peers, Blood Cancer UK and the Anthony Nolan trust to discuss the immunocompromised and the clinically extremely vulnerable. There are over 2 million CEV who had to shield—that is 3% of the population. So, arising from questions I have asked the Minister many times before in your Lordships’ House, I will ask the following. The CEV, of whom I am one, are worried at the total silence to them over recent weeks since shielding ended formally but, with stay-at-home advice still in place, with cases rocketing daily and all restrictions easing, can the Minister explain how advice to them is being co-ordinated publicly by government? One blood cancer patient said today to an APPG of parliamentarians that the dissonance of their safety versus everyone else’s freedom was hard to bear, especially with no advice. In particular, who has clinical responsibility for drawing together the different issues of therapies, responses to vaccines and continuing care for underlying diseases, and which Minister has overall responsibility?

Overnight, there have been some suggestions from journalists that shielding might even return. If so, that needs to be communicated very urgently to those at high risk, who have not been told about their low vaccine antibody rate. They may be planning to mix with people, or perhaps even go on holiday. Will benefit support for the CEV who have to stay at home but cannot work from home be reintroduced? If the Government are serious about the irreversibility of the lifting of all restrictions, some of the CEV will not be able to return to work for weeks, or even months.

I turn to testing. There are reports today that the Government plan to charge for the lateral flow tests from the end of this month. As LFTs are supposed to be the great self-regulators that the Government are relying on, how much are people going to be charged? You do not pay the Government for a blood test to see whether you have picked up any other infection. The level of charging for PCR tests for people returning from abroad also remains a big issue. Last week in your Lordships’ House the noble Baroness, Lady Vere, told my noble friend Lady Ludford that PCR tests could be obtained at a price of £85 for two. My noble friend’s local pharmacy is charging £398 for a test on the same day, or £240 for the next day for two tests. I know other members of the public have reported similar problems. Can the Minister say how the pricing of PCR tests is being managed and, perhaps more importantly, where one can find the “£85 for two” tests?

On Tuesday, I set out what we from these Benches seek in a return to normal life. We want people to return to work as soon as possible, to be able to mix with family and friends and for our children to be able to have consistent access to education without interruption. We also agree that now is the time to start to do some of that but—and it is a big “but”—we cannot get rid of all the safeguards that protect people mixing together while the virus is still live. An effective test, trace and isolate system is essential. This Statement makes it clear that that is being dismantled. Can the Minister explain why that makes any sense?

Last night, Sebastian Payne of the Financial Times reported the re-election of Sir Graham Brady MP as chairman of the 1922 committee, and tweeted:

“Brady’s re-election is … a reminder of why Johnson is dropping masks and nearly all other … restrictions on July 19: ministers privately say the government no longer had the … votes to keep the measures in place. Relying on Labour would have been … difficult for the PM.”


Are the Prime Minister and the so-called Covid Recovery Group now putting health and lives at risk for their own principles?

Finally, with the threat of 100,000 cases by the end of the month, with hospitals saying they are already worried about the increase in patients and with the threat of the new lambda variant and new north-east variant under investigation, please will the Minister confirm that these changes are not irreversible and that the protection of the NHS, and the safety of all the people in this country, remain the Government’s priority?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Bethell) (Con)]

My Lords, I am enormously thankful to the noble Baronesses, Lady Thornton and Lady Brinton, for such thoughtful questions. I will certainly try to address as many of them as I can.

In reply to the noble Baroness, Lady Thornton, on the advice we get, I am afraid, as I said last time, that we of course draw on lots of advice from lots of people. I completely acknowledge, as she rightly pointed out, that no decision in this pandemic is risk-free. She set out the list of possible risks very well. There is always the possibility that there will be new variants. We are extremely concerned about the existing 1 million people who have self-diagnosed with long-Covid symptoms; the possibility that that number may rise is very much on our minds, and we are putting in place NHS provision to assist in diagnosis and treatment of that.

We are extremely concerned that test and trace resources will be stretched. We are therefore looking extremely closely at the policy around testing and isolation, while providing test and trace with the resources it needs to get through any increase in the infection rate. I also completely acknowledge the concerns of the NHS Confederation on hospital beds and hospitalisations —although the statistics on those today are extremely encouraging.

Those are all acknowledged concerns that we keep close track of, while putting in place measures to mitigate and minimise their impact. However, the noble Baroness, Lady Thornton, half-answered her own question, because she is entirely right: we need to focus on getting the NHS back to speed in order to address the very long waiting lists and to get elective surgery back on track. It is very difficult to find an answer to the question, “If not now, when?” That has been tackled by the CMO and a great number of people. It must surely be right that we take the inevitable risks of restarting the economy and getting people back to their normal lives at the moment of minimum risk from the virus, which has to be in the middle of summer. Assessing those risks precisely is incredibly complex. Impact assessments of the kind that we would normally associate with legislation are the product of months of analysis. They often identify one relatively straightforward and simple policy measure. We are talking here about a machine of a great many moving parts.

I cannot guarantee that any model anywhere could give us accurate projections of the exact impact of what is going to happen this summer. We are, to a certain extent, walking into the unknown: the Prime Minister made that extremely clear in his Statement. As such, we are ready to change and tweak our policy wherever necessary in reaction to events. However, what we know very well now on the basis of our assessment of the data, and because of the pause we put in place to give ourselves breathing time to assess and additional time to roll out the vaccinations, is that that direct correlation between the infection rate and severe disease, hospitalisation and death has massively diminished. There is a relationship, but it is a fraction of what it used to be.

We can therefore look at a period where those who are at extremely low risk of any severe disease may see an increase in the infection rate, because we know that those in the highest-risk groups have been protected by two doses of the vaccine, and two weeks, and because we are working incredibly hard to get as many in the high-risk groups vaccinated as possible—half a million a day—and to roll out the vaccine to younger cohorts. That is the balance. I cannot deal in certainty here, because certainty does not exist. Balance is key, and I believe the balance we have here is the right one.

The noble Baroness asked specifically about the NHS Covid app. It is in some ways emblematic of the kind of decisions we are making at the moment. She is entirely right: the anecdotes are loud and clear. The app is pinging loudly around the country as the infection rate moves up. To clarify the legal point, as noble Lords probably know, the app protects privacy. We do not know the identity of the person who has the app. In fact, we have no information about people who have the app at all because it has such rigorous privacy protection. As such, the ping from the app is advisory but a telephone call from test and trace is mandatory. That has a legal status and a breach of that advice could lead to an FPN or a knock on the door. It has a different status in that respect.

Given the large number of infections and the large number of pings, we clearly need to review the way in which the app works. The Prime Minister talked about this earlier today. He talked about moving from a quarantine-and-isolation approach to more of a test-and-release approach. We are not quite there yet but we are clearly well on the way. Therefore, I would be glad to clarify how we have made those decisions once they have been announced.

The noble Baroness, Lady Brinton, talked about the plight of the immunosuppressed. I am grateful to her and to Anthony Nolan, Cancer UK and others who were on the call yesterday. I express complete sympathy with the point made by the noble Baroness. If you are at home and your immune system does not work as well as other people’s, and you see the rest of the country opening up, you will feel extremely uncomfortable, as though the world has moved on and that you have perhaps been left behind. Those were the feelings described to me by the experts I met yesterday. On an emotional level, I completely sympathise with that. There are some people in this country whose immune systems do not protect them from flu and contagious diseases that would have no impact on those with a fully functioning immune system. We have complete sympathy for those people.

I acknowledge the noble Baroness’s point that there is a need for clear advice because the immunosuppressed are a highly diverse group. There may be people recovering in hospital with a completely flatlined antibody system, compared to someone who has rheumatoid arthritis but is otherwise living at home and is mobile. It must be right that that communication is done on a tailored basis through the healthcare system. We will look at ways in which we can ensure that GPs are informed and have the right information in order to give that bespoke advice.

The dissonance is hard to bear. I recognise the noble Baroness’s point but I do not necessarily have a suite of answers for absolutely everyone in this condition. We have large investments in antivirals and in therapeutic drugs, including some of the monoclonal antibodies that may offer some protection to some people in this situation, but it is not going to be a blanket measure. As a result, we are putting a huge amount of investment in the OCTAVE study, which looks specifically at ways in which vaccines, boosters or therapeutics can be used to protect those whose immune systems are not right. Ultimately, it is going to be down to the vaccine. The vaccination of a large proportion of the population, including the carers who look after the immunosuppressed, is how we will offer protection to these people.

On the noble Baroness’ question about the LFT system being dismantled, I do not recognise those press reports. On the provision of PCRs by the private sector, she asked how prices are determined. The answer to that is through the market. The marketplace introduces competition and innovation. I am pleased to say that the price for tests is coming down and will come down further. The one provided by Chronomics for TUI is now £30; that is a very encouraging sign that there is more to go.