Covid-19 Update

Baroness Jolly Excerpts

Thursday 12th November 2020 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, this Statement was made in the Commons on Tuesday and, as we know, events move quickly where the coronavirus pandemic is concerned. Since Tuesday, further details about the welcome breakthrough in the development of a vaccine have been emerging and there is much scope for optimism. Also welcome is that the Government have, at last, agreed to a six-day travel window for students in England next month, after the end of lockdown, so that they can go home before Christmas and undertake periods of isolation, if needed, and be with their families. This requires mass testing on university campuses before students can leave, so can the Minister update the House on the plans and arrangements for this, please?

However, yesterday we also reached the grim milestone of Britain’s Covid-19 death toll passing 50,000—a sobering reminder of the severity of the crisis, as we struggle through the second wave. As Labour’s leader, Keir Starmer, said:

“Behind these numbers is a devastated family, one for every death, and they have to be uppermost in our mind.”


The announcement in Tuesday’s Statement of twice-weekly routine testing for front-line NHS staff is a very important development. It is vital not just for protecting staff, but for infection control in healthcare settings. We have been pressing for a systematic programme for this for months. Can the Minister please update the House on the progress and roll-out timescales to which the Government are now working?

On testing more broadly, the Government have announced plans for the mass distribution of lateral flow tests. I understand that local directors of public health have been asked to develop local strategies, but does the Minister agree that families with a loved one in a care home should be given priority access to these tests, so that they can see, and hold the hand of, that loved one? Will public health teams be put in charge of contract tracing from day one? At a Commons Select Committee this week, the noble Baroness, Lady Harding, who is in charge of test and trace, finally admitted what we have been saying all along: that people are not self-isolating

“because they find it very difficult … the need to keep earning and … feed your family is … fundamental”.

Does the Minister therefore accept that a better package of financial support is needed to ensure isolation is adhered to? Can the Minister also tell the House if it is the Government’s intention to reduce the isolation period? What assessment has been made of evidence that a negative PCR swab, seven days after exposure, could release someone from quarantine?

The vaccine is a moment of great hope and optimism, in a bleak, dismal year that has shattered so many lives and families. The Government need to continue to be optimistic, but must be cautious to resist the urge to talk up and overpromise, and adopt their usual best-in-the-world rhetoric. As further details about the vaccine emerge, there will be many questions, and I am sure noble Lords will follow these up. We strongly support the priority list drawn up by the Joint Committee on Vaccination and Immunisation, under which care home residents and staff get the vaccine first, followed by the over-80s and other NHS and care staff. There will need to be widespread consultation with key stakeholders on the arrangements, timings, resources and logistics. Given past experience, can the Minister specifically reassure the House that the adult social care sector, and care homes in particular, will be fully involved in planning delivery of and administering the vaccine?

Just as important, how will the disproportionate impact of the virus on minority ethnic communities be taken into account, when drawing up the final priority list arrangements? What is the Government’s working assumption of what proportion of the population needs to be vaccinated to establish herd immunity and bring the R rate below one? Can the Minister outline the latest clinical thinking around vaccination of children?

I understand that each person will require two shots of the vaccine, three weeks apart, and that protection develops a month after the first shot. Details of the Government’s plan for what amounts to the biggest vaccine manufacture, campaign and distribution in history are beginning to emerge. We need to learn lessons from the failures of the rollout of test and trace, and the early procurement of PPE. None of us wants to see booking systems overloaded with people told to travel miles, as we have seen with testing, so when will we see the Government develop that plan and their overall strategy?

Are the Government working with international partners to ensure that there are enough raw materials, enzymes and bioreactors to guarantee the mass manufacturing needed? Will there be the cold chain for transport and storage in various parts of the country for the Pfizer vaccine, which needs to be kept at minus 70 degrees centigrade? Have arrangements begun for procurement of the appropriate storage equipment? Will liquid nitrogen and freezers be provided to health centres, doctors’ practices and care homes? How is the vaccine to be distributed and administered to ensure that it is kept at such low temperatures?

On safety, it is comforting that the Deputy CMO, Jonathan Van-Tam, has assured us that he would urge his elderly mother to be vaccinated and that safety will not be compromised, despite the speed of the programme. The regulator, the MRHA, has rightly promised that there is no chance that it will compromise on standards of safety or effectiveness. How do the Government plan to get that message across to the public?

We know that vaccine hesitancy and denial is a growing problem. Labour has offered to work with the Government on a cross-party basis to build public confidence in the vaccine, promote take-up and dispel anti-vax myths, many of which are not just fiction but malicious. I look forward to a positive response from the Minister.

[Baroness Jolly (LD) [V]]

I thank the Minister. I am going to address testing and tracing. He may not have answers but I should be grateful if he could write to me. There have been more than 10 million downloads of the NHS Covid-19 contact tracing app. There have also been many complaints of Bluetooth draining batteries. I second those. Will he confirm whether there is a solution in the pipeline for that issue? If people do as I do and just switch off Bluetooth, the system will not work. How many of these app users are active? If 10 million people are actively telling the world where they are and are checking in and out of where they have been, that is wonderful. But if they do not do so, it is not terribly helpful.

Critically, how many people have been triggered via the app to isolate? Of those, what proportion have had their isolation checked and by whom? Testing is quick and easy but the delay in response time is unhelpful. Swab processing time is not reducing due to the increase in the number of swabs, and labs are taking longer. Is there yet sufficient capacity, and how many staff are being trained weekly to take on the extra capacity? Can the Minister indicate the cost of taking a swab and getting the results back to the individual? Finally, will he confirm when he expects to move to lateral flow tests, which are much quicker and would transform the lives of the staff of care homes, their residents and visiting families?

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

My Lords, I am extremely grateful for the thoughtful questions of the noble Baronesses. I shall try to answer them as completely as I can but will write on any that I have omitted. As regards the questions about students, the programme of works with universities is extremely ambitious. I pay tribute to vice-chancellors and university administrations for working extremely closely with the Government, with the test and trace service and the DfE to mobilising the necessary arrangements in order to achieve the return home for Christmas.

This will include a large amount of mass testing on university campuses and in digs. There have already been successful pilots at Durham and De Montfort, using a variety of testing techniques and formats. Some tests have been done using telemedicine, some using traditional clipboard and picnic table techniques. There is further testing piloting to be done, but the indications are that this is proving an extremely successful model. It means that students can look forward to returning home for Christmas, confident that those who have the disease have been screened, and families can look forward to seeing students safely again.

On the testing of NHS workers, I agree with the noble Baroness that it is a priority. We are moving quickly on this. The purchase of tens of millions of lateral flow tests is a complete game-changer, and we remain committed to providing testing for the 1.3 million NHS workers. We aim to use lateral flow tests for some of these tests. NHS workers are themselves clinically trained, and it is appropriate for them to be able to use these tests. Therefore, we believe we can change the course of staff testing in the NHS environment using the new technology and a new approach to testing. I am extremely grateful to NHS colleagues for their participation in this important initiative.

Turning to DPHs, the noble Baroness is right that this is an important breakthrough. Again, the rollout of the lateral flow tests is important in that. She asked me about care homes, and she could have equally asked me about schools. I can deliver the same message on both: we have been sensitive to the appeals by DPHs for autonomy—for them to be able to make their own decisions, use their local intelligence and use their insight. That is why we have been reluctant to give any firm guidance on how they could or should use those tests. It is entirely up to DPHs to use the tests in the way they choose. But it is our expectation that some of those tests will be used in care homes, though there are other provisions for care home testing, and some will be used in schools, as well as for outbreak management and community testing.

The period for isolation is a subject under constant and rolling review by the CMO’s office and the policy team at DPH. I wish I could provide some kind of breakthrough—that the virus had in some way changed and was no longer infectious in people after a week or eight or nine days—but I am afraid I cannot provide that information. The frustrating thing about this virus is that it sits in the back of the throat or nose and remains infectious for an unfeasibly long time. That is why we are cautious about making dramatic changes in the isolation protocols.

What rapid testing provides is the opportunity to do frequent testing. The noble Baroness asked me about seven-day PCR tests; more likely and efficacious would be regular testing, every day or every other day, using the lateral flow tests, to do some form of test and release. We believe that avenue is more likely, and the CMO’s office is looking closely at that. It is entirely up to that office to make announcements on that score.

On adult social care, I reassure the noble Baroness that adult and child social care colleagues are fully involved in the preparations for a vaccine. She is right that social care provides its own set of challenges for the administration of the vaccine, but those are exactly the people we need to target with the vaccine. That is why they, particularly the elderly, are at the highest level of the JCVI’s prioritisation list. We are putting all our efforts into making sure that the vaccine delivery works for them.

The noble Baroness asked about ethnic minorities. May I put the question slightly differently? A number of difficult-to-reach groups have seen a high infection rate. It is a priority for us to make sure that the message on the vaccine breaks through any cultural, linguistic, demographic or other social barriers to get through to those groups who need it. They are not groups defined by race or the colour of their skin but by their proximity or otherwise to the normal course of government. We have learned through Covid that these groups are incredibly important from a public health point of view. From a values point of view, we owe it to them to do our best to reach them and we are putting the resources in place to do that. As for children, we have no current plans to vaccinate them. In terms of international partners, we are very focused on ensuring that all the intellectual property and manufacturing resources that we can possibly effect are put to work to get the vaccine into the arms of those around the world.

On cold storage, I reassure the noble Baroness that we have been on this for months. We have been aware of the demanding storage need of the Pfizer vaccine for a substantial amount of time and cold storage arrangements have been put in place. It is not necessary for that cold storage to be literally at the end of every street because the travel time for the vaccine is reasonably flexible. We have in place exactly what we need, not only for the Pfizer vaccine but for the Oxford vaccine and the others in the pipeline. JVT and Dr June Raine at the MHRA were crystal clear when they said that safety will not be compromised. I endorse their comments.

I will say a few words about our approach to managing messages to those who might feel anxious about the vaccine. This is not a moment for rebuttal or for attacking those who have questions about the vaccine, whatever those questions are and however far-fetched they might be. Our approach is to take all questions at face value, tackle them sincerely and approach them in an open-hearted way. By being defensive we play into the hands of those who have bad intentions, and by being aggressive we only amplify those causing trouble. Instead, we want to have an open dialogue with those who have concerns to emphasise the safety of the vaccine and, more generally, the normality of taking vaccines. It is with that kind of approach that we hope to deal with those who have concerns about taking vaccines.

The noble Baroness, Lady Jolly, asked a number of questions about the app. I cannot give her precise numbers on absolutely everything she asked but I can reassure her on a couple of things. There have been 20 million downloads, not 10 million. Take-up of the app has been enormous and, week on week, we see a huge number of check-ins on the venue-based element of the app, which is a huge part of its effectiveness. It helps us enormously with contact tracing. As for Bluetooth and the battery, I am disappointed to hear that the noble Baroness has had trouble with her phone. On the whole, that is not the feedback we have had from users and the recent update has emphasised the low-energy aspects of the Bluetooth protocol that the app uses. We think it will improve the performance of the app and lessen its drain on the battery.

The noble Baroness asked about tests; I will answer broadly. The innovation that we have seen in diagnostics for Covid has been incredible. It has included far-fetched—to me at least—technologies such as mass spectrometry. Some innovations have used the plastic lateral flows, which, although low-tech in their appearance, use extremely advanced technologies and chemicals to achieve accuracy, speed and cost performance. Some, such as LAMP, have taken old technologies and repurposed them for a new use. It has been extremely exciting to see. It is my aspiration that we will see an inflection point in diagnostics in the UK. This will aid an overall strategic step towards early intervention and put diagnostics at the heart of our medical science. It has already played an important part for a long time, but this will put it centre stage. I pay tribute to the work of Professor Mike Richards, whose review of the future vision for diagnostics in the NHS provides us with a target to aim for as we expand and invest in our diagnostics around Covid.