Public Health

Huw Merriman Excerpts

Tuesday 30th November 2021 Commons Chamber

[Dr Whitford]

We are still seeing hospitalisations and deaths in people who are doubly vaccinated. The reason we are delivering boosters in all four health services is because that immunity is waning. What we are concerned about with omicron is that if it is able to immune escape, it could push us backwards. Therefore, we simply do not want it to become re-established and undermine the achievement that vaccines have made.

The British Medical Journal review, to which the right hon. Member for South West Wiltshire (Dr Murrison) referred, showed that masks had as big an impact as hand hygiene, so surely we should do both. Neither of them has a major economic impact. We are not talking about locking down. We are not talking about shutting businesses. We are talking about everyone trying to protect everyone else, so that they can continue to be active and continue to be out in society.

It is important to remember that even if our current vaccines were shown to be less effective against omicron, they would not have no impact. We already see that impact on delta with regard to spread: the reduction is only about 50% but it has markedly reduced hospitalisation and death. We would therefore still hope for that with omicron, so pushing vaccination and encouraging people to get boosted remains as important as it always was. Delta is still by far the most dominant variant circulating in the UK.

There is no evidence as yet of differing symptoms or severity, but one of the weaknesses of the data from South Africa is that the initial outbreaks were in students. Young people tend to get milder infections and we do not yet know what omicron will be like in an older or more vulnerable population.

We have one advantage in the diagnosis of omicron: the S gene, which is one of the three genes that common PCR tests look for, is missing. That means that rather than having to wait for genomic testing, which takes quite a long time, we get a heads-up or an early warning on the PCR test. There is a sub-group with S-gene dropout, which means that the chances are that it could be omicron. Those patients could be warned and their samples can then be sent for full genomic testing. In Scotland, a retrospective review of recent PCR results looking for S-gene dropout has identified the nine patients with omicron. I assume that similar work is happening in the other nations across the UK. In contact tracing of the nine patients, there is no evidence of a connection to either COP26 or the South Africa rugby game, but tracking continues.

PCR testing is, therefore, even more important. Lateral flow tests—which, hopefully, we are all doing regularly before coming here—cannot detect variants. It is a simple yes/no that someone does themselves, with no access to take further analysis. Lateral flow tests had been allowed as part of travel testing. In the Netherlands, 600 passengers arriving from South Africa were tested and one in 10 were found to have covid—an incredibly high incidence and much higher than we have anywhere in the UK—and a fifth of those cases were already omicron. Omicron is not just in southern Africa or in the UK. As a result of the use of lateral flow tests, it is probably already more widespread than we think. It is therefore welcome that today the Government returned to PCR testing for travellers rather than lateral flow tests, and that they are quickly re-establishing quarantine, but people should have a PCR test before they travel. It is rather like shutting the stable door if we find that someone is positive when they have just spent eight hours on a plane with hundreds of other people.

[Huw Merriman (Bexhill and Battle) (Con)]

Is the hon. Lady not concerned, as I am, that there is too much emphasis on PCR testing for tracking variants of concern? During a three-week period in July, there were 500,000 PCR tests, of which 7,000 were positive for covid. Only 5% of those 7,000 were tested for variants of concern, so this is not quite the silver bullet on variants of concern that she might hope it would be.

[Dr Whitford]

I was not claiming that it was, because genomic testing takes a couple of weeks generally and it is therefore too late for someone to isolate. What I am saying is that with this variant, as in alpha but not in delta, the missing S gene means that on that initial test—which takes six hours or until the next day, or whatever it is—we already get a heads-up that we are dealing with an omicron case. We can go on to do the genomic analysis, but we can say to the patient, “We think you have this variant. You need to isolate thoroughly and for longer.”

--- Later in debate ---

[Huw Merriman (Bexhill and Battle) (Con)]

Yesterday, I intervened on the Secretary of State and during his statement he repeated to me:

“we will not keep measures in place for a day longer than necessary.”—[Official Report, 29 November 2021; Vol. 704, c. 679.]

With that assurance in mind, I thought I would come to listen to this debate and speak on behalf of the transport sector, which relates to my Select Committee, willing to support these measures as proportionate measures in circumstances where we do not know whether the new variant will have an impact on transmissibility and on our vaccine effectiveness. On regulations 1340, on face coverings, I can get there in that regard because they expire on 20 December and they are well set out. I have concerns about the way the transport sector is somewhat singled out, albeit with retail, as perhaps being an unsafe setting, whereas hospitality is marked differently. If we put £10 billion into the rail network alone just to keep it going, sending out a message that it is a less safe setting than a pub or restaurant will not be the way to give people confidence to get back on to that network which we need to survive.

I also have concerns about what happens on the buses, given what I witnessed today. That may well have been because people had not tuned into this debate and did not realise that these regulations had already come into force. People are still getting on board without a face covering. Despite the powers given to drivers to ensure that they do not do so, there is no questioning and on they go. Not only does that wind people up, but it leaves others thinking, “What’s the point in bothering? If not everyone is wearing a mask, what’s the purpose of anyone wearing one?” However, I can get there on those regulations because of the unknowns that we need to deal with.

One of the wonderful things about coming into this Chamber is to be educated. I might make the point that my hon. Friend the Member for Winchester (Steve Brine) has made: perhaps more of us can come here and be educated. I have grave concerns about the issues around regulation 1338, on self-isolation. If the aim is for us to be covered for no longer than is necessary, why do they have no end date and default to 24 March? The impact of these regulations is even greater than our having to wear a face covering for longer periods because, as has been mentioned, we could well be back to “pingdemic” territory.

I emphasise that the regulations mean that, regardless of a vaccination having been given, one has to self-isolate for a period of time if there is a suspicion that one has been in contact with someone who has the omicron variant. Right now, and perhaps for the period up to 20 December, I can understand that the suspicion would perhaps be linked, as the transmission rates are slower to build—one would hope that would be so for the next few weeks—to whether one had been in contact with someone who had been in South Africa, or something on those lines. If, however, we move to 24 March and the variant has spread fast but, as we hope, it has not had a negative impact on the vaccine, we could see the default option being, “I have come into contact with somebody who has covid. I did not know whether they had omicron or not, because that does not tell me that. Therefore, I must be cautious, as we are always told to be. Therefore, I must self-isolate.” Then we could see the whole country being pinged again, as it has been before.

The situation could even be worse than that. If it turns out, as is currently being discussed in South Africa, that although the strain may transmit quickly it may not have the same impact as even the delta variant, stopping people being out and about may make things worse, because they will not get the antibodies that we want them to get. Surely those on our Front Bench are aware of that. The beta variant was a variant of concern, and the amber-plus regulations were brought in, as there was a concern that beta would have been worse against the vaccine than delta. It turned out that one dose of AstraZeneca was more effective against the beta strain than two doses of it were against delta. So variants of concern can quickly turn out not to be a concern at all.

That is why we must make sure that our legislation stops and is flexible and nimble, yet these regulations will roll on until 24 March. That is what our job in this place is about; I can agree in principle that there is a need to take measures, but I cannot vote for legislation that does not actually do what I believe the Government intended it to do. There are options, and they can be used right now. The Minister could stand at the Dispatch Box and find a way to reassure those of us who have the same concern. Alternatively, the default option for me is to vote against this legislation, not because I disagree with the principle, but because I disagree with voting for legislation that I know to be poor, badly drafted and not to meet the intention. Surely we should not be stubborn and pig-headed when legislation does not work; we should fix it or we should vote against it.

I have one last point to make in relation to a motion that I thought would be before us but is not—one that deals with the restrictions on travel and the introduction of PCR testing. Yesterday, the Secretary of State also reassured me that PCR testing would not be expensive and that we would not be at the mercy of unscrupulous providers, as we saw happen during the summer. A wise person just told me about an incidence of a three-hour PCR test, which many will need to take in order not to have to self-isolate—that is good for the economy—costing more than £200. Why are these regulations being laid under the negative procedure? We need to be discussing that legislation and finding the pitfalls, as we have with the regulations before us—I applaud my colleagues for doing so this afternoon—yet they are not even being brought forward.

[Alec Shelbrooke]

I wish to return to the point I made earlier, and I wonder whether my hon. Friend shares my genuine concern. As he said, we are here today because of a variant that has been discovered. More variants are going to be discovered and the cost of the PCR test will make people think carefully about going abroad, and that is going to have a devastating impact on the high street, travel agents and holidays. Does he agree that this issue has to be taken as a whole, and that it cannot be separated out so that every time there is a variant we say that we have to shut everything down?

[Huw Merriman]

I do agree with that, and it is a good point for me to end on. Let us look at not just the consumer, but those who work in aviation. Some 5,000 jobs have been lost on a monthly basis since February 2020 in that area; this has been an absolute disaster for the aviation and international travel sector, and for those who want to trade around the world. We had just started to see the easing of restrictions, with no damage to public health at all. My right hon. Friend is right to say that we need to learn lessons. It is okay for us to take tentative steps perhaps this once, on a limited basis, but we cannot keep shutting down parts of the economy every time there may be a variant of concern. Otherwise, to quote the Prime Minister, we will never “live with” this virus.