Health Protection (Coronavirus) Regulations 2020

Lord Campbell-Savours Excerpts

Monday 9th March 2020 Grand Committee

Therefore, my question to the Minister is as follows: directors of public health resided inside Public Health England less than five years ago, but because they are no longer in Public Health England, why do they now suddenly no longer qualify? If it is a misunderstanding in Public Health England, please can we have public reassurance about that? If it is due to a lacuna in the legislation, clearly we cannot deal with that through these regulations but we happen to have a handy Bill coming along in the next couple of weeks in which we could perhaps make that clear. From the conversations that I have been having with directors of public health around the country, it seems that they are, as one would expect, heavily involved with both the health side and the community side. The key stakeholders—such as the fire services, the Courts Service, the police, the Prison Service, universities and those involved in education—are absolutely vital in dealing with matters where members of the public or organisations refuse to follow the rules relating to identification, quarantine and isolation.

[Lord Campbell-Savours (Lab)]

My Lords, as I understand it, this is the first opportunity that we have had, outside of UQs and Statements, to fully debate this whole issue. I want to speak at a little greater length on this matter because I think that we are entering a crisis which perhaps we have underestimated at this stage.

As I understand it, these regulations apply where the Secretary of State makes a declaration that the incidence or transmission of coronavirus constitutes a serious and imminent threat to public health, and that the incidence of coronavirus is at such a point that the measures outlined may reasonably be considered as an effective means of preventing the further transmission of coronavirus. I will argue in my contribution that, prior to the use of regulations, advice should be given in the form of information—far more information than is available at the moment to the public—to help individuals avoid contamination and infection.

Before I start, I need to declare an interest. Some years ago, I had surgery on my lung to remove a tumour, leaving me with half a lung and with COPD on the remaining two lobes. As a result, I have major breathing difficulties. I also want to make it clear that I am not speaking only on behalf of myself; I approach this whole debate as one among the many hundreds of thousands who are in the vulnerable group described as “persons with pre-existing conditions”. Before moving to the thrust of my case—on the provision of information, which is what I want to concentrate on—I want to make three points.

First, the use of the terms coronavirus and Covid-19 is unhelpful and confusing. We need single-term terminology in the public debate. Secondly, repeating the statement that masks are of little value and are no defence, which we hear repeatedly on television, is irresponsible. Masks protect others from infection by those who are unaware that they are carriers. If they are so ineffective, why are doctors, nurses, health assistants, virus-testing personnel, ambulancemen, laboratory assistants, research chemists, health professionals generally and even undertakers worldwide all wearing masks, as can be seen on every television screen in the country, every day and every night on every new bulletin?

Thirdly, I am curious about the statistics on mortality rates, particularly among the elderly. The way this debate is being presented, it is as if 1%, 2% or 3% of those who are stricken with this condition may die, but that confuses groups of people, including the elderly and the young. I understand that the real figure for people in the 70 to 80-plus age group is appropriately 15%, which is substantially more. We need clarification on that.

In my view, the public should ignore the advice on masks and follow the practice of health professionals. I understand that this mistaken advice is being given to avoid panic among the wider population. It will do the reverse, as such advice emphasises in the public mind the distinction between the no-panic case from government and the reality of the practice of healthcare professionals on the ground in the real world that they can see on television every evening.

I turn to the provision of information. The best way to secure public co-operation in the avoidance of infection is to provide authoritative information. That is the story behind the calls for freedom of information legislation in the late 1980s. I was at the heart of that debate in the Commons, and our mantra was “information influences conduct”. To avoid infection, we need information from authoritative sources that is regularly updated as more information is made available to government. When the public have confidence in the scale of transparency and the source of the information, individuals are more likely to act responsibly. Apart from providing information, the state can do only so much, as is the case with the National Health Service and local authorities. The less information it provides, the less it will influence conduct. The less it provides, the more the fake news merchants will dominate the debate and the more they will influence public reaction and conduct. Inadequate and confused messages from government will lead only to a mix of panic on one hand and resigned inertia on the other. We need more than “Wash your hands, cough and dispose and do not touch your face”. It is simply not enough. If you provide more information, the public will make far more realistic assessments of the actions that they need to take. The terms contain, delay, research and mitigate are important, but they are meaningless to Joe Public. In fact the public will not even know what they mean. As contain morphs into delay and further morphing goes on, the message will become even more confused and obscure. The public want authoritative messages and updated and detailed information on where the dangers lie, in particular to elderly groups.

I have spoken to a number of people in my former constituency over the past week, and I will now set out what I believe the public want to learn and know. These are questions being asked by the vulnerable groups; they want authoritative information and answers.

We are told that the research money has been increased to £40 million. Reuters put out a very interesting article the other day. It reported:

“A global coalition set up to fight epidemic diseases issued a call on Friday for $2 billion … to support the development of a vaccine against the new coronavirus that is causing COVID-19 infections around the world. Describing the outbreak as an ‘unprecedented threat in terms of its global impact’, the Coalition for Epidemic Preparedness Innovations (CEPI) said that while containment measures would help slow the spread, a vaccine was key to longer-term control … ‘It is critical that we ... invest in the development of a vaccine that will prevent people from getting sick.’ … But on Friday it said these funds would be fully allocated by the end of March. ‘Without immediate additional financial contributions the vaccine programs we have begun will not be able to progress and ultimately will not deliver the vaccines that the world needs’.”


Those were the comments of Mr Hatchett, CEPI’s chief executive. On Friday, the British Government announced another £20 million of additional funding. The total is now £40 million or £50 million; I am not absolutely sure about the final figure. The point is that the budget is insufficient. What pressure are we putting on other countries to contribute to this budget to make sure that it meets the demands of those people who believe that it is necessary if a vaccine can be found in the foreseeable future?

Further, is the virus affected by temperature? We read all sorts of things on the internet. If so, at what temperature is it destroyed? That is the first question on my list of questions about the detail.

Should a vulnerable, at-risk person use public transport, be it a train, Tube train or taxi? The public are asking these questions. Should the elderly be using these facilities?

Can the virus survive any of the following circumstances: a hot drink; water; fruit juice; milk; beer or wine; a drink with a high alcohol content; an ice cream; a burger; takeaway food; or a restaurant meal? In each case, what is the lifespan of the virus? Again, the public are asking these questions, each of which should be answered separately.

What general information do we have on the lifespan of the virus? Can a fish, bird, animal or any other species catch the virus? The internet is full of explanations from people who cannot be described as authoritative sources for this information. Of course, the reference behind that is to pets. To what extent can a pet potentially be dangerous?

Can disposable polyurethane gloves be reused following washing? If so, in what fluids? Tens of millions of them are being sold on the internet. The question is, will they be effective if they are used more than once in contaminated circumstances? Will they wash in hot water? I know that these questions may seem naive to some but they are the kind of questions being asked by the general public.

Can a pair of gloves, whether they be made of fabric, leather, plastic or another daily wear material, pass on the virus? If so, can the gloves be decontaminated and reused? Can a simple face mask made of plastic be used repeatedly? Can it be washed for reuse? Is there a difference in terms of efficacy between a single-fabric face mask and a filter mask? I have two such masks here. The question is, are they in any way of use in the circumstances I described at the beginning of my contribution?

What antiviral substances are effective in killing the virus? Also, what substances are ineffective? Is there a base alcohol requirement in any decontaminant? Can the virus survive on any of the following inanimate items and, if so, for how long? Again, we have seen material on the internet, but we have nothing authoritatively on whether and how long the virus can survive on: a light switch; a newspaper; a piece of correspondence; a letter; a fabric, such as clothing; furniture; metal items; glass; a milk bottle; a plastic container; a piece of china; cutlery; a coin; a bank note; plastic packaging on food; a cash machine; a computer; a mobile phone keypad; a handle; handles on public transport, such as on a Tube train; a handkerchief; a toilet seat; a toilet chain; a towel; or a petrol pump nozzle. There is no authoritative information on these items, and we are getting into a dangerous period.

I have listed some of the items that I have been asked about—and there are more. The public will want clear advice and individual answers that identify the likelihood of contamination for each listed item and, crucially, the length of time that the virus could survive under such inanimate item headings.

What advice can be given on the possible contamination of food, such as cold meat, cooked fish and poultry, raw meat and fish, fresh vegetables and salads, fruit, cheese, and spreads, including butter? It might be that the process of vacuum packing affects contamination one way or another—who knows?

Will the Government publish the stats on the age of persons, which I referred to before, who fall under the following categories: in hospital care and deceased—which I referred to before?

Finally, is Worldometer a good source of information? It seems to be the primary source for the public of information on this matter on the internet.

In conclusion, I fully understand that to some, many of my questions may appear to be simplistic, naive and an indicator of my own ignorance. Such criticism is of no concern to me. These questions will stand the test of time. There are 67 million people in the United Kingdom, and these are the kinds of questions many of them are already asking on the internet and in public meetings. We are Parliament and it is our role to secure answers on these from the Government. I do not expect answers to them today, but only after they have been fully considered. I hope that they are made public and are widely circulated to counter misinformation. I can only repeat that, when the public are told the full truth and given the full information in an authoritative form, they will respond positively and constructively. Until that happens, there will be nothing but panic, confusion, upset, frustration and, in some cases, dangerous indifference, particularly among the elderly and the vulnerable groups, who are the focus of my contribution today.

[Baroness Finlay of Llandaff (CB)]

My Lords, first, I apologise to the Committee that I came in late. The business proceeded slightly faster than I realised, but I am most grateful to noble Lords for allowing me to intervene briefly.

The comments made by the noble Lord, Lord Campbell-Savours, clearly illustrated the need for messaging out to the public. One of the difficulties is that the answers to many of his questions are just not known scientifically. It is a range of probabilities only; the way the virus behaves on different surfaces and with different substances is different. The infectivity may vary with the viral load to the individual as well as the individual’s own immune system. That makes it really complicated in terms of defining. You cannot give a false sense of security to people by saying, “Well, you are fit and well, and your immune system is okay”, because those people may become very ill, particularly if they have a large viral load. We saw that with the Chinese doctor who initially highlighted the problem. Tragically, he died.

I take this opportunity to ask a few questions. This order refers to Public Health England but we have devolved Administrations, and Public Health Wales and Public Health Scotland operate differently. Some aspects of this statutory instrument concern the police and justice, yet the Ministry of Justice and its overarching responsibilities are not devolved, so there is a difficult interface between the devolved and non-devolved competencies. Can the Minister provide some reassurance on the daily round-table consultations that are going on to make sure that decision-making is absolutely seamless and that the devolved Governments are taking forward—and, I hope, mirroring—such legislation so that we do not end up with different systems operating across what are effectively artificial borders? In areas such as Shropshire, there is a huge amount of cross-border flow between England and Wales. Linked to that, can the Minister clarify that equipment, and its distribution to where it is needed, is also part of the consideration of the protection of the public so that we do not have an outcry if one part of the country cannot access equipment as well as another?

Testing is difficult: it is a complex and finite resource, and it takes some hours to run the test. A lot of the public do not understand that it is not like a pregnancy test; it is not a quick dip and a quick answer. With such a finite resource, will the Minister clarify where the governance sits for the management of negative results? One of my anxieties is that people may have a false sense of security from a negative result, because they may get the infection the day after it and subsequently become positive. Although it is helpful to confirm positive cases, a negative result does not mean that you are not going to get the coronavirus infection further down the road.

Linked to the cross-border issues, can the Minister also confirm that the use of beds and the availability of things such as ITU beds and ECMO are being considered across the whole country? I worry that difficult decisions are going to have to be made and it will be very important to have clear standards against which to make them. If it looks as if we are becoming like Italy, that will certainly more than stretch services to the limit; it will take them beyond it.

Will we need additional statutory instruments for the reregistration of people with healthcare professional qualifications of any sort? If so, when will we see them? I was rather hoping that it might be today. This relates to my earlier question about registration on specialist registers. Is the GMC working to find alternative ways of putting those who have completed training on the specialist register without bringing them all together in an exam hall, which seems to be an unwise move when their competencies have already been assessed through training?

That concludes my questions, but I thank the Minister for his clarity, for explaining things really well, for answering questions on the Floor of the House and for answering unanswerable questions with such honesty. It is terribly important that he and those advising him try to be very clear and open about the things that we do not know.

--- Later in debate ---

[Lord Bethell]

The noble Baroness makes a very reasonable point. My understanding is that this decision was made not on a personnel basis but on an administrative basis. We are seeking to restrict the number of people who are able to execute these potentially quite serious powers. Having a list of available people is a legally clear and responsible way of doing things, but creating a new administrative definition goes beyond the powers of these regulations. However, I have already taken on board the noble Baroness’s points about the role of directors of public health in this epidemic. Those points have been listened to and are being followed up, and I will continue the dialogue that we already have in place on that.

The noble Baroness, Lady Thornton, asked why the 2008 powers are not sufficient. The answer is that it is mainly for practical reasons. The 2008 Section 2A powers give local councils powers but mobilising local councils to do things, sometimes at the weekend, sometimes at ports where they are not necessarily administratively present and sometimes overnight, is administratively a challenge. We found that in practice during the containment at Arrowe Park, it was really Public Health England officials on the ground who dealt with the situation and who needed these powers both in their back pocket and in their administration of the situation. That is why we have sought to do this. It is fair to say that a lessons-learned review is expected in the years to come and this will be the kind of issue that we will look at again.

The noble Baroness, Lady Thornton, asked what the difference is between detention and isolation. Although I do not have the legal definitions in front of me, my understanding is that isolation can be in someone’s house—literally holding them away from the rest of society—whereas detention involves confining someone to a place that they cannot leave, such as a police cell or a jail. Both are covered in these regulations. It is worth saying that you could, for instance, seek to isolate someone in a hotel room near the Arrowe Park facility and that would be covered.

The noble Baroness also asked about magistrates’ courts. I reassure her that MoJ colleagues were fully consulted on this and they did not see a problem. The objective was to try to create a low bar for an appeal to make the appeal process as easy and accessible as possible, recognising that these are very serious powers and we want to make them as sensitive as possible. In terms of police involvement and whether the police would wear suitable suits, they absolutely would. Police officials are highly protective of their workforce. Public Health England is working closely with the police to ensure that they have both the guidelines and the kit necessary to protect the workforce.

On the term of the regulations, I agree with the noble Baroness that two years is longer than we hope or pray this virus will continue. However, the advice from the CMO was that we cannot necessarily plan for that. Viruses sometimes last longer than expected; they can create multiple strains, and it may take time to have the lessons-learned review and to bring in new powers. That said, it is also possible that a coronavirus Bill that overtakes these regulations will be brought to the House later this month and the sunset clauses would necessarily be included in that.

[Lord Campbell-Savours]

Will the Minister reconsider something that he said to me? He said that he could not answer many of the questions that I asked. Almost all of them were to do with contamination, and virologists can answer them—I am told by a virologist that they can all be answered; we went very carefully through them. Can the Minister take each of the questions that I asked and answer them individually on the basis that virologists will be able to give him the information that he requires?

[Lord Bethell]

The noble Lord, Lord Campbell-Savours, is entirely right to press me on this. I should be honest: obviously, I am not a doctor. However, we have arranged for another briefing from the Chief Medical Officer in Room G at 4 pm tomorrow. He is the epidemiologist who can convey to the noble Lord both the extent and limits of current understanding of the virus. I have sat with him sufficiently long to have the impression that a lot of speculation, guidelines and history are associated with such viruses that we might reasonably apply to this one. However, its behaviours are not fully understood. Although the genome is broken, we do not fully understand its genetic makeup. The advice from the CMO generally is to hold back on pretending to understand things that are not yet fully explored.

[Baroness Thornton]

I say to my noble friend that I would not use the internet as my source of information on any of these issues. I would use the BBC, which has been running extra programmes—in fact, I have just received an email from the head of the World Service listing all the extra programmes that the BBC is producing which will give us lots of advice. Its website is useful. I want to put it on the record to my noble friend that I would steer clear of those sorts of discussions on the internet and look at the BBC’s websites.

[Lord Campbell-Savours]

The great majority of the British population will not go into some of the technical areas that my noble friend would go into. That is why I am trying to find a single source of information for people to be able to go to which is authoritative and gives answers, with the latest information and knowledge available, on each of the questions I have asked. I persist in believing that the Government should arrange for this information to be made part of the public debate, because it would be helpful to everyone concerned.

[Lord Bethell]

I understand the point and will take it back to the department.

The noble Baroness, Lady Finlay, asked about testing. She is entirely right to focus on that, because we are at the stage of the cycle when questions about testing are very much on our minds. She asked where we were focusing our testing. The most important area for testing is those people who are most vulnerable but who might have the virus. She is entirely right that someone who tests negative today may well test positive tomorrow. Where that is most dangerous is within hospitals. Hospitals are centres of infection. It is one reason why, if you phone 111, they recommend that you do not go to your hospital or your GP. Therefore, testing within hospitals is where we are focusing our resources.

I reassure the noble Baroness, Lady Finlay, that we are moving incredibly quickly to increase capacity of ECMO beds. There will be a huge amount of pressure —we cannot hide that—but those most in need are being prioritised. Training is going on to support those with the technical knowledge of how to run the equipment and purchasing is going on to create new kit.

On reregistration of clinical professionals, all the concerns raised in Committee and in the Chamber about the provenance of people seeking to reregister are fully understood. Provision is being made to make sure that criminal record checks and competence checks are in place. However, these remain incredibly valuable and skilled people who can support us, so we are determined to mobilise them if possible.