Covid-19 Update

Luke Evans Excerpts

Tuesday 14th September 2021 Commons Chamber

[Sajid Javid]

I have to say to the hon. Lady that I do not agree with her. There are commercial reasons why we have cancelled the contract, but I can tell her that it was also clear to us that the vaccine in question that the company was developing would not get approval by the Medicines and Healthcare Products Regulatory Agency here in the UK, and obviously she is not recommending that we administer vaccines that do not get approval.[Official Report, 16 September 2021, Vol. 700, c. 10MC.] I do understand her point about Livingston and the factory there. That is very important to the UK Government and of course to the Scottish Government, and it is something we will be working on together to see what more we can do.

[Dr Luke Evans (Bosworth) (Con)]

I have a clarification and a request. On the clarification, I welcome the boosters, but could the Secretary of State clarify whether people who have had the AstraZeneca or the Pfizer will be having the same vaccine or mixing vaccines? On the request, one of the slowest things when it comes to dealing with the Pfizer vaccination is the 15-minutes that people have to wait to see that they do not have a reaction. We should now have the data, so will he ask the NHS to look at whether this could be removed to relieve some of the pressure on those delivering the vaccines over the winter?

[Sajid Javid]

On the booster programme, everyone on that programme will be offered either the Pfizer vaccine or half a dose of the Moderna vaccine. In the vast majority of cases I think it will be the Pfizer vaccine. On the data that is now available on the 15-minute wait, we are analysing it to see whether we can make any difference to the way in which we administer vaccines.

Covid-19 Update

Luke Evans Excerpts

Monday 6th September 2021 Commons Chamber

[The Minister for Covid Vaccine Deployment (Nadhim Zahawi)]

With permission, Madam Deputy Speaker, I will update the House on covid-19 and our vaccination programme.

Earlier this summer, we took the fourth step on our road map. We were able to take that step because of our vaccines and the way that they are working. The latest data from Public Health England estimates that our jabs have prevented over 100,000 deaths, over 143,000 hospitalisations and around 24 million infections. Across the United Kingdom, we have administered over 91 million vaccines; 88.8% of people over 16 have had their first dose, and 79.8% have had their second dose. Our jabs are building a vast wall of defence for the British people.

But this vital work is not yet complete. With the delta variant sweeping around the world, we have seen how it thrives on pockets of unvaccinated people. Last week, across the UK, we saw an average of 34,000 new cases and 938 hospitalisations each day. It is vital that we continue to plug the gaps in our defences and widen and deepen our wall of defence.

Over the summer, we have continued to do that in several ways. In August, the Joint Committee on Vaccination and Immunisation recommended that vaccines should be offered to 16 and 17-year-olds. It also recommended jabs for 12 to 15-year-olds with specific underlying health conditions and household contacts of someone who is immunosuppressed. We accepted both recommend- ations, bringing us into line with countries such as Sweden. In recent weeks, 16 and 17-year-olds have been coming out to do their bit in droves, travelling with schoolmates and family members to get the jab.

We are taking the jab to people, too, with walk-in and pop-up vaccination sites at football stadiums and shopping centres, and of course at university freshers’ fairs; I think we have got to 20 universities. Over the bank holiday weekend, NHS pop-up sites at the Leeds and Reading festivals made picking up a jab as easy as getting a beer or a burger. As a result of these kinds of efforts, more than half of 16 and 17-year-olds across the United Kingdom have received their jabs since becoming eligible last month. That is in addition to over three in four—76.3%—18 to 34 year-olds, who have already had at least their first dose. Much of young people’s enthusiasm, I believe, comes from the fact that they have seen at first hand the chaos that covid-19 can bring. They have sacrificed so much and shown that age is no barrier to public spirit. I am sure the whole House will join me in thanking them for playing their part in helping us all to live safely.

On Friday, the JCVI outlined its recommendations on the vaccination of children aged 12 to 15 years who do not have underlying health conditions. It concluded that while there are benefits to vaccinating this cohort, taken purely on health terms the benefit is finely balanced. Building on the JCVI’s advice, we will now consider advice from the UK’s four chief medical officers and make a decision shortly. We have already accepted the JCVI’s recommendation that 12 to 15-year-olds with the following conditions become eligible: haematological malignancy, sickle cell disease, type 1 diabetes, congenital heart disease and poorly controlled asthma. That will amount to an extra 200,000 teens becoming eligible.

I also want to take this opportunity to address vaccination in pregnant women. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have both recommended vaccination as one of the best defences for pregnant women against severe covid infection. Extensive real world data show our vaccines are safe and highly effective for pregnant women. We now know that pregnant women are more likely to become seriously ill from covid if they are not vaccinated. In fact, 98% of pregnant women in hospital due to covid-19 are unvaccinated. Yet we also know that not one single pregnant woman with two jabs has required hospitalisation with covid-19. I urge pregnant women to continue to come forward and get the jab. Our new Preg-CoV trial is advancing knowledge on how we can even better protect pregnant women and their babies.

Taking all of that together, our overarching ambition is to widen our wall of defence so that we can protect more and more people. As well as widening that wall of defence, we are deepening it. Last Wednesday, 1 September, the JCVI advised that people with severely weakened immune systems should have a third vaccine dose as part of their primary covid-19 vaccination schedule. It will be offered to people over 12 who were severely immunosuppressed at the time of their first or second dose, such as those with leukaemia, advanced HIV and recent organ transplants. This, I must stress, is separate from any potential booster programme for the rest of the population. The JCVI is still investigating who should receive boosters. Our cov-boost study is comparing immune responses produced by third doses of different brands of vaccines.

[Dr Luke Evans (Bosworth) (Con)]

Will the Minister give way on that point?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. This is a statement, so the hon. Gentleman can bob up later if he needs to.

Health and Care Bill

Luke Evans Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Dr Luke Evans (Bosworth) (Con)]

I declare my interest and my family’s interests in healthcare service.

I welcome the Bill. Those concerned about it should realise that it is an evolution, not a revolution, coming from the ground up. Do not take it from me; take it from the evidence to the Health and Social Care Committee from Simon Stevens, who said:

“We have been working so closely for a number of years with colleagues across the health service and our broader partners. Genuinely, I think this is unusual, if not unique, in having come from the NHS as a series of asks to Parliament rather than something that Parliament is perhaps imposing on the NHS.”

That is the leader of the NHS.

Three minutes is a very short time to try to pull this Bill apart, so I am going to use my time to set out some amendments and new ideas that I would like the Minister to consider. Some are practical, some are short and some are much bigger. The first is simple: annual virus drills for care homes. We have fire drills regularly, but, given the pandemic, care homes may well benefit from being further prepared for future pandemics.

I would like mental wellbeing to be seen as a public health issue. Everyone suffers with their mental wellbeing; not everyone has mental ill health, and this House often gets confused between the two. That is really important, because until we label mental wellbeing as such, it becomes very hard to implement education and protective policies. Many Members will know that my particular interest is body image—the labelling of altered images, just as we label calories on food, so that we have parity between physical health and mental health.

My final idea—this is probably the most revolutionary piece I would like to put across—is to have a named person for change on the frontline. We have named bodies for whistleblowers, and we have protected people who are guardians for data, but fundamentally, change has to come from the bottom. All too often in my career, I was told, “You’re too junior” or “This is the way we’ve always done it.” We want to empower the people on the frontline who understand how the system works to make changes, and I think there is a chance to amend the Bill to do exactly that. I am happy to meet the Minister to explain further.

As I have a little more time, I am keen to comment on the reduction of bureaucracy. It is all very well making sure that there is not a problem when we are commissioning, but fundamentally, we need to look at the admin on the health service side—the barriers between primary care and secondary care. About 5% to 10% of a GP’s workload is dealing with chasing admin. That is not time well spent; it takes services away from the clinical frontline, and it is something that could be remedied, possibly even without legislation.

National Health Service

Luke Evans Excerpts

Tuesday 13th July 2021 Commons Chamber

[Helen Whately]

My hon. Friend asks a reasonable question. We consulted on exactly that point. There are two reasons relevant to the breadth of the policy, which covers not only care workers, but others coming into the care home, such as hairdressers, health professionals and tradespeople.

When somebody, including a tradesperson, comes into a care home, they might spend significant time in the care home, move around and move from room to room, so they might be a significant infection risk to the care home. They might also move between one care home and another, particularly if they are a specialist who serves multiple care homes. We know there is a risk when individuals are moving between care homes, so there is a clinical case for the regulations.

We also heard from providers responding to the consultation that they want a consistent approach for people who enter a care home to work, and these regulations will make it more straightforward for them to implement that.

[Dr Luke Evans (Bosworth) (Con)]

I am grateful to the Minister for giving way. On making sure there is equity, where does she believe the duty of care falls, given these regulations?

[Helen Whately]

My hon. Friend makes a really important point. Throughout the pandemic, the Government and I have felt our responsibility to protect those living in care homes from covid as best we can. We can try to do that by extending to them the protection of being cared for by people who are doubly vaccinated, knowing as we do now, from the increasing evidence, that being vaccinated not only protects the individual but reduces the risk of transmission.

--- Later in debate ---

[Dr Allin-Khan]

I am going to make progress, thank you.

These measures will disproportionately punish groups whose needs are already rarely reflected in mainstream health services or the labour market. Respectfully listening to concerns and offering practical support would not only tackle vaccine hesitancy; it would also help to rebuild trust in health services, which in turn could eventually lead to reduced health inequalities for all minority groups.

Let us be clear: vaccine hesitancy is entirely different from being an anti-vaxxer. Vaccine hesitancy is a challenge for the Government to tackle. It is harder work. There is no quick fix. The Government are trying to make an incredibly complex issue into a black and white one, and that does nothing to pay respect to the sacrifices that care workers have made since the start of the pandemic. More must be done to encourage uptake of the vaccine.

[Dr Luke Evans]

Will the hon. Lady give way?

[Dr Allin-Khan]

I am going to make progress, please.

The UK Government should learn from the fantastic work of the Labour-led Welsh Government, who are running the fastest vaccine programme in the world and have vaccinated a far greater proportion of their staff than England; yesterday’s figures showed that almost 95% of care home residents and 88% of care home staff are double vaccinated. Wales has rejected compulsory vaccinations and instead chosen to work closely with the care sector to drive take-up, as well as valuing the workforce with a proper pay rise. That is the sort of leadership that is needed here.

A failure of leadership here will place the care sector in an even more precarious situation, with even fewer staff than at present. There are serious warnings from the care sector that the Government’s plan could lead to staff shortages in already understaffed care homes. That would have disastrous consequences on the quality of care. More than 100,000 posts in the care sector are currently unfilled, with recruitment and retention already extremely difficult due to low wage levels for difficult and demanding jobs. Not only could this plan have a disastrous impact on those relying on care, but the stress and trauma placed on their relatives will affect so many across the country. We already have a social care crisis. Let us not deepen it.

These proposals are at odds with the Government’s decision to throw caution to the wind by making social distancing and mask wearing optional and up to individuals to decide on. It makes no sense. Surely forcing workers to receive a vaccine is at odds with the individualism that the Government seek to promote at every opportunity. It seems odd that care workers are being singled out. Why is there a different rule for them? Are the Government hoping that the public will simply forget about their failure to protect care homes over the past year? Is that what is going on here?

Forcing carers to choose between losing their job and taking a vaccine that they are afraid of is inhumane. These are people who often work for less than the minimum wage. They are incredibly vulnerable people and their voices must be heard. Many of these people have lost multiple family members during the pandemic. They are being asked to put their faith in a vaccine that they are afraid of. The Government need to be doing more to tackle misinformation, promote the positive benefits of taking up the vaccine and support care home staff to do so. They have not been doing enough to support care workers who have done so much during the crisis. They should be focused on driving up standards and staff retention by treating care workers as the professionals they are, with improved pay, terms and conditions and training.

We have a moral imperative not to force people to take a vaccine that they are afraid of, so I urge the Government to listen to our care workforce. Surely they deserve at least that after the last year.

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

Thank you, Mr Deputy Speaker. I look forward to that, as it will give me time to catch my breath.

Like many hon. Members, I baulk at the prospect of mandatory mask certification or vaccination. I have made that clear privately and to my constituents who ask about it, as I did not think that it was ethically, practically or even medically reasonable. We should always be proportionate in our response. However, I have also made it clear that there are specific carve-outs aimed at those most at risk. Indeed, when it comes to healthcare and public health, this is a prime example, given the essence of who we are dealing with: the elderly and the vulnerable.

This argument boils down to rights versus responsibilities. There is a duty of care by the Government and internal providers both to patients and to members of staff. The House has to navigate the difficult path between limiting the risk to patients and residents from the spread of the virus while respecting the staff’s rights and responsibilities. In the next minute or two, including the break at 7 o’clock, I will go over a couple of principles that are in practice, and some real-world challenges that we face.

According to the Care Quality Commission, when it comes to talking about vaccinations, there are three pieces of legislation that are important: the Health and Safety at Work etc. Act 1974; the Control of Substances Hazardous to Health (Amendment) Regulations 1992; and the Health and Social Care Act 2008.

We are obviously dealing with the latter, but the former two measures set a precedent of safe working environments, dealing with substances dangerous to health, putting responsibility squarely on organisers and providers to mitigate that for staff and users as best as possible.

I do not expect that it will be too long before we see a legal challenge, where a resident dies from covid and the finger is pointed squarely at the care home staff, or at the care home for not having vaccinated staff, given that we know the vulnerability of the elderly. There is a duty—

--- Later in debate ---

Main Question again proposed.

[Dr Evans]

So there is a duty of care, and duty of care is a running theme. Currently, there is no law to say that vaccines are mandatory, so make no mistake: this is a departure from the legal precedent. However, it is not nearly as big or as wide a departure as the public or indeed this House may be led to believe, as, in essence, practically this precedent already exists in the NHS with the likes of TB.

Let us take the example of a medical student or a dental student. When a student joins a medical school, they have to have a TB check, an HIV check, a hepatitis C check and treatment to practise. While it is not a legal requirement, operationally it means that someone cannot do procedures, cannot do hospital placements and, in dentistry particularly, cannot progress. Why? A duty of care.

I do not recall a huge outburst about such concerns when the 2007 Department of Health clearance guidance entitled “Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV”, which was revised in April 2014, was widespread. Why? Because when people enter these professions, the overriding principle hammered in time and again is that there is a duty of care to patients, and medical schools and providers have a duty of care for their students.

[Mr Steve Baker]

Of course my hon. Friend is an expert in these matters, but he has conceded that, in the cases he has referred to, that is not a legal requirement but a matter of health and safety. Why is it that in this case, he wishes to cross the Rubicon and mandate that someone may not be in a care home—apart from the conditions—unless they are vaccinated? Why does he want to put it in law in these circumstances?

[Dr Evans]

My hon. Friend has pre-empted the rest of my speech, in which I will hopefully try to address some of that. It is about recognising the parity between professions. We heard the hon. Member for Tooting (Dr Allin-Khan) talk about the professional recognition we need for social care. That is imperative. We have covered that in the Health and Social Care Committee, and our report is very clear that we need that parity of professional standards. We have heard time and again that people have gone above and beyond in their duty.

I am a realist on this, and I want the Government to draw people’s attention to the fact that there could be difficulties. It is going to cause a problem when there are 16 weeks’ consultation, and there could be an exacerbation of problems with the workforce. I also urge the Government to pick up on what other Members have said and encourage people to take up vaccination in the first place.

Fundamentally, however—perhaps this is what it comes down to for my hon. Friend the Member for Wycombe (Mr Baker)—this comes down to a duty of care to the looked-after. I ask Members to imagine that it was their grandmother, grandfather, father or mother being cared for. I would expect Members to say that they wanted the best possible protections for that individual in the institution where they were resting.

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, we have to leave it there. Four minutes each. I call Dr Ben Spencer.

Covid-19 Update

Luke Evans Excerpts

Monday 5th July 2021 Commons Chamber

[Sajid Javid]

It is right that we provide support, including financial support, for those who are isolating and finding things difficult. We will continue to do so, and we will keep that under review.

[Dr Luke Evans (Bosworth) (Con)]

I draw the House’s attention to the story over the weekend about three batches of AstraZeneca vaccines affecting 5 million people and their prospects of travelling to the EU. I must declare an interest in that I have vaccinated many people with this batch and, indeed, had the batch myself. Can the Secretary of State confirm that this is purely a bureaucratic issue and that the vaccines are exactly the same, and will he update the House about what talks he has had with the EU to resolve this problem?

[Sajid Javid]

I thank my hon. Friend for the work that he has personally been doing during the pandemic. I can tell him that all doses used in the UK have been subject to very rigorous safety and quality checks, including individual batch testing and physical site inspections, and this is all done by the medical regulator, the Medicines and Healthcare Products Regulatory Agency.

Coronavirus

Luke Evans Excerpts

Wednesday 16th June 2021 Commons Chamber

[Dr Luke Evans (Bosworth) (Con)]

For over 800 years, this House has been making decisions on risk, be it sending men and women to war, providing financial support or instigating reform in trade or even laws, and tonight’s vote boils down to an assessment of risk. Essentially, there are three options: we open on the 21st, we delay or we close and put more lockdown measures back in.

If we accept the premise that we cannot get rid of covid, we can disregard the reintroduction of lockdown rules on the basis that it is too risky to the economy, non-covid health and education. I do not think that even a tiered approach to deal with regional variation would be stomached by the public. That leaves us with two options: open as planned or delay.

I checked the data on the dashboard this morning, as many Members have, and it shows that the seven-day increase of cases, the average, is 38.8% and hospitalisation is increasing by 22%, but we also know that we have vaccinated 79% of the population with one dose and 57% with two doses. We also know that no measure is 100% effective, that no mask is 100% effective and that no vaccine is 100% effective, but we know that putting those measures together mitigates the risk.

That is all against the backdrop of a delta variant that is 50% to 70% more contagious than the alpha variant at Christmas, which in turn was 50% to 70% more virulent than the original variant. This House is therefore being asked to make a judgment call: carry on opening as we are, risking further spread and increased hospitalisations, or buy time, see the trend, get more people vaccinated and reassess but, of course, at the expense of businesses and freedom.

This is another Sophie’s choice. I know from my constituents that they will not thank this House for a four-week delay, but they will not forgive this House if further lockdowns return. I will vote to support the motions today, but they still leave certain sectors as zombie industries: not officially closed but not open, because there are not enough customers. For the travel, events and wedding industries, and for the night-time economy, I urge the Government to consider sector-specific support.

Some might mistake my words for the sound of a risk-averse man, or a doctor who thinks too much about health. In my day job, my entire career has been spent managing risk, from dealing with people’s cholesterol to working out whether a headache is stress or a brain tumour. I do that openly and frankly with my patients, and now it is what we need from the Government: a debate on the acceptable level of covid risk.

There were 1,500 deaths and 25,000 deaths or serious injuries on UK roads last year. As a society, we accept this risk. We could ban all road travel and stop all deaths, but of course we would lose the economic benefits and our freedoms. During the next month, I urge the Government to bring forward a debate on the risk this House is prepared to accept from covid. After all, as I said at the start of this speech, the House has been deciding this for 800 years. Why should it change now?

Covid-19: Government Handling and Preparedness

Luke Evans Excerpts

Thursday 27th May 2021 Commons Chamber

[Matt Hancock]

Of course, we have learned a huge amount about how to respond to a pandemic. We have built assets and capabilities such as the vaccination programme and the testing, which is so important both to protect people directly and break the chains of transmission, and to understand where the virus is spreading.

I am glad that we cleared up the issue the hon. Gentleman raised with respect to Kirklees. I worked with colleagues in Kirklees and elsewhere while I was in the west country to make sure that we got the best possible solution to the need in Kirklees: to have a turbocharge on the vaccination programme, to have mass testing to break the chains of transmission, and for people to be cautious and take personal responsibility as we lift measures to make sure that things stay under control.

I am very grateful to the hon. Gentleman for what he said about me personally, and for the leadership he has shown in his community.

[Dr Luke Evans (Bosworth) (Con) [V]]

Yesterday, our Committee meeting was supposed to be about lessons learned. In that spirit, we know that the World Health Organisation stated on 14 January that there was no human transmission. On 11 February, the WHO actually named the virus. We then know that on 14 February, the European Centre for Disease Prevention and Control, in update No. 4, stated that the risk to health systems in the EU and the UK was “low to moderate” and the risk to the population was “low”. We also know that the UK had a plan, but it was mainly based around flu, not brand new viruses. Look at where we are now. Is not the biggest lesson learned that we need a global response and a global resilience plan? Will the Health Secretary be pushing the Prime Minister to make that case at the G7, when we host it here in the UK in June?

[Matt Hancock]

I think that is one of the lessons. I do not need to push the Prime Minister on that; he is absolutely seized of the point. We will be developing the work on that next week at the Health Ministers G7, which is being held in Oxford, and then, of course, at the leaders’ summit which is being held in Cornwall later next month. My hon. Friend is absolutely right in the view he takes as to the importance of reforming and strengthening the global institutions, as well as learning the lessons here at home.

Covid-19

Luke Evans Excerpts

Tuesday 25th May 2021 Commons Chamber

[Nadhim Zahawi]

We are working closely with the Welsh Government to enable the integration of Welsh citizens’ data with the NHS app, NHS.uk, for the purpose of covid status certification, including undertaking the required scoping and impact assessment that will enable us to set out a detailed timeline for the delivery of that integration.

[Dr Luke Evans (Bosworth) (Con) [V]]

The people of Bosworth are a pragmatic bunch, as are the people of Leicestershire. Leicestershire surrounds Leicester. What advice does the Minister give to those people who are in Leicestershire who send their kids to school in Leicester, who work in Leicester, and who are thinking of having bank holiday time with family in Leicester?

[Nadhim Zahawi]

I thank my hon. Friend—[Interruption.] I hear the right hon. Member for Leicester South saying “Good question.” He is absolutely right. We have to exercise caution and common sense, as I described earlier, around visiting. People absolutely can visit family and friends at half-term if they follow social distancing guidelines. I think people absolutely will exercise that personal responsibility and common sense when they go about their family time or school time.

Covid-19 Update

Luke Evans Excerpts

Monday 17th May 2021 Commons Chamber

[Matt Hancock]

We are of course worried about the impact of long covid, and the evidence is growing about the different impacts. The clinical advice is that there are a number of different syndromes that are, together, badged as long covid. For some people it has an impact, as the hon. Member says, on lung scarring; for some people the impact is more neurological. So we have to make sure that the services, the response and, indeed, the research are targeted at the different types of long covid. I am very happy to arrange a discussion between him and our clinical leaders on long covid, because it is a very important topic.

[Dr Luke Evans (Bosworth) (Con) [V]]

The Health Secretary may be forgiven, as he is one of the busiest people in the country at the moment, if he missed Tielemans’s strike from 30 yards and the VAR decision late on in the game, but 21,000 fans saw it live, and many of them were my constituents who were there to celebrate Leicester City winning the cup. Wembley of course holds 90,000 people and it was a test event, so when will we find out the results of the test event and the outcome for things such as the Euros in the future?

[Matt Hancock]

We will find out the results in the next few weeks. Of course, the right hon. Member for Leicester South (Jonathan Ashworth) may have been so cheerful in his opening remarks because he was there, and he saw Leicester triumph. I watched it, and I just thought how brilliant it was to see a live crowd again. It was not full— that is true—and no doubt it could have been filled, but it was not full because we are taking it carefully. I am working with my right hon Friend the Culture Secretary and the Minister for Sport—the Under-Secretary of State for Digital, Culture, Media and Sport, my hon. Friend the Member for Mid Worcestershire (Nigel Huddleston) —who I know found it extremely enjoyable to be able to go to a sports event as the Minister for Sport, which he has missed. We will assess the data that come out of it. Everybody who went is part of a testing regime. We will look at the results, as we will look at the results of the other pilots, such as the Brits and the snooker at the Crucible, and then make an assessment.

Health and Social Care Update

Luke Evans Excerpts

Thursday 18th March 2021 Commons Chamber

[Dr Luke Evans (Bosworth) (Con) [V]]

The Secretary of State will know from his appearances before the Health and Social Care Committee that we are concerned about how the backlog is dealt with, so it is great that he is taking such a proactive stance to deal with it. He set out in his statement just how big the backlog for elective surgeries is going to be. The question from Bosworth is: how long does he estimate it will take to clear the elective-surgeries backlog that has built up?

[Matt Hancock]

I am currently working with the NHS to answer that question, which is a characteristically acute one from my hon. Friend. We are not yet able to answer it simply because the pace at which we can return activity to full, normal levels is not yet clear because the main barrier to that recovery is a combination of infection, prevention and control and the need for staff to get some R and R. We will know more in the coming weeks and months.