Covid-19

Philippa Whitford Excerpts

Monday 11th May 2020 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP) [V]]

I would first like to express my sympathy for all those who have lost a loved one to covid during this epidemic, and to pay tribute to the millions of healthcare staff, key workers and volunteers who have shown that community spirit is alive and well.

Unfortunately, the foundation of this crisis has been 10 years in the making. A decade of Government austerity has taken its toll on health and social care services in England and, through cuts to devolved budgets, right across the UK. The pandemic is unprecedented in our lifetimes and poses a real challenge for every single Government on the planet, but it has been No. 1 on the risk register in the UK for more than 10 years.

In early February, the Government claimed to be fully prepared, yet more than three months on, they are still failing to supply sufficient PPE to protect their healthcare staff. Moreover, testing and contact tracing are still not fully up and running, yet they are lifting the current restrictions. In 2016, Exercise Cygnus highlighted the lack of PPE and ventilators, yet there has been a 40% reduction in the value of the stockpile. The management of it was outsourced to a private company, and we hear that 45% of items in the stockpile are out of date, including 80% of respirator masks. Last June, the new and emerging respiratory virus threats advisory group advised the Secretary of State for Health and Social Care to add gowns to the stockpile. Why was that not done? Is that why Public Health England guidelines, which were issued to all four nations, did not include gowns for staff in covid-positive wards outwith intensive care? Two hundred healthcare staff have died. We need to pay tribute to them, but it should not have happened. None of them were from intensive care units, the most dangerous setting, which shows that full PPE actually works. But now we hear that even ICU doctors in England report struggling to get gowns. There is no point in joining the Thursday clap for carers if you are not willing to protect staff. The excuse for the lack of gowns is that the stockpile was only planned for an influenza pandemic. This is a civil contingency measure, so why would you plan for only one virus? It is not as if this is the first coronavirus outbreak. We had the severe acute respiratory syndrome outbreak in 2002 and the middle east respiratory syndrome outbreak in 2014, and they were both much more lethal.

The Prime Minister set five tests for easing lockdown. The Government clearly are not yet meeting No. 4. Scotland’s NHS has had central procurement and logistics for years and has its own stockpile, but the challenge for all Governments is achieving ongoing supply in the presence of high global demand. Yet the overseas offices of the Department for International Trade have apparently been advised not to assist the Scottish, Welsh or Northern Irish Governments in PPE procurement. Provision of PPE is a devolved responsibility. Why would the UK Government want to undermine those Governments’ efforts to protect the patients and staff in devolved health services?

The Secretary of State for Health prides himself on having ramped up testing to 100,000 on 30 April, but that was only by counting 40,000 tests that were, as we say, “in the post”. I wonder if they are counted again when they come back in. The level, sadly, has not been maintained. One issue being reported is delays in getting results back. It is also the case that the result is not always reported back to the GP or the hospital if it is a staff member. It is not just about how many tests. The World Health Organisation advises that testing, contact tracing and isolation is critical to breaking the chains of infection and controlling the epidemic. Unfortunately, in February, that just was not in place and we ended up with the lockdown as an emergency measure because we could not identify who we should isolate.

Understanding easing the lockdown involves difficult decisions, but we need to be aware that the virus has not changed. We hear all the time about the mystical R number guiding the way out of lockdown, but it is an estimate of how many people are infected by each person with the virus. It has three components: the ease of transmission from one person to another; how long a person is infectious; and how many contacts they have during that time. Ease of transmission is a balance between the infectiousness of the virus and the susceptibility of the population. Covid-19 is very infectious and, as a new virus, the population had no immunity. We can reduce transmission through the personal hygiene measures—I would just emphasise that that should include not shaking hands—but 50% of the spread is asymptomatic and that is the reason to advise the use of face coverings to reduce droplet spread from people without symptoms.

The way to decrease susceptibility is with a vaccine, but that will take time. In early March, the Government seemed to get side-tracked over the idea of herd immunity. I was chair of the all-party group on vaccinations for all and I totally understand the aim of herd immunity, but it is usually achieved with an effective and safe vaccine, not by letting a dangerous disease just rip through the population, especially when we have no proof of how long any covid immunity would last. The duration of infectiousness is about five to seven days and we cannot change that, but one of the problems is that covid patients seem to become infectious about two days before symptoms.

Finally, there is the number of contacts. That is the key thing we can manipulate in one of two ways: either by isolating everyone in a lockdown, which is a blunderbuss approach because we could not identify who we should be isolating; or by isolating just cases and their contacts, so they have no contact with others. That requires strong public health teams to provide testing, tracing and isolation of every single case to control the spread. That should be put in place during lockdown, while people have relatively few contacts, and before lifting restrictions.

The Prime Minister set out a roadmap last night for easing lockdown in England if five tests are met. No. 3 is a sustained fall in new cases, but the UK is still hovering over 4,000 new cases a day, and that is just the ones that are proven by a test. No. 4 is the secure provision of testing and PPE, and neither of those criteria has been met. Telling people to go out to work is not a baby step, especially without clear workplace and transport safety measures—we only have to look at photographs of London transport this morning to see that. If the Prime Minister had wanted more people to leave home, I gently suggest that a “Stay apart” message might have been a bit more helpful. Crucially, local public health teams must be in place to monitor the impact of any changes so that they can spot early warning signs of a local outbreak and take action, and that is not the case.

None of the devolved nations is ready to come out of lockdown. In Scotland, the number of cases is falling, but we do not consider it low enough to be sure that there is no risk of a rise in infections. I know that the political decisions on the next steps are difficult, and I do not underestimate the mental, social and economic impact of lockdown or the misery it is causing. However, a second surge of covid cases would lead to many more deaths and put us right back to square one.