Public Health

Philippa Whitford Excerpts

Tuesday 30th November 2021 Commons Chamber

[Alex Norris]

I cannot cast my mind back to that debate—I believe I had just started secondary school when it took place—but I can foresee the issues that were raised. I would not do down the idea of opening windows; that would be a good thing to do in and of itself, and I would support that. What I am saying is that there are certain places where that will work less effectively, and we ought to have some sense, certainly building by building, of what might be an effective measure. As I said, I do not think this is something that we can just click our fingers and do easily, but I would like to get a sense that we have tried to do any of it at all, and I have yet to get that. I hope the Minister will disabuse me of that.

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

I raised the issue of ventilation last summer—we have known for a long time that covid is airborne—and I wrote to the Chancellor on two occasions asking him at least to remove VAT, to help businesses and public bodies that pay VAT to afford ventilation. Sticking 20% extra on the cost of a ventilation system seems quite weird in the middle of a pandemic.

[Alex Norris]

I am grateful to the hon. Member for that intervention, which gets to the root of the matter. We have been talking about ventilation for a long time. What I would really like to hear from the Minister is whether any progress whatsoever has been made in this area.

I turn to statutory instrument No. 1338 regarding self-isolation. The regulations introduce new rules for self-isolation after contact with a person who is suspected to have contracted the omicron variant of the virus, removing the exemptions to self-isolation. As we saw in the summer, this will be frustrating for those who would otherwise have been able to avoid self-isolation requirements by being vaccinated and who will now have to stay at home for the full period. However, as we wait to see how our vaccines and antivirals respond to the new variant, it is right that we prioritise caution and seek to limit community transmission as much as humanly possible. The Minister may have sensed colleagues’ eagerness to know more about this requirement. I hope that she will tell us when she thinks she is likely to have enough information about the variant to return to Parliament and say whether the Government feel that the regulations ought to remain.

There is, of course, a significant gap in the fence of these regulations. The gap has existed throughout the pandemic, and it is bewildering that we in the Opposition are still having to raise it. It relates, of course, to fixing sick pay. We have learned during the pandemic that the overwhelming majority of the British people want to do the right thing to protect themselves, their family and each other, but that falls short when they are forced to pit it against their need to feed their families. In both rate and availability, sick pay has proven insufficient to protect families against that horrendous choice.

These regulations will be weakened. They will be weakened when people ignore their symptoms and go to work, weakened when people say they are self-isolating and they are not, and weakened when people turn the app off to avoid being a close contact. Surely Ministers have learned this lesson over the last month. I am surprised that we did not hear more from the Minister about that.

The hon. Member for South Dorset (Richard Drax) raised the regulations relating to red list travel. My understanding is that we are not discussing those today because they were laid via the negative procedure, but the elements relating to testing will have an impact on SI No. 1338. Last week, we suggested that the Secretary of State should begin PCR testing for those entering the country, so I am pleased the Government have listened and included day-two PCR tests in the measures announced yesterday, but there are still holes in our defences on international travel.

I am keen to hear from the Minister how she and her colleagues reached the decision to introduce only day-two testing, and not to reintroduce pre-departure tests. I am keen to know the scientific basis behind that. We have heard many reports of private tests not being followed up, especially, perhaps, by those offering the cheapest prices. What are the Government doing to enforce this and to ensure that bringing back day-two PCR tests, which we support, is effective?

I will bring my remarks to a conclusion, because I am conscious of how many colleagues wish to speak in the debate. This is a concerning moment in the pandemic. We have learned over the last 18 months that it is vital that we act decisively at such moments. We are pleased to see these regulations come forward—indeed, in the case of mask wearing, it was premature to stop at all—but there is much more to do if we are to avoid being back here in the coming days and weeks, including working from home where possible, fixing sick pay and improving ventilation. The actions we need to take are clear. It is time for the Government to meet the moment.

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

Happy St Andrew’s Day to all Scots across the parliamentary estate, whether they were born in Scotland or are adopted Scots like myself.

We are in the early days and need more research on omicron, the new variant of concern, but clearly it is heavily mutated, including mutations that suggest increased transmissibility and mutations associated with immune escape, and that is what is causing the concern. Cases are surging in South Africa, but we do not yet have proof that those surges are directly related to omicron. One thing that has emerged from South Africa is evidence of the reinfection of people with previous proven covid infections, which we have not seen often during the pandemic.

The hon. Member for Altrincham and Sale West (Sir Graham Brady) talks about people’s freedom to choose, but the people they might infect—especially those who are immunosuppressed or vulnerable—have the choice removed from them. It is a network. If Members have ever seen the little gif where someone drops a ping-pong ball on to mousetraps, they will realise how things spread. You may have a choice. I, as an immunosuppressed person, may therefore not.

[Sir Graham Brady]

Is exactly the same not true of flu?

[Dr Whitford]

We do not suffer the same deaths, hospitalisations or outcomes from flu. [Interruption.] Well, we don’t. Look at 170,000 deaths over the last 18 months in the UK. We certainly have bad flu winters where we can get up into the teens towards 20,000, but we have never got close to 170,000 over 18 months.

[Mr Harper]

I know the hon. Lady has a great deal of medical experience, but she is referring to a period when we did not have vaccination. Am I not right in thinking that in a vaccinated population, the case fatality rate of covid is not remarkably different from that of influenza?

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[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.”

[Craig Mackinlay]

I thank the hon. Lady for bringing her medical knowledge to the House. It is very interesting, particularly on the S gene. I do not know what magic goes on in a lateral flow test. We put the drips in at one end and then one band, hopefully, appears and not two. Could a lateral flow test be adapted to be specific for this type of variant?

[Dr Whitford]

I think we would be talking about redesigning the test for a whole new antigen. I mentioned just one advantage that we get from PCR testing, which basically looks at genes—I will not talk about the whole long name and what PCR stands for—and the benefit is that we get a heads-up. I do not think it is feasible on any reasonable timescale to change lateral flow tests, so we are lucky that this one has S-gene dropout and that we will get an early warning.

One issue with focusing only on a day-two PCR and then, if someone is negative, they are released—unlike what is being discussed for domestic isolation—is that the incubation period of covid, generally, is much longer than two days. It has generally been reported as an average of five days and it can extend for longer. If someone who may have had contact arrives in the UK, gets a negative PCR result on day two and then goes about their business, there is a real danger that that is a false reassurance. That is why the Scottish and Welsh Governments have asked for a Cobra meeting to debate the evidence on a four-nation basis and to discuss having at least an eight-day isolation period for travellers, with a negative day-eight test required before people can be released.

The Prime Minister should listen on that, because one issue that we had in Scotland when we tried to maintain stricter and broader hotel quarantine was that the majority of long-haul passengers arrive through hubs such as Heathrow. The devolved nations have no ability to have an impact on that and we should be working with the Republic of Ireland to make the whole common travel area safer from the point of view of how we move about inside it.

[Karl MᶜCartney]

The Government Benches are not as sparsely populated as the Opposition Benches—and I do welcome the Opposition Members who are here—but considering what is happening later, am I right to presume that the Scottish National party, which the hon. Lady speaks on behalf of, will be supporting the Government in the vote at the end of the debate?

[Dr Whitford]

The reason that my colleagues are not here is that the debate is largely about the regulations in England and we do not normally vote on English matters. We have not normally voted on England’s covid regulations, but the one related aspect in these proposals is the testing and isolation of travellers. We support that but we think that it should go further.

On domestic precautions, Scotland never got rid of mandatory masks on public transport, in shops and in schools. We have not heard the Minister refer to whether the Government are planning to reintroduce mask wearing in schools. At the moment, with vaccination and its impact, we are seeing that the bulge and peak of cases among those who are unvaccinated is moving down to younger and younger teenagers and primary school children. If there will not be masks in schools, is there a plan to install CO₂ monitoring and ventilation? How do we reduce the incidence in schools?

[Mark Jenkinson]

The hon. Lady perhaps answered some of this question, but will she set out her assessment of the impact of mask wearing in Scotland on case numbers? Is what has happened with younger children not just testament to how well we have done at keeping them apart and proof that we cannot hide from the virus when we come back together?

[Dr Whitford]

It is very difficult at the moment. Cases go up and down and we swap positions. At the moment, Scotland has the lowest incidence of cases at 349 per 100,000. Northern Ireland has the highest at well over 600 per 100,000. Obviously, we have whole baskets of measures, so it is harder—other than in the review that the Royal Society published last June and in the BMJ paper from a week ago—to pick out exactly which measures are having the impact. The BMJ found that masks and hand hygiene were equal in their impact and, in fact, bigger in their impact than physical distancing. To me, they enable people to engage and enable people who are vulnerable to feel safe and to come out, because otherwise, those who were shielding will be stuck in their houses all over again.

Although mask wearing was not mandatory in England, it has remained in this Government’s guidance if someone is in a busy public space. I am sorry to say that that guidance has been undermined by what Members on the Government Benches have demonstrated on television every day. Initially, when we came back in the autumn, approximately five people wore masks, then the number more than doubled to 14, and after the measure was pushed, the proportion rose to about two thirds. On the day when mask wearing in busy places is meant to be promoted, about a third of Government Members are still not wearing masks.

People will be led by the example of not just the Prime Minister, but every one of us.

[Mr Harper]

Will the hon. Lady give way?

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[Dr Whitford]

I have given way a lot, and lots of other hon. Members are waiting to speak.

As for the Leader of the House’s nonsensical claim that people cannot catch covid from their friends, I have to say that words fail me—and as Members can well believe, that is not a common occurrence. It is clear that the most common spread is within households. If the Leader of the House thinks that husbands, wives and children are not friendly with one another, I really worry about his home circumstances.

It is early days, but we should be following a precautionary approach. As Dr Ryan of the World Health Organisation has always said: go early and go hard. In the last three waves, the Government often delayed making decisions until the problem was proven. I welcome the changes that they are making to try to get ahead of the curve this time, but as well as taking action on masks, they should advise those who can easily work from home to do so. They should promote “hands, face, space” again, to push it to people who may have got a little complacent.

The Government should also look at how to support the installation and improvement of ventilation. Covid is airborne. Hon. Members will remember how smoke used to hang in a pub before the smoking ban. Any Member who has ever worked in pubs, as I did as a student, will know that smoke would still be hanging there the next morning. That is the issue with poorly ventilated spaces, as we have seen from the outbreaks associated with Committee Rooms in the House.

The arrival of such a variant was inevitable. Last spring, we heard warm words about a global response to a global crisis, but while more than 85% of adults in the UK have been double-vaccinated, the figure is less than 4% in low-income countries, including many that have not been able to vaccinate their healthcare workers.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Does the evolution of an immune escape variant, which omicron may be, occur because of a vaccinated immune population or because of a naive population?

[Dr Whitford]

I think that its emergence in southern Africa would suggest that it is from a naive population. One of the issues with our complacency here and reliance on vaccination while allowing very high case numbers is that through Darwinism it can pre-select for vaccine-resistant variants and mutations. Those are the ones that will get a grip; the ones that are vaccine-susceptible will not, because we are so vaccinated.

Allowing high spread, which means common mutations, is a problem wherever it happens, but in the naive populations in the global south there is a real danger. They do not have testing, they do not have the materials, they do not have genomics and they do not have vaccines, so the danger is that they will therefore get a variant that builds up and eventually comes to Europe and to the UK. Sending occasional batches that are almost out of date, as was reported recently to us in the all-party parliamentary group on coronavirus, does not allow Governments in the global south to prepare and use vaccines within date.

The UK is still among the countries blocking a TRIPS waiver. We must realise that it is not a matter of just sharing some leftover doses. We need to massively increase global population, which means sharing intellectual property and sharing technological expertise. If anything, this variant should be a reminder that no one is safe until everyone is safe.