A massive cliff fall has blocked the beach between Branscombe and Weston Mouth, east of Sidmouth. 

Before you rush off to look at it, Owl should remind everyone how Devon and Cornwall Police expect people to behave during lockdown regarding travel and exercise.

The latest statement from the force said: “In light of recent guidance issued by the National Police Chiefs Council (NPCC) and College of Policing, Devon & Cornwall Police is not changing advice on travelling.

Cornwall Live reported yesterday how the NPCC issued new guidance saying that people can drive a reasonable distance for exercise during the coronavirus lockdown period.

However, Devon and Cornwall Police has released a statement stating that it will not be changing advice on travelling despite what the NPCC and College of Policing said.

It also stated that travelling to a beauty spot [for example] to surf is “not within the spirit of what we are trying to achieve”.

“Government advice remains the same, and it is expressly to prevent the spread of coronavirus, to save lives, and to protect the NHS. It includes the following:

• Only go outside for essential food, health reasons or work (but only if you cannot work from home)
• If you go out, stay 2 metres (6ft) away from other people at all times
• Do not meet others, even friends or family. You can spread the virus even if you don’t have symptoms.

“There has been much discussion around what the legislation does and doesn’t specifically prohibit. The legal aspects of the legislation are based upon whether a person’s actions are reasonable or not. Officers will continue to make individual judgements based on the specific circumstances presented to them.

Chris Carson  www.midweekherald.co.uk

Beer Coastguard rescue unit is warning people that there are ‘huge rocks’ on the slope that could fall ‘at any time’.

Their advice to coastal walkers is not to go near the landslide.

A spokesman for the team said: “Please keep away from this area – both the clifftop and the beach.”

A spokesman for East Devon District Council said the area was not under its control but was owned by the National Trust.

No one from the National Trust was currently available to comment

The MP for East Devon, Simon Jupp, is to look into shortages of personal protective equipment (PPE) at local doctors’ surgeries during the coronavirus crisis.

Philippa Davies www.sidmouthherald.co.uk

Concerns were raised at Sidmouth Chamber of Commerce’s monthly breakfast meeting on Wednesday, April 8, which was held online with Mr Jupp as a guest.

A member of the chamber said she had spoken to a nurse at a local medical centre, who thought their PPE would run out next week.

Mr Jupp said: “I will raise it specifically with the county council and East Devon District Council, and raise it with the NHS locally as well, to see what can be done.

“This has been raised with me about other doctors’ surgeries, and unless people tell me I don’t know, so I will raise that specific case as I have with other doctors’ surgeries locally.”

He was also asked whether a temporary Nightingale hospital is being set up at Westpoint, near Exeter, to treat Covid-19 patients.

He said: “It’s something being looked at as cases progress.

“I know at the moment our hospitals across the county, including the RD&E, are coping relatively well with the Covid-19 patients.

“I can report that the levels of PPE available in our hospitals for the frontline NHS staff in our part of the county is pretty good, with another supply due today according to the sources I’ve had, and I do speak to the NHS on a regular basis on that.

“I know there are plans in progress for (a Nightingale hospital) if we get to that stage where it’s obvious that our hospitals, and that includes our community hospitals too, can’t cope with the level of cases.

“This is something we are keeping a watching brief on, and this is something that is being led by the CCG and Devon County Council and the local resilience forum.”

He said everything possible is being done to make sure frontline NHS staff have the equipment they need, to the extent of getting the army involved.

“I was told, as an MP, to warn constituents that if you see a tank going down the road don’t be too concerned, it could be delivering PPE.

“Genuinely, every single Government department is doing its utmost to get supplies to the right places at the right time.”

“At the Centre for Applied Microbiology and Research, housed within the high security Defence Science and Technology Laboratory at Porton Down near Salisbury, scientists are pouring over 800 blood samples taken from a representative sample of the English population.”

“They are conducting tests today which, more than any others you may have read about, will decide the shape and timing of Britain’s coronavirus exit strategy. Perhaps, just perhaps, they will provide the key to the door that is lockdown.”

By Paul Nuki, Global Health Security Editor and Sarah Newey, Global Health Security Reoirter www.telegraph.co.uk

If the tests work, and virologists are confident they will, they will provide Britain with the answers to the most important unknowns about Covid-19: How many of us have already had the virus? How common are asymptomatic carriers? And how much immunity, if any, do we acquire after surviving an infection?

The answers to these questions are what virtually every government the world over is rushing to unearth. They are the gold dust of the pandemic. They will inform not just exit through a much more precise modelling of the pandemic’s trajectory, but the best approach to treatments and vaccines.

Little wonder then that this – the “fourth pillar” of the government’s testing strategy – is being conducted behind the high security fences of Porton Down.

“This sort of study is absolutely vital because we are so uncertain about the level of infection in the population”, said Mark Woolhouse Professor of Infectious Disease Epidemiology at the University of Edinburgh. “As things stand we could be out by a factor or 10 or even 100. If work like this gives us even a rough pointer initially it would be hugely valuable”.

While some elements of the British response have been slow, the work at Porton Down is understood to have been underway since January. Moreover, it plays to our skill set as a nation, based as it is on high-end science rather than the more mundane – but crucially important business – of high volume throughput or production.

Experts say the first two months were spent validating high tech “assays” for reliably identifying coronavirus antibodies and designing a robust longitudinal blood sampling study. The first 800 blood samples were delivered to the laboritary in late February.

“We are expanding this programme during April so that we have the potential to test around 5,000 samples per week”, said the Department of Health and Social Care. “We will also roll out a national mass population sample over the coming months… the aim is to enrol 16,000 to 20,000 people who will undergo repeat testing”.

Attention has been focused on swab tests for the virus and cheap home antibody tests to tell people if they have already been infected. While the swab tests are reasonably precise, the home antibody testing kits are currently woefully inaccurate.

In contrast, the antibody tests or “assays” being run at Porton Down are said to be excellent. “The tools are there. The expertise is there. You can be quite confident PHE at Porton Down has access to sensitive assays that can accurately determine antibody levels in patients’ blood,” said Zania Stamataki, a senior lecturer in viral immunology at the University of Birmingham. 

Dr Stamataki added that it was these Porton Down assays that the commercial antibody tests which the government has taken options on are being validated against.

The initial aim of the work at Porton Down is to establish how widely the virus has spread. Current models assume the spread to date is fairly modest, at around three to four per cent of the population. If the modelers had a more precise grip on this crucial variable they would be able to predict the course of the epidemic with much greater certainty.

“Data in the coming weeks will enable estimation… with greater precision,” the team at Imperial College London, whose work underpins the UK’s lockdown strategy, admit in a report dated March 30. 

Prof David Heymann, infectious diseases expert at the London School of Hygiene and Tropical Medicine, added: “Community surveys will provide us with idea of the level of people infected and that is very important to inform the modelling. Modelers use best possible data at the time they do the modelling, but this changes rapidly.” 

Just as a political pollster can take a small but representative sample of the population to establish voting intentions with some accuracy, the scientists at Porton Down hope to pin down a figure for the spread of the virus from the initial 800 blood samples they are currently studying. This will be improved on as they test more blood samples over time.

The study will also provide data on the vexed question of how many people with Covid-19 experience no symptoms or symptoms so mild they carry on as normal and (perhaps) unwittingly spread the disease to others. This again is vital information for those devising Britain’s exit strategy. Current estimates for non-symptomatic carriers vary hugely.

“Blood antibody tests themselves will not tell you about symptoms but if you have gathered detailed clinical information from those you are taking blood from it should do”, said Prof Woolhouse.

Karol Sikora, professor of medicine at the University of Buckingham and former director of the WHO, added: “In studies on cruise ships and small countries, where they’ve tested just about everyone, some 50 per cent of people infected have no symptoms whatsoever, not even a sore throat or cough. 

“That number could mean 20 to 30 per cent of the population have been infected in the UK, which would have huge implications for our strategy – especially around herd immunity and NHS capacity. That information really is vital.”

Last, and perhaps most important, the work at Porton Down will – over the course of six months to a year – show whether or not the antibodies produced as a result of contracting Covid-19 give protection against the virus, and how long that protection lasts. Currently, science is completely in the dark about this, the single most important question of all.

“The hypothesis is that the existence of antibodies means you will have some protection but this is not necessarily the case,” said Dr Stamataki. “We do know that antibodies from some existing coronavirus can last for a year or more. But this is a novel virus and it is possible both that its antibodies are not protective or that they don’t last.”

The Porton Down research will establish this by means of a longitudinal study whereby the participants would have their blood checked for antibodies regularly over time to see how long they last. Animal studies will be run consecutively to test their protective potency.  

“One can’t overstate the importance of establishing the strength of any immunity”, said Dr Stamataki. “Even if it lasts for just a year it would give many of us the chance to return to normality.”

The work at Porton Down puts into perspective the trouble governments around the world are having with home antibody tests. Even if these tests prove accurate they are next to useless unless it is known that the antibodies they test for provide protection.

The work at Porton Down should, within months, start to answer that vital question.   

“Not Boris Johnson, surely. Not that most bouncy and irrepressible of men, who always seemed the definition of a lucky general. While we know this virus does not discriminate, there is still something faintly surreal about the idea of the prime minister lying in intensive care, his own body now a battlefield for the virus that has come to define his fledgling premiership.”

Gaby Hinsliff  www.theguardian.com

Once in a generation – and only then if it’s unlucky – a nation finds itself living through events so dramatic they almost defy belief.

Not Boris Johnson, surely. Not that most bouncy and irrepressible of men, who always seemed the definition of a lucky general. While we know this virus does not discriminate, there is still something faintly surreal about the idea of the prime minister lying in intensive care, his own body now a battlefield for the virus that has come to define his fledgling premiership.

Don’t underestimate how many ordinary people will be shaken by the sight of a 55-year-old laid low like this, despite the best care the NHS has to offer. So many lives have already been touched by this virus in ways we could never have imagined three months ago and now, by a terrible irony, the man responsible for leading us through it is one of them.

Whose heart does not go out out to a heavily pregnant Carrie Symonds, weeks away from giving birth to their baby? The wider Johnson family, too, deserve to feel supported in their distress, like any other family waiting for news from hospital. Yet beyond this private and very understandable distress lies a grave new political reality. Just as the epidemic nears its dangerous peak, a hole is emerging at the heart of government.

It no longer feels like a coincidence that the Queen was finally deployed on Sunday night, just as Johnson was heading for hospital. Her address to the nation was a gentle reminder that in Britain power does not rest solely in one place, yet in practice there is only so much she can do to steady a ship now heading for constitutionally uncharted waters.

Dominic Raab, the foreign secretary, has been asked to deputise for Johnson, yet that official language conceals a very grey area. Unlike America, Britain has no designated survivor to step up in an emergency. Constitutionally speaking, there is no such thing as an acting prime minister either; there are only prime ministers, who serve until they lose an election, resign or die, and in their absence power devolves to the cabinet as a whole.

Raab’s new status is essentially a means of preventing the chain of command from becoming confused or mired in internecine cabinet rivalries, although it remains to be seen whether he really has the authority to knock his colleagues’ heads together. (Those who wonder why it’s him in charge rather than the Cabinet Office minister, Michael Gove, now self-isolating after a family member showed coronavirus symptoms, perhaps miss the point that Johnson was nominating not a successor but a caretaker.)

For now, the opposition seems willing to give all this the benefit of the doubt. Illness transforms the prime minister in the public mind, to the extent that it would seem grotesque for Labour to use this moment for political advantage. Nor can Keir Starmer do anything that might be interpreted as pressuring a sick man back to work; we’ll never know whether Johnson would have got this ill if he’d rested the minute he was diagnosed, but a culture in which politicians don’t feel able to take sick leave even on their hospital beds is in no sense a healthy one.

Yet it remains the opposition’s job to hold government accountable for management of this epidemic, and if Johnson’s absence turns out to be prolonged, questions will eventually have to be asked about the democratic basis on which his chosen substitutes continue to govern.

The cruelty of this situation is that it pits the human imperative to be kind, to make allowances for awful circumstances, against the remorseless political imperatives of a crisis in which many more lives are at stake.

For there are life-changing judgment calls to be made over the coming weeks, as Downing Street grapples not only with clinical questions about when and how to lift the lockdown, but with an economic crisis unfolding alongside it at pace. It no longer seems credible that we will simply pick up where we left off pre-virus, and huge decisions loom about how to restart a hollowed-out economy and how the bills now being racked up will be repaid. With all due respect to Raab, there is only so far a stand-in can go in taking decisions which will determine what kind of society emerges from this.

What exacerbates the problem is that the country didn’t just vote for a Conservative government last December, or even for a slate of policies. It voted, perhaps more than usual, given the degree of switching across party lines, for one man and one idea. Johnson embodies not so much an ideology as a mood, a feeling, a sense of what Britain could be that was inextricably bound up with (but not wholly limited to) Brexit.

Whether his brand of breezy confidence suits the management of an epidemic is not, perhaps, a question to be asked over his hospital bed. But it’s hard to see anyone else in government occupying quite the place he did in the public imagination, should his absence extend for more than a few weeks.

Clearly it’s to be hoped the prime minister makes a swift and full recovery. But nobody bounces straight back from intensive care into 18-hour days at the office, which suggests at best he will need time to convalesce. Downing Street may need to start preparing the public soon for the possibility of a long, slow road back to normality.

Power instinctively fears a vacuum, because of the risk that it will fill with panic. The suspicion at Westminster for days now has been that No 10 was playing down the seriousness of the prime minister’s illness in order to keep the nation calm, a suspicion only reinforced by a curiously strained Monday night press conference in which Raab insisted the boss was still overseeing things from his hospital bed while admitting that he hadn’t actually spoken to him since Saturday.

Within hours, it emerged that the prime minister was in fact heading to intensive care. Sudden deterioration is an emerging hallmark of coronavirus cases, so it is not impossible that his office was as taken aback as anyone else by this decline. But from here on in, candour is essential.

These are extraordinary times, which means voters may well accept extraordinary solutions for a while to allow the prime minister a chance to heal. But we cannot live for ever in a state of democratic ambiguity, and if the road to recovery proves longer or harder than expected, there may come a time when Johnson faces a very personal choice between the job he has craved all his life and the national interest. Downing Street cannot be alone in hoping it doesn’t come to that.

“These are frightening times to be in a care home. It’s incredibly hard not only for the elderly residents, deemed to be at high risk and fearful for their lives, but for their carers too, struggling away while the focus has been on the hospitals.”

Followers of East Devon Watch will be too well aware of how a frightening situation has been turned into unimaginable horror for the residents, and their relatives, of Budleigh Shandford Care Home being closed by Abbeyfield. Under lockdown there can be no contact with loved ones.

Alice Thomson www.thetimes.co.uk

These are frightening times to be in a care home. It’s incredibly hard not only for the elderly residents, deemed to be at high risk and fearful for their lives, but for their carers too, struggling away while the focus has been on the hospitals. Of all the key workers battling through this pandemic, residential carers are in a particularly vulnerable position. Low-paid, often young and inexperienced, or immigrants far from loved ones, they are expected to fight on the forgotten front line with little help or medical equipment and to act as angels when they could become harbingers of death.

There are more than 400,000 elderly in residential homes across the country. Everyone applauds the doctors, nurses, emergency staff, teachers and shelf-stackers but the care workers are too easily shunted to the side and neglected.

Many work long hours on zero-hours contracts as “unskilled” workers, helping the elderly to eat, go to the toilet, bath, brush their hair, cut their toenails, or in the case of those with dementia or Alzheimer’s, encouraging them to connect in small ways with life. The workload is exhausting, turnover is rapid and vacancies were already running at 20 per cent. The pay differential between care workers with less than one year’s experience and those with more than 20 is 15p an hour so they aren’t rewarded for acquired skills. In fact, they are often castigated for being uncaring when the majority are empathetic and selfless.

Both my parents are in care homes where the carers have made huge efforts to make the residents feel as comfortable as possible, reassuring them as they nervously self-isolate in their rooms, feeding them as nutritiously as they can from limited supplies and singing with them. For my father, who has dementia, it’s a struggle not to be able to roam the corridors or countryside.

Carers always worry about the welfare of their beloved residents: now, last in the line for testing, they know they could bring devastation to their workplace if they pick up the virus. Or they could catch it while holding the hand of a dying patient, who may be desolate without their family, or in the case of those with dementia, horribly disorientated.

Sixteen residents at a care home in Glasgow died in just over a week after a suspected outbreak of coronavirus. The patients at the Burlington Court care home were not tested for Covid-19 because they were not admitted to hospital; two staff members are also undergoing treatment. It must be horrific to attempt to provide some dignity to the final moments of so many at once, acting as surrogate family to the dying, while also worrying whether you might bring the virus back to your partner or children.

Sam Monaghan, chief executive of MHA, the UK’s largest charity provider of care for older people, said: “NHS staff are used to dealing with a high volume of end-of-life care; social care staff who develop close personal relationships with residents over months and years are not.”

Care staff have often been the last to receive personal protective equipment (PPE) despite dealing with serious cases. Meanwhile managers are worried that residents and families are being nudged to sign Do Not Resuscitate order forms. Many have been told informally not to call an ambulance for those over 75 or expect them to be admitted to hospital, although NHS England says there is no national guidance.

Rachel Beckett, chairwoman of Wellburn, which has 14 homes across the northeast, says: “With no guidance, financial or moral support, we know for now we’re in this on our own. Our carers, who are overworked, stressed and being pushed to the limit, both physically and mentally, aren’t part of the wider story.” Agency workers have been called in but they could become super-spreaders as they move between homes. So managers are appealing for volunteers to sign up to a national care force while staff self-isolate or recuperate from symptoms.

In Europe, the devastation wrought by the virus has caused a care scandal. France’s retirement homes, shuttered from the world, have reported multiple cases of double-digit death tolls. In Spain, military units had to be dispatched to disinfect care homes after staff fled. Twenty-three people were found dead in a Madrid residence.

There are ways to ameliorate care homes’ plight. In Belgium, families of elderly coronavirus patients have started legal action to ensure their relatives get places for intensive care treatment but the majority of frail octogenarians in Britain would probably be horrified to take the place of a young person on a ventilator. As the 86-year-old Joan Bakewell says in an interview in The Times today: “If I was the oldest by far and a younger person needed a ventilator, I wouldn’t be fighting for my life over theirs.”

However, dying residents could perhaps say goodbye to families if there was more protective equipment and staff must be provided with PPE, and be fast-tracked for testing. Volunteers should sign up to help at nationalcareforce.co.uk and grandchildren can write letters and paint pictures. Arts charities are already performing outside windows.

Above all, when this is over, the government must recognise that it is futile to separate social care from the NHS — they operate in conjunction. Care staff need to be better paid and residential homes should never again be seen as an afterthought. We seem to think of ourselves as a nation that doesn’t care about the old but the coronavirus has shown us how much we do.

Thousands of vulnerable Britons at high risk from coronavirus have not yet been told they should be staying indoors for 12 weeks, it has emerged.

With the peak of the virus thought to be several days away, officials have admitted that there have been “mixed messages” about which people should be “shielding”.

Shaun Lintern Health Correspondent www.independent.co.uk 

Vulnerable people may have been inadvertently putting themselves at higher risk because they are unaware that they should be staying home.

Last month the government announced that it would contact 1.5 million people to tell them that they should be shielding. GPs were then asked to find out more information on other patients they were aware of who needed to follow similar advice.

But in some cases, GPs have been unable to add people to the existing list of those who are entitled to receive food deliveries and urgent supplies during their 12-week isolation.

A letter from deputy chief medical officer Dr Jenny Harries – who has been alongside ministers in daily press conferences from Downing Street – and Dr Nikki Kanani, NHS England’s primary care director, admitted there had been “mixed messages”, telling doctors to “disregard” previous advice as fresh attempts were to be made to identify those at risk.

Alison Thomas, whose 95-year-old mother Else Catchpole is blind, deaf, takes medication for heart failure and suffers bouts of breathlessness, criticised the delays and said people were being left at risk.

Ms Catchpole, who lives in Cambridge, relies on her daughter for care eight hours a day and is unable to leave the house or even prepare her own food and drink.

“I went on the government website and it said she does not fit the criteria. I went to her GP and asked him to add her. He called me and said he totally agreed with me and said he had a long list of people but they had been told they weren’t allowed to add anyone and to wait,” said Ms Thomas.

She worries she could bring the virus into her mother’s house and fears what could happen if she becomes sick herself. She said: “I am angry and frustrated. It seems completely chaotic. I think there could be millions who have been missed.”

A GP in the northwest told The Independent: “We are being told to wait until the centralised lists have been done then we will be told when we can do our searches and add people. Apparently there has been some problems with the coding used for searches and also the wording in the letter sent out.

“We’re getting lots of patients asking why they haven’t received their shielding letter yet. And some asking why they have received one.”

The government introduced the shielding policy on 21 March for 1.5m people thought to be “extremely clinically vulnerable” to the virus.

Asked about the issue at the daily No 10 press conference, chief medical officer Chris Whitty said there were around 16 million people who were aged over 70 and have pre-existing health conditions who he said should be following government advice on isolation.

He added: “There is this particularly vulnerable group, around 1.5 million … who we are very keen to have the absolute minimum contact possible for quite a long period of time.”

He said most had been contacted or would be as a second wave of letters was sent out this week.

“There will be people who go in to the shielding programme who were not initially identified,” he said.

In their letter to GPs sent on Friday last week, Dr Harries and Dr Kanani said: “We know that there have been mixed messages about this patient group.”

They said most patients at highest risk had been identified and written to, but added: “This week we expect more people to be identified as we are validating the centrally held list against general practice data. People identified through this process will be sent a letter in the post and these will also be flagged in your GP system.”

GPs were asked to identify patients they believed should be included, but the letter said: “We are aware that there have been other sources of guidance asking you to identify and contact large numbers of extra patients. We ask you to disregard this.”

The letter said details of patients who had self-identified as vulnerable would be sent to GPs this week, adding: “We ask that you review this list and consider if any of them should be included in the highest clinical risk group. Please send a letter to any you consider to be at highest clinical risk and add a flag to their record.”

Hospital specialists are also working to identify patients they consider to be at risk.

Professor Martin Marshall, chair of the Royal College of GPs, said: “A priority for GPs is to ensure our most vulnerable patients are kept as safe as possible during the pandemic and official advice is that ‘shielding’ is the best way to do this.

“If a patient thinks they meet the criteria to be in the highest risk group and should be shielding but hasn’t received notification, or adversely, if someone has been told they should ‘shield’ but don’t think they meet the criteria, they should contact their GP or hospital specialist.”

“Most will get a mild form of the disease” was the mantra trotted out during the early daily briefings from Downing Street as we were pursuing the “acquiring herd immunity” strategy. Whilst this is true, Covid-19 is distinguished by causing severe symptoms in a minority. 

We all wish the Prime Minister a full and speedy recovery. 

This article presents the brutal facts as they relate to what we know to date in this epidemic of what it can do to a minority. We must all hope that medical science can find effective therapies to alleviate symptoms whilst the world waits for a vaccine.

Tom Whipple  www.thetimes.co.uk 

It was not, we can be fairly certain, the hospital handshakes that did it.

At the beginning of March — a month ago and a world away — Boris Johnson was criticised after saying that he had been going around hospitals greeting patients and, in defiance of the coronavirus, shaking them by the hand.

Today Mr Johnson is back in hospital for very different reasons, and there is neither defiance nor glad-handing.

As foolish as the handshakes may have been, it seems far more likely that his infection can be traced to a fortnight later and what could be called the “Cobra cluster”. On the day when Britain went into lockdown Neil Ferguson, the government’s leading adviser on disease modelling, was in Downing Street.

It turned out that he was also providing a less than theoretical lesson in disease spread — the next day he would announce that he had coronavirus. We will never know for certain if he was “patient zero” for the cabinet. We do know that in the days that followed Matt Hancock, the health secretary, Chris Whitty, the chief medical officer, and Dominic Cummings, Mr Johnson’s chief adviser, all went down with symptoms. And so, on March 26, did Mr Johnson.

We understand enough about the virus’s trajectory to know that most people who get over it easily do so in the first week in which their symptoms appear. As Mr Johnson compared notes with Mr Hancock, who was diagnosed on the same day, they would have not, initially, felt that dissimilar. Inside their bodies — most likely confined largely to their noses and throats — the coronavirus was reproducing, multiplying, and recreating the symptoms of a bad cold.

While Mr Hancock’s immune system was already containing and controlling the coronavirus, in Mr Johnson, for whatever reason, the infection was probably spreading to his lungs. And, about ten days after his symptoms began, the infection had worsened to such an extent that he had to go to hospital.

From the intensive care unit there are two routes out: death or discharge. According to very early data, both are equally likely. That bald statistic ignores both Mr Johnson’s circumstances, however — he is five years younger than the average British coronavirus patient in ICU — and the fact that the present statistics are based on only a fraction of cases. Most Britons who have gone into ICU with this virus are still there.

What we do know from experiences abroad is that the next fortnight is crucial. As more of Mr Johnson’s cells die they will be sloughed into his lungs, clogging them with fluid and debris. At the same time, doctors now believe, he will be in danger of a “cytokine storm”, in which the immune system overreacts, rushing in defensive cells and opening up blood vessels — causing damage and leading to yet more fluid on the lungs.

If he can battle that and come out the other side then, on average, we would expect to see Mr Johnson give a wave — albeit a feeble one — from the steps of St Thomas’ about 18 days after symptoms began, the weekend after next.

Patients who do not survive leave, on average, four days after that.

Owl finds interesting local connections to Dominic Raab, First Secretary of State, now deputising for Boris Johnson.

One of the prominent backers for his leadership bid for the Conservative Party was Sir Hugo Swire MP. And Swire’s replacement as Conservative candidate for the Devon East constituency, Simon Jupp, joined the Foreign and Commonwealth Office in 2019 as a Special Advisor to Dominic Raab when he was the First Secretary of State and Foreign Secretary.

Connections, connections,

Steven Swinford, Lucy Fisher, Oliver Wright  www.thetimes.co.uk 

Dominic Raab was made first secretary of state by Boris Johnson because he offered his “unconditional” support during the Tory leadership contest and was considered “rock solid” on Brexit.

Mr Raab was Mr Johnson’s main Eurosceptic rival during the contest in June last year but was eliminated in the second round of voting. On the evening of his elimination he told Mr Johnson that he had his full support and made clear that he was not asking for any cabinet job in exchange for his backing.

Mr Johnson also believed that Mr Raab was “rock solid” on Brexit and would take Britain out of the EU if he became incapacitated.

By contrast, Michael Gove, who was knocked out in the penultimate round of voting, did not directly endorse Mr Johnson. He said instead that both Mr Johnson and Jeremy Hunt, the final two candidates, would make “great prime ministers”.

“Boris liked the way he just came right out and backed him,” an ally of Mr Johnson said of the foreign secretary. “Dom is also popular with the Vote Leave crew who are in Downing Street.

“There’s also another reason: Dom is rock solid on Brexit. The thinking was that if someone had to take on the prime minister’s role they had to be clear on Brexit.”

Mr Johnson also distrusted Mr Gove after he sabotaged his campaign for the Conservative leadership in 2016. “Boris never fully forgave Michael Gove for betraying him in 2016. The question was more how Michael ended up with such a senior cabinet position. It is a credit to him that he got so much, given what had happened before.”

Mr Raab’s role deputising for Mr Johnson caps a remarkable ascent. The father of two, 46, who is married to a Brazilian marketing executive called Erika, has just one year of cabinet experience behind him.

A former lawyer, he was an adviser to David Davis while the Conservatives were in opposition before becoming an MP himself in 2010. He holds a black belt in karate and is a former member of the British squad for the martial art.

Mr Raab has said that karate helped him cope with the premature death of his father, Peter, who fled to Britain from Czechoslovakia at the age of six to escape the Nazis. Mr Raab was only 12 when his father died of cancer.

“Sport helped restore my confidence, and that hugely benefited my attitude to school and life,” he said last year. “There were strong role models, camaraderie and an ethos of respect. I take the discipline and focus I learnt from sport into my professional life.”

One political aide who has worked with him said that his background had shaped his politics. “On the one hand he is a typical bright suburban grammar school kid. But he doesn’t come from a background of loads of money, and graft means a lot to him.”

Within Westminster, however, Mr Raab has developed a reputation for being cold or even abrupt. Unlike Mr Johnson and Mr Gove, he is not particularly “clubbable” and is seen as a hard taskmaster.

A former diary secretary was secretly recorded by a newspaper in 2018 saying that Mr Raab was “difficult” to work for, “dismissive of women” and demanded exactly the same lunch every day from Pret a Manger.

“He needs loosening up. He’s very uptight,” she told the Mirror. “He has the same baguette with the same smoothie with a pot of fruit everyday. It’s the Dom Raab Special.”

Another former staff member said that the characterisation was unfair. “I’ve never thought of him as cold and in private away from the office he is a totally different person,” they said. “If he is going to a meeting he expects everyone to . . . know what they are talking about. If it’s clear that they don’t he’s not afraid to cancel the meeting and say let’s do this again when we know what’s going on. Some people take that as cold, but it’s not.”

His new position is likely to lead to tensions with other senior ministers, and Mr Gove in particular.

Early in his career Mr Raab was seen as politically close to Mr Gove, now the minister for the Cabinet Office, for whom he worked as a junior minister in the justice department during David Cameron’s premiership.

They were on the same side in the Vote Leave referendum, and in its aftermath Mr Raab switched his support in the 2016 Tory leadership race to Mr Gove after Mr Johnson dropped out.

But relations between the two were damaged in the campaign last year to replace Theresa May when Mr Gove suspected that one of Mr Raab’s aides had leaked details of his cocaine “confession”, which derailed his campaign.

“It would be fair to say that they are no longer the best of friends,” said one senior Tory who knows them both. “But I think they both know they need to work together.”

Ministers are preparing to issue a rallying cry to British industry to build a home antibody test that would help exit the lockdown, The Times has learnt.

Biotech companies will be asked to work together to produce a finger-prick testing kit accurate enough to be sent to millions of homes in an echo of the effort by manufacturing companies to build more ventilators.

Chris Smyth, Whitehall Editor | Alex Ralph, Business Correspondent www.thetimes.co.uk 

Antibody tests that identify people who have recovered from coronavirus are regarded as a key long-term route out of the restrictions. The Times revealed this week that none of the products ordered and evaluated by the government had proven good enough to use in mass testing.

As part of a “national effort”, Matt Hancock, the health secretary, is expected to ask companies to work with government scientists to improve the performance of antibody tests to create an effective British product.

While the UK bought off-the-shelf tests from China and elsewhere, the government would prefer to work with scientists to create a home-grown test. Countries around the world are encouraging their biotech industries to give priority to domestic needs, and ministers believe that the same approach makes sense for Britain.

A government source said: “We have some of the finest scientific minds in the world working in different areas and we want to bring people together to deliver these tests.”

Chris Whitty, the chief medical officer for England, made the first official acknowledgement yesterday that Britain’s inability to increase the scale of the antigen test, which identifies people showing symptoms, had cost lives.

Asked why deaths were rising more slowly in Germany than in other European countries, he told a Downing Street press conference: “We all know that Germany got ahead in terms of its ability to do testing for the virus. There’s a lot to learn from that and we’ve been trying to learn the lessons.”

Mr Hancock has promised 100,000 daily tests by the end of the month so that all NHS staff who are self-isolating can be checked for the virus. On Monday, 14,006 tests were carried out and Dominic Raab, the foreign secretary, who is deputising for Boris Johnson, appeared to distance himself from the commitment yesterday. “The health secretary is very clear on the target,” he said, adding there was “clearly more work to do”.

Industry has welcomed the plan to develop an antibody test, saying that a national focus also makes sense at a time when global supply chains are so disrupted. John Newton, the national testing co-ordinator, said that government scientists were aiming to work with British companies who were working on such products to come up with one that was accurate.

“There are encouraging signs that in the UK our scientists are able to identify antigens and antibodies, which could be the basis of an excellent test,” he said.

“There are testing manufacturers who we think could help with this, which of course would be great if we could have a home-produced test.”

Public Health England has developed a lab-based antibody test that is being used in a research programme at Porton Down, but the ultimate goal is a finger-prick test that could be sent through the post in bulk and give people results in minutes.

Even products that appear about 95 per cent accurate are not considered good enough to send to millions of people because of the risk that large numbers would be wrongly told that they were immune.

Mr Hancock will use a call with industry today to ask for ideas on new ways of testing that can get to 10,000 people a day within two months. Britain’s two biggest pharmaceutical groups are working with Cambridge University to help to accelerate testing.

Glaxosmithkline and Astrazeneca plan to set up a new facility within the university’s Anne McLaren laboratory that it hopes will provide 30,000 antigen tests a day. However, it will only be fully operational by early next month, when it is looking to produce tests in their low thousands.

The lab will also explore the use of alternative chemical reagents for test kits to help to overcome the present supply shortages.

The UK government’s chief medical officer has conceded that Germany “got ahead” in testing people for Covid-19 and said the UK needed to learn from that.

Ministers have been challenged repeatedly during the pandemic over their failure to increase testing quickly enough, prompting the health secretary, Matt Hancock, to promise to deliver 100,000 tests a day by the end of April.

Heather Stewart  www.theguardian.com

Asked about the differences with Germany, where the number of deaths appears to be increasing less rapidly than in the UK, Prof Chris Whitty told the daily government press briefing on Tuesday: “We all know that Germany got ahead in terms of its ability to do testing for the virus, and there’s a lot to learn from that.” Germany is already able to test 500,000 patients a week and is under pressure to increase this further.

Whitty had interjected after the government’s chief scientific adviser, Sir Patrick Vallance, gave a more circumspect reply, saying: “The German curve looks as though it’s lower at the moment, and that is important, and I don’t have a clear answer to exactly what is the reason for that.”

Vallance added that when comparing the experiences of two countries in tackling the virus, it was important to look at the differences between their societies. “There are things to do with demographics, there are things to do with the way systems are organised, and of course there may be differences in the way certain responses have been taken. And we don’t know, but we are in regular contact,” he said.

The two experts were speaking at Tuesday’s Downing Street briefing. Whitty has been absent from the frontline for several days after developing coronavirus symptoms.

His answer appeared to contradict ministers’ insistence that they had done everything they could to speed up the number of checks taking place.

Widespread testing is regarded by many experts as a precondition for lifting the UK lockdown, which Vallance said on Tuesday appeared to be helping to control the spread of the disease.

The former health secretary Jeremy Hunt has repeatedly challenged his successor over whether the government is testing widely enough; and the shadow health secretary, Jon Ashworth, has also pressed the issue, despite being generally supportive of the government’s approach.

There has been particular concern about the lack of availability of tests for NHS staff. Announcing the latest figures on Tuesday, the foreign secretary, Dominic Raab, said a total of 213,181 people had now been tested for Covid-19, of whom 55,242 had tested positive.

Hancock conceded last week that the UK was having to build up a diagnostics industry almost from scratch, and highlighted what he called the “five pillars” of the government’s approach.

These included the creation of new “super-labs” and the involvement of private labs around the country. He admitted that the government had “a huge amount of work to do”.

The government took a decision when it announced the shift from “containing” the virus to “suppressing” it, saying it would no longer seek to isolate individual cases but instead would only test hospital patients.

The 100,000-a-day target has been thrown into doubt in recent days by the fact that several potential antibody tests – to determine whether people have contracted the virus in the past – have so far failed to prove effective.

The government ordered 17.5m such tests from several manufacturers in the hope they would prove to be what Boris Johnson called a “game changer” – but Hancock said on Sunday they were not yet good enough to use, and experts said a successful test could be a month away.

Hancock had previously suggested the government was looking at the idea of so-called immunity passports that could allow people proven to have had the virus to return to a more normal life sooner than others.

Whitty was also asked about the risks of the disease to residents in nursing homes and care homes, and he said they were likely to face some of the biggest challenges in the weeks ahead, and he would expect the death rate in such homes to rise.

“…antibody tests – even if they lack some sensitivity – can be used to estimate what proportion of the population has already been exposed to the virus. This is really helpful in telling us whether there is likely to be widespread immunity in the population and thus how likely there is to be a second wave of infections (and how big that wave might be), once the social-distancing measures are relaxed. These tests would be carried out in a laboratory and could be scaled up very easily…..”

“Public Health England’s laboratories at Porton Down are reportedly making very good progress with this population-level testing, raising hopes that useful data may be available soon.”

Eleanor Riley is professor of immunology and infectious disease at the School of Biological Sciences at the University of Edinburgh www.theguardian.com

How do we return to some semblance of normality without risking a second wave of severe disease and death? Two weeks after lockdown began, discussions are moving towards the prospect of an exit strategy. There is no rule book for this – it has never been done before in modern times – but some are pinning their hopes on large-scale testing to enable this. Is this realistic, and if so how will it work?

There are two basic types of test: tests for the virus itself (swab tests that look for current infection) and tests for antibodies to the virus (blood tests that indicate prior infection). In the past few weeks in the UK we have carried out swab tests on people who are ill enough to be admitted to hospital. Yet many less severe cases of coronavirus are going undiagnosed, so we don’t really know how many people have been infected. We also don’t know if these people are immune to reinfection, or for how long.

Countries such as South Korea have used the swab test to identify all cases (not just the severe cases that are admitted to hospital) and then traced and isolated all the people they have been in contact with. This approach relies on a very large capacity for running swab tests, and a population ready to present for testing as soon as symptoms occur, and adhere to strict observation of self-isolation rules. Scaling up swab-testing in the UK has been problematic and although it will undoubtedly improve as the infrastructure gets better, and new and faster tests are introduced, waiting until we have the capacity to test and contact-trace all suspected cases may mean many more weeks of lockdown.

Antibody tests can be used to find out whether someone who had symptoms but was not swab-tested at the time did indeed have the virus, or whether their symptoms were due to something else. These tests are best done three or four weeks after the initial onset of symptoms, when the majority of people will have developed detectable antibodies. The tests can be carried out in designated laboratories or provided as simple kits for self-testing. The government has discussed the purchase and validation of self-testing kits, and floated the idea that a positive antibody test might lead to the issuing of some kind of immunity certificate. However, we don’t yet have a reliable test and we won’t know for some time whether antibodies predict immunity to reinfection, or for how long.

There seem to be two problems with the self-testing kits. The first is lack of specificity: people who have not been infected with the virus giving a false positive result (most likely due to having antibodies to closely related coronaviruses, but not the one that causes Covid-19). The other is people who have been infected giving a false negative result (possibly because they have very low levels of antibodies, as seems to be the case with people who have had very mild symptoms). Both are obviously problematic and would mean that individuals could not rely on the test to inform their own personal risk or behaviour. Whether highly sensitive and specific self-testing kits will be available in time to inform our exit strategy is unknown.

Perhaps more usefully, antibody tests – even if they lack some sensitivity – can be used to estimate what proportion of the population has already been exposed to the virus. This is really helpful in telling us whether there is likely to be widespread immunity in the population and thus how likely there is to be a second wave of infections (and how big that wave might be), once the social-distancing measures are relaxed. These tests would be carried out in a laboratory and could be scaled up very easily. In this case, as long as the test is highly specific for the Covid-19 virus and we know roughly what proportion of true positives it detects (does it miss half, one in five, one in 10?), we can use the data to model how widely the infection is likely to have spread.

If population-level antibody testing suggests that, say, half of the population has already been infected, relaxing of the social distancing rules is less likely to lead to a second wave of serious infections than if only one in 100 has been infected. Public Health England’s laboratories at Porton Down are reportedly making very good progress with this population-level testing, raising hopes that useful data may be available soon.

In the meantime – given the current absence of population-level antibody data or nationwide test-and-trace capability – a combination of a gradual relaxing of the lockdown, monitoring the impact of this on hospital admissions and continued shielding of the most vulnerable may be our best bet.

Doctors have found tentative evidence that seriously ill coronavirus patients can benefit from infusions of blood plasma collected from people who have recovered from the disease.

Ian Sample, science editor  www.theguardian.com

Two teams of medics working at separate hospitals in China gave antibody-rich plasma to 15 severely ill patients and recorded striking improvements in many of them.

In one pilot study, doctors in Wuhan gave “convalescent plasma” to 10 severely ill patients and found that virus levels in their bodies dropped rapidly. Within three days, the doctors saw improvements in the patients’ symptoms, ranging from shortness of breath and chest pains to fever and coughs.

Xiaoming Yang, from the National Engineering Technology Research Center for Combined Vaccines in Wuhan, described the treatment as a “promising rescue option” for severely ill patients, but cautioned that a larger randomised trial was needed to confirm the findings. Details of the pilot study are reported in Proceedings of the National Academy of Sciences.

Another team of doctors led by Lei Liu, from Shenzhen Third People’s hospital, gave convalescent plasma to five critically ill patients. All showed improved symptoms after the infusions and within 10 days, three patients were able to come off the ventilators that had been keeping them alive, according to a preliminary report in the Journal of the American Medical Association.

The findings raise hopes that donated blood from recently recovered patients could be used to boost the immune systems of more vulnerable people and help them fight the infection. But with only a small number of patients so far treated with plasma, and the infusions given outside of formal trials, it is impossible to know how much benefit the treatment really brings.

Convalescent plasma treatments date back to before the 1918 Spanish flu pandemic. The therapy relies on the fact that people who have recovered from a viral infection have antibodies in their blood that can rapidly detect and destroy the virus the next time it attacks. Infusing the plasma into patients, and potentially into people at risk of being infected, can boost their immune systems and potentially provide protection.

Hints that the therapy may help have prompted US doctors to trial infusions in the outbreak in New York and similar studies are expected to start in the UK in the coming weeks. Britain’s national blood service has begun screening blood from patients to find plasma rich in antibodies to use in those trials.

Professor David Tappin, a senior research fellow at the University of Glasgow, has applied to the UK’s National Institute for Health Research to run two clinical trials with convalescent plasma. They will look for evidence that plasma can protect frontline workers from infection, prevent patients from deteriorating and needing ventilation in intensive care units, and improve the condition of those who are already severely ill.

Tappin said the cases reported from Wuhan were important because they suggested that giving plasma to severely ill patients appeared to be safe. “The outcomes are also encouraging for these patients,” he said. But he added that to be sure plasma improved on the natural course of the disease, and that it was safe in larger groups of patients, formal trials had to take place.

Professor Munir Pirmohamed, the president of the British Pharmacological Society, echoed the need to be cautious about the Wuhan cases. “This was not a randomised trial and all patients also received other treatments including antivirals such as remdesivir, which are currently in trials for Covid-19,” he said.

“It is also important to remember that there are potential safety concerns with convalescent plasma, including transmission of other agents and antibody enhancement of disease,” he added. “Even if shown to work, scalability to treat large numbers of patients may become an issue.”

When Devon and Cornwall Police declared a “major incident” in response to the coronavirus epidemic on 20 March, Owl dared to ask the questions, locally, who is in charge, who takes control? There appears to be no clear answer. The official line is: No single responding agency has command authority over any other agencies‘ personnel or assets. Where multi-agency co-ordinating groups are established to define strategy and objectives, it is expected that all involved responder agencies will work in a directed and co-ordinated fashion in pursuit of those objectives.

Today Owl reports that Devon and Cornwall Police have advised EDDC on the need to close some car parks. Our proto-devolution body Heart of the South West (HotSW) covers Devon and Somerset (and has remained silent, apart from fret about the economic impact). The geographic county is administered by two autonomous unitary authorities: Plymouth and Torbay; and Devon County Council – so no single voice. How the NHS, Quality Care Commission and Public Health England are organised hierarchically in Devon is a bit of a mystery to Owl. Perhaps the most coordinated action has come from the local MPs when they backed the “please come back later” campaign, but it was far from unanimous. 

This article discusses the issue at National level.

With Boris Johnson in hospital, government is adrift 

• Simon Jenkins is a Guardian columnist www.theguardian.com

Boris Johnson is ill and in hospital. That must be wretched for him and his family. We can only wish him well and a speedy recovery. His infection by Covid-19 indicates the extraordinary contagiousness of this disease and possibly its widespread prevalence. Of the first there is now no doubt. Of the second, without testing, there is no clue.

That a prime minister is ill is a serious matter. Yesterday the Queen performed her duty as the nation’s figurehead with remarkable assurance. In clear, undramatic language, she spoke free of cliche and with sincerity. Her few words of hope shone through the darkening forest of the media coverage of these events. It was the first time I smiled at the television in a month.

A prime minister too is a figurehead, but has a harder task. Johnson is the nation’s elected leader at a time of crisis, with millions reliant on his decisiveness, judgment and public demeanour. At least one cabinet minister maintains that these qualities can be deployed from his hospital bed. Sometime soon, that idea will become absurd. It presents the government machine as a driverless car which, in the style of Yes Minister, will perform equally well, if not better, with no politician at the wheel. Leave the experts and “the science” to get on with it, and all will be well.

Rumours abound that since the start of the coronavirus outbreak, this machine has been ramshackle. The nation’s health services, so proudly championed for so long, were unprepared both centrally and locally. This was despite trial runs and forewarning. It does not matter who was to blame. The system malfunctioned. Then in mid-stream the cabinet reversed its policy from mitigation to suppression. Ministers ran in and out of Downing Street press conferences, making pledges, setting targets and micro-managing social distancing. Little of what they said carried full conviction.

Suddenly, leadership mattered. Who was in charge? Johnson’s initial glib Churchill imitations (the Queen wisely chose Vera Lynn) had to change, and they did. As Johnson fell ill, news conferences were conducted by the dull, steady Dominic Raab or the flashy, impetuous Matt Hancock. Experts came and went, spurring debate as to what side they were on.

Government lurched into lecture mode. It began telling people not to work, how to shop, and where and with whom to walk. These are not the normal actions of government in a free society. They are painful and massively intrusive on daily life. They are also being taken by ministers and officials amid extremes of risk and uncertainty. The instinct under pressure was not to welcome argument or accountability. It was to demand obedience.

That is not enough. At the very least the use of such powers requires the most explicit public leadership. Bluntly, they need the qualities of communication for which Johnson was supposedly elected. They also need ready scrutiny and challenge, which is currently being supplied only by the media. Parliament has abandoned what should be its primary role: holding executive decision to account. The new Labour leader, Sir Keir Starmer, was therefore right to refuse Johnson automatic support.

The cabinet cannot operate with half its members in varying degrees of isolation. The wonders of Skype and Zoom cannot replicate the cut and thrust, the body language, the public and private exchanges of a truly deliberative forum. There has to be a conductor knowing when and how to bring the instruments of government into play. There has to be a boss.

Past experience of sick leaders is not happy. Churchill’s doctor, Lord Moran, and his wartime aide, Lord Alanbrooke, related the impact his clinical depressions had on war cabinet morale. The same message came through the 2008 study of sickness in power by the former foreign secretary, David Owen. He traced the hubristic impact that power can have on those who wield it, not least a refusal to believe they might be ill.

Democracies vote for leaders, not anarchists. Every leader’s style is different. Attlee could hardly have been less like Churchill, Heath less like Thatcher, Brown less like Blair. All depended on their close relations in Downing Street with advisers and cabinet colleagues – and suffered when these broke down. Johnson decided from the start that he would not harbour critics in Downing Street, preferring the second rate to the second thought. He made his own indispensability a feature of his rule. In normal times, that is unwise. In a crisis it is stupid.

Britain’s present predicament is yielding lessons aplenty. One is that the formal machinery of government matters. Johnson’s response to coronavirus has been to nationalise, standardise, command and control everything. In his lockdown, one rule must fit all. Such is Britain’s centralist constitution. But if so, it must depend on one thing: efficient and accountable leadership. At present the prime minister is clearly unfit. A public and functioning alternative must surely be in place.

Two examples from Devon and Dorset:

Exeter hotel opens its doors for former patients and NHS staff

Anita Merritt  www.devonlive.com 

An Exeter hotel which closed this week due to the coronavirus lockdown is being converted to accommodate hospital patients who are awaiting care home placements, as well as new frontline staff.

Hampton by Hilton, which is located by Exeter Airport, closed on Tuesday following latest government advice to reduce the spread of Covid-19.

On Friday, it announced on its Facebook page that the hotel was getting ready to support the NHS and Devon County Council.

Today the council has confirmed the hotel is being utilised to help ease the pressure on local hospitals and care homes who are attempting to cope with an increase in demand on its services, while also trying to recruit frontline staff.

A spokesperson for Devon County Council said: “We are currently working on a number of potential options around Devon for creating additional residential care facilities for those with health and care needs being discharged from hospital in case existing care home capacity becomes insufficient.

“We are also planning to accommodate extra staff currently being recruited and redeployed into frontline health and care roles. More information on these arrangements will be given in due course.”

On its Facebook page the hotel said on Friday: “The team are now busy getting the hotel set up in support of the #nhs#repurposed#supportingthenhs#Exeter#Devon#SouthWest ❤️ #staysafe#stayathome#staystrong.”

Yesterday the hotel reported the moving of specialist beds into the hotel has begun.

It has not been confirmed when the hotel will open in its new capacity. [29 March]

Hotel opens as ‘social care’ hospital for non-coronavirus patients – helping NHS in Covid-19 battle

www.dorsetecho.co.uk

A Weymouth hotel which has been turned into a hospital unit has started receiving its first patients yesterday. [6 April]

As part of the efforts to help people get out of hospital when they are fit to do so, a new model is being launched in Dorset with the Best Western Hotel Rembrandt on Dorchester Road ‘repurposed’.

It will offer 31 beds for people who are leaving hospital for reasons not related to coronavirus.

It will be used as a social care base for people who can’t go directly back to their own homes when they are medically fit to leave hospital and are waiting for a social care help and support package to be put in place.

It offers more capacity to the health and care system across the area, keeping hospital beds available to support people with coronavirus.

As the hotel-based care offer is not an extension of a hospital stay for medical reasons, it’s not appropriate to use other hospital settings, such as community hospitals, Dorset Council says.

It is being staffed by Abi Live-In Care and a call system, has been installed to assist people at the facility throughout the day and night. Mobile phones and tablets have also been provided to help people keep in touch with friends and loved ones.

Cllr Laura Miller, Portfolio Holder for adult social care and health at Dorset Council said: “This a great success, showing the dedication of partners across the system to get this set up in just a few days. We’re hearing nationally about the shortage of hospital beds, and we want to be ahead of the curve by providing alternative solutions for people who are medically fit to leave.

“We can then make sure that the most critically ill people have access to the right help and support in hospitals at the right time.

“We also know that care and support in people’s homes is becoming increasingly difficult to find, so this hotel-based care provision will make sure anyone who can leave hospital can do so in a safe way, while we work with them to get the support they’ll need to return home.”

Admissions to the Hotel Rembrandt will be built up gradually over the coming days. Dorset Council and Abi Live-In Care staff will monitor the progress carefully and will build a better picture of the situation throughout the week.

The Grange Hotel at Oborne near Sherborne will be the second base to open offering support for people in the north of the county. They will be taking admissions from Monday, April 13.

District council bosses have shut a pair of Exmouth car parks – and another in Seaton – during the coronavirus pandemic on the advice of police. 

East Devon Reporter  eastdevonnews.co.uk

East Devon authority chiefs say the move has been made to ‘reinforce’ the Government’s social distancing advice to stop people driving to beaches and beauty spots.

They have closed the Maer Road and Foxholes sites in Exmouth and Seaton’s Jurassic long-stay facility.

This action has been taken to reinforce the clearly-stated government advice on social distancing, staying at home and not driving to beaches and beauty spots…

An East Devon District Council spokesperson said it had made the decision ‘on the advice of police’.

They added: “This action has been taken to reinforce the clearly-stated government advice on social distancing, staying at home and not driving to beaches and beauty spots.

“All other car parks currently remain open but are under review.”

Owl wishes Boris Johnson a full and speedy recovery. This is an anxious time for his family and for the Nation. 

The Prime Minister’s case highlights the need for everyone self-isolating with coronavirus symptoms to seek medical advice if their symptoms persist. This advice has not been as clear as it could have been, as this article explains.

Kate Connolly  www.theguardian.com 

Concerns are being raised that people isolating at home with worsening Covid-19 symptoms may not call for medical help early enough when they enter the second, more severe, phase of the virus, possibly reducing their chances of survival.

The NHS does not have a proper monitoring system for those suspected of having coronavirus, said Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter medical school.

“If a patient is developing pneumonia, it can get progressively worse very quickly and hence early admission upon the first signs of difficulty with breathing are very important,” he said.

“It is important for people recovering at home that there be a monitoring system in place too. Something that we have thus far not introduced.”

There is a danger that people will arrive in hospital only when their symptoms are very severe, with more of a risk that they will end up in critical care and possibly die, he said.

The early symptoms of mild disease are a persistent dry cough, a raised temperature and shortness of breath. The advice to anyone with those symptoms is to self-isolate at home. They are not told to inform the health service.

Most people recover within a week, but if their symptoms worsen or they still have a high temperature at the end of that time, the instruction is to fill in a form on the NHS 111 coronavirus website if they can – and to call NHS 111 only if they cannot do that. Depending on their answers, they may get a visit from a doctor or be admitted to hospital.

Covid-19 is said to be mild to moderate in 80% of people, but can cause viral pneumonia. In the most serious cases, the immune system fighting the virus overreacts. If that happens, what is known as a cytokine storm attacks their organs. The individual will need ventilation in hospital to take over their breathing and possibly mechanical support for their heart, liver or kidneys.

People with symptoms at home will not get medical help unless they ask for it, unlike in some other countries, which have testing for people with symptoms and monitoring for them while at home.

Health authorities in the southern German city of Heidelberg have introduced a “corona taxi” service, which allows medical personnel to visit patients with the virus at home and assess their progress. This was introduced after virologists and other doctors recognised that it often comes in two waves and that typically on the eighth day, patients’ health can take a turn for the worse.

Patients with confirmed infections or suspected to have coronavirus are being called on a regular basis by student doctors manning phone lines, and based on their accounts, a taxi crew can then arrange to visit them.

Four of the taxis – small buses usually used for school runs – are constantly travelling around the city visiting patients.

“These daily phone calls and house visits would totally overwhelm the doctors here,” said Uta Merle, a medical director for gastroenterology and infections at Heidelberg University hospital, which is why medical students are being drafted in. Eight hundred have so far volunteered.

Hans-Georg Kräusslich, the head of virology at the hospital, told Frankfurter Allgemeine Zeitung the visits are necessary because “often patients don’t have the courage to ring up the clinic and don’t actually take their worsening state seriously”.

Thanks to the taxis, he said, “our colleagues have discovered quite a few patients who they were able to protect from a drastic worsening of their conditions”.

Many have been brought into hospital and put on ventilators as a result. That crucial move made just in time is believed to have saved many lives in Germany. The taxi crews have received letters of thanks from patients, crediting them with saving their lives.

Pankhania said people in the UK are no longer going to hospital for conditions other than Covid-19 in the sort of numbers that would be expected. “For whatever reason, we have frightened off the patient. Those things we should be seeing are not turning up. These people are soldiering on,” he said.

He has himself heard of cases where people were very sick with symptoms resembling those of Covid-19, but did not seek medical help and died at home.

He said it was possible that some people were put off from calling NHS 111 when their symptoms worsened or if they still had a fever after a week – which are the first clues that their condition may be becoming severe.

He also does not think it is satisfactory for people with symptoms not to be tested. “I don’t think that is good enough,” he said. “I used to be a GP. I would want to know who my patients with Covid-19 were. I would call them and ask them how they were. Unfortunately, that doesn’t happen. The GP may or may not be aware of the patient.”

The Office for National Statistics has recently begun to include deaths from Covid-19 in the community, including care homes. They show the total was more than 20% higher than the figure for hospital deaths alone.

A senior Devon councillor has called for urgent action to be taken to stop visitors coming to the county after reporting that pharmacies are telling him many prescriptions are for people whose address is outside of the area.

Daniel Clark  www.devonlive.com

Cllr Frank Biederman, leader of the Independent Group on Devon County Council, said that while clear messages regarding not wanting visitors to come to the region at this time have been put out, far too many people are ignoring the advice and not staying at their primary address.

Last week, councillors from some of Devon’s local authorities joined the call by Cornwall Council for people not to visit Devon and Cornwall this Easter.

But Cllr Biederman said that already in his area of the county, around Fremington in North Devon, visitors have arrived and it has led to terrible trouble for residents getting prescriptions, saying that it is partly because many prescriptions are for people whose address is outside of the area and they are staying at second homes or holiday cottages.

North Devon MP Selaine Saxby added that she is aware of reports of people coming in after dark cross country and avoiding any roadblocks on the A361.

In an open letter, Cllr Biederman said: “I believe we need to do more to STOP this now, surely given the rules these people should be sent back, once we are aware that they are here. I see a situation arising, where a local will not get a critical care bed, because a visitor ignoring the rules, has got it first.”

He has asked that at Wednesday’s Devon County Council cabinet meeting, which will be held via videolink, he can ask an urgent question about what Devon County Council are doing to stop visitors and how are they working with Partners to stop them?

Cllr Biederman added: “I know the Government, Devon County Council and North Devon Council have been putting out clear messages, regards visitors not coming to North Devon at this time but very much welcoming them in the future.

“I am disappointed, that far too many are ignoring this advice and they are also clearly ignoring the rules set out by government, to stay at their primary address.

“I am helping to co-ordinate the community effort in my ward, we have terrible trouble getting prescriptions for residents, they can’t get through on the phone, so end up ignoring advice and join the queue, to stand for a couple of hours only to discover that their prescription is not ready.

“Virtually every call I am getting, is regards prescriptions and not being able to get through to the chemist, which is causing great anxiety in the community.

“Having spoken to several staff I know that work in pharmacies, they tell me many prescriptions are for people whose address is outside of the area and they are staying at second homes, holiday cottages etc. This is putting extra burden and delay on the pharmacy & ultimately causing delay to our most vulnerable residents.

“My local shop has said the same, so many of his regular holiday home visitors have appeared, they feel it is safer to be here in Devon.

“Given that we are two weeks behind London, the above is likely to ultimately have severe consequences on our hospital.

“I believe we need to do more to STOP this now, surely given the rules these people should be sent back, once we are aware that they are here. Emergency legislation could force Pharmacies, Surgeries & Acute Hospitals to report these incidents to the Local Authority, huge fines administered and they are told to return to their own home.

“I also believe we need permanent checks on the main roads into the area, turning people around, if they are not from the area.

“I see a situation arising, where a local will not get a critical care bed, because a visitor ignoring the rules, has got it first.

“Let’s get a joined up approach to this, it’s simple you stay at your Home Address …. No excuses. I do appreciate all everyone is doing, but I believe this one issue, is going to cost lives here in North Devon and we need to get tougher on it from Central Government Down.”

Last week, councillors from some of Devon’s local authorities joined the call by Cornwall Council for people not to visit Devon and Cornwall this Easter.

All authorities in Devon recognise the importance of the tourism sector for Devon but they are urging people to stay at home, stay safe and wait until COVID-19 restrictions are lifted before paying a visit to the county.

“I could never have imagined as a tourist board leader; I would not only be assisting in the closing down of all holiday accommodation and having to make public pronouncements telling people not to come and even more recently stating don’t come.

“Neither could I have ever imagined the current situation; the word pandemic I associated with  science fiction. There has been health crisis before, Spanish flu occurred at the turn of the last century.  As a society we have become complacent plagues were in the past and were such a thing to happen again it would be dealt with and controlled.  As one of the richest countries in the world, we have been part of process to conquer threats such as SARS and Ebola.  

“In the far South-West it still sometimes doesn’t feel real.  I wake up every morning and the world seems no different; the enemy and threat cannot be seen.  Watching the news from other countries it looks like an episode from a TV Sci-fi programme. I recall my mother telling me of how it felt at the start of the second world war in the phony war period, when nothing seemed to change for a while.

“That said, I am pleased the vast majority of us are abiding by the rules and along with many others, I say a big thank you from myself and everyone else in your community.  But, to the small minority who think going for a trip out, or even worse, those who are thinking or planning to come down to Cornwall and Devon for a few days I have to shout out DO NOT COME – HOW DARE YOU PUT YOURSELF BEFORE THE  LIVES OF OTHERS.  

“This crisis has and will cost lives and will cost far more if people keep breaking the rules.  It will also have a short, medium and long term economic and social impacts that we still cannot calculate, let comprehend.  If people do not abide by the rules, the virus will spread faster and the peak will be stronger; more people will die, the economy will take longer to recover.  In our region if we all work together, we could be open again in June, possibly earlier, however the cost to the region’s economy is estimated to be around £800M.  Should tourism not be operating in the peak months the cost implications jump into billions of pounds resulting undoubtedly in business failures and job losses, not only in tourism but the supply sector, business and professional services.

“I can only re-iterate, if we all abide by the rules fewer lives may be lost, less strain placed on our amazing health and key workers and may bring an earlier date when it will be safe  to reboot the tourism economy this summer; businesses and jobs will be saved and if that is not a good enough reason, then all of us will be able to enjoy the summer in this amazing part of the world.”

Cllr Rufus Gilbert, Devon County Council Cabinet Member for Economy and Skills, said: “Tourism is an important part of Devon’s economy and tourism businesses and accommodation will be suffering, just as many sectors are during this crisis. If we all take the Government advice on board, stay at home and only making essential journeys, the sooner we will get through this crisis and get Devon open for business, so that people can pay us a visit at a later date.”

Leader of South Hams District Council, Cllr Judy Pearce, added: “We really value our second home owners and the many thousands of visitors who come to see us each year. But I cannot stress strongly enough that now is not the time to visit our area. Travelling here for the Easter holiday is not ‘essential travel’.

“If you visit you will put further unnecessary pressure on the local NHS and other community support. Please listen to the Government advice, stay at home this Easter and we will see you all again soon when this is over.”

Leader of East Devon District Council, Cllr Ben Ingham, said: “We know that East Devon is a great place to visit and if we were in normal times we would welcome you with open arms. However we are not in normal times and the message is very clear – ‘Stay at home and save lives’. We won’t be thanking you if action on your part results in our residents becoming infected which could lead to deaths. Please come back when this is all over.”

Every day we get one big figure for deaths occurring in the UK. Everyone jumps on this number, taking it to be the latest toll. However NHS England figures – which currently make up the bulk of UK deaths – in fact reflect the day on which the death was reported, not the actual date of death, which is usually days, sometimes weeks, before it appears in the figures.

Good explanation of how difficult it is to know what is going on in an epidemic moving so fast through the population. – Owl

Niamh McIntyre www.theguardian.com 

New figures reveal that what we think we know about the Covid-19 death toll in the UK is wrong. Here’s why.

Every day we get one big figure for deaths occurring in the UK. Everyone jumps on this number, taking it to be the latest toll. However NHS England figures – which currently make up the bulk of UK deaths – in fact reflect the day on which the death was reported, not the actual date of death, which is usually days, sometimes weeks, before it appears in the figures.

The truth is we don’t know how many deaths have taken place the previous day. In fact the headline figure is likely to under-report the number of deaths that actually happened the previous day.

The number we hear about usually counts deaths which took place at an earlier date. The difference matters because by undercounting the number of deaths we are skewing the curve.

Prof Sheila Bird, formerly of the Medical Research Council’s biostatistics unit at Cambridge University, explains: “We’re on a rising epidemic trend, and so the death counts are currently increasing, and we’re trying to track how steeply they are increasing. If today I’m getting to know about a series of deaths that occurred in the past 10 days, then what I’m getting is not a reflection of the steepness of the curve at this moment.”

On 30 March, NHS England reported 159 deaths in the 24 hours to 5pm on Sunday 29 March. However, the actual number of people who died in that 24-hour period was revised up to 401 in Thursday’s report and again to 463 on Friday as more deaths which occurred on that date were reported. And this figure could be revised up again as more deaths come to light.

“When you’re on a rising trajectory, the reporting delay is likely to mean that you underestimate the steepness [of the curve] and so we may think that we’re doing better than we are. And when we come to the downturn in the epidemic, the slowing, and there’s a decrease in deaths, we’ll be too slow to recognise the change. Hence, we risk getting it wrong in both senses,” Bird adds.

Another complicating factor is that the Department of Health and Social Care’s daily count covers deaths in hospitals, omitting those in the community. Although the ONS this week started releasing the number of deaths including community deaths in England and Wales, there is also a time lag in this data being reported.

There are other datasets we can look at. The number of confirmed cases of the virus is a useful indicator but it relies on testing, which has not been rolled out to cover a broad enough swathe of the general population to give us a sense of how many people are possibly infected.

The number of triage calls and online assessments through the NHS are also useful to give us a sense of potential infection levels – 1.9m at the time of writing in England. But these are people with Covid-19 symptoms, not those with confirmed cases of the virus.

The most solid data we have showing the trajectory of the impact of this virus are deaths. That is why it is imperative that we have timely and reliable data – and why the seriousness of the problem is growing along with the death toll.

“It’s not uncommon that this happens in a new epidemic,” Bird says. “Reporting delays are something to be managed, not to be ashamed of. You manage them down but you don’t want to do that by making people think they will be blamed for reporting late and therefore run the risk of failing to report. That’s the worst possibility.”

None of the antibody tests ordered by the government is good enough to use, the new testing chief has admitted.

Owl believes that science is essential in finding a way out of the crisis and will succeed. But the Government needs to take care with expectation management. It wasn’t very long ago we were told we would be able to stock up on these test kits from Amazon, within weeks. 

Chris Smyth, Whitehall Editor | Dominic Kennedy, Investigations Editor | Billy Kenber, Investigations Reporter www.thetimes.co.uk 

John Newton said that tests ordered from China were able to identify immunity accurately only in people who had been severely ill and that Britain was no longer hoping to buy millions of kits off the shelf.

Instead government scientists hope to work with companies to improve the performance of antibody tests. Professor Newton said he was “optimistic” that one would come good in months.

However, Dame Deirdre Hine, the public health expert who chaired an official review that criticised failures of modelling in the 2009 swine flu pandemic, said that it was “difficult to understand” why the government had not planned for more testing.

The scientist tasked with evaluating the antibody tests for the government said that it would be at least a month until one was good enough to offer to millions of people.

Sir John Bell, regius professor of medicine at the University of Oxford, wrote: “Sadly, the tests we have looked at to date have not performed well. We see many false negatives (tests where no antibody is detected despite the fact we know it is there) and we also see false positives.

“None of the tests we have validated would meet the criteria for a good test as agreed with the MHRA [Medicines and Healthcare products Regulatory Agency]. This is not a good result for test suppliers or for us.”

Sir John acknowledged that “large-scale testing is therefore a strategy which will be crucial for getting us back to our normal lives in the coming months”. He wrote: “The government will be working with suppliers both new and old to try and deliver this result so we can scale up antibody testing for the British public. This will take at least a month.”

Professor Newton, of Public Health England, was appointed to oversee testing last week as Matt Hancock, the health secretary, responded to criticism of the failure to increase checks quickly enough by promising to use private labs and hit 100,000 daily tests this month.

Professor Newton said that his priority was three “mega labs” for testing NHS staff and that he did not expect university and commercial labs to be much help in hitting the target.

“That’s a very clear message: we are not relying on lots of people coming forward to help us to achieve what’s required and we shouldn’t get too distracted by that,” he said. “There’s a big, big ask at the moment which is quite specific [on testing NHS staff]. So a lot of these companies who are offering their capacity may not be directly related to that ask and therefore they might not be as helpful at the moment.”

The antigen test to see who has the virus will be crucial in allowing NHS staff back to work if they do not have the virus, and a separate test that tells who has recovered from infection is seen as crucial to ending the lockdown.

The government has ordered millions of antibody tests but yesterday Mr Hancock said that “we still don’t have any that are good enough”.

Professor Newton said that all of the tests failed evaluations and “are not good enough to be worth rolling out in very large scale”.

Some of the tests have not been total failures, but Professor Newton said: “The test developed in China was validated against patients who were severely ill with a very large viral load, generating a large amount of antibodies . . . whereas we want to use the test in the context of a wider range of levels of infection including people who are quite mildly infected. So for our purposes, we need a test that performs better than some of these other tests.”

The government is still looking for commercial tests but it has accepted that rollout is months away.

Previously officials had spoken of sending millions of home test kits in days, but Professor Newton said “the idea that we might have it in days was based on the fact that we might just buy the existing test, and at the moment the judgment is that that wouldn’t be the best thing to do. It would be better to try and improve the test”.

He added: “The scientists in Oxford who have been evaluating them are working with manufacturers to say, ‘We’ve tested your test, and it doesn’t seem to perform quite well enough, but we think we can work with you to improve it.’ So it is a little bit uncertain but there are commercial partners able to work with us. I’m optimistic.”

Dame Deirdre, who chaired the official review into the swine flu, said: “I am finding it difficult to understand why both the antigen testing and the antibody testing is taking so long to get off the ground.”

In 2010 Dame Deirdre’s report said that ministers and officials had “unrealistic expectations of modelling, which could not be reliable in the early phases when there was insufficient data. Once better data was available, modelling became extremely accurate.”

She said: “I think that if there is anything perhaps where the response could have been better this time it is on the whole question of testing.”

The government also risks losing an opportunity to buy 400,000 tests a week from South Korean manufacturers, because of officials’ failure to respond to the offer, it has been claimed. Ten days ago a British businessman approached health officials after a Korean investor who has connections with LG helped to persuade five manufacturers to sell their diagnostic tests to the UK. Steve Whatley, who runs a financial technology business, said: “We just need a letter saying, ‘Subject to the tests being proven, then the UK will take x amounts of kits per week for x long.’ ”

At-risk doctors kept waiting

Less than a third of doctors with symptoms of Covid-19 are able to get tested for the disease, according to a survey by the Royal College of Physicians (Kat Lay writes).

It also found that one in five did not have access to the personal protective equipment they need to safely treat coronavirus patients.

Andrew Goddard, the RCP president, said the findings of the survey of 2,513 respondents, were “a stark indication of the incredibly difficult situation facing our members working in the NHS”.

Matt Hancock told Sky News yesterday that 8 per cent of NHS frontline staff were self-isolating and off work. However, the RCP’s survey suggested the figure could be as high as 14 per cent.

Many of those off work are thought to be in isolation because of a member of their household with symptoms. The poll found almost nine out of ten doctors could not access Covid-19 testing for someone in those circumstances.

Professor Goddard added: “The government’s current strategy to deliver testing that would support NHS staff to return to the workforce as quickly as possible clearly isn’t working.” He called for the government to publish its plan, timeline, and the challenges that it expected.

Another view on developing an exit strategy from a couple of economists.

(Owl doesn’t think many secrets will be given away by disclosing that Owl remembers attending the odd lecture from one of them).

Larry Elliott, economics editor, the Guardian  www.theguardian.com

Britain has been in lockdown for two weeks and it has been the grimmest of fortnights. The number of daily deaths from Covid-19 has continued to rise steadily and large chunks of the economy have been brought to a standstill.

As yet, there are few hard numbers to judge the economic impact, but the collapse seen in the past few weeks is without precedent both in its speed and its severity. The increase in the numbers applying for universal credit suggest that unemployment is rising rapidly despite the government schemes to support both the employed and the self-employed.

The aim of the Treasury and the Bank of England is to get the UK through the crisis with a minimum of scarring. Hence there are loan guarantees designed to prevent businesses that were perfectly viable a month ago from going bust as a result of the shutdown. The hope is that wage subsidies will prevent workers from losing touch with the labour market and becoming long-term unemployed.

But clearly the longer it takes to tackle the health emergency the greater the economic damage will be. A 20% drop in output in one quarter – a perfectly feasible possibility – would be bad enough, but what if the lockdown were extended into the summer or the autumn?

Mervyn King, the former governor of the Bank of England, said last week that it was unrealistic for the government to keep the lockdown in place indefinitely and that if it went on for months on end there would be a rebellion against it.

That assessment is almost certainly right. The government does need an exit strategy but it is also being warned by epidemiologists that if the restrictions are relaxed too soon the virus could return. A second lockdown would not just be hugely unpopular, it would also magnify the economic damage.

The government says any decisions it takes on ending the lockdown will be based on science, but the scientists don’t always agree. That’s because they are using models and these have limitations. Why? Because the results of epidemiological models depend on what is fed into them, and this requires the scientists to make a number of assumptions about human behaviour.

This is a point made by Gerard Lyons and Paul Ormerod in an important new paper that might just offer the government the sort of exit strategy that King was talking about.

Lyons and Ormerod do not dispute that a lockdown was necessary. Indeed, they think that the government’s initial idea that the population would develop “herd immunity” to the virus was dangerous nonsense.

The evidence from other countries is that social distancing, shutting the restaurants and bars, discouraging unnecessary travel and getting people to work from home if they can does have an impact.

Before the lockdown began, estimates suggested that on average each person with the virus infected between two and 3.5 other people. Without action, the virus would have carried on spreading, putting intolerable pressure on the NHS and killing many more people. This is known as the reproduction number: if it is above one, someone who is infected will pass it on to more than one person. If it is less than one, it will fade away. The experience of China and Italy is that lockdowns will get the reproduction number below one.

But the danger is that the reproduction number could go back up again if Britain went straight back to business as usual the moment the lockdown restrictions were lifted. If people celebrated en masse by going to the pub, to the football or by having a street party, there would be risk that the reproduction number would go up again and the virus would return. It is this possibility that concerns the epidemiologists.

Taken to extremes, this would involve continuing the lockdown until there was no longer a risk of someone with the virus infecting anyone else and so ensuring that no one dies. But as Lyons and Ormerod points out, a similar approach would involve the banning of all road traffic to prevent the nearly 2,000 deaths a year on the road in Britain.

Instead, they suggest that the return to normal life takes place under a traffic light system that will exploit the fact that people are going to be a lot more cautious in their behaviour after the crisis than they were before.

“If people revert very quickly to the patterns of behaviour before the crisis, the epidemiological models are correct. There would be a second wave of infections. But behaviour will be different, either because of the lessons people have learned during this crisis, or because of the constraints placed upon them by rules and regulations.”

The paper suggests that phase one of the process involves moving from lockdown to red. In this period, more but not all shops would open and they would have to observe the strict social distancing currently seen in supermarkets. Travel would be discouraged and many international flights banned.

In the amber phase, unlimited car journeys would be allowed, and the wearing of face masks and disposable gloves would be mandatory on public transport. Restaurants would be allowed to open only if they had strict seating demarcations to keep people at a safe distance.

It would only be when the light turned to green that any sort of sporting event or other mass gatherings, such as music festivals could take place, and the churches, temples and mosques open their doors.

Inevitably there will be those with different views about what should be included in the red, amber and green phases. But it’s worth noting that Lyons was once an adviser to Boris Johnson when he was mayor of London. The prime minister might just be listening.