I am sending this letter to Cabinet members.

Dear Colleague

It is time to review the lock down policy.

You will wish to have as your highest priority taking actions to reduce deaths from this disease. The evidence is abundant that the most at risk groups are the elderly and those with other medical conditions that makes them especially vulnerable to the severe form of the infection.

Policy should make it as easy as possible for all in the at risk groups to self isolate, to prevent infection Efforts need to be redoubled to ensure on line deliveries of food and other items to these households, and proper financial support for those in vulnerable categories who have lost jobs or income over it.

Your review takes place against the background of the good news that NHS capacity has been much increased and is well above current high levels of demand for care from CV 19 patients.

You  need to take urgent action to save the economy. None of us have ever witnessed such a sharp contraction in economic activity, with an all too rapid surge in unemployment. There will also be far too many business failures if this carries on for much longer.  You need to make sure this is the shortest lived downturn as well as the deepest.

This means a new policy of trying to get as many people and businesses as possible back to work, with sensible modifications to working arrangements to reduce risk of infection.  It should be assumed that most businesses re open, with more home working and more remote technology use.  Offices may want to have more people working from home to allow more space for each employee in the office. More business meetings should take place with remote technology even where people are in the same offices. Factories tend to use large amounts of machinery already, reducing the numbers of employees on line and usually allowing social distancing. Where they do not they may need additional automation. You could consider asking people to wear face masks when working with others.

It is urgent to start lifting restrictions. Many more people will lose their jobs if the lock down continues. Many self employed have no income from work. Many small businesses are struggling to pay their overheads with no revenue. There are limits to how much the state can substitute for the loss of income. If we go on like  this large amounts of economic capacity will be permanently lost. An advanced society needs substantial amounts of work to be undertaken so we have the output of goods and services which sustains living standards. It is time to start to get the UK back to work, whilst protecting the vulnerable and reducing the risks of catching the disease for the rest of us in sensible ways.

I write to wish you a happy Easter, despite the difficult circumstances we find ourselves in. I hope many of you can contact your friends and relatives  with suitable technology, and that you can enjoy your homes and immediate family contacts. For any who have illness in the family, I wish you   a speedy recovery.

Let me begin with some better news. On April 10th at the news conference the government showed that most recent  hospital patients  with CV19 actually fell by 2%, mainly owing to a turn down in the graph in London which still has the  most cases. Let us hope we are somewhere near the peak of numbers going into UK  hospitals. There were 20,204 in UK  hospitals with the virus on Friday ( these figures excluded Northern Ireland). There were 3335 UK wide in intensive care. These  large numbers are so far well within the stated  enhanced capacity of the NHS , though I do not doubt the big  efforts required of many  staff in the front line facilities to sustain these numbers.

For me, the daily tasks of trying to get the government to  ease problems for people financially damaged by the shut downs continues, as does the need to help the local NHS and social care providers where required.

I have stressed repeatedly to the government that their cash assistance to people and companies needs to be faster and easier to access. The initial success in getting schemes to allow workers to keep their jobs with state payment of 80% of wages , and with assistance for the self employed, was most welcome. There remain delays and gaps in provision.

The Treasury has made a few improvements and needs to make more. I have passed on frustrations with banks over access to credit lines. The Governor of the Bank of England and the Chancellor have written a joint letter to the commercial banks asking them to open the schemes and lend the money, but issues still remain.

I am  sending  in more detailed proposals for tackling the pinch points in existing financial support  and for widening access to help schemes. Directors of small businesses are not looked after, job changers can lose out, and companies placing employees into furlough are still not in receipt of any cash to help pay the wages. Ministers want to help, but it is taking time for the administrative procedures to be put into place and to operate on the scale required.

There have been issues over the supply of protective clothing for health and care workers. I have taken these up centrally as have many others  and  more is promised. Companies around the country are engaged in increasing manufacture. There is plenty of government money to buy the kit, and plenty of Ministerial will to see more delivered, but the system is stretched by the sudden and continuing surge in demands.

Many people want to see more tests done to see if people have the virus. Testing care staff who are ill or have been in contact with those who are would allow the return to work of those without the disease. Ministers have made very clear they want many more tests carried out. They  were also prepared to buy 3.5 million tests kits to see if people had had the virus and gained some immunity as well. These kits turned out not to be reliable so the order has not yet gone ahead. The tests for the disease that are being supplied are important for patients in hospital and for care workers as priorities. Government is encouraging the ramp up of more production.

The big decision to be made is how long should the lock down continue?  The medical and scientific advice is that it is necessary to limit the spread of the disease. It does do grave damage to the economy, denying many people the right to work, costing us many lost jobs and damaged businesses. I have been putting forward proposals of how we might start to lift the restrictions so more can go to work, whilst keeping strong protections for the old and vulnerable with other medical conditions who are most at risk from the virus. I am also seeking more accurate figures about the impact of the virus and the capacity we have available to handle patients. It is vital that this important decision is taken on the  basis of reliable data.

Yours sincerely

John Redwood

Now I have been sent the published  back up data for the Friday graphs shown at the news conference, I thought I should just highlight the current situation.

Yesterday’s figures for hospital beds occupied by CV19 patients showed a small decline, thanks to London’s graph falling a bit where the most cases are still concentrated. Current patient numbers at 20 204 remain high. 3335 patients are in intensive care.

These are high numbers which we all want to come down. They do  impose a big strain on the staff having to handle this unpleasant disease, which is unrelenting at this level. They do, however, show the UK  is still currently well within the enhanced capacity of the NHS to cope with the crisis. As part of the aim of policy was to avoid an unsustainable peak demand on the NHS, it is encouraging so far to see these numbers and to see the recent levelling off. Of course we  hope to see this being maintained with no dangerous relapse to a steep climb in hospital cases. The NHS handling these volumes will inevitably limit other non urgent work taking place.

The death rate is too high. Every death is a tragedy. We all want to see it going down. The nation mourns those who have lost their lives to this disease.

Soon the government needs to review progress with its object of flattening the curve of the virus spread, to consider how long we need to remain in lock down.

I am glad we are now privy to the figures the government relies on. In the daily briefings we are shown two graphs or “curves”, the trend in hospital deaths from CV 19 and the trend in hospital admissions for the infection.

It is presumably these curves that need to be sufficiently flattened to allow the government to transit to the third phase of its  advisers’ planned handling of the virus crisis.

There are several issues with the Death figures that need getting right. I think it would be good for some administrators and statisticians from government and or from the scientific community advising the government to spend some time ensuring accurate data. This should not involve medical and hospital staff time which is needed to handle the patients.

 There was a change in the basis of their compilation on March 26th, when they shifted from 8 hour to 24 hour reports, moving the numbers up.  Can they smooth the figures to allow for this?

There is the issue of whether the deaths are all recorded on the appropriate day. The day before yesterday we were told the higher number included deaths from earlier days which they thought had not been recorded at the time. Can’t the numbers to be reworked for all but the most recent by reference to the death date on the medical death certificate?

There is the possibility of double counting. If deaths are sometimes recorded promptly  before paperwork is completed, and other times when the paperwork is ready, there needs to be a check that they do not end up recording the same death twice.

The wider ONS figures are also of interest. These are higher as they include deaths not in hospital where CV19 was present. These include  some where  the deaths certified as with CV19  are based on statements  about symptoms with  no tests to confirm the presence of the virus. The figures include cases where  CV 19 is mentioned where other severe conditions mean the patient would probably have died without the virus anyway.

Hospital admission with the virus is an easier series to get right. Presumably all on admission for CV 19 treatment are tested to ensure they have it, to make the correct treatment available. Admission takes place at one stated time and date, so it should be relatively easy to get a clean series of numbers that are accurate. A simple check would be to compare bed numbers and occupancy rates by hospital and to examine any outliers.

This is such an important decision both to control the disease and for the jobs and livelihoods of the many, that the decision takers need the most accurate possible numbers.  

The Fed has been buying bonds, commercial paper and mortgage securities on a huge scale. It has made available large swap lines in dollars to other Central Banks around the world to ease the dollar shortage. It has stabilised the Treasury bond market, assisted the corporate bond market, and reassured the financial world more generally.

The Fed is certainly showing willing to do whatever it takes to avoid a financial crash. It is now looking to governments to do more to cushion economies in lock down.

If rapid and decent assistance to companies  banned from working is not forthcoming from governments, we soon move to a situation where companies are borrowing too much to pay their bills, and firing too many to reduce their costs. In a normal recession companies keep the majority of their turnover from the good times as demand throttles back and people’s incomes are squeezed. In this crisis many companies lose all their revenue overnight and do not know when they might be able to resume trading.

The EU is struggling to come up with package for the Euro area that can help sufficiently. The Dutch and Germans lead a group of northern states who resist the idea that the Euro area should borrow money to give to troubled states that face the worst problems with the virus. They have no wish to underwrite EU wide debt spent in places like Italy and Greece.

The Commission, conscious that it needs to be seen to be supportive of member states at this time, has pledged to direct every spare Euro from its budgets to fighting the virus. It has also sought to broker an agreement about more EU borrowing. It is exploring more loans to places like Italy under the European Stability Mechanism, and wants member states to beef up the capital of European Investment Bank so they can lend more to business.

This presumably will have an impact on the green policies that were the priorities of the  planned budgets of this Commission before the virus hit. There will need to greater clarity soon over what is being removed from plans to accommodate the virus expenditures.

The USA government has put together and passed a $2 trillion package of support, but is finding it difficult to parcel it up and pay it as quickly as the companies in need would like. Japan has come up with a $1 trillion package of measures. This all helps, but the onset of this recession is so fast and the impact so severe from just banning much economic activity overnight that so far the governments have not done enough to offset all the damage. As the Chairman of the Fed has wisely said, many companies need government grants, not more borrowing to see them through.

I am not a doctor and am not about to propose how to treat this virus. I am however willing to give a day and a blog to inviting comments from those who are or those who think they understand the medical issues sufficiently to comment on what is happening. It would be useful if qualified contributors would mention their qualification.  The true  end of the crisis comes  by finding a cure or a vaccine or both. Nothing on this site is medical advice for any individual and anyone needing treatment should of course seek professional advice.

Buying time by restricting the  spread of the virus is a very good strategy if we use that time to find a cure or vaccine. Clearly much resource is going into just that all round the world. Some argue  that there are already treatments and preventative measures that can help.

Some say Chloroquine or Remdesivir could play a role. Others favour Ritonavir and lopinavir with or without interferon beta.  Some urge the case of azithromycin.  President Trump recently did more than send best wishes to Boris, by instructing two US companies to contact the PM’s doctors to recommend treatments they think could help.

Some say bigger doses of Vitamin C help build resistance and fight back against the virus.

The official treatment seems to include doses of oxygen when impaired lung functions leave the patients with low oxygen levels in the blood, and the capacity to operate organs as well as the lungs in intensive care if fighting the disease causes too many strains on them. 

Questions it would be good to have answered include

1. How many placed on a ventilator subsequently recover?
2. What trials have now been completed of existing drugs that might help? 
3. How do doctors work out whether a death was the result of Covid 19 or some other condition the patient suffered from?
4. Which if any of the named drugs do show potential? Do they have to be administered from first discovering the presence of the virus?

These words from Public Health England have framed policy so far. The first phase (Contain)  saw efforts to trace, test and isolate anyone carrying the virus and the people they had met. The second phase (Delay) has seen big efforts to impede the spread of the virus by keeping people apart and keeping them from  places of work as well as from entertainment. The final phase (Mitigate) is to learn to live with the disease, limiting its spreads with sensible precautions  with enough capacity to treat patients who do get it whilst we await vaccinations.

Their initial plan played down the extent of the controls needed for the second phase we are now in.  They told us on March 3 that if we got to this stage it would mean “people distancing strategies such as school closures, encouraging greater home working, reducing the number of large social gatherings- whilst ensuring the country’s ability to run as normally as possible”.  They seemed to move on from  the bit about as near normal as possible when they came to design the detail of the lock down. It emerged it entailed closing all physical shops other than food and medicines, stopping the car and homes markets  and much else besides.  They promised  to “implement a distribution strategy for the UK’s stockpiles of key medicines and equipment” . After early issues with inadequate supplies the army was brought in to help and orders stepped up  to business. .

The idea of  delaying the virus  was to reduce “the risk of overlapping with seasonal flu and other challenges that the colder months bring”. This implies they expected to lift the controls come late Spring and early summer.

We now see some other countries deciding to relax their controls progressively  but carefully in the next few weeks. China has done so.  Austria has just set out a timetable starting next week by re opening lots of small shops. Sweden and South Korea have not gone very far in imposing controls in the first place though Sweden is now taking more powers. The issue is what is the trigger to start relaxing the controls? Is it a tailing off in the death rate? A tailing off in the recorded number of new infections? How much value can we place on the numbers for new infections when most people that get it stay at home and are not tested?

We do need greater visibility on how this crucial call will be made. Some will argue the controls must go on for longer to avoid a possible second wave. Others will point to the big economic damage delays in getting back to work creates. As there was always a three phase strategy it would at least be good to know what the trigger is for going to the third phase and putting Shut Down  UK behind us.

Hearing the news that the PM is in an intensive care ward came as a shock. I wish him a speedy recovery. Many Constituents want me to pass on their good wishes to him and his family.

Public Health England set  out the strategy for handling this pandemic in a document published on 3 March as the “Coronavirus Action Plan”. So far Ministers have followed it.

This body conducts important research into disease, is advised by a scientific advisory committee, and spends £4.25 bn a year. It is run by an Executive team with six people paid more than £200,000 last year including pension benefits.

Its last Report and Accounts to June 2019 says on its cover that the organisation is “credible, independent and ambitious”.  On page 4 it states the aims of the organisation:

“PHE exists to protect and improve the nation’s health and wellbeing, and reduce health PHE exists to protect…” (sic)

If you read on you discover it also exists to reduce health inequalities, but  missed out the crucial last word in  the first iteration of aims. Credibility and ambition do not it appears extend to proof reading a formal annual publication before going to press and putting it on the web.

Last year the body wrote off  £207 million  “in relation to counter measures held for emergency preparedness and vaccines past their shelf life”. It had also written off money the year before in the same way.  Some of this is inevitable when you are holding supplies for a purpose you hope does not  materialise which then deteriorate in store.

On 3 March PHE told us that we “have planned extensively over the years for an event like this, and the UK is well prepared to respond in a way that offers substantial protection to the population”. The Agencies that have to respond are properly resourced with “people, equipment and medicines they need”. “The UK maintains strategic stockpiles of the most important medicines and protective equipment for healthcare staff.” Do you agree?  Tomorrow I will look at the evolving strategy.

We need to lift the ban on people working. A 3 week firebreak against the virus has bought the NHS time to expand capacity and to handle the resulting case load. As a result there are many more Intensive care beds and oxygen systems available.

Government in the next phase should still have as its main aim limiting the number of deaths. That is why it should still strongly advise all those at risk groups and the elderly to stay at home out of contact with possible virus spreaders. It should redouble efforts to ensure all at risk get home deliveries of all they need, and plenty of social contact through the phone and social media.

The rest of us should be free to go back to workplaces whilst continuing with strong hygiene measures and whilst keeping a sensible distance from others where possible. We need to rescue the small businesses and save the self employed by letting them earn money again.

We should not go for the return of just those people who pass a test to say they have had the virus. The right to work should not depend on some government test which might not even be accurate. We do not want to create a perverse incentive to put yourself in harms way to try to catch the virus so you can then win your freedom. It is difficult to see how you could enforce a ban on people who had not had the virus from travelling and working.

The economic cost of continuing with these lock downs will be massive. Unemployment will shoot up to record levels, many  businesses will go bankrupt or go through major financial reconstructions, state spending and debt will leap up, and there will be a major reduction in the standard of living and disposable incomes of many people  previously or still working in  the private sector. Lock down hits the lower paid in the private sector hardest.