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Coronavirus: Claims of power vacuum as PM battles COVID-19 in intensive care

08 April

Senior cabinet ministers are facing questions about who is making the big decisions in government while Boris Johnson battles coronavirus in intensive care.

After England's chief medical officer suggested mistakes had been made in the UK's approach to testing, a strategy for increasing the number of COVID-19 tests is a key issue confronting the cabinet in the prime minister's absence.
But the biggest dilemma for ministers is how and when to end the coronavirus lockdown.
Dominic Raab, the PM's stand-in, has refused to confirm whether a decision on easing restrictions would be taken on Easter Monday - and he suggested it could be delayed.
There are now claims of a power vacuum at the heart of government after Downing Street revealed there are strict limitations on Mr Raab's powers while he is deputising for Mr Johnson in key meetings.
There are also doubts in Whitehall about whether critical decisions on the lockdown can be taken without Mr Johnson's input.
Mr Raab, who is first secretary of state as well as foreign secretary, has struggled to answer questions on whether he has the authority to change course.
Some MPs are calling for a caretaker prime minister to be appointed - and Lord Heseltine, who was deputy prime minister under John Major, has called for greater clarity on the powers handed to Mr Raab.
"There must come a time when a deputy is effectively prime minister," Lord Heseltine told The Daily Telegraph. "I don't think we've probably quite got to that now.
"But the present urgency of the situation and the potential decisions that may need to be taken does mean that Dominic Raab will have to use his discretion and know when to act."
When Mr Johnson announced the lockdown in his TV address on 23 March, he said it would be reviewed after three weeks.
But at the latest Downing Street news conference, Mr Raab said: "We're not at that stage yet."
After two nights in intensive care battling the virus, Mr Johnson's condition is stable and he is in good spirits, according to Number 10. He is receiving oxygen but is not on a ventilator and does not have pneumonia.
Calling the PM "a colleague and a friend", Mr Raab said: "I'm confident he'll pull through because if there's one thing I know about this prime minister, he's a fighter and he'll be back at the helm leading us through this crisis in short order."
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But it was plain from the PM's most recent video appearance, last Friday, that he was struggling to throw off the virus - and he was admitted to St Thomas' Hospital in London on Sunday evening.
Mr Johnson has now spent a third night in hospital - and since a large part of the 55-year-old's stay has been spent in intensive care, Mr Raab's claim that Mr Johnson will soon be back leading the government's fight against coronavirus looks optimistic.
Prompting alarm among Tory MPs, medical experts are claiming Mr Johnson may be off work for at least a month, and his recovery from the shock of a spell in intensive care may last until the summer.
Professor Paul Hunter, an expert in infectious diseases at the University of East Anglia, told the Daily Mail: "If you have been sick enough to go on intensive care and you survive - and only about half of patients survive - clearly you will need some time to recover.
"I would expect most people who were that ill, to need at least a month or possibly two to be sufficiently back and to be able to function."
Professor Mike Grocott, a consultant in critical care medicine at the University Hospital Southampton NHS Foundation Trust and vice president of the Royal College of Anaesthetists, said: "On average a person who spends a while in intensive care on oxygen therapy alone, but basically immobile, would have a decrease in physical function for a period of time, that was likely to extend into weeks.
"A period of inactivity will have an effect on physical function, typically characterised by a loss in muscle mass and strength. It depends on how bad the duration and magnitude of illness was and it also depends on the quality and amount of time invested in rehabilitation."

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Coronavirus: Fourteen transport workers die in London after contracting COVID-19

08 April

Fourteen transport workers have died in London after contracting the coronavirus, mayor Sadiq Khan has told Sky News.

Mr Khan told Kay Burley@Breakfast that the death toll includes nine bus drivers, as well as three Transport for London workers, an Underground employee and a worker for one of TfL's suppliers.
The mayor said his condolences were with all those who have lost their lives as a result of COVID-19, the disease caused by the coronavirus.
Mr Khan stressed that his office was doing a "number of things" to ensure that transport in the capital was "as safe as possible".
"We've made sure, for example, that we're using advanced cleaning regimes," he said.
"We're using antiviral disinfectant, the sort of stuff you use in hospitals, to clean not just the steering wheels, but the handles, the bus garages, the restrooms.
"We've also made sure that passengers can't sit too near a bus driver.
"We've made sure there's perspex glass between the bus driver and passenger with a protective film in there as well."
Mr Khan revealed that on some routes, a trial involving passengers only using the back door of the bus to enter and exit the vehicle will now take place to see if this is a way to mitigate the risks.
TfL says it hopes the new boarding method will mean key workers can continue to rely on buses to travel around London.
The trial will be in place from this week on several routes operated by bus firm Abellio out of its depot in Walworth, south-east London, including two that serve hospitals.
Claire Mann, director of bus operations at TfL, said: "London's hard-working transport workers are making a heroic effort at the frontline of the fight against this pandemic, and it is only right we consider everything we can to protect them.
"We've already delivered many other enhanced safety measures and by trialling middle-door only boarding on buses we can gain the information we need to see if we can further improve safety on London's buses.
"Most Londoners can do their bit to protect our bus colleagues and other critical workers by remembering: stay home, don't travel, save lives."
Travel on the capital's buses has dropped by 85% since the lockdown was announced.
Sky News has spoken to a number of bus drivers in London who have said they do not believe they have the proper protective equipment to do their job safely.
TfL staff members, who wanted to remain anonymous, said they "are all scared" due to a lack of protective equipment during the COVID-19 outbreak.
TfL have told Sky News that the safety of staff and customers is "our absolute priority", adding that it has been working with bus companies, the mayor and the Unite union to "implement a range of changes and improvements to keep the bus network and garages safe for those operating and using it".
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On Tuesday transport minister Chris Heaton-Harris acknowledged that some transport workers do not have the appropriate PPE.
Giving evidence to the Commons' transport select committee, Mr Heaton-Harris said officials are working to pinpoint areas with a "risk of short supply".
He added that the Government wants to ensure the equipment is "in the right place at the right time".

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Coronavirus: Trump threatens to cut off US funding to World Health Organisation

08 April

Donald Trump has threatened to cut off US funding to the World Health Organisation - accusing it of "missing the call" on the coronavirus pandemic.

The US president claimed the UN health agency has made errors of judgement in its handling of COVID-19.
He also described the WHO as "very China-centric" - appearing to suggest the organisation went along with Beijing's efforts to minimise the severity of the crisis.
The WHO has praised China for its transparency on the coronavirus, despite the fact there is reason to believe the country's official tally does not reflect the true number of fatalities.
Beijing is another major financial contributor to the UN health agency, prompting critics to claim that the WHO lacks the independence needed to properly fulfil its role.
During his daily White House press briefing, Mr Trump initially vowed that he was putting a hold on US funding. He later backtracked and said he would "strongly consider" such a move.
The US is one of the World Health Organisation's biggest financial backers. In February, Mr Trump's administration had called for America's contribution to be slashed from $122.6m (£99.5m) to $57.9m (£47m).
Earlier on Tuesday, the president had tweeted: "The WHO really blew it. For some reason, funded largely by the United States, yet very China-centric. We will be giving that a good look.
"Fortunately I rejected their advice on keeping our borders open to China early on. Why did they give us such a faulty recommendation?"
The WHO has firmly rejected Mr Trump's claims, with UN spokesman Stephane Dujarric saying: "It is clear that the WHO has done tremendous work on COVID-19.
"In supporting countries with millions of pieces of equipment being shipped out, on helping countries with training, on providing global guidelines - WHO is showing the strength of the international health system."
The president's attack may be an attempt to deflect criticism about his handling of the pandemic, with the US now having the highest number of confirmed COVID-19 cases worldwide.
Mr Trump played down memos written by a senior adviser in January that warned a pandemic was possible - and that the crisis could cost the US trillions of dollars and put millions of Americans at risk of illness or death.
The president claimed that he had not seen the memos at the time, adding that he would not have wanted to act prematurely.
He said: "I don't want to create havoc and shock and everything else. I'm not going to go out and start screaming 'This could happen, this could happen'. I'm a cheerleader for this country."
The World Health Organisation had declared COVID-19 a public health emergency on 30 January, almost a month before Mr Trump tweeted "the coronavirus is very much under control in the USA".
That declaration also came 43 days before Mr Trump declared a national emergency in the US.
Health experts have warned that weekly death totals will reach a new high in the US this week.
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More than 12,000 Americans have now died after testing positive for the virus, and there are approximately 380,000 confirmed infections.
Mr Trump says the US is starting to see glimmers of hope despite a "very, very painful week".
New York state recorded 731 new coronavirus deaths on Tuesday, its biggest one-day jump yet.
In total, more than 4,000 people in New York City have now died after testing positive for COVID-19 - eclipsing the number of people who lost their lives on 9/11, the deadliest terror attack to ever happen on US soil.

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Coronavirus: 'Heroic city' Wuhan ends lockdown with spectacular party 11 weeks after it was epicentr

08 April

China has ended coronavirus lockdown measures in Wuhan - 11 weeks after it became the epicentre of what has since developed into a global crisis.

Authorities have begun allowing its 11 million residents to travel in and out of the sprawling city where the pandemic began without special authorisation.
Under new rules that came into force as of midnight on Wednesday, people are allowed to enter and leave on the condition a mandatory smartphone application powered by a mix of data-tracking and government surveillance shows they are healthy and have not been in recent contact with anyone infected.
A light show on either side of the Yangtze river marked the occasion, with skyscrapers and bridges radiating animated images of health workers healing patients.
One bears the words "heroic city", a title bestowed on Wuhan by president and Communist Party leader Xi Jinping.
Along the embankments and bridges, people waved flags, chanted "Wuhan, let's go!" and sang capella renditions of China's national anthem.
"I haven't been outside for more than 70 days," said an emotional Tong Zhengkun, who was watching the display from a bridge.
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He said his entire apartment complex was shut down when fellow residents tested positive for COVID-19, meaning he was not allowed to go out even to buy groceries - which neighbourhood workers brought to his door.
"Being indoors for so long drove me crazy," he said.
Shortly after the new rules came into force, traffic began moving swiftly through the newly reopened bridges, tunnels and highway toll booths, while hundreds waited for the first trains and flights out of the city, many hoping to return to jobs elsewhere.
Restrictions in the city where most of China's coronavirus cases and deaths have occurred - which official figures put at more than 82,000 and 3,300 deaths respectively - have been gradually relaxed in recent weeks as the number of new infections fell.
The latest government figures listed no new cases on Tuesday.
Although doubts have been cast as to the veracity of China's count, the unprecedented lockdown of Wuhan and its surrounding province of Hubei have been successful enough that they have been widely replicated in countries around the world.
"The people in Wuhan paid out a lot and bore a lot mentally and psychologically," resident Zhang Xiang said. "Wuhan people are historically famous for their strong will."
Wuhan residents had been allowed out of their homes only to buy food or attend to other tasks deemed absolutely necessary during the 76-day lockdown.
Only those who had paperwork showing they were not a health risk and a letter attesting to where they were going and why they were allowed to leave the city were allowed out - and even some of them were turned back by officials on technicalities.

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Coronavirus: What do the figures tell us about Boris Johnson's chances of a full recovery?

08 April

What do the figures tell us about Boris Johnson's chances of a full recovery after he was placed in intensive care?

Well, news that the prime minister hasn't been put on a ventilator could be a crucial sign, according to the latest figures from an intensive care research centre.
Numbers won't tell the full story, as every case depends on a multitude of extremely personal factors - but, like those now-famous charts showing the curve of cases and deaths - they can help us get a sense of the bigger picture.
For instance: like Boris Johnson, who is 55, the vast majority of patients in an intensive care unit (ICU) - almost three-quarters, or 73% - are men, mostly in older middle age.
The average age of admission to critical care is 60.
There are more men in critical care in their 50s than in their 70s.
That's not to say that the disease is more fatal for people in this age range, as, sadly, many older sufferers may not even make it to the ICU - but it does send a crucial public health message to this group.
They may think they are self-isolating to protect older friends and relatives.
In fact, it is very important they act to protect themselves - not least because (the data tells us) they occupy critical care beds for a significant period of time.
These figures come from the Intensive Care National Audit & Research Centre (ICNARC) which releases reports on patients with COVID-19 admitted to ICUs.
The latest was published on Saturday and examines the experience of 2,249 patients.
Most are still receiving treatment so we must be careful about drawing conclusions, but there are currently outcomes for 690 patients, around half of whom have died.
This bare fact shows just how serious admission to critical care is for most patients.
But anyone wondering specifically about Mr Johnson can find hope in another statistic.
According to his official spokesperson, the prime minister has not been placed on a mechanical ventilator, instead receiving "standard oxygen treatment", most likely using a device which blows air into the lungs.
Patients who don't go on a ventilator in the first 24 hours in an ICU survive 83% of the time.
Those who are put on a ventilator in that period have a much lower survival rate - just 32%.
This is correlation, not causation, so we don't know why that is, but while it's worth stressing again the limited nature of the data, on an individual level, this is good news.
Of course, even if one person does recover, that doesn't mean a visit to the ICU isn't extremely serious.
One sign of that: the proportion of patients receiving support for organs other than the lungs.
Of the 690 patients whose outcome in an ICU is known, almost all received support for their heart, and 143 received what ICNARC calls "advanced cardiovascular support".
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"You're protecting the organs trying to maintain good kidney function, good heart function and so you're giving fluids, nutrition, trying to prevent secondary complications like new infections, pressure sores," says Mervyn Singer, professor of intensive care medicine at University College London.
"There's a whole package of care that needs to be delivered to try and obviously help the patient get over their primary condition. So in this case, lung failure, respiratory failure, but also to try and prevent this domino effect of other organs being compromised."
Without this dreaded domino effect, how long do patients stay in the ICU? The data suggests that, among survivors, five days is the average - although the range is from two to eight. What about full recovery?
There's no data on that. "Unfortunately, that's a bit of an unknown quantity," said Professor Singer said.
"There's something called post-intensive care syndrome, which is very, very well recognised. So patients who are critically ill have had the stuffing knocked out of them and it can take actually weeks or sometimes even months to fully recover."

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