HL Deb 28 April 2003 vol 647 cc512-25

6.57 p.m.

Baroness Andrews

My Lords, with permission, I wish to repeat a Statement made earlier today in another place by my right honourable friend the Secretary of State for Health on severe acute respiratory syndrome—SARS. The Statement is as follows:

"SARS was first reported to the World Health Organisation from a number of countries in south-east Asia in mid-February this year. Subsequent information from the Chinese authorities suggests it probably started to emerge in southern China during November last year. It presented as an unknown illness causing fever and severe chest symptoms, including pneumonia. Since then, laboratories around the world, including those in the United Kingdom, have been working to pinpoint the precise cause of this serious new illness. At this stage there is neither a test to diagnose SARS nor an antidote to treat it.

"SARS has spread to 26 countries but it has been concentrated in a handful of areas, with major outbreaks in Hong Kong, Hanoi, Beijing and other parts of China, Singapore, and Toronto in Canada. According to the most up-to-date information I have received from the WHO this morning, there have been 4,836 probable cases of SARS world-wide and 293 deaths.

"There are of course understandable public concerns about the impact SARS might have in the United Kingdom. I can confirm to the House that in this country to date there have been just six probable cases of SARS. The last reported case was admitted to hospital on 10th April. All the patients involved were quickly identified and have been successfully looked after by the NHS. All have now returned home and are well. The Chief Medical Officer, Professor Sir Liam Donaldson, has advised that at present SARS poses a low risk for people in this country. So, serious though SARS is, it is important to keep it in perspective.

"Our approach has been to take a precautionary but proportionate approach. The handling of SARS in this country has been informed—as it must continue to be—by the best scientific and medical advice. In particular the CMO and the new Health Protection Agency, in advising Ministers and the NHS, have been working extremely closely with the World Health Organisation which has the global responsibility for dealing with this disease. Throughout we have followed WHO advice to the letter.

"It might be helpful if I set out the action taken to date and the further action that we now propose. First, we have provided early, accurate information to both the public and the health service. The CMO contacted all doctors on 14th March and subsequently on 7th April with detailed information on the symptoms and signs of SARS, and what to do if they encountered a possible case. Up-to-date information on SARS is also available to the public on the WHO, HPA and Department of Health websites as well as through the NHS Direct telephone helpline which many members of the public have contacted.

"Secondly, we have put in place high-quality public health surveillance to enable the disease to be tracked closely. In early March, the Health Protection Agency set up a system for reporting suspect and probable cases.

"Thirdly, the CMO issued advice to people travelling abroad—on 2nd April, and subsequently on 23rd April—in line with WHO recommendations. He strongly advised against travel to specific SARS-affected areas. That remains his very strong advice.

"Fourthly, the WHO has advised that screening of passengers should take place at departure from the countries affected. As a further precaution, in line with that WHO guidance, information on SARS has been distributed to the main airports in this country giving advice to returning travellers.

"Fifthly, we have laid down, in line with WHO advice, specific requirements through guidance issued by the CMO on 14th March and 7th April for the management of patients within NHS hospitals to reduce the risks of cross-infection.

"Sixthly, and perhaps most importantly for the long term, we have put our country's considerable scientific expertise to work in helping to identify a causative organism for SARS. The HPA central laboratory in Colindale is a key part of the international collaboration which led to the identification of the likely cause. It is also at the leading edge of work to discover an accurate diagnostic test.

"Over the past few weeks we have been able to draw on the UK's strength in public health and infectious disease control to deal with the threats posed by SARS. I must stress to the House, however, that this is an evolving situation. We are keeping our plans and policies constantly under review. We are learning lessons where they need to be learned, building on good ideas wherever they are to be found and, particularly, tracking this disease very closely in collaboration with our counterparts in other countries around the world. For example, this week we sent an expert from the HPA to Canada to assist them, but at the same time to learn as much as we can from the unfortunate events in Toronto so that we can build the lessons learned there into our own plans here.

"So far the approach taken to dealing with SARS in this country has proven effective. There is, however, no room for complacency. My clinical and scientific advisers have stressed that we need to retain flexibility in how we respond. We do not yet fully understand how SARS spreads. We do know that most of the cases have been transmitted between people who are in close contact with one another—for example, between healthcare workers and SARS patients—rather than through normal social contact in the wider population. But we cannot reliably predict whether the SARS virus will maintain its current pattern of attack or whether it could change in infectivity or find new routes of transmission. That is why it is so important to strike a balance in how we respond to it.

"Some have asked why we do not adopt a policy of screening all entrants to the United Kingdom from countries which have had cases of SARS. The problem is that there is no such test. Screening involves asking people a series of questions about their health to identify any signs or suspicious symptoms. That is being done, according to WHO advice, at airports in the areas most affected.

"I am advised, however, that the early signs and symptoms of SARS occur commonly in the general population and are found with a cold, cough or minor viral infection. Air travel, with its propensity to induce dry throats and coughs, is also a potential source of a large number of false leads. So trying to identify a genuine case of SARS is, as the CMO has put it, like looking for a needle in a haystack. With 4 million British and other visitors travelling between this country and the most affected areas each year, quarantining all those with such non-specific symptoms is simply impractical. Indeed, I have been advised by our scientific experts that none of the six probable cases of SARS so far identified in this country would have been prevented or detected by screening at points of exit, points of entry or on aircraft themselves. Instead each case was picked up because of the patient's awareness of SA RS and because of the high level of awareness among NHS staff.

"Fortunately, the evidence so far is that SARS is transmitted by people only once they have symptoms of the disease and not before. With a disease incubation period of up to 10 days, successful identification and treatment of SARS sufferers so far has been achieved by concentrating public health expertise on those who have returned to this country and developed the disease in the succeeding days. However, this is a changing situation globally. If our experts advise changes to our approach, we will not hesitate to introduce new measures.

"Others have asked why we do not make SARS a notifiable disease. In this early and important stage of the SARS outbreak it is vitally important that we find out about all cases of the disease through rapid notification of cases rather than through the slow and bureaucratic processes associated with the notifiable disease regime. Unfortunately it has become associated with significant under-reporting of disease.

"It is in any case extraordinarily unusual for a person in this country suffering from an infectious disease to refuse treatment, to reject advice and persuasion, and to necessitate the police being called to detain them compulsorily. We do not foresee this power being necessary in detaining people who fall ill with SARS at this stage. For the benefit of the House, however, I should mention that the Public Health (Aircraft) Regulations 1979 provide the power to detain for examination any person leaving an aircraft where there are "reasonable grounds" for suspecting that they are suffering from or have been exposed to infection. There is a similar provision in the Public Health (Ships) Regulations. I can tell the House that should the CMO advise me that wider powers are necessary, then SARS will be made notifiable. If necessary, I am advised that we could do so within 48 hours.

"We remain vigilant to the threat posed by SARS to public health in our country. So I can also tell the House that I am taking further action following advice from the CMO. First, following emerging evidence from the main affected areas that SARS spreads through poor cross-infection control measures, all chief executives of NHS organisations are being reminded to ensure that rigorous controls are in place when treating a patient with possible SARS. This communication will also include an instruction to defer the start date of appointments of any foreign recruits to the NHS from SARS-affected areas.

"Secondly, I am taking steps to check that the exit screening from ports of departure is robust. The UK is sending observers to those areas this week to ensure that passengers are being screened in line with WHO guidance. Where we have doubts that that is the case, we will consider screening passengers on specific flights on entry to Britain, including asking them to make a signed declaration that they have not been in close contact with SARS cases or have symptoms themselves.

"Thirdly, I intend with my right honourable friend the Secretary of State for Transport to ask airlines returning passengers from SARS-affected areas to distribute information along with boarding cards. We also intend to discuss with the airlines other means of informing passengers about SARS on all long-haul flights from affected areas.

"Fourthly, I will be reminding all airlines of their obligations to provide a declaration of health when a plane arrives in the UK. Fifthly, next month, at the World Health Assembly in Geneva, I will be meeting other health ministers to discuss whether there are any further measures above and beyond those already taken which could be put in place at a European or international level.

"The whole House will want to pay tribute to staff in the NHS for their prompt, effective and successful action in responding to SARS. The best advice I have is that the UK, alongside many other countries who have experienced a very low incidence of SARS to date, may see further cases over the months ahead. Given the importance and ease of global travel, we cannot isolate ourselves from the rest of the world. Given the complexity of detection, the test of success of our disease control policy rests on keeping to an absolute minimum the spread of the disease and successfully treating those affected.

"To date the NHS has met that challenge because of the precautionary but proportionate approach taken. We will continue to be vigilant. We will take whatever means are necessary to safeguard the public health of our people. And we will continue working with the international community to tackle and, in time, defeat this serious disease".

My Lords, that completes the Statement.

7.10 p.m.

Earl Howe

My Lords, I begin by thanking the Minister for repeating the Statement and by saying that I very much welcome both the fact that the Statement has been made today and, in broad terms at least, its contents. I say "in broad terms" only because, as the Minister might expect, there are several questions that arise from what she has said, which I hope she can answer. I will not take long over them.

One of the phrases that perhaps caused me to raise an eyebrow very slightly was the statement that SARS poses a low risk for people in this country. Based on the number of cases that we have so far experienced in the UK, that might be taken as a fair judgement. However, as the Minister herself said, the disease is a serious one and there is so much about it that we do not know that I should have thought that it was not yet possible to quantify the extent of the risk. We read only today of new precautions being taken in Taiwan, South Korea and the Philippines, and the Minister will I am sure confirm that the spread of SARS is far from being under control in many parts of the Far East.

I recognise that the Government have acted in accordance with advice from the WHO and the measures that they have taken are sensible and in the main reassuring. It is worth saying that we owe a great debt to the professionalism of the NHS staff who have successfully prevented the six SARS patients in this country from infecting anyone else. Nevertheless, I was always brought up to believe that within reasonable limits, and unless there is a good reason to the contrary, governments should adopt the precautionary principle in dealing with any threat whose cause is not fully understood and where the risk is for practical purposes unquantifiable.

The Minister said that the Government had decided not to make SARS a notifiable disease, at least for the time being. I am no more in favour of bureaucracy than she is, but the 1984 Act is there for a purpose. It is there to enable the authorities to act quickly should they need to protect public health. The value of making SARS notifiable is, as I suggested the other day when we debated this topic, that it would enable the authorities compulsorily to detain those suspected of incubating the disease at port of entry or indeed anywhere else.

The 1979 regulations do not, as I understand them, give the authorities more than a limited scope to examine a person, and then only in certain situations. That might not be sufficient in some circumstances. I take the point she made that most people do not refuse treatment when offered it. Nevertheless that is a proposition which takes a lot for granted when we consider someone who presents with a high fever and all the symptoms of SARS. Does such a person act rationally? Is an infected asylum seeker susceptible to polite requests to go to hospital? If the Government's argument was valid, there would be no need to make any disease notifiable, since everyone with a dangerous and infectious condition would always willingly submit themselves for quarantine and treatment when asked to do so. Frankly, I find it hard to understand why the Government do not take the necessary powers now, as a precautionary measure, to ensure that those powers could be used immediately if required. It is a simple parliamentary process which we on this side of the House would totally back.

Screening people by means of a questionnaire is a good idea but it is not of course guaranteed to yield substantive information, because people do not necessarily know if they have been in contact with someone infected with SARS. Similarly, exit screening at ports of departure abroad is welcome; but we have no means of knowing how efficiently or effectively it is being carried out. I am glad that observers are being sent to the relevant areas of the world to ascertain just that point.

The Minister correctly mentioned that there is no test to diagnose SARS. Nevertheless, I wonder whether the Government have considered using the Actin Serum screening test which, though nonspecific, acts as an early marker for infection when a disease is being incubated. If they have not, I should be grateful if the Minister would look into this idea and let me know what conclusion has been reached.

I welcome the precautionary approach taken to the admission of foreign recruits into the NHS and that the start-date of such appointments from SARS affected areas is to be deferred. Can the Minister say how long the deferral will last? The Minister mentioned that confirmed UK cases of SARS have so far numbered six. Can she confirm that there are no other suspected SARS cases currently being treated in NHS hospitals?

Reverting to the situation in China, can the Minister confirm that the Chinese authorities are now co-operating fully with officials from the WHO as regards up to date information on the SARS outbreak? Have WHO officials been allowed to visit Guandong province to speak to doctors and nurses on the ground?

The key to the future, as the Statement emphasised, will be vigilance and flexibility. There is just a chance that a global pandemic can be avoided if governments across the world take the right measures in a timely fashion. I am pleased and reassured our own Government have taken the measures described today. However, as I have indicated, ideally I should like to see them going a little further.

7.15 p.m.

Lord Clement-Jones

My Lords, I join the noble Earl, Lord Howe, in thanking the Minister for repeating the Statement made in another place. I do not believe that any of us, when commenting on the Government's Statement, underestimates the seriousness of SARS. It is a matter of great concern. It is a major issue, not only with huge potential public health consequences, but as has been seen, huge economic consequences as well. In that context I welcome the Statement. It deals with many points of public concern and seems to be soundly grounded in both WHO and domestic advice from the Chief Medical Officer and the new health protection authority. We on these Benches believe that crises such as this do not lead to political point scoring or that politicians start second-guessing public health professionals.

I pay tribute not only to NHS staff, who, as the noble Earl, Lord Howe, pointed out, detected the six cases, but to the new public health authority. As the Minister knows, I have had my doubts about the nature of the reorganisation, but I have great confidence in our public health professionals—particularly in Colindale's particular expertise. I am pleased that they have taken a full part in international collaboration.

It is important in such major crises for Ministers to provide reassurance and the reasoning behind the decisions that are made, and to be seen to be taking responsibility. It is particularly important in that context, because information is an important antidote to panic—to public concern. It is a pity that the Secretary of State did not have a press conference during the Easter Recess when Parliament was not able to have a Statement from him. There are circumstances when political visibility is important.

However, we on these Benches believe that the Chief Medical Officer and the World Health Organisation have struck the right balance. For instance, we do not yet see the need for enforced quarantine; that is, isolating people who are symptom-free. We also understand the good, practical reasons against compulsory notification, but I want later to raise a caveat in that respect.

That said, I want to take the opportunity to ask the Government a number of questions. First, in the view of the Chief Medical Officer, at what point does the need to notify in terms of the seriousness of SARS outweigh the bureaucracy involved in the 1984 Act? Secondly, have the Government assessed whether adequate resources are available for infection control teams? Clearly, those teams will be of great importance to prevent the spread of infection of SARS.

Thirdly, will the Government consider giving much more comprehensive information to travellers not only about health issues, but also about the rights of cancellation and the complicated matters which arise from insurance? The advice currently being given by agencies, tour companies and airlines varies widely and that is a matter of concern to travellers.

Furthermore, I hope that the Minister will take the opportunity to comment on the demand of the Conservative Party for health checks for each and every immigrant. The noble Earl, Lord Howe, did not mention that, but as the Minister will have seen from today's Evening Standard, that is a wholly opportunistic demand. It admits that they would not reduce the spread of SARS. Is it not the case that health checks should depend on where you come from and not who you are?

Will the Minister explain what advice has come from the Chief Medical Officer regarding the declarations which might be requested in the case of certain flights from certain destinations? What is the legal basis for that? For instance, can passengers be forced to sign the forms or are they purely voluntary in the circumstances?

Finally, regarding bureaucracy and returning to the 1984 Act, does not our public health legislation need an overhaul? Could not that bureaucracy be counter-productive if powers are not taken to have compulsory notification in these circumstances? Cannot the new health Bill, which begins its passage through another place, he used to update our law so that it will be fit for the purpose in pandemics such as we are now facing?

7.22 p.m.

Baroness Andrews

My Lords, I am grateful to both noble Lords for the support they have given the Statement and government policy and for the confidence they have expressed for the excellent work being done by all parts of the health service involved in fighting the epidemic: the researchers at Colindale; the health staff who worked with the six cases to isolate and treat; and the doctors and public health networks involved in surveillance. They are doing a magnificent job and we should give all credit to them.

The noble Earl, Lord Howe, began by asking why we were so confident that we could say that the NHS was a low risk. Perhaps I may add the caveat that there is no room for complacency in our response and in our language. But the point is that the public health surveillance system is being tested. It proved itself to be very robust in the past and it is proving itself to be very robust and effective at present. We have responded quickly and comprehensively and we have also responded proportionately to the challenge. We believe that we have the best scientific and medical advice and that the situation is well in hand. We are doing all we can to control the spread. The six "probable" cases is the best evidence that we have of that.

The noble Earl also asked about the powers of the 1979 regulations and whether we ought to move immediately towards notification. First, we believe that the 1979 regulations give us sufficient powers, but that pro-active surveillance, which is working, is a better response than a reactive notification system. However, I stress that if we receive advice from the Chief Medical Officer that we should move to notification because we need extra powers to enforce isolation where people are not prepared to commit themselves to voluntary isolation, we will consider that most carefully. At the moment, out best advice is that we are making the right response. It is appropriate and we will continue to monitor it.

In terms of exit screening, we are sending our HPA experts, or qualified people, to examine screening in countries where SARS is active. The problem for us as a receiving country is that we do not have a screening test. No test works and it may be some time before we can develop one. In the absence of that, we are left with questionnaires, which some countries are using, to invite people to provide information about any potential contact or symptoms. We will monitor the situation and if it is necessary for us to take that step, we will certainly consider it.

The noble Earl also asked about the start date of NHS staff coming from infected areas and whether I could give him a timeframe. They will be given a breathing space of 14 days before starting work.

The noble Earl asked about prospective cases. Our best evidence is that we have six probable cases who are doing well and have left hospital. A further 50 suspected cases are under investigation and we will follow them with interest. Of course, there may be further suspected cases but all the evidence suggests that the surveillance system is picking them up and they are being treated immediately. Furthermore, the Chinese authority is co-operating with the WHO.

I turn to the points raised by the noble Lord, Lord Clement-Jones. I am pleased that he recognised that the Government have been open. Since the beginning of the epidemic, we have made a serious attempt to make available as widely as possible accurate information. That is so not only in terms of the political discourse but also information from scientists at Colindale, the practitioners and the Chief Medical Officer. There has been a legion of interviews, reports and exchanges and if one listens to the "Today" programme on a regular basis, one realises that we are well-informed about how the public health faculties and researches consider things are going.

The noble Lord asked about the balance between changing bureaucracy and notification. Again, we must be advised by the scientific and medical experts. When they tell us that there is a case for notification irrespective of the potential delay we can move fairly fast. But we will be guided by them and are listening carefully to them.

In terms of resources for infection control teams, all appropriate and necessary resources must be provided. In relation to the information to travellers, the noble Lord will know that information leaflets and posters have been placed in all our international airports. They are being distributed in different ways. We are examining the possibility of providing information leaflets on planes and the best way of doing that. The noble Lord made an interesting suggestion that we might look further at advising travellers about, for instance, rights of cancellation and insurance. I shall take that back to the department for investigation. I agree with his comments about the Conservative Party and immigration, and I also agree that the crucial question is where people come from and not their status or condition. SARS is essentially a disease of contact and the critical advice is that that is in those countries where SARS is spreading.

In terms of the advice from the CMOs on the form of the declaration, we are in the process of considering how that could best be effected if we had to make that decision. I would have thought that, given the seriousness of the disease, most incoming passengers would not have a problem in filling out that declaration. Clearly, we need to consider the possibility that there might be some who refuse. I do not have an answer to that at present. The noble Lord's final question concerned the overhaul of the 1984 Act. Getting Ahead of the Curve, the famous document on communicable disease, pledged that we would consider the Act and that still stands.

I thank noble Lords on the Front Benches for the temperate and thoughtful way in which they have responded to the Statement.

7.31 p.m.

Lord Chan

My Lords, I welcome the Statement. However, there are two issues which have not been specifically discussed. The first concerns the quarantine of students from South East Asia who arrive here. In schools in Knutsford and the Isle of Wight Chinese students have been put into quarantine. What is the advice regarding that? The Chinese community are also practising that as regards people who come from the countries identified. In other words, anyone who comes from such areas is not welcomed in homes, restaurants, and so forth. Can the Minister give any advice as regards that issue? Associated with that is the issue of whether we welcome people coming for conferences from such parts of the world.

Baroness Andrews

My Lords, in general we have to respond to persons coming into the UK in the same way, irrespective of the reason for their coming here. As to the emphasis we place on them, if they are liable to have been in contact with SARS sufferers or if they have any symptoms, obviously the appropriate steps must be taken. However, when they are symptom free, whether they are children, students or people coming to a conference, we have exactly the same problem irrespective of why they are coming into the UK.

As regards school students, on 14th April the DfES wrote to all chief education officers in LEAs and drew their attention to the Government's advice to boarding schools and other institutions. The advice was that, if symptom free, students returning from SARS-affected countries are not a risk to others and should be allowed to continue their schooling as normal, but they are advised to seek medical advice if they develop any symptoms suggestive of SARS up to 10 days after their return. They should certainly not return to school if they have any symptoms. In exceptional circumstances where a student has come into close contact with a known SARS case, it would be prudent if the student's health was monitored for 10 days. Different boarding schools have put in place different strategies. It is largely their privilege to do so, and different rules will apply. However, that is the advice being sent out by the DfES in this instance. As regards conferences, the advice will depend entirely on individual circumstances. I suggest that there should be a case-by-case judgment.

Lord Soulsby of Swaffbam Prior

My Lords, this new "plague", if we can call it that, emphasises the concept that the price of freedom is eternal vigilance. Whether, indeed, there has been a lapsus in vigilance as a result of SARS coming out of China we shall not know for some time. We know that there is frequently a spontaneous re-assortment of genes in viruses such as the influenza virus but this is not a straightforward influenza virus.

Can the Minister tell the House the latest information on the origin of the SA RS virus in China in terms of whether it is animal, human or animal-human? What are the active surveillance undertakings being carried out by the British Government on this virus and other viruses coming out of China in food materials, animals and, indeed, human and animal products which might give us a lead as to what might come next beyond the SARS virus?

7.35 p.m.

Baroness Andrews

My Lords, I am much in awe of the noble Lord's expertise in this area. We do not know the origin. We do not have the science to tell us whether there has been a transmission across species from animal to human. It is hoped that over the next few months, or maybe longer, we shall begin to understand that. As regards our usual surveillance undertakings, I understand that the structures presently in place to protect us at points of entry, whether for infected food or people, would apply as rigorously to China and to the kind of circumstances described by the noble Lord as they would do normally.

Lord Campbell-Savours

My Lords, my noble friend referred to the fact that the UK is dispatching personnel to departure points overseas in areas at risk to monitor the screening arrangements for travellers returning to the United Kingdom. If that is the case, are other countries doing precisely the same? If so, should there not be a co-ordinated effort to continue to monitor all flights by a single officer representing an international authority, even if it means countries increasing the available budget of that organisation, whatever it might be?

Baroness Andrews

My Lords, as regards our own efforts to work out how effective screening programmes are in other countries, we alerted our embassies in areas in which relevant airports are sited. We are collecting information from embassy officials, and we shall build on that information when our own specialists go out. I do not know what other countries are doing. However, one of the features of this response has been its global dimension. For example, there are daily conference calls between the WHO and all the countries affected to update information and ensure that everyone is sharing as much knowledge as possible. There may well be some exchange of information about how screening can best be developed and improved. Certainly, screening at ports of exit was done specifically on WHO advice.

Baroness Masham of Ilton

My Lords, is the virus which is travelling round the world mutating? If so, will that not make it much more difficult to find a vaccine in due course? What is the particular advice given to health workers when looking after SARS patients? If patients, or provisional patients, are isolated in their own homes, surely such information should be made available to the general public so that they know what to do if someone develops SARS.

Baroness Andrews

My Lords, I am informed that all viruses mutate, or are very likely to mutate. The question is whether they mutate significantly and we do not know; the jury is out. However, the scientific consensus is that this is a coronavirus, so we have made progress in at least identifying that. As regards health workers, the advice which has gone out today from the Chief Medical Officer to chief executives reinforces the standard practice which we give in each of these situations as they arise. It is stringent advice concerning the importance of control of infection. It emphasises early recognition of suspected cases, rapid isolation, reducing the risk of cross-infection, high quality sterile practice, no inappropriate re-use of medical devices, and so forth.

The noble Baroness asked about people who may be at home with SARS. From the cases that we know and the surveillance practice we have seen, suspected cases have been picked up extremely quickly and are being investigated in hospital. I do not have any information concerning patients who may be at home in that situation.

Lord Brooke of Sutton Mandeville

My Lords, the Statement makes wide reference to the occasions when the Government are following the advice of the WHO. Can the Minister shed some light on how much universal advice the WHO gives to countries and how much tactical freedom it allows individual countries to make their own determination, as presumably in our own case with notifiability?

Secondly, the late Lord Phillips of Ellesmere was wont to remark that there was no way that a country of our size could maintain a position on the frontiers of every aspect of available science, simply because of resources. I have a highly simplistic question: can the Minister indicate on a scale of one to 10 where our country presently stands in terms of strengths in the disciplines challenged by SARS?

Baroness Andrews

My Lords, the noble Lord asks two very challenging questions. As far as I know, the advice put out by the WHO is universal as to the processes that contain the spread of the disease, whether it is through advice on screening, on treatment and so on.

Each country has its own political culture on issues such as notifiability. I presume that a fair amount of discretion will be built into that. Certainly, our medical and scientific experts would, I am sure, consult—as they do on a daily basis with WHO—should they think that notifiability is an important step forward. It is difficult to draw tight boundaries here. There is a great deal of communication and exchange. This is a pragmatic situation that is managed nationally and in terms of the WHO.

Regarding where we are and our position in the research league—whether virology, communicable diseases or whatever—the reputation of our Central Public Health Laboratory in Colindale is excellent. It has made a significant contribution. It is one of the 11 laboratories world-wide which have been involved in the research. I think that we can be extremely proud of our reputation and our effectiveness in that field.

Lord Turnberg

My Lords, while it is obvious and clear that we must take every precaution, I wonder whether the risk of this disease has been somewhat exaggerated, compared with, for example, most other infectious diseases. My question is: what information have we regarding the relative risk of infection and of death from this disease compared with, for example, TB, hepatitis and influenza in China, in Singapore, Hong Kong and in the UK?

Baroness Andrews

My Lords, I cannot give comparative figures. Professor Roy Anderson, who is an international expert in this area and an epidemiologist, in his most recent research—which I do not think has been published, but which was quoted on the radio this week—said that the disease is possibly less infectious than we thought although it might have a higher mortality rate. The crude death rate seems to be between 5 per cent and 6 per cent. Professor Anderson was looking at core morbidity factors and other factors which might have pushed the death rate up for elderly people. That appears to be the most recent authoritative research on these issues. I shall happily research the second point raised by the noble Lord and write to him.