# data[].attributes.body
https://www.theguardian.com/uk

# data[].attributes.body
https://www.theguardian.com/world/coronavirus-outbreak

# data[].attributes.body
https://www.bbc.co.uk/news/uk-51768274

# data[].attributes.body
https://www.theguardian.com/world/coronavirus-outbreak

# data[].attributes.attachment_link.readable_text
The statement says: "Transmission of Covid-19 is already high in the community, mainly still driven by Delta, but the emergence of Omicron adds additional and rapidly increasing risk to the public and healthcare services."

# data[].attributes.attachment_link.title
Covid: How does the alert level system work?

# data[].attributes.attachment_link.description
The statement says: "Transmission of Covid-19 is already high in the community, mainly still driven by Delta, but the emergence of Omicron adds additional and rapidly increasing risk to the public and healthcare services."

# data[].attributes.attachment_link.readable_text
Future pandemics could be more lethal than the current Covid crisis, one of the creators of the Oxford-AstraZeneca vaccine has warned.

Prof Dame Sarah Gilbert, delivering the 44th Richard Dimbleby Lecture, said there needed to be more funding for pandemic preparedness to prevent the advances made from being lost.

She also warned vaccines could be less effective against the Omicron variant.

Dame Sarah added that people should be cautious until more was known about it.

She said: "This will not be the last time a virus threatens our lives and our livelihoods. The truth is, the next one could be worse. It could be more contagious, or more lethal, or both.

"We cannot allow a situation where we have gone through all we have gone through, and then find that the enormous economic losses we have sustained mean that there is still no funding for pandemic preparedness," she added.

"The advances we have made, and the knowledge we have gained, must not be lost."

Speaking about the Omicron variant, she said its spike protein contained mutations known to increase the transmissibility of the virus.

"But there are additional changes that may mean antibodies induced by the vaccines, or by infection with other variants, may be less effective at preventing infection with Omicron.

"Until we know more, we should be cautious, and take steps to slow down the spread of this new variant."

However, Dame Sarah said reduced protection against infection and mild disease would not necessarily mean reduced protection against severe illness and death.

She also called for the rapid progress seen in delivering vaccines and medicines during the pandemic to become the norm.

There was no reason why a universal flu jab could not be developed in order to wipe out the threat from influenza, she said.

On Saturday, the government announced that travellers heading to the UK will now have to take a Covid test before their departure in an effort to limit spread of the Omicron.

From 04:00 GMT on Tuesday travellers aged 12 and over will be required to show proof of a negative PCR or lateral flow test taken no earlier than 48 hours before departure.

And Nigeria has now been added to the travel red list after a growing number of Omicron cases were linked to the country.

But a scientist advising the government said the travel rule changes were "a case of shutting the stable door after the horse has bolted".

Prof Mark Woolhouse said the new rules had come too late to make a "material difference" to a potential wave of the Omicron variant in the UK.

Prof Woolhouse, a member of the government's Scientific Pandemic Influenza Group on Modelling (Spi-M), told the BBC's Andrew Marr show that Omicron was "spreading pretty rapidly" in the UK, and if current trends here and in South Africa continued in the coming weeks and months, it could replace Delta as the world's dominant strain.

The UK recorded 86 new cases of the Omicron variant on Sunday, taking the total so far to 246. In total, 43,992 cases and 54 deaths within 28 days of a positive coronavirus test were recorded on Sunday.

Dame Sarah - who was recognised with a damehood in the Queen's Birthday Honours earlier this year - began designing a coronavirus vaccine in early 2020 when Covid first emerged in China.

The Oxford-AstraZeneca jab is now the most widely used around the world, with doses sent to more than 170 countries.

The lecture, named after the late broadcaster, Richard Dimbleby, features influential speakers from academia, arts and business and the Royal Family.

The 44th Richard Dimbleby Lecture will be broadcast on BBC One and iPlayer on Monday 6 December at 22:35 GMT.

# data[].attributes.attachment_link.title
Sarah Gilbert: Next pandemic could be more lethal than Covid

# data[].attributes.attachment_link.description
More funding is needed to prepare for pandemics and prevent gains from being lost, Dame Sarah Gilbert says.

# data[].attributes.body
https://www.bbc.co.uk/news/world-us-canada-56159756

# data[].attributes.attachment_link.title
Covid: What is the guidance across the UK now?

# data[].attributes.attachment_link.description
Almost all of the UK's Covid rules have ended, two years after they were introduced.

# data[].attributes.body
https://www.theguardian.com/commentisfree/2021/feb/09/covid-travel-rules-borders-boris-johnson-quarantine

# data[].attributes.body
https://www.theguardian.com/world/2021/jan/28/belgium-launches-investigation-of-astrazeneca-vaccine-plant

# data[].attributes.attachment_link.readable_text
Commenting on Instagram, Lorraine Candy, former editor of Sunday Times Style Magazine who reported on the advert, along with Glamour magazine, said: "Are there no intelligent, smart women advising the government about this? I am perplexed by the lack of awareness."

# data[].attributes.attachment_link.title
Coronavirus: Government withdraws 'sexist' Stay at Home advert

# data[].attributes.attachment_link.description
Commenting on Instagram, Lorraine Candy, former editor of Sunday Times Style Magazine who reported on the advert, along with Glamour magazine, said: "Are there no intelligent, smart women advising the government about this? I am perplexed by the lack of awareness."

# data[].attributes.attachment_link.readable_text
The new variant, which was first spotted in Kent in September, spreads more easily than the previous form of the virus and has now spread across the UK, causing a surge in cases which prompted the current lockdown.

# data[].attributes.attachment_link.title
Covid-19: Cough, fatigue, sore throat 'more common' in new variant

# data[].attributes.attachment_link.description
The new variant, which was first spotted in Kent in September, spreads more easily than the previous form of the virus and has now spread across the UK, causing a surge in cases which prompted the current lockdown.

# data[].attributes.attachment_link.readable_text
More than 100,000 people in the UK have died from a virus, that, this time last year, felt like a far-off foreign threat. How did we come to be one of the countries with the worst death tolls?

There is no quick answer to that question, and there is sure to be a long and detailed public inquiry once the pandemic is over. But there are plenty of clues that, when pieced together, help build a picture of why the UK has reached this devastating number.

Some will point a finger at the government - its decision to lock-down later than much of western Europe, the stuttering start to its test-and-trace network, the lack of protection afforded to care home residents.

Others will spotlight deeper rooted problems with British society - its poor state of public health, with high levels of obesity, for example.

Others, still, will note that some of the UK's great strengths - its position as a vibrant hub for international air travel, for example; its ethnically diverse and densely packed urban populations - exposed its vulnerability to a virus that spreads effortlessly in the close air between people.

In some people's eyes, the UK's island status might have helped it. Other island nations such as New Zealand, Australia and Taiwan managed to stop the virus getting a foothold and deaths have been kept to a minimum - Australia has seen fewer deaths throughout the pandemic than the UK is recording every day on average.

All introduced strict border restrictions immediately and lockdowns to contain the virus before it had spread. The UK did not. It was not until June that quarantine rules were introduced for all arrivals and even then travel corridors were soon set up, relaxing the rules for travellers from certain countries. Only this month were these scrapped.

In those early days ministers and their key advisers were accused of promoting a herd immunity strategy.

This changed in late March, when a full lockdown eventually came. But there was a crucial delay of a week which is estimated to have cost more than 20,000 lives, according to government modeller Prof Neil Ferguson, because of how quickly infection rates were doubling at that point.

This, of course, is said with the benefit of hindsight. Government modellers themselves acknowledge the data was "really quite poor" making it difficult to make a decision that would have significant repercussions. It is a point acknowledged by Prof Chris Whitty, the UK's chief medical adviser. Speaking in the summer he said there had been "very limited information" in early March.

By then, the virus was ripping through care homes. Around 30% of deaths in the first wave happened in care homes; 40% if you include care home residents who died in hospital.

By May, restrictions were beginning to be eased. But was this too soon?

The government seized on the relative lull to focus on building what the prime minister promised would be a "world-beating" test-and-trace system. The idea was that new outbreaks could be nipped in the bud, with comprehensive tracking by a centralised team of tracers.

The mere fact this had to be done some months after the virus had struck, illustrates another factor behind the high number of deaths - the UK was simply not prepared for a pandemic of this nature in the way some Asian nations had been. Countries such as South Korea and Taiwan had established test-and-trace systems in place that were ready to be activated.

The UK had a chance to bed in its system in the summer but it was riven with teething problems, with tracers struggling to reach many contacts and the testing capacity slowing down as demand rose.

Low levels of infection over the summer had created a false sense of security.

Desperate to boost the economy, the government launched the Eat Out to Help Out scheme, offering people discounted meals out during August. To what extent it contributed to the rise in the autumn is much argued about but certainly some doctors blame it in part for an increase in patients seen.

The truth is the virus never went away. Testing in the summer showed even at the lowest levels there were still around 500 cases a day being diagnosed - and random testing in the population subsequently showed the true level may have been twice that.

In late August around 1,000 people a day were testing positive. By mid-September that had trebled and from there it rose five-fold to 15,000 by mid October. The numbers testing positive have never returned below 10,000 a day on average since.

Another decision that has been heavily criticised was the refusal of ministers to introduce a short two-week lockdown, or "circuit breaker", in September - despite their advisers on Scientific Advisory Group for Emergencies (Sage) recommending such a step. The argument was it would have set the spread of the virus back by at least a month, giving test and trace time to regroup.

Wales, however, did introduce its own "fire-breaker" - a 17-day lockdown in October. It got infection rates down, but as soon as it was lifted they rebounded. This is, of course, why lockdowns have been criticised.

Edinburgh University infectious diseases expert Prof Mark Woolhouse, one of the modellers who feeds data into Sage, is on the record in the autumn questioning the logic of them for this very reason. It remains up for debate how effective a circuit-breaker would actually have been.

This after all is the time of year when respiratory illnesses start to increase. Schools had returned as had university students, creating new environments for the novel coronavirus to spread.

When a lockdown was eventually introduced in England in November it was to last four weeks, with Sage members lamenting the delay. "The absence of a decision is a decision in itself," says Wellcome Trust director Sir Jeremy Farrar.

But even before that lockdown was lifted cases had started going up in the south-east of England. Within weeks it became clear what was happening. The virus had mutated and a new faster-spreading variant was on the rise.

By mid-December the clamour for lockdown was growing again, but the plan for a Christmas relaxation of restrictions had already been announced. In every nation of the UK, ministers waited.

At the start of 2021, with hospital admission rising rapidly, the UK's four chief medical officers intervened, issuing a joint statement warning the NHS was at "material risk" of being overwhelmed. Within hours the UK was back in lockdown.

Deeper causes

But it must also be recognised that there are factors outside the control of the government - certainly in terms of its pandemic response - that have contributed to the high number of deaths.

One of the reasons the virus was able to take a hold and spread so quickly was because of geography and the fact the UK - and London in particular - is a global hub. Genetic analysis has shown the virus was brought into the UK on at least 1,300 separate occasions, mainly from France, Spain and Italy, by the end of March.

It was here before we knew it. That's not something Australia or New Zealand had to deal with on such a scale.

Density of population is also a factor. The UK is among the 10 most densely populated big nations - those with populations of more than 20 million. What is more, our cities are more inter-connected than they are in many places.

It meant the virus was able to seed everywhere quite quickly. Contrast this with Italy which saw the vast majority of cases in the north of the country in the first wave.

The ageing population also needs to be taken into account. Once you do this, and adjust for the size of the population - known as age-standardised mortality - deaths have risen, but not by as much as some of the headline figures suggest.

The health of the nation has also been a factor. The UK has one of the highest rates of obesity in the world. And obesity increases the risk of hospitalisation and death, according to Public Health England. One study found the risk of death was almost double for those who are severely obese.

Conditions such as diabetes, kidney disease and respiratory problems also increase the risk - a fifth of Covid deaths have listed diabetes on the death certificate.

Again the UK has relatively high rates of these illnesses.

But many have argued that these high levels of ill-health have been compounded by the levels of inequality in the UK.

Levels of ill health and life expectancy have always been worst in the poorest areas, but the pandemic certainly seems to have exacerbated this.

Office for National Statistics data shows mortality rates have been twice as high in deprived areas as they have been in wealthy areas. The Health Foundation is carrying out its own inquiry into the issue, arguing the Covid death toll needs to be seen through the "lens" of inequality to fully understand it.

It is something that has also been raised by Prof Michael Marmot, one of the country's leading experts on health inequalities. "The UK's dismal record is telling us something important about our society."

The UK was one of the hardest hit countries in the world last spring. But it is harder to compare the experiences or performance of countries in the second wave since the epidemic is following such different patterns around the world.

Countries like Australia have undoubtedly been more successful with milder first and second waves.

But that is not the case for some countries that fared better than the UK last spring.

The US never brought the death rate down over the summer in the way that the UK did and its death toll has been catching up.

And countries like Germany or Poland that had very few deaths in the first wave are now seeing spikes with overall death rates running far above normal levels.

And with the numbers of deaths still increasing, and vaccinations still rolling out, it is too soon to start compiling the definitive league table of hardest hit countries in the second wave.

But Prof Devi Sridhar, an expert in public health from Edinburgh University, is one of those who has been critical of the approach the UK has taken from the start.

She says the UK, like much of Europe, was "complacent" about the threat of infectious disease - choosing to treat the new coronavirus "like flu" and allowing it to spread.

What has struck some is just how similar the mistakes have been in terms of locking down late. "It will take years to unpick why Covid has gone so badly in the UK," says University College London infectious diseases expert Dr Neil Stone. "But the failure to learn from wave one stands out."

Many others share that sentiment, but some lessons have been learned.

A reduction in care home deaths has certainly played a role with extra testing and better availability of PPE reducing the proportion of deaths linked to care homes when you compared the first and second waves.

Of course, all this is easier to judge with the benefit of hindsight. In a recent interview chief scientific adviser Sir Patrick Vallance said: "The lesson is go earlier than you think you want to, go harder than you think you want to, and go a bit broader than you think you want to in terms of applying the restrictions."

All photographs subject to copyright

# data[].attributes.attachment_link.title
UK Covid deaths: Why the 100,000 toll is so bad

# data[].attributes.attachment_link.description
More than 100,000 people in the UK have died from a virus, that, this time last year, felt like a far-off foreign threat. How did we come to be one of the countries with the worst death tolls?

# data[].attributes.attachment_link.readable_text
England's schools inspectorate, Ofsted, has been overwhelmed by more than 10,000 emails from parents, mostly singing the praises of their children's schools, after Gavin Williamson urged them to complain if they were not satisfied with the remote education on offer.

The education secretary's comments last week sparked outrage among teachers and parents, but there are now fears the growing deluge of complimentary emails could result in genuine safeguarding concerns being delayed or missed by overstretched staff.

Ofsted's call centre team are sorting through emails to identify genuine complaints or concerns, but the vast majority are believed to be from parents praising their child's school during lockdown in defiance of Williamson's advice.

Addressing MPs in the Commons last week following the start of the third national lockdown and the closure of schools to all but vulnerable pupils and children of key workers, Williamson said Ofsted would enforce legal requirements for state schools to provide high-quality remote education.

"We expect schools to provide between three and five hours teaching a day, depending on the child's age. If parents feel their child's school is not providing suitable remote education they should first raise their concerns with the teacher or headteacher and, failing that, report the matter to Ofsted."

There have been concerns about patchy remote provision since the pandemic began last year, but Richard Brown, headteacher of the Urswick school in Hackney, north-east London spoke for many in the sector when he said of Williamson's comments: "What an absolute kick in the teeth."

By Friday, according to Schools Week around 5,000 emails had been sent to Ofsted's general enquiries inbox, which normally deals with safeguarding concerns, questions about how to register as a child minder and complaints about schools. By Monday that had more than doubled and additional staff may have to be brought in to deal with the backlog. Ofsted declined to comment.

It coincided with new Ofsted guidance on remote learning, which advised that live online lessons - frequently held up as the gold standard during lockdown - were not always the best way to deliver remote education and that sometimes text books and worksheets might be more effective.

The guidance also found that pupils using a laptop tended to spend longer accessing a remote lesson than those using a phone or tablet.

"This means that we need to think carefully about whether pupils have access to the right kind of device when we're using digital remote education. If they don't, and we can't provide enough devices, it might be better to consider non-digital approaches as well," said Daniel Muijs, Ofsted's deputy director, research and evaluation.

Ofsted will resume on-site monitoring inspections of schools currently judged inadequate or requiring improvement from next week, though grades will not be issued, and inspectors will be expected to assess the remote education on offer.
Topics

# data[].attributes.attachment_link.title
Ofsted gets thousands of emails praising schools after minister's remarks

# data[].attributes.attachment_link.description
England's schools inspectorate, Ofsted, has been overwhelmed by more than 10,000 emails from parents, mostly singing the praises of their children's schools, after Gavin Williamson urged them to complain if they were not satisfied with the remote education on offer.

# data[].attributes.body
The day

# data[].attributes.headline
Covid: UK at 'worst point' of pandemic, says Hancock

# data[].attributes.subject
Covid: UK at 'worst point' of pandemic, says Hancock

# data[].attributes.body
The day

# data[].attributes.attachment_link.title
Covid: 2.4 million vaccinations given in UK, says PM

# data[].attributes.attachment_link.description
Thousands more people are due to receive a jab this week after seven mass centres opened in England.

# data[].attributes.attachment_link.title
Covid-19: UK sees highest daily toll of 1,325 deaths

# data[].attributes.attachment_link.description
A further 68,053 cases are also reported as a third vaccine is approved for emergency use in the UK.

# data[].attributes.attachment_link.readable_text
A-level and GCSE results will be decided by teacher-assessed grades this year after the exams were cancelled because of the nationwide coronavirus lockdown.

The move is designed to avoid the chaos seen last year when an algorithm downgraded the results of tens of thousands of pupils.

A resulting outcry forced ministers to perform a high-profile U-turn, but not before the computer programme had created misery for many.

Labour accused Gavin Williamson, the education secretary, of "incompetence" over his handling of schools, which were closed across England on Monday night just hours after Boris Johnson declared them safe.

Just last week Mr Williamson himself said: "I'm confident that we won't be moving into a national lockdown situation because the tiering structure is the right place to be."

Announcing the new plans, the education secretary told MPs he was unveiling the "contingency plans" he had prepared.

He vowed not to "let schools be closed for a moment longer than they need to be".

But he conceded exams could not go ahead as planned this year. A form of teacher-assessed grades would ensure marks are awarded "fairly and consistently", he said.

He told the Commons: "While the details will need to be fine-tuned in consultation with [the regulator] Ofqual, the exam boards and teaching representative organisations, I can confirm now that I wish to use a form of teacher-assessed grades, with training and support provided, to ensure these are awarded fairly and consistently across the country."

In August, Mr Williamson bowed to intense pressure from pupils, parents and even other ministers to upgrade thousands of A-level and GCSE results.

A system, introduced at short notice after the coronavirus pandemic cancelled last year's exams, used an algorithm which downgraded four in 10 teacher-assessed marks.

In the end, pupils had their original grades restored, but it was too late for many to take up their original first choice of university course last year, even after ministers removed a cap on the number of places.

Mr Williamson also told MPs that this month's exams for technical qualifications could go ahead but added that no college should feel pressured to offer them.

But he said the government would not proceed with primary schools SATs exams this year.

He also confirmed that free school meals would be available while schools are closed and said there would be "extra funding" to pay for them.

The National Education Union criticised Mr Williamson for not announcing the move to teacher-assessed grades earlier.

Mary Bousted, NEU joint general secretary, said: "Gavin Williamson said in parliament today that he and Ofqual had prepared a contingency for teacher-assessed grades to award qualifications in summer 2021 but, if this is the case, why did he keep it from the sector? The NEU alongside other unions had called for structures to enable such a back-up option to exams in October. Had these structures been put in place then we would be in a much better position now to make it happen.

"Instead, there is a danger that implementing such a process fairly and consistently nationally at this late stage will lead to further extreme stress and workload for education staff, students and parents. This stress could have been avoided had government not been so obsessed and blinkered by their pursuit of exams in the face of the obvious prospect that they may not be fair or possible."

Geoff Barton, from the Association of School and College Leaders, said: "It is frustrating that there is not an off-the-shelf plan B ready to go. We have repeatedly called on the government and the regulator to prepare such a plan in the event of exams being cancelled, and have repeatedly offered to work with them in doing so."

"However, ministers have been so busy insisting that exams will take place that they have failed to ensure that there is a contingency system which can be immediately rolled out."

The union's general secretary added: "Ofqual now faces a race against time to come up with the 'fine-tuning' of a credible alternative to exams."

Natalie Perera, from the Education Policy Institute (EPI), welcomed the decision to scrap GCSE and A-level exams this summer, but said Wednesday's statement on the decision was "notably short on detail".

"The government and Ofqual now need to act with some speed, so that students and schools can quickly adapt to the new expectations," the EPI chief executive said.

On Wednesday, the prime minister's press secretary, Allegra Stratton, told reporters Mr Williamson had produced a "full and comprehensive" package of measures for children who will be educated at home.

"It's a huge brief and the prime minister believes the education secretary is doing it to his utmost ability," Ms Stratton said.

One student, Mana Ali, told The Independent she wanted an option to be able to sit exams in 2021. She had been planning to resit her A-levels last year before they were cancelled - and had been revising to take them this year instead.

"I am resitting to prove what I am capable of hence why I want to sit my exams and not rely on centre-assessed grades," she said.

# data[].attributes.attachment_link.title
GCSE and A-level exams replaced by teacher-assessed grades

# data[].attributes.attachment_link.description
A-level and GCSE results will be decided by teacher-assessed grades this year after the exams were cancelled because of the nationwide coronavirus lockdown. The move is designed to avoid the chaos seen last year when an algorithm downgraded the results of tens of thousands of pupils.

# data[].attributes.attachment_link.readable_text
Mainland Scotland will be placed in a full lockdown from midnight on Monday for the duration of January in an effort to stop the coronavirus pandemic spiralling out of control, Nicola Sturgeon has announced.

The first minister said in an emergency statement to Holyrood all Scotland's schools would remain closed for the whole of January, shifting to online learning, because of the risks posed by the new Covid variant B117.

The new "stay at home" rules, mirroring the strict controls imposed last March, would also be legally enforced and greatly restrict who was able to travel, the Scottish government's cabinet agreed earlier on Monday.
UK coronavirus live: Sturgeon announces full lockdown for Scotland from tonight
While Scotland has not experienced the sharp escalation in the number of Covid patients in hospital seen in parts of England over the last week, the number of positive cases has risen to a new record high every day, hitting 2,464 on Sunday.

Sturgeon told MSPs she was more alarmed about the threat posed by Covid-19 than she had been since March. She said there was "compelling" evidence the new variant was about 70% more infectious and could push up the R number of infections by 0.7.

She said the approval of two vaccines was "hugely positive and offers us the way out of this pandemic", but the faster spreading variant was "a massive blow". She added: "Indeed, it is no exaggeration to say that I am more concerned about the situation we face now than I have been at any time since March last year."

NHS boards were already under intense pressure: 96% of Covid-19 beds in Ayrshire and Arran were full, as were 60% of those in Greater Glasgow and Clyde, Borders and Lanarkshire health boards.

With the latest data delayed because of public sector holidays, she said a full update would not be available until Tuesday. However, in the week to 30 December, the seven-day incidence of cases per 100,000 people increased by 65%, from 136 to 225.

"That increased faster spread is undoubtedly driving the very serious situation we now face," Sturgeon said. "Today's case numbers - 1,905 new cases, with 15% of tests being positive - illustrate the severity and urgency of the situation."

She added: "As government, our clear duty right now is to act to save lives and protect the NHS. We know that delay or prevarication in the face of this virus almost always makes things worse not better - even if it stems from an understandable desire to wait for more data or evidence."

The tougher measures will come into effect across mainland Scotland, which is already under the toughest tier of Scotland's alert system, level 4.

Scotland's island groups, the Western Isles, Shetland and Orkney, would remain at level 3 for now, Sturgeon added, although all schools in the islands would also close for the time being; she said a spate of new outbreaks in Shetland was particularly concerning.

Opposition parties said support for schools, parents and businesses had to improve.

Ruth Davidson, the Scottish Tories' leader at Holyrood, said the Scottish children's commissioner, Bruce Adamson, had said children's mental health life chances were being affected by school closures. Richard Leonard, the Scottish Labour leader, said the implementation of online learning across Scotland was erratic and needed to be improved.

Sturgeon said they wanted to increase vaccinations of school and nursery staff not already included in the vaccination priority lists, to improve the chances that schools could reopen later this month, but she admitted the Scottish government could not change the UK-wide rules.

The decision to keep schools and nurseries closed would be reviewed in mid-January. She "desperately wanted" to get schools reopened; speeding up or expanding vaccinations depended on the availability of supplies.

She said 100,000 people in Scotland had already had their first dose; the Scottish government anticipated a million people would get one by the end of January, split between the Pfizer/BioNTech and Oxford/AstraZeneca versions.

Based on the new advice to delay the second dose to 12 weeks, it was expected all 2.5 million Scots on the priority list - those aged over 50 or with specific underlying conditions, would have their first dose by early May.

Business leaders urged Sturgeon to offer greater financial support, including for parents who may want to be furloughed to support children kept at home. While building sites, factories and offices would not be forced to close under the new lockdown, there would be significant impacts on firms.

Liz Cameron, the chief executive of the Scottish Chambers of Commerce, said: "Today's news is another blow to the private sector's recovery from this pandemic. Whilst we fully appreciate the need for the Scottish government to act in response to the worrying rise in Covid cases, we cannot ignore the direct impact this will have on business and livelihoods.
Topics

# data[].attributes.attachment_link.title
Scotland to go into full lockdown at midnight, Sturgeon announces

# data[].attributes.attachment_link.description
Mainland Scotland will be placed in a full lockdown from midnight on Monday for the duration of January in an effort to stop the coronavirus pandemic spiralling out of control, Nicola Sturgeon has announced.

# data[].attributes.attachment_link.readable_text
Nick Triggle

Health Correspondent

Once again it is the threat to the NHS that has forced the hand of ministers.

In England there has been a 50% rise in the number of patients in hospital with Covid since Christmas day.

To put that into context, it equates to 18 hospitals being filled.

Currently around three out of 10 beds are occupied by patients with the disease.

In some hospitals it is more than six in 10.

But what is worrying ministers and NHS leaders is that the number is just going to increase.

In the spring it took nearly three weeks after lockdown for hospital cases to peak.

The last six days have seen in excess of 50,000 new infections confirmed each day across the UK - a number of these infections are next week's hospital admissions.

It is why the UK's chief medical officers were warning there was a "material risk" of some hospitals being overwhelmed if something did not change.

As the prime minister takes further action in England, it is clear that the situation is worse than before the second lockdown began in early November.

Back then, on 5 November, the case rate was 247 cases per 100,000 people.

Now it's more than double that with 519 cases per 100,000.

And looking at the speed of increases before the lockdown, the coronavirus rate has increased by 70% in the past two weeks, compared to 10% in the period running up to the November lockdown.

As ever, we must look at all sources of data, as case rates can also be influenced by mass testing.

Looking at hospital data, the situation is - again - more serious.

There are currently now on average 2,550 new coronavirus admissions every day; this is compared to 1,327 on 5 November.

Prime Minister Boris Johnson is now beginning his televised address, where he is expected to announce new national Covid restrictions for England.

Following the earlier statement by the UK's chief medical officers, Prof Chris Whitty, the chief medical officer for England, has tweeted that the UK "must act now" to combat surging coronavirus cases and protect the NHS.

He wrote on Twitter: "Covid cases are rising rapidly across the UK in large part due to the new variant.

"The NHS is treating many more Covid patients and vaccinating vulnerable citizens. NHS staff deserve our profound thanks.

"But we must act now or the NHS will come under even greater pressure."

While we wait for the PM to announce more lockdown measures, here's a quick round-up of the top headlines in the UK so far:

The UK's chief medical officers and NHS England's medical director have recommended that the UK Covid alert level should move up to level five, the highest possible, after warning that they were "not confident that the NHS can handle a further sustained rise in cases"

All schools and colleges will move to online learning until 18 January in Wales, education minister Kirsty Williams has announced. Some schools had been due to open on Wednesday and others by 11 January

A new lockdown has been announced in Scotland from midnight as Nicola Sturgeon warned she was "more concerned about the situation we face now than I have been at any time since March last year"

Scottish MP Margaret Ferrier has been arrested by police after she admitted using public transport while infected with Covid-19. Police Scotland said she had been charged in connection with "alleged culpable and reckless conduct"

Hospital admissions of patients with coronavirus have hit a record high, according NHS England data. There were 3,145 admissions in England reported for 2 January, exceeding the previous peak of 3,099 recorded on 1 April last year.

Boris Johnson is due to give a televised address at 20:00 GMT, where he is expected to announce a set of new national Covid restrictions for England.

It is expected the measures will be similar to the March lockdown, with people told to work from home if possible and schools closing for most pupils.

The prime minister is likely to urge the public to follow the new rules from midnight - with MPs given a vote to approve them retrospectively on Wednesday.

Mr Johnson will set out plans for England only as the UK's devolved nations have the power to set their own coronavirus regulations.

It comes amid concerns over a new variant of the virus, which has been found to spread much more easily.

We'll bring you the all the latest updates and analysis here.

Maddy Savage

BBC News, Stockholm

A British teacher denied entry to Sweden despite having residency rights says she will be spending a second night on the floor at Gothenburg's Landvetter Airport.

Gina Smart, 25, arrived on a flight from Manchester on Sunday and is among several Brits denied entry because border police say their Covid-19 tests aren't valid.

Smart tells the BBC she hasn't been able to sleep and is "exhausted" from the experience.

"I just want to get back to my home in Sweden," she says. "I'm scared."

Another passenger told Swedish news site The Local that five Brits denied entry were given a room to share at the airport last night.

Smart says Swedish authorities asked her to return to the UK on a flight to London, but she refused because she is from Manchester and has no home in the capital.

The BBC understands Swedish authorities refused to accept some Covid-19 tests - including NHS tests - at Gothenburg and Stockholm airports over the weekend, despite not specifying in advance to passengers which tests were valid for travel.

The British Embassy in Sweden now says all tests carried out by authorised providers, including those on the UK government's official list of private providers of coronavirus testing, should be accepted.

Lebanon is mourning the death of musician Elias Rahbani, who wrote songs for the country's most revered singer Fairouz, among many others. He was reported to be suffering from Covid-19.

The 83-year-old was the younger brother of Assi and Mansour, known simply as the Rahbani brothers. All three siblings produced songs and musicals that defined Lebanese culture for decades.

Their works, particularly their interpretation by Fairouz, are regarded as a high point of Lebanese art that transcended conflict and division.

"Your departure takes with it a large part of the romanticism of our wounded country," said Lebanese singer Ragheb Alama as he joined tributes to Rahbani.

The news comes as the Lebanese government announced a new lockdown beginning on Thursday and lasting until 1 February. Around 1,500 people have died of Covid-19 in the country since the pandemic began, with almost 190,000 infections recorded.

Scottish MP Margaret Ferrier has been arrested and charged by police over an alleged breach of coronavirus restrictions.

She was suspended from the SNP group at Westminster after she admitted using public transport while infected with Covid-19 last September.

The Rutherglen and Hamilton West MP apologised after travelling from London to Glasgow having tested positive for coronavirus.

She said she had experienced "mild symptoms" and taken a test, but had then decided to travel to Westminster because she was "feeling much better".

She then travelled home again on a train after receiving the positive test result, and said she "deeply regretted" her actions.

Despite facing pressure to resign her seat, Ms Ferrier is now an independent MP.

Read more on this story here.

A leading government adviser says he can see schools closing under tougher coronavirus restrictions to be announced in England soon.

John Edmunds, a professor in the Faculty of Epidemiology and Population Health at the London School of Hygiene & Tropical Medicine, told BBC Radio 4's PM closing schools would have "the biggest effect of a single measure and I can see that happening."

He says schoolchildren are the most important route of infection into the typical household, the second being through workplaces and the third due to social interactions.

Data shows the nation is "pretty compliant" in terms of social distancing rules and that wearing masks outdoors will not make a big difference.

He says: "All the evidence that we've collected for Covid up to this point suggests the risk outdoors is very low and mask wearing will help reduce your risk somewhat. I cannot believe if we got people to wear masks outdoors we would turn the epidemic around, that is not the issue."

"The total numbers of deaths will be unfortunately measured in 100,000 or more," he said.

# data[].attributes.attachment_link.title
Covid: PM announces new England lockdown in TV address - BBC News

# data[].attributes.attachment_link.description
Nick Triggle Health Correspondent Once again it is the threat to the NHS that has forced the hand of ministers. In England there has been a 50% rise in the number of patients in hospital with Covid since Christmas day. To put that into context, it equates to 18 hospitals being filled.

# data[].attributes.attachment_link.readable_text
The government faces a major revolt from teachers over its plans to reopen schools, as the Observer understands the UK's largest teaching union is poised to warn teachers not to return to their classrooms on Monday over safety fears.

The National Education Union (NEU), which represents the majority of teachers and more than 450,000 school staff in the UK, will inform its members that it is not safe for them to return to school until mid-January at the earliest.

It expects most of its members will follow its advice, forcing most schools to switch to online learning for the majority of their pupils.
Covid: current advice on reopening primary schools in England
The union will provide its members with a template letter to send to their headteachers, explaining that they are refusing to go into work because their workplace is unsafe, a right enshrined in law by section 44 of the Health and Safety at Work Act.

Staff should still be prepared to work remotely, the union says, and should volunteer to look after vulnerable pupils and the children of key workers on school premises.

The government is expecting primary schools in England to reopen in two days, with the exception, after another U-turn on Friday, of all schools in London and other local authorities in the south where Covid-19 transmission rates are high.

Secondary school pupils in their exam year in England are due to return on 11 January, the date most schools in Wales will also reopen. A week later, on 18 January, all other secondary school students in England are due back, along with all schools in Scotland.

Kevin Courtney, the joint general secretary of the NEU, said the government was being reckless and ignoring the advice of its own experts on the Scientific Advisory Group for Emergencies (Sage).

He said it was clear from the minutes of the latest Sage meeting, which were published on New Year's Eve, that scientists had told ministers before Christmas that schools must be closed to contain the new, highly transmissible coronavirus variant.

The minutes from 22 December state that "R would be lower with schools closed" and that it was highly unlikely that the government would be able to maintain R below 1 in the presence of the new variant if schools remain open, with further analysis only possible after the impact of the school holidays on transmission rates is known in mid-January.

NEU members who are penalised by their headteachers for refusing to work on school premises can rely on the union for support with any legal action, Courtney said. "The Sage minutes show that there is a well-founded case that it is unsafe for schools to be open, and so we think section 44 will be very usable for that, and we will protect members in those situations," he said. "But frankly, I think lots of headteachers will also be really concerned about opening schools."

A paper by the Children's Task and Finish Group for Sage, also released on 31 December, says evidence is accumulating that supports the view that increased transmission occurs between children when schools are open, particularly among secondary school pupils. A number of data sources show a reduction in transmission in children after schools closed for half term, with transmission rates rising again after the return to school.

The latest coronavirus infection survey shows that infection rates are highest among school-aged children.

"We think we should follow the science. We think that everybody in our country should follow the science," Courtney said. "We're confident we're speaking for society, that the government just isn't taking care of us.

"They aren't seeing that you have to take steps to get the virus level down if you want to have continuity of education."

Vik Chechi-Ribeiro, a secondary school teacher and NEU Manchester vice-president, said: "The government's reckless plan for ... reopening of primary schools risk pouring petrol onto a fire for case rates, hospital admissions and deaths. It also ignores their own advice from Sage.

"Education workers have the right to a safe workplace for themselves, students and the community whilst continuing to provide face to face teaching for key worker and vulnerable students."

Courtney said ministers in the Department for Education were so "ideologically committed" to exams going ahead that they were prioritising school attendance over the measures needed to suppress virus transmission, which was causing more disruption to pupils' education overall. "It's so short-sighted," he said.

He also said NEU members were reporting a "huge level of anxiety" about schools reopening. "People know of some staff who've died and other staff who have got long Covid," he said, appealing to parents for understanding and support.

"I'd say to parents: before Christmas, cases of the virus were rising very fast among secondary and primary-aged children, and we know that parents and grandparents have been contracting the virus from children. This is about the community as well as education. Having a further period of home learning, disruptive as it is, will hopefully mean cases are much lower when children return. It's the right thing to do."
Topics

# data[].attributes.attachment_link.title
Government faces major revolt on schools reopening in England over Covid fears

# data[].attributes.attachment_link.description
The government faces a major revolt from teachers over its plans to reopen schools, as the Observer understands the UK's largest teaching union is poised to warn teachers not to return to their classrooms on Monday over safety fears.

# data[].attributes.attachment_link.readable_text
The government has been accused of causing "chaos" after a last-minute decision to keep all London primary schools closed when term begins.

The U-turn comes as high coronavirus infection levels in the capital have put rising pressure on hospitals.

Ministers said closures were a "last resort" and education was a priority.

But Labour said the move had created "huge stress" for pupils, teachers and parents - while a union called for all schools to be shut nationwide.

The daily number of new Covid cases in the UK has topped 50,000 for the past four days, as the country struggles to control a new variant of the virus.

The president of the Royal College of Physicians, Prof Andrew Goddard, told the BBC the variant was spreading across the country, and added: "All hospitals that haven't had the big pressures that they've had in the South East, London and south Wales should expect that it's going to come their way."

It means more than a million primary school pupils will now learn from home for at least the first two weeks of term.

Vulnerable pupils and the children of key workers will continue to attend school, the government said, adding that early years care, alternative provision and special schools will remain open.

Labour and unions representing teachers have criticised the timing of the announcement.

"This is yet another government U-turn creating chaos for parents just two days before the start of term," said Labour's shadow education secretary Kate Green.

"Gavin Williamson's incompetent handling of the return of schools and colleges is creating huge stress for parents, pupils, and school and college staff and damaging children's education."

The joint head of the National Education Union, Dr Mary Bousted, called for all primary and secondary schools to be closed.

"What is right for London is right for the rest of the country," she said.

The NASUWT union said the government had disregarded scientific advice suggesting nationwide school closures could be "essential in breaking the chain of coronavirus transmission".

NASUWT's general secretary, Dr Patrick Roach said primary schools and parents in other areas subject to tier four coronavirus restrictions would "no doubt wonder why the government regards the risks to their health and safety as less significant than in other tier four areas in London and the South East".

But barely two weeks later, it's the government which has changed position.

First, earlier this week it agreed to the closure of primary and not just secondary schools in 50 areas in south-east England - even though its own guidance said this should happen only rarely.

Education ministers maintain it is epidemiology, not expediency, that has forced their hand - decisions are taken in consultation with the Department for Health and public health professionals.

But over the past 48 hours they have listened closely to, rather than lectured, those London authorities - including Greenwich - that were calling for more schools to close.

The Department for Education isn't envisaging further school closures in tier four areas - which cover 75% of England's population.

Sources say that other local authorities are not asking for this. But if more councils do become concerned about local rates of transmission, pressure could grow on ministers to send more children home.

Mr Williamson said the London-wide closures were a "last resort and a temporary solution" to help tackle the particularly high infection rates in the capital.

"We must make this move to protect our country and the NHS. We will continue keep the list of local authorities under review, and reopen classrooms as soon as we possibly can," he said.

"Children's education and wellbeing remains a national priority."

The Department for Education has previously said decisions on school closures and openings were based on new infections, positivity rates, and pressures on the NHS.

The start of term has already been delayed for millions of pupils across the UK.

Secondary schools in England will stagger their return after Christmas. Pupils taking exams in 2021 will now start on 11 January, with other year groups returning in person on 18 January. Most primary schools in England will return on 4 January, but in London and some surrounding areas they will not open for most pupils until 18 January.

In Wales, local councils have been told they can be "flexible" with when they open. According to councils, many schools aim to return for face-to-face lessons from 11 January, with some fully open on 6 January.

In Northern Ireland, primary school pupils will be taught online until 11 January. In secondary schools, years 8 to 11 will be taught online throughout January. Years 12 to 14 will return to school after the first week of January.

In Scotland, the Christmas holidays have been extended to 11 January, and the following week will be online learning only. A full return to face-to-face learning is planned for 18 January.

The Mayor of London Sadiq Khan said closing all London schools was "the right decision" and praised the "constructive conversations over the past two days".

He said the original plan to only keep some London schools closed was "ridiculous and has been causing immense confusion for parents, teachers and staff across the capital".

# data[].attributes.attachment_link.title
Covid-19: Call for all schools to stay shut amid U-turn 'chaos'

# data[].attributes.attachment_link.description
The government has been accused of causing "chaos" after a last-minute decision to keep all London primary schools closed when term begins. The U-turn comes as high coronavirus infection levels in the capital have put rising pressure on hospitals. Ministers said closures were a "last resort" and education was a priority.

# data[].attributes.body
https://www.bbc.co.uk/news/uk-55511662

# data[].attributes.body
https://www.theguardian.com/commentisfree/picture/2021/jan/01/nicola-jennings-on-gavin-williamsons-latest-u-turn-cartoon

# data[].attributes.attachment_link.readable_text
England's chief nurse has said that NHS and care staff are working incredibly hard to cope with record numbers of Covid-19 patients, amid concern that frontline staff are close to burnout.

Ruth May pleaded with the public to follow the coronavirus advice to help relieve the pressure on hospital staff, after two days of record hospital admissions.

Ruth May 💙 (@CNOEngland)
My fellow nurses and other fantastic NHS & care staff are working incredibly hard to care for record numbers of very sick patients with Covid-19 so please, please follow the advice: remember 'hands face, space' and stay home to save lives #teamCNO

Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, told BBC Breakfast that health employees were "tired, frustrated and fed up".

He said: "What is it going to be like over the next couple of months? I don't know, I am worried. We are very much at battle stations.

"There will be short-term surges of morale but people are tired, frustrated and fed up, as everybody is, whether they work in hospital or not. The people who go into emergency medicine expect it to be tough from time to time.

"There is a real worry about burnout."

The Royal College of Nursing's England director, Mike Adams, said staff leave was being cancelled to deal with the surge in demand. Adams told Sky News the expectation of a mass rollout in capacity through the Nightingale hospitals was misplaced.

Adams said: "If we are having to cancel leave to staff these areas, the obvious question is: where will the staff come from to open the Nightingales?
Key London hospital preparing for Covid-only care as cases surge
"I am sure there will be moves to open some beds, there are some beds open in different Nightingale hospitals in different areas of the country. I have real concerns that the expectation that this mass rollout in capacity can happen is misplaced because there aren't the staff to do it."

The concerns come after a major incident was declared at hospitals in Essex, as patients were being airlifted from an overwhelmed hospital in Southend to a hospital in Cambridge.

Lucy Ward, a lead respiratory nurse for Southend hospital, tweeted last night that the hospital was in a "very bad way". Ward pleaded with the public to stay at home after returning home from shift.

lisa ward (@mummacat10)
@everythingleigh @LoveLeighRoad @AroundSS9 @LeighOnSeacom @YourSouthend @WestcliffonSea Just come home from our hospital + I implore you-believe me, we are in a very bad way. Stay home during the DAY or NIGHT. Dont buy alcohol/coffee etc from pub windows- @MSEHospitals distance !

Topics

# data[].attributes.attachment_link.title
NHS staff face burnout as Covid hospital admissions continue to rise

# data[].attributes.attachment_link.description
England's chief nurse has said that NHS and care staff are working incredibly hard to cope with record numbers of Covid-19 patients, amid concern that frontline staff are close to burnout. Ruth May pleaded with the public to follow the coronavirus advice to help relieve the pressure on hospital staff, after two days of record hospital admissions.

# data[].attributes.attachment_link.readable_text
All primary schools in London are set to close for the start of the new term after the government bowed to protests and legal pressure from the capital's local authorities.

The U-turn comes after the government initially named 50 education authorities in the south of England, including many of those in and around London, where primary schools would be closed to most pupils for the first two weeks of term.

But the list omitted several London areas where Covid-19 transmission rates remain high including the borough of Haringey, whose leaders said they was prepared to defy the government and support any schools that decided to close to protect staff and pupils.

The protests from local authority leaders came to a head with a letter to Education Secretary, Gavin Williamson, from nine London authorities, including Islington, Lambeth and the City of London, asking for their primary schools to be closed and suggesting they were prepared to take legal action.

The action provoked an emergency Cabinet Office meeting on New Year's Day, which signed off on the revision, adding the remaining 10 London education authorities to the government's contingency areas.

But the decision leaves question marks hanging over the government's decision-making, and stands as a further humiliating reverse for Williamson in his ill-fated tenure as Education Secretary.

Paul Whiteman, general secretary of the National Association of Head Teachers, said: "Just at the moment when we need some decisive leadership, the government is at sixes and sevens. There is no clear rationale for why some schools are being closed and others are not and why primaries and special schools are being treated differently to secondaries.

"The government appears to be following neither the science nor the advice of education professionals on how best to preserve the quality of education for young people. The government cannot expect to command public confidence with such a confusing and last-minute approach."

Several local authorities were preparing legal challenges to keep primary schools closed to most pupils next week despite not being in the list of 50 "contingency areas" named by the government.

"We ask in the strongest possible terms that your recommendation is urgently reviewed and that our primary schools are added to the list of those that are advised to move learning online, other than for vulnerable children and those of key workers, until 18 January, so that together we can help stop the spread of coronavirus and save lives.

"We are advised by leading counsel that the omissions from the list are unlawful on a number of grounds and can be challenged in court," the letter from the nine London authorities to Williamson, signed by nine authority leaders, states.

Primary school heads in London report that they are facing staff shortages since the Christmas break because of the spread of Covid-19 and its more infectious variant B117.

Meanwhile, the government faces a further rebellion from secondary school leaders in England over its demand that testing pupils is to be mandatory from 11 January.

School leaders and teaching unions have been meeting over the New Year period to discuss a joint response to the demand, with many heads arguing that the testing regime is impractical and unworkable.

# data[].attributes.attachment_link.title
All primary schools in London to remain closed after U-turn

# data[].attributes.attachment_link.description
All primary schools in London are set to close for the start of the new term after the government bowed to protests and legal pressure from the capital's local authorities. The U-turn comes after the government initially named 50 education authorities in the south of England, including many of those in and around London, where primary schools would be closed to most pupils for the first two weeks of term.

# data[].attributes.body
https://www.bbc.co.uk/news/health-55507012

# data[].attributes.attachment_link.readable_text
The next few weeks will be "nail-bitingly difficult" for the NHS, hospital bosses have warned.

Staff absences and the new Covid variant are creating a "challenging situation", Saffron Cordery, of NHS Providers, which represents hospital trusts in England, said.

Doctors are urging the public to "take it seriously and follow the rules" to protect the health service.

From Monday, all schools in the capital will now be required to provide remote learning.

Primaries in nine London boroughs and the City of London district had been set to reopen - while those in the remaining 23 boroughs would have stayed closed from 4 January.

Meanwhile, new analysis by Imperial College London has confirmed the new variant of coronavirus has a much quicker rate of transmission than the original strain.

It found that more than a third of these beds were occupied by patients with Covid-19 on Tuesday, and in three trusts - North Middlesex in London, and Medway and Dartford and Gravesham in Kent - the figure was more than half.

Based on the recent rise in numbers, the analysis suggests that all acute and general beds might soon be filled with Covid-19 patients.

Speaking on BBC Breakfast, Ms Cordery said the surging transmission and death rates were "incredibly hard to deal with".

"When we are seeing major London trusts saying they are under pressure, that's when we know we're in a very challenging space," she said.

A leading intensive care doctor has urged people to follow restrictions until the vaccination programme is fully rolled out.

Prof Anthony Gordon, of Imperial College, told BBC Radio 4's Today programme: "There is light at the end of the tunnel so I would urge people to hold on for these few more months while the vaccination programme makes that difference and then we can truly get back to normal.

"But we can't overrun the health service because this will just lead to thousands more deaths."

Adrian Boyle, vice-president of the Royal College of Emergency Medicine, urged people to follow guidance on hand washing, social distancing and face coverings to stop the "entirely preventable" spread of the virus.

Dr Boyle said staff are "tired" and at risk of "burnout", having "worked really hard over the summer" and "put up with a lot of disruption".

"This time people are frustrated, this is now an entirely preventable disease, we know what we did in spring made a lot of this go away. There's also now a vaccine," he added.

More than three-quarters of England is currently under the strictest tier four - "stay at home" - coronavirus measures, and other parts of the country have joined higher tiers.

Mainland Scotland, Northern Ireland and Wales are under lockdown.

There are also concerns the added pressures of rising numbers of Covid patients seen at London hospitals have begun to spread across the country.

Speaking on Today, Dr Alison Pittard, of the Faculty of Intensive Care Medicine, said it was "only a matter of time before it starts to spread to other parts of country", adding that "we're already starting to see that".

She stressed it was "really important that we try and stop the transmission in the community because that translates into hospital admissions".

It comes as almost half the major hospital trusts in England are said to be dealing with more Covid-19 patients than at the peak of the first wave in April.

And pressure has been so great on some hospitals in London and south-east England that some patients have been moved out of the area.

However, Mike Adams, director of the Royal College of Nursing, questioned whether there were the staff available to run the hospital.

"Nursing is already stretched beyond capacity so there is no magic pile of nurses we can call upon," he told BBC Radio 4's World at One programme.

"I think the real battle is reducing the spread of the virus and getting the vaccine rolled out."

The new coronavirus variant has driven a big rise in cases, with the worst effects felt so far in London.

The UK's latest R number has been estimated at between 1.1 and 1.3. It needs to be below 1.0 for the number of cases to start falling.

Prof Axel Gandy, from the statistic section of Imperial College London, told the Today programme this higher rate of infection means that transmission of the disease would have tripled even during England's November lockdown conditions.

The hunt is now on to find new ways to slow the spread of coronavirus, with the rules on mask wearing potentially coming up for review.

Behavioural science group SPI-B (Scientific Pandemic Insights Group on Behaviours), which reports to the Sage group of government advisers, has said that mandatory face coverings may be necessary in a wider number of settings, such as in workplaces and possibly outdoors.

However, Dr Simon Clarke, associate professor of cellular microbiology at the University of Reading, told BBC Radio 4's World at One he was not convinced a move towards making the wearing of face coverings mandatory outdoors would make "much difference" to transmission rates.

He said the "bigger problem" was people touching their face covering or wearing it incorrectly, adding ministers should focus on ensuring people knew how to wear them and to change and wash them regularly.

The rollout of the newly approved Oxford-AstraZeneca vaccine will begin on Monday, almost a month after the Pfizer-BioNTech jab.

Second doses of either will now take place within 12 weeks rather than 21 days as had been initially planned with the Pfizer vaccine.

The UK has welcomed 2021 with a fireworks and light display over London that included tributes to NHS staff

Most people heeded warnings to stay at home and celebrate, but police issued fines to those who did not

Edinburgh's traditional Hogmanay street party was cancelled, with videos of a drone display filmed across Scotland released instead

First Minister Nicola Sturgeon has warned the next few weeks could be the most dangerous period for Scotland since March in the fight against Covid, saying the new variant was "accelerating spread" of the virus

The delayed 2020 Tokyo Olympics and Paralympics will go ahead this summer despite concern over rising coronavirus cases, says Japan's prime minister

# data[].attributes.attachment_link.title
Covid: 'Nail-biting' weeks ahead for NHS, hospitals in England warn

# data[].attributes.attachment_link.description
The next few weeks will be "nail-bitingly difficult" for the NHS, hospital bosses have warned. Staff absences and the new Covid variant are creating a "challenging situation", Saffron Cordery, of NHS Providers, which represents hospital trusts in England, said. Doctors are urging the public to "take it seriously and follow the rules" to protect the health service.

# data[].attributes.attachment_link.readable_text
"It is making me actually very angry now that people are laying the blame on the virus, and it is not the virus, it is people, people are not washing their hands, they are not wearing their masks," he said.

# data[].attributes.attachment_link.title
Covid rule-breakers 'have blood on their hands'

# data[].attributes.attachment_link.description
"It is making me actually very angry now that people are laying the blame on the virus, and it is not the virus, it is people, people are not washing their hands, they are not wearing their masks," he said.

# data[].attributes.attachment_link.readable_text
"If people clapped for us now, excuse my language but I would probably just tell them to fuck off," said the exhausted junior doctor facing January in Britain on an overcrowded intensive care unit. "The majority of people, even people I know who are supposed to be sensible, are all doing things they shouldn't be and still bubbling with their 80-year-old mother. It feels like almost everyone is breaking the rules in a dangerous way."

The doctor, who asked not to be named, was training in a hospital in the West Midlands. Like many medics she said she felt increasingly frustrated at the behaviour of people who might have applauded the NHS on their doorsteps in the spring. It had been a hard year watching patients struggle for breath and, ultimately, life.

"It's not just elderly people, but people in their 50s, people in their 30s with no comorbidities, who haven't made it," she said. '"We've had two pregnant women in ICU. We had one couple come in, neither were that old but both very ill, and I had to tell one of them that their partner had died. It has been really tough."

The West Midlands, like much of England, is now in tier 4, the highest level of coronavirus restrictions. Yet outside the hospital, she said, too many people were behaving recklessly.

"I cannot go to the shops because it makes me so upset and so angry. I needed milk the other day and I didn't get it because I couldn't face going into the shop near me - seeing people without masks on and with their masks around their chins just drives me mad. It feels like a complete slap in the face."

In London, Hugh Montgomery, a professor who works in intensive care at the Whittington hospital in London, went further. Anyone not social distancing or following the rules had "blood on their hands", he said.

He told BBC 5 live: "They are spreading this virus. Other people will spread it and people will die. They won't know they have killed people, but they have."

In Greater Manchester, also in tier 4, hospital admissions for Covid are creeping back up again. At one emergency department this Thursday a woman in her 90s was admitted. "She'd caught Covid from her family on Christmas Day," said a consultant, who added that she feared her hospital could be overwhelmed within a few weeks.

Although hospitals in the north-west of England were not yet under the same pressure as their London counterparts, ward space was already running out, said the consultant. Ambulances are backing up, corridors are filling with patients on trolleys and it is becoming increasingly difficult to separate Covid cases from people with other illnesses.

"Our greatest fear is we will become overwhelmed," the consultant said. "At the moment we are treating everybody. It might not be in the safest, most socially distant way, but if you come in with a serious problem you will be treated and it will be fine, though a few people might get Covid. But it's getting to the stage where if we have a massive influx of Covid patients our ability to manage that is going to be really seriously compromised."

The consultant said she did not mind that people were no longer out on their doorsteps clapping every Thursday to show support for the NHS, but wished they would think more about how their behaviour could affect others.

"People don't realise or maybe care that what they do as an individual, the risks they are prepared to take, doesn't just affect them - they think 'well, it's up to me'. But they might be asymptomatic and could give it to somebody who could die."

On Wednesday, she said, she had ducked into a hairdresser for a trim before the shutters came down under tier 4, and was horrified to see how many people were bending the rules. "There were two places doing takeaway food and drink and they were basically running an outdoor bar. It seemed to me everyone where I live was going there, buying alcohol and having a night out. I had to fight my way past literally 15 people, all outside the door of the hairdressers, all without masks on because they were drinking. I was thinking, are you crazy?"

She added: "It might feel nice now but it's just not caring. I try not to say anything because people are already on edge, but it's so frustrating. These are people who really should know better."
Topics

# data[].attributes.attachment_link.title
Doctors in England despair over disregard for Covid restrictions

# data[].attributes.attachment_link.description
"If people clapped for us now, excuse my language but I would probably just tell them to fuck off," said the exhausted junior doctor facing January in Britain on an overcrowded intensive care unit. "The majority of people, even people I know who are supposed to be sensible, are all doing things they shouldn't be and still bubbling with their 80-year-old mother.

# data[].attributes.attachment_link.readable_text
The Oxford-AstraZeneca vaccine has been approved for use in the UK, with the first doses due to be given on Monday.

There will be 530,000 doses available from next week, and vaccination centres will now start inviting patients to come and get the jab.

Priority groups for immunisation have already been identified, starting with care home residents, the over-80s, and health and care workers.

It comes as millions more in England are placed in tier four restrictions.

The UK has ordered 100 million doses of the new vaccine - enough to vaccinate 50 million people.

Eventually all over 50s and younger adults with health conditions will be offered a jab in the first phase of the rollout - more than 25 million people in total.

It is hoped that about two million patients a week could soon be vaccinated with two vaccines now approved.

On Tuesday, 53,135 new Covid cases were recorded in the UK - the highest single day rise since mass testing began - as well as 414 more deaths within 28 days of a positive test.

The Medicines and Healthcare products Regulatory Agency (MHRA) has authorised two full doses of the Oxford vaccine, with the second dose to be given four to 12 weeks after the first.

The immunisation campaign will now shift to giving as many people as possible their first dose of vaccine with a second dose following within that period.

When the Pfizer-BioNTech jab rollout began, the aim was to give the second dose after three weeks.

But based on advice from the Joint Committee on Vaccination and Immunisation, the aim now is to give as many vulnerable people some protection from Covid-19, irrespective of the jab they are given.

The Oxford vaccine is easier to store and distribute, as it can be kept at normal fridge temperature unlike the Pfizer-BioNTech jab that has to be kept at -70C.

There is also more confidence about supply as it is UK-made, whereas the Pfizer-BioNTech jab has to be shipped in from Belgium.

Pregnant and breastfeeding women can now take either of the two approved coronavirus vaccines "when the potential benefits outweigh the risks", experts said at an MHRA news conference.

The Pfizer/BioNTech vaccine can also now be administered to people with a wide range of food and medicine allergies, but people allergic to ingredients in the vaccine should not take it.

Dr June Raine, chief executive of the MHRA, told the briefing that "no corners have been cut" in assessing the safety and effectiveness of the Oxford-AstraZeneca jab.

Prime Minister Boris Johnson has hailed the latest vaccine development as "a triumph" for British science, adding: "We will now move to vaccinate as many people as quickly as possible."

And England's chief medical officer Chris Whitty praised the "considerable collective effort that has brought us to this point".

Mr Hancock told the Commons the vaccine's approval was "a huge British success story ", and "the single biggest stride that we've been able to take since this pandemic began."

Speaking on the BBC earlier he said the UK now had enough coronavirus jabs ordered, including the Pfizer vaccine, to vaccinate "the whole population".

"We've got 100 million doses on order - add that to the 30 million doses of Pfizer and that's enough for two doses for the entire population," he said.

Earlier, Prof Andrew Pollard, director of the Oxford Vaccine Group, told BBC Radio 4's Today programme the vaccine approval was an "astonishing achievement" in science and clinical research.

But he said there was still "more work to do", warning: "It's not over yet."

"Our colleagues in hospital are facing some real horrors caused by this virus. The next steps are critical," he said.

Trials showed two full doses of the Pfizer-BioNTech jab were 95% effective at preventing infection, while the Oxford-AstraZeneca vaccine showed 62% effectiveness - although even in cases where people were infected, there were no cases of serious illness needing hospital treatment.

Trials of the Oxford-AstraZeneca vaccine also showed that when people were given a half dose then a full dose, effectiveness hit 90%.

But there was not enough clear data to approve the half-dose, full-dose idea.

However, unpublished data suggests that leaving a longer gap between the first and second doses increases the overall effectiveness of the jab - in the sub-group given the vaccine this way it was found to be 70% effective after the first dose.

All the vaccines are expected to be equally effective against the new variants of the virus that have emerged.

More than 600,000 people in the UK have been vaccinated with the Pfizer-BioNTech jab since Margaret Keenan became the first person in the world to be given a Covid vaccine outside a clinical trial.

The new vaccine approval comes after Public Health England said the country was facing "unprecedented" levels of infections, and health officials in parts of Wales, Scotland and the south of England voiced concerns about the increasing pressure on the NHS.

Do you have any questions about the coronavirus vaccine? Email haveyoursay@bbc.co.uk.

Or use this form to get in touch:

If you are reading this page and can't see the form you will need to visit the mobile version of the BBC website to submit your comment or send it via email to HaveYourSay@bbc.co.uk. Please include your name, age and location with any comment you send in.

# data[].attributes.attachment_link.title
Covid-19: Oxford-AstraZeneca vaccine approved for use in UK

# data[].attributes.attachment_link.description
The Oxford-AstraZeneca vaccine has been approved for use in the UK, with the first doses due to be given on Monday. There will be 530,000 doses available from next week, and vaccination centres will now start inviting patients to come and get the jab.

# data[].attributes.attachment_link.readable_text
Education Secretary Gavin Williamson told the Commons that exam-year pupils would return a week earlier than their schoolmates in the week of 11 January.

In the meantime, schools will have more time to set up mass testing plans.

In a few areas with the highest infection rates, primaries would remain closed temporarily, he added.

The areas where primary schools would remain closed are: most of London, much of Essex and Kent, Hastings and Rother in East Sussex, Milton Keynes and parts of Hertfordshire.

Mr Williamson said the temporary school shutdowns would cut chains of transmission. Primary closures would be reviewed every two weeks.

But teaching unions said the move did not go far enough, and one labelled it another "last-minute mess". They have been calling for a working test-and-trace system since before schools returned from the lockdown in September.

The move comes after most of England was put into the toughest tier four restrictions, and follows warnings from medics about pressure on hospitals - and from government scientists about the increasing contagiousness of the new strain of coronavirus.

Prime Minister Boris Johnson said: "We must face the reality. The sheer pace of and spread of this new variant requires us to to take even tougher action in some areas."

He stressed that the children of key workers and vulnerable pupils would still be able to return to primaries or secondaries next week.

"At this critical moment, with the prospect of freedom within reach - we've got to redouble our efforts to contain the virus," he said.

Mr Williamson said the delay in reopening secondary schools would allow head teachers to develop and set up mass testing plans for their pupils.

"In the face of a rapidly changing situation, I am determined to act to preserve lives and the NHS, as we continue to protect education and put children first.

"We are making changes to the start of term to give more time for the rollout of our first of its kind rapid testing programme, to identify students who have the virus but don't display any symptoms."

He added that the government expects to deliver 50,000 devices to schools across the country on 4 January to support remote learning, with 100,000 devices to be delivered during the first week of term.

But Kate Green, Labour shadow education secretary, said: "Only days before many schools should have been opening again to all pupils, the secretary of state has announced that many will not be returning as planned.

"This delay and disruption to children's education is a direct result of the government's failure. They've lost control of the virus. Now they're losing control of children's education."

Her Labour colleague, Yvette Cooper, said schools in her constituency had received no support or allocation of funding, and no contact from the military, which has been organising testing in some schools.

She added: "They all want to do this mass testing but the support they are getting is always too late, too chaotic."

High Covid rates

But Mr Williamson said the testing programme would help keep education settings as safe as possible for all students.

"Because Covid infection rate is particularly high among this age group," he said, "we are going to allow more time so that every school and college is able to fully roll out testing for their pupils and staff.

"This kind of mass testing will help protect not just children and young people, but benefit everyone in the community.

"It will break those chains of transmission that are making infection rates shoot up."

The primary schools affected would be reopened as soon as possible, Mr Williamson said, adding that testing for primary school staff would follow in January.

'Last-minute mess'

It is a significant step, as ministers have repeatedly stated that schools would remain open - and even threatened council areas which wanted to close their schools early for Christmas with legal action.

The general secretary of the Nasuwt teachers' union, Patrick Roach, said the announcement offered belated clarity but did not go far enough.

"Stronger preventative action is needed to limit the further transmission of the coronavirus in schools and colleges, including enabling the greater use of remote and blended learning which would enable effective social distancing, which is vital to minimising virus transmission."

The leader of the National Association of Head Teachers, Paul Whiteman, said: "This is another last-minute mess which could so easily have been avoided if the government had listened to school leaders before the holidays.

"Instead, back then, schools which wanted to shift to remote learning were threatened with legal action. Now we have a situation where the government is instructing schools to reduce the amount of teaching time available.

"If we'd had the freedom to take action before the holidays, we might have been in a position to have more schools open for more pupils. School leaders will be baffled, frustrated and justifiably angry tonight."

Schools were struggling to remain Covid-safe during the autumn term, despite the intense efforts of teachers and staff, with huge numbers of pupils contracting the virus and then being sent home.

All primary schools had been due to fully reopen on 4 January, along with secondary schools opening for vulnerable children and those sitting exams this year (Years 11 and 13).

Remaining secondary school pupils were to start term working remotely from home.

Effectively, the whole process has been shunted back a week. This is two weeks after the usual start of term.

Scotland: Schools will start term on 11 January, with learning taking place online until at least 18 January.

Wales: Term will start with online learning, but the majority of pupils are expected to resume face-to-face lessons by 11 January. A full return to the classroom is expected to be completed by 18 January.

Northern Ireland: All schools will initially reopen for face-to-face teaching at the start of term, but years 8 to 10 will move to remote learning from 25 January for at least two weeks.

Schools in all the UK nations are remaining open for vulnerable children. England, Wales and Scotland have also committed to maintaining face-to-face teaching for children of key workers.

Do you work in a school? Will you be affected by mass testing in schools? Email haveyoursay@bbc.co.uk.

Please include a contact number if you are willing to speak to a BBC journalist. You can also get in touch in the following ways:

If you are reading this page and can't see the form you will need to visit the mobile version of the BBC website to submit your question or comment or you can email us at HaveYourSay@bbc.co.uk. Please include your name, age and location with any submission.

# data[].attributes.attachment_link.title
Covid: Secondary school new term delayed by two weeks

# data[].attributes.attachment_link.description
Education Secretary Gavin Williamson told the Commons that exam-year pupils would return a week earlier than their schoolmates in the week of 11 January. In the meantime, schools will have more time to set up mass testing plans. In a few areas with the highest infection rates, primaries would remain closed temporarily, he added.

# data[].attributes.body
https://www.independent.co.uk/news/health/coronavirus-uk-update-latest-news-live-covid-b1779814.html

# data[].attributes.attachment_link.readable_text
It's 5pm in a busy London hospital and a patient who came in a few days ago has deteriorated rapidly. The woman in her 60s has coronavirus. In a few days, she has gone from coping well to her oxygen levels dropping dramatically.

This is a moment that replays in the mind of Ian (not his real name), a junior doctor who works in an infectious diseases unit in the capital. It stands out for a number of reasons: Ian had barely eaten that day, surviving an unrelenting shift on coffee, and his unit - which usually has 30 patients a day when things are busy - was full with 55 patients. The woman's deterioration was unexpected and she was someone who would normally be fit and healthy, with years of life ahead of her.

"I was stretched that day, working flat out ... and I got a call from nurses saying the patient was unresponsive and needed 100% oxygen via a face mask, which is bad news usually," Ian says.

Another doctor got there first and it appeared the patient had had a stroke. "We needed to try to call her husband and children to tell them what had happened and communicate it," he says, adding that these are people who never expected to get "that" call and in normal times it would not be happening. This was an otherwise perfectly healthy person.

It's been the hardest nine months of his career, he says, without any hesitancy in his voice. In the last few weeks in particular there has been a "palpable" sense of coronavirus cases rising.

"It happened really quickly with new patients coming in. We had three or four ... and then all of a sudden a few weeks ago the numbers started increasing at a rapid rate. The week before Christmas the number of new people was increasing by 30% per day."

Speaking over the phone on his day off, Ian says he fears he is reaching burnout, describing his long 12-hour shift, which starts at about 9am and ends after 9pm. The day is made up of ward rounds and meetings, assessing who needs tests and scans, or who might need to be referred to intensive care.

He says he has become less able to cope with "unexpected things happening".
NHS boss praises staff 'in the eye of the storm' as Covid cases surge
"You start feeling like you become less empathetic and treat patients more as numbers than humans. You react to stresses in the rest of your life in a more adverse way and you often start to become hard to be around. Essentially, you don't have the emotional reserve," he adds, noting that it takes its toll on personal relationships.

At a recent evening meeting, an emergency buzzer went off to signal a patient was having a cardiac arrest. The man died. After that day, Ian came home and burst into tears due to the "enormous pressure and stress" he was feeling.

"It had been a really hard day, one where you don't get breaks and I had been pushing through. I had been in the hospital for 14 hours ... it's those moments where the light at the end of the tunnel seems too far off and you really struggle," he says.

Obviously, there have been lighter moments, such as seeing patients poorly with Covid recovering, but as they enter another busy period, Ian's emotional reserves are depleted. He also doesn't have the normal releases, such as going on holiday with his partner.

He is lucky because his hospital is relatively well resourced, he says, and while they have not run out of beds, his patient list is just getting longer. He has heard from colleagues who are facing worse.

"We have not had to call incident [due to running out of beds] but it is early days and I imagine we will get close, if not having to do something similar before the whole process is out. Elsewhere things are dire already. For example, a colleague of mine said a patient had to be transferred from an intensive care unit in Kent to Bristol as that was the nearest hospital that could provide help. In normal times that would be unheard of."

He has been able to have a break over the last few days but fears what he faces on his return to the hospital. "Now the second wave is upon us, I have got this constant fear in the background ... I know I am going to go back to carnage, it makes it hard to relax in the best of times really.

"And you just know we are in for a horrendous few months. There is a sense of foreboding that I first had when this kicked off in March."
Topics

# data[].attributes.attachment_link.title
'I'm going back to carnage': a junior doctor on working under Covid

# data[].attributes.attachment_link.description
It's 5pm in a busy London hospital and a patient who came in a few days ago has deteriorated rapidly. The woman in her 60s has coronavirus. In a few days, she has gone from coping well to her oxygen levels dropping dramatically.

# data[].attributes.attachment_link.readable_text
Secondary schools in England are unlikely to fully reopen until after mid-January at the earliest, according to new plans being thrashed out within government that would also see school staff be given high priority for Covid vaccinations.

According to government sources, ministers are torn between heeding its scientific advisers over the rapid spread of the new Covid variant, and warnings from the Department for Education that switching to remote learning for the whole of January would make it hard for schools and colleges to reopen again before Easter, jeopardising next year's exams.

The revised timetable being discussed would see only older students who are taking exams, such as A-levels and GCSEs, receiving remote teaching for the week from 4 January, effectively giving most secondary pupils an extra week's holiday while schools and colleges gear up to carry out mass testing.

For the week beginning 11 January, those taking exams, mainly years 11 and 13, would be allowed back in the classroom while others were taught remotely, followed by all year groups returning in person from 18 January.

Primary schools are unlikely to be affected, and would return according to their normal timetable. Vulnerable secondary-aged children would be able to return to school premises from 4 January, regardless of year group.

Boris Johnson is said to be considering the proposals and the final decision is likely to be announced on Wednesday alongside the tier review for England and more data on the national infection rate.

Geoff Barton, the general secretary of the Association of School and College Leaders, said: "We haven't had any contact from the government since Christmas about whether or not the spring term will go ahead as planned, and it has been intensely frustrating that there has been a swirl of speculation with no clarity and with less than a week before term begins.

"We are expecting to speak with the government shortly and we will be pressing for schools and colleges to be given clear guidance as soon as possible."

The government is also likely to reveal that school staff, including teachers, would be moved into a higher priority group to receive Covid vaccinations, but still below NHS workers and the most vulnerable groups.

"We would very much welcome any plans to prioritise school and college staff for Covid vaccinations because they are being asked to go into an environment which is inherently busy and crowded. Vaccinations would give them extra reassurance, reduce the need for staff to self-isolate, and mean less disruption," Barton said.

The new timetable effectively pushes back the government's plans for a staggered start by a further week compared with the plans it announced before Christmas.

The DfE will also recommit to regular mass testing of asymptomatic school staff and secondary school and college students. The government is expecting secondary schools and colleges to recruit and organise volunteers to conduct testing, while those unable to do so will require 10-days self-isolation for staff and students before returning to school.

The government has promised head teachers the assistance of 1,500 military personnel to prepare for the mass testing regime already announced. But with nearly 4,000 secondary schools and colleges in England, in most cases the direct help will be limited to phone and video calls.

The debates within Whitehall were given fresh urgency after advice from the Scientific Advisory Group for Emergencies (Sage) that the rate of infections could spiral out of control unless schools are closed for the whole of January.

The new timetable supported by the DfE is seen as treading a fine line between extended school closures, which would imperil the sitting of GCSEs and other exams in summer, and the demands to tackle the spread of infection. But concerns remain over how parents and teachers will react to minimal closures, with fears that both groups could vote with their feet and stay away while the virus remains unchecked.

The prime minister's spokesman said on Tuesday: "We're still planning for a staggered opening of schools and we're working to ensure testing is in place.

"But as we've said throughout the pandemic, we obviously keep all measures under constant review."

Pressed on whether all parents could be assured there would be no changes to the timetable next week, the spokesman insisted the government was "planning for a staggered opening of schools" but reasserted that all measures were under review.

Asked if there were any plans for education staff to be prioritised for the vaccine after teaching union leaders called for them to receive jabs alongside health workers, the spokesman said the Joint Committee on Vaccination and Immunisation had clearly set out the first phase of those who should receive the vaccine. "We've always been clear that we need to ensure that we provide the vaccine to those who are seen to be the most clinically vulnerable and that's what we're doing," he added.
Topics

# data[].attributes.attachment_link.title
English secondary schools unlikely to fully open until mid-January at earliest

# data[].attributes.attachment_link.description
Secondary schools in England are unlikely to fully reopen until after mid-January at the earliest, according to new plans being thrashed out within government that would also see school staff be given high priority for Covid vaccinations.

# data[].attributes.attachment_link.readable_text
England's "very high" Covid infection level is a "growing concern" as the NHS struggles to cope with rising patient numbers, a health official has said.

Some data for Scotland and Northern Ireland is not being released over the Christmas period.

Dr Yvonne Doyle, medical director at Public Health England, said: "Despite unprecedented levels of infection, there is hope on the horizon."

She urged members of the public to "continue to play our part in stopping the spread of the virus" as the Pfizer/BioNTech coronavirus vaccine is rolled out.

"This very high level of infection is of growing concern at a time when our hospitals are at their most vulnerable, with new admissions rising in many regions," Dr Doyle said in a statement.

There were 21,286 people in hospital with coronavirus across the UK on 22 December - the last day for which data is available - according to government figures.

Scotland is not releasing data around deaths between 24 and 28 December, while Northern Ireland is not providing either case or death data.

'We cope at a cost'

Hospitals in Wales, Scotland and the south of England have reported a rising pressure on their services as the number of Covid patients rises.

The president of the Royal College of Emergency Medicine said she saw "wall to wall Covid" when she worked at one London hospital on Christmas Day.

Dr Katherine Henderson told the BBC there was a "great deal of difficulty" getting patients into wards.

She added: "The chances are that we will cope, but we cope at a cost - the cost is not doing what we had hoped, which is being able to keep non-Covid activities going.

"It is always challenging in winter, nobody would say that it wasn't, but at the moment the level of patient need is incredibly high."

A Public Health Wales official said hospitals were under enormous and unprecedented pressure.

Prof Jackie Taylor, president of the Royal College of Physicians and Surgeons of Glasgow, said: "We are still seeing significant amounts of patients with Covid and large amounts of standard respiratory infections and other emergency that we see at this time of year."

The chief executive of Homerton hospital in east London urged people to comply with the tier four restrictions in force.

Infection rates in England are currently highest in areas of Essex, London and other parts of the South East.

Cabinet Office minister Michael Gove said the government's tiered system for coronavirus rules in England was the "right strategy - but the important thing to do is take into account the emerging scientific and medical evidence".

Some 24 million people in the south-east and east of England - about 43% of the population - are now living under the strictest tier four rules and a review on 30 December could see more areas placed under the restrictions.

Mr Gove said: "I can't pre-empt that because it obviously has to be a judgement based on the medical situation. But... the NHS is under pressure and these are difficult months ahead."

Mainland Scotland entered level four restrictions from Saturday for three weeks, and similar rules are in place in Wales. Northern Ireland has also entered a new six-week lockdown.

The 7,918 calls it received was up more than 2,500 on the same day last year. An LAS memo said the rising demand was down to the "rapid spread of the new variant of the Covid-19 virus".

Figures seen by the BBC show at one London hospital on Sunday morning, ambulance crews were typically waiting nearly six hours to hand over patients to staff.

One paramedic told the BBC that some patients had been treated in ambulance bays because of a shortage of beds and staff were finding the whole situation "very stressful".

NHS England said coronavirus vaccinations had been paused on Christmas Day and over the weekend but would resume on Monday.

The vaccine from Pfizer/BioNTech was the first to be given approval in the UK.

Prof Andrew Pollard, the chief investigator of the vaccine developed by the University of Oxford and AstraZeneca, said they were hoping regulators would soon give their approval for its use.

How have you been affected by the issues in this story? Email haveyoursay@bbc.co.uk.

Please include a contact number if you are willing to speak to a BBC journalist. You can also get in touch in the following ways:

If you are reading this page and can't see the form you will need to visit the mobile version of the BBC website to submit your question or comment or you can email us at HaveYourSay@bbc.co.uk. Please include your name, age and location with any submission.

# data[].attributes.attachment_link.title
Covid-19: Concern at 'unprecedented' infection level in England

# data[].attributes.attachment_link.description
England's "very high" Covid infection level is a "growing concern" as the NHS struggles to cope with rising patient numbers, a health official has said. Some data for Scotland and Northern Ireland is not being released over the Christmas period.

# data[].attributes.body
https://www.bbc.co.uk/news/world-asia-china-55463241

# data[].attributes.attachment_link.readable_text
When Covid-19 sparked lockdowns around the world, emissions of one of the greenhouse gases responsible for climate change, atmospheric carbon dioxide, plummeted. But is this record drop a short-term effect of the 2020 pandemic or a 'new normal'? BBC Weather's Ben Rich explores the impact of coronavirus on the global climate.
Motion graphics by Jacqueline Galvin Produced by Soraya Auer

# data[].attributes.attachment_link.title
What impact has Covid had on global climate?

# data[].attributes.attachment_link.description
When Covid-19 sparked lockdowns around the world, emissions of one of the greenhouse gases responsible for climate change, atmospheric carbon dioxide, plummeted. But is this record drop a short-term effect of the 2020 pandemic or a 'new normal'? BBC Weather's Ben Rich explores the impact of coronavirus on the global climate.

# data[].attributes.attachment_link.readable_text
Find out what tier your area is in
This guidance is for people who are fit and well. There is additional advice for:

If you live in a Tier 4 area, you must follow the rules below. This means that you cannot leave or be outside of the place you are living unless you have a reasonable excuse. You cannot meet other people indoors, including over the Christmas and New Year period, unless you live with them, or they are part of your support bubble. Outdoors, you can only meet one person from another household. These rules will not be relaxed for Christmas for Tier 4 - you cannot form a Christmas bubble in Tier 4.

Hands. Face. Space

Approximately 1 in 3 people who have coronavirus have no symptoms and could be spreading it without realising it.

Remember - 'Hands. Face. Space.'

hands - wash your hands regularly and for at least 20 seconds

face - wear a face covering in indoor settings where social distancing may be difficult, and where you will come into contact with people you do not normally meet

space - stay 2 metres apart from people you do not live with where possible, or 1 metre with extra precautions in place (such as wearing face coverings)

When meeting people you do not live with, it is important to do so outdoors where possible. If you meet people you do not live with indoors, such as someone working in your home, then you should follow the guidance on meeting others safely including making sure you let as much fresh air in as you can (for example by opening windows). Follow the guidance on meeting others safely.

Stay at home

If you live in Tier 4 you must not leave or be outside of your home or garden except where you have a 'reasonable excuse'. A reasonable excuse includes:

Work and volunteering

You can leave home for work purposes, where your place of work remains open and where you cannot work from home, including if your job involves working in other people's homes.

Essential activities

You can leave home to buy things at shops or obtain services from a business which is permitted to open in your Tier 4 area, but you should stay local. For instance you can leave home to buy food or medicine, or to collect any items - including food or drink - ordered through click-and-collect or as a takeaway, to obtain or deposit money (e.g. from a bank or post office), or to access critical public services (see section below).

Fulfilling legal obligations

You may also leave home to fulfil legal obligations, or to carry out activities related to buying, selling, letting or renting a residential property, or where it is reasonably necessary for voting in an election or referendum.

Education and childcare

You can leave home for education related to the formal curriculum or training, registered childcare, under-18 sport and physical activity, and supervised activities for children that are necessary to allow parents/carers to work, seek work, or undertake education or training. Parents can still take their children to school, and people can continue existing arrangements for contact between parents and children where they live apart. This includes childcare bubbles.

Meeting others and care

1 in 3 people who have coronavirus have no symptoms and will be spreading it without realising it.

You can leave home to visit people in your support bubble, or to provide informal childcare for children aged 13 and under as part of a childcare bubble, to provide care for vulnerable people, to provide emergency assistance, attend a support group (of up to 15 people), or for respite care where that care is being provided to a vulnerable person or a person with a disability, or is a short break in respect of a looked after child.

Exercise and recreation

People can also exercise outdoors or visit some public outdoor places, such as parks, the countryside accessible to the public, public gardens or outdoor sports facilities. You can continue to do unlimited exercise alone, or in a public outdoor place with your household, support bubble, or with one other person if you maintain social distancing. You should follow the guidance on meeting others safely.

Medical reasons, harm and compassionate visits

You can leave home for a medical reason, including to get a COVID-19 test, for medical appointments and emergencies, to be with someone who is giving birth, to avoid injury or illness or to escape risk of harm (such as domestic abuse),or for animal welfare reasons - such as to attend veterinary services for advice or treatment.

You can also leave home to visit someone who is dying or someone in a care home (if permitted under care home guidance), hospice, or hospital, or to accompany them to a medical appointment.

If you are planning to visit, or accompany someone to, a care home, hospice, hospital or other healthcare setting, you should check that this is permitted by the facility.

Communal worship and life events

You can leave home to attend or visit:

a place of worship for communal worship

a funeral or event related to a death

a burial ground or a remembrance garden

a wedding ceremony

However, weddings, funerals and religious, belief-based or commemorative events linked to someone's death are all subject to limits on the numbers that can attend (see below).

Meeting others safely

In general, you must not meet socially or carry out any activities with another person. However, you can exercise or meet in a public outdoor place with people you live with, your support bubble (or as part of a childcare bubble), or with one other person.

You should minimise time spent outside your home. When around other people, stay 2 metres apart from anyone not in your household - meaning the people you live with - or your support bubble. Where this is not possible, stay 1 metre apart with extra precautions (e.g. wearing a face covering).

You must not meet socially indoors with family or friends unless they are part of your household or support bubble.

You can exercise or visit a public outdoor place:

by yourself

with the people you live with,

with your support bubble,

or, when on your own, with 1 person from another household.

Children under 5, and up to two carers for a person with a disability who needs continuous care are not counted towards the outdoors gatherings limit.

Public outdoor places include:

parks, beaches, countryside accessible to the public, forests

public gardens (whether or not you pay to enter them)

allotments

the grounds of a heritage site

outdoor sports courts and facilities

playgrounds

You cannot meet people in a private garden, unless you live with them or have formed a support bubble with them.

You must wear a face covering in many indoor settings, such as shops or places of worship where these remain open, and on public transport, unless you are exempt. This is the law. Read guidance on face coverings.

Support and childcare bubbles

There is separate guidance for support bubbles and childcare bubbles across all tiers. You can form a support bubble with another household if any of the following apply to you:

you are the only adult in your household (any other members of the household having been under 18 on 12 June 2020), or are an under 18 year old living without any adults

you live with someone with a disability who requires continuous care and there is no other adult living in the household

you live with a child under 1, or who was under 1 on 2 December 2020

you live with a child under 5, or who was under 5 on 2 December 2020, who has a disability and requires continuous care

You may need to change your support bubble if your circumstances change. Find out more about changing your support bubble.

You are permitted to leave your home to visit your support bubble (and to stay overnight with them). However, if you form a support bubble, it is best if this is with a household who live locally. This will help prevent the virus spreading from an area where more people are infected.

Where and when you can meet in larger groups

There are still circumstances in which you are allowed to meet others from outside your household or support bubble in larger groups, but this should not be for socialising and only for permitted purposes. A full list of these circumstances will be included in the regulations, and includes:

for work, or providing voluntary or charitable services. This includes picketing outside workplaces. This can include work in other people's homes where necessary - for example, for nannies, cleaners, social care workers providing support to children and families, or tradespeople. See guidance on working safely in other people's homes). Where a work meeting does not need to take place in a private home or garden, it should not - for example, although you can meet a personal trainer, you should do so in a public outdoor place.

in a childcare bubble(for the purposes of childcare only)

for registered childcare, or for supervised activities for children where this enables a parent to work, seek work, attend education or training, or for respite care

education or training - meaning education related to a formal curriculum or training that relates to work or obtaining work

for arrangements where children do not live in the same household as both their parents or guardians

to allow contact between birth parents and children in care, as well as between siblings in care

for prospective adopting parents to meet a child or children who may be placed with them

to place or facilitate the placing of a child or children in the care of another by social services

for birth partners

to provide emergency assistance, and to avoid injury or illness, or to escape a risk of harm

to see someone who is dying

to fulfil a legal obligation, such as attending court or jury service

for gatherings within criminal justice accommodation or immigration detention centres

to provide care or assistance to someone vulnerable, or to provide respite for a carer

for a wedding or equivalent ceremony in exceptional circumstances and only for up to 6 people

for funerals - up to a maximum of 30 people. Wakes and other linked ceremonial events can continue in a group of up to 6 people.

to visit someone at home who is dying, or to visit someone receiving treatment in a hospital, hospice or care home, or to accompany a family member or friend to a medical appointment

for elite sportspeople (and their coaches if necessary, or parents/guardians if they are under 18) to compete and train

to facilitate a house move

Support groups that have to be delivered in person can continue with up to 15 participants where formally organised to provide mutual aid, therapy or any other form of support - but they must take place at a premises other than a private home. This includes, but is not limited to, support to victims of crime, people in drug and alcohol recovery, new parents and guardians, people caring for those with long-term or terminal illnesses, or who are vulnerable, people facing issues relating to their sexuality or gender, those who have suffered bereavement, and vulnerable young people, including for them to meet youth workers.

Parent and child groups can continue where they provide support to parent and/or child, and children under 5 will not be counted within the 15 person limit - meaning parents and carers can attend such groups in larger numbers. These cannot take place in private dwellings.

Where a group includes someone covered by an exception (for example, someone who is working or volunteering), they are not generally counted as part of the gatherings limit. This means, for example, a tradesperson can go into a household without breaching the limit, if they are there for work, and the officiant at a wedding would not count towards the limit.

If you break the rules

The police can take action against you if you meet in larger groups. This includes breaking up illegal gatherings and issuing fines (fixed penalty notices).

You can be given a Fixed Penalty Notice of £200 for the first offence, doubling for further offences up to a maximum of £6,400. If you hold, or are involved in holding, an illegal gathering of over 30 people, the police can issue fines of £10,000.

Keeping you and your friends and family safe

When meeting friends and family you should also:

If you are clinically vulnerable, you could be at higher risk of severe illness from coronavirus. You:

should be especially careful to follow the rules and minimise your contacts with others

should continue to wash your hands carefully and more frequently than usual and maintain thorough cleaning of frequently touched areas in your home and/or workspace

Clinically vulnerable people are those who are:

aged 70 or over (regardless of medical conditions)

under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab each year on medical grounds):

chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis

chronic heart disease, such as heart failure

chronic kidney disease

chronic liver disease, such as hepatitis

chronic neurological conditions, such as Parkinson's disease, motor neurone disease, multiple sclerosis (MS) or cerebral palsy

diabetes

problems with the spleen

a weakened immune system as the result of certain conditions or medicines they are taking (such as steroid tablets)

being seriously overweight (a body mass index (BMI) of 40 or above)

pregnant

There is a further group of people who are defined, also on medical grounds, as clinically extremely vulnerable to coronavirus - that is, people with specific serious health conditions.

Over this period, we are advising the clinically extremely vulnerable to work from home. If you cannot work from home, you are advised not to go to work and may be eligible for the Coronavirus Job Retention Scheme (CJRS), Statutory Sick Pay (SSP), Employment Support Allowance (ESA) or Universal Credit.

We are advising this group to stay at home as much as possible, except to go outdoors for exercise or to attend health appointments. You may wish to meet up with one other person from outside your household or support bubble, for example, to exercise in an outdoor public place. You should always try to do so as safely as possible by maintaining social distancing. Please follow the guidance set out in the shielding section of the CEV guidance.

Travel

Travelling within a Tier 4 area

If you live in a Tier 4 area, you must not leave your home unless you have a reasonable excuse (e.g. for work or education purposes). If you need to travel you should stay local - meaning avoiding travelling outside of your village, town or the part of a city where you live - and look to reduce the number of journeys you make overall. The list of reasons you can leave your home and area include, but are not limited to:

work, where you cannot work from home

accessing education and for caring responsibilities

visiting those in your support bubble - or your childcare bubble for childcare

visiting hospital, GP and other medical appointments or visits where you have had an accident or are concerned about your health

buying goods or services from premises that are open in Tier 4 areas, including essential retail, but these should be within your local area wherever possible

outdoor recreation or exercise. This should be done locally wherever possible, but you can travel a short distance within your Tier 4 area to do so if necessary (for example, to access an open space)

attending the care and exercise of an animal, or veterinary services

If you need to travel, walk or cycle where possible, and plan ahead and avoid busy times and routes on public transport. This will allow you to practice social distancing while you travel.

Avoid car sharing with anyone from outside your household or your support bubble. See the guidance on car sharing.

If you need to use public transport, you should follow the safer travel guidance.

Travelling out of a Tier 4 area

You must stay at home and not leave your Tier 4 area, other than for legally permitted reasons such as:

travel to work where you cannot work from home

travel to education and for caring responsibilities

visit or stay overnight with people in your support bubble, or your childcare bubble for childcare purposes

attend hospital, GP and other medical appointments or visits where you have had an accident or are concerned about your health

to provide emergency assistance, and to avoid injury or illness, or to escape a risk of harm (such as domestic abuse)

The full list of exceptions will be published in the Regulations.

Travelling to a Tier 4 area from a Tier 1, 2 or 3 area

You should not travel into a Tier 4 area from another part of the UK, other than for reasons such as:

travel to work where you cannot work from home

travel to education and for caring responsibilities

to visit (including staying overnight with) those in your support bubble - or your childcare bubble for childcare

to attend hospital, GP and other medical appointments or visits where you have had an accident or are concerned about your health

You should continue to practice safe behaviours on public transport:

plan ahead, check for disruption before you leave, and avoid the busiest routes, as well as busy times

avoid making unnecessary stops during your journey

avoid sharing a car with people not in your household

keep your distance from other people when you travel, where possible

wash or sanitise your hands regularly

International travel to or from a Tier 4 area

If you live in a Tier 4 area, you can only travel internationally - or within the UK - where you first have a legally permitted reason to leave home. In addition, you should consider the public health advice in the country you are visiting.

If you live outside a Tier 4 area you may still transit into or through a Tier 4 area to travel abroad if you need to, but you should carefully consider whether you need to do so. In addition, you should follow the public health advice in the country you're visiting.

If you do need to travel overseas from a Tier 4 area (and are legally permitted to do so, for example, because it is for work), even if you are returning to a place you've visited before, you should look at the rules in place at your destination and the Foreign, Commonwealth and Development Office (FCDO) travel advice.

UK residents currently abroad do not need to return home immediately. However, you should check with your airline or travel operator on arrangements for returning.

For foreign nationals, if you are a resident in a Tier 4 area you are subject to the 'Stay at Home' regulations. You should not travel abroad unless it is permitted.

If you are visiting the UK and are in a Tier 4 area, you may return home. You should check whether there are any restrictions in place at your destination.

Staying away from home overnight

You cannot leave your home or the place where you are living for holidays or overnight stays unless you have a reasonable excuse for doing so. This means that holidays in the UK and abroad are not allowed.

This includes staying in a second home or caravan, if that is not your primary residence. This also includes staying with anyone who you don't live with unless they're in your support bubble.

You are allowed to stay overnight away from your home if you:

are visiting your support bubble

are unable to return to your main residence

need accommodation while moving house

need accommodation to attend a funeral or related commemorative event

require accommodation for work purposes or to provide voluntary services

are a child requiring accommodation for school or care

are homeless, seeking asylum or a vulnerable person seeking refuge

are an elite athlete or their support staff or parent, if the athlete is under 18 and it is necessary to be outside of the home for training or competition

If you are already on holiday in a Tier 4 area, you should return to your home as soon as practical.

Guest accommodation providers such as hotels, B&Bs and caravan parks may remain open for the specific reasons set out in law, including where guests are unable to return to their main residence, use that guest accommodation as their main residence, need accommodation while moving house, are self-isolating as required by law, or would otherwise be made homeless as a result of the accommodation closing.

Accommodation providers are also encouraged to work cooperatively with Local Authorities to provide accommodation to vulnerable groups including the homeless in Tier 4 areas.

Businesses and venues

Businesses and venues which must close

To reduce social contact, the regulations require some businesses to close and impose restrictions on how some businesses provide goods and services. The businesses required to close include:

non-essential retail, such as clothing and homeware stores, vehicle showrooms (other than for rental), betting shops, tailors, tobacco and vape shops, electronic goods and mobile phone shops, auction houses (except for auctions of livestock or agricultural equipment) and market stalls selling non-essential goods - these venues can continue to be able to operate click-and-collect (where goods are pre-ordered and collected off the premises) and delivery services

hospitality venues such as cafes, restaurants, pubs, bars and social clubs; with the exception of providing food and drink for takeaway (until 11pm), click-and-collect, drive-through or delivery

accommodation such as hotels, hostels, guest houses and campsites, except for specific circumstances, such as where these act as someone's main residence, where the person cannot return home, for providing accommodation or support to the homeless, or where it is essential to stay there for work purposes

leisure and sports facilities such as leisure centres and indoor gyms, indoor swimming pools, indoor sports courts, indoor fitness and dance studios, indoor riding centres, and indoor climbing walls

entertainment venues such as theatres, concert halls, cinemas, museums and galleries, casinos, amusement arcades, bingo halls, bowling alleys, skating rinks, go-karting venues, indoor play and soft play centres and areas (including inflatable parks and trampolining centres), circuses, fairgrounds, funfairs, zoos and other animal attractions, water parks and theme parks

indoor attractions at venues such as botanical gardens, heritage homes and landmarks must also close, though outdoor grounds of these premises can stay open

personal care facilities such as hair, beauty, tanning and nail salons. Tattoo parlours, spas, massage parlours, body and skin piercing services must also close. These services should not be provided in other people's homes

community centres and halls must close except for a limited number of exempt activities, as set out below. Libraries can also remain open to provide access to IT and digital services - for example for people who do not have it at home - and for click-and-collect services

Some of these businesses and places will also be permitted to be open for a small number of exempt activities, including:

education and training - for schools to use sports, leisure and community facilities where that is part of their normal provision

childcare purposes and supervised activities for children

hosting blood donation sessions and food banks

to provide medical treatment

for elite sports persons to train and compete (in indoor and outdoor sports facilities), and professional dancers and choreographers to work (in fitness and dance studios)

for training and rehearsal without an audience (in theatres and concert halls)

for the purposes of film and TV filming

Businesses and venues which can remain open

Other businesses and venues are permitted to stay open, following COVID-19 Secure guidelines. This includes those providing essential goods and services, including:

essential retail such as food shops, supermarkets, pharmacies, garden centres, building merchants and suppliers of building products and off-licences

market stalls selling essential retail may also stay open

businesses providing repair services may also stay open, where they primarily offer repair services

petrol stations, automatic (but not manual) car washes, vehicle repair and MOT services, bicycle shops, and taxi and vehicle hire businesses

banks, building societies, post offices, short-term loan providers and money transfer businesses

funeral directors

laundrettes and dry cleaners

medical and dental services

vets and pet shops

animal rescue centres, boarding facilities, and animal groomers (may continue to be used for animal welfare, rather than aesthetic purposes)

agricultural supplies shops

mobility and disability support shops

storage and distribution facilities

car parks, public toilets and motorway service areas

outdoor playgrounds

outdoor gym, pools, sports courts and facilities

golf courses

archery/driving/shooting ranges (outdoors)

outdoor riding centres

places of worship

crematoriums and burial grounds

Public services

The majority of public services will continue and you will be able to leave home to visit them. These include:

the NHS and medical services like GPs and dentists. We are supporting the NHS to carry out urgent and non-urgent services safely, and it is vital anyone who thinks they need any kind of medical care comes forward and seeks help

Jobcentre Plus sites

courts and probation services

civil registrations offices

passport and visa services

services provided to victims

waste or recycling centres

Going to work

To help contain the virus, everyone who can work effectively from home should do so.

Where people cannot do so - including, but not limited to, people who work in critical national infrastructure, construction, or manufacturing - they should continue to travel to their workplace. This is essential to keeping the country operating and supporting sectors and employers.

Public sector employees working in essential services, including childcare or education, should continue to go into work.

Where it is necessary for you to work in other people's homes - for example, for nannies, cleaners or tradespeople - you can do so. Otherwise, you should avoid meeting for work in a private home or garden, where COVID-19 Secure measures may not be in place.

The risk of transmission can be substantially reduced if COVID-19 secure guidelines are followed closely. Extra consideration should be given to those people at higher risk.

Going to school, college and university

Schools and colleges will remain open during term time in Tier 4 areas. The government will continue to prioritise the wellbeing and long-term futures of our young people. It remains very important for children and young people to attend, to support their wellbeing and education and help working parents and guardians. Senior clinicians still advise that school is the best place for children to be, and so they should continue to go to school during term time.

Universities

We expect that the majority of university students, other than those who need or choose to remain at university, will now have returned to their family home during the 'student travel window', , although they are permitted to temporarily move to a "vacation household" during the period that began on 3 December up to 7 February. We have published guidance on how they can do so safely.

We have also published guidance to universities and students on how students can return safely to higher education in the spring term. This guidance sets out how we will support higher education providers to enable students to return as safely as possible following the winter break, by staggering this process and to facilitate testing for all.

If you live at university, you should not move back and forward between your permanent home and student home during term time.

Universities should follow guidance on reopening buildings to ensure they have safety measures in place to minimise the spread of the virus.

If you're a student, you can meet in groups of more than your household as part of your formal education or training. Students should expect to follow the guidance and restrictions. You should socially distance from anyone you do not live with wherever possible.

Schools

The Government has confirmed that all secondary schools and colleges in England will be offered help, support and facilities to implement an additional round of free coronavirus testing from the first week of January.

This will be alongside a staggered return to face-to-face education in secondary schools, starting with exam years, vulnerable children and children of critical workers.

The offer of tests builds on the extensive protective measures already in place in schools and colleges to make them safe, as well as the government's recent announcement that every secondary school and college in England will have access to rapid testing from January.

In schools and colleges where year 7 and above are educated, face coverings should be worn by adults (staff and visitors) and pupils when moving around indoors, such as in corridors and communal areas where social distancing is difficult to maintain.

There is guidance for teachers, school leaders, carers and parents on education and childcare.

Childcare

There are several ways that parents and carers can continue to access childcare in Tier 4 areas:

early years settings and childminders remain open, and you can continue to use these settings as normal

you can access other childcare activities (including wraparound care) where reasonably necessary to enable parents to work, seek work, attend education or training, a medical appointment or respite care

nannies will be able to continue to provide services, including in the home

parents are able to form a childcare bubble with one other household for the purposes of informal childcare, where the child is 13 or under

some households will also be able to benefit from being in a support bubble

Some youth services are able to continue, such as 1-1 youth work and support groups, but most youth clubs and groups will need to cease for this period.

Visiting relatives in care homes

Visits to care homes can take place with arrangements such as substantial screens, visiting pods, or behind windows. Close-contact indoor visits are not allowed.

You should check the guidance on visiting care homes during COVID-19 to find out how visits should be conducted.

Weddings, civil partnerships, religious services and funerals

Weddings, civil partnership ceremonies and funerals are allowed with strict limits on attendance, and must only take place in COVID-19 secure venues or in public outdoor spaces unless in exceptional circumstances.

Funerals can be attended by a maximum of 30 people. Linked religious, belief-based or commemorative events, such as stone settings and ash scatterings can also continue with up to 6 people in attendance. Anyone working is not counted in these limits. Social distancing should be maintained between people who do not live together or share a support bubble.

Weddings and civil partnership ceremonies must only take place with up to 6 people. Anyone working is not included. These should only take place in exceptional circumstances, for example, an urgent marriage where one of those getting married is seriously ill and not expected to recover, or is to undergo debilitating treatment or life-changing surgery.

If you live in a Tier 4 area and are going to a wedding, funeral or linked commemorative event outside the Tier 4 area, the event must follow the Tier 4 gathering limits on the events.

If you live outside a Tier 4 area and are going to a wedding, funeral or linked commemorative event inside the Tier 4 area, you must comply with the Tier 4 gathering limits on the events.

Places of worship

You can attend places of worship for a service. However, you must not mingle with anyone outside of your household or support bubble. You should maintain strict social distancing at all times.

You should follow the national guidance on the safe use of places of worship.

Sports and physical activity

Indoor gyms and sports facilities will close. Outdoor sports courts, outdoor gyms, golf courses, outdoor swimming pools, archery/driving/shooting ranges, riding centres and playgrounds can remain open for individual exercise, and for people to use with others within your household, support bubble, or with one person from another household. Organised outdoor sport for under 18s and disabled people will be allowed.

Moving home

You can still move home. People outside your household or support bubble should not help with moving house unless absolutely necessary.

Estate and letting agents and removals firms can continue to work. If you are looking to move, you can go to property viewings.

Follow the national guidance on moving home safely, which includes advice on social distancing, letting fresh air in, and wearing a face covering.

Financial support

Wherever you live, you may be able to get financial help:

# data[].attributes.attachment_link.description
Find out what tier your area is in This guidance is for people who are fit and well. There is additional advice for: If you live in a Tier 4 area, you must follow the rules below. This means that you cannot leave or be outside of the place you are living unless you have a reasonable excuse.

# data[].attributes.attachment_link.description
France has suspended any travel from the UK, meaning no lorries are allowed to leave the Port of Dover.

# data[].attributes.attachment_link.readable_text
More than 2,850 lorries are stuck in Kent waiting to leave the UK, the county council has said, as politicians thrash out a plan to reopen France's border to trade and travel.

France shut its UK border for 48 hours on Sunday amid fears of a new coronavirus variant.

Any solution would probably include testing for lorry drivers, BBC Paris correspondent Hugh Schofield said.

More than 50 countries have banned UK arrivals following widespread concern about the spread of the new variant.

People should be allowed to travel to their country of residence, provided they take a Covid-19 test or self-isolate, it said. But the commission added that non-essential travel should still be discouraged.

Currently, no lorries are leaving the Port of Dover or Eurotunnel to France.

The leader of Kent County Council, Roger Gough, told the BBC that 2,220 vehicles were at the temporary lorry park at Manston, while 632 were still being held on the M20.

It is the largest daily number of cases recorded yet, though it is thought the infection rate was higher during the first peak in spring when testing was much more limited.

Earlier, Home Secretary Priti Patel told BBC Breakfast discussions were under way between the UK and France "to find a resolution" to the Channel disruption, with an update on the situation expected later.

Prime Minister Boris Johnson and French President Emmanuel Macron spoke on Monday and, according to the BBC's Hugh Schofield, a solution to the blockage will probably include compulsory negative Covid tests for lorry drivers coming into France from the UK.

Any plans agreed between the leaders would come into effect on Wednesday, France's Europe minister, Clément Beaune, said.

Ms Patel said potentially testing lorry drivers at ports was "part of the discussions", adding that setting up testing for this could "happen relatively quickly".

EU member states are understood to be pressing for UK arrivals to be tested for the virus before entering their countries.

Bosses at Eurotunnel estimate that up to 2,500 freight vehicles are expected to arrive in the UK on Tuesday, and the same again on Wednesday.

The port of Harwich in Essex - which is about 130 miles from Dover by road - is also seeing a build up of lorries as drivers divert from Dover, a spokesman for the port said. The port of Felixstowe in Suffolk is also busy but there are no queues.

The British Retail Consortium said trucks needed to be able to start travelling again in the next 24 hours to "avoid seeing problems on our shelves".

Andrew Opie, its director of food and sustainability, told the Commons business, energy and industrial strategy committee: "What we've been told by members is that unless those trucks can start travelling again and go back to Spain and Portugal and other parts of Europe, we will have problems with fresh produce from 27 December."

Labour's Rachel Reeves told BBC Breakfast the government had "wasted the last 24 hours" and called for "testing in place so we can reopen the border".

The border disruption has also affected passenger services - with many air, rail and sea services cancelled between the UK and France, as well as other countries.

Eurotunnel said it hoped passengers would be able to travel between the UK and France from Wednesday or Thursday, if a solution was agreed.

British Airways said it would operate "a reduced and dynamic schedule" amid the uncertainty.

The Channel is a vital trade route, with about 10,000 lorries a day travelling between Dover and Calais at Christmas, largely bringing in the freshest produce.

Shane Brennan, the head of the Cold Chain Federation which represents the UK's temperature-controlled transport industry, said the number of vehicles stuck was worse than the government figures suggested, as lorries were "dispersed around southern England".

Ms Patel said the numbers do "fluctuate", and added there were welfare facilities and support available for hauliers at Manston Airport.

Queues on the M20 in Kent aren't exactly unheard of, but the French decision to close the border is dramatic and has caused a lot of disruption.

Politicians on both sides of the Channel are hopeful they might be able to agree a way of getting things moving again before the end of the year.

But if that requires a massive expansion of testing for coronavirus at the border, that's easy to say, far harder to do.

Are you a lorry driver? Have you been affected by the restrictions? Share your experiences by emailing haveyoursay@bbc.co.uk.

Please include a contact number if you are willing to speak to a BBC journalist. You can also get in touch in the following ways:

If you are reading this page and can't see the form you will need to visit the mobile version of the BBC website to submit your question or comment or you can email us at HaveYourSay@bbc.co.uk. Please include your name, age and location with any submission.

# data[].attributes.attachment_link.title
Covid-19: Almost 3,000 lorries stuck in Kent as UK and France aim to restart freight

# data[].attributes.attachment_link.description
More than 2,850 lorries are stuck in Kent waiting to leave the UK, the county council has said, as politicians thrash out a plan to reopen France's border to trade and travel. France shut its UK border for 48 hours on Sunday amid fears of a new coronavirus variant.

# data[].attributes.attachment_link.title
Kent lorry chaos: More military support deployed for driver tests

# data[].attributes.attachment_link.description
A further 800 personnel are to be sent to Kent on Christmas Day to help test drivers for Covid-19.

# data[].attributes.attachment_link.readable_text
Lorry drivers are still waiting in Kent after France closed their border with the UK due to coronavirus.

The border is now open but drivers are required to test negative for Covid-19 before they are allowed to cross into France.

The backlog is expected to take several more days to clear.

# data[].attributes.attachment_link.description
Lorry drivers are still waiting in Kent after France closed their border with the UK due to coronavirus. The border is now open but drivers are required to test negative for Covid-19 before they are allowed to cross into France. The backlog is expected to take several more days to clear.

# data[].attributes.body
https://www.theguardian.com/world/2020/dec/18/covid-world-map-which-countries-have-the-most-coronavirus-cases-and-deaths

# data[].attributes.attachment_link.title
Covid world map: which countries have the most coronavirus cases and deaths?

# data[].attributes.attachment_link.description
Since first being recorded late last year in China, the Covid-19 coronavirus has spread around the world, and been declared a pandemic by the World Health Organization. However, differences in testing mean that the number of cases may be understated for some countries.

# data[].attributes.body
https://www.theguardian.com/world/2020/dec/18/covid-world-map-which-countries-have-the-most-coronavirus-cases-and-deaths

# data[].attributes.attachment_link.readable_text
If a new virus sounds scary, a new mutating virus sounds scarier still. In Kent in September, scientists now believe, somebody with Covid was the unlucky first person to pass on a variant form of the coronavirus that is maybe as much as 70% more transmissible than the version we have been used to.

The exponential recent rise in cases now blamed on that incident and the UK government response have sparked alarm around the world, with other countries banning flights into the UK for at least 48 hours while everyone figures out what is going on.

We have the new variant, called B117, to thank for cancelled Christmases. London and much of south-east England are locked away in tier 4, quarantined from families in the rest of the UK.

And beyond Christmas and the New Year, prospects for a return to normality do not look great. Children, who were less likely to be infected by the original coronavirus, may be more susceptible to this one. There is no reason to think they are more likely to be ill, but they could be more likely to get the virus and pass it on. That could conceivably have an impact on the return to school in January.

Scientists knew about the variant on 8 December, when they reviewed cases that had been routinely genome-sequenced - about 10% of the total - to see what was going on.

During the November lockdown, case numbers dropped in most places, but in Kent, they continued to rise. There are two possible explanations for that: firstly, people were not observing the social distancing rules through fatigue or loss of faith in the government. Or, secondly, there is a more transmissible version of the virus about.

Christian Drosten, the celebrated virologist in Germany, told a German broadcaster that it was unclear. "The question is: is this virus being washed up by a coming new wave in that region, or is this virus responsible for creating this wave in the first place?" Drosten said. "That's an important difference."

Viruses mutate all the time. Sars-Cov-2 has done so, but no mutation has yet been significant. This time, there are 23 mutations in this one variant.

Experts in the UK on the government's advisory body Nervtag (New and Emerging Respiratory Virus Threats Advisory Group), say they now have high confidence that B117 is more transmissible than the original. But, importantly, they have no evidence at the moment that it makes people sicker.

There is no suggestion - yet - that the hygiene, mask-wearing and social distancing rules we have been told to follow will no longer be enough to keep us safe from infection, although Susan Hopkins from Public Health England pointed out that staying 2 metres away from people and spending less than 15 minutes in proximity were notional figures. The further away we stand, and the less time we spend with people outside of our household, the safer we are.

As people mull over their lost festivities and lift a sad glass to distant loved ones on Zoom calls, there is bound to be some bitterness aimed at the government, which pulled the plug with just five days to go.

Ministers assert that they only knew about the rampaging mutant viral strain on Friday, after a Nervtag meeting. Even if that is so, they knew that cases dipped only briefly after the end of the November lockdown and that the rise has been swift and steep after that. Other countries in Europe and other nations in the UK were talking of lockdown before Friday.

The UK is not the only country with B117 cases. It may be because we do more genome sequencing than others that we have picked up so many.

Asserting that it would be inhumane to cancel Christmas - and then doing it - sent an alarming message, potentially unnecessarily, to the rest of the world.
Topics

# data[].attributes.attachment_link.title
New Covid variant in UK: spreading Christmas fear?

# data[].attributes.attachment_link.description
If a new virus sounds scary, a new mutating virus sounds scarier still. In Kent in September, scientists now believe, somebody with Covid was the unlucky first person to pass on a variant form of the coronavirus that is maybe as much as 70% more transmissible than the version we have been used to.

# data[].attributes.attachment_link.readable_text
Large areas of England are to join London, the south-east and east of England in tier 4, amid a surge in Covid-19 cases and alarm about a new strain of coronavirus spreading rapidly.

What does tier 4 mean?

Under tier 4 restrictions, non-essential shops, hairdressers, and leisure and entertainment venues must close, with a new "stay at home" message introduced.

People who need to travel for education or childcare are exempt, and exercise is unlimited. Where people cannot work from home, they will still be able to travel to work.

Under the measures, households are not allowed to mix, but one person is allowed to meet with one other person outside in a public space. Support bubbles and those meeting for childcare are exempt.

Those who are deemed clinically extremely vulnerable should not go to work and should limit time outside of their homes.

Tier 4 residents must not stay overnight away from home, and cannot travel abroad.

What does this mean for Christmas?

Those in tier 4 must stay at home over Christmas and must not meet up with other households. One resident could meet up with another one person for a walk, but not a whole household of people.

In the rest of England, the window for multiple households meeting has been reduced from a five-day window between 23 and 27 to just Christmas Day.

What can I do in each tier?

People in all tiers are advised to stay local, and if you travel, your restrictions follow you. For example, if you live in a tier 3 area, you must continue to follow tier 3 rules even when you travel to a tier 1 or tier 2 area.

You can find out which tier you live in here.
You can read more on the tier 3 regulations, tier 2 regulations here and tier 1 regulations here.
How long will the measures last?

Due to the unprecedented and ongoing nature of the coronavirus outbreak, this article is being regularly updated to ensure that it reflects the current situation as best as possible. The most recent update will have been made at the date shown at the top of the article. Any significant corrections made to this or previous versions of the article will continue to be footnoted below in line with Guardian editorial policy.

The health secretary, Matt Hancock, has said that these restrictions are likely to last for months, until the vaccine has been rolled out across the UK. The measures will be reviewed on 30 December, as part of a wider review of tier restrictions.

# data[].attributes.attachment_link.title
Covid tier 4 rules in England: latest restrictions explained

# data[].attributes.attachment_link.description
Large areas of England are to join London, the south-east and east of England in tier 4, amid a surge in Covid-19 cases and alarm about a new strain of coronavirus spreading rapidly. Under tier 4 restrictions, non-essential shops, hairdressers, and leisure and entertainment venues must close, with a new "stay at home" message introduced.

# data[].attributes.attachment_link.readable_text
The rapid spread of a new variant of coronavirus has been blamed for the introduction of strict tier four mixing rules for millions of people, harsher restrictions on mixing at Christmas in England, Scotland and Wales, and other countries placing the UK on a travel ban.

So how has it gone from being non-existent to the most common form of the virus in parts of England in a matter of months?

The government's advisers on new infections now say they have "high" confidence that it is more able to transmit than other variants.

All the work is at an early stage, contains huge uncertainties and a long list of unanswered questions.

Three things are coming together that mean it is attracting attention:

It is rapidly replacing other versions of the virus

It has mutations that affect part of the virus likely to be important

Some of those mutations have already been shown in the lab to increase the ability of the virus to infect cells

All of these come together to build a case for a virus that can spread more easily.

However, we do not have absolute certainty. New strains can become more common simply by being in the right place at the right time - such as London, which had only tier two restrictions until recently.

But already the justification for tier four restrictions is in part to reduce the spread of the variant.

"Laboratory experiments are required, but do you want to wait weeks or months [to see the results and take action to limit the spread]? Probably not in these circumstances," Prof Nick Loman, from the Covid-19 Genomics UK Consortium, told me.

It was first detected in September. In November around a quarter of cases in London were the new variant. This reached nearly two-thirds of cases in mid-December.

You can see how the variant has come to dominate the results of testing in some centres such as the Milton Keynes Lighthouse Laboratory.

Mathematicians have been running the numbers on the spread of different variants in an attempt to calculate how much of an edge this one might have.

But teasing apart what is due to people's behaviour and what is due to the virus is hard.

The figure mentioned by Prime Minister Boris Johnson was that the variant may be up to 70% more transmissible. He said this may be increasing the R number - which indicates if an epidemic is growing or shrinking - by 0.4.

During the talk he said: "It is really too early to tell... but from what we see so far it is growing very quickly, it is growing faster than [a previous variant] ever grew, but it is important to keep an eye on this."

There is no "nailed on" figure for how much more infectious the variant may be. Scientists, whose work is not yet public, have told me figures both much higher and much lower than 70%.

But there remain questions about whether it is any more infectious at all.

"The amount of evidence in the public domain is woefully inadequate to draw strong or firm opinions on whether the virus has truly increased transmission," said Prof Jonathan Ball, a virologist at the University of Nottingham.

How far has it spread?

It is thought the variant either emerged in a patient in the UK or has been imported from a country with a lower ability to monitor coronavirus mutations.

The variant can be found across the UK, except Northern Ireland, but it is heavily concentrated in London, the South East and eastern England. Cases elsewhere in the country do not seem to have taken off.

Data from Nextstrain, which has been monitoring the genetic codes of the viral samples around the world, suggest cases in Denmark and Australia have come from the UK. The Netherlands has also reported cases.

A similar variant that has emerged in South Africa shares some of the same mutations, but appears to be unrelated to this one.

Has this happened before?

Yes.

The virus that was first detected in Wuhan, China, is not the same one you will find in most corners of the world.

There have been changes to the spike protein - this is the key the virus uses to unlock the doorway to our body's cells.

One mutation called N501Y alters the most important part of the spike, known as the "receptor-binding domain".

This is where the spike makes first contact with the surface of our body's cells. Any changes that make it easier for the virus to get inside are likely to give it an edge.

"It looks and smells like an important adaptation," said Prof Loman.

The other mutation - a H69/V70 deletion, in which a small part of the spike is removed - has emerged several times before, including famously in infected mink.

Work by Prof Ravi Gupta at the University of Cambridge has suggested this mutation increases infectivity two-fold in lab experiments.

Prof Gupta told me: "It is rapidly increasing, that's what's worried government, we are worried, most scientists are worried."

Where has it come from?

The variant is unusually highly mutated.

The most likely explanation is the variant has emerged in a patient with a weakened immune system that was unable to beat the virus.

Instead their body became a breeding ground for the virus to mutate.

There is no evidence to suggest that it does, although this will need to be monitored.

However, just increasing transmission would be enough to cause problems for hospitals.

If the new variant means more people are infected more quickly, that would in turn lead to more people needing hospital treatment.

Almost certainly yes, or at least for now.

All three leading vaccines develop an immune response against the existing spike, which is why the question comes up.

Vaccines train the immune system to attack several different parts of the virus, so even though part of the spike has mutated, the vaccines should still work.

"But if we let it add more mutations, then you start worrying," said Prof Gupta.

"This virus is potentially on a pathway for vaccine escape, it has taken the first couple of steps towards that."

Vaccine escape happens when the virus changes so it dodges the full effect of the vaccine and continues to infect people.

This may be the most concerning element of what is happening with the virus.

This variant is just the latest to show the virus is continuing to adapt as it infects more and more of us.

That would put us in a position similar to flu, where the vaccines need to be regularly updated. Fortunately the vaccines we have are very easy to tweak.

# data[].attributes.attachment_link.title
New coronavirus variant: What do we know?

# data[].attributes.attachment_link.description
The rapid spread of a new variant of coronavirus has been blamed for the introduction of strict tier four mixing rules for millions of people, harsher restrictions on mixing at Christmas in England, Scotland and Wales, and other countries placing the UK on a travel ban.

# data[].attributes.attachment_link.readable_text
German Health Minister Jens Spahn said on Saturday: "This really is a happy Christmas message. At this moment, lorries with the first vaccines are on the road all over Europe, all over Germany, in all federal states. Further deliveries will follow the day after tomorrow.

# data[].attributes.attachment_link.title
Covid: EU launches mass vaccination in 'touching moment of unity'

# data[].attributes.attachment_link.description
German Health Minister Jens Spahn said on Saturday: "This really is a happy Christmas message. At this moment, lorries with the first vaccines are on the road all over Europe, all over Germany, in all federal states. Further deliveries will follow the day after tomorrow.

# data[].attributes.attachment_link.readable_text
Boris Johnson summoned ministers for an emergency meeting on Friday to discuss how to tackle mounting concerns about the new strain of coronavirus identified in parts of south-east England.

The variant is thought to be more infectious and could trigger possible restrictions including curbs on travel between the south-east, including London, and the rest of the country, according to reports, but ministers insisted that no decisions have been made.

The health secretary, Matt Hancock, expressed concerns earlier this week about the new strain as he announced that a large swathe of the south-east would be placed under the toughest, tier 3 restrictions.

It is understood that government scientists have subsequently presented new evidence to ministers about the behaviour of this variant. A government official said: "There are concerns that it is more transmissible than the existing strain - and that sense is hardening."

An announcement could be made as soon as Saturday about how ministers plan to try to contain the new threat, with particular concerns about the risks of cross-UK travel in the run-up to Christmas.

Professor Sir Mark Walport - a member of the government's scientific advisory group for emergencies (Sage) - said there was a real possibility that the strain could have a "transmission advantage".

"What happens with viruses is they do naturally mutate all the time and the ones that are likely to do well are the ones that increase transmission," he told BBC2's Newsnight. "We know that this is a new variant, it has been seen in other countries but it seems to be quite widespread which suggests that it has got a transmission advantage. Scientists are working extremely hard to work out what is going on. But it does definitely seem possible that this transmits more easily. It will make the social-distancing even more critical."

Hancock told the Commons on Monday that cases of the variant were found in almost 60 areas. He said: "Over the last few days, thanks to our world-class genomic capability in the UK, we have identified a new variant of coronavirus which may be associated with the fastest spread in the south-east of England.

"Initial analysis suggests that this variant is growing faster than the existing variance. We've currently identified over 1,000 cases with this variant, predominantly in the south of England, although cases have been identified in nearly 60 different local authority areas and numbers are increasing rapidly.

"Similar variants have been identified in other countries over the last few months. We've notified the World Health Organization and Public Health England is working hard to continue its expert analysis at Porton Down."

Hancock added: "I must stress at this point that there is currently nothing to suggest that this variant is more likely to cause serious disease and the latest clinical advice is that it's highly unlikely that this mutation would fail to respond to a vaccine.

"But it shows we've got to be vigilant and follow the rules and everyone needs to take personal responsibility not to spread this virus."

Prof Chris Whitty, England's chief medical officer, had denied that tier 3 was introduced in London and surrounding areas because of the variant during Monday's Downing Street press conference.

He added there was no evidence that the symptoms are different or worse or that different Covid-19 testing is required.

# data[].attributes.attachment_link.title
Boris Johnson calls crisis meeting over new Covid strain

# data[].attributes.attachment_link.description
Boris Johnson summoned ministers for an emergency meeting on Friday to discuss how to tackle mounting concerns about the new strain of coronavirus identified in parts of south-east England. The variant is thought to be more infectious and could trigger possible restrictions including curbs on travel between the south-east, including London, and the rest of the country, according to reports, but ministers insisted that no decisions have been made.

# data[].attributes.attachment_link.readable_text
Sweden's state epidemiologist Anders Tegnell and the health agency's director Johan Carlson have long resisted recommending face masks to the general public.

They have argued that it gives a false sense of security and risks encouraging the public to stop keeping a distance from one another.

At the press conference, Carlson said the agency would recommend that those over the age of 16 use masks on public transport at certain times.

"People have learnt now how to cope with public transport and avoid crowding. But there are certain hours in the day, certain vehicles, where it's unavoidable, and we're trying to focus on that," he said.

He reiterated that if recommended too generally, face masks still risked being counter-productive.

"In other situations, it could hamper our efforts at containing the disease, because face masks will replace social distancing," he said.

"I think this has been a very common phenomenon out in the world. If you look at North America, where a lot of focus has been on face masks, very little focus has been on big gatherings of people.

"Whether they're wearing face masks or not is not the big thing; big gatherings are the problem."

The face masks recommendation is one of a barrage of new restrictions and recommendations which will come into force from Christmas Eve.

From December 24, the maximum group allowed in restaurants and bars will be limited to four, alcohol sales will be banned after 8pm, and there will be a "strong recommendation" to shop and gym owners to limit the number of customers to a safe level.

"If that doesn't work then the government can shut them down," Mr Löfven warned.

Asked why the country had not acted faster and more decisively when infection rates began to rise rapidly in October, Mr Löfven defended Sweden's incremental, initially light-touch approach.

"Since the summer, when the spread was very low, we have increased these restrictions constantly, because we've seen that the spread is increasing," he said.

"We are making sure with these decisions that we are doing the utmost to...restrict the spread, so it's totally in accordance with this strategy that we have chosen, namely to take the right decisions at the proper time."

# data[].attributes.attachment_link.title
Sweden moves towards adopting face masks in public as pressure over Covid deaths grows

# data[].attributes.attachment_link.description
Sweden's state epidemiologist Anders Tegnell and the health agency's director Johan Carlson have long resisted recommending face masks to the general public. They have argued that it gives a false sense of security and risks encouraging the public to stop keeping a distance from one another.

# data[].attributes.attachment_link.title
Coronavirus: Swedish King Carl XVI Gustaf says coronavirus approach 'has failed'

# data[].attributes.attachment_link.description
Sweden has been widely criticised for its more relaxed approach to handling the pandemic.

# data[].attributes.attachment_link.title
Toughest Covid rules extended in south of England

# data[].attributes.attachment_link.description
More parts of the east and south-east of England will face tier three restrictions from Saturday.

# data[].attributes.body
https://www.theguardian.com/uk

# data[].attributes.attachment_link.readable_text
Why some people with coronavirus have no symptoms and others get extremely ill is one of the pandemic's biggest puzzles.

A study of more than 2,200 patients in intensive care has identified specific genes that may hold the answer.

They make some people more susceptible to severe Covid-19 symptoms than others.

The findings shed light on where the immune system goes wrong, which could help identify new treatments.

'Angry' cells

Scientists looked at the DNA of patients in more than 200 intensive care units in UK hospitals.

They scanned each person's genes, which contain the instructions for every biological process - including how to fight a virus.

Their genomes were then compared with the DNA of healthy people to pinpoint any genetic differences, and a number were found - the first in a gene called TYK2.

"It is part of the system that makes your immune cells more angry, and more inflammatory," explained Prof Kenneth Baillie, a consultant in medicine at the Royal Infirmary in Edinburgh, who led the Genomic project.

But if the gene is faulty, this immune response can go into overdrive, putting patients at risk of damaging lung inflammation.

A class of anti-inflammatory drugs already used for conditions such as rheumatoid arthritis targets this biological mechanism. including a drug called Baricitinib.

"It makes it a very plausible candidate for a new treatment," Prof Baillie said. "But of course, we need to do large-scale clinical trials in order to find out if that's true or not."

Too little interferon

Genetic differences were also found in a gene called DPP9, which plays a role in inflammation, and in a gene called OAS, which helps to stop the virus from making copies of itself.

Variations in a gene called IFNAR2 were also identified in the intensive care patients.

IFNAR2 is linked to a potent anti-viral molecule called interferon, which helps to kick-start the immune system as soon as an infection is detected.

It's thought that producing too little interferon can give the virus an early advantage, allowing it to quickly replicate, leading to more severe disease.

Two other recent studies published in the journal Science have also implicated interferon in Covid cases, through both genetic mutations and an autoimmune disorder that affects its production.

Prof Jean-Laurent Casanova, who carried out the research, from The Rockefeller University in New York, said: "[Interferon] accounted for nearly 15% of the critical Covid-19 cases internationally enrolled in our cohort."

Interferon can be given as a treatment, but a World Health Organisation clinical trial concluded that it did not help very sick patients. However, Prof Casanova said the timing was important.

He explained: "I hope that if given in the first two, three, four days of infection, the interferon would work, because it essentially would provide the molecule that the [patient] does not produce by himself or by herself."

'When things go wrong'

Dr Vanessa Sancho-Shimizu, a geneticist from Imperial College London, said that the genetic discoveries were providing an unprecedented insight into the biology of the disease.

"It really is an example of precision medicine, where we can actually identify the moment at which things have gone awry in that individual," she told BBC News.

"The findings from these genetic studies will help us identify particular molecular pathways that could be targets for therapeutic intervention," she said.

But the genome still holds some mysteries.

The Genomic study - and several others - have revealed a cluster of genes on chromosome 3 strongly linked to severe symptoms. However, the biology underpinning this is not yet understood.

More patients will now be asked to take part in this research.

Prof Baillie said: "We need everyone, but we're particularly keen to recruit people from minority ethnic groups who are over-represented in the critically ill population.

He added: "There's still a very urgent need to find new treatments for this disease and we have to make the right choices about which treatments to try next, because we don't have time to make mistakes."

The research is published in Nature.

# data[].attributes.attachment_link.title
Covid: Genes hold clues to why some people get severely ill

# data[].attributes.attachment_link.description
Why some people with coronavirus have no symptoms and others get extremely ill is one of the pandemic's biggest puzzles. A study of more than 2,200 patients in intensive care has identified specific genes that may hold the answer. They make some people more susceptible to severe Covid-19 symptoms than others.

# data[].attributes.attachment_link.readable_text
Teachers have warned of a "collapse" in secondary school attendance after the second wave of the pandemic spread across the UK during autumn.

Relatively few pupils have tested positive, but hundreds of thousands have had to learn from home after being required to self-isolate.

What impact is that having on schools, parents and pupils themselves, as many prepare for exams?

Even before mid-October, when Northern Ireland's "huge wave" of cases came to Lisneal College in Londonderry, principal Michael Allen says about five of the GCSE year group of 135 pupils had not returned because of mental health and anxiety issues.

He says the impact of self-isolation was to reduce overall attendance to below 85%. At that level, for an individual student, the school would normally refer families to education welfare services, Mr Allen says.

The first case meant 60 pupils in year 12 - Northern Ireland's GCSE exam year - had to go into self-isolation, just weeks before exams started in November.

"We have just had 20 Year 12s return from two weeks of self-isolation, and at 9.30am many of those young people had to walk into an exam hall and sit a single-award GCSE chemistry exam," Mr Allen said.

There is "total and utter disregard" for the disadvantage pupils like this face in the exam system, he says, with pupils with special education needs being especially badly affected.

Remote teaching is made harder because teachers cannot work simultaneously with pupils in the classroom and those working at home. "That's not living in the real world," Mr Allen said.

The work of contact tracing falls to school leaders themselves, meaning they have to respond to sudden alerts of positive cases at any time.

Mr Allen said pupils give him or his vice-principal a "look of dread" when they walk into the classroom, because they know it means someone will end up missing school. Some have begged them to review the contact tracing process.

"Two weeks ago we had a girl in tears asking us to go back and measure the two metres. No one seems to be taking any notice of what these young people are going through."

"It's been a bit of a nightmare", said Emily Proffitt of the asymptomatic spread that forced her to temporarily close Cooper Perry Primary School in Staffordshire on the advice of public health officials.

First, a staff member tested positive over half-term, forcing a few others to self-isolate. Then a few days later another member of the team tested positive.

But there was no traceable connection to other positive cases, so public health authorities said all the staff at the small village school - which has open-plan teaching spaces - needed to be tested.

That eventually uncovered another three asymptomatic cases. By that point so many staff had to self-isolate that the school was forced to close for a week.

They reopened this week, only for a pupil to test positive, meaning two year groups and five members of staff were sent home.

"For the parents, I feel so sorry for them," Ms Proffitt said. With several pupils having had four weeks out of school since half-term, some of their parents will have had to take time off work. For some of them, they will have been unpaid.

She said she was worried it looked like the school had not prepared for the risk, when in reality "we've got hands that are red-raw from sanitising".

Pupils are anxious, with some asking to wear masks even when they are not required. Staff are working in isolation from each other and are stressed, as many prepare two sets of lessons for in-person and remote teaching, Ms Proffitt said.

"We're looking at probably a decade of attachment and trauma issues that are going to be related back to Covid."

"However much we paint our smiles on in the classroom, and we're good at that, children read us very well and they know things aren't quite right."

Merseyside has been one of the areas worst-hit in the UK's second wave of the pandemic.

And at The Prescot School in Knowsley that has meant a collective 700 days in the classroom lost for the year 11 students preparing for exams in the summer.

One student, Ben, told the BBC: "Year 11 is such a crucial year, you've got exams and mock exams and that's the main thing that's going to set you for life.

"As someone who's self-isolated already, I think it's really stressful to even think about the exams that we've got to do in a few months' time when we've missed out a large chunk of school."

He says the year group is still learning content that they had missed when schools were closed in the first lockdown.

"In any other time period we would be revising and going over past things now."

"I don't really think it's fair," he said, pointing out that some areas have seen much more disruption to education in this wave of the virus, while everyone will face the same exam conditions.

"We've obviously all gone through Covid and it's been strange for everyone. But there are other places it hasn't affected as much as here," he says.

Felicity Sandford said her daughter Cerys was the only one in her form to be sent home after contact with another child in her Spanish class who had tested positive.

"She was a bit traumatised to be pulled out of her class and not know what was going on, and she was the only one," Felicity said.

Students were reassured they had not done anything wrong but had to wait a while before they learned why they were being taken out of class. "I had to go and meet her and she was pretty upset."

Felicity said she was "absolutely gutted" herself as her work as a marketing consultant for children's activity providers in west London was hitting a busy time.

But she says it was a "pleasant surprise" how organised the remote learning has been, with Cerys using Microsoft Teams to keep in touch, taking online lessons from Oak National Academy and logging her homework and progress with photographs.

"In lockdown, at primary school there wasn't any structure. With this one I haven't had to get very involved," Felicity says.

The strict remote learning regime surprised Cerys too, who had hoped "she might just get to chill out in her pyjamas" only to find that her schedule of work had been emailed the night before.

But with both parents working from home, finding space in the house has been one of the main challenges. "I've actually been working from her bedroom today while she's been at the dining table," says Felicity.

# data[].attributes.attachment_link.title
Covid and schools: 'Children know things aren't right'

# data[].attributes.attachment_link.description
Teachers have warned of a "collapse" in secondary school attendance after the second wave of the pandemic spread across the UK during autumn. Relatively few pupils have tested positive, but hundreds of thousands have had to learn from home after being required to self-isolate.

# data[].attributes.body
"In a year that left us speechless, 2020 has been filled with new words unlike any other.”

# data[].attributes.attachment_link.readable_text
For the first time, the Oxford English Dictionary has chosen not to name a word of the year, describing 2020 as "a year which cannot be neatly accommodated in one single word". Instead, from "unmute" to "mail-in", and from "coronavirus" to "lockdown", the eminent reference work has announced its "words of an 'unprecedented' year".

On Monday, the dictionary said that there were too many words to sum up the events of 2020. Tracking its vast corpus of more than 11bn words found in web-based news, blogs and other text sources, its lexicographers revealed what the dictionary described as "seismic shifts in language data and precipitous frequency rises in new coinage" over the past 12 months.

Coronavirus, one of its words of the year, is a term that dates back to the 1960s, although it was previously mainly used by scientists. By March this year it was one of the most frequently used nouns in the English language. "Covid-19", first recorded on 11 February in a report by the World Health Organization, quickly overtook coronavirus in frequency of use, noted the dictionary.

One of the year's most remarkable linguistic developments, according to the OED, has been the extent to which scientific terms have entered general discourse, as we have all become armchair epidemiologists, with most of us now familiar with the term "R number".

"Before 2020 this was a term known mainly to epidemiologists; now non-experts routinely talk about 'getting the R down' or 'bringing R below 1'. Other terms that have become much more common in everyday discourse this year include 'flatten the curve' and 'community transmission'," said the dictionary.

Use of the phrase "following the science", it added, has increased in frequency more than 1,000% compared with 2019.

Other coronavirus-related language cited by the OED includes "pandemic", which has seen usage increase by more than 57,000% this year, as well as "circuit breaker", "lockdown", "shelter-in-place", "bubbles", "face masks" and "key workers".

The revolution in working habits has also affected language, with both "remote" and "remotely" seeing more than 300% growth in use since March. "On mute" and "unmute" have seen 500% rises since March, while the portmanteaus "workation" and "staycation" increased by 500% and 380% respectively.

Other news events have also been reflected in language. In the early months of 2020, there were peaks in usage of "impeachment" and "acquittal", and "mail-in" has seen an increase of 3,000%. Use of "Black Lives Matter" and "BLM" also surged, as did the term "QAnon", up by 5,716% on last year. The phrase "conspiracy theory", meanwhile, has almost doubled in usage between October 2019 and October 2020. Use of "Brexit", however, has dropped by 80% this year.

"What words best describe 2020? A strange year? A crazy year? A lost year? Oxford Languages' monitor corpus of English shows a huge upsurge in usage of each of those phrases compared to 2019," said the OED in its report. "Though what was genuinely unprecedented this year was the hyper-speed at which the English-speaking world amassed a new collective vocabulary relating to the coronavirus, and how quickly it became, in many instances, a core part of the language."

Previous choices for word of the year from Oxford have included "climate emergency" and "post truth". Rival dictionary Collins chose "lockdown" for its word of the year earlier this month.

"I've never witnessed a year in language like the one we've just had," said Oxford Dictionaries president Casper Grathwohl. "The team at Oxford were identifying hundreds of significant new words and usages as the year unfolded, dozens of which would have been a slam dunk for word of the year at any other time. It's both unprecedented and a little ironic - in a year that left us speechless, 2020 has been filled with new words unlike any other."

# data[].attributes.attachment_link.title
Oxford Dictionaries: 2020 has too many Words of the Year to name just one

# data[].attributes.attachment_link.description
Instead, the dictionary says 'a year that has left us speechless' is best reflected by expanding its annual selection to a whole list

# data[].attributes.body
https://www.theguardian.com/world/2020/nov/13/covid-world-map-which-countries-have-the-most-coronavirus-cases-and-deaths

# data[].attributes.attachment_link.readable_text
Hopes are soaring that a Covid vaccine is within reach, following news that an interim analysis has shown Pfizer/BioNTech's candidate was 90% effective in protecting people from transmission of the virus in global trials.

The vaccine performed much better than most experts had hoped for, according to the companies' analysis, and brings into view a potential end to a pandemic that has killed more than a million people, battered economies and upended daily life worldwide.

The data is from an interim analysis and the trial continues into December but the headline results were emphatic. Regulators will be looking to process an emergency licence application at record speed.

Global stocks surged to record highs on the news, while companies that have become synonymous with lockdowns in the west, including Zoom's video conferencing and food delivery firms, saw falls in their value.

John Bell, Regius professor of medicine at Oxford University, who is involved with the Oxford vaccine, said that the Pfizer team had shown "an amazing level of efficacy" and it could mean a return to normality by spring (efficacy connotes performance of the vaccine under the orderly conditions of a trial, as distinct from use in everyday life). "I'm the first guy to say that but I will say it with some confidence," he told the BBC.

Manufacturing is already under way. Pfizer said they expect to supply globally up to 50m vaccine doses in 2020 and up to 1.3bn doses in 2021. Countries will decide who they prioritise for vaccination. In the UK, the joint committee on vaccination and immunisation has recommended that - presuming the vaccines work well enough in elderly people - the first vaccines go to care home workers and residents, followed by anybody over 80 and other health and social care workers. After that, people are expected to get them in decreasing age order.

The news comes too late to help Donald Trump's re-election campaign in the US, but the vice-president, Mike Pence, tried to claim their administration's Operation Warp Speed programme had helped the vaccine's development. Pfizer denied the suggestion.
Covid vaccine tracker: when will a coronavirus vaccine be ready?
"We were never part of the Warp Speed," Kathrin Jansen, a senior vice-president and the head of vaccine research and development at Pfizer, said in an interview. "We have never taken any money from the US government, or from anyone."

BioNTech, the small biotechnology company that is the originator of the vaccine, was founded by two married German scientists, Uğur Şahin and Özlem Türeci, both born to Turkish immigrant parents, and the Austrian oncologist Christopher Huber. It originally set out to develop new types of immunotherapy for cancer, but has concentrated its capacities on the race for a Covid-19 vaccine.

There are so far no safety concerns around the vaccine, with the two companies reporting no serious side-effects. The high percentage of those protected makes it especially compelling. Regulators have previously said they would approve a vaccine that has just a 50% effectiveness rate - protecting half of those who get vaccinated.

"Today is a great day for science and humanity. The first set of results from our phase 3 Covid-19 vaccine trial provides the initial evidence of our vaccine's ability to prevent Covid-19," said Dr Albert Bourla, the Pfizer chairman and chief executive.

"We are reaching this critical milestone in our vaccine development programme at a time when the world needs it most with infection rates setting new records, hospitals nearing over-capacity and economies struggling to reopen."

Other scientists tried to marry caution with their obvious excitement at the early results, warning that the full data was not yet available and that the trial was continuing.

"In the absence of any data from Pfizer and BioNTech, we have to take these very exciting claims at face value," said Dr Simon Clarke, an associate professor of cellular microbiology at the University of Reading. "It seems highly unlikely that a major pharmaceutical company would get such eagerly awaited news wrong."

Prof Peter Horby of Oxford University, who runs the Recovery Covid drug trial, said it seemed like an important moment.

"This news made me smile from ear to ear," he said. "It is a relief to see such positive results on this vaccine and bodes well for Covid-19 vaccines in general. Of course we need to see more detail and await the final results, and there is a long, long way to go before vaccines will start to make a real difference, but this feels to me like a watershed moment."

As news of the breakthrough buoyed the scientific community, Brazil's health regulator said it had suspended a clinical trial for China's Sinovac coronavirus vaccine citing a severe adverse event. Trial organisers said there had been a death but it was unrelated to the vaccine.

The health regulator, Anvisa, said on Monday the "adverse event" took place on 29 October but did not specify if the incident took place in Brazil or in another country. It also did not give an indication of how long the suspension of the large late-stage trial might last.

Pfizer/BioNTech's mRNA vaccine, which uses the genetic code rather than any part of the virus itself, has been one of the leaders in the global vaccine race. Interim results are also expected this month or in early December from trials for the Oxford University/AstraZeneca vaccine, which is based on a different technology.

mRNA vaccine

The phase 3 trials have involved more than 43,000 people and are intended to establish whether the vaccine works. Volunteers are given either the Covid vaccine, which was administered in two shots about three weeks apart, or a placebo alternative such as the meningitis vaccine, and neither they nor their doctors know which they have had.

There have been concerns that black and minority ethnic populations are particularly vulnerable to Covid. Approximately 42% of global participants and 30% of US participants in the trials have racially and ethnically diverse backgrounds and appear to have been as well-protected as everyone else, the company says. But one important unanswered question is how long the vaccine will last.

The US and UK both welcomed the development but urged patience.

"I congratulate the brilliant women and men who helped produce this breakthrough and to give us so much cause for hope," the US president-elect, Joe Biden, said. "It is also important to understand that the end of the battle against Covid-19 is still months away ... a mask remains a more potent weapon against the virus than a vaccine. Today's news does not change this urgent reality."

The UK's prime minister and deputy medical adviser warned that nobody should assume the pandemic was over and let down their guard. "We can't let our enthusiasm run away with us," said Boris Johnson, adding that the public must continue to observe the lockdown restrictions. Prof Jonathan Van-Tam said the results showed the vaccine prevented disease, but "we don't know what this means yet for when we can get life back to normal ... please don't relax."

Many countries already have orders for the Pfizer/BioNTech vaccine. The UK has bought 40m doses - enough for 20 million people because two doses are required. The EU has secured 200m doses, which it will distribute. The companies have a $1.95bn (£1.5bn) contract with the US government to deliver 100m vaccine doses beginning this year.

Low-income countries could face problems, however, because the vaccine needs ultra-cold chain; it must be stored at -70C. The BioNTech chief executive, Uğur Şahin, has said his company is researching whether the vaccine might be able to survive for up to five days at a normal fridge temperature of 4C.

In Germany, the government is planning to set up vaccination centres equipped with ultra-low-temperature freezers for the first phase of vaccinations.
Topics

# data[].attributes.attachment_link.title
Hopes rise for end of pandemic as Pfizer says vaccine is 90% effective

# data[].attributes.attachment_link.description
Hopes are soaring that a Covid vaccine is within reach, following news that an interim analysis has shown Pfizer/BioNTech's candidate was 90% effective in protecting people from transmission of the virus in global trials.

# data[].attributes.body
https://www.theguardian.com/uk

# data[].attributes.attachment_link.readable_text
"Early results show that T-cell responses may outlast the initial antibody response, which could have a significant impact on Covid vaccine development and immunity research," said Dr Shamez Ladhani, study author and consultant epidemiologist at Public Health England.

# data[].attributes.attachment_link.title
T-cell response 'lasts six months after Covid infection'

# data[].attributes.attachment_link.description
"Early results show that T-cell responses may outlast the initial antibody response, which could have a significant impact on Covid vaccine development and immunity research," said Dr Shamez Ladhani, study author and consultant epidemiologist at Public Health England.

# data[].attributes.body
https://www.telegraph.co.uk/news/2020/10/31/prime-minister-orders-fresh-month-long-national-lockdown-told/

# data[].attributes.attachment_link.title
Covid-19: England gets ready for new four-week lockdown

# data[].attributes.attachment_link.description
The move has sparked anger among Tory MPs, with one saying the PM was "pressurised" by scientists.

# data[].attributes.body
https://twitter.com/BBCHelena/status/1322662064528175111?s=09

# data[].attributes.attachment_link.readable_text
News Health

Follow all the latest updates and statistics

<p>Boris Johnson is mulling plans for a new national lockdown</p>

A second national lockdown to save Christmas is being considered by Boris Johnson after the publication of chilling scientific papers predicting that coronavirus deaths this winter could outstrip the 85,000 envisaged in the government's "worst case scenario".

It is being reported that the prime minister will hold a press conference on Monday to announce a new national shutdown beginning as early as Wednesday and last until 1 December.

Key Points Show latest update

1604146666

The Cabinet will hold an emergency meeting at 1.30pm today, No 10 has announced - fuelling speculation that a fresh lockdown will be imposed even earlier than expected, Rob Merrick reports.

Ministers are expected to be briefed by government scientists ahead of the remote meeting, which follows a leak of plans for new, harsher coronavirus restrictions.

It was reported that Boris Johnson would hold a press conference on Monday, with the measures to come into force on Wednesday, but the timetable may have been derailed by the leak.

Any announcement that the restrictions - either a national lockdown, or tougher 'tier 4' measures in hot spot areas - are coming in before the Commons sits on Monday would be hugely controversial.

Tory MPs opposed to a new shutdown won a promise that they would be able to vote on such a proposal in advance.

1604146355

Just 10 days ago at PMQs, Boris Johnson called the idea of a second lockdown "the height of absurdity", a policy that would that would inflict unnecessary "misery" on the public and would "turn the lights out", our deputy political editor Rob Merrick reports.

PM calls a second lockdown 'the height of absurdity' that would 'turn the lights out'

An No 10 source, hiding behind anonymity, went further, branding Keir Starmer "a shameless opportunist playing political games in the middle of a global pandemic" by even proposing it.

Now the prime minister is poised not only to adopt that very policy - another national lockdown of the economy and much of society - but for a longer period, because he delayed.

'Let us try to avoid the misery of another national lockdown, which he would want to impose in a headlong way'

1604145463

With talk of a second lockdown to "save Christmas", thousands of Hindus, Sikhs and Jains would likely be unable to visit their relatives during the festival of lights, which is a fortnight away.

1604143864

My colleague Samuel Osborne has more on Sage member Professor Calum Semple's warning that the virus is "now running riot across all age groups".

Prof Semple said there are "many more cases particularly in younger females between the ages of 20 and 40", and that three to four times as many women in that age group than men are being hospitalised, because they are exposed in hospitality, retail and some educational settings.

Prime minister considers imposing strict new national lockdown restrictions

1604143244

ICYMI, Belgium yesterday became the latest European country to declare a partial lockdown, after France and Germany.

The government will restrict travel and shopping, remote work will be mandatory and family contact will be reduced to an absolute minimum of one outside the closest cluster for the next six weeks.

The European Center for Disease Prevention and Control on Friday ranked Belgium as the worst affected nation in the EU, with 1,600 cases per 100,000 people.

Restrictions introduced in bid to curb highest national infection rate in EU

1604142353

"We've been significantly above that reasonable worst-case scenario for some time actually," said Professor John Edmunds, of the government's Scientific Advisory Group for Emergencies' previous forecasts for a second spike.

"It is really unthinkable now, unfortunately, that we don't count our deaths in tens of thousands from this wave," warned Prof Edmunds, a Sage member.

"The issue is, is that going to be low tens of thousands if we take radical action now or is that going to be the high tens of thousands if we don't?"

Asked if measures would have to be more severe than a "circuit-breaker" proposed last month, Prof Edmunds said: "Decisions are horrible - they are very difficult - but putting them off doesn't make them any easier, in fact it makes them more difficult.

"And so if we are going to put the brakes on the epidemic now, then unfortunately we're going to have to put the brakes on harder and longer to bring the cases down to what might be an acceptable level."

1604141658

Our international correspondent Borzou Daragahireacts to reports that Boris Johnson has ordered a "leak inquiry" into how the news of a possible second lockdown made its way to the media yesterday.

1604141193

Here are the documents viewed by the BBC which have reportedly jolted Downing Street into action over a possible second lockdown.

The first, allegedly a Cabinet Office document, appears to show hospitals becoming overwhelmed in several regions in just three to four weeks.

The second shows a variety of modellers' forecasts on daily fatalities.

All of their peaks significantly outstrip the government's "reasonable worst case scenario", which is represented by the black line, with even the most optimistic predictions suggesting a peak of nearly 2,000 deaths per day by Christmas.

1604140241

Meanwhile in the the US, Donald Trump is rowing with the governor of an increasingly virus-stricken Minnesota after the latter imposed time limits on one of the president's final rallies ahead of election day.

More than 3,100 Covid-19 cases were reported in the northern state on Friday, marking its second consecutive day of record-breaking daily cases.

The Minnesota Department of Health has linked at least 28 coronavirus cases to other Trump campaign events in the state, including at least 16 infections connected to a rally in Bemidji.

Alex Woodward has the details here:

Joe Biden and president hold duelling rallies in election battleground with second consecutive day of record-breaking infections

1604139554

The editor of Politico's London Playbook reports that he has been told Boris Johnson has ordered a "leak inquiry" into how news of a possible second lockdown made its way to The Times and the Daily Mail.

More about

1/1 Boris Johnson Johnson poised to order shutdown from Wednesday - live

Boris Johnson Johnson poised to order shutdown from Wednesday - live

Boris Johnson is mulling plans for a new national lockdown

Lindsey Parnaby/AFP via Getty Images

Daily Coronavirus Briefing

No hype, just the advice and analysis you need

Sign up
Already have an account? Log in here

# data[].attributes.attachment_link.title
Boris Johnson Johnson poised to order shutdown from Wednesday - follow live

# data[].attributes.attachment_link.description
News Health Follow all the latest updates and statistics Boris Johnson is mulling plans for a new national lockdown A second national lockdown to save Christmas is being considered by Boris Johnson after the publication of chilling scientific papers predicting that coronavirus deaths this winter could outstrip the 85,000 envisaged in the government's "worst case scenario".

# data[].attributes.headline
Vaccine is 'likely to be imperfect' and 'might not prevent infection', warns head of UK task force

# data[].attributes.subject
Vaccine is 'likely to be imperfect' and 'might not prevent infection', warns head of UK task force

# data[].attributes.attachment_link.readable_text
The first generation of Covid-19 vaccines "is likely to be imperfect" and "might not work for everyone", the chair of the UK Vaccine Task force has said.

No vaccine in the history of medicine "has been as eagerly anticipated" and it is "widely regarded as the only true exit strategy from the pandemic", Kate Bingham wrote in The Lancet.

However, she cautioned against over-optimism and that any vaccine might not work for everyone, or for very long.

"We do not know that we will ever have a vaccine at all," she wrote. "It is important to guard against complacency and over-optimism.

"The first generation of vaccines is likely to be imperfect, and we should be prepared that they might not prevent infection but rather reduce symptoms, and, even then, might not work for everyone or for long."

She also cautioned that the global manufacturing capacity for vaccines was vastly inadequate for the billions of doses that were needed, and that Britain's manufacturing capability to date had been "equally scarce".

The Environment Minister, George Eustice, said that a vaccine would be the answer to the Covid-19 crisis, but that Ms Bingham's analysis was "probably right."

"It is too early to say precisely when that vaccine will come," he told Sky News. "There's always a lot of doubt and uncertainty with vaccines."
Follow the latest updates below.

# data[].attributes.attachment_link.title
Coronavirus latest news: Plans to test 10 million people a day could mean tens of thousands self-isolating needlessly, experts warn

# data[].attributes.attachment_link.description
Plans to test 10 million people a day could see tens of thousands of people self-isolating needlessly, experts have said. Plans being developed under Operation Moonshot will reportedly see 10 million people tested every day at a cost of £100 billion. But academics said that under the plans, around 10,000 people could receive a false positive each day.

# data[].attributes.body
https://www.theguardian.com/world/2020/oct/28/covid-cases-and-deaths-today-coronavirus-uk-map

# data[].attributes.body
https://www.theguardian.com/world/2020/oct/28/covid-world-map-which-countries-have-the-most-coronavirus-cases-and-deaths

# data[].attributes.body
https://www.theguardian.com/world/coronavirus-outbreak

# data[].attributes.attachment_link.readable_text
There's no getting around the importance of age when it comes to Covid-19. But as we learn more about the virus, some in the medical world think we should also consider one's ' Covid age' - how various factors like age, weight, kidney function and diabetes coalesce to determine your vulnerability to the virus. Being fit and healthy puts you in a better position to combat Covid-19.

Here, we hear from three people in their 70s who not only kept themselves active during lockdown, but got creative in the process.

'I'm considering the next London marathon'
Norman Norrington, 78
I've always kept myself fairly active by going to the gym, and taking long walks.

But, at my age, I've never been more aware of how important it is to stay healthy. When lockdown first happened, I was worried that I wouldn't be able to keep up my exercise regime. Instead of resigning myself to the sofa to watch television, I decided to get creative. I bought myself some small weights so I can do my whole exercise routine from the comfort of my sitting room. I also do a couple of workouts that I found on YouTube.

I'm trying to change my lifestyle, and eat a bit healthier, too. I used to love cream cakes, and lots of meat, but now I allow myself the occasional treat on what I call "chocolate Friday". In total, I do two 30 minute workouts a day, and I feel fitter than ever.

When you're feeling trapped by restrictions, you want to escape - and exercise is a great way of doing that. Coronavirus also made me much more aware of my health, and the importance of maintaining a healthy weight.

Two months ago, I even did a skydive for singer Casey Sana's music video - something I thought I would never do, let alone at my age. It was an unbelievable feeling; I was falling at 120 miles an hour until the parachute opened, and my cheeks were flapping in the wind.

# data[].attributes.attachment_link.title
The over-70s who not only embraced exercise in lockdown, but got creative

# data[].attributes.attachment_link.description
When it comes to being at risk of coronavirus, age is one of the most prominent factors. But as we learn more about the virus, some in the medical world think we should consider one's ' Covid age' - how various factors like age, weight, kidney function and diabetes coalesce to determine your vulnerability to the virus.

# data[].attributes.attachment_link.readable_text
Scientists said the findings showed Britain is "miles off" achieving herd immunity, which they warned might never be reached without a vaccine.

However, the research did not examine the role played by other forms of immunity. Some scientists believe the part played by T-cells - a type of white blood cell that helps the immune system fight off viruses and is linked with prior infections by common colds - could be more crucial in fighting the virus.

Scientists analysed home fingerprick test samples from hundreds of thousands of adults to establish "detectable antibody levels" over a period of three months, and found levels fell by 26.5 per cent overall.

The largest fall was among those most vulnerable to serious illness from Covid. Among those aged 75 and over, antibody levels fell by 39 per cent, while a drop of only 15 per cent was seen in those aged between 18 and 24.

Researchers stressed that it is not yet known what level of antibody response is required to protect against reinfection - meaning it is possible that even levels of antibodies that were not found by the tests were offering some protection. But they said the findings suggested a significant rapid decline in immunity, raising the prospect that those infected by Covid could suffer repeat infections in further waves.

The possibility that a vaccine may have to be administered as often as every six months increases the scale of the challenge ahead. However, the researchers said vaccines may prove more powerful than natural immunity.

On Monday, Matt Hancock, the Health Secretary, said the NHS and the Army were working on plans to roll out the vaccine programme as soon as a breakthrough is achieved.

He said he expected "the bulk of the rollout" to occur in the first half of next year, although he had not ruled out the possibility that some jabs might be administered before Christmas. NHS workers are expected to be among the first to be offered vaccines.

# data[].attributes.attachment_link.title
Covid immunity may only last months, study finds

# data[].attributes.attachment_link.description
Scientists said the findings showed Britain is "miles off" achieving herd immunity, which they warned might never be reached without a vaccine. However, the research did not examine the role played by other forms of immunity.

# data[].attributes.attachment_link.readable_text
One of the world's leading Covid-19 experimental vaccines produces an immune response in both older and young adults, raising hopes of a path out of the gloom and economic destruction wrought by the novel coronavirus.

The vaccine, developed by the University of Oxford, also triggers lower adverse responses among elderly people, said the British drug maker AstraZeneca, which is helping to manufacture the vaccine, on Monday.

A vaccine that works is seen as a game-changer in the battle against coronavirus, which has killed more than 1.15 million people, shuttered swathes of the global economy and turned normal life upside down for billions of people.
Covid vaccine tracker: when will a coronavirus vaccine be ready?
"It is encouraging to see immunogenicity responses were similar between older and younger adults and that reactogenicity was lower in older adults, where the Covid-19 disease severity is higher," an AstraZeneca spokesman said.

"The results further build the body of evidence for the safety and immunogenicity of AZD1222," the spokesman said, referring to the technical name of the vaccine.

AstraZeneca did not provide detail of the data behind the statement or say when it would publish eagerly awaited late-stage phase 3 trial data, which would show whether the vaccine works well enough in large-scale trials for it to be approved.

The vaccine is expected to be one of the first from big pharma to secure regulatory approval, along with one from Pfizer and BioNTech.

The news that older people get an immune response from the vaccine is positive because the immune system weakens with age and older people are those most at risk of dying from the virus.

If it works, a vaccine would allow the world to return to some measure of normality after the pandemic.

The British health secretary, Matt Hancock, said a vaccine was not yet ready but he was preparing logistics for a possible roll out, mostly in the first half of 2021.

Asked if some people could receive a vaccine this year, he told the BBC: "I don't rule that out but that is not my central expectation."

Work began on the Oxford vaccine in January. Called AZD1222 or ChAdOx1 nCoV-19, the viral-vector vaccine is made from a weakened version of a common cold virus that causes infections in chimpanzees.

Immunogenicity blood tests carried out on a subset of older participants echo data released in July that showed the vaccine generated "robust immune responses" in a group of healthy adults aged between 18 and 55, the Financial Times reported earlier.

"We need to see the data before concluding that the responses were 'similar'," said Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine.
At 75, I've volunteered for a Covid vaccine trial. It could set people free
He said that reactogenecity - the common side-effects of vaccines such as soreness and redness of the arm - was "often, but not always" associated with a vaccine's immunogenicity.

"Studies carried out in the first stage of development of a vaccine will result in choosing a dose that does not cause too much reactogenicity," he said.

AstraZeneca has signed several supply and manufacturing deals with companies and governments around the world as it gets closer to reporting early results of the late-stage clinical trial.

It resumed the US trial of the experimental vaccine after approval by US regulators, the company said on Friday.

Staff at a London hospital trust have been told to be ready to receive the first batches of the Oxford-AstraZeneca vaccine, the Sun reported on Monday.
Topics

# data[].attributes.attachment_link.title
Oxford Covid vaccine works in all ages, trials suggest

# data[].attributes.attachment_link.description
One of the world's leading Covid-19 experimental vaccines produces an immune response in both older and young adults, raising hopes of a path out of the gloom and economic destruction wrought by the novel coronavirus.

# data[].attributes.attachment_link.readable_text
Levels of protective antibodies in people wane "quite rapidly" after coronavirus infection, say researchers.

Antibodies are a key part of our immune defences and stop the virus from getting inside the body's cells.

The Imperial College London team found the number of people testing positive for antibodies has fallen by 26% between June and September.

They say immunity appears to be fading and there is a risk of catching the virus multiple times.

More than 350,000 people in England have taken an antibody test as part of the REACT-2 study so far.

In the first round of testing, at the end of June and the beginning of July, about 60 in 1,000 people had detectable antibodies.

But in the latest set of tests, in September, only 44 per 1,000 people were positive.

It suggests the number of people with antibodies fell by more than a quarter between summer and autumn.

"Immunity is waning quite rapidly, we're only three months after our first [round of tests] and we're already showing a 26% decline in antibodies," said Prof Helen Ward, one of the researchers.

The fall was greater in those over 65, compared with younger age groups, and in those without symptoms compared with those with full-blown Covid-19.

The number of healthcare workers with antibodies remained relatively high, which the researchers suggest may be due to regular exposure to the virus.

Antibodies stick to the surface of the coronavirus to stop it invading our body's cells, and attract the rest of the immune system.

Exactly what the antibody drop means for immunity is still uncertain. There are other parts of the immune system, such as T-cells, which may also play a role.

However, the researchers warn antibodies tend to be highly predictive of who is protected.

Prof Wendy Barclay said: "We can see the antibodies and we can see them declining and we know antibodies on their own are quite protective.

"On the balance of evidence, I would say it would look as if immunity declines away at the same rate as antibodies decline away, and that this is an indication of waning immunity."

There are four other human coronaviruses, which we catch multiple times in our lives. They cause common cold symptoms and we can be reinfected every six to 12 months.

There have been very few confirmed cases of people getting Covid twice. However, the researchers warn this may be due to immunity only just starting to fade since the peak infection rates of March and April.

The hope is the second infection will be milder than the first, even if immunity does decline, as the body should have an "immune memory" of the first encounter and know how to fight back.

The researchers say their findings do not scupper hopes of a vaccine, which may prove more effective than a real infection.

One of the researchers, Prof Graham Cooke, said: "The big picture is after the first wave, the great majority of the country didn't have evidence of protective immunity.

"The need for a vaccine is still very large, the data doesn't change that."

Commenting on the findings, Prof Jonathan Ball from the University of Nottingham said: "This study confirms suspicions that antibody responses - especially in vulnerable elderly populations - decrease over time."

However, he said it was still important to get a better overall view of "what protective immunity looks like".

Prof Eleanor Riley, from the University of Edinburgh, said it would be "premature" to assume immunity did not last, but "the data do lend weight to the concern that antibodies induced by natural infection may be short-lived, as is the case for other seasonal coronaviruses."

# data[].attributes.attachment_link.title
Covid: Antibodies 'fall rapidly after infection'

# data[].attributes.attachment_link.description
Levels of protective antibodies in people wane "quite rapidly" after coronavirus infection, say researchers. Antibodies are a key part of our immune defences and stop the virus from getting inside the body's cells. The Imperial College London team found the number of people testing positive for antibodies has fallen by 26% between June and September.

# data[].attributes.headline
The six crucial pandemic lessons the government ignored

# data[].attributes.subject
The six crucial pandemic lessons the government ignored

# data[].attributes.attachment_link.readable_text
It took seven months, the threat of legal action and the intervention of the Information Commissioner but on Tuesday Whitehall reluctantly published its secret report on Exercise Cygnus, the ill-fated simulation which exposed the weakness of Britain's pandemic plans a full three years before the coronavirus hit.

The existence of the cross-government exercise and its "terrifying" high-level findings were first detailed by the Telegraph on March 28. But the full report, marked "Official - Sensitive" (now redacted) on each of its 57 closely worded pages, was kept under wraps.

Despite formal applications for its release by the Telegraph and others under the terms of the Freedom of Information Act and a copy being leaked to the Guardian in May, Whitehall refused to publish, arguing that to do so would undermine the formulation of government policy.

The health minister Lord Bethell, a former journalist and nightclub manager, told the House of Lords in June that reports of Cygnus-style simulations should remain secret "so that the unthinkable can be thought".

But last week the Information Commissioner's Office rejected the Government's case and ordered that the report be released no later than October 23.

The battle lost, officials at the Department of Health and Social Care (DHSC) quietly published the report last Tuesday amid the media storm over Manchester's lockdown - a good day to bury bad news.

And bad news it is. The Telegraph understands that there are several subsidiary reports relating to Cygnus that have yet to be released but the document published on Tuesday is enough to have officials and ministers squirming.

It states bluntly that "the UK's preparedness and response, in terms of its plans, policies and capability, is currently not sufficient to cope with the extreme demands of a severe pandemic". And it exposes as false the claim relayed by the Health Secretary Matt Hancock from his officials that "everything that was recommended [in the report] was done".

It is in the report's detail that the danger for Government lies. Officials have published the document, in breach of government policy, with the search and copy functions turned off, but the further Covid-19 progresses, the more salient its long-buried lessons become. Here are five highlights and one big unanswered question:

1/ Surge capacity, population triage and the NHS

Problem: Cygnus modelled a respiratory pandemic very similar to what Covid-19 turned out to be. Left unmitigated (which it was in the simulation, for reasons not fully explained) between 200,000 and 400,000 excess deaths were expected and NHS capacity was quickly overwhelmed.

The twin issues of "surge capacity" and "population-based triage" (who is treated and who is not) were therefore central to the Cygnus war game, just as they have been with Covid-19.

On the issue of triage, the report cryptically notes: "On the first day of the exercise a decision was made to consider an alternative model of population based triage to manage capacity and respond to the excessive demand for hospital care as set out by the exercise scenario."

As the Telegraph reveals today, this is an oblique reference to a decision by the then health secretary Jeremy Hunt to "stop playing" when he was asked in a faux Cobra meeting to make the final call on who should be treated and who should not.

Mr Hunt says he was within his rights to do so. He says he was asked to turn off 4,000 ventilators, believing that to be "morally repugnant" and so paused the exercise. But others involved say he undermined the simulation by refusing to play by the rules.

The report says responsibility for the final decision on triage was then passed to the NHS during the exercise. It does not say exactly what then happened, but it is clear hospitals were emptied, care-homes were overwhelmed and bodies quickly piled up.

"We've just had in the UK a three-day exercise on flu on a pandemic that killed a lot of people", Dame Sally Davies the then Chief medical Officer said of Cygnus in December 2016. "It became clear that we could not cope with the excess bodies, for instance".

Recommendations: On triage, the report says the Chief Medical Officers of the four nations should be asked to come up with a plan. It should cover the "triggers" for such a policy and (not surprisingly given what had unfolded in the dry run) a "proposal for who would make the decision to move to population-based triage and in what circumstances".

On surge capacity, "further work" was also recommended. The NHS was charged with modelling the impact of hospital closures to "identify lives saved or lost". It was also asked to devise a "rapid discharge protocol" so better decisions could be made on whether someone stays in hospital or is "discharged to residential care."

Results: It is not known if either of these plans now exist. Prof Neil Ferguson of Imperial said in March that one of the reasons it had been hard to model the impact of the virus on the UK in a timely fashion was because NHS capacity data was late in coming. The decision to close the NHS to non-emergency cases and empty its beds of non-Covid patients (mainly the old) was made in public at least by Simon Stevens, the Chief executive of the NHS. If a pre-pandemic tally exists of the estimated "lives saved or lost" through these actions, it has not been made public.

2/ The danger of "silos", disparate plans and localism

Problem: Cygnus, which involved 950 representatives from local and central government and many other bodies, exposed "silo planning between and within some organisations" and a good degree of confusion as a result.

There was a "lack of understanding about the potential impacts of a pandemic". Some had plans, others didn't, and the devolved administrations had their own strategies. Some were up to date, others weren't. Some relied on documents and protocols that no longer existed. "It became clear there is no overview of pandemic response plans and procedures", says the report.

"There are too many plans [and] there's a question about how up to date all the plans are and whether there are contradictions between them", it quotes one participant as saying.

Recommendations: Cygnus recommended a single body be set up - a "Pandemic Concept of Operations" - to avoid similar chaos in a real pandemic.

Result: No single body was set up to coordinate information and disparate, often conflicting actions within and between government departments and localities has been a hallmark of the UK's response to Covid-19.

3/ Department of Education (DFE) to study the impact of school closures on society

Problem: Schools were hit hard in Cygnus. The simulated pandemic forced the closure of many and it became clear that contingency planning was needed.

Recommendations: DFE was asked to "examine the impact of school closures" on society and create backup plans.

Result: Few if any contingency plans appear to have been put in place ahead of Covid-19, nor is it understood what long term impact school closures will have. Schools were forced to close by Covid and the lack of online teaching and the exams fiasco have left lasting scars. In a grid on page 47 of the Cygnus report, detailing which participants engaged with the exercise by providing feedback, the DFE's entry is blank in all four columns.

4/ Care home capacity planning and "ring-fenced" funding

Problem: Cygnus identified that care-homes would be a pinch point, predicting that hospitals would need to move patients into homes and that the sector could be overwhelmed.

"Social care is currently under significant pressure.... [yet] there was little attention paid to this sector by ministers during the [Cygnus] Cobra meetings", notes the report. "Any extra pressure on the Social Care sector could be very challenging".

Recommendations: The report makes a series of recommendations to avert disaster in the sector including an audit of care home capacity, "ring-fenced" funds, provision of PPE and active engagement with providers on the vital issue of "surge capacity".

Results: Social care budgets were cut and the sector was caught off guard by Covid-19. The policy of moving hundreds of patients from hospitals into homes is thought to have caused the virus to spread and many vulnerable residents to die. Providers say they were not engaged ahead of time on surge capacity or pandemic planning.

5/ Data and the efficient flow of information

Problem: Cygnus identified that the flow of data in a pandemic could quickly become problematic. Participants were "overwhelmed" by what was being requested from them. Local bodies said data coming from the centre "impeded their ability to act", while the central government struggled to make sense of what it was receiving from the regions.

Recommendation: The report recommends a cross-government working group be established to "consider carefully the information needed to guide the response."

Result: The inefficient flow of data between central and local government has been widely criticised as hindering the UK Covid-19 response.

6/ Social distancing, the missing key

Whitehall is under mounting pressure to explain why, unlike countries including Taiwan, South Korea, Singapore and even the US, it did not have plans in place to slow the spread of a pandemic virus through early social distancing or so-called non-pharmaceutical interventions (NPIs).

In a preamble to the Cygnus report published last week on the DHSC website, officials frame the document in a way that deflects this criticism.

"The aim was to test systems to the extreme, to identify strengths and weaknesses in the UK's response plans, which would then inform improvements in our resilience", it says.

"Exercise Cygnus was not designed to consider other potential pandemics [beyond influenza], or to identify what action could be taken to prevent widespread transmission".

The same defence was run up the pole last week by Lord Sedwill, the recently departed head of the civil service, in his first media interview since leaving Downing Street.

"If it had been a different pandemic by the way, the answer wouldn't have been a lockdown", he said.

This is not correct. The NPIs other countries had in place were explicitly designed to deal with influenza. Like the UK, they also saw flu as the most likely pandemic candidate - the whole world did.

As experts involved in putting those social distancing protocols in place recently told the Telegraph, the notion that influenza is unstoppable through social distancing is "colossally stupid" and "palpably false".

It is also not the case that Exercise Cygnus only looked at the late stages of a pandemic.

Although the bulk Cygnus was run in week seven - the "treatment and escalation" phases of the simulated pandemic - it included an element codenamed Exercise Cygnet which covered week four which sits firmly in the "detection and assessment" timeframe.

The report reveals that Cygnet recommended a "whole system" approach to the distribution of PPE covering both NHS and social care staff. It also called on Public Health England to "define and communicate" who will receive PPE from the national stockpile in the event of a pandemic so others, including private businesses, could make their own arrangements to protect workers in advance.

But what Cygnet, like Cygnus, did not do is consider how a pandemic virus might be stopped, as happened in so much of southeast Asia.

Of all the mysteries surrounding Exercise Cygnus, this remains the biggest unanswered question.

Why did the simulation not try to slow the spread of the virus in week four when the tools existed to do so?

The same question will be asked of the government's response to Covid-19.
Protect yourself and your family by learning more about Global Health Security

# data[].attributes.attachment_link.title
The six crucial pandemic lessons the government ignored

# data[].attributes.attachment_link.description
It took seven months, the threat of legal action and the intervention of the Information Commissioner but on Tuesday Whitehall reluctantly published its secret report on Exercise Cygnus, the ill-fated simulation which exposed the weakness of Britain's pandemic plans a full three years before the coronavirus hit.

# data[].attributes.headline
Steep rise in younger adults flouting UK's Covid restrictions

# data[].attributes.subject
Steep rise in younger adults flouting UK's Covid restrictions

# data[].attributes.body
https://www.theguardian.com/world/2020/oct/24/poll-reveals-steep-rise-in-younger-adults-flouting-uks-covid-restrictions

# data[].attributes.attachment_link.readable_text
A simple virus has brought life as we know it to a screeching halt.

We have faced viral threats before, including pandemics, yet the world does not shut down for every new infection or flu season.

So what is it about this coronavirus? What are the quirks of its biology that pose a unique threat to our bodies and our lives?

Master of deception

In the early stages of an infection the virus is able to deceive the body.

Coronavirus can be running rampant in our lungs and airways and yet our immune system thinks everything is a-ok.

"This virus is brilliant, it allows you to have a viral factory in your nose and feel completely well," says Prof Paul Lehner from the University of Cambridge.

Our body's cells start releasing chemicals - called interferons - once they are being hijacked by a virus and this is a warning signal to the rest of the body and the immune system.

But the coronavirus has an "amazing capability" of switching off this chemical warning, Prof Lehner says, "it does it so well you don't even know you're ill".

He says when you look at infected cells in the laboratory you cannot tell they have been infected and yet tests show they are "screaming with virus" and this is just one of the "joker cards" the virus can play.

The amount of virus in our body begins to peak the day before we begin to get sick.

But it takes at least a week before Covid progresses to the point where people need hospital treatment.

"This is a really brilliant evolutionary tactic - you don't go to bed, you go out and have a good time," says Prof Lehner.

So the virus is like a dangerous driver fleeing the scene - the virus has moved on to the next victim long before we either recover or die.

In stark terms, "the virus doesn't care" if you die, says Prof Lehner, "this is a hit and run virus".

This is a massive contrast with the original Sars-coronavirus, back in 2002. It was most infectious days after people became ill, so they were easy to isolate.

There are four other human coronaviruses, which cause common cold symptoms.

Prof Tracy Hussell from the University of Manchester, said: "This is a new one, so we don't think there's much prior immunity there."

The newness of Sars-CoV-2, to give it the official name, she says, can be "quite a shock to your immune system".

Building an immune defence from scratch is a real problem for older people, as their immune system is slow off the mark.

Learning to fight a new infection involves a lot of trial and error from the immune system.

But in older age we produce a less diverse pool of T-cells - a core component of the immune system - so it is harder to find ones that can defend against Coronavirus.

Covid starts off as a lung disease (even there it does strange and unusual things) and can affect the whole body.

Prof Mauro Giacca, from King's College London, says many aspects of Covid are "unique" to the disease, indeed "it is different from any other common viral disease".

And Prof Giacca says you can have "complete regeneration" of the lungs after severe flu, but "this does not happen" with Covid.

"It is quite a peculiar infection," he said.

Blood clotting also goes strangely awry in Covid, with stories of doctors unable to get a line into a patient because it is immediately blocked with clotted blood.

Clotting chemicals in the blood are "200%, 300%, 400% higher" than normal in some Covid patients, says Prof Beverly Hunt from King's College London.

The virus can cause runaway inflammation in some patients, making the immune system go into overdrive, with damaging consequences for the rest of the body.

Covid is worse if you are obese, as a generous waistline increases the risk of needing intensive care, or death.

"Its very strong association with obesity is something we haven't seen with other viral infections. With other lung injuries, obese people often do better rather than worse," said Prof Sir Stephen O'Rahilly, from the University of Cambridge.

"It looks pretty specific [to Covid] it probably happens in pandemic flu, but not regular flu."

Fat deposited throughout the body, in organs like the liver, causes a metabolic disturbance which seems to combine badly with coronavirus.

Obese patients are more likely to have higher levels of inflammation in the body and proteins that can lead to clotting.

# data[].attributes.attachment_link.description
A simple virus has brought life as we know it to a screeching halt. We have faced viral threats before, including pandemics, yet the world does not shut down for every new infection or flu season. So what is it about this coronavirus?

# data[].attributes.body
https://www.bbc.co.uk/news/explainers-52530518

# data[].attributes.body
https://www.bbc.co.uk/news/explainers-52530518

# data[].attributes.body
https://www.bbc.co.uk/news/explainers-52530518

# data[].attributes.body
https://www.bbc.co.uk/news/explainers-52530518

# data[].attributes.attachment_link.title
Covid: What is the guidance across the UK now?

# data[].attributes.attachment_link.description
Almost all of the UK's Covid rules have ended, two years after they were introduced.

# data[].attributes.attachment_link.title
Covid-19: Call for 'exit strategy' as South Yorkshire enters tier 3

# data[].attributes.attachment_link.description
The new rules are needed but ministers must set out an exit strategy, Sheffield City Region's mayor says.

# data[].attributes.headline
Covid-19: South Yorkshire enters tier 3 and praise for free meals response

# data[].attributes.subject
Covid-19: South Yorkshire enters tier 3 and praise for free meals response

# data[].attributes.attachment_link.readable_text
As Strictly Come Dancing returns to our screens, Nell Mackenzie looks at how professional ballroom dancers and coaches around the world are continuing to cope with the impact of pandemic restrictions. Many have moved lessons online, with some offering free coaching: "I wanted to give a sense of belonging... and to make my students understand they can stay in dancing shape from their living room," said US Latin dance champion Tatiana Keegan.

# data[].attributes.attachment_link.title
Covid-19: South Yorkshire enters tier 3 and praise for free meals response

# data[].attributes.attachment_link.description
As Strictly Come Dancing returns to our screens, Nell Mackenzie looks at how professional ballroom dancers and coaches around the world are continuing to cope with the impact of pandemic restrictions. Many have moved lessons online, with some offering free coaching: "I wanted to give a sense of belonging...

# data[].attributes.headline
Covid: The NHS workers 'still recovering' as second wave looms

# data[].attributes.subject
Covid: The NHS workers 'still recovering' as second wave looms

# data[].attributes.body
October 2020 https://www.bbc.co.uk/news/explainers-54623919

# data[].attributes.attachment_link.readable_text
"I still have nightmares most nights about being completely out of my depth."

Gemma, a ward nurse in Northern Ireland, was redeployed to a critical care unit at the end of March when the first wave of coronavirus struck.

"I had never looked after a critically ill intensive care patient in my life," she says.

"I just thought, I'm coming in here and I'm going to die. I'm going to catch Covid and I'm going to be one of those patients in the beds."

As the second wave of the pandemic takes deep root across parts of the UK, thousands of NHS workers are struggling to recover from what they have already been through.

"We were all in PPE all the time," recalls Nathan, a senior intensive care nurse at a hospital in the Midlands. "All you can see is people's eyes, you can't see anything else."

He describes trying to help junior members of staff survive long and difficult days.

"And I'd see these eyes as big as saucers saying help me, do something. Make this right. Fix this."

"The pressure was insane, and the anxiety just got me," he says. "I couldn't sleep, and I couldn't eat, I was sick before work, I was shaking before I got into my car in the morning."

Nathan ended up having time off with severe anxiety, but he is now back at the hospital, waiting for the beds to fill up again.

We've spoken to a number of nurses and doctors across the UK who are deeply apprehensive about what lies ahead this winter.

We're not using their real names because they shared their views on condition of anonymity, in order to speak freely.

All believe it is important that the general public hears first-hand about the enormous strain the health service and its staff have been under.

It has not just been about coping with the devastating effects of a new and deadly disease.

Pressure to deal with the huge backlog of other medical treatments, which had been put on hold, meant some health care workers didn't have much of a break during the summer either.

"I finally went on holiday in September and it was like I came out of a fog," says Danny, an intensive care doctor and anaesthetist based in Yorkshire.

"Almost the last six months of my life was just some kind of haze that I don't remember very well. You just became all about Covid and nothing else," he says. "And I think that got us through the first wave, but obviously it isn't a sustainable mechanism to carry on."

That widely shared feeling of exhaustion has been heightened by long-standing concerns about staff shortages, and by deep resentment - particularly among nurses - about pay and conditions.

One of the lasting images of the first wave of Covid is of the weekly "clap for carers" - that moment of national unity that took place on doorsteps at 20:00 every Thursday night.

Health care workers have been very appreciative of public support, but many say they would prefer a proper pay settlement to another round of applause.

And Jo Billings, a psychologist from the Covid Trauma Response Working Group at University College London, says "the narrative of health care workers being heroes or angels has largely been really unhelpful."

It painted a picture that people do this because they're special, not because they're simply doing their job, for which they should be adequately paid and protected.

"It's also been a real barrier to people seeking help with their own problems," Ms Billings says, "because they feel heroes don't struggle. An angel doesn't get PTSD."

Mental health

The first wave of Covid-19 could have been much worse than it was. In fact, many doctors expected it to be. A lot of the extra capacity that was created so quickly in the health system, in temporary Nightingale hospitals and elsewhere, was not needed.

But health care staff speak of an "all hands on deck" mentality, when people were doing long shifts and were often away from home for extended periods to protect their families.

"It was mentally draining, and we've not really had a proper downtime," says Moussa, a respiratory consultant from Greater Manchester. "As soon as the first wave finished, we started catching up with the backlog of other cases. So, there was another mountain to climb."

That sense of fatigue and frustration, in a health service already stretched to the limit before Covid struck, is captured in data put together by the Covid Trauma Response Working Group.

Its Frontline Covid study of nearly 1200 health care workers from across the UK between May and July found that nearly 60% of them met the criteria for at least one of three things - anxiety, depression and post-traumatic stress disorder.

Various risk factors were identified, including fear of transmitting Covid to others, unreliable access to Personal Protective Equipment (PPE) at the time, feeling stigmatised due to their role, and not feeling able to talk to a manager about how they were coping.

Conversations with NHS staff reveal a system of support for staff welfare and mental health which is patchy - fantastic in some places, not so in others.

"A junior doctor I spoke to the other day was talking about what a difficult time she'd found in another hospital," says Dorothy Wade, a psychologist at University College Hospital in London. "And I said, 'Didn't you have anything like this at the other hospital?' And she said, 'No, absolutely nothing. There was nothing on offer at all.'

She says quite a lot of hospitals still don't have a staff psychologist, and didn't have resources to offer any provisions.

It has been a similar story in intensive care units, says Nicki Credland of the British Association of Critical Care Nurses.

"In some places there have been significant amounts of psychological support," but in others "staff are reporting that they're needing to go to their GP."

NHS England says nearly half a million staff were given extra support with their health and mental wellbeing needs during the first wave, via self-help apps, text services, online forums and telephone helplines.

But in most cases, it is down to local management, and sometimes support isn't available at the time that shift workers need it.

"Members of staff in our ward have been permanently scarred by Covid," says Jacqui, a nurse at a small community hospital in London. "They sometimes struggle now doing some of the more minor tasks. [But] we were very lucky that we're in a very good, small trust," she says, "which has taken all that on board and is supporting them."

A large number of health care workers, however, were redeployed into new hospitals or new wards, or even into entirely new areas with very little training and very little preparation.

And the Frontline Covid survey reveals that many of them were distressed by what they saw.

That is partly because even at the best of times in critical care, a lot of patients are going to die.

"You have to have this slight disconnect with what's going on because you have to accept that you can do everything right, and the patient still might not survive," says Danny, the ICU doctor in Yorkshire. "But people coming from elsewhere in the hospital haven't had the time to develop that kind of mentality."

In Northern Ireland, Gemma was asked recently by her manager if she would like to volunteer to go back into an ICU.

"I laughed in her face and said no," she admits. "I don't know if I'll be made to go. But as soon as you walk over the threshold of a hospital, you cannot refuse to look after a patient. And the thought is, you've done it before, you can do it again."

Pay and conditions

There's little doubt that morale in the NHS would be higher if staff felt they were being rewarded more fairly.

The Royal College of Nursing (RCN) surveyed more than 40,000 of its members in the aftermath of the first Covid wave, and found that pay, and feeling under-valued, was their number-one concern.

"It may feel like now is not the time to talk about pay, with so many people in lockdown and in serious financial difficulty," says Mike Adams of the RCN, "but we've thought about this very carefully.

"If you want to do one thing for nurses who need a boost to get through the rest of this year, and through the winter, it would be to show you value them with a meaningful pay rise."

Many staff are frustrated because they know that is unlikely to happen.

Nearly three quarters of respondents to the RCN survey said they thought they were more valued by the general public after the onset of Covid-19. But less than one fifth thought they were more valued by the government in their part of the UK.

"All that clapping, and all that goodwill," says Nathan, "and now it's back to normal."

Doctors earn more money than nurses, but express similar sentiments.

"We've lost 40% of our pension pot in the last five years," says Jack, a consultant in London. "And everyone is looking at it and wondering whether they should get out now before we lose any more.

"I think by next March, it's going to be a great deal worse," he says

That in turn highlights another message delivered by members of the RCN. In the aftermath of the first Covid wave, 35% of more than 40,000 people said they were actively considering leaving the profession.

Staff shortages

An NHS spokesperson told the BBC that there are now more than 300,000 nurses in England, including 13,000 who joined recently.

"And this year there was a 22% increase in applications for nursing degrees, on top of our £28m fund to boost international recruitment," the spokesperson continued.

It takes years to train new recruits, however, and there were more than 40,000 nursing vacancies across the NHS at the beginning of the year.

Now, with Covid an ever-present danger, many experienced members of staff are thinking of leaving, and many of them are not coming back.

"Nurses approaching retirement used to - in significant numbers - retire, and then return on a smaller number of hours," says Mike Adams at the RCN. "But that is just not happening as much. We're losing the guides and mentors for the student nurses and the newly qualified nurses."

Gemma in Northern Ireland says she plans to leave the NHS when this next Covid phase is over, and get a job in the private sector where she won't be redeployed at a moment's notice.

"A lot of what got us through is the camaraderie, informal chats in the tearoom," she explains. "But we're not even allowed to chat in the tearoom anymore. We have to sit apart with masks on.

"I'd say a large proportion of my team feel the same. A couple of nurses have just taken early retirement saying, 'No, not doing it anymore.'"

Many people in the NHS think the public aren't always aware of how acute staff shortages could become.

"The focus during the first wave was all on ventilators and the Nightingales and beds and things like that," says Danny in Yorkshire. "But the actual thing we need is staff."

He highlights a concern raised by a number of NHS staff that we talked to - an awful lot of people were so burnt out by the first wave that they may not be able to commit so much this time.

"We've noticed there's a real reluctance among doctors, nurses, everyone to pick up these extra shifts now," he says. "People are realising the importance of family, the pandemic has encouraged everyone to make life simpler, and they want to do something more sustainable second time around."

The challenge could be particularly acute in intensive care.

In south-west London, Jacqui worked in an ICU during the first wave, and has the rights skills and experience. But she doesn't think she can do it again.

"Intensive care is incredibly physical, and I hurt my shoulder last time trying to roll a patient over," she says. "Psychologically, I'm not sure I could completely cope with it again."

"It has actually made me go, 'Right, next year, I really will take my pension, I won't work full time anymore.' I've done my bit."

Back in March and April, staff were redeployed in large numbers from other parts of the health system, particularly from operating theatres, to bolster intensive care.

But if the government wants things like elective surgery and operations elsewhere in the health system to continue, many of those extra staff may not be available.

"We haven't miraculously managed to find an extra 10,000 ICU nurses over the past five months," says Nicki Credland. "That gives us a problem, which is compounded by staff that are off sick because of the psychological and physical response to the first wave of Covid."

Local approach

There are potential solutions to ease serious staff shortages if the virus strikes specific areas hard. Seriously-ill patients could be moved to hospitals under less pressure, or experienced staff, based in areas where the virus is spreading more slowly, could be moved into hotspots.

"We're taking a much more local approach," the medical director of NHS England Stephen Powis said last week, "and we are determined to keep the capacity for non-Covid services open for as long as possible.

"That involves hospitals helping each other, the use of independent sector hospitals where we can, and it might involve some of the Nightingale hospitals."

A doctor at an NHS trust near Liverpool - which is in tier three - confirmed that her hospital was on standby to take patients from Liverpool City Region, even though its ICU was already full.

But if the pandemic gets a lot worse, the effectiveness of local cooperation like this could be limited. And there is no national plan for moving people or resources around the country.

"In France, they reconditioned trains and made carriages into mobile intensive care units," says Jack, the consultant in London. "In Holland, they had a big double-decker bus, a mobile ICU to move large numbers around. But I'm not aware that we've got anything other than fleets of ambulances."

Winter is coming

When you look back to March, there is no doubt some things have changed for the better. There is far more testing of NHS staff, including testing staff without symptoms in hotspot areas, and there is far less anxiety about the supply of personal protective equipment.

Doctors also know more about the disease and ways to try to treat it, which should have a positive effect on staff morale.

"We still don't have a cure, but seeing people get better obviously makes staff stronger psychologically," says consultant Jack. "We're only human after all."

Even so, a long winter looms.

"We will put our best foot forward, and we'll do the best for the patients," says Nathan, the ICU nurse in the Midlands, "but I can genuinely say all of my colleagues, including senior management, are terrified."

"We're not sure how, in terms of resilience, we are going to be able to get through this."

Across the NHS you can hear similar concerns - a determination to step up to the plate again, but also the knowledge that adrenalin only gets you so far.

The desire to continue with business as usual in the NHS - treating other conditions and diseases as normal - is a laudable, and probably an essential, aim.

But that may not prove possible - some hospitals are cancelling operations already.

"The pressure to still run all the normal functions of the NHS and deal with a Covid second wave that's got the potential to be bigger than the first one," says Moussa, "that's a harsh, harsh thing when we feel we need to prioritise."

Many doctors were expecting a second wave to start around November, so it has come in some places a little earlier than predicted. And even in a normal year, the onset of winter and the flu season puts huge additional capacity pressure on the NHS.

The government argues that the system has shown extraordinary resilience in the face of a pandemic unprecedented in living memory.

But Moussa argues that as a country, "we could have done more to be ready for the second wave".

"When you think about it," he says, "it's a bit of a perfect storm."

# data[].attributes.attachment_link.title
Covid: The NHS workers 'still recovering' as second wave looms

# data[].attributes.attachment_link.description
"I still have nightmares most nights about being completely out of my depth." Gemma, a ward nurse in Northern Ireland, was redeployed to a critical care unit at the end of March when the first wave of coronavirus struck. "I had never looked after a critically ill intensive care patient in my life," she says.

# data[].attributes.attachment_link.readable_text
Its latest figures, for the two weeks to 11 October, found the fastest acceleration of cases in the north west, while Scotland, Wales, London and the Midlands were also increasing, but more slowly.

# data[].attributes.attachment_link.title
Coronavirus infections still rising rapidly

# data[].attributes.attachment_link.description
Its latest figures, for the two weeks to 11 October, found the fastest acceleration of cases in the north west, while Scotland, Wales, London and the Midlands were also increasing, but more slowly.

# data[].attributes.body
https://www.telegraph.co.uk/

# data[].attributes.body
https://www.theguardian.com/world/2020/oct/06/coronavirus-world-map-which-countries-have-the-most-covid-cases-and-deaths

# data[].attributes.body
https://www.theguardian.com/world/coronavirus-outbreak

# data[].attributes.body
https://www.theguardian.com/uk