Babak Belurs

Selasa, 28 April 2020

Dozen children have needed intensive care due to ‘mystery new coronavirus-linked condition’ - The Sun

MORE than a dozen children have reportedly needed intensive care due to a "mysterious new coronavirus-linked condition".

The youngsters had all fallen ill with a potentially fatal combination of symptoms similar to toxic shock syndrome.

⚠️ Read our coronavirus live blog for the latest news & updates

Doctors say the syndrome is similar to toxic shock syndrome and Kawasaki disease, which can cause redness of the tongueCredit: Shutterstock

The symptoms of the mysterious condition include rashesCredit: Shutterstock

According to the Guardian, at least one child had to be put onto an extra corporeal membrane oxygenation (ECMO) machine - an aggressive form of life support.

These are seen as a "last resort" treatment and the prognosis for those who end up on an ECMO machine is, by definition, poor.

A number of other kids admitted to intensive care also needed treatment for heart inflammation.

NHS bosses are so concerned that they sent an urgent alert to doctors warning of a rise in cases in recent weeks.

They warned that the cases have features of toxic shock syndrome and Kawasaki disease, an inflammatory condition that attacks blood vessels and the heart.

These conditions can cause harmful internal swelling, fever and breathing problems - which are all also the main symptoms of coronavirus.

Some also reported suffering from abdominal pain and gastrointestinal symptoms, like vomiting and diarrhoea, as well as heart problems.

Dr Liz Whittaker, a consultant at St Mary’s hospital in London and a member of the Royal College of Paediatrics and Child Health’s allergy, immunology and infectious diseases committee told the Guardian: “Our worry is that paediatricians who see children with fever and abdominal pain will do blood tests to look for problems such as appendicitis, but might not do bloods that look for inflammatory issues."

'Plausible link'

Professor Stephen Powis said it was "too early to say" whether there is a link between the Kawasaki-like disease and coronavirus.

But chief medical officer Prof Chris Whitty said it was "entirely plausible".

They have instructed medical experts to look into the potential link as a "matter of urgency".

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It comes after the UK Paediatric Intensive Care Society (PICS) tweeted an alert it said was from NHS England which says in the "last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK".

NHS England confirmed it had shared the warning through its incident teams to clinical commissioning groups and hospital trusts.

The alert said the effects had been seen in children both with and without Covid-19 but there was evidence that some patients had had coronavirus previously.

Mr Hancock said he was "very worried" about reports of a new illness in children and experts are "looking into it with great urgency".

The Paediatric Intensive Care Society (PICS) published this message on Twitter last night

SIGNS TO WATCH OUT FOR

NHS doctors have been told to watch out for signs of an 'inflammatory syndrome' in kids, after a rise in cases of the new condition.

Health chiefs said in an alert to GPs the signs include:

stomach pain
gastrointestinal symptoms - like vomiting and diarrhoea

The mysterious condition has been compared to toxic shock syndrome and Kawasaki disease.

The signs of TSS are:

high temperature
flu-like symptoms, like headache, feeling cold, aches, sore throat and cough
feeling and being sick
diarrhoea
widespread burn-like rash
lips, tongue, and whites of the eyes turning bright red
dizziness or fainting
difficulty breathing
confusion

Signs of Kawaski disease include:

a rash
swollen glands in the neck
dry, cracked lips
red fingers or toes
red eyes

He told LBC: "We put out at the weekend a call across the NHS because some cases of this had been identified and then this call essentially says to doctors in other parts of the country 'have you seen this condition?' and then they collate the information and find out what's going on."

He said: "We have lost some children," adding: "There are some children who have died who didn't have underlying health conditions."

The Health Secretary explained: "It's a fresh, new disease that we think may be caused by coronavirus and the Covid-19 virus.

"We're not 100 per cent sure because some of the people who got it hadn't tested positive.

"We're doing a lot of research now but it is something we're worried about.

"What I would also stress is that it is rare.

"Although it is very significant for those children who do get it the number of cases is small."

Speaking at the daily Downing Street press conference last night, Professor Stephen Powis said: "We have become aware in the last few days of reports of severe illness in children which might be a Kawasaki-like disease.

"Both Chris (Whitty) and I are aware of that, and we have asked our experts, I have asked the national clinical director for children and young people to look into this as a matter of urgency."

He urged parents who are worried about a child who is sick and not recovering to seek medical help.

Prof Whitty added: "This is a very rare situation but I think it is entirely plausible that this is caused by this virus, at least in some cases.

"Because we know that in adults who of course have much more disease than children do, big problems are caused by an inflammatory process and this looks rather like an inflammatory process, a rather different one.

"Therefore, given that we have got a new presentation of this at a time with a new disease, the possibility - it is not a definite, we need to look for other causes as well - but the possibility that there is a link is certainly plausible."

Bizarre symptoms

According to the alert, which was originally shared with GPs in north London, children affected display signs similar to toxic shock syndrome (TSS), a severe illness associated with infections, and have blood markers in line with severe Covid-19 in children.

They may also have abdominal pain and symptoms of inflammation around the heart.

The alert says: "There is a growing concern that a Sars CoV-2 (Covid-19) related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases."

HEALTH WORKERS USING NEW APP TO FLAG PPE NEEDS IN REAL TIME

Health workers on the frontline are using a new data platform to communicate their protective equipment needs in real time during the coronavirus crisis.

Frontline.Live gives health workers the opportunity to say what specific PPE they need and where manufacturers can help, and hopes to match medical staff with the relevant suppliers across the country.

According to the latest data from the platform, PPE needs are highest in the Midlands, London and the South West.

Figures also show that gowns (around 50%) and safety glasses/visors (50%) are the most in-demand items across the board.

From the suppliers who have registered, 70% can provide safety glasses/visors, and 30% can provide gowns to NHS staff in need.

Frontline.live, set up by a team of dedicated volunteers, is free to sign up to, and over 70 suppliers have already joined to help NHS heroes.

The alert talks about atypical Kawasaki disease, a condition that mainly affects children under the age of five.

Symptoms include a high temperature that lasts for five days or more, often with a rash and/or swollen glands in the neck.

NHS England stressed there was no confirmed connection between Kawasaki-related diseases and Covid-19.

Professor Simon Kenny, the NHS's national clinical director for children and young people, said: "Thankfully Kawasaki-like diseases are very rare, as currently are serious complications in children related to Covid-19, but it is important that clinicians are made aware of any potential emerging links so that they are able to give children and young people the right care fast.

"The advice to parents remains the same: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please go to hospital."

Rare cases

Professor Russell Viner, president of the Royal College of Paediatrics and Child Health (RCPCH), said parents should be reassured that children are unlikely to be seriously ill with Covid-19.

He said: "We already know that a very small number of children can become severely ill with Covid-19 but this is very rare - evidence from throughout the world shows us that children appear to be the part of the population least affected by this infection.

"New diseases may present in ways that surprise us, and clinicians need to be made aware of any emerging evidence of particular symptoms or of underlying conditions which could make a patient more vulnerable to the virus.

"However, our advice remains the same: parents should be reassured that children are unlikely to be seriously ill with Covid-19 but if they are concerned about their children's health for any reason, they should seek help from a health professional."

According to the NHS, children are contracting Covid-19 at the same rate as adults but are suffering less severe symptoms on the whole.

However, children have died, including 13-year-old Ismail Mohamed Abdulwahab, from Brixton, south London, who died in King's College Hospital at the end of March.

The latest figures for hospital deaths of patients testing positive for Covid-19 in England show that up to 5pm on April 25 there had been nine deaths between the ages of 0 and 19.

This represents 0.05 per cent of all hospital deaths in England.

In Scotland, no Covid-19 deaths had been registered by April 19 for people aged 0-14. In Northern Ireland, no Covid-19 deaths had been registered by April 17 for people aged 0-14.

Chris Whitty and Stephen Powis on link between coronavirus and cases of 'inflammatory syndrome' in children

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2020-04-28 09:23:16Z
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Coronavirus UK: Lockdown-easing plans could start this weekend - Daily Mail

Boris Johnson's lockdown exit plan 'could let Britons go out to see family and friends in "bubbles" of TEN people, council tips reopen THIS weekend, and everyone told to wear DIY masks' - but schools 'will stay closed until June'

Boris Johnson is set to flesh out details this week of how the UK could start to ease coronavirus lockdown
Speculation that Britons could be allowed to see family and friends in 'bubbles' of 10 to limit risk of spread
Council tips could reopen this weekend if the authorities give the green light that they can cope with a rush
Ministers are also drawing up plans to bolster railway services as more of workforce is encouraged to return
Shoppers and passengers could be urged to wear homemade masks with floor marks to enforce distancing
Timing of an easing still highly uncertain with scientists warning small changes could spark a second peak
Here’s how to help people impacted by Covid-19

By James Tapsfield, Political Editor For Mailonline and Jack Elsom For Mailonline

Published: 02:24 BST, 28 April 2020 | Updated: 09:46 BST, 28 April 2020

Boris Johnson is mulling a blueprint to loosen the coronavirus lockdown that could let family and friends mix in 'bubbles' - as well as reopening more public services and urging more people to return to work as early as this weekend.

Britons could be allowed to choose 10 people they can socialise with in an easing of draconian restrictions that have split families over the past month, despite the risk that the outbreak could return.

Ministers are also looking at getting public services such as tips up and running in a matter of days, although sources stressed that they had never been formally ordered to close and it is a decision for local authorities.

Garden centres and other shops where social distancing can be most enforced could follow shortly afterwards, while ministers are also drawing up plans to bolster rail services as more of the nation's workforce is encouraged to return. The government's key 'stay at home' message is expected to be overhauled to make clear people should do their jobs wherever possible.

Shoppers and passengers will likely be instructed to fashion a homemade mask while floor markings will enforce the two-metre separation rule, an insider told the Daily Telegraph.

However, despite the frantic work going on in Whitehall, the timetable for easing the curbs that are strangling the economy is far from certain. The lockdown is not officially due to be reviewed until May 7, and scientists have been warning that even small changes could spark a deadly new peak and inflict even worse damage.

Downing Street has been playing down the prospect of schools opening before June - regarded by many as essential for a wide-scale reopening of UK plc.

The outline of the plan is emerging after the PM returned to work yesterday and braced the public for a 'new normal' which will juggle the need to revive the economy with limiting the threat of the infection running rampant again.

Mr Johnson offered a glimmer of hope by saying the exit strategy will be fleshed out 'in the coming days', although No10 sources were today playing down the prospect of any major announcements this week.

He also cautioned that the UK is at a moment of 'maximum risk' and the public must be 'patient'. Chief Medical Officer Chris Whitty said last night that there is still a 'very long way to run' in the crisis.

In another desperate day in the fight against coronavirus:

Ministers have been holding urgent meetings with businesses that fear millions of workers will be too terrified to return to work even if the lockdown eases;
Business groups have warned that government bailouts must stay in place long after the restrictions loosen to avoid thousands of firms going bust;
Health Secretary Matt Hancock has been confronted over PPE shortages by the son of a doctor who died from coronavirus;
An adviser to the government has suggested pubs could be reopened, but only if they ration the number of drinks for customers;

Boris Johnson has mapped out a blueprint to loosen the lockdown after returning to work yesterday (pictured after addressing the nation)

Back at the helm after three weeks recovering from his own battle with the virus, Mr Johnson was on top form as he chaired meetings with his most senior ministers

JOHNSON IN 'PROPERLY GOOD NICK' AS HE STORMS BACK TO WORK

Boris Johnson was on top form as he stormed back into Downing Street and chaired a 'full' cabinet coronavirus meeting in person to the wry smiles of ministers, sources said yesterday.

The Prime Minister, 55, ditched Zoom despite appeals from advisers to avoid appearing in person and walked confidently into a packed cabinet room for his 9.15am meeting on Monday.

Social distancing rules were 'pushed to the limit', with so many ministers back at No10, reports The Times.

But Mr Johnson, who returned to London from his two-week stint at Chequers on Sunday, was in 'properly good nick' and looked in better shape than he was before falling ill, according to the paper.

There was no sign of his pregnant fiancee Carrie Symonds, 31, who also fell ill with the virus, but she is believed to be returning to the flat at No11 soon.

Some watching today's war cabinet meeting told The Times the PM was 'asking very detailed questions' and 'sounded like he was very much on top of it'.

One adviser told the paper there was 'much more energy' at this meeting than ones before Mr Johnson was struck down with a fever.

On his first full day back in Downing Street, the Prime Minister spoke optimistically about entering a 'second phase' of the battle against the coronavirus in which some of the crippling restrictions can be relaxed.

The PM said this phase would see the Government 'continue to suppress the disease... but begin gradually to refine the economic and social restrictions, and one by one to fire up the engines of this vast UK economy'.

But he added: 'We must also recognise the risk of a second spike, the risk of losing control of that virus... because that would mean not only a new wave of death and disease but also an economic disaster.

Mr Johnson was said to be in 'properly good nick' as he took the helm of government again yesterday after three weeks recovering from his own battle with the virus.

The 55-year-old premier delivered a speech to the country on the steps of Downing Street before chairing the morning 'War Cabinet'.

Social distancing rules were 'pushed to the limit' as ministers and officials ditched video conferencing to physically attend the meeting at Number 10, according to The Times.

During Mr Johnson's absence, his de facto deputy Dominic Raab has remained tight-lipped over an exit strategy out lockdown.

But the PM hinted at a change to the lockdown yesterday morning as he addressed the nation.

He said the UK was nearing the end of the first phase of the crisis and would be looking at ways to 'refine' the restrictions, amid mounting Tory alarm and warnings that a third will be wiped off GDP as millions of jobs are destroyed.

Speculation has been swirling about what could change and how quickly - although ministers have apparently been advised that nothing major can be done until the UK has capacity to test everyone with symptoms and 'track and trace' who they have been in contact with.

That would require the estimated number of cases to be around 100,000 - a third of the current level - and the government to reach its target of carrying out 100,000 tests a day.

However, work is continuing at pace in Whitehall over options for loosening curbs.

Of one of the most eye-catching plans to insist on masks, a Whitehall source told the Telegraph: 'The plan for masks will be more than a recommendation. It is more of a compulsion for them to be worn in shops and on public transport.

'On social distancing, transport bosses will need to have two-metre markers in place so people can safely keep their distance.'

In his first public appearance since he was hospitalised with coronavirus, Mr Johnson said he had been 'away from my desk for much longer than I would've liked'.

He said: 'Once again I want to thank you the people of this country for the sheer grit and guts you've shown and are continuing to show.

'Every day I know that this virus brings new sadness and mourning to households across the land.'

Mr Johnson said: 'It is still true that this is the biggest single challenge this country has faced since the war and I in no way minimise the continuing problems we face.

'And yet it is also true that we are making progress with fewer hospital admissions, fewer Covid patients in ICU and real signs now that we are passing through the peak.

'And thanks to your forbearance, your good sense your altruism, your spirit of community, thanks to our collective national resolve, we are on the brink of achieving that first clear mission to prevent our National Health Service from being overwhelmed in a way that tragically we have seen elsewhere.

'And that is how and why we are now beginning to turn the tide.'

Mr Johnson, drawing on his own battle with Covid-19 which put him in intensive care, said: 'If this virus were a physical assailant, an unexpected and invisible mugger - which I can tell you from personal experience, it is - then this is the moment when we have begun together to wrestle it to the floor.

'And so it follows that this is the moment of opportunity, this is the moment when we can press home our advantage, it is also the moment of maximum risk.

'I know there will be many people looking at our apparent success, and beginning to wonder whether now is the time to go easy on those social distancing measures.'

Public transport routes have been operating a significantly cut-back timetable and officials are reportedly mulling how to expand services while maintaining social distancing

In a statement in Downing Street, the PM assured the country he is back in charge after weeks recuperating from a serious scare with the killer disease

BRITAIN FALL SILENT AT 11AM FOR KEY WORKERS KILLED BY PANDEMIC

The nation will fall silent today to pay tribute to NHS staff and other key workers who have lost their lives in the fight against coronavirus.

The tribute will be led by Boris Johnson, who returned to work yesterday after being struck down by the virus, at 11am.

Government workers will be asked to take part and the Prime Minister's official spokesman said it is hoped others will participate 'nationwide'.

The Unison union, the Royal College of Midwives and the Royal College of Nursing launched a campaign last week for the nation to take a moment to honour frontline staff who have died during the crisis.

Between them, the organisations represent more than a million NHS and public service workers including porters, refuse collectors and care staff.

The PM's official spokesman said yesterday: 'We will be supporting the minute's silence.

'We will be asking everybody who works in the Government to take part and we would hope that others will take part nationwide as well.' The silence will coincide with International Workers' Memorial Day.

Yesterday Health Secretary Matt Hancock confirmed 82 NHS workers and 16 social care staff have died of the virus so far.

During yesterday's Downing Street press conference Mr Matt Hancock promised the family's of all medics who have lost their lives on the frontline will get a £60,000 life assurance payout.

He said he understood 'how hard and stressful it has been to give up, even temporarily, those ancient and basic freedoms'.

But he said the potential of a second spike in cases risked 'economic disaster'.

Mr Johnson added: 'And so I know it is tough. And I want to get this economy moving as fast as I can, but I refuse to throw away all the effort and the sacrifice of the British people and to risk a second major outbreak and huge loss of life and the overwhelming of the NHS.'

Mr Johnson's words about the end of the first phase evoked Churchill's famous 1942 speech after the Allies defeated Rommel's forces at El Alamein.

The wartime PM said: 'This is not the end. It is not even the beginning of the end. but it is, perhaps, the end of the beginning.'

It is understood Mr Johnson's pregnant fiancee Carrie Symonds, who was with him at Chequers during his recuperation, has also moved back into Downing Street. She has also recovered from coronavirus.

Mr Johnson has returned to work 'full time', taking back all of the responsibilities handed over to Dominic Raab, Downing Street said.

The Prime Minister's official spokesman said: 'He's back full time. In terms of responsibilities and duties, he will be doing all of those.'

Mr Johnson is expected to chair Cabinet on Thursday, but the plan for PMQs is not yet clear.

The PM's official spokesman said he would be speaking to Sir Keir Starmer soon to discuss the way forward - although the idea of a government of national unity has been dismissed.

'He plans to speak with the leader of the Opposition this week and the leaders of all the Westminster parties next week, hopefully alongside the chief medical officer and the chief scientific adviser,' the spokesman said.

Allies have suggested the premier is ready to act earlier than May 7 to get UK plc up and running again, with hints the blanket 'stay at home' message from Whitehall will be ditched in favour of a more nuanced stance stressing the public should work where possible.

Pandemic planning shambles: Hushed-up government drill on killer flu outbreak 'FAILED to consider PPE, ventilator and testing shortages and found UK woefully unprepared for any new disease'

by Jack Elsom for MailOnline

A government pandemic response drill four years ago found that the UK was woefully under-prepared to fight a future outbreak, it was revealed last night.

The shortcomings exposed by Exercise Cygnus in 2016 included a lack of capacity in hospital and social care settings which risked becoming overwhelmed.

Checking Britain had a sufficient supply of personal protective equipment and ventilators, as well as assessing testing capacity, were reportedly both glaring omissions from the three-day simulation.

It once again asks hard questions as to why the country's pandemic defences were not shored up ahead of the current coronavirus crisis despite repeated warnings.

Calls for the findings of Exercise Cygnus to be de-classified and made public have been deflected by the government in recent days.

But the bombshell report, which has been seen by the Sun, now puts pressure on ministers to explain why the advice was not acted upon.

An NHS worker with a fluid-resistant surgical mask

A government pandemic response drill four years ago found that the UK was woefully under-prepared to fight a future outbreak, it was revealed last night (medical staff put on PPE at a testing centre)

Whitehall departments, the NHS, health bodies and councils were all included in the nationwide mock test of how the UK would cope with a deadly disease.

A subsequent report made 22 recommendations and concluded 'the UK's capability to respond to a worst case pandemic influenza should be critically reviewed,' according to the newspaper.

A source last night told MailOnline the government has 'been extremely proactive in implementing lessons learnt around pandemic preparedness, including from Exercise Cygnus'.

One of the holes uncovered by the exercise was an incapacity to deal with an influx in demand for hospital beds as cases soared.

At the start of the coronavirus crisis, the government was accused of being caught flat-footed as it raced to erect brand new Nightingale hospitals to expand capacity.

Concerns were also raised on creaking social care capacity, the effects of closing schools and the impact on prisons, the Sun reports.

It also claims dispatching PPE to frontline staff was mentioned only once in the 57-page document.

Members of the British Army wearing PPE work at a testing centre in Ebbsfleet, south London

NHS workers in PPE take a patient with an unknown condition to an ambulance at Queens Hospital in London

Matt Hancock has been asked to release the findings of Exercise Cygnus (pictured speaking at the Downing Street press briefing yesterday)

CHILDREN SICKENED WITH 'TOXIC SHOCK LINKED TO COVID-19'

Health chiefs have vowed to investigate reports of a coronavirus-related inflammatory syndrome in children as a 'matter of urgency'.

Doctors were issued an alert about a sharp rise of infants being admitted to intensive care with a Kawasaki-like disease.

Chief medical officer Professor Chris Whitty said it is 'entirely plausible' this spike is linked to the Covid-19 outbreak.

NHS medical director Professor Stephen Powis has instructed his experts to drill down into the alarming numbers.

Health Secretary Matt Hancock said he was 'very worried' by the flurry of symptoms displayed by children, who are among the least vulnerable to the effects of coronavirus.

In an alert sent to GPs, health chiefs at an NHS board in London said: 'There is growing concern that a [COVID-19] related inflammatory syndrome is emerging in children in the UK.

'Over the last three weeks there has been an apparent rise in the number of children of all ages presenting with a multi-system inflammatory state requiring intensive care across London and also in other regions of the UK.'

Children are not thought to be badly affected by COVID-19. The children being seen with this syndrome often suffer from stomach pain, cardiac inflammation and 'gastrointestinal symptoms' - which could include vomiting and diarrhoea.

Prof Whitty added: 'This is a very rare situation but I think it is entirely plausible that this is caused by this virus, at least in some cases.'

Doctors have compared the mysterious complication to toxic shock syndrome and Kawasaki disease which, combined, cause harmful internal swelling, fever and breathing problems - all hallmark signs of COVID-19.

It is not clear how many children have had the inflammatory syndrome, nor whether any have died with it.

NHS and social care staff have been crying out for PPE in recent weeks amid alarming scenes from hospitals of medics forced to fashion makeshift gowns from curtains and bin bags.

Exercise Cygnus, which forecast a H2N2 influenza outbreak similar to Covid-19, took place under Theresa May's premiership while Jeremy Hunt was Health Secretary.

A government spokesperson said: 'As the public would expect we regularly test our pandemic plans and these exercises have enabled us to rapidly respond to this unprecedented global pandemic.

'What we learned from these exercises helped us prevent the NHS from being overwhelmed and, now, start to pass through the peak of the virus.

'There is still more to do but our response will continue to be guided at all times by the best scientific advice.'

The government could face legal action if it does not publish the findings of Exercise Cygnus, lawyers have said.

NHS doctor and campaigner Dr Moosa Qureshi is demanding the results, which have not been made public, of the drill.

Law firm Leigh Day, which represents Dr Qureshi, said an urgent pre-action letter has been sent to Health Secretary Matt Hancock asking for a response by 4pm on Monday.

He will seek a judicial review if Mr Hancock does not disclose the Cygnus findings or give 'adequate reasons' for the refusal, his lawyers said.

Dr Qureshi said: 'There is no persuasive argument for secrecy when managing a healthcare crisis.

'Successful science and healthcare provision depend on transparency, peer review, collaboration and engagement with the public.

'I believe that if the Government had followed the Cygnus exercise by engaging transparently with health and social care partners, with industry and with the public, then many of the deaths of my heroic healthcare colleagues and the wider public during the Covid-19 pandemic could have been avoided.

'For this reason, I strongly believe that we need to see transparency throughout the entire process of preparation and delivery of care during this pandemic, including the social care sector and NHS Nightingale hospitals.'

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2020-04-28 08:52:45Z
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Coronavirus UK: Lockdown-easing plans could start this weekend - Daily Mail

Boris Johnson's lockdown exit plan 'could let Britons go out to see family and friends in "bubbles" of TEN people, council tips reopen THIS weekend, and everyone told to wear DIY masks' - but schools 'will stay closed until June'

Boris Johnson is set to flesh out details this week of how the UK could start to ease coronavirus lockdown
Speculation that Britons could be allowed to see family and friends in 'bubbles' of 10 to limit risk of spread
Council tips could reopen this weekend if the authorities give the green light that they can cope with a rush
Ministers are also drawing up plans to bolster railway services as more of workforce is encouraged to return
Shoppers and passengers could be urged to wear homemade masks with floor marks to enforce distancing
Timing of an easing still highly uncertain with scientists warning small changes could spark a second peak
Here’s how to help people impacted by Covid-19

By James Tapsfield, Political Editor For Mailonline and Jack Elsom For Mailonline

Published: 02:24 BST, 28 April 2020 | Updated: 09:13 BST, 28 April 2020

Shoppers and passengers will likely be instructed to fashion a homemade mask while floor markings will enforce the two-metre separation rule, an insider told the Daily Telegraph.

Downing Street has been playing down the prospect of schools opening before June - regarded by many as essential for a wide-scale reopening of UK plc.

In another desperate day in the fight against coronavirus:

Ministers have been holding urgent meetings with businesses that fear millions of workers will be too terrified to return to work even if the lockdown eases;
Business groups have warned that government bailouts must stay in place long after the restrictions loosen to avoid thousands of firms going bust;
An adviser to the government has suggested pubs could be reopened, but only if they ration the number of drinks for customers;

Boris Johnson has mapped out a blueprint to loosen the lockdown after returning to work yesterday (pictured after addressing the nation)

Back at the helm after three weeks recovering from his own battle with the virus, Mr Johnson was on top form as he chaired meetings with his most senior ministers

The plans were revealed on a day that saw:

Hospital deaths from coronavirus drop below 400 for the first time in four weeks;
Boris Johnson liken his personal battle with coronavirus to a mugging;
Matt Hancock insist the NHS was open for patients with other illnesses and said cancer treatments would be restored;
It emerge that he may not be able to confirm whether he has met his 100,000-a-day testing target on the deadline of this Thursday;
A fleet of rapid-response testing units is being set up to stop a coronavirus resurgence;
Small firms able to get interest-free loans of up to £50,000 under a fast-track scheme;
It revealed four million workers have been furloughed by 500,000 firms, costing the Treasury £4.5billion;
Chancellor Rishi Sunak say he was planning a 'gradual' winding-down of the scheme;
Traffic data suggest drivers are returning to the roads amid lockdown fatigue;
Rising numbers of children be admitted to intensive care with symptoms linked to coronavirus;
Ministers braced for grim figures on deaths in care homes, where shortages of PPE have been acute;
An education watchdog warn of the impact of school closures on children from vulnerable backgrounds.

Back at the helm after three weeks recovering from his own battle with the virus, Mr Johnson was on top form as he chaired meetings with his most senior ministers.

JOHNSON IN 'PROPERLY GOOD NICK' AS HE STORMS BACK TO WORK

Boris Johnson was on top form as he stormed back into Downing Street and chaired a 'full' cabinet coronavirus meeting in person to the wry smiles of ministers, sources said yesterday.

The Prime Minister, 55, ditched Zoom despite appeals from advisers to avoid appearing in person and walked confidently into a packed cabinet room for his 9.15am meeting on Monday.

Social distancing rules were 'pushed to the limit', with so many ministers back at No10, reports The Times.

But Mr Johnson, who returned to London from his two-week stint at Chequers on Sunday, was in 'properly good nick' and looked in better shape than he was before falling ill, according to the paper.

There was no sign of his pregnant fiancee Carrie Symonds, 31, who also fell ill with the virus, but she is believed to be returning to the flat at No11 soon.

Some watching today's war cabinet meeting told The Times the PM was 'asking very detailed questions' and 'sounded like he was very much on top of it'.

One adviser told the paper there was 'much more energy' at this meeting than ones before Mr Johnson was struck down with a fever.

The 55-year-old premier ditched Zoom despite appeals from advisers to avoid appearing in person and walked confidently into a packed cabinet room for his 9.15am meeting.

Social distancing rules were 'pushed to the limit', with so many ministers back at Number 10, according to The Times.

During Mr Johnson's absence, his de facto deputy Dominic Raab has remained tight-lipped over an exit strategy out lockdown.

But reports from insiders last night suggested a plan had been fleshed out for the country to creep out of lockdown.

'On social distancing, transport bosses will need to have two-metre markers in place so people can safely keep their distance.'

The PM hinted at a change to the lockdown yesterday morning as he addressed the nation on the steps of Downing Street.