Health

The Omicron wave could lead to up to 1,000 daily deaths, according to government modelling, The Independent understands – heightening concern among ministers that a lockdown will be needed in the coming weeks.The estimates are a worst-case scenario modelled by members of the government’s Scientific Advisory Group for Emergencies (Sage), and have placed Downing Street on high alert.Ministers believe that parliament could be recalled as early as next week to debate the imposition of further restrictions, with multiple senior sources claiming that the government is coming round to the realisation that Christmas cannot go ahead as normal.The prime minister is set to hold an emergency Cobra meeting with the devolved administrations over the weekend, where it’s expected the Sage modelling will be discussed.The cabinet will also be presented with a Covid data briefing on Saturday, but the government is understood to be awaiting further evidence on the impact of plan B measures and the booster rollout before decisions are taken.One insider said the figures that had been presented by Sage to No 10 on Friday afternoon were “very disturbing”. Another said they could be enough to convince ministers of the need to impose a lockdown.However, the sources emphasised that the 1,000 daily deaths figure was likely a worst-case estimate, with a wide range of other scenarios being presented to Downing Street in respect of the possible impact of the Omicron wave.A record 1,359 people died from Covid on 19 January this year, during the second wave. However, at this stage, the UK was in the early stages of its vaccination programme. Now, more than 80 per cent of the population have received two vaccine doses.In leaked papers seen by the BBC, Sage also emphasised that more stringent restrictions may need to be brought in “very soon” to prevent hospitalisation admissions in England reaching 3,000 a day.The warning comes as 93,045 new Covid infections were reported on Friday – the third day in a row that a pandemic record has been set. However, the true number of infections is thought to be far higher. Officials believe the UK could reach a million daily infections by next week.Separate modelling from the UK Health Security Agency (UKHSA) shows that cases of the Omicron variant are doubling every one-and-a-half days in some of the most populous regions of England, including London, the West Midlands, the northeast and Yorkshire and the Humber.Research from Imperial College London has meanwhile shown that the risk of reinfection with Omicron is 5.4 times greater than with Delta – implying that the protection past infection offers against reinfection by Omicron may be as low as 19 per cent.“This study provides further evidence of the very substantial extent to which Omicron can evade prior immunity, given by [either] infection or vaccination,” said Professor Neil Ferguson, one of the study’s authors. “This level of immune evasion means that Omicron poses a major, imminent threat to public health.”The research also found no evidence that the variant is less virulent than Delta – though the finding was based on a low number of hospital admissions.Some 65 patients infected with Omicron were in English hospitals on Friday, the UKHSA said. The number of people in hospital with Covid in London has increased to 1,534, up 25.6 per cent on last week. These rising pressures have been attributed to both Omicron and the continuing spread of Delta.Downing Street is publicly resisting calls to impose further Covid restrictions as the variant continues its rapid spread through the population, though it’s understood a number of ministers now believe harsher measures than those currently in place are required.One senior official said there were mounting fears in No 10 that a fourth lockdown would be required to combat Omicron and prevent hospitalisations and deaths from surging. Another said it was “unlikely”, based on the emerging data, that Christmas would be normal. The Times reports that plans are now being drawn up for a two-week “circuit breaker” after 25 December.Boris Johnson spoke with Scottish first minister Nicola Sturgeon on Friday and discussed “the shared challenges” presented by the variant, according to a spokesperson for the PM. Counterparts from all four devolved administrations will join this weekend’s planned Cobra meeting to “continue discussions” around Omicron, the spokesperson added.Recent modelling from Imperial College professor Neil Ferguson, whose projections first convinced No 10 of the need to lock down in March 2020, paints a far bleaker outlook than Sage’s own analysis.Published on Friday, it made a number of estimates on what infection rates and deaths could look like in various scenarios.Among them is one scenario in which there could be up to 100 daily deaths per million in a high-income nation – not specified as the UK – where the majority of people over 10 were vaccinated and the majority of over-40s had received boosters.However, Professor Azra Ghani, an epidemiologist at Imperial and one of the researchers behind the modelling, said: “I think it’s an illustration of the need to act, rather than a prediction.”Prof Ferguson said: “We’re ahead of the rest of Europe in terms of the Omicron wave.“I agree that time is of the essence. I think if we’re going to make additional decisions – which remains to be seen – they probably will need to be made in the next week or two to have a substantial impact.”In separate comments on BBC Radio 4’s Today programme on Saturday, he said that the epidemic of Omicron was now “very obvious” in London and would become more apparent across the country in the coming week.“The thing we’re most anxiously looking at, analysing, is what is happening to hospitalisation numbers – the key indicator in terms of how well we’re coping with this epidemic,” he said.“We’re seeing quite a significant surge in hospitalisations in the London region, which is most ahead, but less of an indication in other regions.”Asked whether the country was heading for “a very serious position” in hospitals in the coming weeks, he replied: “Yes, and … Chris Whitty said exactly the same in his last press conference. That is the major concern, and we’ll be more certain of … exactly what we’re heading to in the next few days, I think, with increasing amounts of data coming in.“But it is a real concern we’ll be heading into something which has the risk of overwhelming the health service.” More

Paul Givan, Northern Ireland’s first minister, said on Monday 13 December that the omicron variant of the coronavirus represented a “storm coming our way” while his deputy, Michelle O’Neill, warned that the country would “very, very soon” be overwhelmed by infections.“If ever there was a time for a united front on the public health message, it’s today because we’re facing into a very, very difficult period in the weeks ahead where we see this new variant now coming on stream,” Ms O’Neill told Stormont Assembly members during Executive Office questions.“We are going to be overwhelmed with this new variant very, very soon. My priority is to keep businesses open and safe. I want to keep every door opened but to make sure it’s a safe space for people to enter.”At that point, Northern Ireland had 10 confirmed cases but, three days later, it had 151, according to the Public Health Agency, only underlining the severity of the situation and the urgency of their message.Ministers are set to meet on Thursday 16 December to discuss the situation as a Department of Health paper being circulated warned that “significant intervention” could become necessary after Christmas to hold back the tide.“If omicron is associated with disease severity close to that of delta, significant intervention would be required immediately after Christmas at the latest to have a reasonable chance of keeping hospital inpatient numbers at less than 1,000,” the paper read.“It is likely that a peak in case numbers will occur in the middle third of January, with hospital admissions and occupancy peaking in late January/early February.“The extent of the hospital peak will depend on the severity of omicron illness, but without further measures is likely to exceed numbers observed earlier in the epidemic, potentially several fold.”Responding to the latest figure on the variant, chief medical officer Sir Michael McBride said he was “more concerned at this stage than he has been at any stage in the pandemic”, calling on the public to get their vaccine booster jabs and warning that new social restrictions could be forthcoming.Boosters are currently available to all adults aged over 30 in Northern Ireland who have had their second dose at least three months previously and are being made available at walk-in centres across the nation in a bid to stop the spread of the latest Covid strain.Those aged between 18 and 29 will be eligible from Monday 20 December.Other measures in place include the familiar guidance on masks and social distancing plus a Covid passport scheme requiring people to present proof of vaccination, a negative lateral flow test result or evidence of a previous infection in exchange for entry to large-gathering hospitality venues, which became legally enforceable from Monday 13 December after Assembly members voted 59-24 in favour.That came despite heated political opposition to the passes on ideological grounds, similar to that seen in England when backbench Tory rebels joined with Liberal Democrats to revolt against Boris Johnson, and saw demonstrations held outside the chamber by protestors.Their implementation means the passes are now mandatory for access to pubs, restaurants and other licensed premises as well as live sporting events and gigs.Professor Ian Young, the country’s chief scientific officer, entertained the possibility of further restrictions being brought in to tackle omicron when he pledged that “we will respond rapidly” to any case spike and said the public should be reassured that there are contingency plans in place “which can be activated very quickly by the executive”.The state of play at present is thought to be around two weeks behind the outbreaks in England and Scotland, although Dr Tom Black, chairman of the British Medical Association in Northern Ireland, has moved to discourage people from needless socialising as a precautionary preventative measure.“You go out and mix with a crowd next week, one of them will have omicron,” Dr Black told BBC Radio Ulster.“It’s so infectious, you’ll then come home with it. Which is why I won’t be going out socialising this week or next.”Mr Givan had previously said it was acceptable for people to attend festive parties so long as they followed the rules, commenting: “We want to keep things open and to do things safely, so people should continue to make their plans now and in the run-up to Christmas, but to do it safely and to follow the public health advice around that.” More

Welsh first minister Mark Drakeford has warned his compatriots that more severe coronavirus restrictions could be implemented after Christmas in response to the omicron variant.Wales currently has relatively light Covid-19 guidance in place, asking the public to observe social distancing and meet outdoors when possible, wear masks in public spaces, wash hands with care and be prepared to show an NHS Covid Pass for entry to cinemas, theatres and concert halls.But speaking during a televised address on Monday 13 December, Mr Drakeford said all eligible adults in Wales would be offered a booster jab by the end of the year, which he said was “vital” to seeing off the threat posed by the new strain of the virus, which has infected 62 people in Cymru so far.Interviewed subsequently on ITV Wales, the first minister said: “As we know, the traditional way of doing things in Wales is people go out together and socialise in the run-up to Christmas, and then in the post-Christmas period there’s a standing back from that.“There may be a period in the post-Christmas days when we can do more to stem the flow of the omicron variant. But, in this business, what will happen in three or four weeks’ time is a long way away.”Mr Drakeford is expected to give a further update on the situation on Friday 17 December.His health minister, Baroness Eluned Morgan, had earlier warned that the devolved government was “currently not taking anything off the table” as infections rise.“The last thing we want to do is cancel Christmas. I think it is important we make that absolutely clear,” she told journalists at a briefing.“But we are not currently taking anything off the table either, so the best thing for people to do, in order to see if we can remain in a situation where we are all able to see each other over Christmas is to take precautions now, so that we don’t see the kind of increasing rates that we are all expecting.“A lot of this is in our hands, as individuals and as a community. The more you mix now, the more likely you are to contract Covid, and this particular form of Covid.“Certainly, at the very minimum we will be asking people to take lateral flow tests before they mix at Christmas but that is something they should be undertaking already, particularly if they are meeting older and vulnerable people,” she added.“I think people should plan because we don’t know what the situation will be at Christmas time. Taking the opportunity to do things early would be a sensible option, but we have no idea what Christmas will look like because it’s such an unpredictable situation.”Baroness Morgan’s department is striving to hit a target of 200,000 booster vaccinations a day, with health boards again opening pop-up centres, including walk-in and drive-through clinics with longer opening hours, often partially staffed by volunteers.Dr Gill Richardson of Public Health Wales has meanwhile suggested that the rules surrounding the NHS Covid Pass may have to be reviewed in light of the ramping up of the booster programme.On schools, the national picture is currently being assessed after two local councils, Denbighshire and Anglesey, decided to close theirs early – from 17 December – forcing students to take their learning online for the final days of term. More

Boris Johnson’s “plan B” social restrictions to address the surging omicron variant in England were yesterday approved in the Commons, with the prime minister surviving a major rebellion by his own Tory backbenchers to see them confirmed.Many Conservatives and Liberal Democrats were opposed to the new rules, particularly the NHS Covid Pass, considering it an infringement of civil liberties, while others seized on the vote as an opportunity to express their disdain for Mr Johnson’s increasingly troubled and discredited leadership.But, with the support of the Labour Party, who agreed that the new measures were in the national interest, the new Covid rules passed, with vaccine passports approved by 369 votes to 126 – meaning 97 Tories voted against their own leader in the biggest revolt so far of Mr Johnson’s premiership.The first new restrictions imposed on England since “Freedom Day” on 19 July make it mandatory to wear face masks in shops, cinemas, theatres and places of worship and on public transport (but not bars and restaurants), working from home is advised and the NHS Covid Pass, displayed via the NHS app on smartphones, is now required for entry to unseated indoor venues with more than 500 people in attendance and in unseated outdoor spaces with more than 4,000 people present – and in any venue with more than 10,000 such as sports stadia.“Plan A”, encouraging the takeup of vaccine booster jabs, is still in effect and has been expanded to gradually make a third shot available to all over-18s by the end of December as early testing indicates it could be crucial to preserving immunity against the latest strain of the virus.Instilling a new sense of urgency in that strategy has already seen the NHS website crash to cope with the heightened demand for appointments and queues forming around the block at walk-in vaccination centres and at pharmacies offering the jab.As it stands, abiding by these rules and getting the booster are the only requirements in England as we enter the final working days before Christmas.However, that could all change, with Mr Johnson and health secretary Sajid Javid repeatedly declining opportunities to rule out further restrictions or even a fourth national lockdown as the extent of the threat represented by omicron becomes clearer.Transport secretary Grant Shapps has meanwhile said that Parliament will be recalled over the festive season should tighter rules become necessary while expressing the hope that the present arrangements will “see us through to the New Year”.“We want people to be able to enjoy Christmas this year. We are certainly in a better position than we were this time last year. We want people to be sensible but to enjoy their Christmas,” he told Sky News.While it is true that the vaccines have kept coronavirus deaths and hospitalisations low, the UK’s daily infection rate is actually more than twice as high as it was in December 2020 when Mr Johnson was forced to abandon a Christmas amnesty and impose tough “tier 4” measures on much of the south east, with almost 60,000 cases recorded on Tuesday just prior to the Commons vote.Should those numbers begin to translate into hospitalisations and threaten to overwhelm the NHS, the rules could change again.A “Plan C” has reportedly already been drawn up behind the scenes at Whitehall in the event of a further downturn in fortunes of the sort the UK suffered in January and February this year, although it is still considered, at this juncture, a last resort. More

First minister Nicola Sturgeon has urged people in Scotland to limit their socialising to three households before and after Christmas in order to curb the spread of the omicron variant of coronavirus.Announcing new measures on Tuesday 14 December, Ms Sturgeon insisted she was “not asking anyone to cancel Christmas”, but advised Scots to rein in their social commitments over the course of the festive season. She stressed it was not a legal requirement but instead strong advice to be considered.Setting out the new guidance north of the border, the Scottish National Party leader insisted that she was not asking Scots to change their plans for Christmas Day, Christmas Eve or Boxing Day. “And we are not proposing limits on the size of household gatherings,” she added.“My key request today is this: before and immediately after Christmas, please minimise your social mixing with other households as much as you can,” the first minister said, characterising the advice as “strong guidance” and warning citizens: “Please do not think of it as optional.”Care home visits are also being limited to two households, with all visitors asked to present a negative Covid test before entering to reduce the risk to vulnerable residents.Businesses are meanwhile being told to encourage their staff to work from home where possible and to implement “a return to the kind of protections in place at the start of the pandemic.This means Scottish shops enforcing social distancing and putting up protective screens and pubs, bars and restaurants all having to implement systems to prevent crowding and make sure customers’ details are taken for contact tracing.Vaccine booster appointments are being made available to all over-18s through online booking as of Wednesday, with the programme being given priority over the flu vaccine and “additional capacity” being made available, Ms Sturgeon assured Holyrood.“Just as vaccines started to win this race, the virus learned to run faster. That means we must deliver boosters even faster,” she told MSPs.“This is all the more important in light of early data telling us that the protection we have against omicron infection with just one or two doses is significantly lower than it is for delta – we need a booster jab to ensure a substantial level of protection against omicron.”Scotland had just recorded a further 110 confirmed omicron cases on the day Ms Sturgeon announced her restrictions, taking the total to 226. It has since more than doubled to 554.Deputy first minister John Swinney warned on BBC Radio Scotland on Wednesday that further coronavirus restrictions may “potentially” be needed before Christmas if the omicron situation worsens.“Potentially that could be the case, but we want to avoid that,” he said.“We hope we have done enough in the announcements that were made yesterday and we hope members of the public and businesses will work with us in a co-operative spirit to make sure we can take these provisions forward.”That came after Professor James Chalmers of Dundee University said the new measures put in place by Ms Sturgeon may slow the spread of omicron but they are not enough in themselves to reverse the rise in infections.“I think the government need to be ready next week, as we get more data on the vaccine protection against severe disease and other gaps that currently need to be filled in terms of our knowledge, to think about what other measures may be required,” Professor Chalmers said.“If this is as bad as we think it is going to be, there may still be other measures required over the Christmas and the new year period.“The modelling looks like in the worst case scenario we could have a really difficult winter, and we can’t allow the health service to be overwhelmed.“We need to be prepared and we need to prepare the public that we may require further restrictions.” More

The last phase of the UK government’s current “Plan B” social restrictions for England to tackle the spread of the omicron variant of the coronavirus is due to come into effect on Wednesday when NHS Covid passes become mandatory in certain settings. Following the return of mandatory mask-wearing in shops, cinemas, theatres and places of worship and on public transport and orders to work from home, members of the public will, from 15 December, be required to produce an NHS Covid Pass in exchange for entry to crowded venues.The pass, presenting proof of your vaccination status and/or proof of a negative test result, will be required in unseated indoor venues with more than 500 people in attendance and in unseated outdoor spaces with more than 4,000 people present – and in any venue with more than 10,000 such as sports stadia.It may also be required as a condition of foreign travel.“The NHS Covid pass can still be obtained with two doses but we will keep this under review as the boosters roll out,” the prime minister, Boris Johnson, said when he announced the further tightening of restrictions on 8 December.“And having taken clinical advice since the emergence of omicron, a negative lateral flow test will also be sufficient.“As we set out in Plan B, we will give businesses a week’s notice, so this will come into force in a week’s time, helping to keep these events and venues open at full capacity while giving everyone who attends them confidence that those around them have done the responsible thing to minimise risk to others.”The NHS Covid pass rules are by no means popular with all of Mr Johnson’s fellow Conservatives, some of whom consider them an infringement of civil liberties, a stance Tory MP Marcus Fysh took to extreme lengths this week when he compared their introduction to Nazi Germany.A backbench rebellion is expected when MPs vote on the Plan B restrictions in the House of Commons on Tuesday, also in part a protest against the prime minister’s increasingly frazzled and scandal-ridden leadership.The Liberal Democrats have likewise raised objections to the passes, accusing the government earlier this year of introducing ID cards “by stealth” when the app was updated and have since labelled them “illiberal and destructive”, warning they “represent a massive change in the relationship between everyday people and their government”.However, given that Sir Keir Starmer’s opposition Labour Party has signalled it will support the government’s position in the national interest, any such mutiny is not expected to hinder the measures’ adoption.To access your digital NHS Covid Pass, you need to have the free NHS app downloaded to your smartphone – and to be registered with a GP in England to be able to access it.By simply signing into the app, you will be able to show proof of your Covid-19 vaccination or negative test status upon request, the information presented along with a QR code for scanning.The code proving your vaccination is valid for 30 days from the moment you access it or download it as a PDF, after which you will need to refresh to obtain a new version.A Covid Pass secured via a negative test result will meanwhile only last for 48 hours before a new version is needed (obtained via the same simple means).If you are unable to use the app for any reason, you can also view your vaccination status on the NHS website or print a paper version at home before heading to your destination.Those unable to access online services can also call 119 to request a letter to serve as evidence of their vaccination status instead.Those unable to get vaccinated or tested for medical reasons can apply to the NHS for an exemption to stand in its place.You can find more information on the government’s website. More

The last phase of the UK government’s current “Plan B” social restrictions for England to tackle the spread of the omicron variant of the coronavirus is due to come into effect on Wednesday when vaccine passports are introduced.Following the return of mandatory mask-wearing in shops, cinemas, theatres and places of worship and on public transport and orders to work from home, members of the public will, from 15 December, be required to produce an NHS Covid Pass in exchange for entry to crowded venues.The passport, presenting proof of your vaccination status and/or proof of a negative test result, will be required in unseated indoor venues with more than 500 people in attendance and in unseated outdoor spaces with more than 4,000 people present – and in any venue with more than 10,000 such as sports stadia.It may also be required as a condition of foreign travel.“The NHS Covid pass can still be obtained with two doses but we will keep this under review as the boosters roll out,” the prime minister, Boris Johnson, said when he announced the further tightening of restrictions on 8 December.“And having taken clinical advice since the emergence of omicron, a negative lateral flow test will also be sufficient.“As we set out in Plan B, we will give businesses a week’s notice, so this will come into force in a week’s time, helping to keep these events and venues open at full capacity while giving everyone who attends them confidence that those around them have done the responsible thing to minimise risk to others.”The vaccine passport is by no means popular with all of Mr Johnson’s fellow Conservatives, some of whom consider them an infringement of civil liberties, a stance Tory MP Marcus Fysh took to extreme lengths this week when he compared their introduction to Nazi Germany.A backbench rebellion is expected when MPs vote on the Plan B restrictions in the House of Commons on Tuesday, also in part a protest against the prime minister’s increasingly frazzled and scandal-ridden leadership.The Liberal Democrats have likewise raised objections to the passes, accusing the government earlier this year of introducing ID cards “by stealth” when the app was updated and have since labelled them “illiberal and destructive”, warning they “represent a massive change in the relationship between everyday people and their government”.However, given that Sir Keir Starmer’s opposition Labour Party has signalled it will support the government’s position in the national interest, any such mutiny is not expected to hinder the measures’ adoption.To access your digital NHS Covid Pass, you need to have the free NHS app downloaded to your smartphone – and to be registered with a GP in England to be able to access it.By simply signing into the app, you will be able to show proof of your Covid-19 vaccination or negative test status upon request, the information presented along with a QR code for scanning.The code proving your vaccination is valid for 30 days from the moment you access it or download it as a PDF, after which you will need to refresh to obtain a new version.A Covid Pass secured via a negative test result will meanwhile only last for 48 hours before a new version is needed (obtained via the same simple means).If you are unable to use the app for any reason, you can also view your vaccination status on the NHS website or print a paper version at home before heading to your destination.Those unable to access online services can also call 119 to request a letter to serve as evidence of their vaccination status instead.Those unable to get vaccinated or tested for medical reasons can apply to the NHS for an exemption to stand in its place.You can find more information on the government’s website. More

Omicron is spreading at a “phenomenal rate” and 10 people in England have now been hospitalised after getting infected with the Covid variant, health secretary Sajid Javid has said.Mr Javid said there had been no deaths yet confirmed in England, but revealed that omicron was probably behind around 40 per cent of infections in London and warned the NHS could be overwhelmed without a rapid expansion of the booster programme.“What we now know about omicron is that it’s spreading at a phenomenal rate, something that we’ve never seen before – it’s doubling every two to three days in infections,” the minister told Sky News.“In England, there’s about 10 people that are confirmed in England with omicron,” said Mr Javid, who said he did not know how seriously ill the omicron patients are in hospital.The health secretary added: “At this point in time I can’t confirm a death [from omicron] … There is always a lag between infection and then hospitalisation and then, sadly, death.”Encouraging people to come forward for their booster jab, Mr Javid added: “We’re facing a tidal wave of infection, we’re once again in a race between the vaccine and the virus.”Boris Johnson said on Sunday evening that the nation must “urgently reinforce our wall of vaccine protection” as he set the new deadline of getting everyone over 18 a booster by the end of December – which would mean jabbing almost a million people every day.The prime minister said scientists had discovered that two doses of a vaccine is “simply not enough” to prevent the spread of the new variant and that without a massive expansion booster campaign the NHS could be overwhelmed.The NHS booking system will be open for those over the age of 18 from Wednesday, though it is hoped many young adults will be able to use vaccination walk-in centres from today.The “emergency operation” will be assisted by deploying 42 military planning teams across every region and setting up additional vaccine sites and mobile units, and the clinics will be open seven days a week.Prof Robert Read, a member of the Joint Committee for Vaccines and Immunisation (JCVI), told LBC radio that scientists already knew omicron was “highly infectious, transmissible, and it will get through the UK population pretty quickly.”He said the severity of illness was not yet known but people were vulnerable, especially the unvaccinated, warning: “We need to get those third doses in to as many adults as we possibly can, just in case this virus turns out to be a raging bull just rather than a pussy cat.”It comes as the boss of the organisation which represents NHS trusts said pressure on the health service is “not sustainable” as the UK faces a wave of omicron Covid infections.Chris Hopson, chief executive of NHS Providers, told Sky News: “It’s a worrying time, but as you’d expect everybody on the NHS frontline is doing absolutely the best they can to provide the best possible care.”He added yesterday’s request from the prime minister for “extraordinary effort” comes as staff are “very, very tired”, adding: “I think staff are worried, to be frank, that this level of pressure is going to become normalised and it’s not sustainable.”The NHS will have to postpone some planned appointments in order to meet the target of giving every adult in England a booster jab by the end of the year.Mr Javid said it “should not be the case” that people die because they can’t get treatment on the NHS during the Covid booster drive.The health secretary said some appointments and some surgical procedures may be “pushed into the start of the new year” while vaccinations are ramped up, bust said there will still be a focus on “urgent need”.Asked about people who fear they might have cancer, who are normally seen within two weeks, Mr Javid told BBC Radio 4’s Today programme: “That will be completely unaffected. That is an urgent appointment.” More