Dave, a retired dockworker, has smoked since his teens. When he develops a persistent cough, he dismisses it as “just a smoker’s cough”.

Then he loses weight, develops fevers and wakes at night drenched in sweat. After several courses of antibiotics, he continues to deteriorate and is admitted to hospital.

Doctors find emphysema, a smoking-related condition in which damaged air sacs make breathing difficult. A chest X-ray also shows a white patch in his lung, raising concerns about cancer. A sample of sputum, the mucus coughed up from the lungs, is sent for further testing.

Dave dies before the laboratory identifies tuberculosis (TB).

Dave is fictional, but his story shows how easily TB can be missed when its symptoms resemble those of other illnesses. In a 2026 study, colleagues and I found that 574 people in England were diagnosed with TB only after death between 2010 and 2022. That is almost one person every week.

The people who died represented 0.8% of all TB diagnoses, but nearly one in five deaths recorded among people with TB. The data could not establish whether TB caused or contributed to each death.

TB is the world’s leading cause of death

TB is a bacterial infection that usually affects the lungs and spreads through the air. It remains the world’s leading cause of death from a single infectious organism. In 2024, an estimated 10.7 million people developed TB and 1.23 million died. Global progress has recovered from setbacks during the COVID pandemic, but remains too slow.

England cannot eliminate TB without international progress. In 2024, more than four in five people diagnosed in England were born outside the UK. This is sometimes presented simply as a migration issue. It instead reflects global inequalities in prevention, diagnosis and treatment.

TB also affects UK-born people and remains closely associated with poverty. Rates in England’s most deprived areas are more than five times those in its least deprived.

Homelessness, imprisonment, smoking and harmful alcohol or drug use can increase exposure, weaken the body’s defences or make healthcare harder to access. These factors all contribute to active TB disease.

England is close to losing its status as a low-incidence country, defined by the World Health Organization as fewer than ten cases per 100,000 people. Its rate reached 9.4 per 100,000 in 2024, following the largest annual increase since 1971.

Early diagnosis is vital. Globally, about one in five people who develop TB are not diagnosed, officially reported or treated. Many of these “missed millions” die. In England, the median interval between symptoms beginning and diagnosis of lung TB was 72 days in 2024.

During that delay, an infectious person may transmit TB while their illness worsens. Delays can also disrupt family and working life and create avoidable, sometimes catastrophic costs for people with TB, their households and health services.

The most extreme delay

A national study examined the most extreme delay: TB confirmed only after death. This meant a sample had been collected while the person was alive, but the result arrived later.

TB bacteria grow slowly, so traditional laboratory cultures can take several weeks. Rapid molecular tests, which detect the bacteria’s genetic material, can sometimes provide results much sooner, but doctors must first suspect TB.

The likelihood of diagnosis after death rose sharply with age. It was also higher among men, UK-born people, people with recorded harmful drug or alcohol use, those with TB outside the lungs and those diagnosed outside London.

Older UK-born people may have encountered TB during childhood, when infection was more common. The immune system can contain the bacteria for decades without symptoms. This is called latent TB infection. It can later become active, particularly when immunity weakens because of age, illness or medicines.

Smoking damages the lungs’ defences and increases TB risk. An older man with a cough and weight loss may therefore be investigated for cancer or chronic lung disease before TB is considered. Previous BCG vaccination – the childhood vaccine that was once routinely offered in the UK to protect against tuberculosis – does not rule it out. The vaccine protects young children against severe disease, but does not reliably prevent TB in adults.

TB outside the lungs can affect the lymph nodes, bones, bowel, kidneys, brain or other organs. Diagnosis may require scans or tissue samples. It is generally much less infectious than lung or throat TB, although people can have both forms.

People outside London were more likely to receive a diagnosis after death. Doctors in London may encounter TB more often and have better access to specialist services. Differences in reporting may also contribute. Our findings probably underestimate the problem because some people may die without being tested.

A diagnosis made only after death should be treated as an important patient-safety warning. TB deaths are not currently defined as a formal NHS “never event”, a term reserved for a small number of wholly preventable incidents. Based on our study findings, we recommend that each post-mortem TB diagnosis should prompt a review of symptoms, tests and referral decisions.

Public awareness also matters. A persistent cough, fever, drenching night sweats or unexplained weight loss deserves medical attention, regardless of age or birthplace. Healthcare professionals must consider TB even when cancer, pneumonia or chronic lung disease initially appears more likely.

Prevention must extend beyond detecting active TB disease. England offers some recent migrants testing for latent TB, but only 17% of those eligible were tested in 2024. Strategies should also consider historical exposure among older UK-born people.

England can learn from countries with much greater TB burdens. Lessons include reaching people at higher risk of being missed, such as the homeless, the poor and the socially excluded; reducing stigma; and making services easier to access.

Dave’s fictional laboratory result arrived too late. The next person with an overlooked cough should receive theirs while treatment can still help.

When you’re the Prime Minister, you are used to being recognised.

But this time around, the country is still catching up to having its fourth leader in five years.

One care home resident said what many in the nation are thinking about this revolving door, but straight to Andy Burnham’s face.

He told the new PM that the occupant of No 10 ‘keeps changing every five minutes’ in a hilarious exchange.

Burnham was touring a Jewish Care home in north west London as he introduced his new plans for social care in England.

Meeting residents, he met one man who wasn’t familiar with who he was.

He asked the Prime Minister: ‘You are the local candidate, are you?’

Burnham chuckled and referenced the recent Makerfield by-election he won in June.

He replied: ‘I was a local candidate; I had a by-election a few weeks ago. I am now the Prime Minister.’

Stunned, the care home resident asked: ‘You’re what?’

A nurse helped him out, telling him: ‘He’s the Prime Minister.’

The resident asked: ‘What, a new one?’

Seeing the funny side, Burnham joked: ‘Another one.’

His counterpart also saw the funny side, adding: ‘Well it keeps changing every five minutes.’

Burnham answered with a smile: ‘I know.’

The country has had seven Prime Ministers in the 10 years since the 2016 Brexit referendum.

After only two years in office, Keir Starmer quit in June and was replaced by Burnham this month.

One of his first acts as Prime Minister has been a pledge to end a decade of government inaction of fixing social care in England.

Speaking at the care home this afternoon he said it had been a ‘major dereliction of public duty’ that previous governments had not addressed the crisis.

He plans to introduce a new national care service and wants care workers to have better pay and training.

In a sign of his determination to fix the sector, he said a landmark review of social care by Baroness Casey would be published next summer, instead of 2028.

Burnham admitted his plans for social care ‘will require difficult decisions’ that he said would be ‘put before the country’ for the people’s consent.

This afternoon he also held talks with the Lib Dems and Conservative Party to generate cross-party backing for his plans.

Get in touch with our news team by emailing us at webnews@metro.co.uk.

For more stories like this, check our news page.

An air ambulance was called to the scene as three people were taken to hospital following a dog attack in Bolton

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Three individuals have been rushed to hospital this afternoon (July 29) following a suspected dog attack in Bolton.

Greater Manchester Police confirmed they received a call just before 3:30pm reporting a dog bite incident at a property on Barrie Way.

An air ambulance touched down at Hall i’ Th’ Wood, with paramedics working alongside police dog units and armed officers at the scene.

Officers confirmed that three victims were transported to hospital by ambulance and that a dog had been seized, though its breed remains unknown at this stage, reports the Manchester Evening News.

Armed police were spotted entering the property, accompanied by a dog handler who removed the animal and secured it in an animal transport van.

GMP stated that investigations remain ongoing and no arrests have been made.

In an official statement, a spokesperson said: “Officers were called just before 3.30pm on Wednesday 29 July 2026 to a report of a dog bite at an address on Barrie Way in Bolton.

“Emergency services attended and three people have been taken by ambulance to hospital.

“One dog has been seized. No arrests have been made and enquiries are ongoing.”

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The by-election, which will be the biggest in UK history with more than two million people eligible to vote, was triggered after Mr Burnham resigned from the post earlier this year as part of his plan to become Prime Minister.

He was elected as the Labour MP for Makerfield in June before taking over from Sir Keir Starmer this month.

Seven candidates are standing to succeed Mr Burnham, including Ms Craig for Labour, Phil Eckersley for the Conservatives, Geraldine Coggins for the Green Party, and Sian Astley for Reform UK.

(Image: NQ)

Liberal Democrat Richard Kilpatrick is also standing, alongside Restore Britain’s Marlon West and independent candidate Marcus Farmer.

Residents of Bolton, Bury, Manchester, Oldham, Rochdale, Salford, Stockport, Tameside, Trafford, and Wigan will be able to have their say on Thursday.

Mr Burnham came first in all 10 areas in 2017, 2021, and 2024.

Speaking ahead of polling day, he said serving as mayor for nearly a decade was an “immense privilege”.

He added: “After years working alongside Bev Craig, I have no doubt that she will work every single day to build on the progress we’ve all made together.

“Bev will focus on putting more money in your pocket, giving families more breathing space on the cost of living, and making sure young people across every borough have the opportunities they need to thrive.

(Image: The Labour Party)

“Bev will do this by working in lockstep with every community across our city region so we can shape our future together.

“She is the only candidate who will make sure every town, every borough, and every person shares in Greater Manchester’s success.

“Together, for our future, vote Bev Craig today to be our next mayor of Greater Manchester.”

Labour’s Ms Craig is the leader of Manchester City Council.

Bev Craig, commenting ahead of polls opening in the Greater Manchester Mayoral By-election, said: “I’m proud to call Greater Manchester home, and I know our best days are still ahead of us – but only if we keep moving forward together, face up to our biggest challenges, and make life better for everyone. That’s why, today, I am asking you to choose hope and vote Labour.”

Reform’s Ms Astley and Lib Dem Mr Kilpatrick also sit on the council.

(Image: Supplied)

Both Conservative Mr Eckersley and the Greens’ Ms Coggins are Trafford councillors.

Ms Coggins argued Greater Manchester needs “full-fat devolution, not semi-skimmed”, adding: “Labour in Greater Manchester has been a developers’ paradise, handing over large sums of money to developers to build unaffordable flats.

“I will be demanding powers to take them back and to impose tough financial penalties for land banking.”

Mr Eckersley has previously said “as a business owner, father and local councillor, I understand the challenges facing families, businesses, and communities across our city-region”.

(Image: Phil Eckersley)

Restore’s Mr West works as a mental health nurse but he was given an 18-month suspension earlier this month by the Nursing and Midwifery Council (NMC) following comments he made on social media about sexual grooming by Pakistani men.

Mr West has co-written a book, In Plain Sight, with his daughter, Scarlett, about rape and sexual abuse she suffered at the hands of Asian men.

Restore Britain’s leader, Rupert Lowe, said Mr West “is the best qualified candidate for any mayoral race for a very long time”, adding: “He has lost so much in his fight, including just being struck off nursing because he spoke out about his daughter’s rape.

(Image: Restore Britain)

“It’s scandalous.”

Mr Farmer, an independent candidate, previously stood against Mr Burnham in 2021, receiving just under 1% of the vote.

He also stood in 2017.

Polls will open at 7 am and close at 10 pm on Thursday.

Votes will not be counted until Friday, with the result likely to be announced in the afternoon.

It is the first time a by-election has been necessary to fill a vacancy for one of England’s combined authority mayors.

The cost of the contest is expected to run into the millions, with the 2024 mayoral election costing the taxpayer £4.7 million.

In 2024, Mr Burnham won by 63%, with 420,749 of the 663,631 valid votes cast in his favour across the 10 authorities.

The Conservatives followed in second place with 10%, an independent candidate was third on 50,304 (8%), Reform UK fourth on 49,532 (7%), the Greens fifth on 45,905 (7%), and the Liberal Democrats sixth on 28,195 (4%).

Mr Burnham was elected in a first-past-the-post (FPP) system in 2024, the same method of voting used in UK general elections, where the candidate with the most votes is declared the winner.

This week’s by-election is using the supplementary vote (SV) method, which was used in both 2017 and 2021.

Labour passed legislation earlier this year to return to the SV system.

Under this, voters mark their ballot papers with a first and second choice.

If any candidate wins more than 50% of the first-choice votes, they are declared the winner.

But if no candidate has more than 50% of first-choice votes, all but the top two candidates are eliminated and the count moves to a second round.

The ballot papers of the eliminated candidates are counted again and if there are any second-choice votes for the two remaining candidates, these are added to their first-choice totals.

The candidate with the highest overall total of first and second-choice votes is declared the winner.

Voters do not have to mark a second choice on their ballot papers, but they must mark a first choice or else their vote will not be counted.

By ISABELLA MACHIN, REPORTER

Published: 01:37 BST, 30 July 2026 | Updated: 01:55 BST, 30 July 2026

A French couple has been arrested after the bodies of five infants were found in cardboard boxes in their home. 

The remains were found in a house in the town of Orange, in France‘s southeastern Provence region, on Monday. 

The discovery came a day after the 32-year-old woman gave birth to a healthy boy at home, before being taken to hospital.

The man and his wife, who cannot be named for legal reasons, had been arguing about what was in the boxes just a day after she had given birth following a pregnancy she denied. 

Local media reported this was the third time she had denied being pregnant.  

But after she began suffering from abdominal pains, she went to hospital while her husband stayed behind and looked inside. 

An investigating source previously told the Daily Mail that he ‘looked inside the cardboard boxes they had been arguing over – that’s when he found the five dead babies’.

They added: ‘All the foetuses were decomposing, and had been around for quite a while.’

The horrifying discoveries were made at a house in the French town of Orange in the Provence region on Monday morning

He called the police, who are now investigating the incident. 

The couple also had two children aged eight and nine, who have been taken in by relatives. The newborn was placed with social services, the prosecutor’s office said.

Medical examinations will determine the exact nature of the remains, as well as the circumstances and date of their deaths.  

Florent Jean, a neighbour, told Le Parisien that the couple were ‘charming people’ who had moved into the building around two years ago and whose children attended a local primary school. 

After she saw emergency services arrive for the mother, she asked herself: ‘Is she pregnant? That’s impossible, she’s so thin.’

Florent added that the woman would ‘pick up the children from school at lunchtime to eat’, while the man would ‘go to work in the morning and come back in the evening.’

The Orange horror has drawn parallels with the Dominique Cottrez multiple murder case.

Cottrez, a 45-year-old nursing assistant from northern France, confessed to killing her eight newborn children at birth and hiding their bodies.

The so-called ‘house of horror’ in Villers-au-Tertre was used to hide the bodies over almost 20 years.

Cottrez committed the murders between 1989 and 2006, by suffocating eight of her children shortly after giving birth.

The entrance to a building in Orange, Vaucluse department, southeastern France, 28 July 2026

An apartment in Orange, southern France, on July 28, 2026, after the bodies of five deceased infants were discovered

Cottrez was able to conceal her pregnancies from her husband and doctor due to being overweight, according to prosecution evidence.

In July 2010, two of the bodies were discovered in plastic bags by new owners working in the garden of Cottrez’s old house. 

When police contacted her, she immediately admitted that the bodies belonged to two infants she had given birth to.

She also told police that six more infants’ bodies were hidden in the garage.

In July 2015, Cottrez was found guilty of eight counts of infanticide and sentenced to a total of nine years in prison.

In March, a French court jailed a 44-year-old woman for 25 years over the deaths of two of her newborn babies, who police found in the family freezer. 

And in 2018, a court sentenced a woman with a depressive and sometimes violent husband to eight years in prison for drowning five of her newborn babies and freezing their bodies. 

The Moon in Aquarius links to Mars in Gemini, setting a practical tone for the day ahead. Productivity and rationality come easily.

Pisces, Aquarius and Capricorn, you know you can depend on yourself to get what needs to be done, done. Be your own biggest advocate.

Your sights have been set on a goal for some time now. Keep focused, and results will be shining.

Ahead, you’ll find all star signs’ horoscopes for today: Thursday July 30, 2026.

Like checking your horoscope every morning? You can now sign up to our free daily newsletter to get a personalised reading for your star sign delivered straight to your inbox.

To order your unique personal horoscope based on your time, date and place of birth, visit patrickarundell.com.

Aries

March 21 to April 20

The buzz of yesterday’s once-in-every-dozen years Jupiter/Sun Cazimi in the most self-expressive part of your chart is likely to be sustaining you today. In fact, as the Moon in fair-minded Aquarius links to your ruler Mars in Gemini, friends and colleagues can provide exactly the spark you crave. Conversations flow easily, making this an excellent day to network.

Head here for everything you need to know about being an Aries

Taurus

April 21 to May 21

They say that home is where the heart is, and if you are wanting to make any improvements to your abode, your enthusiasm to do so can be strong. Quick decisions and practical thinking can really help. Trust your instincts where the costs are concerned and avoid overthinking what already feels right. A little investment can bring a greater sense of comfort and peace.

Head here for everything you need to know about being a Taurus

Gemini

May 22 to June 21

Your words have rarely carried greater clout, but even if you are not trying to build a profile, your ability to showcase ideas in a very positive and dynamic way is absolutely supercharged. With the Moon also giving you a nudge to enjoy speaking freely, and Mars in your sign linking to her brilliantly, don’t hold back from speaking with confidence and verve.

Head here for everything you need to know about being a Gemini

Cancer

June 22 to July 23

When it comes to managing things, you are one of the canniest members of the zodiac. Be it family resources, a business or even a corporation. Your instinctive and protective nature sniffs out value better than most. And currently, you can be feeling an extra appreciation of what you have. It may not be all you want, or need, but your sense of gratitude is heightened.

Head here for everything you need to know about being a Cancer

Leo

July 24 to August 23

Your personal charisma is being burnished in a very special way. This can see people drawn to you and keen to follow your lead. And with the Moon and Mars collaborating to help you, whether it is friends, group involvements or colleagues, you have a chance to be right at the heart of things, perhaps in a leadership role. All sorts of new beginnings can also beckon.

Head here for everything you need to know about being a Leo

Virgo

August 24 to September 23

Your great gift is for grappling with the details of situations but then finding ways to produce practical results. Today, someone can emerge whose ideas capture your imagination. Not only might they talk a lot of sense, but they can inspire you to see a situation from an entirely different angle. Sometimes one conversation really can change our perspective, helpfully.

Head here for everything you need to know about being a Virgo

Libra

September 24 to October 23

Every so often the planets literally align to create a feel-good day, and this can be one. You can feel lighter and brighter, so even if you have been dealing with some of life’s grittier strands, you will feel more than equal to them. Some Scales may even opt for a midweek meet-up with friends, and it can prove to have a lively and uplifting vibe.

Head here for everything you need to know about being a Libra

Scorpio

October 24 to November 22

Admit it, the limelight is calling out to you. Even if you can be happier being a little bit off the radar, the planets are conspiring to raise your profile or connect you to influential people. Mars, your traditional ruler, is part of this, and your talent for business or shrewdly managing resources, mixed with your canny people skills, can see you make quite the impression.

Head here for everything you need to know about being a Scorpio

Sagittarius

November 23 to December 21

You are a naturally enthusiastic person, but this can be really amplified, as several planetary placements all help you to showcase your natural passion and appreciation of life’s broad canvas. Conversations, meetings, and short or long journeys all hold promise, and an unexpected exchange or connection could point you towards an exciting opportunity, Sagittarius.

Head here for everything you need to know about being a Sagittarius

Capricorn

December 22 to January 21

Your practical approach to finances or work can pay dividends. This can come from your natural ability to remain calm whilst thinking on your feet. Knowledge really is power today, and you can gather a lot of information quickly that gives you a deeper view of a situation that may not be obvious to others. A bold investment may come from this and excite you.

Head here for everything you need to know about being a Capricorn

Aquarius

January 22 to February 19

Your independent nature can make you less in need of connections with others, and that means when you do bond, they can be more meaningful and lasting. With the Moon in Aquarius arcing to bold Mars, and the Sun having powered up Jupiter, the chance to make one of your unique alliances is heightened. You can also be encouraging to others.

Head here for everything you need to know about being an Aquarius

Pisces

February 20 to March 20

You’re in the mood to get things done, and even if you are laid back about domestic or work chores that run on the dull side, you can find the spark to crack on and get them done. Is there someone who is showing up just now that you feel drawn to, even if they are not your usual type? It’s possible with current planetary influences, and it may be in a very mundane setting too.

Head here for everything you need to know about being a Pisces

Your daily Metro.co.uk horoscope is here every morning, seven days a week (yes, including weekends!). To check your forecast, head to our dedicated horoscopes page.

Head here for this week’s tarot horoscope reading, and see what the cards have in store for you!

Check out the tarot horoscope reading for the month of July here.

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Donald Trump has said he warned Andy Burnham that he is ‘killing’ the UK with an influx of migrants. 

Speaking from the Oval Office, the US President said he had spoken to the new Prime Minister and claimed ‘people [are] coming from all over the world and just camping out’ in Britain. 

He added: ‘He’s going to have to mention it because it’s killing your country.

‘I know Starmer did very little about it, and they’re coming from all over the world.

‘They’re coming from Africa, they’re coming from South America, they’re coming from different parts of Asia, and they’re invading Europe.’

Mr Trump indicated the UK was a ‘prime’ destination for migrants. 

The President said he also spoke to Mr Burnham about energy, adding that the new leader had indicated he was keen to take oil from the North Sea. 

He said if the Prime Minister followed through on his commitment the UK was ‘going to be a wealthy country’. 

Trump said he had spoken to the new Prime Minister (pictured) and claimed ‘people [are] coming from all over the world and just camping out’ in the UK

The US president, a vocal supporter of fossil fuels, has long championed the move as he has railed against ‘windmills’. 

‘He’s got windmills all over the place, and any time you see windmills, you see a failing country,’ Trump said. 

‘They’re made in China, not used by China, but they’re made in China.’

He went on: ‘You have one of the most valuable oil finds anywhere in the world, and if the United Kingdom would use it, they’d be a wealthy country again. And I tell you what, I could not get Starmer to use it. It was incredible.’

Mr Trump said: ‘You have your own oil and gas. If you use the North Sea, the UK will be a really rich country. I cannot get the point across.

‘The new gentleman, when I spoke to him, he said he’s going to open up the North Sea. Let’s see if that happens.’

Following the phone call between the two leaders on Mr Burnham’s first day in office, Downing Street would not be drawn on any potential future plans for North Sea drilling after Mr Trump talked up a change in policy under Mr Burnham. 

Just days after Mr Burnham took office, Trump wrote on Truth Social that the UK was a ‘poverty-stricken disaster’.

Migrants board an inflatable boat on the beach at Hardelot-Plage in an attempt to cross the English Channel in northern France on July 28, 2026 

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He claimed that new drilling in the North Sea would ‘make the United Kingdom, from a Poverty Stricken Disaster, to one of the Richest Countries anywhere in the World’. 

Mr Trump had lost a legal battle with the Scottish Government to stop a wind turbine development visible from his Aberdeenshire golf course.

Labour’s 2024 manifesto said the party would not issue new North Sea licences. 

Labour’s deputy leader Lucy Powell said on Sunday Mr Burnham would stick to the party’s manifesto commitments on North Sea drilling but would ‘pursue a more pragmatic approach’.

In 2024 Labour said the party would not issue new North Sea licences, arguing to do so would ‘not take a penny off bills’ or improve energy security while accelerating climate change. 

But Mr Burnham is said to be ‘open-minded’ about the policy.

It is understood Mr Burnham believes he would not breach the manifesto by backing further drilling in the Scottish Rosebank and Jackdaw fields because licences had already been granted there.

Ms Powell did not say whether Mr Burnham would back more drilling but said she expected a ‘change of emphasis’ rather than a ‘change of policy’.

Regulators initially approved oil exploration at the two locations in 2022 and 2023 under the then-Tory government, but saw their efforts overturned last year after a legal challenge.

Ed Miliband, who held the energy and Net Zero brief under Sir Keir Starmer and had been a strong supporter of the election pledge, has now taken up the Foreign Secretary role.