Tell us first, How big do you think the threat from Corona virus now is around the world?

But I think that the threat is very significant.

The potential of the virus It's already demonstrated in China.

Yeah, I think it's demonstrating that potential in Italy, In Iran, there were three cases identified in Italy two weeks ago.

Yesterday there were over 3000.

I think there are many epidemiologist who talk about the potential of the various in terms of attack rates globally that could be between 50 and 70% of the global population.

And when you talk about those Italy figures looking at what's happening here in the UK, are we on a similar trajectory?

Well, I don't like to make predictions.

I think talking about the potential of the virus is important so that you can understand how dangerous a threat it is.

I think it's up to society's how they will respond to the various an example that I've been talking about a lot people have.

Some people are skeptical about China's reports of declining cases.

W.

H.

O just came back from a two week commission.

They were very impressed with the Chinese response.

They believe the Chinese numbers.

But even if you don't believe the Chinese numbers, you can look at places like Singapore and Hong Kong.

Singapore had its first case on January 23rd.

Yesterday they had gotten up to, I think, about 115 cases, so fewer than the UK viewers in the UK over six weeks.

And basically they have been able through their public health interventions through the public health response for contact, tracing isolation of cases and through engaging the public.

They have been able to keep the virus under control.

So I would say it's up to us how we respond to the Valorous.

I don't want to say that we will be like Italy.

I do think it's important to recognize the virus is here and has tremendous potential.

Thio, you know, be disruptive and two cars, high rates of illness and even high rates of death.

But that is not a future that is locked in well, given the rate of increase that we're seeing now in the UK So what does the government now need to do well, eh?

The contact tracing is very important.

The voluntary quarantine of contacts is very important.

The isolation of cases is very important.

I think there may be a time to close schools, Uh, other society, it seems to be backing away from that.

But other societies that have responded aggressively have undertaken that intervention.

There's a there's a lot of there's a lot of controversy about school closure right now because it's very unclear what's happening with schoolchildren.

With flu, for example, we know that schools are amplification points within society.

It's very clear that attack rates of flu are much higher and Children than they are in a daughter or certainly in the elderly.

Children have been minimally affected by covert 19.

What's unclear is whether they've been infected and just handled the infections well or whether they actually are not being infected.

Um, I think there's there's there's some limited data that suggests that Children are probably at risk If you look at the Diamond Princess cruise ship.

The attack rates among people on that ship who were under the age of 20 were identical to the attack rates overall, so that's you know that's anecdotal, but that is evidence that the younger people can be infected if they can be infected, then schools are probably an environment where the epidemic would be amplified.

And if you look at the rate of increase, how quickly do you think the government should move to exploring shutting down schools?

Well, I think that if you look at places where death have occurred, which is England now falls into into that category.

A death probably signifies circulation of the virus.

It's been going on for at least weeks, perhaps more than a month, because it takes time for people to get sick.

It takes time for him to go to the hospital, and it takes time for them to expire.

So so the virus has been circulating here for some time, and I think I think the government doesn't recognize the criticality of the situation.

I think that I actually think Chris, Woody and his colleagues air doing a good job at communicating the risk to the public.

I don't think they're minimizing the threat.

I think they recognize the potential of the virus toe overall and certainly relative to some other countries.

I think the UK is doing a good job.

Is there a danger, though, of an overreaction given when you look at the scale of flu deaths worldwide upto 600,000 year, and you don't shut down public transport networks to stop people getting the flu.

I don't think we're dealing with the flu.

Um, here, uh, W h o, who has looked at this virus most intensively, has looked extremely closely at the experience in China, has has looked at the mortality rates in China, and it has tried to estimate whether there's a lot of undercounting in China does not feel that we're seeing the tip of the iceberg.

They, as at Bruce Aylward, who led that expedition, said, We're seeing the pyramid, actually, so So they think the mortality rate is actually higher than 1% which if it if it were even 1% that would be 10 times the rate of your average seasonal flu.

And because this is a virus that is now circulating in a population that has absolutely no immunity to it, you would expect the attack rates to be much higher than the attack rates that we normally see with seasonal flu.

So you might have an attack rate that's three times higher than seasonal flu with the mortality rate that's 10 times higher.

What scientists know about this virus so far.

What concerns you most about it?

I think the most concerning thing about this virus is the combination of infectiousness and the ability to cause severe disease were death.

And we have not since 1918 the Spanish flu, the Spanish flu seen a virus that combined those two qualities in the same way.

We have seen very lethal viruses we have seen certainly Ebola or Nipah or any of the other diseases that set me the organization that I've run works on.

But those viruses have high mortality rates.

I mean, Ebola's mortality rate in some settings is greater than 80% but they don't have the infectiousness that this factory says they don't have the potential to explode and spread globally.

You know, you fear this could end up being on a scale of the Spanish flu.

I again, I don't want to make a prediction because I think what happens with this virus is actually up to us.

I do think this virus has the potential to cause a global pandemic if we're not already there.

Ah, and I do think the virus has demonstrated that it has the lethality that is likely many fold higher than normal flu.

And do you believe the W H O figure of 3.4% mortality rate?

Because, I mean, the UK puts it a 1% roughly in some respects.

If it is between 1% and 3.4% it really doesn't matter what after the decimal point.

I think what we're seeing is a virus that is many, many times more lethal than flu and right now, a population that is completely vulnerable to it and that we're seeing its ability to explode.

I mean, it's increased in some countries over the last two weeks.

It is increased by 1000 fold and many countries air seeing, you know tenfold or 100 fold increase in cases.

And there is nothing to stop that expansion from continuing unless those societies move aggressively, engage their publics, implement multiple public health interventions, including focusing on cases but also introducing so social distancing interventions.

There's there's nothing to stop right now, social distancing.

I think I think everybody should be doing what we call the Ebola handshake the elbow bump.

Instead of shaking hands and we did that earlier.

We did that earlier, and and I don't I don't think we're doing it to be cute.

I think we're doing it because we need to modify our behavior.

We need to start practicing that now is doing at home working from home, all of that right now in the UK I think I think it may be a little bit early to recommend.

You know, across the UK everybody worked from home and there are plenty of people who cannot work from home, and I think we have to recognize that society has to continue.

But we do have to modify our behavior in ways that reduces the risk of transmitting the virus.

And if I could just make one more point on that front, one problem that we face is a society.

When we have a virus that might have ah fatality rate of one per cent or possibly even less, it could end up being less bunch and that mortality is concentrated in certain parts of the population one elderly, the elderly, for example, or the chronically ill.

One challenge that we face is is that people who are young and generally healthy won't perceive personal risk and they'll govern their behavior based on what they perceive their personal risk to be.

And I think we need to start thinking in terms of the social risk I could be.

I could be.

I mean, I am generally healthy.

I'm not that concerned about my own personal risk, but if I then had a cold or felt like I had symptoms, but I was well enough to go toe work and I goto work and I shake hands with my older colleague who's got a chronic medical condition, I could be responsible for that colleague's death.

And I think we need to all think about our responsibility to each other as we think about how we're going to govern our behavior.

We can't view the you know, the epidemic in terms of our personal risk.

We need to at collectively in a cooperative manner.

And one of the things that Bruce Aylward has his tongue that from W.

H.

O has talked about coming back from the investigation in China is the degree to which the Chinese people have been mobilized against the virus and he put it in terms of it is like they are at war with the virus.

All of society is mobilized in the fight against the virus.

And in the greatest country, though, here are we to selfish to capitalists, to globalists, to be capable of that kind of mobilization.

You know, a zone American who was always admired Britain.

Um and particularly, I mean, I think I don't think it's a crazy analogy to compare this toward war, too.

The British people have faced much greater threats, and they have come together as a people against much greater threats.

I think the British people, if they, um I came to understand that this is something we're responsibility sits with.

Everyone I think the British people could could accomplish what Singapore and Hong Kong have accomplished.

Blitz spirit.

But spirit.

Absolutely.

A lot of people might be really surprised, if not sort of vaguely insulted, that you're comparing this to a war World War two.

Well, I don't w h o is using those kinds of terms in talking about what's required to mobilize people.

They're they're using metaphors that are derived from war, and it's because they have seen what this virus is capable of doing.

I mean, I mean it.

The outbreak in Bhutan was clearly a mitigated outbreak.

It was mitigated by the incredible sets of interventions that were introduced.

And yet, even though it was mitigated, it had not played out to the full extent it overwhelmed the health care system it caused.

And I think at this point it's something like 2400 deaths in Wuhan.

In a normal year in Wuhan, you would probably anticipate about 1500 deaths from flu.

This was a mitigated version of this outbreak.

It could have continued on and going to probably several multiples of what actually happened.

And you saw the breakdown of the medical care system yourself, people who couldn't receive care not just for covert 19 but for any of their other medical conditions.

And you saw a society that was completely paralyzed.

So I don't think that comparing this to a war or even to the blood spirit, I think that's actually an appropriate analogy.

And I think that's the mindset that people need to get into.

How worried are you about what's happening in the states with transmission there?

I'm what the government's doing.

I'm I'm very concerned about the situation in the United States.

The U.

S is a big country.

It's decentralized.

It doesn't have a unified national health system.

It doesn't have a unified national public health system.

CDC is a marvelous institution, but but a lot of the actual management of public health problems is delegated down to states and local communities.

And I I am concerned that the embedded injustices and inequities in the American system will play out that the virus will hit vulnerable Americans will hit Americans who don't have access to health care.

It will hit Americans who don't have health insurance.

It will hit Americans who actually depend on the school system to provide meals for their Children.

And in a terrible way.

Three government here has announced funding for vaccine vaccine or several trial vaccines against the virus.

Do you agree that there's no hope off securing a vaccine and rolling that out across population in time for this outbreak?

It depends on what you mean by this outbreak, and it depends on how the outbreaks that are taking place actually play out.

If the viral transmission can be suppressed through a mobilization of the British public in public's globally If If If.

If you can convince the public's toe look at the success stories and to emulate that and they can succeed in suppressing transmission, then you can buy a lot of time and it may be the case.

I mean, we're all hoping this will be the case that there may be some reduction of transmission is we get into the summer months and that buys more time.

So I think there is a potential that you know the way we can keep the virus under some degree of control.

I mean, I think there are a lot of people that will get sick and a lot of people that will unfortunately die before vaccines become available.

But I do think there is a potential that the delivery of a vaccine if we treated as a moon shot, if we treat it with the urgency of a wartime mobilization that we can deliver a vaccine in time to save a lot of lives.

I think it's important in asking the public to step up and to mobilize in this fight against the virus toe, understand what those timelines aren't to be realistic about it, um, our timelines, the timelines of the N I H in the U.

S.

And the timelines of many knowledgeable vaccine developers.

We don't see any way that a vaccine can be available much more rapidly than 12 to 18 months.

And and even if it were to be available in 12 to 18 months, that would literally be in the world record for developing and delivering a vaccine and the vaccine that would become available in 12 to 18 months.

The supply would be such that we would need, I think, ethically to prioritize it.

For those who were at highest risk, we wouldn't have seven billion doses of vaccine in 12 months.

So if this is a war in your terms is a lengthy room, it is a lengthy When this is a virus, it's going to be with us for some time.

Um, I'm there.

There are many epidemiologist.

You think that the virus is likely to become globally endemic and be with us in perpetuity?

If I had to bet, I would think that that is the most probable scenario.

So I think it's critical to develop a vaccine as fast as we possibly can.

I think we're gonna need a vaccine for the long term.

I think this virus is going to be with us, even if it were somehow magically to go away.

I think this is a virus we're going to be dealing with four years.

What do you say to people who say you know you You're using this thes Marshall metaphors.

You make it sound very scary.

You have a vested interest in making people fearful.

So you get the investment in a vaccine.

What do you say to that?

I've been working on epidemic preparedness for about 20 years and completely dispassionately without without elevating the temperature or speaking hyperbolically.

This is the most frightening disease I've ever encountered in my career.

And that includes Ebola.

It includes murders.

It includes stars.

And it's frightening because of the combination of infectiousness and lethality that is appears to be many fold higher, then flew.

Um, it set the We, uh, want to be utterly transparent about what we're doing.

We actually are not trying to secure any resource is for Sepp.