TRIGGERnometry - Coronavirus Expert: "The NHS will be OVERWHELMED"

Episode Date: March 21, 2020

Coronavirus questions answered by Dr Michael Head. Michael is an epidemiologist and Senior Research Fellow in Global Health at the University of Southampton. Support TRIGGERnometry: Paypal: https://bit.ly/2Tnz8yq https://www.subscribestar.com/triggernometry https://www.patreon.com/triggerpod Find TRIGGERnometry on Social Media:  https://twitter.com/triggerpod https://www.facebook.com/triggerpod https://www.instagram.com/triggerpod About TRIGGERnometry:  Stand-up comedians Konstantin Kisin (@konstantinkisin) and Francis Foster (@failinghuman) make sense of politics, economics, free speech, AI, drug policy and WW3 with the help of presidential advisors, renowned economists, award-winning journalists, controversial writers, leading scientists and notorious comedians. Learn more about your ad choices. Visit megaphone.fm/adchoices

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I'm Francis Foster. I'm Constance Tim Kishen. And this is a show for you, if you want, honest conversations with fascinating people. Our guest this week, unsurprisingly, is a medical expert. He's a global health researcher and an epidemiologist. the word that I find impossible to say, Dr. Michael Head, welcome to Trigonometry. Thank you. Thank you for having me on. Thank you for coming to my home. Thanks for letting us in to spread our corona, if we have it. But epidemiologists, I managed to say it. It's a profession has become a lot

sexier these days, isn't it? Yes, no one had heard of us until about two or three months ago, and then suddenly we're in the news everywhere. So our sexiness rating has gone from zero to, well, maybe a little bit, but it is there now. Absolutely, nailing it on Tinder. Well done. Tell us what an epidemiologist is, first of all, because I assumed it was someone who studies epidemics, but actually it's just someone who studies disease. Yeah, so the word epidemiology, epidemiology, hard to say, literally means the study of disease. So you do have epidemiologists who study non-infectious disease stuff. So there's epidemiologists who do cancer and heart disease and stroke and all that sort of thing.

And then there's those of us like me who do infectious diseases. And suddenly, we are sexy. Oh, wow. So you've become a celebrity now. Yes, I mean, in the last couple of months, coronavirus has kicked off big time. Rarely in the past have I been in demand like this, have done the occasional bit in the media in the past. But when my press office first asked me about this outbreak

that's kicking off in China, and they said, if the press come along, do you want to comment? I said, yeah, fine, no worries. And then the press did come along and actually ask me the comment. I thought, hang on, let's get Googling now, I guess you had really, hadn't I? Because no one knew anything about it, the people were asking us questions that we didn't know the answers to. So I think it certainly initially are kind of collective responses

to the media was basically, I don't know, really. Let's try and find out things as we go along. So, yeah, so we've been in a large amount of demand at the last couple of months. All right, well, let's get into the reason why, obviously this situation has come to the fore in a way that many people didn't expect, myself included.

Francis has been banging on about it for months now. I've been banging on about it, and in Constantine's words, don't worry about it, it's just a bit of flu. That's what I thought. I readily admit to it, but what I started to notice is, all the people that I follow on Twitter, scientists that we've had on the show in the past,

all of them were taking it seriously. And it was dickheads like me going, oh, it's just the flu. So on balance, I thought maybe this is serious. And obviously now it really is. We're recording this on Thursday, probably go out in a few days from now, things that seem to be picking up. So one of the things I wanted to start with is how serious is it now and how serious is it likely to get? So where are we at the moment? So it is proper serious. Often you see people like being a bit more pragmatic and sort of saying, well, it's not serious yet, that sort of thing. We are at the stage where globally and the UK, it is serious.

It's bad and it is quite scary. We now have at least 200,000 diagnosed cases around the world. There'll be many, many more times than that undiagnosed. Focusing on the UK, you've seen all the grass with the various peaks on them that are constantly in the news. We are basically at the start of that peak. or sorry, at the start of that graph at the bottom end of it. The peak is yet to come. That will be over the coming weeks or months.

And then hopefully, in a few months' time, at least the numbers will subside, if not the problem. But even to get to the point where we've reached the top and it's starting to come down again, that's still a long way off. So there's a lot of pain yet to come. So we're at the very, very beginning of this. Do you think that the government were reckless

in their pursuit of herd immunity and saying, well, the majority of people will get it and then they will create essentially a group of people who are immune to it and then we can carry on as a society. I think that was slightly poorly explained, but there's a theory behind it and the theory works, whether the practice does or not is another matter, that when you get an infection, after most infections, you do have a bit of immunity left to it. So if you have the flu, you don't normally get that strain of flu again quickly, if at all. If you get the common cold, you almost never will get that strain again. There's lots of different types of

common cold, which is why we always get colds. So the theory here, and there's a little bit of evidence to back it up, but we don't really know properly yet, is that people will have some level immunity, we don't know how long for. So if enough people do get it, we don't want that to happen clearly, because that's a problem. But if enough people do get it, then that might have some protective effect upon those who haven't got it yet. But we don't know the answer to that. And what we do need is a test, which is coming in probably a few weeks, but not yet, that will tell us if people have had the disease. So the tests at the moment are testing for the kind of the virus as you've got it. It tests for RNA, which is a bit like DNA, but their genetic code basically.

So we can test accurately for that. Whether you've already had it, you need to test for antibodies, essentially. So various diagnostic firms in the UK and around the world are sort of frantically racing each other to, produce some really good quality tests to look at the people who have already had the disease. And then that can inform our sort of our strategies going forward. If we know that everyone's had it, you can then send them back to work, for example, things like that. So it would be a bit of a game change if and as and when we do have it.

We will have it at some point. But that's a few weeks away and a few weeks in a pandemic is a very, very long time indeed. Yeah. Well, actually, this is one of the reasons I wanted to get into how serious it is because, you know, my wife went into town to do some shopping yesterday, and she was saying, I don't think people getting the message, because particularly older people, they're still out and about. They think like a comedian friend of us posted saying they think it's a bank holiday for old people, this thing that's happening. I don't think people are taking it seriously, but going

off the government's figures, if they're estimating up to 80% of the public are going to get this disease, and 1%, which seems to be pretty reasonable estimate, will die from it, well, if you do the mass. It's like half a million people, minimum. Half a million people will die from this. And a lot of people, you know, we saw these videos from, you know, English fans, football fans or whatever in Tenerife or whatever. You know, it's just a bit of flu, mate. Just like me. Just have a beer is going to be fine, you know. Behaving like legends, basically. I'm not even sure they were football fans. It just looked like football fans. Anyway, so my point is, there are people who are not taking it seriously. When we're

talk about it being serious. How many people are going to die from this? Well, we don't know. I think we can probably safely say it's going to be thousands, maybe tens of thousands. That half a million figure and the 80% figure, that's the kind of upper level estimates. That's the worst case scenario. So when we get modlers to calculate, to kind of try to predict the future, which is obviously so uncertain than something like this, they do have to calculate basically kind of the worst level scenarios so that people can plan for that scenario. If you put measures in place, like all this social distancing and shutting things down, we should not get anywhere near that worst case scenario, but it is still a possibility. There's just no guarantees. People often sort of say,

right, how many people are going to die? How bad is it going to be? I don't know. It's a short answer. But I don't think we will get that 80% and a half a million people dying, but obviously there still will be plenty of excess deaths. That is not good. And who are the people most good? risk of this? Is it particularly the elderly? Is it the people who, for instance, having cancer treatments, chemotherapy? And there are a particular set of people who are at risk? I mean, it is the most vulnerable people in society, which includes elderly. So the kind of the rough cutoff is 70 or above. And the older you get, the bigger the risks are. I think if you're over 90, the death rate for about 20 or 25%. It's pretty big. If you're between 70 and 90, again,

it kind of goes up from 70 to 80 and beyond. But it's a lot. But it's a lot of. But it's it's many percent of people would die in that particular demographic. In terms of children and young adults, the death rate is actually pretty low. There still are some complications. People are still being admitted to hospital, children and so on. But the overwhelming big burden of disease, the serious burden of disease, isn't the elderly. It's in people, like you say, who are having cancer treatments, people with cystic fibrosis. And if you've got other comorbidities, as we call it, basically, they've got other things

already wrong with you, like hypertension and diabetes, if you've had a lot of stroke. To a certain extent, respiratory conditions like asthma or chronic obstructive problem with disorder, C-O-P-D. They're all risk factors that increase the chances of, if you get COVID, if you get the coronavirus, then you're likely to be a bit more ill than people who are younger and haven't got comorbidities. What about lifestyle stuff like being overweight, smoking, stuff like that? Yeah, so smoking is certainly linked to increased risk of being hospitalized. That's the kind of often metric we use as to how serious it is. Do you need to go to hospital? That's the kind of benchmark for a serious case often.

Definition is very little bit, but you can kind of use that as a benchmark. So you're more likely to be hospitalized if you're a smoker. I mean, if you are obese and overweight, you're more to have things like diabetes and so on. So that would then contribute to a risk factor that would elevate the likelihood of seriousness in your particular case. It's all risk factors. It doesn't mean it's going to happen, but it increases the chances of a worse. case. And I saw, like, and I'm going to use a lot of this interview to explode some myths, because as we're all on social media, we've seen a lot of people saying certain things and, you know, people getting quite worried about it. They were saying there was a link between anti-inflammatories

and exacerbating the condition. Is this true? Is this not true? Or do we simply not know? Just for people who may not know, anti-inflammatories being things like ibuproofing and such, right? So that probably is true, that one. We don't know. So the link first came from, I think it's the French health minister who first stated it. And then a few doctors have given a few sort of pragmatic viewpoints that it's probably is the case that paracetamol is a better painkiller. I think the latest guidance, as I say this right now, is that if you are, have been told by your doctor to take things like ibuprofen, then carry on doing so, but maybe have a word with them just to see what the latest score is. And if you do have symptoms of the coronavirus. try and take paracetamol rather than ibuprofen. I'm on quite strong ibuprofen as myself at the minute. I've got a slightly dodgy hip, so I'm on these anti-inflammatory. So I'm watching that one with great interest.

And it's interesting you said that. And also as well, I really want to focus on this because I find it deeply worrying. You know, people are just going, oh, I'm just living my life normally, blah, blah, blah. Like, for instance, if I'm young, I'll be fine. What effect does that actually have? And are you putting people at serious risk? if you essentially go and live your life like you used to last month or three weeks ago?

You are putting people at risk because you might be fine, but that therein is not the problem here. The population at large, and if you want to personalise it, your elderly relatives might be fine. So if you live your life as normal and mix a lot and have lots of contact with other people, if you then take a coronavirus into your grandmother's house, for example, then there might be problems of foot, because that's a vulnerable person you're affecting right there. So we do all have a big responsibility to actually just behave a little bit and follow the public health guidance.

The kind of measures have been put in place to reduce the amount that we mix with each other and large gatherings and things like that. There is a point to it and it is to kind of reduce those big peaks and just to make the whole country a bit more a slightly easier place to live in. And we all have a responsibility to contribute to that.

So there you go, at Trigonometry. We're being irresponsible by having this face to face so you don't have to. And also, I don't get to see my mother. Excellent. Thank you for that. Actually, I would say that I think the current guidance suggests that gatherings of more than 10 are ill-advised. And there's currently three of us in front of the camera, there's somebody behind the camera,

four, we're fine. We're fine. We don't have symptoms, do we, don't think? Anybody? No. I actually have a feeling I might have had it already because, like, three or four weeks ago, I had a dry cough and a bit of a fever. I mean, that could easily have been the coronavirus.

And again, in many people, the symptoms of the same mile. You may be superhuman in a very precise way. Thank you very much. Shut up. I am superhuman. No, I like to say only the good die young. Anyway, so now that's the point. So, for instance, in February the 14th,

I remember it because it was Valentine's weekend. And my girlfriend was very angry. But I had, I developed a fever and a cough. How likely is it that people have already had this, like last month in February? Or did it only really appear in March? and so on. I mean, it was around in February.

There were far fewer cases. It's actually less likely that you have had coronavirus. The thing is, January, February, March, it's flu season. Northern Hemisphere, there's flu and coughs and colds everywhere. So that's also been a bit of a problem because hospitals and doctor surgeries are handling flu cases and other respiratory infections as well, along with this brand new thing that's been thrown into the mix. One of the reasons why it's better to try to deal with these things over the summer is

that there's fewer things like that out, the fewer cases of flu out there. So if people are getting these symptoms now, from now on, it's more likely to be coronavirus because there's less flu around. So that makes the kind of diagnosis and case management that bit easier than it has been across the winter. Look, I spend a lot of time telling you what's wrong with the world, so let me tell you about something that's actually right. Sleep, specifically getting more of it, better quality, the kind where you wake up and feel like a human being,

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These are mass-produced objects. Someone has put thought into them. I'll be honest. I'm not the person who thinks carefully about where he's saying. sleeps. My dating history will tell you that. I'm the person who's been on the same mattress for eight years and called it fine. But the older I get, the more I notice that fine isn't actually fine. Your body tells you, if you're going to invest in anything for your home, your bed is the one that pays you back every single night. Avicado products are made, not manufactured, and thoughtfully

crafted with real materials to deliver lasting comfort and support. Go to avocado green mattress.com Trigger to check out their mattress and furniture sale. That's Avacadogreenmatress.com slash trigger. Avocado green mattress.com slash trigger. And another question I really want clarified is if somebody who is young, fit and healthy gets it, what are they likely to experience in terms of symptoms and what impact is it likely to have on them? Because again, people have been sharing all sorts of nonsense articles on Facebook and Twitter and so on. I mean, most people, I mean, roughly 80% of people who get it are not fine, but it's very low-level symptoms.

It's the equivalent, you feel about as grotty as you do when you get a normal cold, for example. But obviously, the key, as has been emphasised repeatedly by the chief medical officer, is it's kind of it's not about you as a relatively young, healthy person who's kind of all right. It's about protecting the people around you who are potentially not going to be right if they get it. And it's also about protecting the health system from a large swamping of cases where, People who need access to ICU beds or ventilators, whatever, there's not enough of those things to go around if everyone gets the disease at the same time. Yeah, so, I mean, if there's going to be a lot of people with a fever on the cough at the minute, as we go forward to be even more, they need to hang around at home and self-isolate so that the health facilities, GPs and hospitals are freer than the otherwise would have been so they can concentrate on the proper serious stuff. And you were saying that we're at the start of the process. what does that mean? Can you guide us through what you think the government are going to do

and the modellers are going to advise a government to do? Well, I think we've probably got a clear strategy in place for the next few weeks, which will be schools closed to kind of keep me distance from everyone, to protect the elderly, so there's kind of fewer visits to granny and that sort of thing. The kind of advice is out there, as I speak right now, is probably the sort of advice we're going to have with us for at least a few weeks. I suspect that I'll probably look at that again. I mean, we looked at again all the time, but then we might see significant changes maybe around May or so.

As we start to hit the peak. Yeah, hopefully by then we'll be somewhere nearer the peak. And things like we might see, for example, schools opening up again for a short period of time. Because closing schools is a big step. It's got such an impact upon everyone else. It has the potential to take frontline health workers out of the way. It means parents can't go to work and can't earn money. So there's all these kind of secondary consequences.

from the relatively simple act of closing schools, but it then gets complicated. And obviously, we, to some extent, need to live our lives at least a little bit, and also compliance with these public health guidelines. We've talked a little bit about lack of compliance that we've seen. It is likely, very likely, that compliance will get less as we go through, as people get a little bit fed up with it and get a bit of, if you're excused the phrase, cabin fever from being at home the whole time. So I think it's been mentioned that we might have this course, so-called,

switching on and off of these big interventions. So we might switch off school closures and open them up again for a bit, a few weeks maybe. So we might. Just to give parents a bit of a relief. So basically, I mean, I have two kids myself, so I'll be delighted in schools that back up again. But so for example, I've no idea if this will happen, but a guess of my part might be that around the May half term. With that kind of second half of that term, we might see the schools open up until July. And then you've got the six weeks summer holiday break.

There's kind of a natural time when schools are closed anyway. So that sort of switch you on and off. That's the sort of thing we might see going forward. So you don't think that actually things are going to get stricter and harsher in the weeks to come. We're not going to, you don't expect a lockdown where everyone just has to stay at home and you get to go out for an hour a day to walk the dog and buy some food. I mean, that might happen. My senses it won't, but it does depend a little bit on whether, again, whether the population are not applying.

At the moment in the UK, we kind of done this guidance for the public rather than in other scenarios and other countries where it has been locked at me, you are staying at home, like we've seen, for example, in China and some other countries. They're big on human rights anyway. China is quite big on telling us population what to do. So I think on the whole, the slightly more, if you want to call it, softly approach of guiding people rather than telling people is certainly in the short term better. So I actually, I do hope we don't need to have these kind of legally enforced lockdowns.

They could happen, but we shall see. from what you're saying, basically what I'm hearing is this is going to be with us until autumn at the very least. Right? Is that fair to say? I think that's fair to say. Yeah. And what about the second peak idea where essentially, like with the Spanish flu, there was the first peak and then actually there was a lull and then it came back? Do you think we may see that with this? Is it too early to tell? Well, it's too early to tell, but we might do. So with flu most seasons, actually, even with seasonal flu, peaks that vary according to, in the case of flu, according to when school shut for school holidays and so on. So when they shut over Christmas a couple of weeks, flu cases drop. There's normally children that are spreading it on the whole.

That word, yes. And as a former teacher, I hardly concur with Constantine. The only time that's happened on our show. Sorry, carry on. My wife is a teacher. If she was here, she may well contribute to this particular conversation. It's similar fashion I expect, but I wait to speak for her. So in flu, they often, they are the key, transmitters. With coronavirus, although children do seem to be getting it, they're not obviously the centre of it, they're not the kind of conduits that really spread. So we do see those peaks though in flu seasons anyway, and like you say with Spanish flu, there was clear peaks. With coronavirus could easily see a peak, we might find the peak that's coming in a few weeks.

If we can get out the other side of that and have much lower cases, the problem might then come in the winter when everything's back, flu's back, common colds are back, and the coronavirus might increase as well. So we might have to see a fair amount of, again, switching on of those interventions, switching on on the social distancing and so on in the winter. It's a trickier time to live in the winter, particularly for the vulnerable people, even more so at that point. Comedians. Are you a vulnerable, are you kind of a stage of speeches or vulnerable these days? Oh, there's no comedy shows anymore.

No. Right now. So we are vulnerable just through the hunger that we experience. But to be fair, I need to lose weight. Yes, you do, mate. Absolutely. But so this is going to be with us for quite some time. And in terms of the potential for it to make a comeback,

on an immune level, are we going to be better prepared for it coming back? To be confirmed, again, we don't know. If this herd immunity theory takes hold might not be too bad. If a vaccine rocks up in 12 months Will it? Don't know There's lots and lots of vaccine candidates being looked at But because we are pretty much starting from the beginning

There's been a bit of research looking at other coronaviruses down the years Now the common cold one of the causes of that is a coronavirus Oh really? Yeah yeah There's several different ups of coronavirus Some of which are seen in animals And not so far being the senior humans The Common Cold is a coronavirus You've heard of SARS of course from years back

MERS, Middle Eastern respiratory syndrome Camels, right? Camels, exactly, yeah. Bit racist at times, anyway. You know, when I went to Egypt, someone offered me 130 camels for my wife. Did they? Yeah. Did they have a virus? I don't know if they had the virus. 130 camels, mate.

You'd be richer and happier. Anyway, with the camels. But yes, there's lots of different coronaviruses, of which is one of the causes. One of the main causes of common cold, I'd just like the word, is the rhinovirus. Oh, really? Yeah, yeah. So the coronavirus causes

the common cold. I've actually lost a point to what the question originally was. The question was, are we going to get a vaccine anytime soon? So, yeah, so there has been lots of research on the common cold, including vaccine stuff, fairly recently and back in the day. And with SARS and SARS and just coronavirus is generally, there's been a bit of laboratory stuff going on to kind of prod and poke the virus and look at the immune response in a laboratory setting. But it's not really got anywhere and it's not really been a focus. And actually, I would argue, going to forward and it should have been already that viruses with pandemic potential, I mean, we've had warning shots with SARS and things like that, that coronavirus is potentially that.

We should have done tons more in the what we call interpandemic period between scary times with research and development, looking at things like vaccines and therapeutic and diagnostics and all those other sorts of things. But we haven't done. So we've been playing catchups. So with the bowler when that was big outbreak in West Africa, a lot of work has been done since. But one of the other things I do actually for research is looking at how research money is spent. So we've got this big global database of how about $100 billion of research money has been spent around the world over the last 20 years on infectious diseases. And we've looked at things like coronavirus and Ebola and flu. And if you want to, look at mad cow disease.

Remember that from years back? But that's not a virus. That's a prion, isn't it? That's a prion. It's a protein. Very good knowledge there. I'm impressed. I'll give you a gold star afterwards.

But funding follows the kind of public health emergencies or the public health concerns rather than being in advance. And there's something being very bad at in the global health community is looking at problems in advance, doing a better kind of forecasting and trying to work things out more so. We've started to get a bit better, but we've seen here that we're knowing are good enough. So I still haven't answered the question. Coronavirus vaccines, the first phase one trial, that's the first time you chuck a vaccine into a human being to see what happens to it. That's just started in America. Over the next

few weeks, we'll probably see a few more vaccine candidates trialled in a similar fashion, but we are way behind the curve. So it'll be minimum in 12 months, I reckon, before we have even a half decent vaccine. The first vaccines you see are often not necessarily the best ones. Because it's a process of refinement, I imagine. It might help that there's lots and lots of competing vaccines and who will, hopefully, all share data so you can kind of just process all that information a bit more real time you would normally. But we'll be exceptionally lucky and fortunate

to have a cracking vaccine in 12 months' time. I suspect it'd probably be longer than that. A vaccine might be better than nothing, but it might not be the kind of holy grail that cures everything. It might give you cancer. Thanks, mate. Keep it, like. Michael, what is the chance that this could mutate

into an even more serious strain, which proves even more deadly for us? See, viruses mutate all the time anyway, and they very rarely mutate into a more serious strain. And generally speaking, what you see actually is when a virus hangs around in the human long enough, it kind of adapts to its host. It's not good for the virus if it kills everyone at sees instantly, because then it can't be spread. The chain stops. So something like flu is quite good. So it doesn't kill that many people, but it kind of is easy to spread, measles as well.

that's the kind of most successful kind of virus is one that makes you ill enough to spread it but doesn't kind of knock you out altogether so mutations of viruses don't necessarily mean bad they mutate all time anyway most mutations mean nothing and whilst it theoretically could get worse and more difficult to treat or so on actually it's more likely to get slightly more mild if anything but we don't know what will happen that that's all to be confirmed it's such a new virus it's only jumped into human three months ago Whereas measles and flu we've had for hundreds and thousands of years. So we know a bit more about how they evolve and so on.

But you can expect probably the coronavirus to behave in a similar fashion. And what do you say to those people who go, this is a man-made virus. It was made in the laboratories of Wuhan. How convenient. They have this massive laboratory. And all of a sudden it started there. And the Chinese are using it to dominate the world.

See, there was a paper published, as I speak just yesterday. in, I think it was in nature, one of the big scientific journals that pointed out that this is, I'm going to swear, actually, this is bollocks, this kind of man-made theory. And they pretty much, they don't use that swear by, but they pretty much say exactly that. Basically, dear conspiracy theorists, please stop it. So they can show the sort of the genetic lineage of it and exactly how it's evolved and show that it's not a man-made virus. It's probably come from, almost suddenly come from bats as the first originator. Bats host viruses so well, and they don't have symptoms. many of our sort of potential future threats are hanging around the bats right now.

There was probably an intermediate... Mike, you've got to be careful. This could initiate a whole swathe of racist attacks against bats. I think people... I think I can say people should steer clear at bats, including eating them, which has been the problem in China, that bats are on the menu. And in these weirdly kind of big markets with... You've seen the sort of the menus and Chinese have everything they've got in the menu,

and people have translated it. And there's pangolins, this kind of cute little animal that's on the menu there. They basically chuck all these animals in this market together. And then they eat them all. So there's kind of the potential for transfer of genetic material and viruses are between the animals. And then the humans are eating it. And also humans are preparing it. So they're kind of slaughtering and coming of blood and so on.

So that's probably where the virus started in bats, probably by an intermediate host. And a pangolin is one of the theories. We don't quite know that yet. But this paper kind of refutes the man-made theory. And also that point about there's a lab in Wuhan that's the only level four lab in China. Level four is the kind of highest level of pathogen, Ebola and things like that. That's how it's kind of level one to four.

So Commercold is level one, a bowler's level four. Everything else is in the middle. I don't know if it's still the only level four one in China, but there is one in Wuhan. The way that conspiracy theory falls down, in my view, is that Carina-Ros is not a level four pathogen. It's in level two labs or level three labs at best. So the level four thing is completely irrelevant

because you don't need level four level four lab to deal with it or research it. So again, I'm going to use a swear bit again. It's bollocks. But also, I mean, our regular views will find this funny, but a relative of mine used to work on the Soviet bioweapons program because I'm from Russia originally.

Okay. And I spoke to him. I'm edging slowly away. Well, we did have to drive past Salisbury to get there, actually. Brought back great memories for Constantine. Yes. That spire is still looking good. But he was saying, look, if you were developing a biological weapon, this is like the worst

biological weapon in history because what you want with a biological weapon is you want to kill healthy young men who are the enemy army and you want to do it quickly. You don't want to have a week-long incubation period when they don't even have any symptoms. And you want to have a lethality rate over 1%, significantly over 1%. So it certainly wasn't, you know, the idea that it's designed as a biological. It's so much like the virus was made in China. It's no quality. And breaks down after six months.

Yeah. So I do agree. I think it's ridiculous. But people do like the conspiracy theories, don't they? Especially in times of panic, because people are desperate of information. They don't trust a lot of people. They don't trust Boris Johnson and telling them things. And I understand that. I don't like Boris Johnson either. Where I think Boris Johnson has actually done quite well so far,

in this is he's not said very much at all. He's basically pointed at the scientists either side of him and basically said, right, you answer those questions. So when you have the press conferences with him, the chief scientific advisor, the chief medical officer, who are both brilliant, chief medical officer Chris Whittie, his background has affected diseases. He's the perfect man for this situation right now. But generous press conferences, you kind of see Boris answering questions on a subject he knows nothing about, nor should he. He's a politician who's kind of used to handling questions about whether Prissy Patel bullied people in the ministry or whatever, he can handle those questions. That's what he's designed to do. To ask, to answer some questions

on public health and epidemiology, he can't assume he's panicking slightly whenever he's speaking about it, but he does at least refer to the people either side of it, which is good. We need to hear from those people. But obviously, when it's still framed as the government is telling us to stay indoors and not go to the pub, and so a lot of distrust about that. And conspiracy theories crop up. So someone I know email me the other day. I've had so many inquiries and people I've not spoken to in years. So remember me, I've got a question for you.

One of the questions I have was there's a conspiracy theory going around that if you blast yourself in the face of the head or either he would kill the virus. That sounds brilliant. Just as a layman, can I have a theory that the temperature you would need to do that

would be so hot you would burn your face off? I suspect there might be secondary consequences before you got as far as a virus. The thing is that's all we haven't researched. We haven't done a clinical trial on blasting yourself in the face of the hair dryer.

So we haven't tested this. We can't sort of say, we can say, no, that's nonsense. But then if somebody says, prove it, we can't prove it. We can say, look, it's nonsense. You'll also have to go and take that theory further and say, right,

all the world's infected disease experts. All of them. None of them reckon you can cure it by blasting yourself in the face with a hair dryer. But to you, like, crackpot conspiracy theorist person over there, you reckon you can. So the video I got sent of it was by someone who just happened to have a few books to sell. By someone who is, I can't know their name,

otherwise I would have said it. But they wrote a book called something like Cure the Common Cold. It's quite an old book. So whoever that person is, they're not a doctor, they're not a medical researcher. They have no background effects of diseases, but they do think you can cure coronavirus blasting stuff on the face of the hair dryer. And by the way, here's a few books I've written in the past. So again, the conspiracy theorists rock up with their things to sell. and a theory that it doesn't have to be accurate, and that's clearly so silly. It doesn't have to be an accurate theory.

It just has to catch people's attention and be circulated for it to kind of achieve its goal. And there's just so much of that out there. There's a lot of scam potential in times of scariness. One thing I'm concerned about with this kind of community spirit that's building, which is great, there'll be a lot of very well-meaning actions that will have consequences that no one had really thought of,

And that probably will include a few unscrupulous types doing kind of supermarket runs for old people, whilst nicking a few of their valuables while the back's turn. There will be a bit of that happening. You can just guarantee it. So those secondary consequences of it are also important. We need to try to – we have to work it out as we go along. How much kind of community action groups, how much good will come out of then compared to how much negative will come out of then. Hopefully it will be kind of a net positive.

But we do need to think a little bit about, again, the vulnerable people in the Sarty who are trying to help, and who are a few, a very small number of unscrupulous types, will try to very much not help. Well, the law of unintended consequences are so important here because you were talking early about shutting schools. You get these people, you know, Pierce Morgan and others screaming on Twitter, oh, you got to do this, you've got to do that. And, you know, there's so many unintended consequences to many of these issues. I mean, you know, shutting down schools, the point you made is nurses, doctors have children. If they have to stay at home with the children, they can't work.

Also, children then end up with grandparents, potentially spreading the virus to vulnerable people. Although teachers' mental health will skyrocket, not being around children. No one cares about it today. So, I mean, we've got to be sensible about this. And the other point, of course, is you start shutting things down that has a huge economic impact. The economy tanks, that kills people too. So there's got to be a balanced response to this. We can't just shut everything down and just focus on that alone, can we?

No, so the economic consequences will be huge of this. and the social consequences, some of which we just touched on. But again, elderly people not being visited by the relatives anymore or not as much as they were, that's a problem for them because they rely on that kind of social contact to kind of enjoy their day. Get a respirator and go and see your mother. That's ironically what a friend of mine has done.

He's actually taking a respirator to go and see his parents. Full on respirator, or just a mask. No, no, no, full-on respirator. But can you console these people who are looking at their elderly relatives and think, oh, they're going to die and all the rest of it? Is that hyperbole? Or should we prepare ourselves for the fact that actually these people we've had in our lives for so long, our grandparents, our great uncles, they might not be around for a while?

We're going to see excess death in the elderly from this. So some people are going to lose relatives or they otherwise wouldn't have lost if this pandemic hadn't occurred. It gets slightly cheerier. The death rates in the over 70s is kind of, depending on how old they are, it kind of varies kind of 5, 10, 20%, sort of number. So actually most people aren't dying of it.

But obviously many people still are dying. I mean, I'm in epidemiologist, so I look at numbers on the spreadsheet quite a lot. It's kind of depersonalized. It's just a mortality rate. But then if I kind of think back to my own family and think about my elderly relatives, I've got one relative who's over 90,

and I'm sort of thinking, if she gets it, big problems potentially in terms of her health. And she's in relatively good health for someone in their 90s, very stubborn and very cheerful. So the kind of withdrawal of social contact for her in particular because she is a very sociable person still is a tricky thing and I don't quite know how to handle that for the best, to be honest, in the same way that I do worry if she and other older relatives, particularly those who've got existing comorbidities, as we've discussed, if they get it, again, it's more likely to be serious. So I can number crunch during the day and then at home I come at night and I do worry. I think about these things.

So, and I don't know what the answer is on that particular point. And touching and going to the situation in Italy, is that why the situation in Italy is so bad? Because they have a very high percentage, I think so much 23% of people aged 60 or over, or is there something very specific happening in Italy? Because at the moment, people are going, look what's happening in Italy, this is going to be happening here.

So we probably think that are at least numbers of cases, those kind of peaks and curves on the graphs or follow something similar to Italy. We are a few weeks behind, so that's an advantage so we can kind of watch what other countries are doing and plan it a little bit accordingly.

So I think our early case detection and contact tracing, which is basically when you find out a case, you kind of ask who have you met, who would be in a room with, that sort of thing. That did slow the progress of the virus in this country,

which has been very helpful to bias time, just to work out a bit better of what to do. The high mortality rate in Italy, I don't actually quite know precisely why it's much higher there or a lot higher than in the main countries.

I think that demographic profile of Italy and England is not too different. I think they do have more older people as a purport of their population than we do. But I don't quite know precisely why it's probably as a range of factors that each contribute a bit. It might be that there's more older people. It might be that the health services weren't quite so prepared as us in the UK. I don't know if that's true. I'm just hypothesising. It might be true. There's also more kissing.

They're more tactile, more affectionate people. And families are closer together in different generations. Yeah, so, I mean, those are all really valid point. And actually, the behavioural science of this is firstly tricky. Secondly, I think massively underrated. People like me who are number crunches, we kind of look at the numbers and then there's the modulars who come along to predict numbers. Throwing in the behavioural side of things is so important.

It's why you can't obviously say Italy or somewhere else is doing lockdowns, why aren't we doing that here? It might be we should be doing that here, but we know from previous studies in times of, for example, during the 2009 swinefully pandemic, that there were analyses done looking at the behavioral factors across different countries. And we know that people in different countries have responded in different ways. There's different levels of compliance. When it comes to washing your hands, people wash their hands in a similar manner way, but when it came to restricting your contact patterns, your social distancing, that was massively very very very. across countries. So again, a country like Italy, which is very, very, like you said, lots of kissing,

lots of hugging, lots of intergenerational living, if that's the right phrase, those are different factors that will apply into modelling in Italy that isn't so relevant here. The waiting should be a bit different. So I'm always a little bit cautious of saying the government's doing the wrong thing, particularly when it is clearly backed by some of the leading scientists. They're seeing data that we haven't seen. I think we should see it. There should be more transparency about what evidence they're using to make decisions. But as I speak, we haven't seen it. They have. They've got an idea of what the evidence says and of the local context. So we can learn lessons from Italy, but we shouldn't necessarily replicate Italy because it's not the same situation here. We're all

at different stages of the outbreak as well. So there will be different interventions at different times. That's fair enough, I think. And London is fair to say that it seems to be ahead of the curve, if you will. Why is that, just if you could break that down as to why? Is it the fact that people are going on the tube a lot? Is it buses? What is it about being in London? Or is it a fact that a lot of people rent and live together? It's a high density of population, which is one key factor. In rural areas, population density is much lower. And the fact that in London, you are often cramming more people into a small space, for example, on public transport. Public transport is an interesting one. We know that international travel is a big conduit for

spread of effects diseases. That's kind of fairly obvious in a way. But we also have the of us to prove it, because we can track people. We know who gets on and off a plane. We can track where they go. If they become a case in the new country, then you see exactly where it's come from. With buses and trains, you've no idea who's on the train. So you don't quite know, you can kind of do some contact tracing. You can say, well, I was on the Piccadilly Live for 20 minutes this morning. But you're in a cram space for a fairly short period of time. And you also don't quite no, if you pick up a virus, you've done lots, there's been lots of other contacts during the day as well. So there's lots of opportunities for contacts in London that you don't have in a rural

area, for example, but it's also hard to pin down where you picked up your infection from. It could be any one of those contacts. It could be the door handle. As you left the train, it could be on the train, it could be in the office, it could have been in the pub in the evening, it could be on the pint glass you touched that someone else had used beforehand that hadn't been properly cleaned, all those sorts of things. So it makes sense. It makes a kind of the epidemiology of things so fascinating but often hard to disentangle. But the higher population entities is the big one and that makes a lot of sense. And that kind of leads me into the question that I wanted to ask you is in the world that we live in now, the globalized,

interconnected, everyone traveling everywhere, world, is this going to keep happening with all kinds of different things? Because we've seen it, you know, you mentioned SARS and MERS. Those didn't explode to the level that this is likely to go to. But Are we going to continue to see this kind of thing happening? It's easier now for outbreaks to happen, for, easier for pandemics happen. Pandemics just don't happen very often. But we know that always will be in next time. So certainly when this is said and done, whenever that be, we need to learn lessons and properly prepare globally.

There's health systems in the poorer parts of the world that if they do get a lot of pandemic cases in their country, they're not going to be able to cope. The bollah decimated parts of West Africa that they're not recovered from now. So, globalization includes the spread of infectious diseases, but also in sub-Saharan Africa, wherever you go, there's a can of Coke. These things, which then sort of leads to things like tooth decay and obesity and cardiovascular disease. So even non-infected diseases do spread because of globalization and increased connectivity. Obviously, it's great that we can travel to all parts of the world. and we've got the internet that can connect everyone.

The downsides is that sometimes, as infectious diseases generally decline, clearly not right now with this one, but on the whole, infectious diseases in most parts of the world are going down, we're seeing non-communicable diseases like diabetes, hypertension, cancer, go up. That's in part also because there's increasingly aging populations. So whereas in the poorer parts of Africa, let's say, the life expectancy even 10, 20 years ago might have been 40, now that might be 60 or so. So those age-related conditions kick in, plus also the fact that you might

see a fast food branch or a can of Coke almost anywhere in different parts of the world. So it brings new health challenges to everyone, including infectious diseases and including things that have pandemic potential. Well, one of the things that also shows, isn't it, that we are as weak as our weakest link, in a sense, as a global society of people. So if there's a web market in China where you've got these different animals all, you know, bleeding all over each other as they're being slaughtered and whatever, even close interaction with humans, we can't just like be, okay, that's nothing to do with us because that then leads to what we're having now, which is thousands of people dying all over the world. Yeah, so occasionally that'll be that perfect storm where the animal is slaughtered

that happens in the infectious in the context another animal, which then absorbs the infection, and it then meets a human, meets a human, and the human is able to spread it, and then it kind of grows explanationally, it kind of needs a lot of factors to come together, but we've seen that it's possible that kind of mechanism does work and sometimes works frighteningly well. With those food markets, I did see one newspaper article a few weeks back saying that China had now banned them. I didn't see any follow-up on that. And I didn't see that claim more widely. So I don't know if that's the case. But I think certainly that Chinese will need to look very closely at those food markets and try and work out, do they need to be eating all these random animals?

Some of them are endangered. I think pangolins are probably endangered. Probably high in China anyway. Well, yes. They're very dangerous life in China. Yeah. But there's not many of them around the world. So whether that kind of importation of sort of fun and funky animals needs to happen anyway. But food markets are kind of embedded in Chinese culture.

So it's hard just to say to someone, you're not doing that anymore. But also they have a huge population and lots of mouse to feed. They're doing everything they can to try and feed them. Yeah, indeed. I don't know to what extent pangolins might be feeding many people in some of the food prices. I'll tell you the point. they need to feed their populations. And they have different diets to us, and that's obviously fair enough.

But we saw, again, it's a back to the behavioural side of things. Can you shut down these food markets without much of consequence? If the Chinese government says to the population we're doing it, well, you probably can. In other cultures, it's harder. So here's an example from bird flu, 2005 or thereabouts. There was a lot of concern that it would get into Africa and spread there with such poor health systems. that's a really big problem. In, I think it was Nigeria,

there were some cases in chickens, which was kind of the host of bird flu. The bird flu is around today. It affects a few people in Southeast Asia. It affects birds a lot. Some birds are fine and can fly around, and therein does a problem. They then infect other birds who suffer.

So it still happens. But a few chickens in a Nigerian village got infected. And the kind of the ministry came along and said, well, we'll take those, thank you very much. And on the way out they said, we'll give you compensation. That's no good to the village because that's their food

for the next few days right there. So the village followed them at a discreet distance. The ministry people basically went a few miles at the road and buried them. The village waited till they'd gone and then dug them up and at them.

So clearly, public health-wise, you shouldn't be doing that. But these are people who have one source of food and that's their chickens. And they've been promised money but they don't trust the government and they may well not get it.

Therefore, you see why they've done it. And we saw it. with Ebola as well, that a lot of the problems are kind of with the bodily fluids. So if you're touching a dead body, which happens a lot in Africa, there's some kind of part of their burial process. It's very intimate. It's not like in the UK where they're in a boxing, you don't see them. You do have the bodies open, you touch them a lot. And there was spread of Ebola quite significantly from touching dead bodies. And with Ebola around, there were more dead bodies to touch. So it was a problem. And we in the kind of Western world, the global north,

that is often the phrase now, handle it quite badly by basically kind of running into Africa saying, stop that. And the population said, no, these are our embedded cultures. What do you know about us? My dad's just died. Leave me alone. Again, you understand that kind of response. So, again, I'll come back to the point. I think social science and anthropology and behavioral sciences, it's so underrated. We do take them making out of them a little bit, particularly us number crunches. We look down on the social sciences and we so shouldn't because they are probably more valuable than us, I think, in these kind of average situations. And do you think if it gets into, for instance, South America, like you said, or parts of

Africa, where the health system isn't what it should be and, you know, the networks aren't strong enough, that it could decimate a population? No, I mean, there are already some cases in, for example, in Africa. There's quite a few in Egypt. But other countries are any reporting anyway, a few very low numbers of cases, there will probably be a lot more than what they've got. And the problem is, I do research in Ghana and West Africa and also started links with colleagues in Togo, which borders Ghana. And I was in both countries and just a few weeks ago. And you see their health services and health systems, and there's no spare

capacity. The NHS has a limited amount of capacity that will be overwhelmed at some point in the coming months. It will be. We just know it will. In Africa, most countries have no capacity at all. So there is the potential that it could get very, very scary for their populations with if there are vast number of cases there. Hold on. You say the NHS will be overwhelmed. We know that. Isn't the whole part of the government's strategy to flatten the peak so that we never get to that point? Are you saying it's inevitable they will be overwhelmed? I mean, all the evidence we have, including the recent modelling papers that came out of Imperial College, says yes, the NHS will be overwhelmed at some point. And the chief medical officer has said that in his press conferences as well. So the kind of these interventions to try to reduce these big peaks, the peak is still going to go above NHS capacity. So we will, what you're saying is within weeks or maybe months, we will be in the position where Italian doctors are now, where they're having to basically triage who they give life-saving support to. I mean, almost certainly, yeah.

And that's pretty clear that we can expect that. Hopefully it won't happen. But that is what we expect to happen in two or three months' time. Well, I think this is really important because when we talk about people not complying with the government's advice and all this kind of thing, that's what we're talking about, right? That's the end product of that behavior. Yeah, so social distancing is a key part of this. And it's something that we all have to do. We all contribute to.

So if there is low compliance with these kind of measures that we put in place and then the NHS is even more overwhelmed than it could have been, actually that's our fault to some extent. So before we wrap up with the interview, then, just tell us, wash our hands, right? But this virus is mainly spread through just breathing the same air as other people, isn't it? So it's a respiratory one, so it kind of goes out in aerosol, but you touch services and so on where the virus is. So washing your hands, it's so unsexy and dull, but it's so important anyway, or we should be washing our hands thoroughly many times a day. Let me ask the question a different way. If you had it now, would we get it? potentially you would be defined you two and behind the camera there you'd be defined as contacts of mine so a contact was defined as something like within two meters for 15 minutes or more so if you sat at a

restaurant next to someone who's two meters away then that's a contact we've been sat in that kind of proximity so there would certainly there'd be a reasonable chance that you would have it so actually if i have got it and i develop symptoms tomorrow i'm probably infectious now oh yeah you've been infectious for days if you if you had symptoms tomorrow right I'll probably be an infectious one or two days, I reckon. The amount that you can spread the virus before you show symptoms, most respiratory infections is a day or two beforehand. It's not usually a long period of time.

The incubation period from when you get exposed to when you show symptoms, that's usually most of them is about five days. So I think the infectious period, which is the timing you can spread the virus before you show symptoms, it's a slightly different definition. That's probably one to two days. Can I just say I'm offended I am that you've referred to him as my contact? Anyway, but there we go.

But there's one question I really want to dig down on, which was that you said the NHS would be overwhelmed. And I think people are not really taking on board what that means. Can you explain in clear detail? What does it mean when the NHS health system is overwhelmed? What does that look like in real world? Figures, data, situations? I can't provide the figures or the data on it

because it's kind of a hypothetical probably-will-happen scenario, but what it means is there won't be enough beds in hospital, there won't be enough doctors and nurses and someone to treat you, there won't be enough bits of equipment like respirators and ventilators. We've heard a lot about that in the last few weeks. So, I mean, like you say, with doctors in Italy, they haven't to triage their patients to try to work out who to treat, who to give the ventilators to.

At the moment, if someone needs a ventilator, they can have it on the whole because there's enough capacity in the health service. when we get overwhelmed, there won't be enough ventilators. So it could get very, very tricky at that point. So again, it's down to all of us to lessen the impact of that because that could be our grandmother or mother or relative or so on that sat in that hospital bed who hasn't got the equipment they need

because in part we weren't very good with our social distancing compliance. So that effectively means that the doctor looks at two patients. They've got a respirator and they go, well, this one's over 75, this one's 65, this one stands, a 20% chance more of making it. I'm going to give the respirator to them. And unfortunately, that patient is left to their own devices. I mean, they'll be treated as best they can.

But if you've not got enough bits of equipment to go around, then you do have to work out who to give it to. And again, to kind of get back to Ghana, I want to speaking to people in the hospitals there, and they say, we've got loads of children with pneumonia here. I've got a very limited amount of capacity to test what bug they've got. I've got maybe two tubes a day, two blood tests I can take a day. to kind of work out what's wrong with the children. There's 50 of them in the hospital.

Which two are my picking? That's what happens in Ghana and country-related every single day. To a lesser extent, but still important extent here, our medics are going to be facing those sorts of questions. It's not going to be fun. It doesn't sound like fun at all, which is why we wanted to talk to you, because I think it's important that this information gets out there as much as we can help with that. But thank you very much for taking the time and having us in your home and not infecting us hopefully. We'll reserve judgment on that. Let's come back to me in a few days time. We'll kind of compare notes. We'll find out if we're still alive in a few days. But the last, we only have one more question for you. And the last question we always ask is,

and in this case, in this particular context, what is the one thing that no one is talking about that we ought to be talking about? Do you know, I'm going to say the word scapeys. You weren't expecting that, were you? No. No. Now, scabies is one of my most fascinating bugs I do research on, including in Ghana. It's a mite, it's a bit like a head lice, that is literally everywhere. It causes itchiness, rashes. It's really unpleasant. It doesn't kill many people.

She certainly won't have heard much about Skaibis in the last few weeks because everyone's talking about stuff that does kill people, which is fair enough. But Scabies is kind of these one of the underthought-about conditions that is rife around the world. We did a study in the UK looking at Skaabas and care homes, where there's plenty of it, and it infects people with dementia more than people without dementia. So it affects the most vulnerable people and so on. 4th, there's about 400 million cases or so of scabies every single year around the world.

It's vast. It's unpleasant. It's hard to get rid of. It's badly diagnosed. There's a lot of stigma attached to it. We should talk more about scabies. When we stop talking about coronavirus, do that first, but then secondary scabies. And who thought epiderminal just weren't sexy? There you go. Well, Mike Head, thank you so much for taking the time. It's great chatting with you. And are you on social media, by the way? You sharing information, putting anything out there, for people to follow. Spreading fake news. I'm on Twitter.

Michael Ghead is my Twitter handle. I'm not really on many other social media, so Twitter's probably the key to use. Not TikTok. Not yet. Maybe I've got more time in any kind of a lockdown situation. Maybe I'll be bored and do a few videos.

But for now, that's where I am. So go follow Michael, and we'll see you very soon if we're all still here with another brilliant episode. See you next week, guys.