TRIGGERnometry - "Lockdown Was an Overreaction" - Professor Karol Sikora

Episode Date: September 9, 2020

Karol Sikora is a UK based physician specialising in oncology, who has been described as a leading world authority on cancer.  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 (@francisjfoster) 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

Hello and welcome to Trigonometry. I'm Francis Foster. I'm Constantine Kisian. And this is a show for you if you want honest conversations with fascinating people. Our fantastic guest today is a consultant oncologist and a professor of medicine at the University of Buckingham. Professor Karasakura, welcome to Trigonometry. Thank you very much. It's a great pleasure to have you here. COVID-19 has obviously been a huge factor in the life of this country and in fact, the world. in the last few months. Before we get into that, tell everybody a little bit about who are you, what's been your

background, how are you here today? So I'm an oncologist, someone that treats cancer with chemotherapy, radiotherapy, and did medicine, went straight into academic medicine and oncology, and went to the States for a couple of years at Stanford. Fantastic experience in the States. Came back here. And I've been a consultant in the NHS for 40 years. I started young as a consultant.

Now I'm very old. So I've been through the whole thing. And then, of course, COVID came out of nowhere. I'm really out of nowhere. In February, you can see it building up. I said it's not going to happen. Nothing's going to happen. It's all back to normal by Easter.

And, of course, we know it wasn't back to normal. It's getting continuing now. Here we are in the autumn. The leaves are turning brown. And we're still dealing with COVID daily. I said myself is just the flu. So I know how you feel. The thing we really wanted to ask about, there's a thing that's been bothering us, and we exchanged them emails and we talked about this, which is that it seems like the consequences of the lockdown are not being given as much weight and attention as the consequences of the coronavirus itself.

So people don't seem to be thinking about the fact that the lockdown leads to economic problems, and economic problems leads to social problems, to medical problems, to health issues. And are we right to feel that those consequences are not being properly looked at when we consider the balance of the actions that are being taken? I mean, when I look at it, it looks to me constantly as though the politicians are making it up as they go. They don't have a long-term strategy, and nor do they their advisors. There are probably too many advisors. These sage committees would hear about 40 or 50 people. They like to get consent. If you have a committee, it wants to get consensus.

seen it in the NHS over the years. They want consensus. So you don't really get leadership. You just get a sort of democracy of votes and then people discuss and then you all go down one route. And it changes. It's like watching birds flying around in groups and swarms of birds and they suddenly change direction and they all go the other way. And that's what we've been seeing with this. And whether the decisions at different time points are going to prove the correct ones, you won't really ever know. I mean, you summarized it well. There's the health, there's the economy, but there's also COVID versus other health, and that's sort of been forgotten about. You know, that was the reason that I joined Twitter to point out, look, hey, we can't stop

everything. We can't stop cancer being treated. And not only that, we can't stop the diagnostic process to cancer. So what's really important is to think of it, COVID is one box, other health is another box and if you spend a lot of time on COVID you won't have the other box for other specialties and not just cancer but heart disease, mental health all these things. And then at the

other end you've got the economy which loops round back into health because social destruction, fabric unemployment, mental health, poverty, deprivation, child abuse, they're all connected in that. It's not

they're not isolated. And so have ruined the economy and you'll get different health problems. And Carol, we've been talking about COVID. And at the start, there was the stat of half a million people are going to die if we don't do something. How dangerous is it as a disease? Is it, as some people say that it's, for most people it's absolutely fine? Do you risk long-term complications if you get it?

How virulent is it? That is the great puzzle, Francis. So if you take the cruise ships, they were the best studied. The cruise ship, and there was an aircraft carrier, a French aircraft carrier, an American battleship, all got infected. Roughly the same statistics. High levels of infection, thousands of people on the ships got infected, very few people died. And the cruise ship that was stuck in Yokohama Harbor, if you remember in April of this year,

it was a luxury cruise ship. and the average age of the customers was 72. So these are old people. And yet there were very few deaths, something like 10 deaths altogether, out of 700 people infected. Not only that, you've got people that get infected clearly when they have a PCR test, or the virus is present, the virus genomic material is present. And yet they've got no symptoms at all. No fever, no shortness of breath, nothing, no loss of smell and taste, which are the key features of COVID.

and yet they've definitely been infected. So it's a huge puzzle. And the real problem for public health, normally you go chasing the disease. So if you take cholera, you look for people with diarrhea, you isolate them, you make the family wash their hands, you go to the source of where they're eating from, they're drinking from,

and try and see where the cholera was coming from. They're ill before they get the infection, and then they become ill. With this, you get infected, and you don't become ill in many cases. So it's very difficult to go tracing it. And so you do have to have, in fact, a good test for the disease. What we've seen just this morning, Matt Hancock has announced

that he's going to enlarge the testing program. You know, this should have been done three months ago. You really want to find out where it is. But we do seem things have changed. They've definitely changed since we started in April. The peak was obviously March, then. peaked in April in terms of severity of disease. Now, people are not going to hospital.

And it's a slightly younger age group as being infected, but we're testing everybody. The more you test, the more you find. So especially if you target your testing. So if you go to hospitals, you go to Lester, you go to Oldham, Rotherham, places like that, knock on doors, shall sticks up people's nose. They're much more likely to be positive.

Yeah. Now, and also, if we convert to saliva, testing. We just tested all our staff with saliva testing just yesterday for the first time. That is such an easy way of doing it because it's not at all intrusive. It doesn't have any ethical issues. People don't like having a stick up their nose. And it requires someone, you don't have so much skill to do it, but you have to be able to do it. And the other risks of sticking sticks up people's nose is they splutter at you. If they're affected and they're spluttering, this is not good for you. So you have to wear something.

sort of protective clothing, and that looks frightening, especially for children. So collecting a piece of sample of spit into a tube is a lot less invasive, basically. And one of the questions that I want to ask is, obviously, as we ramp up the testing, one of the things we are doing is uncovering lots of people, as you say, who have been infected, who we weren't aware of before. Is one of the consequences of that not an indication that this disease is a lot less lethal than we thought? Absolutely. And the fact, you know, hospitalization is a key to death because if you don't get admitted to hospital, you're unlikely to die. That's usually how, sure, there have been deaths at home and care homes and so on.

But most people that die go to a hospital. Most people not only go to a hospital, the ones that are going to die, go to intensive care and then they die. So that's the pathway. So if no one's going into hospital, that means something's different. There are several explanations for that. The nice explanation, which I'd like is that the virus wants to be kind to us. That sounds like medically verifiable. It's got a little white flag.

It's waving a little on the end of those little spikes that you can see in the kids' diagrams, you've got a little white flag saying, I want to be friends. But evolutionary-wise, that's not a bad strategy for the virus. That means it will stay with us forever. Now, we may not like the sound of that, but, you know, the common cold virus is staying with us forever, and we've adapted to it. The flu virus is staying with us and we've adapted. Why not coronavirus too? Coronavirus 1, which is the SARS virus way back from 2003, 17 years ago, it's still around, even though it doesn't trouble society.

And that's the great puzzle, how these viruses can insert themselves into us. You know, I try to involve philosopher at Oxford on the philosophy of why does the virus exist. You're not too interested. No, no, it's a lot. Does the virus have a soul? Can it tell between good and evil and all this sort of stuff? Of course not. It's a little bag.

It's the simplest form of life. Well, and even whether it's alive or dead is contentious. I think it's alive. It borrows life. On its own, it doesn't do anything. It's in a bunch of chemicals. Once it gets into a solid. It hijacks living processes that we have become alive, basically.

And then it comes out again and reverts to being dead. I know people like that. You're talking about me. But Carol, just for people watching a home who are not medical experts, compared to, let's say, the common, the flu, which kills a lot of people, as we now discover, most medical professionals, of course, would have known that anyway. but ordinary people don't think of the flu as this great killer.

But it does kill a lot, particularly old and vulnerable people every winter, especially. Compared to the flu, the coronavirus as it is now, is it more lethal, less lethal, about the same? Do we have any sort of idea about that? It's about the same. And that's the problem with it all. And the other thing we haven't come to you yet is vaccination. Yes. We have a vaccine for the flu, but it's never very good.

No. It's 50% effective. And we make a lot of fuss. Some people have it. Some people don't. And if you're over 60, you get it free. If a healthcare professional, you get it free. And if you're vulnerable as a young person, if your young age, you'd also get it free. But we forget that the flu kills more people than this has killed this year. But it doesn't happen in quite the same way. The other similarity is the age difference that flu like COVID too. is an age related. The average age that's died this year with COVID is 82. That's the average age. 82. 82, exactly.

It's the same with flu. Younger people, 70-year-olds, they get over it. It's people with bad lungs, previous infections that die from flu in hospital, that don't respond to the antibiotics, basically. Happens every winter, and we accept that. Flu is winter-related. That's one of the big differences. COVID is not. It seems to go just even throughout the year. So as we go into winter now, the biggest worry is that we get a second wave. I don't believe the world. It's just imagine you get a big spike of infection around

the country. At the same time, you get the flu. And so you get people with chest infections. You can't tell the difference. You've got older people, some with COVID, some with pneumonia because of the flu, and you'll start with a whole lot of patients and the NHS shuts down, and that's the disaster. And there was a very gloomy prediction report from, say, two weeks ago, predicting 85,000 deaths in the second wave and moving into winter pressures. And, you know, the top echelons of the NHS, they have to plan for that sort of scenario. You have to plan for it, which would involve closing down cancer and everything again.

it would also mean for society closing down a lot of other things, schools, shops, pubs, the rest of it. And, of course, that would have huge economic disaster if we had to shut down again. So I think, you know, that's the disaster scenario, which epidemiologists like, by the way, from Ferguson downwards. Ferguson was the half a million deaths predictor at the beginning. And so Neil Ferguson and his colleagues. He was slightly distracted when he was working. And as we now know. Their importance depends on how gloomy they can be.

Right. If a politician here, he's going to have half a million deaths to answer for, he's going to wake up and say, okay, come in here, tell me what I have to do. If you said, no, it'll blow over, it'll only be 40,000, it will all blow over, and they'll all be 82 and above anyway, and all this sort of thing. The politicians, well, that's not too bad. We'll just ride with it.

So it's very difficult. And I've noticed the epidemiologists love it. They phrase the whole thing. This is not a prediction. This just could happen. And I remember seeing a very funny cartoon where, you know, it's got four boxes. And the first boxes, you know, predict gloom. I'm wrong.

They cheer. They say, I saved you from the gloomy prognosis. If it happens, I've told you so. That's what happened. If you predict no gloom, it's all going to be okay. And it goes bad. You'll fire. So what can an epidemiologist do?

They're just body counties, basically. It's a very strange scenario. So the doctors, the actual treatment doctors like me, say, come on, you can't do that. You've got to be more realistic. And otherwise, the implication of gloomy epidemiology is you shut things down. You build 19-year hospitals completely wasteful in terms of money and not thought. So obviously, we'll talk about the second wave potentially and the second lockdown. let me just get something clear in my head because I have a confusion that I know from listening

to our viewers is shared by many people, which is this. We were told that the first lockdown, the purpose of the first lockdown was protect the NHS, crush the sombrero, whatever Boris Johnson said, right? And it's about preventing the NHS from being overwhelmed. We achieved that overwhelmingly. The NHS is not overwhelmed. The nightingale. The nighting a lot. hospitals, which you just mentioned, were essentially unused, saw almost no patients. At the moment, the numbers of people in hospital, as you say, are very, very low. And yet, we continue to have what you might describe as quite restrictive measures, people wearing masks indoors, social distancing, there's certain things that you can't do,

etc., etc. If the rationale for all of these measures was to protect them in chess, why are we still doing All of stuff. No. It was to start with. There was no doubt. Before Easter, Easter was about the open of April. And as we came up, the worry was what happened to Italy, the health service nearly got overwhelmed.

It was sort of, it was overwhelmed. There was prioritisation of younger versus older people in intensive care and so on. We never got overwhelmed here. There was one hospital declared an emergency in northwest London, Northwick Park Hospital. And that's just a redistribution, too many. people pitched up in the emergency Europe at the same time. You see, you just solve. You just go somewhere else.

You take them out of it somewhere else. And so that was solved. The problem we've got is that the problem then was you couldn't predict what was going to happen. And so, and the logo, the strap line of, you know, protect the NHS, save lives, stay home, was the line that frightened everybody. That was the line to keep people. And, you know, older people especially were doing it.

because they thought they were protecting other people, protect the NHS, which implied protect them. And of course, cancer patient can come forward. During that period of April and May, 45% reduction in the number of people having heart attacks. Now, it can't be that there was a 45% reduction. It just said no one came because they suffered chest pain and didn't do anything about it. The attendance, the emergency, if anything, was dropped to 50% of what it normally is. That's because people weren't got out on Saturday night. That's right.

You want to get out there. They'd go have knife fights and drug deals. But as you move forward, now it's about trying to protect the whole system from winter pressures coming. There's the same measures of social distancing, hand-washing, mask wearing, protect you from other infections like flu. So it's a bit of both now. The real truth, constantly is nobody knows what's going to happen. Neither me as an oncologist and not the epidemiologist, nor my infectious disease colleagues. They really don't know what's going to happen.

And to me, there are really three options now the virus has got. It can fizzle out, which is a great option. We all want a fizzler here. We want it just to go weak and learn to live with us, and we'll just cope with it, and that's fine. The second option it has is local spike, and that's what we're seeing, which are politically quite damaging, because, you know, you get this rival reach in Scotland, Wales, Northern Ireland, and trying to show that they're coping better and so on. And, you know, when you do see a local outbreak, it's not like we're really doing that drastic measures.

We may make confusing rules. You can't socially go and visit Grandma, but you can go to a pub with Grandma and have a meal in the pub. So this makes no sense. And what you really have to do, if you really believe in public health, strategy, you have to shut the town down. You have to cut off the roads, put road blocks around it, close the railway station, so that's it. That's what we did. I'm from Russia. I'm from Russia. That's that way of war. Yeah, exactly. That's what they did in Italy.

The police roadblocks everywhere. You couldn't go from north to southern Italy. I said, no, you'd go back. And we haven't done that anywhere. All these other places, all the Manchester suburbs that are hot. So the third thing for the virus is, you know, we haven't been. And we have to, is the full-blown second wave, when it really comes back, the higher peak that you can't squash with hospital admissions, intensive care, flooding the system. Now, it's clear that nobody really believes that third option is going to happen, and it probably is between the two, fizzling out with a few local spikes,

and we can cope with that. And it's the same pattern around Europe. The difficulty is how serious do you have to take things, like beginning of this week, I remember seeing the story about the Zanchi and the chewy flight that came from Zanche to Carver to Cardiff and 11 people were infected on it, testing positive. What do you do about that? Do you suddenly close down Greece? Do you make quarantine for everybody?

It's very difficult. There's no right or wrong answer. My own feeling is you just ignore it and you just leave it. Carol, what I'm getting at, and I think this is a question a lot of people, minds is you've said that the average age of death for a patient, a COVID patient, this country, is 82. We had a period which was the summer and late spring when the NHS was not overwhelmed. Are we not overreacting with everything that we're being forced to do, particularly given that there's a cost to the reaction? The cancer people who are not coming in to get a diagnosis,

the heart attacks that are going, treated, mental health, alcohol abuse, drug abuse, child abuse, All of these things are exacerbated by people being forced to isolate. There's a lack of communication between different generations. All of these things cause a problem. Have we not overreacted? I think we have. And I think if you're taking it as a doctor, we're certainly overreacted putting too much emphasis in healthcare on COVID

and removing it from the other things. In terms of the economy, I think we've already discussed the fact that economy and health are intertwined. You can't separate the two. And if the economy goes down the tubes, then even people that are currently in deprivation areas, they're going to be worse off. They're not going to be healthier. They're not going to be Carol, there's a question that I really wanted to ask you. So you're an oncologist, you're a cancer specialist. What effect has this had on people having cancer treatments, people being diagnosed

with cancer? What are the real world implications of this? So for people with cancer that we've known at the beginning, say you had cancer at April, has it really impacted. We've tried to minimize the impact. So if you're on chemotherapy or radiotherapy, you've got it. If you're about to have surgery, except in the period in March and early April, most people got it. The biggest impact, which is still ongoing, is on people that have got symptoms, they've gone to the doctor, and they haven't really been got into a diagnostic pathway. So you only diagnose cancer by taking a little bit of tissue called biopsy from wherever the cancer is, four common areas, breast, lung, prostate, and colon. So you've got to get in that,

which means doing some technique, some image, ultrasound, CT scan, MR scan. And there's been a complete shutdown of all the diagnostic pathways for far too long now. First three months you could perhaps excuse, but some of them are still not operating as normal. One estimate last week suggest that 15 million people were actually waiting for a diagnostic test. The problem is a lot of people have diagnostic tests and only a small proportion, thank goodness, have cancer. But we don't know which they are in there. So if you take CT scans, you screen maybe 100 people and only 12 or 13 will actually have cancer in there. But there's no way of prioritising them. We've tried to fast-track people with cancer-like symptoms, but it's not like that. The other problem for the NHS, which is

to this country is that it's undercapacitized anyway for diagnostic tests. So in France, if you need a CT scan because you've got a cough or coughed up a bit of blood, you'll get it by next week. It'll all be sorted out by next week. Here you may take three months. And that's normally, that was 2019 before all this happened. And so now, because of the huge backlog, if you have cancer that don't know it, it's going to take longer to diagnose.

And the danger in that is it gives cancer the opportunity to spread. And whilst we're very good at treating localized cancer in the four main organs, but anywhere else you have it, we're not so good if the disease starts spreading. The outcome, the prognosis, goes down. And the treatment gets more difficult, more arduous for the patient. So chemotherapy, radiotherapy, immunotherapy, all these things, which we can do. But the prognosis is much worse if the cancer spreads out to the primary organ. And so that's the impact of this.

five published papers in the UK looking at trying to quantitate that impact and they vary from 20,000 excess deaths because of the delay to 50,000 excess deaths already and that's the worrying feature and we're still not back to normal again that our health minister said we were nearly back to normal I would dispute that if there are 15 million people waiting for this is not normal even in the NHS. There aren't 15 million people in France waiting for a diagnostic. We've really got to speed that whole thing out. And the other thing, of course, it's not just the big diseases.

There's all sorts of other diseases that we need to look at. I mean, children with deafness, they've just been ignored. People with, you know, things that are, you say, well, they can just wait, just put it on hold. Deaf children, for example, that need hearing assessment, people with painful hips, painful knees. They're not urgent because they've had pain for years. They need a hip replacement. They need a hip replacement.

The waiting list, at the best of times, is often more than a year anyway. Now, it's going to be two or three years before they get the NHS to get them the operations. A lot of pain and suffering is caused by the virus, not directly, but the indirect effects on our health service. 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.

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as a result of the virus purely from cancer. Is that correct? That's correct. Why is this not a bigger scandal? I know. I keep saying everybody. It is a scandal. And the reason it's such a variance that how can you not know whether it's 20,000 at 1 or 50,000?

And the reason is the only way to know. will be next year, when we look back on it all, you'll be able to look and see how the cancer behave. We can't do it now. We can make predictions, and all these things are predictions for delay. So if the delay is only one month, it's not going to make that much difference. If it's six months, that'll be the other end, that'll be the 50,000 end. And the 20,000 is about four months delay. Altogether, the mass of cancer in this country are very simple. There are 360,000 new patients a year, about 30,000 a month. and that means a thousand a day.

At the moment, the cancer diagnostic rate is running about half of that. So it's running about 500 a day. So it's not that the other 500 aren't getting cancer, that COVID has suddenly prevented cancer and everyone's not getting it. It's just hiding the fact because these people haven't been able to get the diagnostic necessary to work. So half the people who need to be tested for cancer

are not getting tested? Well, they're in the key. Yeah, but they're not getting it now. They're not there now, and they don't know it, of course. So certain things are picked up. So mammography, which are breast-sweaning, that's really picked up. And because it's simple, it doesn't generate any aerosol. There's no touching involved necessarily, so it can be done.

Your flow of patients isn't affected by it. At the other end, you've got endoscopy, which involves putting a tube down in the mouth or into the back passage, down into the mouth, people are going to cough and splutter. It generates aerosol. You've got to wear full protective clothing for the operator. You've got to clean everything between each patient, disinfect the whole place. So instead of doing 10 endoscopies a morning, for example, it would be the average endoscopy list. You're down to three or four a morning.

And yet you've got a backlog for four or five months backlog. So it's very difficult at the slow pace. What's the solution? You just have to work harder, work longer, and do what it takes, and change the processes. Industry, a pub, just change the way it works. It wants the revenue. You know, I'm a little bit in the public, private. Private sector is much more efficient going to change.

Public sector has the luxury of time, luxury well, there's no incentive to do anything. We can discuss the problem, set up a committee, do a working party, write a few papers, piece of work is a paper in the NHS. It's not actually doing anything. And once you've got that, you know, what you need, it's difficult to get rid of the backlog. Plus the fact the staff feel,

you know, during the whole COVID thing, there was a lot of effort, and it was sort of, I hate to say it, but it was fun. It was different from normal. People pulled together. It was great spirit. And they were recognized by the public and all the heroes, the banging of spoons,

all that stuff. Great. That's all gone. And so now people are beginning to complain. They've been on a list. They've been told to come back next month and nothing's happening. The problem there is a lot of GPs just shut up shop. They don't like me when I say this, but it's true.

Some work through. But when you look, we have a health service at primary care base. Why didn't they take control if the whole pandemic in reality? All the testing should be done in GP's surgeries. It should be done in the car parts. of GP surgeries. I mean, why should people go up to Aberdeen if you live in Sussex for a test to have a swab put in your nose when there's a perfect network of primary care, doctors, nurses, healthcare technicians in these places? So I think that's probably what we have to get back to.

And why is it that it's now taboo to criticise lockdown, to criticise the government's handling of it, to even say that maybe our reaction was overblown, especially in there's numbers of the excess deaths that you've just quoted? I mean, if we were in a dictatorial state, we'd all be arrested, and they'd be breaking the doors down. The Stasi would be at the gates out there and breaking you down. But you say that. There's the footage of this pregnant woman being arrested in Australia.

I know. I've seen it. I think that's the over-abuse of power. And I think that's, on the whole, in Britain, we've handled it very, I must say, I think the police have handled it as well. as well as they could. If there was good footage, it would certainly be on mainstream media, and we haven't seen it. And a few people got arrested, you know, people with raves and so on, no one's too sympathetic about that. What you do object to is, you know, there was one,

I saw something right at the beginning when we were in proper lockdown, some little old lady was made to open a shopping bag at a police checkpoint to see if she'd really been shopping. I mean, that just seems if you allow people to go shopping, you just have to assume they're going to take their own responsibility where they've really been shopping or gone to visit someone. It's not policeable, this whole thing. And I think that's the, that is an abuse of power. And I'm sure reading about a police that broke up a child's birthday party somewhere. This is just not what police want to do. You imagine your hands up, you're surrounded. We've got tear gas wagon, we've got water cannon, we're going to bust up your party.

as a little five-year-old girl in tears. This is not how we handle it here. And on the whole, it's been handled really well, I think. The difficulty is that the politician maybe get a kick out of power. And it's the taste of power you don't normally have. Emergency regulations always give people more power than the public health guys the same. You imagine some overzealous public health inspector in a council. His moment of glory can't put a black cross on your door.

and that's it, you're finished. Even yesterday, at the hospital, I was going around the straight mandible hospital. And I was not wearing my mask properly. This is a confession. I don't normally make confessions on TV, and it was just after my nose is visible. And this very nice lady, a nurse in a sister's uniform,

came, I showed me her car, infection control nurse. Your mask is not on your nose. I'd have to put it back. Thank you. And she walked off. I felt brilliant. Imagine if she could get, you know, you are surrounded.

Put your mask on and you'll be arrested. Well, we joke about it. But sometimes in my more paranoid moments, I think are we going to arrive at that point? No, I think we're going to get out of it before we get that. Well, let's talk about that, because you've said repeatedly that, You don't think there's going to be a second wave. Isn't there some evidence that this is a sort of seasonal disease that is likely to make a comeback?

Or have all the people who are going to sort of get it and die from already got it and died from it? Well, the two things are the main bulk of vulnerable people already suffered and gone. And that's one thing. And the second thing is the virus changing to be more immediate to live with us and not to cause severe infections. and cause the lung damage that results in death via intensive care units and so. So we really just don't know. And time will tell the next few weeks are critical as we increase testing and as we increase risk, schools going back does increase the risk, but, you know, it's the first week's too early to tell.

We'll know by the end of next week how many schools have to shut because of it, hopefully none. and then as we go forward, as more and more offices open, especially in London. If you look at the last few weeks, London's become, if we just take London, because that's where we are now, but I'm sure it's the same for all major cities. It's opened up, and we've not seen any change. Nothing's happened, basically. Certainly the emergency rooms are empty, which is the best indicator of severe disease. So I think we're going to go forward with that.

Now, we've kept mentioning, we may as well talk. talk about it now, I guess, the second wave concept. Yes. The second wave comes from influenza, where we talk about Spanish flu. It wasn't in Spain, really. It was in France and Germany and Britain, but it's called Spanish because Spain is a neutral country in the First World War, and therefore the military and the censorship and the countries at war meant they couldn't talk about their military strength being wiped out by flu.

more people died of flu in the first world, more servicemen died of flu in the first war than by enemy action, which is amazing. I only learned that relatively recently. So when we move forward, the Spanish flu, the first wave killed about 5 million people, and the second wave, 50 million people. So that was just massive, which, if you remember, well, you don't remember, nor do I. The population of the world is a fraction of what it is now, the 50 million. million people in 1918 in a massive percentage of the total population.

If you take the age group, it was tragic. And so the second wave, then there was a third and fourth wave. And it's to do with the fact that winter came along and because flu is a winter disease, that just produced the right condition as the flu. This isn't 1918. We've got better technology. We've got antibiotics now, which they didn't have then. And of course, it's COVID-CO-2, which isn't seasonal on the whole.

It's constant throughout. So we're not so worried about it and winter. We are worried about, of course, getting overwhelmed by winter pressures, which is due to flu, coming at the same time if we can't get rid of COVID-2. If you look at countries that are a little bit further along, so there are three countries that opened up at mid-Apr, 14th of April. and that was Austria, Czech Republic and Denmark. They all opened that time.

When I say open, they're open schools, they open pubs, restaurants, all of the same. And we look at what's happened there. There has been a rise, but rather like here, it's a slow rise, and it's now coming down again. And the predictors is that they've got away with it. Certainly no second wave of hospitalisation, which is the key thing. That's all that matters in reality, especially if the rise is. is due to better testing and more frequent testing, picking up people. Can I put you a hypothetical, and it will take some time to sort of set out.

We've said that the initial lockdown that we've had and the other responses were a bit of an overreaction, I think. That's fair to say. If there is contrary to your predictions, which we believe, but if you're not right, and there is a second wave, what would be the appropriate response to that, given everything that we've talked? talked about with Francis where it's hard to say what's done more damage, COVID or the lockdown. What would be the right reaction in that situation? As long as the hospitalisation are not going up, as long as people are not getting out, we just carry on, just keep everything open, keep the schools open, keep workplace open,

obviously pubs, shops, restaurants, normal life goes on. And every week or two, we're adding to it, we're adding the risk. I mean, probably the last thing to go is spectator sports and things like opera. I mean, it's just because you're generating aerosol when people sing and you've got a crowd in front of you. Similarly, you play at Wembley, a football match with a crowd. You're generating a lot of people shouting, standing up and song, and you can't get away from that. You can hardly ask the audience to shut up. No shouting.

You're going to wear a plaster around your mouth for the whole of the match. So we have this ridiculous vision of football when you've got artificial applause. I mean, it's absolutely ridiculous to watch and listen to it. And sometimes it gets out of sync with where the ball is. That's the strangest thing. But I think moving forward, what will happen is that society has already got used to it. People of all ages have got used to it. There's an extreme with older people.

A lot of people are frightened. And that's partly the government's fault. They frightened them right at the beginning for this protect the NHS, which was unnecessary. And that means there's too frightened still to go back to normal society. And we've got to get back to normal. But again, you get the gloom and doom book. It's how, I mean, you see them everywhere. Good Morning Britain, ITB morning television, daytime television.

I've been on a couple of times now. And their resident doctor, he's always predicting, Two weeks, there'll be the second way. He said that a month ago, and luckily it's not. But let's say that there is, and there are more hospitalizations, and we start to see that coming back. What should the government do in that situation? Okay, so that would be the doomsday scenario, which if hospitalizations go up, ICU admissions go up, 85,000 deaths happen just like the gloomy of epidemiologist's prediction.

We would have to take action. Now, can we do it without lockdown? That's the question. Can we just blast away? Sweden did it without any lockdown. Well, it's not true they did it without lockdown. They did it with social distancing and they did it with hand washing and all those. And Sweden is a very disciplined country.

The whole of Scandinavia is very disciplined. We're not so disciplined. We're freer spirits, I guess. We're more revolting against the sort of things we've been talking about. we don't like it. And so imagine if you really lock down this part of London and put the roadblocks up, you would object. You can't get out of your flat.

You can't leave your studio. This would be terrible. So I think what will happen if we do get a lot of hospitalisation, there will be a sort of balance. It will never be as bad as it was in April, March April. But we may see some. Now, the other thing we may see is local, more serious local lockdown. What's curious, the last.

which is well-being well-studied. Now, not a blip in hospital admissions in Wester. So you can see the classic dome-shaped curve for infection in Wester going up and going right down again now, and look at hospital admissions to flat throughout the whole thing. So totally different. If you look at Lester way back in March and April, and the missions went up and the numbers went up. So something different happened. So I think it's a hypothetical question, as you say, constant thing, but it's likely that it's not going to happen. But if it did happen, we'd have to reconsider the strategy. I mean, politicians would have to look at how they could do some sort of local shift in policy. Carol, I know that you're not a psychiatrist, but I do want to talk

about half a day. I did some personal help. Yeah, I do. I'm a comedian. We're all unhinged to one degree or another. But we don't seem to be talking about mental health. when it comes to the lockdown, I feel, and the impact it has had on people and the public as a whole. I read a stat that apparently, according to the National Office of Statistics, that depression has more than doubled. One of the problems with mental health, and we do ridiculous as small amounts when you're a medical student, then you forget it until something happens. We've got a mad patient and you're stuck trying to work out what to do.

The problem with mental health is so difficult to measure the severity. So depression is a great example. Someone comes to, I'm depressed, doctor. So what do I do? How do I measure? How serious this person is? Well, someone said, I want to kill myself. So you get into the suicide conversation.

How can you assess, is it serious? I remember there was a lady about, when I was a young doctor, I did general practice for several weekends, and I'd go out, and there was a lady about to jump on. built from the high ledge on a above a pub in Whitehall, the White Cross, the Silver Cross, the Silver Cross, the Silver Cross in White. And I phoned up 999 because I couldn't handle it myself. And it's how serious is it? She's sitting on the ledge. I've been called as a doctor and we need to get help. We need to get an ambulance, probably the FAR Brigade here. But it's very difficult

to assess and serious. So when you say depression's gone up, if you ask people, if you ask people, How do you feel today and give them a scale on the linear analog scale? Mark here, or a number of smiles on a thing. So there's the number of smiles, lots of smiles you're not depressed, or the other way around. Lots of sad faces, you're depressed, lots of happy phases, you're not depressed. It's a very crude measurement of the reality of depression. But I think very good indicators, there's a suicide rate going up. That's pretty extreme. Child abuse going up, because it is a form of mental aberration, if you like. It's not normal family to beat children up or to harm children.

And then the other thing is how many people actually got admitted to mental institutions, section, the compulsory detention, are much fewer. And the reason for that, of course, the whole system is broken. And people weren't called. Psychiatrists weren't called. Psychosocial workers weren't.

psychiatric social workers weren't called to go and section people. So again, when this is all over, probably not until September. It may not be over. Well, we're in September now, aren't we? We are, you're right, I was forgetting. We've moved on. When I say when it's over, when we can actually collect all the data, just like cancer, you can look at mental health of the nation and look through it.

And what will be fascinating is to compare it with other countries, to start looking at the same thing in other countries. who've handled it differently, the timing being differently, the enforcement's been different. And, you know, I have a granddaughter that lives in Peru, and that's a military police state. It's strictly enforced. You can't go out without a permit and that sort of thing. People stop you, and you get fined if you do. And so we've never had that here. And that generates its own mental health problems.

Essentially feeling locked up for six months is not a good feeling. And but yeah, so that's all the problem with mental health. And there's also a question that we talk about stats and data, we talk about excess deaths, but then it came to the fall that actually the data that has been used by everybody isn't even reliable. I think the worst one has been the deaths, you know, public health England, which has made its own demise over this whole issue. It was only pointed out two months ago that the death figures were greatly exempt. exaggerated and it was a simple error.

And what they were doing, if you've been tested positive, you were flagged up on one register as positive. And then if you died and the computer matched the two, wherever you've had your test in positive, you were called a COVID death. So if you walked down the hospital, having been tested positive, got hit by a bus, you die from COVID. If you died of terminal cancer, you died with an axe in your head because your wife didn't like you anymore. talking about my future there.

Yeah, exactly. You got all these things. And so the number, it was ridiculous. And so then they tried to say, well, let's do it 60 days after testing positive. And then so there was the 60 day death. And then they made it 28 days, which is much more realistic. If you test positive, you die within 28 days. It doesn't get you up from being run over by a bus, but it's less likely.

It's more likely to be COVID than other things. But none of it was based. And no one understood that even the health minister didn't understand that when he was quoting these deaths, they weren't based on reality. And at one point, four weeks ago, they had to change the number down there. It was embarrassing. It appeared on the WHO website. And it said Britain 46,000 a week ago, and now only 41,000 deaths. So where have the 5,000 gone? Well, they were wrongly attributed to COVID.

That was the little byline there. So measurement is key because if we are going to make comparisons, France, Germany, Switzerland, Sweden and us, we need to make sure we're comparing apples with apples and not apples and oranges. So we've got to get these numbers. The same with the infection rate, we've got to make sure we're comparing the same thing. And if you go and collect people in London, where the infection rate is probably about one in 60,000 of us has it. So you never find someone. one of 60,000, the chance of you finding someone this afternoon down the commercial road that has COVID is almost zelch. But if we go to an area where you know there's a lot of people that are positive

just in the last few days, then you're much more like to find it. There may be one in every 20 people's got COVID. So put no swabs up, collect saliva, you'll find it. So it can bias the numbers, whichever way you want to. So looking at it. everything that's happened, there's been mistakes makes, there's been good decisions made. What do you think should be the lessons learned that we have so far from this whole episode? I think the first lesson is to strengthen public health communication. I had no idea as a consultant that this was really going on until about February, and I thought it would just blow away.

I mean, I couldn't believe what happened in the end. And so we've got to prepare for the same thing happening again in exactly the same way. And we've got to prepare for it in a way that doesn't involve lockdown. Can we do it without locking down all services, and including health services, can we do it in a way that maintains the emergency function for an infection without closing down the system? The second thing is much better public education about what to do. And then the third thing is the politicians probably should stay out of it. I mean, it was dominated by the Boris show, you know,

Boris or some other deputy of Boris is standing there in the centre, flanked by his undertakers, Chris Witty and the chief scientists often, dressed in black suits and black ties as though the executioners of the country. And I think it's not a political thing. It's a, he needs one guy to take control of it and say, this is a spokesman for the medical profession. Like Anthony Fauci did in the States, although him and Trump are just bizarre to watch,

because Trump is a bizarre character. But I think that's the way forward. And, you know, the health service really should have kept going for, everything else throughout the whole thing. And then you get things like 19 gales, which were based on the gloomy predictions of the epidemiologists and proved to be complete waste of time. Oh, sure, 40 patients were admitted to the one in Eastmore near here in Excel. But that was just tokenism to show it could be done. And even that project wasn't thought through. But the way you're going to get the staff on, you're going to have to take the existing hospital.

You're not going to recruit staff in the timeframe to suddenly open. staff with a limiting factor in healthcare has always been so, always will. So a question that a lot of ordinary people will be asking is when do we get back to normal? And I don't mean new normal. I mean normal where we meet, we shake hands, we don't wear, you know, masks to go to a supermarket and then you walk out of the supermarket, go into a pub and you'll fine to sit with people. Like all of these things that don't make any sense. Right.

When do we get back to actual normal? My prediction is first of January. We'd be back to normal when you can get rid of everything. No social distancing. All those silly signs everywhere and we've gone on London Transport. I mean, they put a lot of effort into it. They've had to. But I think it's an overreaction.

The virus is on that tube. It's going to get you, you're two metres or five metres. As the tube's crowded, you're going to get the virus in this there. So I think January is the time to new year, new vision, new normal. Sounds great, but what would do you think we need to see in terms of the data to facilitate? Because putting a date on it is sort of a little arbitrary, isn't it? Whereas I think I guess a more interesting way of looking at might be what needs to happen with the virus in order for us to feel comfortable doing. Obviously, number one would be a vaccine.

Yeah. If we get that, that sort of takes care of it. Is that broadly accurate? I mean, vaccine is not necessarily the answer because, first, it may take longer than we think. Yeah. It's got to be completely safe before any of the regulators will allow it. Otherwise, they'll be pummeled if it calls some bizarre neurological degenerative syndrome, for example. That doesn't sound good.

No. It's not like to get caught in this one. It's one of the complications of viruses of vaccines, especially they're not fully tested. But more importantly, it's not worked for the flu, really, and it's not worked for SARS, so it may not work for this. In a way that we hope, it will have partial immunity, it will help, but it may not be the only solution. The effort to vaccinate millions of people is quite significant. But I think by January, it will be in a much better place. As long as the hospitalisation stayed down, we could experiment.

We can start removing things like the masks and the masks. like the social distancing. Hand-washing is not a bad idea. The shaking hands, if you wash your hands, then it's fine, you know. So I think we'll get back to North quicker than we think, and people will stop being scared. What I find amazing is children, like six grandchildren. I look at them and talk to them.

They're not frightened about it. They're fine. Well, they're pretty much immune. Yeah, exactly. So they've got no reason to be right. But some of them would be locked up, you know. Yeah. Oh, yeah.

And so, but they, they haven't a better understanding. The children are much more adaptable than we are. Yeah. In wartime, children just went through it with bombs going off and no problem. I mean, some of them have psychological scars, but they tolerated it. People from war zone, children were down to the talk. Whereas, yeah. And what do you think about the New Zealand's position in that they've taken extreme lockdowns?

The moment they got four cases, I think it was everything shut, literally everything. Francis has been wanting to close the borders for a long time. But no, do you agree with that, that approach to it, or do you see it as being a huge overreaction? I think that's a huge overreaction. I mean, they're now getting cases because cases are coming, and that's the problem. I haven't looked at the New Zealand in Ferguson for the last two weeks, but I gather they're bouncing back a bit because they get people. coming, whether they're legal or not legal, they come, and the figures start going up. The countries that, if you look at the countries of the world, they've all had slightly

different strategies, but the trouble is how firm was the policy of not admitting people from a broad UK? Returning residents have always been allowed back. So if you're in New Zealand and you come back from somewhere, you're allowed in. And that may be, and you may have to quarantine, but how effective is that quarantine. If you want to do it properly, you've got to take people straight off the plane into a camp. Remember the pictures at the very beginning of all this? People coming from, where were they coming from now?

They were coming from Wuhan. They were coming from China. And they were bused from Brise Norton to the Milton Keynes to accommodation in Milton Keynes and kept there for two weeks. And that was before they had any compulsory detention laws. and that was the first we saw that it seemed like years ago. Yeah, it does.

So how firm your quarantine is, how firm your policing of the border. And if you allow residents in, who knows what's going to happen? And that's what's probably happened in New Zealand. Because it's also as well, is that we don't know how long the virus has been here. So, for instance, I was still a teacher in December time. And I remember around about January, there was a thread on Twitter with Assistant Head, and head teachers talking about having COVID-like symptoms. And we discussed ourselves about, I think I had it in mid-February.

I had all the symptoms. There was a case in France in December. Yeah. Wasn't there? There was cases in France. There's even cases in November at a shooting party in Worcestershire, believe it or not. Really? Wiltshire, Wiltshire.

And there were three cases out of six people that stayed in a big country. house and they've proven positive. I mean, how it all arose and how it spread, the most likely scenario arose in Wuhan somehow, whether it was... Do you have any unorthodox thoughts on the origins of the virus? Yeah, you mean it was an escape from the laboratory? Yeah. It was a weaponized virus.

It was a research program to weaponize the virus. It escaped probably accidentally. The viruses do escape. People break the safety rules. They don't wear gloves. They don't wear whatever you need to wear. and the virus got out. And then, you know, I like to think it's a luxury virus.

It went straight down the airport road to the first class lounge. And then went, quote me first class, around the world. All its little friends, all these little viruses said goodbye with their little suitcases and went off. And they went first class because they could meet fat people. They could meet rich people. They could meet people that were old because older people can travel because they have more money than young. And they shifted it. And before we finish, the one thing I'd really like to say, because it reminds me of that one of the economic consequences that the mainstream media don't bring out is this business of generational theft, which has now been increased.

The generational theft comes. People my age had free education completely. My kids had free, more or less free. I think I just bought a thousand pounds fee a year, for university education for the youngest. Then we've had house prices that every time, my first house got $12,000, imagine that. Get out. And you sell it for $60,000, then you get the next one for $70,000, then you sell that for, you

know, $200,000. And it goes. And it goes on up. So all my generation to a different, and we've had end scheme pensions, the final year pensions, whereas your generation is not going to have that. It's not possible. Now what happens with COVID, of course, it disproportionately affects the younger people whose education has been stopped.

Younger than you, education has been abruptly stopped and are just going to be no jobs to get started. So all those graduates that are out there, a lot of them are not going to, were promised internships. They may get their internship because it's free. They may get the SUNAC scholarships or whatever they call it in government, but they're not going to have a proper job. So with that in mind, then, before we ask our last question, should we have done and should we in the future in a similar situation, shield the vulnerable, shield the elderly, and allow the rest of society to get on with their lives as normal? Is that the right solution here? That seems a good solution. I think you've got to give a free choice to people. It's educational messages. If you're over 70, consider your health, for example.

Are you, if you're a fit, active 70-year-old to speak, carry about your business. But remember, you are at greater risk than if you were 50. And it's up to you what you decide to do, not to try and enforce it. Not to say every, you know, 70-year-old is on the street and shoot at sight. Shoot to kill. ID, sir, and boom. And that's the way forward. And that protects them.

And so the others can act whatever. do whatever they want because they're not likely to be seriously damaged. So if a young person on chemotherapy, for example, for cancer, then they should be prepared to protect themselves by isolating from the rest. But it's mainly about avoiding crowds where you don't control your meetings. So going to a shop is you have no control on social distance, whereas in your garden, you have perfect control on social distance. And thank you so much from coming on the show. It's proved incredibly enlightening. The last question we always finish with is, what is the one thing we're not talking about as a society that we really should be? So we're not talking about death. And

Western society never talks about death. And it's become even more difficult with the demise of religion, of organised religion, church of England, whatever, not just Christianity, but all the religions. At the moment, we sort of blank it out of our lives. There is no end to it. We're going to go on forever. We're eternal beings. And I think that's what we've seen with this. I've got a Twitter account, as you know, and if I mention death, it's like a whole load of bees suddenly come from it saying or being unpleasant mentioning death. And I guess doctors are closer to death than most people. cancer doctor, a lot of the patients are going to have done, and you have to accept it. But I think

we don't talk about it in a meaningful way, and we don't accept it. And I think it's become a failure. It's a failure for the medical establishment if someone dies. It's a failure for the politicians, the death rate goes up. And I think it's really reflected in the conversation we've had. if the average age of death is 82 for COVID person, then that is actually very close to the average age of death in the UK anyway, which is 82.3. So you're not actually taking life away, but look at what we have taken away from people. So maybe the balance of death is not too bad a thing. Now the problem is the argument is that I'll be being harsh because there have been 40-year-old people in their prime with no comorbidities, they've also died. Well, that's the nature of things.

You cross a road, a certain proportion of people get flattened by the bus coming by. That's always going to happen. You don't close the road because it will stop the buses traveling. So it's getting a balance of risk in that. Death has got to become an acceptable outcome for people. It is in hospices. That's the only place of it is. It's not out there in society. There's such a good point. I'm glad you make that point because I feel like on a lot of the response to this virus, the thinking has been very one-dimensional, very one-dimensional.

We'll save lives, as the slogan was, but how many lives are now affected by the other things? And I'm really glad we've had a chance to discuss that with you. Professor Sikora, thank you so much for coming on. If people want to follow your commentary, the things that you're putting, where do they go to find out? Prof-Carras Sikora on Twitter and... two or three a day is about the most i can make yeah fantastic well thank you very much for coming on

and thank you for watching we will see you very soon with another live stream or episode and they all go out at 7 p m uk time take care and see you soon guys bye bye