Live chat with John Sunday 1 March

[Music] well hello everyone I think we are live I think good can you hear me my own yeah hello from Tokyo hello there alright lots of questions coming through already I think what I'll do is I'll do a couple of questions and then and then we'll talk about a few different things now I've just seen a question here I have to make one now after this go slow right now you can never do these at the right time for the right time for everyone so this one was kind of supposed to be a Australia friendly so my apologies to friends in the United States it's not a United States a friendly time but there we go now the first question I've got his can dogs catch it now there was a case in Hong Kong where a dog tested weak positive and haven't heard anything more about that so what I suspect has happened there is that the owner the owner had the virus and the owner was shedding the virus in his breath and his coughing and it just settled on the dog's mouth in the dog's mouth and the dog's mucous membranes so I don't think there's any evidence that the dog got it it would probably be just as positive as as an apple that was sitting on his bench or something it was on his bench so as far as we know at the moment there's no evidence that dog sir can get it so um carry on being kind to your dogs and of course dogs are a great source of reassurance in times of times that are difficult so I think the answer to that question at the moment is no I don't think dogs can get it it did come from bass it's a zoo a notic virus and the thing about viruses is they're normally very species specific so there's lots of diseases your dog can get like kennel cough and distemper that that you can't get even then when you get diseases very often your dog won't get it well usually well virtually never your dog will get it there are a few infections can spread from dogs to people in feces and things like that but it's said it's not that common so at the moment the evidence is that dogs and other animals that we have domestically can't get it now this is remarkably boring but I've had lots of questions about me so we've got a pandemic on our hands and people are asking or asking about people like me which is very nice but I'll tell you about me anyway so I trained as a psychiatric nurse and then as a general nurse and did various jobs doing that did some work in the tropics did some work on theatres and in neurology and then I went to spend a little time on intensive care and cardiac care and then I went away and did a nurse tutors course as we called it in those days and I became an official person who trained nurses and did that for 27 years so I've trained up a couple of generations I've actually had a few cases where I've trained mother and daughter so the mother of I've trained the mother and then towards the end of my career so the daughter came in for training 18 19 years later so yeah I did that but then in the course of that I went a bit academic so did various degrees Bachelor of Science degree Master of Science degree health science and I'd stayed doing research so I did a PhD and did research he type things and so if you do if you can make an original contribution to your field they give you a PhD for that if you write it up so that's what I did and I looked it actually pretty well what I'm doing now looking at how open learning materials and resources can be used in different settings and I analyzed my books so Joe my academic friends are a couple of books so I started off with this one you can get these as PDFs I'm not advertising just just background about me that was on physiology so you know all nurses and doctors need to know about basic physiology and that's in white and then black disease is bad news so that one's in black that's the pathophysiology one that's in black that's about disease processes so I did that I did the research then a few years ago I retired from full-time teaching and started doing some part-time work on a local A&E department so I was in a nice toughness for part time for a few years and I'm now we're now sort of semi-retired so that's me so that's that's the boring bit out of the way so I'm basically a bit of a burnt-out academic so you can make what you what you'd like that nurse academic and nurse teacher but I've always I've always kept up to date with a clinical work I've had teaching trips to Cambodia and India and places like that and Africa Kenya and try to keep up to date with clinical things as well and looking at disease really has been what I've done all my life looking at diseases and you know I'm looking at the microphone should be looking at the camera looking at diseases and physiology and how the body works and how it goes wrong so that's kind of my thing really all right let's take another question having done with that boring bit good morning you proved a saint good morning he's very polite when you go into class sometimes when you're just thinking about the content you just say right get your pens out we're gonna start drawing a heart or something and you should always kayo good morning first it's always essential to be polite first right I think we'll just do a little bit of a news by way of background it's hard not to be a little bit pessimistic at the moment then let's look at some news anyway just just try and keep to the facts we don't want conspiracy theories you want to we want to look at what the science is telling us and what the accurate reporting is telling us so it's Sunday the 1st of March the year of grace 2020 and we're looking at covered 19 and this is caused by the virus called SARS coronavirus - that's the name of the virus the World Health Organization has given it that's a bit of a confusing name because SARS was the 2002 2003 epidemic but it's severe acute respiratory syndrome c/o corona virus and it's not the one that caused the 2002 outbreak it's this new one so it's type 2 and the disease it causes is corona virus disease first identified in 2019 so remember that it's a novel virus this is a new disease it's novel and we haven't seen it before last the beginning of last December I don't thing I'd ever heard of it certainly in November had never heard of it so we've been trying to learn about as we go along this thing's starting to come out on it now it's hard to keep up to date things are changing very quickly so let's give a quick recap of the news 59 countries now have cases now a pandemic is when there are there is community spread spread from person to person going on in a wide variety of countries and in my view now we are in the early stages of a pandemic unfortunately now just by way of background here that the copied 19 virus is just that it's a virus and yes it's a virus so you can get infections with different types of organism so you get infected with bacteria and since just after the Second World War we've had very effective antibiotics to kill bacterial infection although we are struggling now with bacterial resistance to antibiotics but viruses were still not very good at treating now there are some antiviral drugs for HIV for example look or keep HIV at bay the sum for herpes simplex virus is that there's even one that's been developed for a bowler which is being developed been tested at the moment as we speak couldn't Kiner to see if it's suitable for treat treating and covet 19 it's not looking promising but the point is with viruses we can't treat them with antibiotics and viruses are difficult to treat they are tiny things about a hundred Michael this particular virus the copied 90s about 100 microns in diameter it's absolutely tiny it's about 10 times smaller than a bacteria and a bacteria is about seven or eight times smaller than a normal human cell like the cells that are in you and these viruses actually get inside the body cells that's how they work so the virus when you inhale it doesn't do any harm the problem is it gets inside yourselves it parasitizes the cells because a virus is an obligate intracellular parasite it can only live inside cells and this covered 19 the SARS I'm gonna call it the common nineteen five to get confused when I could talk about SARS copy two so the size 19 virus it gets into the respire tree tract and that's why it causes these respiratory features and to some extent gets into the gastrointestinal tract as well so so that's why there's a problem really viruses are transmissible but difficult to treat and our main line of defense against viruses is vaccination it's prevention and all the clever scientists all around the world now are working frantically for us on the covered 19 vaccine but it's difficult to do there's a lot of stages to go through it's a complicated process and there needs to be animal trials and human trials and trials of efficacy to see if it works safety has got to be safe we can't go injecting people with something that's not safe and that takes a lot of time so realistically we're probably not going to have a vaccine for this disease until 2021 so our main line of protection like we use for mumps measles rubella all those other things I've known about for years we haven't got the vaccine yet this is why there's a problem this is why it's spreading so the fact that doesn't respond to antibiotics the fact that viable infections are difficult to treat the fact that it's transmissible and the fact that we haven't got a vaccine because it's new why we're having this problem this is this is why were in the early stages of this pandemic this is what's happening so South Korea a lot of cases I'm afraid 36 countries have stopped travelers from South Korea churches are having online services it's a very good idea because public gatherings are not good in this this environment and it's a critical moment the South Korean government to tell asking people to stay at home so you know that's the situation in South Korea look at some more news in a minute but let me just try and answer some live questions I need to work out how to put this in slow mode okay question there about the death rate yep now I will oh now they're put in slow mode for the next time now the the the debt the death rate to emojos no yeah the death rate now the death rate in covered nineteen is is substantially higher than it is in in am i back my wife's told me I'm back on ok thank you right now I don't know what happened there this happened last time I was live-streaming could just be a fault in my computer so apologies about that and so P doesn't do that again thank you for all the tips I'm getting here right I'm back on right so yeah question about the death rate now the death rate is higher than influenza and it's looking at the moment like the death rate is probably going to be about 0.5 to 1 percent but it's very hard to give figures on that in the early stages of an epidemic now when we look back on this in a few years time we'll be able to see how many people got the infection and how many people died but it's hard to tell at the meantime but what we do know so the current sort of guesstimate is is around about the 1% mark that's what we're thinking at the moment but the people that are more likely to get severe disease are older children at the moment it seems they're less likely to get severe disease which is good news and the people with comorbidities so that means they've got other diseases at the same time are more likely to get serious complications and to die from this so people with chronic chest diseases heart diseases and poorly managed diabetes hypertension things like that so I guess it's important to try and optimize the state of your the state of your health as much as you can so that seems to be the factors that are affecting the death really the other thing that's affecting the death rate is the availability of medical care so and the quality of medical care so one of my concerns is when this gets into countries with less developed healthcare systems that people are not going to get the health care they require and in fact even in advanced Western countries if there's a lot of people sick all at the same time it's going to be remarkably difficult to provide them all with with quality healthcare so if we say about one percent now for the death rate we won't be too far out now let me just do a couple more news items just to guide us to what's going on today Italy now Italy again remarkably concerning a lot of cases and a lot of deaths and quite a few cases have spread from Italy as well as we'll see Iran we've looked at complications and Iran religious shrines are still opening around apparently there's been a lot of coming and going for the fortieth anniversary of the founding of the Islamic Republic and these are certainly unreported or underreported and a lot of members of the or several members of the Iranian government are affected and Japan there's been quite a few new cases as well Singapore some more cases France ban on public gatherings over 5,000 guess that means football matches are off Hong Kong which was badly affected by the original SARS in 2002 UK has got 23 cases and US Australia Thailand to report the first deaths now these are them informative really the the death in Thailand was a 35 year old man which seems alarmingly young but he also had dengue fever now Deng is a common mosquito-borne virus in in Thailand in various places in Asia so what it's looking like is if people get the covered 19 and another virus at the same time that's a bad combination so this is another reason to try and avoid crowded areas and to be meticulous with hygiene because there's a lot of influenza around us now so we don't have data on what happens if you get covered 19 and influenza together but clearly it wouldn't be an ideal situation an Australian has 25 cases and the first death in Western Australia it was someone who was repatriated from the Diamond Princess cruise ship which is in this somewhat ill-fated quarantine in in Yokohama in Japan all right let's try and take some questions how close in similarities this is blue rose you're the coven 19 - the Spanish flu yeah so isn't the Spanish flu different called different names it probably originated in the United States in 1918 and it was influenza I think it was an influenza type area it came from animals and it infected a chicken farmer in the United States and then he seemed to join the army went to an army base and it spread from there and it spread in the the troop ships and in 1918 in the later parts of the First World War and then it spread into Europe and spread around the world from there so 1819 there was a pandemic of influenza probably 60% of the world's population were infected at one time or another and it caused well no one knows how many deaths 50 to 100 million deaths now can we compare these two well medical care is much better now producing vaccines is much better although we're not there yet antiviral drugs are much better now but of course the thing that's gone against us this time around is the interconnected nature of the world people flying around the world traveling round I mean people traveling within China was one of the original problems because it was Chinese New Year and now we've got people the disease is spreading round from China from Singapore from Singapore one guy caught it from a Chinese man in Singapore flew back to France and back to the UK with it flies people carrying it out of Italy so an epidemic a pandemic can move around the world much quicker these days unfortunately it's far too early to compare the two epidemics far too early wee-bey so the answer to the question is I don't know the answer to the question is let's hope not right for people who recovered from severe cases are there any known long-term complications such as reduced lung capacity so after diseases you can get seek well II so after after a viral illness it's normal to feel quite tired for a period of time sometimes quite depressed I had influenza once and just yeah it was actually quite depressed for a couple of months afterwards so you just don't want to do things and them so you can get those effects now it may be there are some cases that there are some indications that there may be damage to the lungs in a minority of patients but I would hope it's the minority of patients and there's also some possibility of cardiac damage in a minority of patients but again like so many things with this virus is there's not a lot of data on it yet there are some isolated reports that it may happen although it's looking like most people do make a full recovery always remember that about 81 percent of people get a very mild illness and we would expect to make a full recovery so seek well I limit limited data on that at the moment is is the answer question-there about commercial livestock and safety well outside my area of expertise I would expect as we've said with dogs were not expecting this disease the literature doesn't seem to be expecting this disease to be transmitted by animals despite the fact it is an original zoonotic infection but I would imagine veterinary officers in various countries will be making statements on that fairly soon so we have to go by the guidelines guidelines of our own national veterinary officers who specialized in exactly this sort of thing at the moment there's some things I'm worried about but personally I'm not worried about animals transmitting it or catching it from animals so it's not a concern I have know at the moment someone says prepare don't panic absolutely so we need to optimize the condition of our immune system now to be fair at the moment I think we do need to moderate our social socialising and and I've traveled as much as we can now I know people need to travel forward this is difficult I don't want the airlines telling me off but um travel at the moment should be just for essential purposes only really in my view and that the problem is because we're getting cases popping up in how many countries did I say 59 countries at the moment what we're actually seeing and we'll look at a specific example of this lately is people that are asymptomatic carrying it now what we mean by that is that people can have it be infected by the virus they can be shedding the virus to those around about them but still feel fine they have no symptoms of the disease themselves now whether they've got a very mild version of the disease and they are asymptomatic and they're not going to get ill with the disease is one possibility another possibility is they are pre-symptomatic so people are infectious during the incubation period this is a big part of the reason why this is spreading if people only spread this when they were really sick then we would know to isolate and avoid really sick people without taking the full precautions as we care for them but the problem is than not so this could be spread by someone down the street potentially once community transmission is established who seems perfectly healthy so my view at the moment is we need to stop sharing common utensils so one example of spread has been religious institutions in Iran and South Korea so I feel the urge is at the moment for communion should not be using a shared company if you have individual cups and cut the bread up into small pieces before it is distributed to the to the worshippers that's just one example recently in the UK don't know what it is where you've lived but we've become a bit continental lately in the UK who do want more hugs and this kiss on cheek thing never used to do that in this country we just shake hands but at the moment I think we need to moderate hugs kisses and and handshakes that the Pope apparently has been tested for this because he was shaking hands I believe with people from Iran so handshaking could be moderated for a period of time I believe now it's hard when you meet someone you know you go to church or somebody just bought you you're just just automatic in English culture so maybe we just need to do this you know like to do in Asia for a while and how to know it so we need to moderate large gatherings especially indoor gatherings where a lot of people are together especially of this poor if there's poor ventilation so I think these are all sort of expedient things to start thinking about now someone else about the UAE I think I think there are one or two cases in the United Arab Emirates go on to the Johns Hopkins site I will put the link to the Johns Hopkins site up and the John Hopkins site keeps everything updated on all the countries around the world where we are getting accurate data now from most countries around the world which is which is a good to know how to protect smokers hmm now I don't think there are too much data on this but in China there's a lot of pollution and smoking and and that certainly won't help and there was some early data they showed that smokers were more prone to getting complications which doesn't make sense so if you smoke really this would be a good time to stop I know it's difficult but um it is an addiction but if you could stop smoking I think that can only do good now smoking does Inc increase the amount of vitamin C that's broken down and excreted from the body so if people smoke I think it's important that they make sure they get plenty of vitamin C oranges and tomatoes and things like that if active people smoke they might even consider a vitamin C supplement now I'm not a big fan of supplements generally but I've been a sload of questions about is vitamin C protective now vitamin C might provide some mitigation of some viruses with this one basically we don't know but it's not a big effect so I think the main thing is not to be sure - vitamin C serve your smoke certainly talk to your nurses and doctors about it but you know if you take 50 milligrams or 100 milligrams of extra vitamin C a day that's going to be fine but better just to improve the quality of your diet oranges and tomatoes and things like that with vitamin C in and cut down on smoking the trouble is you smokers take things like vitamin C to think of our smoke better take vitamin C so it's alright is not smoking as many things that are damaging so one good time to stop smoking if you possibly can lots of bugs around at the moment I've got a coffee just for the past month or so I mean I often do in winter there's just lots of viruses around and I'm not short a vitamin C but what people are sometimes short of in in northern climates especially I live in the north of England is vitamin D and vitamin D is evolved involved in immunity so the National Institute for clinical excellence in my country advise you can take 25 25 micrograms of vitamin da day as a supplement in the winter months which I do when I remember other than that I don't really like supplements but a healthy diet of course is very important for immunity people that are malnourished will be immunocompromised and sleep is also important there's some new study showing that sleep is important to help our immune function as well let's just go and look at them few more news items yeah so could this Thailand guy probably comorbidities the the Australian one probably is likely you might have caught it on this ship how the virus was transmitted around the ship we're not really sure was it in the air was it on contaminated surfaces probably a bit of both droplet infection now a Mexico for cases in Mexico no this is concerning a lot of people in Mexico don't have good access to health care so that's concerning and apparently was a 20 year old woman who flew from Italy who herself was asymptomatic she had no symptoms but was spreading the virus to those roundabout to which ISM which is part of the problem this pre-symptomatic spread the u.s. 71 cases now this is concerning as well a 50 year old man died with no epidemiological links so that the the US health authorities couldn't work out where he caught him from as far as I know he hadn't traveled to China oh he hadn't been mixing with people from China he just seemed to can't yet and so no epidemiological links there and the other thing was a bit depressing this morning that the new cases in China slightly now the Chinese had cut down on the new cases quite dramatically but few new cases what more new cases now in China despite large-scale bans on travel and restrictions on public meetings and everything on Saturday those 47 deaths so that's kind of a a review of the situation in the world at that I would now let's go back to questions our people with HIV at more risk that's a good question at how many data to answer that common sense would indicate that anyone who is immunocompromised does have greater risk because the immune system is not working as well as we would like but if people with HIV are maintained on good medications then I would imagine that's getting the new system back up to pretty well normal so if they're well controlled on medication I would expect the additional risk to be fairly minimal but I don't have data on that Chinese food okay let's talk about food cooking will destroy the virus Chinese foods no differ from any other food just that the epidemic started in China that saw it's not from the food it's because the virus probably got from bats into some other animal into humans that's at that era started now so cook food I'm not worried about yeah cook food I'm not too worried about but um one thing that would be concerning is if food was prepared and then someone was to cough or sneeze onto that food or to touch that food with contaminated hands and this could be a particular issue with uncooked food so food could be I don't know whether you call it a vector or for my - for my - I think it's an inanimate object which could spread the virus just like a dirty pen good or something like that because we know it can spread on hands so could spread if someone had coughed on their hands touched some food fed that food to you then that food would be contaminated but it's absolutely not the type of food no so Chinese food is delicious and absolutely fine and I would have no hesitation eating it yo people pointing out we should be washing fruit before eating anyway which I agree with I agree with that completely now is the strain in Iran more virulent that is a good question now the death rate in Iran the death rate in Iran does seem to be higher than other places but that may be because poor medical care and difficulty getting to medical care not necessarily that there's a more virulent strain and I was worried about this a few days ago but I'm less worried about it now because I've been reading some more data on this and what it seems to show is that the virus is is fairly stable now what we mean by this is so if we think about this virus it's a single-stranded RNA virus so it's a single strand of RNA that gets into a cell a respire true cell these are ones with cilia from the top so the viral particles that's about the scale of them next to the cell they get into the cell they take over the cells that's the nucleus of the cell they take over the cell's genetic apparatus produce many more viruses they go onto the surface and they're breathed out so that means as many more copies of the virus and inside the virus that the same RNA as in the infecting virus and then that goes on to infect someone else but this means you've got millions of copies of the virus all over the world so the virus could mutate and mutate means there's a change in this genetic material which could make it more more virulent so what sometimes happens is there's a big genetic shift in an influenza virus it mutates into a form of virus that the immune system doesn't recognize and that can cause a pandemic but the dates are so far on on the coronaviruses is shown that genetically they seem to be relatively stable so the virus in Iran is probably the same as the virus in Italy basically the same so is it a more virulent strain of the virus given that data receiving to show that there's ago the corona virus has got a relatively slow mutation rate the answer to that question is I suspect not I suspect it is not a more virulent form of the virus but I suspect it's more difficulty with health care and accessing healthcare in Iran which is more likely probably to be the problem I do hope it's not a more virulent form of the virus we don't doesn't look like it at the moment so that's that's somewhat good news now the the other thing about the virus if a virus is mutating all the time like HIV changes quite a lot that's another RNA virus then that makes a vaccine difficult because of course I still have no vaccine for HIV after after all these years of HIV problems so if the virus is relatively stable that's going to make it easier for one vaccine to be to be globally effective and this really is the big there's two big hopes for this epidemic one is behavioral changing when we reduce the spread and the other is the spread can be stopped with with vaccination because once people are vaccinated and immune they're not going to get the disease and they're not going to spread it and we can stop the epidemic in its tracks pretty well then but we haven't got that vaccine yet this is the this is the problem so yeah yeah Darrin what's the risk for pregnant women well there's only limited data on this data from women in the third trimester the later parts of pregnancy in China seemed to be that they were okay that there was problems in the first trimester of pregnancy with the the corona virus in 2002 2019 so that is a concern in the SARS warned in 2002 2003 there was problems with with pregnancy with this one we don't know yet so far it's looking like not but it does room until we get hard data on that that that is is it worried because you know it's is one of the things we're not really sure about at the moment we there's many thing there's many things we don't know yeah someone is saying there are differences in the vibes that there are be mutations in the virus sermon it may be but it's kind of not known as as a fast mutating virus yeah why do people die from this virus even though they have a good medical care that's a good question it's probably related to what so what happens is if the severe inflammation in the lungs the small Airways there the bronchioles that divide into small respire tree bronchioles that go into the alveolar air sacs these are the near microscopic air sacs in the lungs where the oxygen goes into the blood and the carbon dioxide goes from the blood back into the lungs there's something called a RDS acute respiratory distress syndrome so what can happen is that due to the inflammation the fluid collects in here and if lots of fluid is collecting in there you can't get the oxygen in and you can't get the carbon dioxide out this is the problem and also as well as the a RDS this can cause pneumonia a pneumonia is infection at the level of the alveoli down here in the lungs now if the pneumonia is caused by the virus at the moment we don't have antiviral treatments but sometimes the pneumonia can be caused by secondary bacterial infection and if it's caused by secondary bacterial infection of course we can treat bacterial infections with antibiotics so very often these patients will be given antibiotics for the bacterial component but if it's viable we can't treat it so that can be difficult to treat so that's going to reduce the amount of oxygen in the blood which of course we need for all life-giving processes now having said that that there's many clinical trials going on in China now about therapeutics so we should know in a week or twos time what drugs how about what level of efficacy against this virus and of course this is information we're absolutely desperate for and we should be starting to get that fairly soon so there's some antiviral drugs which for sharing promise and there's other drugs like chloroquine which might have some efficacy efficacy against this virus they might work to some degree either as prevention or as a treatment and we should have that data really soon we need to delay things as much as we possibly can so we can get more science done so can we cure the virus yet no we can't cure the virus yet alas not yet okay right when you said not to use steroids right okay now this is not a prescribing channel you have to ask your own doctor what drugs you should take what we did say is that I was told by people in Iran that they take a lot of corticosteroids at an early stage and that probably wouldn't help in the prognosis because the steroids will reduce the inflammation and reduce the efficiency of the immune system but if you're taking any medications for goodness sake don't stop for anything I say always call your own doctor people with asthma sometimes do take steroids and be guided by whatever your doctor says on that there are no rules you are an individual you have to be treated as an individual by your own doctor or your own prescriber so if you're worried about it ring up your doctor and ask them does strong alcohol kill it yes with strong hand rubs alcohol will kill the virus but I think it's better fact I'll do this now so let's go on to you know we're on the corner one already so if you look up your own national guidelines for this everyone has national guidelines on it so this is the one I've looked up for from the NHS for hand-washing so get whatever get get this from your own country they are available there's videos and all sorts on it and check on the proper way to wash your hands because when you wash hands it's so easy to miss Pipps now this is the way we would wash hands work before carrying our clinical procedure and it seems a good way to wash your hands so first of all you're wet your hands then you put on plenty of soap on your hands plenty of soap then you rub your hands palm to pop so like that to get the soap lathered up a bit like that palm to palm rub the back of each hand with the palm of each hand so that means this so pants palm then you would do that and then wash the back of the other hand like that that sort of washing there like that then palm to palm fingers together like that so that is that motion there we'll bring your hands together like that that way so you're covering all the bits of your fingers and then back up the fingers from side to side so that motion is this so hands together like that blob like that that's the next one and then thumb so the way I watch the films is like this that one and that one getting in that little crack not crack that divide there so thumbs there like that and then the next one is telling us to do is fingertips and pumps such clean your fingertips so that he's cleaning your palm on your fingertips and then of course with that hand as well palm to fingertips as the next movement and then rub each wrist with the opposite hand so it's washing the hands and then washing the wrists so basically you're washing up to up to you you know whoops about there so wash each wrist like that and that one like that then rinse your hands now the good thing about using soap is the soap breaks down the sebum this oil in the surface of the skin and the viruses are attached to that sebum and they'll be washed away in the flow of water which is good and then not the tap off with your elbow now in some public toilets some public toilets they have the old-fashioned type of taps you have to turn with a handle so what I'm recommending I think it's a good idea start carrying your own tissue around I think that's a good idea so you can take off the tissue you can dry your hands then if the tap is one of the old fashions won't wake up knock it off with the elbow you can turn it off with the tissue so you don't dirty hands again and then as well as that when you if you're if you're in a public toilet they're probably twice are especially dirty places this virus and other viruses are spread in feces and we think this virus is also spread in urine so when people flush the toilet that can be flushing of the virus into the air it can get onto the walls look and we're suspended in the air for a period of time so you could breathe it in that's called fecal oral transmission or you could touch the walls or the toilet seat with your dirty hands so we'll always put the lid down before you flush the toilet but then when you finish washing your hands then if you got your own tissues especially you can't do it with these hand drying machines but you got tissue you can now suppose my torch here is the I suppose my torch here is the toilet door so what you would do is you'd have the tissue in your hand like that because that you've dried your hand with and you can open the toilet door touching it like that and then when you open the toilet door you can hold that any hand like that that's the dirty side inside crumple that up and discard that so regular hand washing because of this risk of the virus growing from surfaces into your mouth absolutely vital so because not a where has it just start carrying some tissues why not you know carry some tissues the other thing about tissues is it suppose you needed to press them a button in a lift and smudging my tortures okay so you can have the tissue and you need to press a cache line perhaps or buttons in a lift and of course you can put the tissue over and put yeah press it like that and in Chinese lifts that have got boxes of tissues where you can press the buttons through a couple of layers of tissue and of course when you get home always wash your hands when you get home now if you look on these national websites there's another one here for hand hand gels rubbing so most the same really cleaning with them cleaning with hand gels much the same procedure and my guidelines here are saying that which were washing hands for 15 to 30 seconds so I think if we say 20 to 30 seconds so it's not a quick done you know you've got to wash your hands as a purposeful purpose purposeful activity keep your hands clean and then considered not recontaminate in them afterwards Glover's of course also a good idea if you use gloves that's gonna keep your hands protected so if you have access to gloves also also a good idea to use gloves okay some more questions yes some more questions about asthmatic stopping their steroid inhalers for goodness sake talk to your own doctor do not take advice from the internet especially from me on taking your own medications for your own medical conditions talk to your providers now if you're worried about this then try and get through to your doctor or your nurse practitioner or whatever it is at this stage be prepared this is part of being prepared getting there the medications in that you're likely to need yourself and the medications that you need to maintain your own medical condition if you have one and talk to your doctor about the best thing to do right summer temperatures will reduce coronavirus spread the answer is to that at the moment we actually don't know now influenza is very seasonal as you know you get much more cases of influenza in winter than you do in summer it's a very seasonal condition but with the corona virus we don't know if it has seasonality or not I don't know of any evidence so far that it does have seasonality but they're going to have no evidence that doesn't have seasonality what what what we do know from the SARS one is that the virus lasted for longest on surfaces at cooler temperatures so if the temperatures went up to 20 degrees the virus didn't last for as long it didn't survive for as long on surfaces and at 40 degrees it survived even less time but we are seeing transmission in Singapore and southern China and Hong Kong places that are relatively warm so I'm hoping that it's spread less in the summertime in in the northern hemisphere and in Australia and of course Australia's in summer now isn't it New Zealand is summer now but the answer to that question is we don't we just like so many things we don't know so we hope so but we don't actually know the seasonality now John Martin what type of soap you know that's a good question John I've never thought about that before liquid soap is good because you can kind of you know it gets or you can get it all around your hands quickly and easily so it's but maybe quicker to use liquid soap but the principle with soap is I don't think it matters too much what type it is as long as you get a bit of a lather because the soap has got a solvent as we said mobilizes the sebum on the surface of the skin this sebum on the surface of the skin and that allows you to wash the virus away once it's mobilized so what I'm doing now I'm touching her face from a thumb you know it's just just you know is this it's just such a terrible habit isn't it if it got contaminated hands it's not a good thing to do try and try and avoid that get your mom to tell you off every time you touch your face with your hands on me what do I recommend for people flying traveling well heck I think someone American Airlines and British airlines aren't flying to Milan at the moment so the airlines were already starting to take precautions from formulas the airlines already started to do that the World Health Organization I'm not sure what their latest thing is but initially the World Health Organization were telling us that we can still fly to China in January so that was looking back that was the World Health Organization it's easy to criticize them but they've got this balance that they've got this balance to make between public anxiety economic effects they didn't have crystal balls looking back were they little cautious in what they were doing yeah yeah they work they should have made me more proactive but it's easy to criticize afterwards but yeah I do wish they'd been more proactive in the early stages and the Chinese response was very two-faced to begin with it was terrible but then later on it was it was very good and still is still is very good but yeah yet there's still an increase in cases in China yesterday so that that was and let's hope that is just a blip will this go away like SARS that is a good question SARS was easier to isolate because it was sick people that were spreading the virus I fear this is going to go on spreading because it's spread by healthy people now will it go away the answer to that question is we don't know will it go away completely at the end of this epidemic as previous epidemic viruses have certainly hope so but there is a possibility that it could become endemic endemic means it's pretty well always present in the population so for example I think we could say the influenza is basically endemic there's always people with influenza as always people with common colds so I really hope this virus will not become endemic and we'll better look back in a few years time and say remember when we used to have coronavirus if we get a good vaccine that is going to help massively but at the moment I'm afraid I don't know the answer to that question and I'm not sure anyone does know the answer to that question but we certainly hope so got some more questions someone says we're all going to die we're not all going to die 80% of people get a mild case you know I think part of the problem here is that throughout human history there's always been infectious diseases if you look in the Bible there was something called the plague of Assad and you know there's always been plagues has always been epidemics there was the Black Death the bubonic plague that swept through Europe there was cholera there was influenza there's been SARS more recent HIV of course it has been a pandemic but you know people people used to get infectious diseases before antibiotics and and that was a big problem we've kind of grown up in a generation where infectious diseases haven't really been a problem and we've kind of in a sense we were spoiled a couple of generations my generation and the generation which most of you are in are suspect have been a bit spoiled but we're not used to this idea of infectious diseases but it's always been part of the human condition and very often what happens is a certain proportion of the population of a natural immunity to it but with this virus as we know 80% of people are going to get a mile to a mile till nurse round about 10 to 14 percent are going to get a more severe illness and hopefully most of those will just lie down and recover but some are going to need medical management and this remains my concern we really need to contain and delay this as long as we can because what we don't want is getting thousands of cases all at the same time and the potential for that is there but how quickly people get affected is going to depend on our behavior how much we change our behavior how much we change the way we work if we work from home or if we travel less if we practice meticulous hygiene if we catch it bin it kill it so have your cough or sneeze into a tissue cough sneeze into your tissue wrap it so the inside is protected Bennett straight away you know coughs and sneezes bread diseases good toilet hygiene not spreading contamination to uncooked food all these things can massively helped or baying obeying the instructions from from the authorities if they're telling us to do things to do them most people in China are doing this the discipline has been very good for most people in China these videos you see in China have been told from contacts in China a people being bungled away apparently these are people who have broken their quarantine when they're infected and even after warnings are still broken the quarantine and then they'll have to be taken to centers so I don't think it's as bad as it is disappearing but um but really we have to be considerate you know now we are no longer individuals we are this amazing wonderful human race and we have to we have to work together and a vital part of that is protecting others around you and as you protect others around you that will also help to protect yourself and your family we really need to work together on preventing and protecting from from this from this condition so in New Zealand what precaution should we're taking now while getting into the right habits I think is probably the answer now because this is coming this virus if I'm right about the pandemic it is coming to basically every country in the world was looking that way at the moment okay what is close contact that's a good question the answer is probably two meters a meter or two is probably close contact for a period of time so that could include things like getting your haircut couldn't it now that would be close contact for a period of time there are beauty therapists with positive yeah yeah I mean that's close contact you know you within a meter of someone for 15-20 minutes I wouldn't define that as as close contact yes right if you get it are you immune to it later well what happens normally let's just have a look at what happens normally so what happens normally with a viral infection if you get the the virus and that's recognized by your body as being foreign and that's an antigen so an antigen is anything that your immune system recognizes it being foreign that stimulates some white cells called lymphocytes others as well but mostly lymphocytes these lymphocytes produce antibodies and an antibodies are the immune proteins the immunoglobulins and it's these antibodies these immune proteins that fight the infection so for example the the immunoglobulins can clump lots of viral particles together all in one place then a nice big cell can come along and eat them from called a macrophage can eat them up cells can either that's the process that's called phagocytosis cell eating but the point is you make these antibodies so an antigen is an antibody generating molecule so the antigen that is the thing that's foreign in this case the virus stimulates the body to make antibodies now these antibodies would confer immunity if you were reinfected by the same virus now what we haven't got yet and clever people around the world are working on this so for example if I want to know if you've had HIV HIV is the human immunodeficiency virus then I wouldn't test for the presence of the virus what I would do is test for HIV antibodies now if you've got HIV antibodies those antibodies were made in response to the HIV antigen so if your antibody positive that would indicate you've been exposed to the virus that you have the HIV virus and of course the HIV virus persists in the body it persists now as far as we know the covered 19 virus doesn't persist in the body we're expecting it to be eliminated now the reason I'm saying that is the people that were quarantined in my country in the UK they flew from Wuhan they were quarantined for 14 days they didn't get symptoms there was a hundred of them in this quarantine and before they were released there were all tested three times and they were all negative but there again they probably never rubbed the disease in the first place but um in China the criteria for being cured is an improving chest x-ray no fever for ten days and two negative tests and then they're declaring someone cured so that's quite a high bar really so it seems to be that the Chinese data is showing that when someone is better clinically some time after that now the thing with this disease is we don't know how long that is now normally you'd expect that a number of viruses to go down quickly but when the antibody number goes up but with this disease it may be that the virus does hang around for a little longer so to be safe at the moment after someone is clinically better after they've had the virus ideally they would be tested to demonstrate that they are negative but until we know how long it takes to clear the virus from the body it will be safer to leave people in isolation for a week perhaps after they are feeling better until it's highly probable that they are no longer infectious you seem choosing my words carefully because there's a lot of things we don't know that's the problem so what I would say is be cautious that people may still be infectious for a period I'm doing again look tell habit and be aware that people may be infectious for a period of time after they are clinically better that's an issue but it doesn't seem to persist like HIV but what I was saying is HIV produces these antibodies and we test for the antibodies now the reason the antibodies don't clear the HIV virus is because it hides in your your white blood cells but that's a different story so these antibodies and as well as that these lymphocytes make another type of cell called a memory cell a memory lymphocyte and this remembers that infection so you're exposed to the antigen again the memory cells can start bashing out lots of antibodies in pretty short order so like you can get a cold sufferer from the cold then if you re exposed to the same cold virus and there you probably won't get the cold again because your ante bottles will kill it before it's got a chance to cause disease so the problem at the moment is for the cough in nineteen we don't have the antibody test now when we do get the antibody test and I'm hoping it won't be long that's going to be useful because at the moment we're only diagnosing with the virus with the antigen we're using the virus to diagnose that that's what this PCR test is preliminary a chain reaction test we can't test for the antibody so an antibody test would be an extra very useful extra weapon in our armory against this condition because we could tell if people had been positive so to get back to the original question do people completely clear the virus we think the antibodies completely clear the virus at the moment because people in China are getting negative cultures and we hope that is the case now having said that there are some cases of reported reinfection now what's happening here is unclear now if the virus mutates a lot then you could be reinfected but we think that is not happening so it could be that people's immunity is not very high for a week or two after they've had one infection and then if they re infected again they could get the disease again that that's possible because it might take time for the antibodies to build up so what we're saying is this disease might be a little bit atypical in that it takes time for the virus to be cleared maybe a good few days after people stop being ill and we're also saying it might take time for the antibodies to build up to give us protection so that means that someone who is recovered from the virus perhaps at the moment given the data we know at the moment is best to could carry on being self isolated because we don't know if they're spreading the virus for the people yet we don't know how long that takes for them to stop shedding the virus after they start feeling clinically better and as well as that we don't know what their risk of reinfection is for a period of time while we assume their antibody numbers are building up so there's a couple of things we don't know there so to be cautious just assume that people could be reinfected after they get better for a period of time and if we assume that people can be infectious after they're feeling better for a period of time because they have anything like me as soon as you feel better you tended to go back to work and you can go back to work too earlier so it's not a good thing now about quite a few questions about self isolation and of course this is remarkably difficult so if you if you live in a nice big country house somewhere you could just go up to the west wing and isolate yourself and it will be fine but most of us just live in relatively small houses so if you live on your own it's not so bad you just go in shut the door no visitors get food delivered to the doorstep and that's okay you can isolate yourself but if you live in a family it's much more difficult so a sick person should be nursed in a separate room if at all possible with the door shut and ventilate that keep that room well ventilated is probably the best advice keep warm take plenty of fluids my advice of you ill if you feel like eating eat if you don't feel like eating don't eat when you've got viral infections your body kind of guide you I think what the best thing to do is regards food for most of us if we don't eat for a couple of days it's not going to do me too much harmless for sure though that that's acceptable for most of us for children is not of course we need to keep children well-fed but um but it's looking like children get less severe form of the disease which is very encouraging that's not always the case by no means is that always the case so it's encouraging with children at the moment a couple more questions then we'll finish must be getting bored by now do children get infected you going okay okay right this question is do children get infected do they get sick and do they act as carriers now children often get infected with influenza virus and even though they might not get the disease themselves what children are very good at is carrying the disease home to their parents so children often carry viruses they can act as carriers so is it that children get infected less with covering 19 or is it that the get milder symptoms is currently not that clear so does the young immune system actually protect them from getting the virus in the first place or does the young immune system mean that their life's less likely to get severe form of the disease now I suspect they still carry the virus for a period of time but fortunately get a less serious form of the disease but of course if they're carrying the virus for a period of time that means they will be infectious so I would expect children to act as carriers in this disease that would be my working hypothesis on this so for now I would assume that children can be carriers until proved otherwise but I don't suspect it will be proved otherwise I think we probably will find out the children are acting as a as carriers how can we get across yeah yeah how can we educate our children about this very difficult but we have to read the educate them as best as we can children learn by example so teachers need to show children how to wash their hands parents need to show children how to wash their hands how to avoid touching dirty services and touching the face we just have to teach them as best as we can the children are renowned for being quite unhygenic unfortunately they need supervise of course as part being a child than you supervise right if Adelaide Australia as massive festivals over the next month maybe 500,000 attending well yeah I think it's North Italy anyways band football matches I think France has banned football not yes I think Switzerland has banned football matches now obviously if there's 50,000 people gathering together and there is no virus in the community none of them are going to get it if you've got no rabbits in a box and you come back a year later there's gonna be no rabbits but if you've got two rabbits in a field and you come back a year later it can be full of rabbits so um it depends how much virus is around now at the moment we are testing in the UK to find this out so there's 11 hospitals and 100 GP surgeries in the moment at the moment that are testing people who come in with fevers and breathing difficulties then the symptoms that could be caused by cough in nineteen to see if it's caused by normal influenza or whether it's caused by covered 19 because we actually don't know all I know so far is that one GP from the practices that were chosen as the pilot site for testing has tested positive now this GP presumably didn't know he was positive until he tested and of course the day before I was tested he could have been spreading it to all his patients if he was at work presumably he was feeling okay so my question would be of this mass gatherings coming up in Adelaide do we know that no one in that crowd is carrying the virus in an asymptomatic way now I don't know of any cases in Adelaide but there are cases in Australia so I would think in the next few weeks we have to assume that the virus is present that there is some community spread so if we take the situation in Italy I made a video a few days ago about the situation in Italy and I said look the death rate seems high in Italy here because they've only had the virus for a week but then people wrote in to correct me and said no the virus has probably been in Italy for two or three weeks before it was known to be there so the Italians had a problem but didn't know they had a problem for a week or two and that's a concern so the question is is that the situation in Australia is the virus there but we don't know that it's there because if it was there in asymptomatic or pre asymptomatic individuals and he was in close contact with people in the football match or a big crowd than he would spread it so my feeling is at the moment we should be avoiding large crowds because we don't know how many people in the population are carrying it a symptomatically it's like that 50 year old man that died in America we had no obvious epidemiological links don't know how he got it presumably some form of community spread so I feel that it would be inappropriate to have large meetings in other layers we know Italy's ban football matches so but they know they've got it but for the next few weeks you see there's a delay here when it starts community spread like in the Italian situation so God willing this hasn't happened I suppose community spread started yesterday and underlaid then we might not know about that for a week or two and in which case he could have already gained a self-perpetuating foothold now God willing that's not the case but I don't know that I can't tell you it's not there just that we're not recognizing it yet so avoiding crowds at the moment I would say yeah yeah I think we should be avoiding crowds everywhere for the time being and instigating these changes in social behavior around around the world I think he probably has time to do that the more we can isolate this the better John Ellis is the virus engineered no I do not believe it is I've had debates about this recently I'm not a brilliant geneticists are going to do basic genetics but genetics is a remarkably complicated subject but the the accepted wisdom is that this is a zoonotic virus the other coronaviruses the MERS the Middle East respiratory syndrome the SARS one 2002 2003 corona virus they are known now the work has been done retrospectively they are known to be zoonotic the geneticists all except they are zoonotic they have come from what most geneticists that they accept they have come from animals and I believe this to be the same now because I don't understand the genetics here you get people saying about this sequence and that sequence don't pretend to understand it I understood I'm just a simple A&E nurse and teacher and most doctors of work with don't understand that either that's what you know medical doctors don't understand it very well geneticists do but so I would only accept that this virus is genetically engineered if that was in the peer-reviewed publications in proper journals like like nature or science journals or genetics journals because I don't understand the science well enough I would only I retain the geneticists word for it and if it was in a peer-reviewed publication that it was engineered I would then believe it until then I won't I think it's a zoonotic virus the same as the other corona viruses that we've had problems with in the past there's also for corona viruses that cause the common cold type features that are well known and again that these have been fairly well studied in characterized I believe and they are recognized as zoonotic infections they come from animals so I suspect the Chinese will be much stricter in future about eating animals taken from the wild and the whole management of hundred animals taken from the wild so no I but I do not believe is engineered and I believe it is xuer not it Rahila any thoughts on India Rilla I'm not quite sure is there any confirmed cases in India yeah I haven't heard any check on the Johns Hopkins website any thoughts in India the answer is yes I visited in worked in India a little bit a few times and a lot of people live in very poor quality housing very close together often many members of the family and other workers all packed into a relatively small space so if one of those became infected the virus called the possibility to spread quickly the other thing India it's a bit like China people often work away from home so dad will go away and work in the city and then come back to his village and all that traveling around is also a good way to start spreading the virus around a lot of people in India don't have access to a quality healthcare so am I worried about India yeah I am Bangladesh Pakistan many African countries areas where there's a lot of people living close together limited limited opportunities for quarantine and limited access to expert healthcare advice so I'm worried about all of these places and it's not just me the World Health Organization has been worried about these places where there's poor health infrastructure for a long time in a ran for example I think there's probably many more cases than we are we are currently receiving news about at the moment and the problem is that causes a cluster of new cases you can end up getting self-perpetuating communities spread in those clusters and from there it can spread out into other places so yes I am worried about India although I think that the problem is not very grave there yet but really time to start taking precautions now did the u.s. drop the ball you know I think we might look back and say quite a few others have dropped the ball on this the reason I started doing these broadcasts was I became worried about it when I realized the way this virus was transmitted and realized this this potential so yeah I think a lot of people have dropped the ball we really need to try and contain this as much as we can now through the sort of things we've talked about does gargling whiskey help no no because because the reason being is firstly I'm not sure of the alcohol strong enough these alcohol gels of 70% plus whereas whiskeys 40% but of course it won't get into the lower Airways where the virus is reproducing so gargling whiskey I would not currently recommend at this stage unless you particularly like it of course there wouldn't be a recommendation yeah okay couple of questions here does flatulence spread the disease I don't know feces can feces can so don't actually know the answer to that question but contaminated feces can cause freak law transmission possibly through the air possibly through the this spraying out effect when toilets are flushed because some people do excrete the virus from the gastrointestinal tract and urine possibly infected as well and that's that's possible now can mosquitoes spread the virus I think that is very unlikely because the mosquitoes are going blood to blood and most people that ill from the early data we have from China that most people that had the infection didn't have the virus in their blood they didn't have what we call a very Mia so for it to be spread by insects and we'd have to go from the blood of one person into the blood of another person and as far as no that's not happening at the moment so it's not a concern at the moment no pneumonia will pneumonia vaccine hope so pneumonia vaccines only work against particular bacteria they won't work against the virus so so the answer's no will they reduce the possibility of some types of secondary bacterial infection possibly yes but the vaccines against pneumonia we have now will not protect against the virus it is a different antigen we need a specific vaccine for this specific virus I've been going for an hour and a half now I think it's nearly time to finish is the UK ready for this well the problem with the UK is that at the moment our hospitals already quite full with people with flu so when it's going to be difficult to look after a lot of extra sick people all at the same time in the UK are we ready for some cases that we can isolate at early stages as we have done certainly are we ready for thousands of people getting sick all at the same time no no we're not ready for that situation in Africa haven't joke johns-hopkins on that this morning but yesterday there was one case in Nigeria one case in Egypt but as we have said any area with poor healthcare infrastructure is going to be more at risk so sub-saharan Africa is clearly a concern and another reason for being pessimistic about that is there's been an awful lot of coming and going between African countries and China there's a lot of very impressive infrastructure projects in Africa that are organized by Chinese engineers so there's quite a lot of links I would be somewhat pessimistic African countries should be preparing absolutely as much as they can now if they have this opportunity can acyclovir so acyclovir can acyclovir antiviral medication helped now a strong suspect that acyclovir might be one of the ones that the Chinese are testing at the moment now acyclovir is quite an effective antiviral but it only works against herpes simplex virus as far as I know so I've used it it's good for cold sauce you know you get this cream for cold sores that's herpes virus it's good for those and some systemic herpes simplex virus infections we use acyclovir for now if ia Cyclovia works against the the the corona virus I would be surprised because the corona virus is different from the from the herpes virus the herpes simplex virus so the answer is does acyclovir work against the virus I don't know I suspect probably not but it may well be one of the drugs the Chinese are testing so we could know the answer to that question in a couple of weeks but it's a very good question the remedy severe the antiviral drug that was developed for Ebola is showing promise now that's not mean to say the coronavirus the same as a bolo is not but there seems to be some promise that it might be effective against the the coronavirus so we should know these things in a couple of weeks it would be great if acyclovir was effective I would be surprised if it was but let's wait for thee for the data very good question right Hugo's asked and sperm spread it now it can be spread by mucous membranes so mouth to mouth could obviously spread it and presumably sexual spread is also possible but we don't know there was a study done in China but vaginal secretions were not actually tested to see if the virus was excreted so don't know that one but mucous membrane - mucous membrane leave you to use your initiative on that device is possible so certainly mouth to mouth kissing good could transmit it yes its mucous membrane especially to mucous membrane lots of so many questions about masks so we should could give you a definitive answer about masks I think masks if you wear them a lot for example I've heard about because in China it's obligatory to go out with a mask it's illegal not so in most areas I think then people have been using secondhand masks which is just a disastrous idea although masks are being made available through Chinese outlets at very low prices controlled by the Chinese government if a mask is wet it's worse than nothing at all probably and the mask is contaminated it's certainly worse than nothing at all so masks are going to be of some benefit in some close-quarters situations but the idea that a mask is going to stop me getting this is not true because you can get in through the eyes as well it might stop you spreading the virus as much to other people but if it gets wet it's going to be pretty useless and the big thing about masks is it reminds you to stop touching your face and the other concern I have about masses people might think I'm wearing a mask so it's okay you know masks are not a panacea against infection and how effective they are really is open to open to question at the moment so masks yes many governments are suggesting we use them are they going to fully protect us no partly if if at all is the answer ultraviolet light or hydrogen peroxide right so for disinfectants for clean

Channel: Dr. John Campbell

Views: 458,500

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Id: AAwYFEcvvOc

Length: 93min 53sec (5633 seconds)

Published: Sun Mar 01 2020