WHO, Viral origins full report

well a warm welcome to this talk it's wednesday the 31st of march now today i want to focus on the world health organization report that was released yesterday uh we did give a bit of a preview of it the day before but it was released yesterday so we want to talk about that today and here is the report it's uh downloadable it's public domain it's all there a pretty extensive report it has to be said i found it uh well written very detailed report if i just uh flick down to the uh contents here clearly clearly professionally written report but but intelligible um and it stretches to what 120 pages so it took quite some uh quite some wading through but feel free it's all there it's in the public domain but i want to give you the gist of it and um interesting for interesting things right so this is the world health organization covered report that that's the site to download it click on there you can download it that's where i got it from uh the mission of course uh a joint international team of 17 chinese and 17 international experts have compiled this report so that sounds good so far they were on the ground in wuhan the team from the 14th of january to the 10th of february 2021 this was after a long delay it has to be said and even this report itself is delayed and it is quite a lot later than we expected it so um everything has been rather slow really they want us they wanted to say sort of the terms of reference of this report that they want to prevent reinfections in animals and humans so this is interesting of course looking back uh well it's essential to look back but the reason we need to know this the reason this is vital is we have to be able to prevent the next one and and stop this becoming endemic you know it's vital to know how this started to know how we go on and how we react with future pandemics i mean it's not exaggeration to say many lives depend on the quality of this report for for the future as well as explaining the past they want to prevent establishment of new zoonotic reservoirs so in other words they don't want the virus to take root in mink or cats for example which are very prone to capturing the virus because if there was a zoonotic reservoir that means an animal reservoir then the disease could jump from animals from time to time back into humans and this would become endemic and we will probably never get rid of it so it's this is a vital uh vital ongoing importance it's not just a historical study now been on the timeline now this is interesting the outbreak may have started sometime in the months before the middle of december 2019. now this is based on on molecular sequencing data so it may have started um the outbreak may have started sometime in the months before so they're not ruling out that it started in the months before so what happened was um they were able to get genetic sequencing data from um december and early january and they looked and they found mutations in in those viral strains already at that time and then what you can do is you can estimate the rate of mutation and from the rate of mutation and the differences in the mutation between two contemporary strains of the virus you can like compute back and establish a hypothetical timeline into the past it's called a phylogenetic analysis so so that that's what they've done and that's what they come up with so it could be the few months before december 19 based on molecular sequencing data we do the same thing now with humans i mean you know this is well known in genetics so um people have studied the mitochondrial dna for example in different humans and worked out the mutation rating you can extrapolate that back to one individual woman that we probably um all uh have our can trace our descent through fascinating but that's for another day circulation of size coronavirus 2 preceded the initial detection of cases by several weeks i think that is pretty well established and this isn't surprising of course because we we know that when this well we know from new virus arriving or new variants are rising that it starts off very slowly this is the nature of the exponential rights and then it goes up all of a sudden so it wouldn't be surprising if it had been brewing for a period of time that would be not remotely surprising um virus transmission widespread in wuhan by the first week of 2020 they've established so certainly by 2020 it was widespread community spread in the city of wuhan epidemic in wuhan preceded the spread to the rest of the hubei province so by looking at the timeline when cases were diagnosed you could see that this was happening first in wuhan then it spread out to hubei so so that that's good information that this outbreak certainly started in wuhan now there's debate about how it got into wu-ram but it certainly started in wuhan and then spread out to hubei and then to china and other parts of china and then of course as we unfortunately know all parts of the world but that was the order it started in wuhan city um 174 covered 19 cases with onset of symptoms in december 2019 so definitely 174 cases there confirmed diagnosed cases to have confirmed in september 2019. so again confirming what we know but but they give a lot of data to support this so it is it is worth looking at if you're interested um 8th of december first official diagnose confirm case so the first time that there's a definite case was the eighth of uh december 2019 hence the term covered 19. uh 76 000 cases from october and november unlikely now what they did here was they looked back at medical records and they found 76 000 cases which looked like it might be covered 19. but when they looked at those from october and november they thought it was unlikely now i think this is probably accurate because even although the cases would be developing in uh october and november we believe they would be starting to go up very very gradually before the steep increase to have 76 000 cases would have meant the steep increase had already taken place so i think that is um that is probably accurate so the retrospective review of cases probably wasn't sharing cases before december even though there would be some community transmission before then we believe so this is the graphic of the uh the pandemic um weekly number of influenza like illness cases uh so basically um this is the this is the number of uh so that's this is this line here is what you'd expect the dotted line is what there actually was so there was less cases than you would expect for a while there and then in week 47 uh week 48 we get that sudden increase so of course week 48 is uh four weeks before the end of the year so that's um that's that's the way the pandemic started in uh in wuhan that their is in wuhan in 2019 so they've drawn up that graph of the start of the the pandemic then of course the deaths were delayed and this graph is really quite poignant um comparison of the trends of um pneumonia mortality rate in 2019 to us 2020 versus the average so pneumonia average deaths along the bottom there this spike was the actual number so as we would expect because the first cases were in december it was early january when a lot of people started dying of course as we know we typically have this three or four or five week lag from the cases to people starting to dying so this is completely consistent and it just shot up to very high numbers but then it came down dramatically as a result of the chinese lockdown measures now um this is this is impressive as as you know as we all know the cases in the united states the deaths went up and they stayed high the united kingdom they've stayed high okay it's been in waves europe's that a lot of people are dying but the the nature of the restrictive measures taken in china meant that people stopped dying pretty quickly so uh something to learn from china there for a future pandemic that could be way more deadly than this that uh dramatic some might say draconian action in the very early stages of the pandemic saves untold amounts of lives let's imagine the chinese response have been as lackluster as say the response in europe or the united states or in my country in the uk then those deaths would have carried on presumably rising and stayed high for a long period of time but they didn't because of the the community health measures primarily that the chinese took so that is uh interesting and a lesson for us all from the future because remember the next pandemic could be twice as deadly as saskarinovirus ii it could be 10 times as deadly it could be 20 times as deadly and we need to learn that that dramatic action is necessary in the early stages i somewhat doubt we have in western countries but that's what the chinese did now i get lots of emails saying well isn't the lots of the pandemics still raging in china it's not possible that the chinese or authorities are hiding ongoing massive community transmission it's just simply not possible we've had reports from china that shows that there aren't these ongoing cases in china so we know that the chinese are able to clobber it quickly okay there was delays there was cover-up at the start we know that but nevertheless that graph we believe is accurate and speaks for itself now going on to the genomics of the virus hunan market uh the the originally proposed uh epicenter of the pandemic market at the point of its closing so when they closed the market they did 900 the chinese scientists did 923 environmental samples from that market and 73 of those were positive mostly contaminated surface so a very large cluster of positive viral rna samples discovered in the wuhan market so no question there was an outbreak in the wuhan market the question is did it start there that's the question of course so you can certainly say there was a lot of positive samples widespread contamination of surfaces of the cytoskeletal virus through yes hunan market cluster had identical viral genomes now people caught the disease from this market so many different individuals were infected from this market and they went on and infected more individuals and all of these people had the same viral genetics so there is a um what we call a phylogenetic clade a descent from that market that caused that cluster but and it's important but other genomes were also discovered from december january so there's other outbreaks with different genetics that appear not to come from this market because they have different genetics so um not wider different genetics but different so that you can um infer that there wasn't common descent so there was other genomes going around so in other words the the pandemic was already multi-multi-viral genome types there was multiple types of genomes in the same size corona virus too but by december january so it wasn't one simple spread out from the uh the hunan market is what that genetics shows us now they did check upstream supplies to the hunan market taking during 2020 and they found nothing circulating in the animals in other words they looked at places that supply animals to the wuhan market and they didn't find any uh any evidence of the virus in those according to the data that was analyzed um quite detail this but it is important to if you want to understand this quite important to go through this in some detail really initial cases associated with the hunan market but cases were associated with other markets and cases were associated not with any markets at all as we've said because there are several different genotypes of the virus spreading in december and january coronavirus most highly related to stars coronavirus 2 found in bats and pangolins the closest match the closest match was coronaviruses found in bats and pangolins now pangolins are these uh mammals uh that this with the the like they've like got armed little armor platings on them they're endangered because people hunt them for food unfortunately so they're endangered and that they were um captured and sold appallingly in these markets now we say we say that and these wet markets are despicable places with with animal wild animals being caught kept alive and then butchered on site at the point of sale very often um now this happens in china but it happens quite a few places in southeast asia as well um you know quite a few other countries i'm not going to run through a list of names of countries but you know which countries are in that region and these kind of wet markets are a feature of that and of course there's problems with bush meat and things from africa as well this is not uniquely a chinese problem but nevertheless it's one that should be acted on legally and of course the chinese authorities do have the power to stamp on this illicit trade in wild animals and i really hope they do so but again having said that the massive monoculture that we have in western societies for breeding up huge amounts of of animals because they are so genetically related there's great potential spread for zoonotic transmission from them as well so basically the whole world needs to rethink its relationship with animals uh favoring the natural ecosystems on which we depend for our very lives and um yeah as i say rethinking it this is not i'm not pointing fingers at china i get accused of pointing fingers at china and being china phobic and all these things and then people and then i get accused of all sorts of things i'm not against anyone i'm just saying we need to rethink we need to rethink this i get accused of being anti-scottish anti-irish anti-french anti-german everything goes with the territory i'm afraid but it's not it's just a genuine scientific opinion that we need to rethink our relationship with animals but none of the viruses in the batsor pangolin were sufficiently similar to saskarona virus ii to serve as a direct progenitor so the corona viruses they found in bats and pangolins were the closest similarity to the ones that caused the the virus that caused the pandemic but they weren't the direct ancestors of it so what this means is uh we we haven't got to an answer yet we still don't know my sampling before and after the outbreak now this is interesting so the chinese authorities supplied information on widespread sampling before the pandemic and after the pandemic and the results of that are are are interesting well the good results really basically before the pandemic they didn't find any size coronavirus 2 in domesticated or um or wild animals from the survey that they did meaning that this probably is a genuine novel spillover event from animals and the other good news is they haven't found any either afterwards so it looks like so far in china size coronavirus 2 has not become endemic in agricultural or wild animals so far of course you can never know that you can't prove negatives but they've taken 80 000 wildlife and livestock samples 31 provinces in china and they haven't found any so that is encouraging as far as it goes now the next thing is about cold chains of course which the chinese authorities were keen to talk up now cold chain products were not tested at the time because they hadn't thought of this at the time but confirmed international transmission in cold chains in other words frozen foods can transmit the virus around the world um that that can happen the virus can be frozen and then kind of regenerated when it gets to the other end but of course that tells us nothing about what actually did happen it just tells us it's a possibility so the four conclusions drawn from this report now the team did say it's a qualitative risk analysis qualitative means it's not really based on firm data so the converse of uh qualitative is quantitative which of course would much rather see but it's all we've got so um we'll put a question mark on it and move on right first direct zoonotic spillover is considered to be a possible to likely pathway okay i think we knew that introduction through an intermediate host is considered to be a uh likely to very likely pathway okay but whether it was bats or pangolins we don't really know um yet introduction well what we know it's probably not bats and pangos well it comes from bats but probably not vibe pangolins but even in bass they didn't find the direct progenitor virus so whatever those animals were unclear introduction through cold food chains products is considered a possible pathway that's their third conclusion um but uh you know the idea that this virus didn't arise in china that that is perhaps suggested to intimate is is in my view inaccurate uh introduction through a laboratory laboratory incident was considered to be an extremely unlikely pathway according to the team now i know some of you are now bouncing up and down on your chairs but just a minute that we're going to get to some interesting bits when we look at the world reaction next phase that's not over widespread testing of domestic and wild animals which is is good is going to happen um ryan rhino lofouloflus rhinolofous bats i would say rhinologists bats where they think this might be transmitted through that their distribution is uh southern parts of southern provinces of china countries around east asia southeast asia and many other regions so that's where they want to be looking because these are rhinophilous bats rhinophilous bats they think are the likely origin of the virus even though they didn't find direct progenitor virus in these uh the these rhinolophelous bats they're going to do more cold chain analysis and they're going to look at positive results in sewage serum from blood samples human of animal tissue swabs and other size coronavirus 2 tested at the end of 2019 so we've heard these reports that sars coronavirus 2 might have been found in sewage systems in spain at the end of 2019 they're going to check on that and hopefully we'll get some something definitive and the world health organization team also said they're going to convene a global expert group which is good where we always want meritocratic experts right um lots more links there to check on the the reaction to this particularly particularly this link here will take you directly to the transcript of the world health organization director general dr tedros it will take you directly to his response to this and it is a little bit surprising it has to be said encouraging as well um anyway just let's let's keep going now this group's got together um united states united kingdom australia canada uh czech republic denmark estonia israel japan anyway you can read it for yourself um quite an interesting diverse group of countries there i've all got together and they've written a report made a statement well a statement rather than a report so interesting group of countries there have come together to make a common um a common response now direct quote from their statement it is equally essential that we voice our shared concern so they're doing it together which is good uh that the international expert study on the source of sas coronavirus ii was significantly delayed so they're unhappy that it was delayed the team was on the ground about a year later and lacked access to complete original data and samples so the team lacked access to complete original data and samples a lot of what the team were going on was information supplied by the chinese half of the team and they've been supplied it by other chinese authorities one would assume so that's a direct quote but while regretting that the late while we're guessing the late start of the study the delayed deployment of the experts in the limited availability of early samples and real data so they're concerned about that we consider the work carried out to date uh out to date and the report released today as a helpful first step so yeah okay they're saying it's helpful first step but they're regretting lots of uh problems um that they have identified european union also commented um called on all relevant authorities to help with the next stage so they want all relevant authorities now the european union don't say who they mean by all relevant authorities so i wonder who they could mean i mean i mean why don't they just say so it's so obviously talking about china or you know it's all wrapped in diplomatic language but they want all relevant authorities to help which of course we agree with but it's namby pamby language really anyway never mind the diplomats i suppose so that any gaps in data needed to further investigations can be addressed so any gaps in data so they're clearly implying there's gaps in data need further need to further the investigation and can be addressed called for timely access to independent experts at an early stage in future pandemics that could result in saving thousands millions or billions of lives access to china after months of fraught negotiation so they did notice that fraught negotiations were needed even to get to that stage so a very diplomatic expression of displeasure is how i would read that the white house has weighed in urges the world health organization to take additional steps there's a second stage in this process that we believe should be led by international and independent experts i'm just wondering there if the white house wants to bypass the world health organization on this reading between the lines don't know they should have unfettered access to data again implying that they haven't so far and they should be able to ask questions of people who are on the ground at this time and that's a step the world health organization could take so it looks like they're going to give the world health organization a bit longer yet seeing how they respond now um this is interesting now this i've given you that reference there just a bit back so click on there make sure i'm interpreting this correctly but so dr ted ross is uh has been commenting and these are direct quotes from this statement in my discussion with the team they expressed the difficulties they encountered in assessing raw data so they were like given data by the chinese not the original raw data for them to process themselves in other words i mean what's the difference between information and data so data is kind of the raw numbers that you collect information is the sense that you make of that data so it looks like they were saying they want the data at a level where the data is much closer to the ground not information what you want the data they're quite capable of analyzing the data for themselves thank you very much um i expect this is doctor tetris again i expect further collaborative studies to include more timely and comprehensive data sharing now this is dr tedraw saying this so um he's saying he wants more timely and more comprehensive data sharing in other words he's saying so far well he's i would think this is what he's saying don't want to put words in his mouth but is he saying that it has so far it hasn't been timely is he saying that so far it hasn't been comprehensive that that would appear to be what he's saying scientists would benefit from full access to data including biological samples from at least september 2019 interesting at least so it looks like dr treadross here once biological samples like from august september october november december and of course the world is more than capable of analyzing these biological samples for themselves and making their own conclusions this is this is what i mean we so what he's saying is we don't want the report on the biological samples we want access to the biological samples we want access to the raw data so so we can uh analyze this for ourselves the world's labs are quite capable of analyzing this biological material i concur with the team's conclusions that farmers suppliers and their contacts will need to be interviewed so more interviews need to be conducted on the ground team also visited several laboratories in wuhan and considered the possibility that the virus entered the human population as a result of a laboratory incident so direct quote from uh dr teddross here so um you can see why i'm a little bit surprised by this apparent change in tone from dr ted ross i see an apparent change in tone however i do not believe that this assessment was extensive enough so he's saying that this could have come from a laboratory and that i do not believe that this assessment of the likelihood that it came from a laboratory was extensive enough it needs to be more extensive i think from memory the team was in the wuhan institute for virology for three hours as far as we know not doing experiments on the bench just talking to people in in the lab um so dr tedros unhappy with that further data and studies will be needed to reach a more robust conclusion right and then he said this is he talking about the laboratory leak here well who knows what he had in mind but he said this is what he said let me say clearly that as far as the who is concerned all hypotheses remain on the table although the team has uh concluded that a laboratory leak is the least likely hypothesis this requires further investigation potentially with additional missions involving specialist experts which i am ready to deploy so dr tedros is saying here that at his disposal he has uh experts in viral laboratory uh techniques and he is happy to deploy them to china um interesting and interesting uh this report is a very important beginning fair enough um but well it's not fair enough we'd hope for more um but but but it's not the end so doctor said i was saying this is not the end of the matter we have not yet found the source of the virus and we must continue to follow the science and leave no stone unturned as we do so so well we agree continue to follow the science we need to follow the science we need to follow the evidence but of course to do that we have to have full access to it so really quite a significant change in flavor really i i perceive here from dr tedros and and encouraging um we need scientific answers to inform us about what happened and to inform us for the next pandemic uh peter van embark danish i believe uh one of the lead scientists on on the mission uh uh possibly virus may have been circulating as early as november some cases may have been abroad so not is that an elaboration of what he said in the report perhaps uh areas where his team had difficulty getting down to the raw data in china so even peter's admitting that he had difficulty getting down to the raw data data would need to be re-examined in the next phase of the probe okay interesting raw data and then re-examine the data and he says only scratching the surface of the understanding of the origins of the pandemic so they go um look at it for yourself lots of graphs lots of interesting uh stuff in it surprisingly accessible um you know all the specialist technolo terminology is there um it probably helps drop a bit of a scientific basis to background to understand it but um i would say the average uh the average intelligent layer reader would make quite a lot from this so that's my interpretation um i if it turns out my interpretation's uh wayward i'll certainly correct that but that's my interpretation at the moment and that's after quite a bit of waiting through the report okay so that is for today so many other things to comment on um increasing incidents in europe europe really is heading in for continental europe unfortunately really heading in for difficult times at the moment and then of course there's the whole story about vaccinations and things still to discuss but i thought that was quite important to um to prioritize that because as i've said repeatedly the next pandemic could be much more deadly than this and we need to learn how to truncate um pandemic at the earliest possible stage okay thank you of course for watching this video

Channel: Dr. John Campbell

Views: 171,112

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: 2FD54-7qc88

Length: 32min 42sec (1962 seconds)

Published: Wed Mar 31 2021