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[00:00:01]

That pot Kenny show on Newstalk. Now, some good news after yesterday's National Public Health Emergency Team meeting. The government announced that Killdeer was out of lockdown with immediate effect after three weeks with extra restrictions in place. However, according to new figures from the European Center for Disease Control, the incidence of covid-19 in Ireland is up to 12 times higher than it was two months ago.

[00:00:26]

To talk about this and much more, consultant virologist, chair of the covid-19 Expert Advisory Group and director of the National Virus Reference Laboratory in UCD and Dr. Kelly into Gascoine is on the line.

[00:00:38]

Gillian, good morning. Good morning. How are you? I'm very well, thank you at Touchwood. I do have the covered up and I have subscribe.

[00:00:49]

It's interesting, my sister in Skerries and there's a lot of stuff coming out of Skerries said that a message flashed up on her screen to say one potential exposure. She ran, rang the helpline and it said that it was probably someone she passed on the street. She wasn't in their company for long enough. So not to worry. How are you told? I mean, do you get a big red box or do you get flashing lights when you have a dangerous exposure?

[00:01:20]

Oh, now, that's a good question, and I don't think that's one that I can I can answer for you, I'm afraid, in relation to the app. My understanding is that it does inform you that you have been a contact. So it does distinguish between whether you've just as happened with your sister, that you've been in very brief contact with somebody who has been identified by either claim to have symptoms or identified as the case, but that if you've been a close to a confirmed contact, that the message is more clear.

[00:01:47]

But unfortunately, I can't be specific and that I'm afraid. Sorry.

[00:01:51]

Yes. Now, at the Irish Independent has that story from Skerries in county, Dublin. As it happens, the sports clubs have shut their doors because of concerns locally about a face licking video. And it turns out the background to this is 30 young people hired a bus to go to Dublin City for a fake debs because the Deb's not happening. Six of them tested positive a week later and some of those worked in local restaurants and the golf club and some were gay players, hence the shutdown.

[00:02:24]

What does this teach us? I suppose that obviously the majority of people aren't aren't acting in that manner, I think it just shows that given the right set of circumstances, this virus remains very transmissible. And we all really need to reduce the number of contacts that we have in order to allow us to continue to do as much as possible from a previous normal perspective, if you like, in the context of going back to school, going back to work, being able to socialize.

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But the thing is, if we don't implement the public health measures that everybody's very familiar with now in the context of distancing, of hand hygiene, of face coverings, then if the virus gets an opportunity, it can spread very, very quickly. And obviously, we have seen that with with large outbreaks in recent weeks and then the large number of of outbreaks within the household setting.

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So it's a it's obviously disappointing behaviour to see, but it's not representative of the majority.

[00:03:32]

Messages are not getting through to that particular cohort.

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I mean, I see all the time when I'm out and about wearing a mask, walking the dog, whatever, lots of young people very close together, you know, multiple units, not just three units.

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Now, you know, maybe they're with each other all day in school and so on. So they feel as if if they're going to get it, they're going to get it. But it does seem to me that the public health messages simply aren't reaching a particular cohort. Yes, that's possible, but I think the agency and the department have done a huge amount in the last couple of weeks to assess to rectify that and ensure that the younger generation is receiving the message.

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And the communication around that has has changed, I think, as of yesterday. Yesterday's figures that 75 percent were under the age of 45. And we're certainly seeing that trend over the last number of weeks. And I think with the department certainly is very cognizant of that younger age group. And it's important that I was there. Thankfully, I was the majority of them won't have severe illness. But obviously the concern is that the more virus we have circulating in the community, in any population or in any cohort increases the risk of us drifting and bleeding into that vulnerable, vulnerable group and the older age group, which suffered so badly and so significantly in the early part of the outbreak.

[00:05:03]

But I do take your point. I think notwithstanding the communications message, that will always be I was a small number of individuals that that will disregard the message no matter how clear it is.

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Now, the number of cases that have been identified with sporting activity, what exactly does that mean?

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I mean, does it mean there are people who are playing the game or is it spectators or, you know, we need more information on this kind of statement. I'm just I understand that sentiment. I don't have the additional information to him now, but my understanding of that is the majority of cases have been linked with activities or congregation settings or social gatherings, either before or after a sporting activity, which was the logic behind the change to the guidance.

[00:05:55]

I'm just there in the middle of the week, the week before last just gone. But I think the important thing to highlight in the context of the the figures and the data that we were able to provide as much information as possible to the public. And there's certainly an appetite for us. But we know that sports in and of itself, we want people to get out towards. We want people to be active. We want people to it's so important for physical health and for mental health.

[00:06:25]

And and that's why sporting activities can, broadly speaking, continue purely because we know that that's not where the risk lives. But in the context of of the numbers associated with with the congregated settings that either before or after, it's it's more the social side of things where where people perhaps just understandably, perhaps after a match, you know, let their guard down. But I don't think a huge number of other sports individuals themselves have been involved. And I think we've seen some really positive information over the last couple of weeks.

[00:06:58]

And obviously, the TGA released the information from their school camps and I think it was child care. Ireland released the information from and the crashes over the last number of weeks. So we do know that in the in the younger age groups and certainly as we move back to school, that the children probably don't transmit to each other as as readily as we might see in the adult setting. So I think there's some positives to take out of the last number of weeks.

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Obviously, the tendency is to focus on on the numbers and it can be a little bit bleak sometimes. But I think we have seen some positive findings from the the pandemic over the last number of weeks.

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And I think it's important to remember that we see that there are fewer deaths now. So there are two possible explanations. One is that the virus itself is a less lethal than it was, or else it's that the cohort who are now diagnosed with covid-19 are younger, not in vulnerable groups, and therefore are more capable of surviving an attack by the virus.

[00:08:00]

But the numbers of deaths certainly have gone down and we're keeping our hospital admissions at a fairly low level. But are you worried at all about, you know, the scale of diagnosis or do you put that down to increased testing? So that's a really great question on the fatality rate, because this isn't we're not an outlier on this. A number of countries have seen that over the last number of weeks. So generally speaking, in simple terms, why we don't have any evidence, definitive biological evidence at this point in time.

[00:08:35]

But the virus has has weakened. And and typically it would be a surprise for that to happen in, say, seven or eight months after the virus has crossed into a new host. But it wouldn't be surprising for it to happen ultimately. So if we look at the other human coronaviruses, the seasonal human coronaviruses that typically cause the common cold, they would also have crossed over the species barrier at some point in the past. We don't know exactly when, and unfortunately, we don't know exactly how severe the illness was when they first crossed over.

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But as it was at a population level, if a virus is very aggressive and very lethal, the people who tend to come most quickly obviously pass away and therefore don't transmit. So the viruses that tend to be transmitted are those that are very transmissible, but perhaps not as lethal. So over the course of a number of years, decades, even centuries, viruses do tend to mitigate somewhat if they've had an opportunity to coevolve or to adapt to the species because it's in their best interest to to to keep their host alive, in essence, while they while they transmit the virus.

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But we wouldn't expect to see that over the last seven to eight months. And instead, we see nothing at virological at this point that definitively demonstrates that. I think what I think the other element to it is that I think the older cohort has been I think so responsible over the last number of months. And I think they've been really following the public health guidance for their own sake and for their families. They can and think they'd really be protecting themselves and also the community.

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I think, generally speaking, we've been in recent months doing well at protecting our our older cohorts in the context of, you know, protected time in shops and that sort of thing. But I think the concern remains that if the virus continues to circulate in the younger age group, it will at some point spill over into that older age group. And we know that's the outcome in that situation may be quite severe. I think the other thing we want to be be careful about is giving people the message that even if you are young, it's OK to get it, because we've heard a number of stories about people having significant long lasting effects after the virus.

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And it's still a very new virus. And we still don't know what the long term impact is going to be. So I would I would caution against anyone thinking, you know, it's fine, I'll get it now and then I'll be ground. I don't think we have enough information to to encourage that at any at any point.

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Now, the citizen's information tells us the advice on the number of people you can have indoors or outdoors in your home. It says a maximum of six people from no more than three different households are allowed at a table, no events, parties or gatherings involving more than six people indoors.

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And it says 15 people outdoors are permitted in a pub or restaurant settings. A number of people are worrying about first communion lunches and so on. And they're wondering, you know, there are a lot of us now might amount to 18 people say, can we book in a restaurant? Three tables of six. I think the concern with that, and obviously it's very it is very restrictive for people, but I think the concern with that is that people will gather together either before or after that gathering.

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So really, it's about minimizing the number of contacts that we have and having three different three tables of six in order to try and suppose gamed the system to a certain degree, is really not what we want people to see. We know how difficult it is for people.

[00:12:10]

As you're saying, the child, for example, will be going round from table to table to see Uncle Sean, who booked Table one, Auntie Nellie, who booked Table three to our mom and dad, who booked table whatever that child to be running around talking to the constituent members of each table and therefore becomes a vector or that is certainly and that's certainly a possibility.

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And I suppose that's the type of behavior that we are trying to discourage. Obviously, we know that a huge number of people, including children, and have missed out on on significant milestones in their lives over the last over the last eight months. But I think we've seen over with the with our increasing case numbers over the last few weeks that that this virus hasn't hasn't gone away. We had a good period of time there in June and July when when our accumulative instance race was very, very low.

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And I think perhaps we collectively I think perhaps we all maybe felt that this was like a seasonal influenza virus that had gone away and it wasn't going to come back until the winter. But we just we don't have the Segodnya.

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You know, I was just going to get Carrisi here for a family who want to celebrate anything. Bottom line, one table of six and no more than three units present at that table. Is, is that the situation?

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Yes, I hear exactly that. And it comes back to just restricting the number of contacts that people have. We know that the risk associated with this virus comes back to the the number of contacts, the distancing between them, the the location, the weather, the ventilation, the presence or absence of face coverings, you know, shouting, laughing. All of those all of those things are are behaviours that we want to try and encourage people to, you know, in the safety of you, in the comfort of your own home, with your own household contacts, your family.

[00:14:05]

Obviously, that's an uncontrolled setting and that's fine. There's very little we can do to prevent transmission in that setting, obviously, unless there's a case. But I think the key thing we want people to remember when they're out in the community are engaging with others who will be ideally will have no symptoms because if they have symptoms, they won't be going out in public. But when you're interacting or engaging with anybody, you kind of have to work on the basis that that's one of the two of you may may be infected.

[00:14:33]

Either they may be infected or you may be infected. And really, we want you to behave with that in the back of your mind all the time. And it is, again, as I think over perhaps over the summer, understandably, we we probably lost that physical distancing a little bit as a collectively. But I think what's really important is that we know it still works. We've seen from from the tremendous efforts of people. And clearly, not only that, if we that's public health measures are still effective against the virus.

[00:15:01]

The virus hasn't changed in any way. It hasn't evolved in any particular way. That means it can get around those public health measures. They're still very effective. But the problem is, if we let those slip them, we can see in terms of the families, families gaming the system.

[00:15:17]

You know, the restaurants, though, if they take a booking for three tables of six, what about them?

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I think it's very difficult to to place the responsibility on on restaurants themselves, because the thing is, again, I'm sure your your listeners will have heard as well. We've all heard stories about people, you know, going to one restaurant for a starter and and a couple of drinks and then, you know, booking a second restaurant for a main course and another couple of drinks. And and again, we really need to ask people and appeal to people to take on the individual responsibility.

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I don't think we can expect the people in the hospitality industry to to police this completely for us. I think we have to ask people to follow the guidance because it's in our own best interests, both individually and collectively as a population, because if we do, as you know, we're coming into the autumn of the winter and if we want to, you know, keep our children back in school and if we want to protect the most vulnerable in society, and if we want to ensure that our health care system survive the winter, then I think all of these measures remain so important and that I think there's only so much that people in the hospitality industry or in the retail sector can do ultimately comes down to all of us as individuals to take responsibility and to to follow the public guidance.

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This question from a listener, please, on. Dr. Chilian, about the testing time, 72 hours is not going to be acceptable for entire households to isolate waiting for test results. My daughter came home from school with the temperature already now awaiting a test. But the entire household is isolating until the test results are back. I can't see that long with pressure parents will be under with work. I can't see that persisting, that idea of parents having to stay at home, ringing their employers, saying, my kid came home from school with the temperature.

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Sorry, can't turn up. You know, I that's going to be challenging and I would agree, 72 hours is not where we where we want to be. And I did hear that at the briefing last night. And I think that would be the exception rather than the rule, because obviously we've we've capacity now for about 15000 a day. And certainly over the last month, we've been up to there certain weeks and days. We've gone up to 12, 13000 per day.

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So there may have been some delays in on the contact tracing side, which have been rectified. Obviously, we had to stand back up some sampling hubs and some contact tracing centers. But I think the key thing for us coming into the winter and in particular with children, what we would like to see is that in that situation where there's a case potentially in a school setting or setting or in a setting where you may be looking at a potential outbreak that there that those that those first couple of samples could be, you know, prioritized and go through, say, one of our rapid testing platforms.

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Obviously, there's been a lot of attention around rapid testing and in the hospital setting that we do have access to rapid testing platforms and maybe desperately more expensive or what, you know, rapid testing.

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We heard about the Abbott machine very early on in the pandemic. I mean, are they terribly, terribly expensive compared to the swab up the nose and going to the lab and all the rest of it?

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It's at the balance, not about the numbers that you're trying to get through. So certainly, unfortunately, there was a very high profile that was Abbott's platform early in some of that, didn't have a it didn't have the the sensitivity and diagnostic accuracy that we were hoping for, but from the agency has put a huge amount of effort and investment into the hospitals and the community laboratories for for the coming season. And as people know, the capacity had to be brought in.

[00:19:04]

What we've seen with the on the rapid testing front, actually, is that many of the companies aren't in a position to to supply the type of numbers that that people would need. So therefore, we can't build a structure and infrastructure around those. We we have them. We have access to a certain amount of them and we want to use them in certain settings or whether that's perhaps in an emergency room, perhaps before emergency surgery or something like that.

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Or is that perhaps in an outbreak setting? But instead, we have been informed by a number of companies that there is a global supply chain won't be sufficient to allow everybody to have a rapid test. But we are continuing to work with the agency and the department and to make to see what the new platforms are, to see what the new technologies are and to to implement mass testing programs as necessary. Obviously, at the moment we're doing testing in the nursing homes and the direct provision and the meat processing plants.

[00:20:03]

So we want to go out and find this virus in the community. That's that's a real key priority for us. But obviously, while we're doing that, we also need to make sure this, like your caller, that the children and the people who are symptomatic and get their testing done as a matter of a as a matter of urgency. So they're not caught up in a serial testing program, if you like, where people are perhaps asymptomatic and not acutely unwell.

[00:20:30]

Christenings in church. Would you advise more than six people to attend church's huge space in the church? But of course, people might be gathering around the font for the actual christening. Another one I was at a country funeral yesterday. Numbers were limited in the church. A large number of people over 500 walked after the hearse and congregated closely in the cemetery, shaking hands, etc.. No masks. That's from Mike and from Chondra.

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And I think that's that's really difficult for people around those family events and certainly funerals. But I think while and again, as you know yourself, why the outdoor setting is in certainly lower risk and probably significantly lower risk. It's certainly not a zero risk. And in the setting where you find yourself outdoors in it, in a close, close, sort of closely congregated setting idealizes, we've asked you not to be there, but if you do need to be there, then, you know, we should be wearing masks in that situation as well as that the the outdoors is is lower risk than indoors.

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But it's not a it's not a magic shield.

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But if you end up shaking hands with somebody, if you have hand sanitizer in your pocket, use it immediately afterwards because you might shake hands even by accident, you know.

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Yeah, I know. Exactly. Exactly. It's force of habit of illness.

[00:21:47]

Yeah. And the funny thing is about the flu vaccine. And there is, you know, some concern that there might be a delay in the administration of the flu vaccine and supplies.

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Indeed. What can you tell us?

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So I don't think I have updated information for you. Unfortunately, I did. I saw the report last week that said that the manufacturers were going to be two weeks late in delivering it, but I don't think that will impact. Huge Vianna, on our own immunization strategy here, purely because the Hajazi typically gets the flu vaccine delivered fairly early on in the season. And today in our last our last influenza season was a little bit early, sort of activity started to increase in November from from memory and then December.

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Typically, we are in the second half of December, probably early January, before we see significant levels of influenza activity. So I don't envisage it being a major concern at this point. But obviously, we would hope that we wouldn't see any further delays. But what is that? That it's important that that's coming from the manufacturer and supplier point of view rather than anything that the agency or the department can do. But certainly once we get it on, Ireland will be in a position to to roll it out promptly.

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Well, the last question I hate to mention the word Christmas, but people are wondering a stock question from a listener. Do you want more than six people in your house on Christmas Day? What's going to happen now is probably the time to prepare mentally for that and emotionally for it. I think that, you know, I think now it's important to realize, I suppose, that the two numbers, six and 15 are at the moment in case in place, rather, until September 14th.

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So obviously, if it keeps all of the the matrix, a case numbers the trends and the Orndorff and all of those things are under constant review. And as I said, that the measures that were put in place just the middle of last week or the week before last, we would hope to start seeing an effect from those, you know, the weekend and through this week now. And hopefully we will get through to the 14th and we'll see that we'll be able to to lift some restrictions again.

[00:24:01]

So Christmas is a long ways away. So hopefully we'll wait and see. Exactly.

[00:24:06]

All right. And Chilian, thank you very much for joining us. That's Dr. Chilian Degustation, who is a consultant virologist, chair of the covid-19 Expert Advisory Group and director of the National Virus Reference Laboratory in UCD.