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All you want to do is sit in a cafe and quietly enjoy this podcast when you can, I have it all Demi semi half caf McClarty. Oh, and can you served in a macchiato class?

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Oh, give me strength.

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Cut the nonsense and keep it real. With Trebor, pick up a refreshing boost of Trebor Extra strongman's for a cherry trees of Trigo self-defense.

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But now Professor Luke O'Neil, a professor of biochemistry at Trinity College in Dublin. Good morning and welcome. Good morning. How's it going? It's going pretty well, but when we look at covid not so well, I suppose. But let's talk positively first. Vaccination in Israel. We should simply copy what they do.

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Well, it's incredible. I mean, obviously, countries differ in so many ways. So we've got to be slightly careful. But we've looked at Israel closely and they are top of the league when it comes to vaccination. They vaccinated 12 percent of their population at this stage. That's one point one million people. They're predicting the whole country will be vaccinated by the end of March, which is amazing. And this is the second shot as well. By the way, you know, we might discuss the TV shopping in a minute, but that's an amazing sort of if they achieve that, it'll be incredible.

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And the question is why? Why are the Israelis managed to achieve what other countries haven't? And they are no wonder the league table now, by the way, the countries have done best at this stage. And Israel's number one, UK is number two, by the way. But there's a few reasons. One is they've got a highly digitized health care system, which I suspect we don't have as good a digital system as not everybody's tracked from birth.

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So you can you can find everybody basically is what is one reason central government organizes everything interesting? You've got they bought loads of vaccine supply very early.

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They got in quick to stock up on a huge amount of supply. They probably paid above the price, by the way, as a rumour, they paid a bit extra to get this supply and they felt that was justified for obvious reasons. And one great one. But I think Netanyahu took the bull by the horns and was a hugely effective leader. He did some of the negotiating on the price that that's one rumour. Secondly, he was the first to be vaccinated.

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He got a photograph taken at the 500000 person to be vaccinated. Very important. He encouraged the Arab Israelis because they were a bit reluctant and got a leader there. A guy got some SUV, sent 25000 voice messages. Can you believe I've had the Arab Israelis? The Orthodox Jewish people were also a bit reluctant. He got a guy called Yitzchak Zilberstein again to roll out the vaccine with that community as well. So it looks like it was a combination of things it looks like is the reason why they've got such a high level of vaccination.

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Yeah, they have an extraordinary health system. I was reading about that. They have it's public health care, but it's run by four different outfits who compete with each other for excellence. And this has led to, you know, huge efficiencies in their system.

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But also they don't have a huge cohort of I was going to call them anti vaccines, but you'd like to call them vaccine hesitant people.

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Yeah, there's less. But the two communities that were reluctant and hesitant and of course, we do respect hesitancy with this, trying to convince them where the Orthodox Jewish people and then the Arab Israelis and they worked very hard in those two communities. Now, the ones who you might call, as we say, vaccine deniers, that's a very small minority in Israel, it turns out overall. And that must have been good to there was less misinformation being released, I suppose, during this process.

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So that was a very I think I think it was a very important factor. I do think it's Netanyahu's leadership they're pointing to now as a key factor here. He does want to get re-elected, of course, the march not to be too political about it, but he's really trying very, very hard to make Israel, Israel top of the class when it comes to vaccination.

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And also so I think on CNN this morning, there was a pregnant woman who was actually breastfeeding and they found at the end of their day that they'd run out of people to vaccinate and gave her a shout. And then she came and got the vaccine. In other words, they were wasting absolutely nothing when they had spare vaccine at the end of the day, because. That's right. Given how it's got to be stored and all the rest of it, if you don't use it, you lose it sort of thing.

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Signs of the huge primacy in Israel that the Weitzman Institute, which which Art Institute twinned with actually at one point, they've got fantastic scientists in Israel and they were pressing all the time and in the media bit like this was to some extent. But there's a fantastic scientific literacy in Israel that we reckon as well, which is another reason why there's been such a huge uptake in the vaccination program.

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Erm now in the UK, it seems like they're going to try and eke out whatever vaccines they have and they've already vaccinated the first man with the AstraZeneca vaccine, which is great news. So they've got two on the go.

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And the idea here being that they'll extend the gap between the first and second shots in order to get more people vaccinated with the first shot.

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Dr. Fauci does not agree with this kind of approach.

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It's a matter of debate, but a at oh, yesterday while I was looking online and various sources was big debate going back and forth among immunologists, for instance, in America as to whether you should use up all the first shot in the hope that the second shot would be produced. You see, now they are there all to shot vaccines. So the question becomes, you know, when should you deploy the second shot? And let's say you use up all your supply and I'm going to say in Ireland.

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We could use up the entire first supply, you see, in the hope that the second supply will come in and then we revaccinated at the 21 day point, you know, now the thing is, is that a risk? Because maybe the second supply won't come and that means it won't be efficacious as you'd like, because there's no doubt that the second child boosts everything, you know. But then with AstraZeneca, there's evidence the first shot actually is quite strong on its own.

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And certainly you can wait 12 weeks for the second time. They've said there's evidence for this now that if you wait 12 weeks, initially they were saying a three week interval between the first and second. Then I was saying you can go to 12 weeks and you'll still see 80 percent protection, which is high, you know, at a 12 week point. Now, they haven't published the paper yet as the usual thing, but the data has to be seen.

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But they're claiming that first shot with AstraZeneca is a very strong shot. Basically, the Canadians part of aside to do it, by the way, they're using up all their supply. Some of the provinces in Canada are saying, let's use up all the supply now in the hope that the second supply will come in on time. They're saying that will decrease cases by 42 percent by the time if the use up that their first batch, if you like.

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So in other words, it's a hot debate at the moment as to whether we should, I guess, burn our first supply in the hope that the second one comes in.

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Now, Pfizer seem to be saying, look, the protocol that we developed in our Phase three testing is, you know, after 21 days, I think in Moderna, it's 28 days, but there are thereabouts. And they're saying stick to the protocol. And Dr. Fudgie seems to agree he does because it's not about the data for him.

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You see, and nobody's tested this yet, say give one shot away three or four months and see what happens. That didn't happen in the trials. Every trial involved a second shot. So it's hard to tell if they have that first shot is fully efficacious after the debate is about. But there is some data there to suggest it is. But but Tony Fauji being slightly cautious is going to hang on a minute. We need the second. The worry is.

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But if you don't give the second shot, the first shot wears off and then you're back to square one and you've got to do it again and then have a third shot, you see. So that's one concern they have at the moment. But it's a debate that's going to go back and forth. I think now obviously, it's just a supply issue. If the vaccine makers can keep the supply coming, then that this problem goes away, I guess.

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And that's sort of the ultimate hope here, I guess.

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So what the the Brits are gambling on, really, is that the supplies will keep coming and that they will have supplies to do the second vaccination when it's due. That's the idea.

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Yeah. They've got they've issued 500000 doses of this AstraZeneca vaccine already that's being distributed. Now, we saw the first case this morning in Oxford. So there's no question they're going to ramp up massively the supply of that vaccine. Now, meanwhile, in Europe, they have to approve that one yet. And the German health minister is now asking the EMA to approve the AstraZeneca vaccine quickly. He's saying, come on, let's get this approved because we need it, you know, to solve this supply problem.

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So our prediction now is that the AMA will approve AstraZeneca. It might take two or three weeks, but then it will be approved and then there'll be another vaccine to have at our disposal.

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Now, maybe you could clarify exactly what 60 percent effective, 70 percent, 80 percent, 90 percent effective means. Does it mean that you vaccinate, say, 10 people? And in the case of 60 percent effectiveness, six of them will get total immunity and four of them for some reason, it won't take.

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Is that what it means? Or does it mean that if you're really attacked badly by a big dose, that it'll get you now that that's what the trials that's are the numbers come to some of the trials.

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But the vaccinated group, there were less people getting infected in that group compared to the placebo group. And then you can do the numbers and then get it, get that idea. Another way to vaccinate is a decrease. Risk is the way to describe it sometimes as well. So you've got a 60 percent decrease in risk of getting it over 90 percent decrease risk is fantastic for the families and that's the way to think about it. Less people get infected and get sick basically if they're vaccinated and a lot of them are are not getting sick, if you see what I mean.

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So if you take 90 percent in the case of Moderna and Pfizer, it means that one person in ten will not be protected according to the stats, which is pretty good because you'll develop herd immunity pretty quickly with mass vaccination. But do they understand the science of why that one person in ten is not protected?

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What's happening in that person's body, again, is this that's kind of a random thing in a way. There's biological variation. Maybe on that particular day that person takes the vaccine and their immune system is a bit suppressed in some way for whatever reason. You know, that's one possible reason. The second is there could be something genetic there that seems to be unlikely. It's just a range of things, really, that that explain this. And most vaccines are like this.

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And I'm like the flu vaccines, only 60 percent efficacious. But that doesn't stop us using it. And as you say, then you do stop the spread because a lot less people now can be hosts for the virus, if you like, and that has a massive effect on spread.

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But now the other debate, which we started before Christmas, was the effect of the new variant and whether or not it is really that significant. We heard Kilcunda Gascoine saying, well, there isn't that much of it in the smallish sample that we've checked in this country. And yet, as they've told us, the virus is rampant. So if it's not that widespread here yet and yet. The virus is rampant. It tells us something about the reason for the spread that is not necessarily the UK variant.

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That's right. It's being debated whether that's the science behind this, but it's still a work in progress. So most most scientists know the evidence. There is evidence in there to say it is more transmissible, about 70 percent more. But still, that's not 100 percent certain. So in other words, it might be the same as the old variant, if you like, in terms of transmissibility. But at the moment, the evidence would suggest that it is more transmissible, which is the big worry.

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Now, that's what's fueling this debate to use up all the first stock, because if it's very transmissible, we've got to vaccinate as many people as we can as quickly as we can to stop the spread of it. You see, so that's what that's what's informing the debate in the U.S. at the moment as to whether all the vaccine should be used. Obviously so. But at the moment, you kind of play it safe and assume it's more transmissible.

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That's the sensible thing to do. But very interesting fact. There's something about him about a week ago that seems to be the new variant might cause less severe disease. And there's an interesting one. So even though it's more transmissible, if you catch it, it may not get a sick man. Again, that's being looked at closely.

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And one reason is that's missing a gene called off a of these viruses have many different genes or if it is a gene that suppresses the immune response against the virus. So if this was missing that you get a better immune response and they don't get a sick no if that bears out. That's a good thing because it may be spreading more, but there's less illness. But it's still very much a work in progress, you see, and it's still not fully tied down yet.

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We can't, in my opinion. But you can't really say that the massive increase we're having in the last few days is only because of this new strain being highly transmissible. That seems unlikely that we don't know the full extent of this new strain yet. By the way, it has to be a combination of our our mingling and mixing around Christmas time, maybe combined with a bit of this new strain. That's probably the reason for this increase in cases.

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Looking back on what we did and didn't do, I mean, we were opening up everything at a time when we hadn't achieved our targets for the the ah rate the the number of people that each contact is infecting. And when Europe was and the UK was closing down. Yeah. Mean it was quite bizarre. No checks at airports even now. No curfews, no quarantines.

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I know. I know. Exactly. It's complicated. But that's about I mean, there's examples in Europe where there was a lockdown there claiming in the UK, by the way, that was quite a good lockdown. And yet this thing spread like wildfire anyway, you know. Now, why was that? Was that because the lockdown wasn't as effective or people weren't going along with the guidelines? Maybe. So these things are definitely more complicated than they were seem.

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But you're right, though. I mean, there's no doubt that our social contacts are the reason for this, hence the reason to stay home. The big card at the moment, as we've heard several times, it's just people just stay home for these next few weeks to get these numbers back down.

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Now, what about the schools? Look, what's your view? Because heretofore they were saying, listen, children don't get this particular the Yonatan's so they can carry on. And if there's going to be infection in school, it's likely to be brought in by a teacher or some of the staff rather than by a child. But then in the UK, I saw a report of an eight year old child, no underlying conditions who died from covid-19 one swallow doesn't make a summer, but it's very difficult, isn't it?

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I mean, closing the schools would have all kinds of knock on effects. So it's very hard when I think it'll depend on the numbers this week, as you know. But day by day, we are looking at these numbers. I don't know if we get to Wednesday, Thursday, Friday, and the numbers are even higher. I can't see the schools opening because that's another risk. I mean, it may not be a huge risk if you reopen the schools, but if these numbers are out of control, which we're hearing is very serious, isn't it?

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Like I can't say, I believe yesterday many of the ministers who were asked are assuming the schools won't reopen.

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So there's heading in that direction, it looks like, in the UK. And the education secretary wanted to open the primary schools, but the unions have said, sorry, we're not doing it.

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Our so, you know, we could be in for a confrontation here, too, if the government does not address the fears, at least, of teaching staff and parents who are threatening to keep their kids home if they're in a position to to do so. And some of the questions coming in. Look, could you ask Professor O'Neill, what is the current wisdom on those suffering from lung covid? Someone close to me experienced first symptoms on 20th of March and is still extremely unwell with persistent chronic fatigue, debilitating respiratory issues and foggy brain.

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For someone in her early 40s, hugely active and never ill, it has totally put her life on hold. That's from Leam.

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It's itself cold. It's so important because this is now what other viral infections you get post viral fatigue, for instance. It's a well known thing actually that's been happening for decades with viral infections. Anyway, it's almost as if you have the virus and your immune system is then reset when you're infected and it doesn't go back to normal and it's on fire, then for longer, even though the virus has gone away and we think it's an autoimmune thing, maybe.

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So the immune system is suddenly now overreacting to your own tissues in some way. And some of the symptoms might be down to that. And people have worked on this for years and tried to find the basis for what Kevin is doing is the focus. And I was really on this because when the vaccine is rolled out and worked through this awful phase, it'll turn into Lanco with it more and more abaqus because there will be people still who have got these persistent symptoms, you know, so it's a massive area of research.

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And let's hope that our insights into covid will yield new treatments and new ways to approach this because it's so serious. Now, luckily enough, I think something like 40 percent plus of people have at least one symptom that persists well beyond the infection. So it's a lot of people, you know, and then there's this sad minority where it's very, very severe, you see. So so, again, we're hoping that we learn from this and then potentially have new treatments.

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Sadly, there aren't any specific treatments at the moment. The good news party is they don't seem to resolve after a few months because obviously we've seen this now for the past year, haven't we? This is virus first emerged six, eight, nine months out. It does seem to resolve a bit sort of something that people are observing.

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But it's such an important question to get our heads around right now at two questions in this next text, one of our listeners, Frank, says, Could an incomplete, i.e., one of two doses of the vaccine enable a vaccine tolerant virus to mutate?

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That's the first part.

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In other words, if you don't Hamrah really hard, could it say, hang on a second, I've got to get find a way around this particular vaccine? And the second part of the question is RNA a more robust basis for a vaccine than, say, the AstraZeneca approach?

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Were the first ones are really important. That's one thing that's worrying people. So you might imagine if you give someone the first shot and the immune system is kind of working a bit and yes, they get infected, that virus might get a foothold in that person's body. A mutant might emerge because it's able to grow and divide in this sort of environment where the immune system puts pressure on it without killing it, if you see what I mean. So it's a bit like survival of the fittest in a way.

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And that's something they're going to look at closely. And that's one reason why Tony Fauji would say, no, definitely give the second dose, because that's a really hammer the virus dead, you know, and that is a concern. And it's not a huge concern dispute among immunologist at the moment as to how serious that might be. But it's a consideration for definitely something that people are slightly concerned about. I don't think it'll affect the debate too much.

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And as I said, the Canadians have already decided to go with the one shot and kind of hope for the best. There's no doubt you need the second shot, but that's the key thing. And it's going to be a question of how soon after the first can you give it and the sooner the better kind of thing. So if the supply issue is sorted, that out might be a bit ambitious, that this won't be an issue because you will see the second shot going in in sufficient time, you think?

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And the question of the different approaches, that's more robust than the other.

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Well, we got this marvellous 90 percent plus efficacy with the orany approach, with two separate vaccines. And these are highly efficacious vaccines. The AstraZeneca one, as you might remember, that they're saying 62 percent with more than protocol, maybe 90 with the other. It could turn out to be as effective. And some of the predictions are now that if they if they'd done it properly, in inverted commas or at least that hadn't made that mistake, they could have had a protocol that would have been as good as the RNA approach.

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So I would think they're both equally good approaches, really.

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Now, the European Commission before Christmas put forward rules on rapid antigen testing and also bought 20 million antigen tests for member states. I don't know how they're going to be rolled out or spread out or sold or whatever. Antigen testing.

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We seem to have turned our faces against antigen testing, which is inexplicable when you hear about infections in hospitals, in clusters. And I would have thought at this stage, every day a health worker goes in, there should be antigen testing, you know, 10 minutes, 15 minutes. And, you know, you're cleared to work or not. Yeah, it is strange for you and you and I've been saying this for a while.

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I mean, it's bit strange that the testing isn't at that level because it's been you know, we were predicting this six months ago even that we should be at that stage and testing for some reason. It's just taking a lot longer. Now, I wonder what is it? Because they're just focusing now completely on the vaccine program and that's where all their energies are going in the HSC anyway, you see, and that's the thing to really focus in on.

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But testing has to be.

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Yeah, what the EU says is considered in particular the use of rapid antigen test in the following situations and settings, covid-19 diagnosis among symptomatic cases, contacts of confirmed cases, outbreak clusters, screening in high risk areas and closed settings. I mean, you couldn't be clearer. That was before Christmas on the 18th of December, and still nothing from our lot.

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I know it's strange. And now the numbers are so high that it's terrible in a sense because it seems as if the numbers are so high. Be very hard to implement that going to look at this, whereas we could have implemented it, let's say, a month ago when the numbers were less, you see. So it's a missed opportunity.

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I got a text from someone who's trialling antigen tests in the home and he says the tests have been more useful than I would like, unfortunately, to with covid in the house, my son tested positive with two antigen tests thirty minutes apart, two days before the first symptoms of loss of smell, he tested positive PCR two days after. The antigen test, my two daughters tested negative on antigen and then negative on PCR, I've had two negative antigen tests.

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So the antigen tests appear to be accurate. Yeah. Yeah, they are. Yeah.

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This is an important tool, important tool. And they've got better and better those antigen tests over the past six months as well. And the current ones that are being recommended and these are the most recommended ones as well. These are very effective tests. So you're right. And I remember we were dreaming, but remember that each household will have 10 tests to it and the postcard thing, you know, and that hasn't happened. So it hasn't happened yet.

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Why is close to schools being discussed when construction sites are still open? And that's a Newstalk listener. Maria in Ruth Farnam.

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Well, these are the big questions that will keep coming up in this phase of the I suppose I mean, you can imagine if the numbers are really bad. As we know, we've had this a thousand times and we've got to double down on everything. Is the great phrase now about doubling down might mean is go back to what it was like back in March, basically where we have a stringent lockdown of everything and just for consistency. So there's some sense in that.

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In our small town, we had record low levels of the virus, but thanks to two separate pubs having lock ins over Christmas with someone who traveled home, we've had dozens of covid positive tests yesterday. All I hear is pubs don't call spreading. But thanks to the pub being open, our village is in ruins this morning. I mean, the idea that pubs, particularly, you know, where they allowed people into the so-called gastro pubs and doors, closed small spaces.

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I mean, you brought us the science on how it could spread and in a restaurant through the air conditioning.

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The sad thing is there's no surprises here, but a respiratory virus will spread in this in the winter because we're all back indoors again. The flu, you know, obviously the common cold spreads indoors because we're all back indoors for a long time together in a poorly ventilated space. That's what's happened here, you know, and it's not rocket science. And then if they combine that with the fact that it is more contagious anyway and then secondly, if there is the NuvaRing that's even more contagious again, then you can see how a single case in a pub with the doors closed and poor ventilation with lots of people in there, over the course of an hour, you're going to see lots of cases emerging.

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And we've known that for months now, you know.

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All right. Well, Luke, and the news, of course, on those numbers and not great if it's less likely to be lethal, that might be good news, but that the jury's still out on all of that.

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One more thing, if you want to say this is very clear, that analysis of the new variants, which was really I read this over the weekend, really detailed analysis. The conclusion is this, whether it's more transmissible or not, we've got to double down on everything now in the next few weeks with all the guidelines have to double down and every bit of energy funding and relentlessness should go into vaccination in every country. Now, that was a killer sentence I saw.

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You know, we know this, though. I mean, look what Israel has done. So the hope is Ireland will be energetic with lots of funding and relentless in rolling out the vaccine. Is the key goal now? Obviously, no.

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Luke Oneal, professor of biochemistry at Trinity College in Dublin, thank you very much for joining us.

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