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That part Kenny Show on Newstalk. As it's Thursday, talk to Professor Lucchinelli, professor of biochemistry at Trinity College in Dublin at the stage. Luke, good morning.

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Now, there's never a day without a covered story. And you want to talk about the United States as colleges have gone back. They go back earlier than we do.

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And already the auspices of four covid-19 are not great yet striking productions, 1400 colleges have gone back and then they've looked at the numbers very closely, 26000 cases of covid-19 across those colleges and 64 deaths already now. Remember, this is in an environment where the virus is running ragged. The community transmission in America is huge. So it was almost predictable that we'd see all these cases. But certainly it's, again, a warning for us. You know, when you reopen any educational institution, there's a risk of outbreaks and spread of the virus again.

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I'm looking at the figures. I mean, 26000 cases, 64 deaths. So 64 deaths in 26000 would be approximately 250 and 100000, which would be 2500 per million. And our rate per million of deaths here is 350 now.

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Now, that's the point. Again, that just shows you that this is a very contagious virus. I mean, if you look, it's, again, kind of an experiment in that is sort of a system where the colleges reopen this are measuring cases and then deaths inevitably follow a number of cases. These are young people dying. That's the tragedy, of course. And some of those deaths are probably high risk groups that might have gone back, you know, when you break it down a bit.

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But certainly it's really alarming. I mean, the University of South Carolina, the universities themselves are perturbed by this, of course. And South Carolina is alarming increase in cases in the South Carolina and Missouri. They're going to test all the students twice a week now and the staff, because they know this is a big risk that they might get infected and pack your old alma mater, Georgia Tech, at 51 new cases. And that's not a very big university, you know, so we're seeing outbreaks in American universities.

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But again, it's not like it is here because the virus is still very prominent in the states.

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OK, well, it is a salutary warning that the virus is no respecter of young people, that's for sure.

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Now, last week we were kind of rejoicing in the news that it looked like you couldn't get reinfected by covid-19. That was what the science was telling us. However, from Hong Kong, we've got a different story, one different story, but a different story.

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It's a striking thing. Yes, this came out and within like a minute it was all over the world. This and The New York Times ran it. And I got 20 notifications of this because I'm following lots of stuff, obviously. So it's a person in Hong Kong, 33 year old, was coming through the airport that got great screening in the airports there. By the way. They screened everybody, which is great. And lo and behold, I pick up the virus in this person.

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This person says, I've had that before. I was sick, you know, a few months back. And then they looked at the virus and I was slightly different to the one that had before. That's the first thing that they knew. It had to be a reinfection. Sometimes you can detect the virus for weeks on end and it seems to be a reinfection with the same old virus. But there's a tiny difference. Now, this strain was almost identical, but this was a mis configured, in my view, by the media.

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This person had no symptoms. Remember, they were perfectly healthy. Now it's a single person. Massive caveats because you can't do science around one person. But you're quite right. This science will keep moving forward. No immunologists immediately said this is a good news story because this person had been infected before and they were protected. So let's say, for example, you had the vaccine to measles, right? You might go in somewhere and pick up a tiny bit of measles of someone and your immune system kills it.

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You know, you may well test positive for measles, but you won't have any disease because you're protected because you've been vaccinated. So in other words, the fact that this person had no symptoms was the more positive side of this. Now, of course, we need to see more cases because it's a single case. There was a report in Belgium as well, by the way, of someone getting reinfected. And again, they had very mild disease, you see.

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So so, again, you can you can twist this in a way that says, look, it's a good one, you know, because the person didn't get sick.

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Only time will tell. But it appears this was a variant of the virus that is found in Spain and your man had come back from Europe. So it's interesting, you know, that it can vary and possibly find a way in but can't do you harm. Yeah, yeah.

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And it's a tiny, tiny difference. But that was the detective work in a way. They knew this person had been reinfected because the virus was a tiny bit different, the one they have before, which they had information on, you see. So that was that's good science. Basically, they could prove then that that was a so-called reinfection case, but the infection didn't give rise the disease. That that's the other part of the story, really.

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Now, the whole question of the mutation being tied to a less severe illness, I mean, it's wonderfully optimistic to believe that that might be so equally a little twist in the the genome might make it far worse. Yeah.

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Yeah, that's that's the that's the fear. And there's another good thing has happened. But there's a study from East Asia in Asia. Again, they have found a variant now that is milder for definite and this is strong science. There's been hints of this, but this particular study looks very robust. And lo and behold, there is a strain of Cavuto out there now that's much milder, which is great. And the reason why they can say this for a particular part of the genome of the virus, the recipe of the virus has changed.

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It's called off seventy eight, the usual awful jargon. But this particular part of the virus is used by the virus to suppress the immune system. And that's what the virus wants to do. Remember to get a foothold. This this bit's a bit different in this strain and therefore the immune system should be able to handle it. Hence, it's a bit milder. But it's good. It's got science because this is the first really compelling evidence that there is a milder version out there.

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Now, there has been from the beginning the question of vulnerable people, including those with Type two diabetes and obesity, is often associated with Type two diabetes, certainly until it's diagnosed and it starts being treated. There is science about obesity.

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Now, there is this this is the worrying one, because obviously, as we've said before, there's massive analysis going on of risk factors and who might be more vulnerable and who mightn't. They spotted obesity very early on as a risk. In other words, if you end up in the ICU, there was a big risk if you're obese. And lo and behold, now a huge number of patients, 30 to forty percent, increased risk of death if you're obese.

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That's a very high, by the way. It's almost like as if if you're obese, you're like you're in your 70s or 80s. That's how much at any age, if you not. I mean, some of their obesity carries the same risk as aging. And this study was very large. But they looked at all these risk factors, age, you know, they even looked at sunlight. Can you believe in certain parts of the world without protective it, a food supply, GDP and by far and away ageing is the biggest risk factor, as we know.

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And obesity came up second. So this kind of confirms the worry. And if you talk to any intensive care doctor, they'll tell you the ones that end up on ventilators or have a severe disease are inclined to have a high BMI, inclined to be obese.

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And this study really confirms that now. And Llamas, what on earth can Lammers have to do with the fight against covid-19?

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Now get ready for some immunology, but this is great. So a strange thing happened about twenty five years ago. Scientists were studying antibodies in different species because scientists like to compare one species to another. And Lammers had a strangely different antibody. Their antibodies are much smaller than a tenth the size of our antibodies, for instance, and still do the same job. And that was intriguing, just a scientific observation that llamas and camels and alpacas there are on the same kind of family, had different antibodies, much smaller temptresses.

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Secondly, they seem to be very potent and because they were small that they could get into places other antibodies couldn't reach, you see. So immunologists began to study these in great detail, and then they began to wonder, could these be used as drugs? Because they're easier to make, because they're a bit smaller. They're very potent. So that's a good thing as well. And this has been going on for the past 20 years or so. And guess what?

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Of course, you could make antibodies in llamas for the Kobe to virus. And lots of companies out there now are making these antibodies. The cull camels, not a funny name comes from Camel. And we have now an antibody that's much easier to make, much smaller and could actually be a therapy for covid-19 and no issue at all about the species barrier and all of that.

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Well, there's great science there, but you can modify it to make it look a little bit like the human antibody because we obviously antibodies are similar between speech, those bits that are sort of somewhat shared. So you can change it into a kind of semi human form and then it won't cause a reaction if you use it. And another example of that is you can put them into aerosols because they're a bit smaller. You can deliver them to the body in a different way.

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Are antibodies, if you like, a bit too big to put an aerosol Okaka through your nose. If you if you use an aerosol, these ones will actually be used in aerosols. And again, a company is developing an antibiotic is the spray. So instead of having to inject it, which it normally do with antibodies as a therapy, because that's to go into your blood, obviously this can be used in an aerosol and they spray it up your nose and the antibody goes into your lungs and kills the virus of the idea.

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The called Arrow nabs great name. That's a trade name for this particular company, of course. But so now they're looking at other ways to deliver these antibodies. There's a massive hope here, by the way. We all think this will be the first big therapeutic will be an antibody based therapy. And we've seen that the convalescent plasma before, monoclonal antibodies before, and these lahmar antibodies could be another option. And again, it's yet another example of a shot on goal.

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So there's optimism that these lahmar of all creatures. Can you imagine? I mean, people say to me, what's this? That Lamis. But they could turn out to be part of the answer to this, I think with they're very highly specialised antibodies.

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The only thing I know about llamas from my time as a child in Dublin Zoo with my father and so on, is that they can spit and they can bite, but they can say they've got one hell of a spit.

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Whether that's got anything to do with what's in their throat a nose is the question. Then you can at the moment they're looking at and nasal sprays, possibly inhalers. Would this have to be a daily application, a twice daily application? You know, it's giving it's targeting the virus.

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But if you were attacked by the virus several times in a day, do you need more of this stuff?

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Well, what's remarkable, antibodies last in your body. If you take a drug, you have to take it every day because your body metabolizes it. Obviously, we call this the Half-Life, by the way, of a drug and we measure that how long it lasts. And the body. Some drugs have a Half-Life for four hours. That means you've got to take them three times a day. So antibodies last four weeks. So a single injection site of an antibody for something like arthritis, because we use antibodies to treat diseases like rheumatoid arthritis, for example, it's an injection once a month because the antibody persists in your body.

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So it's the same. But these and these larmer, it's like as if it's a gift to us from the animal kingdom. These these Lamba antibodies are highly stable things. They can last in your body for weeks on end. So again, you imagine the occasional spray or the occasional injection of the efforts which would suffice. So they see this as a great thing. Now remember the other thing, it could be a prophylactic. So what they're proposing is if you're in a nursing home, for example, the staff would spray everybody wants once a week and that antibody is in their body.

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And if they get infected, then it stops the infection, you see. So so, again, it could be a very convenient way to deliver something that would protect you against the virus as well as treating you if you have the disease in the first place. But we also remember that we discussed the other week about Lilly, the company. Again, the mission here is to give you something to protect you from getting infected. And the antibodies are yet another option that might protect you from picking up the infection in vulnerable groups.

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And I'm thinking of people who have dementia and so on in nursing homes where, you know, administering pills and all that could be quite difficult to be able to just a little spray, which would just come over them for a second or two. That would be wonderful.

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Now, how soon is this company, Aero NEBs, you know, how soon will they get this to market and other really big hurdles to be overcome with the regulatory authorities?

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Yeah, I mean I mean, this company's been kicking around for a while. I mean, as I say, we use antibiotics for all kinds of diseases and now they're considering using lahmar based antibodies. Even for cancer. You can use antibodies to attack tumours, for instance, as well. So this company has been kicking around for a while. What's happened now? But as massive investment into that company, because obviously there's a massive race to get therapies.

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Any company working in this area has now got backers in the US government themselves are investing partly in some of these companies. So so the whole thing will get speeded up. But you're right, though. We'll take a bit of time that this won't be available in the next two or three months for. For instance, we're definitely not going to take time to develop sit at the early stage as other Allama based antibodies are more advanced, by the way, the regular ones that you inject there further down the track.

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So I would predict, you know, again, the timing is always the question, but in these next few months, we may well see Allama based antibody becoming available.

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Now we are in the middle of a very delicate situation. We heard the minister for Health, Stephen Donnelly, referring to a tipping point.

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And the whole idea was that we would get rid of community transmission as best we could. The R number would be down below one, and then it would be safe to open the schools.

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We've got the very opposite because there are a number gone up. Yeah, we don't have the kind of situation ideally to open up the schools, but we're doing it because of other pressures, I suppose.

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Yeah, I mean, we have to prepare for outbreaks. There's no doubt that there's going to be outbreaks in schools that I'd be 99 percent sure of that because it's that in the community now we have to open the schools. As you were saying. You balance the risk, don't you? But it's essential for all kinds of reasons that the schools reopen. But prepare now for localized outbreaks because once it's done in the community, it will be picked up.

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It's such a contagious virus, it's almost impossible to stop it happening. And of course, the measures in the schools, though, will stop it spreading, hopefully. So all the things they're doing is great. It is still a safe thing to do to send our kids back to school. We must re-emphasize that. But just now, if we're smart, get ready for outbreaks and how they are going to be containing to discuss this before with other people.

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But the question is, how do you contain the outbreaks when they happen, the lower it is in the community, the less likely the outbreak is going to happen. And so we've got to keep trying to move in that direction to get the virus right. And look, as we just discussed in America, rampant in the community, outbreaks in colleges and universities as night follows day. So such as something to prepare us for. And the big question is how will they handle these outbreaks?

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And as you know, the kind of discussing that, aren't they? To my knowledge, and I might differ from one school to another, you'll certainly see kids being sent home and having to self isolate and some of their contacts will isolate as well. And we just have to prepare for it. If we're lucky, there'll be less of that. And as time goes on, if the viral count, the community continues to go down, there's less of a chance that you see.

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So it's just something they're going to get very close.

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I hope now our listeners listen very carefully to what you have to say. Look, so this one hour, please ask. Luke had the case in Hong Kong mild symptoms at the time of their first infection. Otherwise, they're just getting maybe the same reaction as they got the first time.

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That's a really that's an important point. Now, the thing of it that there could be other reasons why this person didn't get sick. It could be a low dose of virus, you know, so that's why we've got to be careful with this study, because a single patient, they do think, though, that I think there was a more severe disease earlier and there was a milder version next time. And is that the immune system or does it some other reason and we still don't know is the truth of it.

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But but we like this study because it's the first indication that if you get reinfected, you might you might be you might do better. You know, certainly they were worse the first time. You are definite. At this one here is about diabetic's, I mentioned that overweight tends to be associated with type two. Add this person says I am type one, very slightly overweight, but nowhere near obese.

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So I am of less risk as a diabetic than a Type two diabetic.

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It's sort of a strange with no blood sugar because it turns out if you have lots of sugar in your blood, the virus quite likes that. So there's the high sugar. That's the risk. And in a way, one reason why diabetics are at risk is the sugar in your blood. If you can control that, the risk is a lot less. And you see, if you combine high sugar with obesity, that's a double whammy. And the reason is obesity causes kind of like a systemic kind of low level inflammation in your body.

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And of course, the virus is going to drive inflammation. So you get two punches and that's why these people get really sick. The other thing we think about obesity, but it's not just obesity. Obese people are inclined to have respiratory problems as well. They have slightly more asthma, COPD, respiratory stress, if you like. And again, the virus causes respiratory stress. So, again, you're getting you're getting two hits from the virus there.

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So if a type one diabetic is being well managed and has a slight increase in BMI, that wouldn't be especially worrisome.

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Harvard epidemiologist, among others, has recommended a fast, cheap self antigen testing with an 85 percent sensitivity. This is done with sputum, with the result in minutes. I don't understand why this is not being considered here. More people would know their disease status before leaving the house. That's from Catherine.

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Yeah, no, they were. Look, this has been going on for a few months trying to get an antigen test. And what you're measuring there is a protein in the virus, you see, because the virus will have proteins and you can detect them very easily with an antibody test, actually. And it's a very rapid test can be done in the home. You know, they've been trying to develop those now for a few months. The other test is the picture that's for the RNA of the virus.

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That's the one that takes longer and is a bit more tricky to do. You see, so so the big hope was to develop an antigen test. Yeah, that's true. There's some of them now. There was this literally overnight. One was announced as being highly effective and highly sort of sensitive. And so there will move in that direction. But of course, if you've cleared the virus, then it's gone away. There's no more antigen to detect, you see.

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So so it is all about the timing of the test as well. But antigen testing is a very important thing to develop. Can you ask Luke to clarify the effect on the brain from covid-19, his information on Monday was very worrying for me as someone who had covid-19, what should one do medically to find out if they're at risk from the effects on the brain? That's from em. It's hard to predict.

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I mean, again, it's just based on symptoms. So what they've noticed is people will have fatigue and that can be a brain based thing. They can have this thing called brain fog. And, you know, this happens in other viral diseases as well. It's not unique to cover, but obviously there does seem to be prominent in. But not everybody gets it, by the way. But but still, it's just something you got to keep an eye on.

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The kind of symptoms are inclined to be this sort of thing like fatigue, very disturbing for people. Obviously, the more severe end of the spectrum, when people are getting sort of real injuries that are very rare, thankfully.

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But a lot of people are reporting these brain symptoms and got just going to keep an eye on them, I suppose, as some of them, you know, may just go in time like any post viral condition. My daughter is a kidney transplant recipient of seven years now. And on immunosuppressants every day, she's going into fifth class, will be wearing gloves and a mask. Should we wait a couple of weeks to see how the spread of the virus pans out before we send her to school?

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Very worrying times that some Garrett and lots of people are in that category when they're worried about their children because they might have preexisting conditions. I mean, the advice would be if the child is generally healthy and, you know, reasonably, you know, sort of their constitution is good and so on, then send them back and just keep a very close eye on it. If the child develop symptoms, then you want to get them out, you know, and obviously look at what you would anyway, I guess.

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But I think parents of children who are in a vulnerable group have to be especially cautious. But I wouldn't keep them out of school unless, you know, what other health problems correspond with the question about immunosuppressants.

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You know, if your immune system is being suppressed, does it suppress your ability to fight the virus?

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Yeah. Would that would be in a vulnerable group, you see so.

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Well, as I say, if the child is generally healthy, back to school and just keep a close eye on it and ask Luke, please, about ivermectin. We talked about that before. That's Tom nine wants to know any developments there.

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Yeah, and that's another we're waiting for. I think the big thing in a way to remember all the something like twelve hundred trials, separate trials, running with different things, still running because it takes time to do these trials and ivermectin is in that category. So, again, we're waiting to see what's going to happen with ivermectin. There's a massive still interest in that, by the way, because as we discussed before, it was predicted to show great promise.

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But again, we're just waiting. It's the usual waiting game by waiting for the trials to read out.

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Why did it take another 100 years for a pandemic, you know, 1918, 2020?

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Well, there were other pandemics. It flew had three of them, not as big as the 1918 one. By the way, the Asian flus that you might remember, the 50s, there was one, for example, that one of the 60s. And then, of course, there was the swine flu. So there have been other smaller pandemics burning away. And we got those under control, of course, by the way, because those particular viruses were easier to contain.

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The reason why this one is so troublesome is the asymptomatic spread. That's the key pernicious feature of this virus. That's people spreading it and they have no symptoms or the ones you'd have a symptom and then spread it. You can stay home because the symptom, you know, so that that's why this one is especially sort of tricky because of this asymptomatic aspect before they have another pandemics concerning school buses at full capacity, no social distancing possible.

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What does Luke think that's bad for that? I mean, we know from the epidemiology, the buses were places where this virus transmits. If you're in a stuffy bus full of people with the windows closed, that will spread the virus. And that's been shown in several studies now. So so buses, good ventilation is very important on a bus. And then the less people, the better. Basically, you know, if you can and of course, mask wearing as critical as ever, you know.

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So if you're on a bus, it isn't massively overcrowded. You're wearing a mask and not for too long. Long bus journey journeys increased the risk as well. Lots of ventilation then. They're pretty. They're pretty. They're pretty reasonable things to do. Can you ask Luke about cross contamination from mask wearing, there have been mandatory for a couple of weeks now and we've seen a rise in cases instead of a fall from being a city. Every day, I see people constantly touching them and then touching items in shops.

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Also, they seem to be just another accessory now with people putting them on on risk and upper arms when not in use. Roads also littered with use masks impacting the environment. Sorry for the rant, but I just feel this is a serious issue that's leading to a bigger risk of the virus spreading as the most important measure of hand hygiene is being forgotten, as some really, really got.

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I mean, the one thing we all said, masks are part of the strategy. You can't wear a mask and think you're bulletproof. You've got to keep observing all the other things. That mask is just another weapon to use among many you see. And again, the science supports this, which is great. But that's a really good point. You know, you got to follow the guidelines. That's the usual thing. There's guidelines how to wear a mask.

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You'll see it on the Hajazi website. And it's straightforward. But just wash your hands, put the mask on. Do go about your business. Come home, take the mask off, put it away. You know, wash your hands again that they won't be fiddling with it and they'll be hanging around your neck and wear your nose in your mouth right in front. And then there you do see masks as a letter now, which is terrible, isn't it?

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So people just need to be aware of how to handle masks properly.

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A commentary spitting on the street is disgusting. I've been walking up the street and on a few occasions a man will walk past and spit. We need to introduce a law against this. Joggers and pedestrians are both at fault, but it's been mainly men doing this. So I think there might well be a law. I'm not sure because there used to be on the buses.

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Schluter Mishka, you can't spit on the bus.

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Luckily there's no lamb, no llamas on the buses. They'll be spitting everywhere I they there of. That's the question of at the rate of infection and exposure done in Ireland.

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I seem to remember something a while ago that's from a listener.

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And I'm just wondering, we seem not to be given the kind of forensic information that a lot of people would like to have about.

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You know, we've got 95 cases in Dublin. How do they arise? Did they arise from a well-known case where someone did something, either went on holiday somewhere or went to a factory or, you know, where there was a case or went to an institution where there was a case? We don't seem to know enough, really.

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The epidemiologists, they love this data. You see. Where did you catch it? How did you catch it? Where was it spreading those kinds of questions? And obviously, they've got that kind of data that drilling into it. It takes a lot of diligence to figure out exactly where somebody was and so on. But there could be more information released. I think that would be useful to us already. And give us give us more of it at this stage.

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But you could give it good to give a good account of the Irish kobun experience. And they're doing that.

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I'm sure they've got this date and they're very careful with their report writing and citations. Correct. So you could see a really detailed account of the history of this virus in Ireland and have threat of spread from the U.S. But in America, there was a single conference in Boston which gave rise to 20000 cases because there were several cases at the conference and it spread among them all. And next thing, they can track 20000 cases to that conference. That's a very useful thing to know.

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It means you got to avoid conferences but to start to see. So we could do a similar thing in Ireland for Daphne.

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All right, look it.

[00:24:19]

Science never sleeps, as you often say. And every day, every night, more developments. We'll hear more about them on Monday. But for the moment, Luke ONeil, professor of biochemistry at Trinity College in Dublin, thank you very much for joining us.

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