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[00:00:08]

Hello and welcome to The Stand with Amy Dumphy.

[00:00:11]

The stand is proudly supported by Tesco and Tesco, our exclusive ours for over 65 family carers and extremely medically vulnerable customers are every weekday, Monday to Friday, up to nine a.m.. Health care and emergency services have priority access at all other times now more than ever. Every little helps. Now we have received a serious setback in our struggle with the coronavirus and the acting and chief medical officer, Dr Ronan Glynn has expressed deep concern and has stressed that we cannot go on the way we are going on.

[00:00:53]

The numbers are very, very concerning. Two hundred new infections reported on Saturday, 66 yesterday. We have more over the last 14 day average, higher rates in the UK and Germany and 770 new infections in the fortnight to Saturday. 82 percent of those infections were in people under 45. All of those numbers are worrying. And we're joined now by somebody who has expressed concerns and more or less predicted we would get into trouble if we didn't be more rigorous.

[00:01:38]

Estamos Ryan Thomas is associate professor in the School of Biochemistry and Immunology at Trinity College and also at the Trinity College Institute of Neuro Science. Thomas, you have told us on a number of occasions on this podcast that we were living dangerously. What do you make of the latest figures and the way this is playing out at the moment?

[00:02:09]

I'm very concerned about the current situation during the current numbers. The rate of increase across the country rate an increase of positive cases is very concerning. And the deputy excuse me, the acting chief medical officer, Dr Onin Glenn, has been unequivocal in expressing his own concerns that we now have a large degree of secondary transmission going on in the community. We have a consistent degree of community transmission. That means transmission that we don't know the origin of in the community and a lot of other cases that are under investigation, which means I'm actually not sure what it means.

[00:02:58]

But to me it also means community transmission until they've been until the source has been identified. And the I think it's clear that, in other words, that unfetter being as strong as they can be in communicating their concern for the current situation and of course, and are operating with more information than the rest of us. Meantime, an independent scientific observer. So I work with the data that's published by the agency and the Department of Health when I'm seeing what's going on and that are working with far more information because they know what date each individual has samples, who their contacts were, how long it took, and they have a lot of information that we don't have.

[00:03:43]

And they have their own modelling which which isn't completely transparent. So so they have a degree of intelligence about what's happening that the broader scientific community in Ireland doesn't have. Yes, they are. They're concerned.

[00:03:58]

Let me be clear about where you're coming from to us. And there were a thousand physicians and scientists who signed a letter to say that we needed to eliminate this virus.

[00:04:10]

You also were invited to give a submission to the Iraqis Health Committee, and you are part of a group that urges caution and that believes we have made mistakes and are continuing to make mistakes. And in fairness to you, you didn't you were saying this when the numbers were really low, when we were down to single figures and in infection's day by day and no deaths, you are still insisting that there were things we needed to do that we were not doing and that there would be a price to pay.

[00:04:54]

And dangerous was the word we put in one of your headlines. And of course, you did say to us about a week ago that the next 10 days were critical and now we're here at. I want to and also we need to ask you about the schools, because kids are supposed to be going back to school next week and in this and shall we say, heightened a situation, it's really quite febrile at the moment. People are worried, but people are misbehaving badly.

[00:05:31]

We saw something on social media at the weekend about the Berlin pub in town and but also from my own observations at walking around, living close to the city, young people in particular are behaving badly and irresponsibly.

[00:05:51]

Does the number. Eighty two percent of new cases on the forty five resonate in any way? And shouldn't they be told of the health consequences of not dying, but perhaps on your heart or other vital organs?

[00:06:09]

The number of people under forty five getting infected is is expected in many respects because these are the people who are most social and they're most exposed. They have the most contacts. They tend to not be at risk of death. As we've discussed before, they have a huge degree of risk for comorbidities. So things that damage you that are not going to kill you. Most people who get infected with this virus, even if they're asymptomatic, end up with scars on their lungs.

[00:06:38]

We don't know how long they last or what the effects is. And it's a multisystem disorder. So it affects people in all kinds of ways. And people have covid-19 symptoms in an acute sense that can last for months and that can interact with other conditions and cause of their condition. So it's a nasty disease. I don't want to get it. I will not be looking to to expose myself to this. I don't want to live in a community that is in any way either passively or actively heading towards herd immunity.

[00:07:08]

But there's just two points to to make on this beyond the risk to young people, which is still there. And we can talk about risk to children when we get on to schools. Yes, but the the issue is that young people are more likely to cause super spreader events. So a lot of transmissions of covid-19 are caused by a small number of of of people who at their most infectious time are in the wrong place at the wrong time and contribute to a super spread event.

[00:07:38]

And young people are most likely to do that. But when it comes to how we interpret this, there's been some misinformation going around that has unfortunately, unfortunately entered a very high level conversation amongst even our politicians, amongst our leading politicians, which is a kind of complacency with the idea of young people getting it. Yes, because what they say is it's OK that young people are getting it because the death rate is low. And if the death rate is low, then it's OK.

[00:08:13]

And and this this feeds into some ideas that are floating around, which basically amounts to conspiracy theories about covid-19 becoming less infectious. There is no evidence that this is becoming less infectious. There is no evidence that this is becoming less patha path, a pathological, less disease causing. And what we're going to see in the coming weeks is that the hospital, ICU rates are going to increase and eventually the death rates are going to start to increase, too, as it starts infecting more older people and more vulnerable people.

[00:08:46]

So it's the same virus. It is the same degree of risks to the population. And it is completely unsurprising that at this point in time we would have had a low death rate. Now, stepping back and looking at the bigger picture of how we got here, how we got to the stage where erm you use the word predictions, even earlier you said about how different people, including myself, have predicted where we'd end up. But a prediction is, is almost a flattering term because of prediction basically requires a certain degree of skill in in, in figuring out what's going to happen despite uncertainty.

[00:09:27]

I don't consider it to be a prediction. When you're standing in the middle of the street and there's a lorry coming at you from the other side of the street, if you stay standing there, the lorry is going to hit you. You could call that a prediction, but I wouldn't call that a prediction. I'd call that a certainty. The uncertainty is when exactly is it going to happen? Yes. And how bad the damage is, is going to be when it happens.

[00:09:50]

Now, what happened with the whole covid-19 saga in Ireland? If we were to summarize it in a 90 second or two minute summary, we had it enter the Republic of Ireland, probably in. Jan, we've had community transmission since early February or late January, and as we got into early March, it started to grow exponentially in the population and we were beginning to see this, even though testing was not very good back then. And then we locked down after closing the schools in March and the lockdown did what we knew it would do.

[00:10:32]

People complied very well and mistakes were made. But we suppressed the virus. We flattened the curve. We did not crush the curve. We flatten the curve. And then we came out of it and then people were essentially distancing. We didn't have good mass usage, but that came along after a certain amount of time and cases were low. There were very low. In fact, they were so low we could have eliminated the virus back then in Ireland.

[00:11:00]

And people did become complacent, including our leaders, I think became quite complacent that that things were seemed to be manageable but wanted. But it was always predictable. It was always clear that if this virus was left unchecked in any country, it would lead to a surge. It was always clear that a lockdown, if enacted properly, would flatten the curve. And we did that. And it was always clear that there would be a lag time after that where things would be OK that the virus wouldn't have built up in the community.

[00:11:33]

Yes, yes. As I said, this started in January. But we but even without social distancing, even in winter, we didn't accumulate enough of the virus in the population for it to go exponential and until March. So in summer, with social distancing and improved hand hygiene, it was completely unsurprising that there would be a few months where everything would be on an even keel just by coasting, just by just by going along and essentially living off the fumes of the lockdown and the gradual easing of restrictions.

[00:12:06]

We definitely became complacent as a population in that point in time. I'm not too worried about people's behavior in the way that you are. I mean, I am. What happened in that bar in central Dublin the other night was was egregious. I do see incidences of people not behaving very responsibly. I see a lot of people where I live not wearing masks, and these would be people in their 30s and 40s going about their business. So personal behavior is not perfect and it's a problem and it needs to be improved.

[00:12:40]

But I also feel like there is a lack of the attitude of the public in general is guided by the media, has not been one of caution. And we move through the summer without the primary conversation being how do we prepare for the winter? The main conversation has been, can we go on holidays? And what about the green list and what about pub reopening? And these are the questions we've been having. The the conversations have not been about how do we make hay for the winter?

[00:13:15]

And many people, including myself, for sort of opening, hoping the government. We're doing that in the background and we're not we're not doing the usual PR around it there. We're not trying to put their best foot forward in terms of perceptions, but we're doing the real work in preparing for the winter. And more and more, it seems to me that that has not been the case. Our testing situation has not improved. We don't have a plan in place for schools.

[00:13:43]

Now, what's happened in the past few weeks. So we are moving more, zooming in on what's been happening in the past few weeks within the context of the bigger story is that about two weeks ago, we started to see that we were having outbreaks in clusters, principally in the Midlands, and this was always going to happen. Also, even if you had everything under control, what happened two to three weeks ago was going to happen. You're going to see spikes.

[00:14:13]

And the question was, how would we respond to them? How would we deal with them? And it was clear to me and many of my colleagues that the period which was the last ten days was going to tell us an awful lot about how we would be prepared as a country to deal with those spikes. And that would tell us whether our test based isolation infrastructure went under pressure, might be able to step up to the mark and actually prioritise things locally enough to to get things under control and give us confidence that we had active suppression measures in place to take care of business.

[00:14:52]

And what we saw was surprising in some respects. In one sense, I'm impressed with the government's response and I'm impressed that local lockdowns happened because I thought. Regionalised approach was appropriate. I think it's very good that we have a regionalised approach in Ireland and it's very good that we can implement it. So that's all very positive. But I never anticipated that in that 10 day period, local lockdown's would be necessary. Local lockdown's, though better than national lockdowns, are still, I would consider to be an emergency reactive procedure.

[00:15:30]

You keep it in the back pocket in case you need it, but you shouldn't have to use it. And this situation was preventable, particularly with respect to the Midpines. So it was. So I'm left with a view of the last 10 days that have we taken care of this situation is the first question. The answer is I don't know. It more and more doesn't look like we have it looks like this is getting out of control. We don't know if the case is increasing around the country.

[00:15:58]

Came from those three counties. Probably they didn't. But it's not clear to me that even those local lockdowns have managed the cases. What is worrying is that the government would not have enacted local lockdowns if they had confidence in the Testarossa isolation infrastructure. If they knew that this could they could take care of it by another way. They would have they didn't. They made a decision to go for local lockdowns. And since then, our testing and tracing situation has slowed down.

[00:16:26]

Yeah. So relative to ten days ago, it's now taking longer for people to get swabbed. It's taking longer for people to get tested and it's taken longer to contact trace people. So we know that this system is not able to perform under this degree of stress.

[00:16:43]

And the orate is the last I heard up around one point six, having had it as low as zero point zero six and a few weeks ago. And that is significant, is it not? Very significant, yes.

[00:17:01]

So the orate gives us an idea of how much the virus is multiplying itself. And just for perspective, in the UK and the UK is not a model for how to deal with covid-19 at all, but they're having a conversation at the moment about whether they should be opening schools because their rate is approaching one and we have been consistently above one. And that's averaging across the country. In local counties. We have we probably have much more dramatic situations, but we don't have that data publicly available.

[00:17:28]

So we are in what I would now call. An unpredictable situation, so everything from March to everything from early March to about two weeks ago was entirely predictable. That story was always going to happen. It was just a question of when everything happened. Now, we have entered the really unpredictable phase of our story in this pandemic, which is that from here, anything can happen. And if we keep going the way we're going, it's only going to be bad news.

[00:18:07]

We don't know how bad. We don't know how quickly. But we're basically now if based on based on testing numbers, based on the rate of increase, we're back where we were in early March, not just in total numbers, but in the rate of increase. So back in back in early June, when many of us started to advocate for elimination, for going for a New Zealand result by a different method, but but going for the New Zealand result in Ireland, we made the point that we had the same case numbers then as we did in early March.

[00:18:40]

And we had essentially traveled back in time to early March. And we had we had we had a choice to make. But we also recognised that that was the stated case numbers, because we knew that in June we didn't have the rate of increase in case numbers that we had in late February and early March because we were still coming out of lockdown because of social distancing and everything. But now we're in a situation where we have far more case numbers in early March.

[00:19:06]

But we also have the acceleration, we have the acceleration of the curve. So it's it's a very troubling time. And the reality is we are on course to open the schools in two weeks. So we need a plan to at least mitigate for that. And currently it feels like that doesn't exist.

[00:19:28]

Now, there are a number of questions I want to ask you. One is about the two hundred cases that were reported infections on Saturday and. Basic arithmetic, how do we know roughly how many? People were infected by the two hundred infected on Saturday. I don't know if the government has more information on that.

[00:19:57]

I certainly don't think we, the public know it's troubling, is it not, that 200 people were walking around, presumably infecting others?

[00:20:08]

Yes, because once you get symptoms, you've been infecting other people potentially for two days before that. And because they're unfit now, admit that we have secondary transmission now. We're getting webs of people infecting each other. Yes. And more and more, we're hearing anecdotal stories of people waiting days and days for tests, even though they were a family member of someone who tested positive. Yes. And so on. And the entire process was never, ever fast enough at the best time.

[00:20:36]

A couple of weeks ago, it took three point one days to go from GP referral to contact tracing all contacts. And you have to add on then the time for get getting a GP appointment in the first place or getting on to your GP to get the referral because it starts with when you have symptoms and now that's extended. Now it's taking longer to get swabbed, it's taking longer to get tested and it's taking longer to for contact tracing to happen.

[00:21:03]

So the wheels are coming off the cars of the test trace isolation machine, which in itself was not fast enough and in the first place. So we don't have that weapon working yet to contain sars-cov-2 transmission in Ireland. We only have it as an indication of the rate of acceleration of cases. So our weapons are masks, hygiene, social distancing, of course. But it seems to me and this is a worrying thing to say, but it seems to me the only weapon that the government have at its disposal right now is local lockdowns or increasing restrictions for the entire country.

[00:21:44]

The let me ask you briefly about the meat cuts. It seems to me, given the working conditions in those plants, the fact that many of the people working there were in direct provision or or were foreign nationals and the fact that they had no trade union representation and therefore couldn't agitate for proper health conditions, it is impossible to work in the meat plant, apparently, and social distance. Shouldn't we have spotted that in any assessment of the covid pandemic months ago?

[00:22:28]

Yes, and there was precedent for this because in Germany, they had outbreaks in France, too, and they learned how to deal with this. I can tell you that many of our leaders anticipated this in Ireland, even without the German example. Yes, it doesn't take a lot of knowledge about the virus to understand that environments like that, where you have a lot of people working together in colder, confined and noisy environments, that this is somewhere where you have a high risk of transmission.

[00:23:01]

And if you send those people back then to a direct provision center where they're living, they're going to infect others. Absolutely. Where you go? Absolutely.

[00:23:12]

I mean, it's one of those cases where it's just not rocket science. Yeah. I mean, it's a it's a situation that you're almost engineering the problem if if you let it happen. The solution to this, of course, was to have very rigorous inspections of the meat plants with a covid-19 perspective. That wasn't done because we learned that inspectors were worried about their own exposure to covid-19.

[00:23:35]

Well, I can also I can also tell you, Thomas, that the thirty nine meat plants that were checked of those thirty nine, 30 and were given advance notice that they were going to be checked, it's something I read about that.

[00:23:53]

Well there is, you know, there is we have to reinvent the way we do things on, on those kind of measures. So the problem with how we do many things in Ireland is that we know that many of our bureaucratic ways of doing things, if you follow them to the letter of the law, would not allow for people to be productive in their jobs. So people find this sort of accommodation between what you need to be doing to be getting on with work and what we need to be seen to be doing as as things are as things are evolving.

[00:24:28]

So, you know, as a country that has been catching up with the European Union and catching up with much of the world because we've had such a fast growing economy, this was seen as a necessary evil. The balancing of bureaucracy that was unworkable with with kind of turning a blind eye to things you could get on with your work. And in some in many instances, that was a sensible approach. But in many instances it hasn't been a sensible approach.

[00:24:53]

In general, in the last 10 to 20 years, there's been a huge amount of human cost to this sort of attitude. And with respect to the pandemic, with respect to covid-19, there's no room for that attitude. We need to be doing things the proper way. But on the subject of meat plants, it's not just about inspections, it's about preventative measures. We should have been testing all of them regularly. All Dupont employees should have been tested every week as they have been.

[00:25:20]

One thing that the government did, which I thought was extremely progressive and was that they tested health workers every two weeks for a period of time following recommendations from a number of sources. That's not happening anymore because they're repurposing, obviously, their testing priorities now. But it will have to start happening again, because if you test health care workers every two weeks, you significantly reduce the spread in the health care environment. Everyone wins. The same is true of places like meat plants.

[00:25:52]

If you test everyone there all the time, then you you know, you have control over the situation and it's very doable. You just have to have the will to do it. So I think that the meeting situation was was preventable on many, many fronts. But for the people of in those areas, it's I mean, we can pretend this was not inevitable if you're in Kildare or at least you're awfully if this had been done the proper way, you would now not be under the soft lockdown you're under.

[00:26:22]

OK, now, the question of schools is on most people's minds. It's widely discussed in the media. In fact, it's impossible to turn on radio or television when there's a news bulletin and not see a discussion about the schools. And that's just not Ireland. It's everywhere at tomorrow's.

[00:26:46]

Can we we open our schools and in the present circumstances and be sure that. It is a safe. Environment in which to work, whether you're a janitor, a teacher or indeed a child, no.

[00:27:10]

And there's evidence from the United States that I saw Dr. Anthony Fauci talking about and which suggests the possibility that 45 percent of children may be asymptomatic. I don't know if you are aware of that and it may be irrelevant. And how are we going to open schools in the present environment?

[00:27:37]

So this is the most emotive issue, I think, for many people. How do we open schools in the coming weeks? I have to say, I'm very, very biased on the topic of conflicts of interest here because I have two young children and I want them to go back to school because it's important for their education. It's also important for their social organization and their mental health, certainly also because I just want to be able to work normally. Yes.

[00:28:04]

And it's important for me and my partner that we're able to work normally. So schools have a central function in our society and you can multiply that across a lot of the population. So on top of that, I'm I'm I'm an educator myself because as well as being a scientist, I lecture undergraduates in university. So I value education hugely from my perspective. It's the central thing that we do as a society. And I think it's I put it up there on the same level as health care.

[00:28:37]

Yes. It in a way, I put education as being more important in some respects than health care, because it's about the quality of life for future generations at the same time. We are in this situation and we have to manage this, and, of course, we have to balance the importance of schools with the risk of opening them. And Aymond with everything that surrounds covid-19, whether it's schools, whether it's the economy, whether it's just the rules of social distancing people to say we need to balance the risk, we need to manage the risk.

[00:29:17]

And they are often very vague on what that risk is there. The people who are saying we need to open up the economy as soon as possible as a priority to be concerned about how we manage covid-19 they can be very, very vague about what is the risk they're willing to tolerate. Yes. What are the what are the numbers that they're talking about in terms of the risk of infections? They don't know how to calculate it, do they?

[00:29:43]

I mean, most of the people I listen to in on media don't know how to make the calculation. If you don't really understand the virus and how it's transmitted, you're not in a position to judge the best guy, you know.

[00:29:57]

But but you can talk to people and there are the core facts, the known knowns that everyone is comfortable with. And then there are the unknown stuff. And scientists and medics are always very happy to to distinguish between the two for people. So, for instance, one of the core known knowns is that sars-cov-2 has an infection fatality rate of about one percent. Yeah, that's holding internationalising one. An average one percent of people who get infected with this will die.

[00:30:24]

And that's assuming the health care system is not overwhelmed. But going to the question of schools, the mortality rate for children is is so much lower. So according to the European Centers for Disease Control and studies for children are are not as plentiful as studies for adults because in general, schools have been closed for most of this pandemic and general children have been shielded from being infected. And children do have weaker symptoms and are much less likely to have to have to have to be admitted to hospital or to an ICU.

[00:30:57]

But it does happen now. According to the European Center for Disease Control, point zero three percent of children who are infected will die. Now, that's children as people who are under 18 years of age now, that's very low compared to one percent. So if one percent of the general population will die and it's above 10 percent if you're once your older point, zero three percent for minors. Now, I know this isn't the primary issue when we talk about opening schools, because there's three different types of risk we need to be concerned with.

[00:31:34]

We need to be concerned with risk to students, risk to children. We need to be concerned with risk to teachers, of course. Yes. And then we need to be concerned with risks to the population, which is the main issue we need to be talking about. But just dealing with the first one briefly, because I think this needs to be put on the table for anyone who wants to let the virus rip through the population for herd immunity.

[00:31:58]

Now, letting the virus rip through the population to get the herd immunity means sixty five percent of people need to be infected, at least maybe more. And it hasn't worked so far because even in countries like Sweden and the UK, which have either fully or partially gotten at one point or another for herd immunity strategy, in the end they end up with a very high death rate. But only about five to seven percent of people have been infected. So they're nowhere near herd immunity.

[00:32:24]

But if you do go for herd immunity strategy, the attitude is, well, let the younger people get it because it's better to mop up that sixty five percent of the population with as much young people as possible absorbing the virus. So imagine that we had every person who was under 18 years of age in the Republic of Ireland infected with sars-cov-2. That would lead to one hundred and eleven deaths in that age group. So if we went for herd immunity, we're going to kill one hundred and eleven kids.

[00:32:57]

Now, some people would say, oh, but most of those one hundred eleven kids are going to be teenagers. Yes, most of them aren't going to be infants, some of them will be infants, five and six year olds, but most of them will be teenagers. But we're talking about one hundred and eleven kids. Yes. Now, for a reference point, you need to think about how many children were killed in the worst days of the troubles.

[00:33:20]

Yes, and you're dealing with minuscule numbers in comparison. So that's what you're talking about and that's what we're facing into. If we keep going the way we're going and the tiniest Leo Varadkar has said we may have to go for herd immunity, that's that's what we're facing into now. That's just the mortality rate. Children are also susceptible to morbidity. We don't quite know what it looks like yet. We don't quite know some. Some children have neurological symptoms, but it is a small number.

[00:33:52]

So we just haven't had the opportunity to observe it yet. It is, however, clear that children are at far less risk to this virus than adults are probably. And I say probably because we haven't had enough time to observe it.

[00:34:05]

Yes, I understand that. But the way they can spread the virus and they can give it to teachers, they can if you like, it can circulate within the community they live in, kind of not through their parents or through their grandparents. Yes. And that's something we haven't simply been able to evaluate yet. Isn't that the case?

[00:34:32]

Yes, that's that's the key thing. So risk to teachers is obviously the same for as the risk of anyone else to that age group. Yes. And the attitude is, of course, is that teachers are essential staff like doctors and nurses. I suppose I would have sympathy with that attitude, provided that teachers are provided with appropriate protection and support in terms of the infrastructure, how schools are operating and exactly. Yes, and that's not happening adequately. But when we talk about the structure of schools, I think we can get distracted, like the physical distancing measures within schools, which is very important.

[00:35:13]

And it's very important that we look at Denmark and we look at South Korea and we look at schools that are really doing this very well. But how we manage an individual school is secondary to the issue of how we manage the population. Yes. And this is this is the third aspect of risk, which is the risk of schools to the population in general. Yes. Now, the the issue with schools is if you accept the risk to children as as a given and you accept the risk to teachers as a given, you're left with a situation of is the school going to cause any problems for the wider population?

[00:35:50]

And we've seen how it can. We've seen Israel where they flattened the curve arguably better than we did. And then they opened up their schools. And in one school, they had an outbreak of more than one hundred and thirty cases. This happened in multiple schools. And then they ended up in the second surge that was worse than their first surge and was on par now with the United States. Right. We've also seen major outbreaks in many local places around the world, such as in it in Georgia, in the United States, where at a summer camp, yes.

[00:36:25]

Over seventy five percent of people had got covid-19 and many of the staff were tested beforehand. So they were they were operating under restrictions there that were far more nuanced than we have in Ireland. They tested all the staff before the camps started for the summer camp started, but they didn't test the children and the staff were required to wear face masks and the children weren't. And within two weeks, 70 percent of them had covid-19. So that just shows how quickly it can spread in a school.

[00:36:54]

And then the question is how that affects the wider population.

[00:36:56]

The question that arises here is why we're not discussing this. I have heard at numerous discussions on radio and television in Ireland and indeed in Britain, and this these facts and these realities have not been approached. They have not been talked about.

[00:37:16]

So we've had a historically fraught discussion about children and covid-19, particularly in Ireland. And it just got off to a very bad start in March. Everyone agreed to close the schools in March. That was clear. Then the question was, would we open them before June? And that didn't happen. This led to a lot of polarizing discussion which which people didn't really have an appetite for, because national unity is important, because social cohesion is important. And it got very personal, I think, for a lot of commentators.

[00:37:54]

I think on fairly personal in both directions for for a lot of journalists and a lot of people representing teachers and so on. And it was partly because there was a lot of unknowns at the time. We didn't really know a lot about covid-19 and children. And the thing that was clear even as early as March was that children seemed to be at lower risk. And this kept us all sane at the beginning of the pandemic and certainly helped me stay sane when understanding that my children did not have a two percent case fatality.

[00:38:29]

A one percent infection fatality rate, I mean, that made us all, I think, able to manage this as it was happening, unfortunately, then that was extrapolated in the direction of thinking that therefore children would not transmit it either. Yeah, well, that's foolish. And it was always foolish because we knew about asymptomatic transmission early on and we knew that half of even adults who have this were likely to be asymptomatic. And it did not help that nefesh were in denial of asymptomatic transmission in general for a long time.

[00:39:02]

And that's on the record that they were stating that they didn't think asymptomatic transmission was happening when the international evidence was unequivocally clear that it was happening. And so people were hoping that because of this and because children seem to have slightly less of the particular receptors, you need to be infected with sars-cov-2 that maybe children weren't having it. Then you had other people who are saying, well, what if children are silent spreaders or super spreaders, which people got very defensive about?

[00:39:32]

And you ended up with this polarized discussion that that didn't have a lot of facts in it. And that kind of is the background to how we consider the issue of covid-19 in children. But now we know a lot more and we know a lot more about how children carry the virus, how likely they are to be infected and how likely they are to be infected others. And there's also things that we still don't know. So if I was to summarize very quickly, what do we know?

[00:40:01]

We know that all children of all ages can be infected with sars-cov-2. The fact that children have less of the receptor is just incidental. You know, children have smaller bones in their body, but they can still get bone cancer. Yes. So the yes. Children have lots of of of two, but they they still get infected. We don't know exactly how easy it is to infect children. We don't know exactly how susceptible children are to infection because we don't have enough data of children being exposed to it.

[00:40:36]

But it looks like it's at least a third as likely as adults. So the children are at least thirty three percent is likely to be infected as adults. And some studies indicate that they're as likely to be infected as adults. So children are somewhere between a third and fully is likely to be infected with sars-cov-2. If they're exposed to it as a normal adult is, then we know that once they're infected, they carry an equivalent amount of viral load.

[00:41:06]

So you if you take swabs from from children of all ages and then you extract urine and you ask how what is the viral load of of the sars-cov-2 virus in that individual children from ages five and over carry just as much as adults and children under five seem to carry up to ten times as much as adults. However, those children who are younger seem to shed the same amount of viral particles as as adults. So there's no reason to think that the under fives are more infectious.

[00:41:42]

But for some reason they do carry more based on that, based on based on the studies so far. And then the crucial last question is how likely are children to infect others in the population? And there's been a lot of patchy studies and and local studies and different schools and environments for a landmark study that was done in South Korea of sixty thousand people showed very clearly that teenagers transmit the virus as much as adults, in fact, possibly more, because this study found that teenagers are more transmissible than adults.

[00:42:18]

That could be because of hygiene or social behavior. But but in and around as much as adults, whereas children under the age of 10 years old transmitted 50 percent as much as adults. So so a child under the age of 10 is half as likely to pass on the virus. If they have it, then an adult would. We don't know. What we don't know is how many children are really asymptomatic. So about 50 percent or more of adults are asymptomatic.

[00:42:44]

Probably it's more than that for children, but it's not clear to us four to five percent, according to a study in the United States. I haven't read that particular study, but if Tony Foushee is saying it and I'm sure it's something that is credible and pay attention to and which was about the same numbers as adults and and so in adults, we know that asymptomatic people pass it on fine so we can assume that children who are asymptomatic pass it on to.

[00:43:11]

But but strictly speaking, we don't know yet how much asymptomatic versus symptomatic children pass on the virus. But of course, children with symptoms have weaker symptoms than adults. So you may not even realize they're symptomatic. OK, and sorry. I want to thank. We just don't know the major unknown is how this affects the population. Yes, a major unknown is how does a group of children in a cluster, like a school where you have 20 or 30 of them together for extended periods of time, if they, in fact, each other.

[00:43:52]

And this happens in multiple and if this happens in multiple schools, what we don't know is how that affects out the country.

[00:43:59]

OK, I want to just summarize before I let you go atomos. We have a major problem now.

[00:44:13]

We are testing and tracing system is not really working as it ought to and needs to at the infection rate is growing and it's growing exponentially. I think it's fair to say. And we are now going to open schools without really the information to make kind of the kind of calculations you would ideally want to make.

[00:44:45]

And we're not. In a good position, and when Ronan, Glenn, Doctorand and Glenn expresses deep concern, he might be just understating the trouble we can be in if schools open and we continue on this journey on the road we're on.

[00:45:06]

I think that's a fair assessment of the situation thus far. Ronan, England is probably understating it at the same time. I don't want to I don't want to cause any kind of I don't want to put you in that enough invidious position. But, um, in relation to schools, do we need to think very, very carefully before we open any of.

[00:45:33]

The crucial thing is that we have to accept that children are transmitting the virus and this has to be at the forefront of our minds with respect to schools. And when you look at other countries that have managed this situation badly or managed it well, it's you see that the school situation is a product of the community. So it's hard it's hard to say how much schools have had an effect on the overall country's situation because many things are going on at the same time.

[00:46:14]

But we see countries that are managing the schools very well, like Finland, like Switzerland, like Denmark. And, you know, parents now are looking at these countries. And there are I think their fingers are crossed with respect to Ireland. And they say, well, Denmark's got it under control. Switzerland had it under control. So therefore, if we were really. But Israel but Israel and the state of Georgia in the US have not handled it well.

[00:46:40]

Exactly. And so that we fall into the situation, though, in being too optimistic, we start to say, well, if we really are very careful with how we manage our schools, if we had rigorous hygiene as they had in South Korea, which we don't have, if we had the physical space in schools in Denmark, which we don't have, but if we did all these things as well as possible, then we would be like those countries and we would be OK.

[00:47:11]

But the reality is, it's not just about how you manage your own school. In fact, it's it's probably less about how you manage your own school and how you manage the community. Yes, because children are active transmitters of sars-cov-2. What we see when we look at the international situation is that a school is only as safe as the community. It's yes. And if you have low transmission in your community, then your schools can be safe, as they were in Switzerland and Finland and Denmark.

[00:47:45]

If you have higher transmission, your schools are not safe because the virus will get in. This virus does not magically appear in the school. It doesn't come from children. It has to be brought into the school. Yes. And if you have high community transmission in your county, then your schools are at risk. And then what happens is the school can act as a conduit, as a multiplier of the virus, and it amplifies it in the community because you can have one case come into the school.

[00:48:14]

It can infect a large number of children, which then goes into their families and their families, workplaces and their families, social networks. So this is what the school can do to the greater environment. And we've never seen what this really looks like. We've never seen how bad this can get anywhere if you keep your schools open as your country is having a surge, I don't think that will happen in Ireland because I think what will happen is as soon as that starts to happen, hopefully the government will just shut the schools.

[00:48:43]

But I don't even want to have to approach that situation. The reality is that we've been orientating and we've talked about this also in other contexts that we've we've been orientating our skepticism to to the from a perspective of bad things aren't going to happen until we know they're going to happen, until we've seen them happening. And we need to orientate our perspective, not in the way that many European countries have been doing, the way that Asian countries have been doing from the beginning, assuming that covid-19 would be like a SARS type infection, which it is, and assuming the worst and preparing for the worst and orientating their skepticism that this was going to be a big problem in their transmissibility, including in children, including in nursing homes, until we're proven otherwise.

[00:49:30]

Yes. And we unfortunately have taken the opposite approach in many parts of the story and we are still taking that approach. Yes.

[00:49:39]

With respect to schools, we're crossing our fingers and hoping I should be Grant. OK, Thomas Ryan, associate professor. In the School of Biochemistry and Immunology at Trinity College and of course, in the Trinity College Institute of Neuroscience, we're very grateful to you for joining us on the stand. Thank you very much indeed. Thanks to all of you for listening. And, of course, a very special thanks to Tasco, our sponsor. That's all we have time for now.

[00:50:09]

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