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Hello and welcome to The Stand with Eamon Dunphy. The stand is proudly supported by Tesco at Tesco, our exclusive house for over sixty fives. 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, until a couple of weeks ago, Ireland had reason to believe that we were coping quite well in relative terms relative to the rest of Europe, of course, to Britain and to the United States with the covid-19 pandemic.


But in the past two weeks and it has been a sharp rise in infections. And of course, this coincides with return to school of children and to college of young adults. So and of course, we had a golf game. But the crisis now seems to be more acute than we are and have been led to believe to discuss where we are. It's a pleasure to welcome to the Stand. Professor Anthony Stain's is professor of Health Systems at DCU and specialises in particular on public health and policy.


Anthony, I have a statistic here which was released yesterday. In the last two weeks there have been twelve hundred and sixty nine new infections compared to two hundred and sixty four for the same period in July. That's a comparative rise of three hundred and eighty percent. How concerned are you by that figure and by the trend? At the moment?


I am concerned. I think everyone in the business is concerned about this. The numbers are rising. They have risen before we bring them down before. And there's been some success in parts of the countryside, Kildare in Australia, for example, where numbers had spiked very high. They have now started to fall again. So this is something we can control. We can bring under control. It's not particularly easy to do now.


We see the same phenomenon across the world, in Europe, in France and Spain, for example, and there's been a resurgence of this virus. And is it inevitable that when a country tries to open up again and ease the restrictions and the lockdown, that we have seen these rises and they are almost inevitable?


One of my colleagues describes this as an idea of European exceptionalism. Europe hasn't got experience of a major pandemic illnesses. Yes. Oh, over many, many years. Which is good. It's a good thing that we don't have that. But it's it's made us maybe unable to realise that the risks are what the problems are.


And it's made us a little complacent in how we react to those problems. Yes.


And I suppose in in Korea, Taiwan, for example, places where there have there has been a good response. They had SARS, they had Ebola. And in, for example, with masking, there's no question about it. They just wear them, don't they?


Yes, they do. And they wear them not just for infectious disease reasons, but also for air quality reasons. Yes, SARS has driven a lot of the thinking and particularly the East Asian countries, because the first SARS outbreak was very nearly a global public health disaster, which would have led to far more deaths than this disease has caused because the first SARS was far more lethal. We've seen in both Hong Kong and Canada the enormous efforts that are required to bring it under control.


But they succeeded. And I think there's a message there for everybody else that this can be brought under control, but it isn't easy. Yes.


And I believe you are among the group of physicians and scientists who would like to see us pursue a policy of elimination of the virus. I think it's called zero at covid Group. Now, yesterday, the acting chief medical officer, Dr Ronan Glynn, said that he didn't believe that we could eliminate the virus. He believed. We had to manage it, and that is a huge difference, isn't there, between you and other very notable clinicians and scientists.


And I suppose the prevailing view on it is it's not as huge as you might think.


The first thing to say is the high regard for Rosenblad. And we're fortunate to have a this position is a very, very smart, capable individual. Yes. As Tony Holder, if you look at the policy at the moment, the policy is to keep the virus down at a low level. And that's a very reasonable policy objective. The problem is that it's hard to keep the virus low, as we have discovered and many other European countries have discovered.


If you ask yourself what do we need to do to get from where we are now right today to a low level virus?


And what we need to do to get from where we are today to zero violence, they're actually the same path.


But you just keep going somewhat longer to go to zero, would it be fair to say that? And a certain point about a month ago that we had the new infections down to a daily number, maybe single digits, maybe 10, maybe less, and we were in a position had we doubled down, as it were, to eliminate it?


Yes, I think that is fair to say. But the thing to remember about that is that it it can take as long to get from one hundred to ten as from ten to one as from one to zero. That's just the nature of how these things spread. So it's it's it's not you wouldn't get 10 from 10 to one in a day. No, it might take another two weeks.


So a judgment was made then that we could sustain the virus at a low level.


With hindsight and, you know, I'm amazed how clever I am with hindsight, that was that was a mistake. We were not able to sustain us at a low level with what we were doing. So we're now in a different situation. The virus is rising again. We have had successes so Kildare and isolate where the virus had spiked. It has begun to fall. But that was a piece of news that disappeared in the world around golfing events in the west of Ireland.


Yes, but nonetheless, it happened. So there's no there's not we are not we're not going to be overwhelmed by this virus. We're not going to wake up one morning and find 5000 cases a day because we're not going to sit around and do nothing. But we are going to have to change what we do to bring the virus down. And if you look at what Nevitt plan, its plan is more intensive use of masks, cough hygiene, hand hygiene, social distancing, all of which I 100 percent agree with.


Medford's plan is much more effort going into testing, tracing, tracking and isolation. We have put a lot of effort into that, we've got a lot better at it. I don't think we're good enough at it. Yes, but that's a judgment. Other people disagree with that judgment, but that's on both our plans. What's different about our plan is two things. One is that we bring in. Quarantine at the airports and testing at the airports.


Yes. And the how this is done will probably change because there are fast tests becoming available, and it seems very likely to me that if you have a test a couple of days before you come, you have a test and you arrive at any of the tests again a day or so later, and they're all negative. You can go your way in peace. Yes, play golf or whatever you want to. So we at the moment thought what we need to do involves a significant quarantine at the airports with better testing that could well change and change very positively.


And the other thing that we're suggesting that methods are not suggesting is that we try and break this up at county level. And the idea there is that we're trying to deal with an infection which really spread throughout the whole country. But we have areas in the country with this very little Leitrim, I think has had no cases for 20 something days. Roscommon, Slagle have very few cases. These are areas where we could get the virus down to zero very quickly.


So what we say to people is no nonessential travel, Cross County boundaries. I doubt that will badly affect the tourist trade. Let me be really honest about that. Yes, but it allows us to to deal with this piece by piece by piece. And the idea is, as you clear out a piece, you link it up to other pieces that are clear and then people can do more and have more freedom in those areas than they do in the areas where there's still infection.


And part of our agenda is keeping schools open. I mean, we are very, very clear that it is imperative to open schools.


But the best way to open schools safely is to push down infection in the communities in which those schools are located.


Yes, there's another fact that has emerged recently over the last three or four weeks, I think, and it is that around 70 percent of the people now being infected are under the age of 45. They are younger people. And of course, I think there is anecdotal evidence and the evidence of my own eyes living in south Dublin and just observing there does appear to be among young groups of young men and women, for example, less fear and less caution than there might be.


And when then you see the statistics come out from an effort, it shows there are people and even under 30 many who are being infected. Is that that has the messaging failed in terms of the effect this virus can have on even healthy young people who contract that they may not die, but there is sufficient evidence, isn't there, to suggest it does leave scarring on the lungs? It can have cardiac effects, and that hasn't really been absorbed by people in those categories.


I think there's two slightly different things going on. One is that older people are staying out of circulation. So what are the awful things about this virus? There's a lot of people now living very constrained lives within their houses, within their apartments. Yes, I'm really going at very seldom. The other piece of it is that, as has happened in most countries where this has been looked at, the peak of viral infection has shifted to younger age groups.


There's a there's several things going on. One is we're doing or detecting it better. We're testing for it better. One is that younger. The message has got out that younger people are very unlikely to die and not that likely is seriously ill to the extent they need ventilation with this virus. Yes. What perhaps has not got out is that people who have an infection with this virus, even people who are not particularly sick with it, can be left with very serious, as you said, cardiac and lung problems, but also very serious neurological problems.


And people describe what they call a brain fog, finding it very hard to concentrate on, finding it very hard to focus. People get physically very tired. Quite often, though, their heart rate rises up to extraordinary levels on very modest amounts of exercise. Walking up the stairs, these you flush for half an hour and we don't know how long the effects are going to last. We hope they will go away. We hope they'll will go away quickly.


But actually, we don't know how. These effects are a little bit like some of the other post viral fatigue syndromes that we've seen. And they they frequently last several years. I hope that's not going to be the case with this, but we could have a significant portion of people really out of circulation for a couple of years after these infections.


Yes. And the, um, are we dealing here, Anthony, with a two almost irreconcilable. Value systems, one is public health and what it requires of us in coping with this pandemic, and two is the need to keep our economy afloat and to, as somebody has put it in the last 24 hours, without a strong economy that's working, you won't have a health service. And so there are these forces in society, people in business, people who see their businesses going, people who fear unemployment or are indeed unemployed.


And depending on government, they have their case. They are suffering in a certain way. And they argue there's risk everywhere. As the minister for Health and notoriously said, there's risk on going on a trampoline and otherwise there are people who are prepared to take risks. Isn't that a core problem we have as a society here and probably elsewhere? But I'm thinking of Ireland that we haven't reached a consensus about this virus and how to deal with it.


There's two pieces to that. The first is what's the link between the virus, government responses to the virus and the economic damage? The economic damage is very, very evident. Aren't economic analysis from Europe are one of the reasons for that is that most European countries, the whole country has done the same thing at the same time. Yes, and that makes it very hard to unpick what's going on. But there's two places where that's not true. One is in South Korea where they didn't have a lockdown.


They had a variety of restrictions, but nothing approaching the level of lockdown that we had, for example. And what they found there was that the amount of local economic damage was related to the amount of local virus, and the other was the United States, where they did practically everything from the one extreme holding covid parties and the other extreme quite significant lockdown. Yes. And they found the same thing. They found that was the virus that drove the damage.


So there isn't an opposition between health and the economy. They they're mutually dependent on each other. And the reality from another reason we argue for zero covid is that the faster we get rid of the virus, the faster the economy bounces back. We look at Sweden, which didn't have a lockdown, and compare it to its Scandinavian neighbors. Which are basically very similar economies, Sweden's economy fell about as much as Denmark's with a similar amount of infection, but they're a lot more deaths in Sweden.


Yes, and they had a care home problem. And we regularly take reports from a very good Irish journalist who's living in Sweden. In fact, we talked to him yesterday. I saw you on prime time and you had a brief encounter with a Swede and a Swedish doctor who was working at Harvard Medical School who who was quite cavalier. I thought. And this is a problem, too, isn't it, that there are people that people do point to Sweden, but the evidence is really that they are conducting a rather extraordinary experiment.


And to a considerable degree, it's based on the Swedish temperament, the Nordic temperament, if you like. They're not tactile. They don't want to hug each other. They don't want to stand up. And Bob's saying it's out. There are more restrained people, but the outcomes they're getting, their economies dropped actually by five percent, which is, you know, a serious enough.


Yeah, Sweden is very different from from Ireland or around 45 percent of Swedes living there are single person households. So the the the fundamental level of social contact in Sweden is different to what it is here. And the Swedes are very sociable and they do drink and they do sing.


But those are different table servers only. Yes, absolutely critical. But it's a different culture where we compare ourselves with other countries. Sweden is not the most obvious example. If we were more in many ways and temperament were more like the Italians and the Spanish are more like a southern European culture and a northern European culture. But the bottom line on that is that the economy depends on getting the virus down. And the faster you get it to the future, the less the economic damage.


And that that's our analysis. And bringing it down to zero is probably feasible that the two things that would be raised against that, and they're both very reasonable critiques. What is that? Getting it down to zero depends on a very good level of test, trace, track and isolation. And as a question as to whether Hajazi is able to do that. My feeling on that is, yes, they are. They need they need the resources. They need to focus.


But the staff are well capable of doing it. Don O'Brien gave evidence to the Iraq this committee on this matter. And Don would not be a wild eyed radical by any means. No. His comment was that it might it might cost tens of millions to do this properly. And I think he's probably right. But the cost of this virus is billions. Yes. So just spend the money, just put in the money and do it and run a very high intensity operation, you know, decides you're going to run it for two years and maybe they'll spend the last six months doing crochet.


Yes, but it's worth it. The other side is Northern Ireland. Yes. There is no way that I can ever see anything blocking the Northern Ireland border, either between ourselves and Northern Ireland or between the rest of the UK and Northern Ireland. I don't think that's. Open to discussion, what is happening in England and the United Kingdom right now is Scotland have decided to go for zero and they obviously have an open border with England, England, England is a mess.


Yes, there's a lot of work happening in England. We're working closely with a group called Independent Sage who are a group of people like us. Yes. Epidemiologists and social scientists. What have you who have been arguing for zero covered in England. And it's beginning to get some traction in Westminster. It has been discussed in Northern Ireland by their health, the health committee, and they have recommended it be considered by their department. And the at the moment, the public health coordination between north and south is really good.


We've worked together on human health issues, on animal health issues, important health issues since Northern Ireland and the Republic were set up. And that continues, so there's a fear that there is a fair chance that Northern Ireland will, if we go down the zero Colbert route, will explore very seriously doing the same thing themselves and they will make their own minds up. But if Scotland is doing it and the Republic of Ireland is doing it, it could be quite attractive to Northern Ireland to do the same thing.


But that's their that's their call. Of course, we say to people whose only worry about the stuff you can control. Yeah.


Now, I want to find things before we let you go first. This one is about the virus itself. How much do we know? I asked that question in the context of a case in Hong Kong where somebody who had contracted the virus and worked through it then got it again. It's something that only emerged this week, but it did. It seems alarming that this virus could conceivably bite you twice and very quickly. And it raises the question, which I've asked all of the contributors, including Professor Paddy Mallon, who's been on the stand, and Thomas Ryan and others.


How much do we know about the behaviour of this virus, how it mutates and all of the things we need to know?


Not a lot. Yes. All right. I'm not a virologist, but my understanding from older coronavirus is that they stay relatively stable genetically over time. So it's not like flu where there's a new strain every couple of years. But the immunity from coronaviruses is limited coronavirus cause colds. So if you got a second cold, it's by no means the end of the world. Yeah, well, it is possible to be infected again with the same coronavirus. Right.


The Hong Kong case, the person concerned is relatively sick the first time and not sick at all the second time. But there seems no doubt that it was a separate infection. It's expected that being infected with this virus will give you immunity for at least months afterwards. And that's all the time we've had to observe it. Yes. So this case, there's a case there's one or two other cases reported in Europe this week in the newspapers, but this case has been written up and well documented this.


But this case says it's reinfection is possible. The good news is this person wasn't particularly sick the second time. Yes. We don't know if that's a general thing. It looks as if reinfection is relatively rare at short time periods or we don't know yet is in 12 months time. Can he be reinfected again and infectious diseases which are capable of infecting multiple times, behave very differently to those which can only infect humans, but not nothing unmanageable, but they do pose different public health issues.


OK, just a final question about the schools and colleges who are going back now and the feasibility of that, particularly when you see, as you said, the UK is a mess. And last night they did a U-turn on masks and face masks in schools, but they are not really a good place to look. But the question of teachers health, the question of particularly children over 10, possibly going back, infecting their families and us having real problems with that.


How sanguine are you, Professor Staines, and how sanguine can anybody be? Or are we heading into an unknown here? An unknown. Unknown?


It is. We know some things. We know children get this disease, but they seem to be less commonly infected and less sick with it than adults. Secondary school aged children behave more like adults. We know children can spread this disease, but again, they seem to spread it less than adults. We don't really know why. Looking at schools openings around the world, there have been outbreaks. Most places have opened schools. The most dramatic have been in Australia and in Israel.


There has been smaller outbreaks in the UK and in Germany. The UK made a U-turn, as you say, that it was a U-turn in the right direction. Yes. Were wearing masks, which is our policy here is the right choice. If we are. Careful, I think we could reopen our schools relatively safely, but there, as the Tanisha said two weeks ago, there will be outbreaks and it's a question of dealing with those managing those.


What we're trying to avoid is a situation where we have to close a lot of schools. If we have to close a small number of schools, that is not the end of the world. But if we have to close as as has happened in Israel, I think that close third of their schools now. Yes, that that is a real problem and it is up to us to reduce infections in the community as much as possible. Zailckas That gives us the space to open the schools safely.


And for ISIS, opening the schools is a real priority. And whether we go for a suppress the virus a lot strategy or we go to suppress the virus a lot and keep going straight to zero strategy. Either of those will help schools open and stay. And it's up to all of us to cooperate with whatever strategies come out to to benefit our children.


OK, Professor Anthony Stain's professor of health systems at DC. We're very grateful to you for joining us on the stand. Thank you very much indeed. And thanks to Professor Staines, to all of you who listened and of course, to Tasco, our sponsor.


And that's all we have time for now to talk to you soon.