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Hello and welcome to The Stand with Eamon Dunphy.

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The storm 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 9am. Health care and emergency services have priority access at all other times now, more than ever, every little helps.

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Now, regardless of yesterday's budget or indeed almost anything else, the covid 19 pandemic and its virus is dominating our lives. People are fearful for their health, for their livelihoods, for their relatives. And most of all, perhaps they are fearful because we have no idea where this crisis is going. Yesterday, the 811 cases, new cases in the public, three deaths in the north, and there have been six thousand two hundred eighty six new infections in the last seven days.

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It's 8000 in the past fortnight here.

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The median age here of people infected is 30, and 70 percent of those infected are under 45. We're joined now by Professor Patrick Mullan. Professor Mullen works at St Vincent's Hospital. He is a specialist in infectious diseases.

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And at UCD, he is professor for microbial diseases and one of the most renowned infectious diseases experts in the world. Professor Martin, thank you for joining us. I want to ask you where we are now. Are we in the second surge? Have we lost control of the virus and not just here, but in the UK and across Europe?

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So I think that we're well into a second wave of covid-19 right across Europe. So that would be the answer to the first question is very simple in terms of whether we've lost control. I think that it's that's a story that's per country story. And certainly what's going on in the Republic of Ireland is very different even to what's going on in Northern Ireland or the rest of the UK and right across Europe. Some countries are dealing with this better than other countries and even within countries.

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If you look at what's happening in Ireland at the minute, some regions are having a more controlled or maybe a better time in terms of controlling the infection than other countries. So it's a it's a scenario or a with it's very much in flux at the moment. And there's all to play for.

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The failure to find a compromise between people concerned with public health and people concerned with livelihoods, jobs and businesses is a critical factor, is it not?

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Because, you know, everyone has an opinion and people aren't sure who to listen to or what to listen to?

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Yeah, I don't know that I would call it a failure, I guess, because, you know, in reality, what we're doing in Ireland at the minute is pursuing a strategy that is exactly what what you refer to. It's a strategy that aims to balance health care needs with economic needs. And that's this is strength and resilience type strategy. Or some people have called it living with the virus strategy. And that's the strategy that we have all to play for at the moment.

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The strategy has been put in place to try and balance people's livelihoods against people's health. And and I don't think that the two of them necessarily need to be constantly in competition. But we are in the process, I guess, as a society of trying to say no one of this strategy works. And number two, trying to find ways as we go along to make the strategy better. So I don't think the strategy has failed yet. I think that over time we're starting to realise how difficult this strategy is.

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You know, I think maybe back in June and July, it was easy to say, yep, we're going to live with the virus, because at that stage, the society was built up in the radio transmissions were at the minute when I started to realise that this is a very complex strategy to implement. And what you really need is buy in from all levels of society. So it's not something that the government can be fully responsible for and just be fully responsible for our doctors and nurses.

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This is really from the very top to the very bottom of this is going to work. Everybody needs to buy into it. And I think that the big key that people are starting to realise right across this this strategic spectrum is that this strategy becomes much, much easier provided the community transmission rates are low. And that that that is, I think, a realisation that is going on. Everybody. This is the process that we can just sit back and let this infection sweep through society in some way, end up in this sort of economic economic place where we get herd immunity that is just not based in reality.

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And the more science that comes out suggests that that is not a realistic goal. It's immoral and it's not going to work. So I think there's a realization that we're all coming together towards having to find a strategy that drives transmission rates down, are not allies at all of us to start having more more freedoms at a social level here for education, safer health care, more efficient health care, and also helps society to recover.

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Now, community transmissions in the last fortnight. Sixty 1763 community transmissions and they're rising.

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On July 4th, we reopened society, having had a fairly strict lockdown on the 3rd of on the 2nd of July on this podcast, speaking to Thomas Ryan, who's a scientist, we were able to say that there have been three deaths the day before and three new infections.

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So we were at a point where the numbers looked really good and then we reopened on July 4th. And steadily since then and the numbers have grown.

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Should we have maintained that lockdown another three or four weeks? I asked a professor in the context of the news of just before we started talking, that in the north of Ireland, the first minister has announced a circuit breaker for four weeks. This is a severe lockdown for four weeks to try and break this.

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Yes. The key here, if you go back to where we were in July, to answer your first question, should a wake up call for two to three weeks to try and eliminate the virus? My answer would be a qualified no. The no was qualified by the it's not about how long your lockdown is. It's about what you do after you come out of the lockdown. And if you haven't, if the very fact that you get to a position where you need to lock down or you need to go to level four, level five suggests that there are intrinsic, systematic issues that aren't working.

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And unless you fix those. The last time you could have it for two months, you could have for six months, will not work because as you come out of the lock lockdown, the same intrinsic issues will still be there and you'll end up back in the position that you find yourself in before the lockdown. And that is the key. You know, there are a lot times are effective, but a lockdown will only be effective if you fix the problems that led to the lockdown.

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And it's that key. We we never really sat back on July the 4th. I think we we didn't really take into account all of the issues that needed to be addressed at a societal level that led us to the initial lockdown around St. Patrick's Day. And as a result, we've ended up with a resurgence of the virus. That's not so much a criticism because maybe we can't fix everything. But there were certainly some big issues that could have been addressed better over the summer months that weren't addressed, that over the summer months and other big issues such as travel, which really still still haven't been properly addressed.

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And that's really the scenario that the north no, the north are in a particularly bad place at the minute. They have a completely a completely different set of rules from what we're doing down here. They have a different approach from what we're doing down here. Then I have to look at why they're in the space that they're in at the minute and try and figure out what they need to fix in the next two or three weeks during this circuit breaker, whatever it is, so that when they come out of that circuit breaker and they don't end up rebundle.

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And that's that's the trick. Yes.

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When you talk about the ways we have to behave, we have to wear masks and observe the social distancing rules and also make sure that we wash our hands. Now, the test and trace element isn't that important also. And we haven't, it appears, quite got that done.

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And the other thing that you mentioned, there was travel.

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Only 30 percent of people who signed forms in the airport responded when there was a follow up call. We haven't really made decisions, tough decisions, have we, about travel. So I think the first thing around the test and Trius is that. You know, I would have been incredibly frustrated about this when you started seeing the numbers going up back in August and and it's it's on record that we were caught. You know, we were caught with a we were caught off guard with what happened in and around Killdeer, a large outbreak that took hold within the community very quickly.

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And it was really over a number of days that our testing, our testing capacity was overwhelmed. And since then, we've been playing catch up. So that that's a lesson that we need to learn. You know, since then, however, that we're getting closer and closer to the virus. When you look at the sheer volume of tests that we're doing at the moment and you look at the recent turnaround times for the test and the actual swabbing, the laboratory, given the results back to the individual timelines are pretty tight with big volumes.

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And I think that there's still room to increase that in terms of scale and efficiency. But it's it's on a different level now completely to work to where it was even back in June and July. So that's a really good thing. Where we need to focus on is in the last place, which is the investigation. Going back to what you said earlier on about community transmissions. Yes, the definition of a community transmission is that we don't know where the person picked the virus up from.

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And one of the reasons that we don't know where the person picked the virus up from is that until recently, we were only really looking back 48 hours. So we weren't at a national level taken. That investigative approach was becoming very apparent around the approach to covid-19 within community is that investigative piece, which is run by public health specialists, is really important if you're going to get to the root cause of why you've ended up in the position that you're in.

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So Northern Ireland, for example, or Donegal or where we are even around the rest of the country now, we're in a process of trying to find those investigative partners that look at particular behaviours and particular social gatherings or particular activities that really will inform us as to where things are going wrong and that will put us in a much better position to put things right. And without that, I don't think you're going to really move on. So we're getting better, but we we're getting better in a lot of areas.

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But distilleries that we can improve in terms of the travel to me, the travel like there's been a huge amount of discussion around the travel and the travel piece really hasn't been fixed. People will argue that where we're out at the minute, it's not that big a deal because it contributes very little to the overall infection rate at the moment. But as we progress through this and hopefully as we get down levels and we get community transmission under control, the relative importance of new infections coming in through travel becomes higher.

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And so rather than waiting until that becomes a problem, why don't we put in place the measures need to take care of that problem so that so that we're actually preparing ourselves. We're being proactive rather than reactive. And I do think there's work going on in the background there. But I just think that there's still not enough in terms of what could be done and should be done in terms of controlling the potential for travel related infections. And we need to get that right because we all want to travel again, but we want to be able to travel safely.

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And that's not going to happen overnight. We need to be prepared for that right now.

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I don't want to get you into moral judgments or things like that, but personal behaviour and we have seen examples of irresponsibility.

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Golf gave the go away fresher's week where thousands of young people on Freshers Week were out on the street very close and know this and seeing no masks or anything like that was the Tyrone football final when the winning penalty was scored, a couple hundred people charged onto the bench and hugged each other. And there have been there's a report in this morning's Irish Times about shebeens, house parties where drink is flowing. All of that stuff matters, doesn't it?

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If it matters, probably more than people realize. So when we talk about these big social gatherings, you've got you've got the big visible social gatherings that everybody gets very exercised about. And, you know, there's a lot of media attention and a lot of blaming. A lot of that, I think is the absolute contribution of a single event to what's going on around the country is probably minimal. Yes, it's the small things that matter and that the characteristics of this virus spread in communities is that it loves groups and it loves indoors.

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And that group could be it could be a wedding. That could be a fun. An extended family gathering of four or five different households from one family sitting down to a large meal, maybe to celebrate one of the elders birthdays, something like that. Those sorts of those sorts of gatherings where people are in close contact, especially indoors. From more than one household is is the perfect recipe for what we call a super spreader of. All you need is one infected person and they may not even have any symptoms enters that area and everyone leaving that area, a vast proportion of the people live in that area become infected.

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And then they disperse back to their own households and they unwittingly spread their infections around the world. So if you think about it from the contact with an investigation perspective, that then becomes a huge headache whereby if I was to meet you for a cup of coffee or I was to meet you and and invite you round to my house for dinner, that's one contact from one other household. They unwittingly spread covid-19 disease. Then it's a much easier outbreak to control.

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So these big events, no matter where they're going to talk about big events, really, it's where you have more than one household in an enclosed space, create conditions where you can get rapid spread of this virus within a community and just give one a sort of example, because I think this is really particularly relevant for rural Ireland, more so than for urban Ireland. If you have, for example, a wick or you have a wedding or you have a function in a small rural community where people from around the community are gathered together and you have a super spreader event, you could end up knocking out your local shops, you could end up knocking out your local chemist.

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Your local schools are a super spreader event where multiple households within a rural community are involved could actually have quite a significant impact on the whole rural community functions. And I've seen that that personal experience of that from, for example, my wife lives in rural dairy or famish rural area, and they had a sort of incident similar to that recently. And they've seen that impact right across the society. You're not going to get to the same extent with places like Dublin and Cork.

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So so this is it's not super spreader event and it's a multiple contact event that we really need to focus on in terms of changing our behavior. And that's why the CMO and ruling plan have been they've really been pushing this cut down the number of contacts that you have and specifically to try and prevent the spread of events that are real characteristic of sars-cov-2 in the 90s.

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Why do we to take from and the median age of people now being infected in this country being 30 and 70 percent of the infections being under 45?

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How have we managed to make it clear to particularly young people that they don't feel they're at risk of their lives with this virus?

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Did we get the messaging wrong?

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Because there is now talk of long covid, which are affects to your lungs, your heart and other organs that are serious and long term. How have we got that message out there? Because they are the ones who appear just to feel invulnerable.

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So I think there's two trains of thought here. Certainly when you look at it, the data show that it's it's actually people between the ages of 15 and 69. When you look at the data within those age groups that they're tracking each other in terms of the increases in cases. So this isn't just something, although it's reported as under 40 fives when you actually look at the size of all of those age groups are escalating very quickly and they're following almost exactly an exact trajectory.

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The two groups that we're seeing that are completely different in terms of trajectory are those over the age of 70 and those under the age of 14. So if the very young, probably because of the fact that they're just not transmitting and and the older people and I actually see that I would rather than saying that people are doing something wrong, I actually would flip that on its head and say that this is a reflection of as a society that we're doing something right and the reasons that we're not seeing high levels of hospitalisations, high levels of death at the minute, despite large numbers of cases, is that as a society, we're actually doing quite a good job of preventing this infection spreading into the older age groups.

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Yes. And so I see that as a real positive. And why that is, it's a number of reasons. Certainly, you know, there are huge numbers of young people around the country that will be helping out in terms of of protecting their older parents or grandparents from getting infected and providing social supports. And I think that has that that really has to be acknowledged. But it's having a big impact on older people themselves, are more knowledgeable about how to avoid contracting.

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The infection itself is a good thing where it could all go wrong. Yemen is that the if we see the numbers continue to rise within the community. Then the everything becomes riskier, so at the moment, older people can go about their daily lives, take precautions and by and large avoid contracting this infection. And that's reflected in the numbers. But if the community transmission rates increase dramatically, like we're seeing happening in some of the poorer counties, then even there was normal day to day activities can become riskier.

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And that's really a point, again, that the CMO and according to animator's is if this continues to increase, we will see spread in the older age groups because mainly because of the fact that day to day activities will become riskier and people will end up just through the normal day to day activities coming into contact either with a surface that's infected or someone that's infected because that's just more of it out there. So our success and our continued success in this area is continue again on keeping community transmission rates low.

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And the key to do that is dropping back on the contacts.

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I've just two more questions to ask you, Professor Marlan. One is, it seems to me what you're saying is if we go even to level five or if we have the so-called circuit breaker, it's no good unless we learn the lessons and we find a way as a society to emerge from that lock down and do the right things. And therefore, there is a degree of understanding in the community and personal responsibility. How would that be fair?

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Yeah, so I think that. What what needs to happen at the community level is that the community needs to buy in the way we need to lock down and buy and the reassurances that this will not happen again. Again, that dichotomy around this is that you have these two camps, you have this zero covid camp, and then you have this living with the virus camp. And and the two of them of have taken quite polarizing views to some respect.

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But but the bottom line is that where the reality needs to be is somewhere in the middle, but definitely more towards zero covid more towards the lower community transmissions for all the reasons that I have said before. Now, if we if we take that on board and these are decisions that may be happening within the next week or two. However, if a country like Northern Ireland goes into a lockdown like a circuit breaker and if the border counties are going towards level for another five, which is in effect a lockdown, there are people within those kinds of people within Northern Ireland, they're going to want to know that, yes, appropriate measures are being taken to mitigate and stop this happening again.

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And the reason that one of the big reasons that's been that's been put forward from a policy perspective of government as to why we can't use this type of approach of very low transmissions is that we share a common border with the north. And it's it is so important. That the the politicians north and south of the border need to recognize from a scientific perspective that if we are going to find solutions here, it needs to be and a solution that is across the whole island.

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And at the moment, if you look at the look at everyone who's talked on this, I don't know. A single scientific course that's talked on this theory has suggested that it makes sense for us to have two different policies for Congress.

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Yes, we need all of our own and we need an all Ireland solution and that everyone buys into.

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And that that rests at the moment at the feet of politicians in the north and politicians in the republic to sit down and try and put measures in place that make sense across the island from a health perspective. This isn't this isn't a politics thing. This is politicians making policies that make makes sense for health. And that needs to be the first step. And we've been you know, clinicians have been singing from the rafters about this since March. I've been talking to some clinician colleagues in the north.

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And the last couple of days, they I think every single clinician right across the Atlantic is looking at this and he's dealing with it, sees the sense of having a common set of approaches. Yes. And the politicians really need to get on and start taking this take take on this aspect of it and driving it forward with much more rigor and much more urgency over the next couple of weeks.

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A final question, Professor Mullen. A report in today's Irish Times shows that 78 per cent of principals in colleges surveyed this is the school principals, 78 percent of them feel drained at the end of the workday due to the scale of challenges they face in the health service. For people like you and the frontline staff, nurses, porters, hospital orderlies, everybody, this experience is taking, I imagine, a shocking toll that should be understood, too, by the community, should it not?

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I think that I think everyone right throughout the community is it's having a toll on I think even when you look at young people. Yes, like I have particular pity for young people, mainly because of the fact that the the approaches that were taken at the moment are telling us what we're not allowed to do. And we haven't really. Again, it's another thing that we need to look at. We need to provide opportunities to tell people, especially young people, what they can do and how they can do it safely and provide those opportunities, because that if everything becomes prohibitive, if restaurants are shot at bars or shot, driver's licenses are shot and if schools are shot.

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It drives society back into the home. Yes, and particularly young people, you cannot we cannot realistically expect young people to be sitting at home for the course of a year and not being able to live their life. And what will happen if you do that? If you if you have a completely restrictive policy and you drive everything into the home, you create just the sort of conditions that we were talked about earlier and the potential for large gatherings, those spaces with sars-cov-2 logs.

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So what we do want to do is to inadvertently create conditions which make transmissions, uncontrolled transmissions of this virus worse. And what we really need to do is to have conversations quite quickly about a strategy where we start to open up society again, to give opportunities, especially for young people to be able to socialize, but to be able to give them opportunities to socialize safely. And I think there needs to be a balance between the restrictions, get the numbers under control, but also give them people that like to say if we get to a certain level of community transmission, this is what we're going to do to give you an opportunity to start getting their life back on track.

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And I think that that's the balance of things that we need to reach. And I think we're still we're still in the process of learning how to do that.

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OK, Professor Patrick Mullin of St Vincent's Hospital. And you said famously for joining us on the stand. Thanks to Bethesda, Maryland, to you for listening and to Tasco, our sponsors. That's all we have time for now. We'll talk to you soon. The stand is proudly supported by Tesco at 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..

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Health care and emergency services have priority access at all other times now more than ever. Every little helps.