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Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:03.68,0:00:07.17,Default,,0000,0000,0000,,Hello, I'm Chris Anderson.\NWelcome to The TED Interview.
Dialogue: 0,0:00:07.19,0:00:10.82,Default,,0000,0000,0000,,We're gearing up for season four\Nwith some extraordinary guests,
Dialogue: 0,0:00:10.85,0:00:14.32,Default,,0000,0000,0000,,but I don't want to wait for that\Nfor today's episode,
Dialogue: 0,0:00:14.34,0:00:17.26,Default,,0000,0000,0000,,because we're in the middle of a pandemic,
Dialogue: 0,0:00:17.29,0:00:20.64,Default,,0000,0000,0000,,and there's a guest\NI really wanted to talk to now.
Dialogue: 0,0:00:21.51,0:00:23.59,Default,,0000,0000,0000,,He is Adam Kucharski,
Dialogue: 0,0:00:23.62,0:00:26.05,Default,,0000,0000,0000,,an infectious diseases scientist
Dialogue: 0,0:00:26.08,0:00:29.47,Default,,0000,0000,0000,,who focuses on the mathematical\Nmodeling of pandemics.
Dialogue: 0,0:00:29.99,0:00:31.32,Default,,0000,0000,0000,,He's an associate professor
Dialogue: 0,0:00:31.34,0:00:33.90,Default,,0000,0000,0000,,at the London School of Hygiene\Nand Tropical Medicine
Dialogue: 0,0:00:33.92,0:00:35.27,Default,,0000,0000,0000,,and a TED Fellow.
Dialogue: 0,0:00:35.29,0:00:37.39,Default,,0000,0000,0000,,(Music)
Dialogue: 0,0:00:37.42,0:00:39.81,Default,,0000,0000,0000,,(TED Talk) Adam Kucharski:\NSo what kind of behavior
Dialogue: 0,0:00:39.84,0:00:41.60,Default,,0000,0000,0000,,is actually important for epidemics?
Dialogue: 0,0:00:41.62,0:00:45.26,Default,,0000,0000,0000,,Conversations, close physical contacts?
Dialogue: 0,0:00:45.28,0:00:47.82,Default,,0000,0000,0000,,What sort of data should we be collecting
Dialogue: 0,0:00:47.84,0:00:49.02,Default,,0000,0000,0000,,before an outbreak
Dialogue: 0,0:00:49.05,0:00:51.58,Default,,0000,0000,0000,,if we want to predict\Nhow infection might spread?
Dialogue: 0,0:00:52.27,0:00:56.43,Default,,0000,0000,0000,,To find out, our team\Nbuilt a mathematical model ...
Dialogue: 0,0:00:56.45,0:00:59.33,Default,,0000,0000,0000,,Chris Anderson: When it comes\Nto figuring out what to make of
Dialogue: 0,0:00:59.36,0:01:01.78,Default,,0000,0000,0000,,this pandemic, \Nknown technically as COVID-19,
Dialogue: 0,0:01:01.81,0:01:04.76,Default,,0000,0000,0000,,and informally as just the coronavirus,
Dialogue: 0,0:01:04.78,0:01:07.68,Default,,0000,0000,0000,,I find his thinking unbelievably helpful.
Dialogue: 0,0:01:07.70,0:01:10.05,Default,,0000,0000,0000,,And I'm excited to dive into it with you.
Dialogue: 0,0:01:10.47,0:01:12.48,Default,,0000,0000,0000,,A special callout to my friends on Twitter
Dialogue: 0,0:01:12.51,0:01:14.82,Default,,0000,0000,0000,,who offered up many\Nsuggestions for questions.
Dialogue: 0,0:01:14.85,0:01:18.02,Default,,0000,0000,0000,,I know this topic\Nis on everyone's mind right now.
Dialogue: 0,0:01:18.05,0:01:19.100,Default,,0000,0000,0000,,And what I hope this episode does
Dialogue: 0,0:01:20.02,0:01:22.35,Default,,0000,0000,0000,,is give us all a more nuanced way
Dialogue: 0,0:01:22.37,0:01:26.08,Default,,0000,0000,0000,,of thinking about how this pandemic\Nhas unfolded so far,
Dialogue: 0,0:01:26.11,0:01:27.85,Default,,0000,0000,0000,,what might be to come
Dialogue: 0,0:01:27.87,0:01:30.50,Default,,0000,0000,0000,,and what we all collectively\Ncan do about it.
Dialogue: 0,0:01:31.21,0:01:32.40,Default,,0000,0000,0000,,Let's dive in.
Dialogue: 0,0:01:32.43,0:01:33.58,Default,,0000,0000,0000,,(Music)
Dialogue: 0,0:01:37.78,0:01:39.79,Default,,0000,0000,0000,,Adam, welcome to the TED Interview.
Dialogue: 0,0:01:39.82,0:01:41.50,Default,,0000,0000,0000,,Adam Kucharski: Thank you.
Dialogue: 0,0:01:41.52,0:01:44.84,Default,,0000,0000,0000,,CA: So let's just start\Nwith a couple of basics.
Dialogue: 0,0:01:44.86,0:01:48.34,Default,,0000,0000,0000,,A lot of skeptical people's response --
Dialogue: 0,0:01:48.36,0:01:51.31,Default,,0000,0000,0000,,certainly over the last few weeks,\Nmaybe less so now --
Dialogue: 0,0:01:51.33,0:01:53.93,Default,,0000,0000,0000,,has been, "Oh, come on,\Nthis isn't such a big deal,
Dialogue: 0,0:01:53.95,0:01:56.49,Default,,0000,0000,0000,,there's a relatively tiny number of cases.
Dialogue: 0,0:01:56.51,0:01:58.90,Default,,0000,0000,0000,,Compare it to the flu,\Ncompare it to anything else.
Dialogue: 0,0:01:58.93,0:02:01.01,Default,,0000,0000,0000,,There are much bigger\Nproblems in the world.
Dialogue: 0,0:02:01.04,0:02:04.38,Default,,0000,0000,0000,,Why are we making such a fuss about this?"
Dialogue: 0,0:02:04.85,0:02:08.48,Default,,0000,0000,0000,,And I guess the answer to that fuss\Nis that it comes down to the mathematics.
Dialogue: 0,0:02:08.50,0:02:12.48,Default,,0000,0000,0000,,We're talking about the mathematics\Nof exponential growth,
Dialogue: 0,0:02:12.50,0:02:13.87,Default,,0000,0000,0000,,fundamentally, right?
Dialogue: 0,0:02:13.90,0:02:15.04,Default,,0000,0000,0000,,AK: Exactly.
Dialogue: 0,0:02:15.07,0:02:19.90,Default,,0000,0000,0000,,And there's a number that we use\Nto get a sense of how easy things spread
Dialogue: 0,0:02:19.93,0:02:22.36,Default,,0000,0000,0000,,and the level of transmission\Nwe're dealing with.
Dialogue: 0,0:02:22.86,0:02:24.66,Default,,0000,0000,0000,,We call that the reproduction number,
Dialogue: 0,0:02:24.68,0:02:26.12,Default,,0000,0000,0000,,and conceptually, it's just,
Dialogue: 0,0:02:26.15,0:02:27.87,Default,,0000,0000,0000,,for each case you have, on average,
Dialogue: 0,0:02:27.90,0:02:29.59,Default,,0000,0000,0000,,how many others are they infecting?
Dialogue: 0,0:02:29.61,0:02:32.62,Default,,0000,0000,0000,,And that gives you a sense\Nof how much is this scaling,
Dialogue: 0,0:02:32.65,0:02:34.65,Default,,0000,0000,0000,,how much this growth\Nis going to look like.
Dialogue: 0,0:02:34.67,0:02:37.88,Default,,0000,0000,0000,,For coronavirus, we're now seeing,\Nacross multiple countries,
Dialogue: 0,0:02:37.90,0:02:41.35,Default,,0000,0000,0000,,we're seeing each person on average\Ngiving it to two or three more.
Dialogue: 0,0:02:42.52,0:02:44.13,Default,,0000,0000,0000,,CA: So that reproduction number,
Dialogue: 0,0:02:44.15,0:02:48.38,Default,,0000,0000,0000,,the first thing to understand\Nis that any number above one
Dialogue: 0,0:02:48.40,0:02:50.77,Default,,0000,0000,0000,,means that this thing is going to grow.
Dialogue: 0,0:02:50.79,0:02:54.88,Default,,0000,0000,0000,,Any number below one\Nmeans it's going to diminish.
Dialogue: 0,0:02:55.51,0:02:57.50,Default,,0000,0000,0000,,AK: Exactly -- if you have it above one,
Dialogue: 0,0:02:57.52,0:02:59.59,Default,,0000,0000,0000,,then each group of people infected
Dialogue: 0,0:02:59.62,0:03:02.63,Default,,0000,0000,0000,,are going to be generating more infection\Nthan there was before.
Dialogue: 0,0:03:02.65,0:03:04.58,Default,,0000,0000,0000,,And you will see the exponential effect,
Dialogue: 0,0:03:04.61,0:03:07.92,Default,,0000,0000,0000,,so if it's two, you will be doubling\Nevery round of infection,
Dialogue: 0,0:03:07.94,0:03:09.11,Default,,0000,0000,0000,,and if it's below one,
Dialogue: 0,0:03:09.13,0:03:12.23,Default,,0000,0000,0000,,you're going to get something\Nthat's going to decline, on average.
Dialogue: 0,0:03:12.60,0:03:14.20,Default,,0000,0000,0000,,CA: So that number two or higher,
Dialogue: 0,0:03:14.22,0:03:17.51,Default,,0000,0000,0000,,I think everyone here is maybe familiar\Nwith the famous story
Dialogue: 0,0:03:17.54,0:03:19.78,Default,,0000,0000,0000,,of the chessboard and the grains of rice,
Dialogue: 0,0:03:19.80,0:03:24.32,Default,,0000,0000,0000,,and if you double the number of grains\Nfor every square of the chessboard,
Dialogue: 0,0:03:24.34,0:03:27.71,Default,,0000,0000,0000,,for the first 10 or 15 squares\Nnothing much happens,
Dialogue: 0,0:03:27.74,0:03:30.40,Default,,0000,0000,0000,,but by the time you've got\Nto the 64th square,
Dialogue: 0,0:03:30.43,0:03:33.83,Default,,0000,0000,0000,,you suddenly have tons of rice\Nfor every individual on the planet.
Dialogue: 0,0:03:33.85,0:03:34.90,Default,,0000,0000,0000,,(Laughs)
Dialogue: 0,0:03:34.93,0:03:38.01,Default,,0000,0000,0000,,Exponential growth is an incredible thing.
Dialogue: 0,0:03:38.03,0:03:39.38,Default,,0000,0000,0000,,And the small numbers now
Dialogue: 0,0:03:39.40,0:03:42.03,Default,,0000,0000,0000,,are really not what you\Nshould be paying attention to --
Dialogue: 0,0:03:42.06,0:03:45.40,Default,,0000,0000,0000,,you should be paying attention\Nto the models of what could be to come.
Dialogue: 0,0:03:45.98,0:03:47.13,Default,,0000,0000,0000,,AK: Exactly.
Dialogue: 0,0:03:47.16,0:03:49.51,Default,,0000,0000,0000,,Obviously, if you continue\Nthe exponential growth,
Dialogue: 0,0:03:49.54,0:03:51.62,Default,,0000,0000,0000,,you do sometimes get\Nthese incredibly large,
Dialogue: 0,0:03:51.64,0:03:53.20,Default,,0000,0000,0000,,maybe implausibly large numbers.
Dialogue: 0,0:03:53.23,0:03:55.59,Default,,0000,0000,0000,,But even looking at a timescale\Nof say, a month,
Dialogue: 0,0:03:55.62,0:03:57.38,Default,,0000,0000,0000,,if the reproduction number is three,
Dialogue: 0,0:03:57.40,0:03:59.44,Default,,0000,0000,0000,,each person is infecting three on average.
Dialogue: 0,0:03:59.47,0:04:02.90,Default,,0000,0000,0000,,The gap between these rounds\Nof infection is about five days.
Dialogue: 0,0:04:02.93,0:04:05.19,Default,,0000,0000,0000,,So if you imagine\Nthat you've got one case now,
Dialogue: 0,0:04:05.21,0:04:09.39,Default,,0000,0000,0000,,that's, kind of, six of these\Nfive-day steps in a month.
Dialogue: 0,0:04:09.41,0:04:10.78,Default,,0000,0000,0000,,So by the end of that month,
Dialogue: 0,0:04:10.80,0:04:12.96,Default,,0000,0000,0000,,that one person could have generated,
Dialogue: 0,0:04:12.98,0:04:15.71,Default,,0000,0000,0000,,I think it works out at about 729 cases.
Dialogue: 0,0:04:15.74,0:04:17.29,Default,,0000,0000,0000,,So even in a month,
Dialogue: 0,0:04:17.32,0:04:19.58,Default,,0000,0000,0000,,just the scale of this thing\Ncan really shoot up
Dialogue: 0,0:04:19.60,0:04:21.14,Default,,0000,0000,0000,,if it's not controlled.
Dialogue: 0,0:04:22.24,0:04:23.40,Default,,0000,0000,0000,,CA: And so certainly,
Dialogue: 0,0:04:23.42,0:04:26.50,Default,,0000,0000,0000,,that seems to be happening\Non most numbers that you look at now,
Dialogue: 0,0:04:26.52,0:04:29.40,Default,,0000,0000,0000,,certainly where the virus\Nis in the early stages
Dialogue: 0,0:04:29.42,0:04:31.45,Default,,0000,0000,0000,,of entering a country.
Dialogue: 0,0:04:31.47,0:04:32.65,Default,,0000,0000,0000,,You've given a model
Dialogue: 0,0:04:32.67,0:04:38.03,Default,,0000,0000,0000,,whereby we can much more clearly\Nunderstand this reproduction number,
Dialogue: 0,0:04:38.05,0:04:41.82,Default,,0000,0000,0000,,because it seems to me this is almost\Nlike the core to how we think of the virus
Dialogue: 0,0:04:41.84,0:04:46.43,Default,,0000,0000,0000,,and how we respond to it\Nand how much we should fear it, almost.
Dialogue: 0,0:04:46.46,0:04:48.01,Default,,0000,0000,0000,,And in your thinking,
Dialogue: 0,0:04:48.03,0:04:50.90,Default,,0000,0000,0000,,you sort of break it down\Ninto four components,
Dialogue: 0,0:04:50.92,0:04:54.36,Default,,0000,0000,0000,,which you call DOTS:
Dialogue: 0,0:04:54.38,0:04:57.03,Default,,0000,0000,0000,,Duration, Opportunities,
Dialogue: 0,0:04:57.05,0:04:59.07,Default,,0000,0000,0000,,Transmission probability
Dialogue: 0,0:04:59.09,0:05:00.29,Default,,0000,0000,0000,,and Susceptibility.
Dialogue: 0,0:05:00.32,0:05:02.42,Default,,0000,0000,0000,,And I think it would be\Nreally helpful, Adam,
Dialogue: 0,0:05:02.45,0:05:04.30,Default,,0000,0000,0000,,for you to just explain each of these,
Dialogue: 0,0:05:04.32,0:05:07.26,Default,,0000,0000,0000,,because it's quite a simple equation
Dialogue: 0,0:05:07.28,0:05:11.52,Default,,0000,0000,0000,,that links those four things\Nto the actual reproduction number.
Dialogue: 0,0:05:11.54,0:05:13.15,Default,,0000,0000,0000,,So talk about them in turn.
Dialogue: 0,0:05:13.18,0:05:14.66,Default,,0000,0000,0000,,Duration, what does that mean?
Dialogue: 0,0:05:14.69,0:05:18.36,Default,,0000,0000,0000,,AK: Duration measures\Nhow long someone is infectious for.
Dialogue: 0,0:05:18.74,0:05:19.92,Default,,0000,0000,0000,,If, for example,
Dialogue: 0,0:05:19.94,0:05:23.78,Default,,0000,0000,0000,,intuitively, if someone is infectious\Nfor a longer period of time,
Dialogue: 0,0:05:23.80,0:05:25.97,Default,,0000,0000,0000,,say, twice as long as someone else,
Dialogue: 0,0:05:25.99,0:05:27.72,Default,,0000,0000,0000,,then that's twice the length
Dialogue: 0,0:05:27.75,0:05:30.13,Default,,0000,0000,0000,,that they've got\Nto be spreading infection.
Dialogue: 0,0:05:30.98,0:05:35.82,Default,,0000,0000,0000,,CA: And what is the duration\Nnumber for this virus,
Dialogue: 0,0:05:35.84,0:05:39.90,Default,,0000,0000,0000,,compared with, say, flu\Nor with other pathogens?
Dialogue: 0,0:05:40.44,0:05:41.81,Default,,0000,0000,0000,,AK: It depends a little bit
Dialogue: 0,0:05:41.83,0:05:43.86,Default,,0000,0000,0000,,on what happens\Nwhen people are infectious,
Dialogue: 0,0:05:43.88,0:05:47.46,Default,,0000,0000,0000,,if they're being isolated very quickly,\Nthat shortens that period of time,
Dialogue: 0,0:05:47.48,0:05:49.75,Default,,0000,0000,0000,,but potentially, we're looking\Nat around a week
Dialogue: 0,0:05:49.77,0:05:54.09,Default,,0000,0000,0000,,people are effectively infectious\Nbefore they might be isolated in hospital.
Dialogue: 0,0:05:54.84,0:05:58.74,Default,,0000,0000,0000,,CA: And during that week,\Nthey may not even be showing symptoms
Dialogue: 0,0:05:58.76,0:06:00.96,Default,,0000,0000,0000,,for that full week either, right?
Dialogue: 0,0:06:01.40,0:06:05.22,Default,,0000,0000,0000,,So someone gets infected,\Nthere's an incubation period.
Dialogue: 0,0:06:05.68,0:06:08.57,Default,,0000,0000,0000,,There's a period some way\Ninto that incubation period
Dialogue: 0,0:06:08.59,0:06:11.14,Default,,0000,0000,0000,,where they start being infectious,
Dialogue: 0,0:06:11.16,0:06:14.64,Default,,0000,0000,0000,,and there may be a period after that,\Nwhere they start to show symptoms,
Dialogue: 0,0:06:14.67,0:06:17.42,Default,,0000,0000,0000,,and it's not clear, quite,\Nhow those dates align.
Dialogue: 0,0:06:17.45,0:06:18.60,Default,,0000,0000,0000,,Is that right?
Dialogue: 0,0:06:18.62,0:06:20.56,Default,,0000,0000,0000,,AK: No, we're getting more information.
Dialogue: 0,0:06:20.58,0:06:24.80,Default,,0000,0000,0000,,One of the signals we see in data
Dialogue: 0,0:06:24.82,0:06:27.85,Default,,0000,0000,0000,,that suggest that you may have\Nthat early transmission going on
Dialogue: 0,0:06:27.88,0:06:31.89,Default,,0000,0000,0000,,is when you have this delay\Nfrom one infection to the next.
Dialogue: 0,0:06:32.35,0:06:34.62,Default,,0000,0000,0000,,So that seems to be around five days.
Dialogue: 0,0:06:35.19,0:06:37.84,Default,,0000,0000,0000,,That incubation period,\Nthe time for symptoms to appear,
Dialogue: 0,0:06:37.86,0:06:39.48,Default,,0000,0000,0000,,is also about five days.
Dialogue: 0,0:06:39.51,0:06:41.31,Default,,0000,0000,0000,,So if you imagine that most people
Dialogue: 0,0:06:41.34,0:06:44.81,Default,,0000,0000,0000,,are only infecting others\Nwhen they're symptomatic,
Dialogue: 0,0:06:44.84,0:06:46.42,Default,,0000,0000,0000,,you'd have that incubation period
Dialogue: 0,0:06:46.45,0:06:49.51,Default,,0000,0000,0000,,and then you'd have some more time\Nwhen they're infecting others.
Dialogue: 0,0:06:49.53,0:06:51.85,Default,,0000,0000,0000,,So the fact that those values\Nseem to be similar,
Dialogue: 0,0:06:51.87,0:06:53.95,Default,,0000,0000,0000,,suggesting that some people\Nare transmitting
Dialogue: 0,0:06:53.97,0:06:57.81,Default,,0000,0000,0000,,either very early on or potentially\Nbefore they're showing clear symptoms.
Dialogue: 0,0:06:58.40,0:07:01.88,Default,,0000,0000,0000,,CA: So almost implies that on average,
Dialogue: 0,0:07:01.90,0:07:03.65,Default,,0000,0000,0000,,people are infecting others
Dialogue: 0,0:07:03.67,0:07:06.91,Default,,0000,0000,0000,,as much before\Nthey show symptoms as after.
Dialogue: 0,0:07:07.40,0:07:08.57,Default,,0000,0000,0000,,AK: Potentially.
Dialogue: 0,0:07:08.59,0:07:10.35,Default,,0000,0000,0000,,Obviously these are early data sets,
Dialogue: 0,0:07:10.37,0:07:13.35,Default,,0000,0000,0000,,but I think there's good evidence\Nthat a fair number of people,
Dialogue: 0,0:07:13.37,0:07:15.97,Default,,0000,0000,0000,,either before they're\Nshowing clear symptoms
Dialogue: 0,0:07:15.99,0:07:19.42,Default,,0000,0000,0000,,or maybe they're not showing the kind of\Nvery distinctive fever and cough
Dialogue: 0,0:07:19.43,0:07:21.92,Default,,0000,0000,0000,,but they're feeling unwell\Nand they're shedding virus
Dialogue: 0,0:07:21.94,0:07:23.20,Default,,0000,0000,0000,,during that period.
Dialogue: 0,0:07:23.62,0:07:28.34,Default,,0000,0000,0000,,CA: And does that make it\Nquite different from the flu, for example?
Dialogue: 0,0:07:29.42,0:07:32.02,Default,,0000,0000,0000,,AK: It makes it actually\Nsimilar to flu in that regard.
Dialogue: 0,0:07:32.04,0:07:34.54,Default,,0000,0000,0000,,One of the reasons pandemic flu\Nis so hard to control
Dialogue: 0,0:07:34.56,0:07:36.39,Default,,0000,0000,0000,,and so feared as a threat
Dialogue: 0,0:07:36.41,0:07:40.74,Default,,0000,0000,0000,,is because so much transmission happens\Nbefore people are severely ill.
Dialogue: 0,0:07:40.76,0:07:44.15,Default,,0000,0000,0000,,And that means that by the time\Nyou identify these cases,
Dialogue: 0,0:07:44.17,0:07:47.25,Default,,0000,0000,0000,,they've probably actually spread it\Nto a number of other people.
Dialogue: 0,0:07:47.28,0:07:49.52,Default,,0000,0000,0000,,CA: Yeah, so this is\Nthe trickery of the thing,
Dialogue: 0,0:07:49.55,0:07:54.50,Default,,0000,0000,0000,,and why it's so hard\Nto do anything about it.
Dialogue: 0,0:07:54.52,0:07:56.39,Default,,0000,0000,0000,,It is ahead of us all the time,
Dialogue: 0,0:07:56.41,0:08:00.17,Default,,0000,0000,0000,,and you can't just pay attention\Nto how someone feels
Dialogue: 0,0:08:00.19,0:08:01.41,Default,,0000,0000,0000,,or what they're doing.
Dialogue: 0,0:08:01.43,0:08:03.43,Default,,0000,0000,0000,,I mean, how does that happen, by the way?
Dialogue: 0,0:08:03.45,0:08:05.32,Default,,0000,0000,0000,,How does someone infect someone else
Dialogue: 0,0:08:05.35,0:08:08.11,Default,,0000,0000,0000,,before they're even showing\Nsymptoms themselves,
Dialogue: 0,0:08:08.13,0:08:11.75,Default,,0000,0000,0000,,because classically, we think of,\Nyou know, the person sneezing
Dialogue: 0,0:08:11.78,0:08:14.90,Default,,0000,0000,0000,,and droplets go through the air\Nand someone else breathes them in
Dialogue: 0,0:08:14.92,0:08:16.55,Default,,0000,0000,0000,,and that's how infection happens.
Dialogue: 0,0:08:16.57,0:08:20.76,Default,,0000,0000,0000,,What is actually going on\Nfor infection pre-symptoms?
Dialogue: 0,0:08:21.95,0:08:24.53,Default,,0000,0000,0000,,AK: So the level of transmission\Nwe see with this virus
Dialogue: 0,0:08:24.55,0:08:26.67,Default,,0000,0000,0000,,isn't what we see,\Nfor example, with measles,
Dialogue: 0,0:08:26.70,0:08:29.03,Default,,0000,0000,0000,,where someone sneezes\Nand a lot of virus gets out
Dialogue: 0,0:08:29.05,0:08:32.00,Default,,0000,0000,0000,,and potentially lots of susceptible\Npeople can get exposed.
Dialogue: 0,0:08:32.03,0:08:34.16,Default,,0000,0000,0000,,So potentially, it could be quite early on
Dialogue: 0,0:08:34.18,0:08:36.29,Default,,0000,0000,0000,,that even if someone\Nhas quite mild symptoms,
Dialogue: 0,0:08:36.32,0:08:37.53,Default,,0000,0000,0000,,maybe a bit of a cough,
Dialogue: 0,0:08:37.55,0:08:39.72,Default,,0000,0000,0000,,that's enough for some virus\Nto be getting out
Dialogue: 0,0:08:39.74,0:08:40.92,Default,,0000,0000,0000,,and particularly,
Dialogue: 0,0:08:40.94,0:08:42.48,Default,,0000,0000,0000,,some of the work that we've done
Dialogue: 0,0:08:42.50,0:08:44.52,Default,,0000,0000,0000,,trying to look at sort of\Nclose gatherings,
Dialogue: 0,0:08:44.54,0:08:45.87,Default,,0000,0000,0000,,so very tight-knit meals,
Dialogue: 0,0:08:45.90,0:08:47.78,Default,,0000,0000,0000,,there was an example in a ski chalet --
Dialogue: 0,0:08:47.81,0:08:50.87,Default,,0000,0000,0000,,and even in those situations,\Nyou might have someone mildly ill,
Dialogue: 0,0:08:50.89,0:08:53.80,Default,,0000,0000,0000,,but enough virus is getting out\Nand somehow exposing others,
Dialogue: 0,0:08:53.82,0:08:55.82,Default,,0000,0000,0000,,we're still trying\Nto work out exactly how,
Dialogue: 0,0:08:55.85,0:08:58.32,Default,,0000,0000,0000,,but there's enough there\Nto cause some infection.
Dialogue: 0,0:08:58.96,0:09:03.12,Default,,0000,0000,0000,,CA: But if someone's mildly ill,\Ndon't they still have symptoms?
Dialogue: 0,0:09:03.15,0:09:07.89,Default,,0000,0000,0000,,Isn't there evidence that even before\Nthey know that they're ill,
Dialogue: 0,0:09:07.91,0:09:11.94,Default,,0000,0000,0000,,something is going on?
Dialogue: 0,0:09:11.97,0:09:14.06,Default,,0000,0000,0000,,There was a German paper\Npublished this week
Dialogue: 0,0:09:14.09,0:09:18.07,Default,,0000,0000,0000,,that seemed to suggest\Nthat even really early on,
Dialogue: 0,0:09:18.10,0:09:20.97,Default,,0000,0000,0000,,you take a swab from the back\Nof someone's throat
Dialogue: 0,0:09:20.99,0:09:24.27,Default,,0000,0000,0000,,and they have hundreds\Nof thousands of these viruses
Dialogue: 0,0:09:24.29,0:09:26.30,Default,,0000,0000,0000,,already reproducing there.
Dialogue: 0,0:09:26.32,0:09:30.17,Default,,0000,0000,0000,,Like, can someone just\Nliterally just be breathing normally
Dialogue: 0,0:09:30.20,0:09:33.47,Default,,0000,0000,0000,,and there is some transmission\Nof virus out into the air
Dialogue: 0,0:09:33.49,0:09:35.08,Default,,0000,0000,0000,,that they don't even know about
Dialogue: 0,0:09:35.10,0:09:36.97,Default,,0000,0000,0000,,and is either infecting people directly
Dialogue: 0,0:09:36.99,0:09:39.00,Default,,0000,0000,0000,,or settling on surfaces, is that possible?
Dialogue: 0,0:09:39.03,0:09:41.34,Default,,0000,0000,0000,,AK: I think that's what\Nwe're trying to pin down,
Dialogue: 0,0:09:41.36,0:09:42.55,Default,,0000,0000,0000,,how much that [unclear].
Dialogue: 0,0:09:42.57,0:09:43.74,Default,,0000,0000,0000,,As you said,
Dialogue: 0,0:09:43.77,0:09:46.48,Default,,0000,0000,0000,,there's evidence that you can have\Npeople without symptoms
Dialogue: 0,0:09:46.51,0:09:48.45,Default,,0000,0000,0000,,and you can get virus out their throats.
Dialogue: 0,0:09:48.47,0:09:51.43,Default,,0000,0000,0000,,And so certainly there's potential\Nthat it can be breathed out,
Dialogue: 0,0:09:51.46,0:09:54.80,Default,,0000,0000,0000,,but is that a fairly rare event\Nfor that actual transmission to happen,
Dialogue: 0,0:09:54.83,0:09:58.38,Default,,0000,0000,0000,,or are we potentially seeing more\Ninfections occur through that route?
Dialogue: 0,0:09:58.41,0:10:00.78,Default,,0000,0000,0000,,So it's really early data,
Dialogue: 0,0:10:00.80,0:10:02.68,Default,,0000,0000,0000,,and I think it's a piece of the puzzle,
Dialogue: 0,0:10:02.70,0:10:04.91,Default,,0000,0000,0000,,but we're trying to work out\Nwhere that fits in
Dialogue: 0,0:10:04.93,0:10:08.39,Default,,0000,0000,0000,,with what we know about the kind of\Nother transmission events we've seen.
Dialogue: 0,0:10:08.41,0:10:13.65,Default,,0000,0000,0000,,CA: Alright, so, duration is the duration\Nof the period of infectiousness.
Dialogue: 0,0:10:13.67,0:10:18.29,Default,,0000,0000,0000,,We think is five to six days,\Nis that what I heard you say?
Dialogue: 0,0:10:18.32,0:10:19.77,Default,,0000,0000,0000,,AK: Potentially around a week,
Dialogue: 0,0:10:19.80,0:10:23.03,Default,,0000,0000,0000,,depending on exactly what happens\Nto people when they're infectious.
Dialogue: 0,0:10:23.05,0:10:25.97,Default,,0000,0000,0000,,CA: And there are cases\Nof people testing positive
Dialogue: 0,0:10:25.100,0:10:28.73,Default,,0000,0000,0000,,way, way later,\Nafter they've got infected.
Dialogue: 0,0:10:29.38,0:10:32.45,Default,,0000,0000,0000,,That may be true, but they are probably\Nnot as infectious then.
Dialogue: 0,0:10:32.47,0:10:35.16,Default,,0000,0000,0000,,Is that basically right,\Nthat's the way to think of this?
Dialogue: 0,0:10:35.18,0:10:37.00,Default,,0000,0000,0000,,AK: I think that's our working theory,
Dialogue: 0,0:10:37.03,0:10:39.41,Default,,0000,0000,0000,,that a lot of that infection\Nis happening early on.
Dialogue: 0,0:10:39.43,0:10:42.05,Default,,0000,0000,0000,,And we see that for a number\Nof respiratory infections,
Dialogue: 0,0:10:42.07,0:10:44.35,Default,,0000,0000,0000,,that when people obviously\Nbecome severely ill,
Dialogue: 0,0:10:44.37,0:10:45.91,Default,,0000,0000,0000,,their behavior is very different
Dialogue: 0,0:10:45.94,0:10:49.19,Default,,0000,0000,0000,,to when they may be walking around\Nand going about their normal day.
Dialogue: 0,0:10:49.91,0:10:52.83,Default,,0000,0000,0000,,CA: And so again, comparing\Nthat D number to other cases,
Dialogue: 0,0:10:52.85,0:10:54.04,Default,,0000,0000,0000,,like the flu,
Dialogue: 0,0:10:54.07,0:10:55.53,Default,,0000,0000,0000,,is flu similar?
Dialogue: 0,0:10:55.56,0:10:57.61,Default,,0000,0000,0000,,What's the D number for flu?
Dialogue: 0,0:10:58.41,0:11:01.46,Default,,0000,0000,0000,,AK: So for flu,\Nit's probably slightly shorter
Dialogue: 0,0:11:01.49,0:11:04.78,Default,,0000,0000,0000,,in terms of the period\Nthat people are actively infectious.
Dialogue: 0,0:11:04.80,0:11:07.25,Default,,0000,0000,0000,,I mean, for flu,\Nit's a very quick turnover
Dialogue: 0,0:11:07.27,0:11:09.05,Default,,0000,0000,0000,,from one case to the next, actually.
Dialogue: 0,0:11:09.08,0:11:11.51,Default,,0000,0000,0000,,Even a matter of\Nabout three days, potentially,
Dialogue: 0,0:11:11.54,0:11:13.100,Default,,0000,0000,0000,,from one infection\Nto the person that they infect.
Dialogue: 0,0:11:14.85,0:11:17.96,Default,,0000,0000,0000,,And then at the other end of the scale,\Nyou get things like STDs,
Dialogue: 0,0:11:17.98,0:11:20.68,Default,,0000,0000,0000,,where that duration could be\Nseveral months, potentially.
Dialogue: 0,0:11:21.23,0:11:22.38,Default,,0000,0000,0000,,CA: Right.
Dialogue: 0,0:11:22.40,0:11:26.96,Default,,0000,0000,0000,,OK, really nothing that unusual so far,\Nin terms of this particular virus.
Dialogue: 0,0:11:26.98,0:11:29.79,Default,,0000,0000,0000,,Let's look at the O, opportunity.
Dialogue: 0,0:11:29.82,0:11:30.97,Default,,0000,0000,0000,,What is that?
Dialogue: 0,0:11:30.100,0:11:34.44,Default,,0000,0000,0000,,AK: So opportunity is a measure\Nof how many chances
Dialogue: 0,0:11:34.46,0:11:37.22,Default,,0000,0000,0000,,the virus has to spread\Nthrough interactions
Dialogue: 0,0:11:37.24,0:11:38.71,Default,,0000,0000,0000,,while someone is infectious.
Dialogue: 0,0:11:38.73,0:11:41.06,Default,,0000,0000,0000,,So typically, it's a measure\Nof social behavior.
Dialogue: 0,0:11:41.65,0:11:45.01,Default,,0000,0000,0000,,On average, how many\Nsocial contacts do people make
Dialogue: 0,0:11:45.04,0:11:48.53,Default,,0000,0000,0000,,that create opportunities for transmission\Nwhile they're infectious.
Dialogue: 0,0:11:48.55,0:11:53.70,Default,,0000,0000,0000,,CA: So it's how many people\Nhave you got close enough to
Dialogue: 0,0:11:53.72,0:11:56.10,Default,,0000,0000,0000,,during a day, during a given day,
Dialogue: 0,0:11:56.12,0:11:58.06,Default,,0000,0000,0000,,to have a chance of infecting them.
Dialogue: 0,0:11:58.09,0:12:00.99,Default,,0000,0000,0000,,And that number could be,
Dialogue: 0,0:12:01.01,0:12:04.61,Default,,0000,0000,0000,,if people aren't taking precautions\Nin a normal, sort of, urban setting,
Dialogue: 0,0:12:04.64,0:12:07.16,Default,,0000,0000,0000,,I mean, that could run\Ninto the hundreds, presumably?
Dialogue: 0,0:12:07.18,0:12:08.75,Default,,0000,0000,0000,,AK: Potentially, for some people.
Dialogue: 0,0:12:08.78,0:12:11.73,Default,,0000,0000,0000,,We've done a number of studies\Nlooking at that in recent years,
Dialogue: 0,0:12:11.76,0:12:13.99,Default,,0000,0000,0000,,and the average,\Nin terms of physical contacts,
Dialogue: 0,0:12:14.02,0:12:15.45,Default,,0000,0000,0000,,is about five people per day.
Dialogue: 0,0:12:15.48,0:12:17.63,Default,,0000,0000,0000,,Most people will have\Nconversation or contacts
Dialogue: 0,0:12:17.66,0:12:19.01,Default,,0000,0000,0000,,generally with about 10, 15,
Dialogue: 0,0:12:19.03,0:12:20.20,Default,,0000,0000,0000,,but obviously,
Dialogue: 0,0:12:20.22,0:12:22.52,Default,,0000,0000,0000,,between cultures,\Nwe see quite a lot of variation
Dialogue: 0,0:12:22.54,0:12:25.10,Default,,0000,0000,0000,,in the level of physical greetings\Nthat might happen.
Dialogue: 0,0:12:25.12,0:12:29.71,Default,,0000,0000,0000,,CA: And presumably, that number\Nagain is no different for this virus
Dialogue: 0,0:12:29.73,0:12:30.90,Default,,0000,0000,0000,,than for any other.
Dialogue: 0,0:12:30.92,0:12:34.37,Default,,0000,0000,0000,,I mean, that's just a feature\Nof the lives that we live.
Dialogue: 0,0:12:35.28,0:12:37.05,Default,,0000,0000,0000,,AK: I think for this one,
Dialogue: 0,0:12:37.07,0:12:39.44,Default,,0000,0000,0000,,if it's driven through\Nthese kind of interactions,
Dialogue: 0,0:12:39.46,0:12:42.37,Default,,0000,0000,0000,,and we've seen for flu,\Nfor other respiratory infections,
Dialogue: 0,0:12:42.39,0:12:46.32,Default,,0000,0000,0000,,those kinds of fairly close contacts\Nand everyday physical interactions
Dialogue: 0,0:12:46.34,0:12:49.44,Default,,0000,0000,0000,,seem to be the ones\Nthat are important for transmission.
Dialogue: 0,0:12:49.46,0:12:51.65,Default,,0000,0000,0000,,CA: Perhaps there is one difference.
Dialogue: 0,0:12:51.67,0:12:56.40,Default,,0000,0000,0000,,The fact that if you're\Ninfectious pre-symptoms,
Dialogue: 0,0:12:56.42,0:12:59.79,Default,,0000,0000,0000,,perhaps that means that actually,\Nthere are more opportunities here.
Dialogue: 0,0:12:59.81,0:13:02.78,Default,,0000,0000,0000,,This is part of the virus's\Ngenius, as it were,
Dialogue: 0,0:13:02.81,0:13:06.61,Default,,0000,0000,0000,,that by not letting on\Nthat it's inside someone,
Dialogue: 0,0:13:06.63,0:13:09.98,Default,,0000,0000,0000,,people continue to interact and go to work
Dialogue: 0,0:13:10.00,0:13:11.78,Default,,0000,0000,0000,,and take the subway and so forth,
Dialogue: 0,0:13:11.80,0:13:13.73,Default,,0000,0000,0000,,not even knowing that they're sick.
Dialogue: 0,0:13:13.75,0:13:14.92,Default,,0000,0000,0000,,AK: Exactly.
Dialogue: 0,0:13:14.94,0:13:16.29,Default,,0000,0000,0000,,And for something like flu,
Dialogue: 0,0:13:16.32,0:13:20.28,Default,,0000,0000,0000,,you see when people get ill, clearly,\Ntheir social contacts drop off.
Dialogue: 0,0:13:20.30,0:13:23.28,Default,,0000,0000,0000,,So to have a virus that can be infectious
Dialogue: 0,0:13:23.31,0:13:26.15,Default,,0000,0000,0000,,while people are going around\Ntheir everyday lives,
Dialogue: 0,0:13:26.17,0:13:28.71,Default,,0000,0000,0000,,really gives it an advantage\Nin terms of transmission.
Dialogue: 0,0:13:28.74,0:13:29.90,Default,,0000,0000,0000,,CA: In your modeling,
Dialogue: 0,0:13:29.93,0:13:34.76,Default,,0000,0000,0000,,do you actually have this\Nopportunities number higher than for flu?
Dialogue: 0,0:13:35.41,0:13:39.94,Default,,0000,0000,0000,,AK: So for the moment,\Nwe're kind of using similar values,
Dialogue: 0,0:13:39.96,0:13:43.02,Default,,0000,0000,0000,,so we're trying to look at, for example,
Dialogue: 0,0:13:43.05,0:13:45.45,Default,,0000,0000,0000,,physical contacts\Nwithin different populations.
Dialogue: 0,0:13:45.47,0:13:47.88,Default,,0000,0000,0000,,But what we are doing is scaling the risk.
Dialogue: 0,0:13:47.90,0:13:50.21,Default,,0000,0000,0000,,So that's coming on to the T term.
Dialogue: 0,0:13:50.24,0:13:52.47,Default,,0000,0000,0000,,So that between each contact,
Dialogue: 0,0:13:52.50,0:13:55.35,Default,,0000,0000,0000,,what's the risk that a transmission\Nevent will occur.
Dialogue: 0,0:13:55.37,0:13:57.62,Default,,0000,0000,0000,,CA: Alright, so let's go on\Nto this next number,
Dialogue: 0,0:13:57.64,0:14:00.30,Default,,0000,0000,0000,,the T, transmission probability.
Dialogue: 0,0:14:00.32,0:14:01.98,Default,,0000,0000,0000,,How do you define that?
Dialogue: 0,0:14:02.01,0:14:04.61,Default,,0000,0000,0000,,AK: So this measures the chance
Dialogue: 0,0:14:04.63,0:14:07.21,Default,,0000,0000,0000,,that, essentially,\Nthe virus will get across
Dialogue: 0,0:14:07.24,0:14:10.11,Default,,0000,0000,0000,,during a particular opportunity\Nor a particular interaction.
Dialogue: 0,0:14:10.13,0:14:13.12,Default,,0000,0000,0000,,So you may well have\Na conversation with somebody,
Dialogue: 0,0:14:13.14,0:14:16.57,Default,,0000,0000,0000,,but actually, you don't cough\Nor you don't sneeze
Dialogue: 0,0:14:16.60,0:14:19.30,Default,,0000,0000,0000,,or for some reason,\Nthe virus doesn't actually get across
Dialogue: 0,0:14:19.32,0:14:20.97,Default,,0000,0000,0000,,and expose the other person.
Dialogue: 0,0:14:20.99,0:14:23.79,Default,,0000,0000,0000,,And so, for this virus, as I mentioned,
Dialogue: 0,0:14:23.82,0:14:25.93,Default,,0000,0000,0000,,say people are having\N10 conversations a day,
Dialogue: 0,0:14:25.95,0:14:28.81,Default,,0000,0000,0000,,but we're not seeing infected people\Ninfect 10 others a day.
Dialogue: 0,0:14:28.83,0:14:31.25,Default,,0000,0000,0000,,So it suggests that not all\Nof those opportunities
Dialogue: 0,0:14:31.28,0:14:33.71,Default,,0000,0000,0000,,are actually resulting\Nin the virus getting across.
Dialogue: 0,0:14:34.54,0:14:38.92,Default,,0000,0000,0000,,CA: But people say\Nthat this is an infectious virus.
Dialogue: 0,0:14:38.94,0:14:42.45,Default,,0000,0000,0000,,Like, what is that transmission\Nprobability number,
Dialogue: 0,0:14:42.48,0:14:44.41,Default,,0000,0000,0000,,again, compared with, say, the flu?
Dialogue: 0,0:14:44.86,0:14:48.62,Default,,0000,0000,0000,,AK: So, we did some analysis\Nlooking at these very close gatherings.
Dialogue: 0,0:14:48.64,0:14:51.06,Default,,0000,0000,0000,,We looked at about 10\Ndifferent case studies,
Dialogue: 0,0:14:51.08,0:14:54.89,Default,,0000,0000,0000,,and we found that about a third\Nof the contacts in those settings
Dialogue: 0,0:14:54.91,0:14:56.76,Default,,0000,0000,0000,,subsequently got infected
Dialogue: 0,0:14:56.79,0:14:59.14,Default,,0000,0000,0000,,in these early stages,\Nwhen people weren't aware.
Dialogue: 0,0:14:59.17,0:15:01.44,Default,,0000,0000,0000,,So if you had these, kind of,\Nbig group meals,
Dialogue: 0,0:15:01.46,0:15:05.18,Default,,0000,0000,0000,,potentially, each contact\Nhad about, a kind of, one in three chance
Dialogue: 0,0:15:05.20,0:15:06.56,Default,,0000,0000,0000,,of getting exposed.
Dialogue: 0,0:15:06.58,0:15:10.19,Default,,0000,0000,0000,,For seasonal flu,\Nthat tends to be slightly lower,
Dialogue: 0,0:15:10.21,0:15:12.32,Default,,0000,0000,0000,,even within households\Nand close settings,
Dialogue: 0,0:15:12.35,0:15:14.48,Default,,0000,0000,0000,,you don't necessarily\Nget values that high.
Dialogue: 0,0:15:14.51,0:15:18.37,Default,,0000,0000,0000,,And even for something like SARS,\Nthose values have, kind of --
Dialogue: 0,0:15:18.39,0:15:21.70,Default,,0000,0000,0000,,the risk per interaction you had
Dialogue: 0,0:15:21.72,0:15:24.47,Default,,0000,0000,0000,,was lower than what we seem\Nto be getting for coronavirus.
Dialogue: 0,0:15:24.49,0:15:25.93,Default,,0000,0000,0000,,Which intuitively makes sense,
Dialogue: 0,0:15:25.96,0:15:28.12,Default,,0000,0000,0000,,there must be a higher risk\Nper interaction
Dialogue: 0,0:15:28.14,0:15:30.10,Default,,0000,0000,0000,,if this thing is spreading so easily.
Dialogue: 0,0:15:30.12,0:15:31.27,Default,,0000,0000,0000,,CA: Hm.
Dialogue: 0,0:15:32.35,0:15:35.90,Default,,0000,0000,0000,,OK, and then the fourth letter of DOTS
Dialogue: 0,0:15:35.93,0:15:38.48,Default,,0000,0000,0000,,is S for susceptibility.
Dialogue: 0,0:15:39.87,0:15:41.04,Default,,0000,0000,0000,,What's that?
Dialogue: 0,0:15:41.07,0:15:45.59,Default,,0000,0000,0000,,AK: So that is a measure of the proportion\Nof the population who are susceptible.
Dialogue: 0,0:15:45.62,0:15:48.17,Default,,0000,0000,0000,,If you imagine you have\Nthis interaction with someone,
Dialogue: 0,0:15:48.19,0:15:50.38,Default,,0000,0000,0000,,the virus gets across, it exposes them,
Dialogue: 0,0:15:50.40,0:15:52.35,Default,,0000,0000,0000,,but some people may have been vaccinated
Dialogue: 0,0:15:52.37,0:15:54.18,Default,,0000,0000,0000,,or otherwise have some immunity
Dialogue: 0,0:15:54.20,0:15:55.99,Default,,0000,0000,0000,,and not develop infection themselves
Dialogue: 0,0:15:56.02,0:15:57.78,Default,,0000,0000,0000,,and not be infectious to others.
Dialogue: 0,0:15:57.80,0:16:01.29,Default,,0000,0000,0000,,So we've got to account for this\Npotential proportion of people
Dialogue: 0,0:16:01.32,0:16:04.38,Default,,0000,0000,0000,,who are not actually\Ngoing to turn into cases themselves.
Dialogue: 0,0:16:06.37,0:16:11.70,Default,,0000,0000,0000,,CA: And obviously, there's no vaccine yet\Nfor this coronavirus,
Dialogue: 0,0:16:11.72,0:16:16.31,Default,,0000,0000,0000,,nor is anyone, at least initially,\Nimmune, as far as we know.
Dialogue: 0,0:16:16.34,0:16:20.36,Default,,0000,0000,0000,,So are you modeling that\Nsusceptibility number pretty high,
Dialogue: 0,0:16:20.38,0:16:22.10,Default,,0000,0000,0000,,is that part of the issue here?
Dialogue: 0,0:16:22.12,0:16:23.73,Default,,0000,0000,0000,,AK: Yeah, I think the evidence
Dialogue: 0,0:16:23.75,0:16:26.58,Default,,0000,0000,0000,,is that this is going to fully\Nsusceptible populations,
Dialogue: 0,0:16:26.60,0:16:29.14,Default,,0000,0000,0000,,and even in areas,\Nfor example, like China,
Dialogue: 0,0:16:29.16,0:16:31.09,Default,,0000,0000,0000,,where there's been a lot of transmission
Dialogue: 0,0:16:31.12,0:16:33.27,Default,,0000,0000,0000,,but there's been very strong\Ncontrol measures,
Dialogue: 0,0:16:33.29,0:16:35.34,Default,,0000,0000,0000,,we estimated that up to\Nthe end of January,
Dialogue: 0,0:16:35.36,0:16:38.12,Default,,0000,0000,0000,,probably about 95 percent of Wuhan\Nare still susceptible.
Dialogue: 0,0:16:38.14,0:16:39.82,Default,,0000,0000,0000,,So there's been a lot of infection,
Dialogue: 0,0:16:39.84,0:16:43.06,Default,,0000,0000,0000,,but it hasn't really taken much\Nof that component,
Dialogue: 0,0:16:43.08,0:16:46.10,Default,,0000,0000,0000,,of the DOTS, of those four things\Nthat drive transmission.
Dialogue: 0,0:16:47.36,0:16:49.37,Default,,0000,0000,0000,,CA: And so the way the mathematics works,
Dialogue: 0,0:16:49.40,0:16:55.22,Default,,0000,0000,0000,,I have to confess, amidst the stress\Nof this whole situation,
Dialogue: 0,0:16:55.24,0:16:58.39,Default,,0000,0000,0000,,the nerd in me kind of loves\Nthe elegance of the mathematics here,
Dialogue: 0,0:16:58.41,0:17:00.82,Default,,0000,0000,0000,,because I'd never really\Nthought about it this way,
Dialogue: 0,0:17:00.85,0:17:03.55,Default,,0000,0000,0000,,but you basically just multiply\Nthose numbers together
Dialogue: 0,0:17:03.57,0:17:05.51,Default,,0000,0000,0000,,to get the reproduction number.
Dialogue: 0,0:17:05.53,0:17:06.68,Default,,0000,0000,0000,,Is that right?
Dialogue: 0,0:17:06.71,0:17:07.89,Default,,0000,0000,0000,,AK: Exactly, yeah,
Dialogue: 0,0:17:07.91,0:17:10.84,Default,,0000,0000,0000,,you almost take the path\Nof the infection during transmission
Dialogue: 0,0:17:10.87,0:17:12.37,Default,,0000,0000,0000,,as you multiply those together,
Dialogue: 0,0:17:12.40,0:17:14.54,Default,,0000,0000,0000,,and that gives you\Nthe number for that virus.
Dialogue: 0,0:17:14.56,0:17:17.78,Default,,0000,0000,0000,,CA: And so there's just\Na total logic to that.
Dialogue: 0,0:17:17.80,0:17:20.57,Default,,0000,0000,0000,,It's the number of days,\Nduration that you're infectious,
Dialogue: 0,0:17:20.59,0:17:23.43,Default,,0000,0000,0000,,it's the number of people\Nyou're seeing on average
Dialogue: 0,0:17:23.46,0:17:26.06,Default,,0000,0000,0000,,during those days\Nthat you have a chance to infect.
Dialogue: 0,0:17:27.19,0:17:32.18,Default,,0000,0000,0000,,Then you multiply that\Nby the transmission probability,
Dialogue: 0,0:17:32.20,0:17:34.88,Default,,0000,0000,0000,,is virus getting into them, essentially,
Dialogue: 0,0:17:34.90,0:17:36.75,Default,,0000,0000,0000,,that's what you mean by crossing over.
Dialogue: 0,0:17:36.78,0:17:38.86,Default,,0000,0000,0000,,And then by the susceptibility number.
Dialogue: 0,0:17:38.89,0:17:41.95,Default,,0000,0000,0000,,By the way, what do you think\Nthe susceptibility probability is
Dialogue: 0,0:17:41.97,0:17:43.31,Default,,0000,0000,0000,,for this case?
Dialogue: 0,0:17:43.80,0:17:47.05,Default,,0000,0000,0000,,AK: I think we have to assume\Nthat it's near 100 percent
Dialogue: 0,0:17:47.07,0:17:49.11,Default,,0000,0000,0000,,in terms of spread, yeah.
Dialogue: 0,0:17:50.13,0:17:52.43,Default,,0000,0000,0000,,CA: Alright, you multiply\Nthose numbers together,
Dialogue: 0,0:17:52.46,0:17:57.45,Default,,0000,0000,0000,,and right now, it looks like,\Nfor this coronavirus,
Dialogue: 0,0:17:57.48,0:18:02.23,Default,,0000,0000,0000,,that you say two to three\Nis the most plausible current number,
Dialogue: 0,0:18:02.53,0:18:04.66,Default,,0000,0000,0000,,which implies very rapid growth.
Dialogue: 0,0:18:05.14,0:18:06.31,Default,,0000,0000,0000,,AK: Exactly.
Dialogue: 0,0:18:06.33,0:18:07.88,Default,,0000,0000,0000,,In these uncontrolled outbreaks,
Dialogue: 0,0:18:07.90,0:18:10.49,Default,,0000,0000,0000,,we're seeing now a number\Nof countries in this stage --
Dialogue: 0,0:18:10.52,0:18:13.53,Default,,0000,0000,0000,,you are going to get\Nthis really rapid growth occurring.
Dialogue: 0,0:18:13.80,0:18:18.64,Default,,0000,0000,0000,,CA: And so how does\Nthat two to three compare with flu?
Dialogue: 0,0:18:18.66,0:18:22.22,Default,,0000,0000,0000,,And I guess, there's seasonal flu,
Dialogue: 0,0:18:22.24,0:18:23.94,Default,,0000,0000,0000,,in the winter, when it's spreading,
Dialogue: 0,0:18:23.97,0:18:28.24,Default,,0000,0000,0000,,and at other times during the year\Ndrops well below one
Dialogue: 0,0:18:28.27,0:18:30.40,Default,,0000,0000,0000,,as a reproduction number, right?
Dialogue: 0,0:18:30.43,0:18:33.09,Default,,0000,0000,0000,,But what is it during seasonal flu time?
Dialogue: 0,0:18:33.83,0:18:36.04,Default,,0000,0000,0000,,AK: During the early stage\Nwhen it's taking off
Dialogue: 0,0:18:36.07,0:18:37.60,Default,,0000,0000,0000,,at the start of the flu season,
Dialogue: 0,0:18:37.62,0:18:41.74,Default,,0000,0000,0000,,it's probably, we reckon,\Nsomewhere between about maybe 1.2, 1.4.
Dialogue: 0,0:18:41.76,0:18:43.71,Default,,0000,0000,0000,,So it's not incredibly transmissible,
Dialogue: 0,0:18:43.73,0:18:47.74,Default,,0000,0000,0000,,if you imagine you do have some immunity\Nin your population from vaccination
Dialogue: 0,0:18:47.76,0:18:48.95,Default,,0000,0000,0000,,and from other things.
Dialogue: 0,0:18:48.97,0:18:50.56,Default,,0000,0000,0000,,So it can spread, it's above one,
Dialogue: 0,0:18:50.58,0:18:54.14,Default,,0000,0000,0000,,but it's not taking off, necessarily,\Nas quickly as the coronavirus is.
Dialogue: 0,0:18:55.02,0:18:58.27,Default,,0000,0000,0000,,CA: So I want to come back\Nto two of those elements,
Dialogue: 0,0:18:58.29,0:19:00.86,Default,,0000,0000,0000,,specifically opportunity\Nand transmission probability,
Dialogue: 0,0:19:00.88,0:19:05.55,Default,,0000,0000,0000,,because those seem to have the most\Nchance to actually do something
Dialogue: 0,0:19:05.58,0:19:07.39,Default,,0000,0000,0000,,about this infection rate.
Dialogue: 0,0:19:07.41,0:19:08.56,Default,,0000,0000,0000,,Before we go there,
Dialogue: 0,0:19:08.58,0:19:10.93,Default,,0000,0000,0000,,let's talk about another\Nkey number on this,
Dialogue: 0,0:19:10.95,0:19:13.91,Default,,0000,0000,0000,,which is the fatality rate.
Dialogue: 0,0:19:13.93,0:19:15.61,Default,,0000,0000,0000,,First of all, could you define --
Dialogue: 0,0:19:15.63,0:19:18.41,Default,,0000,0000,0000,,I think there's two different versions\Nof the fatality rate
Dialogue: 0,0:19:18.43,0:19:20.44,Default,,0000,0000,0000,,that maybe confuse people.
Dialogue: 0,0:19:20.47,0:19:22.47,Default,,0000,0000,0000,,Could you define them?
Dialogue: 0,0:19:22.49,0:19:26.58,Default,,0000,0000,0000,,AK: So the one that we often talk about\Nis what's known as the case fatality rate,
Dialogue: 0,0:19:26.61,0:19:30.48,Default,,0000,0000,0000,,and that's of the proportion who show up\Nwith symptoms as cases,
Dialogue: 0,0:19:30.51,0:19:33.56,Default,,0000,0000,0000,,what proportion of those\Nwill subsequently be fatal.
Dialogue: 0,0:19:34.18,0:19:36.31,Default,,0000,0000,0000,,And we also sometimes talk\Nabout what's known
Dialogue: 0,0:19:36.34,0:19:37.83,Default,,0000,0000,0000,,as the infection fatality rate,
Dialogue: 0,0:19:37.85,0:19:39.79,Default,,0000,0000,0000,,which is, of everyone who gets infected,
Dialogue: 0,0:19:39.81,0:19:41.03,Default,,0000,0000,0000,,regardless of symptoms,
Dialogue: 0,0:19:41.05,0:19:43.74,Default,,0000,0000,0000,,how many of those infections\Nwill subsequently be fatal.
Dialogue: 0,0:19:43.76,0:19:45.87,Default,,0000,0000,0000,,But most of the values\Nwe see kicking around
Dialogue: 0,0:19:45.89,0:19:49.03,Default,,0000,0000,0000,,are the case fatality rate, or the CFR,\Nas it's sometimes known.
Dialogue: 0,0:19:49.96,0:19:54.03,Default,,0000,0000,0000,,CA: And so what is\Nthat fatality rate for this virus,
Dialogue: 0,0:19:54.06,0:19:57.26,Default,,0000,0000,0000,,and again, how does that compare\Nwith other pathogens?
Dialogue: 0,0:19:57.67,0:20:00.48,Default,,0000,0000,0000,,AK: So there's a few numbers\Nthat have been bouncing around.
Dialogue: 0,0:20:00.51,0:20:04.19,Default,,0000,0000,0000,,One of the challenges in real time\Nis you often don't see all of your cases,
Dialogue: 0,0:20:04.21,0:20:06.69,Default,,0000,0000,0000,,you have people symptomatic\Nnot being reported.
Dialogue: 0,0:20:06.71,0:20:07.87,Default,,0000,0000,0000,,You also have a delay.
Dialogue: 0,0:20:07.90,0:20:09.24,Default,,0000,0000,0000,,If you imagine, for example,
Dialogue: 0,0:20:09.26,0:20:11.82,Default,,0000,0000,0000,,100 people turn up to a hospital\Nwith coronavirus
Dialogue: 0,0:20:11.84,0:20:13.31,Default,,0000,0000,0000,,and none have died yet,
Dialogue: 0,0:20:13.33,0:20:15.68,Default,,0000,0000,0000,,that doesn't imply\Nthat the fatality rate is zero,
Dialogue: 0,0:20:15.70,0:20:18.57,Default,,0000,0000,0000,,because you've got to wait to see\Nwhat might happen to them.
Dialogue: 0,0:20:18.59,0:20:21.48,Default,,0000,0000,0000,,So when you adjust for that\Nunderreporting and delays,
Dialogue: 0,0:20:21.51,0:20:24.60,Default,,0000,0000,0000,,best estimate for the case fatality\Nis about one percent.
Dialogue: 0,0:20:24.62,0:20:26.73,Default,,0000,0000,0000,,So about one percent\Nof people with symptoms,
Dialogue: 0,0:20:26.75,0:20:28.13,Default,,0000,0000,0000,,on average,
Dialogue: 0,0:20:28.16,0:20:29.40,Default,,0000,0000,0000,,those outcomes are fatal.
Dialogue: 0,0:20:29.43,0:20:32.28,Default,,0000,0000,0000,,And that's probably about 10 times\Nworse than seasonal flu.
Dialogue: 0,0:20:33.51,0:20:37.17,Default,,0000,0000,0000,,CA: Yeah, so that's a scary\Ncomparison right there,
Dialogue: 0,0:20:37.20,0:20:40.35,Default,,0000,0000,0000,,given how many people die of flu.
Dialogue: 0,0:20:40.38,0:20:44.84,Default,,0000,0000,0000,,So when the World Health Organization\Nmentioned a higher number,
Dialogue: 0,0:20:44.87,0:20:47.61,Default,,0000,0000,0000,,a little while back, of 3.4 percent,
Dialogue: 0,0:20:47.63,0:20:50.33,Default,,0000,0000,0000,,they were criticized a bit for that.
Dialogue: 0,0:20:50.36,0:20:54.10,Default,,0000,0000,0000,,Explain why that\Nmight have been misleading
Dialogue: 0,0:20:54.13,0:20:57.17,Default,,0000,0000,0000,,and how to think about it\Nand adjust for that.
Dialogue: 0,0:20:57.20,0:21:00.30,Default,,0000,0000,0000,,AK: It's incredibly common that people\Nlook at these raw numbers,
Dialogue: 0,0:21:00.32,0:21:03.24,Default,,0000,0000,0000,,they say, "How many deaths\Nare there so far, how many cases,"
Dialogue: 0,0:21:03.26,0:21:04.63,Default,,0000,0000,0000,,and they look at that ratio,
Dialogue: 0,0:21:04.66,0:21:08.14,Default,,0000,0000,0000,,and even a couple of weeks ago,\Nthat number produced a two percent value.
Dialogue: 0,0:21:08.16,0:21:10.79,Default,,0000,0000,0000,,But if you imagine\Nyou have this delay effect,
Dialogue: 0,0:21:10.82,0:21:13.06,Default,,0000,0000,0000,,then even if you stop all your cases,
Dialogue: 0,0:21:13.08,0:21:15.92,Default,,0000,0000,0000,,you will still have these kind of\Nfatal outcomes over time,
Dialogue: 0,0:21:15.94,0:21:17.69,Default,,0000,0000,0000,,so that number will creep up.
Dialogue: 0,0:21:17.71,0:21:21.62,Default,,0000,0000,0000,,This has occurred in every epidemic\Nfrom pandemic flu to Ebola,
Dialogue: 0,0:21:21.64,0:21:23.23,Default,,0000,0000,0000,,we see this again and again.
Dialogue: 0,0:21:23.25,0:21:26.98,Default,,0000,0000,0000,,And I made the point to a number of people\Nthat this number is going to go up,
Dialogue: 0,0:21:27.01,0:21:28.54,Default,,0000,0000,0000,,because as China's cases slow,
Dialogue: 0,0:21:28.56,0:21:30.22,Default,,0000,0000,0000,,it will look like it's increasing,
Dialogue: 0,0:21:30.24,0:21:32.69,Default,,0000,0000,0000,,and that's just kind of\Na statistical quirk.
Dialogue: 0,0:21:32.72,0:21:35.13,Default,,0000,0000,0000,,There's nothing really\Nkind of, behind a change,
Dialogue: 0,0:21:35.16,0:21:37.64,Default,,0000,0000,0000,,there's no mutations or anything going on.
Dialogue: 0,0:21:38.97,0:21:41.94,Default,,0000,0000,0000,,CA: If I have this right,\Nthere are two effects going on.
Dialogue: 0,0:21:41.96,0:21:45.06,Default,,0000,0000,0000,,One is that the number of fatalities
Dialogue: 0,0:21:45.08,0:21:47.62,Default,,0000,0000,0000,,from the existing caseload will rise,
Dialogue: 0,0:21:47.64,0:21:51.63,Default,,0000,0000,0000,,which actually would boost\Nthat 3.4 even higher.
Dialogue: 0,0:21:51.66,0:21:55.48,Default,,0000,0000,0000,,But then you have to offset that\Nagainst the fact that, apparently,
Dialogue: 0,0:21:55.51,0:21:58.09,Default,,0000,0000,0000,,huge numbers of cases\Nhave just gone undetected
Dialogue: 0,0:21:58.12,0:21:59.58,Default,,0000,0000,0000,,and that we haven't,
Dialogue: 0,0:21:59.60,0:22:02.02,Default,,0000,0000,0000,,due to bad testing,
Dialogue: 0,0:22:02.05,0:22:04.59,Default,,0000,0000,0000,,that the number of fatalities don't --
Dialogue: 0,0:22:04.61,0:22:07.96,Default,,0000,0000,0000,,they probably reflect\Na much larger number of early cases.
Dialogue: 0,0:22:07.98,0:22:09.15,Default,,0000,0000,0000,,Is that it?
Dialogue: 0,0:22:09.18,0:22:10.35,Default,,0000,0000,0000,,AK: Exactly.
Dialogue: 0,0:22:10.37,0:22:12.44,Default,,0000,0000,0000,,So you have one thing\Npulling the number up
Dialogue: 0,0:22:12.47,0:22:13.93,Default,,0000,0000,0000,,and one thing pulling it down.
Dialogue: 0,0:22:13.95,0:22:16.24,Default,,0000,0000,0000,,And it means that on these\Nkind of early values,
Dialogue: 0,0:22:16.27,0:22:18.28,Default,,0000,0000,0000,,if you actually just adjust for the delay
Dialogue: 0,0:22:18.31,0:22:20.41,Default,,0000,0000,0000,,and don't think\Nabout these unreported cases,
Dialogue: 0,0:22:20.44,0:22:22.87,Default,,0000,0000,0000,,you start getting really\Nvery scary numbers indeed.
Dialogue: 0,0:22:22.90,0:22:24.88,Default,,0000,0000,0000,,You get up to 20, 30 percent potentially,
Dialogue: 0,0:22:24.91,0:22:26.21,Default,,0000,0000,0000,,which really doesn't align
Dialogue: 0,0:22:26.23,0:22:29.19,Default,,0000,0000,0000,,with what we know\Nabout this virus in general.
Dialogue: 0,0:22:29.54,0:22:30.87,Default,,0000,0000,0000,,CA: Alright.
Dialogue: 0,0:22:31.62,0:22:33.14,Default,,0000,0000,0000,,There's a lot more data in now.
Dialogue: 0,0:22:33.16,0:22:36.78,Default,,0000,0000,0000,,From your point of view,\Nyou think the likely fatality rate,
Dialogue: 0,0:22:36.80,0:22:41.50,Default,,0000,0000,0000,,at least in the earlier stage\Nof an infection,
Dialogue: 0,0:22:41.53,0:22:43.69,Default,,0000,0000,0000,,is about two percent?
Dialogue: 0,0:22:44.33,0:22:45.48,Default,,0000,0000,0000,,AK: I think overall,
Dialogue: 0,0:22:45.50,0:22:48.81,Default,,0000,0000,0000,,I think we can put something probably\Nin the 0.5 to two percent range,
Dialogue: 0,0:22:48.83,0:22:51.64,Default,,0000,0000,0000,,and that's on a number\Nof different data sets.
Dialogue: 0,0:22:51.67,0:22:53.67,Default,,0000,0000,0000,,And that's for people who are symptomatic.
Dialogue: 0,0:22:53.69,0:22:56.74,Default,,0000,0000,0000,,I think on average, one percent\Nis a good number to work with.
Dialogue: 0,0:22:56.76,0:22:58.30,Default,,0000,0000,0000,,CA: OK, one percent,
Dialogue: 0,0:22:58.32,0:23:01.37,Default,,0000,0000,0000,,So flu is often quoted\Nas a tenth of a percent,
Dialogue: 0,0:23:01.39,0:23:06.51,Default,,0000,0000,0000,,so it's five to 10 times or more\Nmore dangerous than flu.
Dialogue: 0,0:23:06.54,0:23:10.01,Default,,0000,0000,0000,,And that danger is not symmetric\Nacross age groups,
Dialogue: 0,0:23:10.03,0:23:11.40,Default,,0000,0000,0000,,as is well known.
Dialogue: 0,0:23:11.42,0:23:14.47,Default,,0000,0000,0000,,It primarily affects the elderly.
Dialogue: 0,0:23:14.49,0:23:16.82,Default,,0000,0000,0000,,AK: Yeah, we've seen\Nthat one percent on average,
Dialogue: 0,0:23:16.84,0:23:19.46,Default,,0000,0000,0000,,but once you start getting\Ninto the over 60s, over 70s,
Dialogue: 0,0:23:19.48,0:23:21.32,Default,,0000,0000,0000,,that number really starts to shoot up.
Dialogue: 0,0:23:21.35,0:23:24.11,Default,,0000,0000,0000,,I mean, we're estimating\Npotentially in these older groups,
Dialogue: 0,0:23:24.13,0:23:28.88,Default,,0000,0000,0000,,you're looking at maybe five,\N10 percent fatality.
Dialogue: 0,0:23:29.24,0:23:31.01,Default,,0000,0000,0000,,And then of course, on top of that,
Dialogue: 0,0:23:31.04,0:23:33.66,Default,,0000,0000,0000,,you've got to add what\Nare going to be the severe cases
Dialogue: 0,0:23:33.68,0:23:35.95,Default,,0000,0000,0000,,and people are going to require\Nhospitalization.
Dialogue: 0,0:23:35.97,0:23:38.85,Default,,0000,0000,0000,,And those risks get very large\Nin the older groups indeed.
Dialogue: 0,0:23:41.19,0:23:43.30,Default,,0000,0000,0000,,CA: Adam, put these numbers\Ntogether for us.
Dialogue: 0,0:23:43.32,0:23:44.47,Default,,0000,0000,0000,,In your models,
Dialogue: 0,0:23:44.49,0:23:49.41,Default,,0000,0000,0000,,if you put together\Na reproduction rate of two to three
Dialogue: 0,0:23:49.43,0:23:53.55,Default,,0000,0000,0000,,and a fatality rate\Nof 0.5 percent to one percent
Dialogue: 0,0:23:53.57,0:23:56.06,Default,,0000,0000,0000,,and you run the simulation,
Dialogue: 0,0:23:56.09,0:23:57.62,Default,,0000,0000,0000,,what does it look like?
Dialogue: 0,0:23:58.70,0:24:01.52,Default,,0000,0000,0000,,AK: So if you have\Nthis uncontrolled transmission,
Dialogue: 0,0:24:01.54,0:24:04.03,Default,,0000,0000,0000,,and you have this reproduction\Nnumber of two or three
Dialogue: 0,0:24:04.05,0:24:05.78,Default,,0000,0000,0000,,and you don't do anything about it,
Dialogue: 0,0:24:05.81,0:24:07.48,Default,,0000,0000,0000,,the only way the outbreak ends
Dialogue: 0,0:24:07.50,0:24:11.29,Default,,0000,0000,0000,,is enough people get it\Nand immunity builds up
Dialogue: 0,0:24:11.31,0:24:15.40,Default,,0000,0000,0000,,and the outbreak kind of ends on its own.
Dialogue: 0,0:24:15.42,0:24:16.59,Default,,0000,0000,0000,,And in that case,
Dialogue: 0,0:24:16.61,0:24:19.86,Default,,0000,0000,0000,,you would expect very large numbers\Nof the population to be infected.
Dialogue: 0,0:24:19.88,0:24:21.45,Default,,0000,0000,0000,,It's what we see, for example,
Dialogue: 0,0:24:21.47,0:24:24.02,Default,,0000,0000,0000,,with many other uncontained outbreaks,
Dialogue: 0,0:24:24.04,0:24:26.36,Default,,0000,0000,0000,,that it essentially burns\Nthrough the population,
Dialogue: 0,0:24:26.38,0:24:27.86,Default,,0000,0000,0000,,you get large numbers infected
Dialogue: 0,0:24:27.88,0:24:30.87,Default,,0000,0000,0000,,and with this kind of fatality rate\Nand hospitalization rate,
Dialogue: 0,0:24:30.89,0:24:35.02,Default,,0000,0000,0000,,that would really be hugely damaging\Nif that were to occur.
Dialogue: 0,0:24:35.05,0:24:37.25,Default,,0000,0000,0000,,Certainly at the country level,\Nwe're seeing --
Dialogue: 0,0:24:37.28,0:24:39.13,Default,,0000,0000,0000,,Italy is a good example at the moment,
Dialogue: 0,0:24:39.16,0:24:41.92,Default,,0000,0000,0000,,that if you have that early\Ntransmission that's undetected,
Dialogue: 0,0:24:41.94,0:24:43.07,Default,,0000,0000,0000,,that rapid growth,
Dialogue: 0,0:24:43.07,0:24:47.26,Default,,0000,0000,0000,,you very quickly get to a situation\Nwhere your health systems are overwhelmed.
Dialogue: 0,0:24:47.28,0:24:50.90,Default,,0000,0000,0000,,I think one of the nastiest\Naspects of this virus
Dialogue: 0,0:24:50.92,0:24:55.00,Default,,0000,0000,0000,,is that because you have the delay\Nbetween infection and symptoms
Dialogue: 0,0:24:55.03,0:24:57.28,Default,,0000,0000,0000,,and people showing up in health care,
Dialogue: 0,0:24:57.30,0:24:59.14,Default,,0000,0000,0000,,if your health system is overwhelmed,
Dialogue: 0,0:24:59.17,0:25:00.38,Default,,0000,0000,0000,,even on that day,
Dialogue: 0,0:25:00.41,0:25:02.43,Default,,0000,0000,0000,,if you completely stop transmission,
Dialogue: 0,0:25:02.45,0:25:05.33,Default,,0000,0000,0000,,you've got all of these people\Nwho have already been exposed,
Dialogue: 0,0:25:05.35,0:25:08.26,Default,,0000,0000,0000,,so you're still going to have cases\Nand severe cases appearing
Dialogue: 0,0:25:08.28,0:25:10.18,Default,,0000,0000,0000,,for maybe another couple of weeks.
Dialogue: 0,0:25:10.20,0:25:13.15,Default,,0000,0000,0000,,So it's really this huge\Naccumulation of infection and burden
Dialogue: 0,0:25:13.17,0:25:16.14,Default,,0000,0000,0000,,that's coming through the system\Non your population.
Dialogue: 0,0:25:17.50,0:25:19.56,Default,,0000,0000,0000,,CA: So there's another\Nkey number, actually,
Dialogue: 0,0:25:19.58,0:25:24.10,Default,,0000,0000,0000,,is how does the total case number
Dialogue: 0,0:25:24.12,0:25:27.79,Default,,0000,0000,0000,,compare to the capacity\Nof a country's health system
Dialogue: 0,0:25:27.82,0:25:30.22,Default,,0000,0000,0000,,to process that number of cases.
Dialogue: 0,0:25:30.85,0:25:33.01,Default,,0000,0000,0000,,Presumably that issue\Nmakes a huge difference
Dialogue: 0,0:25:33.04,0:25:34.24,Default,,0000,0000,0000,,to the fatality rate,
Dialogue: 0,0:25:34.26,0:25:37.04,Default,,0000,0000,0000,,the difference between people\Ncoming in with severe illness
Dialogue: 0,0:25:37.06,0:25:40.41,Default,,0000,0000,0000,,and a health system that's able\Nto respond and one that's overwhelmed.
Dialogue: 0,0:25:40.43,0:25:43.36,Default,,0000,0000,0000,,The fatality rate is going to be\Nvery different at that point.
Dialogue: 0,0:25:43.39,0:25:45.14,Default,,0000,0000,0000,,AK: If someone requires an ICU bed,
Dialogue: 0,0:25:45.16,0:25:47.82,Default,,0000,0000,0000,,that's a couple of weeks\Nthey're going to require it for
Dialogue: 0,0:25:47.84,0:25:50.33,Default,,0000,0000,0000,,and you've got more cases\Ncoming through the system,
Dialogue: 0,0:25:50.36,0:25:52.04,Default,,0000,0000,0000,,so it very quickly gets very tough.
Dialogue: 0,0:25:52.07,0:25:54.94,Default,,0000,0000,0000,,CA: So talk about the difference\Nbetween containment
Dialogue: 0,0:25:54.97,0:25:56.53,Default,,0000,0000,0000,,and mitigation.
Dialogue: 0,0:25:56.55,0:25:59.90,Default,,0000,0000,0000,,These are different terms\Nthat we're hearing a lot about.
Dialogue: 0,0:25:59.92,0:26:06.11,Default,,0000,0000,0000,,In the early stages of the virus,\Ngovernments are focused on containment.
Dialogue: 0,0:26:06.13,0:26:07.74,Default,,0000,0000,0000,,What does that mean?
Dialogue: 0,0:26:07.76,0:26:11.47,Default,,0000,0000,0000,,AK: Containment is this idea\Nthat you can focus your effort on control
Dialogue: 0,0:26:11.49,0:26:13.74,Default,,0000,0000,0000,,very much on the cases and their contacts.
Dialogue: 0,0:26:13.76,0:26:16.47,Default,,0000,0000,0000,,So you're not causing disruption\Nto the wider population,
Dialogue: 0,0:26:16.49,0:26:19.17,Default,,0000,0000,0000,,you have a case that comes in,\Nyou isolate them,
Dialogue: 0,0:26:19.19,0:26:21.46,Default,,0000,0000,0000,,you work out who they've come\Ninto contact with,
Dialogue: 0,0:26:21.48,0:26:24.55,Default,,0000,0000,0000,,who's potentially these\Nopportunities for exposure
Dialogue: 0,0:26:24.57,0:26:26.54,Default,,0000,0000,0000,,and then you can follow up those people,
Dialogue: 0,0:26:26.56,0:26:30.13,Default,,0000,0000,0000,,maybe quarantine them to make sure\Nthat no further transmission happens.
Dialogue: 0,0:26:30.16,0:26:32.68,Default,,0000,0000,0000,,So it's a very focused, targeted method,
Dialogue: 0,0:26:32.70,0:26:35.30,Default,,0000,0000,0000,,and for SARS, it worked remarkably well.
Dialogue: 0,0:26:35.98,0:26:37.82,Default,,0000,0000,0000,,But I think for this infection,
Dialogue: 0,0:26:37.85,0:26:41.40,Default,,0000,0000,0000,,because some cases are going to be missed\Nor undetected,
Dialogue: 0,0:26:41.42,0:26:44.63,Default,,0000,0000,0000,,you've really got to be capturing\Na large chunk of people at risk.
Dialogue: 0,0:26:44.65,0:26:46.15,Default,,0000,0000,0000,,If a few slip through the net,
Dialogue: 0,0:26:46.18,0:26:48.36,Default,,0000,0000,0000,,potentially, you're going\Nto get an outbreak.
Dialogue: 0,0:26:48.38,0:26:49.75,Default,,0000,0000,0000,,CA: Are there any countries
Dialogue: 0,0:26:49.77,0:26:51.86,Default,,0000,0000,0000,,that have been able\Nto employ this strategy
Dialogue: 0,0:26:51.88,0:26:55.19,Default,,0000,0000,0000,,and effectively contain the virus?
Dialogue: 0,0:26:55.21,0:26:58.76,Default,,0000,0000,0000,,AK: So Singapore have been doing\Na really remarkable job of this
Dialogue: 0,0:26:58.78,0:27:00.32,Default,,0000,0000,0000,,for the last six weeks or so.
Dialogue: 0,0:27:00.74,0:27:03.16,Default,,0000,0000,0000,,So as well as some wider measures,
Dialogue: 0,0:27:03.18,0:27:04.90,Default,,0000,0000,0000,,they've been working incredibly hard
Dialogue: 0,0:27:04.93,0:27:07.48,Default,,0000,0000,0000,,to trace people\Nwho have come into contact.
Dialogue: 0,0:27:08.12,0:27:09.58,Default,,0000,0000,0000,,Looking at CCTV,
Dialogue: 0,0:27:09.61,0:27:12.57,Default,,0000,0000,0000,,going through to find out\Nwhich taxi someone might have gotten,
Dialogue: 0,0:27:12.59,0:27:13.77,Default,,0000,0000,0000,,who might be at risk --
Dialogue: 0,0:27:13.79,0:27:15.45,Default,,0000,0000,0000,,really, really thorough follow-up.
Dialogue: 0,0:27:15.47,0:27:18.66,Default,,0000,0000,0000,,And for about six weeks,\Nthat has kept a lid on transmission.
Dialogue: 0,0:27:19.36,0:27:20.53,Default,,0000,0000,0000,,CA: So that's amazing.
Dialogue: 0,0:27:20.55,0:27:22.97,Default,,0000,0000,0000,,So someone comes into the country,
Dialogue: 0,0:27:22.100,0:27:24.55,Default,,0000,0000,0000,,they test positive --
Dialogue: 0,0:27:24.58,0:27:27.13,Default,,0000,0000,0000,,they go to work, and with a massive team,
Dialogue: 0,0:27:27.16,0:27:29.27,Default,,0000,0000,0000,,and trace everything
Dialogue: 0,0:27:29.29,0:27:31.13,Default,,0000,0000,0000,,to the level of actually saying,
Dialogue: 0,0:27:31.16,0:27:33.16,Default,,0000,0000,0000,,"Oh, you don't know what taxi you went in?
Dialogue: 0,0:27:33.18,0:27:34.66,Default,,0000,0000,0000,,Let us find that out for you."
Dialogue: 0,0:27:34.69,0:27:36.93,Default,,0000,0000,0000,,And presumably,\Nwhen they find the taxi driver,
Dialogue: 0,0:27:36.95,0:27:40.34,Default,,0000,0000,0000,,they then have to try and figure out\Neveryone else who was in that taxi?
Dialogue: 0,0:27:40.37,0:27:43.46,Default,,0000,0000,0000,,AK: So they will focus on\Nclose contacts of people most at risk,
Dialogue: 0,0:27:43.49,0:27:47.33,Default,,0000,0000,0000,,but they're really minimizing the chance\Nthat anyone slips through the net.
Dialogue: 0,0:27:47.92,0:27:51.68,Default,,0000,0000,0000,,CA: But even in Singapore,\Nif I'm not mistaken,
Dialogue: 0,0:27:51.70,0:27:54.05,Default,,0000,0000,0000,,numbers started to trend\Nback down to zero,
Dialogue: 0,0:27:54.08,0:27:56.52,Default,,0000,0000,0000,,but I think recently,\Nthey've picked up again a bit.
Dialogue: 0,0:27:56.55,0:27:58.44,Default,,0000,0000,0000,,It's still unclear
Dialogue: 0,0:27:58.46,0:28:01.62,Default,,0000,0000,0000,,whether they will actually\Nbe able to sustain containment.
Dialogue: 0,0:28:01.64,0:28:02.80,Default,,0000,0000,0000,,AK: Exactly.
Dialogue: 0,0:28:02.82,0:28:05.03,Default,,0000,0000,0000,,If we talk in terms\Nof the reproduction number,
Dialogue: 0,0:28:05.05,0:28:07.44,Default,,0000,0000,0000,,we saw it dipped to maybe 0.8, 0.9,
Dialogue: 0,0:28:07.47,0:28:09.40,Default,,0000,0000,0000,,so under that crucial value of one.
Dialogue: 0,0:28:10.20,0:28:11.55,Default,,0000,0000,0000,,But in the last week or two,
Dialogue: 0,0:28:11.55,0:28:14.88,Default,,0000,0000,0000,,it does seem to be ticking up\Nand they're getting more cases appearing.
Dialogue: 0,0:28:14.90,0:28:16.14,Default,,0000,0000,0000,,I think a lot of it is,
Dialogue: 0,0:28:16.16,0:28:18.13,Default,,0000,0000,0000,,even if they are containing it,
Dialogue: 0,0:28:18.15,0:28:20.06,Default,,0000,0000,0000,,the world is experiencing outbreaks
Dialogue: 0,0:28:20.09,0:28:22.16,Default,,0000,0000,0000,,and just keeps throwing\Nsparks of infection,
Dialogue: 0,0:28:22.18,0:28:23.76,Default,,0000,0000,0000,,and it becomes harder and harder
Dialogue: 0,0:28:23.78,0:28:26.52,Default,,0000,0000,0000,,with that level of intensive effort\Nto stamp them all out.
Dialogue: 0,0:28:26.55,0:28:32.35,Default,,0000,0000,0000,,(Music)
Dialogue: 0,0:28:47.71,0:28:49.58,Default,,0000,0000,0000,,CA: In the case of this virus,
Dialogue: 0,0:28:49.60,0:28:52.69,Default,,0000,0000,0000,,you know, there was warning\Nto most countries in the world
Dialogue: 0,0:28:52.71,0:28:54.17,Default,,0000,0000,0000,,that this thing was happening.
Dialogue: 0,0:28:54.20,0:28:58.38,Default,,0000,0000,0000,,The news out of China\Nvery quickly became very bleak,
Dialogue: 0,0:28:58.40,0:29:01.12,Default,,0000,0000,0000,,and people had time to prepare.
Dialogue: 0,0:29:01.14,0:29:05.63,Default,,0000,0000,0000,,I mean, what would ideal\Npreparation look like
Dialogue: 0,0:29:05.65,0:29:07.80,Default,,0000,0000,0000,,if you know that something\Nlike this is coming
Dialogue: 0,0:29:07.83,0:29:09.83,Default,,0000,0000,0000,,and you know that there's\Na lot on the line
Dialogue: 0,0:29:09.86,0:29:12.81,Default,,0000,0000,0000,,if you can successfully contain it\Nbefore it really escapes?
Dialogue: 0,0:29:13.29,0:29:16.02,Default,,0000,0000,0000,,AK: I think two things\Nwould make a really big difference.
Dialogue: 0,0:29:16.05,0:29:20.77,Default,,0000,0000,0000,,One is having as thorough a follow-up\Nand detection as possible.
Dialogue: 0,0:29:20.79,0:29:22.42,Default,,0000,0000,0000,,We've done some modeling analyses,
Dialogue: 0,0:29:22.44,0:29:25.53,Default,,0000,0000,0000,,looking at how effective\Nthat kind of early containment is.
Dialogue: 0,0:29:25.55,0:29:29.67,Default,,0000,0000,0000,,And it can be, if you're identifying\Nmaybe 70 or 80 percent
Dialogue: 0,0:29:29.70,0:29:32.80,Default,,0000,0000,0000,,of the people who might have\Ncome into contact.
Dialogue: 0,0:29:32.82,0:29:36.35,Default,,0000,0000,0000,,But if you're not detecting\Nthose cases coming in,
Dialogue: 0,0:29:36.37,0:29:38.37,Default,,0000,0000,0000,,if you're not detecting their contacts --
Dialogue: 0,0:29:38.39,0:29:41.95,Default,,0000,0000,0000,,and a lot of the early focus, for example,\Nwas on travel history to China,
Dialogue: 0,0:29:41.97,0:29:44.67,Default,,0000,0000,0000,,and then it became clear\Nthat the situation was changing,
Dialogue: 0,0:29:44.69,0:29:47.85,Default,,0000,0000,0000,,but because you were relying on that\Nas your definition of a case,
Dialogue: 0,0:29:47.88,0:29:50.86,Default,,0000,0000,0000,,it meant a lot of maybe other cases\Nthat matched the definition
Dialogue: 0,0:29:50.88,0:29:52.05,Default,,0000,0000,0000,,weren't being tested
Dialogue: 0,0:29:52.08,0:29:54.62,Default,,0000,0000,0000,,because they didn't seem\Nto be potentially at risk.
Dialogue: 0,0:29:54.64,0:29:59.23,Default,,0000,0000,0000,,CA: So I mean, if you know\Nthat early detection is key to this,
Dialogue: 0,0:29:59.25,0:30:01.13,Default,,0000,0000,0000,,an essential early measure, I guess,
Dialogue: 0,0:30:01.16,0:30:06.27,Default,,0000,0000,0000,,would be to rapidly ensure\Nthat you had enough tests available
Dialogue: 0,0:30:06.29,0:30:07.99,Default,,0000,0000,0000,,and where needed,
Dialogue: 0,0:30:08.01,0:30:09.78,Default,,0000,0000,0000,,so that you could respond,
Dialogue: 0,0:30:09.81,0:30:13.72,Default,,0000,0000,0000,,be ready to swing into action\Nas soon as someone was detected,
Dialogue: 0,0:30:13.74,0:30:19.03,Default,,0000,0000,0000,,you then have to very quickly,\NI guess, test their contacts and so forth,
Dialogue: 0,0:30:19.05,0:30:21.91,Default,,0000,0000,0000,,to have a chance\Nof keeping this under control.
Dialogue: 0,0:30:21.93,0:30:23.22,Default,,0000,0000,0000,,AK: Exactly.
Dialogue: 0,0:30:23.24,0:30:26.41,Default,,0000,0000,0000,,In my line of work, we say\Nthere's value in a negative test,
Dialogue: 0,0:30:26.43,0:30:29.76,Default,,0000,0000,0000,,because it shows that you're looking\Nfor something and it's not there.
Dialogue: 0,0:30:29.78,0:30:33.28,Default,,0000,0000,0000,,And so I think having\Nsmall numbers of people tested
Dialogue: 0,0:30:33.31,0:30:36.32,Default,,0000,0000,0000,,doesn't give you confidence\Nthat you're not missing infections,
Dialogue: 0,0:30:36.34,0:30:39.31,Default,,0000,0000,0000,,whereas if you are doing\Nreally thorough follow-up on contacts,
Dialogue: 0,0:30:39.33,0:30:41.32,Default,,0000,0000,0000,,we've seen countries even like Korea now,
Dialogue: 0,0:30:41.34,0:30:42.90,Default,,0000,0000,0000,,huge numbers of people tested.
Dialogue: 0,0:30:42.92,0:30:45.01,Default,,0000,0000,0000,,So although there are still\Ncases appearing,
Dialogue: 0,0:30:45.04,0:30:46.43,Default,,0000,0000,0000,,it gives them more confidence
Dialogue: 0,0:30:46.45,0:30:49.24,Default,,0000,0000,0000,,that they have some sense\Nof where those infections are.
Dialogue: 0,0:30:49.26,0:30:51.96,Default,,0000,0000,0000,,CA: I mean, you're in the UK right now,
Dialogue: 0,0:30:51.99,0:30:54.77,Default,,0000,0000,0000,,I'm in the US.
Dialogue: 0,0:30:54.79,0:30:58.37,Default,,0000,0000,0000,,How likely is it that the UK\Nis going to be able to contain,
Dialogue: 0,0:30:58.39,0:31:02.19,Default,,0000,0000,0000,,how likely is it that the US\Nis going to be able to contain this?
Dialogue: 0,0:31:03.16,0:31:06.62,Default,,0000,0000,0000,,AK: I think it's pretty\Nunlikely in both cases.
Dialogue: 0,0:31:06.65,0:31:10.05,Default,,0000,0000,0000,,I think the UK is going to have\Nto introduce some additional measures.
Dialogue: 0,0:31:10.08,0:31:12.41,Default,,0000,0000,0000,,I think when that happens\Nobviously depends a bit
Dialogue: 0,0:31:12.43,0:31:13.66,Default,,0000,0000,0000,,on the current situation,
Dialogue: 0,0:31:13.68,0:31:16.01,Default,,0000,0000,0000,,but we've tested almost 30,000 people now.
Dialogue: 0,0:31:17.40,0:31:21.74,Default,,0000,0000,0000,,Frankly, I think the US\Nmay well be moving beyond that point,
Dialogue: 0,0:31:21.76,0:31:24.69,Default,,0000,0000,0000,,given how much evidence\Nof extensive transmission that has,
Dialogue: 0,0:31:24.71,0:31:27.81,Default,,0000,0000,0000,,and I think without clear ideas\Nof how much infection there is
Dialogue: 0,0:31:27.83,0:31:30.10,Default,,0000,0000,0000,,and that level of testing,
Dialogue: 0,0:31:30.13,0:31:33.52,Default,,0000,0000,0000,,it's quite hard to actually see\Nwhat the picture currently is in the US.
Dialogue: 0,0:31:35.31,0:31:39.03,Default,,0000,0000,0000,,CA: I mean, I definitely don't want to get\Ntoo political about this,
Dialogue: 0,0:31:39.05,0:31:40.89,Default,,0000,0000,0000,,but I mean, does this strike you as --
Dialogue: 0,0:31:40.92,0:31:43.44,Default,,0000,0000,0000,,you just said that the UK\Nhas tested 30,000 people --
Dialogue: 0,0:31:43.46,0:31:45.96,Default,,0000,0000,0000,,the US is five or six times bigger
Dialogue: 0,0:31:45.99,0:31:49.18,Default,,0000,0000,0000,,and I think the total number\Nof tests here is five or six thousand,
Dialogue: 0,0:31:49.20,0:31:50.46,Default,,0000,0000,0000,,or it was a few days ago.
Dialogue: 0,0:31:50.48,0:31:52.67,Default,,0000,0000,0000,,Does that strike you as bizarre?
Dialogue: 0,0:31:52.70,0:31:56.64,Default,,0000,0000,0000,,I don't understand, honestly,\Nhow that happened in an educated country
Dialogue: 0,0:31:56.67,0:31:59.46,Default,,0000,0000,0000,,that has so much knowledge\Nabout infectious diseases.
Dialogue: 0,0:32:00.17,0:32:01.34,Default,,0000,0000,0000,,AK: It does,
Dialogue: 0,0:32:01.36,0:32:04.54,Default,,0000,0000,0000,,and I think there's obviously\Na number of factors playing in there,
Dialogue: 0,0:32:04.57,0:32:05.89,Default,,0000,0000,0000,,logistics and so on,
Dialogue: 0,0:32:05.92,0:32:08.11,Default,,0000,0000,0000,,but there has been that period of warning
Dialogue: 0,0:32:08.13,0:32:10.21,Default,,0000,0000,0000,,that this is a threat\Nand this is coming in.
Dialogue: 0,0:32:10.24,0:32:13.56,Default,,0000,0000,0000,,And I think countries need to make sure\Nthat they've got the capacity
Dialogue: 0,0:32:13.58,0:32:16.70,Default,,0000,0000,0000,,to really do as much detection as they can\Nin those early stages,
Dialogue: 0,0:32:16.72,0:32:18.87,Default,,0000,0000,0000,,because that's where\Nyou're going to catch it
Dialogue: 0,0:32:18.90,0:32:22.45,Default,,0000,0000,0000,,and that's where you're going to have\Na better chance of containing it.
Dialogue: 0,0:32:22.47,0:32:24.75,Default,,0000,0000,0000,,CA: OK, so if you fail to contain,
Dialogue: 0,0:32:24.78,0:32:28.09,Default,,0000,0000,0000,,then you have to move\Nto some kind of mitigation strategy.
Dialogue: 0,0:32:28.11,0:32:31.50,Default,,0000,0000,0000,,So what comes into play there?
Dialogue: 0,0:32:31.52,0:32:34.57,Default,,0000,0000,0000,,And I think I almost want\Nto bring that back
Dialogue: 0,0:32:34.60,0:32:38.42,Default,,0000,0000,0000,,to two of your DOTS factors,
Dialogue: 0,0:32:38.44,0:32:41.44,Default,,0000,0000,0000,,opportunity and transmission probability,
Dialogue: 0,0:32:41.47,0:32:43.72,Default,,0000,0000,0000,,because it seems like\Nthe virus is what it is,
Dialogue: 0,0:32:43.74,0:32:46.51,Default,,0000,0000,0000,,the actual duration when someone\Nis potentially infectious,
Dialogue: 0,0:32:46.53,0:32:47.76,Default,,0000,0000,0000,,we can't do much about.
Dialogue: 0,0:32:47.79,0:32:49.88,Default,,0000,0000,0000,,The susceptibility side,
Dialogue: 0,0:32:49.90,0:32:52.50,Default,,0000,0000,0000,,we can't do much about\Nuntil there's a vaccine.
Dialogue: 0,0:32:52.53,0:32:54.76,Default,,0000,0000,0000,,We could maybe talk about that in a bit.
Dialogue: 0,0:32:54.78,0:32:58.45,Default,,0000,0000,0000,,But the middle two of opportunity\Nand transmission probability,
Dialogue: 0,0:32:58.48,0:32:59.87,Default,,0000,0000,0000,,we can do something about.
Dialogue: 0,0:32:59.90,0:33:03.42,Default,,0000,0000,0000,,Do you want to maybe talk\Nabout those in turn,
Dialogue: 0,0:33:03.44,0:33:04.66,Default,,0000,0000,0000,,of what that looks like,
Dialogue: 0,0:33:04.69,0:33:09.27,Default,,0000,0000,0000,,how would you build a mitigation strategy?
Dialogue: 0,0:33:09.30,0:33:11.62,Default,,0000,0000,0000,,I mean, first of all,\Nthinking about opportunity,
Dialogue: 0,0:33:11.65,0:33:13.78,Default,,0000,0000,0000,,how do you reduce\Nthe number of opportunities
Dialogue: 0,0:33:13.80,0:33:15.07,Default,,0000,0000,0000,,to pass on the bug?
Dialogue: 0,0:33:15.88,0:33:17.64,Default,,0000,0000,0000,,AK: And so I think in that respect,
Dialogue: 0,0:33:17.67,0:33:21.33,Default,,0000,0000,0000,,it would be about massive changes\Nin our social interactions.
Dialogue: 0,0:33:21.35,0:33:23.88,Default,,0000,0000,0000,,And if you think in terms\Nof the reproduction number
Dialogue: 0,0:33:23.90,0:33:26.07,Default,,0000,0000,0000,,of being about two or three,
Dialogue: 0,0:33:26.09,0:33:27.47,Default,,0000,0000,0000,,to get that number below one,
Dialogue: 0,0:33:27.50,0:33:30.76,Default,,0000,0000,0000,,you've really got to cut\Nsome aspect of that transmission
Dialogue: 0,0:33:30.79,0:33:32.19,Default,,0000,0000,0000,,in half or in two-thirds
Dialogue: 0,0:33:32.22,0:33:33.62,Default,,0000,0000,0000,,to get that below one.
Dialogue: 0,0:33:34.02,0:33:35.75,Default,,0000,0000,0000,,And so that would require,
Dialogue: 0,0:33:35.77,0:33:38.13,Default,,0000,0000,0000,,of the opportunities\Nthat could spread the virus,
Dialogue: 0,0:33:38.15,0:33:40.10,Default,,0000,0000,0000,,so these kind of close contacts,
Dialogue: 0,0:33:40.12,0:33:42.38,Default,,0000,0000,0000,,everybody in the population, on average,
Dialogue: 0,0:33:42.40,0:33:45.32,Default,,0000,0000,0000,,will be needing to reduce\Nthose interactions
Dialogue: 0,0:33:45.35,0:33:47.97,Default,,0000,0000,0000,,potentially by two-thirds\Nto bring it under control.
Dialogue: 0,0:33:47.99,0:33:50.70,Default,,0000,0000,0000,,That might be through working from home,
Dialogue: 0,0:33:50.73,0:33:52.74,Default,,0000,0000,0000,,from changing lifestyle
Dialogue: 0,0:33:52.76,0:33:56.10,Default,,0000,0000,0000,,and kind of where you go\Nin crowded places and dinners.
Dialogue: 0,0:33:56.65,0:33:59.49,Default,,0000,0000,0000,,And of course, these measures,\Nthings like school closures,
Dialogue: 0,0:33:59.51,0:34:01.58,Default,,0000,0000,0000,,and other things\Nthat just attempt to reduce
Dialogue: 0,0:34:01.60,0:34:03.39,Default,,0000,0000,0000,,the social mixing of a population.
Dialogue: 0,0:34:03.71,0:34:06.51,Default,,0000,0000,0000,,CA: Well, actually, talk to me more\Nabout school closures,
Dialogue: 0,0:34:06.54,0:34:08.93,Default,,0000,0000,0000,,because that, if I remember,
Dialogue: 0,0:34:08.96,0:34:15.31,Default,,0000,0000,0000,,often in past pandemics has been cited\Nas an absolutely key measure,
Dialogue: 0,0:34:15.33,0:34:18.60,Default,,0000,0000,0000,,that schools represent this sort of\Ncoming together of people,
Dialogue: 0,0:34:18.62,0:34:21.45,Default,,0000,0000,0000,,children are often --
Dialogue: 0,0:34:21.48,0:34:23.60,Default,,0000,0000,0000,,certainly when \Nit comes to flu and colds --
Dialogue: 0,0:34:23.62,0:34:25.42,Default,,0000,0000,0000,,they're carriers.
Dialogue: 0,0:34:25.57,0:34:27.19,Default,,0000,0000,0000,,But on this case,
Dialogue: 0,0:34:27.21,0:34:31.09,Default,,0000,0000,0000,,children don't seem to be getting sick\Nfrom this particular virus,
Dialogue: 0,0:34:31.12,0:34:33.96,Default,,0000,0000,0000,,or at least very few of them are.
Dialogue: 0,0:34:34.37,0:34:39.30,Default,,0000,0000,0000,,Do we know whether they\Ncan still be infectious?
Dialogue: 0,0:34:39.32,0:34:41.90,Default,,0000,0000,0000,,They can be the unintended carriers of it.
Dialogue: 0,0:34:41.92,0:34:45.34,Default,,0000,0000,0000,,Or actually, is there evidence\Nthat school closures
Dialogue: 0,0:34:45.37,0:34:48.66,Default,,0000,0000,0000,,may not be as important\Nin this instance as it is in others?
Dialogue: 0,0:34:49.09,0:34:51.16,Default,,0000,0000,0000,,AK: So that point\Non what role children play
Dialogue: 0,0:34:51.18,0:34:52.34,Default,,0000,0000,0000,,is a crucial one,
Dialogue: 0,0:34:52.36,0:34:54.68,Default,,0000,0000,0000,,and there's still not\Na good evidence base there.
Dialogue: 0,0:34:54.70,0:34:56.94,Default,,0000,0000,0000,,From following up of contacts of cases,
Dialogue: 0,0:34:56.97,0:34:59.62,Default,,0000,0000,0000,,there's now evidence\Nthat children are getting infected,
Dialogue: 0,0:34:59.64,0:35:01.97,Default,,0000,0000,0000,,so when you're testing,\Nthey are getting exposed,
Dialogue: 0,0:35:01.100,0:35:05.63,Default,,0000,0000,0000,,it's not that somehow they're just\Nnot getting the infection at all,
Dialogue: 0,0:35:05.65,0:35:09.12,Default,,0000,0000,0000,,but as you said, they're not showing\Nsymptoms in the same way.
Dialogue: 0,0:35:09.14,0:35:11.44,Default,,0000,0000,0000,,And particularly for flu,
Dialogue: 0,0:35:11.47,0:35:14.20,Default,,0000,0000,0000,,when we see the implications\Nof school closures,
Dialogue: 0,0:35:14.22,0:35:17.12,Default,,0000,0000,0000,,even in the UK in 2009 during swine flu,
Dialogue: 0,0:35:17.14,0:35:19.95,Default,,0000,0000,0000,,there was a dip in the outbreak\Nduring the school holidays,
Dialogue: 0,0:35:19.98,0:35:21.88,Default,,0000,0000,0000,,you could see it on the epidemic curve,
Dialogue: 0,0:35:21.91,0:35:25.32,Default,,0000,0000,0000,,it kind of comes back down in the summer\Nand goes back up in the autumn.
Dialogue: 0,0:35:25.34,0:35:28.40,Default,,0000,0000,0000,,But of course, in 2009,\Nthere was some immunity in older groups.
Dialogue: 0,0:35:28.43,0:35:31.54,Default,,0000,0000,0000,,That kind of shifted more the transmission\Ninto the younger ones.
Dialogue: 0,0:35:31.56,0:35:34.83,Default,,0000,0000,0000,,So I think it's really something\Nwe're trying to work to understand.
Dialogue: 0,0:35:34.86,0:35:37.73,Default,,0000,0000,0000,,Obviously, it will reduce interactions,\Nwith school closures,
Dialogue: 0,0:35:37.76,0:35:39.75,Default,,0000,0000,0000,,but then there's knock-on social effects,
Dialogue: 0,0:35:39.77,0:35:41.88,Default,,0000,0000,0000,,there's potential\Nknock-on changes in mixing,
Dialogue: 0,0:35:41.90,0:35:45.74,Default,,0000,0000,0000,,maybe grandparents and their role,\Nin terms of alternative carers
Dialogue: 0,0:35:45.77,0:35:47.11,Default,,0000,0000,0000,,if parents have to work.
Dialogue: 0,0:35:47.13,0:35:50.72,Default,,0000,0000,0000,,So I think there's a lot of pieces\Nthat need to be considered.
Dialogue: 0,0:35:52.10,0:35:56.86,Default,,0000,0000,0000,,CA: I mean, based on all of the different\Npieces of evidence you've seen,
Dialogue: 0,0:35:56.89,0:35:58.17,Default,,0000,0000,0000,,if it were down to you,
Dialogue: 0,0:35:58.19,0:36:01.58,Default,,0000,0000,0000,,would you be recommending\Nthat most countries at this point
Dialogue: 0,0:36:01.60,0:36:05.88,Default,,0000,0000,0000,,do look hard at extensive school closures\Nas a precautionary measure,
Dialogue: 0,0:36:05.90,0:36:09.46,Default,,0000,0000,0000,,that it's just worth it to do that
Dialogue: 0,0:36:09.48,0:36:14.50,Default,,0000,0000,0000,,as a sort of painful two,\Nthree, four, five-month strategy?
Dialogue: 0,0:36:14.53,0:36:16.16,Default,,0000,0000,0000,,What would you recommend?
Dialogue: 0,0:36:16.19,0:36:17.50,Default,,0000,0000,0000,,AK: I think the key thing,
Dialogue: 0,0:36:17.53,0:36:20.68,Default,,0000,0000,0000,,given the age distribution of risk\Nand the severity in older groups
Dialogue: 0,0:36:20.71,0:36:25.49,Default,,0000,0000,0000,,is reduce interactions that bring\Nthe infection into those groups.
Dialogue: 0,0:36:25.51,0:36:28.98,Default,,0000,0000,0000,,And then amongst everyone else,\Nreduce interactions as much as possible.
Dialogue: 0,0:36:28.100,0:36:30.60,Default,,0000,0000,0000,,I think the key thing is
Dialogue: 0,0:36:30.63,0:36:34.47,Default,,0000,0000,0000,,we've got so much of the disease burden\Nin the kind of 60-plus group
Dialogue: 0,0:36:34.50,0:36:37.99,Default,,0000,0000,0000,,that it's not just about\Neveryone trying to avoid
Dialogue: 0,0:36:38.01,0:36:39.18,Default,,0000,0000,0000,,everyone's interactions,
Dialogue: 0,0:36:39.20,0:36:40.68,Default,,0000,0000,0000,,but it's the kind of behaviors
Dialogue: 0,0:36:40.70,0:36:43.15,Default,,0000,0000,0000,,that would drive infections\Ninto those groups.
Dialogue: 0,0:36:44.45,0:36:47.26,Default,,0000,0000,0000,,CA: Does that mean\Nthat people should think twice
Dialogue: 0,0:36:47.29,0:36:50.46,Default,,0000,0000,0000,,before, I don't know, visiting a loved one
Dialogue: 0,0:36:50.49,0:36:55.45,Default,,0000,0000,0000,,in an old people's home\Nor in a residential facility?
Dialogue: 0,0:36:55.48,0:36:59.28,Default,,0000,0000,0000,,Like that, we should just pay\Nsuper special attention to that,
Dialogue: 0,0:36:59.30,0:37:02.16,Default,,0000,0000,0000,,should all these facilities\Nbe taking great care
Dialogue: 0,0:37:02.18,0:37:03.63,Default,,0000,0000,0000,,about who they admit,
Dialogue: 0,0:37:03.65,0:37:06.91,Default,,0000,0000,0000,,taking temperature and checking\Nfor symptoms or something like that?
Dialogue: 0,0:37:06.93,0:37:09.83,Default,,0000,0000,0000,,AK: I think those measures\Ndefinitely need to be considered.
Dialogue: 0,0:37:09.86,0:37:11.39,Default,,0000,0000,0000,,In the UK, we're getting plans
Dialogue: 0,0:37:11.41,0:37:13.86,Default,,0000,0000,0000,,for potentially what's known\Nas a cocooning strategy
Dialogue: 0,0:37:13.89,0:37:15.17,Default,,0000,0000,0000,,for these older groups
Dialogue: 0,0:37:15.20,0:37:17.81,Default,,0000,0000,0000,,that we can really try\Nand seal off interactions
Dialogue: 0,0:37:17.83,0:37:19.21,Default,,0000,0000,0000,,as much as possible
Dialogue: 0,0:37:19.24,0:37:21.85,Default,,0000,0000,0000,,from people who might\Nbe bringing infection in.
Dialogue: 0,0:37:22.20,0:37:24.88,Default,,0000,0000,0000,,And ultimately, because as you said,
Dialogue: 0,0:37:24.90,0:37:27.37,Default,,0000,0000,0000,,we can't target these other\Naspects of transmission,
Dialogue: 0,0:37:27.40,0:37:30.33,Default,,0000,0000,0000,,it is just reducing the risk\Nof exposure in these groups,
Dialogue: 0,0:37:30.36,0:37:34.10,Default,,0000,0000,0000,,and so I think anything\Nat the individual level you can do
Dialogue: 0,0:37:34.12,0:37:36.32,Default,,0000,0000,0000,,to get people reducing their risk,
Dialogue: 0,0:37:36.34,0:37:39.38,Default,,0000,0000,0000,,if either they're elderly\Nor in other risk groups,
Dialogue: 0,0:37:39.41,0:37:40.56,Default,,0000,0000,0000,,I think is crucial.
Dialogue: 0,0:37:40.58,0:37:43.02,Default,,0000,0000,0000,,And I think more at the general level
Dialogue: 0,0:37:43.04,0:37:47.08,Default,,0000,0000,0000,,those kind of more large-scale measures\Ncan help reduce interactions overall,
Dialogue: 0,0:37:47.10,0:37:49.70,Default,,0000,0000,0000,,but I think if those\Nreductions are happening
Dialogue: 0,0:37:49.72,0:37:50.96,Default,,0000,0000,0000,,and not reducing the risk
Dialogue: 0,0:37:50.98,0:37:53.24,Default,,0000,0000,0000,,for people who are going\Nto get severe disease,
Dialogue: 0,0:37:53.27,0:37:56.91,Default,,0000,0000,0000,,then you're still going to get\Nthis really remarkably severe burden.
Dialogue: 0,0:37:58.11,0:38:03.36,Default,,0000,0000,0000,,CA: I mean, do people have to almost\Napply this double lens
Dialogue: 0,0:38:03.38,0:38:04.90,Default,,0000,0000,0000,,as they think about this stuff?
Dialogue: 0,0:38:04.92,0:38:07.29,Default,,0000,0000,0000,,There's the risk to you\Nas you go about your life,
Dialogue: 0,0:38:07.32,0:38:09.35,Default,,0000,0000,0000,,of you catching this bug.
Dialogue: 0,0:38:09.66,0:38:12.84,Default,,0000,0000,0000,,But there's also the risk\Nof you being, unintentionally, a carrier
Dialogue: 0,0:38:12.86,0:38:15.90,Default,,0000,0000,0000,,to someone who would suffer\Nmuch more than you might.
Dialogue: 0,0:38:15.92,0:38:19.57,Default,,0000,0000,0000,,And that both those things\Nhave to be top of mind right now.
Dialogue: 0,0:38:19.59,0:38:22.20,Default,,0000,0000,0000,,AK: Yeah, and it's not just\Nwhose hand you shake,
Dialogue: 0,0:38:22.23,0:38:24.43,Default,,0000,0000,0000,,it's whose hand that person\Ngoes on to shake.
Dialogue: 0,0:38:24.46,0:38:27.32,Default,,0000,0000,0000,,And I think we need to think\Nabout these second-degree steps,
Dialogue: 0,0:38:27.35,0:38:29.53,Default,,0000,0000,0000,,that you might think you have low risk
Dialogue: 0,0:38:29.55,0:38:31.33,Default,,0000,0000,0000,,and you're in a younger group,
Dialogue: 0,0:38:31.36,0:38:34.45,Default,,0000,0000,0000,,but you're often going to be\Na very short step away
Dialogue: 0,0:38:34.47,0:38:37.08,Default,,0000,0000,0000,,from someone who is going to get hit\Nvery hard by this.
Dialogue: 0,0:38:37.10,0:38:39.74,Default,,0000,0000,0000,,And I think we really need\Nto be socially minded
Dialogue: 0,0:38:39.77,0:38:43.08,Default,,0000,0000,0000,,and think this could be quite dramatic\Nin terms of change of behavior,
Dialogue: 0,0:38:43.11,0:38:44.76,Default,,0000,0000,0000,,but it needs to be
Dialogue: 0,0:38:44.79,0:38:47.24,Default,,0000,0000,0000,,to reduce the impact\Nthat we're potentially facing.
Dialogue: 0,0:38:48.56,0:38:51.14,Default,,0000,0000,0000,,CA: So the opportunity\Nnumber, we bring down
Dialogue: 0,0:38:51.16,0:38:53.80,Default,,0000,0000,0000,,by just reducing the number\Nof physical contacts we have
Dialogue: 0,0:38:53.83,0:38:55.53,Default,,0000,0000,0000,,with other people.
Dialogue: 0,0:38:55.56,0:38:58.81,Default,,0000,0000,0000,,And I guess the transmission\Nprobability number,
Dialogue: 0,0:38:58.83,0:39:01.33,Default,,0000,0000,0000,,how do we bring that down?
Dialogue: 0,0:39:01.36,0:39:03.19,Default,,0000,0000,0000,,That impacts how we interact.
Dialogue: 0,0:39:03.21,0:39:04.56,Default,,0000,0000,0000,,You mentioned hand-shaking,
Dialogue: 0,0:39:04.58,0:39:06.88,Default,,0000,0000,0000,,I'm guessing you're going to say\Nno handshaking.
Dialogue: 0,0:39:06.90,0:39:08.91,Default,,0000,0000,0000,,AK: Yeah, so changes like that.
Dialogue: 0,0:39:08.93,0:39:10.34,Default,,0000,0000,0000,,I mean, another one, I think,
Dialogue: 0,0:39:10.36,0:39:12.03,Default,,0000,0000,0000,,handwashing operates in a way
Dialogue: 0,0:39:12.05,0:39:16.36,Default,,0000,0000,0000,,that we might be still be doing\Nactivities that we've previously done,
Dialogue: 0,0:39:16.39,0:39:20.60,Default,,0000,0000,0000,,but handwashing reduces the chance\Nthat from one interaction to another,
Dialogue: 0,0:39:20.62,0:39:22.17,Default,,0000,0000,0000,,we might be spreading infection,
Dialogue: 0,0:39:22.20,0:39:23.63,Default,,0000,0000,0000,,so it's all of these measures
Dialogue: 0,0:39:23.66,0:39:26.34,Default,,0000,0000,0000,,that mean that even\Nif we're having these exposures,
Dialogue: 0,0:39:26.36,0:39:29.66,Default,,0000,0000,0000,,we're taking additional steps\Nto avoid any transmission happening.
Dialogue: 0,0:39:30.35,0:39:32.82,Default,,0000,0000,0000,,CA: I still think most people\Ndon't fully understand
Dialogue: 0,0:39:32.85,0:39:34.89,Default,,0000,0000,0000,,or don't have a clear model of the pathway
Dialogue: 0,0:39:34.91,0:39:38.89,Default,,0000,0000,0000,,by which this thing spreads.
Dialogue: 0,0:39:38.91,0:39:40.88,Default,,0000,0000,0000,,So you think definitely people understand
Dialogue: 0,0:39:40.90,0:39:42.66,Default,,0000,0000,0000,,that you don't breathe in
Dialogue: 0,0:39:42.69,0:39:46.94,Default,,0000,0000,0000,,the water droplets of someone\Nwho has just coughed or sneezed.
Dialogue: 0,0:39:46.96,0:39:49.12,Default,,0000,0000,0000,,So how does it spread?
Dialogue: 0,0:39:49.14,0:39:51.40,Default,,0000,0000,0000,,It gets onto surfaces. How?
Dialogue: 0,0:39:51.43,0:39:54.59,Default,,0000,0000,0000,,Do people just breathe out\Nand it goes on from people who are sick,
Dialogue: 0,0:39:54.61,0:39:56.78,Default,,0000,0000,0000,,they touch their mouth\Nor something like that,
Dialogue: 0,0:39:56.81,0:39:59.11,Default,,0000,0000,0000,,and then touch a surface\Nand it gets on that way?
Dialogue: 0,0:39:59.13,0:40:01.02,Default,,0000,0000,0000,,How does it actually get onto surfaces?
Dialogue: 0,0:40:01.05,0:40:03.86,Default,,0000,0000,0000,,AK: I think a lot of it would be\Nthat you cough in your hand
Dialogue: 0,0:40:03.89,0:40:05.50,Default,,0000,0000,0000,,and it ends up on a surface.
Dialogue: 0,0:40:05.87,0:40:09.56,Default,,0000,0000,0000,,But I think the challenge, obviously,\Nis untangling these questions
Dialogue: 0,0:40:09.59,0:40:10.95,Default,,0000,0000,0000,,of how transmission happens.
Dialogue: 0,0:40:10.97,0:40:12.79,Default,,0000,0000,0000,,You have transmission in a household,
Dialogue: 0,0:40:12.81,0:40:15.40,Default,,0000,0000,0000,,and is it that someone coughed\Nand it got on a surface,
Dialogue: 0,0:40:15.43,0:40:17.33,Default,,0000,0000,0000,,is it direct contact, is it a handshake,
Dialogue: 0,0:40:17.36,0:40:18.78,Default,,0000,0000,0000,,and even for things like flu,
Dialogue: 0,0:40:18.80,0:40:22.01,Default,,0000,0000,0000,,that's something that we work\Nquite hard to try and unpick,
Dialogue: 0,0:40:22.04,0:40:25.25,Default,,0000,0000,0000,,how does social behavior correspond\Nto infection risk.
Dialogue: 0,0:40:25.27,0:40:28.54,Default,,0000,0000,0000,,Because it's clearly important,\Nbut pinning it down is really tough.
Dialogue: 0,0:40:29.23,0:40:32.44,Default,,0000,0000,0000,,CA: It's almost like embracing the fact
Dialogue: 0,0:40:32.47,0:40:34.99,Default,,0000,0000,0000,,that for a lot of these things,\Nwe actually don't know
Dialogue: 0,0:40:35.01,0:40:38.86,Default,,0000,0000,0000,,and that we're all\Nin this game of probabilities.
Dialogue: 0,0:40:39.16,0:40:42.12,Default,,0000,0000,0000,,Which, in a way, is why I think\Nthe math is so important here.
Dialogue: 0,0:40:42.14,0:40:48.15,Default,,0000,0000,0000,,That you have to think of this\Nas these multiple numbers
Dialogue: 0,0:40:48.17,0:40:49.89,Default,,0000,0000,0000,,working together on each other,
Dialogue: 0,0:40:49.91,0:40:51.54,Default,,0000,0000,0000,,they all have their part to play.
Dialogue: 0,0:40:51.57,0:40:56.56,Default,,0000,0000,0000,,And any of them that you can\Ntake down by a percentage
Dialogue: 0,0:40:56.59,0:40:58.06,Default,,0000,0000,0000,,is likely contributing,
Dialogue: 0,0:40:58.09,0:41:00.81,Default,,0000,0000,0000,,not just to you but to everyone.
Dialogue: 0,0:41:00.83,0:41:04.61,Default,,0000,0000,0000,,And people don't actually know\Nin detail how the numbers go together,
Dialogue: 0,0:41:04.63,0:41:06.73,Default,,0000,0000,0000,,but they know that they\Nprobably all matter.
Dialogue: 0,0:41:06.75,0:41:11.66,Default,,0000,0000,0000,,We almost need people to, somehow,\Nyou know, embrace that uncertainty
Dialogue: 0,0:41:11.69,0:41:16.80,Default,,0000,0000,0000,,and then try to get some satisfaction\Nby acting on every single part of it.
Dialogue: 0,0:41:16.82,0:41:18.08,Default,,0000,0000,0000,,AK: I think it's this idea
Dialogue: 0,0:41:18.11,0:41:21.80,Default,,0000,0000,0000,,that if on average,\Nyou're infecting, say, three people,
Dialogue: 0,0:41:21.82,0:41:24.70,Default,,0000,0000,0000,,what's driving that and how can you\Nchip away at that value?
Dialogue: 0,0:41:24.72,0:41:26.12,Default,,0000,0000,0000,,If you're washing your hands,
Dialogue: 0,0:41:26.15,0:41:29.40,Default,,0000,0000,0000,,how much might that chip away\Nin terms of the handshakes,
Dialogue: 0,0:41:29.43,0:41:32.01,Default,,0000,0000,0000,,you know, you may have had virus\Nand you no longer do,
Dialogue: 0,0:41:32.03,0:41:35.74,Default,,0000,0000,0000,,or if you are changing\Nyour social behavior in a certain way,
Dialogue: 0,0:41:35.77,0:41:37.90,Default,,0000,0000,0000,,is that taking away\Na couple of interactions,
Dialogue: 0,0:41:37.93,0:41:39.13,Default,,0000,0000,0000,,is that taking away half?
Dialogue: 0,0:41:39.16,0:41:42.58,Default,,0000,0000,0000,,How can you really chip into that number\Nas much as you possibly can?
Dialogue: 0,0:41:43.70,0:41:47.20,Default,,0000,0000,0000,,CA: Is there anything else to say\Nabout how we could reduce
Dialogue: 0,0:41:47.23,0:41:51.69,Default,,0000,0000,0000,,that transmission probability\Nin our interactions?
Dialogue: 0,0:41:51.72,0:41:54.52,Default,,0000,0000,0000,,Like, what is the physical distance
Dialogue: 0,0:41:54.55,0:42:00.14,Default,,0000,0000,0000,,that it's wise to stay away\Nfrom other people if we can?
Dialogue: 0,0:42:00.66,0:42:02.68,Default,,0000,0000,0000,,AK: I think it's hard to pin down exactly,
Dialogue: 0,0:42:02.70,0:42:06.22,Default,,0000,0000,0000,,but I think one thing to bear in mind\Nis that there's not so much evidence
Dialogue: 0,0:42:06.24,0:42:08.87,Default,,0000,0000,0000,,that this is a kind of aerosol\Nand it goes really far --
Dialogue: 0,0:42:08.90,0:42:10.43,Default,,0000,0000,0000,,it's reasonably short distances.
Dialogue: 0,0:42:10.45,0:42:11.76,Default,,0000,0000,0000,,I don't think it's the case
Dialogue: 0,0:42:11.78,0:42:14.85,Default,,0000,0000,0000,,that you're sitting a few meters\Naway from someone
Dialogue: 0,0:42:14.87,0:42:17.03,Default,,0000,0000,0000,,and the virus is somehow\Ngoing to get across.
Dialogue: 0,0:42:17.74,0:42:19.08,Default,,0000,0000,0000,,It's in closer interactions,
Dialogue: 0,0:42:19.11,0:42:22.10,Default,,0000,0000,0000,,and it's why we're seeing\Nso many transmission events
Dialogue: 0,0:42:22.12,0:42:25.91,Default,,0000,0000,0000,,occur in things like meals\Nand really tight-knit groups.
Dialogue: 0,0:42:25.93,0:42:27.27,Default,,0000,0000,0000,,Because if you imagine
Dialogue: 0,0:42:27.30,0:42:30.31,Default,,0000,0000,0000,,that's where you can get\Na virus out and onto surfaces
Dialogue: 0,0:42:30.33,0:42:31.88,Default,,0000,0000,0000,,and onto hands and onto faces,
Dialogue: 0,0:42:31.91,0:42:36.03,Default,,0000,0000,0000,,and it's really situations like that\Nwe've got to think more about.
Dialogue: 0,0:42:37.82,0:42:39.02,Default,,0000,0000,0000,,CA: So in a way,
Dialogue: 0,0:42:39.05,0:42:41.99,Default,,0000,0000,0000,,some of the fears that people have\Nmay actually be overstated,
Dialogue: 0,0:42:42.02,0:42:44.72,Default,,0000,0000,0000,,like, if you're in the middle\Nof an airplane
Dialogue: 0,0:42:44.74,0:42:47.27,Default,,0000,0000,0000,,and someone at the front sneezes,
Dialogue: 0,0:42:47.29,0:42:49.08,Default,,0000,0000,0000,,I mean, that's annoying,
Dialogue: 0,0:42:49.10,0:42:53.46,Default,,0000,0000,0000,,but it's actually not the thing\Nyou should be most freaked out about.
Dialogue: 0,0:42:53.48,0:42:57.22,Default,,0000,0000,0000,,There are much smarter ways\Nto pay attention to your well-being.
Dialogue: 0,0:42:57.24,0:43:00.70,Default,,0000,0000,0000,,AK: Yeah, if it was measles\Nand the plane was susceptible people,
Dialogue: 0,0:43:00.72,0:43:02.85,Default,,0000,0000,0000,,you would see a lot\Nof infections after that.
Dialogue: 0,0:43:02.87,0:43:05.40,Default,,0000,0000,0000,,I think it is, bear in mind,\Nthat this is, on average,
Dialogue: 0,0:43:05.42,0:43:07.18,Default,,0000,0000,0000,,people infecting two or three others,
Dialogue: 0,0:43:07.21,0:43:11.03,Default,,0000,0000,0000,,so it's not the case of your\Nmaybe 50 interactions over a week,
Dialogue: 0,0:43:11.05,0:43:12.98,Default,,0000,0000,0000,,all of those people are at risk.
Dialogue: 0,0:43:13.01,0:43:14.63,Default,,0000,0000,0000,,But it's going to be some of them,
Dialogue: 0,0:43:14.66,0:43:16.62,Default,,0000,0000,0000,,particularly those close contacts,
Dialogue: 0,0:43:16.65,0:43:19.33,Default,,0000,0000,0000,,that are going to be\Nwhere transmission's occurring.
Dialogue: 0,0:43:19.36,0:43:21.50,Default,,0000,0000,0000,,CA: So talk about,
Dialogue: 0,0:43:21.52,0:43:25.63,Default,,0000,0000,0000,,from a sort of national\Nstrategy point of view.
Dialogue: 0,0:43:25.66,0:43:29.86,Default,,0000,0000,0000,,There's a lot of talk about the need\Nto "flatten the curve."
Dialogue: 0,0:43:29.89,0:43:31.21,Default,,0000,0000,0000,,What does that mean?
Dialogue: 0,0:43:31.24,0:43:35.95,Default,,0000,0000,0000,,AK: I think it refers to this idea\Nthat for your health systems,
Dialogue: 0,0:43:35.97,0:43:38.64,Default,,0000,0000,0000,,you don't want all your cases\Nto appear at the same time.
Dialogue: 0,0:43:38.66,0:43:40.71,Default,,0000,0000,0000,,So if we sat back and did nothing
Dialogue: 0,0:43:40.74,0:43:42.26,Default,,0000,0000,0000,,and just let the epidemic grow,
Dialogue: 0,0:43:42.28,0:43:44.62,Default,,0000,0000,0000,,and you had this growth rate\Nthat, at the moment,
Dialogue: 0,0:43:44.65,0:43:46.38,Default,,0000,0000,0000,,in some places is looking like maybe
Dialogue: 0,0:43:46.40,0:43:48.55,Default,,0000,0000,0000,,three to four days,\Nyou're getting doubling.
Dialogue: 0,0:43:48.57,0:43:51.10,Default,,0000,0000,0000,,So every three or four days,\Nthe epidemic is doubling.
Dialogue: 0,0:43:51.12,0:43:52.80,Default,,0000,0000,0000,,It will skyrocket and you'll end up
Dialogue: 0,0:43:52.83,0:43:55.98,Default,,0000,0000,0000,,with a whole bunch\Nof really severely ill people
Dialogue: 0,0:43:56.01,0:43:58.04,Default,,0000,0000,0000,,needing hospital care\Nall at the same time,
Dialogue: 0,0:43:58.07,0:44:00.03,Default,,0000,0000,0000,,and you just won't have capacity for it.
Dialogue: 0,0:44:00.05,0:44:03.20,Default,,0000,0000,0000,,So the idea of flattening the curve\Nis if we can slow transmission,
Dialogue: 0,0:44:03.23,0:44:05.28,Default,,0000,0000,0000,,if we can get that\Nreproduction number down,
Dialogue: 0,0:44:05.30,0:44:07.16,Default,,0000,0000,0000,,then there may still be an outbreak,
Dialogue: 0,0:44:07.19,0:44:08.54,Default,,0000,0000,0000,,but it will be much flatter,
Dialogue: 0,0:44:08.57,0:44:09.74,Default,,0000,0000,0000,,it will be longer
Dialogue: 0,0:44:09.76,0:44:12.05,Default,,0000,0000,0000,,and there will be fewer\Nsevere cases showing up,
Dialogue: 0,0:44:12.08,0:44:14.76,Default,,0000,0000,0000,,which means that they can get\Nthe health care they need.
Dialogue: 0,0:44:16.22,0:44:23.22,Default,,0000,0000,0000,,CA: Does it imply that there will be\Nfewer cases overall, or --
Dialogue: 0,0:44:24.32,0:44:26.78,Default,,0000,0000,0000,,When you look at the actual images\Nof people showing
Dialogue: 0,0:44:26.80,0:44:28.58,Default,,0000,0000,0000,,what flattening the curve looks like,
Dialogue: 0,0:44:28.60,0:44:31.88,Default,,0000,0000,0000,,it almost looks as if you've got\Nthe same area still under the graph,
Dialogue: 0,0:44:31.90,0:44:34.86,Default,,0000,0000,0000,,i.e. that the same number of people,\Nultimately, are infected
Dialogue: 0,0:44:34.88,0:44:37.67,Default,,0000,0000,0000,,but over a longer period.
Dialogue: 0,0:44:37.70,0:44:40.26,Default,,0000,0000,0000,,Is that typically what happens,
Dialogue: 0,0:44:40.29,0:44:45.25,Default,,0000,0000,0000,,and even if you adopt\Nall these strategies of social distancing
Dialogue: 0,0:44:45.27,0:44:49.01,Default,,0000,0000,0000,,and washing hands and etc.
Dialogue: 0,0:44:49.03,0:44:52.15,Default,,0000,0000,0000,,that the best you can hope for\Nis that you slow the thing down,
Dialogue: 0,0:44:52.17,0:44:54.91,Default,,0000,0000,0000,,you actually will get\Nas many people infected in the end?
Dialogue: 0,0:44:54.93,0:44:57.79,Default,,0000,0000,0000,,AK: Not necessarily --\Nit depends on the measures that go in.
Dialogue: 0,0:44:57.82,0:45:00.21,Default,,0000,0000,0000,,There are some measures like,\Nshutting down travel,
Dialogue: 0,0:45:00.24,0:45:03.42,Default,,0000,0000,0000,,which typically delay the spread\Nrather than reduce it.
Dialogue: 0,0:45:03.44,0:45:05.72,Default,,0000,0000,0000,,So you're still going to get\Nthe same outbreaks,
Dialogue: 0,0:45:05.74,0:45:07.84,Default,,0000,0000,0000,,but you're stretching out the outbreaks.
Dialogue: 0,0:45:08.34,0:45:09.78,Default,,0000,0000,0000,,But there are other measures.
Dialogue: 0,0:45:09.81,0:45:11.68,Default,,0000,0000,0000,,If we talk about reducing interactions,
Dialogue: 0,0:45:11.70,0:45:13.57,Default,,0000,0000,0000,,if your reproduction number's lower,
Dialogue: 0,0:45:13.59,0:45:15.85,Default,,0000,0000,0000,,you would expect fewer cases overall.
Dialogue: 0,0:45:16.38,0:45:18.18,Default,,0000,0000,0000,,And eventually, in your population,
Dialogue: 0,0:45:18.21,0:45:20.11,Default,,0000,0000,0000,,you will get some buildup of immunity,
Dialogue: 0,0:45:20.14,0:45:22.96,Default,,0000,0000,0000,,which would help you out\Nif you think about the components,
Dialogue: 0,0:45:22.99,0:45:24.24,Default,,0000,0000,0000,,reducing susceptibility,
Dialogue: 0,0:45:24.27,0:45:26.55,Default,,0000,0000,0000,,alongside what's going on elsewhere.
Dialogue: 0,0:45:26.58,0:45:29.16,Default,,0000,0000,0000,,So the hope is that the two things\Nwill work together.
Dialogue: 0,0:45:29.85,0:45:33.73,Default,,0000,0000,0000,,CA: So help me understand\Nwhat the endgame is here.
Dialogue: 0,0:45:34.90,0:45:37.12,Default,,0000,0000,0000,,So, take China, for example.
Dialogue: 0,0:45:38.97,0:45:42.57,Default,,0000,0000,0000,,Whatever you make\Nof the early suppression of data
Dialogue: 0,0:45:42.59,0:45:43.76,Default,,0000,0000,0000,,and so forth
Dialogue: 0,0:45:43.78,0:45:47.71,Default,,0000,0000,0000,,that seems pretty troubling there.
Dialogue: 0,0:45:47.74,0:45:53.43,Default,,0000,0000,0000,,The intensity of the response\Ncome January time or whatever,
Dialogue: 0,0:45:53.45,0:45:57.45,Default,,0000,0000,0000,,with the shutdown\Nof this huge area of the country,
Dialogue: 0,0:45:57.47,0:45:59.36,Default,,0000,0000,0000,,seems to have actually been effective.
Dialogue: 0,0:45:59.38,0:46:04.88,Default,,0000,0000,0000,,The number of cases there are falling\Nat a shockingly high rate in some ways.
Dialogue: 0,0:46:04.90,0:46:06.79,Default,,0000,0000,0000,,Falling to almost nothing.
Dialogue: 0,0:46:06.82,0:46:09.97,Default,,0000,0000,0000,,And I can't understand that.
Dialogue: 0,0:46:09.99,0:46:14.12,Default,,0000,0000,0000,,You are talking about a country\Nof, whatever, 1.4 billion people.
Dialogue: 0,0:46:14.14,0:46:16.24,Default,,0000,0000,0000,,There have been a huge\Nnumber of cases there,
Dialogue: 0,0:46:16.27,0:46:19.72,Default,,0000,0000,0000,,but it was a tiny fraction\Nof the population have actually got sick.
Dialogue: 0,0:46:19.74,0:46:24.61,Default,,0000,0000,0000,,And yet, they've got the number way down.
Dialogue: 0,0:46:24.64,0:46:29.46,Default,,0000,0000,0000,,It's not like every other person in China\Nhas somehow developed immunity.
Dialogue: 0,0:46:29.48,0:46:33.40,Default,,0000,0000,0000,,Is it that they have been\Nabsolutely disciplined
Dialogue: 0,0:46:33.42,0:46:37.51,Default,,0000,0000,0000,,about shutting down travel\Nfrom the infected regions
Dialogue: 0,0:46:37.53,0:46:43.34,Default,,0000,0000,0000,,and somehow really dialed up,\Nmassively dialed up
Dialogue: 0,0:46:43.36,0:46:46.36,Default,,0000,0000,0000,,testing at any sign of any problem,
Dialogue: 0,0:46:46.39,0:46:50.06,Default,,0000,0000,0000,,so that literally, they are back\Nin containment mode
Dialogue: 0,0:46:50.09,0:46:52.27,Default,,0000,0000,0000,,in most parts of China?
Dialogue: 0,0:46:52.30,0:46:55.62,Default,,0000,0000,0000,,I can't get my head around it,\Nhelp me understand it.
Dialogue: 0,0:46:55.65,0:46:58.20,Default,,0000,0000,0000,,AK: So we estimated,\Nin the last two weeks of January,
Dialogue: 0,0:46:58.22,0:46:59.58,Default,,0000,0000,0000,,when these measures went in,
Dialogue: 0,0:46:59.61,0:47:02.01,Default,,0000,0000,0000,,the reproduction number\Nwent from about 2.4 to 1.1.
Dialogue: 0,0:47:02.04,0:47:04.40,Default,,0000,0000,0000,,So about 60 percent decline\Nin transmission
Dialogue: 0,0:47:04.43,0:47:06.42,Default,,0000,0000,0000,,in the space of a week or two.
Dialogue: 0,0:47:06.44,0:47:08.92,Default,,0000,0000,0000,,Which is remarkable and really,
Dialogue: 0,0:47:08.94,0:47:13.49,Default,,0000,0000,0000,,a lot of it is likely to be driven\Nby just fundamental change
Dialogue: 0,0:47:13.51,0:47:14.80,Default,,0000,0000,0000,,in social behavior,
Dialogue: 0,0:47:14.82,0:47:16.26,Default,,0000,0000,0000,,huge social distancing,
Dialogue: 0,0:47:16.29,0:47:19.06,Default,,0000,0000,0000,,really intensive follow-up,\Nintensive testing.
Dialogue: 0,0:47:20.17,0:47:21.54,Default,,0000,0000,0000,,And it got to the point
Dialogue: 0,0:47:21.56,0:47:23.82,Default,,0000,0000,0000,,where it took enough\Noff the reproduction number
Dialogue: 0,0:47:23.85,0:47:25.05,Default,,0000,0000,0000,,to cause the decline,
Dialogue: 0,0:47:25.08,0:47:28.17,Default,,0000,0000,0000,,and now, of course,\Nwe're seeing, in many areas,
Dialogue: 0,0:47:28.19,0:47:30.86,Default,,0000,0000,0000,,a transition back to more\Nof this kind of containment,
Dialogue: 0,0:47:30.89,0:47:33.26,Default,,0000,0000,0000,,because there's few cases,\Nit's more manageable.
Dialogue: 0,0:47:34.32,0:47:36.49,Default,,0000,0000,0000,,But we're also seeing them\Nface a challenge,
Dialogue: 0,0:47:36.52,0:47:40.31,Default,,0000,0000,0000,,because a lot of these cities\Nhave basically been locked down
Dialogue: 0,0:47:40.34,0:47:41.51,Default,,0000,0000,0000,,for six weeks
Dialogue: 0,0:47:41.53,0:47:43.97,Default,,0000,0000,0000,,and there's a limit to how long\Nyou can do that for.
Dialogue: 0,0:47:43.100,0:47:47.16,Default,,0000,0000,0000,,And so some of these measures\Nare gradually starting to be lifted,
Dialogue: 0,0:47:47.19,0:47:48.81,Default,,0000,0000,0000,,which of course creates the risk
Dialogue: 0,0:47:48.83,0:47:51.57,Default,,0000,0000,0000,,that cases that are appearing\Nfrom other countries
Dialogue: 0,0:47:51.59,0:47:54.71,Default,,0000,0000,0000,,may subsequently go in\Nand reintroduce transmission.
Dialogue: 0,0:47:57.61,0:48:00.85,Default,,0000,0000,0000,,CA: But given how infectious the bug is,
Dialogue: 0,0:48:00.87,0:48:05.37,Default,,0000,0000,0000,,and how many theoretical pathways\Nand connection points there are
Dialogue: 0,0:48:05.40,0:48:09.05,Default,,0000,0000,0000,,between people in Wuhan, even in shutdown,
Dialogue: 0,0:48:09.08,0:48:10.37,Default,,0000,0000,0000,,or relatively shut down,
Dialogue: 0,0:48:10.40,0:48:13.32,Default,,0000,0000,0000,,or the other places\Nwhere there's been some infection
Dialogue: 0,0:48:13.35,0:48:14.74,Default,,0000,0000,0000,,and the rest of the country,
Dialogue: 0,0:48:14.76,0:48:21.01,Default,,0000,0000,0000,,does it surprise you how quickly\Nthat curve has gone down to nearly zero?
Dialogue: 0,0:48:21.86,0:48:23.02,Default,,0000,0000,0000,,AK: Yes.
Dialogue: 0,0:48:23.04,0:48:26.86,Default,,0000,0000,0000,,Early on when we saw\Nthat flattening off in cases
Dialogue: 0,0:48:26.89,0:48:28.70,Default,,0000,0000,0000,,in those first few days,
Dialogue: 0,0:48:28.72,0:48:32.27,Default,,0000,0000,0000,,we did wonder whether it was just\Nthey hit a limit in testing capacity
Dialogue: 0,0:48:32.29,0:48:34.05,Default,,0000,0000,0000,,and they were reporting 1,000 a day,
Dialogue: 0,0:48:34.08,0:48:36.11,Default,,0000,0000,0000,,because that's all the kits they had.
Dialogue: 0,0:48:36.13,0:48:38.37,Default,,0000,0000,0000,,But it continued, thankfully,
Dialogue: 0,0:48:38.40,0:48:41.49,Default,,0000,0000,0000,,and it shows that it is possible\Nto turn this over
Dialogue: 0,0:48:41.51,0:48:43.28,Default,,0000,0000,0000,,with that level of intervention.
Dialogue: 0,0:48:43.30,0:48:46.53,Default,,0000,0000,0000,,I think the key thing now\Nis seeing how it works in other settings.
Dialogue: 0,0:48:46.55,0:48:51.22,Default,,0000,0000,0000,,Italy now are putting in\Nreally dramatic interventions.
Dialogue: 0,0:48:51.24,0:48:53.29,Default,,0000,0000,0000,,But of course,\Nbecause of this delay effect,
Dialogue: 0,0:48:53.32,0:48:54.90,Default,,0000,0000,0000,,if you put them in today,
Dialogue: 0,0:48:54.92,0:48:57.09,Default,,0000,0000,0000,,you won't necessarily see\Nthe effects on cases
Dialogue: 0,0:48:57.12,0:48:58.28,Default,,0000,0000,0000,,for another week or two.
Dialogue: 0,0:48:58.30,0:49:00.42,Default,,0000,0000,0000,,So I think working out\Nwhat impact that's had
Dialogue: 0,0:49:00.44,0:49:02.65,Default,,0000,0000,0000,,is going to be key for helping\Nother countries
Dialogue: 0,0:49:02.67,0:49:04.14,Default,,0000,0000,0000,,work on how to contain this.
Dialogue: 0,0:49:04.71,0:49:06.04,Default,,0000,0000,0000,,CA: To have a picture, Adam,
Dialogue: 0,0:49:06.07,0:49:09.99,Default,,0000,0000,0000,,of how this is likely to play out\Nover the next month or two,
Dialogue: 0,0:49:10.01,0:49:13.58,Default,,0000,0000,0000,,give us a couple of scenarios\Nthat are in your head.
Dialogue: 0,0:49:14.56,0:49:17.32,Default,,0000,0000,0000,,AK: I think the optimistic scenario
Dialogue: 0,0:49:17.34,0:49:20.46,Default,,0000,0000,0000,,is that we're going to learn a lot\Nfrom places like Italy
Dialogue: 0,0:49:20.49,0:49:22.53,Default,,0000,0000,0000,,that have unfortunately\Nbeen hit very hard.
Dialogue: 0,0:49:22.56,0:49:25.18,Default,,0000,0000,0000,,And that countries are going to take\Nthis very seriously
Dialogue: 0,0:49:25.20,0:49:27.69,Default,,0000,0000,0000,,and that we're not going to get\Nthis continued growth
Dialogue: 0,0:49:27.71,0:49:29.34,Default,,0000,0000,0000,,that's going to overwhelm totally,
Dialogue: 0,0:49:29.36,0:49:33.14,Default,,0000,0000,0000,,that we're going to be able\Nto sufficiently slow it down,
Dialogue: 0,0:49:33.16,0:49:35.41,Default,,0000,0000,0000,,that we are going to get\Nlarge numbers of cases,
Dialogue: 0,0:49:35.43,0:49:38.21,Default,,0000,0000,0000,,we're probably going to get\Na lot of severe cases,
Dialogue: 0,0:49:38.23,0:49:40.04,Default,,0000,0000,0000,,but that will be more manageable,
Dialogue: 0,0:49:40.06,0:49:41.95,Default,,0000,0000,0000,,that's the kind of optimistic scenario.
Dialogue: 0,0:49:41.98,0:49:43.26,Default,,0000,0000,0000,,I think if we have a point
Dialogue: 0,0:49:43.28,0:49:45.67,Default,,0000,0000,0000,,where countries either\Ndon't take this seriously
Dialogue: 0,0:49:45.70,0:49:49.72,Default,,0000,0000,0000,,or populations don't respond well\Nto control measures
Dialogue: 0,0:49:49.74,0:49:51.39,Default,,0000,0000,0000,,or it's not detected,
Dialogue: 0,0:49:51.41,0:49:52.70,Default,,0000,0000,0000,,we could get situations --
Dialogue: 0,0:49:52.72,0:49:55.39,Default,,0000,0000,0000,,I think Iran is probably\Nthe closest one at the moment --
Dialogue: 0,0:49:55.41,0:49:58.50,Default,,0000,0000,0000,,where there's been extensive\Nwidespread transmission,
Dialogue: 0,0:49:58.52,0:50:01.48,Default,,0000,0000,0000,,and by the time it's being responded to,
Dialogue: 0,0:50:01.50,0:50:03.54,Default,,0000,0000,0000,,those infections are already in the system
Dialogue: 0,0:50:03.56,0:50:06.31,Default,,0000,0000,0000,,and they are going to turn up\Nas cases and severe illness.
Dialogue: 0,0:50:06.34,0:50:08.20,Default,,0000,0000,0000,,So I'm hoping we're not at that point,
Dialogue: 0,0:50:08.23,0:50:10.21,Default,,0000,0000,0000,,but we've certainly got, at the moment,
Dialogue: 0,0:50:10.23,0:50:13.55,Default,,0000,0000,0000,,potentially about 10 countries\Non that trajectory
Dialogue: 0,0:50:13.57,0:50:15.80,Default,,0000,0000,0000,,to have the same outlook as Italy.
Dialogue: 0,0:50:15.82,0:50:18.92,Default,,0000,0000,0000,,So it's really crucial what happens\Nin the next couple of weeks.
Dialogue: 0,0:50:19.81,0:50:22.30,Default,,0000,0000,0000,,CA: Is there a real chance\Nthat quite a few countries
Dialogue: 0,0:50:22.33,0:50:25.09,Default,,0000,0000,0000,,end up having, this year,
Dialogue: 0,0:50:25.11,0:50:30.77,Default,,0000,0000,0000,,substantially more deaths from this virus\Nthan from seasonal flu?
Dialogue: 0,0:50:31.94,0:50:34.61,Default,,0000,0000,0000,,AK: I think for some countries\Nthat is likely, yeah.
Dialogue: 0,0:50:34.63,0:50:36.82,Default,,0000,0000,0000,,I think if control is not possible,
Dialogue: 0,0:50:36.84,0:50:38.76,Default,,0000,0000,0000,,and we've seen it happen in China,
Dialogue: 0,0:50:38.78,0:50:43.12,Default,,0000,0000,0000,,but that was really just an unprecedented\Nlevel of intervention.
Dialogue: 0,0:50:43.14,0:50:45.63,Default,,0000,0000,0000,,It was really just changing\Nthe social fabric.
Dialogue: 0,0:50:45.66,0:50:51.77,Default,,0000,0000,0000,,I think people, many of us,\Ndon't really appreciate, at a glance,
Dialogue: 0,0:50:51.79,0:50:53.02,Default,,0000,0000,0000,,just what that means,
Dialogue: 0,0:50:53.05,0:50:55.78,Default,,0000,0000,0000,,to reduce your interactions\Nto that extent.
Dialogue: 0,0:50:55.80,0:50:58.97,Default,,0000,0000,0000,,I think many countries just simply\Nwon't be able to manage that.
Dialogue: 0,0:51:00.77,0:51:03.41,Default,,0000,0000,0000,,CA: It's almost a challenge\Nto democracies, isn't it --
Dialogue: 0,0:51:03.43,0:51:07.94,Default,,0000,0000,0000,,"OK, show us what you can do\Nwithout that kind of draconian control.
Dialogue: 0,0:51:07.96,0:51:10.06,Default,,0000,0000,0000,,If you don't like the thought of that,
Dialogue: 0,0:51:10.09,0:51:12.86,Default,,0000,0000,0000,,come on, citizens, step up,\Nshow us what you're capable of,
Dialogue: 0,0:51:12.89,0:51:14.86,Default,,0000,0000,0000,,show that you can be wise about this
Dialogue: 0,0:51:14.88,0:51:17.45,Default,,0000,0000,0000,,and smart and self-disciplined,
Dialogue: 0,0:51:17.47,0:51:19.86,Default,,0000,0000,0000,,and get ahead of the damn bug."
Dialogue: 0,0:51:19.89,0:51:21.29,Default,,0000,0000,0000,,AK: Yeah.
Dialogue: 0,0:51:21.32,0:51:25.12,Default,,0000,0000,0000,,CA: I mean, I'm not personally\Nsuperoptimistic about that,
Dialogue: 0,0:51:25.14,0:51:29.80,Default,,0000,0000,0000,,because there's such conflicting messaging\Ncoming out in so many different places,
Dialogue: 0,0:51:29.83,0:51:35.75,Default,,0000,0000,0000,,and people don't like\Nto short-term sacrifice.
Dialogue: 0,0:51:35.78,0:51:38.18,Default,,0000,0000,0000,,I mean, is there almost a case that --
Dialogue: 0,0:51:38.67,0:51:40.58,Default,,0000,0000,0000,,I mean, what's your view
Dialogue: 0,0:51:40.60,0:51:43.57,Default,,0000,0000,0000,,on whether the media has played\Na helpful role here
Dialogue: 0,0:51:43.59,0:51:44.76,Default,,0000,0000,0000,,or an unhelpful role?
Dialogue: 0,0:51:44.79,0:51:46.58,Default,,0000,0000,0000,,Is it actually, in some ways, helpful
Dialogue: 0,0:51:46.60,0:51:50.53,Default,,0000,0000,0000,,to, if anything, overstate\Nthe concern, the fear,
Dialogue: 0,0:51:50.55,0:51:53.21,Default,,0000,0000,0000,,and actually make people\Npanic a little bit?
Dialogue: 0,0:51:53.24,0:51:55.62,Default,,0000,0000,0000,,AK: I think it's a really\Ntough balance to strike,
Dialogue: 0,0:51:55.64,0:51:58.13,Default,,0000,0000,0000,,because of course, early on,\Nif you don't have cases,
Dialogue: 0,0:51:58.16,0:52:01.46,Default,,0000,0000,0000,,if you don't have any evidence\Nof potential pressure,
Dialogue: 0,0:52:01.49,0:52:05.03,Default,,0000,0000,0000,,it's very hard to get that message\Nand convince people to take it seriously
Dialogue: 0,0:52:05.05,0:52:06.26,Default,,0000,0000,0000,,if you're overhyping it.
Dialogue: 0,0:52:06.28,0:52:08.73,Default,,0000,0000,0000,,But equally, if you're waiting too long,
Dialogue: 0,0:52:08.75,0:52:11.78,Default,,0000,0000,0000,,and saying it's not a concern yet,\Nwe're OK for the moment,
Dialogue: 0,0:52:11.81,0:52:14.21,Default,,0000,0000,0000,,a lot of people think it's just flu.
Dialogue: 0,0:52:14.55,0:52:17.71,Default,,0000,0000,0000,,By the time it hits hard, as I've said,
Dialogue: 0,0:52:17.74,0:52:20.86,Default,,0000,0000,0000,,you're going to have weeks\Nof an overburdened health system,
Dialogue: 0,0:52:20.88,0:52:23.67,Default,,0000,0000,0000,,because even if you take interventions,
Dialogue: 0,0:52:23.70,0:52:26.53,Default,,0000,0000,0000,,it's too late to control the infections\Nthat have happened.
Dialogue: 0,0:52:26.56,0:52:28.09,Default,,0000,0000,0000,,So I think it's a fine line,
Dialogue: 0,0:52:28.11,0:52:30.52,Default,,0000,0000,0000,,and my hope is there is\Nthis ramp-up in messaging,
Dialogue: 0,0:52:30.54,0:52:33.02,Default,,0000,0000,0000,,now people have these\Ntangible examples like Italy,
Dialogue: 0,0:52:33.04,0:52:36.56,Default,,0000,0000,0000,,where they can see what's going to happen\Nif they don't take it seriously.
Dialogue: 0,0:52:37.04,0:52:39.80,Default,,0000,0000,0000,,But certainly, of all\Nthe diseases I've seen,
Dialogue: 0,0:52:39.82,0:52:42.46,Default,,0000,0000,0000,,I think many of my colleagues\Nwho are much older than me
Dialogue: 0,0:52:42.49,0:52:44.28,Default,,0000,0000,0000,,and have memories of other outbreaks,
Dialogue: 0,0:52:44.30,0:52:47.75,Default,,0000,0000,0000,,it's the scariest thing we've seen\Nin terms of the impact it could have,
Dialogue: 0,0:52:47.78,0:52:49.66,Default,,0000,0000,0000,,and I think we need to respond to that.
Dialogue: 0,0:52:49.68,0:52:52.31,Default,,0000,0000,0000,,CA: It's the scariest disease you've seen.
Dialogue: 0,0:52:53.04,0:52:54.19,Default,,0000,0000,0000,,Wow.
Dialogue: 0,0:52:54.22,0:52:58.73,Default,,0000,0000,0000,,I've got some questions for you\Nfrom my friends on Twitter.
Dialogue: 0,0:52:58.76,0:53:04.97,Default,,0000,0000,0000,,Everyone is obviously\Nsuper exercised about this topic.
Dialogue: 0,0:53:04.100,0:53:06.54,Default,,0000,0000,0000,,Hypothetically,
Dialogue: 0,0:53:06.56,0:53:09.05,Default,,0000,0000,0000,,if everyone stayed home for three weeks,
Dialogue: 0,0:53:09.08,0:53:11.79,Default,,0000,0000,0000,,would that effectively wipe this out?
Dialogue: 0,0:53:11.82,0:53:14.66,Default,,0000,0000,0000,,Is there a way to socially\Ndistance ourselves out of this?
Dialogue: 0,0:53:15.35,0:53:20.30,Default,,0000,0000,0000,,AK: Yeah, I think in certain countries\Nwith reasonably small household sizes,
Dialogue: 0,0:53:20.32,0:53:22.86,Default,,0000,0000,0000,,I think average in the UK, US\Nis about two and a half,
Dialogue: 0,0:53:22.89,0:53:26.33,Default,,0000,0000,0000,,so even if you had a round of infection\Nwithin the household,
Dialogue: 0,0:53:26.36,0:53:28.02,Default,,0000,0000,0000,,that would probably stamp it out.
Dialogue: 0,0:53:28.04,0:53:29.27,Default,,0000,0000,0000,,As a secondary benefit,
Dialogue: 0,0:53:29.29,0:53:31.68,Default,,0000,0000,0000,,you may well stamp out\Na few other infections, too.
Dialogue: 0,0:53:31.68,0:53:33.36,Default,,0000,0000,0000,,Measles only circulates in humans,
Dialogue: 0,0:53:33.37,0:53:35.15,Default,,0000,0000,0000,,so you may have some knock-on effect,
Dialogue: 0,0:53:35.17,0:53:37.53,Default,,0000,0000,0000,,if, of course, that were\Never to be possible.
Dialogue: 0,0:53:37.55,0:53:41.74,Default,,0000,0000,0000,,CA: I mean, obviously that would be\Na huge dent to the economy,
Dialogue: 0,0:53:41.77,0:53:46.04,Default,,0000,0000,0000,,and this is in a way almost, like,\None of the underlying challenges here
Dialogue: 0,0:53:46.07,0:53:49.56,Default,,0000,0000,0000,,is that you can't optimize public policy
Dialogue: 0,0:53:49.58,0:53:54.95,Default,,0000,0000,0000,,for both economic health\Nand fighting a virus.
Dialogue: 0,0:53:54.97,0:53:57.63,Default,,0000,0000,0000,,Like, those two things are,\Nto some extent, in conflict,
Dialogue: 0,0:53:57.65,0:54:01.56,Default,,0000,0000,0000,,or at least, short-term\Neconomic health and fighting a virus.
Dialogue: 0,0:54:01.59,0:54:03.56,Default,,0000,0000,0000,,Those two things are in conflict, right?
Dialogue: 0,0:54:03.59,0:54:06.50,Default,,0000,0000,0000,,And societies need to pick one.
Dialogue: 0,0:54:06.99,0:54:10.69,Default,,0000,0000,0000,,AK: It is tough to convince\Npeople of that balance,
Dialogue: 0,0:54:10.71,0:54:12.91,Default,,0000,0000,0000,,the thing we always say\Nof pandemic planning
Dialogue: 0,0:54:12.93,0:54:15.19,Default,,0000,0000,0000,,is it's cheap to put\Nthis stuff in place now --
Dialogue: 0,0:54:15.22,0:54:17.22,Default,,0000,0000,0000,,otherwise, you've got to pay for it later.
Dialogue: 0,0:54:18.21,0:54:20.29,Default,,0000,0000,0000,,But unfortunately,\Nas we've seen with this,
Dialogue: 0,0:54:20.31,0:54:22.85,Default,,0000,0000,0000,,that a lot of early money\Nfor response wasn't there.
Dialogue: 0,0:54:23.34,0:54:26.75,Default,,0000,0000,0000,,And it's only when it has an impact\Nand when it's going to get expensive
Dialogue: 0,0:54:26.77,0:54:30.72,Default,,0000,0000,0000,,that people are happy to take\Nthat cost on board, it seems.
Dialogue: 0,0:54:31.61,0:54:33.65,Default,,0000,0000,0000,,CA: OK, some more Twitter questions.
Dialogue: 0,0:54:33.68,0:54:36.44,Default,,0000,0000,0000,,Will the rising temperature\Nin coming weeks and months
Dialogue: 0,0:54:36.46,0:54:39.22,Default,,0000,0000,0000,,slow down the COVID-19 spread?
Dialogue: 0,0:54:39.78,0:54:42.11,Default,,0000,0000,0000,,AK: I haven't seen any convincing evidence
Dialogue: 0,0:54:42.13,0:54:44.49,Default,,0000,0000,0000,,that there's that strong pattern\Nwith temperature,
Dialogue: 0,0:54:44.51,0:54:48.77,Default,,0000,0000,0000,,and we've seen it for other infections\Nthat there is this seasonal pattern,
Dialogue: 0,0:54:48.79,0:54:51.40,Default,,0000,0000,0000,,but I think the fact\Nwe're getting widespread outbreaks
Dialogue: 0,0:54:51.43,0:54:53.90,Default,,0000,0000,0000,,makes it hard to identify, and of course,
Dialogue: 0,0:54:53.92,0:54:55.36,Default,,0000,0000,0000,,there's other things going on.
Dialogue: 0,0:54:55.38,0:54:58.51,Default,,0000,0000,0000,,So even if one country doesn't have\Nas big an outbreak as another,
Dialogue: 0,0:54:58.53,0:55:00.89,Default,,0000,0000,0000,,that's going to be influenced\Nby control measures,
Dialogue: 0,0:55:00.91,0:55:04.10,Default,,0000,0000,0000,,by social behavior, by opportunities\Nand these things as well.
Dialogue: 0,0:55:04.12,0:55:07.04,Default,,0000,0000,0000,,So it would be really reassuring\Nif this was the case,
Dialogue: 0,0:55:07.07,0:55:09.32,Default,,0000,0000,0000,,but I don't think\Nwe can say that just yet.
Dialogue: 0,0:55:10.04,0:55:11.76,Default,,0000,0000,0000,,CA: Continuing from Twitter,
Dialogue: 0,0:55:11.78,0:55:15.37,Default,,0000,0000,0000,,I mean, is there a standardized\Nglobal recommendation
Dialogue: 0,0:55:15.39,0:55:16.57,Default,,0000,0000,0000,,for all countries
Dialogue: 0,0:55:16.60,0:55:18.36,Default,,0000,0000,0000,,on how to do this?
Dialogue: 0,0:55:18.39,0:55:19.72,Default,,0000,0000,0000,,And if not, why not?
Dialogue: 0,0:55:20.63,0:55:23.45,Default,,0000,0000,0000,,AK: I think that's what people\Nare trying to piece together,
Dialogue: 0,0:55:23.48,0:55:25.04,Default,,0000,0000,0000,,first in terms of what works.
Dialogue: 0,0:55:25.34,0:55:28.49,Default,,0000,0000,0000,,It's only really in the last\Nsort of few weeks
Dialogue: 0,0:55:28.51,0:55:31.33,Default,,0000,0000,0000,,we've got a sense that this thing\Ncan be controllable
Dialogue: 0,0:55:31.35,0:55:32.98,Default,,0000,0000,0000,,with this extent of interventions,
Dialogue: 0,0:55:33.00,0:55:35.86,Default,,0000,0000,0000,,but of course, not all countries\Ncan do what China have done,
Dialogue: 0,0:55:35.89,0:55:37.31,Default,,0000,0000,0000,,some of these measures
Dialogue: 0,0:55:37.34,0:55:41.08,Default,,0000,0000,0000,,incur a huge social, economic,\Npsychological burden
Dialogue: 0,0:55:41.10,0:55:42.55,Default,,0000,0000,0000,,on populations.
Dialogue: 0,0:55:42.92,0:55:44.73,Default,,0000,0000,0000,,And of course, there's the time limit.
Dialogue: 0,0:55:44.74,0:55:46.73,Default,,0000,0000,0000,,In China they've had \Nthem in for six weeks
Dialogue: 0,0:55:46.74,0:55:48.08,Default,,0000,0000,0000,,it's tough to maintain that,
Dialogue: 0,0:55:48.12,0:55:49.94,Default,,0000,0000,0000,,so we need to think of these tradeoffs
Dialogue: 0,0:55:49.97,0:55:52.80,Default,,0000,0000,0000,,of all the things we can ask people to do,
Dialogue: 0,0:55:52.82,0:55:56.70,Default,,0000,0000,0000,,what's going to have the most impact\Non actually reducing the burden.
Dialogue: 0,0:55:57.81,0:55:59.01,Default,,0000,0000,0000,,CA: Another question:
Dialogue: 0,0:55:59.03,0:56:02.01,Default,,0000,0000,0000,,How did this happen\Nand is it likely to happen again?
Dialogue: 0,0:56:03.30,0:56:07.54,Default,,0000,0000,0000,,AK: So it's likely that this originated\Nwith the virus that was circling in bats
Dialogue: 0,0:56:07.57,0:56:10.81,Default,,0000,0000,0000,,and then probably made its way\Nthrough another species
Dialogue: 0,0:56:10.83,0:56:12.04,Default,,0000,0000,0000,,into humans somehow,
Dialogue: 0,0:56:12.07,0:56:14.93,Default,,0000,0000,0000,,there's a lot of bits\Nof evidence around this,
Dialogue: 0,0:56:14.96,0:56:16.91,Default,,0000,0000,0000,,there's not kind of single, clear story,
Dialogue: 0,0:56:16.93,0:56:18.92,Default,,0000,0000,0000,,but even for SARS, it took several years
Dialogue: 0,0:56:18.95,0:56:22.25,Default,,0000,0000,0000,,for genomics to piece together\Nthe exact route that it happened.
Dialogue: 0,0:56:22.28,0:56:25.33,Default,,0000,0000,0000,,But certainly, I think it's plausible\Nthat it could happen again.
Dialogue: 0,0:56:25.36,0:56:27.88,Default,,0000,0000,0000,,Nature is throwing out\Nthese viruses constantly.
Dialogue: 0,0:56:28.42,0:56:31.00,Default,,0000,0000,0000,,Many of them aren't\Nwell-adapted to humans,
Dialogue: 0,0:56:31.03,0:56:32.21,Default,,0000,0000,0000,,don't pick up,
Dialogue: 0,0:56:32.23,0:56:35.44,Default,,0000,0000,0000,,you know, there may well have been\Na virus like this a few years ago
Dialogue: 0,0:56:35.46,0:56:37.21,Default,,0000,0000,0000,,that just happened to infect someone
Dialogue: 0,0:56:37.23,0:56:40.05,Default,,0000,0000,0000,,who just didn't have any contacts\Nand didn't go any further.
Dialogue: 0,0:56:40.08,0:56:42.05,Default,,0000,0000,0000,,I think we are going to face these things
Dialogue: 0,0:56:42.07,0:56:44.47,Default,,0000,0000,0000,,and we need to think\Nabout how can we get in early
Dialogue: 0,0:56:44.50,0:56:47.29,Default,,0000,0000,0000,,at the stage where we're talking\Nsmall numbers of cases,
Dialogue: 0,0:56:47.32,0:56:49.36,Default,,0000,0000,0000,,and even something like this\Nis containable,
Dialogue: 0,0:56:49.39,0:56:51.34,Default,,0000,0000,0000,,rather than the situation we've got now.
Dialogue: 0,0:56:51.36,0:56:53.38,Default,,0000,0000,0000,,CA: It seems like\Nthis isn't the first time
Dialogue: 0,0:56:53.40,0:56:56.71,Default,,0000,0000,0000,,that a virus seems to have emerged\Nfrom, like, a wild meat market.
Dialogue: 0,0:56:57.66,0:57:00.35,Default,,0000,0000,0000,,That's certainly how\Nit happens in the movies. (Laughs)
Dialogue: 0,0:57:00.37,0:57:03.03,Default,,0000,0000,0000,,And I think China has already taken\Nsome steps this time
Dialogue: 0,0:57:03.05,0:57:05.70,Default,,0000,0000,0000,,to try to crack down on that.
Dialogue: 0,0:57:05.72,0:57:08.50,Default,,0000,0000,0000,,I guess that's potentially\Nquite a big deal for the future
Dialogue: 0,0:57:08.53,0:57:11.66,Default,,0000,0000,0000,,if that can be properly maintained.
Dialogue: 0,0:57:11.68,0:57:13.57,Default,,0000,0000,0000,,AK: It is, and we saw, for example,
Dialogue: 0,0:57:13.59,0:57:15.63,Default,,0000,0000,0000,,the H7N9 avian flu,
Dialogue: 0,0:57:15.66,0:57:19.76,Default,,0000,0000,0000,,over the last few years, in 2013,\Nit was a big emerging concern,
Dialogue: 0,0:57:19.78,0:57:21.80,Default,,0000,0000,0000,,and China made a very extensive response
Dialogue: 0,0:57:21.83,0:57:24.49,Default,,0000,0000,0000,,in terms of changing\Nhow they operate their markets
Dialogue: 0,0:57:24.51,0:57:26.22,Default,,0000,0000,0000,,and vaccination of birds
Dialogue: 0,0:57:26.24,0:57:29.79,Default,,0000,0000,0000,,and that seems\Nto have removed that threat.
Dialogue: 0,0:57:29.82,0:57:33.58,Default,,0000,0000,0000,,So I think these measures can be effective\Nif they're identified early on.
Dialogue: 0,0:57:34.32,0:57:35.85,Default,,0000,0000,0000,,CA: So talk about vaccinations.
Dialogue: 0,0:57:35.87,0:57:37.74,Default,,0000,0000,0000,,That's the key measure, I guess,
Dialogue: 0,0:57:37.77,0:57:41.17,Default,,0000,0000,0000,,to change that susceptibility\Nfactor in your equation.
Dialogue: 0,0:57:44.72,0:57:49.05,Default,,0000,0000,0000,,There's obviously a race on\Nto get these vaccinations out there,
Dialogue: 0,0:57:49.08,0:57:51.69,Default,,0000,0000,0000,,there are some candidate\Nvaccinations there.
Dialogue: 0,0:57:51.71,0:57:54.05,Default,,0000,0000,0000,,How do you see that playing out?
Dialogue: 0,0:57:55.10,0:57:58.65,Default,,0000,0000,0000,,AK: I think there's certainly some\Npromising development happening,
Dialogue: 0,0:57:58.67,0:58:00.69,Default,,0000,0000,0000,,but I think the timescales of these things
Dialogue: 0,0:58:00.71,0:58:03.80,Default,,0000,0000,0000,,are really on the order\Nof maybe a year, 18 months
Dialogue: 0,0:58:03.82,0:58:05.73,Default,,0000,0000,0000,,before these things be widely available.
Dialogue: 0,0:58:05.75,0:58:08.67,Default,,0000,0000,0000,,Obviously, a vaccine has to go\Nthrough these stages of trials,
Dialogue: 0,0:58:08.69,0:58:11.12,Default,,0000,0000,0000,,that takes time,\Nso even if by the end of the year,
Dialogue: 0,0:58:11.15,0:58:13.49,Default,,0000,0000,0000,,we have something\Nwhich is viable and works,
Dialogue: 0,0:58:13.52,0:58:16.83,Default,,0000,0000,0000,,we're still going to see a delay\Nbefore everyone can get ahold of it.
Dialogue: 0,0:58:16.86,0:58:18.78,Default,,0000,0000,0000,,CA: So this really puzzles me, actually,
Dialogue: 0,0:58:18.81,0:58:21.76,Default,,0000,0000,0000,,and I'd love to ask you\Nas a mathematician about this as well.
Dialogue: 0,0:58:21.78,0:58:23.72,Default,,0000,0000,0000,,There are already several companies
Dialogue: 0,0:58:23.74,0:58:27.74,Default,,0000,0000,0000,,believing that they have\Nplausible candidate vaccines.
Dialogue: 0,0:58:28.06,0:58:31.84,Default,,0000,0000,0000,,As you say, the process\Nof testing takes forever.
Dialogue: 0,0:58:32.91,0:58:37.55,Default,,0000,0000,0000,,Is there a case that we're not\Nthinking about this right
Dialogue: 0,0:58:37.58,0:58:42.55,Default,,0000,0000,0000,,when we're looking at the way\Nthat testing is done
Dialogue: 0,0:58:42.58,0:58:45.28,Default,,0000,0000,0000,,and that the safety calculations are made?
Dialogue: 0,0:58:45.30,0:58:47.88,Default,,0000,0000,0000,,Because it's one thing\Nif you're going to introduce
Dialogue: 0,0:58:47.90,0:58:49.47,Default,,0000,0000,0000,,a brand new drug or something --
Dialogue: 0,0:58:49.50,0:58:53.68,Default,,0000,0000,0000,,yes, you want to test to make sure\Nthat there are no side effects,
Dialogue: 0,0:58:53.70,0:58:55.12,Default,,0000,0000,0000,,and that can take a long time
Dialogue: 0,0:58:55.15,0:58:58.48,Default,,0000,0000,0000,,by the time you've done all\Nthe control trials and all the rest of it.
Dialogue: 0,0:58:58.51,0:59:00.48,Default,,0000,0000,0000,,If there's a global emergency,
Dialogue: 0,0:59:00.51,0:59:02.99,Default,,0000,0000,0000,,isn't there a case,
Dialogue: 0,0:59:03.02,0:59:04.90,Default,,0000,0000,0000,,both mathematically and ethically,
Dialogue: 0,0:59:04.93,0:59:07.28,Default,,0000,0000,0000,,that there should just be\Na different calculation,
Dialogue: 0,0:59:07.30,0:59:08.74,Default,,0000,0000,0000,,the question shouldn't be
Dialogue: 0,0:59:08.77,0:59:13.81,Default,,0000,0000,0000,,"Is there any possible case\Nwhere this vaccine can do harm,"
Dialogue: 0,0:59:13.83,0:59:15.86,Default,,0000,0000,0000,,the question surely should be,
Dialogue: 0,0:59:15.88,0:59:18.29,Default,,0000,0000,0000,,"On the net probabilities,
Dialogue: 0,0:59:18.32,0:59:22.19,Default,,0000,0000,0000,,isn't there a case\Nto roll this out at scale,
Dialogue: 0,0:59:22.21,0:59:27.25,Default,,0000,0000,0000,,to have a shot at nipping\Nthis thing in the bud?"
Dialogue: 0,0:59:27.27,0:59:30.17,Default,,0000,0000,0000,,I mean, what am I missing\Nin thinking that way?
Dialogue: 0,0:59:30.65,0:59:32.88,Default,,0000,0000,0000,,AK: I mean, we do see that\Nin other situations,
Dialogue: 0,0:59:32.91,0:59:36.75,Default,,0000,0000,0000,,for example, the Ebola vaccine in 2015
Dialogue: 0,0:59:36.78,0:59:39.72,Default,,0000,0000,0000,,showed, within a few months,\Nvery promising evidence
Dialogue: 0,0:59:39.74,0:59:44.60,Default,,0000,0000,0000,,and interim results of the trial in humans
Dialogue: 0,0:59:44.62,0:59:47.18,Default,,0000,0000,0000,,showed what seemed very high efficacy.
Dialogue: 0,0:59:47.20,0:59:50.43,Default,,0000,0000,0000,,And even though\Nit hadn't been licensed fully,
Dialogue: 0,0:59:50.46,0:59:53.14,Default,,0000,0000,0000,,it was employed for what is known\Nas compassionate use
Dialogue: 0,0:59:53.16,0:59:54.68,Default,,0000,0000,0000,,in subsequent other outbreaks.
Dialogue: 0,0:59:54.70,0:59:56.60,Default,,0000,0000,0000,,So there are these mechanisms
Dialogue: 0,0:59:56.63,0:59:59.47,Default,,0000,0000,0000,,where vaccines can be\Nfast-tracked in this way.
Dialogue: 0,0:59:59.93,1:00:03.22,Default,,0000,0000,0000,,But of course, we're currently\Nin a situation where we have no idea
Dialogue: 0,1:00:03.24,1:00:05.17,Default,,0000,0000,0000,,if these things will do anything at all.
Dialogue: 0,1:00:05.20,1:00:08.02,Default,,0000,0000,0000,,So I think we need\Nto accrue enough evidence
Dialogue: 0,1:00:08.04,1:00:10.14,Default,,0000,0000,0000,,that it could have an impact,
Dialogue: 0,1:00:10.16,1:00:12.57,Default,,0000,0000,0000,,but obviously, fast-track that\Nas much as possible.
Dialogue: 0,1:00:13.78,1:00:16.95,Default,,0000,0000,0000,,CA: But the skeptic in me\Nstill doesn't fully get this.
Dialogue: 0,1:00:17.44,1:00:19.44,Default,,0000,0000,0000,,I don't understand
Dialogue: 0,1:00:19.46,1:00:24.79,Default,,0000,0000,0000,,why there isn't more energy\Nbehind bolder thinking on this.
Dialogue: 0,1:00:24.81,1:00:28.25,Default,,0000,0000,0000,,Everyone seems, despite the overall risk,
Dialogue: 0,1:00:28.28,1:00:31.21,Default,,0000,0000,0000,,incredibly risk-averse\Nabout how to build the response to it.
Dialogue: 0,1:00:31.76,1:00:33.16,Default,,0000,0000,0000,,AK: So with the caveat that,
Dialogue: 0,1:00:33.19,1:00:35.37,Default,,0000,0000,0000,,yeah, there's a lot\Nof good questions on this,
Dialogue: 0,1:00:35.40,1:00:37.98,Default,,0000,0000,0000,,and some of them are slightly\Noutside my wheelhouse,
Dialogue: 0,1:00:38.00,1:00:40.82,Default,,0000,0000,0000,,but I agree that we need to do more\Nto get timescales out.
Dialogue: 0,1:00:40.85,1:00:42.28,Default,,0000,0000,0000,,The example I always quote
Dialogue: 0,1:00:42.30,1:00:45.05,Default,,0000,0000,0000,,is it takes us six months\Nto choose a seasonal flu strain
Dialogue: 0,1:00:45.07,1:00:47.04,Default,,0000,0000,0000,,and get the vaccines out there to people.
Dialogue: 0,1:00:47.06,1:00:51.08,Default,,0000,0000,0000,,We always have to try and predict ahead\Nwhich strains are going to be circulating.
Dialogue: 0,1:00:51.11,1:00:53.23,Default,,0000,0000,0000,,And that's for something\Nwe know how to make
Dialogue: 0,1:00:53.25,1:00:55.37,Default,,0000,0000,0000,,and has been manufactured for a long time.
Dialogue: 0,1:00:56.21,1:00:58.54,Default,,0000,0000,0000,,So there is definitely more\Nthat needs to be done
Dialogue: 0,1:00:58.56,1:01:00.51,Default,,0000,0000,0000,,to get these timescales shorter.
Dialogue: 0,1:01:00.54,1:01:02.62,Default,,0000,0000,0000,,But I think we do have to balance that,
Dialogue: 0,1:01:02.64,1:01:05.79,Default,,0000,0000,0000,,especially if we're exposing\Nlarge numbers of people to something
Dialogue: 0,1:01:05.81,1:01:08.08,Default,,0000,0000,0000,,to make sure that we're confident \Nit's safe
Dialogue: 0,1:01:08.10,1:01:10.93,Default,,0000,0000,0000,,and that it's going to have\Nsome benefit, potentially.
Dialogue: 0,1:01:12.55,1:01:14.90,Default,,0000,0000,0000,,CA: And so, finally,
Dialogue: 0,1:01:14.93,1:01:18.02,Default,,0000,0000,0000,,Adam, I guess going into this --
Dialogue: 0,1:01:18.94,1:01:23.17,Default,,0000,0000,0000,,There's another set of infectious things\Nhappening around the world
Dialogue: 0,1:01:23.20,1:01:24.36,Default,,0000,0000,0000,,at the same time,
Dialogue: 0,1:01:24.39,1:01:28.12,Default,,0000,0000,0000,,which is ideas and the communication\Naround this thing.
Dialogue: 0,1:01:28.15,1:01:33.80,Default,,0000,0000,0000,,They really are two very dynamic,\Ninteractive systems of infectiousness --
Dialogue: 0,1:01:33.82,1:01:36.100,Default,,0000,0000,0000,,there's some very damaging\Ninformation out there.
Dialogue: 0,1:01:37.02,1:01:41.83,Default,,0000,0000,0000,,Is it fair to think of this as battle\Nof credible knowledge and measures
Dialogue: 0,1:01:41.85,1:01:44.04,Default,,0000,0000,0000,,against the bug,
Dialogue: 0,1:01:44.07,1:01:47.74,Default,,0000,0000,0000,,and just bad information --
Dialogue: 0,1:01:47.76,1:01:50.15,Default,,0000,0000,0000,,You know, part of what\Nwe have to think about here
Dialogue: 0,1:01:50.17,1:01:55.02,Default,,0000,0000,0000,,is how to suppress one set of things\Nand boost the other, actually,
Dialogue: 0,1:01:55.05,1:01:56.70,Default,,0000,0000,0000,,turbocharge the other.
Dialogue: 0,1:01:56.73,1:01:58.11,Default,,0000,0000,0000,,How should we think of this?
Dialogue: 0,1:01:58.13,1:02:02.07,Default,,0000,0000,0000,,AK: I think we can definitely think of it\Nalmost as competition for our attention,
Dialogue: 0,1:02:02.10,1:02:03.81,Default,,0000,0000,0000,,and we see similarly, with diseases,
Dialogue: 0,1:02:03.84,1:02:06.42,Default,,0000,0000,0000,,you have viruses competing\Nto infect susceptible hosts.
Dialogue: 0,1:02:06.44,1:02:08.23,Default,,0000,0000,0000,,And I think we're now seeing,
Dialogue: 0,1:02:08.25,1:02:11.33,Default,,0000,0000,0000,,I guess over the last few years\Nwith fake news and misinformation
Dialogue: 0,1:02:11.36,1:02:12.90,Default,,0000,0000,0000,,and the emergence of awareness,
Dialogue: 0,1:02:12.93,1:02:14.10,Default,,0000,0000,0000,,more of a transition
Dialogue: 0,1:02:14.12,1:02:16.73,Default,,0000,0000,0000,,to thinking about how do we\Nreduce that susceptibility
Dialogue: 0,1:02:16.76,1:02:19.39,Default,,0000,0000,0000,,if we have people that can be\Nin these different states,
Dialogue: 0,1:02:19.42,1:02:21.88,Default,,0000,0000,0000,,how can we try and preempt\Nbetter with information.
Dialogue: 0,1:02:21.90,1:02:24.29,Default,,0000,0000,0000,,I think the challenge\Nfor an outbreak is obviously,
Dialogue: 0,1:02:24.32,1:02:26.57,Default,,0000,0000,0000,,early on, we have\Nvery little good information,
Dialogue: 0,1:02:26.59,1:02:30.84,Default,,0000,0000,0000,,and it's very easy for certainty\Nand confidence to fill that vacuum.
Dialogue: 0,1:02:30.87,1:02:32.97,Default,,0000,0000,0000,,And so I think that is something --
Dialogue: 0,1:02:33.32,1:02:36.58,Default,,0000,0000,0000,,I know platforms are working\Non how can we get people exposed
Dialogue: 0,1:02:36.61,1:02:38.11,Default,,0000,0000,0000,,to good information earlier,
Dialogue: 0,1:02:38.13,1:02:40.87,Default,,0000,0000,0000,,so hopefully protect them\Nagainst other stuff.
Dialogue: 0,1:02:41.83,1:02:44.41,Default,,0000,0000,0000,,CA: One of the big unknowns to me\Nin the year ahead --
Dialogue: 0,1:02:44.43,1:02:47.92,Default,,0000,0000,0000,,let's say that the year ahead includes\Nmany, many more weeks,
Dialogue: 0,1:02:47.95,1:02:49.29,Default,,0000,0000,0000,,for many people,
Dialogue: 0,1:02:49.32,1:02:52.66,Default,,0000,0000,0000,,of actually self-isolating.
Dialogue: 0,1:02:52.68,1:02:57.73,Default,,0000,0000,0000,,Those of us who are lucky enough\Nto have jobs where you can do that.
Dialogue: 0,1:02:57.75,1:02:59.43,Default,,0000,0000,0000,,You know, staying home.
Dialogue: 0,1:02:59.46,1:03:01.81,Default,,0000,0000,0000,,By the way, the whole injustice\Nof this situation,
Dialogue: 0,1:03:01.83,1:03:06.29,Default,,0000,0000,0000,,where so many people can't do that\Nand continue to make a living,
Dialogue: 0,1:03:06.32,1:03:10.33,Default,,0000,0000,0000,,is, I'm sure, going to be\Na huge deal in the year ahead
Dialogue: 0,1:03:10.36,1:03:16.12,Default,,0000,0000,0000,,and if it turns out that death rates\Nare much higher in the latter group
Dialogue: 0,1:03:16.15,1:03:17.50,Default,,0000,0000,0000,,than in the former group,
Dialogue: 0,1:03:17.53,1:03:19.49,Default,,0000,0000,0000,,and especially in a country like the US,
Dialogue: 0,1:03:19.52,1:03:22.58,Default,,0000,0000,0000,,where the latter group\Ndoesn't even have proper health insurance
Dialogue: 0,1:03:22.60,1:03:24.33,Default,,0000,0000,0000,,and so forth.
Dialogue: 0,1:03:25.34,1:03:30.61,Default,,0000,0000,0000,,That feels like right there,\Nthat could just become a huge debate,
Dialogue: 0,1:03:30.63,1:03:33.75,Default,,0000,0000,0000,,hopefully a huge source\Nof change at some level.
Dialogue: 0,1:03:33.78,1:03:36.08,Default,,0000,0000,0000,,AK: I think that's an incredibly\Nimportant point,
Dialogue: 0,1:03:36.11,1:03:37.73,Default,,0000,0000,0000,,because it's very easy --
Dialogue: 0,1:03:37.75,1:03:41.16,Default,,0000,0000,0000,,I similarly have a job\Nwhere remote working is fairly easy,
Dialogue: 0,1:03:41.19,1:03:44.99,Default,,0000,0000,0000,,and it's very easy to say\Nwe should just stop social interactions,
Dialogue: 0,1:03:45.01,1:03:48.28,Default,,0000,0000,0000,,but of course, that could have\Nan enormous impact on people
Dialogue: 0,1:03:48.30,1:03:51.10,Default,,0000,0000,0000,,and the choices and the routine\Nthat they can have.
Dialogue: 0,1:03:51.12,1:03:53.30,Default,,0000,0000,0000,,And I think those do need\Nto be accounted for,
Dialogue: 0,1:03:53.32,1:03:55.70,Default,,0000,0000,0000,,both now and what the effect\Nis going to look like
Dialogue: 0,1:03:55.73,1:03:57.26,Default,,0000,0000,0000,,a few months down the line.
Dialogue: 0,1:03:57.28,1:03:58.70,Default,,0000,0000,0000,,CA: When all's said and done,
Dialogue: 0,1:03:58.72,1:04:03.78,Default,,0000,0000,0000,,is it fair to say that the world has\Nfaced, actually, much graver problems
Dialogue: 0,1:04:03.81,1:04:04.96,Default,,0000,0000,0000,,in the past,
Dialogue: 0,1:04:04.98,1:04:08.07,Default,,0000,0000,0000,,that on any scenario,
Dialogue: 0,1:04:08.09,1:04:11.76,Default,,0000,0000,0000,,it's highly likely that at some point\Nin the next 18 months, let's say,
Dialogue: 0,1:04:11.79,1:04:16.10,Default,,0000,0000,0000,,a vaccine is there and starts\Nto get wide distribution,
Dialogue: 0,1:04:16.12,1:04:22.10,Default,,0000,0000,0000,,that we will have learned\Nlots of other ways to manage this problem?
Dialogue: 0,1:04:22.12,1:04:24.26,Default,,0000,0000,0000,,But at some point, next year probably,
Dialogue: 0,1:04:24.28,1:04:30.41,Default,,0000,0000,0000,,the world will feel like\Nit's got on top of this
Dialogue: 0,1:04:30.44,1:04:31.84,Default,,0000,0000,0000,,and can move on.
Dialogue: 0,1:04:31.86,1:04:33.60,Default,,0000,0000,0000,,Is that likely to be it,
Dialogue: 0,1:04:33.63,1:04:36.99,Default,,0000,0000,0000,,or is this more likely to be,\Nyou know, it escapes,
Dialogue: 0,1:04:37.01,1:04:42.06,Default,,0000,0000,0000,,it's now an endemic nightmare\Nthat every year picks off far more people
Dialogue: 0,1:04:42.08,1:04:44.63,Default,,0000,0000,0000,,than are picked off by the flu currently.
Dialogue: 0,1:04:44.66,1:04:47.48,Default,,0000,0000,0000,,What are the likely ways forward,
Dialogue: 0,1:04:47.50,1:04:49.55,Default,,0000,0000,0000,,just taking a slightly longer-term view?
Dialogue: 0,1:04:49.57,1:04:52.59,Default,,0000,0000,0000,,AK: I think there's plausible ways\Nyou could see all of those
Dialogue: 0,1:04:52.61,1:04:54.20,Default,,0000,0000,0000,,potentially playing out.
Dialogue: 0,1:04:54.23,1:04:58.84,Default,,0000,0000,0000,,I think the most plausible is probably\Nthat we'll see very rapid growth this year
Dialogue: 0,1:04:58.86,1:05:03.46,Default,,0000,0000,0000,,and lots of large outbreaks\Nthat don't recur, necessarily.
Dialogue: 0,1:05:03.49,1:05:05.64,Default,,0000,0000,0000,,But there is a potential\Nsequence of events
Dialogue: 0,1:05:05.66,1:05:09.74,Default,,0000,0000,0000,,that could end up with these kind of\Nmultiyear outbreaks in different places
Dialogue: 0,1:05:09.77,1:05:10.92,Default,,0000,0000,0000,,and reemerging.
Dialogue: 0,1:05:10.95,1:05:12.83,Default,,0000,0000,0000,,But I think it's likely we'll see
Dialogue: 0,1:05:12.85,1:05:15.70,Default,,0000,0000,0000,,most transmission concentrated\Nin the next year or so.
Dialogue: 0,1:05:15.72,1:05:18.76,Default,,0000,0000,0000,,And then, obviously,\Nif there's a vaccine available,
Dialogue: 0,1:05:18.78,1:05:21.34,Default,,0000,0000,0000,,we can move past this,\Nand hopefully learn from this.
Dialogue: 0,1:05:21.36,1:05:24.55,Default,,0000,0000,0000,,I think a lot of the countries\Nthat responded very strongly to this
Dialogue: 0,1:05:24.58,1:05:26.01,Default,,0000,0000,0000,,were hit very hard by SARS.
Dialogue: 0,1:05:26.03,1:05:29.16,Default,,0000,0000,0000,,Singapore, Hong Kong,\Nthat really did leave an impact,
Dialogue: 0,1:05:29.18,1:05:31.91,Default,,0000,0000,0000,,and I think that's something\Nthey've drawn on very heavily
Dialogue: 0,1:05:31.93,1:05:33.28,Default,,0000,0000,0000,,in their response to this.
Dialogue: 0,1:05:33.30,1:05:34.46,Default,,0000,0000,0000,,CA: Alright.
Dialogue: 0,1:05:34.48,1:05:37.16,Default,,0000,0000,0000,,So let's wrap up maybe by just\Nencouraging people
Dialogue: 0,1:05:37.18,1:05:39.10,Default,,0000,0000,0000,,to channel their inner mathematician
Dialogue: 0,1:05:39.12,1:05:44.41,Default,,0000,0000,0000,,and especially think\Nabout the opportunities
Dialogue: 0,1:05:44.44,1:05:48.36,Default,,0000,0000,0000,,and the transmission probabilities\Nthat they can help shift.
Dialogue: 0,1:05:48.38,1:05:52.76,Default,,0000,0000,0000,,Just remind us of the top\Nthree or four or five or six things
Dialogue: 0,1:05:52.78,1:05:54.72,Default,,0000,0000,0000,,that you would love to see people doing.
Dialogue: 0,1:05:54.74,1:05:57.62,Default,,0000,0000,0000,,AK: I think at the individual level,\Njust thinking a lot more
Dialogue: 0,1:05:57.64,1:06:00.02,Default,,0000,0000,0000,,about your interactions\Nand your risk of infection
Dialogue: 0,1:06:00.04,1:06:02.01,Default,,0000,0000,0000,,and obviously, what gets onto your hands
Dialogue: 0,1:06:02.04,1:06:03.73,Default,,0000,0000,0000,,and once that gets onto your face,
Dialogue: 0,1:06:03.76,1:06:06.34,Default,,0000,0000,0000,,and how do you potentially\Ncreate that risk for others.
Dialogue: 0,1:06:06.36,1:06:09.04,Default,,0000,0000,0000,,I think also, in terms of interactions,
Dialogue: 0,1:06:09.06,1:06:13.90,Default,,0000,0000,0000,,with things like handshakes\Nand maybe contacts you don't need to have.
Dialogue: 0,1:06:13.92,1:06:16.70,Default,,0000,0000,0000,,You know, how can we get those down\Nas much as possible.
Dialogue: 0,1:06:16.72,1:06:19.13,Default,,0000,0000,0000,,If each person's giving it\Nto two or three others,
Dialogue: 0,1:06:19.16,1:06:22.37,Default,,0000,0000,0000,,how do we get that number\Ndown to one, through our behavior.
Dialogue: 0,1:06:22.40,1:06:26.20,Default,,0000,0000,0000,,And then it's likely that we'll need\Nsome larger-scale interventions
Dialogue: 0,1:06:26.23,1:06:29.17,Default,,0000,0000,0000,,in terms of gatherings, conferences,
Dialogue: 0,1:06:29.19,1:06:31.83,Default,,0000,0000,0000,,other things where\Nthere's a lot of opportunities
Dialogue: 0,1:06:31.85,1:06:33.22,Default,,0000,0000,0000,,for transmission.
Dialogue: 0,1:06:33.24,1:06:36.20,Default,,0000,0000,0000,,And really, I think that combination\Nof that individual level,
Dialogue: 0,1:06:36.22,1:06:39.23,Default,,0000,0000,0000,,you know, if you're ill\Nor potentially you're going to get ill,
Dialogue: 0,1:06:39.25,1:06:40.52,Default,,0000,0000,0000,,reducing that risk,
Dialogue: 0,1:06:40.54,1:06:42.15,Default,,0000,0000,0000,,but then also us working together
Dialogue: 0,1:06:42.17,1:06:44.27,Default,,0000,0000,0000,,to prevent it getting\Ninto those groups who,
Dialogue: 0,1:06:44.30,1:06:46.13,Default,,0000,0000,0000,,if it continues to be uncontrolled,
Dialogue: 0,1:06:46.15,1:06:48.39,Default,,0000,0000,0000,,could really hit some people\Nvery, very hard.
Dialogue: 0,1:06:49.43,1:06:51.06,Default,,0000,0000,0000,,CA: Yeah, there's a lot of things
Dialogue: 0,1:06:51.08,1:06:54.30,Default,,0000,0000,0000,,that we may need\Nto gently let go of for a bit.
Dialogue: 0,1:06:54.32,1:06:58.55,Default,,0000,0000,0000,,And maybe try to reinvent\Nthe best aspects of them.
Dialogue: 0,1:06:59.08,1:07:00.42,Default,,0000,0000,0000,,Thank you so much.
Dialogue: 0,1:07:00.44,1:07:03.24,Default,,0000,0000,0000,,If people want to keep up with you,
Dialogue: 0,1:07:03.26,1:07:05.97,Default,,0000,0000,0000,,first of all, they can follow you\Non Twitter, for example.
Dialogue: 0,1:07:05.100,1:07:07.35,Default,,0000,0000,0000,,What's your Twitter handle?
Dialogue: 0,1:07:07.37,1:07:09.99,Default,,0000,0000,0000,,AK: So @AdamJKucharski, all one word.
Dialogue: 0,1:07:10.01,1:07:12.52,Default,,0000,0000,0000,,CA: Adam, thank you so much\Nfor your time, stay well.
Dialogue: 0,1:07:12.55,1:07:13.93,Default,,0000,0000,0000,,AK: Thank you.
Dialogue: 0,1:07:13.95,1:07:20.95,Default,,0000,0000,0000,,(Music)
Dialogue: 0,1:07:29.26,1:07:32.53,Default,,0000,0000,0000,,CA: Associate professor\Nand TED Fellow Adam Kucharski.
Dialogue: 0,1:07:33.34,1:07:35.93,Default,,0000,0000,0000,,We'd love to hear what you think\Nof this bonus episode.
Dialogue: 0,1:07:35.96,1:07:38.80,Default,,0000,0000,0000,,Please tell us by rating\Nand reviewing us in Apple Podcasts
Dialogue: 0,1:07:38.82,1:07:40.76,Default,,0000,0000,0000,,or your favorite podcast app.
Dialogue: 0,1:07:41.24,1:07:43.22,Default,,0000,0000,0000,,Those reviews are influential, actually.
Dialogue: 0,1:07:43.24,1:07:44.62,Default,,0000,0000,0000,,We certainly read every one,
Dialogue: 0,1:07:44.64,1:07:46.79,Default,,0000,0000,0000,,and truly appreciate your feedback.
Dialogue: 0,1:07:46.82,1:07:48.77,Default,,0000,0000,0000,,(Music)
Dialogue: 0,1:07:48.79,1:07:52.59,Default,,0000,0000,0000,,This week's show was produced\Nby Dan O'Donnell at Transmitter Media.
Dialogue: 0,1:07:52.62,1:07:54.65,Default,,0000,0000,0000,,Our production manager\Nis Roxanne Hai Lash,
Dialogue: 0,1:07:54.67,1:07:56.99,Default,,0000,0000,0000,,our fact-checker Nicole Bode.
Dialogue: 0,1:07:57.01,1:07:59.29,Default,,0000,0000,0000,,This episode was mixed by Sam Bair.
Dialogue: 0,1:07:59.31,1:08:01.36,Default,,0000,0000,0000,,Our theme music\Nis by Allison Layton-Brown.
Dialogue: 0,1:08:01.38,1:08:03.93,Default,,0000,0000,0000,,Special thanks to my colleague\NMichelle Quint.
Dialogue: 0,1:08:04.25,1:08:06.47,Default,,0000,0000,0000,,Thanks for listening to the TED Interview.
Dialogue: 0,1:08:06.50,1:08:07.100,Default,,0000,0000,0000,,We'll be back later this spring
Dialogue: 0,1:08:08.02,1:08:11.37,Default,,0000,0000,0000,,with a whole new season's worth\Nof deep dives with great minds.
Dialogue: 0,1:08:11.76,1:08:14.93,Default,,0000,0000,0000,,I hope you'll enjoy them\Nwhether or not life is back to normal.
Dialogue: 0,1:08:15.63,1:08:16.85,Default,,0000,0000,0000,,I'm Chris Anderson,
Dialogue: 0,1:08:16.87,1:08:18.88,Default,,0000,0000,0000,,thanks for listening and stay well.