Disseminated cancers at the pats would have been treated through curable if picked up 7 months ago because theyve not been able to see their doctors and theyve not been able to get in the hospitals for assessment and another colleague in Palliative Care says the same thing that theyre getting overwhelmed with palliation now of people who otherwise might have been treatable so its a good point we must remember that whilst we are all trying to save the lives of coated patients there really is a genuine big impact going on in the general population with treat diseases such as cancer thats a not getting treated that is a balance that we do have to address on the issue of the mutation viruses all mutate and in fact genomes new to it we know that there are vast numbers of minor variations in this virus already the one that was most dominant was known as a g d change its one of my no acid in the spike protein protein uses to attach to cells and the one thats now dominant is not the one that came originally out of hand. It seems as if this g. Variant is a little bit more infectious it gave it just enough of an edge to become the dominant form so my guess is yes it will mutate it will change in an activity possibly in its severity over time its hard to know at what point if and when that just changes the efficacy of a vaccine and crisper piro water emailing him from the south africa he asked the question what is the rate of covered 1000. 00 mutations with other viable strains in the wild we have for example the flames in the world and streams should we be watching with taishan rate plus other novel protect new vital activity how long therefore with a vaccine remain effective push push push amounts of to beate are actually the biggest fly in the ointment is the fact that we dont make very long term immunity to coronaviruses if we compare this new coronavirus to the existing coronaviruses that just naturally circulates in humans there are 4 other coronaviruses that scores cold like symptoms but one of them infects our cells in a very similar way to the new corona virus so we can use that as Something Like a proxy marker for whats likely to be the case with this new virus what we can do is knowing that these viruses might not drive very powerful immune response when you catch them we can make sure our vaccines do and there are various ways to do that by adding chemicals called adji of thems to the vaccine that give your immune system a kick up the backside so that you make a more profound response than the natural infection does hopefully conferring longer term protection but at the moment we just dont know or that brings us neatly on to the questions of treatment because poor fernandes writing in for from spin says why are most of the efforts in the Mainstream Media coverage she says are focused on finding a vaccine where we dont know anything of a little about other treatments and medicines every chance of failing on effect of treatment soon so it could become a part of bin that vances. Interesting less the virus in the last 6 months or so there is good news on the treatment front and its a good news story that comes worldwide also particularly in Great Britain where our National Health service is very well integrated has a fantastic leadership in research and it allowed us to do some trials very quickly and very effectively with great power to try to find things that worked the 1st of those actually that really was much more generic around the world is we realized a lot of these severity of illness in the sudden deaths we saw in hospital releasing to blood clots that wasnt something we did a trial for we identified it very quickly and patients now were admitted to hospital will now be given much higher doses of blood thinning agents and they were before and now the patients we are seeing in hospital all get that routinely and were picking up clots much much earlier and that in itself is going to make a big difference the 2nd 2 studies out of Great Britain we have to run recovery in one called. And they identified same signal but low doses of steroids which are anti inflammatory drugs and a very very cheap make a very big difference they reduce death rates in intensive care admissions by around 30 percent and in medicine that is a really really big effect of any drug this is cheap very safe to give and highly effective and finally there was a study out of the United States with a trickle theres a fear that shortens sometimes thats volatile over 4 days we dont have a really strong signal for mortality this in the n. H. S. At the moment most patients who are severely ill of getting both steroids and or hydrocortisone Western Desert there i think that with the answer calculation will make a difference now those platforms are still running in britain we fortunately had a big drop in admissions and actually though the downside to that has been we have not had enough patients to be able to start expanding our knowledge of whats afaik effective numbers are going back up again and those trials are still recruiting and there are other trials ongoing. The world will produce new treatments so its a good news story in many ways weve got some big wins already and i think there will be more coming as these other trials particularly brutal with their Knowledge Base numbers start reporting so dont of the big question here then who if youre caught if you are lucky and fortunate enough to catch covert no. September 2020 as your chances of surviving it if you go into hospital much better than they were in february or march we dont know but i think that would be the case we certainly use or signal over time during the 1st wave that intensive care mortality fail as time progressed now about my party being organizational because one we were beginning and that was very difficult to manage just organizationally but actually we did learn a lot about for instance the use it and to try to be certain to make a difference so yes i think from a trial data mr woods to there will be a much aggressive chance of surviving if ones admitted to hospital or to an intensive care unit just for clarity that is not what is driving the reportedly quote mortality rate case the moment this isnt because were better at treating it this is largely because the page were testing a lot of people infected are much lower risk use. Regarding the tension between drug treatments and vaccines the other thing to bear in mind here is that prevention is always better than cure and what a vaccine offers us is the ability to defend ourselves not just today not tomorrow not next year but for years to come and as the World Health Organization of pointed out many times this is this problem is not going away any time soon theres at least 5 years of the present predicament to run and thereafter we fully anticipate this new coronavirus is going to settle down and become an endemic human infection is going to continue to circulate joy. Ending the other car dray of coronaviruses that caused seasonal infections in humans and therefore its likely we are going to need to prevent this sort of infection or at least the severe manifestations of it in at least a susceptible population all over the world in years to come and that means that having a vaccine that does that does that reliably and does that safely is a huge potential win and will enormously tip the balance in our favor in the future while acute drugs for managing the crisis here now are very important and lots of investments going into trying to find them including cutting edge Ai Technologies im talking to colleagues who have got very clever ways of using Artificial Intelligence learning systems to look at how when viruses going to cells they change the spectrum of genes that are turned on and turned off in a cell and they can marry that pattern up with the changes that different drugs produce and theyre using the argument well if a drug produces a mirror image changes in the gene profile in a cell that the virus does perhaps that drug could interact with that virus and stop it growing so people are looking at enormous numbers of drugs that we already have on the shelves to see if they can see these sorts of matches and that will help us here and now but one must never take your eye off the longer term because this problem is not going to go away and therefore having a long Term Solution that will work well before we get anyone in such extreme Health Conditions that theyre going to need to use help unfortunately im trying not trying to do our business you but you know thats going to be the really really critical thing here which is why investment in a vaccine is very important. Join us after the break alex asks our top experts what they think too holds when will this contagion finally joined us it. Was a pandemic no certainly no borders im just glad to nationalities. As a marketable turkey we took a backseat world peace to be. Judged as coming every crisis like this is the sentence if. We can do better we should. Everyone is contributing each of our own way but we also know that this crisis will not go on forever the challenges craig has to respond has been much so many good people are helping us. It makes us feel very proud that we are in it together. Karas calendar is drawing all forms over a long day and theres cherishing page hes dard served our. His 1st words were i will i will see you are a challenging post you got to use to me as. I have no doubt that what happened was criminal. Offense concentrate maki 1000000000. 00 industry these companies how does huge financial motivations to solve these problems there are numerous talking showing that doctors were keen to test facts right concentrates for insights of its own that patients wont use them it was the wrong choice to play golf or curve why they would keep me from security procedures. On people still die i dont know which question were still alive arent being allowed to live where so many have. Been there by social class laws passed people also in poverty by 1st place if youre born into a poor family i od youre born into a minority family if youre born into a family that only has a single parent that really constrains your life chances people die on average 15 years old a good morning to generational poverty. Its awfully tough fight every day seem to meet your needs and the needs of your family. Welcome back alex is in conversation with professor human chair of intensive care unit at University College london and dr chris smith for all the just id cambridge university. So well have a lot of questions about immunity and scott want to know how many people have a complete immunity to disease so the complete easy dont know we dont know what Community Mean at the community does exist and to say it does exist im quite certain that this where how complete it is how long it lasts i dont know and we do know that the current a virus does mount a significant immune response your body just defend itself and it does that in a couple of ways it makes these chemicals good antibodies which are proteins that jumps to the vowel sound and help your body attack that cell so if you want my guess my guess is that you do get some degree of affected immunity but quite at what level of antibodies you need and how long you see last i dont know the christmas j. T. Us just the direct question that has been alluded to after contracting covered 19 are we have mutant of the seas lots of people want to go thats of that question if you get it once can we get again you alluded to that earlier but you also said this disease could be endemic in the population what do you mean by that we dont know what proportion of people will have long term immunity having had natural infection with this corona virus and as we are beginning to see alarmingly there are people who were sufficiently ill with it the 1st time around to take them off the hospital they recovered but then they have been confirmed as catching it again and its not just that the virus looked in their body we can prove genetically that theyve been infected with a new strain of the virus or a new variant of the virus proving that the immunity that you make at least in some people is short lived now on the subject of pandemics versus epidemics and so at the moment this is a pandemic came from one corner of china as far as we know it has eclipsed the entire world and now were dealing with it but will it switch to become an endemic infection we think it. Probably will endemic means its effectively tied up bound up and circulating relentlessly within a population yes we think thats the case of the good examples of this h. I. V. Has caused a pandemic it came from one corner of africa it spread to involve the entire world its now endemic in the human race so thats a good example of a pandemic virus that was a newly emerging infection that then has become and in demick infection an endemic relentless problem in the human race so one last question for you both for a start if you really in this great struggle the mast and between the virus and the one and the science and medicine and the other whos going to come out top. Weve got to remember that weve had 3 emerging diseases in only 17 years is partly due to the way we treat our Natural Environments and Animal Husbandry and so forth this wont be the last unless we start changing the way ben you behave there will be more of these and well go round this circle again so its a call to arms echoing what chris said earlier on prevention you know announce a prevention is worth a pound of cure lets not take a rocket ball lets start changing the way we treat our Natural Environment try to stop these emergencies at the current quite so frequent and prevalent because 3 in 17 years is quite a lot part of the smurfs really the take home message is if we want to prevent this again we have to look beyond just how we cure the present problem but what the mechanism is of the present problem of the mechanism of fortune is is our fault and it is not a coincidence that these diseases are emerging from areas where there have been big population explosions history keeps repeating itself we saw the same thing happen with a bone in the air bone or outbreak of 2030 and 40 that occurred in parts of africa where theyve been a 500 percent increase in population so our target is to look at sustainability we absolutely have to look at making sure we exist sustainably and we have more respect for the Natural World and the animals in it to avoid these kind of jumps in future because otherwise its absolutely certain the viruses will win dr chris murphy professor human governor thank you so much for sharing your knowledge announcing of your questions thank you thank you. With the search for a vaccine still ongoing and treatment still developing it is Public Health initiatives which have taken the strain of vitus control alex asked the new president of the British Medical Association professor heidi brains whether venue to plant a can hold the bite is it baby and why some kind to save succeeded and by some i feeling. So are they joined from. Glasgow by professor honey buns the newly elected president of the British Medical Association many congratulations holly thank you very much for coffee our 1st question from lily she says how long can it is some to mattick katty have coffee and spread this virus is that one of the big challenges of controlling coal that its simply part of says that pattern of spread of that bias the 14 day limit i think its probably not you know right definition no one knows if somebody said the magic. Never tested you dont know if have been stated by us but by i dont know why hes counsel is it or if youve been close to some point definitely has its or is it just so far a sleep for 2 weeks and youre a straight face baby not at the time a skull and thinking about scotland and specifically says how can we deal with if we cant control a badass doesnt that mean continual cross infection. Yeah thats thats an issue that ive hared a number of debates ahead and im a republican say that we really needed to shut the bark or stop people from coming in and i know of the same thats a relatively minor tribute to the strange weve got enough infectious people within our borders just to be and the way in which theyre behaving in terms of not socially distance saying you know goods that pop in a lamp into saying thats whats driving the increase in cases at the moment so yes it is an issue but its probably not be crime issue that driving the crease in the number of cases system is strained within show as it takes a look at the cost says that shes very suspicious she says something the history of man must have always been the controlling the man im bushnell will be this as a possible that history is repeating in a sophisticated modern way to stop more control over all mankind suspicions justify how to i dont think so not unless of course. Pangolin is as being agent since Authority Government or whatever one of the things that instrument of this is rolling back the destruction of natural habit to shoot for 7 my children my grandchildren situation so i know this isnt a fiendish law by evil foreign governments not even the westminster government and what it has been a natural occurrence that you would expect when you are beginning to see and change in the way nature or Human Interaction with nature is occurring one of us questions a very poignant one from louise hawke she says must contact us and hand washing could continue before now if nothing homestay couldnt be lasting 2 years. Why would the elderly choose the existence of a helmet for the final years for the strayed off between the quality of life and the risk of catching this virus from the elderly i have a huge amount of sympathy with that question but the fact is there were people we have heard that in and out of Nursing Homes in the rightly everyone is to be infected at the deaths of patients in Nursing Homes it was a originally suggested that in the Scottish Parliament that there salute these these deaths were due to people with corona virus being sent to those Nursing Homes from acute hospitals right the data i seen would suggest that it was mainly infected stock that were responsible for the transmission of Nursing Homes so the fact is that anyone going in or out of the snuffly rooms is likely to be a carrier and then it will spread like wildfire and what some people some who are not seen their relatives are going to die so weve got to be very careful about who said we need to continue to be that hardy bums of the us nobody more experienced in Public Health and the what will the new yourself is that really possible to control a highly infectious virus with the pubs open the governments been keeping us by suggesting that was possible. When we went out from 2 meters distance into one this beach or this and saying i have to have a behavioral Scientists Say in your head 2 meters is a distance but one metre sist late reaching youre touching someone and we see this i mean i i have not been in a public this year and have no intentions of going into one but when you see people sitting outside 8 people sent for her leaning forward their heads are close together theyre breathing droplets over chocolate and i just dont think its possible to control the virus that is taking place you havent been since that encounter date is that had someone walked out over the past few weeks you havent insists that rate of transmission slowing may have been so the fact it would be limited to the number of people you can have in your house and meetings and outside insular is having a fake cricket probably not having to face fast enough so whatever is said. I think were going to have to maybe not completely shot pops but were really going to have to have people behaving very different. Come Public Health measure of get the survive us bottom of control and doesnt the messaging have to be Crystal Clear yes said mrs james the messaging has to be 2 things as to be very clear but it has to be very positive you know telling people that they are irresponsible idiots and soren is not a good way of persuading them to do the messaging that we had initially which is war which was behave in this way and it will be a good citizen helping you know other people sad kind of positivity were all in this together that how angry d having low necks in the paul steiger a mormon so on is not helping your granny has not helping your fellow students its not helping your mom and dad their whole if anything is going to kill them and were already beginning to see increasing numbers of elderly people testing positive which was what we predicted 3 or 4 weeks ago so it has to be a message that says being a good citizen involves practice doing what the government is telling you and being sensible about it. And finally had above this they look at internationally as ive been one saying from a Public Health perspective of all the countries experience of scene that stood out for you you saw it and said right thats the way from a Public Health perspective to get the sort of virus under control you see that your question new zealand where people grass so they had to have a government who was very honest west of the nuclear some big it was sorry seeing new zealand went to other places have been very successful in this and its all come from the 3 people who are unshared were going to help each other out here 1st hard above those newly elected president of the British Medical Association thank you so much for joining me on the examen show so a pleasure. The virus is back the u. K. Threat level heightened and few western countries have been able to cope certainly not the u. K. Were locked into is now is very real possibility certainly not the us where deaths per 1000000 have this week overtaken the u. K. And certainly not in france where the oldest Holiday Season has come with a very high corporate price there are countries which have been islands of success and many of them have indeed been islands however worldwide on Current Trends by the end of this week the mortality rate will approach 1000000 and by the end of the shear the International Infection numbers will surpass 50000000 people today are 3 experts have given state responses to some of the biggest questions and deployed them with profound commonsense their comments on the connection between the threat of new emerging viruses and the destruction of the Natural Environment and therefore the sustainability of the human condition were particularly pertinent. Whether that can be translated into a new and better policy direction remains to be seen but for now from alex myself and all the short stay safe im hope to see you all again next week. Thank. You. Segregated to anywhere by social class laws fail fast people dont also in poverty by 1st plan if youre born into a 4 family was your born into a minority family if youre born into a family that only has a single parent that really constrains your life chances people die on average 15 years younger if youre going to generational poverty. Its a fact its a fight every day to meet your needs and the needs of your family. Cash cow and there is downright alfonzo among. Those chasing page hes dard served our heart. His 1st words were at our senior a challenging post youve got to use to me if. I have no doubt that what happened was scriven. Lets concentrate maki is a 1000000000. 00 industry these companies how does huge financial motivations to solve these problems there are numerous talking showing that doctors were keen to test facts right concentrates for the insights of its own that patients wont give them doctors the wrong ones to play golf or term system why they would keep me from secure those years day to day and people still die and im always question michel right arent being allowed to live where so many have. Its going to be hard to reclaim freedom and were going to have to work at it but as people recognize from examples like. What were pression Digital Systems need to. I hope people will start fighting. Saying we wont tolerate systems. Streets in our homes that cant possibly track what were doing. In. Russia says germany is a stalling of the probe into the alleged poisoning of election avali by holding back crucial data goes on to the Global Chemical weapons watchdog talks are to you. Through deliberately delaying the process the impeded the completion of the preliminary inquiry and that was held in order to ascertain whether there is an offense or not. First voiced their anger over the governments tough new coronavirus restriction saying that they were never consulted. And the pentagon is accused of spending up to a 1000000000. 00 of coronavirus funds on the old terry dear