you came back from China ten days ago
and I want to talk about your experience
in China in a minute but first of all
your boss the head of the WHI put out a
mortality rate number yesterday that had
us all gasping frankly three point four
percent mortality rate for those
infected which is quite a lot higher
than the 1% that we were kind of dealing
with roughly before hand explained that
number to us and why he's now made that
public well when you look at the numbers
in in China there's different numbers
right and I think one of the things that
worried the director-general
was that people were cherry-picking the
lowest possible numbers and they were
they were under estimating what this
disease could actually do and the number
that you heard yesterday that's if you
take from the beginning of the outbreak
including Wuhan and the area's worst hit
right through to today and all of China
the number is over is over three and
what people often do is they just look
at those provinces outside of who Bay
and and where Wuhan is and they
calculate from once people really knew
what they were doing and they say okay
at that point it was down around 1% or
under 1% but you know what the
director-general was highlighting was if
you don't get on this fast if you don't
know what you're doing if you're not
taking care of your older population
properly this is going to have worse
mortality than then then you're
expecting and we have to be careful Matt
not not to extrapolate directly from
China China has a different demographic
than the UK and also they're really
really good at keeping people with this
disease alive long enough to survive it
ok but should we now be treating the
three-and-a-half percent mortality rate
as our benchmark is that the new number
that we should be looking at for all of
us now what you should be looking at is
you know this is a serious disease 1% 2%
3% this is a serious dangerous disease
what you should be looking at and sorry
madam said a little bit earlier but what
we should do is how many people are
going to get severely ill and are we
going to have to put in specialized
centers and
so the event delayed to help them get
through this and possibly do that for a
few weeks how many people are gonna have
mild disease that we're going to have to
put in repurposed facilities etc to be
able to make sure they're not infecting
other people we should be looking at
those numbers because that's how you're
gonna manage and control this and bring
your mortality down we know it's a bad
dangerous disease how do you bring your
mortality down you concentrate your
resources use shorten the time frame to
make sure you can identify them very
quickly you look at the high-risk ones
and get them into the specialized
centers in case they crash these are the
things that that we should focus on
mortality rate it's going to be
different in different contexts it
doesn't have to be that high that's the
key message okay so when you went to
China what did you discover there that
should become a lesson to all of us all
over the world the first thing that we
discovered that I think the most
important message and and I have to
admit I went there with quite a bias
because this is a respiratory pathogen
and we're not used to seeing these kind
of viruses controlled through these
traditional that's-a approaches and that
was the first you know big learning from
China and and then but in terms of
applying that outside of China I think
the critical things that China did well
were first of all the population knew
what it was looking for they knew what
this disease was they knew where to go
to get tested and they could be isolated
and taken care of very very quickly
people were part of the solution they
were the surveillance system you weren't
waiting for it to walk into hospitals
and in fact the hospitals they had a
very well informed population then they
had and planned the capacity to be able
to isolate these commit cases and they
planned the capacity be able to find the
close contacts quarantine them and then
take care of them for the 14 days during
which five to ten percent of them would
become cases and the big takeaways are
those and what worries me always mad as
everyone starts with like we can't do
what China did and I said well why not
and they said well we can't lock down a
whole city
I said well China didn't either I mean
they have thousands and thousands of
Sydney's they lock down a few
where it had really gotten out of
control and they never ever did that
again they only did it in one province
not in the other 30 because they figured
out how to how to respond but still it's
a much bigger country as well I mean did
they lock down effectively 60 million
people which is virtually the whole
population of the UK can you seriously
imagine this government doing something
similar in a country like ours I would
be seriously surprised and and and
frankly disappointed if the country ever
got into a situation where they'd even
have to contemplate that and the great
thing you see Matt is that you know
remember this it's not a function of the
virus whether or not you get in a
situation like China's it's a function
of how you respond and what you're
seeing as a result of the work of public
health England the NHS etc is they're
fighting these cases fast they're
jumping on the transmission chains
they're getting them under control you
should never get in that situation
should never have to even contemplate it
and there's a lot of things you could do
before you get there
right so to be clear China had to take
these draconian measures because it
didn't keep its eye on the ball at the
beginning of this infection well no one
would have had their eye on the ball
this was a new virus nobody had seen
before they had to isolate the virus
find out what they were dealing with
find out how it was transmitted find out
then test different approaches they did
all the testing and now the rest of the
world the rest of China knows how to how
to approach this thing so um you know
and look at Matt and fairness and and
I'm not saying this to to be popular in
China every other country in the world
is known about this for six weeks and
we're still seeing it get out of control
in these places that never happened in
other parts of China afterwards okay so
what is the rest of the world not doing
that they should be doing right now
yeah countries like Italy or perhaps
also in a couple of weeks or you know
Iran South Korea well what lots of
countries are doing the right thing but
we have to what we have to look at Matt
is there any barrier to finding cases
very very quickly getting them tested
and getting my slated and those barriers
can be simple things as simple as our
materials available in the right
language does the population really know
that it's they're looking for a fever
and a cough not a
not a runny nose this is a different
thing do they know what they're looking
for then do they know how to get tested
what I've heard in some places people
say is call your GP well try and get
through to your GP during the day right
maybe they're all for though Friday
writer and then they're out for the
weekend you've left this infected person
potentially in the community for three
or four more days you have to look at
every single thing that might slow down
the chance of you finding that person
isolating them to help them survive the
disease and to help others not get them
affected that's what we've got studying
there's a big debate about closing down
schools what's the point of closing down
schools of kids according to the
evidence are very unlikely to get this
well kids are a pretty special part of
our population Matt I have one of them
oh there you go so so we do you know we
exercise an abundance of caution with
our children and that's a good thing but
what we what you and in terms of what
you just said we actually don't know
what happens with children in this
disease it appears that they're less
likely to get infected it appears that
they're less likely to get a sick but a
lot of that may be an artifact of the
fact that this happened in China at the
start of the Spring Festival because
remember the spring festival in China
all the schools are closed for two weeks
and then they extended them so we don't
really know what would have happened if
children were exposed to big doses of
this thing in school environment would
they have gotten sicker and we don't
know probably not in in my minor but
would they have carried the virus back
to their families and caused more
outbreaks that way
quite possibly we simply don't know so
one of the things we're looking at in
places like Italy and and and others
that get infected are do haven't seen
any school clusters that might either
result in more sickness kids or help
spread it so far the evidence is in
there and it's one more you know piece
of the puzzle that we haven't got the
tools to study properly yet you soon
will but that way yeah okay just just to
bring it back to Britain and we've just
the numbers out over 80 cases now in
this country it was 50 yesterday what
can you infer from that your cases are
increasing quite obviously and it's what
I would it's hard to infer from the
number what we need to know are they
geographically clustered and clustered
in time and clustered around certain
events or are these just popping up all
over the country and it's it's evidence
of widespread transmission that had been
missed mild cases that have been missed
so the number itself doesn't tell you
anything or everything what it may be
telling you is the population is way
more aware they're getting them much
more fast and that could be a very good
sign so it depends a little bit what's
behind it Matt okay and finally you came
back from China ten days ago I gather
why don't you self isolating because you
you isolate the people who are the cases
right so I'm clearly not a case and then
the people that might know that because
you've been tested or yes actually I
have been tested but that was for a
different reason but the first is is is
another case well I'm not I'm not ill
let's say the second thing is I'm not a
close-contact of anyone so I'm not
quarantine so isolation is what you do
for the case so the virus doesn't spread
quarantine is what you do for someone
who has a contact so if they get
infected they won't spread in the
meantime but but you're not isolating in
the sense of they have the virus
necessarily and neither was I and I
wasn't even a let's say a low-risk
contact never came in contact with any
cases never came in contact with any
known contacts everywhere I was the
incidence was falling you know and I I
wash my hands every half hour I wore a
mask because I was in China but social
distancing you know you take all the
right precautions and and you know we
have to be careful because we could end
up in a situation where you've got 80
cases in in the UK and people start
saying why isn't all of the UK isolated
no you have to it's got to be a
risk-based decision but we're gonna be
very careful obviously but other people
have come back from the places that
you've been to like Wuhan have been told
to basically stay self isolated for two
yes so so different countries have
different recommendations and you know
WH o all of our of our guidance is
really evidence-based we try and
identify the evidence and then base
guidance now Switzerland where we're
based uses the w-h-o guidance takes that
you know I'm not gonna say off the shelf
but implements that in other countries
they often decide well we want to add X
Y & Z to it for various reasons and and
and that's the case in some countries
where they isolate but the reality is in
wuhan now remember I went into Wuhan 15
million people were in apartment
buildings I was in big empty Boulevard
by myself from our team we think we came
in less contact with people in Wuhan
than anywhere I've been since one very
brief and final month is there anything
you can tell us about the average age of
those people who are deceased as a
result of this disease yeah this is a
tragic thing Matt it it is it is
generally the population over 65 and and
Devon when you get over 80 the the the
mortality rates skyrocket but as soon as
you get over 60 65 and that should be
very concerning here in the West because
we have older populations and also we
need to remember is all of the mortality
is not in the older age group there is
young healthy people that die rapidly of
this disease and we don't understand why
I spend a lot of time in China talking
to docs trying to understand what do you
think's going on and and and they didn't
even have a gut feeling and and that's
concerning that must be very scary yeah
it is now remember we don't want to
scare populations this is a disease that
can be managed that you can respond to
the population is the most important
part it's a surveillance system it's
what gives you the speed and if you take
the right precautions you don't thought
with the advice public housing or their
experts that this stuff you know you're
really going to reduce your risks and
and help them find it fast because you
know an orderly response to this thing
and that's what they kept saying in
China is you you you can you can manage
it dr. Bruce thank you very much for
your time
you