Richard Hatchett tells first how big do
you think the threat from coronavirus
now is around the world well I think
that the threat is very significant the
potential of the virus it's already
demonstrated in China yeah I think it's
demonstrating that potential in Italy in
Iran there were three cases identified
in Italy two weeks ago yesterday there
were over 3000 I think there are many
epidemiologists who talked about the
potential of the virus in terms of
attack rates globally there could be
between 50 and 70% of the global
population and when you talk about those
ashlee figures looking at what's
happening here in the UK are we on a
similar trajectory well I don't like to
make predictions i I think talking about
the potential of the virus is important
so that you can understand how dangerous
a threat it is I think it's up to
societies how they will respond to the
virus an example that I've been talking
about a lot people have some people are
skeptical about China's reports of
declining cases w-h-o just came back
from a two-week commission they were
very impressed with the Chinese response
they believe the Chinese numbers but
even if you don't believe the Chinese
numbers you can look at places like
Singapore and Hong Kong Singapore had
its first case on January 23rd yesterday
they had gotten up to I think about a
hundred and fifteen cases so fewer than
the UK viewers in the UK over six weeks
and basically they have been able
through their public health
interventions through the public health
response through contact tracing
isolation of cases and through engaging
the public they have been able to keep
the virus under control so I would say
it's up to us how we respond to the
virus I don't want to say that we will
be like Italy I do think it's important
to recognize the viruses here and it has
tremendous potential to you know be
disruptive and and to cause high rates
of illness and even high rates of death
but that is not a future that is locked
in well given the REA
to increase that we're seeing now in the
UK so what does the government now need
to do well I the the contact tracing is
very important the the voluntary
quarantine of contacts is very important
the isolation of cases is very important
I think there may be a time to close
schools other society seems to be
backing away from that but other
societies that did have responded
aggressively have undertaken that
intervention there's a there's a lot of
there's a lot of controversy about
school closure right now for because
it's very unclear what's happening with
school children with flu for example we
know that schools are amplification
points within society it's very clear
that attack rates of flu are much higher
in children than they are in adults or
certainly in the elderly children have
been minimally affected by Cova tonight
team what's unclear is whether they've
been infected and just handled the
infections well or whether they actually
are not being infected I think there's
there's there's some limited data that
suggests that children are probably at
risk if you look at the Diamond Princess
cruise ship the attack rates among
people on that ship who were under the
age of 20 were identical to the attack
rates overall so that that's you know
that's anecdotal but that is evidence
that that younger people can be infected
if they can be infected then schools are
probably an environment where the
epidemic would be amplified and if you
look at the rate of increase how quickly
do you think the government should move
to exploring shutting down schools well
III think that if you look at places
where deaths have occurred which is
England now Falls into into that
category a death probably signifies
circulation of the virus it's been going
on for at least weeks perhaps more than
a month because it takes time for people
to get sick it takes time for them to go
to the hospital and it takes time for
them to experimenter q lating here for
some time and i think i think
the government does recognize the the
criticality of the situation I think the
I actually think Chris woody and his
colleagues are doing a good job at
communicating the risk to the public I
don't think they're minimizing the
threat I think they recognize the
potential of the virus to overall and
certainly relative just to some other
countries I think the UK is doing a good
job is there a danger though of an
overreaction given when you look at the
scale of flu deaths worldwide up to six
hundred thousand a year and you don't
shut down public transport networks to
stop people getting the flu I don't
think we're dealing with the flu here
w-h-o who has looked at this virus most
intensively has looked extremely closely
at the experience in China has has
looked at the mortality rates in China
and is and has tried to estimate whether
there's a lot of undercounting in China
does not feel that we're seeing the tip
of the iceberg they as at Bruce Aylward
who led that expedition said we're
seeing the pyramid actually so so they
think the mortality rate is actually
higher than 1% which if it if it were
even 1% that would be 10 times the rate
of your average seasonal flu and because
this is a virus that is now circulating
in a population that has absolutely no
immunity to it you would expect the
attack rates to be much higher than the
attack rates that we normally see with
seasonal flu so you might have an attack
rate that's three times higher than
seasonal flu with a mortality rate
that's 10 times higher what scientists
know about this virus so far what
concerns you most about it I think the
most concerning thing about this virus
is the combination of infectiousness and
the ability to cause severe disease or
death and we have not since 1918
a Spanish clay the Spanish flu scene a
virus that combined those two qualities
in the same way we have seen very lethal
viruses we have seen certainly Ebola or
NEPA or any of the other diseases it's
epi the organization that I've run works
on but those viruses have high mortality
rates I mean
ebolas mortality rate in some settings
is greater than 80% but they don't have
the infectiousness that this virus has
they don't have the potential to explode
and spread globally
you know you fear this could end up
being on a scale of the Spanish flu I
again I don't want to make a prediction
because I think what happens with this
virus is actually up to us I do think
this virus has the potential to cause a
global pandemic if we're not already
there and I do think the virus has
demonstrated that it has a locality that
is likely mini fold higher than normal
flu and do you believe the whio figure
of 3.4% mortality rate because I mean
the UK puts in a 1% roughly in some
respects if it is between 1% and 3.4
percent it really doesn't matter what
after the decimal point I think what
we're seeing is a virus that is many
many times more lethal than flu and
right now a population that is
completely vulnerable to it and that we
are seeing its ability to explode I mean
it's increased in in some countries over
the last 2 weeks it is increased by
1,000 fold and many countries are seeing
you know 10 fold or 100 fold increase in
cases and there is nothing to stop that
expansion from continuing unless those
societies move aggressively engage their
publics implement multiple public health
interventions including focusing on
cases but also introducing social social
distancing interventions there's there's
nothing to start right now
social distancing I think I think
everybody should be doing what we call
the Ebola handshake the elbow bump and
stead of shaking hands and we did that
earlier we did that earlier and and I
don't I don't think we're doing it to be
cute I think we're doing it because we
need to modify our behavior we need to
start practicing that now I'm working
for Miriam all of that right now in the
UK I think it I think it may be a little
bit early
to recommend you know across the UK
everybody work from home and there are
plenty of people who cannot work from
home and I think we have to recognize
that society has to continue but we do
have to modify our behavior in ways that
reduces the risk of transmitting the
virus and an inch and if I could just
make one more point on that front one
problem that we face as a society when
we have a virus that might have a
fatality rate of 1% or possibly even
less it could end up being less one chat
and and and that mortality is
concentrated in certain parts of the
population
why now today the elderly for example or
the chronically ill one challenge that
we face is that people who are young and
generally healthy won't perceive
personal risk and and they'll govern
their behavior based on what they
perceive their personal risk to be and I
think we need to start thinking in terms
of the social risk I could be I could be
mean I mean I am generally healthy I'm
not that concerned about my own personal
risk but if I then you know had a cold
or felt like I you know it had symptoms
but I was well enough to go to work and
I go to work and I shake hands with my
older colleague who's got a chronic
medical condition I could be responsible
for that colleagues death and and I
think we need to all think about our
responsibilities to each other as we
think about how we're going to govern
our behavior we can't view the you know
the epidemic in terms of our personal
risk
we need to act collectively in a
cooperative manner and and one of the
things that Bruce Aylward
has has talked about
w-h-o has talked about coming back from
the investigation in China is the degree
to which the Chinese people have been
mobilized against the virus and he put
it in terms of it is like they are at
war with the virus all of society is
mobilized in the fight against the virus
and in the newest country though here
are we - selfish - capitalist -
globalists to be capable of that kind of
mobilization you know as an as an
American who has always admired Britain
and and and particularly I mean I think
I don't think it's a crazy analogy to
compare this to world war two the
British people have faced much greater
threats and they have come together as a
people against much greater threats I I
think the British people if they came to
understand that that this is something
where responsibility sits with everyone
I think the British people could could
accomplish what Singapore and Hong Kong
have accomplished split spirit split
spirit absolutely I mean a lot of people
might be really surprised if not sort of
alien salted that you're comparing this
to a war world war - well I I don't I
waho is is using those kinds of terms in
talking about what's required to
mobilize people there they're using
metaphors that are derived from war and
it's because they have seen what this
virus is capable of doing I mean I mean
it the the outbreak in Wuhan was clearly
a mitigated outbreak it was mitigated by
the incredible sets of interventions
that were introduced and yet even though
it was mitigated it had not played out
to the full extent it overwhelmed the
healthcare system it caused and I think
at this point it's something like 2,400
deaths in Wuhan in a normal year in
Wuhan you you would probably anticipate
about 1500 deaths from flu this was a
mitigated version of this outbreak a it
could have continued on and
and gone to probably several multiples
of what actually happened and you saw
the breakdown as a medical care system
you saw people who couldn't receive care
not just for kovat 19 but for any of
their other medical conditions and you
saw a society that was completely
paralyzed so I don't think that
comparing this to a war or even to the
Blood spirit III think that's actually
an appropriate analogy and I think
that's the mindset that people need to
get into how worried are you about
what's happening in the states with
transmission there and what the
government's doing I'm I'm very
concerned about the situation in the
United States the u.s. is a big country
it's decentralized it doesn't have a
unified national health system it
doesn't have a unified national public
health system CDC is a marvelous
institution but but a lot of the actual
management of public health problems is
delegated down to states and local
communities and I am concerned that the
embedded in justices and inequities in
the American system will play out that
the virus will hit vulnerable Americans
will hit Americans who don't have access
to health care it will hit Americans who
don't have health insurance it will hit
Americans who actually depend on the
school system to provide meals for their
children and in a terrible way the
government here has announced funding
for that's a vaccine or several trial
vaccines against the virus do you agree
that there's no hope of securing a
vaccine and rolling that out across
population in time for this outbreak it
depends on what you mean by this
outbreak and and it depends on how the
outbreaks that are taking place actually
play out if the viral transmission can
be suppressed through a mobilization of
the British public it and public's
globally if you can convince the public
to look at the six
stories and to emulate that and they can
succeed in suppressing transmission then
you can buy a lot of time and it may be
the case I mean we're all hoping this
will be the case that there may be some
reduction of transmission as we get into
the summer months and that buys more
time so I think there is a potential
that you know the the that we can keep
the virus under some degree of control I
mean I think there are a lot of people
that will get sick and a lot of people
that will unfortunately died before
vaccines become available but I do think
there is a potential that the delivery
of a vaccine if we treat it as a
moonshot if we treat it with the urgency
of a wartime mobilization that we can
deliver a vaccine in time to save a lot
of lives I think it's important in in
asking the public to step up and to
mobilize in this fight against a virus
to understand what those timelines
aren't to be realistic about it our
timelines the timelines of the NIH and
the US and the timelines of many
knowledgeable vaccine developers we
don't see any way that a vaccine can be
available much more rapidly than 12 to
18 months and and even if it were to be
available in 12 to 18 months that would
literally be you know the world record
for developing and delivering a vaccine
and the vaccine that would become
available in 12 to 18 months the supply
would be such that we would need
I think ethically to prioritize it for
those who were at highest risk we
wouldn't have 7 billion doses of vaccine
in 12 months so if this is a war in your
terms it's a lengthy one it is a lengthy
one this is a verus it's going to be
with us for some time I'm there there
are many epidemiologists who think that
the virus is likely to become globally
endemic and be with us
in perpetuity if I had to bet I would
think that that is the most probable
scenario so I think it's critical to
develop a vaccine as fast as we possibly
can I think we're gonna need a vaccine
for the long term I think this virus is
going to be with
even if it were somehow magically to go
away I think this is a virus we're going
to be dealing with for years what do you
say to people who say you know you
you're using this these martial
metaphors you're making it sound very
scary you have a vested interest in
making people fearful so you get the
investment in a vaccine what do you say
to that I've been working on epidemic
preparedness for about 20 years and
completely dispassionately without
without elevating the temperature or
speaking hyperbolically this is the most
frightening disease I've ever
encountered in my career and that
includes a bola it includes MERS it
includes SARS and it's frightening
because of the combination of
infectiousness and a locality that is
appears to be mini fold higher than flu
it's epi we want to be utterly
transparent about what we're doing we
actually are not trying to secure any
resources for seppies functions we are
only trying to secure resources to make
a coup vat19 vaccine and we've actually
said but we have a fund at the World
Bank so we have oversight by the World
Bank we have said that if funds are
allocated into this financial
intermediary fund at the World Bank and
for whatever reason the virus magically
goes away the pandemic comes and goes
and the virus disappears you know the
world decides that it doesn't need a
vaccine we are happy to restore any
unspent funds to the investors we're not
trying to profit from this in fact we
want to be very organizationally modest
about what we're doing and we want to be
an instrument of the global will
you