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you are very welcome to today's talk it's the last day in january now we didn't look before about the number of symptoms people have in the first week when they get uh covered 19 disease with a sas coronavirus 2 infection that the more symptoms they have in the first week the more likely they are to develop longer term complications this so-called long-covered now there's new data out now that also shows that the more symptoms people have in the first week the more likely they are to require oxygen or medical support and indeed the higher risk they are generally so i want to look at that in a bit of detail because this is very important for anyone at home what it means is people at home can log their symptoms and and alert healthcare providers at an early stage if it's looking more likely that they may require oxygen or other medical support at some stage so a very practical uh very practical session today hopefully that one a lot of people should find useful and hopefully to some extent reassuring before that i just want to do um a bit of background now the states and the united kingdom united states united kingdom it's just coincidence that their figures are so mirrored uh like that they're so similar that the uk is slightly lower cases now the united states case is still dropping off nicely and canada dropping off nicely as well but um you probably know why i'm concerned about this and why i'm showing this graph because this is portugal and this is the effect of the new variant in portugal just starting to get a little bit on top of that now with their restrictive measures that have been instigated in portugal but this shows what the new variant can do we've seen what the new variant can do in other places as well of course we have the new uk variant in the united kingdom obviously where it was first identified but this is coming down with fairly strict lockdown measures although there are some breaches of course and why this matters is um new daily new confirmed covered 19 deaths per million in portugal it's absolutely shot up absolutely shot up and we know that in portugal the health services are overstretched overstretched and of course if there's this number of people here um dying this means there's an awful lot more people that are sick so i just want to reiterate my warnings really that i am so concerned about the united states and canada because the new variant is growing in prevalence and could just take off so restrictions really need to be carefully observed in in the united states and canada because of this risk that we've had in the uk we've seen it in ireland we've seen it in portugal and it really is a concern but anyway the the talk today is mostly something that's fairly useful practically as we've said so and this is from the covered symptom tracker app and uh this is the um i'll put this the link up there you can go to it yourself um gives all the uh all the information um now where am i there we are right um so the question is what is your risk of hospitalization should you become uh infected with um sars coronavirus 2 suffering covered 19. now it's actually quite hard to get data on this but the last time i calculated the figures for the uk um it was about between five and six percent of people that are diagnosed officially with an antigen swab test go on to require some form of medical support so it's really quite significant and of course this is the whole problem that this is putting such a strain on medical or medical services um so uh predictions based on data of the first wave now it's important to mention that this is all information that we've got here from the first wave now of course information is coming in all the time from the second wave but hasn't been processed yet but so this information is from the first wave and we believe that the virus in the first wave was less virulent than the current strain that we have so the risks now are probably slightly higher than they were in the first wave so this is an underestimate of risk if anything unfortunately but check it out for yourself now this is dr claire steve's clinical research king's college london now she's developed simple charts called monograms to identify the risk of uh severe people becoming severely ill people getting severe illness and that means that they require oxygen and other treatments so basically it's the risk of people requiring hospitalization what is the degree of that risk now the factors that she's identified here are the number of symptoms experienced on the first five days of the illness so this is a key indicator the number of symptoms on the first five days of the illness i'm going to show you how to collect this and of course your sex whether you're male female and your age are also going to be important now the covered symptom tracker app from millions of cases has come up with some um more clinical features than the classic one well that's for sure i think there's 13 altogether so let's look at these now and then we'll look at how to um how to use them so uh symptoms so loss of smell uh high temperature or fever persistent cough severe tiredness or fatigue undue fatigue headache abdominal pain chest pain sore throat severe shortness of breath skipping meals what we call anorexia not feeling hungry muscle pains the achy muscles the horse rough voice the new confusion the delirium disorientation for time place and person diarrhea and skin rashes so there's quite a few symptoms here that a lot of people actually don't know about but have been clearly identified on the coverage symptom tracker app now all you need to do i put these in the description so you can just you can just print those out like i've done just a simple print out and then all i've done here is i've just like made a chart up so they're the symptoms and i've put day one day two day three day four five six as you go along and then you can just chart your symptoms so um just print out those print out those features and uh day one two three and monitor your own symptoms now we did we did do this before back at the early stages of the pandemic we did this but this is this has got this application now that it will indicate your risk of getting more severely ill or of getting longer term complications and of course you can do this for family members and loved ones and you can even do it remotely for for friends and neighbors of course as well so i think that's a probably a good idea just it's just just very simple that's you know the lower tech the better um now what has happened here is these of the the this information you count the number of symptoms you have now i know you can't see this i've got a magnified version in a minute but um that that grouping there is going to be uh that grouping there's less than 25 uh chance of needing medical intervention that groups are 25 to 50 percent that groups are 50 to 75 and that groups are more than 75 chance so so these are all um these are all on the site but i've just blown a couple up so we can uh hopefully see it a little clearer uh yeah there we are so um what we have here this is just the start of that one for for male so this is the male one now this is the number of symptoms here one two three four five six seven eight so you just count the number of symptoms that you have and then this is age going along here 18 up to and of course the age goes along there to greater ages then here we see greater ages so by the time you get to um 60 for example your symptoms the risk of requiring hospitalization increases quite uh quite substantially and there's different there's different graphics there for males and uh and females so really very simple you can actually plot this i'll just put the original one back on um there we go um now interestingly here um interesting difference between males and females females actually have a risk with lower numbers of symptoms um although males have a greater risk of becoming severely ill so interesting this is the sort of thing that uh big data can uh can throw up things that you wouldn't um obviously think of so oh oh just so simple just have one of those and then count the symptoms and then you know then you can work this out um the number of symptoms seems to be an indication an indication at early stages of how severe the disease actually is so i think that's remarkably um useful to know about um so medical professionals can use this and the public can use it so um we're talking you know this is this is just a home we can use that identify people with covet who might be most likely to need medical care so that's good to anticipate that monitor appropriately and get to hospital quickly should it become necessary so we can have a higher index of suspicion for for people and we can we can monitor them and these these are two useful monitoring devices as you know um a home thermometer now this is an electronic one doesn't have to be um you get many different sorts have i got a temperature i've got a temperature but it's 36.9 so we'll accept that as being uh as being normal and of course the other thing that's remarkably useful to have is our old friend the oxygen saturation probe to monitor the amount of oxygen in the blood now we're going to say mine good so my oxygen saturations are which way around is it oxygen saturation is on the bottom oxygen saturations are 98 and i've been running around my heart rates settling down in mid 90s there good so but the key thing there is to monitor your oxygen saturation levels and that can be done with these simple devices so monitoring at home is a remarkably good idea if you're into the red or dark red zone you should contact your doctor for advice at an early stage oh ask if they can send you a pulse oximeter or buy one online for about 20 pounds 20 30 uh you don't need to spend a lot of money on expensive ones the cheap ones seem to work equally well check heart rate and check heart rate temperature regularly so what we'll be concerned about is uh temperature remaining high or temperature becoming very high heart rate becoming higher because as you generate a temperature your heart has to work harder because of the increased metabolic demand and of course also what we'll be worried about is the oxygen saturation is going down that will be our concerns and then wherever you fall on the chart if you're struggling to breathe uh have a pain in your chest become very confused or drowsy or your lips or face turn blue that would mean your oxygen saturations are very low of course they're red flag symptoms and and always of course inform whatever healthcare advisors there are in in your area anytime you are remotely worried so um interesting prediction there the number of symptoms so we now know that the number of symptoms in the first five days as a predictor for more severe disease and for longer term disease and for for the minority of people that do get longer term disease if you have this sort of thing that you've kept this is going to be very useful to your doctors at a later stage so very good idea to keep some documentation of uh the evolution of the infection should you become infected now i'm going to go into the united states in a minute before we do that um some unfortunate news from um south australia now i've just got this from nigel who's a retired doctor in in western australia so after 10 months without a community spread of cases we now we now have one in western australia now we assume this is in perth we don't know for sure yet a security guard at one of the quarantine hotels has contracted covered 19. they're doing genomics but they expect it to be the uk variant now this is concerning because the uk variant as we know is 55 more transmissible than the old variant this is a worry and it's also i i think australia needs to take this as a bit of a shot across the bowels because australia have no pla i can't remember when they're planning to start the vaccinations i don't think it's till march i really think australia needs to get a crack on with its vaccination program uh as soon as possible rather than say well with no cases we can wait because there's always this risk of the more transmissible variants it seems he and we believe it is a he has been visiting many places in and around perth his he's got three flat mates and they've been exposed and that he'd possibly been transmitting the disease for up to five or six days without knowing this says he did have symptoms for several days but continued to move around so he should have suspected he's now been quarantined of course and i've heard from other sources unofficially that he might have been an uber driver now if he is an uber driver that means there could be pretty widespread transmission potentially in in perth at the moment which is a concern as a result of this perth and the uh southwest of the state southwest of west australia has been put into a strict lockdown from 6 p.m saturday night about three hours ago when this email was written pretty soon after this alert uh we're only allowed to leave the house for the following strict reasons masks must be worn outside so strict reasons so the whole area is locked down for quite a few days genomics should be out on monday um you can leave the house for one hour for exercise with only one other person and you still must wear a mask even outside and then just like going outside for things like pharmacist emergency grocery necessary grocery shopping work from home if you can all pubs gyms etc of course completely closed school was due to restart but that's been postponed for a week and these restrictions are in in force for five days but will be extended i'm sure if they need to be um so we had an area there south australia and this this guy had symptoms carried on working rather than reporting for a test i can't imagine he is the most popular guy in western australia at the moment so contact racing of course going on at a dramatic rate but if the genomics come back as the uk variant which you probably will do then there's no question that this is a significant risk that there could be ongoing community transmission in western australia as as we speak so that is really quite a concern for western australia having done so brilliantly well it just takes one weak link and we saw yesterday in new zealand that there was a weak link where one of the workers at hotel quarantine went into a room for 20 minutes in private with a resident on the quarantine programme the element of risk is there let's let's hope they get on top of it i really hope they they do now just going on quick review of the united states things appear to be going well i know i do hope this is a trend and that my concerns about the new variant which i believe is multiplying in the states now are unfounded um but if we act as if my concerns are founded that is the safe way to do it so uh new daily reported cases now this is the seven day average for the last seven days as of a day or two ago for where data is available up to 26 million people officially diagnosed um down 40 this number is down 14.4 on the week so looking good uh new daily reported deaths um again seven day rolling average as of two days ago three thousand two hundred twenty two deaths per day four hundred and thirty thousand one hundred twenty deaths that figure there three two two two is up two percent on the week before so the deaths in the states thankfully starting to level out but will remain high for a period of time because of the number of cases that are already baked into the numbers covered related hospitalizations down slightly down down 13.9 on the week still very patchy depends on where you are in in the united states but good to see the number dropping below 100 000 of copied related hospitalizations test positivity rate also down it was about 11 or twelve percent a week or two back now down to eight point two percent back so that's good over 30 million vaccine dose has been given five and a half million people have had their second dose that is 1.67 of the population of the united states now just a quick look at what's going on in the uk um here we are so this is this is uh cases in the uk and we do see as we saw in the written initial graph that the numbers are going down now having said that they're still quite high there's no cost for complacency here the numbers are still high it's just that they're going down from this peak but this people of course was totally appalling so that that's good health care um again hospitalization admissions starting to drop off slightly but still a horrendously high level still a fairly unsustainable level and the number of people in hospital hardly gone down at all so still very very high numbers of people in hospital this is still severely severely stretching the nhs and the number in intensive care again still very high so the uk is still suffering severely from this wave deaths in the uk starting to drop off thankfully the lag effect as we anticipated this is pretty well exactly what we said would happen at the start of this lockdown so not surprising there but still high and we notice that numbers are still high now vaccination data for the uk how are we doing uh okay this is the number so these are the doses given on the 29th of january two days ago so getting on for half a million doses in the 24 hour period so um plenty of data there to browse on on your own now that's actually all i'm going to say today myself but we're going to hear from dr tom rob now who is a former government advisor and uh we were talking to david davis a few days ago a member of parliament and uh scientist and um we discussed our um fear of another pandemic well not fear the the inevitability of another pandemic and uh dr tom rob is going to talk about this and then we'll mention one or two of things he says after that so let me see if i can get it hello my name is dr tom robb i have a phd in cognitive science and i worked to direct statistical research to provide evidence best advice to government in australia i now retired i'm here because dr campbell has kindly asked me to do a short video explaining on some comments i made on an interview he did recently with david davies during the interview the question was put will there be future pandemics the answer of course is yes and one of the reasons cited was that as long as people continue to interact with animals in wet markets through bush meat to exotic animal trade and so on you have the opportunity for zoonotic viruses or other illnesses to come across from the animal kingdom to humans and to then spread out into pandemics one thing that wasn't mentioned though was the very much larger service of interaction between animals and humans which is provided by large-scale industrial food production involving animals why does this matter just to take one example some of you may recall 14 15 years ago an outbreak of avian flu that was caused by the h5n1 virus it started in farmed birds and spread to wild bird populations and was devastating both this was bad enough but at some point the virus worked out how to infect humans and several hundred people that we know of caught the virus and sadly 60 of them died as a result h5n1 was particularly concerning because it could infect the wild bird populations as well as the found ones so closing off your borders shutting your airports wasn't going to stop the spread of the virus because effectively the virus had its iron airline which could fly it wherever it wanted to go so alarm bells rang antiviral drugs were stockpiled emergency measures were discussed and in fact vaccines were even in trial at some point so everything was looking fairly fair something pandemic looked to be on the cards and then suddenly it didn't happen as it happened purely by chance the h5n1 virus was not very efficient at transferring from person to person and so the outbreak was contained and things rather went quiet again but those of you who have been following the current outbreak of the cover-dope brick will know that variants of the virus such as the b117 have arisen spontaneously normal process of evolution and they significantly increase the infectivity of the virus had such a thing happened with h5n1 the outcome would have been very different now h5n1 and some of its scary cousins h7n9 and numerous others haven't gone away they're just sitting there and arguably we're only a few mutations away from the next pandemic so what can we do to help to reduce these risks well part of the response at the time was a joint report that was released by the uh will by the um whi the world health organization along with the food and agriculture organization and the world organization for animal health they looked at the factors which create the circumstances that give rise to these zoonotic pandemics and first and foremost among them they identified the changes in agricultural practice which have arisen and continue to spread as a result of the ever increasing demand for animal protein now uh who suggested some things that might be done about this but as you can tell these uh monitoring systems and whatnot that are in place they are in class they don't always work perhaps as well as they should as kovit has shown nevertheless what governments can do what large organizations can do is one thing what can we as individuals perhaps do to help with reducing this risk well one small cause for optimism is that there's currently an increasing interest in seeking out alternative sources of protein uh certainly from what i've seen in the uk uh the us throughout the eu there has been significant growth in eating a plant-based diet looking into plant-based diets and so on that's one strategy another thing is this uh so-called vat produced or that grown meat which the press assures me as jews of the market any day now uh the idea being you take a few cells of whatever tissue it is that you want to grow put into a vat and you produce a product which can be sold as meat that doesn't require agricultural practices or indeed an animal to produce it whatever else you think about those things from the point of view of pandemic risk they work to reduce it and there are certain things that we you i any anyone can do that manages or helps to bring down the demand for animal protein which is driving providing the economic incentive for these practices which you or i probably can't change so perhaps this simple dietary intervention like taking your vitamin d is something we should all get behind anyway thanks for watching and thanks to dr campbell for letting me have some space on his channel cheers dr rob thank you so much for that i mean that's probably one of the most important things we've actually looked at this year you know i've said this repeatedly with this pandemic we've been lucky we could have had a virus that spreads like measles and kills like ebola um we were just lucky and it's bad enough but we were just lucky so so dr rob there will there be another pandemic the answer is yes there's no debate another zoonotic virus uh there's about 10 to the 23 different types of viruses just knocking around outside there that's types of virus i mean that you know that that's that's that's a one with 23 knots on the end i think so so the number is just massive now we we've rightly criticized uh wet markets where wild animals are abused uh kept in appalling conditions uh brutally uh killed in in ways that aren't always very humane on the streets uh of the wet market now to to our culture this is completely unacceptable and we rightly criticize that as a possible source of zoonotic spread but then what we don't see as our own culture where where animals are kept in um conditions which aren't natural environments and that the main concern i have in terms of a new pandemic is they are not genetically diverse they're very often very clonal they're all much the same breed almost almost as if they're all twins or identical twins and that means a virus can spread through them very readily and we looked at the example of h5n1 and we were just lucky that that turned out not to be very transmissible that could have been highly transmissible we could have had another 1918 uh if the infectivity had been higher we've seen that the infectivity of coronavirus is increasing so we talk about animal protein plants that grow meat of course another couple i'd like and i'm really glad dr rob mentioned vitamin d there because that's so important a couple he didn't mention there insects we could grow up huge amounts of insects now if you go i spent a bit of time working in cambodia teaching in cambodia and stuff and if you go to the market there you'll get different insects and you can just you know you can have a 100 grams or you know they're all dead and cooked and fried or whatever they do with them so you know you can cook them you can do what you want with them you can crunch them up as a snack you can buy a hundred grams 200 grams a kilo two kilos whatever you want i mean john the baptist in the bible like locust and wild honey didn't it so locust is a good protein source so insects is one and the other one i think is really important is human beings need need nutrients from the sea these omega-3 things that we need now when you eat oily fish you're getting lots of healthy omega-3 oils from that fish omega-3 fats which are good but you're also getting pollutants that the fish the fish has experienced during its life like heavy metals and of course if you eat game fish like tuna or shark that they're amplified this by amplification process and we can't keep eating fish anyway because there's actually none left we've eaten them all already and we need to restore marine uh habitats marine environments because if we don't look after the ecology of the planet that we're all stuffed anyway you know a million future generations of humans could be eradicated so i think a big part of the way ahead is um is marine microplankton phytoplankton so phytoplankton plankton so basically microscopic plants that grow in the sea so we would have massive um legumes uh by the sea where we grow up huge amounts of marine phytoplankton now the the oily the oils that are in this oily fish so if you're eating some mackerel or something then you get this these oils then that that oil was not made by the fish the mackerel didn't make it that all the fish did was purify it from the uh the marine phytoplankton that the fish had eaten so it's actually all these oils are actually made um they're actually made by the plants just in the same way that all the all the proteins and carbohydrates in my body they've all been bolted together fused together with energy from the sun i i didn't make i didn't make it i didn't make it myself i can rearrange the amino acids once i've eaten them but the actual amino acids are all made by plants and it's the same with these fats so if we grew up huge amounts of marine phytoplankton we could get any amount of this remarkably beneficial fatty acid we can improve diets we can give it to the food technology so we can make it taste absolutely fantastic and everyone will be a lot better off when we're cutting animals out of the chain and we could also control the heavy metal pollutants well to a large extent we could control that so um alternative protein sources the way ahead couldn't agree more carry on as we are we'll have another pandemic could be next week could be 10 years time could be 20 years time we don't know but this pandemic was inevitable i've been teaching students for 30 years now that um there's going to be a pandemic and it's going to be in your working lifetime and of course this is exactly what it's turned out to be and there will be another if we've learned from this and we've changed the way that we procure our protein then um that would be a massive benefit and really think the marine phytoplankton would answer tick a lot of boxes in terms of protein and fats so any entrepreneurs out there who've got any money uh um invested in in marine phytoplankton and uh that is potentially the way ahead and there's no reason why we shouldn't have tens of thousands of more generations of humans on this planet um because the planet's going to be here for a long time the only question is will we be okay so that that's us for today just looking at the pandemic in in a bit of a in a bit of a broader broader context there so always good to get outside experts on i appreciate it uh dr bob's expertise their former government advisor and uh pretty sound uh pretty sound warnings like let's heed them so thank you for watching of course