well warm welcome and thank you for
coming back it's Sunday the 23rd of
February 2020 now my main message today
is to the World Health Organization and
that is I believe we are now in the
early stages of a pandemic and I'm going
to give evidence for that in this video
and to be quite honest that don't quite
understand why the World Health
Organization has not declared this event
as a pandemic at the moment it's easy to
criticize from the outside but it seems
to me that a lot of the World Health
Organization is thinking till now has
been reactive something happens and they
kind of react to that almost reluctantly
almost you might think as late as they
could react whereas what we need now is
proactivity we need to be thinking ahead
declare a pandemic stimulate the funding
that's required stimulate the
preparation that's required and let's
get ready for the International spread
of this that is occurring which we're
going to look at now because the
evidence is there so just to start off
here with some some headlines Sunday
23rd of February as we've said many
times that is the virus severe acute
respiratory syndrome coronavirus to the
disease is corona virus disease covered
corona virus disease identified in 2019
now there's something that concerns me
about today's figures that I've got
partly from Johns Hopkins and partly
directly from the live Chinese site and
I'll tell you what that is so current
confirmed cases these are people that
are actually sick at the moment who
actually have the disease at the moment
now the accumulated confirmed we know
obviously is growing high all the time
so obviously that's going to carry on
increasing but in China the rate of
increase has decreased so it's still
increasing but it's not increasing as
quickly so that's good
suspected cases that mostly in China now
this is what concerns me current severe
cases
now this is the number of current
confirmed cases and this is the number
of current severe cases and according to
my sums that is 20 percent nearly 21
percent of cases are severe and this is
an increase in what we've been seeing in
the past so the Chinese data is saying
that of the current cases 20.7%
are severe and this is concerning
because if we have large numbers of
cases we cannot cope with 20% 21% of
them being severely ill we simply don't
have the medical facility to do that and
that will mean that the case fatality
rate will rise so this has been a
concern of mine for some time now and it
continues to be a concern verified by
that Chinese data confirmed deaths at
the moment are 2 4 6 3 recovered is
going up nicely so that's good to know
2 negative smears no fever for 10 days
and improving chest x-ray we're going to
talk about this and the basic
reproduction rate the disease is roughly
doubling every 7 days but we'll see
there are exceptions to that where is
going much quicker than that so I want
to look at a few international
situations now to justify my suggestion
strong suggestion that we are in the
early stages of a pandemic now first of
all I want to say something about the
case fatality rate and this is from
calculations by Australian
epidemiologists now globally they're
saying the case fatality rate including
China is 3 percent and this is
artificially high we believe because of
the large amount of unreported cases at
the start of an epidemic so the case
fatality rate here might appear
artificially high
because of the large number of
undiagnosed cases but there again as
we've said that is counterbalance by the
fact that a lot of people die at home
and the disease is never reported but on
the overall balance the early stage of
the epidemic is more likely that we're
going to get over calculations for the
case fatality rate now outside mainland
China the case fatality rate so far is
north point nine percent as far as we
know from the data that we have is nor
point nine percent so it's looking like
that the mortality rate is going to be
between these two hopefully nearer this
one here but as we go as we've said the
case fatality rate is going to
critically depend on the quality of
medical care that is available now
Australia 22 confirmed cases eight
Queensland four New South Wales six in
Victoria three in South Australia one in
Western Australia and ten of these are
reported to have recovered and the rest
are described as being in a stable
condition so presumably that means
they're not severe and they're not
critically ill although stable
technically means you're not varying
it's just staying put
now I've heard different reports about
Australia the Australian government
claimed to be well prepared but I've
talked to quite a few clinicians and
people who are well informed on the
ground in Australia and they say the
situation is much the same as in the UK
the government's saying they're well
informed or well prepared but that they
are already fully stretched as things
are and to have extra cases would be
very difficult for them so they're fully
prepared so they say but in actual fact
when you challenge and say well could
you take a thousand extra cases the
answer is no so bit of a mismatch
between what the Australian government
in the UK government is saying and the
reality on the ground as far as I can
see and that's based on firsthand
reports from clinicians in Australia
now South Korea not good news I'm afraid
two days ago they had 206 cases
yesterday they had 433 today Sunday the
23rd 23rd of February 602 cases
officially reported in South Korea
diagnosed officially reported and I do
trust these figures the South Koreans
are very exacting in this sort of thing
three deaths reported so far the
epicenter is still Daegu this city where
there is this religious meeting and a
thousand people from that religious
group now have symptoms and have been
told to self isolate while the
authorities try to get around to test
them all so it looks like a thousand
people from this religious group might
have contracted the infection but as
well as Daegu the city Daegu there's
quite a few other provinces in South
Korea which are reporting cases that
seem to have arisen without any obvious
epidemiological connections which is
concerning and of course there's no
cases in North Korea if you want to
believe my sarcasm now Italy this is
another convincing reason why I think we
need to call a pandemic because Italy
has been caught really by surprise here
yeah no other way to describe it at the
big core on the hop
so three cases four days ago 30 cases
yesterday probably more than a hundred
cases today with two deaths confirmed
now the epidemiologic the epidemiology
here is quite confusing there was an
initial person from China who they
thought might be a super spreader who
they thought the disease had come form
but when he was tested he was negative
for the virus now I assume they're going
to test him again but so far has come
back negative for the virus
so was this disease spread from
somewhere else did have an alternative
cause of infection that's possible does
that mean there's already
community-based self-perpetuating spread
in Italy that's possible what does it
mean that someone's transmitting the
disease and they were negative or are
negative or does it mean that they are
now negative but they were positive we
don't know we don't know what it means
but what we do know is people have
tested negative who have not been
infected who have been kept in isolation
and have subsequently tested positive so
we have to say that the PCR testing is
unsatisfactory at the moment we
desperately need an easier quicker
cheaper test but um but so but to get
back to the case in point the Italian
situation where this epidemic came from
is unclear the most likely probability
is that this person from China was
positive spread the disease and then his
immune system cleared the disease then
he remained fairly asymptomatic which of
course is concerning in itself because
he could become a super spreader now
these are in North Italy so the Italian
government has invoked special powers to
close off 12 towns where people are
banned from entering or leaving roads
closed rails closed towns shut down very
similar to the situation in in Wuhan in
Hubei Province in China and very wise of
the Italian government to do so I would
say football matches are canceled which
is quite a big deal in it to live the
council football matches you know
something's wrong
universities in in this area of the
north are closed for a week I think
schools probably are as well and the
authorities are still working on this
possible super spreader now the World
Health Organization is very concerned
about Iran and I'm remarkably concerned
about to run as well I'll tell you why
well tell you why now I've had several
emails from people in around medical and
non-medical people people in Iran itself
and expatriates from Iran and they are
remarkably concerned now the official
figures i've
forty-three cases a deaths in Iran
officially unofficially I've heard
there's many many more cases than this
and many many more deaths now it's been
reported to me by reliable sensible
people in Iran that or Iran as you'd say
in the States but in Iran there are
apparently a very high proportion of
more serious cases now I have had some
death rates quoted to me but I'm not
going to quote them because they're just
from one individual clinician so I'm not
going to report them but but they are
significantly higher than 3% now why is
this is it because the disease isn't
being properly diagnosed and people are
dying from another type of pneumonia or
that's possible or is it and this is
what really concerns me that there is a
strain of the virus which is mutated to
become more virulent now this is quite
possible because the virus that's
infecting people in Iran has been
isolated presumably for a period of time
those strains of the virus could mutate
whereas others in China or other
countries might not have mutated but the
Iranian one could have mutated become to
become a more virulent strain and
thereby increases the case fatality rate
and to have heard a lot of people
getting respiratory failure in Iran and
I've also heard of people getting viral
myocarditis of the myocardium of the
heart both of which I find really quite
frightening now I just listen to the the
big boss in Iran I don't know quite who
he is some Ayatollah I think and he said
that the opposition were trying to
reduce the number of people turning out
to vote by using copied 19 as an excuse
to keep people at home now if we've got
that kind of mentality that really is a
problem because there is a problem in
Iran the scale of it isn't known but to
politicize it when people like sick and
people are dying is not good now given
province in northern Iran one doctor
died last week now this hasn't been
officially reported but I have been
reliably told this by
people from Iran who obviously I know a
bit will remain completely confidential
now this doctor before he died had
worked for a full week in a hospital
without any quarantine so he'd been
working normally for a week then he got
sick and then he died so there's no real
question he would have been incubating
the disease when he was working in this
hospital so it's inconceivable that this
doctor hasn't spread the disease to be
quite honest and apparently his
colleagues through a friend of a friend
of a friend have told me that he caught
the disease while he was working in a
small town four weeks ago so again just
like dr. Li in China we're talking about
a 28 week a 28 day period between
getting symptoms and dying don't know
how old this doctor was but presumably
was otherwise fit and well now another
thing that's concerning there was he
caught it in a small town so that means
that the covered 19 was already in
sports some random small town in
northern Iran the disease was already in
the community there four weeks ago
that's concerning
how far could it have spread in in Iran
in that time now Tehran district 13 the
13 district over Tehran that the mayor
is infected know to be infected but the
mayor just attended prayers on Friday
Friday prayers upwards of 10,000 people
were present or standing close together
for the year for the Islamic prayer and
apparently at the end of the Islamic
prayer they are where they sit close
together and there is a cultural kissing
on the face and shaking hands
I don't need to spell that out do I know
that the risks for cross infection there
are huge kissing on the face and shaking
hands now the tur the town of Combe in
in Iran is shut down but the rest of the
country country is open to travel so to
really concernings I think things that
seems to be gross under reporting of
cases in Iran and this fairly strong
anecdotal evidence and it's come this
has come to me from two completely
separate sources one in Iran one an
expat that the death rates in Iran are
higher and these sources aren't in
contact with each other so this may well
be the case that the death rates are
higher so quite a lot concerning me
there about Iran now Indonesia again
have been getting emails from people
clinicians and concerned members of the
public in Indonesia and India Indonesia
at the moment has no confirmed cases but
a doctor there's told me they have no
test case and heard of a patient who
went to the doctors with a fever and a
cough and the doctor said it can't be
covered 19 because there is no covered
19 in Indonesia I do hope that doctors
right but we don't know we don't know
now hand-washing isn't done very often
and apparently people are ridiculed who
do wash their hands as part of some
aspects of Indonesian culture which is
concerning now in in Indonesia there's
many people with uncontrolled indeed
unrecognized and undiagnosed diabetes
mellitus type 2 and hypertension now
this is quite common in Asia for example
you might remember about 10 days ago I
talked about the case of the Thai taxi
driver who developed covered 19 from a
Chinese tourist and he went into
hospital he told the nurses and doctors
who was fit and well but it turned out
he had quite severe hypertension and
quite severe undiagnosed diabetes
mellitus type 2 there is a global
epidemic of these two diseases to be
fair
and in Asia is particularly bad so the
main symptom of uncontrolled
hypertension is that you get no symptoms
and even with with diabetes very often
you don't get symptoms or they come on
so insidiously you don't notice them you
might get some blurring of vision
predisposition to infections but very
often the first that people know about
this disease is when they come in with
complications I've seen this a lot in
Asia people will come into hospital not
when they develop diabetes but when they
get gangrene in their toes or when they
get renal failure quite an appalling
situation but can you see that these are
both conditions which are now almost
certainly predisposing comorbidities to
people getting the infection and getting
more severe versions of the infection so
it's as if the field is is ripe for
harvest in Indonesia almost by this
disease this fair amount of poor
nutrition in Indonesia there's a lot of
poverty poor high housing people come
together in relatively small areas very
often and in many most places limited
health care so if there's no cases in
Indonesia I would be delighted but I
suspect there might be now United States
18 of the 239 passengers who flew back
from the diamond princess tested
positive when they got back to the
States
so these people were already positive on
the diamond princess now these are all
in quarantine now but of course those 18
could have infected those although they
did say that precautions were taken but
from what I can gather it looks like
some of these weren't recognized as
being infected when they were on the
flight and this is a concern
people sometimes test negative only to
subsequently test positive
this is a problem the American CDC is
working with state and local health
departments to ready the public health
workforce so to respond to it possible
so the CDC is talking in terms of a
possible pandemic so good to see that
the American Center for Disease Control
is taking this as seriously as it is
other countries including my country
including what I can gather in Australia
for example are not how this is
transposing on to changing the ground in
the United States I don't know but
officially this is what they're doing
the CDC is preparing collaborating with
partners hospitals pharmacies
manufacturers getting the PPE get the
medical supplies get everything that's
needed in so that is now being done in
the States proactively how many actual
cases there are in the states of course
we don't really know the CD is reviewing
all of his pandemic materials and
adapting those for copic 19 so again on
paper that looks reassuring that the
United States is preparing and we often
think of the United States having good
health care but I get so many emails and
questions from people from the United
States have done for years who basically
don't have access to good health care
who can't afford a good health care who
have had a very poor quality health care
so you get absolutely world leading
health care next door to very poor
health care and people that often can't
afford health care and can't afford
medications and can't afford to buy
enough insulin and things like that so
we think of the state as being very
advanced but there is a bit of an under
an undercurrent of questionable
healthcare provision in the United
States as well and finally the UK 100
people have been released from
quarantine from I've come back from who
Bay now all the from Wuhan actually all
these hundred people have been inquiring
for a fortnight and they've all got no
symptoms no fever and they've had three
negative tests so yeah okay I'll accept
that kind of accept that they've had
three negative tests I don't know how
far apart they were that information
hasn't been released and the diamond
princess passengers are still quarantine
and have no updated news on those so
just to conclude this video I think I've
given evidence to suggest that we've got
almost certainly a degree of community
spread and the disease is now so
widespread it's reasonable to call it a
pandemic what I would expect is further
cases and further spread over the next
few days now I think the World Health
Organization will call a pandemic but I
think we'll do it as late as they can
and reluctantly is the count and we'll
do it reactively so the final plea is to
the World Health Organization let's act
proactively on this and get this
pandemic status declared and let's get
the world geared up for the pandemic
that I believe it is it's coming