{"version":"1.0.0","segments":[{"startTime":0.23,"endTime":2.83,"body":"- Today, I'm going to be"},{"startTime":0.23,"endTime":2.83,"body":"talking about infections"},{"startTime":2.83,"endTime":5.26,"body":"transmitted via the respiratory route."},{"startTime":5.26,"endTime":8.51,"body":"And this is part of a series of lectures"},{"startTime":8.51,"endTime":9.527,"body":"on the different routes"},{"startTime":9.527,"endTime":12.833,"body":"via which major infections"},{"startTime":9.527,"endTime":12.833,"body":"get into the body."},{"startTime":14.18,"endTime":15.88,"body":"And the reason this is important"},{"startTime":15.88,"endTime":19.09,"body":"is that the route of transmission is key"},{"startTime":19.09,"endTime":23.04,"body":"both to understanding how"},{"startTime":19.09,"endTime":23.04,"body":"the disease is transmitted,"},{"startTime":23.04,"endTime":26.41,"body":"but very importantly,"},{"startTime":23.04,"endTime":26.41,"body":"also how we can combat it,"},{"startTime":26.41,"endTime":29.72,"body":"and combating things by"},{"startTime":26.41,"endTime":29.72,"body":"one route is very different"},{"startTime":29.72,"endTime":33.133,"body":"from diseases transmitted"},{"startTime":29.72,"endTime":33.133,"body":"by a different route."},{"startTime":34.06,"endTime":36.27,"body":"I've talked already in this series"},{"startTime":36.27,"endTime":38.11,"body":"about vector-borne diseases"},{"startTime":38.11,"endTime":40.69,"body":"passed on by insects or arachnids,"},{"startTime":40.69,"endTime":45.2,"body":"the oral route, food"},{"startTime":40.69,"endTime":45.2,"body":"and water in particular,"},{"startTime":45.2,"endTime":48.46,"body":"about sexual and bloodborne transmission,"},{"startTime":48.46,"endTime":51.09,"body":"potent diseases for example like HIV."},{"startTime":51.09,"endTime":52.33,"body":"And today, I'm going to be talking"},{"startTime":52.33,"endTime":55.37,"body":"about one of the major"},{"startTime":52.33,"endTime":55.37,"body":"routes of transmission,"},{"startTime":55.37,"endTime":56.593,"body":"the respiratory route."},{"startTime":57.56,"endTime":60.97,"body":"Now thinking about routes"},{"startTime":57.56,"endTime":60.97,"body":"of transmission, usually,"},{"startTime":60.97,"endTime":65.97,"body":"most infections have either a"},{"startTime":60.97,"endTime":65.97,"body":"single route of transmission,"},{"startTime":65.98,"endTime":69.423,"body":"or they have two routes but"},{"startTime":65.98,"endTime":69.423,"body":"one of them is dominant."},{"startTime":70.3,"endTime":72.23,"body":"I'm going to be talking"},{"startTime":70.3,"endTime":72.23,"body":"today about diseases"},{"startTime":72.23,"endTime":75.373,"body":"where the principle route of"},{"startTime":72.23,"endTime":75.373,"body":"transmission is respiratory."},{"startTime":77.95,"endTime":80.32,"body":"Now, if you are from an"},{"startTime":77.95,"endTime":80.32,"body":"infections point of view,"},{"startTime":80.32,"endTime":82.26,"body":"from an evolutionary point of view,"},{"startTime":82.26,"endTime":85.3,"body":"the respiratory route has"},{"startTime":82.26,"endTime":85.3,"body":"got several advantages"},{"startTime":85.3,"endTime":86.363,"body":"for the infection."},{"startTime":87.45,"endTime":90.88,"body":"Unlike some routes,"},{"startTime":87.45,"endTime":90.88,"body":"such as oral or vector,"},{"startTime":90.88,"endTime":95.73,"body":"it does require for transmission,"},{"startTime":90.88,"endTime":95.73,"body":"the person who's infecting"},{"startTime":95.73,"endTime":98.24,"body":"to be near the infected person,"},{"startTime":98.24,"endTime":100.94,"body":"but not necessarily at the same time."},{"startTime":100.94,"endTime":105.94,"body":"So for example, someone can"},{"startTime":100.94,"endTime":105.94,"body":"produce droplets or aerosols,"},{"startTime":106.01,"endTime":107.65,"body":"and then someone can"},{"startTime":106.01,"endTime":107.65,"body":"come into a room later."},{"startTime":107.65,"endTime":110.55,"body":"So they don't have to be"},{"startTime":107.65,"endTime":110.55,"body":"in exactly the same time."},{"startTime":110.55,"endTime":112.02,"body":"They don't need to know the person"},{"startTime":112.02,"endTime":112.9,"body":"that they're transmitting."},{"startTime":112.9,"endTime":115.1,"body":"This for example is very"},{"startTime":112.9,"endTime":115.1,"body":"different to the sexual route,"},{"startTime":115.1,"endTime":117.98,"body":"where people almost"},{"startTime":115.1,"endTime":117.98,"body":"invariably know the person"},{"startTime":117.98,"endTime":122.98,"body":"they're transmitting to, and"},{"startTime":117.98,"endTime":122.98,"body":"they do not need to touch them."},{"startTime":123.56,"endTime":128.22,"body":"So therefore, to have a"},{"startTime":123.56,"endTime":128.22,"body":"stranger in a crowded room,"},{"startTime":128.22,"endTime":129.43,"body":"but with an infection,"},{"startTime":129.43,"endTime":132.61,"body":"someone can actually spread that infection"},{"startTime":132.61,"endTime":135.13,"body":"around several households,"},{"startTime":135.13,"endTime":137.36,"body":"'cause in a sense from an"},{"startTime":135.13,"endTime":137.36,"body":"infection point of view,"},{"startTime":137.36,"endTime":140.43,"body":"each household is separate,"},{"startTime":137.36,"endTime":140.43,"body":"and then people can go home"},{"startTime":140.43,"endTime":142.55,"body":"and then they will infect"},{"startTime":140.43,"endTime":142.55,"body":"their own household"},{"startTime":142.55,"endTime":146.97,"body":"'cause infections within"},{"startTime":142.55,"endTime":146.97,"body":"households are very efficient."},{"startTime":146.97,"endTime":149.77,"body":"So it's a very useful"},{"startTime":146.97,"endTime":149.77,"body":"way of spreading disease"},{"startTime":149.77,"endTime":153.84,"body":"around between strangers who"},{"startTime":149.77,"endTime":153.84,"body":"happen to be in the same place"},{"startTime":153.84,"endTime":155.273,"body":"at roughly the same time."},{"startTime":156.47,"endTime":159.93,"body":"But to work, the infection"},{"startTime":156.47,"endTime":159.93,"body":"has got to be viable"},{"startTime":159.93,"endTime":162.37,"body":"outside the host for long enough"},{"startTime":162.37,"endTime":165.113,"body":"to get from the infecting"},{"startTime":162.37,"endTime":165.113,"body":"person to the infected person."},{"startTime":167.311,"endTime":169.183,"body":"And many infections cannot do that."},{"startTime":171.93,"endTime":174.6,"body":"Now several major infections have evolved"},{"startTime":174.6,"endTime":178.82,"body":"to take advantage of the"},{"startTime":174.6,"endTime":178.82,"body":"respiratory route of transmission."},{"startTime":178.82,"endTime":180.38,"body":"And I'll be talking about several of them,"},{"startTime":180.38,"endTime":183.04,"body":"not all of the ones listed here"},{"startTime":183.04,"endTime":185.273,"body":"in the second part of this lecture."},{"startTime":186.24,"endTime":191.07,"body":"They include the mycobacteria,"},{"startTime":186.24,"endTime":191.07,"body":"things like tuberculosis,"},{"startTime":191.07,"endTime":193.15,"body":"bacteria, including pneumococcus,"},{"startTime":193.15,"endTime":195.46,"body":"which is a major cause of pneumonia,"},{"startTime":195.46,"endTime":197.92,"body":"meningococcus a major cause of meningitis,"},{"startTime":197.92,"endTime":201.36,"body":"but also major diseases"},{"startTime":197.92,"endTime":201.36,"body":"of historical importance"},{"startTime":201.36,"endTime":204.47,"body":"like plague, which is passed"},{"startTime":201.36,"endTime":204.47,"body":"on partially by vector"},{"startTime":204.47,"endTime":207.34,"body":"and partially via respiratory 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transmission"},{"startTime":236.25,"endTime":239.3,"body":"usually has several different routes"},{"startTime":239.3,"endTime":241.51,"body":"by which it can be achieved."},{"startTime":241.51,"endTime":244.02,"body":"Probably the most"},{"startTime":241.51,"endTime":244.02,"body":"prominent, certainly the one"},{"startTime":244.02,"endTime":247.01,"body":"that people have concentrated"},{"startTime":244.02,"endTime":247.01,"body":"on historically are droplets,"},{"startTime":247.01,"endTime":250.76,"body":"droplets that people produce"},{"startTime":247.01,"endTime":250.76,"body":"when coughing, sneezing,"},{"startTime":250.76,"endTime":253.963,"body":"laughing, shouting, or"},{"startTime":250.76,"endTime":253.963,"body":"even just breathing."},{"startTime":255.17,"endTime":256.67,"body":"The second is objects"},{"startTime":256.67,"endTime":259.67,"body":"that these droplets could have landed on,"},{"startTime":259.67,"endTime":263.15,"body":"that people can then touch and"},{"startTime":259.67,"endTime":263.15,"body":"then touch their own faces,"},{"startTime":263.15,"endTime":266.87,"body":"which we all do"},{"startTime":263.15,"endTime":266.87,"body":"unconsciously the whole time."},{"startTime":266.87,"endTime":269.99,"body":"And some of these droplets"},{"startTime":266.87,"endTime":269.99,"body":"and the infections from them"},{"startTime":269.99,"endTime":273.04,"body":"can be quite persistent on surfaces"},{"startTime":273.04,"endTime":274.993,"body":"for a number of hours or even longer."},{"startTime":276.38,"endTime":280.29,"body":"The third route is aerosols,"},{"startTime":276.38,"endTime":280.29,"body":"and aerosols are different"},{"startTime":280.29,"endTime":282.95,"body":"because they can hang"},{"startTime":280.29,"endTime":282.95,"body":"around in the environment"},{"startTime":282.95,"endTime":286.58,"body":"for a lot longer and they can"},{"startTime":282.95,"endTime":286.58,"body":"spread through the environment"},{"startTime":286.58,"endTime":290.13,"body":"in a way as we'll come back to,"},{"startTime":286.58,"endTime":290.13,"body":"droplets are less likely to,"},{"startTime":290.13,"endTime":294.12,"body":"and the way you combat those"},{"startTime":290.13,"endTime":294.12,"body":"is therefore rather different."},{"startTime":294.12,"endTime":299.11,"body":"And then not strictly"},{"startTime":294.12,"endTime":299.11,"body":"airborne or respiratory"},{"startTime":299.11,"endTime":301.57,"body":"in the ordinary sense,"},{"startTime":299.11,"endTime":301.57,"body":"but mouth to contact,"},{"startTime":301.57,"endTime":304.843,"body":"particularly kissing would"},{"startTime":301.57,"endTime":304.843,"body":"be an example of this."},{"startTime":308.35,"endTime":309.87,"body":"Now, because droplets are important,"},{"startTime":309.87,"endTime":311.78,"body":"just a little bit about"},{"startTime":309.87,"endTime":311.78,"body":"the ballistics of droplets."},{"startTime":311.78,"endTime":315.88,"body":"A droplet is an object which"},{"startTime":311.78,"endTime":315.88,"body":"once coughed out or sneezed out"},{"startTime":315.88,"endTime":319.56,"body":"or produced in ordinary speech,"},{"startTime":319.56,"endTime":320.977,"body":"will then travel a certain distance,"},{"startTime":320.977,"endTime":323.19,"body":"and then it drops to the"},{"startTime":320.977,"endTime":323.19,"body":"floor with ordinary gravity."},{"startTime":323.19,"endTime":324.1,"body":"So it's like ballistics."},{"startTime":324.1,"endTime":327.313,"body":"It's just like ballistics,"},{"startTime":324.1,"endTime":327.313,"body":"for example in artillery."},{"startTime":328.34,"endTime":332.52,"body":"And the cough or sneeze"},{"startTime":328.34,"endTime":332.52,"body":"can extend the range"},{"startTime":332.52,"endTime":335.01,"body":"and increase the number of droplets,"},{"startTime":335.01,"endTime":336.59,"body":"but they're still subject to gravity."},{"startTime":336.59,"endTime":339.89,"body":"They're still going to go downwards."},{"startTime":339.89,"endTime":343.54,"body":"And they may contaminate"},{"startTime":339.89,"endTime":343.54,"body":"surfaces for some time."},{"startTime":343.54,"endTime":346.59,"body":"Very small droplets however"},{"startTime":343.54,"endTime":346.59,"body":"can remain suspended in the air"},{"startTime":346.59,"endTime":348.04,"body":"for a long period of time."},{"startTime":348.04,"endTime":352.86,"body":"And these are the ones which"},{"startTime":348.04,"endTime":352.86,"body":"can tend to lead to wide areas"},{"startTime":353.73,"endTime":355.72,"body":"potentially being contaminated."},{"startTime":355.72,"endTime":356.78,"body":"But usually with droplets,"},{"startTime":356.78,"endTime":358.94,"body":"you have to be relatively near someone"},{"startTime":358.94,"endTime":361.2,"body":"and relatively near them"},{"startTime":358.94,"endTime":361.2,"body":"for a period of time"},{"startTime":361.2,"endTime":362.683,"body":"that they have produced them."},{"startTime":367.38,"endTime":368.79,"body":"Although the route of transmission"},{"startTime":368.79,"endTime":372.16,"body":"of diseases I'll talk about"},{"startTime":368.79,"endTime":372.16,"body":"is the respiratory route,"},{"startTime":372.16,"endTime":374.84,"body":"infections transmitted by that route"},{"startTime":374.84,"endTime":377.113,"body":"can cause damage throughout the body."},{"startTime":378.16,"endTime":380.7,"body":"Some infections transmitted"},{"startTime":378.16,"endTime":380.7,"body":"via respiratory route"},{"startTime":380.7,"endTime":383.37,"body":"cause their main damage in the"},{"startTime":380.7,"endTime":383.37,"body":"lungs, including pneumonia."},{"startTime":383.37,"endTime":386.36,"body":"And that's the route which in"},{"startTime":383.37,"endTime":386.36,"body":"a sense is the most obvious,"},{"startTime":386.36,"endTime":389.56,"body":"but many others cause most of their damage"},{"startTime":389.56,"endTime":390.56,"body":"elsewhere in the body."},{"startTime":390.56,"endTime":392.77,"body":"So although it's come in"},{"startTime":390.56,"endTime":392.77,"body":"through the respiratory route,"},{"startTime":392.77,"endTime":394.03,"body":"it's other bits of the body"},{"startTime":394.03,"endTime":396.42,"body":"which will tend to"},{"startTime":394.03,"endTime":396.42,"body":"cause the major problems"},{"startTime":396.42,"endTime":397.713,"body":"for the person infected."},{"startTime":398.8,"endTime":401.72,"body":"Several of the major causes"},{"startTime":398.8,"endTime":401.72,"body":"of meningitis for example,"},{"startTime":401.72,"endTime":403.96,"body":"are passed on by the respiratory route."},{"startTime":403.96,"endTime":406.542,"body":"Sepsis and generalized inflammation"},{"startTime":406.542,"endTime":410.84,"body":"is often transmitted this"},{"startTime":406.542,"endTime":410.84,"body":"route, diseases that cause this."},{"startTime":410.84,"endTime":412.79,"body":"Diseases of the nerves,"},{"startTime":410.84,"endTime":412.79,"body":"for example leprosy"},{"startTime":412.79,"endTime":414.97,"body":"is passed on by the respiratory route,"},{"startTime":414.97,"endTime":418.38,"body":"and diseases of the heart,"},{"startTime":414.97,"endTime":418.38,"body":"diseases like diptheria."},{"startTime":418.38,"endTime":419.89,"body":"So these are diseases"},{"startTime":419.89,"endTime":423.27,"body":"which can be dangerous"},{"startTime":419.89,"endTime":423.27,"body":"for any part of the body,"},{"startTime":423.27,"endTime":426.33,"body":"even if they actually came in"},{"startTime":423.27,"endTime":426.33,"body":"through the respiratory route"},{"startTime":426.33,"endTime":427.543,"body":"in the first place."},{"startTime":431.25,"endTime":433.51,"body":"Medical staff, doctors, nurses, and others"},{"startTime":433.51,"endTime":435.3,"body":"divide respiratory infections"},{"startTime":435.3,"endTime":437.21,"body":"into upper respiratory infections,"},{"startTime":437.21,"endTime":439.74,"body":"things that cause most of the trouble"},{"startTime":439.74,"endTime":443.88,"body":"from infecting the upper"},{"startTime":439.74,"endTime":443.88,"body":"part of the airways,"},{"startTime":443.88,"endTime":448.42,"body":"the mouth, nose, throat,"},{"startTime":443.88,"endTime":448.42,"body":"very upper airways,"},{"startTime":448.42,"endTime":450.71,"body":"and lower respiratory tract infections,"},{"startTime":450.71,"endTime":452.993,"body":"which tend to affect the lungs."},{"startTime":454.6,"endTime":457.4,"body":"Many of the trivial"},{"startTime":454.6,"endTime":457.4,"body":"infections that we think about"},{"startTime":457.4,"endTime":459.22,"body":"that are passed by the respiratory route,"},{"startTime":459.22,"endTime":461.65,"body":"things like coughs and colds"},{"startTime":461.65,"endTime":464.47,"body":"are upper respiratory tract infections,"},{"startTime":464.47,"endTime":467.1,"body":"but the upper respiratory"},{"startTime":464.47,"endTime":467.1,"body":"tract is also the route"},{"startTime":467.1,"endTime":470.45,"body":"by which many very serious"},{"startTime":467.1,"endTime":470.45,"body":"infections get into the body."},{"startTime":470.45,"endTime":471.94,"body":"They don't go as far as the lungs."},{"startTime":471.94,"endTime":474.75,"body":"They just infect the"},{"startTime":471.94,"endTime":474.75,"body":"upper part of the airways,"},{"startTime":474.75,"endTime":476.74,"body":"or at least that can"},{"startTime":474.75,"endTime":476.74,"body":"be the principle route"},{"startTime":476.74,"endTime":478.57,"body":"by which they get in."},{"startTime":478.57,"endTime":480.04,"body":"Lower respiratory tract infections"},{"startTime":480.04,"endTime":482.253,"body":"are things like pneumonia, in particular."},{"startTime":483.16,"endTime":485.2,"body":"And some infections can be both."},{"startTime":485.2,"endTime":488.38,"body":"And actually an example"},{"startTime":485.2,"endTime":488.38,"body":"of that is COVID-19,"},{"startTime":488.38,"endTime":489.52,"body":"which has both an upper"},{"startTime":489.52,"endTime":493.973,"body":"and a lower respiratory presentation."},{"startTime":497.88,"endTime":500.84,"body":"Now the body is not defenseless"},{"startTime":497.88,"endTime":500.84,"body":"to of these droplets"},{"startTime":500.84,"endTime":503.97,"body":"and aerosols that come into the airways."},{"startTime":503.97,"endTime":506.85,"body":"We have multiple layers of defense."},{"startTime":506.85,"endTime":510.81,"body":"The first and probably the"},{"startTime":506.85,"endTime":510.81,"body":"least aesthetically pleasing,"},{"startTime":510.81,"endTime":513.55,"body":"but actually incredibly"},{"startTime":510.81,"endTime":513.55,"body":"important to all of us is mucus,"},{"startTime":513.55,"endTime":515.43,"body":"otherwise known as snot."},{"startTime":515.43,"endTime":517.22,"body":"Very important, is a physical barrier"},{"startTime":517.22,"endTime":520.06,"body":"and it's constantly being excreted."},{"startTime":520.06,"endTime":525.06,"body":"And it traps viruses and bacteria."},{"startTime":525.21,"endTime":528.16,"body":"It can via enzymes damage them,"},{"startTime":528.16,"endTime":530.41,"body":"antibodies are as part of it."},{"startTime":530.41,"endTime":533.52,"body":"And there's what's called"},{"startTime":530.41,"endTime":533.52,"body":"the mucociliary escalator,"},{"startTime":533.52,"endTime":536.8,"body":"which gets mucus all the"},{"startTime":533.52,"endTime":536.8,"body":"way from the lungs up"},{"startTime":536.8,"endTime":539.463,"body":"and then people cough"},{"startTime":536.8,"endTime":539.463,"body":"them out or swallow them."},{"startTime":540.35,"endTime":541.74,"body":"So this is a very important way"},{"startTime":541.74,"endTime":544.33,"body":"in which many infections"},{"startTime":541.74,"endTime":544.33,"body":"are stopped really"},{"startTime":544.33,"endTime":547.22,"body":"at the first point of contact."},{"startTime":547.22,"endTime":549.01,"body":"Behind this though are several layers"},{"startTime":549.01,"endTime":550.21,"body":"of immunological defense,"},{"startTime":550.21,"endTime":552.98,"body":"and the body's ability"},{"startTime":550.21,"endTime":552.98,"body":"to respond to infections,"},{"startTime":552.98,"endTime":555.01,"body":"something we've discussed"},{"startTime":552.98,"endTime":555.01,"body":"at several points"},{"startTime":555.01,"endTime":556.4,"body":"is really quite remarkable."},{"startTime":556.4,"endTime":560.85,"body":"First to infections that the"},{"startTime":556.4,"endTime":560.85,"body":"body has not seen before,"},{"startTime":560.85,"endTime":565.85,"body":"first time round, and then"},{"startTime":560.85,"endTime":565.85,"body":"also a learnt response,"},{"startTime":566.4,"endTime":568.94,"body":"which actually is when"},{"startTime":566.4,"endTime":568.94,"body":"they see the same infection"},{"startTime":568.94,"endTime":569.773,"body":"a second time round."},{"startTime":569.773,"endTime":572.17,"body":"This of course is the basis"},{"startTime":569.773,"endTime":572.17,"body":"of the fact that people"},{"startTime":572.17,"endTime":574.78,"body":"have less severe disease"},{"startTime":572.17,"endTime":574.78,"body":"often the second time."},{"startTime":574.78,"endTime":578.22,"body":"And in particular is the"},{"startTime":574.78,"endTime":578.22,"body":"basis of vaccination,"},{"startTime":578.22,"endTime":581.093,"body":"your own immune system's ability to learn."},{"startTime":585.73,"endTime":589.64,"body":"Now, stopping transmission"},{"startTime":585.73,"endTime":589.64,"body":"via the respiratory route"},{"startTime":589.64,"endTime":592.41,"body":"is more difficult than"},{"startTime":589.64,"endTime":592.41,"body":"some of the other routes"},{"startTime":592.41,"endTime":593.64,"body":"that we've considered before."},{"startTime":593.64,"endTime":596.83,"body":"So for example, when you're"},{"startTime":593.64,"endTime":596.83,"body":"talking about the oral route,"},{"startTime":596.83,"endTime":599.57,"body":"the extraordinary engineering feats"},{"startTime":599.57,"endTime":601.84,"body":"that have made it much less likely"},{"startTime":601.84,"endTime":604.54,"body":"that things will be"},{"startTime":601.84,"endTime":604.54,"body":"transmitted by that route,"},{"startTime":604.54,"endTime":606.4,"body":"much harder when all you have to do"},{"startTime":606.4,"endTime":609.617,"body":"is have several people in"},{"startTime":606.4,"endTime":609.617,"body":"a room at the same time."},{"startTime":609.617,"endTime":612.01,"body":"But there are several things we can do"},{"startTime":612.01,"endTime":615.67,"body":"to reduce the risk of"},{"startTime":612.01,"endTime":615.67,"body":"respiratory transmission."},{"startTime":615.67,"endTime":619.759,"body":"The first, arguably the"},{"startTime":615.67,"endTime":619.759,"body":"easiest is to be outdoors,"},{"startTime":619.759,"endTime":623.8,"body":"where you get a rapid dilution"},{"startTime":619.759,"endTime":623.8,"body":"of droplets and aerosols,"},{"startTime":623.8,"endTime":625.61,"body":"generally much more spaced out people,"},{"startTime":625.61,"endTime":628.55,"body":"much less crowded together,"},{"startTime":625.61,"endTime":628.55,"body":"ultraviolet lights,"},{"startTime":628.55,"endTime":631.66,"body":"several reasons mean that"},{"startTime":628.55,"endTime":631.66,"body":"outdoors is much safer."},{"startTime":631.66,"endTime":636.66,"body":"Now of course, if someone coughs"},{"startTime":631.66,"endTime":636.66,"body":"inadvertently in your face"},{"startTime":636.69,"endTime":639.91,"body":"from a couple of feets distance,"},{"startTime":639.91,"endTime":642.75,"body":"then you are actually at risk"},{"startTime":639.91,"endTime":642.75,"body":"of catching an infection,"},{"startTime":642.75,"endTime":645.763,"body":"but it is much safer"},{"startTime":642.75,"endTime":645.763,"body":"in outdoor environment."},{"startTime":646.8,"endTime":649.28,"body":"The second, something which"},{"startTime":646.8,"endTime":649.28,"body":"of course we've talked about"},{"startTime":649.28,"endTime":652.83,"body":"a lot during the COVID"},{"startTime":649.28,"endTime":652.83,"body":"pandemic and will continue to,"},{"startTime":652.83,"endTime":655.81,"body":"improving ventilation indoors."},{"startTime":655.81,"endTime":658.35,"body":"The natural ventilation,"},{"startTime":655.81,"endTime":658.35,"body":"opening the windows"},{"startTime":658.35,"endTime":660.07,"body":"remains a very important"},{"startTime":658.35,"endTime":660.07,"body":"way of doing this,"},{"startTime":660.07,"endTime":663.02,"body":"obviously harder in winter months."},{"startTime":663.02,"endTime":665.5,"body":"And also particularly in large buildings,"},{"startTime":665.5,"endTime":669.1,"body":"engineering in ventilation"},{"startTime":665.5,"endTime":669.1,"body":"whilst keeping in heat."},{"startTime":669.1,"endTime":671.46,"body":"Those two are often intention,"},{"startTime":671.46,"endTime":674.39,"body":"and the engineering"},{"startTime":671.46,"endTime":674.39,"body":"challenges keep the heat in"},{"startTime":674.39,"endTime":676.693,"body":"whilst keeping the ventilation going."},{"startTime":677.9,"endTime":681.02,"body":"And then finally, in terms of"},{"startTime":677.9,"endTime":681.02,"body":"these physical environments,"},{"startTime":681.02,"endTime":684.04,"body":"either keeping people at a distance,"},{"startTime":684.04,"endTime":687.61,"body":"again, something we've all"},{"startTime":684.04,"endTime":687.61,"body":"got used to during COVID,"},{"startTime":687.61,"endTime":690.15,"body":"or direction, making sure"},{"startTime":687.61,"endTime":690.15,"body":"when people are closer,"},{"startTime":690.15,"endTime":693.02,"body":"that they're seating side"},{"startTime":690.15,"endTime":693.02,"body":"by side or back to back,"},{"startTime":693.02,"endTime":694.255,"body":"or physical barriers."},{"startTime":694.255,"endTime":697.28,"body":"These are particularly useful,"},{"startTime":694.255,"endTime":697.28,"body":"in fact, for droplet spread."},{"startTime":697.28,"endTime":699.173,"body":"They have less effect on aerosols."},{"startTime":703.6,"endTime":706.41,"body":"Just a quick digression"},{"startTime":706.41,"endTime":708.38,"body":"into the very important"},{"startTime":706.41,"endTime":708.38,"body":"issue of ventilation."},{"startTime":708.38,"endTime":711.26,"body":"Something I think we really"},{"startTime":708.38,"endTime":711.26,"body":"need to take very seriously"},{"startTime":712.56,"endTime":716.2,"body":"as a result of having seen"},{"startTime":712.56,"endTime":716.2,"body":"what has happened during COVID,"},{"startTime":716.2,"endTime":718.46,"body":"and indeed this happens in every winter"},{"startTime":718.46,"endTime":720.54,"body":"with respiratory infections."},{"startTime":720.54,"endTime":725.15,"body":"Engineers via the route of ventilation"},{"startTime":725.15,"endTime":727.06,"body":"yet again, improved public health."},{"startTime":727.06,"endTime":729.18,"body":"And I've talked a lot in this series"},{"startTime":729.18,"endTime":731.93,"body":"about how engineering has underpinned"},{"startTime":731.93,"endTime":734.0,"body":"a lot of improvements we've seen"},{"startTime":734.0,"endTime":736.37,"body":"in reductions in transmission."},{"startTime":736.37,"endTime":740.41,"body":"So here are some three sort"},{"startTime":736.37,"endTime":740.41,"body":"of broad kind of examples"},{"startTime":740.41,"endTime":741.5,"body":"and there are many."},{"startTime":741.5,"endTime":744.18,"body":"On the left, we have really the simplest."},{"startTime":744.18,"endTime":746.08,"body":"This is a TB Sanitorium,"},{"startTime":746.08,"endTime":749.41,"body":"and the children that have been infected,"},{"startTime":749.41,"endTime":752.41,"body":"have been put just near"},{"startTime":749.41,"endTime":752.41,"body":"very large open windows."},{"startTime":752.41,"endTime":756.19,"body":"This is just straight"},{"startTime":752.41,"endTime":756.19,"body":"forward mountain breezes"},{"startTime":756.19,"endTime":757.213,"body":"going through."},{"startTime":758.42,"endTime":761.27,"body":"In the middle, we have"},{"startTime":758.42,"endTime":761.27,"body":"two examples of schematic"},{"startTime":761.27,"endTime":766.27,"body":"and then a local landmark"},{"startTime":761.27,"endTime":766.27,"body":"of ventilation using heat."},{"startTime":767.24,"endTime":769.93,"body":"And here, engineers put ventilation"},{"startTime":769.93,"endTime":771.41,"body":"at the bottom of the building"},{"startTime":771.41,"endTime":773.447,"body":"and then they have a"},{"startTime":771.41,"endTime":773.447,"body":"chimney towards the top up"},{"startTime":773.447,"endTime":777.55,"body":"and the heat rises and it pulls"},{"startTime":773.447,"endTime":777.55,"body":"fresh air in from the bottom"},{"startTime":777.55,"endTime":779.03,"body":"up through the system."},{"startTime":779.03,"endTime":781.61,"body":"And what an example of this"},{"startTime":781.61,"endTime":783.88,"body":"is the Central Tower of"},{"startTime":781.61,"endTime":783.88,"body":"the Palace of Westminster,"},{"startTime":783.88,"endTime":787.5,"body":"as I say, a major landmark,"},{"startTime":783.88,"endTime":787.5,"body":"which is designed var heat"},{"startTime":787.5,"endTime":789.35,"body":"to help ventilate the whole building."},{"startTime":790.41,"endTime":794.2,"body":"And then really at the more extreme end"},{"startTime":794.2,"endTime":796.17,"body":"of the engineering challenges,"},{"startTime":796.17,"endTime":798.53,"body":"we have buildings which actually"},{"startTime":796.17,"endTime":798.53,"body":"have got sealed windows."},{"startTime":798.53,"endTime":801.21,"body":"On the right here is UCLH Hospital"},{"startTime":801.21,"endTime":804.05,"body":"where in fact, I and many"},{"startTime":801.21,"endTime":804.05,"body":"other colleagues work,"},{"startTime":804.05,"endTime":807.97,"body":"and this requires mechanical ventilation"},{"startTime":807.97,"endTime":810.4,"body":"because you can't use natural ventilation"},{"startTime":810.4,"endTime":811.733,"body":"for a variety of reasons."},{"startTime":812.74,"endTime":815.81,"body":"So these kinds of"},{"startTime":812.74,"endTime":815.81,"body":"ventilation are essential,"},{"startTime":815.81,"endTime":818.27,"body":"and we need, I think to take"},{"startTime":815.81,"endTime":818.27,"body":"this much more seriously"},{"startTime":818.27,"endTime":819.76,"body":"now that we've seen the impact"},{"startTime":819.76,"endTime":823.313,"body":"of having insufficient ventilation"},{"startTime":819.76,"endTime":823.313,"body":"in many public buildings."},{"startTime":826.64,"endTime":829.71,"body":"Personal behaviors can"},{"startTime":826.64,"endTime":829.71,"body":"also reduce the chances"},{"startTime":829.71,"endTime":832.86,"body":"of passing on or acquiring"},{"startTime":829.71,"endTime":832.86,"body":"respiratory infections."},{"startTime":832.86,"endTime":835.32,"body":"And most of them are common sense"},{"startTime":835.32,"endTime":837.48,"body":"that people would've handed down"},{"startTime":837.48,"endTime":839.87,"body":"from their parents and grandparents."},{"startTime":839.87,"endTime":842.41,"body":"Staying at home and self isolating"},{"startTime":842.41,"endTime":845.64,"body":"went unwell with a seasonal"},{"startTime":842.41,"endTime":845.64,"body":"respiratory infection."},{"startTime":845.64,"endTime":847.81,"body":"Struggling into work with a streaming cold"},{"startTime":847.81,"endTime":850.844,"body":"is not actually remarkably"},{"startTime":847.81,"endTime":850.844,"body":"helpful to your colleagues,"},{"startTime":850.844,"endTime":852.703,"body":"often quite the reverse."},{"startTime":853.58,"endTime":857.22,"body":"Maximizing social time outdoors"},{"startTime":853.58,"endTime":857.22,"body":"or with good ventilation"},{"startTime":857.22,"endTime":858.55,"body":"where that's possible,"},{"startTime":858.55,"endTime":861.36,"body":"covering mouth and nose"},{"startTime":858.55,"endTime":861.36,"body":"when coughing and sneezing."},{"startTime":861.36,"endTime":864.89,"body":"This is an old campaign that's"},{"startTime":861.36,"endTime":864.89,"body":"been running for many years,"},{"startTime":864.89,"endTime":868.69,"body":"illustrated here from some decades ago."},{"startTime":868.69,"endTime":871.2,"body":"Washing hands and disposing of tissues"},{"startTime":871.2,"endTime":872.91,"body":"is a way in particular of making sure"},{"startTime":872.91,"endTime":876.09,"body":"that droplets that have got onto objects"},{"startTime":876.09,"endTime":880.52,"body":"don't lead to infections by"},{"startTime":876.09,"endTime":880.52,"body":"people touching something"},{"startTime":880.52,"endTime":882.49,"body":"and then touching their own face."},{"startTime":882.49,"endTime":884.4,"body":"And in periods of high transmission,"},{"startTime":884.4,"endTime":886.01,"body":"something which I think the importance of"},{"startTime":886.01,"endTime":889.89,"body":"we've really begun to"},{"startTime":886.01,"endTime":889.89,"body":"recognize during COVID,"},{"startTime":889.89,"endTime":894.89,"body":"the use of face masks, which"},{"startTime":889.89,"endTime":894.89,"body":"can reduce both the impact"},{"startTime":896.49,"endTime":901.49,"body":"and distance of droplets"},{"startTime":896.49,"endTime":901.49,"body":"and also aerosols,"},{"startTime":902.05,"endTime":904.48,"body":"which can lead to other"},{"startTime":902.05,"endTime":904.48,"body":"people being infected."},{"startTime":904.48,"endTime":906.8,"body":"So these are things"},{"startTime":904.48,"endTime":906.8,"body":"people can themselves do"},{"startTime":906.8,"endTime":908.377,"body":"to reduce the risk to others."},{"startTime":908.377,"endTime":910.46,"body":"And all of us we've being doing them"},{"startTime":910.46,"endTime":912.043,"body":"during the last two years."},{"startTime":915.03,"endTime":916.22,"body":"There are some broader things"},{"startTime":916.22,"endTime":920.03,"body":"which also tend to drive"},{"startTime":916.22,"endTime":920.03,"body":"respiratory infections."},{"startTime":920.03,"endTime":922.08,"body":"There is a very strong correlation"},{"startTime":922.08,"endTime":926.11,"body":"between poverty and deprivation,"},{"startTime":926.11,"endTime":928.29,"body":"relative and absolute deprivation,"},{"startTime":928.29,"endTime":930.453,"body":"and many respiratory infections."},{"startTime":931.4,"endTime":934.43,"body":"Then the reasons for this in"},{"startTime":931.4,"endTime":934.43,"body":"a sense are fairly obvious"},{"startTime":934.43,"endTime":935.68,"body":"in most cases."},{"startTime":935.68,"endTime":938.85,"body":"Housing being poor and very crowded,"},{"startTime":938.85,"endTime":942.89,"body":"very often, working conditions"},{"startTime":938.85,"endTime":942.89,"body":"often again being cramped,"},{"startTime":942.89,"endTime":944.62,"body":"poorly ventilated."},{"startTime":944.62,"endTime":947.14,"body":"Diet and malnutrition"},{"startTime":944.62,"endTime":947.14,"body":"making it much easier"},{"startTime":947.14,"endTime":949.68,"body":"for people to be"},{"startTime":947.14,"endTime":949.68,"body":"susceptible to infections."},{"startTime":949.68,"endTime":952.38,"body":"And then there's the wider access"},{"startTime":952.38,"endTime":956.0,"body":"to vaccines and curative medical services."},{"startTime":956.0,"endTime":957.43,"body":"So when you look at maps"},{"startTime":957.43,"endTime":959.77,"body":"of many of the respiratory infections,"},{"startTime":959.77,"endTime":964.35,"body":"they correlate quite"},{"startTime":959.77,"endTime":964.35,"body":"closely with maps of poverty"},{"startTime":964.35,"endTime":968.04,"body":"around the world, and"},{"startTime":964.35,"endTime":968.04,"body":"indeed within the UK."},{"startTime":968.04,"endTime":970.95,"body":"And if you remember all the"},{"startTime":968.04,"endTime":970.95,"body":"maps we've seen of COVID,"},{"startTime":970.95,"endTime":973.27,"body":"they've tended to get"},{"startTime":970.95,"endTime":973.27,"body":"very heavily concentrated"},{"startTime":973.27,"endTime":975.133,"body":"in areas of relative deprivation."},{"startTime":976.92,"endTime":980.37,"body":"As poverty has decreased, this"},{"startTime":976.92,"endTime":980.37,"body":"is the positive side of this,"},{"startTime":980.37,"endTime":982.32,"body":"many infections have as well."},{"startTime":982.32,"endTime":984.23,"body":"And I will go through a few of those"},{"startTime":984.23,"endTime":985.78,"body":"in the second half of the talk."},{"startTime":989.18,"endTime":992.22,"body":"Smoking, when it comes"},{"startTime":989.18,"endTime":992.22,"body":"to respiratory infections"},{"startTime":992.22,"endTime":994.61,"body":"is a self-inflicted wound."},{"startTime":994.61,"endTime":996.58,"body":"There is really clear evidence"},{"startTime":996.58,"endTime":1000.17,"body":"that of increases of many"},{"startTime":996.58,"endTime":1000.17,"body":"respiratory infections"},{"startTime":1000.17,"endTime":1002.76,"body":"are among smokers, includes tuberculosis,"},{"startTime":1002.76,"endTime":1005.46,"body":"influenza and pneumococcal"},{"startTime":1002.76,"endTime":1005.46,"body":"pneumonia, and many others."},{"startTime":1006.34,"endTime":1007.76,"body":"And the main reason for this probably"},{"startTime":1007.76,"endTime":1010.043,"body":"is that it damages the lungs defenses."},{"startTime":1011.73,"endTime":1014.73,"body":"Additionally, people who've"},{"startTime":1011.73,"endTime":1014.73,"body":"got very damaged lungs"},{"startTime":1014.73,"endTime":1017.67,"body":"as a result of this chronic"},{"startTime":1014.73,"endTime":1017.67,"body":"obstructive airways disease"},{"startTime":1017.67,"endTime":1022.437,"body":"of really serious and unpleasant"},{"startTime":1017.67,"endTime":1022.437,"body":"long term disease group"},{"startTime":1022.437,"endTime":1024.48,"body":"as a result of smoking"},{"startTime":1024.48,"endTime":1027.17,"body":"are very vulnerable to"},{"startTime":1024.48,"endTime":1027.17,"body":"respiratory infections,"},{"startTime":1027.17,"endTime":1030.93,"body":"but even people who smoke"},{"startTime":1027.17,"endTime":1030.93,"body":"more likely than that"},{"startTime":1030.93,"endTime":1033.193,"body":"are at greater risk of infection."},{"startTime":1035.68,"endTime":1037.7,"body":"And then there are some occupations"},{"startTime":1037.7,"endTime":1042.08,"body":"which increase the risk"},{"startTime":1037.7,"endTime":1042.08,"body":"of respiratory infections."},{"startTime":1042.08,"endTime":1046.71,"body":"Those include close contact occupations."},{"startTime":1046.71,"endTime":1048.344,"body":"So healthcare workers, for example,"},{"startTime":1048.344,"endTime":1051.33,"body":"who properly have to come close to people,"},{"startTime":1051.33,"endTime":1054.89,"body":"social care workers, but"},{"startTime":1051.33,"endTime":1054.89,"body":"also workers, for example,"},{"startTime":1054.89,"endTime":1057.15,"body":"taxi drivers and people"},{"startTime":1054.89,"endTime":1057.15,"body":"who are also involved"},{"startTime":1057.15,"endTime":1060.03,"body":"in public services, security guards,"},{"startTime":1060.03,"endTime":1063.29,"body":"anyone who's front of house"},{"startTime":1060.03,"endTime":1063.29,"body":"that has a lot of contact"},{"startTime":1063.29,"endTime":1066.79,"body":"relatively close to multiple strangers"},{"startTime":1066.79,"endTime":1069.76,"body":"are at potentially greater risks."},{"startTime":1069.76,"endTime":1071.29,"body":"Then there's a group of occupations"},{"startTime":1071.29,"endTime":1074.05,"body":"that damage the lung defenses."},{"startTime":1074.05,"endTime":1075.53,"body":"Mining, for example,"},{"startTime":1075.53,"endTime":1078.05,"body":"whether it's coal mining or gold mining."},{"startTime":1078.05,"endTime":1081.17,"body":"Gold mining's a very big risk,"},{"startTime":1078.05,"endTime":1081.17,"body":"for example tuberculosis."},{"startTime":1081.17,"endTime":1083.78,"body":"Many other occupations that cause dust"},{"startTime":1083.78,"endTime":1085.94,"body":"are likely to increase the risk"},{"startTime":1085.94,"endTime":1088.483,"body":"of someone acquiring an infection."},{"startTime":1089.44,"endTime":1090.57,"body":"And then some occupations"},{"startTime":1090.57,"endTime":1093.34,"body":"may increase the risk"},{"startTime":1090.57,"endTime":1093.34,"body":"of specific infections"},{"startTime":1093.34,"endTime":1094.6,"body":"and the response to them."},{"startTime":1094.6,"endTime":1096.82,"body":"For example, fungal diseases"},{"startTime":1096.82,"endTime":1098.63,"body":"and zoonotic diseases from animals"},{"startTime":1098.63,"endTime":1101.08,"body":"are unsurprisingly more"},{"startTime":1098.63,"endTime":1101.08,"body":"common among people"},{"startTime":1101.08,"endTime":1103.293,"body":"who are in farming or livestock."},{"startTime":1108.29,"endTime":1111.78,"body":"Important when considering"},{"startTime":1108.29,"endTime":1111.78,"body":"how to address these,"},{"startTime":1111.78,"endTime":1115.973,"body":"respiratory infections"},{"startTime":1111.78,"endTime":1115.973,"body":"tend to be highly seasonal,"},{"startTime":1117.08,"endTime":1118.913,"body":"not all, but the great majority."},{"startTime":1119.95,"endTime":1122.57,"body":"They include in particular infections"},{"startTime":1122.57,"endTime":1124.15,"body":"where the population immunity"},{"startTime":1124.15,"endTime":1127.073,"body":"is in rough balance with the infection."},{"startTime":1128.3,"endTime":1131.3,"body":"And in winter, several changes occur,"},{"startTime":1131.3,"endTime":1133.41,"body":"which are to the advantage"},{"startTime":1131.3,"endTime":1133.41,"body":"of the infection."},{"startTime":1133.41,"endTime":1138.41,"body":"They include more time"},{"startTime":1133.41,"endTime":1138.41,"body":"together inside, windows shut,"},{"startTime":1139.75,"endTime":1142.46,"body":"ventilation reduced."},{"startTime":1142.46,"endTime":1144.45,"body":"This is really because of this tension"},{"startTime":1144.45,"endTime":1148.59,"body":"between keeping heat in and"},{"startTime":1144.45,"endTime":1148.59,"body":"keeping ventilation going."},{"startTime":1148.59,"endTime":1151.66,"body":"Lower temperatures and"},{"startTime":1148.59,"endTime":1151.66,"body":"changes in humidity,"},{"startTime":1151.66,"endTime":1153.56,"body":"outdoors, lower ultraviolet light."},{"startTime":1153.56,"endTime":1155.88,"body":"There are a variety of"},{"startTime":1153.56,"endTime":1155.88,"body":"things, but in particular,"},{"startTime":1155.88,"endTime":1158.9,"body":"crowding together indoors is a high risk."},{"startTime":1158.9,"endTime":1160.24,"body":"And here what I've illustrated"},{"startTime":1160.24,"endTime":1165.24,"body":"is several different years"},{"startTime":1160.24,"endTime":1165.24,"body":"of influenza in the UK,"},{"startTime":1166.01,"endTime":1169.17,"body":"and the size of the wave is different"},{"startTime":1169.17,"endTime":1170.95,"body":"depending on which year it was."},{"startTime":1170.95,"endTime":1174.43,"body":"But when the wave was very stereotypical,"},{"startTime":1174.43,"endTime":1177.68,"body":"it's over the late"},{"startTime":1174.43,"endTime":1177.68,"body":"autumn and winter months,"},{"startTime":1177.68,"endTime":1180.553,"body":"and the same is true for many"},{"startTime":1177.68,"endTime":1180.553,"body":"other of these infections."},{"startTime":1183.49,"endTime":1186.49,"body":"Now medicine has developed"},{"startTime":1183.49,"endTime":1186.49,"body":"for against these,"},{"startTime":1186.49,"endTime":1188.96,"body":"in addition to the control"},{"startTime":1186.49,"endTime":1188.96,"body":"measures I've talked about,"},{"startTime":1188.96,"endTime":1192.08,"body":"engineering and personal"},{"startTime":1188.96,"endTime":1192.08,"body":"behaviors in particular,"},{"startTime":1192.08,"endTime":1193.38,"body":"there are medical countermeasures."},{"startTime":1193.38,"endTime":1195.21,"body":"And for many of the major diseases,"},{"startTime":1195.21,"endTime":1198.14,"body":"the medical countermeasures"},{"startTime":1195.21,"endTime":1198.14,"body":"have been highly effective."},{"startTime":1198.14,"endTime":1201.82,"body":"Broadly, drugs such as"},{"startTime":1198.14,"endTime":1201.82,"body":"anti tuberculous drugs, TB,"},{"startTime":1201.82,"endTime":1204.68,"body":"antibiotics against bacterial"},{"startTime":1201.82,"endTime":1204.68,"body":"diseases and antivirals,"},{"startTime":1204.68,"endTime":1208.41,"body":"so treatments, but also"},{"startTime":1204.68,"endTime":1208.41,"body":"depending on diagnosis."},{"startTime":1208.41,"endTime":1209.94,"body":"So diagnostic tests are needed"},{"startTime":1209.94,"endTime":1214.44,"body":"before you get to the drugs in"},{"startTime":1209.94,"endTime":1214.44,"body":"many case, and then vaccines."},{"startTime":1214.44,"endTime":1217.36,"body":"And we have effective vaccines for some,"},{"startTime":1217.36,"endTime":1220.827,"body":"but not all of the infections"},{"startTime":1217.36,"endTime":1220.827,"body":"via the respiratory route."},{"startTime":1220.827,"endTime":1224.423,"body":"And where they exist, they"},{"startTime":1220.827,"endTime":1224.423,"body":"have transformed the picture."},{"startTime":1225.47,"endTime":1227.72,"body":"Some prevent infection altogether,"},{"startTime":1227.72,"endTime":1231.3,"body":"and others are effective at"},{"startTime":1227.72,"endTime":1231.3,"body":"preventing severe disease,"},{"startTime":1231.3,"endTime":1233.28,"body":"but don't prevent transmission so easily."},{"startTime":1233.28,"endTime":1238.28,"body":"So, they vary in terms of"},{"startTime":1233.28,"endTime":1238.28,"body":"how effective they can be."},{"startTime":1241.66,"endTime":1243.0,"body":"And I'd like to illustrate this"},{"startTime":1243.0,"endTime":1245.78,"body":"with several major infections,"},{"startTime":1245.78,"endTime":1247.39,"body":"starting off with a group of infections"},{"startTime":1247.39,"endTime":1252.04,"body":"who have their impact across"},{"startTime":1247.39,"endTime":1252.04,"body":"many parts of the body."},{"startTime":1252.04,"endTime":1255.64,"body":"And the first and historically"},{"startTime":1252.04,"endTime":1255.64,"body":"one of the most important,"},{"startTime":1255.64,"endTime":1258.7,"body":"still important in many"},{"startTime":1255.64,"endTime":1258.7,"body":"areas, tuberculosis, TB,"},{"startTime":1258.7,"endTime":1261.033,"body":"still a leading cause of death worldwide."},{"startTime":1261.92,"endTime":1263.55,"body":"It was common absolutely everywhere,"},{"startTime":1263.55,"endTime":1267.373,"body":"killing people in all walks"},{"startTime":1263.55,"endTime":1267.373,"body":"of life, including in the UK."},{"startTime":1268.75,"endTime":1270.57,"body":"When we think about more recently,"},{"startTime":1270.57,"endTime":1273.25,"body":"I'm just taking a pre-COVID thing in 2020,"},{"startTime":1273.25,"endTime":1276.29,"body":"around 10 million people"},{"startTime":1273.25,"endTime":1276.29,"body":"who fell ill with TB,"},{"startTime":1276.29,"endTime":1279.55,"body":"and 1.5 million people died,"},{"startTime":1279.55,"endTime":1283.35,"body":"included around 1 million"},{"startTime":1279.55,"endTime":1283.35,"body":"children who were infected."},{"startTime":1283.35,"endTime":1288.35,"body":"So TB is still very much"},{"startTime":1283.35,"endTime":1288.35,"body":"alive and around in the world,"},{"startTime":1288.4,"endTime":1290.47,"body":"but it is much more heavily concentrated"},{"startTime":1290.47,"endTime":1292.87,"body":"in countries where there"},{"startTime":1290.47,"endTime":1292.87,"body":"is significant poverty."},{"startTime":1293.91,"endTime":1296.96,"body":"It's mainly spread by droplets"},{"startTime":1293.91,"endTime":1296.96,"body":"via the respiratory route."},{"startTime":1296.96,"endTime":1299.08,"body":"And people can be chronically infected."},{"startTime":1299.08,"endTime":1301.1,"body":"What we have here is of an x-ray"},{"startTime":1301.1,"endTime":1303.2,"body":"of someone who's got chronic infection,"},{"startTime":1303.2,"endTime":1306.98,"body":"and infectious spitting"},{"startTime":1303.2,"endTime":1306.98,"body":"out or coughing out TB"},{"startTime":1306.98,"endTime":1308.87,"body":"over many years."},{"startTime":1308.87,"endTime":1310.77,"body":"People who are malnourished,"},{"startTime":1310.77,"endTime":1312.37,"body":"and people who are immunosuppressed,"},{"startTime":1312.37,"endTime":1315.21,"body":"for example those with uncontrolled HIV"},{"startTime":1315.21,"endTime":1316.713,"body":"are most at risk now."},{"startTime":1319.38,"endTime":1322.54,"body":"When the NHS started here in the UK,"},{"startTime":1322.54,"endTime":1325.393,"body":"TB was a very major cause of mortality."},{"startTime":1326.32,"endTime":1328.96,"body":"And what we have on the"},{"startTime":1326.32,"endTime":1328.96,"body":"left here is a graph,"},{"startTime":1328.96,"endTime":1332.58,"body":"the top line showing, and"},{"startTime":1328.96,"endTime":1332.58,"body":"this is a logarithmic scale."},{"startTime":1332.58,"endTime":1335.26,"body":"The top line is showing"},{"startTime":1332.58,"endTime":1335.26,"body":"there's been a steady reduction"},{"startTime":1335.26,"endTime":1337.36,"body":"in the number of cases,"},{"startTime":1337.36,"endTime":1340.47,"body":"and in the bottom line,"},{"startTime":1337.36,"endTime":1340.47,"body":"an even steeper reduction"},{"startTime":1340.47,"endTime":1342.823,"body":"in the number of people who've died of TB."},{"startTime":1344.19,"endTime":1346.77,"body":"And the same is shown in"},{"startTime":1344.19,"endTime":1346.77,"body":"a slightly different way"},{"startTime":1346.77,"endTime":1347.95,"body":"on the right."},{"startTime":1347.95,"endTime":1350.5,"body":"The green boxes are people"},{"startTime":1347.95,"endTime":1350.5,"body":"who died of infection"},{"startTime":1350.5,"endTime":1353.18,"body":"and TB was very heavily involved in this."},{"startTime":1353.18,"endTime":1355.56,"body":"And what this shows in"},{"startTime":1353.18,"endTime":1355.56,"body":"different age groups"},{"startTime":1355.56,"endTime":1360.47,"body":"over different decades from 1915 onwards."},{"startTime":1360.47,"endTime":1363.26,"body":"And in the first few"},{"startTime":1360.47,"endTime":1363.26,"body":"decades of the last century,"},{"startTime":1363.26,"endTime":1367.33,"body":"infection really dominated"},{"startTime":1363.26,"endTime":1367.33,"body":"the causes of mortality"},{"startTime":1367.33,"endTime":1370.5,"body":"across very large numbers"},{"startTime":1367.33,"endTime":1370.5,"body":"of the age groups,"},{"startTime":1370.5,"endTime":1372.32,"body":"and then steadily that has improved."},{"startTime":1372.32,"endTime":1375.12,"body":"And this is a combination"},{"startTime":1372.32,"endTime":1375.12,"body":"of medical countermeasures,"},{"startTime":1375.12,"endTime":1377.63,"body":"drugs in particular, in the case of TB,"},{"startTime":1377.63,"endTime":1379.973,"body":"and improved living standards."},{"startTime":1383.85,"endTime":1388.85,"body":"In a pre-drug era, and also"},{"startTime":1383.85,"endTime":1388.85,"body":"pre-HIV, without treatment,"},{"startTime":1389.74,"endTime":1392.3,"body":"smear-positive TB, these are"},{"startTime":1389.74,"endTime":1392.3,"body":"people who got a lot of TB,"},{"startTime":1392.3,"endTime":1395.31,"body":"they were coughing out a lot"},{"startTime":1392.3,"endTime":1395.31,"body":"of bacteria around the system,"},{"startTime":1395.31,"endTime":1398.71,"body":"had a mortality of around 70%,"},{"startTime":1398.71,"endTime":1400.78,"body":"and this would happen over about 10 years."},{"startTime":1400.78,"endTime":1403.11,"body":"So over really quite a long period."},{"startTime":1403.11,"endTime":1405.877,"body":"People who got less TB are"},{"startTime":1403.11,"endTime":1405.877,"body":"rather lower mortality,"},{"startTime":1405.877,"endTime":1407.4,"body":"and they were less infectious,"},{"startTime":1407.4,"endTime":1411.063,"body":"but those were the broadly the two groups."},{"startTime":1411.97,"endTime":1416.54,"body":"And the treatment for these"},{"startTime":1411.97,"endTime":1416.54,"body":"had to be often quite dramatic"},{"startTime":1416.54,"endTime":1419.16,"body":"'cause people otherwise"},{"startTime":1416.54,"endTime":1419.16,"body":"would've died of their disease"},{"startTime":1419.16,"endTime":1420.55,"body":"and sometimes still did."},{"startTime":1420.55,"endTime":1422.4,"body":"Examples were collapsing lungs."},{"startTime":1422.4,"endTime":1424.7,"body":"And what I've illustrated here"},{"startTime":1422.4,"endTime":1424.7,"body":"is something called plombage"},{"startTime":1424.7,"endTime":1427.82,"body":"where material was put into the lung"},{"startTime":1427.82,"endTime":1432.163,"body":"to try and collapse it down"},{"startTime":1427.82,"endTime":1432.163,"body":"and kill the TB by scarring."},{"startTime":1433.6,"endTime":1434.95,"body":"This is really all it was available"},{"startTime":1434.95,"endTime":1437.57,"body":"until the first effective drug in 1946,"},{"startTime":1437.57,"endTime":1439.49,"body":"the drug was streptomycin."},{"startTime":1439.49,"endTime":1441.85,"body":"And we now have highly"},{"startTime":1439.49,"endTime":1441.85,"body":"effective treatments"},{"startTime":1441.85,"endTime":1444.083,"body":"for the great majority of TB."},{"startTime":1446.27,"endTime":1449.18,"body":"And the key to preventing"},{"startTime":1446.27,"endTime":1449.18,"body":"the spread of pulmonary TB,"},{"startTime":1449.18,"endTime":1451.96,"body":"TB of the lung, is early diagnosis,"},{"startTime":1451.96,"endTime":1455.05,"body":"and then six months of directly"},{"startTime":1451.96,"endTime":1455.05,"body":"observed multi-drug therapy."},{"startTime":1455.05,"endTime":1456.59,"body":"On the left are the drugs."},{"startTime":1456.59,"endTime":1458.83,"body":"People would typically take"},{"startTime":1456.59,"endTime":1458.83,"body":"usually a smaller number"},{"startTime":1458.83,"endTime":1461.29,"body":"after the first couple of months."},{"startTime":1461.29,"endTime":1466.29,"body":"And on the right, one of the"},{"startTime":1461.29,"endTime":1466.29,"body":"buses that goes around London,"},{"startTime":1466.36,"endTime":1469.35,"body":"finding people who are homeless"},{"startTime":1469.35,"endTime":1470.84,"body":"and checking they don't have TB"},{"startTime":1470.84,"endTime":1472.47,"body":"'cause they're at particularly high risk,"},{"startTime":1472.47,"endTime":1473.98,"body":"and then treating them if they do."},{"startTime":1473.98,"endTime":1476.86,"body":"So, it's very important"},{"startTime":1473.98,"endTime":1476.86,"body":"to go out to find people"},{"startTime":1476.86,"endTime":1478.11,"body":"and then to treat them,"},{"startTime":1478.11,"endTime":1479.94,"body":"'cause this is both a preventable disease,"},{"startTime":1479.94,"endTime":1483.263,"body":"a serious disease, and a"},{"startTime":1479.94,"endTime":1483.263,"body":"highly transmissible disease."},{"startTime":1485.21,"endTime":1487.71,"body":"Now TB is a respiratory"},{"startTime":1485.21,"endTime":1487.71,"body":"transmitted disease."},{"startTime":1487.71,"endTime":1489.42,"body":"It does cause problems in lung,"},{"startTime":1489.42,"endTime":1491.87,"body":"but it is not just a lung disease."},{"startTime":1491.87,"endTime":1494.73,"body":"And so although old-fashioned"},{"startTime":1491.87,"endTime":1494.73,"body":"consumption with lung disease"},{"startTime":1494.73,"endTime":1497.14,"body":"killed many in the pre-treatment era,"},{"startTime":1497.14,"endTime":1498.5,"body":"you've got TB meningitis,"},{"startTime":1498.5,"endTime":1501.39,"body":"a very dangerous form of meningitis,"},{"startTime":1501.39,"endTime":1504.85,"body":"generalized TB, so called"},{"startTime":1501.39,"endTime":1504.85,"body":"miliary TB of the whole body,"},{"startTime":1504.85,"endTime":1507.92,"body":"TB around the heart, TB of the spine."},{"startTime":1507.92,"endTime":1510.12,"body":"And what we got here is an MRI of a spine"},{"startTime":1510.12,"endTime":1512.95,"body":"with someone who's got TB, of the kidneys,"},{"startTime":1512.95,"endTime":1515.02,"body":"of the glands and of the lymph node."},{"startTime":1515.02,"endTime":1516.443,"body":"So TB can get all around the body."},{"startTime":1516.443,"endTime":1519.11,"body":"It's not just in the lungs."},{"startTime":1519.11,"endTime":1519.96,"body":"And this is typical"},{"startTime":1519.96,"endTime":1523.0,"body":"for some of the major"},{"startTime":1519.96,"endTime":1523.0,"body":"respiratory infections"},{"startTime":1523.0,"endTime":1524.573,"body":"that we have to deal with."},{"startTime":1526.72,"endTime":1530.18,"body":"There is a vaccine for TB, this is BCG,"},{"startTime":1530.18,"endTime":1533.03,"body":"and this does help prevent severe disease,"},{"startTime":1533.03,"endTime":1535.523,"body":"but it is a limited"},{"startTime":1533.03,"endTime":1535.523,"body":"impact on transmission."},{"startTime":1536.46,"endTime":1539.0,"body":"It remains one of the"},{"startTime":1536.46,"endTime":1539.0,"body":"most widely used vaccines"},{"startTime":1539.0,"endTime":1542.48,"body":"in the world, but it's fairly effective"},{"startTime":1542.48,"endTime":1544.7,"body":"at preventing severe TB in children,"},{"startTime":1544.7,"endTime":1546.59,"body":"less effective in adults,"},{"startTime":1546.59,"endTime":1548.21,"body":"less effective in low income settings"},{"startTime":1548.21,"endTime":1549.52,"body":"for a variety of reasons,"},{"startTime":1549.52,"endTime":1551.653,"body":"and less effective against lung TB."},{"startTime":1553.13,"endTime":1555.94,"body":"And there are a variety of"},{"startTime":1553.13,"endTime":1555.94,"body":"new vaccines, but so far,"},{"startTime":1555.94,"endTime":1558.9,"body":"none of them have really proved"},{"startTime":1555.94,"endTime":1558.9,"body":"a significant improvement"},{"startTime":1558.9,"endTime":1560.83,"body":"on this really quite old vaccine."},{"startTime":1560.83,"endTime":1563.07,"body":"So for TB, rather like for HIV"},{"startTime":1563.07,"endTime":1565.11,"body":"which we talked about in the last lecture,"},{"startTime":1565.11,"endTime":1568.49,"body":"really the main basis of prevention"},{"startTime":1568.49,"endTime":1570.973,"body":"is finding cases and treating early."},{"startTime":1573.44,"endTime":1578.44,"body":"The outlook overall has"},{"startTime":1573.44,"endTime":1578.44,"body":"some very major pluses"},{"startTime":1578.55,"endTime":1582.393,"body":"over the next decades, but"},{"startTime":1578.55,"endTime":1582.393,"body":"also one significant threat."},{"startTime":1583.39,"endTime":1587.43,"body":"As internationally,"},{"startTime":1583.39,"endTime":1587.43,"body":"development is occurring,"},{"startTime":1587.43,"endTime":1590.82,"body":"people are moving out of poverty,"},{"startTime":1590.82,"endTime":1593.087,"body":"the general reduction in"},{"startTime":1590.82,"endTime":1593.087,"body":"global poverty improvements"},{"startTime":1593.087,"endTime":1596.6,"body":"and living standards"},{"startTime":1593.087,"endTime":1596.6,"body":"improvements in curative care"},{"startTime":1596.6,"endTime":1600.22,"body":"are likely to lead to"},{"startTime":1596.6,"endTime":1600.22,"body":"reductions in TB over time."},{"startTime":1600.22,"endTime":1602.08,"body":"We're getting improved diagnosis,"},{"startTime":1602.08,"endTime":1604.47,"body":"and there are improving treatments,"},{"startTime":1604.47,"endTime":1606.42,"body":"including shorter courses of treatment."},{"startTime":1607.32,"endTime":1609.49,"body":"And HIV has driven a lot of TB,"},{"startTime":1609.49,"endTime":1611.63,"body":"and the very effective treatment"},{"startTime":1611.63,"endTime":1614.72,"body":"and in some areas prevention of HIV"},{"startTime":1614.72,"endTime":1619.72,"body":"is also going to help have"},{"startTime":1614.72,"endTime":1619.72,"body":"an impact in improving TB."},{"startTime":1620.22,"endTime":1621.61,"body":"The threat, however,"},{"startTime":1621.61,"endTime":1625.87,"body":"is that we do have significant"},{"startTime":1621.61,"endTime":1625.87,"body":"multi-drug resistant TB,"},{"startTime":1625.87,"endTime":1630.87,"body":"remembering that the basis of"},{"startTime":1625.87,"endTime":1630.87,"body":"prevention of TB is treatment."},{"startTime":1630.88,"endTime":1633.29,"body":"And this map shows where"},{"startTime":1630.88,"endTime":1633.29,"body":"this is concentrated,"},{"startTime":1633.29,"endTime":1636.92,"body":"and it's actually concentrated"},{"startTime":1633.29,"endTime":1636.92,"body":"in particular, in some areas"},{"startTime":1636.92,"endTime":1639.213,"body":"including, for example, Eastern Europe."},{"startTime":1643.39,"endTime":1646.75,"body":"The other major mycobacterium of humans"},{"startTime":1646.75,"endTime":1648.6,"body":"that's transmitted this way is leprosy."},{"startTime":1648.6,"endTime":1649.57,"body":"And I'm illustrating this,"},{"startTime":1649.57,"endTime":1650.71,"body":"not because it's a common disease."},{"startTime":1650.71,"endTime":1652.88,"body":"Now it is much less common than it was,"},{"startTime":1652.88,"endTime":1654.64,"body":"but because here's an example of a disease"},{"startTime":1654.64,"endTime":1657.12,"body":"that you would not think of"},{"startTime":1654.64,"endTime":1657.12,"body":"as a respiratory infection,"},{"startTime":1657.12,"endTime":1660.69,"body":"but this is in fact how it's"},{"startTime":1657.12,"endTime":1660.69,"body":"thought to be transmitted."},{"startTime":1660.69,"endTime":1663.68,"body":"One of the most feared"},{"startTime":1660.69,"endTime":1663.68,"body":"and stigmatized diseases"},{"startTime":1664.81,"endTime":1668.2,"body":"if you look through both"},{"startTime":1664.81,"endTime":1668.2,"body":"historically and now."},{"startTime":1668.2,"endTime":1670.75,"body":"And transmission is"},{"startTime":1668.2,"endTime":1670.75,"body":"probably through droplets"},{"startTime":1670.75,"endTime":1672.35,"body":"through from the nose and mouth."},{"startTime":1673.53,"endTime":1676.35,"body":"Transmission needs very"},{"startTime":1673.53,"endTime":1676.35,"body":"close prolonged contact."},{"startTime":1676.35,"endTime":1678.17,"body":"This is not something you would catch"},{"startTime":1678.17,"endTime":1682.583,"body":"from being a few meters"},{"startTime":1678.17,"endTime":1682.583,"body":"away from someone in a room."},{"startTime":1684.33,"endTime":1687.05,"body":"Its effect however, once"},{"startTime":1684.33,"endTime":1687.05,"body":"it's got into the body"},{"startTime":1687.05,"endTime":1691.52,"body":"is really devastating for"},{"startTime":1687.05,"endTime":1691.52,"body":"individuals, destroys nerves,"},{"startTime":1691.52,"endTime":1695.7,"body":"can make people blind, and"},{"startTime":1691.52,"endTime":1695.7,"body":"has a whole variety of impacts"},{"startTime":1695.7,"endTime":1696.61,"body":"as a result of that."},{"startTime":1696.61,"endTime":1698.33,"body":"And this gentleman here,"},{"startTime":1698.33,"endTime":1701.71,"body":"you can see the effects of leprosy on him,"},{"startTime":1701.71,"endTime":1705.663,"body":"and you can just see what that"},{"startTime":1701.71,"endTime":1705.663,"body":"would do to his life chances."},{"startTime":1707.08,"endTime":1710.5,"body":"There is however effective"},{"startTime":1707.08,"endTime":1710.5,"body":"multi-drug treatment,"},{"startTime":1710.5,"endTime":1712.5,"body":"some similarities to TB treatment,"},{"startTime":1712.5,"endTime":1714.16,"body":"and BCG, the same vaccine"},{"startTime":1714.16,"endTime":1716.43,"body":"is actually a fairly effective vaccine"},{"startTime":1716.43,"endTime":1718.63,"body":"against leprosy as well."},{"startTime":1718.63,"endTime":1722.25,"body":"And so this disease, which"},{"startTime":1718.63,"endTime":1722.25,"body":"had tens of millions of cases"},{"startTime":1722.25,"endTime":1725.26,"body":"as late as the 1960s is much rarer now."},{"startTime":1725.26,"endTime":1727.45,"body":"Many people are still living"},{"startTime":1725.26,"endTime":1727.45,"body":"with the after effects"},{"startTime":1727.45,"endTime":1730.86,"body":"of leprosy, but in terms of new cases,"},{"startTime":1730.86,"endTime":1733.45,"body":"this is now fairly highly concentrated"},{"startTime":1733.45,"endTime":1735.583,"body":"in a small number of countries."},{"startTime":1739.15,"endTime":1739.983,"body":"I now like to..."},{"startTime":1739.983,"endTime":1741.9,"body":"There's a few other examples of diseases"},{"startTime":1741.9,"endTime":1744.27,"body":"which go through the respiratory route,"},{"startTime":1744.27,"endTime":1746.74,"body":"but have their effect"},{"startTime":1744.27,"endTime":1746.74,"body":"elsewhere in the body."},{"startTime":1746.74,"endTime":1750.46,"body":"And diptheria is another"},{"startTime":1746.74,"endTime":1750.46,"body":"very major example of this."},{"startTime":1750.46,"endTime":1752.02,"body":"It used to be a major cause of death,"},{"startTime":1752.02,"endTime":1753.76,"body":"particularly in children."},{"startTime":1753.76,"endTime":1757.68,"body":"There were over a million"},{"startTime":1753.76,"endTime":1757.68,"body":"cases before the 1980s."},{"startTime":1757.68,"endTime":1759.81,"body":"It's mainly transmitted by droplets,"},{"startTime":1759.81,"endTime":1761.59,"body":"and it then colonizes the throat,"},{"startTime":1761.59,"endTime":1766.49,"body":"and the photo here really"},{"startTime":1761.59,"endTime":1766.49,"body":"shows a typical example"},{"startTime":1766.49,"endTime":1769.6,"body":"of someone with the diptheria,"},{"startTime":1766.49,"endTime":1769.6,"body":"infection of the throat."},{"startTime":1769.6,"endTime":1771.65,"body":"But the damage is caused by toxins"},{"startTime":1771.65,"endTime":1774.17,"body":"which are released by the bacteria."},{"startTime":1774.17,"endTime":1776.83,"body":"And they can either cause"},{"startTime":1774.17,"endTime":1776.83,"body":"massive swelling in the throat,"},{"startTime":1776.83,"endTime":1777.85,"body":"which can compress it,"},{"startTime":1777.85,"endTime":1780.82,"body":"almost strangling the person who has it,"},{"startTime":1780.82,"endTime":1783.1,"body":"or they can circulate in the body"},{"startTime":1783.1,"endTime":1785.1,"body":"and cause what's called heart block."},{"startTime":1785.1,"endTime":1788.38,"body":"So the heart can be highly affected"},{"startTime":1788.38,"endTime":1791.05,"body":"and in some cases"},{"startTime":1788.38,"endTime":1791.05,"body":"essentially stop working,"},{"startTime":1791.05,"endTime":1793.15,"body":"or peripheral nerve damage."},{"startTime":1793.15,"endTime":1794.85,"body":"So this is sitting in the throat,"},{"startTime":1794.85,"endTime":1797.21,"body":"but causing its life threatening effects"},{"startTime":1797.21,"endTime":1799.093,"body":"very often a long way from that."},{"startTime":1802.12,"endTime":1805.46,"body":"Diptheria has almost entirely gone"},{"startTime":1805.46,"endTime":1807.52,"body":"from high income countries now."},{"startTime":1807.52,"endTime":1810.62,"body":"And this is a combination of"},{"startTime":1807.52,"endTime":1810.62,"body":"improved living conditions,"},{"startTime":1810.62,"endTime":1812.56,"body":"people being less crowded,"},{"startTime":1812.56,"endTime":1815.77,"body":"antibiotics to treat people"},{"startTime":1812.56,"endTime":1815.77,"body":"when they have disease,"},{"startTime":1815.77,"endTime":1818.98,"body":"and vaccination, which"},{"startTime":1815.77,"endTime":1818.98,"body":"is around 95% effective."},{"startTime":1818.98,"endTime":1822.29,"body":"And if you look at the"},{"startTime":1818.98,"endTime":1822.29,"body":"time over a long period,"},{"startTime":1822.29,"endTime":1825.14,"body":"you can see the downward"},{"startTime":1822.29,"endTime":1825.14,"body":"pressure of diptheria"},{"startTime":1825.14,"endTime":1828.34,"body":"largely by improvements in"},{"startTime":1825.14,"endTime":1828.34,"body":"living, but on the right,"},{"startTime":1828.34,"endTime":1831.38,"body":"what you can see is what"},{"startTime":1828.34,"endTime":1831.38,"body":"happened to diptheria"},{"startTime":1831.38,"endTime":1832.75,"body":"when vaccines came in."},{"startTime":1832.75,"endTime":1835.18,"body":"So they had an extraordinary impact"},{"startTime":1835.18,"endTime":1838.023,"body":"in reducing this major killer of children."},{"startTime":1840.93,"endTime":1843.63,"body":"Another major killer of"},{"startTime":1840.93,"endTime":1843.63,"body":"children also now very rare,"},{"startTime":1843.63,"endTime":1844.713,"body":"rheumatic fever."},{"startTime":1845.6,"endTime":1847.55,"body":"This came from streptococcal sore throat,"},{"startTime":1847.55,"endTime":1849.38,"body":"a slightly different picture"},{"startTime":1847.55,"endTime":1849.38,"body":"on the back of the throat,"},{"startTime":1849.38,"endTime":1850.977,"body":"you can see here."},{"startTime":1850.977,"endTime":1853.023,"body":"Again, spread by droplets."},{"startTime":1854.24,"endTime":1856.62,"body":"This is not the infection"},{"startTime":1854.24,"endTime":1856.62,"body":"causing the problem,"},{"startTime":1856.62,"endTime":1859.04,"body":"but the immune response to the infection"},{"startTime":1859.04,"endTime":1861.82,"body":"can cause really serious"},{"startTime":1859.04,"endTime":1861.82,"body":"damage to the body."},{"startTime":1861.82,"endTime":1864.28,"body":"And three things tended to happen."},{"startTime":1864.28,"endTime":1867.203,"body":"Joint swellings, this is why"},{"startTime":1864.28,"endTime":1867.203,"body":"it's called rheumatic fever."},{"startTime":1868.46,"endTime":1869.41,"body":"Problems with the brain,"},{"startTime":1869.41,"endTime":1872.96,"body":"people had significant"},{"startTime":1869.41,"endTime":1872.96,"body":"neurological problems,"},{"startTime":1872.96,"endTime":1874.34,"body":"and also the skin,"},{"startTime":1874.34,"endTime":1877.76,"body":"but the really major one"},{"startTime":1874.34,"endTime":1877.76,"body":"was problems of the heart."},{"startTime":1877.76,"endTime":1882.76,"body":"And this caused lifelong damage"},{"startTime":1877.76,"endTime":1882.76,"body":"in children to heart valves,"},{"startTime":1883.03,"endTime":1884.84,"body":"that would cause them problems"},{"startTime":1883.03,"endTime":1884.84,"body":"for the rest of their life"},{"startTime":1884.84,"endTime":1887.3,"body":"and increase their risks"},{"startTime":1884.84,"endTime":1887.3,"body":"for example of stroke"},{"startTime":1887.3,"endTime":1888.52,"body":"at an early age."},{"startTime":1888.52,"endTime":1891.92,"body":"So rheumatic fever caused by"},{"startTime":1888.52,"endTime":1891.92,"body":"streptococcal sore throat,"},{"startTime":1891.92,"endTime":1895.453,"body":"another example of a generalized"},{"startTime":1891.92,"endTime":1895.453,"body":"disease from the throat."},{"startTime":1898.33,"endTime":1901.6,"body":"With a still, but again"},{"startTime":1898.33,"endTime":1901.6,"body":"significantly improved"},{"startTime":1901.6,"endTime":1905.91,"body":"as a result of modern"},{"startTime":1901.6,"endTime":1905.91,"body":"medical countermeasures,"},{"startTime":1905.91,"endTime":1908.46,"body":"bacterial meningitis and septicaemia."},{"startTime":1908.46,"endTime":1911.943,"body":"And the classic case for"},{"startTime":1908.46,"endTime":1911.943,"body":"this is Meningococcus."},{"startTime":1913.225,"endTime":1915.77,"body":"It's carried by about 10% of"},{"startTime":1913.225,"endTime":1915.77,"body":"adults in the nose or throat,"},{"startTime":1915.77,"endTime":1917.25,"body":"just completely normally."},{"startTime":1917.25,"endTime":1921.94,"body":"And it's transmitted by close"},{"startTime":1917.25,"endTime":1921.94,"body":"contact, coughing, kissing,"},{"startTime":1921.94,"endTime":1923.61,"body":"but not by casual contacts,"},{"startTime":1923.61,"endTime":1926.65,"body":"but people have to be relatively close."},{"startTime":1926.65,"endTime":1931.65,"body":"It can cause really rapid"},{"startTime":1926.65,"endTime":1931.65,"body":"onset menengitis or septicaemia"},{"startTime":1933.7,"endTime":1935.27,"body":"as seen in this child,"},{"startTime":1935.27,"endTime":1938.92,"body":"and her parents decided"},{"startTime":1935.27,"endTime":1938.92,"body":"they really wanted people"},{"startTime":1938.92,"endTime":1941.75,"body":"to understand how"},{"startTime":1938.92,"endTime":1941.75,"body":"serious this disease was,"},{"startTime":1941.75,"endTime":1945.75,"body":"so that they could prevent it or both."},{"startTime":1945.75,"endTime":1948.23,"body":"And a child can be playing in"},{"startTime":1945.75,"endTime":1948.23,"body":"the playground in the morning,"},{"startTime":1948.23,"endTime":1950.03,"body":"and intensive care by the evening."},{"startTime":1950.03,"endTime":1952.71,"body":"It's extraordinarily rapid onset."},{"startTime":1952.71,"endTime":1956.21,"body":"Untreated, a very high"},{"startTime":1952.71,"endTime":1956.21,"body":"mortality around 50%."},{"startTime":1956.21,"endTime":1958.06,"body":"It's antibiotic sensitive,"},{"startTime":1956.21,"endTime":1958.06,"body":"so you can treat it,"},{"startTime":1958.06,"endTime":1959.5,"body":"but you have to get in early."},{"startTime":1959.5,"endTime":1962.978,"body":"There are a variety of"},{"startTime":1959.5,"endTime":1962.978,"body":"different types of it."},{"startTime":1962.978,"endTime":1967.0,"body":"Which one's important depends"},{"startTime":1962.978,"endTime":1967.0,"body":"where in the world you are."},{"startTime":1967.0,"endTime":1968.65,"body":"But fortunately now,"},{"startTime":1968.65,"endTime":1972.123,"body":"we have effective vaccines"},{"startTime":1968.65,"endTime":1972.123,"body":"available for all of them."},{"startTime":1974.44,"endTime":1977.01,"body":"Globally, the most important"},{"startTime":1974.44,"endTime":1977.01,"body":"ones are Meningococcus A,"},{"startTime":1977.01,"endTime":1979.04,"body":"which is really dominant in Africa,"},{"startTime":1979.04,"endTime":1982.08,"body":"and B and C, which are"},{"startTime":1979.04,"endTime":1982.08,"body":"dominant here in the UK,"},{"startTime":1982.08,"endTime":1983.6,"body":"although rarer."},{"startTime":1983.6,"endTime":1987.4,"body":"There used to be massive"},{"startTime":1983.6,"endTime":1987.4,"body":"epidemics of meningococcus A"},{"startTime":1987.4,"endTime":1989.9,"body":"in west Africa, particularly"},{"startTime":1987.4,"endTime":1989.9,"body":"in the Sahara region."},{"startTime":1990.76,"endTime":1993.89,"body":"These have been virtually"},{"startTime":1990.76,"endTime":1993.89,"body":"eliminated by vaccination,"},{"startTime":1993.89,"endTime":1997.463,"body":"and there's been a over 70%"},{"startTime":1993.89,"endTime":1997.463,"body":"decline in meningitis cases."},{"startTime":1998.4,"endTime":2001.52,"body":"In the UK we've had a"},{"startTime":1998.4,"endTime":2001.52,"body":"significant reduction"},{"startTime":2001.52,"endTime":2004.68,"body":"in invasive meningococcal"},{"startTime":2001.52,"endTime":2004.68,"body":"disease, as I said,"},{"startTime":2004.68,"endTime":2007.23,"body":"potentially fatal disease in children"},{"startTime":2007.23,"endTime":2012.23,"body":"from over 2,500 cases at"},{"startTime":2007.23,"endTime":2012.23,"body":"the turn of the century,"},{"startTime":2012.82,"endTime":2016.783,"body":"through to about 755 more recently."},{"startTime":2017.81,"endTime":2020.89,"body":"And we've had first"},{"startTime":2017.81,"endTime":2020.89,"body":"Meningococcus C vaccine"},{"startTime":2020.89,"endTime":2025.89,"body":"available since 2000, and"},{"startTime":2020.89,"endTime":2025.89,"body":"Men B vaccine since 2015."},{"startTime":2026.72,"endTime":2029.55,"body":"As a result of these, we've"},{"startTime":2026.72,"endTime":2029.55,"body":"seen a steady reduction"},{"startTime":2029.55,"endTime":2033.36,"body":"in these major causes of"},{"startTime":2029.55,"endTime":2033.36,"body":"meningitis in children"},{"startTime":2033.36,"endTime":2035.283,"body":"and also in fact in adults."},{"startTime":2037.57,"endTime":2040.32,"body":"The other major bacterial"},{"startTime":2037.57,"endTime":2040.32,"body":"cause of meningitis in children"},{"startTime":2040.32,"endTime":2043.12,"body":"was Haemophilus influenzae b, Hib."},{"startTime":2043.12,"endTime":2046.62,"body":"Despite its name, a bacteria"},{"startTime":2043.12,"endTime":2046.62,"body":"rather than a virus."},{"startTime":2046.62,"endTime":2048.55,"body":"It was the commonest cause of meningitis"},{"startTime":2048.55,"endTime":2050.53,"body":"in the youngest children,"},{"startTime":2048.55,"endTime":2050.53,"body":"those under four."},{"startTime":2050.53,"endTime":2054.33,"body":"Again, passed on by droplets,"},{"startTime":2050.53,"endTime":2054.33,"body":"coughing and sneezing."},{"startTime":2054.33,"endTime":2057.07,"body":"One in 20 children who got this died."},{"startTime":2057.07,"endTime":2059.47,"body":"One in five who survived"},{"startTime":2059.47,"endTime":2061.44,"body":"were left with serious"},{"startTime":2059.47,"endTime":2061.44,"body":"neurological disability,"},{"startTime":2061.44,"endTime":2063.38,"body":"they will be lifelong."},{"startTime":2063.38,"endTime":2068.26,"body":"The Hib vaccine was introduced"},{"startTime":2063.38,"endTime":2068.26,"body":"in UK and Ireland in 1992."},{"startTime":2068.26,"endTime":2070.54,"body":"And it reduced the"},{"startTime":2068.26,"endTime":2070.54,"body":"incidents by more than 90%."},{"startTime":2070.54,"endTime":2074.74,"body":"And you can see again, the"},{"startTime":2070.54,"endTime":2074.74,"body":"dramatic impact of the vaccine"},{"startTime":2074.74,"endTime":2079.46,"body":"when it was introduced on this"},{"startTime":2074.74,"endTime":2079.46,"body":"major cause of meningitis,"},{"startTime":2079.46,"endTime":2081.58,"body":"death and disability in children."},{"startTime":2081.58,"endTime":2083.5,"body":"And then a catch up campaign"},{"startTime":2083.5,"endTime":2084.69,"body":"when there was a bit of a resurgence."},{"startTime":2084.69,"endTime":2087.913,"body":"So really big impact"},{"startTime":2084.69,"endTime":2087.913,"body":"from this vaccination."},{"startTime":2091.52,"endTime":2093.79,"body":"Measles is a disease"},{"startTime":2093.79,"endTime":2097.29,"body":"which I think is"},{"startTime":2093.79,"endTime":2097.29,"body":"underestimated by many people."},{"startTime":2097.29,"endTime":2099.0,"body":"It's spread by coughs and sneezes."},{"startTime":2099.0,"endTime":2102.38,"body":"Again, it's incredibly infectious."},{"startTime":2102.38,"endTime":2105.43,"body":"So if you are in a room"},{"startTime":2102.38,"endTime":2105.43,"body":"with immune naive children"},{"startTime":2105.43,"endTime":2107.14,"body":"or indeed adults,"},{"startTime":2107.14,"endTime":2110.07,"body":"and people around the"},{"startTime":2107.14,"endTime":2110.07,"body":"person who is infected,"},{"startTime":2110.07,"endTime":2112.27,"body":"around 90% of people would catch it."},{"startTime":2112.27,"endTime":2115.4,"body":"So this is extraordinarily easy to catch."},{"startTime":2115.4,"endTime":2119.37,"body":"And it can be in the"},{"startTime":2115.4,"endTime":2119.37,"body":"air for up to two hours"},{"startTime":2119.37,"endTime":2121.23,"body":"after someone has actually left the room."},{"startTime":2121.23,"endTime":2125.08,"body":"So, it's not even necessarily"},{"startTime":2121.23,"endTime":2125.08,"body":"you are actually in the room"},{"startTime":2125.08,"endTime":2125.913,"body":"with them."},{"startTime":2127.17,"endTime":2129.16,"body":"When it occurs in epidemics,"},{"startTime":2129.16,"endTime":2131.04,"body":"particularly in areas of poor nutrition,"},{"startTime":2131.04,"endTime":2134.43,"body":"the mortality rate can be extremely high,"},{"startTime":2134.43,"endTime":2137.1,"body":"and a mortality rate of five to 10%"},{"startTime":2137.1,"endTime":2138.5,"body":"can be seen in big epidemics,"},{"startTime":2138.5,"endTime":2141.49,"body":"particularly in areas where"},{"startTime":2138.5,"endTime":2141.49,"body":"there's low vitamin A."},{"startTime":2141.49,"endTime":2144.713,"body":"Vitamin A is a very major"},{"startTime":2141.49,"endTime":2144.713,"body":"protection against measles."},{"startTime":2145.61,"endTime":2148.45,"body":"Fortunately, there is a"},{"startTime":2145.61,"endTime":2148.45,"body":"highly effective vaccine"},{"startTime":2148.45,"endTime":2152.19,"body":"giving largely lifelong protection."},{"startTime":2152.19,"endTime":2154.62,"body":"The great majority of children"},{"startTime":2152.19,"endTime":2154.62,"body":"are vaccinated against it"},{"startTime":2154.62,"endTime":2158.57,"body":"through MMR, and that has led"},{"startTime":2154.62,"endTime":2158.57,"body":"to a significant reduction"},{"startTime":2158.57,"endTime":2159.683,"body":"in this disease."},{"startTime":2161.36,"endTime":2163.35,"body":"But it's not just the mortality"},{"startTime":2163.35,"endTime":2165.37,"body":"that is associated with big epidemics"},{"startTime":2165.37,"endTime":2166.66,"body":"we need to be aware of."},{"startTime":2166.66,"endTime":2170.35,"body":"It's also the fact that it"},{"startTime":2166.66,"endTime":2170.35,"body":"can cause significant rates"},{"startTime":2170.35,"endTime":2173.56,"body":"of measles encephalitis,"},{"startTime":2170.35,"endTime":2173.56,"body":"inflammation of the brain,"},{"startTime":2173.56,"endTime":2175.24,"body":"which can either be fatal"},{"startTime":2175.24,"endTime":2178.053,"body":"or leave people with"},{"startTime":2175.24,"endTime":2178.053,"body":"lifelong brain damage."},{"startTime":2179.48,"endTime":2182.53,"body":"So about one to three in a"},{"startTime":2179.48,"endTime":2182.53,"body":"thousand children with measles"},{"startTime":2182.53,"endTime":2185.07,"body":"will develop encephalitis with measles."},{"startTime":2185.07,"endTime":2190.03,"body":"Of these, around 10 to 15%"},{"startTime":2185.07,"endTime":2190.03,"body":"will die, and a further 25%"},{"startTime":2190.03,"endTime":2192.12,"body":"will be left with permanent"},{"startTime":2190.03,"endTime":2192.12,"body":"neurological damage."},{"startTime":2192.12,"endTime":2194.643,"body":"This is not a trivial disease."},{"startTime":2195.55,"endTime":2197.89,"body":"In addition, about one in a"},{"startTime":2195.55,"endTime":2197.89,"body":"thousand children with measles"},{"startTime":2197.89,"endTime":2199.95,"body":"will develop post-infectious encephalitis."},{"startTime":2199.95,"endTime":2203.65,"body":"This happens later on"},{"startTime":2199.95,"endTime":2203.65,"body":"and about one in 25,000"},{"startTime":2203.65,"endTime":2205.65,"body":"will develop a much later thing"},{"startTime":2205.65,"endTime":2208.08,"body":"called subacute sclerosing"},{"startTime":2205.65,"endTime":2208.08,"body":"panencephalitis,"},{"startTime":2208.08,"endTime":2211.25,"body":"again, inflammation of the"},{"startTime":2208.08,"endTime":2211.25,"body":"brain up to a year later,"},{"startTime":2211.25,"endTime":2212.37,"body":"usually fatal."},{"startTime":2212.37,"endTime":2215.27,"body":"So this is very serious,"},{"startTime":2212.37,"endTime":2215.27,"body":"indeed potentially."},{"startTime":2215.27,"endTime":2218.57,"body":"And this is in comparison to"},{"startTime":2215.27,"endTime":2218.57,"body":"much lower rates of people"},{"startTime":2218.57,"endTime":2221.12,"body":"who would develop any problems"},{"startTime":2218.57,"endTime":2221.12,"body":"with a measles vaccination."},{"startTime":2221.12,"endTime":2223.3,"body":"So the benefit to risk ratio"},{"startTime":2223.3,"endTime":2226.71,"body":"is really way over towards vaccination."},{"startTime":2226.71,"endTime":2230.69,"body":"I've illustrated this"},{"startTime":2226.71,"endTime":2230.69,"body":"with the very sad example"},{"startTime":2230.69,"endTime":2234.01,"body":"of Olivia Dahl, Roald Dahl's daughter"},{"startTime":2234.01,"endTime":2238.47,"body":"to whom \"The Big Friendly"},{"startTime":2234.01,"endTime":2238.47,"body":"Giant\" and the \"Giant Peach\""},{"startTime":2238.47,"endTime":2240.01,"body":"were both dedicated."},{"startTime":2240.01,"endTime":2243.75,"body":"She got measles, got"},{"startTime":2240.01,"endTime":2243.75,"body":"encephalitis and died,"},{"startTime":2243.75,"endTime":2246.22,"body":"and Roald Dahl campaigned for parents"},{"startTime":2246.22,"endTime":2249.363,"body":"to get their children"},{"startTime":2246.22,"endTime":2249.363,"body":"vaccinated as a result of that."},{"startTime":2251.37,"endTime":2255.55,"body":"The other two infections"},{"startTime":2251.37,"endTime":2255.55,"body":"which are in the MMR vaccine,"},{"startTime":2255.55,"endTime":2258.437,"body":"which are also transmitted"},{"startTime":2255.55,"endTime":2258.437,"body":"by the respiratory route"},{"startTime":2258.437,"endTime":2259.76,"body":"are mumps and rubella,"},{"startTime":2259.76,"endTime":2262.473,"body":"both almost entirely vaccine preventable."},{"startTime":2263.751,"endTime":2264.91,"body":"In pre-vaccine days,"},{"startTime":2264.91,"endTime":2268.28,"body":"around one in four cases of"},{"startTime":2264.91,"endTime":2268.28,"body":"viral meningitis in children"},{"startTime":2268.28,"endTime":2269.513,"body":"were from mumps."},{"startTime":2270.67,"endTime":2275.54,"body":"And mumps is passed on by"},{"startTime":2270.67,"endTime":2275.54,"body":"direct saliva and droplets."},{"startTime":2275.54,"endTime":2279.147,"body":"Rubella is otherwise"},{"startTime":2275.54,"endTime":2279.147,"body":"known as German measles,"},{"startTime":2279.147,"endTime":2281.67,"body":"has significant risk"},{"startTime":2279.147,"endTime":2281.67,"body":"slightly later in life."},{"startTime":2281.67,"endTime":2285.38,"body":"This is a risk in particular"},{"startTime":2281.67,"endTime":2285.38,"body":"in women who are pregnant,"},{"startTime":2285.38,"endTime":2287.16,"body":"a significant risk for miscarriage,"},{"startTime":2287.16,"endTime":2289.593,"body":"stillbirth and fetal abnormalities,"},{"startTime":2290.57,"endTime":2292.8,"body":"particularly if women"},{"startTime":2290.57,"endTime":2292.8,"body":"catch an early pregnancy,"},{"startTime":2292.8,"endTime":2294.75,"body":"again, passed on by droplets."},{"startTime":2294.75,"endTime":2297.6,"body":"All three of these diseases,"},{"startTime":2294.75,"endTime":2297.6,"body":"measles, mumps, and rubella"},{"startTime":2297.6,"endTime":2299.943,"body":"are prevented by a single vaccination."},{"startTime":2303.78,"endTime":2304.78,"body":"So those are diseases"},{"startTime":2304.78,"endTime":2307.74,"body":"which are diseases of the general body,"},{"startTime":2307.74,"endTime":2311.9,"body":"but where the transmission"},{"startTime":2307.74,"endTime":2311.9,"body":"is via the respiratory route."},{"startTime":2311.9,"endTime":2312.89,"body":"And very often,"},{"startTime":2312.89,"endTime":2315.59,"body":"the infection doesn't get"},{"startTime":2312.89,"endTime":2315.59,"body":"any further than the throat."},{"startTime":2316.72,"endTime":2318.483,"body":"Then we move on to pneumonia."},{"startTime":2319.5,"endTime":2321.8,"body":"Now, pneumonia, which is inflammation"},{"startTime":2321.8,"endTime":2326.8,"body":"and often a significant gas"},{"startTime":2321.8,"endTime":2326.8,"body":"exchange problems in the lung,"},{"startTime":2327.88,"endTime":2331.04,"body":"can be caused by bacteria, by viruses,"},{"startTime":2331.04,"endTime":2333.59,"body":"and occasionally by fungi"},{"startTime":2331.04,"endTime":2333.59,"body":"in the immunosuppressed."},{"startTime":2333.59,"endTime":2336.18,"body":"I won't deal with that in this talk,"},{"startTime":2336.18,"endTime":2338.89,"body":"but in people who got"},{"startTime":2336.18,"endTime":2338.89,"body":"significant immunosuppression,"},{"startTime":2338.89,"endTime":2342.92,"body":"this is a serious risk, very common."},{"startTime":2342.92,"endTime":2347.75,"body":"Around 450 million cases a"},{"startTime":2342.92,"endTime":2347.75,"body":"year globally of pneumonia."},{"startTime":2347.75,"endTime":2349.74,"body":"And in the pre-antibiotic era,"},{"startTime":2349.74,"endTime":2352.6,"body":"these would've killed people"},{"startTime":2349.74,"endTime":2352.6,"body":"throughout their lives,"},{"startTime":2352.6,"endTime":2354.41,"body":"so would, including young adults"},{"startTime":2354.41,"endTime":2356.363,"body":"were susceptible to dying of pneumonia."},{"startTime":2357.49,"endTime":2359.09,"body":"As a result of treatment,"},{"startTime":2359.09,"endTime":2364.09,"body":"deaths now tend to occur in"},{"startTime":2359.09,"endTime":2364.09,"body":"the very young, the very old,"},{"startTime":2364.2,"endTime":2366.64,"body":"those living in less wealthy countries,"},{"startTime":2366.64,"endTime":2368.64,"body":"and people who are immunosuppressed."},{"startTime":2368.64,"endTime":2370.21,"body":"So those are the groups who tend to die,"},{"startTime":2370.21,"endTime":2373.12,"body":"but pneumonia can happen at other stages."},{"startTime":2373.12,"endTime":2374.39,"body":"In many parts of the world,"},{"startTime":2374.39,"endTime":2376.8,"body":"pneumonia is the commonest"},{"startTime":2374.39,"endTime":2376.8,"body":"cause of mortality,"},{"startTime":2376.8,"endTime":2378.12,"body":"particularly in children"},{"startTime":2378.12,"endTime":2380.43,"body":"and particularly in low income countries,"},{"startTime":2380.43,"endTime":2382.77,"body":"but even in high income countries,"},{"startTime":2382.77,"endTime":2385.57,"body":"pneumonia is a significant"},{"startTime":2382.77,"endTime":2385.57,"body":"cause of mortality"},{"startTime":2385.57,"endTime":2387.81,"body":"particularly in older adults."},{"startTime":2387.81,"endTime":2392.13,"body":"And if you go into any hospital"},{"startTime":2387.81,"endTime":2392.13,"body":"ward particularly in winter,"},{"startTime":2392.13,"endTime":2393.93,"body":"you'll see many people who have pneumonia,"},{"startTime":2393.93,"endTime":2395.153,"body":"many of them very sick."},{"startTime":2397.46,"endTime":2401.93,"body":"The most common bacterial cause"},{"startTime":2397.46,"endTime":2401.93,"body":"is pneumococcal pneumonia."},{"startTime":2401.93,"endTime":2403.36,"body":"And this is a bacteria"},{"startTime":2403.36,"endTime":2405.34,"body":"which is carried in the"},{"startTime":2403.36,"endTime":2405.34,"body":"throats of many adults"},{"startTime":2405.34,"endTime":2408.53,"body":"and over half of preschool"},{"startTime":2405.34,"endTime":2408.53,"body":"children, so it's really common."},{"startTime":2408.53,"endTime":2412.15,"body":"It's transmitted by"},{"startTime":2408.53,"endTime":2412.15,"body":"droplets and by secretions."},{"startTime":2412.15,"endTime":2415.42,"body":"And it causes a pneumonia,"},{"startTime":2412.15,"endTime":2415.42,"body":"which is the commonest cause"},{"startTime":2415.42,"endTime":2420.283,"body":"of pneumonia certainly in"},{"startTime":2415.42,"endTime":2420.283,"body":"the UK and probably globally."},{"startTime":2421.14,"endTime":2423.37,"body":"It can be treated with antibiotics,"},{"startTime":2423.37,"endTime":2426.8,"body":"but obviously you need to"},{"startTime":2423.37,"endTime":2426.8,"body":"do so relatively early on."},{"startTime":2426.8,"endTime":2429.17,"body":"And this is an x-ray"},{"startTime":2429.17,"endTime":2431.68,"body":"of someone who's got a lobar pneumonia,"},{"startTime":2431.68,"endTime":2434.453,"body":"which would typically be"},{"startTime":2431.68,"endTime":2434.453,"body":"pneumococcal pneumonia."},{"startTime":2437.02,"endTime":2438.2,"body":"It doesn't just cause pneumonia."},{"startTime":2438.2,"endTime":2442.93,"body":"It also can cause meningitis,"},{"startTime":2438.2,"endTime":2442.93,"body":"and a generalized sepsis."},{"startTime":2442.93,"endTime":2444.91,"body":"And this is particularly a risk"},{"startTime":2444.91,"endTime":2449.26,"body":"for young children under"},{"startTime":2444.91,"endTime":2449.26,"body":"two and people over 65"},{"startTime":2449.26,"endTime":2451.403,"body":"as illustrated in this painting."},{"startTime":2453.0,"endTime":2456.94,"body":"There's a very high mortality"},{"startTime":2453.0,"endTime":2456.94,"body":"from pneumococcal meningitis,"},{"startTime":2456.94,"endTime":2459.52,"body":"and roughly one in five survivors"},{"startTime":2459.52,"endTime":2461.73,"body":"will have significant disability,"},{"startTime":2461.73,"endTime":2463.48,"body":"again, for the rest of their lives."},{"startTime":2464.53,"endTime":2468.61,"body":"There is a fairly effective"},{"startTime":2464.53,"endTime":2468.61,"body":"vaccine against pneumococcus,"},{"startTime":2468.61,"endTime":2472.05,"body":"but it's not as effective"},{"startTime":2468.61,"endTime":2472.05,"body":"as MMR vaccines for example,"},{"startTime":2472.05,"endTime":2474.19,"body":"but it is certainly well worth having"},{"startTime":2474.19,"endTime":2476.19,"body":"for something which is extremely common."},{"startTime":2477.97,"endTime":2481.17,"body":"And it's given slightly"},{"startTime":2477.97,"endTime":2481.17,"body":"differently in children"},{"startTime":2481.17,"endTime":2483.61,"body":"and in older adults who are the two groups"},{"startTime":2483.61,"endTime":2484.923,"body":"who are most at risk."},{"startTime":2486.13,"endTime":2489.69,"body":"And you can see in these"},{"startTime":2486.13,"endTime":2489.69,"body":"graphs what happened"},{"startTime":2489.69,"endTime":2491.42,"body":"when the initial vaccine"},{"startTime":2491.42,"endTime":2492.87,"body":"against seven of the different types,"},{"startTime":2492.87,"endTime":2495.67,"body":"'cause there are several"},{"startTime":2492.87,"endTime":2495.67,"body":"different types of pneumococcus,"},{"startTime":2495.67,"endTime":2498.613,"body":"were introduced in the UK first in 1996."},{"startTime":2499.659,"endTime":2503.393,"body":"And there was a real substantial"},{"startTime":2499.659,"endTime":2503.393,"body":"reduction in pneumococcus"},{"startTime":2504.41,"endTime":2506.9,"body":"as a result of this"},{"startTime":2504.41,"endTime":2506.9,"body":"particularly invasive disease"},{"startTime":2506.9,"endTime":2508.92,"body":"where it's picked up in the blood."},{"startTime":2508.92,"endTime":2512.06,"body":"But a slight increase in"},{"startTime":2508.92,"endTime":2512.06,"body":"other forms of pneumococcus,"},{"startTime":2512.06,"endTime":2514.41,"body":"and then that was replaced by something"},{"startTime":2514.41,"endTime":2517.0,"body":"which covered 13 different"},{"startTime":2514.41,"endTime":2517.0,"body":"types of pneumococcus,"},{"startTime":2517.0,"endTime":2518.73,"body":"and there was a further reduction."},{"startTime":2518.73,"endTime":2520.723,"body":"So this is a good vaccine."},{"startTime":2522.62,"endTime":2524.2,"body":"It's had a very big effect"},{"startTime":2524.2,"endTime":2528.28,"body":"when it comes to people who"},{"startTime":2524.2,"endTime":2528.28,"body":"have got serious illness,"},{"startTime":2528.28,"endTime":2530.39,"body":"also in older adults."},{"startTime":2530.39,"endTime":2532.04,"body":"And again, what you can see"},{"startTime":2532.04,"endTime":2536.13,"body":"is the initial vaccine reduction,"},{"startTime":2536.13,"endTime":2539.67,"body":"the types that were affected"},{"startTime":2536.13,"endTime":2539.67,"body":"by that vaccine went down,"},{"startTime":2539.67,"endTime":2540.64,"body":"the other types didn't,"},{"startTime":2540.64,"endTime":2542.53,"body":"and then we brought in the second one"},{"startTime":2542.53,"endTime":2546.46,"body":"with 13 Valeant vaccine and"},{"startTime":2542.53,"endTime":2546.46,"body":"further reduction pneumococcals."},{"startTime":2546.46,"endTime":2547.73,"body":"So these vaccines"},{"startTime":2547.73,"endTime":2550.333,"body":"have a significant effect"},{"startTime":2547.73,"endTime":2550.333,"body":"on invasive disease."},{"startTime":2551.99,"endTime":2554.73,"body":"They do also reduce pneumonia."},{"startTime":2554.73,"endTime":2558.58,"body":"And what this shows, these"},{"startTime":2554.73,"endTime":2558.58,"body":"are data from the USA."},{"startTime":2558.58,"endTime":2560.67,"body":"And they do lead to a"},{"startTime":2558.58,"endTime":2560.67,"body":"significant reduction"},{"startTime":2560.67,"endTime":2562.55,"body":"in number of hospitalizations"},{"startTime":2560.67,"endTime":2562.55,"body":"in pneumonia."},{"startTime":2562.55,"endTime":2564.92,"body":"But a lot of people still get pneumonia."},{"startTime":2564.92,"endTime":2566.68,"body":"So this is a good vaccine,"},{"startTime":2566.68,"endTime":2570.02,"body":"but it is only partially"},{"startTime":2566.68,"endTime":2570.02,"body":"effective, not fully effective."},{"startTime":2570.02,"endTime":2573.24,"body":"Now it is still much"},{"startTime":2570.02,"endTime":2573.24,"body":"better to have a vaccine"},{"startTime":2573.24,"endTime":2575.25,"body":"which significantly reduces your risk"},{"startTime":2575.25,"endTime":2578.2,"body":"of the most severe forms of infection"},{"startTime":2578.2,"endTime":2581.95,"body":"and has a reduction in"},{"startTime":2578.2,"endTime":2581.95,"body":"chance of pneumonia."},{"startTime":2581.95,"endTime":2582.82,"body":"But we shouldn't see it"},{"startTime":2582.82,"endTime":2584.33,"body":"as something that eliminates it completely"},{"startTime":2584.33,"endTime":2587.163,"body":"in the way that some of"},{"startTime":2584.33,"endTime":2587.163,"body":"the other vaccines can do."},{"startTime":2590.03,"endTime":2593.64,"body":"And looking at pneumonia"},{"startTime":2590.03,"endTime":2593.64,"body":"globally, under five deaths"},{"startTime":2593.64,"endTime":2597.69,"body":"due to lower respiratory"},{"startTime":2593.64,"endTime":2597.69,"body":"tract infections pneumonias"},{"startTime":2597.69,"endTime":2601.52,"body":"have decreased by an estimated 37%"},{"startTime":2601.52,"endTime":2605.297,"body":"just in the decade 2005 to 2015."},{"startTime":2605.297,"endTime":2607.12,"body":"And I would expect that to have continued"},{"startTime":2607.12,"endTime":2608.72,"body":"when this study is repeated,"},{"startTime":2608.72,"endTime":2610.66,"body":"I would expect this"},{"startTime":2608.72,"endTime":2610.66,"body":"improvement of continued."},{"startTime":2610.66,"endTime":2614.55,"body":"This is a combination of"},{"startTime":2610.66,"endTime":2614.55,"body":"vaccines being available,"},{"startTime":2614.55,"endTime":2618.65,"body":"antibiotics being available,"},{"startTime":2614.55,"endTime":2618.65,"body":"and improved living conditions"},{"startTime":2618.65,"endTime":2621.73,"body":"coming together to lead to"},{"startTime":2618.65,"endTime":2621.73,"body":"a significant improvement"},{"startTime":2621.73,"endTime":2625.053,"body":"in child mortality from pneumonia."},{"startTime":2628.84,"endTime":2632.23,"body":"Alongside these bacteria,"},{"startTime":2628.84,"endTime":2632.23,"body":"and there are several others,"},{"startTime":2632.23,"endTime":2635.28,"body":"I've just concentrated on"},{"startTime":2632.23,"endTime":2635.28,"body":"pneumococcus in particular,"},{"startTime":2635.28,"endTime":2638.12,"body":"viruses make up a very large"},{"startTime":2635.28,"endTime":2638.12,"body":"proportion of pneumonia."},{"startTime":2638.12,"endTime":2639.23,"body":"So there are lots of viral pneumonias,"},{"startTime":2639.23,"endTime":2641.85,"body":"and of course those"},{"startTime":2639.23,"endTime":2641.85,"body":"pneumonias do not get better"},{"startTime":2641.85,"endTime":2643.5,"body":"when you give people antibiotics."},{"startTime":2644.36,"endTime":2645.99,"body":"They are a large portion of pneumonias,"},{"startTime":2645.99,"endTime":2647.81,"body":"but a much smaller proportion of deaths."},{"startTime":2647.81,"endTime":2651.08,"body":"The bacterial pneumonias"},{"startTime":2647.81,"endTime":2651.08,"body":"tend to be more severe,"},{"startTime":2651.08,"endTime":2655.53,"body":"although you can get"},{"startTime":2651.08,"endTime":2655.53,"body":"significant pneumonias"},{"startTime":2655.53,"endTime":2658.29,"body":"with viruses as well,"},{"startTime":2655.53,"endTime":2658.29,"body":"particularly in children,"},{"startTime":2658.29,"endTime":2661.67,"body":"something called RSV,"},{"startTime":2658.29,"endTime":2661.67,"body":"respiratory syncytial virus"},{"startTime":2661.67,"endTime":2666.67,"body":"and influenza, both in"},{"startTime":2661.67,"endTime":2666.67,"body":"children and in older adults."},{"startTime":2667.67,"endTime":2670.64,"body":"Currently, no vaccine for RSV,"},{"startTime":2670.64,"endTime":2675.64,"body":"and as we'll come onto"},{"startTime":2670.64,"endTime":2675.64,"body":"influenza tends vary by season"},{"startTime":2676.09,"endTime":2676.923,"body":"and year."},{"startTime":2682.0,"endTime":2685.62,"body":"Now influenza, which is"},{"startTime":2682.0,"endTime":2685.62,"body":"the most important of these"},{"startTime":2685.62,"endTime":2688.74,"body":"that we really had for"},{"startTime":2685.62,"endTime":2688.74,"body":"the general population"},{"startTime":2688.74,"endTime":2693.483,"body":"until very recently, has"},{"startTime":2688.74,"endTime":2693.483,"body":"a very seasonal pattern."},{"startTime":2694.43,"endTime":2698.22,"body":"And so for seasonal flu, endemic flu,"},{"startTime":2698.22,"endTime":2701.83,"body":"it comes with some predictability"},{"startTime":2701.83,"endTime":2705.033,"body":"in the great majority of winters."},{"startTime":2706.04,"endTime":2711.04,"body":"And what you see is the"},{"startTime":2706.04,"endTime":2711.04,"body":"annual rate of flu globally"},{"startTime":2711.05,"endTime":2716.05,"body":"since 2009/10, when the"},{"startTime":2711.05,"endTime":2716.05,"body":"H1N1 swine flu pandemic"},{"startTime":2718.52,"endTime":2720.04,"body":"occurred globally,"},{"startTime":2720.04,"endTime":2722.79,"body":"and then what's happened every year since."},{"startTime":2722.79,"endTime":2725.92,"body":"And some years globally have"},{"startTime":2722.79,"endTime":2725.92,"body":"been more cases than others,"},{"startTime":2725.92,"endTime":2730.92,"body":"but every year, there's been"},{"startTime":2725.92,"endTime":2730.92,"body":"a flu outbreak in the winter."},{"startTime":2730.98,"endTime":2734.74,"body":"The exception is the last year"},{"startTime":2734.74,"endTime":2738.02,"body":"and so far in the UK this year,"},{"startTime":2738.02,"endTime":2740.76,"body":"where rates of flu have"},{"startTime":2738.02,"endTime":2740.76,"body":"been incredibly low."},{"startTime":2740.76,"endTime":2741.737,"body":"And the reason for that is that people"},{"startTime":2741.737,"endTime":2746.01,"body":"have been doing things"},{"startTime":2741.737,"endTime":2746.01,"body":"like social distancing,"},{"startTime":2746.01,"endTime":2748.64,"body":"which have reduced significantly the risks"},{"startTime":2748.64,"endTime":2752.45,"body":"of a whole range of"},{"startTime":2748.64,"endTime":2752.45,"body":"respiratory infections."},{"startTime":2752.45,"endTime":2754.05,"body":"And we've seen a real reduction"},{"startTime":2754.05,"endTime":2757.73,"body":"in many respiratory infection"},{"startTime":2754.05,"endTime":2757.73,"body":"as a result, particularly flu."},{"startTime":2757.73,"endTime":2758.563,"body":"And therefore,"},{"startTime":2758.563,"endTime":2762.86,"body":"as a positive benefit of"},{"startTime":2758.563,"endTime":2762.86,"body":"this over these two years"},{"startTime":2762.86,"endTime":2765.41,"body":"when hospitals have been"},{"startTime":2762.86,"endTime":2765.41,"body":"full of people with COVID,"},{"startTime":2765.41,"endTime":2767.55,"body":"flu rates have been much lower,"},{"startTime":2767.55,"endTime":2771.75,"body":"but we can anticipate they"},{"startTime":2767.55,"endTime":2771.75,"body":"will reestablish themselves"},{"startTime":2771.75,"endTime":2774.16,"body":"as measures are released"},{"startTime":2774.16,"endTime":2777.623,"body":"and people go back to more"},{"startTime":2774.16,"endTime":2777.623,"body":"normal behaviors over winter."},{"startTime":2781.34,"endTime":2786.34,"body":"Now although you tend to see"},{"startTime":2781.34,"endTime":2786.34,"body":"flu occurring every winter,"},{"startTime":2787.91,"endTime":2789.98,"body":"how big the peak is,"},{"startTime":2789.98,"endTime":2792.98,"body":"varies substantially"},{"startTime":2789.98,"endTime":2792.98,"body":"year on year in the UK"},{"startTime":2792.98,"endTime":2794.52,"body":"and indeed in every other country."},{"startTime":2794.52,"endTime":2796.89,"body":"And sometimes a year will be a lot worse,"},{"startTime":2796.89,"endTime":2799.19,"body":"and sometimes a a year"},{"startTime":2796.89,"endTime":2799.19,"body":"will be a lot better."},{"startTime":2799.19,"endTime":2801.94,"body":"They will occur at the same"},{"startTime":2799.19,"endTime":2801.94,"body":"time, but the size of the peak"},{"startTime":2801.94,"endTime":2803.3,"body":"can be very substantially different."},{"startTime":2803.3,"endTime":2804.8,"body":"And on the left, what I've got"},{"startTime":2804.8,"endTime":2808.9,"body":"is influenza-like GP consultations"},{"startTime":2804.8,"endTime":2808.9,"body":"showing the difference"},{"startTime":2808.9,"endTime":2812.34,"body":"between the 2009 pandemic year,"},{"startTime":2812.34,"endTime":2817.01,"body":"huge numbers of consultations"},{"startTime":2812.34,"endTime":2817.01,"body":"of GPs, and a typical flu year"},{"startTime":2817.01,"endTime":2819.3,"body":"where the numbers are much"},{"startTime":2817.01,"endTime":2819.3,"body":"lower and then the last years"},{"startTime":2819.3,"endTime":2822.233,"body":"where almost none have been seen at all."},{"startTime":2823.67,"endTime":2828.02,"body":"At the same time, some"},{"startTime":2823.67,"endTime":2828.02,"body":"of these flu viruses"},{"startTime":2828.02,"endTime":2831.64,"body":"are more likely to cause"},{"startTime":2828.02,"endTime":2831.64,"body":"severe disease than others."},{"startTime":2831.64,"endTime":2832.88,"body":"And that is a combination"},{"startTime":2832.88,"endTime":2835.3,"body":"of the intrinsic property of the virus,"},{"startTime":2835.3,"endTime":2840.3,"body":"but also how well matched"},{"startTime":2835.3,"endTime":2840.3,"body":"the vaccine is to the flu,"},{"startTime":2841.07,"endTime":2843.09,"body":"because flu changes every year."},{"startTime":2843.09,"endTime":2845.01,"body":"Every year we develop vaccines"},{"startTime":2845.01,"endTime":2848.02,"body":"that are meant for the seasonal flus."},{"startTime":2848.02,"endTime":2851.22,"body":"But if one of them is"},{"startTime":2848.02,"endTime":2851.22,"body":"slightly less well targeted,"},{"startTime":2851.22,"endTime":2853.36,"body":"you can have a more severe flu year."},{"startTime":2853.36,"endTime":2856.77,"body":"So it's a combination of"},{"startTime":2853.36,"endTime":2856.77,"body":"the virus and the vaccine."},{"startTime":2856.77,"endTime":2858.6,"body":"And what we have on the right here"},{"startTime":2858.6,"endTime":2862.84,"body":"is the annual cycle of increasing"},{"startTime":2858.6,"endTime":2862.84,"body":"mortality in the winter"},{"startTime":2862.84,"endTime":2864.16,"body":"and decreasing in the summer."},{"startTime":2864.16,"endTime":2868.02,"body":"That happens in all of Europe."},{"startTime":2868.02,"endTime":2870.25,"body":"And onto top of that, the black lines,"},{"startTime":2870.25,"endTime":2872.82,"body":"the blue lines is kind"},{"startTime":2870.25,"endTime":2872.82,"body":"of the underlying rate."},{"startTime":2872.82,"endTime":2875.94,"body":"On top of that, the black"},{"startTime":2872.82,"endTime":2875.94,"body":"line is the excess mortality."},{"startTime":2875.94,"endTime":2877.57,"body":"And what you can see is some years,"},{"startTime":2877.57,"endTime":2881.33,"body":"substantial excess mortality"},{"startTime":2877.57,"endTime":2881.33,"body":"above what you'd expect."},{"startTime":2881.33,"endTime":2884.86,"body":"In other years is pretty well"},{"startTime":2881.33,"endTime":2884.86,"body":"bang on what you'd expect."},{"startTime":2884.86,"endTime":2886.42,"body":"And that's because in certain years,"},{"startTime":2886.42,"endTime":2889.77,"body":"the flu either was more"},{"startTime":2886.42,"endTime":2889.77,"body":"severe, was more common,"},{"startTime":2889.77,"endTime":2892.653,"body":"or was less well matched to the vaccine."},{"startTime":2893.93,"endTime":2898.93,"body":"By contrast, the HIN1"},{"startTime":2893.93,"endTime":2898.93,"body":"influenza pandemic of 1918"},{"startTime":2899.02,"endTime":2902.02,"body":"just over a century ago, probably killed,"},{"startTime":2902.02,"endTime":2903.34,"body":"estimates vary quite a lot,"},{"startTime":2903.34,"endTime":2906.223,"body":"but 50 to 100 million people globally."},{"startTime":2907.55,"endTime":2910.78,"body":"And people died of"},{"startTime":2907.55,"endTime":2910.78,"body":"primary viral pneumonia,"},{"startTime":2910.78,"endTime":2914.6,"body":"and also of a secondary"},{"startTime":2910.78,"endTime":2914.6,"body":"bacterial pneumonia,"},{"startTime":2914.6,"endTime":2918.17,"body":"and that may well have killed"},{"startTime":2914.6,"endTime":2918.17,"body":"even the majority of people."},{"startTime":2918.17,"endTime":2920.44,"body":"And that would be much less in this era"},{"startTime":2920.44,"endTime":2922.49,"body":"because of antibiotics."},{"startTime":2922.49,"endTime":2926.84,"body":"But this was a really"},{"startTime":2922.49,"endTime":2926.84,"body":"massive impact globally."},{"startTime":2926.84,"endTime":2929.48,"body":"And two things are probably"},{"startTime":2926.84,"endTime":2929.48,"body":"worth highlighting."},{"startTime":2929.48,"endTime":2932.763,"body":"On the right here, just"},{"startTime":2929.48,"endTime":2932.763,"body":"for a sense of perspective,"},{"startTime":2933.63,"endTime":2935.97,"body":"the number of people in the US"},{"startTime":2935.97,"endTime":2939.98,"body":"who died in the 1918 flu pandemic"},{"startTime":2939.98,"endTime":2942.4,"body":"compared to the total number of people"},{"startTime":2942.4,"endTime":2946.87,"body":"who died in every war the US took part in,"},{"startTime":2946.87,"endTime":2949.92,"body":"World War I, World War"},{"startTime":2946.87,"endTime":2949.92,"body":"II, Korea, and Vietnam."},{"startTime":2949.92,"endTime":2951.81,"body":"And if you put all of those together,"},{"startTime":2951.81,"endTime":2954.65,"body":"more people died in this single pandemic."},{"startTime":2954.65,"endTime":2956.66,"body":"So it was a really massive event."},{"startTime":2956.66,"endTime":2958.49,"body":"It happened incredibly fast"},{"startTime":2958.49,"endTime":2960.61,"body":"over a relatively short period of time."},{"startTime":2960.61,"endTime":2965.01,"body":"And importantly, it had a very"},{"startTime":2960.61,"endTime":2965.01,"body":"different pattern of severity"},{"startTime":2965.01,"endTime":2968.92,"body":"and who died to what we've"},{"startTime":2965.01,"endTime":2968.92,"body":"seen with, for example, COVID,"},{"startTime":2968.92,"endTime":2970.67,"body":"and what we see in a typical flu year."},{"startTime":2970.67,"endTime":2972.12,"body":"So in a typical flu year,"},{"startTime":2972.12,"endTime":2974.94,"body":"what you see is very elderly"},{"startTime":2972.12,"endTime":2974.94,"body":"people and very young children"},{"startTime":2974.94,"endTime":2976.423,"body":"are most at risk of flu."},{"startTime":2978.25,"endTime":2981.35,"body":"In the flu pandemic,"},{"startTime":2978.25,"endTime":2981.35,"body":"those groups are at risk,"},{"startTime":2981.35,"endTime":2984.37,"body":"but also on the left here,"},{"startTime":2981.35,"endTime":2984.37,"body":"what we have is the ages,"},{"startTime":2984.37,"endTime":2987.69,"body":"a significant peak of"},{"startTime":2984.37,"endTime":2987.69,"body":"people who are young adults."},{"startTime":2987.69,"endTime":2988.66,"body":"And as a result of that,"},{"startTime":2988.66,"endTime":2992.09,"body":"there was mortality all"},{"startTime":2988.66,"endTime":2992.09,"body":"across the age spectrum."},{"startTime":2992.09,"endTime":2994.05,"body":"This is quite different"},{"startTime":2992.09,"endTime":2994.05,"body":"from let's say COVID"},{"startTime":2994.05,"endTime":2996.2,"body":"where apart from people"},{"startTime":2994.05,"endTime":2996.2,"body":"who are immunosuppressed,"},{"startTime":2996.2,"endTime":2998.49,"body":"the really big, heavy burden of disease"},{"startTime":2998.49,"endTime":3000.5,"body":"in terms of mortality and severe disease"},{"startTime":3000.5,"endTime":3003.903,"body":"has fallen almost entirely"},{"startTime":3000.5,"endTime":3003.903,"body":"on older citizens,"},{"startTime":3007.12,"endTime":3010.213,"body":"which brings us finally to COVID-19."},{"startTime":3011.69,"endTime":3014.31,"body":"Now I've full lecture on"},{"startTime":3011.69,"endTime":3014.31,"body":"COVID early in the pandemic,"},{"startTime":3014.31,"endTime":3016.46,"body":"and I'm not going to"},{"startTime":3014.31,"endTime":3016.46,"body":"cover the same ground,"},{"startTime":3016.46,"endTime":3021.46,"body":"but many of the things I laid"},{"startTime":3016.46,"endTime":3021.46,"body":"out there remain current,"},{"startTime":3022.36,"endTime":3024.56,"body":"some of them have moved on."},{"startTime":3024.56,"endTime":3026.22,"body":"And I've also talked about the vaccines"},{"startTime":3026.22,"endTime":3027.21,"body":"in a lecture about vaccines."},{"startTime":3027.21,"endTime":3028.52,"body":"So I don't want to, again,"},{"startTime":3028.52,"endTime":3031.9,"body":"cover things I've"},{"startTime":3028.52,"endTime":3031.9,"body":"recently covered on this,"},{"startTime":3031.9,"endTime":3034.47,"body":"but I think there are some"},{"startTime":3031.9,"endTime":3034.47,"body":"important things to bring out"},{"startTime":3034.47,"endTime":3035.94,"body":"from COVID 19,"},{"startTime":3035.94,"endTime":3040.5,"body":"which is a major respiratory"},{"startTime":3035.94,"endTime":3040.5,"body":"transmitted pandemic."},{"startTime":3040.5,"endTime":3042.13,"body":"The early transmission,"},{"startTime":3042.13,"endTime":3044.22,"body":"I think everyone knows started in Wuhan"},{"startTime":3044.22,"endTime":3046.63,"body":"and then spread rapidly through China,"},{"startTime":3046.63,"endTime":3048.24,"body":"and then rapidly worldwide."},{"startTime":3048.24,"endTime":3050.83,"body":"So this demonstrates"},{"startTime":3048.24,"endTime":3050.83,"body":"the extraordinary speed"},{"startTime":3050.83,"endTime":3053.55,"body":"at which a respiratory"},{"startTime":3050.83,"endTime":3053.55,"body":"transmitted infection,"},{"startTime":3053.55,"endTime":3056.82,"body":"because it can transmit between strangers,"},{"startTime":3056.82,"endTime":3060.34,"body":"can actually achieve, its global spread"},{"startTime":3060.34,"endTime":3063.13,"body":"was over a matter of weeks."},{"startTime":3063.13,"endTime":3065.9,"body":"Prior to COVID, we had had experience"},{"startTime":3065.9,"endTime":3068.36,"body":"of four previous human coronaviruses"},{"startTime":3068.36,"endTime":3069.87,"body":"and two other coronaviruses"},{"startTime":3069.87,"endTime":3071.953,"body":"that had jumped species into humans."},{"startTime":3072.98,"endTime":3076.25,"body":"The four human coronaviruses"},{"startTime":3072.98,"endTime":3076.25,"body":"named (indistinct) 229E"},{"startTime":3077.11,"endTime":3081.83,"body":"and similar names generally"},{"startTime":3077.11,"endTime":3081.83,"body":"cause coals and sore throats."},{"startTime":3081.83,"endTime":3086.43,"body":"They're often quite common, and"},{"startTime":3081.83,"endTime":3086.43,"body":"they're very rarely serious."},{"startTime":3086.43,"endTime":3091.11,"body":"At the other extreme, we'd"},{"startTime":3086.43,"endTime":3091.11,"body":"had two coronaviruses,"},{"startTime":3091.11,"endTime":3093.93,"body":"the first of importance,"},{"startTime":3091.11,"endTime":3093.93,"body":"not chronologically,"},{"startTime":3093.93,"endTime":3095.847,"body":"but is MERS-CoV."},{"startTime":3096.89,"endTime":3098.47,"body":"This has been passed on"},{"startTime":3098.47,"endTime":3101.92,"body":"mainly by dromedaries in the"},{"startTime":3098.47,"endTime":3101.92,"body":"Arabian Peninsula to humans,"},{"startTime":3101.92,"endTime":3103.613,"body":"and some human to human spread."},{"startTime":3104.8,"endTime":3108.623,"body":"This has typically had a"},{"startTime":3104.8,"endTime":3108.623,"body":"35% case fatality rate,"},{"startTime":3109.6,"endTime":3111.5,"body":"and there was one significant outbreak"},{"startTime":3111.5,"endTime":3112.84,"body":"in South Korea in 2015,"},{"startTime":3113.8,"endTime":3116.2,"body":"brought under control by"},{"startTime":3113.8,"endTime":3116.2,"body":"public health measures."},{"startTime":3117.78,"endTime":3121.53,"body":"We also had slightly earlier, SARS,"},{"startTime":3121.53,"endTime":3125.85,"body":"which came from coronaviruses"},{"startTime":3121.53,"endTime":3125.85,"body":"in bats in China,"},{"startTime":3125.85,"endTime":3126.7,"body":"almost certainty."},{"startTime":3127.64,"endTime":3132.64,"body":"Just over 8,400 cases, less"},{"startTime":3127.64,"endTime":3132.64,"body":"than a thousand deaths."},{"startTime":3132.83,"endTime":3136.07,"body":"But this did have a"},{"startTime":3132.83,"endTime":3136.07,"body":"significant mortality rate."},{"startTime":3136.07,"endTime":3141.04,"body":"So, somewhere between 11"},{"startTime":3136.07,"endTime":3141.04,"body":"and 15% case fatality rates."},{"startTime":3141.04,"endTime":3142.65,"body":"So four coronavirus,"},{"startTime":3142.65,"endTime":3146.69,"body":"we had experience of both mild"},{"startTime":3142.65,"endTime":3146.69,"body":"forms and more severe ones."},{"startTime":3146.69,"endTime":3150.173,"body":"COVID-19 fell between these two."},{"startTime":3152.21,"endTime":3154.5,"body":"The thing which I want to"},{"startTime":3152.21,"endTime":3154.5,"body":"really highlight in this talk"},{"startTime":3154.5,"endTime":3158.19,"body":"in addition to points I've"},{"startTime":3154.5,"endTime":3158.19,"body":"made in previous ones on COVID,"},{"startTime":3158.19,"endTime":3161.76,"body":"is just ready to look at"},{"startTime":3158.19,"endTime":3161.76,"body":"what has happened in the UK"},{"startTime":3161.76,"endTime":3163.17,"body":"as an example,"},{"startTime":3163.17,"endTime":3167.54,"body":"over the period that we've"},{"startTime":3163.17,"endTime":3167.54,"body":"been suffering this pandemic,"},{"startTime":3167.54,"endTime":3171.12,"body":"remembering that it is only two years"},{"startTime":3171.12,"endTime":3174.033,"body":"since the first cases"},{"startTime":3171.12,"endTime":3174.033,"body":"arose back in the UK."},{"startTime":3175.06,"endTime":3179.64,"body":"The first wave that we received in the UK,"},{"startTime":3179.64,"endTime":3182.0,"body":"we had very limited diagnostic tests."},{"startTime":3182.0,"endTime":3183.25,"body":"In fact, one of the issues we had"},{"startTime":3183.25,"endTime":3184.68,"body":"is we didn't really see the wave"},{"startTime":3184.68,"endTime":3187.4,"body":"until it had actually started"},{"startTime":3184.68,"endTime":3187.4,"body":"putting people into hospitals"},{"startTime":3187.4,"endTime":3189.7,"body":"'cause there weren't"},{"startTime":3187.4,"endTime":3189.7,"body":"sufficient diagnostic tests."},{"startTime":3189.7,"endTime":3192.59,"body":"We had no known treatment for it."},{"startTime":3192.59,"endTime":3194.58,"body":"We had no vaccine and we didn't know"},{"startTime":3194.58,"endTime":3197.22,"body":"whether we were going to"},{"startTime":3194.58,"endTime":3197.22,"body":"get a vaccine at that stage."},{"startTime":3197.22,"endTime":3200.063,"body":"And we had no population immunity at all."},{"startTime":3201.68,"endTime":3205.59,"body":"We were therefore entirely"},{"startTime":3201.68,"endTime":3205.59,"body":"dependent on social measures"},{"startTime":3205.59,"endTime":3209.73,"body":"to limit damage from cases,"},{"startTime":3209.73,"endTime":3212.92,"body":"hospitalizations which"},{"startTime":3209.73,"endTime":3212.92,"body":"threatened to overwhelm the NHS,"},{"startTime":3212.92,"endTime":3214.16,"body":"and deaths."},{"startTime":3214.16,"endTime":3216.413,"body":"And it was due to everybody"},{"startTime":3216.413,"endTime":3219.35,"body":"taking really extreme"},{"startTime":3216.413,"endTime":3219.35,"body":"social distancing measures,"},{"startTime":3219.35,"endTime":3221.52,"body":"because those were the only things we had,"},{"startTime":3221.52,"endTime":3223.81,"body":"to limit spread through the population"},{"startTime":3223.81,"endTime":3225.165,"body":"that we brought this wave under control"},{"startTime":3225.165,"endTime":3228.4,"body":"and prevented the NHS being overwhelmed"},{"startTime":3228.4,"endTime":3231.2,"body":"and many more deaths than"},{"startTime":3228.4,"endTime":3231.2,"body":"would otherwise have occurred."},{"startTime":3232.6,"endTime":3235.0,"body":"There was then a beginning of a wave"},{"startTime":3235.0,"endTime":3236.67,"body":"that was from the original variant"},{"startTime":3236.67,"endTime":3239.37,"body":"and then the Alpha wave on top of that,"},{"startTime":3239.37,"endTime":3242.58,"body":"which occurred in the winter of last year."},{"startTime":3242.58,"endTime":3244.4,"body":"By that stage, we had"},{"startTime":3242.58,"endTime":3244.4,"body":"good diagnostic tests."},{"startTime":3244.4,"endTime":3246.59,"body":"So we saw this at a fairly"},{"startTime":3244.4,"endTime":3246.59,"body":"early stage and it allowed us"},{"startTime":3246.59,"endTime":3250.02,"body":"to help concentrate our care much better."},{"startTime":3250.02,"endTime":3251.36,"body":"There was better hospital treatment."},{"startTime":3251.36,"endTime":3253.01,"body":"Several things had been developed"},{"startTime":3253.01,"endTime":3255.473,"body":"that led to mortality rates going down."},{"startTime":3256.34,"endTime":3258.04,"body":"We had some early vaccine rollout,"},{"startTime":3258.04,"endTime":3259.96,"body":"but only to the very"},{"startTime":3258.04,"endTime":3259.96,"body":"top end of the age range"},{"startTime":3259.96,"endTime":3263.97,"body":"when this really was going, and"},{"startTime":3259.96,"endTime":3263.97,"body":"no antivirals at that stage."},{"startTime":3263.97,"endTime":3268.093,"body":"So we were still heavily"},{"startTime":3263.97,"endTime":3268.093,"body":"dependent on social measures."},{"startTime":3269.06,"endTime":3271.36,"body":"Although we could see"},{"startTime":3269.06,"endTime":3271.36,"body":"an exit by this point,"},{"startTime":3271.36,"endTime":3272.74,"body":"'cause we had a vaccine,"},{"startTime":3272.74,"endTime":3274.923,"body":"and we were beginning to"},{"startTime":3272.74,"endTime":3274.923,"body":"get better treatments."},{"startTime":3275.89,"endTime":3278.55,"body":"By the point that the Delta wave hit,"},{"startTime":3278.55,"endTime":3281.15,"body":"which was really the third major event,"},{"startTime":3281.15,"endTime":3282.65,"body":"we now had vaccines rolled out."},{"startTime":3282.65,"endTime":3284.17,"body":"So we had really quite high levels"},{"startTime":3284.17,"endTime":3286.72,"body":"of protective population immunity,"},{"startTime":3286.72,"endTime":3289.55,"body":"not complete, but really quite high."},{"startTime":3289.55,"endTime":3291.37,"body":"We also had better treatments"},{"startTime":3291.37,"endTime":3292.93,"body":"on top of the ones we previously had"},{"startTime":3292.93,"endTime":3294.49,"body":"still have the diagnostics."},{"startTime":3294.49,"endTime":3298.12,"body":"So we did need social measures,"},{"startTime":3294.49,"endTime":3298.12,"body":"but they were more limited"},{"startTime":3298.12,"endTime":3300.61,"body":"because we were able to"},{"startTime":3298.12,"endTime":3300.61,"body":"put a lot more weight"},{"startTime":3300.61,"endTime":3302.67,"body":"on the medical"},{"startTime":3300.61,"endTime":3302.67,"body":"countermeasures of vaccines,"},{"startTime":3302.67,"endTime":3304.73,"body":"drugs and diagnostics,"},{"startTime":3304.73,"endTime":3307.95,"body":"but we still required population measures."},{"startTime":3307.95,"endTime":3310.05,"body":"And finally we had the Omicron wave,"},{"startTime":3310.05,"endTime":3313.75,"body":"which we are still in the throes of,"},{"startTime":3313.75,"endTime":3316.18,"body":"and now we have a vaccine plus a booster."},{"startTime":3316.18,"endTime":3317.5,"body":"We have some antivirals."},{"startTime":3317.5,"endTime":3320.149,"body":"So some people are being"},{"startTime":3317.5,"endTime":3320.149,"body":"detected early and treated"},{"startTime":3320.149,"endTime":3322.23,"body":"and that stops them"},{"startTime":3320.149,"endTime":3322.23,"body":"developing severe disease"},{"startTime":3322.23,"endTime":3323.51,"body":"and going to hospital."},{"startTime":3323.51,"endTime":3326.14,"body":"And we also had a less severe variant,"},{"startTime":3326.14,"endTime":3328.76,"body":"but still, substantial"},{"startTime":3326.14,"endTime":3328.76,"body":"numbers of hospitalizations."},{"startTime":3328.76,"endTime":3331.76,"body":"People say this is mild. This is not mild."},{"startTime":3331.76,"endTime":3335.783,"body":"It is less, it is still more"},{"startTime":3331.76,"endTime":3335.783,"body":"significant than seasonal flu."},{"startTime":3335.783,"endTime":3337.97,"body":"It's still substantially more significant"},{"startTime":3337.97,"endTime":3339.71,"body":"than other coronaviruses,"},{"startTime":3339.71,"endTime":3342.22,"body":"but it certainly is a less severe variant."},{"startTime":3342.22,"endTime":3345.43,"body":"And that's an important"},{"startTime":3342.22,"endTime":3345.43,"body":"part of what has happened."},{"startTime":3345.43,"endTime":3348.77,"body":"But in countries where"},{"startTime":3345.43,"endTime":3348.77,"body":"there's less vaccination,"},{"startTime":3348.77,"endTime":3349.93,"body":"the impact of the Omicron wave"},{"startTime":3349.93,"endTime":3351.793,"body":"has been significantly greater."},{"startTime":3352.94,"endTime":3354.71,"body":"So if we just look at"},{"startTime":3352.94,"endTime":3354.71,"body":"what happened on these"},{"startTime":3354.71,"endTime":3356.205,"body":"and these are familiar charts,"},{"startTime":3356.205,"endTime":3359.3,"body":"but I want to make a"},{"startTime":3356.205,"endTime":3359.3,"body":"general point about this."},{"startTime":3359.3,"endTime":3361.21,"body":"This is COVID cases over time."},{"startTime":3361.21,"endTime":3364.36,"body":"And what we see is the first"},{"startTime":3361.21,"endTime":3364.36,"body":"wave really, we didn't see"},{"startTime":3364.36,"endTime":3366.04,"body":"because we didn't have"},{"startTime":3364.36,"endTime":3366.04,"body":"the diagnostic capacity."},{"startTime":3366.04,"endTime":3369.84,"body":"This is really a case"},{"startTime":3366.04,"endTime":3369.84,"body":"ascertainment problem."},{"startTime":3369.84,"endTime":3371.86,"body":"But by the time he came"},{"startTime":3369.84,"endTime":3371.86,"body":"to the second wave,"},{"startTime":3371.86,"endTime":3376.1,"body":"initially original variant"},{"startTime":3371.86,"endTime":3376.1,"body":"and then the Alpha wave,"},{"startTime":3376.1,"endTime":3377.717,"body":"significant what we thought"},{"startTime":3376.1,"endTime":3377.717,"body":"was a very large wave,"},{"startTime":3377.717,"endTime":3381.1,"body":"but that stage brought under"},{"startTime":3377.717,"endTime":3381.1,"body":"control in both those cases"},{"startTime":3381.1,"endTime":3384.5,"body":"by people doing a very"},{"startTime":3381.1,"endTime":3384.5,"body":"significant social distancing"},{"startTime":3384.5,"endTime":3386.02,"body":"and taking all the measures"},{"startTime":3386.02,"endTime":3389.14,"body":"that were so difficult for the population."},{"startTime":3389.14,"endTime":3390.38,"body":"And as a result of that,"},{"startTime":3390.38,"endTime":3394.01,"body":"although there were a large"},{"startTime":3390.38,"endTime":3394.01,"body":"number of deaths in these waves,"},{"startTime":3394.01,"endTime":3396.96,"body":"and a large number of people"},{"startTime":3394.01,"endTime":3396.96,"body":"did end up in hospital,"},{"startTime":3396.96,"endTime":3399.87,"body":"the impact was much less"},{"startTime":3396.96,"endTime":3399.87,"body":"than it would've been"},{"startTime":3399.87,"endTime":3404.27,"body":"if those social distancing"},{"startTime":3399.87,"endTime":3404.27,"body":"measures had not been in place."},{"startTime":3404.27,"endTime":3405.87,"body":"In the Delta wave,"},{"startTime":3405.87,"endTime":3410.04,"body":"we were able to get away"},{"startTime":3405.87,"endTime":3410.04,"body":"with fewer social measures,"},{"startTime":3410.04,"endTime":3412.47,"body":"still using them, but"},{"startTime":3410.04,"endTime":3412.47,"body":"fewer social measures."},{"startTime":3412.47,"endTime":3414.4,"body":"And it happened particularly in summer,"},{"startTime":3414.4,"endTime":3416.79,"body":"which probably helped to some degree."},{"startTime":3416.79,"endTime":3419.35,"body":"And it was extended though"},{"startTime":3416.79,"endTime":3419.35,"body":"for over longer period."},{"startTime":3419.35,"endTime":3423.1,"body":"Significant numbers of cases,"},{"startTime":3419.35,"endTime":3423.1,"body":"but over a longer period."},{"startTime":3423.1,"endTime":3424.99,"body":"And then the Omicron wave hit,"},{"startTime":3424.99,"endTime":3428.07,"body":"and what you saw was an"},{"startTime":3424.99,"endTime":3428.07,"body":"absolutely massive spike."},{"startTime":3428.07,"endTime":3429.64,"body":"And this is the size of spike"},{"startTime":3429.64,"endTime":3431.36,"body":"we could easily have got"},{"startTime":3429.64,"endTime":3431.36,"body":"with previous variants"},{"startTime":3431.36,"endTime":3433.47,"body":"if people had not done"},{"startTime":3431.36,"endTime":3433.47,"body":"the social distancing."},{"startTime":3433.47,"endTime":3435.38,"body":"So, this is a clear demonstration"},{"startTime":3435.38,"endTime":3437.7,"body":"of what would potentially have happened"},{"startTime":3437.7,"endTime":3440.253,"body":"if people had not acted as they did."},{"startTime":3442.11,"endTime":3444.35,"body":"How did this translate"},{"startTime":3442.11,"endTime":3444.35,"body":"into hospitalization?"},{"startTime":3444.35,"endTime":3447.13,"body":"Well, as you'd expect, the first wave"},{"startTime":3447.13,"endTime":3449.803,"body":"led to substantial numbers"},{"startTime":3447.13,"endTime":3449.803,"body":"of hospitalizations,"},{"startTime":3450.76,"endTime":3452.65,"body":"brought under control"},{"startTime":3450.76,"endTime":3452.65,"body":"by social distancing."},{"startTime":3452.65,"endTime":3454.39,"body":"Second wave also led"},{"startTime":3454.39,"endTime":3457.243,"body":"to substantial numbers"},{"startTime":3454.39,"endTime":3457.243,"body":"of people in hospital."},{"startTime":3459.74,"endTime":3461.92,"body":"Very large proportion of"},{"startTime":3459.74,"endTime":3461.92,"body":"the NHS was taken over"},{"startTime":3461.92,"endTime":3463.43,"body":"to treating COVID."},{"startTime":3463.43,"endTime":3466.2,"body":"As a result, people couldn't"},{"startTime":3463.43,"endTime":3466.2,"body":"treat cancers and heart disease"},{"startTime":3466.2,"endTime":3467.033,"body":"and many other things."},{"startTime":3467.033,"endTime":3469.88,"body":"Only by bringing COVID under"},{"startTime":3467.033,"endTime":3469.88,"body":"control was it possible"},{"startTime":3469.88,"endTime":3473.69,"body":"to bring the NHS back"},{"startTime":3469.88,"endTime":3473.69,"body":"to doing what it needs"},{"startTime":3473.69,"endTime":3475.5,"body":"in all those other diseases."},{"startTime":3475.5,"endTime":3476.61,"body":"And then the Delta wave,"},{"startTime":3476.61,"endTime":3478.75,"body":"a prolonged period of people in hospital,"},{"startTime":3478.75,"endTime":3481.18,"body":"but a lower rate because of vaccination."},{"startTime":3481.18,"endTime":3482.09,"body":"And then there has been"},{"startTime":3482.09,"endTime":3485.78,"body":"a significant increase in"},{"startTime":3482.09,"endTime":3485.78,"body":"hospitalizations with Omicron."},{"startTime":3485.78,"endTime":3490.1,"body":"And again, you know, you don't"},{"startTime":3485.78,"endTime":3490.1,"body":"end up with 17,000 people"},{"startTime":3490.1,"endTime":3492.95,"body":"in hospital in the UK in winter,"},{"startTime":3492.95,"endTime":3494.68,"body":"unless people have got"},{"startTime":3492.95,"endTime":3494.68,"body":"significant problems."},{"startTime":3494.68,"endTime":3498.03,"body":"So this was a non-trivial wave,"},{"startTime":3498.03,"endTime":3500.59,"body":"but, look at what happened to mortality."},{"startTime":3500.59,"endTime":3502.52,"body":"And this is not the mortality rates"},{"startTime":3502.52,"endTime":3506.32,"body":"that are usually quoted"},{"startTime":3502.52,"endTime":3506.32,"body":"in the various briefings,"},{"startTime":3506.32,"endTime":3508.323,"body":"which are about COVID specific ones."},{"startTime":3509.18,"endTime":3512.74,"body":"Sadly, we've had a very large"},{"startTime":3509.18,"endTime":3512.74,"body":"number of people who died"},{"startTime":3512.74,"endTime":3516.77,"body":"entirely due to COVID or"},{"startTime":3512.74,"endTime":3516.77,"body":"partially due to COVID"},{"startTime":3516.77,"endTime":3518.41,"body":"in terms of it's on the death certificate."},{"startTime":3518.41,"endTime":3523.41,"body":"So over 176,000 people"},{"startTime":3518.41,"endTime":3523.41,"body":"have died due to COVID."},{"startTime":3526.03,"endTime":3528.38,"body":"But this is all cause mortality."},{"startTime":3528.38,"endTime":3530.89,"body":"So this includes people who"},{"startTime":3528.38,"endTime":3530.89,"body":"died for other reasons as well,"},{"startTime":3530.89,"endTime":3532.81,"body":"including pressures on the health service."},{"startTime":3532.81,"endTime":3535.62,"body":"And you can see very big increase"},{"startTime":3535.62,"endTime":3538.01,"body":"in excess mortality in the first wave,"},{"startTime":3538.01,"endTime":3540.94,"body":"very big increase in excess"},{"startTime":3538.01,"endTime":3540.94,"body":"mortality in the second wave,"},{"startTime":3540.94,"endTime":3543.79,"body":"brought under control by people's actions."},{"startTime":3543.79,"endTime":3545.253,"body":"But then you see an excess mortality"},{"startTime":3545.253,"endTime":3546.36,"body":"over a prolonged period,"},{"startTime":3546.36,"endTime":3550.1,"body":"but nowhere near that"},{"startTime":3546.36,"endTime":3550.1,"body":"size with the Delta wave."},{"startTime":3550.1,"endTime":3552.16,"body":"And that's because of"},{"startTime":3550.1,"endTime":3552.16,"body":"the effect of vaccines"},{"startTime":3552.16,"endTime":3554.41,"body":"and to some extent, better treatment."},{"startTime":3554.41,"endTime":3557.61,"body":"And with Omicron, really much less impact,"},{"startTime":3557.61,"endTime":3561.35,"body":"that's a combination of"},{"startTime":3557.61,"endTime":3561.35,"body":"widespread vaccines, boosters,"},{"startTime":3561.35,"endTime":3564.373,"body":"better treatment, and"},{"startTime":3561.35,"endTime":3564.373,"body":"a less severe variant."},{"startTime":3565.34,"endTime":3567.01,"body":"So, a real change"},{"startTime":3567.01,"endTime":3569.07,"body":"in terms of the mortality"},{"startTime":3567.01,"endTime":3569.07,"body":"pattern we're seeing"},{"startTime":3569.07,"endTime":3571.27,"body":"as a result of medical counter measures,"},{"startTime":3571.27,"endTime":3573.59,"body":"and you can rely much more on them"},{"startTime":3573.59,"endTime":3575.293,"body":"and less on social measures."},{"startTime":3576.73,"endTime":3580.01,"body":"So, in summary, infections transmitted"},{"startTime":3580.01,"endTime":3582.096,"body":"via the respiratory route,"},{"startTime":3582.096,"endTime":3585.3,"body":"it's an extremely effective"},{"startTime":3582.096,"endTime":3585.3,"body":"route of transmission."},{"startTime":3585.3,"endTime":3588.63,"body":"And what has happened with"},{"startTime":3585.3,"endTime":3588.63,"body":"COVID, I think demonstrates"},{"startTime":3588.63,"endTime":3591.593,"body":"just how effective the"},{"startTime":3588.63,"endTime":3591.593,"body":"respiratory route can be."},{"startTime":3592.792,"endTime":3595.13,"body":"But once in the body,"},{"startTime":3595.13,"endTime":3597.26,"body":"infections can affect"},{"startTime":3595.13,"endTime":3597.26,"body":"all parts of the body."},{"startTime":3597.26,"endTime":3599.026,"body":"And I gave examples of infections"},{"startTime":3599.026,"endTime":3601.523,"body":"where they get in by"},{"startTime":3599.026,"endTime":3601.523,"body":"the respiratory route,"},{"startTime":3601.523,"endTime":3605.4,"body":"but damage is done in many"},{"startTime":3601.523,"endTime":3605.4,"body":"other parts of the body."},{"startTime":3605.4,"endTime":3608.36,"body":"Medical countermeasures,"},{"startTime":3605.4,"endTime":3608.36,"body":"drugs, vaccines, diagnostics"},{"startTime":3608.36,"endTime":3610.95,"body":"have substantially reduced the impact"},{"startTime":3610.95,"endTime":3613.973,"body":"of many of these"},{"startTime":3610.95,"endTime":3613.973,"body":"infections via this route."},{"startTime":3615.24,"endTime":3616.44,"body":"Simple social measures,"},{"startTime":3616.44,"endTime":3618.56,"body":"ones that people should"},{"startTime":3616.44,"endTime":3618.56,"body":"be perfectly happy with,"},{"startTime":3618.56,"endTime":3621.403,"body":"like staying at home if"},{"startTime":3618.56,"endTime":3621.403,"body":"you've got a very bad flu,"},{"startTime":3622.5,"endTime":3624.29,"body":"and ventilation,"},{"startTime":3624.29,"endTime":3625.76,"body":"which is something we"},{"startTime":3624.29,"endTime":3625.76,"body":"should all be aiming for,"},{"startTime":3625.76,"endTime":3629.363,"body":"particularly in public buildings"},{"startTime":3625.76,"endTime":3629.363,"body":"can reduce transmission,"},{"startTime":3630.25,"endTime":3632.1,"body":"but they will remain a major cause"},{"startTime":3632.1,"endTime":3634.24,"body":"of hospitalization and mortality"},{"startTime":3634.24,"endTime":3636.66,"body":"for the lifetimes of"},{"startTime":3634.24,"endTime":3636.66,"body":"everybody watching this."},{"startTime":3636.66,"endTime":3639.3,"body":"Medical countermeasures"},{"startTime":3636.66,"endTime":3639.3,"body":"have really changed this,"},{"startTime":3639.3,"endTime":3643.25,"body":"but nevertheless, many of"},{"startTime":3639.3,"endTime":3643.25,"body":"these remain very potent"},{"startTime":3643.25,"endTime":3645.61,"body":"and long lasting threats."},{"startTime":3645.61,"endTime":3646.733,"body":"Thank you very much."}]}