social contacts. And curing the brain has unfortunately yielded a very significant increase in incidence across those groups. And again, it underlines the extent to which we we have reason to believe that this progressive increase right through September now very sharply at the end of October is increases. Pretty quickly, then the demand for testing remains very high indeed, haven't seen demand for testing at this level since January. And unfortunately, in the red line, you can see a unrelenting increase in test positivity. So the red that solid red line is, is the proportion of tests processed in public health labs that are reported as positive. That was around 6%, in mid September, has increased progressively over the weeks and now is in excess of 15%. So, equally, test positivity is increasing across all age groups, most markedly interesting in those aged 13 to 30 years of age, but right across the full spectrum of ages. So all of that data reflects a very high force of infection in the population, the infection is spreading, because we have all increased our social contact on perhaps, because we are not as attentive to the risk reduction measures in those social contexts. In terms of hospitalization, you'll be aware that the numbers of people in hospital and the number of people dropped in recent days, I think, when you look at it in the long run here, right back to the beginning of the pandemic, far too early to ascribe any anything to that. It may be because booster vaccinations are offering additional protection to older and immunocompromised people, it may be an A further shift to the age mix. We're beginning to see more cases in younger people as a proportion than we did two or three weeks ago. Or it may simply be one of those transient things that occurs around Bank Holiday mid term periods. We did see this this time last year. So foreign and 60 people in hospital today because of concern, the highest number of admissions per day that we've seen in some time, on average, in around 60 admissions per day. Similarly, in intensive care, the number of people in intensive care drops it over the last week or so the number of admissions per day remaining constant on the number of people requiring mechanical ventilation comes from the number of deaths per day. Also, fortunately constant, we are concerned that this might rise is likely to rise in the coming weeks because of this very large burden of infection that has evolved over the last two weeks. That said those booster doses are going to offer an important cohorts the population additional protection, so the relationship between cases and mortality may be changing as we speak. For me, then yes, the epidemic continues to grow really quite rapidly. With estimates of growth rates somewhere between two and 3% per day for cases around 1% per day for hospitalizations. So in summary, then incidents very high and increasing very high force of infection in the population growth rate of say, two to 3% per day or cases and 1% per day for hospitalizations in terms of cases or the growth of infection that that corresponds to an effective reproduction number around 1.4 1.5. And I can vouch that in a moment. As I said, this is very clearly driven by increased social contact and a reduction in the mitigation of risk during those social contacts. We have that evidence. The social activity measure data from the Esri and frankly from the evidence of our own eyes. We know that compliance could be improved. The mark data tells us the mark survey tells us that about one in four people attending hospitality over the last weekend, were not checked for their COVID passes. And that COVID policy is an essential element in terms of reducing the risk of social contacts. On all of our mobility patients showing pre pandemic levels of mobility are higher than pre pandemic levels of mobility. So with all of that said, The future tech tree is very uncertain.
We've seen this kind of increase in cases during and after school breaks before We haven't seen it in this context for a very, very high force of infection, and a highly vaccinated population. So it's hard to say, what's going to happen over the next week or two. There may also be a changing relationship between cases and hospitalizations. But again, it's too early to draw that conclusion. So we are in the situation where we need to bring this horse infection down. That's a matter for us in terms of managing our social context. And it's a matter for institutions and sectors in terms of the supports they offer, it's to remind us and to support us in managing those social contracts. And to kind of we are in the territory now saying to people, you need to culture social contracts, valid individually and voluntarily. If reproduction number is 1.4. If you are planning to see 1520 People next week, it would be much better to plan to see eight 910, reducing the social context by 30 or 40%, bringing a reproduction number back down towards one, or equally, consider how much more careful you could be in each of those. So in each social context, it doesn't requires a significant but not enormous effort from each and every one of us to bring the level of effective social contact and the risks associated back towards a manageable level.
Thank you. Compensate me, questions are
immediate. So over the last few weeks, the message had been go back to basics on my writing thing in the new message, I was caught your social contacts that you're hoping that both of those things combined can make a big difference over the next two weeks,
we are I mean, the combination of all of these important measures they've worked before, and if we can find it within ourselves to festival unknown says, maybe not a huge improvement. So it's not as if we think we've seen the population completely abandoning all the public health measures, indeed, a lot of the suppression of the infection that we see at the moment, I made this point last week, coming from both vaccinations, and the high level of compliance with the public health measures has brought a reproduction number down from something like six to eight, which is what just sort of would be if there was no suppression whatsoever to something in the order of the year, perhaps 1.4, we need a little bit more. And it's going to be the combination of all of those basic measures. Perhaps that isn't what everybody wants to hear. It's not what I want to be telling people. But it is important, we know what works. So all these basic measures that people can take us an individual level, protect themselves, the basic measures are under spiritual hackers mask wearing, and social distancing. And that will mean cutting contacts and thinking a little bit and being more mindful of the plan for to have over a period of time over the next week over the next two weeks, to kind of ration, if you like the kinds of discretionary activities that you might undertake. And if it is a thing as professional and says you're planning to, you know, have a number of people over to the house, maybe it's a smaller number of people, those kinds of measures, oppositely will have a significant impact, we hope in terms of reducing transmission, and a message that we've we've issued in the past that if we, if we can have most of the people observing most of the measures most of the time, and we can all be mindful of that, that can make a significant difference. We have seen a significant shift in hospitalization, sorry, in socialization, I should say, if you can just easily can easily pull up the slides and activity. Just to make this point to you. You'll have seen these graphs before. So the next slide, I think, have the data. Referring to it, I can I can I can tell us to look up to go to Google and Apple mobile is the data that we rely on. And that gives us an NSF here, this is the one that shows return and recreation of the Google data. The black line running across the middle, is the pre pandemic level of socialization. We touched on that the week running into Christmas last year. We touched on it in the summer, when the incidence levels are much, much lower than they are now. And we've now exceeded that. And this is the highest level of socialization, at least as measured by that, that we've seen in the entire pandemic. And of course, we know that this is the explanation behind such a widespread every age group, every part of the country, every social setting. And that transmission can only be explained by such a widespread increase in socialization. And we need to dial that back. So each one of us needs to be looking at our own adherence to the basic measures to protect ourselves, as well as the plans that we have in terms of engaging with other people in social contexts. And in particular, again, to emphasize the point that we made last week, if one is engaged, there are high risk activities and we know what they are available to people because society is fully open. And for people who have broken demonstrates immunity can have access to nightclubs and pubs and all of those kinds of things. So if you're planning to meet up over the course of the coming weeks, in particular with people that you know to be vulnerable with severe effects of disinfection, it's best to avoid that if you've been involved in high risk activities for a period of time. So it's being mindful of the importance of each of these basic measures. And reminding people around that stuff. That's what I mentioned. So it hasn't it doesn't change message. It's just people with the basics.
You appreciate there's actually that there might be people kind of watching this at home who might say, is this, what the future looks like for us in terms of, you know, what life is going to be like, where are we going to go through 30 years, whether it's just going to if I would enzyme it kind of looks like is that is this sort of the reality that we have to accept and get used to moving forward?
The force of infection is a very important factor in all of this with really, really high levels of infection. So very small changes in socialization would produce a big effect in terms of the numbers of disease, at the numbers of cases that result from that. And that's what we're seeing at the moment, we're in a more controlled and lower level of transmission. Yes, that which is where we want to be, and that we can get there being in a position then to spot small, localized changes in the incidence and responding to those as quickly as we can. And putting in place measures to try to limit that becoming established widespread community transmission, that's where we want to be. But endemic will mean that that even if we get back to a lower level of incidence that we will see a continuing challenge with outbreaks, with with surges, potentially of the infection. And with this infection, still representing a risk, particularly people who are vulnerable, vulnerable, particularly to people who are not vaccinated. And so we still stressed the importance of vaccination. Just as a reminder, although we've done really well in terms of vaccination, overall, there are still groups of people who were vaccination is not at a level that we would like. So our agents 30 population, approximately one in five of those are yet to be vaccinated, are 12 to 15, age group, approximately two and five, but those have yet to be vaccinated within that overall 7%, who are yet to be vaccinated. So the 7% can hide the fact that quite high numbers of relative terms, people under the age of 30, are not yet vaccinated. And we know that they're socializing. And we can now see from both the age specific incidents and the positivity specific figures we've seen for that particular age group that that are very, very high levels of transmission going on about age,
I just have to methacrylic in this debate, the school situation and other people are quite high in the five star growth, are we out to about nine, if they're planning to go back to testing close contacts, and
thank you, I suppose the first thing I'd like to do is take the chance to talk to the children. And because we often talk about the children, we don't talk to them often enough. And I suppose the first thing I'd like to say to the children is Thank you. It's been a difficult couple of years, and you've been brilliant, you prefer the last new product to the last to yourselves, and your classmates and your teachers, and everybody else says, so I think we all ought to be Thank you. The second thing is, I'd like to say to the children is the numbers we're looking at now it is not your fault. It's not because you're going to school, you've been going to school for a long time, now, you've done everything that's been asked of you, most of you will be very careful to kept the rules, we need you to ask it, I need to keep asking you to keep doing that. So we need you to stay home when you're sick. We need you to stay home, when there's somebody in your house was COVID, we get to do what teachers ask you in terms of we keep keeping the rules. And what we see from you know, what we see is the truth about your lives to children is that the least where COVID spreads, is for you to give it to a grown up. The next the spread spread is huge. Give it to another kid. The next one is for an adult to give it to you. And the next thing is for an adult to give it to an adult. So So you're doing great, keep it up. And thank you. And and and what you're doing is working. And at the moment, what working in schools is working, and we've no immediate plans to change what we're doing in schools. And it's a credit to the children, first of all, to their teachers and their parents that they're making it work. And as Dr. Holland said, we've seen a huge increase in social socialization. That's what's driving the increase. And it's not because children are going to school. They've been doing that for a while now. And the numbers haven't that's not Australian.
And just I know last week, I asked you about a circuit breaker and what would that look like? Gone? Is there any thoughts as far as like a breaker might look like anything?
discussion we're having. I mean, we know that the measures that we're recommending focused as we as we are on individual's behavior and compliance with adherence, adherence to the public health messaging, as well as personnel resides across all the sectors making the environments in which people will spend time, particularly indoor environments, as safe as they reasonably reasonably can be in when we hear this, you know, in the hospitality sector over the course of the last weekend, from the mark data, that people are reporting lesson one and four situations they're not being checked for the COVID Pass. These are These are the kinds of basic measures we want to say. We want to encourage people to do the right thing. And as I said last week, in particular people who have leadership responsibilities, whether they're running businesses, providing services, or otherwise have influence across society, that they would encourage people, and demonstrates through their adherence to the environment that they create for individuals, a commitment to the spirit of the guidance that's there. And so through an improvement in our collective adherence, and an improvement in the kind of environments in which we're spending time, and each must be more mindful about how we plan and our social contexts and being at being careful, if you like about. Managing that in a way that limits the risk of transmission, it's, these are the kinds of measures that we think can be successful, we're not giving contemplation at this point in time to additional and wider measures. The reality is that, you know, the economic and social restrictions that were in place, not just in this country, but in many, many other countries, in a way to the discretion away from individuals about what it is they might do. So if I can just use the puppets, an example of the public closed decision is made for you about when they go to the pub, the pub is now open, and you can make that decision of whether you go there and your behavior in preparation for going there. Particularly the importance of a few symptoms staying away, we have to keep emphasizing that message. That's one of the most critical messages that we have. And people have respiratory symptoms, they need to stay home, they need to contact their GP, the need to arrange for a test. And those are still the same basic message that we're issuing the pub environment itself, it can be influenced by people who are running pubs, to make it as safe as possible to ensure that the COVID pass and those other protections that are in place for customers and stuff are in place. And so we want to see people using these as safely as we possibly can. And we think with not necessarily a huge improvement, but an improvement in terms of our collective performance across all those basic measures that we can reduce the level of transmission that we're seeing with the infection at the moment. That's what our that's what our plan is.
Can I just ask for an update on their deltas of lineage? Is there how many cases we have?
And we're just around 90 at the moment. So we should have more data coming through this week. But it certainly hasn't kicked off since we last spoke,
as it was the same as last week. Yeah.
Thanks our
point when you're expecting cases to level off, and then for
a very important issue to address it. Understandably, there's a sense out there. And there's validity to this to this sense that cases should at some point in the future plateau and fall. And why might that happen? Because more people become vaccinated more people are boosted. And more people who, for one reason or another haven't been vaccinated may become infected. And therefore, the level of immunity in the population reaches the critical level where the epidemic can't sustain itself, or can't grow further. But it's very hard to say when so some of our models, the most recent set of models that we've run, would suggest that Latin relatively soon in the course of November, but principles an important caveat there is waning immunity, waning vaccine induced immunity is not contained to those models yet. There's, it's very hard to estimate how many people out there have become infected that we don't know about because there were asymptomatic undetected infections. And if you change those assumptions, you get a very different profile over the coming months. So it's, it's it's very hard to say one set of models shows peak or plateau developing in late November into early December, and cases declining from that point. But other models show later, longer, higher and much slower to decline, peaks. And it simply depends on the assumptions and some of those assumptions, we simply don't have good estimates for those for those assumptions. So, to cut a long story short, that's an impossible question. To answer is inevitable that we would even if nothing else changed, we'd reach a plateau and it's time and it's for data reason that we have to pull back to. The fourth information we have here is simply too high. To to the question asked by advisor unless by our actions we bring down false infection over the coming weeks or less things unless unless everything else is in our favor. We're really going to struggle to control this virus for a month to comb through the winter
and the 15,000 cases Over the last week, do we know what percentage of them were fully vaccinated or partially?
We I couldn't give you a precise figure on that. At this point,
the evidence is sort of an increasing number of bracer infections.
Well, just be careful with the interpretation out there, there isn't evidence of an increasing proportion of breakthrough infections that would lead you to worry about waning immunity. There is what what we always see with vaccination that as more and more people are vaccinated, more and more of the cases of vaccinations. But the the proportion of vaccinated cases is what you would expect, given the protection offered by vaccination, and the number of people who are vaccinated. So a very small number of people are unvaccinated and very small number of adults 7% of adults or so who are unvaccinated are disproportionately represented in cases. So 7% of people in terms of adults are unvaccinated. But close to 30 or 40% of cases are unvaccinated. So there's a there's a big difference there in terms of the protection of vaccinations. So we're not we're not seeing any fundamental shift in the proportion of cases vaccinated that would lead us to believe there's something going on. means
that approximately on a given day, approximately 40% of people who are in intensive care units with COVID could be regarded as as broad as breakthrough infections and the remainder not not not vaccinated, as in having had the two full doses and so on. And so that's a continued concern. So the substantial overrepresentation among the cases but also more intensive care units. And as we know, among the deaths relative to the overall population,
you're talking about quite a rapid increase in incidence among 19 to 24 year olds, were a bad sort of 10 days on their from the reopening of nightclubs and a lot of big venues across the country, is there anything to suggest that that sort of first weekend has played into the refund type case on earth?
Well, if you look at the time periods, so over the course of the last two to three weeks, we've seen a significant change in terms of probably the last two weeks in particular, in terms of socialization, you can see that from the data I showed you on that. And then you can see a change in the increase in the increase in cases not confined to 19 to 20 fours, they come out ahead of all of the other groups, but we're seeing rising incidence across qualities, which is Phillips as up as far as the mid 70s. And the only would be encouraging pattern. And, you know, we need a little bit more time and days to know for certain that this is an effective booster, especially if you're looking for a positive effect to the boosters he would see us in a change in the incidence pattern among the age groups where we are seeing that change in the incidence pattern. In other words, the slight leveling in in the 75 days before we will do half of whom have been in the target group for boosters for some time. And then the overeasy fives where it's where it's reduced further, particularly include those who live in residential care facilities. So we've seen an effect there. But in all of the other age groups, we're seeing a rising incidence. And it happens that as the 19 to 24 is a commercial up, but by no means is the message that in some way, something that they've done around nightclubs is the cause of all of this, there's been a collective increase in socialization across the entire population. The resultant impact of that is a collective, an increase in age set instance, right across the entire population, with the exception of the possible protection through boosters of the over 75. And then a significant shift in that. And of course, that also tells us that this isn't about one age group, and one particular behavior that it's our collective behavior across every setting, and across all the age groups
that we just heard from him and immunologist the TCU today suggesting that free antigens have to be sent to every home in the country. In the UK, they ultimatum freely available to people if that's something that you'd support.
So in our most recent advice, we from another point of view, we did point to the possibility now everything is open, there isn't a dependence on something being open by the use of antigen test and asymptomatic population. Our concern previously had been embers. We've articulated many on many occasions in the data and evidence and this hasn't particularly changed in the low instance situation applied to asymptomatic populations. It's not realized well enough. But that's not the situation we now find ourselves in. First of all, everything is open. Second of all, our incidence in the population is high, and particularly high among close contacts. So we have advised in the use of admission testing close contact situations, we've asked the rapid testing group to have a specific level as they have the potential use as an add on. So if somebody is thinking about using an antigen test needs to number one, be an add on to all of the other measures. So if it's not in place of your compliance with everything else, it's an addition. So if you're thinking about, for example, going to nightclubs, societies or things, an advisor has a positive and you stay away, that's a further positive contribution to reducing risks if you're going to that nightclub in any case. And that's a key difference in terms of the potential use of them in previous situations. Before, you know my thoughts are open. And people were saying, if we would use antigen test, we could we could open a nightclub that wouldn't otherwise be safe to open. And accumass message when we're talking about agencies, because they are freely available in many settings, is that they are being used. And we know this by people to determine whether or not to have COVID to come in. A symptomatic person who gets a negative result is concluding that we don't have COVID, it is not a safe conclusion. And in particular, not safe in the context of having continuing symptoms and going on to do other things. So in other words, keeping children out of school, sending children to school, I should say, when a COVID test is negative, even though they're symptomatic, or going to work or going to the pub or going to wherever it is you need because on some test is negative No, you're symptomatic the basic message that we have to have everybody here, if you have respiratory symptoms, stay at home, irrespective and be guided them by your GP and the result of a PCR test. If you're if you're being tested. That's the key test for for you if you have symptoms. And as we've mentioned, we've just had to look at the experience we've had so far in young children. In RSV. This winter, we've seen many, many more young children being admitted to hospital with RSV, and the COVID. So the idea that all we need to do is do an antigen test to prove symptoms to determine whether somebody can safely that's that's very unsafe. So if people have symptoms, they simply need to stay home and go to bed. There's also a PCR test. Some other GP might say, yeah, and
I'd say it's only one tool, but would you be in favor of that example, you gave someone thinking of going to a nightclub or a pub, they're doing everything else under thinking I'll take an oxygen test as well. But you'd be in favor of, you know, free testing said to every home in the country, that they have that option as an extra as an extra safety precaution that we
haven't advised in relation to that particular issue. I think the the concern is that if if if people don't fully understand the circumstances, and the issue of admission test has always been not about do we use that test or not. But when are the appropriate circumstances, there have always been appropriate circumstances for oxygen test to be used. But in a widespread situation with a widely available, there's a real risk because I think there is a substantial amount of public confusion about action tests, that they get applied to circumstances because they shouldn't be applied used in situations where people are symptomatic. And other circumstances. As I've outlined, we haven't given specific advice that they should be made widely available free of charge. Dry, they are widely available in many settings. And hence the reason we're given that basic advice to the public about how to appropriately.
Thank you for asking, but the technical issue that affected the the numbers that are reported, I think yesterday, so yesterday did my writing thing, and we had an artificially low number of notifications yesterday. So does that mean that yesterday's figure of 3700 plus should probably be in higher? And you know, should have been?
I think mostly factors related to today's figure. So you Right, yeah, so so so in other words, so. So today's finger is an estimate on the basis of test results, which we've done in the past, when we had a challenge with the cyber effect. This is, as I understand things a one day technical issue, which is now resolved. And if we rely just on the side, or days, or what would have happened without a number would have given you a number today, which is artificially low. And that number then will be corrected by an artificially higher number tomorrow of the cider. And those two will be balanced out actually, when we when we when we look at the day of the seven day and things figure out efficiently notice and also today's figure that the 3000 spoon with the precise we have 33174 I think you can double check that I'm precise my recollection of that. That figure is an estimate based on the number of tests and you can take it as bloodlust, it will be corrected in terms of its precision. But all of this and we have been situations before particularly as a consequence of the cyber attack where for an extended period of time we use this system of assessment or estimation. And there was a technical issue which I understand was short lived, it arose yesterday affects the number that cider would have reported Today, which is the system we've been using for, for the last number of weeks or so it's been it's been it's been fixed that issue,
not only the backlog of cases here, the technical issues. Yeah, exactly. We did face back in December, January last year.
This
is not, this is not as luxurious. And I understand that it's resolved. And in the 14 day and seven day reports that we'll be giving you in the coming days, these will all be corrected. So we always get back to just underscore the importance of sometimes we can't relate just to one finger one day, its fingers are telling us there could be reasons why that can vary. And here's the reason why. And we're just being clear and open about that. The issue has been resolved the reliable data, which comes from our assessment of what's happening to the 14 and the seven, and the details, which are the professionals, as outlined,
can ask you about what NIH accepted vaccine effectiveness for the under 60s, effectively that it sustained against sustains against serious illness, hospitalization, and ICU admission, except for people who are immune compromised at this point. So would you concur that at this point in time, it's not necessary to give at booster vaccines for those under 60.
So that hasn't been advised on yet. But that matter is being kept under continuing review. Bye, bye now as a number of other issues around potential for the vaccination. So the NOC has continued to examine the evidence in relation to that, and I'm not at all so that hasn't happened as yet another tall saying that a reasonable
interpretation of what that means, though, is that a reasonable reasonable to interpret at this point in time that you could Concur at the moment in terms of what we know, at this point in time, that there's no grades and evidence yet to show benefits for giving a booster dose to people under 60, except for the categories?
And that's the reason why not? Because given the advice I've given so far, and how often does he ask advice in relation to people under the age of 60. Although it has indicated bilateral that it will continue to look at the evidence in relation to that point. Obviously, the priority for us now is to focus on those for whom vaccination hasn't been recommended all of those over the age of 60. And now also people who work in the healthcare setting, and and he has a has a substantial job and had to roll out as quickly as we can reasonably do so booster doses to those people in those age groups, while NIH continues to assess the case, for those and also the case potentially, that might arise for others who are not yet the subject of vaccine recommendations. And just to remind you, the EMA is looking at authorization around the question of school, primary school aged children, five to 12 year olds, in terms of potential vaccinations, all these things have been kept under review.
And Professor Nolan can ask you if we didn't have the levels of vaccination to high levels that we have, at this point in time, given what you know, and what type of daily cases would could we be seeing today?
There's different ways to answer that question. But the simplest way to answer the question is to imagine that just right now, we could turn off everybody's vaccine protection, rather than going back in Tony. So that we turned off everybody's vaccine protection now. within a generation time, which is, you know, four or five days, you'd see somewhere north of 10,000 cases a day. And a generation time if nothing else changed everybody freely Mexican society, three or four days later, there is no reason to believe you wouldn't see four times not again. So there are unimaginable numbers in a way. So it's a very good question to us, because it is underlines this huge job that vaccine protection is doing in keeping a very large number of infections, insert an interrupting a very significant number of transmissions. And then everybody is reducing their level of social contact, to a certain extent, observing basic measures to a certain stance, and that's gaining us a little bit of extra suppression. And that's bringing us from back in the wild as far as reproduction number, perhaps judge variants and reason five and eight for sake of argument, honey, if there was nothing, no protection based on the person would in fact five to eight other people. So the fact that any person right now is is infecting on average 1.4 Other people shows you just how much protection vaccination is offering and the added protection that the observation of the basic measures is offering.
And Dr. Hulan, I mean, I thought probably the starkest line from today really is that the level of socialization of the population is at its greatest level since the pandemic began. That is quite a quite a statement, and quite a reflection of what's happening out there. And the reason why I suppose that may be a Stark is that we were here two or so weeks ago, and the point was being made You know, there would have been an increase in social interaction, but even small changes in the right direction on dogs could bring numbers down. But it seems on the face of this, people aren't hearing what you said. Because if anything seems to have gone in another direction, or correct,
yeah, you're correct. And like what we're seeing at the moment in terms of that pattern of socialization, accepting the limitations, the methodologies that are used to. So this is the Google and the apple mobility data that we use. We also have the more survey data. But insofar as we rely on those, yes, that's telling us that we're having levels of socialization that are an excessive, those that we've seen at any other point in the pandemic, as measured by those same metrics. So we think they're reliable. And yes, you're absolutely right. This isn't the trend in terms of socialization that we're looking for in terms of the message that we're we're giving out. But we're still continuing to give out that message. Because although people are probably sick and tired of listen to it, and in many ways don't want to hear it. And we understand that we don't want to be giving that message any more than people want to hear it. It is still the set of measures that have worked in the past, the basic set of measures that we need to, to adhere to, and if I can go back to the kind of the the lines of defense that we spoken about before the most effective line of defense, in terms of transmission of disinfection are the behaviors of the public, in terms of compliance, and adherence to all of the basic measures, augmented by vaccination and the boosting of immunity that that gives us all after that, then our system in terms of detection of cases, identification of those cases and resulting behavior, hopefully people staying out of the out of circulation when they're when they're when they're identify those cases. That's our that's our second line through our primary care and public health system. And then ultimately, our hospitals and the provision of hospital services and ICU services. For those preventive in situations where people require and can only require hospitalization, we're seeing that line those two. In other words, the frontline in terms of the health service, the primary care, public health system, and then the acute hospital system, and all the other parts as well under extreme pressure, by any metric, as things now stand, because because we're not, we're just not getting enough protection in that first line. And that's why I keep coming back and stressing the same basic and boring messages around mask wearing, staying away from crowds, avoiding socialization, and he hasn't about when we have symptoms, the importance of physical distancing. And each of us be mindful about our contexts and trying to minimize them as much as we can. Those contexts. These are the things that we each have control of
that from the Irish independence, can I ask innovation to antigen testing schools? So we've heard donors to say last week that the government might put in a system where, for example, you have a pot of children's school, and there's a confirmed case in that pod, and all the other children in the pod are sucks and actually test? Can I ask if Is that what you're currently considering at the moment and as the correct that it will be initially on a pilot basis.
We haven't drawn any conclusions ultimately, in relation to that we've looked at additional measures that we might need to undertake. We've asked ourselves the question in the context of the transmission that is that we were seeing in, in school going age children, most of that transition, we know is not happening in school environment, it's happening in community, it's happening in households in particular, we know that, are there additional measures that we can take. So we've taken a look. And we're still giving ongoing consideration to the the most recently published a CDC guidance in relation to contact tracing, which does have guidance that relates to the school setting, as well as many, many other settings and giving ongoing consideration if there's any further changes we need to make to our public health advice in relation to that.
Is that something that you yourself would be in favor of?
Well, we it's not just about my opinion, we're giving consideration to this as part of our process and ultimately make it further consideration to this. We're due to meet next week as part of an effort. But we have given some initial consideration to that. And at this point in time, we're satisfied that look, first, Cormac, and has outlined the situation in relation to schools. And I might want to add further to what I'm saying that the school environment itself through all the good work, we've talked about this in many occasions, are in relative terms, in spite of the very high levels of community transmission, continuing to offer an education environment, which is important for all the reasons that we know which which limits the risk of transmission. We continually redo not just this question, but every question, we get new guidance makes it easier we see a change in terms of the patterns of transmission or the age specific incidents or whatever it might be. And we'd look and ask ourselves the question, is this something further we need to do? So the fact that we're doing that is is not at all like the ordinary political reasons or do you want to
just miss this my point and I agree with a JSA. We have to keep all of this under control. But it's under review. But one of the things I suppose we have to ask ourselves is, is everything we do has consequences. And so if we're going to do that is, what is the evidence that it's going to make things better? And what impact does it have in the lives of the children that I was trying to speak to a few minutes ago, that the children think about this, because it's really important to think that, you know, that the all of these things impact on the lives of children whose lives have been hugely impacted already. And they are our future. And and, you know, we can't objectify them, we have to think about what, what's good for them? What would they benefit? How does this impact and then, and it's not the greatest thing for many children who go to school think that they have to have this test on all the time? So should we keep an open mind? Absolutely, we should. And if the evidence is there, that this makes children and our teacher safer? Well, then we need to look at it. And we need to say, well, we accept the consequences of that, in terms of the unpleasantness and it is, for some children, this is very unpleasant to having these samples taken. We may have to live with it, if we see that it protects people. But we would want to know that protecting people before we do something that makes the lives of kids harder than they've been already because the last year a couple of years have been really hard to
write why is getting a child to mention tests? How was that object? objectifying them?
If you I mean, if you talk about it, I don't mean that that's objectifying everything. We sometimes talk about children instead of thinking what it looks like from the child's point of view. So I'm not accusing you objective. But But I think putting something up your nose all the time for some children is very distressing. It's not. And so the question is, do we know it's doing good. And if we know it's doing good evidence that it's doing good, then I think we have a reason for doing it. But if we don't know it's doing good, we just need to bear in mind that actually, for some children, that would be very unpleasant. And in some countries where they've introduced us and very few countries have introduced this free primary school children are in some or they have one of the things they've had is that some parents have started to take their children out of school, which is an unintended consequence. Now, you might say that that's the parents choice, or it's the children is that the children's quality impacted that proposed children in the long term? So I suppose, I think the key point is that everything that we look at, and I think this is what everything that we look at, may have an upside and may have a downside. And we need to consider them both. And if there's evidence that it does good to protect, because then we may have to live with a certain amount of downside. But we need to know that it's going to do some good before we accept the downside. That's what I mean, about kind of keeping the children in the picture of what they want, and what makes their lives. Good, because as the it's been a tough couple of years. Okay,
can I ask, how long can we keep going with these rising cases before? Now if we're going to consider bringing in new restrictions.
But as I said last week, in relation to that, I'm going to, you know, optimistically regard that as a hypothetical situation, we still have good reason to believe that measures that we have, have advised on in the past, in terms of the behaviors that we've emphasized over the course of this afternoon, are things that we can improve our collective adherence to. And if we can do that, we're hopeful that we will see a change in terms of transmission. So I don't want to kind of get drawn into it personally. But I hope I will still regard as a hybrid type of situation, if we don't have these places, ultimately, under under some level of control, that we're not seeing that at the moment. And that's the reason for us raising the level of concern that we're raising.
Is there a certain number that you have in mind, in terms of deli cases?
No, there isn't a specific number, as I said, it's the same as it always has been, we look at the in the round all of the measures, both in terms of the incidence in terms of socialization, but also then in terms of the impact on hospitalization and other factors in coming to around it decision at any point in time as to what the advices we should provide.
And on the flip side of that thing, can I ask, you know, if the hospital numbers are kind of remaining relatively stable, and perhaps we shouldn't be as worried about these very high cases?
Not necessarily because like behind some of the data that's, that's there. So we're looking at a relatively more stable with a huge number of hospitals. That's influenced by lots of things. And not just the number of new people being admitted to hospital. If we look at the number of new people who live near the hospital, we see that increasing and continuing to increase. And that's what we expect to see in line rising incidence. And insofar as we know that these ultimately are potentially preventable infections, particularly those for the severe cases that require a dependence on intensive care. We think there is more and should do to try to prevent that. Because people we shouldn't we shouldn't have we shouldn't have a recourse to such high levels of ICU admission, such high levels of hospitalization, as a control measure in relation to protecting the public's health from this disease.
prevention model modeling PTG expectancy in November I believe your last letter it says the last letter was two to 3000 cases and that's the peak So isn't it fair to say that was probably start The past out of one or two days. And
again, looking at that letter closely. For any given model, we run that model, maybe 100 times, it's slightly different assumptions. And 3000 was the mean the average of all of those with different assumptions, you got higher numbers or lower numbers. So there's quite a wide confidence interval around those. So we actually said was, it could be anywhere between 2005 1000. So we're still within the confidence limits. In other words, the range of possibilities that the model showed, I think the more important thing about those models is to remember, all of the other assumptions that I mentioned earlier that are in there isn't, just because the model shows the case numbers might try to design doesn't necessarily mean that they will. And there are other possibilities. And again, those range which would see this going on for considerably longer. So I get this isn't a time to be either pessimistic or optimistic. It's time to say the Forrester infection is too high, right? We need to get it down by first infection is creating risks for us into the future. Things could go in a number of different directions. Over the next six or eight weeks, the important thing is to reduce the risk to us as a population by very, really quite strict adherence to the public health guidance about how we go about or taking business. Moderation in a social context, those two things together should bring numbers down. And that's much more important than kind of allowing some hypothetical peak to happen. Over the next Who knows 2468 10 weeks, with an ongoing, very high level, very high force of infection in the population, because that high force infections and say, things can go rapidly, badly wrong from a high force infection.
Simon Carson, the Irish Times, and talked to the gasketing just mentioned there 90 cases of the death Plus, I'm just wondering, and your look back so far, just in terms of the age profile, the geographical makeup, and the instant, that severe D disease metrics, have you seen anything in the Delta plus cases that you've looked at so far, that would give you cause a concern about maybe the viruses behaving slightly differently with this variant.
But I don't have that data to hand Simon, to be honest. So I probably better not comment, but I can liaise with HSE and send it on to that it will be patriarchy that would probably conduct that analysis, they would get decided that we wouldn't necessarily get the lab side from the enhanced surveillance perspective. So I can follow up on that for you.
Professionally useful for clearly and answer to Fergus question there about the effect effectiveness of the vaccine. And if we were to switch it off, but looking at some of the figures that you'd mentioned there with where the disease is coming, the infection rate is coming down amongst the older groups who have been recipients that the booster does not point to a solution here, essentially, that we will potentially may have to look at boosting the entire population as a as a two or more effective to, to to bring down case numbers.
But that's that's more a policy question, to be honest with the positive message be taken out of this is where boosters are necessary to offer protection against severe illness and disease. They very quickly and very clearly offered that protection. It's a much bigger question to ask yourself, are we going to reimagine an entire population as a substitute for observing some basic public health measures like washing your hands or cops wearing a mask on public transport? So I have no doubt in other jurisdictions have shown if you decide to re vaccinate the entire population, you will cut transmission. It's a very big policy question about whether that's an appropriate thing to do.
You don't start till
yesterday? Sure. So the question of boosting we need to see as in terms of as festival and records has primarily about protecting the individuals from the severe effects of disease and maintaining that good benefit that we've seen from the vaccination. And we have good evidence that that is working, and we believe is already beginning to have an effect. And we can see a little of that effect also, in terms of transmission, or just what we'd expect from it from a booster population if the booster does what we'd like it to do. And that's the primary objective, and that we don't see boosters as a potential control measure, particularly we're looking at the rising incidence and the speed at which that is changing in all of the age groups as offering any significant potential in terms of control measure around transmission, and that linking the two of those This is Just so your question is doing that number, it has they have been linked that we should simply boost people in order to prevent this level of transmission, as you see in many, many of the age groups in which we're seeing this very rapidly rising transmission, they're not currently part of our plan in terms of, of boosting, because we don't believe that as yet, the evidence has has, has has, is in favor of that, that may change in time as in your behind request is the potential for that to change that may well change in some parts of the world countries have made declarations that they see themselves boosting an entire population. That's not an unreasonable extrapolation in terms of where we, you know, our current understanding of the disease, but our current plan based on my advice is to focus vaccination for healthcare workers, but also then those over the age of 60. And again, I'm not suggesting this is behind your question. But I understand the kind of environment in which there is hope or a desire on our collective part that there is one thing we can do, we can find one solution, it might be the antigen test, some magic solution that might be there. It might be the booster or whatever, in people's minds. Unfortunately, the level of transmission of this disease, and the scale of particular carnivores infection means that we're going to rely have to rely on every single tool that we have at our disposal. And the collective turns to all of those including boosters, including vaccination for those yet to be vaccinated. And then all the basic public health measures, we're going to need every single day to achieve the turnaround, turnaround and transmission. And that means an effort for all of us, as I say, most of the people do most of the things most of the time, I think arguments to be our focus, as opposed to one specific
measure that's going to do this for us to just pick up on a governor, Dr. Rollins comes there, because as far as maybe saying something that everybody knows, but I think we would all want to say is that if you haven't, the biggest concern we have is the people who haven't had any vaccine yet. And if you haven't had the vaccine yet, and if you're thinking about it, we'd love to see it. The door isn't closed. Anybody who hasn't had a vaccine yet, if you change your mind, if we can talk to you about if you can, if the health care provider could talk to you about it, you haven't been vaccinated yet? I think for all of us, the biggest concern we have is for the safety and welfare of people who haven't taken vaccine yet, because that's as Dr. Holland said earlier, that's what we're seeing in developed disproportionately nice view. That's who we're seeing in the Gulf disproportionately in hospital, it is your choice. But please consider very carefully what it means for you and for everyone else. And as far as the HSE is concerned, we'd love to see
you anytime. It's the doors wide open. Just final question for me, Dr. Hood, I suppose people would see the vaccine. And there's talked before about the vaccine bonus. And people slides were affected so much for 18 months, that they're probably quite keen to cash on cash in on the vaccine bonus, and try and get back to some normality. And the figures that you point to in terms the increase in socialization problem maybe reflects that. And I guess the question is, is this dashed? Is the vaccine itself create a false sense of security? Do you think for people that well, I've been vaccinated? So I don't, I don't understand. Right, I now need to
continue to restrict my life as I had. I think it's a fair point. And the problem is a certain level of improvement, perhaps in terms of our collective understanding the vaccine on its own, without adherence to any other measures is not going to be enough. That's not just me saying this. This is the advice of ECDC has looked at the evidence and provided guidance and advice to countries and very different levels of vaccination as to what kind of Reliance we will need to have in terms of other non pharmaceutical interventions. And and there's no scenario in terms of vaccine uptake that the CDC advises that no requirement for additional measures, there will always be a requirement for additional measures. And in the collective understanding, I think there probably is room for some improvement of that. But we're still going to need particularly at these high levels of transmission and with this high force infection, to have a strict as we can adherence to some of the basic public health measures that we keep emphasizing. And it's understandable that people would might feel that look, have a cold or have these symptoms, had a vaccine, this couldn't be COVID. Unfortunately, that is not true. That is not true. And it's important that people understand that and are open to the possibility that this may well be COVID. We know unprofessionally guards can cannot do this, that the viral loads that can arise for people who are vaccinated can be as high as those who are unvaccinated. And so that potentially greater risk than in terms of transmission to other individuals. And we need to have that as part of our awareness. That's the science if you like and the technicals behind the basic advice that were given around the measures that people need to take to reduce
that risk of transmission. Yeah, things are turned on. I think that's a really important point because there's been a lot of discussion around the the viral load and the vaccinated and I suppose commentary that well if You know, viral loads can be the same and unvaccinated and not are not vaccinated. And where is the point in the vaccine. And I think it's really important that people remember two separate issues. So the first issue is that these vaccines are really effective at preventing against severe disease and hospitalization. And they're also really effective at preventing against infection. So they're probably 75% effective against infection over the first six months following the vaccine. And what people sort of omit from the calculus is that that cohort is not transmitting. So we're impacting on virus transmission, by preventing people getting infected in the first place. So then you've the other group that is vaccinated and does get infected what happens to them. So what we've seen from the data coming out of the UK, and more recently from from Israel is that the viral load in that cohort, is probably equivalent in the unvaccinated group as vaccinated. But what's interesting is that the viral kinetic seem to be different. So the rate of incline the rate of growth in the vaccinated individuals for will be slower, and the rate of decline is probably greater. So even though they have a, an equivalent peak viral load, they're probably responsible for fewer on retransmissions, because they're probably infectious for a shorter period of time. And the data from the UK, and the data from Israel would read would really say the same thing. There's, again, there's a little bit of a narrative saying that these data are contradictory. And that's the Israeli data would suggest that the viral load and vaccinated is lower. And actually, they've done a really nice piece of work and a very large piece of work much larger than that. The study from the UK was study from the UK was about a household transmission study looking at the impact on on Delta, and that showed that the secondary attack rate with Delta in household of vaccinated individuals was was less than in a non vaccinated household. What is ready data suggests that immediately after vaccination, the viral load may be slightly slightly lower. By about six months, that difference is gone. So the viral load is equivalent between the vaccinated and unvaccinated individuals. So just because the viral load may be equivalent, if you have been vaccinated, you're probably still less likely to transmit because of the viral kinetics. But equally, what we need to include in that calculation is the cohort of individuals that is completely protected and doesn't get infected, because they have been vaccinated. So vaccines are still incredibly effective, but they're not 100%. We know that. And we also know from the emerging data that people who are vaccinated can get infected, and people who are vaccinated can transmit the vaccine to other individuals who have also been vaccinated. But again, what we're seeing from the data that the majority of these transmission events are occurring in the household setting, versus the exposure is prolonged and intense, then the vaccine is likely not to be or others, there's an increased chance that the vaccine won't be completely protective. But at the same time, we still know it's very good at protecting against severe disease and the goes down list because it has primed
your immune system for when it sees the virus.
Looks like you're feeling familiar. Just in relation to 19 to 24 year olds and their
levels of socialization. A lot of young nurses and doctors are in that age group as well. I just want to know, would you be comfortable with young people that are working in the health service going to nightclubs, if you're asking people as well for do for social contacts. And if you're caring for vulnerable people in hospitals that are either either being treated COVID Or
are vulnerable to other diseases? I suppose obviously, the risk is there that if people socialize that the virus is going to spread, having said that, we've asked a lot of our health care workers over the last couple of years and and they need to socialize too. So I think what we are asking our healthcare workers to do is to get vaccinated which overwhelmingly they have done and to follow good infection prevention control practice and training which we provide for them. And and to be sensible and practical, practical about how they live their lives. But I think a given what our sense coworkers have given to all of us in the last couple of years, our colleagues and our friends and many guests, their families, I think asking them to have no social life is a lot to ask when all their friends are. So I think I'll follow the rules, good infection prevention control practice,
stay out of work when your snake is a message. Thank you. I think it'd be unfair to target any one particular sector notwithstanding. And I think that healthcare workers will be mindful of the totality of potential risks and how to influence in the round all of the risks. That was not to say that they need to stay away completely from certain high risk activities. We know that higher risk activities are not possible for people. If you're mindful of that, if you're responsive in terms of let's say symptoms, He might develop his day at work in those situations. He followed the basic advice that Professor Carmack was given, there's no reason why you can't incorporate responsibly higher risk activity into your thinking and mindfulness and planning about how you manage your risk overall. And and it wouldn't simply wouldn't be fair to healthcare workers to suggest this in some way or other, they should be different to everybody
else in the population. In terms of that advice. On pubs, you're saying that their moral precepts are showing one in four people asked last weekend, was it that they didn't they weren't asked for COVID vaccine? Can you appeal to Republicans who may not be adhering to what's been asked of them? Or what's your message to them? Because I suppose they're probably feeling that they're, they're having a hard time maybe finding stuff. And after the 18 months that
they've experienced, as well as it's tough time for them to firstly, say, it's not just pubs, I think that data was pubs, but also experiences in restaurants and cafes.
So something across a broad is not just publicans and relatives, or you
mentioned pub environment, or your aunt's I did, but it's just making the point that it wasn't confined necessarily to that about one in four people who reported being out and about in those kinds of settings, indicated that hadn't been asked to show their code path. And the two messages one is for the people who are responsible for running and providing those services. Yes, of course, we accept and understand that it's been a difficult time for them, particularly given that their services have been under restriction for much, much longer than many, many other parts of society in the economy and had to bear the brunt of definitely understand the impact of having been economically we understand the impact that's had on staff. And then the question is availability of stuff that we do understand and are sensitive to all of those kinds of things. But there's still an important message, these basic measures that we're talking about, and not no single measure, but the collective measures and there are, there is good guidance now in place for that sector that needs to be applied, that includes the corporate path. And that the purpose of those is to protect staff, and to protect customers who use those services. And ultimately, to the extent that we can continue to, to protect staff and customers and services in all settings, we know we can have assurance about the ability to maintain those those those services themselves, it's in the interest ultimately, of those sectors themselves, to protect their staff and customers now, for the purpose of protecting their businesses into the into the longer term as we deal with the challenges that this infection creates for us. So that's our message to and the majority, by the by indication of that data. And we know this is the case, are responsible, and are doing their best to try and implement. That's according my own experiences, as that has been the case. But there are some where there are the levels of compliance, or the existence of measures along the lines of guidance that I'm referring to, are either not sufficiently or in place at all. And that brings me to the second part of the message has to be for each one of us as members of the public going out and about visiting a pub and a restaurant, a cafe, which is which is a good thing to do. And an enjoyable thing to do to be mindful of the kind of risk environment. And we know the difference, we should know the difference between a pub, and I'm just using an example of the pub in which we feel safe, we can see that was clear adherence to the basic measures, but hand sanitizers, and all of those kinds of things are in place at the protective measures around the implementation of the guidance are clearly in place that the COVID Pass has been asked for the people have been asked for their their their their identity to ensure that that is their COVID. And all of these, these should give us all assurance and say this, this feels to me like a safe environment. It's not overcrowded, the public health guidance has been implemented, versus the public, which clearly isn't the case, because that's not a safe environment. And people should vote with their feet. And I've said before, I think it is different for people to complain that Irish people I think have a particular challenge with that in the hospitality sector. But certainly, you can take your business elsewhere and
not go back to a particular environment where you don't feel safe. And lastly, just in case I said the incidence rate or the case numbers or positivity rates among five to 12 year olds,
in comparison to last week is that has that increased. Just in the run up to the midterm break. So the week before the midterm break, it looks like the incidence in five to 12 years might be starting to stabilize. It was stable through the midterm break. But we know when kids are off school, they're less likely to be tested and some of them may have traveled. And then unfortunately, as the disease took off in the course of the midterm break across all of the other adult age groups that has forced some infections into children. So it's an uncertain picture there. But because all of the instance data at the moment is showing to us. That's just the broad mixing in the adult mobile population that's driving instance into both
children and older adults. And just for people who are questioning where the data is coming from the proves that there's a low transmission of the disease and in schools, Can you just elaborate on that? Because some people would argue that
we don't have contact tracing. So how could you know? Well, first of all, the evidence, there's three categories of evidence, the first category evidences a huge amount of international evidence, and the most reliable evidence is from major systematic reviews, where groups have looked at all of the available studies, brought them together, and come up with estimates of the likelihood of children or adults transmitting and pressor calm can give me a brief summary of what that looks like. The second form of evidence is that within our own models, we modeled off what happen if children were transmitting as much as adults are not. And we're following the low charge scenario. And the third thing is the really the suspension of testing of asymptomatic contacts in the school setting. That isn't really making it because it was detecting very few cases anyway, on transmissions that weren't occurring, many of those children would be will become symptomatic and present for testing through other channels. So all of that evidence taken to it's not that we would miss it, because of this, actually, that whole operation was detecting very few cases in the first place. So all of that evidence together. And we weren't absolutely certain about this. Remember, in the run up to September, we're saying no touches a different variants. So we need to see what happens. But all since that time has passed, pharmacy schools have been a board opener for weeks, an instance, was coming down, actually after and ascertains bike. So all of that evidence together tells us that the relative risk of transmission in the school setting is significantly lower than the risk of transmission in other social settings. And that in itself is lower, again, than the risk of transmission in the household, which is where the majority of
transmissions are occurring. Mr. Griffin from Arizona start maybe a lot of talk about maybe bringing in COVID passes to hospitals to you know, to allow to open up for visitors. And I saw the return. I mean, it was for all our studies for the return does that happened to put out an announcement saying they're going to implement that?
Do you know what's happening without a bigger scale? So the A, the efforts, raised criminal network mentioned meeting of the 18th of October, and there was a decision made about a requirement for COVID passes for visitation and healthcare settings, and subject feasibility. And so there's a lot of discussion going on at the moment with including consultation with stakeholders about how we do that, and how we implemented in line with that issue about feasibility. So we have guidance on visitation various and and other access in in health care settings. And as I say, we be we are updating that guidance in consultation with stakeholders that we would normally discuss that kind of guidance with in terms of making sure that it reflects the needs of people with a net address the issue, so we're working on it, it was just what I would say. We're working quite hard in it. But we want to do it right, by talking to people and working through the process. And I think that's what was intended by the never decision in terms of looking at the feasibility is that we would work through the process and get to a position of how we do this in a way that's practical that works for people,
and that this has been appropriate consultation getting.
It could be quite different to how it's working in hospitality. Well, I suppose hospitals and hospitality are very different settings. I think one of the issues in that NEFAs decision also is the is the need for exceptions and compassionate grounds, which is part of the decision. So we need to work that through it to make sure that none of us want to end up in situations where we want to implement this in a way that is sensitive to the needs of the fact that healthcare settings are very different. And and if there's, you know, if there are exceptional circumstances around a family member who is perhaps approaching vendor life or whatever, we need to make sure that it's done sensitively. And
that's what we're working through. Thank you and we We're talking here about the antigen test for under fives. Is there any consideration given to asking a court to look at mask wearing for under for sorry for under twelves? Maybe not just in school, but when they're going
into the shops and into restaurants is the same as adults. My recollection is that they've already done
that. They updated that in September. There's nothing more since then nothing changed. A substantial updating of the review in September was considered by Nevers. And on that basis, no policy change in respect of not wearing dermatologists was recommended. And it's not being reconsidered now going forward and say they don't have to be reconsidered. But there is, there isn't an updating of that review underway by headquarter. So that's a very detailed and systematic evaluation of the published evidence, there wouldn't be any significant change in that evidence in such a shortage of between now, and when that
device was presented to them for
temporary feels like a long time ago, a lot in some respects, I grew to there. Okay. And then just in the context of just, you know, beyond going conduct
and an updating of systematic reviews, okay. And then you were talking about sectors, I don't know if any of you were listening to Joe Duffy, this afternoon, with a lot of people working in the store, Joe, yet. They were talking about ventilation and people who work in taxis and use the Dart and take buses, were saying they're having real problems lately. So I wonder you were had a message for the publicans? Is there any message for like the staff on the diet about Windows and
things? I thought people were quite stressed as professionals, and just to say a word in more general terms about ventilation. But again, it's all the basic and we understand the course that
staff will,
passengers actually variation. Yeah, that these kinds of environments or environments where the risk of transmission is increased, it's part of the reason why our ongoing advice around the mask wearing and public transportation is still really important. The duration that people spend on public transport, close proximity to another relative terms short compared to some of the other things that we might do, we might go to the cinema and spend an hour and a half or two hours of movie, go to the pub and spend a couple of hours and so on. So there are differences. In terms of the the application, I think we still continue to encourage, as high level of compliance as we can on the part of those who are responsible for operation, public transport. And, and the basic measures around making sure that the dispensers, the hand cleaners, and all of those kinds of things are full and available to people that the messaging is is refreshed, and the signs are visible, as well as the continued emphasis around the adherence to do the recommendation and mask wearing those specific circumstances.
Just very briefly, I mean, I mean, ventilation is important. That's let's start with that. It's important that the air in a room or a classroom, or a bus or a train is changed at a minimum a couple of times an hour, preferably more. But I do think we also need to get this in perspective. In other words, it's not necessary for the windows, these things to be wide open on the air blasting through the board just to think about, yes, this this is an airborne virus it's carried and it's carried on the air, in droplets on aerosols that are exhaled by an infected person. But but it's not as if this then spreads out kind of uniformly in the room and the risk is uniform everywhere, the risk remains much higher, closer to the person exceeding those droplets and aerosols and diminishes with time. And of course, this is diluted in the volume of the room as well. So many of you think of yourself on the bus or a train. And the person beside you is symptomatic officer is infected. When we told them to be there, if there was symptomatic, the person beside you is in fact a tough person is a risk to you. There's no doubt about it. They're probably not much of a risk to somebody who's five or six meters away on the bus. And the mask wearing on public transport is there to protect you if you're right beside them from an asymptomatically infected person. beside you, so how do we prevent transmissions on public transport? symptomatic people stay away from the public transport. asymptomatic people in the public transport wear their masks? And yes, of course in addition to that, we try and make sure that the bus or the train or the tram is reasonably well ventilated. But that's an additional measure of the other two. The thing that's offering huge protection is an HD Ranjan is the mask wearing. And I think we need to get in perspective To the risk of the virus being transmitted over much longer distances, which is a much less common phenomenon, and is mitigated by by ventilation. Thank you,
Mark. Hey, Mark Hoffman from time to time you stand the force of infection is too high and it needs to come down. And the way that you've hoped it will come down on the last couple of weeks is the kind of cumulative effect of everybody's behavior change. And then you told Fergal there, there isn't any evidence to say that the mobility and the mobility data to say that that behavior has changed. At the same time, you say you're not going to consider in imposing restrictions, are we advising restrictions? So is there any reason our data suggests
cases will come down? So others might add to this? I'm saying that for now with the question and restrictions as it is a hypothetical one. And I think we just need to collectively, and individually focus on as much as we can on the basics. And without reiterating all of that non boring you the these are the most that we think can work. It is true to say in your rice, that the evidence that we have in terms of for example, mobility data, showing that as yes, we're not seeing the kind of pattern of behavior change that we'd like our levels of collective socialization across all the age groups across the whole society is at a level that we haven't seen over the course of the pandemic, it's in excess of the level of socialization as appears that we had before the pandemic began, in excess slightly upper level that we saw on the run into Christmas last year. And so I think that we need to concentrate it like that, because all those measures are still going to be important. Even if even if one must turn this is not in our contemplation at this point, to be considering further restrictions are walking back a road that no country wishes to walk back, or is planning at this point in time to do will still need as high level of compliance with these basic public health measures, because it will still be the case to the extent that we can achieve high level and measure that the dependence on other things will be less. But the force infection at the moment, because of the gospel, we set the number of opportunities that the virus has to infect, for example, a vulnerable person is simply too many, and the vulnerable person that is exposed to a substantial amount of additional risk. Because of that level of community infection, even though they're as well protected as they can be with the levels of accident, they might be practicing good and effective behaviors themselves. These levels of community transmission do represent a level of risk that we simply can't
regard as something we can with it doesn't seem to be any indication that
it's going to change direction anytime soon as the measures that were the measures that we're recommending, we think because we've seen this happen before, have the potential to bring about we haven't seen the evidence of that yet, as the festival said, and in response to an earlier question, it may well be that factors will arise that will, we'll see a change in the pattern of transmission over time, if it was continued to go up. That would happen naturally in any case, but we're not forecasting that it's going to happen. And we have no certainty at all, that the level of transmission will reduce if these patterns of socialization continue to increase, as we get through November. And we're starting to come to a point where, you know, as we get through November, we'll be getting into the Christmas season. I think it's a very risky time for us to be continuing with such high levels of socialization, given the burden of disease that's in the population at the moment, this level of socialization might well be something that we're dealing with, if we had a very different pattern of transmission that some other countries have at this point in time, our pattern of transmission is very high, as now as things now stand that force infection very, very high, increasing cost, all of the age groups have virtually under the age of 75. And driven as we as we know, by a very widespread pattern of of socialization. It isn't, as I said at the outset today, that like we have collectively just abandoned adherence to public health measures. But there has been a change in terms of our collective and if we can, if we can dial that back a little by each of us doing our best in terms of compliance with the basic measures, forward planning, understanding risk, stay away from this good promise. In particular, we're going to keep emphasizing if we have symptoms, we need to get out of circulation, whether that's work, school, socialization, inviting people to our houses, etc. These are the measures that we need to concentrate on. These are the tools that can work. And we just have to wait and see as we monitor the effects of the disease and the trends of the disease. Is it in fact working? So far, we're waiting to see the evidence of that the encouraging signs we're seeing the potential impact of boosters and so on. But But, but the change in terms of socialization that can
affect basic transmit Should we be able to see evidence? Just as a follow up on that, we were talking about seeing evidence of anticipated, we used to call it anticipate every behavior. Like we would, as far as I understand, from looking at the previous patterns in the data, we would have expected to see that anticipated really behavior kick in two weeks after you began your messaging about being more cautious. So we haven't yet seen that. So my takeaway from what you're telling me is, we don't expect you don't expect to see cases turning anytime soon. And sorry, I'm on your answer. Just there. You also said that there's a danger heading into Christmas have a high force of affection. Can you expand on that?
What your thinking is in that regard? Well, look at these low high levels of transmission, even small changes in our collective socialization have big effects on the total impact of disease. And obviously, you know, I don't tell you Christmas at the time of the earth. And you know, one of the things we tend to socialize more than other times to get us into that period of time, as long as we possibly can be given an attorney November, we're looking at these kinds of numbers, that's going to be a challenge for us. But that's what we would like to get down as low as we can, as quickly as you can. Can I predict that that's going to happen in the near term that No, it's my expectation that it's going to change the next week or two, not necessarily high, because I think quite a number of the infections we're going to report in the next 10 to 14 days have already occurred. But we still, so I'm not concluding that we won't see that change. But I think your point is a fair one, that like in the past, we have seen people respond to very high levels of cases, and change their behavior and change our collective behaviors as a result of that. There are within our, our data in terms of population behavior, you know, evidences that maybe at least in some respects, and those measures aren't getting through, which is why we continue to emphasize the importance of these
measures. I mean, it's the simple truth that unless the levels of social contact come down, and or we redouble our efforts in terms of mitigating the risk of any contact case, numbers will not come down. And I will share to CMOS optimism that, you know, if we message this signal, this clarity that people may well realize that we do have to be, we do have to be really careful about these things. Because running along at three, four or 5000 cases a day, every day puts a really substantial cohort of vulnerable people at risk day after day after day after day. And we have a collective obligation to reduce that risk, bring the force of infection to more management that was and that significantly reduces the risk for for the vulnerable. And I think added to that. One of the reasons that we're so keen to point out the need for enforcement reminders in a variety of sectors is not only to has been your COVID pos been checked on entry to a premises are the rules about wearing your mask on your way to the bathroom, not only does that protect you in the premises, but it acts as a collector of reminder, it's still here, we need to observe these measures, these things are keeping us safe. So I think the fundamental message here is twofold to the public. It is absolutely worth your while to make modest adjustments over the next few weeks, to how you go about your daily business, you're free to do almost anything you could want to do. But could we do somewhat less of it. And we could we do it more carefully. And to the to the various sectors, you also have an obligation not only to kind of enforce the rules, so to speak, but to just serve as a support and a reminder to everybody that, unfortunately, because of the Delta variant and all sorts of other things, we are going to have to stick with some basic, not particularly Causey and not particularly restricted things. And the reason for doing that is the risk to the
vulnerable, or the very high force of infection that we have at the moment. Dr. Holland said there that a lot of the cases that you expect to see in the future are have already occurred. You said there, it's equivalent, you seem to infer that we could be looking at three, four or 5000 cases a day over a period.
Is that Is that fair? So we only expect to see if nothing changes. I mean, the
sorry. Sorry. I just have to supplement that question. There doesn't seem to be any evidence of
anything changing either something is expected. But well, we're gonna persuade the cases we're reporting today are infections that probably occurred a week ago, maybe a little bit more. So So what's gonna happen for the next 10 days is predetermined, but after that, Nothing is predetermined. So so all we know right now is how the virus was transmitted 10 days ago. And I think that that's so people could have changed their behavior over the last week. They could change their behavior over the coming week. And I don't like using that word behavior. But the fundamental message here is sure, I mean, we've done this before, we're tired. But it is. And it's harder, because we've done it before, and we're tired. But it's our job to clear the message the necessity. And we have to remain optimistic that people
will hear that message.
Right, thanks, Mark. Courageous from the Irish Daily Mail. Talk to be a fair assessment of the provinces they say that in English on the 30s the DNA of this group produce the high levels of batteries with a population relative to the populations. First formerly known as asked people to avoid crowded places. I mean, it's unnecessary for
younger people to avoid type things. And no, not necessarily. I mean, like, it's not, we're not singling out. But like, what, what am I regard, that's a vaccination as something extra that if you're in that age group that you might consider because one in five people in that age group have yet to have the benefit of vaccination. And those benefits we've talked about in their extensive. But the message in terms of the behaviors and the adherence to the public health advice, and so on, is a message across the entire population, because we are seeing socialization across the entire populations, not just, this isn't just young people going to nightclubs. Of course, that's part of the pattern of socialization that we're now experiencing. But that's not the explanation for everything that we're seeing. We're seeing transmission now happening at an increasing rate across all of the age groups, certainly under the age of 75. And everybody, irrespective of what age bands you belong to, has to think about the kinds of measures that they can take the activities that are undertaken, and be mindful about, let's say, activities they undertake, particularly their higher risk activities. So a nightclub is a higher risk activity, a large gathering indoors, tickets, there was an ventilation and what turns to two measures that can often happen in households in another informal settings. These are high risk situations and to understand and recognize that we, like if we individually are nice, after nice engaging in high risk activities that carries a certain risk profile. But if individually, we decide we're going to undertake a relatively speaking higher risk activity, we need to follow that up with let's say, lower risk activities. I'm planning to go to concerts in military distant future, I won't be more specific than that. That's a relatively speaking, high risk activity, and other things that I might otherwise intend to do expect the environment and we'll be in will we'll deal with those kinds of vessel protective measures in place, but it's not a safest thing at all. But I'm going to undertake that, but I won't be going to concerts, seven nights in a row. So it's that
kind of thinking that I think we all need to people might wonder like, what what is a safe match time to go to a nightclub, you know, is once a month, what what you're recommending is once a week, not acceptable? Because I just think people find it a bit hard to say, you know, don't engage in high risk activity, avoid crowded places, I just wanted people might say what if I go to a nightclub hoping to avoid being in a
crowded environment, you can't. So what is an acceptable level? Maybe things have changed since my day, but like going to a nightclub once a week was was quite an amount of nightclubbing. But others might have a different view. But certainly, like if you think in terms of the incubation period, the likely incubation period of this virus, that's it's, you know, if you're if you're not going to nightclubs more frequently than you know, once every 10 days or once a fortnight in terms of transmission, you're likely to that that would make sense. But going to nightclubs like every second or third night, if that's something that there may well be people who do that and want to be that sense. That that that would constitute probably too high a level of intermixing with a
lot of a lot of other people in those kinds of environments. You might ask you on the boosters Can I just get a sense of what the thinking would be overnight perspective of why not to extend that beyond where we are currently in terms of like what I would do would not be for everyone who's been vaccinated after that they've had this expectation six months on? What's the thinking there in terms of not doing that? I know, obviously, because the larger policy decisions were made by your CFO and the minister in terms of whether that's adequate or whether she should go ahead but just purely from an AI perspective, why wouldn't be
progress would extend the boosters further. I suppose I'm not necessarily here representing the act today. So I think nyck receives requests from the department to look at various iterations and continuous review the evidence around all of those sort of the like, there's ongoing discussions and evidence reviews at NIACC across a range of areas in relation to vaccinations or vaccines and boosting. I don't think it'll be helpful for me necessarily is that I'm not here representing night today.
I'm here as a as a jobbing
virologist. I know, but I think I need to sit
on what will be various kinda understand, you know what, why it was so so for example, I think just give us like, an insight into the top process there and what
the delays would be in those decisions.
Yeah, so this was, yeah, it's certainly decisions that have already been made. I would file the disagrees like, it was slow. But I'll take that on board. There are a couple of issues, I suppose when you're starting out of vaccination broken what you're trying to achieve. So obviously, people remember we first want to protect the vulnerable. That was the one of our first issues to protect the health service, and to minimize harm. And we also want to protect the individual. And that's why we went through the population with the initial course. So the question in relation to this, in the end is what you're trying to achieve. So the first step is trying to protect the vulnerable questions which we have done because an individual level. And then the second question is trying to minimize harm. And if you're looking purely at the cohort of healthcare workers based on their age, and their underlying health conditions, individually, they're probably not at increased risk of severe disease, and therefore don't necessarily need a booster of an individual's perspective. However, from a point of view, from a societal perspective, and to minimize harm, and to protect the vulnerable and protect the patients in the health service, and you could argue to protect the health service as a whole over the coming winter, then that's a justifiable decision to that to administer boosters for that reason. And I suppose that was really what that would have been one of the things that were probably the crux of the discussion we would have had over recent weeks. Because I from a global equity perspective, a huge proportion of healthcare workers around the world haven't had a single dose of vaccine yet. So we have to take all of those things into account. And I think, yeah, that's probably it was never about not wanting to vaccinate the healthcare workers. It was always about what do we find to achieve by vaccinating the healthcare workers? And is it does it fit into our ethical framework was established in conjunction with the Department at the very start of the vaccination program. And unfortunately, they're not withstanding a lot of the commentary there. They're not straightforward decisions, in many respects are a lot of considerations that we have to take into account. And we also have to look at the evidence which frequently is coming out as well as from different jurisdictions because they're, they've moved more quickly than us. And they've, they've larger populations than us, or they've used different facts. And so lots of different considerations. But yes, was there, there were things that we put into that. And I think we've come up with the right decision, and hopefully help our will will available
in the next couple of weeks when the program starts. But I just really just add something that's very good. And it's not just it's just that it's not fair question, the premise that there's a delay here and so on. In fairness to knock. It is a complicated process. I'm not a member of nags party to the actual detailed deliberations that happened, but we do receive the advice and understand the importance of having a group of experts, led by Professor Butler, and given the time and space, the owner's responsibility of assessing that evidence and advice and advising and what needs to happen. And we've changed course, in many occasions in response to that evidence, whether the evidence is in relation to the impact of the disease and locations or the vaccines, I should say, and the locations that cells have been in relation to safety data that might have arisen that led to changes in in the advice and guidance over the course of the entire pandemic. And it's that, you know, careful consideration of it, which does require time and sometimes that isn't as well understood, but people should understand that and the importance of that is part of the reason why the public has had such high level of both trust and confidence in the advisor ultimately that's based on nyak advice about who should receive fax and of course, there's an impatience around. But but the net position we're in we have achieved in this country, a very, very significant level of vaccination. We will continue to point out areas where we can improve further in terms of uptake for example, among the one in five of the agents 33 Yesterday vaccinated for example. And we continue to advise in relation to that nyoka has has taken its responsibility seriously and has been part of the put been a key plank and part of why we have such high levels of vaccination in the country, and relative to where the country is right in terms of booster programs are in to the patient. This is not too late. There's no side by side comparison that would suggest that it could be regarded that we delayed on the implementation of other measures
in comparison to other countries. And despite this there, is there a date for the next
meeting and the additional being brought forward if cases keep rising.
Date is sheduled to be tomorrow week.
And whether we see any circumstances at the moment we're planning at the base of that particular case. Next Thursday,
the 11th. Experts might have been asked what I thought of the room, I'm just wondering what is the percentage of new confirmed cases that
you expect will translate into hospitalization at this current point in time, but we were over the last couple of weeks looking about a 35 admissions to hospital per 1000 cases. So three 3.5% that that has dropped a little bit, as I say distinct the age mix cases might be shifting. So it's time to make a projection forward to say every 1000 cases, we have now translation to into 35 admissions. But even if you look at today's numbers, seven day average 2660 admissions to hospital. So we're not far off that kind of ratio at the moment. And that
