could care but these kidneys are doing well and then they disappear crash and burn and we now know who the virus is directly attacking the kidney and very cleverly is causing the kidney to increase the numbers of receptors that the virus uses to get into the kidney muscle was badly affected we weren't expecting that there's an enzyme chemical with more muscle releases and you normally have a level let's say up to maybe a $110.00 or 120 and the 1st patient we soarin had a level of 249000 if we can quite used to seeing levels 'd in the 10s of thousands so muscle was affected and brain was affected we started seeing people coming in with confusional states fits that they've never had before and then through intensive care we started finding that people weren't waking up and we expected in some time that was due to strokes and sometimes it's been too direct involvement of the brain so this isn't just a bit of flu it's not just a bit of a lung infection it's in every organ infection that range of infection so it's very

very frightening indeed or what a certain professor like the many about the potential longer term affects of in those who actually survive but could have long term debilitating health conditions where we're set to begin to see this now and in fact we were alerted to it very early on in that we arranged a meeting with the whole college of general practitioners in the intensive care society to trade notes essentially and it was the g.p.'s that we were telling them look this is what we're seeing and i to you and this seems a long tale of recovery because people are very very debilitated we thought it was nothing more than that you know several weeks of being ventilated on an intensive care and your lungs go down it would take a long time to recover from that and we know that you can critical illness it can take 5 years and people still aren't fully recovered from general severe intensive care but the general practitioners are saying what we're seeing out here people who go. this coronavirus you seem to linger on for weeks the police slowly recover

a bit but they're still weeks later complaining of breathlessness that see sleepiness and so forth and friends of mine you've had to call it you know brain they say my brain just didn't work properly for weeks and weeks and weeks afterwards they way they describe sort of sensation for there and still is level of fatigue and sleepiness now we don't know what's causing that directly chris may have better data my guess is that we are seeing in some cases some sort of it or to music thing set up so your body in attacking the virus is being exposed to a bunch of proteins it doesn't normally see like those from muscle and we may be seeing a setup where the body continues to attack itself i've got no evidence for that yes and from chris's intimation he may have such data but that would be my guess we've got some patients with badly damaged lungs and clots on their lungs and that causes

long term symptoms that have got weak muscle it will take time to come back though on top of that we may have some other process going on and that would be a guess at the moment for me dr from a role just point of view or do you have the data that shows the virus behaving in the in that sort of manner it seems to fall into 2 phases there's this acute phase which is definitely caused by the physical presence of the virus because when viruses infect cells and grow in those cells they damage cells and when they damage cells they cause inflammation and inflammation attracts the it written the immune system to move in and then do onward damage to tissue and most of those effects are immediately manifest in the risk of tree tract so it hits the lungs and this is why you see the symptoms that people present with which is they get breathless. there can be under certain circumstances early on or so onward infection of heart muscle

tissue and other organs including possibly the liver and kidneys and possibly also the nervous system we've just published them some information on that but what then happens is you move into phase 2 and the person usually gets rid of the virus but the disease doesn't stop there in fact it can intensify and also broaden in terms of its presentation and there are people with symptoms that last for months there dumping themselves the long haul coated sufferers and what appears to be happening in these people is that there is some kind of almost like biochemical footprint left behind by the physical presence of the virus which even though it's now gone that metabolic footprint continues and there is on wood damage to tissues in the body we think that at least part of this is down to the immune system and that the immune system is being reshaped by the virus infecting you and that in the course of fighting off the virus the immune system is being directed to attack healthy

tissue that it would normally regard as nonhostile and we don't know exactly why that's happening but also intriguingly we have sent hundreds of samples that we collected at the university of cambridge to our collaborators murdoch university in perth where they've set up something recently is called the australian national pheno center and they can process thousands and thousands of samples very fast to look for hundreds or even thousands of different molecules that are present in samples and what we're looking for are chemical fingerprints as it were unique combinations of chemicals at different concentrations that can that can change when a person has this infection and having done this what we are seeing and we've just published some of this data this week there is a characteristic pattern that is left almost as a say like foot. prints by chemically in a person after they've had severe coated now we don't think this is present in

everybody we think this is present in people who have coded which is the disease that this virus causes in some people we don't know why they have these lasting legacy effects but we can see clear metabolic disturbance in these people and we think that this is at least in part why people are presenting with these long term symptoms what the long term for these people will be though and how long this is going to be and whether they're going to go back to normal if ever at the moment we just don't know. that's what governing the volage of surf sharing information what a white have at their tents of care community how much of 11 from each other to deal with the most acute symptoms of the survivors a very great deal is the answer so in britain within the 1st few days we were having telephone calls with one another and then indeed national meetings. of line every major intensive care center sharing what they were seeing and in fact it was a massive benefit to us because these things we weren't expecting the kidney

problems the blood clot problems were flagged within days because people were saying we've seen one of these has anyone else and they would have said yeah we've seen 3 or 4 of those 2 and we very rapidly expanded that to international meetings from a far away as in calls with germany and france spain italy britain but also korea iran you know a vast number of places where they were seeing these days and indeed china where we were able to compare notes very quickly and that was a real lesson learned there actually rather than waiting for publication in the traditional scientific way of spreading information we were able to do it very rapidly by word of maps so that we have a very much better understanding now of the problems we see and we certainly have a better handle on how to manage them but there's no i'm going process indeed that's already begun for us to very quickly dive in to say well what do we know but what of the known unknowns what are the bits where we still have a big gap that we need to learn very quickly of when to strikes and we're doing

that by starting to compare major senses there's got to differing outcomes to say well how much of this can be ascribed to different case things older people different backgrounds eases and so forth but how much can we find a way where one center was doing something slightly differently and maybe they were doing that saying and it made a difference and outcome was better and that's a process that we're we're urgently progressing at the minute to see if we can find that little differences that might make the big differences and have. join us after the break with our 2 top experts examine the reef for a vaccine with thieving. so what we've got to do is identify the threats that we have it's crazy from day shouldn't let it be an arms race is on off and spearing dramatic development the only really i'm going to resist i don't see how that strategy will be successful

very critical time to sit down and talk. has changed lives the pharmaceutical companies have a miraculous solution. based drugs the people who are chronic pain patients believe that their opioid prescription is working for them and the remedy be said to. price that they pay closer dependency and addiction to opiates the long term use that really isn't scientifically justified and i'll study actually suggest that. the long term effects might not just be the absence of benefit but actually that they may be causing long term.

welcome back cambridge for all they just chris smith a professor human gummy i mean conversation with. guys the we have are we have these 3 new clusters of taking place even the most successful countries the countries which dealt with the virus best are seeing renewed clusters what's going on near christmas. the reason this is happening so put simply is that as far as we can tell the vast majority of the world's population has not had coronavirus the estimates we have are that about 95 percent of the u.k. population and we're similar to pretty much every other country that we've seen data for have not had the virus but because the problem remains and the population remains susceptible as soon as we start or for the virus more revenues through which it can spread things like people socialising people becoming complacent about

social distancing things like the hospitality industry opening up again those sorts of avenues will for the virus chances to spread it's taking them and that's why we're seeing resurgence is not just in this country but in many countries in australia in the state of victoria they've got a state of disaster and a curfew in place this was a country that had an excellent track record new zealand they've broken their 100 day long straight of not having any cases a tall with a new resurgence in or clint mushrooming at the moment they have no idea they're looking but they have no idea where that came from same with germany belgium has got problems france has got problems skate spain's got problems italy is now got problems it is not about how good your country was at the start of all of this it's all about the fact that we remain a susceptible population the virus hasn't gone away and therefore given half a chance shores eggs is eggs and as arnold schwarzenegger said i will be back 1st

and cover the cliffs and see which seems to be settling in to some extent with some people's attitude to the violence you think that's because the mobility of the death rate seems to be falling but of course that doesn't mean that the the sort of symptoms and long term effects you alluded to earlier aren't still there it is there is something to do with that that people seem to be adopting a more casual attitude to catching this violence and i think it probably usually criticism. absolutely spot on we've got to remember that this is the same virus that was there 8 weeks ago it's just as infectious is just as lethal and the reason the death rates have fallen really just be not because doctors are very very clever it's because people have behaved themselves they've maintained social distance they've used alcohol gel and they wash their hands they wore masks and they've done what they were asked to do and that's one faction rates down not because the virus is different and the death rate style here is

a function of the reduced number of cases now it's fair to say that if we do get another big surge we may be slightly better at managing this in hospitals and we were before we now know that there are blood clots that happen and they would have killed people early on because we didn't know they were coming and we now have a texan at present the steroids which we know siri should be able to reduce intensive care admissions by 30 percent but these are marginal gains on the population scale infection and the worst thing that happy people can saying is well the case numbers are relatively low although i would agree with chris that as such as 1000 cases a day is still quite a lot. that they go well the time of the rates low without understanding why and that they go back to paging as normal because if they do if they go back to where we were before that old saying if you ways do what you were is done you will get what you always got and we will get another the tinderbox that chris described will ignite and we will have

a flood of severe case again this 4th intervention the hospitality industry area i mean if you think about transmission system a path a transmission system for for this virus or a pub and violent we would seem to check all the the dreadful boxes of compatibility any country to have a pub hospitality environment and keep the survivors under control. it's a challenge and you've got to think of it in terms of from the way the government are approaching this is a numbers game if we look in ireland for example they've generated some data showing that about 2 thirds of their cases are in the under 45 age group in sweden for which i've seen data the 20 to 29 year age group had more cases than all other ages put together in that country you'll also notice that when boris johnson came out at the beginning of the month with chris witty and chris witty use those immortal words we're at the limits of what we think we can do there may have to be

some tradeoffs and the hospitality industry was cited as one of those possible trade offs and indeed in order to meet the obligation to try to get schools back in business which of again is going to afford the virus more opportunities to spread it may well be that we have to row back on some of these other potential avenues for transmission and that would include things like the hospitality industry but remember people are still expected to be sensible in these venues when you go to the pub it's not a free for all you're not allowed to loiter at the bar although people probably still do abuse the system a bit you're supposed to sit at tables it's supposed to be table service and because it's regarded as an indoor venue even though most people are trying to go outside it's still supposed to be 2 households getting together which is analogous to 2 households getting together in their own house so steps have been taken in the planning to try to mitigate the minimize the risks that is there attendant when you

go to one of these places but because they are not essential in the same way that other things like schooling is it may well be that they are the sacrificial lamb that we have to we have to close those down if we see uncontrolled spread subsequently but that may be done on a region by region basis let's hope it is. a failed gentleman or let's look at the search for the cure the search for the vaccine 1st professor macdermid that the polity of drugs have been introduced in your experience on the on the front line the whole effect of these these treatments a whole effect of the b. . well in all honesty in great britain we haven't really had the chance to demonstrate their accuracy efficacy outside of a trial so the big game changer well the biggest game changer so far in terms of drugs the use in patients with the disease has been the standard treatment dexamethasone it's a very very cheap drug it's been around for ages and ages decades and decades the difference treatments so we understand it very well and it's

a very very cheap very easy to deploy very few side effects and the trial data suggest that we can reduce mortality from the worst affected patients by around 30 percent and the boring stuff about anticoagulation keeping the thing that will indeed make a difference to now we've got upwards of $26.00 different organizations trying to make a vaccine a moment that's a positive thing because each of them will be taking a slightly different approach and this is excellence it means we hedge bets and indeed this government in britain has purchased from 6 different suppliers again hedging their bets so it's 300000000 difference vaccine doses but we're would i be an optimist i'm a great deal more optimistic now than i was 10 weeks ago when i thought that the odds were perhaps against us getting a vaccine readily and against us being able to deploy it fast i'm now slightly more optimistic to say that i think we may well get a vaccine ziff active and that we may well be able to deploy to scale and speed but

my guess would be that that's still looking a quite a long tail to achieve that that this isn't going to be done by christmas this is going to be a probably another another year before we've got this under control be my best guess and finally if dr chris smith put out we have to nationally the sputnik from russia or the chinese vaccines in the in the field the west or not since that professor human government alluded to where do you think we are and to match them how much sharing is going on in the international community in terms of the cept for the vaccine. i think we're in very good shape there are more than i think 23 different products are now in clinical trials for this is a different vaccine options which are being tested so that's good because we know when you ask a pharmaceutical company how often do you expect to succeed when you make a new drug you'll be alarmed to learn that actually it's all budgeted around

a 90 percent failure rate pharmaceutical companies know that 90 percent of the time that when they start on an endeavor it is not going to bear fruit it's a one in 10 chance that we're going to hit the target hit the bull's eye so the fact that there are $170.00 different vaccine initiatives running all around the world and actually it is a big collaborative venture is very reassuring and so we need a range of options and not all vaccines that we make in one country will be useful for all people in that one country so we need a range of options i'd like to finish on making one point though which is just a manage expectations a bit here and point out that one thing that people seem to have overlooked is that in this rush for a vaccine is that we're all assuming that a vaccine will usher in this great panacea that will bring this whole thing to a close and unfortunately i don't believe that's going to be the case and i don't believe that for the following reason i looked up the data last year for measles now measles has been around in the human race for about 2000 years since it jumped

into us from animals in much the same way that coronaviruses probably jumped in to us from animals now last year measles caused around the world $10000000.00 cases of disease it's a very severe infection not quite as severe as kovi it but it's still killed over 150000 people internationally that we know about. kogut has killed about 600000 people ok that's 4 times more they've done this once measles does this every year i mean saul's has a very successful vaccine and in the u.k. doest year we had many many cases of measles and many many people who chose not to get vaccinated so it is not to give them that just because we have a vaccine the job is done on the problem goes away there are many outstanding issues how long will that vaccine give us immunity for how do we get it to 8000000000 people on earth probably with more than one dose needed and if we need to keep repeating that dosage every couple of years or so how we're going to do that there's an old saying it's become an old saying since it was 1st mooted at the

beginning of the year if covert is anywhere kovi it is everywhere and it's absolutely true this is a global problem we need a global solution but we all need to sign up to it a lot for finally we're going naught dr chris smith professor human thank you so much for joining me on the alec salmon show pleasure thank you. and if pandemic nothing is more certain than any country drops its guard then the virus comes roaring back while feeding countries such as new zealand have had to take strong measures to retain vitus free status and even a tiny feeder would have had to cope with new clusters meanwhile countries like the us in brazil have never been able to cope i still heading up the unhappy league table of corporate victim countries heavily reliant on tutors them end up fighting the virus on the beaches and perhaps what is most difficult to understand is why any government anywhere believes that opening night clubs or pubs can be done with

impunity in reality every single country which had stuck its chain out at this virus has been hit and then hit again. one consolation is that the metallic trait has been falling everywhere probably as a function of the younger age group to account to the contagion and the holiday season against this as professor mcgovern had a mind to toss the long term effects i does yet little understood every indication is a tough the turn to normality will have to wait a successful vaccine whether that race is won by russia china or the many western countries the more important question is if a successful vaccine is indeed forthcoming but even then when it's all for long term protection we are living through a nightmare and as in the very worst of bad genes sometimes it is difficult to wake up but for now from alex myself and all that issue is good bye stacey and we hope to see you all again next week.

it's seems wrong. to me. to. become agitated and engagement equals betrayal. when something. is a party we choose to look for common ground. this

hour's headlines stories nation wide sweep for a 12 day in the wake of the country's election. take place in the eastern city. if you warnings against meddling in european leaders agreed to impose sanctions themselves all minsk. also russian opposition figurehead election is in intensive care. flight. western media speculation of. even a. treatment.