Dr. David Nabarro:

I thank the Deputy for his questions.

Most of the new viruses that emerge come from animals. The H5N1 bird flu virus that I worked on in 2005 seemed to emerge from the area around the Mekong River, which is China plus other countries in what used to be called the Indochina region but I would refer to now as the Mekong area.

The H1N1 virus that caused the last influenza pandemic seemed to originate in Mexico, not in China. I would not want to say therefore that this originates 100% from the area referred to by the Deputy. We think HIV originated from simian populations in Africa. Some have emerged in China but not all. We believe that anywhere humans and animals are in close juxtaposition, the virus can jump. We think the Ebola outbreak in west Africa came via a bat in a part of the interior of Guinea. All of the time we are looking at interactions between animals and humans.

The countries that were really successful in east Asia at the beginning had a dress rehearsal, which was the SARS outbreak in 2003. They learned one basic reality about dealing with these coronaviruses, which is that one has to stop the transmission immediately one sees the first cases. This does not necessarily require a whole lockdown, but there must be a focus on the area where the virus is present. One must make certain that one interrupts transmission by isolating people and finding their contacts and isolating them. This is a basic rule in dealing with infectious diseases. As the Deputy mentioned, Taiwan was successful.

Japan was rocky and tricky at the beginning. It was not an enormous success straight away. They did and have got it right. South Korea is the same. They still have resurgent cases from importation. They know they cannot keep their borders shut and hermetically sealed. They have to maintain their defences. It is about being rapid and robust at the very beginning. Due to the exponential spread of these viruses, if one delays for one, two, three, four or even five weeks before one takes it seriously, one has a massive problem and one ends up with virus in multiple locations. That is why certain countries that have been slow to act have much bigger challenges. The Deputy is right to point to the fact that it is rapid action that really matters.

When we put countries in lockdown, particularly when there is a lot of virus, it holds the virus in place, whereas the actual process of getting rid of the virus is all about interrupting transmission through case detection, testing and then isolation, with special attention to high-risk areas. I do not see lockdown as a control measure. It buys time while we put the other pieces in place, as has been done in Ireland and as it is planning going forward.

As to how flights will re-open, I think there will be analysis by countries of destination places, asking: is their risk profile the same as ours, are they taking the same basic strategy as us and have they got their level of disease down in the way that we have, so that the incidence is at the same sort of level? If it is a “Yes”, then we create an open corridor and do the quarantine in there. Obviously, if they have a lot more disease, then we are going to be rather careful of people coming from their countries and we might have some kind of quarantine. If, by chance, we have a lot more disease than they have, then they might ask us to go into quarantine. I do not think the blanket two weeks quarantine is going to stick in any part of Europe. I think it will be much more on a negotiated basis between countries, with very careful discussions between public health experts on either side to try to check they have equivalent risk profiles.