Dr Chris Williams, Health Protection Agency
Chris - One of the things we have to think about when we gather a large number of people into a small space is the risk of spreading diseases. We’ve seen in the past how outbreaks of diarrheal illnesses like norovirus can spread rapidly through hospitals, care homes, and even cruise ships. The UK’s Health Protection Agency, HPA, is charged with making sure that we’re prepared for such an eventuality and to tell us more is Consultant in Communicable Disease Control and also the Olympics Lead for the HPA in the East of England, and that’s Dr. Chris Williams. Chris, hello.
Chris W. - Good evening.
Chris - Chris, first of all, are we on the sort of verge of a pandemic with the Olympics or is this not going to happen?
Chris W. - There are a lot of people coming and we’ve looked at some statistics on this: 204 countries are involved, around a million overnight visitors and possibly another 5.5 million – what they call ‘day trippers’ coming to London and increased numbers of people in the hotel rooms. But we also must remember that this isn’t the first ever international sporting event and at each event that’s happened in the past, infectious disease specialists and similar organisations through the Health Protection Agency have done surveillance, watched out for threats and managed them. So really, we’re not expecting the next pandemic to happen here. In fact, the Health Protection Agency looked at this in 2011 and found no significant risk of that happening from this kind of event.
Chris - Oh, well you can go home now! Thanks for that reassurance. But the thing I'm getting at is, if we look back in history, we know that mass movements of people do bring with them various things and people coming back from World War 1 is said to have, at least, played a part in the distribution of Spanish flu. So if we do have lots of people moving and that’s a lot of people movement – the numbers you’ve cited – then there must be a risk.
Chris W. - It’s fair to cite incidents like the first World War, there were obviously mass movements of people all around the world, but then you have to look that their living circumstances and the durations of the time that they were moving is a lot different to the Olympics. With something like the Olympics, you’re looking at essentially a lot of young, relatively prosperous, given the travel costs etc., people coming to an international city that’s used to having vast amounts of visitors every year. And looking in the media, it’s not clear how many extra visitors there will actually be because London is used to getting lots of people. Even commuting every morning is a large movement in and out of people.
Chris - London Transport says it’s 3 million a day at least, isn’t it?
Chris W. - It’s comparable in terms of the numbers moving - obviously the tubes and transport system will be more full because of the Olympics, but you know, we don’t worry about a pandemic happening in Hertfordshire every morning because of the commuting. We do have to prepare. We do have to look out to make sure that nothing is happening, and the Health Protection Agency are doing a lot of what we usually do, which is looking out for, preparing for and responding to cases or outbreaks of disease. But also, some additional surveillance, counting not just cases of known infection, but doing some things called ‘syndromic surveillance’ where if you phone up NHS Direct and say, “I’ve got vomiting” or “my child has got a cough” or whatever, this gets counted. We’ll be monitoring those figures which normally come out weekly, actually, coming out daily from these sites in the country. Also, they’ve included GP out-of-hour services and some action and emergency departments. So, we’re doing what we do every day, but we just extended it a bit further.
Chris - That sort of thing means that you should be able to spot if there is an emerging outbreak of something early so you would go in and nip it in the bud. What will you do if someone says, “Right, we seem to be picking up an outbreak of something – let’s say, measles or something – in this area.” What will you do? How do you manage that?
Chris W. - You’d start out by trying to work out if there really was a problem. Sometimes there’s an artefact in the figures or there might be a lot of laboratory reports coming at one time. So you make sure that you’ve got a problem and then you try and see how big the problem is. So, are there any other cases associated? You might need to communicate with the people to find out further cases often by going to the venue, asking other people. And then you start to bring together information about all the cases and describe it. Are these old people, young people, what have they been doing, are there any characteristics that bring them together? This is called descriptive epidemiology. Out of that, you can generate a hypothesis as to what has happened and how we can control and prevent it. Obviously, you might get a good idea on the first day; if it’s diarrhoea and vomiting, we tell everyone to wash their hands and not prepare food, etc. So, we have control measures that go all the way through, but you can then do further statistical investigations to work out sources of outbreaks and incidents. I was looking out on the way up at quite an interesting one in Germany where there was a triathlon competition. Out of the athletes, they had one case of quite a rare disease called leptospirosis which you may have heard of.
Chris - Weil’s disease, isn’t it?
Chris W. - Yes, Weil’s disease which occasionally, people talk about contracting it from the Cam etc. Obviously in the triathlon, people are in non-swimming pool water. So, having found one case, they wrote to all of the 200 or so athletes to see if there were any other cases. Actually, there were around 600 and they managed to get about 140 blood specimens from them. Out of that, they only found five cases in total. So again, quite a rare illness, but they found there was a statistical association with having cuts or abrasions on the skin, and that’s how the bug gets in through the dirty water. So, that was a good example of a rare disease picked up through surveillance and then investigated.
Chris - What about something much more in nefarious? There’s also a concern that Al Qaeda could for example seed an event with an infectious agent or send the infectious equivalent of a suicide bomber to an event spread something? Have you got plans for that?
Chris W. - Obviously, the everyday surveillance that we do is continually looking at not just for the usual things, but for rare items. Some of the laboratories that are involved are doing more rapid testing of infectious agents to turn around things more quickly. And we’re also doing surveillance for undiagnosed severe infections. So if someone did come up with something particularly unusual, and they were people in intensive care units trying to work out what was wrong with them, there's a surveillance system for picking up those sorts of rare events and then investigating them.
Chris - Some people are saying that if you get an outbreak, by the time you discover it’s an outbreak, it’s too late because the thing is already spreading.
Chris W. - Obviously, it depends what sort of infection you're talking about and the circumstances. We do, in fact, usually learn about outbreaks after there’ve been a few cases. The classic one we have is at a wedding where the meal has been served to a hundred people and one of the items sometimes, the chicken liver parfait is one of the current bugbears, has become contaminated with something or has been improperly prepared. And so, what you get is, a number of people have been ill. But the wedding has happened and there's not much you can do to take that away from them, but you can try to prevent the caterer using the same techniques in other weddings, and you can also prevent people passing it onto each other having become ill. So, that’s a fairly every day – well not quite every day, but every month perhaps.
Chris - Been there, done that, got the t-shirt, or t-shirt without the ‘r’ actually! It wasn’t liver parfait. It was vol au vents in my case, I think. What do you think, just to finish off, about the claim earlier this year, it was one of the medical advisers to the Olympic team and he was saying, “Don’t shake hands with these receiving lines of other athletes because this will transmit diseases.” Sounds like a load of tosh.
Chris W. - The Health Protection Agency would emphasise good hygiene and all the sensible things that you should do and particularly, if you’ve got some kind of diarrhoeal illness then washing your hands before shaking hands with anyone, or if you’ve got a cold or cough is always a good idea. But I don’t think that shaking hands in general should be prohibited and would seem to be against the Olympic spirit.
Chris - It would, and also the fact that yes, you can avoid shaking hands, but you can’t avoid touching a door handle and all these other things that we have to do to go about our daily lives. And if other people are insalubrious, have something and have touched all those same surfaces, they're going to pick it up.
Chris W. - That does happen. You mentioned earlier norovirus in care homes and cruise ships; that happens all over the place unfortunately because these things are often very difficult to clean off. But you have to remember that most of our experience is that most people go through their daily lives without coming down with these infections. And that most mass events nothing largely of note has happened. Touch wood, but there's been no major instance at international sporting events, and we just hope that that’s the health and sporting aspects that could dominate rather than any infections.
Chris - Very assuring words. Thank you very much, Chris Williams from the Health Protection Agency.
Part of the show An Olympic Effort - Keeping Crowds Safe and Healthy from the 1st Jul 2012