Simone Gao: Thank you very much Mr. Trevan for being with us. Zooming in today.
Tim Trevan: My pleasure.
Ms. Gao: There’s so many things we don’t know about this disease and also, you know, how they spread and the severity of the infection and stuff like that. So just based on the information we already know how do you compare this to any, you know, epidemic in recent history?
Mr. Trevan: Well, I think this is very similar to the, the, the process we went through with the H1N1. It’s very similar to the process we went through with Merz and with SARS. When a deadly disease first appears, people are scared naturally. People are afraid of the unknown. People are afraid of things they can’t control and people are afraid, afraid of things which cause stress and trauma and these new diseases which result in fatalities, particularly a large number of fatalities. They create all those fear factors. And so we are scared of it. But you know, once the science starts coming in, we can more rapidly get a handle on how to control it. So as I say, the mere fact we know it’s a coronavirus means that we know already that the virus can be decontaminated with very simple, easily available materials like soap or like alcohol
Ms. Gao: So you think it’s on the level of SARS, MERS maybe Ebola but not to the level of, for example, Spanish flu in 1917.
Mr. Trevan: We always hope it’s never going to get to that stage. But at this early stage of an outbreak, we can’t tell what’s going to happen, whether it’s going to break out and become a pandemic or whether it’s going to stay relatively local as an epidemic, but be contained within the to a large extent within the origin. So medicine size, thankfully were largely contained. It didn’t become true pandemics. H1N1 became a pandemic, but fortunately it didn’t end up being as disastrous as was feared. So it’s just too early-day to say how it’s going to go. Hopefully the Chinese authorities have discovered it and acted soon enough that it can be contained with it, mainly within China.
Ms. Gao: When can medical authorities tell which direction this is gonna go?
Mr. Trevan: Right. Well the first indications will be once we understand the full course of the disease, say it takes three weeks from infection to full recovery or say it takes 10 days from initial infection to when you’re no longer infectious, when you no longer can pass on the disease to someone else. If we find that over a, say a one week or two week period, the number of people who are progressing from initial infection out of the period from which they’re infectious starts exceeding the number of new cases, then we can believe that we’ve got it under control. Or at least we’re going in the right direction. So what we’ll definitely be looking for is what is the rate of new cases. If the rate of new cases such that continues to go up geometrically, then our control measures not working. If it starts to plateau or slow down, then we can have some faith that our control measures are working.
Ms. Gao: Just within the last day. I think the infection number has gone up quite a bit. Right? What was the number?
Mr. Trevan: The number I read today was 2,790 something.
Ms. Gao: In my impression it was a big jump. And also we have to consider, you know, in China now those numbers heavily underestimated because, not necessarily because the government is lying, but because those cases are only, can only be identified in what so-called 3A hospitals, the top hospitals and consider a lot of people stop going to the hospitals because they don’t want to wait in line for seven hours to get cross effected. Right.
Mr. Trevan: And again, the early days of an outbreak, it’s really tough to know what the true numbers are for some of the reasons you’re saying. First of all, you can only diagnose those patients who present to physicians who are capable of doing the diagnosis right. Second row or so that will push you towards underestimating segment or once there’s been a public a public information campaign, you might get a wave of people presenting themselves for diagnosis who have been infected for several days. So that might folks keep pushing up the number higher for the day to day new infection rate. So it takes a little while before the numbers settled down that where you’re getting a steady state of the number of people, the percentage of people who are getting infections who are presenting and the ability of the medical authorities to actually do the diagnosis. So early numbers, it’s always tough to say.
Ms. Gao: Okay. Let’s talk about the lab, the virus research lab. It’s called MSB 4, (which is) the maximum security laboratory level four. Tell me about, you know, the requirements for those labs and using, there’s some worry that China might not be able to handle this, right?
Mr. Trevan: So BSL 4 labs are the highest level of security for biological laboratories. Basically they’re designed to enable safe work on the most dangerous of pathogens are the ones for which there’s no prophylaxis, no cure, no treatment and basically which transmit very easily between humans and cause a high morbidity and high mortality. The, the basic requirements for these labs is that you have controlled access into and out of the lab that the lab should be hermetically sealed. That means there should be an under pressure in the lab. The, the atmospheric pressure inside the lab should be lower than the external normal atmospheric pressure of the air so that if there is a leak in the body, in the building, the air comes from the inside, from the outside in, not from the inside out. Right. So obviously all that’s designed to keep whatever’s inside the lab, inside the lab, they have to have filtered air coming in and filtered air going out.
They have to be very frequent as changes. People who are going to the lab have to go in through an airlock system. They have to take decontaminating showers on the way in and on the way out. And so and then once they’re in the lamp, they’re working in by safety cabinets wearing full personal protective equipment. That’s the suits with the ventilator and hoods and masks and everything. So they don’t have exposed skin. They work in the bag to safety cabinets so that whatever they’re working on is worked on within that enclosed space, within the enclosed lab. And, and so that, that’s the basic requirements of working in that sort of lab. The trouble is when you create a very complex organization like that with very complex engineering as the F the, the structure of the building, very complicated equipment complicated procedures that people have to go through, then and then you’ve got a living organism that you’re working with which is not controlled, you know, it’s a living organism.
Then you have what’s called a complex adaptive system and things can go wrong that you can simply cannot foresee. So the original comments are made back in the nature article were more to do with not whether China should have these labs. I mean, China has a right to have public health labs. In fact, under the international health regulations, countries are encouraged to have a good network of labs so that all populations are close enough to a lab who can, can make diagnosis for their diseases. My question was more whether the culture that exists in Chinese government structures and in organizations is structured in a way that can learn to adapt very quickly when the rules don’t work. So in complex adaptive systems, you get things called emergent properties. These are things that you cannot forecast.
And so there you have to be able to react to the unexpected very quickly. This means that you need to organize to be able to learn quickly, which means that even the most junior person has to be able to question the decisions and knowledge of the most senior person. And it means that the most senior people have to respect and listen to all the junior people too. So that was the concern that I was stating this, that I think in these sorts of labs, not just in China, but in countries around the world, we need to get a change in management attitude from one of very hierarchical structures where the bosses say this is the only way to do it, to ones where the people doing the work understand how they have to do it safely. And when, when a new knowledge appears, they’re able then to change the system themselves to keep it safe.
Ms. Gao: According to you, the nature magazine SARS virus has been leaked from the Beijing lab multiple times. What does that tell you?
Mr. Trevan: Well, to me that if, if you have a major unintended release of a dangerous pathogen like that several times within the same organization, over a short span of time, to me it would be indicative that there’s a systemic problem there. There’s a problem with the system of management and of risk management in that facility. And so I would want to go in there if, if I were responsible for trying to prevent these, these future releases of the, the virus I’d want to go in there and study what were the core, what were the underlying causes for why people made the decisions, which led to the actions which led to the release. What were the management structures that made them think that that was the right thing to do that way. So as I say, it becomes an issue of how you learn about your organization and how you learn about the way you do things.
Ms. Gao: And those BSL research labs, they are also, there have been reports that they are potentially being used for bio chemical weapons development. What’s your opinion?
Mr. Trevan: I have not seen any evidence of that. China is a full member of the biological weapons convention. They’re a full member of the chemical weapons convention. And under both of those conventions, it’s illegal to, to develop and produce, stockpile research on offensive biological weapons or even talks in weapons that are chemicals created by biological organisms. So China has international obligations not to work on those organisms for offensive purposes or to keep weapons or develop anything that might enable them to have weapons like that. As, as I say, to my knowledge, there’s no indication anywhere that other countries suspect China of actually developing these biologic weapons.
Ms. Gao: Tell me why don’t you think China is developing biological weapons.
Mr. Trevan: Biological weapons have been banned internationally since the early seventies, 1972, the biological weapons convention came into effect. China was an original secondary and is a full, fully signed up member for that convention.
Ms. Gao: By the way, that wouldn’t persuade me.
Mr. Trevan: But the main reason I don’t think we see biological weapons at the level of state enterprise is that they aren’t very effective militarily. And they’re very hard to control. You need to protect your own population, whether that’s your soldiers or whether your civilian population, particularly if you’re talking about a live agent, and for them to have any impact on the field, you need to produce some very, very large quantities and deliver them effectively.
Ms. Gao: So you were talking about (the fact that it) is not effective in the battlefield, but what if it’s not used in the battlefield?
Mr. Trevan: Well, it’s certainly biological weapons are being used for assassination purposes. There was a classic case of Mark off who was a blog Arion defecto who was murdered in London with a biological weapon by the Bulgarian secret services. So as a weapon of assassination, biological weapons are effective as a weapon of terror. They could be very, very effective for you remember the anthrax letter outbreak here? Well, just a very few, a few letters sent in the early nineties with white powder, which turned out to be anthrax toxin caused a massive overreaction security action, which was very, very disruptive. Now, if you put it in the big picture of things, a number of people died, which is very tragic, but many, many more people die on the roads or many, many more people die by going to hospital, by getting infections while they’re in hospital than they did through anthrax. But the fact of the matter is those letters did disrupt American society quite, quite considerably. So you can see how biological weapons could be used for assassination. And you can also see how they might be used by a terrible organization to disrupt. But as a battlefield weapon I don’t see them as being very effective, which makes them not very attractive to States national governments to have in the arsenal.
Ms. Gao: Okay. What if they release the virus to another country in the populated areas?
Mr. Trevan: Well, we see with a real pandemic you can’t just release a virus into one country. It won’t just stay in one country. If it’s an effective virus in terms of warfare purposes, it’s going to be virulent and it’s going to be passed off, which means then it can come back to your borders, in which case before you release it, you have not only to have a treatment and prophylaxis for it, but you need to have prepared your entire population to be protected against it. So it makes it very ineffective.
Ms. Gao: So the main reason you think China or any other countries not developing biological weapons is because it’s not effective?
Mr. Trevan: Yes. Okay. As a military weapon.
Ms. Gao: What about chemical weapons?
Mr. Trevan: Chemical weapons also…
Ms. Gao: Before that, which countries are currently developing biological weapons?
Mr. Trevan: No country admits to having a biological weapons program, but certainly there were concerns that Syria might be developing them when they were the uses of chemical weapons recently in the civil war there. And there’s always a concern about North Korea. What are the North Koreans developing? So there’s a concern that North Koreans have both chemical and biological weapons programs in addition to their nuclear program.
Ms. Gao: So why does China need five to seven? Those high level virus research centers?
Mr. Trevan: If you look at countries around the world, most countries only have one such laboratory. Most countries don’t have any labs. And the advanced countries that do have them tend to have one. The US has a number, I think probably in that same order of five to seven. So China, which is obviously a much bigger country in terms of population, it’s five to six times bigger than the United States. You could make a case that both in terms of population, in terms of the scientific endeavor and biology that China has as much right to that number of biological laboratory research laboratories as the United States. Certainly every country has been encouraged by the world health organization to have a network of laboratories spread out geographically so that people have access to diagnostic capabilities. So there will always be that (case) as to whether we really need that many BSL for labs.
But I think the underlying question of do we need this research into biology? Do we need to understand diseases better? Certainly we do. I’m one of those who believes that most people in science or in science for the good of the world and particularly most people in biology go into biology to, to improve the human condition. And so I think the more people we have working on understanding disease, the more chances are we going to get to a position, a position where these outbreaks are much less scary. Because even if it’s a new disease, we would have developed the capability to foster detection fastest a diagnosis that isn’t understanding what is the disease and how it progresses, and therefore getting to the position where we can create vaccines much more quickly.
Iraq was developing nuclear weapons, chemical weapons and biological weapons and long range missiles.
Ms. Gao: And why do they develop them? Because you said those weapons are not effective. Right?
Mr. Trevan: So Iraq, if you think of it, at the time it had come out of a long war with Iran which went on for 8, 10 years and Iraq’s population was much smaller than rights. At one stage, they were worried they were going to be completely overwhelmed. And so they were looking at any weapons system they could have, which would give them an advantage. Chemical weapons did actually prove to be militarily useful for them in the foul peninsula when tens of thousands of Iranian soldiers overwhelmed their defenses. And they use chemical weapons against the Iranians that was effective because the rains had no protection. They weren’t a modern army with all the detection and protection equipment against chemical weapons. But they also do biological weapons because they saw the war with Iran as being a war of attrition because of the numerical disadvantage in population because of the economic disadvantage, because of the difference in scale of the size of the two countries. They were looking for weapons of attrition as well as weapons of military significance. And so they were looking at biological weapons either to attack Iran’s agriculture weapons, like wheat routes and things like that or things which might cause long term chronic diseases. Aflatoxin is a cost, an agenda, for example…
Ms. Gao: Talking about that, you know, if you affect another country, it will eventually come back to your own people.
Mr. Trevan: Right. And so I think for someone, a country like Iraq, then these become more like doomsday weapons. They never intend to use them. They want the neighbors to know they have them so that if the existence of Iraq becomes threatened, then they will use them. So it’s, it’s more like a deterrence rather than a weapon they ever intend to use.
Ms. Gao: Would you say any country who has a doomsday mentality would likely develop (chemical weapons)?
Mr. Trevan: I think this is part of the reason why you see North Korea so interested in its nuclear weapon. They do see themselves as being as, as being vulnerable to outside pressures. Therefore, if they have this weapon a nuclear weapon, then they will be effectively immune from, from military attack. And I think that’s why the Israelis so clearly have a nuclear weapon is using a nuclear weapon against Egypt will probably be very detrimental to Israel itself because of the proximity. But you know, they have it there so that the Arab community knows as a whole that if the state of Israel’s very existence is threatened, then there is this weapon that will be used.
Ms. Gao: And the reason you think China is not developing a bio, a biological weapon is because they don’t have a doomsday mindset. At least you believe they don’t.
Mr. Trevan: I believe they don’t, no. China has a very, very long history. It has a long set, a real sense of itself. I once was involved in a conversation with Egyptian diplomats and Israeli diplomats and certainly a lack of understanding of each other’s basic belief systems in that Israel at that stage had only been a state for 50 years, whereas Egypt with being three thousand five thousand years, right. You know, Egyptian mentality is Egypt may cease to exist for a hundred years, but it doesn’t matter because it will come back. The Israelis don’t have that mentality. Israel has only been there 50 years. If it’s wiped off the face of the earth, it may never come back. China has been there since history began. China will always be there. I don’t think as a country you have that mentality now.
Ms. Gao: I think as a country, China doesn’t, but what about the CCP? The Chinese Communist party.
Mr. Trevan: Okay. That’s beyond my level of competence. Yeah. I wouldn’t want to go into that.
Ms. Gao: Okay, thank you very much, Mr. Trevan.
Mr. Trevan: Thank you.