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friends. Everyone, please move! Commute Because we're getting quite a little background noise. Big commute. Apart from the speaker, you can move to them by their own. Oh, yeah. Good job. Can you hear me? Now? That's an echo, Senator, because I think you've got two devices on. So you have to choose which one? Trying again. Now, can you guys hear me? Yeah, we Can you please, please, go ahead. I'm going to because of the tech difficulties, Uh, I'll ask you to introduce yourself, uh, and then we can get cracking. We ask everyone to be on mute. If there are any questions or comments, please put them in the chat. Um, just before the end, I'm going to put a link to feed back, which is really important for us. So please make sure you get you do the feedback, and then we will send, uh, the certificate across as well. And please make sure whoever is on that you've also booked on registered on eventbrite. That's really important. Welcome, everyone, and welcome to our bigger Okay, so we can get started. Um, good afternoon. My time. And somebody just told me, um, time in Ukraine. Um So you're still in the afternoon time, So good afternoon. I'm sorry, Chakrabarty. I, um uh, public health consultant, but I worked with in the National Health Service. Um, I'm a clinician by background. Um, I work in, um, obstetrics and gynecology. Um, and also public health. So lovely to meet you all. Um, today's lecture is on a topic, a very important topic in public health. Um, and it's around health protection, So this is protecting the health of our population. Um, and I've got a few slides which we will go through, Um, and we can. Then I have a few discussions and questions, and you can ask me I will send the slides to Sharon, which I've done already. So I'm assuming they will be a way to get the slides to you. And before the end of the call, I will leave my contact details, Um, for any further questions that, um, students would like to ask, um, if I don't know the answer, I will try and get them for you. My classes see better. Okay. Okay. So I will start to share. Um oh, um, Sharon, I think I need I need to have sharing sharing rights because hostess, disabled participant screen sharing you host, Just check. You should be. You know, it doesn't look like you're from. What else? I don't know. No, it's not for me. Um, it's a minute. Mhm. I'm not sure why I can't like your host. So strange. One sec. Do you want to keep talking while I try and work out how to do it? Okay, son Heater, do you want to Do you want to keep talking and start while I try and see how to? So I know, uh, maybe you've had public health lectures, um, in your university or you have had some kind of interaction in your course. Um, what will be helpful to know is, um what or if are the important topics that you'd like to get lectures on? Because that'll help me, um, Taylor, some of the topics to, um, your need your learning needs. Um, today's topic is around health protection. So this is about how, as a system, um, we protect our population against, uh, pandemics against infectious disease against nuclear emergencies. Um, well, you are already in an emergency yourself, so I don't have to elaborate on that and and what kind of systems we have. Um I'm going to apologize first hand, and I'm going to say I'm going to be describing the system we have here in the United Kingdom as part of the National Health Service. Um, and I'm sure you might want to resonate with some of that, but the principles are pretty much the same. Um, so it'll be good to hear from yourselves as well. Um, what or if are areas of interest within that that you would like to know more about? And then I can bring a separate lecture around that. So you're okay also. Okay. Awesome. Thank you. Um, and I'm gonna see if I can just give me two seconds. So I moved my slides up. Yeah. Mhm. Okay to ship. Can people see slides now? Yes. Okay, great. Fantastic. Okay, so I have a few slides. But as I said, um, uh, we can take questions at the end because I'm not going to want to see your hands as well as, um uh What? I'm presenting. So, um, but if you absolutely have to interrupt, do put your hand up and then I will try and come back to you. So, um, what do we want to get out of today? We want to be able to explain the principals around health protection and why it is important. Um, consider our clinical responsibilities for health protection. Um, and particularly in future practice, understand some of the role of public health. England. Well, they don't exist anymore. But UK Health Security Agency, which is the current agency now in predicting our public health. And this is where I said, I'll describe a little bit about the infrastructure that we have in the U. K. Which is quite unique and specific to the National Health Service here. Um, and we'll get to a point as to whether we can start to think about how as a group work. But we can do that in another point or through here. Um, developed some thinking around if there was a new health protection, um, situation. So you know, you just come out of a pandemic. But if you if you suddenly saw, um, in your area, um, suddenly there is a big number of Children with diarrheal disease or more numbers of, you know, people presenting with certain kind of meningitis. How or what systems do we bring into place? And what kind of, um uh, measures do we do we put into place to make sure that we understand the system, but more importantly, protect other people from any risks arising from a situation like that. So let's just start off from the beginning. What is health protection? So health protection is, as I said, and as as I described, it's protecting individuals, groups and populations from single cases of infectious disease and all communicable diseases. Incidents and outbreaks noninfectious environmental hazards such as chemicals or radiation. So what you get to see is, um, you know, you know, when the pandemic started, you remember seeing China alerting the rest of the world, saying, You know, we'll be seeing some unusual viral activity here. We're losing people. Please can get everybody into gear. And that's what you saw is that the W, uh, W W h o World Health Organization put into gear the entire world activated the public health system so that we could all get our systems together and put our wrap around our populations. And that's what basically, the health protection function is now that was a global pandemic. And, you know, we've lived. It will come out to the other side issues learning from that. But that can happen in a small place. As I said, you could have a meningitis outbreak. You could have a, uh, infectious disease outbreak in a care home that you're dealing with and all of that encompasses protection. So how does that involve you? Um, so there are lots of other facets of protecting our population. Um, and some of them are prevention provision as well. So how do we know for sure? Now that you know we are protected against Covina or flu or or, you know, a number of, uh, infectious diseases? It's because we've got immunizations, which which gives us immunity, and therefore we develop antibodies in future. If their outbreaks and we are in that situation, we have antibodies that can fight off the virus. So immunizations are one of the most successful and cost effective investments in our history that absolutely is the bedrock of our health protection system. So if you remember from the from the pandemic days, when you look back in the you know, it seems about a long time ago. But, you know, 23 years ago, we all went to the lock down, but the world was crying out for immunization for vaccines, and it was about let's get something that could boost the immunity within the human system. And we can then protect thousands and millions from this deadly virus that had emerged. So one of the most successful in the cost effective health is investments in history. Um, is our immunization programs and we have different immunization programs all across the world. Uh, every country has got their own. Um, and then some immunizations are part of a prophylaxis. For example, the MMR vaccines, the hepatitis B vaccines. Um, And So, for example, if we have, uh, hepatitis B outbreaks somewhere, the first thing we do is and you check, uh, you know, have people got the immunization and one of the one of the treatments. One of the management is we could boost to vaccinate people with hep b, uh, and protect people from it for people who are not affected. Yet. We do that in outbreaks for, you know, for measles for meningitis, and and some of them are prophylaxis to just prevent other people from getting the infection if they're in an outbreak situation. So in the England, in England, and well, in the United Kingdom, we've got a joint committee on vaccinations and immunizations, and they are our governing body, and they're called J C B I. And they are constantly interviewing the evidence around new vaccines. Um, and and they're making subtle changes to the current vaccination program and then making recommendations to the governor into the health secretary to say Okay, the immunization program has to now evolve. And this is the part of the new immunization program. So again, talking to the recent pandemic, when the coated vaccines first came in, it was a joint committee on vaccinations and immunizations. We then have to review all the evidence of the literature, all the studies, um, and then make the around which vaccines were suitable for war. Who, um, and you know who to give it. So you know, as the as the vaccination program involved, as you could remember, young people could get some vaccines. Older people couldn't get some of the vaccines and all of that evidence, um, review is done by J CPI. The joint committee on vaccines and immunizations in the United Kingdom. I'm sure you've got a similar counterpart in your country, and you might want to look them up. The other big area of health protection is around notifiable diseases. So when you see an unusual activity in a particular condition which are in a list of conditions which are already, um, to be notified, so it is almost, um, kind of it's kind of enshrined in law. If you're a clinician and you come in, come in contact with some diseases, then you have to notify them, too. The authorities, as in we've got a we've got a national frame work around that. And what that means is that we keep a track of those notifiable conditions. And then if there's certain pockets we start to see those notifiable conditions start to rise, then we have we can. We've got systems to go in and and and make sure that there's nothing unusual going on or there is no spread going on, um, and and that and that that puts a system around the population. So we had a little flurry of activity recently, which is still ongoing because we started to see a new virus in the form of a monkey pox virus. Now it's it's kind of an endemic virus in the African states. However, we started to see pockets of that, uh, in certain groups of people. Um, in, um um, in the UK So we had to suddenly go and do some more investigations to understand whether they were affecting certain groups of people. And it was, and then we have to put in vaccination programs in in a whole surveillance programming and and so now it's kind of a notifiable disease. But other than that, I mean, that is a new and emerging, Um, But now, but we've we've got we've got notifiable diseases and and that's the list of the notifiable diseases that we've got. So, for example, if if, uh if a meningitis cases diagnosed when the diagnosis is absolutely confirmed, we have to notify this to the Health Protection Agency used to call them Health Protection Agency. But they're now most recently changing to Paxil, which is the United Kingdom Health Safety, um, security agency and we have to notify them. What they do is, um, discuss and put put prophylaxis around everybody who's come in contact with that one particular index case and then make sure that there's ongoing monitoring to understand that there is no more additional cases of that condition. So, as you can see on here, there are these list of cases. So if at Covina 19 is now on there. So So if if if any of those cases are diagnosed, the first part of call has been notified them to access, uh, and and they then they work with the clinician to develop a program around, making sure that everybody who was in contact with that one index case is well protected. And there is no spread of that infection. Okay, so Okay, so who does the notification? And, you know, um, when do you notify and and how do you notify? So, you know, um, the notification can be whoever is the clinician in charge. So it could be the doctor attending the patient. Um, but it's important. Have a definite diagnosis before you start to notify, because in the clinical world, we often work with probable and possible diagnosis. But that doesn't mean that they're definitely that case. So, you know, Children with meningitis present with a lot of symptoms, and we then diagnose them as a, uh, you know, you know, we kind of run a whole lot of battery of tests. And when they become, when some of those tests become positive, then only for sure we can say that they're definitely they're definitely got meningitis. But before that, we are working with the assumption that they could have meningitis, so there are possible or probable diagnosis. Um, so even then, you start to notify while you're running your battery of, uh, questions. But when you've got a definitive diagnosis, it's definitely a statutory responsibility. Then notify. Absolutely. Um, so how do we notify? So in in in the United Kingdom, we've got specific systems. As I said, it says on their health protection agency, because the websites are changing the the systems just change with the pandemic. Um, and we've got forms and we've got some sort of a system, of course, up. And then, um uh and there's usually a registrar or a consultant from the accident who are on call who then attend to your call, take lots of details, and then they make the necessary plants and they work with you and put the necessary plans in place. So who, when and how it can be any anybody who's in contact or is aware of the patient who's running the investigations and even on clinical suspicion, you can make the notification again. This is the UK system. So you might want to find out how the system is working Ukraine. And I'm sure now with your situation, um, those are even more heightened. You might just want to find out a little bit more about that. And why is notification important? And I was talking about that a little bit when I was alluding to my examples of sort of the monkey pox virus situation. We've had covert pandemic. We've we've had, um but, you know, in war zones and other places, we have cholera outbreak. We have TV outbreaks and why notification is so important. The importance of notification is so that we can take action to identify the source. So we need to find out who is the person who is infected or which cluster of people are infected. And what we want to do is we have to look after them clinically, but we have to prevent the spread of that disease and minimize the risk to the rest of the people who are in contact with them. So, you know, um, in the in the early part of the pandemic, if you remember, we put in this self isolation thing We kind of said, if you call it positive, you need to isolate from the rest of your family, you need to lock yourself away. 14 days. You need to stay in there. Don't come in contact with anybody because we didn't have a virus. We didn't have any management. We had some ways of kind of just monitoring them. Um, so So what are we trying to do? We're trying to protect the rest of the people who are in contact with this person who's got the index case so that we can minimize the risk to the context. And we'd rather do something early than late. Uh, and that's why it's done on suspicion. So if you remember those days in the UK, we had the three symptoms and for Kobe, then you said if any of those were, um, you know, if you had fever, if you had a, uh, sort of, uh although the other couple of things. It's just Sunday escape me about three symptoms. If you had any of those fever cough and I think a lot of sense of, uh, taste or smell. Um, then definitely. You need to isolate yourself first before you start to do your tests. So So what we're trying to do there is We're intervening early and making sure that that there is no, um, you know, that there is no risk of spread of that, uh, that infection then. So basically, you're doing a risk assessment, and there is an opportunity then to do public health action, okay? And what is an outbreak? So we've been talking about. So you just come out of the pandemic, which is a global pandemics, you know, little pockets of outbreak then become big, and they become, you know, pandemics. Um, so what is an outbreak? An outbreak. So it's an incident. So this is the definition that we use here. An outbreak is an incident affecting two or more people thought to have a common exposure to a potential source in which the experience similar illness or proven infection. So we just talked about the whole Covic situation which was global and pandemic, and people were getting infected over the world. But as I started off early to say, you could have an outbreak of a Clostridium difficile, uh, infection in a care home. And you can just have two of those inmates with that infection. We then have other vulnerable residents within that care home situation. So what we have to do, we have to notify that. And then we have to make sure that be investigated. Find out that there are not other sources which resulted in those two residents getting the infection. So it could be kind of somebody a carer Who's carrying them, uh, infection. Somebody who's doing their meals, somebody who's going I/O to deliver their drugs, Maybe a doctor whose whose hand washing is not right? We don't know. So that investigation then starts, and then basically we have to then put in measures to control and control that infection, but also protect the people. So an incident affecting two or more people, it could be as small as that. The rate of infection or enlist above the expected rate for that place and time is also important to watch. So how many people are getting infected from the one person that was infected? So that is important to also watch? Um, and sometimes, um, it's just a single case is an outlet can be just a single cases of certain diseases because we haven't seen those, um, infections in many, many, many, many years. But even if you see the one case, then that in itself can be called an outbreak. So, for example, over the current period, we had a huge decline in our uptake of Children's immunization. Now, as you know, diphtheria immunization is part of Children's immunization. We had vulnerable people because Covic had reduced our immunity. Anyway, we started to see pockets of one or two Children in the UK presenting with diphtheria, which is a condition we have not seen in this country for a long time. Even if you've seen it, we've kind of seen it in people who maybe traveled abroad and brought it in, not something that was in this country. So what we have to do is we have to put the whole system in gear, find out the next case, find out the source of infection and start to vaccinate. A similar thing happened for us in London. Most recently, we didn't even find poliovirus in people. We started to notice sort of our sewage containing poliovirus. That's a potential risk. We haven't seen poliovirus in the United Kingdom for many years. You know, we've all been vaccinated for polio, so we suddenly had to put in our system, and it was only in London in certain pockets. And we had to put vaccination programs in because you can see outbreaks can doesn't have to be global and how it doesn't have to be. A huge number of people certainly infections because they're so rare. Even if there's one infection that can be an outbreak surveillance. So what does public health surveillance do? And again, please look this up in your systems and find out what that actually does. Public and surveillance is a continuous systematic collection, analysis and interpretation of health related data needed for planning, implementation and evaluation of public health practice in the UK There's a huge system under AXA, which is the national body whereby most infectious diseases and even the rare ones are being monitored constantly, and, um, it's kind of then you know policies are then developed accordingly. So let me give you an example. So we are in the flu season now, so we've got a big flu vaccination program. Um, but as you know, or you may not know that the flu vaccine is changed every year to meet to the needs of the virus, the strain flu strain that's circulating at the time. What we do through the winter is we constantly monitor all of the flu cases and all the lab results from the flu cases, so that we continue to monitor whether there is any emerging viruses or some emerging strains that the vaccine will not cover. Or there are certain population groups who are probably, um, feeling that they, you know, they're becoming more vulnerable in spite of the vaccination program. We then tailor the vaccination program, which is a national vaccination program, which is eligibility is across the big populations retailer the program to support the people and and cover the most vulnerable. We couldn't have done that if we didn't have a great surveillance system. And so that's what public health surveillance does. And the UK we've got the system. But there is a worldwide system of surveillance. So why did China tell the rest of the world because of their surveillance system triggered something which then everybody else picked up on the similar thing happens with, you know, in your you know, we had many, many, many years ago with it's something called the Mad cow disease, which which which then triggered something in Europe And then, you know, we just coming out of some of those restrictions as well. So because we've got this beauty of public health surveillance districts across the world, we're always able to monitor constantly any any infections coming up. Any disease is coming up. That is a potential harm that can cause potential harm human beings. So the service, um, surveillance systems have got early warning systems and they're based on public health emergencies. What they do is they document the impact of an intervention. So, for example, you know, after every flu season, we document the learning from the flu season. How many people were protected from the flu vaccine? How many people got infected in spite of the flu vaccine? What were their profiles? How could that influence our flu vaccination program for next year? so documenting the impact of the intervention is very important. And then are we meeting the the the the targets that we set ourselves in in, In, In, in, in the United Kingdom we have. So what we know is that to bring to keep flu at a low level, we need to have 75% over 75% of our over 65 people vaccinated. So with the civilian system constantly keeps telling us, Have we achieved that? Where have we not achieved that? Do we need to put put more initiative into those areas? Because if a flu outbreak starts in one pocket, it could quite easily spread as we know. So the vaccination program is to therefore then tailor the need to the right people and then also monitors and clarifies epidemiology of health problems to allow priorities to certainty from public health policies and strategies. So, for example, the coated 19 all of that surveillance. All of that learning is ongoing even now. So, for example, if you feel you've got coded like symptoms or if your coated positive do you go to work? Do you not go to work? When do you go to work. All of those policies are influenced by the health protection surveillance system because we studied the epidemiology of coated, which makes sure if you had the vaccine, the fact that had the vaccine a year ago and you have your boosters, your risk is higher than somebody who's had a booster more recently. So do we have to then change policies to say Okay, well, what does that actually mean? So So, as you can see, it's kind of quite, uh, you know, it's a very lively system and huge number of people, very intelligent people, constantly analyzing data and making sure that the epidemiology is right and helping to support our policies and strategies. So then, then, then there is the infection controlled side of health protection. Um, so there is a pandemic influences strategy. Well, you know, we we've had that for many, many, many, many years. Um, but again, the coated pandemic came and hit us left field because we found that are influenced a pandemic strategies were not, you know, not going to help us for covert pandemic. So we have to go back and re look, and we think all of that kind of stuff. We've got infection control policy from migrant house in the United Kingdom. We have lots of migrant population, say, coming over to us through the channel on little boat coming over through us through the through the through our airport by road. Um, when we have people who migrated to the country from other parts of the world, they might be susceptible to infections that are endemic to those parts of the world. So we need to be screening them, and then we need to be vaccinating them and making sure that their health is protected as well. And they don't become the source of spreading sort of endemic conditions that they bring in a bit. But it's a big program work around my great health, which means so I was responsible for responsive last year when we had the huge crisis in Afghanistan. Um, we're now responding to, you know, sort of so so residents coming to us from Ukraine, where we have to put in a whole surveillance system around making sure you've got the right health support for you, but also looking after making sure any condition that you have is well protected and you know that there is. You're having the right protection in the system as well, to make sure that you don't get any infections that are in their making this part of the world as well. Port help So all of our borders. So there's a whole border security forces. Our ports are airports are road links. All have helped officers who are in charge of making sure that people coming in through the port You don't have to be a migrant. You could have got I spent time in Thailand, you know, with with your friends. Um And then you know, there are some endemic diseases in violence and Thailand, and then you kind of bring that in. So, you know, the port health is always about sort of making sure that we're not bringing any infectious disease back into the country. And then there is a non infectious hazards that will come to them in a minute. I'll stop because I've been talking constantly for half an hour. Are there any burning questions and see if I can take those? Do I have a moderator who can tell me if there's any burning questions in the chat? Any burning questions. Okay, shout out. If you if you can't put your hand up or you don't you start typing any burning, burning questions. Now I'll take I'll take silence, as I know and you're on. Um, okay, so so far we've been talking about infectious disease and how the health protection system and the importance of those elements around the health protection system is to protect our population from those infectious disease. Okay, but you could have a health hazard at the population level from a noninfectious condition. So in this kind of situation, it's the, um you know, chemical spills contaminated land murky through mercury thermometers, individual adverse events, fire, asbestos, air quality, police, fire services are involved. And then we've got hazmat officers and they are located. Different parts of our country in the United Kingdom were alerted if there was. If there is any kind of this kind of chemical hazard, which is a risk to the population and two large groups of population, so it doesn't have to always be infectious disease, it can be anything. So you may or may not be aware of the situation we had in Salisbury, which is a little tiny quite went village, and we had two people who were poisoned. And it was extremely difficult because it's something that we haven't seen in this country for a long time. And they the the the chemicals that they were poisoned, we're kind of, uh, almost sort of in, uh, controlled in our country. Um, So it kind of then lecture a huge, huge investigation to find out what was the source who? How they could have got infected. But the most important thing the health protection function was that Okay, well, the two people were poisoned. But how could we protect the rest of the people in that little town? I don't play the video here, but you can go and look this up in your in your spare time because you can then actually look at what actually happened and how the health protection system came in and supported. Um, that kind of, uh, investigation And that incident that happened in Salisbury. We can also have radiological hazards. Um, and and, you know, I don't have to tell you I'm listening to the news all the time, um, in in in other parts of the world, and of course, now in Ukraine with the war, You know, many of our nuclear power plants are under a lot of threat. Um, so you know, if there is some something that you know, some attacks help in release of nuclear radiation, but that is likely to affect people. We also have electromagnetic radiological hazards. So again, you know, we've got mobile towers and stuff like that running through all of our, you know, Um uh, systems and, you know, localities, villages. You know, what if something was, you know, being released from them or there was damage, and that meant that they would be affecting the people. That's an area that's again under constant surveillance. But again, it's a hazard. We've had hazards from radon. We've had laser radiation, so you know, there are a whole lot of things that happen from time to time. But as I said, that's why the health protection surveillance system is quite important to just be aware that these are also radiological hazards that one needs to be aware of. And if you become aware of it, then we get the system into place so that they don't protect so they protect other people and the healthy general general people from anything that can cause harm to them. And then they have the protection system also protects from extreme events as well. So, um, in our part of the world, we have heat waves. When we have really cold waves, we have floods. Um, so we have to Then, um, make sure that vulnerable people are protected and they're not suffering until probably from any of those extreme environmental events. Unfortunately for us, because of the climate change and all of the changes that are happening globally, um, more and more of these extreme climate change, it's becoming a normal, um, and that's what the health protection system picks up. So if there is a flood, the first things we need find out is who are the vulnerable? How can remove them, how they got medication. Um, you know, uh, there's no break out of cholera or any of the water borne diseases you know? Are there other, uh, you know, infectious disease that people could be more vulnerable to, And then the whole system kicks in as to support those extreme events and protect the people from any untoward harm to their health. So any burning questions. So I'm giving you like, a breath of all of the hazards that can affect the human body and the population level support that is there within the health protection system to make sure that wider harm doesn't happen. Um, any burning questions? I can't see the chart, but is anybody putting any questions? No. Um, okay. Any burning questions from anybody? Oh, God. Okay. All right. Let me just come out of this. Just come on the chat. Okay. Perfect. Carry on. Carry on. Can somebody say yes? Yes. Carry on. Carry on. Thank you. Okay, So great. So now I'm going to talk about Well, it says east of England, but east of England is where I work. So these lines are from my current teaching cohort, where I teach students. So please marry me. It says east of England. But this is kind of a system that, um that is in place all across England and the United Kingdom as well. Um, but just to give you a flavor and you might again want to find out how the systems work in your system in your part of the world. So? So it's not public health England anymore. It's It's an organization called Laksa. Um, United Kingdom Health Security Agency. Um, and they've been brought in since the pandemic, and it's slightly different, but the functions are pretty much the same. They are the safeguards safeguarding organization across England around everything to do with health health, uh, protection and And who is involved in in in health protection. So, um, so the central organization is called Pradaxa, as I said, and then we've got acute hospitals. We've got local authority, which are These are counsellors. Um, uh, we've got our national experts. We've got patients in public, and we've got primary care, which is our GPS and our nurses, and are people who are working in the ground closely with people every day. Um, and they all part of making sure that we've got the right safeguards around the protection of our population against all these hazards that I've just been describing. Okay, so, yes. So I was just saying so the public health England bed has now been converted into you can Health Security agency and, you know, we've got a new chief executive, as you can see there, Um, and, uh, since the pandemic. We've realized that some of our systems needed changing and adapting and renovating and and becoming much more robust. And and that's the process that's happening now. So I'll still they're still talks about public health. England. But the actually the UK help security agency have still got some of these functions. Um, and we need these functions because of all of the hazards that I just explained. Um, in the previous slides, um, so we've got a system where there is a center for rate irritation, chemical and environmental hazards. Um, and that's in London. Um, and and just say they constantly, um, they constantly monitor if there is any harm from radiation, chemical or environment, environmental risks. We've got the emergency response department, uh, which which would come in. So you know, when Salisbury happened or when there's a flood or or somewhere they come in and and they started with the response in, um, because the antibiotic microbial resistance. Um, so, you know, endemic, uh, diseases. Sorry. There's a bit of a noise because I'm in a bit of a corridor and, um so, uh, apologies. So the antimicrobial protected resistance is so there are certain endemic disease we constantly monitor. So, for example, hepatitis and tuberculosis, because we absolutely have to make sure that we're not getting increase in those numbers. Um, and and there are no unusual strains arising. So maybe maybe you have studied or you have You may not have studied, um, that we used to have tuberculosis. We found a cure for it, and we were doing absolutely fine. But then now we're getting drug resistant tuberculosis, and they are also modifying. So we're now getting certain, very vulnerable cohorts who got drug resistant tuberculosis. And we are finding, um, that we have to treat them with different, uh, antimicrobial regiments. We would have not been able to do that if we didn't have a health protection system, which is constantly studying. They did a reality. Then there is a group that studies global public health. So, you know, uh, you know what's happening everywhere else. So So that because we have people traveling I/O of the countries, people traveling globally. Um, and, you know, it just takes 40 lbs to go from one city to another in your legs these days. So, you know, people are traveling all the time for reasons. So you need to be understanding what the risk is from each of the, uh if there's any risks in any other parts of the world, then there is the whole infectious disease surveillance and control, which is which I was talking about. And then in our part of the world in the United Kingdom, we've got regional centers. We've got screening immunization teams. We've got knowledge, intelligence teams and whole lot of, um, sort of local teams who are all doing this work locally and feeding up into a national body. So it's it's it's a big organization constantly. 20 people. Seven. Making sure that as populations can function, liver lives in a productive way without making without being at home. Yeah, okay. I'm just gonna cover. I'm gonna skip those because those are my, um those are our local. So I just want to talk about the old school systems. As I said, it's a 24 7 service. So 24 7, you got people on call who you can notify or anything. So it's a community people disease to notify. Yeah. Sorry. Somebody asking a question or talking? No. Just keep going? We Can I just ask everyone? Everyone knew their devices, your devices, and, uh, you just continue there. Any questions The moderator will let you know. Thank you. You too. Uh, notified. Uh, Doctor Chakrabarty, you have to run you yourself. Sorry. Oh, sorry. I think I got muted. Anyway, I just wanted to emphasize the fact that there is a whole system which works 24 7 to to be notified for any any problems. Okay, when you get those slides, you'll be able to see, um, some guidelines those that you can guidelines. Sharon's told me that some of you are trying to, um, see how we could do blood and other things. And these guidelines might be helpful for you to prepare for blood and other things. Because in case you're trying to wanting to come and work in the United Kingdom, they might be of benefit to you. Okay, Um and then and then we got, like, a little scenario. And Sharon, um, well, I just go through it myself because I think it would be quite difficult to involve everybody else if you don't mind going through it yourself. You've got rheumatica on who's moderating. So if you need anything, please ask for rheumatica. Thank you so much. Problem. Okay, so here is a real life situation. Okay, so this is the kind of situation we get based in day in and day out, but, um, this kind of places you. So in our part of the world, we've got medical students are going to gp surgeries. So, um, you are a medical student in a GP surgery and a patient calls up, and they said they had covert 19 test two days ago, and it has come back positive this morning. But they said they attended the surgery two days before the test or a diabetes review and a flu vaccine. So they were there in the surgery two days before. Okay, so they could already been infected with coated 19 because the test is, um, just come back positive. And they've obviously come in contact with lots of members of the staff within the GP surgery. So, for example, the reception is the nurse who did their diabetes review the nurse who gave them the flu vaccine. Any other people they met with, but they could also be sort of, you know, sat in the GP surgery. Um, well, we don't get get that many these days, but still, um, or they might have been in a in a situation where there have, you know, they had somebody was vulnerable in that vicinity as well. So what do you do? So in those kind of situations, So in this case, they infection control lead in the GP, surgery will take a lead, and they will start to investigate. Who are the people who came in contact with this particular person? Have they developed any new symptoms? Um, when was the what was their vaccination status? Um, if they have not had the vaccine and they're still asymptomatic to get the vaccine, try and do a testing protocol to make sure everybody's had their tests to just make sure. And not just the one test depends on which test you're doing. And and then, of course, um, make sure that if there's anybody positive, they are taken on to the system, um, two until they cover the incubation period and then they can come back into their service. So every little tiny area has got an infection control lead. Who will take that? lead, and then they will work with the Health Protection Agency and make sure that the right system is put in there to protect that. So what does that give you an impression of? So that is how health protection works in your day to day in your work today in your clinic today. And although there is this big system, but everybody is a little clogged in the wheel who can then support and make sure that that things that are hazards to human beings are contained. Okay, I think that brings me to the end of my slides. I'm going to, um, stop there and, um, see if there's any questions. Hello, Professor. No one's posted any questions on your hair. Maybe I'll just wait. Okay? Someone else? If we talk about those who are involved in public health protection, who has the biggest role primary care doctors, everybody's got a big role. Okay, As I said before, we all as clinicians, members of the public cover role of intimidating information gathering information sharing primary care colleagues are right at the front. So of course, they pay a very, very big role. But that is not to say you're a nurse in the hospital, you don't have a big role. You could pick up the meningitis case. You could be the member of the public who might see a pile of tire burning somewhere and and call up the agencies and make sure that you've got that information through in the clinical sector. As I said, primary care colleagues are right at the front line. And of course, therefore, they have a bigger role because they're they're constantly interacting with people healthy and with symptoms all the time and making sure that there's no infectious disease. Does that answer the question? What, are you still here? Yeah. Yes, it has any other questions? Okay. Yeah, That seems to be no other questions. Okay, great. So I'm going to put in the chat my email address, because if you thought, um, sorry if, uh sorry. Give me two seconds. Um, um, yeah, um, if you go, if you have any questions or you go through my slides and you think didn't quite understand that, um, or something like that. Then just drop me a line. Um, and I'll be very, very happy to answer your questions. So I put my, um, email address on the chat box. And, um, Sharon's got my slides. So Rebecca very happy for colleagues to have my slides. These slides were actually developed by some of our medical students for yourselves as well. So a big thank you to them. When I said I was doing this today, they I've tried to put it together. So, um so I think, you know, uh, if you want more on the slides, please give me some feedback as well. And let me know if there's things that you wanted to see in this lecture that you haven't seen and I'll make sure that my next lecture is better than this one. Okay, excellent. Thank you. Thank you to worry about that. I think what we'll do is we'll get some views from students about the best topics, topics for them that meet the criteria and the syllabus, and we'll make sure that those topics will be covered. I see that we've got quite a few people now, so I'm going to get Ruppert if she hasn't already just supposed to link to the feedback because we're very dependent on the people in this lecture. Everyone, please to the leg and the feedback for me the last minute of the lecture. So just you know, 1 29. Well, post the certificate. We must have the feedback. And just be sure to the details of the lecture today. The date. Thank you very much. Thank you. Thank you. Stay safe for you. Okay. Thank you. I'm going to take leave because I have to go to my next, uh, commitment. Um, it has been an absolute pleasure and extremely humbling a big thank you to Sharon for making, um, this all happen. And we hope we can support you in the best way possible. Um, but as I said, you've got my contact details. Contact me for any questions or anything else I can help you with you. Let me know, and we will be there to help you. And in the meantime, stay safe. Stay safe by. Thank you. Thank you. Bye bye. Bye bye. Thank you. And what we'll do that everyone can hear me. What we'll do is we'll post the certificate now just because the lecture has left. So, Rebecca, can I get you to post the certificate? Yep. Posted it, Posting it Now it's loading. Okay, so we'll stay for a couple more minutes while people are filling in the feedback A certificate. There's an email address there. We'll post that detail again. The email address so that you can contact you for any medical issues with the certificate. And we post that information. Okay, everyone, we'll see you on Thursday. Thank you very much. We got to lectures on Thursday and thank you to Aerobika and everyone that's joined. Can you please put in the chart if you've got any issues with the feedback for me, please? Mm. Well, when we reach 1 30 we will end the meeting. Thank you very much. Thank you. Thank you. Everyone else.