Transcript: Episode 11
Proud to Help
ucl, people, sophie, patients, felt, ventilator, david, respiratory, device, return, nhs, wards, pandemic, medical school, medical students, hospital, pap, called, graduated, staff
Sophie Bracke, David Lomas, Vivienne Parry
Vivienne Parry 00:04
Hello and welcome to Coronavirus The Whole Story. I'm Vivienne Parry, writer, broadcaster UCL alumna, and right now your guide to Coronavirus as seen through the eyes of UCL staff, students and research over the past three months. Couldn't believe I just said that three months! I've been speaking to people from a whole range of disciplines, from engineers to public health experts to historians of the Middle Ages to try and understand every aspect of this global pandemic and its impact. This week's episode is slightly different. It's all about being proud to help during this pandemic. In support of the Universities UK’s hashtag we are together campaign. We're sharing how UCL staff and students responded to the pandemic, not only with impactful research, but also by working for frontline services. Today we hear from a professor – a vice provost of health even who heard the call and went back to the wards and from a medical student who gave up her graduation celebration and threw herself into stressful days and nights in hospitals at the height of COVID.
My first guest this week is Professor of Medicine and Vice Provost for Health at UCL, David Lomax. Now when Coronavirus has a lot of researchers in the UCL community use their knowledge and expertise to help out. We've heard, for instance, about the breathing devices or the ways to assess viral spread here on this podcast. But for David, it was altogether different. He was a respiratory physician back in the day and for him when the NHS called, there was no other course of action than to return to the wards. My other guests that I'm speaking to was a UCL medical student. So welcome, Sophie Brack, and in absentia here, can I also welcome Abdul Elmi, who would have been with us today, were it not for the fact he is delayed on the wards and I also should say, Dr Sophie Bracke and Dr Abdul Elmi because they graduated ahead of time so that they could join the frontline. Sophie worked in ICU at the Royal Free hospital at the height of the pandemic and Abdul at UCLH, which is where he is today. So let me turn to David, first of all, with your doctor's hat on, walk us through the decision to return to patient facing work. What was the opportunity and what made you want to take it?
David Lomas 02:30
Thanks Viv, so we were in unprecedented times. If you remember back three months, two predictions from the Imperial modelling from the SAGE group were that we were going to have about 250,000 deaths from Coronavirus. It was going to sweep through the country at the health service was going to be overwhelmed. You might remember stories of Hyde Park being turned into a temporary mortuary. And so at that time, we needed All hands to the pumps and and UCL I think rallied brilliantly. And we released our staff we were, I think the first university to to recommend that our clinical scientists or clinicians or research staff should be released from their UCL roles, to return to the frontline to help everyone needed to help everyone needed to, to get there and do that bit. And for me, I really couldn't ask people to do that without doing it myself. So it was it was a no brainer. It was time to go back and return to respiratory medicine. I said I'd never really stopped in respiratory medicine but but the the challenge here was to put yourself in harm's way and to volunteer to return to the front line.
Vivienne Parry 03:38
So how difficult was it, David? Because you, you know, it's quite a long time since you've been on the wards. Was it? Was it just like riding a bike?
David Lomas 03:51
Well, not not quite as long so I even though advice, promise health and even though I look after the medical school and the school of life, medical sciences, I still do clinical practice. I don't do a great deal. Do about a month a year of clinical service at UCLH and I do a clinic once a month at the Royal Free. So I still practice respiratory medicine. And the challenge here was to go really to put yourself in harm's way to deal with a respiratory position does at a time of need. And,
Vivienne Parry 04:18
and I want you to know listeners that of course he looks 23 with a light behind him. But you are. You are older David. I mean, I will come to Sophie, you know, perhaps people who are younger, don't worry quite so much about the risk of infection but certainly older people do. Was that on your mind?
David Lomas 04:41
Yeah, absolutely. So Sophie and I are at different ends of the spectrum I think in different different ends of our careers if I may say that Sophie, and so I returned back to work on the CPAP unit. It had been rapidly constructed unit at UCH and it was the step down from ITU if you will from People who are getting better and it was to prevent the poorly people getting to ITU and it was to use the device that UCL helped pioneer the use of the Ventura device and other CPAP devices to assist with breathing to stop people progressing and requiring expensive, difficult high resources of ITU. So I returned to the ward and it was actually on over the Easter weekend, which was the peak of the search. And I have to say that it was fabulous. The the team, the teams were in the camaraderie was just outstanding, the nurses, the support staff, the administrators, the junior doctors, just brilliant. But I did pause and look around and thought, oh, Crikey, unless you're the oldest person here and Coronavirus does affect the aged so there is a bit of a risk.
Vivienne Parry 05:47
So in some senses, I mean obviously there's a there's tales of tragedy unfolding all around you. But in some senses working on that CPAP initiative must have been thrilling
David Lomas 06:00
It was actually So my role in this UCL Ventura was really to, to steer it through the approvals process and to persuade the Cabinet Office that they really wanted to invest in this device. At a time when you might remember they were focused on a ventilator challenge. So their gap analysis instead, what they wanted was ventilators, however make shift, and you might remember the early ones really, really makes you whereas we said Actually, that's not what you need. What you really need are mass production of devices to keep people away from ventilators, i.e. the CPAP device and when we started that particular journey, and I can tell you that you couldn't even use the path for Coronavirus patients.
Vivienne Parry 06:41
So see something in just in case people don't know is you would normally use CPAP to be typically given to people who have problems snoring and who stopped breathing during the night. So they're given these devices to wear that have error to kind of slightly increase pushed in to stop them snoring and actually to stop this sudden respiratory arrest that they have, but this is what was being developed differently for these patients.
David Lomas 07:12
Correct. Absolutely right. So, so it used to go and use the oxygen therapy and if you failed an oxygen therapy straight to ITU on an oxygen ventilator, and that was the NHS guidelines, and we felt – Mervyn Singer, Becky Shipley, Tim Baker, Andy Cowell, and the Mercedes f1 team felt that actually having this intermediate stage developing device developing a CPAP device that we could do in mass production, would actually allow people to be treated in an intermediate way. It's a step between oxygen and, and, and a ventilator. And at the time, and the government and the community didn't think that's what they needed. They thought they needed ventilators. So on the CPAP making device was an achievement. actually getting the NHS to recognise that they needed it and have adopted was an extraordinary challenge. And then getting the government to fund it was was quite remarkable. So it is really quite an astonishing story. And then to be on the unit where that device was being used, was quite a thrill.
Vivienne Parry 08:09
You have an overview, David of all the UCL teaching and non teaching staff. How have they responded to the wider efforts to stop COVID?
David Lomas 08:23
it's been truly truly terrific and actually quite humbling to be entirely honest. And everyone pivoted from their normal work to focusing on the challenges of Coronavirus and we have hundreds and hundreds of projects that were set up from scratch to focus on Coronavirus. We've we've been given the highest amount of money from UKRI of any university in this country for our work on on Coronavirus, and we've now raised about a million pounds in external funding for the Coronavirus fund to try and help that research method. So not only have we pivoted ourselves to try and help the understanding of the diagnosis and the treatment of Coronavirus, but also our staff have stepped up remarkably, people have been selfless in the way that they've given up their time and and of themselves and what we hear from Sophie again, the challenges for new medical students who go on to the wards are huge to take a deep breath and to step into an unusual environment. That's a huge, huge undertaking. And our medical students did it. Our scientists did it clinical scientists and clinicians did it. And our research nurses did as well. So the whole community really, really stepped up and wants to one anecdote I made when I was on this unit, the family liaison nurse who I've working with Jenny who was superb, actually, as an MS nurse, she spends a day in the MS clinic, the people who helped me put on full PPE The so called the donning the donning and doffing putting on taking off PPE. The donning people were actually speech therapists from the EMT department or from the Ear Institute. So people came from all walks of life to contribute. Our junior doctors were neurologists would come from Queens Square to try and help on their respiratory unit. So it's a really quite unprecedented times and unprecedented and truly brilliant response from UCL colleagues.
Vivienne Parry 10:15
So Sophie, let's turn to you now because you were at the other end of that spectrum. How did you end up at the Royal Free?
Sophie Bracke 10:22
Yes. And thank you, Vivienne, very much for having me here. today. I graduated from UCL Medical School in March, we had our final exams in the middle or sorry, I graduated in April, but we had our finals in the middle of March, I found out that I passed final year towards the end of March, and then I started at the Royal Free four days after getting those final results. I think everything was kind of up in the air. I was supposed to go on elective to Australia in April, and then I was supposed to return to UCL in June for another month of teaching, but it became variable apparent towards the end of March that none of this is going to be possible. So I had to start thinking about what I would do for the next few months. And I think there's never really any question that I wanted to go back into the clinical environment. Just as David mentioned, there's just so much in the media and on the news about how horrible the situation was, and how hard the country was going to be struck by it. And I just wanted to be a part of that I just wanted to help as much as I could in any capacity or form. So as soon as they announced that the Royal Free was looking for volunteers, I signed up, and I ended up working in the ITU department there.
Vivienne Parry 11:38
So that is being like, thrown into the deep end big time. I mean, he couldn't be in a more high pressured environment. What was it like?
Sophie Bracke 11:46
Yes, definitely. I work in ITU for the end of March and the entirety of April so very much throughout the entire peak. And I just remember my first day in the department just being completely shocked because I'd seen the news reports about how bad Coronavirus was I'd read all about it. But I don't think anything can really prepare you for going into the ITU in a central London hospital. And just seeing the hundreds and hundreds of patients who are intubated, or heavily sedated. And just every single one of them has a COVID positive status. It was very shocking. It was almost quite emotional. So I just really wasn't quite ready if seeing, seeing over 100 patients who are all intubated, and COVID positive. And it was certainly a scary sight. On the first day, I felt very much intimidated by all that being a healthy young person and I was living by myself. I wasn't living with anyone who needed shielding. I was aware that I was in a good position to help on ITU. And so I was happy to put myself forward for that role.
Vivienne Parry 12:47
Can I just get back to our grandfather here, David? Just give me Yeah, that'd be you. I know him very well, listeners, don't worry. And I just wonder. So you've got had long, long experience of respiratory medicine. You've seen many, many, many people with severe pneumonias in ITU. Was this like anything that you had ever experienced in your career as a respiratory physician?
David Lomas 13:15
No, this was this was really unprecedented. And my sense was very similar to Sophie's to be honest. So not only was it was the sheer numbers of people coming in all at once, which was extraordinary challenge the system of dealing with a huge spike of, of patients all arriving at once and being unwell. And also it was a disease that that we've never seen before. So, so you will have heard the people present with cough and fever and most people have mild disease and of course, that's, that's true. When they come into hospital that they're, they're striking in that people are very short of oxygen, probably because they have lots of little clots in the lungs, so called mitral thrombosis. So they're really dependent on oxygen. And then there's a group of people and so if you will see in this from the from the ITU setting, who would have cytokine storm syndrome who released huge amounts of cytokines, and then flood their flood their their lungs with with fluid, and they're, they're desperately sick. So we can recognise three different components of this disease, none of which we've seen before. And frankly, there were no guidelines to know how to treat it. And if I'm being entirely honest, in that Easter where we had no guidelines, I was using Spanish guidelines for anticoagulation that's to break down the clots. And I was making up my own guidelines to use steroids for people with the cytokine release syndrome. And that's what you should do just as soon as you a large dose of steroids. And interestingly, the recent study from the recovery trial showed the dex method was actually useful in that in that group of people but we were flying blind. We've not seen it before. We've not seen disease before. We've not seen this pattern of symptoms and signs before and we have no proven therapies. So we were making it up as we went along.
Vivienne Parry 14:57
Sophie how did UCL support you during this very difficult time,
Sophie Bracke 15:01
I think UCL support firstly comes from all the years previously, I do feel like I was quite well prepared to head into this environment. I felt that I was taught the necessary skills to help me along the way. But during the actual pandemic, I felt that the most important thing that UCL did was just to have open channels of communication. We had a forum on which we could talk directly with people from the medical school, even our director, Professor Deborah Gill, and we are constantly updated on what was happening within the medical school and how they're handling the situation. I also felt like an important thing that they did was to not actually put pressure on students to go and work in the hospital or to go and volunteer. They made it very, very clear that this was your own choice, and that they would support you no matter what you chose to do. And I think this is important because I think a lot of my colleagues who weren't able to go into the hospital environments say Because they were living with a family member who is vulnerable and who they needed to shield definitely had some guilt about that. And I think it was very good on the university's part to make it clear that whatever you chose to do was a good option for you. And that there was no right answer in this situation,
Vivienne Parry 16:15
David, how did UCL support the students more generally, particularly the medical ones, and particularly the doctors as well, who were returning to duties. And we were already seeing that PTSD and some severe mental health problems arising in those who went back to these very intense days of frontline duty.
David Lomas 16:38
Yeah, absolutely. Right. Everything happened really quickly. And so at the outset, we try very hard to actually facilitate people going back to work. And I did write all the chief execs and pointed out that there was a duty of care to medical students like Sophie, that we expect them to be looked after that we expect them to have PPE as appropriate and we expect them to be kept out of harm's way. Although that's that's, that's difficult sort of setting that Sophie describes. So we we try to do the legal the medical, the, the aspects that look after care. But as people have returned, we do recognise what you described in terms of the people who've seen terrible things of trying to cope with returning to normality, whatever normality may be like and, and our, our, our office, the Office of the Vice Provost Health have a training training run by called the venire binaries and Colby has been setting up training courses or courses that people who want to talk through the experiences they've had to try to come to terms with them so that they can move on and return back to their life.
Sophie Bracke 17:46
One more thing that I also wanted to add in which in how the university and the hospital has supported us, which also kind of surprised me was I I felt like we were very well prepared to go into our apartments. So with me joining it, you I very much thought that it would be a case of straight into the action. Because I joined the end of March, we were very much in the height of it. And I very much just expected to be thrown in. What actually happened was that we had a whole day of teaching about how ITU works, a little bit of a reminder of how to take observations in ITU and what the patients are like, we got a proper one hour session on how to don and doff our PPE and how to wear it appropriately. And then we had about two days of shadowing an ITU. So I was very pleasantly surprised by this because I very much expected to be thrown into the deep end. But I did feel like they really did take the time to teach us to allow us to shadow and to really get us feeling comfortable for going into this environment. And I felt that was a very nice thing.
Vivienne Parry 18:54
You're listening to Coronavirus, the whole story a podcast brought to you by UCL Minds if there's a question about Coronavirus you'd like our researchers to answer Do you feel free to email us at firstname.lastname@example.org or tweet at to UCL. And whilst you're at it, we'd love it if you could find a spare five minutes to fill out our survey, the link to that can be found wherever you downloaded this podcast. So let's return to you both in your wards. We had way back in Episode One of this podcast series, had different working on the frontline during Coronavirus has been for medical professionals. And what I was going to ask you, David, first of all is what was it from your past experience that helped you most? I mean, is it a bit like when doctors come across an emergency in the street for instance, even if they haven't been involved in any work for years, there's a level of training that just kicks in and some of its automatic
David Lomas 19:59
Yeah. That's right, actually. And it's about pattern recognition and know what to do when you see a certain pattern of signs and symptoms. But it's also teamwork. And I think that that's what I'd like to stress so that it's not just me or Sophie or any of the ITU consultants or nurses or physiotherapists. It's everybody working together. And it was that camaraderie that pulled the NHS through. It was a willingness of everyone to go that extra mile and to work together. And what I would say is that, I, I shouldn't say this, but I thoroughly enjoyed it. It was one of the most memorable things I've ever done. Because we were pitched into a situation we didn't know what was what was happening. We didn't know the personal risks, as we discussed earlier on. I am in my late 50s now so there is a there is a risk to being there in terms of that in terms of getting infected. But but it was everyone pulling together. Everyone being under the cosh that's a wartime spirit. That was really quite remarkable.
Vivienne Parry 21:00
Sophie, how does your medical training prepare you? Was it helpful? Did you do these things automatically that you've been trained for?
Sophie Bracke 21:09
I think yes. And no, to some extent, any of the knowledge that you learned in medical school, any of the hard science knowledge was completely useless in the situation, because as we mentioned earlier, no one really knew how to treat this condition. The pathophysiology was still quite unknown. So it was just something there's a lot of confusion around it from a medical perspective. But I think something that UCL teaches you very well is communication skills, both with patients and with other colleagues. And I think this was very much a situation where communication was so important. Many of the patients on ITU, you were intubated, and so you weren't necessarily able to talk with them. But communication with your colleagues, I found so important. I was a member of the proning team on some days. Explain what a proning team is. So a proning team is a team that turns a patient over from their back to their front or from their front to their back. And it's been shown in research or at least suggested that turning a patient over every 12 hours can improve oxygenation of the lungs, because it recruits more lung space. So it was one of the things that we tried to do in order to help patients get as much oxygen as they possibly could. So every 12 hours, we would turn the majority of the patients over from their back to their front or their front to their back. The thing about Coronavirus, though, is that it's been shown that it has quite it can have quite a severe impact on patients who are on the heavier side. So some of these patients were a bit heavier than usual. So it required kind of a team of six or seven doctors to turn them over. And there's just a lot of requirement for communication, a lot of counting down together a lot of knowing what your role is, and so there's definitely a lot of teamwork involved. A lot of communication necessary. But this was something that as David mentioned, I also thoroughly enjoyed it was the first time. I'm also I'm very early in my career. It was just incredible to see everyone work together so much. I very much felt that any hierarchy almost disappeared. And we are just very much one team. Whether you were a medical students or junior doctor or consultants, we're very much all working together for a common aim. And there's something really enjoyable and certainly very memorable about that.
Vivienne Parry 23:33
Fantastic. Did you make a decision there then to go into ITU or are you going to go for another specialty?
Sophie Bracke 23:41
I am hoping to go into Obstetrics and Gynaecology, and that's actually where I'm currently working. Because the wonderful thing is that the Royal Free it has, from what I've heard only about two Coronavirus, positive patients currently. So a lot of us have been redeployed to other departments and I have been redeployed, upset. metrics and Gynaecology, which I'm very passionate about. And to some extent, that's very nice, because unfortunately, the mortality on it was quite high. So I did see a lot of patients passing away. And now on obstetrics, I'm seeing a lot of babies being born. So I'm going from one extreme of life to the other extreme of life, which is quite nice.
Vivienne Parry 24:17
So something to celebrate. And just tell me, if you will, is about your, your graduation ceremony on zoom. Because this is a this is a wonderful story. How did you graduate on zoom Sophie?
Sophie Bracke 24:31
Yes. And so we were supposed to have a graduation at Royal Festival Hall in July, as the medical school has have has done for many, many years in the past. But it soon became apparent that that wasn't going to be possible. So that ceremony got cancelled. And I think a lot of us were expecting that nothing would happen. But then the medical school announced that they would do a zoom graduation, where we have to make our own gowns and make our own hats and we would all have our video cameras. Oh, And it was officiated by Wil Cupola who works for the medical school. And it was just a link that we could send to friends and family to watch along. It was certainly concept I'd never imagined would happen before. But it was a fun day and it just required a little bit of creativity. I decorated my house and made it look like a graduation hall. I used a cereal box to make my hats and a bin bag to make my gown. And I think the creativity of it all was quite fun. And certainly, again, very memorable.
Vivienne Parry 25:32
Wonderful, I think we ought to put those items in the UCL museum. The graduates definitely definitely capes I saw your cape, a bin bag cape, it was fantastic. Finally to you both. If you went back to the start of lockdown, would you make the same choice again, David
David Lomas 25:52
from for me, without a doubt, without a doubt actually. So it locked down it was it was a mix of clinical service when required and then and then my vice provost role trying to help release staff to what was rather grandly called the national effort. So releasing staff equipment, PCR machines, PPE, etc. And so it was a mix between the two. And if I look back, the highlight without any doubt, was the clinical service. It's the bit that I will remember forever.
Sophie how about you?
Sophie Bracke 26:22
Yes, same answer for me. Really, I'd absolutely do it all. Again, it was a very emotional time. For me it was difficult to see at all, but again, just very memorable, wonderful to work together with so many other healthcare professionals. And I just learned so much. I learned so much about the hospital environment, I learned so much about communication and teamwork. And I sometimes feel guilty almost for saying that it was a memorable, enjoyable time because of course, the nation was struck with something so absolutely horrible. But from a professional development perspective and a learning perspective, I would say that I'm sure it will be one of the times of my A career that I always remember and that I take many things from for the years to come.
David Lomas 27:04
And I agree with that. So just what I've one thing is I went back to the wards to help on the CPAP unit now just closed actually, because Sophie's just said there's a new Coronavirus coming into UCH at the moment and actually going back and do Ward rounds for people who are now recovering people who've been desperately desperately sick with almost a huge anticlimax compared with the peak or the adrenaline surge, the rush, the excitement, the terror of those of those days across the Easter weekend.
Vivienne Parry 27:35
And David will this experience because we we've we've seen so much that has become the new normal change that took place that would perhaps normally have taken, I don't know three to five years take place in three weeks. How will this experience of Coronavirus change the medical curriculum
David Lomas 27:58
that's a really, really good point. And the changes were extraordinary. So if I give you a couple of facts, so the 80% of consultations in hospital care are actually done face to face overnight, or over one or two days. 80% went online. I mean, people have been trying to do that for years. And it happened almost overnight, given that given the crisis, you heard about the C pap device. We had that approved in 24 hours by the HRA approval process, it would normally take months, if not years, the health Regulation Authority were approving clinical trials in a day to get things through. So so so when we look back and say these were really extraordinary times, and the can do mentality was just something wonderful. And we have to keep that we have to keep that we can't go back to the old treacle in the NHS of everything taking ages and lots of people saying no to things. So I think we have to celebrate some of those the changes that we introduced or things that we've done at a pace and try and retain those as we go forward.
Vivienne Parry 29:04
Great. Thank you very much.
David Lomas 29:05
Now, one thing I'd like to add, if I may, is just just to thank Sophie and all the medical students who, who took a deep breath and did exactly what Sophie has done. Actually, it was a huge testament, to their courage and to that training that they put themselves forward to do this. So, so can I just say thank you to all of them?
Vivienne Parry 29:23
Well, I'm delighted to have been able to celebrate both of you. And in absentia here Abdal, too, because I think that you've done a remarkable thing for which not only are so many patients and their families grateful, but actually it just makes all of the UCL community so proud to be part of this. So you've been listening to Coronavirus the whole story The episode was presented by myself Vivienne Parry, produced by UCL with support for the UCL Health of the Public and UCL Grand Challenges and edited by the lovely Cerys Bradley. Our guests today were Professor David Lomax, Dr. Sophoe Bracke and in absentia here, Abdul Elmi. If you'd like to hear any more of these podcasts UCL Minds, subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus, where you can also fill out our survey. This podcast is brought to you by UCL Minds bringing together UCL knowledge, insights and expertise through events, digital content and activities that are open to everyone. It's been great to be with you today and I hope to be with you again very soon. Bye for now.