Transcript: Episode 33
2020 Wrapped Up
ucl, people, pandemic, vaccine, virus, uk, affected, differences, mask, sociality, world, minority ethnic groups, experienced, families, terms, icu, manufacturing, mental health, children, racism
Vivienne Parry, Lee Hudson, Martina Micheletti, Judith Breuer, Nick Tyler, Susan Michie, Delan Devakumar, Daisy Fancourt, Sophie Bracke, Amelia Roberts, Suzanne Farid, Eli Keshavarz-Moore, Mervyn Singer, Mark Miodownik, Rob Aldridge, Rochelle Burgess
Vivienne Parry 00:03
Hello and welcome to Coronavirus the whole story. My name is Vivienne Parry. I'm a writer broadcaster and UCL alumna. And back in March, we began recording what we thought would be a limited episode podcast about the way UCL was tackling the pandemic. But here we are in 2021, on episode 33, and that virus isn't done with us yet. Although today's news seems rather similar to when we began, soaring cases, overwhelmed hospitals, country close to complete lockdown, actually, so much has changed. We're in a very different and much more hopeful place. We know so much more than we did. And UCL and its researchers, staff and students have played a vital role, with some of its researchers becoming household names. And the thing that perhaps is UCL's most celebrated attribute - its interdisciplinarity - tend to be of key importance in combating the virus. UCL acted as a hive mind, always cutting edge, but also world-leading and lifesaving with a strong focus on its community. To kick off the new year, we're going to look back at some brilliant moments from 2020 - moments that not only showcase exemplary work happening at UCL, but which also tell the unfolding story of Coronavirus. This episode has everything and if you've not listened before, you'll get some idea of the breadth of disciplines that have tripped their way through our virtual studio. Yeah, medicine of course, but also engineering, psychology, education, political science, sociology, history, geography, so many more. But let's begin by hearing about the ways in which UCL has been at the forefront of Coronavirus research, developing tools used in ICU working on the front line, advising the government as well as holding them to account and racing to develop a vaccine. And please note, virologist Judith Breuer talking about starting a little project called COG UK. Without it we wouldn't know today about the new variant virus now stalking the land. Let's start with intensivist Professor Mervyn Singer, who in our very first episode, was getting to grips with a shortage of ventilators.
Mervyn Singer 02:32
But the big problem and that's when COVID-19 came along. We looked in our trust and we had enough for our Intensive Care Unit. We could augment those with a few other ventilators, we begged borrowed scrounged and we only had 12 standalone CPAP devices in the whole trust. So there was an identified need for more of these machines. And so my idea was, you want something simple, which didn't rely on lots of clever electronics that could be very quickly developed, and mass produced… And we found one of these in the anaesthetic department Museum, and basically handed it over to Becky and Tim in engineering. And the following day, they handed it over to the Mercedes Formula One team... And a day later, they'd actually got a beautiful working model that myself and one of my clinical colleagues, Dr. David Brealey, we tried on ourselves and it worked… And then we did some bench testing and some human volunteer testing. And then that gave us within a few days, the technical dossier to go to the MHRA the medicines healthcare regulatory agency that approved drugs and devices in the UK. And they were brilliant, extremely helpful. Within 36 hours they approved it. And a day later we trialled it on our first patients at UCH.
David Lomas 04:09
and UCL I think rallied brilliantly. We released our staff, we were I think the first university to to recommend that our clinical scientists are clinicians, our research staff should be released from their UCL roles to return to the frontline to help. 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 challenge here was to put yourself in harm's way and to volunteer to return to the frontline. So I returned back to work on the CPAP unit. It has been a 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 UCL ventura device and other CPAP devices to assist with breathing to stop people progressing and requiring expensive, difficult high resources of of ITU. So I returned to the ward and I was actually on over the Easter weekend, which was the peak of the surge. 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, there must you're the oldest person here. And Coronavirus does affect the aged. So there is a bit of a risk.
Sophie Bracke 05:40
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. Everything was kind of up in the air. 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. 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, who are heavily sedated, and just every single one of them has a COVID positive status. So with me joining ITU, 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 and ITU know what the patients are like, we got a proper one hour session on how to don and doff 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.
Nick Tyler 07:31
No, I don't think there is such a thing as a post COVID world I think COVID is here to stay. I think the question is how we as a species adapt to it, and and socially how we change our behaviours in order to cope with the differences that it implies. When COVID came… suddenly we were required to be two metres apart. And so what happened? Well, what happened was the the sort of the primitive desire for sociality, that the thing that made the species divide and able to collaborate and find food 10,000 years ago, comes into play, and people start to do other kinds of social apps. So we have Italian people singing across balconies. We have Spanish people dancing on Roos, we had even in the dear old utero, people clapping for the NHS, whether or not they were clapping for the NHS, what they were actually doing was engaging in a communal social activity because we need we crave that social reality. So for me, I really dislike the term, so social distancing, because it that is not what we're doing. We are physically distancing. And we are retaining the sociality of society. Now the question for going forward in the COVID world is how do we maintain that sociality if the physical distance has to be different?
Mark Miodownik 08:55
If we're going to be wearing masks, for the end of the until the end of the year, we all need to get into good habits about them. So imagine you're asymptomatic and you're, you don't know you're, you're depositing the virus on your own mask, but you're protecting other people by wearing it. So that's great, but now you've got virus on your mask. So What you don't want is when you come back in or come out of the public transport, if you then just take that off and scrunched up and put it in your pocket. Now you've got virus on your hands, and then whatever you touch, you're spreading that around the place. So what you've got to do is take off your mask, at that point, put it into some sort of bag, put that in your pockets, till you can wash it later, then you've got to clean your hands. And this is very, very important. Otherwise, a lot of the value of wearing masks is going to is is going to disappear. And this goes for everyone. We just got to get really good habits of washing our hands very regularly, when we put take masks off, and then washing that mask as well. I mean the beauty of the reusable mask is A) it's sort of as I was saying before you produces less waste. But also, I mean economic from an economic perspective, and lots of people, you know who this is, you know, it's not gonna be easy thing to suddenly get two or three masks you can use over the next few months. And so washing it in your washing machine is up is what we recommend, for two reasons. One, it's the cheapest way to do it. But two is that it uses the least energy and you might think, oh, gosh, no, you're really going too far. But when you when you look at environmental impacts, for millions of people wearing masks, it turns out the amount of energy used to wash them is actually a significant factor. And if if people hand wash these in hot water, and if millions of people do that, the amount of energy use creates a huge amount of pollution.
Nick Tyler 10:43
Behavioural science tells us that there's a lot more to getting people to do things than just educating and persuading people. And so it allows you to take a broader perspective, for example, looking at how you can best train people in whatever skills may be required, for example, in the safe handling of face masks, but also in things like environmental measures, how can you adapt and construct environments, which are more conducive to the sorts of behaviours that we need to see in operation.
Susan Michie 11:23
So if I can just take an example of that, you probably remember early on in the pandemic, the first sunny weekend when we and most of the rest of Britain went out to the local park, which is indeed what we're being encouraged to do. But suddenly, there were a lot of people in that situation. And so it was quite crowded and looked even more so when the media photographed it, not aerially, but with telescopic lenses, but the response from government, rather than to look at the evidence and show that around 90% of people were highly motivated to keep socially distanced. And it wasn't a motivational issue, but rather was an opportunity issue. What they did was respond as if it was a motivational issue with threatened punishment, saying, If this happens, again, we will close down the parks. And what I got onto the media very quickly to say was that the response should have been, there's not enough opportunity, you are motivated to keep distance, but you also want to go outside, we're encouraging people to go outside. So therefore, for example, in London, let's open the 45,000 acres of golf courses and all those playing fields that are unused in the Independent School sector.
Judith Breuer 12:40
Well, I'm involved in a number of studies… And one of the things that we've started doing as a country is a national project called the cog UK project, which sequences, all the viruses that we can get hold of to look at the genetic code and look at the number of the letters that make up each sequence. And that helps us to link one sequence to another and that's giving us information about how the virus is spreading in this country, where the viruses first came from, when they first came into the country and how they are mutating and and that will give us information that will feed into vaccine design… It will feed into understanding whether drugs are causing mutations, it will tell us whether the virus is becoming more virulent or less virulent, and it will also help us manage things after lockdown.
Suzanne Farid 13:35
So as you said, developing a new biological treatment or vaccine is typically a lengthy, costly and risky journey. at a national level. UCL Biochemical Engineering is feeding into national manufacturing task forces that have been set up by the bile Industry Association on things like monoclonal antibodies and vaccines. At the moment, we have been working and doing the groundwork that has been instrumental in the manufacturing of the Oxford to file vector vaccine to ensure that it can be made in enough quantities and at the right quality for phase one clinical trials.
Eli Keshavarz-Moore 14:16
Globally, apart from what is happening within the UK, there are overall 20 vaccines which are in clinical trials worldwide. And that's this is part of over 100 I think about 100 to 100 150 candidates which have been actually looked into. Now the one that obviously is very much in the news is the one that co-director of the Vax hub, Sara Gilbert has been working on and and in terms of what UCL is doing to help is that the actual manufacturing part is one part obviously is the the front end creation of the sort of vector which is going to be used as a as a fulfilment Providing the vaccine data. Another part of it is effectively manufacturing this, and the manufacturing is quite a complex process. And there are bottlenecks that currently are being resolved our Vax hub at UCL So helping the Oxford group to overcome using engineering techniques that we have developed at UCL to the company's bottlenecks, so that there's a platform available, which would make it suitable for scale up, which is going to be taking place. As you know, it has been taken over by large pharmaceuticals to make, I think around 2 billion doses.
Martina Micheletti 15:41
Yeah, so I would say that we can what has happened before in the sort of vaccine manufacturing space in a Western Western countries and large biopharma, you know, meet those, those vaccines and then distributed to low and middle income countries. But there is, you know, maybe there is something different that we can do. And I'd like to suggest here. So within Vax, we work with the low and middle income countries manufacturers, so that they can adopt some of their technologies, maybe make some efforts towards, you know, innovating their processes, so that they become essentially better producers of the vaccines for their own people. You know, we work with companies, for example, in Indonesia, in Vietnam, in India, and their only interest is to really make the vaccines for their own people when they need it. And I think that that could be an approach that could ensure better access to vaccines for the larger population.
Vivienne Parry 16:49
As well as fighting Coronavirus. The UCL community has also been monitoring it spread to try to understand who is being most affected, and how. We heard time and time again, how the virus has laid bare existing inequalities before adding a further heap of its own. Guests on the podcast have spoken about the disproportionate even unique effects on minority ethnic populations on those from lower socioeconomic backgrounds on young people and women.
Rob Aldridge 17:22
So when we think about in terms of hospitalisation, and severe illness, we find that 6.2% of new hospitalisation were in Asian minority ethnic groups. And yet this same group represents 17.9% of all admissions in intensive care. So quite a difference in terms of the hospital admission and those who end up in intensive care. Similarly, we find that in black African, black Caribbean and black British people, this group accounts for 2.1% of hospitalizations, but a 7.8% of intensive care admissions. And this was some of the early data that we had in the UK that suggested that there was a really increased risk in minority ethnic populations. Back in April, we undertook a study using data from people who were admitted to hospital and diagnosed with COVID and died, we accounted for the differences in age and geographical region between those individuals admitted to hospital, and we found a lower risk of death for people with white Irish and white British ethnic groups. But an increased risk of death for black African, black, Caribbean, Pakistani, Bangladeshi and Indian minority ethnic groups,
Delan Devakumar 18:29
I think we need to, I guess, start with the basis that really there is no biological difference between races, that there's much more variation within one racial group than the risk between racial groups. And the differences are largely just appearance what you see physically. So then the question is, why are there differences between racial or ethnic groups, and fundamentally, that comes down to acts of discrimination, and that can work through the social social determinants of health as have been discussed. So someone's occupation, the kind of accommodation that they live in, but also racism and xenophobia are fundamental causes of ill health, and that goes a little bit further. So as well as working through the social determinants, racism is a persistent health inequality that despite changes in diseases, risk factors or treatments, there are still differences due to racism. And really at the root cause of these biological causes is racism. It's not about race itself. Racism is the the underlying cause.
Rochelle Burgess 19:43
Inequality that we are seeing, being reminded of now during COVID has very much always been there. You know, in the UK before COVID hit, there were already 50% of UK families who did not Have any savings in preparation for things like this and and the social determinants of health report the 10 year update that Professor Marmot put out sort of a couple weeks before things sort of went totally bonkers for lack of a better word, but essentially reminding us that one third of families in the UK were one paycheck away from homelessness. And those realities were always there. And that is what made the impact of COVID so starkly unequal, is because the world it came into was already unequal.
Lee Hudson 20:38
So I think the first thing to do is to start with a contrast of how the infection itself has affected children and young people. We've got enough data now and experience to know that while some children do get on well, with COVID, the vast majority of children actually do not seem to be affected at all. And so I think it's it's interesting to reflect as an age group compared to other age groups, that the major impact that COVID is likely to have is on mental health, and also broader aspects of their health. But what seems to be clear from different settings in the world, including some reports have come out from the UK, it seems to be the younger children, so the four to 10 year olds who seem to be affected more, and they seem to be affected in multiple ways, with emotional difficulties, more unhappy and more worried. There's also some evidence that their parents are affected as well, that slightly older 16 to 24 year olds, that they seem to been affected by anxiety as well. And that's a big problem from the data we have. So I think, overall, it's going to be mental health. And it's going to be things like the way that the economy and the way that lack of education is going to affect this generation. And that's what I'm really worried about.
Amelia Roberts 21:54
So what we're really looking at is that any child who's in a situation of disadvantage, is likely to be more affected by COVID-19. And the Sutton Trust did a report looking at social mobility and COVID-19. And some areas of real concern of the widening attainment gap in early years. And there's lots of reasons for that. But we know that building relationships with younger children socialisation skills, and also vocabulary and language skills, have a an ongoing impact on their school attainment and their lifelong chances. We also know that a third of families This is reported also whether sometimes a third of families don't have a separate computer for children, which means that those children aren't going to be able to access learning in the same way. And from the same report we also know that schools in rich areas, which in the UK is defined by children being on free school meals or not being on free school meals, the gap between schools that are able to broadcast lessons to children, is actually 47% in rich areas, and only 34% in poor areas. And the schools in the poor areas only about half of those are accepting work remotely from children compared to 75% in more affluent areas. So we're absolutely seeing an impact in terms of more vulnerable people and less vulnerable people being affected disproportionately by COVID-19. And I just want to flag up something else. But in terms of safeguarding and young people's mental health, we know that the organisation refuge that helps families who have experienced domestic violence. We know that there has been a 700% increase in calls and a similar picture from the NSPCC, ChildLine, their costs have gone up 300% from 545 to 2274.
Daisy Fancourt 23:57
So we've been tracking the experiences of over 72,000 adults living in the UK since the middle of March, just before lockdown came in. And our participants have been giving us data once a week about how they've been experiencing things psychologically and socially. So over the last 33 weeks or so, we've collected over three quarters of a million surveys that's around one every 20 seconds across the pandemic, giving us a real time insight into how people are being affected. Women have unfortunately had a worse time psychologically across pretty much every single measure that we've looked at through this pandemic anxiety, depression, stress, loneliness isolation. And I think on the one hand, we sort of expect this unfortunately, because women's mental health is often worse, outside of pandemic situations, but it's been concerning to see this exacerbated the gap between men and women has been greater than normal at some of the highest stress periods of this pandemic. Think that women were particularly burdened by things like child care children not being able to go to school early on in the pandemic alongside their work. We also know that many women work in roles, for example, frontline health care roles where the stress of the job has been high. And also many women have worked in sectors that have been particularly badly hit or have not been allowed to reopen, and therefore have experienced employment issues. But I think there are a couple of other important factors as well. One of them is that women have had lower trust in the government to handle the pandemic. And this lower trust has probably gone alongside a lower optimism, and therefore affecting mental health. And there are also some women who've been experiencing domestic violence abuse. They've had very challenging pregnancy experiences or childbirth, or issues around family planning and contraception that's added extra load on top of what the pandemic itself has been bringing them.
Vivienne Parry 25:44
So there you have it. In 2020 Coronavirus, dramatically altered our way of life. And not just in terms of health. As we said it's highlighted existing inequalities and exposed fundamental problems with the way our world operates. It's shown us that we need to change and to build back better to create a world that works for everyone. UCL’s researchers are right at the heart of this challenge and indeed at the centre of so many problems created by the pandemic. The one thing that you can be sure of is that we'll be keeping you updated on their progress. I'll raise my glass to a better 2021 everyone.
You've been listening to Coronavirus: The Whole Story. The episode was presented by myself Vivienne Parry, produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges and edited by the wondrous Cerys Bradley. It featured interviews with Professors Mervyn Singer, David Lomas, Nick Tyler, Mark Miodownik, Robert West, Susan Michie, Judith Breuer, Suzy Farid, Eli Keshavarz-Moore, Martina Micheletti, Rob Aldridge, and also Doctors Delan Devakumar, Rochelle Burgess, Lee Hudson, Amelia Roberts, Daisy Fancourt, and Sophie Bracke.
If you'd like to hear more of these podcasts from UCL Minds, I know you would, subscribe wherever you download your podcasts or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights and expertise through events, digital content, and activities open to everyone. I know we'll be with you again soon.