Transcript: Episode 52

Are we already experiencing a third wave?

Vivienne Parry  0:03  
Hello and welcome to Coronavirus the Whole Story. I'm Vivienne Parry. I'm a writer, broadcaster, UCL alumna and your host for a very special edition of one of I said myself, a rather special podcast. Last year we began this podcast in response to the coronavirus pandemic and we wanted to document UCL's response in all its multi disciplinary glory to everything from the medical response to the experience of lockdown, effect on education, transport, and even what history teaches us about pandemics. And that's exactly what we've done. Over the past year and a bit, we've spoken to medical students who took to the front line instead of taking their exams, to the UCL researchers instrumental to the vaccine development and roll out, to community leaders working hard to share vital information, and to many more people who conducted groundbreaking research under incredibly difficult circumstances in order to help us all get through the pandemic. In the process, we've met some incredible, reached out to over 80,000 listeners and even one reward along the way. Now with the end of the summer term, Coronavirus: The Shole Story is also coming to an end. Although can I just mention that this does not spell the end of the virus, which I'm sure still has some surprises up its little protein spikes for us. Next month. We're planning a very special finale to thank all of our incredible guests and of course you - our wonderful listeners. You can find more about that event via the link in the description to this podcast. But in the meantime, we've managed to squeeze one last episode in. Today I'm talking to a previous guest of ours Professor Francois Balloux and Dr. Keri Wong about the lockdown extension, a potential third wave here in the UK, and what this means for us mentally and physically. Professor Francois Balloux is chair in computational systems biology and chair the UCL genetics Institute. His research involves the reconstruction of disease outbreaks and epidemics in the human population, and uses tools from genomics, epidemiology, evolution and ecology. Working with Dr. Lucy Van Dorp, their team conducted the first large scale analysis of SARS-Cov-2 genomes in order to understand the origins of COVID-19. My other guest today is Dr. Keri Wong. She is assistant professor of psychology in the department of psychology and human development at UCL Institute of Education. In April last year, she launched the UCL-Penn Global COVID study, a longitudinal study to investigate the short and long term impacts of the pandemic, on mental and physical health and on social trust. This work was supported by the UCL Global Engagement fund, and has reached over 2000 participants. So let's start with you Francois. Many people were expecting the lifting of restrictions on the 21st of June, which is the day that this podcast is released. But that's been postponed by month to France, or why has the government taken this decision on what's the scientific evidence on which they're basing that decision?

Francois Balloux  3:11  
Yes, I think people were right to expect the lifting of remaining measures on the 21st of June, but then the situation changed a little bit. So today doesn't look very good. And then we had an outbreak, an epidemic of a new variant Delta. And this is more transmissible. And this has led to a spike, which currently which is still ongoing, and the situation didn't feel ideal to lift the final restrictions.

Vivienne Parry  3:43  
So should we be more worried about the Delta variant? We know that it's much more transmissible, but what's the evidence that it's more pathogenic?

Francois Balloux  3:52  
Yes, so it is definitely more transmissable, despite that we haven't seen the same kind of spikes everywhere in the world. So we've seen them in Asia, particularly in India, Nepal, Vietnam, in the UK. But at this stage, the situation is still a bit unclear in other parts of the world, including in continental Europe, where variant is not surprisingly fast.  Now concerning its virulence or essentially the risk of associated morbidity and mortality, there seems to be evidence that the risk of hospitalisation seems increased relative to previous versions and circulation.

Vivienne Parry  4:32  
And does that mean that? I mean, we're not seeing a huge rise in hospitalizations at the moment and presumably that's because of the vaccine programme. But where there isn't a vaccine programme in place, there are more hospitalizations. Would that be a fair way of putting it?

Francois Balloux  4:47  
Yes, I think we we're very fortunate to have a large part of the population vaccinated. But essentially most people most of the risk and obviously this keeps hospitalisation down not as much as we could help and even a fraction of the young healthy people can get hospitalised. This rarely translates into death. So definitely remain very, very low relative to what we've seen in previous waves. But the number of hospitalizations is not not trivial. And this is just some people feeling very ill. A few of those people have been vaccinated. So they are the few breakthrough and so called breakthrough infections that can be less severe, but less severe can still mean hospitalisation.

Vivienne Parry  5:35  
So on the variant front, Sir John Bell said, I paraphrase what he said, but we shouldn't be going down the variant rabbit hole every time another variant appears because they will keep appearing. What's the evidence that this will become an endemic, viral infection that becomes perhaps lesser in its effects as it progresses, in other words, becomes more and more transmissible, but not as deadly? Or is that a myth?

Francois Balloux  6:04  
So we've seen at least three jumps in transmissibility, the first one was quite early on in the pandemic was this lineage, carrying these x 140. And then other three mutations, but at the time, we didn't speak about variants, then we have the b1 on seven or alpha alpha variant, and then the Delta variant. And each time we saw an increase in transmissivity. Now, we also are twice as the unfounded Delta observed an increase in virulence so people were more sick on average, when infected. And to some extent, we cannot really make a real prediction on the evolution of variance or the intrinsic virulence. And so there is a bit of a dogma the myth that pathogens become nicer as they adapt to their hosts. Now, that's only strictly true for pathogens that pass vertically from mother to child, because then the fitness and the pathogen on the host are correlated, essentially, the host die, the pathogen doesn't, isn't passed on to anyone. And also for extremely virulent pathogen, if it's a pathogen that kill maybe 80% of the hopes, and then there's selective pressure to reduce words. But for something like sounds good to first, the difference is just not high enough to limit the risk of death of the host. It's just not high enough to exert a very strong selective pressure on the virus. Moreover, a large fraction of the transmissions of the infection happened prior to any symptom. So I really don't think we can make any good prediction about the variance. But that is really intrinsic. What happens is the people who have been exposed to the virus or who have been vaccinated, they generally will feel very mild symptoms, maybe no symptoms at all. So once the population has sufficient functional provision has been exposed and is protected either by the vaccine or prior infections, then the virus will seem much less.

Vivienne Parry  8:03  
So I understand now Francois even managed to explain why it is that we think this is that it's actually principally because what we're observing is not the virus becoming less virulent, but the effect of more and more people having at least partial immunity to it. So whereas you would have got the full blown symptoms before now you could just sniffling instead. So are we expecting a third wave? And how bad is this wave going to be? So?

Francois Balloux  8:32  
It depends a bit on the definition. But we could argue that the UK is currently experiencing a sad wave, it is obviously not at the stage as dramatic as previous waves, there's a lot of uncertainty, how the situation will evolve over the coming days and weeks, I have to admit that I really don't know. So I would not be particularly surprised if that's a doubling tripling of normal cases over the coming weeks. But I would not be much more surprised it started plateauing, or even slightly, slightly decreasing. We were really on the on the edge of a knife here in terms of the TDD epidemic dynamic. You could turn then Ponte it's quite difficult situation at all, I would say psychologically and politically to do this.

Vivienne Parry  9:20  
And should we be putting more restrictions in place? Or should we be balancing on our knife edge a little longer?

Francois Balloux  9:28  
That's an interesting point. I don't think that scientists like me should make such recommendations in public. I feel these are deeply political decisions. And when I mean political, I don't mean it in a bad way. I mean it as decisions that should be taken by elected politicians to the benefit of the population. So what the epidemiology and the sciences actually can inform on is what's happening but also make some projections that are often imperfect, especially long term projections. But they we have some half decent projections over the coming weeks or some scenarios, essentially this sometimes constant uncertainty. And I feel scientists should inform the public and politicians about those. But I don't think it's the role of scientists actually to the side of the more kind of measures that should be taken, or governance,

Vivienne Parry  10:25  
which brings us perfectly to carry to talk about, I guess, the other side of this equation, know what it means for the public. You've been conducting this study on the mental and physical health impacts of the pandemic. What have you found,

Keri Wong  10:41  
We've learned quite a lot actually given the longitudinal design of the study, and the continued support from our participants around the world. But just briefly, the survey included a 330 minute survey, which coincided with UK lockdowns, one UK lockdowns, two and three, and also right now the easing of lockdown. So we're currently still collecting new data from from the easing of lockdown, and we're going to be analysing some of that too. I'll highlight about three or four key results from the study so far. The first one is related to age differences for some of the mental health variables that we've measured, consistent with quite a lot of the ongoing COVID studies out there, where they've sampled people every week, and sometimes monthly, we find that even over a six month and 12 month period, the young people in our sample aged 18 to 24 years old as a group, they were reporting generally higher mean levels of anxiety, depression, aggression, they were exercising less than before lockdown, of course, but this is slowly improving. Given the easing of restrictions, the same group are they are reporting poor asleep and higher levels of stress. Although we don't really find age differences across levels of loneliness and empathy as well, we find that this is interesting, because it's not different across the various countries that respondents have been responding from. And then in terms of stress, people have identified various stressors. The top five that have been identified over the first six months of the lockdown have been things like other people, not social distancing. There's the uncertainty surrounding COVID. Future plans being up in the air. Other people not wearing face masks, for example, unclear government guidelines, that has definitely been a key feature in the second wave of our survey. But most of these stressors have actually improved now that we're 12 months down into the line and more. But the persistent causes of stress reported in our latest wave, not surprisingly, yes, restrictions are easing have been about mental health, physical health, work worries, as well as marriage and romantic relationship conflict and challenges as well. So I would say these four kinds of areas are key concerns in areas that perhaps will still be ongoing concerns even after the lockdown eases. And then we come to social trust and mistrust, which is a key component of our study. When we look at all of these variables together social trust and the mental health measures in our study, we find that they are highly correlated, meaning that people who are reporting higher levels of mistrust and others, they tend to also report poor mental health and poor physical health as well. In fact, individuals who've been persistently mistrustful over the 12 month period, we found that they are reporting especially high level of anxiety, reactive aggression, loneliness, depression, and so forth. So, you know, it's it's important that we are focusing also on individuals that are constantly I guess, this have the sustained, persistent mistrust over this long period of time, although most people in our society, they will have high social mistrust, perhaps at the beginning of the COVID pandemic, because of various reasons. But most of them return back to normal as we would expect, as well as really as the the individuals who have the sustained fear that other people are not safe, or that we are not able to safely go about our day to day lives, those individuals are the ones that are the group that we need to be most concerned about.

Vivienne Parry  14:28  
So you've got those two groups, you've got those people who are really probably still afraid to go out, they're very anxious about it. And then you've got the rages on the other end who are raging about not being able to do what they want. So that those are the two ends of the spectrum.

Keri Wong  14:44  
Yes, pretty pretty much it. And then I guess the final kind of key theme or finding that's really come through quite strongly in our most recent wave, as we know across the data collection time points as well, is that more people are experiencing loss and grief, this is either directly through losing close family members or loved ones, and or friends as well. So we know that about 8% of our respondents say that they've experienced a loss of a family member or close friend between October last year in January this year, and that this has increased to about 15%. In the latest wave, so between April this year and our current survey, so I would say you know, that's also another area, a key area of concern, when we think about how to recover from the pandemic and the easing of lockdown does even thinking about our relationships with people around us and being aware and cognizant of other people's situations as well, I think will be quite important.

Vivienne Parry  15:46  
So if there were to be another lockdown, rather than just a kind of locked down extension, locked down light it might be, what kind of toll Do you think this is having on those two groups at your extremes?

Keri Wong  16:02  
Yeah. So I would say for the extreme group, where they are desperate to, you know, return to normal and go out again, I think that will definitely not be welcome news for them. We are as humans also not as patient as well. And the whole pandemic has really drawn out probably longer than most people would have expected. But I do think also, given the fact that we're constantly being updated, we're getting constant updates from scientists and people are perhaps engaging with the news and the facts, that they are then able to understand the reasons perhaps why the easing of lockdown has has to be postponed. The on the other side, you know, with the group where they have constantly felt this sustained mistrust anyway, that they're feeling fearful of re entering into society and re you know, going back into work, I think there, we really need to highlight the importance of safety. So how can we make people feel safe enough to reintegrate and go back to work, for example, or even safe enough to walk around on the streets or go to the shops think it's very important that we're able to ensure that that support is available to people?

Vivienne Parry  17:16  
And it is very confusing for people at the moment, there seems to be no logic in allowing lots of people to be watching the euros together. And yet no dancing allowed at weddings. Yes. That seems to me as a as a step mother of a bride whose wedding is this weekend? I'm feeling those restrictions and those in consistencies. But one of the things that particularly interests me about your research, Keri, is, is the social trust aspect, because social trust is the glue that binds us all. How low is social trust at the moment? And how hard is it going to be to rebuild social trust and emotional resilience? So that whatever comes next, we're better prepared for it? Yes,

Keri Wong  18:05  
that's a great question. And definitely a key component of my research interests. I guess there are two parts to that. The first is that we have to remember or think about trust, as an ongoing relationship and something that builds on. And the fact that you know, once you lose that trust is very hard for people to regain that trust. This could be with other people, just general relationships you have in your life, but also with institutions and governments, in which we vest that, you know, we invested this trust in them to make good decisions on our behalf, I would say there's two groups in the inner in our society, for example, those who are more forgiving, you'll be able to regain their trust over time with better perhaps policies or improvements in their situations and environments. But there will also always be a smaller group where that level of trust in others is always going to be quite low. And in my research, I studied specifically that group where they have high what we call social mistrust in others. And therefore, over time, if they have this persistent mistrust, that can be harmful for their health, both mentally and physically. But also overall now as we see it in this pandemic, for public health policies as well. It's difficult for us to then convince the same maybe small group to engage in adopting vaccines, for example, or to enable them to be able to function then their daily lives as well to feel safe enough to go out. So yes, it's going to be hard. It has changed as well, social trust over the pandemic here. We only have data for the pandemic year, unfortunately, so I can only speak to that. But levels of trust have been improving in this last wave as we're seeing the easing of lockdown. I do think we need to be cautious in thinking about how quickly we ease lockdown as well, because there are still some groups who may need to feel safe before they can then get on with their lives, so to speak.

Vivienne Parry  20:06  
Francois, I wanted to ask you about social trust, where it involves scientists, because there's been a bit of an attempt lately, I think, to blame scientists for all of this. But how do you feel? How's your perception of how the public feel about science and scientists and how they've done in COVID?

Francois Balloux  20:30  
Yeah, that's an interesting question. I think it probably depends who you would ask. But very generally, in society, I think there's been a lot of interest in science and this post on Twitter to discuss topics require some kind of background knowledge with lots of people who are not scientists, and it's completely impossible. So a year ago, so people have learned a lot, there's been a lot of interest in science. And well, there's also been some disappointments, I would say, maybe some realisation that science can also go that far. And I would say maybe some of my colleagues may not always have been carefully off when the kind of presented evidence, maybe not twisty core uncertainty, and the doubts and I would probably personally argue that science has been sometimes conflated is more ethical views that have very little to do with science. And they were kind of sold under the umbrella of science. I mean, people obviously disagree strongly. And they see that something is so long, in front of science, they might criticise the science watered down. Well, as of maybe we'll read a scientific statement. So I think, as scientists, and continually the image of science will face and interesting situation and post pandemic, with this kind of cure dynamic of a huge interest in science, particularly, infection, mineralogy, but also the risk that there might be some distrust, actually probably additional response that was not fully present before the pandemic, I foresee some quite interesting times, possibly difficult moments in the relationship between scientists and the wider public.

Vivienne Parry  22:30  
That's very interesting. And it's interesting, because I suspect we all when we were first taught science at school, were taught that science was about certainty. And you know, if you gave the wrong answer to what colour is copper sulphate, then, you know, there was only one answer, it wasn't like history where there could be interpretation. And maybe that's something that we need to get out to the public more is that, you know, Sciences is right until it's wrong, and you're constantly trying to disprove it, the uncertainty is something that we have not yet managed to get across. But I wanted to finish by asking you both to do something that I've asked lots of guests during this podcast series, which is to give you each a magic wand. And with this magic wand, you are able to do anything you like. And the thing that I would ask you to address in this particular instance, is, what would you do with your magic wand? And by the way, it comes with a money, no object clause attached to it? What would you do to help the public right now?

Keri Wong  23:44  
That's a great question. As a psychologist, I would probably try and make everyone see eye to eye. So being able to find similarities between yourself and others around you, I think at this crucial moment, given that we've, we've this shared global experience together, I think will be something that will be good

Francois Balloux  24:06  
influence. Well, how about you? Yeah, I think for me, it would clearly be better vaccine equity. So essentially, being able to offer possibly to vaccination to everyone in the world quite soon, because that's the end of the pandemic quite dramatically, because I think we actually slowly getting out of the pandemic in Europe in the US, but will linger on for for quite a while

Vivienne Parry  24:30  
and part of goods. And there will be many more variants to come. I suspect because of that,

Francois Balloux  24:36  
not because of that, I think there will be many more variables to come. And this is not as horrible as a nice, I think, I think actually there will be so many events that at some point, no one will be able to know them all on people who just we just start ignoring them, except a few people are obsessed by them. All.

Vivienne Parry  24:55  
Right, Francois Balu.

Francois Balloux  24:57  
Yes, but that's my job, and I don't think everyone To be obsessed with.

Vivienne Parry  25:02  
Well, there you have have it from Francois Balloux himself, you should not be obsessed by variance. It's been such a pleasure talking to you both. And I really appreciate you coming on to this particular programme. You know, here we have a new boast - a microcosm of some of the very best things being brought together, you know, the genomics and the psychological aspects of COVID and both being presented together -fantastic stuff. So you have been listening to Coronavirus:The Whole Story. This last episode was presented by myself Vivienne Parry, produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges. It was edited by Cerys Bradley, who has been absolutely outstanding. And because of the last episode, I wanted to give a special shout out to Stephanie Limuaco, Daisy Voake, Evie Calder and Anna Cornelius. I was joined today by Professor Francois Balloux and Dr. Keri Wong. And if you'd like to hear more of these podcasts, and there's a fantastic back catalogue now, from UCL Minds, subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus. And if you want to hear more about Keri's work, which is fascinating. It's going to be shared in a free webinar series, lessons from COVID-19 reflections, resilience and recovery and we've put the registration link in the description of this podcast. 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. Thank you so much for listening to this series. It's been the greatest pleasure presenting it. Bye for now.