Transcript: Episode 9
How has the pandemic highlighted BAME inequalities?
Vivienne Parry 0:05
Hello and welcome to Coronavirus: The Whole Story. I'm Vivienne Parry, a writer broadcaster, UCL alumna, and the person lucky enough to be your guide to UCL's extraordinary and wide ranging research on Coronavirus. Now if you're new to this podcast for the past nine weeks, I've been talking to UCL researchers and staff trying to get to the bottom of the Enigma that is Coronavirus, and we've looked at it every which way from life on the front line to what studies a 14th century plague can add to our understanding. A lot, t turns out, there's still time to catch up. You can find all of our episodes on the UCL website or through your favourite podcasting app.
Vivienne Parry 0:47
We're recording this episode in a week which has seen the funeral of George Floyd statues toppling and publication of the long-awaited report on disparities in risks and outcomes of COVID-19 So of course, issues of inequality, particularly those affecting black, Asian and minority ethnic populations had to be our topic this week. To discuss these I'm joined remotely, of course, and because we're in lockdown, we may have some noises of children, by researchers in Child and Adolescent Health, epidemiology and health informatics, so let's introduce them to you. First up Dr. Rob Aldridge and associate professor and Wellcome Trust clinical research career development fellow at the Institute of Health Informatics. His aim in life is to make invisible populations visible through data. There are many cultural and socio-economic factors that contribute to inequality and to guide us here we have Professor Nish Chaturvedi, who's director of the MRC lifelong health and ageing unit and a professor of clinical epidemiology. Our research focuses on cardiovascular disease and diabetes, which disproportionately affect ethnic minority communities. And finally, I'm joined by Dr. Delan Devakumar, an associate professor in Child and Adolescent Health and an honorary consultant in public health in the Global Health Division of Public Health England. With him, we'll be talking about how the protest movement sparked by George Floyd's death might be the catalyst for meaningful change in public services. Rob, can I start with you? What are the facts here for the risks of COVID-19 for people of different ethnicities?
Rob Aldridge 2:27
There's clear and consistent picture that there's an increased risk of getting infected by Coronavirus and higher levels of hospitalisation and death across a range of minority ethnic groups. So we when we think about in terms of risk of infection, data from the National surveillance system at Public Health England shows that after accounting for differences in age coronavirus, diagnosis rates are highest in black minority ethnic groups with men, slightly higher than women and lowest in white ethnic groups. It's important to note here that the way that the majority of this data have been collected until now has been from hospitalised patients, so not those in the community. And we urgently need to fill this gap. 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 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. And 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 in those in those individuals admitted to hospital, and we found a lower risk of death for people with white, Irish and white, British and ethnic ethnic groups, but an increased risk of death for black African, black Caribbean, Pakistani, Bangladeshi and Indian minority ethnic groups. And evidence from our studies show it's very similar findings to subsequent data released by ONS, an analysis of hospitalisation records from Elizabeth Williams and others LSHTM. So in summary, these data describe consistent findings of an increased risk of infection, severe hospitalisation, and death across a range of different minority ethnic groups.
Unknown Speaker 4:39
So we're seeing an increase in infection as well as in severe disease and mortality.
Rob Aldridge 4:46
Yes, it looks like that's the case. But just going back to that caveat, the data on infection, really right now is a little bit difficult to interpret because of the fact that it's taken from individuals who are in hospital and because We weren't able to do community testing. So we need information from studies like Virus Watch that will be led by Professor Andrew Hayward, who I think you had on a previous podcast that will tell us about infection levels and case levels in the community among people who don't need to see don't get admitted to hospital to really help us on pick what are the what are the case lates and infection rates in the community prior to being getting so unwell that you need to enter a hospital? Well, I think we need to think about it in terms of the differences in exposure, the differences in vulnerabilities and the differences in the social consequences. So if we just think about exposure and take one particular issue - occupation, we know for example, that black communities are over represented in the caring and leisure industries, and Pakistani and Bangladeshi community to are over represented in sales and consumer service occupations. These are data from the Office of National Statistics, and we know that a major risk factor for being exposed to this is the relates to the number of people you've come in contact with, and the kind of levels of protection when you have when you're in those occupational roles. So that's so that will put these individuals at an increased risk. And we know that minority ethnic groups work at higher rates in these in these groups. Then we think about the differentials in terms of the vulnerability once you've been infected, and you have the infection. And here we know that pre existing medical conditions such as diabetes, hypertension, and heart disease, increase your risk. And again, there are differences in these levels of, of medical conditions and the way that they've been treated and how well they've been managed until this point that may explain that increased poor outcomes. And then finally, we need to think about the differential social consequences that lead to all of this. So for example, we know that this is highly related to socio-economic, wider socio-economic inequalities and ethnicity is an important factor in that so we have data from them Michael Marmot report that shows this. And we know that low income and zero-hour contracts workers are more likely to come from ethnic minority groups. That makes it harder to follow the social distancing restrictions, and harder to kind of follow the stay at home and working from home advice. And all of these factors combined a lightly to explain what we're seeing in terms of the increased rates of infection, hospitalisation and death.
Vivienne Parry 7:25
And it's very interesting with the Runnymede Trust published some work showing that for every pound of white household wealth, Pakistani ones have 50 Pence, black Caribbeans 20 Pence, and Africans and Bangladeshis, 10 pence. So there's a really stark economic divides there.
Rob Aldridge 7:47
Yes, absolutely. And I think that that is, you know, this is brought to the, to the fore those Stark inequalities that we've known about. We've been trying to add support and I think there's there's a stay. There's a saying that I've had that I think quite nicely captures this point that we're all in a storm in this situation, but different people are in different boats that we're not all in the same boat and that level of income and the disparities in those income play a major part in the way that you're able to respond to this and take precautions and act in relation to your risk of infection and an outcome.
Vivienne Parry 8:22
Yes, and if you're on, you know, zero hours contract and you haven't got much money in the household, the idea of being able to isolate is, is really not possible.
Rob Aldridge 8:34
Absolutely. It's really difficult. And there was a very important piece in Channel Four news last night that showed how actually so migration and ethnicity is an overlapping concept not all minority ethnic groups are migrants, but there is a proportion of migrants that sit there and there is a particularly vulnerable group that have no recourse to public funds. And this means that this this group of individuals has no way of getting access to the social protection mechanisms that the large number of other people are able to access to. And we need to urgently think about that and think about the fairness in that and how we protect these individuals who, who, you know, are bolstering our society and protecting our society. They're working in the care homes, they're working on hospitals, and we're not able to support them, and they are a particular risk of this and the children of these families are. I know, I worry enormously about that.
Vivienne Parry 9:30
So you're our Data King Rob, I mean, data really is just it's so important here. Do you think that the acquisition of this data and this really stark picture that we're getting of disparities revealed by COVID I mean, it was always there, but revealed even more starkly by COVID is going to have an impact?
Rob Aldridge 9:55
I think we need the data. We need the transparency around the data to highlight these issues, but data alone is nowhere near enough. We need to know that there is still some uncertainties around, you know, the different mechanisms and the different vulnerabilities. And we must undertake that research to kind of really unpick some of the my new shy around the causal mechanisms by which we're seeing. But I think we shouldn't rely just on the data. So data can only tell us and he can, he can shine a light on that. And it can, you know, to go back to how I described my work around and making invisible populations visible. That's why we need the data to do that to shine the light on that and to hold policy and decision makers to account. But we also need to act now and data doesn't, doesn't need you. We don't need data to do that we know enough to take action to you know, start reducing the risk of infection and hospitalisation and death in these groups. And we don't need any more data to do that and we must act this is an urgent situation that needs to be acted upon now.
Vivienne Parry 11:00
Okay, thank you. Nish, can I bring you in now because you've been researching the impact of these on marginalised communities long before Coronavirus came into view. What have you found in your research that can help explain why people of different ethnicities have such a high likelihood of diving dying from COVID.
Nishi Chaturvedi 11:20
There are marked ethnic differences in certain pre-existing conditions capabilities, such as diabetes, heart disease and stroke, high blood pressure and respiratory disease that may offer some insights into why certain ethnic groups are particularly high risk. So I'm going to talk about the differences in risks. The different interrelations between these conditions, gender differences and differences in age of onset. So many of these ethnic minority groups share an excess risk of diabetes people, black African descent, have about a three-fold excess of diabetes. Compared to white Europeans, and people of South Asian descent, that access is fourfold. But there's considerable heterogeneity within these groups. So for example, within South Asians, diabetes prevalence is markedly higher in Bangladeshi origin populations, then Pakistani folk, and people of Indian origin have the low rates of diabetes, but I must stress that all these groups have very high rates of diabetes compared to what Europeans. We also see greater risks of high blood pressure in people black African descent lesson in South Asians, and I've mentioned the interrelationships between these comorbidities differ in the different ethnic groups. So for example, diabetes is well known to increase the risk of cardiovascular diseases, such as heart attack and stroke. And not surprisingly we do see that in South Asians. But in strikingly, we don't see that in people of black African descent. So despite higher rates of diabetes and high rates of hypertension, risks of curry disease in particular, are lower in people of black African descent. And this is especially true in men. So we're aware that severe COVID appears to affect men, much more than women. And in general, cohabitees are much more frequent in men than women. But this is less true and people are black, African descent, so diabetes, hypertension, obesity, much more frequent in in women of black African descent than men. So I would suggest that maybe COVID disproportionately affects women in those in that ethnic group,
Vivienne Parry 13:51
which is fascinating and, and one of the things that we've come to see now is that COVID is not just a respiratory disease, restrict infection, people are beginning to see it as also a vascular infection. So it's getting into the cells that line the blood vessels. And it's causing chaos throughout the body through the vascular system, which of course is in a already parlous state is going to mean that the infection is more severe.
Nishi Chaturvedi 14:24
Yes, that's right. And, and one of the valuable things about studying ethnic differences and vulnerability to covert is, as you've suggested, the recognition now that COVID as much more vascular disease and respiratory disease, and people of ethnic minority groups generally have lower rates of chronic respiratory disease. And in large part because smoking rates are lower in some not all, but in some of these ethnic minority groups. So it's the vascular aspects that I think are predisposing these individuals to disease in the first place. And predisposing some of these groups to severe disease.
Vivienne Parry 15:04
What about the cultural and socio-economic issues that underlie the way that people get infected more often? I mean, we were talking, Rob was talking about exposure by occupation, but there's also multi-generational households are common.
Nishi Chaturvedi 15:21
Yes, that's right. Well, again, these factors differ according to the different ethnic groups. So you've mentioned household structures, for example, that perhaps Indians and Pakistanis and Bangladeshis have large multi-generational households. Whereas for Caribbeans, it's largely solo individuals and ethnic minority groups tend to live in dense urban environments where you're living perhaps in a block of flats, you have to share a lift or a stairwell to get in and out of the flat. So making social distancing Much more challenging. And accommodations generally much more overcrowded. Again, keeping your distance is much harder in an overcrowded environment. So all of these factors contribute from a socio-economic perspective, to greater exposure to virus in the first place.
Vivienne Parry 16:17
Yes, and we mentioned a channel for news, but there was a recent report showing a care worker who was having to share a very, she had a very small room, but she was also sharing her bathroom facilities with about 10 other people in the same household. So it's not really surprising that you get a much greater exposure to, to virus that way. And and when we say greater exposure to virus, it's not just that you're coming across more people, so you're more likely statistically to come into contact with an infected person. But actually, it's about viral load, isn't it that you, you're more likely to come into close contact with people
Nishi Chaturvedi 17:00
Yes, that's absolutely right. And particularly people working in the health care sector, our loads are bound to be much higher than they are in the general population.
Vivienne Parry 17:09
What mitigating factors do you think needs to be put into
Nishi Chaturvedi 17:13
place? So one of the things I wanted to raise with this with the comorbidities, we've talked about the hypertension, the diabetes, these have a long, many year subclinical phase, there are no symptoms. We have an NHS health check system that kicks off at the age of 40, where people are checked out for things like diabetes and hypertension. But I think minority groups the age of onset of these conditions are some five to 10 years earlier. So by the age of 40, many of these ethnic minority groups have already had been some their community for many years. So one thing is to introduce these health checks at a younger age in ethnic minority I think we should also be aware that once we know that individuals have a burden, comorbidity, we may, we should offer greater occupational shielding for those individuals. And that's already taking place in some healthcare settings.
Vivienne Parry 18:15
But we have to be careful, don't we, when when I was talking to a group of Asian health workers, who were very unhappy about the the being shielded from frontline duties, because they felt that they were invisible enough as it as it was on the front line in terms of promotion, and you know, what they did, and that being taken off the front line would mean that actually they were, they were then forgotten completely.
Nishi Chaturvedi 18:46
So in contrast, I've also heard that for a given occupation, say nursing or medicine, that the kind of jobs and the kind of exposures to some ethnic minority groups have mean that they come into contact with much greater viral load than other groups. And it's just the nature of that job. And that's something that the British Medical Association has been very concerned about. So I think it's a difficult issue. And I think there's a balance to be sought here, around the quality of the occupation that people have, and their desire to contribute, which is very natural to the national average.
Vivienne Parry 19:24
So we've heard from you about different exposures about underlying disease and social conditions. But it still doesn't account for all the disparities, we see does it
Nishi Chaturvedi 19:38
at the moment, we don't have high-quality data on either the health or the socio-economic factors that determine risk of disease in any of the data sets that we might talk about. So far. The data analysis shows that these factors account for some but not all of it, not all of our excess risk. So there are other factors going on.
Vivienne Parry 20:02
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, please email us at email@example.com or tweet at UCL. So we're not seeing yet the whole picture. But well, let's stay on this theme of how society affects our health. But think more from a public health perspective. Delan, who is there in Sri Lanka? Fantastic. Does racism and discrimination play a part in this increased mortality?
Delan Devakumar 20:40
Yes. So I guess we should start by acknowledging this very unusual time we're in when the world is engulfed by a pandemic and then simultaneously woken up to the concept of racism. And we really need to acknowledge the events in the US the killing of Mr George Floyd, and all the protests that have happened, the Black Lives Matter movement across the world. But this isn't unusual. There are police homicides every day. I was speaking to a colleague of mine in Brazil, who was saying that in the last year in San Paolo, so one city in Brazil, there were 300 police homicides, almost one every day. These are disproportionately young black men. But two thirds of the deaths were in black men, when they black population constitute about a third of the population in Sao Paolo. So this is everywhere and racism, xenophobia discrimination happen in every society across the world. But what we're seeing now is on the back of the Coronavirus, COVID deaths and the increased mortalities as has been described, and then this killing of Mr. Floyd the This, these two issues have really come to the fore. 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 and 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 they racism, you is persistent health inequality and despite changes in diseases, risk factors or the treatments, there are still differences due to racism. This can occur at an individual level. So overt or covert acts of discrimination towards people of colour, for example, or it can act as a much more structural level. And I guess most of the research is around individual perceived discrimination. But really, the elephant in the room is structural forms of discrimination that lead to people have certain groups having increased risk of diseases, shorter life expectancy. And this works biologically through a number of mechanisms. The increase in stress responses or hormonal adaptations that lead to these risks of non-communicable diseases that were justified. past. And this trauma can be accumulated throughout your life course. So from early childhood into adolescence and into adulthood, and it can also be passed from parent to child. So we see this transmission of trauma passing down from particularly mother to the child. And really at the root cause of these biological causes is racism. It's not about race itself. Racism is the the underlying cause.
Vivienne Parry 24:32
And it becomes a self perpetuating vicious cycle, doesn't it? Because, you know, there are such well documented examples of racial discrimination and, and abuse in terms of health. I mean, you you think of Tuskegee, you think of all of those kinds of things in the past, and it becomes this vicious cycle in which people become more and more distrustful of health services and yet, you need to improve The health services. I mean, how do we break that cycle?
Delan Devakumar 25:03
Absolutely. And I think as Rob was mentioning about micro group, so there's a degree of overlap between minority ethnic groups and migrant groups. And we see that there are barriers to access that prevent migrants from seeking health care. This is in the UK where we have a national health system. There are charges for migrants that mean that they are less likely to go and seek access and very complicated system where, you know, even as medical professionals don't fully understand who's eligible or ineligible for free care, and some of these barriers, purely act at a psychological level where you may just not present early. If you're unwell, you may come later, you may be worried about what happens to your data, whether it's shared with the home office, for example. So these are Some of the kind of structural barriers have prevented people seeking access.
Vivienne Parry 26:05
And then we do something we do something really daft like when we do testing. We do it in places drive through places where only people who've got a car can use, which was just were ridiculous, which immediately cut out perhaps that some of the most vulnerable people who were most likely to be affected by COVID.
Delan Devakumar 26:28
Yeah, absolutely. If we think about the use of technology as well, and we assume that everybody has access to kinds of technology to a car, for example, and portions of the population don't have sensors, and it's disproportionately people of colour who don't. And, and, and there are other things for cultural factors. Language is one and that's a simple idea. But in terms of cultural competence, are we really reaching the people who we need to? Are we actually having discussions with potentially elderly people who may not know all the rules and regulations about who they can see or they can't? I think we need to go much further and actually accessing these groups of people so that we can we reach equitable outcomes.
Vivienne Parry 27:29
I want to come to you all to talk about what kind of recommendations you each have for reducing inequalities in our health system. But before I do, Delan, how can public movements and advocacy be a catalyst for change? I mean, we've seen you know, Black Lives Matter, all those big big movements, and I detect that there's quite a lot of posturing going on. I mean, that you know, a lot of big companies for instance, who you know, added their name to protest, but you can't see them doing much change. Can these big movements really be a catalyst for change? Or are we just seeing a cycle that's going to be repeated?
Delan Devakumar 28:17
I mentioned that the world has woken up to racism. And my worry is that the world will fall asleep in another week or two. I mean, it's true that a number of groups and organisations have come up with statements, particularly around Black Lives Matters. And that's useful if there's some substance behind it. And I think we have to be positive. I mean, we have to use this tide of interest and try and build on it. So in terms of the kind of work that we do, we we can advocate ourselves and certainly link up with policymakers, but also link up with organisations work in this field and who had done for a long time. dots the world, for example, I know Rob has worked up with them and med act and other groups who work in terms of advocacy. And actually Today we are launching a new movement called race and health, which was going to come a little bit later will be pushed it forward to now, the focuses is very much on racism, xenophobia discrimination. And it's it comes from a kind of academic sources link to some academic work on The Lancet that will be coming out. But we want to go much further than that link to activists to advocates and have, see how can we translate the academic findings into action? How can we help other organisations make arguments? I think the, the optimist in me would say that there hasn't been a movement like this for for a very long time. Angela Davis, a very prominent activist from the US was saying this is the most powerful movement that she's seen in her long and illustrious career. So I think we have to take the interest that we have at the moment to try and push forward in these matters.
Vivienne Parry 30:19
Okay, let's now go to all because I, one of the things, of course, about the Public Health England disparities report that raised so many hackles was the fact that it didn't have any recommendations. So I want to come to each of you for recommendations as to really what we should do next to reduce inequality, some really practical things. Rob, besides making people visible through data, what are your recommendations?
Rob Aldridge 30:51
Yeah, I mean, I'd like to just firstly, also recognise my positionality and this is a white man and and the fact that this is a moment of pain and anger. And, you know, I have a unique skill set to bring to this, but we must work together. You know, this is not something that I as a white, as a white man can, you know, I have to be aware of my position in this situation and my privilege. But to kind of talk about something that I've done a lot of work on in the past, as Delan mentioned earlier, and I'll just kind of talk about that very briefly. And I've been working with doctors of the world who provide care for people who have been excluded from the NHS and seek care with doctors to the world, their humanitarian Health Organisation, working in London Who would have thought that we that we need a humanitarian Health Organisation in London, but we do. And the work that I've been doing with them over the past few years has shown the really terrible situation that migrants in the UK face. So we looked at the way we're using the docs of the world data, we should Actually, they saw hundreds of people who were too scared of using the NHS or national health service for fear of arrest, for fear of having their data shared with the home office and being deported. And so when I think about the recommendations that I would like to really focus on as a kind of an immediate step, and I know the others will have other other things too, but I think this is an important subsection that we can do something about really easily so we can stop sharing that NHS data with the home office. We can remove those barriers in access to care so that people are able to navigate and access health care services, and we can remove the charges so that right now if you if you have you know right now, people are not probably unable to get a diagnosis in some situations because they aren't, you know, as we've been talking about Coronavirus, is this disease that doesn't necessarily present just in the kind of cough and fever it may have unusual symptoms and people are scared of of getting seeking health care for fear being charged for that health care we've got this as a pandemic and an urgent situation. And we should have a blanket removal of those charges whilst we're in this situation because that will benefit everyone in society.
Vivienne Parry 33:11
Okay, thanks very much. Nish, what are your thoughts? What would you do if you if I was giving you the magic wand?
Nishi Chaturvedi 33:22
so I just echo a general point that Delan and Robert made that ethnicity is not biology. So this is all about inequalities is about inequalities in socioeconomic status that drives exposure to the virus that drives excess comorbidity so it affects us all whatever ethnic group we belong to. It's not just an ethnic minority problem. Second, I think more specific thing I'd say is about comorbidities that they should a lot of COVID says up subclinical on diagnosed, we should extend our ability to diagnose these capabilities to the younger age in ethnic minority groups. They're also poorly managed in large part hypertension is poorly controlled diabetes is not well controlled, and should increase our efforts through primary care to ensure that blood pressure, diabetes, cardiovascular disease is prevented or if not prevented, treated to the highest possible standard in all groups.
Vivienne Parry 34:27
And that's why we're talking about the biology then my background is in genomics. And one of the things that we must make sure is that as we increasingly go towards a personalised medicine that we represent all groups within our data set. I think it was very interesting to see that 23andme suddenly revealed that they've been selling all these, you know, tests and it's all based on a on a on a Caucasian centric data set. And we mustn't allow that to happen because it further disadvantages people. Let's come to you, Delan, I'm giving you the magic wand. You've suggested some things, what would be your top your top recommendation?
Delan Devakumar 35:15
So I don't think probably similar to the previous speakers, reducing barriers to access and linked with actual engagement and going out and speaking to groups who may be more vulnerable. But But I also want to draw attention to the many groups who have commented on this. So one of the criticisms of the Public Health England report was that it didn't have recommendations, but had a consultation process. In the British Medical Journal this week there is a an article on this and a summary of some of the main recommendations from the different groups. And it's things like NHS England should look at changing ways in which ethnic minority staff are represented. And including decision making. It's taking stratified risk assessments for particular health workers, staff. So there are a number of recommendations out there already from these specific groups. I think leadership is important and representative leadership going forward. It may not be this pandemic and might be the next one that comes along. But we need to have leadership within the health service that looks like and that can speak to the whole population.
Vivienne Parry 36:39
Yes, and we're still in a situation that we were the for the GMC, for instance, the number of complaints against ethnic minority doctors, which come from hospitals are, you know, ridiculously out of kilter. And so there are all sorts of discriminatory practices in Holland Hospitals which don't allow that leadership, which I absolutely agree with you is it is vital to the future. There is so much here to discuss. We're going to have to bring this to a close. And I hope that so this is a plea to the people at UCL. We'd like to do more on this, please, because we've only just begun to scratch the surface here. So you've all been terrific contributors. Thank you very much. And you've been listening to Coronavirus the whole story with this episode 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 splendid Cerys Bradley, our guest today with Dr. Rob Aldridge Professor Nish Chaturvedi, Dr. Delan Devakumar, and if you'd like to hear more of these podcasts from UCL Minds, subscribe wherever you download or podcast or visit ucl.ac.uk forward slash Coronavirus
Vivienne Parry 38:01
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 hope to be with you again very soon. Bye for now.
Transcribed by https://otter.ai