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Global Health - COVID-19 news

The latest news from the Global Health and Infection team at BSMS in relation to the COVID-19 pandemic.

In conversation with Chi Eziefula

Ever since that very first COVID-19 patient in the UK, I have been very busy. An interview with Chi

What has it been like as an infectious diseases clinician stepping in the middle of this pandemic?

It’s been an extraordinary time. We’ve had quite a revolution in the way we run our services at the hospital as a result of our response to the COVID-19 pandemic. The first thing that was relevant to my experience, is that we had the very first case in the UK and so it was a patient in our catchment area that was the first to be diagnosed with COVID in the UK. That was quite remarkable, and it was very busy trying to work out all the contacts for that patient and how we deal with it and how we handle the infection risk to anyone in contact with the patient. That patient was then sent to London but then gradually there started to be more cases in the community. Ever since that very first patient, I have been very busy.

For me the clinical service has got busier in that we have increased the number of doctors covering this service, so we have been doing more shifts than normal. On a personal level, everyone has had problems to solve and questions about infection risk and how they should go about their day to day activities so it’s been a real point of giving lots of people information on a formal and informal basis so quite round the clock actually, lots of WhatsApp messages at 11pm, friends or connections lots of emails, with questions from people asking how to manage their businesses etc so it’s been personal and work based, personal and professional.

Then there has been the work itself, it’s been very interesting having not just to learn about something but do it at the same time and put things in place, it matters immediately how we decide to go forward. We really restructured the way the hospital works so that almost every aspect of our work we changed in order to respond to the pandemic, which patients come into the hospital, where we discharge patients to, where patients are seen in the hospital.

Were you taking these decisions at a local level with Brighton and Sussex Community hospital or at an East Sussex level or were you in co-ordination at a national level, how did it work?

All of those actually. We did a lot of local based changes, it was really impressive how people stepped up to leadership and team work. I must say was really fantastic, to make these very drastic changes even if someone had to have a blood test, we had to determine where their blood would go, to which lab and how it would be dealt with when the sample was finished with just every level of care and whether or not operations should go ahead and even how the teams were structured so that we did locally. But there was also a layer of central or national decision making, which for better or worse, when decisions are being made in one place and being actioned elsewhere then it depends on how well it fits to the local circumstance but there was definitely a lot of central decision making and we also got together as a region, so all of those really.

Do you feel that after that period of rapid adaption of practice that now, should there be a second wave, or should more patients come, do you think you are more prepared because you have the protocols in place?

It’s exactly what it was, protocols, we had protocol’s coming out of our ears! There was a protocol for everything, and we had to work on those protocols, tweak those protocols, review and edit, then launch the activity and then possibly re-edit the protocol if it wasn’t working. So, there was has been a flurry of protocol development, but this has slowed down now as we have looked at pretty much every activity we do, finally, so if we do go back into lockdown again or into another surge, we have a lot that is ready, I’m pretty confident about that, as we had to examine pretty much everything.

What about the health of the health workers themselves?

Having said that we would be ready, every situation still has its own uniqueness about it and even though we are easing out of lockdown, that is very complicated because who is at risk becomes much less defined, but there is still that work, constantly, constantly reviewing what we are doing.

You and Tim wrote that paper on the risks of COVID and clotting and I was wondering how that came about?

It was remarkable, I ended up being the consultant on the wards at the peak of the epidemic in Brighton so we had the most cases that week and I had been off for a couple of weeks before that, so I hadn’t seen cases before then suddenly came in at the peak of the epidemic. I think I would say it took 24 hours, either the first or the second day, for me to realise this was like no other infection I had seen before, it was something completely different and what was remarkable is that so many people had blood clots and I hadn’t seen that in the literature or in the reports from China or Italy. So, I wasn’t expecting it and the more I tested patients for clots, the more I could see. If you didn’t look for it, then you would miss it. But the more you looked, the more you found.

At the same time I spoke to Tim Corbett, who is a Haematologist and Intensive Care Consultant, Barbara Philipps, and they had also both noticed the same things and we got together and discussed it and decided we needed to set up a clinical trial to work out how best to treat these patients and also worked on gathering data with our data set which we then published to look at the frequency of clots and to look at the characteristics of patients with clots.

So it was partly the clinician head looking this is like nothing we had ever seen and the academic head thinking we must report this because I haven’t seen this in the literature and we clearly need to know about it. At the same time, other people were recognising this and now there is a body of evidence on it but to me I think it’s not yet fully explored. I think a lot of the pathology due to Covid, a significant proportion could be due to micro embolisms in different body compartments not just in the lungs I think there is definitely more to look at there.

Do you think you will be changing the focus of your research going forward as a consequence of this pandemic?

I think COVID work is essential and really important we do it, but I don’t think it’s going to determine what I do in the future because other global health themes are still really important and the background of collaborations and work that we have so I think some things that may change are the way that I do my work and we have to fold in that pandemics like this can occur. Considering also the social, it’s shown us very clearly how an infectious disease can impact on every aspect of people’s lives, socio economic so folding in a more broader picture impact of a disease on people’s health is very important. I think we all have the responsibility to research COVID as it’s happening now, and we have to contribute to the research, but I’m still really interested in women’s global health and general infectious diseases research.

Building on that theme, it became apparent in the UK that people who have the highest mortality rate are those from certain BAME backgrounds obviously because of health reasons but there was also talk of other reasons this was more along the gender lines, like men were generally more affected than women. I know you are interested in the gender perspective of things and also on your work around your commitment to Black Lives Matter and issues around racism and how do you tie it all together during a pandemic? How do you keep perspective of this bigger picture which is socio economic pandemic with the rise of an infectious disease?

Well I think the first thing would be that what this highlight is that we didn’t realise that black and Asian minority ethnic people may be more likely to die from COVID, this wasn’t picked up until quite late. Probably because in China there is less diversity and also in Italy maybe and also because it’s not being measured, a lot of the systems don’t collect ethnicity data in a lot of data sets so there is no signal to recognise that something is impacting a certain ethnicity more. So that’s a structural issue because if people in those groups are disadvantaged we will never know about it because our broad data collection systems don’t even collect it so that reinforces that inequality therefore because it’s not even looked at.

We have that issue with women’s health because there is lots of research that is not disaggregated by gender. People don’t realise that a drug works differently in women to men because the data is not looked at with regards to gender. For example, less than 20% of HIV drug trial participants are women meaning that women with HIV are taking drugs that have not necessarily been tested enough on women to know their safety in the female body. There is this issue, before research and any work is done, we need to think about how we are structuring it so what I would say in response is intersectionality is very important and we need to look at all the aspects that make people diverse and make sure that the way we design our work and the way we design our data collection and the way we design our analysis takes that into account so that we can pick up if there any people who are doing badly with intervention or with this disease or with this epidemiology and that we can pick that up where if the people who are designing this work are from a specific sector which may be white, male, privileged then that’s the lens they are using to do their work. For the women, yes, there are definitely fewer women dying from COVID. Women do get COVID and there are is a lot of morbidity associated with COVID, not just mortality, but in those that survive it there is lots of ongoing consequences and complications of it and we also need to start looking now at whether women are more or less likely to have long term complications from it and what they are and if they are same as in men and in women and the same as with other intersectionality and different ethnicity groups.

On a more personal level, you have young kids, it’s been Spring, is there anything that you have time to do outside work?

My kids have been at school as I’m a key worker and they were the only kids at the school as I’m on the only key worker at the school which was strange for them. I’ve had an allotment since January, so I’ve been trying to escape to the allotment during this pandemic and the weather has been great, so I’ve been bringing lots of fresh produce home. I’ve grown lots of greens, radishes, lettuces, Kale, chard, cucumbers, peppers, carrots, cooker lemons, herbs, tomatoes, beetroots, beans and some raspberries, gooseberries, blackcurrants. It’s been a meditation, sowing seeds, tending to them and weeding. We just got chickens too.

In conversation with Jas Islam

My name is Jas and I’m one of the Infectious Disease and Microbiology Registrars based at the Hospital but I’m also one of the NIHR academic clinical lecturers in infection which allows me to combine academic work with clinical trialling which is really nice, I’m quite lucky to be able to do that. My main research interest is in antimicrobial resistance and I suppose more specifically antimicrobial stewardship efforts and that would have been predominantly UK based but more recently with a global focus.

Esther: How did the global focus come about?
Jas: I think probably I’ve always had an interest in infectious diseases which lends itself to global health but I suppose when I did my Clinical Academic Fellow year when I was mid-way through my training I did the diploma in tropical medicine hygiene at the London School. My PHD research had been very much UK based hospital acquired infection but actually that kind of drew the spotlight on antibiotic use in a more global context and I would say it really started then, and as part of that year I ended up working on developing the protocol for the Fleming Fund which is now this huge fund that’s funded by multiple different sources that include The Department of Health in the UK, DFID and Bill & Melinda Gates and the focus of this is to address microbrial resistance in low to middle income countries. I was one of the four authors on that protocol and that really opened up my eyes to that work. Also during that year I worked as a NICE scholar which again was looking at developing antibiotic stewardship in the UK but I ended up being seconded to work with NICE International which was a subsection of NICE and I did some work for them developing guidelines in Vietnam in restricting infection. I think those things together started me on the path in a global context.

Esther: Am I right in thinking that a big part of that stewardship has to do with hand washing and hygiene and good practice?
Jas: Yes, you think of it as the hand hygiene and the hand washing is more infection prevention control which fits in with antimicrobrial resistence they kind of fit together. I had that experience in UK setting because my research had been part of acquired infections and my day to day job is on infection control, an area that is often overlooked in hospital or healthcare settings.

Esther: What link do you make in your mind, now we are in the middle of this pandemic, between hospital acquired infections and what do you think will happen now that there are all these new protocols. Do you think types of infections will change that you will see in hospitals?
Jas: So I think in a global setting, yes it’s quite interesting because one of the areas that I’m quite interested to look at is the unintended consequences of COVID. Understandably lots of research efforts and resources have focused on addressing the current pandemic but during that time, in the UK, a lot of antibiotic use has gone out of the window. I would say the UK has a pretty robust stewardship programme in place and it comes from the Government down, so it will be very interesting to see with the use of lots of different antibiotics are we going to see more resistant organisms occurring again and you would think we probably will.

I guess on a global level it’s slightly different because in some countries we are kind of at that stage where we don’t have that baseline data so we don’t really know what’s happening, but certainly you know you can expect the same thing where a lot of healthcare is also going to be diverted away from routine efforts. For example a lot of people in Bangladesh have had to leave the city and be displaced back to the villages as a lot of factories have closed down and you have to think about their access to healthcare and potentially other different infections that they may pick up now that they had not picked up previously and yes, I think it’s going to have huge knock on effects.

Esther: Have you seen an initiative and funding for research allocated to this area?
Jas: I suspect bits of research have been going on, but I think the initial research has been focused on COVID but again standard work out the mechanism for transmission, best treatment so e.g the Brighton/Lusaka Pharmacy link, which I’ve been involved with, got a grant from THET and the Commonwealth Pharmacy to look at stewardship efforts in Zambia. And then while I was on maternity leave they got a second grant, a smaller amount of money to look at upscaling their efforts in light of the COVID pandemic. Increasing production of hand alcohol gel which was one of the outcomes from the original grant so there is funding available and I know that there are other funding calls coming up and how has COVID affected antimicrobial resistance and I think it’s going to take some innovative thinking from different research groups to think about what they want to look at.

Esther: Tell me a little bit more on a personal level to be on maternity leave and to come back to a quite a different workplace?
Jas: It was interesting, as before I went on maternity leave I always thought I’d keep working I’d still go to conferences etc and I’ll be a mum and still manage to do all these things and I did actually go on a conference with Rory when he was 3 months old and I did chair a whole day session and I have a very supportive husband who looked after Rory and I had to rush out and feed him in between. That was interesting. I was due to go to a big meeting in Kuala Lumpur in February when he would have been 5 months old but it was actually cancelled due to COVID and I was quite glad because when it came down to it as I was thinking I don’t actually want to leave him for 5 days. Then the pandemic kicked off and there was a huge part of me that felt quite sad, to be missing out and not to be involved at the forefront both clinically and academically to help the effort as this is something that has never happened before in my lifetime I actually felt I do really want to go back and help out but at that stage Rory was only 7 months old and it was a bit soon. I did say I would come back if they needed me but at that point they could manage. Ultimately, I was asked if I could come back early and help out and I suppose by then Rory would be 9 months old and I felt happy to come back and help because he was older then. If he was two months I probably wouldn’t have gone back. I have only gone back part-time, initially I was going to go back full-time, working 5 days or working 4 days and using accrued leave and I thought it would be fine but in reality it has been quite hard going back from maternity leave. I’ve actually had a number of times in my career where I’ve taken out big periods of time from clinical work, for example my PHD, where I took out 4 years from clinical practice, which is quite a long time and it was a bit weird coming back but it was actually fine but even doing the ACF that was another year out but then this time I suppose I did a year, the ACL year, clinical lecturer year, based in London, then a bit of BSMS and then a did year of maternity leave and then I came back and actually it has been a lot harder than I’d imagined. It’s probably the first time in my career that I found it a bit more challenging.

Esther: Is this because of the circumstances, the knowledge or more to do with you have to commute and you have a baby at home?
Jas: I think it’s a combination of all of those factors. I have commuted for 4 years, the commute isn’t really a big deal, but when you factor in a small child and you are not getting a continuous nights sleep. I’m lucky that my baby does sleep well but I’m still up once in the night, so there is that and then there is the fact that I’ve been away for two years and I think it’s probably a common myth and I don’t think it is true that you have your baby brain, I don’t this is true but you are a bit more rusty, your focus has changed and you are a bit more deskilled, those are factors.

Then coming back towards the end of a pandemic, the way the hospital works is now very different, the way our ward works is now very different, we had different juniors, we don’t have our usual team, we don’t go and see patients as you normally would and the patients you are looking after aren’t the usual patients you’d be looking after, those are all factors that are all quite stressful, on top of coming back to a job that you haven’t done in a couple of years and at the moment I’m doing clinical work but starting to do academic work on the side but ultimately it’s quite hard when you are only doing 3 days because on the other two days you think you can do the work on those days but my husband has to do work and he’s busy and has work to do on those days. When your baby is very small and sleeping 4 hours at a time that’s fine but when they are not you can’t really sit down until say 9:30pm, hence why we are doing this interview at night!! It has been very interesting for me and an eye opener because I just thought it would fine and to be fair, I’m much more comfortable now than I was 2 months ago and you do just adapt and it is fine. I remember thinking when people went on maternity leave and came back to work, it wasn’t a big deal. You don’t know until you’ve done it. It also highlights that people who are clinical academics long term and have a family it can very challenging you do need to have a lot of drive and discipline and a very supportive family.

Esther: Thanks for sharing, it is so important to voice these things…..
Jas: Yes, you have to be honest about it, as I thought it would be fine as I’ve had big periods out before but I remember speaking to some of my mentors when I was back at work, and they used to say to me, you just need to give yourself more time, Bethany and Chi said, you need to be easier on yourself, you have only been back 2 weeks. It can just feel very uncomfortable, initially when you feel a bit out of control and it’s fine now and settled.

Esther: Where do you see things developing with you?
Jas: I’ve been trying to think about this in the last few weeks as I’m right at the end of my training as a registrar and due to finish and become a consultant in December, so I’m literally having those thoughts as well and getting my application ready. It’s interesting and having a baby does change the way you think about things initially so I’m still at a point where I’m thinking about that. I would still love to keep doing some academic work and doing some applications now with the Brighton/Lusaka Link, it’s a really good team, they are very motivating and the Zambian team are amazing, would love to do a bit more with them.

I also love clinical work and I wouldn’t want to starting off as a consultant lose that because I think as you become more senior and you get pulled in to different projects, it could be harder to lose some of your general knowledge if you become more specialised. It’s about finding the right job where I can do some clinical work with some academia or some policy work with Public Health England. The sort of person I am, I would have to do something alongside clinical work, what that will be I don’t know.

I have got the opportunity over the next 4 years, I am on the emerging leaders programme with The International Society of Infectious Diseases so that’s a great opportunity to continue to work in the context of AMR so I will keep doing that alongside my clinical work, even if I don’t end up writing lots of grants. I still don’t see myself as a traditional academic. I took a more unusual route as my PHD was in an area that I didn’t want to continue working in, so I spent a lot of time doing all these different things, like a NICE scholarship or Fleming etc possibly at the expense of building a strong academic platform, but I suppose it’s given me other skill sets, that have been interesting, I’ve met lots of interesting people and gone to interesting meetings and I think it’s important to remember for medical students and more junior doctors that sometimes you don’t always take the more traditional academic route, you can still end up doing interesting things eventually and squeeze a family in!

COVID reflections by Leena Al-Hassan

The COVID-19 pandemic has been a strange time for everyone, and we have all had to adapt to a new normal: lockdowns and self-isolation.

I felt that everything escalated so rapidly back in March. I had several research trips planned for the spring/summer: I was due to go to Sudan in mid-March, an annual international conference in Paris in April, and I was invited as a speaker at another international conference in Montreal in June.

The pandemic and the subsequent lockdown has affected the projects I am working on, as all research activities had to stop immediately. I am lucky that I have a lot of office-based work that I’m keeping busy with, and on one hand, the lockdown has given me the time to focus on data analysis and write-up, which was frequently done ‘out of hours’ in the pre-pandemic time. On the other hand, a lot of my work relies on outputs from the lab and that has had to be put on hold until further notice.

In terms of the international collaborations and work that I’m involved with in Egypt and Sudan. Everything had to be put on hold as countries went into lockdown and curfews were imposed. Thanks to the virtual meeting, we have been keeping in touch, and planning how and when to get back to work. I still have hopes that I can manage a trip (or two!) before the end of the year!

On a personal level, the world going into lockdown was particularly hard as my extended family are dispersed all around the world. I always took ease of travel for granted, and always thought that “I’m just a flight away!” – but suddenly I wasn’t!! The realisation that I was actually far was quite hard. Fast forward three months and we managed to come to Denmark to be with family, and are planning our return to the UK as things have now settled. I look forward to going back to the lab over the coming weeks, and hoping the life resumes some normality over time.

Join Zaman for live webinar

Join Zaman for live webinarJoin Professor Shahaduz Zaman, Reader in Medical Anthropology and Global Health, for an online presentation titled 'How can rapid exploratory anthropological studies support public health COVID-19 responses: experience from Bangladesh'. This webinar will explore two studies he led with his team of researchers conducted during April in Bangladesh. The first study explores the communication crisis and misinformation, and the second study focuses on fear and stigma in relation to COVID-19. Zaman will draw from various innovative anthropological methods applied in a lockdown situation to illustrate how the idea of simple messaging and 'one size fits all' is not always appropriate, and you need social science contributions to contribute to any effective public health campaign. Zaman's webinar will take place on Wednesday 10 June from 11am-12pm on Zoom.

Join here >

A day in the life…of an ECR

Dr Caroline Ackley shares her experiences of being an Early Career Researcher (ECR) during the lockdown period in the form of a photo diary.

Download the photo diary here >

Locked down here but not shut down

By Collins Iwuji

I left the UK for South Africa on 29 February 2020, one month after the first two confirmed cases of the novel coronavirus were diagnosed in the UK. I was excited about this particular trip because I had just established a new collaboration with Wits Reproductive Health and HIV Institute (Wits RHI) in Johannesburg through an NIHR-HPSR grant to investigate models of integrating diagnostic STI care with HIV Pre-exposure prophylaxis. I met my new collaborators, who have now become friends, on 2 March and we got to work.

From time to time we interjected with discussions about how the coronavirus was disrupting lives in other parts of the world. Things changed rather quickly in the days that followed; South Africa reported its first case on 5 March and discussions about COVID-19 started to take centre stage not just in South Africa but in the rest of Africa as well. In the meantime, colleagues in the UK were starting to take steps to mitigate the impact of the coronavirus on the health system and livelihoods in general as it became apparent that we were dealing with a catastrophic pandemic.

As non-pharmacological interventions to combat the virus gained prominence with social distancing becoming a household phrase, we started to think of new ways of working. My colleagues at the Lawson unit did a phenomenal job of transitioning to virtual consultations with allowance for face-to-face consultations for those who absolutely needed to see a doctor. On my part, as chief investigator of a multi-centre clinical trial in the UK, we had to halt new recruitments into the trial, scaled down clinic visits while ensuring the safety of participants already enrolled in the trial. All the trial sites did a wonderful job in making this arrangement possible. A few weeks later, I had to repeat the same process of shutting down projects with colleagues in South Africa, both at the Africa Health Research Institute (AHRI) in KwaZulu-Natal and Wits RHI as the government instituted social distancing measures from 15 March and a full lockdown from midnight of 26 March. We brought all projects that required interaction with study participants to a complete halt and modified some to allow only telephonic collection of data where possible.

As someone already used to doing a lot of work from 'home', the transition to home working was not that challenging but having several hours of virtual meetings required some adjustments. I have my plate full, with respect to academic work, with a new grant award from the Royal Academy of Engineering to develop a dashboard system to optimise viral load monitoring in rural South Africa. At the same time, I was trying to keep up with our university's response to the pandemic and was impressed with how everyone rallied to minimise the impact on students, taking full advantage of technology to ensure learning continues. Great job!

At AHRI, all the faculty members, which included myself, started to meet virtually weekly to discuss how to support the South African government’s response to the coronavirus pandemic. Things happened at lightning speed. The AHRI household and demographic surveillance which has been carrying out HIV surveillance through household visits and telephone interviews has now been repurposed to undertake surveillance for COVID-19. Conceptualisation of this idea to field data collection took only a couple of weeks and preliminary data are already starting to roll in. Other colleagues are busy with mechanistic basic science research on COVID-19 in the context of high HIV prevalence. The AHRI director has done a fantastic job facilitating the collaboration of all research institutes in KwaZulu-Natal to support the KwaZulu-Natal Department of Health in their pandemic preparedness. I have also collaborated with a great colleague from the Science and Policy Research Unit at Sussex in a COVID-19 grant proposal that involves six countries including South Africa. We are crossing our fingers on the outcome of the proposal.

It is May, and I am still in South Africa. I should have returned to the UK at the end of March; I'm locked down here but not shut down! I feel at home in South Africa at the moment but I really need to get back to the UK. Special arrangements to fly UK residents home have mostly ignored those of us in Durban, with those flights having been from Cape Town and Johannesburg and people in Durban not being able to travel due to lockdown. I miss all my colleagues in the UK, both at the university and hospital, hence I really look forward to the weekly Zoom calls to connect with all of you, support each other and share our stories at this very challenging times.

I last saw my lovely three boys in the flesh in February, even though we have regular video calls, it is just not the same. Since then, I have missed two birthdays (March/May), the next one is in October, so I'm looking forward to being present for that. Needless to say they are bored out of their minds, but they understand the importance of staying home and in that respect, they have been exemplary.

We have all been affected by this pandemic, some more so than others. My heart goes out to all the families who have lost loved ones prematurely, may they be comforted. I salute all frontline staff/keyworkers who have stepped up to help and support at this time of national need. It may seem so dark now but we need to remain hopeful and keep believing that the sun will shine again.

From Vietnam to London via Cambodia

PhD student Angela Mcbride shares her journey

Angela Mcbride covid news story

As I’m sure it has for many, COVID-19 has been quite an eventful, and changeable time for me. I am usually based in Ho Chi Minh City, Vietnam. However, I am also a member of the UK Emergency Medical Team, and I was called up to deploy into the WHO Cambodia office and support COVID-19 preparedness activities. I had only ever deployed as part of a complete field hospital before, so being the ‘clinical expert advisor’ seemed like a daunting idea initially.

First, the Ministry of Health requested that I write a national treatment guideline, and acutely aware that I had never worked in Cambodia before, I assembled a panel of local clinicians who helped me to write a guideline appropriate for the local context. I visited lots of hospitals in Phnom Penh to understand the capacity of the health system, gave advice about infection prevention and control, and earmarked health facilities and hotels for surge capacity.

Quickly however, preparedness turned into response, as cases increased from 1 to 120 within 10 days of my arrival. Compared with other countries, that seems like a miniscule number, but there were 10 hospital beds and 3 ventilators designated for the whole country, and most hospitals outside the city had very limited capacity for testing, PPE or oxygen supplies. So, although it wasn’t the objective of the deployment, I mostly ended up chasing around the country alongside some very resourceful WHO National officers, doing infection prevention and control assessments in reaction to new clusters of cases. We rapidly pulled together hands-on training in PPE, case management, cleaning and waste disposal. Working within the WHO incident management system was an overwhelmingly positive experience, and it challenged some of the assumptions I had previously made about their organisational efficiency – at least at country level, the emergency response was rapid, focused and free from bureaucracy.

Suddenly though, Vietnam closed its borders, and there was no route home. As the world started to close at the end of March, I had a rapid exit from Cambodia, landing in London in a t-shirt and flip flops, having left my life (and cat!) in Vietnam. I initially went back to my old hospital in central London and worked on the COVID cohort wards, but the patient numbers dropped very quickly – after a week we had more doctors than patients. It felt very odd to be the least busy I can remember in 10 years of NHS work, during a global pandemic; this experience also seemed somewhat at odds with the media coverage. But despite not being particularly busy, and all that PPE training (!), I did manage to acquire a COVID-like illness…

I have now transitioned to mostly working on clinical research; the phase III Oxford vaccine trial, and an observational study to improve understanding of the risk of healthcare worker infection. You might think that healthcare workers are reliable study participants, but trying to coordinate a few hundred doctors and nurses to submit swabs twice a week is like herding cats.

Vietnam has done a remarkable job in containing COVID-19, and domestic life has re-started there with gusto after several weeks without local transmission. However, international borders remain closed, and it will be some time before I can get back to enjoy 2 weeks in a military quarantine camp, and re-start my PhD study. For the meantime, though, I feel grateful to have a meaningful role, working amongst old friends. I’m glad to have sight of my parents from a safe social distance, and I have rediscovered the joys of cycling in clean air!

Jaime Vera in conversation

In conversation with Dr Jaime Vera on the COVID-19 lockdown

Esther: In which way has the COVID-19 pandemic impacted you?

Jaime: I've been thinking of this carefully, and the pandemic has impacted me in two kind of facets: one on a personal level and the other on a professional level.

On a professional level I think it has been quite a shock for all of us. During the first weeks of the pandemic there was a lot of work going on figuring out how we could continue to provide our service, continue caring for people with HIV without them having to come to clinic, moving our service to a virtual type of scenario. There were lots of meetings and things to do, and I think we achieved a good result. Now we are providing mainly telephone conversations with patients, delivering medication by post, instead of patients having to come to the clinic, multiple communications with patients to inform them what is going on.

However, I do a few clinics that specialise for example cognitive clinics, and that has suffered due to not being able to do face to face neuro cognitive assessments.
So, on a professional level, yes we have had to change the way we work and this has been shock. We have had to go back to general medicine and go into the wards again to do this and other non-HIV patients. Personally, for me it has not been that difficult because we do this within HIV. But for some of my colleagues who do sexual health they haven’t been doing this for years and it has created a lot of anxiety for them.

On a personal level the impact has been in terms of organising our lives around all these changes. As NHS key workers, both myself and my wife who is a doctor as well, we are having to organise our family life around work: we both cannot be on call; thinking about what happens if one of us falls ill, we don’t want the two of us to be ill at the same time; who's going to look after our kids; you a cannot get an au-pair, my in-laws are old and frail and they need to shielded.

Likewise the fear of getting infected; the fear of infecting your kids when you get home; the fear is always there. Going to the wards and seeing the equipment and it is not as we expected.

We haven’t felt the lockdown maybe as strongly as other people, we still go to work, and the children are still going to school. I believe the lockdown will go on for some time and we must, and will, adapt.

As an academic the research side of things has had to stop. Many of the studies I am involved in are patient lead, hence the MSc students I supervise have had to change their research to systematic reviews. Other research projects I am involved with are conducted in other locations, for example in Zambia; luckily most of the funders are going to extend deadlines for outputs. It has been stressful; how are we going to complete these studies. On the other hand, the lockdown has given me the opportunity to write papers that I have not had time to do before and also look at research and grant applications.

In terms of the future, I guess my fears for the future relate to when I will be able to start doing research with patienets, and in terms of funding whether it will all fo to COVID research, which of course it's important, but what will happen to funding for other areas such as cancer.

I am going to put an application on COVID and HIV, we need to adapt and to tap into that. I have fears that people with HIV will not be able to access vaccine trails because they have another condition so they probably will be excluded from this. We are supportive other COVID research, but we don’t have much to offer that now.

I also have concerns about staff on short term contracts, what’s the impact of delivering the research overall; what is the University’s financial position and what’s going to happen in the next 5 to 6 months.

Esther: Just in terms of HIV, one of the last big pandemics, have you drawn any parallels or has it helped your thinking, has it evolved your thinking, in terms of virus, and the spread, public understanding, stigmas in any way?

Jaime: Yes, we are having discussions and think one of the studies that we are requesting funding for has to do with the impact o COVID on people with HIV, stigma being one of them, so there will be a double stigma.

These two conditions are a bit different, but once you know what the mode of transmission of an infection is, that probably determines what the impact on society and what the response will be. HIV being a blood born virus is perhaps a little less scary than a respiratory infectious disease. COVID does not discriminate by gender, age, race etc whereas HIV does, and it stigmatises a certain group of people. The impact of this on mental health will be interesting.

Esther: How are you spending your time between clinic and research.

Jaime: I was on call 3 days over the weekend, my clinical work has increased, my academic work has been protected. Monday to Friday: I am working in my office in the clinic or in the Lawsons unit. We are having to see some patients, but it is definitely a different way of working.

Esther: Do you get to meet any BSMS colleagues?

Jaime: No I haven’t ‘seen’ any BSMS colleagues so the Global Health team weekly meeting have been great. I am seeing the clinical team and seeing Malcolm’s videos have been good.

Finding positives during lockdown

Finding positives in total lockdown by Maho Yokoyama

It doesn’t need to be said that the current situation is difficult for all of us. Everyone has had to adapt to living differently and is facing the uncertainty around when this will all be over. Being post-docs on a temporary contract, there is the added worry around completing our projects and whether we will have more time or not.

To complicate matters further, I fall in to the “shielding” category; this means that I’m not allowed to go outside at all. Not even to take the bins out, or go check the post downstairs… no going to the shops for a quick chocolate bar or crisps, or to grab some milk… I must say that the first month was really tough, as I’m sure it was for everyone as we all adjusted to this situation!

The silver lining in all this is that what we do as researchers is flexible; there is always something that can be done away from the lab, whether that is analysing data or working on papers or grants. This has definitely been helpful, as it has given me some form of structure to my otherwise structure-less days! And I’m definitely glad that I now have the time to really focus on working with my data and thinking about what papers can be written around them.

Another aspect that has been welcome is being able to find ways to improve my wellbeing and the way I work. For example, it has been nice to explore what sort of (gentle) exercises help me feel better within myself, which has been great for my health. Also, I’ve found that dividing up my work hours to 25 mins blocks, then giving myself 5 mins away is definitely better for my focus than trying to carry on for the whole day – sometimes, starting this way gets me “in the zone” that allows me to just carry on!

Of course, there are days when I’m just fed up with all this, and have no motivation to do work. It comes and goes. But I know that this feeling will pass, and one day this whole situation will be over – whenever that may be. And I have things planned for when I can go outside again!

Thankfulness in a time of Corona

Thankfulness in a time of Corona by Sarah Marshall

Hi, how are things with you? How are you managing with this Lockdown? I am at home with my retired husband and teenagers of 17 and 19. Early on in lockdown I was challenged to keep a journal of all the things that I am grateful for at the end of each day.

I have been doing this every evening and have actually found it really helpful in keeping a sense of perspective amongst media reports and continually reviewing data trends. As a friend said to me yesterday “Our grandparents went to war and all we have to do is stay at home on the couch!”

This Thankfulness Diet has been more difficult some days (the day a COVID-19 outbreak began in my Dad’s nursing home) than others. But however hard the day, I have found there is always something to be grateful for. These have ranged from simple things such as sunshine, spring flowers, my daughter’s baking and hot tea, to being able to work with a lovely team of colleagues with a shared sense of humour and better IT skills than me! So Thank You to all of you too!