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So first of all, could you just say your name and your current position and affiliation?

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I'm Trish Greenhill, Shawn, professor of Primary Care Health Sciences in the Department of Primary Care Health Sciences at the University of Oxford.

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Thank you. So, first of all, could you just tell me a little about yourself?

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I mean, very briefly, but how you got to where you are now? I'm a medical doctor.

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I'm trained initially in diabetes and then moved into general practice quite soon.

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And I've also trained in social sciences and in public health.

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So I spent most of my academic career at University College London brief period.

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Queen Mary, University of London.

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And I started in Oxford on the 1st of January 2015, and I lead a research team called Eiris, which is Interdisciplinary Research in Health Sciences.

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Actually, we co-lead that team my job share the leadership of the research unit with Sara Shaw,

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who's an associate professor with a social policy background.

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So we have a we our approach is to bring people in from lots of different disciplines.

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So we have philosophers, anthropologists, computer scientists, health economists, doctors, nurses, pharmacists, physiotherapists, paramedics.

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And we do a very broad range of research basically at the interface between social sciences and medicine.

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Thank you. So if you had to define the single big question to get you out of bed in the morning, what would it be?

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The question that gets me out of bed. Currently we're talking November 2021 is how are we going to end this pandemic?

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How are we ever going to get back to normal in inverted commas?

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I think I was trying to go for something slightly higher level, but. What's the nature of the questions that you explore in your resort research?

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We're going to get on code, obviously, but the nature of the questions I explore are like real world questions.

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I like practical questions. So I'm getting quite interested in a kind of philosophy called pragmatism, which is, if you like, looking at concrete,

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real world issues and trying to decide what kind of academic theories and approaches and methods can be brought to bear on those practical problems.

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Oh, I think you've answered the next one. Yes. So you mentioned you've mentioned that your research unit is extremely interdisciplinary.

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Why do you think that's important? Oh, I think I got into interdisciplinarity when I did my doctorate.

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So as I said, I trained in diabetes and the topic that I was studying in my doctorate was unstable diabetes type one diabetes,

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what we call brittle diabetes in those days, this was the mid 1980s,

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and my task as someone who worked in a diabetes lab was to bring people in and stress them and see what happened to their diabetic control.

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And over the couple of years when I was doing my field work,

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I got less and less interested in the kind of stress that had been assumed by my supervisor, which was a sort of biochemical physiological stress,

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and more and more interested in the stories that people were telling me about that diabetes, about their marriage,

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about their financial challenges, about trying to give their kids a good upbringing and how that's affected their diabetes.

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Now, of course, that might well have been mediated through the molecules that I was studying, things like counter regulatory hormones.

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But the thing that interested me most was the narratives themselves and the meaning systems of

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different patients and how that seemed to have a real bearing on how their diabetes unfolded.

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And that actually, as soon as I finished my doctorate, I applied to the Wellcome Trust for some funding and was successful to collect stories.

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And so I'd gone from collecting blood to collecting stories.

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And I think that that little story of my own journey, it sort of sums up the contrasts that you can get looking at a single topic,

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which was stress and diabetes through different disciplinary lenses.

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And I think the biochemistry of stress is hugely important, but so is the anthropology and the psychology of stress.

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And then, of course, we get a very rich perspective on that kind of topic if we bring in lots of different disciplines.

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I suppose the other thing that is worth saying about interdisciplinary work is it's inherently conflict ridden.

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If you are feeling totally comfortable and on the same page as everybody you're working with, you're probably not doing interdisciplinary research.

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If, on the other hand, you're around a table discussing some research data and one person's interpretation really irritates you and you think,

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why are they looking at it like that? That's not the right way to look at it.

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Then you are starting to get the kind of productive conflicts from which higher order interdisciplinary insights can come.

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And I think that's what really excites me, too.

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You're you're comfortable with dealing with conflicting ideas?

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I'm more than comfortable. I think unless we have those kind of conflicts, we stay in a little bubble that is just a little bit too comfortable.

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Now, this isn't the topic of this interview,

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but I think there are destructive forms of conflict in academia and there are constructive forms of conflict.

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And I think the challenge when you're running an interdisciplinary research unit is to ensure that conflict is constructive and productive.

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So can you remember when you first heard that there was a pandemic in the offing?

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Yes, I can. Can you remember what you were doing this time? I was checking my emails.

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I'm sure. So one of the things that I was doing back in 2019 and indeed for a couple of years before that,

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was I was working internationally with Chinese academics and we had already brought a group of

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Chinese professors over to Oxford for what was known as the Chinese Academic Medicine Course.

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And I think I did one of those in 2019.

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Someone else had led one in 2018. So this was a bit of a tradition where the Chinese academics would come and they would pay and various

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Oxford academics would would be arranged to give lectures and the Chinese would ask questions,

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and then they take all the ideas back to China and, you know, be very it was it was a lovely international kind of exchange of ideas.

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And one of the things we were actually trying to do with the Chinese was was get them

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to do more interdisciplinary research because they were a bit multidisciplinary.

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And so that was one of the selling points of this particular project.

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Anyway, we had a group from Guangdong on probably pronouncing that wrong and they had been planning to come over mostly cardiologists actually,

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and they'd been planning to come in March 2020. And I'd been lining up different speakers and visits to the labs and all that kind of thing.

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And come about December 2019, I got an email from one of the Chinese saying, look, we may have to postpone our visit.

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And I said, Why would that be? And they said, We may have heard that there's a new disease being discovered in Wuhan and it's now hit Guangdong.

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So Guangdong is the second city in China to have to be hit by what we now call COVID 19.

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And. I then said, oh, good gosh.

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So this is a this is a serious one. Is it as bad as sales and murders?

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And they may well turn out to be worse. And so from liaising with the Chinese to arrange their visit to us, we flipped round to them, helping us.

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To try and prepare for what looked like it was going to inevitably hit Europe.

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And indeed it did. So I think I was serendipitously forewarned, quite early that this was likely coming our way.

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The other thing is, I'm a very keen social media person.

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I do a lot on Twitter and I follow various people around the world.

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There's one person I follow on social media, Dina Grayson from America, who mostly tweets about American politics, actually.

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But but she had done her Ph.D., I think, on Ebola.

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And she was very interested in pandemics.

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And I think it was a tweet from Dina way back in December 2019 saying this is serious, this is going to be a global pandemic.

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We need to prepare. And then I realised, I think that.

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My life was going to be taken over by this pandemic quite early in 2020.

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So how did you react? How did you go about organising your colleagues or discussing the colleagues?

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What were the questions were that you could approach with the resources at your disposal?

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Yeah. So one of the first things that was very, very clear was that this was a highly contagious disease.

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You could see on the television, you could see by social media pictures.

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But I also knew from the emails I was getting from my Chinese colleagues that the Chinese clinicians were wearing hazmat suits.

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They were treating this as a very, very contagious disease, which needed the highest level of infection control and.

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I thought. UK is not ready for this.

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We. Years ago I applied for a job that I didn't get in an infectious diseases hospital in London.

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I remember going and visiting it because I really wanted the job. This is when I was a very junior doctor.

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I can't remember the name of the hospital. It was an outpost of the Royal Free Cop, its wards Infectious Diseases Hospital long since closed.

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But I remember being shown the Lassa fever ward, which was a a very small room in the middle of a field.

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And the idea was that if a patient came with Lassa fever, you put them in the middle of this field in a room, and you kind of put on all this kit.

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You went and dealt with them.

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And the assumption, of course, was that there would only be one person in the country with a disease that was so contagious and so terrible.

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And, you know, that is a metaphor for. Hang on a minute. COVID could affect huge numbers of people.

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We don't have enough fields with hospital wards put in the middle of those fields.

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We don't have enough hazmat suits.

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We don't have enough of the high grade, what we now call PPE, those those fancy masks that much more protective than the standard ones.

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And so I very quickly realised that one of the things we were going to have to do was mobilise remote care, remote consultations.

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Now, by happy coincidence, I have been doing research into remote consultations since about 2009.

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And in fact, I've been writing grant applications since 2009.

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We wrote to Grant. For what is now the National Institute for Health Research to look at video consultations in diabetes,

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actually with those working in the east end of London. And this is all relevant.

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I was working the east end of London and the did not attend rate for diabetes appointments was 50%.

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Half the patients never showed up. And this was mainly because the patients were were in low status jobs, often in the deep economy,

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and they couldn't afford to take time off to spend half a day going to their diabetes appointment.

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But the consultant was very progressive and she said, Well, have you got a smartphone?

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And they said, Yes. And she said, Well, why don't I Skype you on your phone?

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And they said, That would be fine. I'll just take a break.

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And that's how it started. Very adult, very informally.

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And she said to me, maybe we could do some research on this.

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So we put in a bit to the NIH as it is now and said, we'd like to research video consultations.

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We got shortlisted and then we got turned down because they said this will never happen.

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This will never become policy. So we got rather cross about this.

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We said, Well, you can't say that. And actually, within a year, policy had changed to support and promote the use of video consultations.

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So we put in the same grant application with literally no changes.

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And we said, the only reason that you turn this down is you said it would never happen.

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Well, it is happening. Please, with you. It.

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So from about 2010, 2011, we were funded to look at the introduction and mainstreaming and spread and scaled up of video consultations in the NHS.

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And over the next sort of nine or ten years we got lots of different contracts from governments, from charities.

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We had a big study from the Health Foundation. We got funded by the NIH.

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We've had some MRC money, so lots of different sources of our research and we did some theoretical or theoretical work.

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On the challenges to moving video from a demonstration project.

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Everyone can set up a demonstration project saying, Oh, look, isn't it pretty?

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You know, it works on a small scale to something that is business as usual within the fabric of the NHS.

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So we were particularly interested in the organisational changes needed to spread and scale

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up video consultations and we're actually doing a piece of work for the Scottish Government.

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I spent a couple of weeks in November 2019 driving around Scotland, which was lovely.

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We have to go to all these remote areas like the Outer Hebrides and the Orkneys and things,

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and see how people connected to the mainland through state of the art video technology.

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So we've just done them just writing out that report and then bang the pandemic hit.

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We got approached. I got approached by NHS England NHS Improvement to say, Trish, you've got to help us,

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we need to change the NHS overnight to dealing with as many problems as possible by remote means.

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And that meant digital trialists.

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That was one of the things that everybody who wanted to see a doctor or nurse had to do.

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First of all, I could go online or phone up and and the receptionist would help them fill out an online form to say what the problem was.

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And then they would wait for a call back. So the digital triage, what they call total triage, was introduced literally overnight in March 2020,

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and that is the only all nighter I did in the whole of the pandemic.

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I stayed up all night to help write the initial briefing document for the total trials,

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along with Minor Back I and a couple of others from NHS England and NHS Improvement.

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Because GP practices needs guidance and a sort of standard operating procedures and all that kind of thing.

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This was an academic was very much, you know, the kind of in the down and dirty of implementation.

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And so that was a really major piece of work applying the insights that we had developed

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over the last ten years at pace and scale to flip the NHS across into a remote by.

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Fault service.

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Except, of course, it was a remote by default.

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But of course, if you were sick, you needed seeing and then you had to be seen face to face, which know that's as we know what happened.

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And you went on to look at how that works in practice as a research project, is that right?

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Yes, we applied for them.

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The interesting thing was that from about the beginning of March, know look, 11th of March is my birthday.

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11th of March 2020 was the day the pandemic was declared.

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And I also think that was the last day of any semblance of normality, because it was my birthday, my husband,

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I went to Bletchley Park because I love going to Bletchley Park and looking around those old computers and things.

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We were the only people wearing masks and we were a little bit nervous.

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But we said, Well,

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Bletchley Park be right because it's there's lots of open spaces and you can pop your head into various little pots and things like that.

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To me, it's been very long inside and there weren't many people there.

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We got there when it opened and I remember driving back and seeing the W.H.O. announcement that the pandemic had been declared.

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And I said to my husband, we probably shouldn't have gone to Bletchley Park, but at least we didn't go to Cheltenham Races, you know.

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So after that. I don't think I left my desk apart from to take an hour's exercise every day.

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And I worked as from as soon as I got up to when I went to bed for about four or five months without a break.

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It was that for long.

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So in that context, and I told you about the the very rapid pace of work that I did with the NHS England people to support the flip over to remote.

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What then happened was. The pandemic hit.

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And at the end of February 2020, maybe beginning of March, one of my trainees was a GP,

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a part time GP in the part of London where the pandemic was hitting hardest and earliest.

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And it affected her practice very, very dramatically.

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She said to me at the beginning of the week, she said,

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We're beginning to see one or two patients with what we think is covered by the end of the week.

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Her receptionist was on intensive care and by the following Monday the receptionist was dead.

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This was a 45 year old woman who had been completely well, was not overweight, had no risk factors.

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And at that point, we thought, crikey. And it seems odd now when hundreds of health and care workers have died.

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But then. It hit me like a cannonball.

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The. This disease. People would walk into a GP surgery and try and book an appointment and the person who had dealt with that individual with that,

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with that very routine, normal sort of thing, the person maybe hardly had any symptoms.

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Maybe they didn't even have any symptoms. That receptionist who died of the disease.

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This has never happened in my memory. And it didn't it hasn't happened in anyone else's memory either.

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You know, this was something that nobody alive could remember.

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You know, the old. Yes. Catching flu or that kind of thing. But when young, healthy people working at the front line of the health service were dying.

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Because of the interactions. So this was beginning to be really, really scary.

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And my trainee was saying that she I think she was pregnant at the time.

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And I said, you've got to stop. We don't know what it does to pregnant women. You've got to stop seeing patients face to face.

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And she said, Yeah, that's true. I'll try and volunteer for phone calls.

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So that was on the Friday. And on the Monday, she said she took 100 calls from patients, 100 phone calls.

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And by the Tuesday, she said, I know everything there is to know about this disease in terms of diagnosing it over the phone.

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And I said, well, that's extraordinary, because only Friday you said you knew nothing.

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So from taking a hundred calls, you now now know what it's like to have COVID.

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You can diagnose it over the phone. You can decide who needs to go straight into an ambulance, she said.

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Yet she said 100 calls with it. It's a very busy day.

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So I said, That's extraordinary. We need to tap into your expertise.

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So I said, Do you know anyone else who has been dealing with this amount of COVID?

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She said, Yeah, I can find you ten more people. I said,

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We need to set up some online focus groups and we need to capture that wisdom that

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you have acquired because the Chinese data was based only on hospital patients.

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So I should say that I've been liaising with my Chinese colleagues and they've been

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sending me guidelines that even been translating them from Chinese to English.

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And I was also working with people in this country who were Chinese by birth but were now, you know, academics in this country.

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So we were trying to spark as much information as possible from China.

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We've been through this a couple of months earlier, but the problem was that they didn't really have a primary care system.

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The denominator population was people who'd been admitted to hospital.

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So we didn't know anything about who should be admitted to hospital and who can be safely managed back in the community.

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So going back to my trainee and and her colleagues, who had quite by chance received, if you like,

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the first wave of patients or the the shoulder of the first wave, you know, that early shoulder.

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I also put out some messages on Twitter and I said, is anyone actually seeing patients with probable COVID yet?

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And we pulled together some online focus groups and we got 72 GP.

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In fact, I think we got about about 65 of them with GP's.

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And then there were a few, what we call advanced nurse practitioners who are basically doing the job of a GP,

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one or two paramedics, but mostly of GP's.

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And we got them to talk, we got them to tell us what their impressions were.

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And just to give you an example, one of the things that we that we picked up from these discussions was.

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The idea that patients were sometimes unaware of how sick they were,

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and in particular that they didn't feel breathless when they should have felt breathless, happy hypoxia, happy hypoxia or silent hypoxia.

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Now, a colleague of mine has a daughter who is a junior doctor, and this daughter said she described it as.

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iPhone positive, oxygen negative.

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What she meant by that was there would be an oximeter clipped to the patient's finger, which would show terrifyingly low oxygen levels.

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But the patient would be sitting there oblivious to their own illness and playing on their iPhone.

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And that was really odd because if you have a standard bacterial pneumonia and your oxygen levels with that low,

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you would be you would feel very breathless. But for reasons which I won't go into in depth, because I'm not a respiratory physician.

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COVID was giving people an odd mismatch between the level of sickness and the level of symptoms.

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And that was picked up quite early on by some of the GPS who would tell quite horrific stories

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of perhaps doing a video consultation with a patient who would say they felt all right,

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but they would be noted to be deeply sore on those.

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You know, they have blue lips and and yet the patient would not be aware of that anyway.

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So we had a number of things followed from that.

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I was asked by the British Medical Journal to write.

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A rapid article on how to assess people in the community, mostly using telephone or video who might have COVID.

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So I've pulled together all these Chinese guidelines which were, as I say, of limited use.

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I talked, I pulled together some of the early data from the focus groups that we were doing,

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and I guess I put together a bit of common sense as well, plus all the stuff we knew about what did and didn't work in the remote environment.

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And we published that paper on the 25th of March.

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So two weeks after the pandemic was declared, we had got a major paper into the British Medical Journal, which had already been peer reviewed,

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which had an infographic and one of those sort of arrow diagrams, if this,

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then that and it was called something like assessing possible acute COVID, you know, remotely or something like that.

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And in the next. Three weeks.

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I think that article had a quarter of a million hits and it became the go to article as COVID rolled across the country.

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People say, Oh yeah, there's not going to be MJ about that. And I was nervous about it because of the kind of.

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Pulling together. It felt it felt very pragmatic.

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It felt, look, this is as much as we know right now.

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It may actually prove not to be 100% correct.

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But this is as good as it's going to get right now.

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But I wasn't too worried because apparently there was going to be a nice guideline coming out in a couple of weeks after that.

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So that was a nice guideline. Well, give us the kind of the definitive truth on it.

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And we don't want. You didn't have any formal responsibility to report to nice or no.

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Any other advisory body. No, no. But when those guidelines came out, the section on assessing patients in the community just quoted our article,

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and then suddenly it was sort of it set in stone.

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This is what you do. And we thought, okay, but then the nice guy comes also quoting all sorts of other,

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shall I say, cobbled together, kind of best guess perhaps his at the time.

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So. We still didn't have any research money.

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And I think it's probably worth saying. What happened to some of the big research projects at the beginning of the pandemic.

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So. That's where to start.

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First of all, the National Institute for Health Research, the Wellcome Trust, the MRC,

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everybody puts out messages to their researchers saying, okay guys, we've got this pandemic.

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Stop doing what research you're doing and start doing research on COVID just via the money across.

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Redeploy your staff. Forget about the research questions you were pursuing.

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There are more urgent ones right now and that was brilliant because it meant that those of our staff who could work and

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many of them couldn't because they were locked down and they were looking after their kids or they was stressed out.

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But the ones who were able to work could be immediately redeployed on the pandemic response, which was great.

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You know, we started doing all sorts of literature reviews and publishing those very, very quickly on preprint.

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So it's that kind of thing. But.

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But actually I was coming towards an end of a grant, so I had to write a grovelling letter to the Wellcome Trust saying,

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look, we've actually run out of this grant, but please, could you give me some more money?

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And they were very good and they did. They gave me an extra £80,000, which paid everyone's salary till the end of the year, and that was very nice.

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So there was a bit of that.

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But I realised quite quickly that we also needed to bring in more research money because, you know, that was just the way it was.

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But I didn't get round to writing that application until about May to do a study called Remote by Default.

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That's now become a bit by default one because we got some more money to do it, but by default too quite recently.

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But anyway, it was then remote by default.

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And the argument was what can we learn from the in pandemic unprecedented shift from a face to face service to a remote by default service?

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What can we learn from that which will help us make it through the pandemic and will which will also generate lessons that may go beyond the pandemic?

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And we use the case study approach we were looking at for localities across England and Wales,

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and we also had a project which was funded separately by the Scottish Government to look at Scotland.

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And we interviewed people remotely, we interviewed, you know, clinicians, patients, managers, policymakers,

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technology suppliers and we pulled together stories within different localities of how people were responding to the pandemic,

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but also an overarching story of the National Health Service.

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And we've just published some of those actually.

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But one of the things that I was. Fascinated by was balancing the risks of doing remote consultations with the benefits,

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and conversely, balancing the risks of doing face to face consultations with the benefits.

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And that required it required me to use all the different aspects of my training.

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You know, I've trained as a GP, I'd trained as a hospital doctor, I've trained in social sciences,

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I've trained particularly in the social science of new technologies and in innovation and in policy analysis.

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And you know, in some ways I could say I was in the right place at the right time,

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but but the remote beautiful study was the first funded study we had.

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And one of the things we did was we retrospectively funded some of the people

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who'd been working on those online focus groups of GPS to get that early data out.

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But what we then managed to do, we ran a Delphi study to sort of formalise and and Delfi Delphi study is it's basically

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a survey or several rounds of a survey where you have to get a sample of experts,

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you have to get the right experts. Otherwise, you know, it's garbage in, garbage out.

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But the idea is that we would have we'd have conditions, we'd have patients, we'd have call handlers,

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we'd have people who deal with remote consultations in all sorts of aspects.

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And then what you do is you make you give them a set of statements.

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Here's 20 statements about, you know, what should happen or what have you, and then you ask them to rate those.

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Do you agree with it? Do you agree broadly with it?

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Would you like to change the wording? Would you like to improve the wording, etc.?

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And then you do all that and you get the responses back and you change the statements, you send them out again, etc.

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So we did a full round Delphi panel and we came up with.

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A preliminary set of questions that you could ask someone over the phone to decide

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whether or not you should send them to hospital or send them to a hot tub,

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rush them in, in a blue ambulance and take them straight to intensive care.

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You know, that kind of thing. What are the things that predict whether or not someone needs what we called escalation of care?

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Because of course, the thing I haven't sent was because it's also so it's still so, so raw.

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This was the time when the NHS was completely overwhelmed and you know, all routine work had stopped.

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There was real problems with the back door because the question was how are we going to discharge people?

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And there was all that stuff about discharging people back to care homes, which, you know, in retrospect was a bad idea.

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But but the idea was that we needed to clear the hospital to make capacity for more people going in through the front door.

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So people got sent out the back door, back to their care homes.

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But but the other thing that was happening was we needed to control the front door by keeping people out of hospital.

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It didn't need to be that. And so the slogan was Stay at home, protect the NHS.

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The problem is that some of those people who were staying at home to protect the NHS were actually very sick and should have been in hospital.

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So so our Delfi study was to decide which people should be kept at home to protect the NHS and which people should be sent in because they need care.

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So the other thing that the beautiful study did was it allowed us to do a big quantitative study on data linkage.

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Now this is not my area of expertise, but through Twitter I make friends with the people who are the kind of big experts on that.

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Charcol Brendon Delaney from Imperial and some of those know from my department

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in Oxford and we put together a component of what's called the RBD study,

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where patients contacted the NHS by telephone, either by the GP or via the COBRA Clinical Advisory Service,

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which was the special NHS one on one phone service for people who might have COVID and any body contacting those would get

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these 1011 questions and then we would follow those patients up for the next few months to see who was admitted to hospital,

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who was admitted to intensive care and who died. So we followed them up and followed up.

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Off the top of my head, something like 12,000 patients using data linkage.

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So we had the individual patient record in general practice, GP record and we through the patient's NHS number,

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we would link that to what's known as hospital episode statistics and also to coroners.

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Oh no, not coroners, sorry. Office of National Statistics Deaths.

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And the idea was that the statisticians would produce kind of graphs and of.

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Which of those questions best predicted whether or not the patient ended up dead or admitted to hospital,

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etc., etc. And I've recently had a sneak preview of the results of that study,

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which was very interesting findings that the early impressions of those GP's,

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like my trainee who said after 100 calls I know who should go to hospital.

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Well actually they were right.

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They could predict with remarkable accuracy which questions to ask of patients in order to decide who needs to go to hospital.

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And I suppose one bottom line thing that we've now demonstrated,

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but which the GP's were saying with their hunches back in March 2020, patients need an oximeter at home.

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That little thing that you click on your finger and with any luck it comes out to 98 per showing you your nascent health.

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You know, if that oximeter is only reading 92%, that is a very serious thing and you should be going off for a proper assessment.

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Now. It's perhaps worth saying that.

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We had that hunch earlier, but it took a very long time to demonstrate quantitatively just how important oximetry data was.

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And just to give a personal aside, at Christmas time, my mother became ill with COVID,

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and the last photograph I have of my mother is a photograph of her hand with an oximeter on it, which we've sent to her by Amazon showing 86%.

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And my mother was sitting in her rocking chair at home saying, I don't know, I don't feel all that bad.

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Do you think I should call the doctor? And he said, Yes, I do think you should.

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And I, in fact, contacted nine, nine, nine, and my mother didn't last much longer.

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So this is all affecting me really quite personally.

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But that I'd say that just to illustrate the idea of the patient at home feeling that they shouldn't trouble and overwhelmed service,

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not feeling all that breathless but the oximeter reading showing that they had a red flag sign.

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And the remote by default study has now shown that, you know, very conclusively, very decisively.

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We haven't yet published, but we are about to by the time this is available, it will be you can look it up.

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It's known as the recut study remote coded assessment in primary care that that substudy of remote by default.

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So that that was all. If we come back to the theme of interdisciplinarity.

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I had been very comfortable looking at the social science, if you like, of the introduction of remote services.

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I was very comfortable running online focus groups, doing qualitative interviews.

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Those are the kind of things that I'm good at, if you like.

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I was not at all comfortable doing large scale data linkage studies across these different databases and

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working with geeky statisticians to produce what's known as receiver operated characteristic curves.

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But I knew that we had to prospectively test the hypotheses that we'd come up with with our qualitative data.

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And so we just we just brought on a whole load of quantitative database type researchers, and I've never done that kind of research before.

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But, you know, it was what was needed. Excellent.

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So I'm just I'm just going back to a question and we'll go on because there's another area of research that I particularly want to get into.

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But I wondered whether your very rapid reaction and sense that something needed

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doing and I suppose what you've said about the funding bodies partly answered this,

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but was was that a common reaction, reaction among the research community that we all need to just drop everything and get on with this?

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Um, did did it feel collective? Did it feel as if you were really engaged in the collective?

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Yes, but I think there's also the fact that we weren't allowed to carry on.

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So I had one post-doc who was, I would say, just slightly sleepy about this,

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that this person was not clinically qualified and was quite nervous about shifting everything across to COVID and wanted to

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carry on studying a different project and then got an email to say all projects that are not to do with COVID are stopping.

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You may not carry on with them. And at that point this person came to me and said, Oh, it looks like I'm going to have to help you with the.

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But now it wasn't because they were being lazy.

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It was because they they felt they didn't have the skills to to contribute.

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And I think a lot of people who were clinical felt, gosh, there's nothing for me to do.

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You know, I might as well be furloughed if you like. But I said, look, there's plenty you can do.

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Go and do X, you know, but they did need quite a bit of guidance.

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And you mentioned that you were at your desk 14 hours a day or whatever, even though it was something like four or five months.

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Were there other ways in which the lockdown impacted on what you were able to do?

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Um. I think I was very lucky in my set up with lockdown in that my kids have grown up.

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One of my kids actually is a junior doctor and he was he was off travelling actually, and came back in March 2020 and went to work on a COVID ward,

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immediately caught COVID and got better from it very quickly, went back home to the COVID board, you know, all that kind of thing.

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So so he wasn't causing me any trouble. He was helping with the COVID response in another way.

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And then my other sons living abroad. So we didn't have the kids to worry about.

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So there was just my husband and myself. I converted the living room to a study and I, you know, my desk was already in it,

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but my living room became my office and I had quite a comfortable setup.

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I had wi fi at home. I could connect.

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The one thing we wanted to do, we couldn't do when we were doing the Adelphi study was we wanted to use specialist software,

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which we couldn't access remotely, mainly because the person who gave out the passwords wasn't there.

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So it was one of those things. So we had to use this slightly more.

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What's the word? Generic piece of software. SurveyMonkey. But it works, right?

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It works all right in the end. But apart from that, the kind of work that I personally was doing, the qualitative interviews,

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the analysis of policy documents, the writing of policy advice could perfectly easily be done at my desk at home.

386
00:46:53,920 --> 00:46:58,899
So I think I was quite lucky there. I'm also very lucky to live close to Port Meadows.

387
00:46:58,900 --> 00:47:05,920
So, you know, the morning jogging or in the summer, the swimming all just happened, you know, perfectly easily.

388
00:47:06,610 --> 00:47:15,130
I think that wasn't the case for many members of my staff, particularly the young academics who were living in small flats.

389
00:47:15,460 --> 00:47:20,800
Perhaps two of them were sharing a desk and.

390
00:47:21,740 --> 00:47:25,970
You know, having to take turns using one computer, you know, all those kinds of things.

391
00:47:27,770 --> 00:47:37,690
So so I think I was I was lucky in that respect. Q Did you find that with the phones you could not look at your email and turn off Twitter that

392
00:47:37,690 --> 00:47:42,640
actually getting the writing done was in some ways easier to do if you weren't in an office.

393
00:47:43,360 --> 00:47:44,830
It was certainly no more difficult.

394
00:47:44,840 --> 00:47:50,200
You know, I had poetry that the office actually doesn't even have a windows because it was skylights on right up in the attic.

395
00:47:50,200 --> 00:47:53,860
But and so you have a nice window in my living room.

396
00:47:54,760 --> 00:48:00,490
And I think when you say, you know, checking your email and turning off Twitter, look,

397
00:48:01,030 --> 00:48:08,409
research at that time of the pandemic, Twitter was my data source and Twitter was my way of connecting to people.

398
00:48:08,410 --> 00:48:10,210
That's really important to get across.

399
00:48:11,500 --> 00:48:21,370
I got contacted early in the pandemic by a guy called Florian Stigler, who I think is Austrian, and FLORIDO met me once.

400
00:48:21,370 --> 00:48:27,070
He reminded me that we'd met in a pub somewhere in London when he was doing an earlier piece of research,

401
00:48:27,190 --> 00:48:33,130
but and he said, Would I join a COVID 19 researcher's email group?

402
00:48:34,070 --> 00:48:37,210
And I thought, well, I got enough emails, but yeah,

403
00:48:37,220 --> 00:48:43,070
or I'll join your group as we had a nice mate in the pub and all that kind of thing for you for the, for old time's sake.

404
00:48:43,850 --> 00:48:55,700
And it was one of the most important connections that I made, because we all realised early on that he needed to create networks of researchers.

405
00:48:56,180 --> 00:48:59,410
This was real time research.

406
00:48:59,420 --> 00:49:03,200
This was not something, this was not your conventional stuff.

407
00:49:03,950 --> 00:49:08,210
We needed to generate and share knowledge in real time.

408
00:49:08,840 --> 00:49:17,790
And he put together up about 100 researchers from around the world, and there was this email list that you could just send stuff out to.

409
00:49:18,140 --> 00:49:24,530
It was called COVID 19 researchers. And people would come up and say things like, you know,

410
00:49:24,530 --> 00:49:33,160
I've got a patient on a ward with seems to go fungal infection having been treated with antibiotics.

411
00:49:33,170 --> 00:49:39,650
Should we start treating these patients with antibiotics when we know that this is a virus because maybe they'll get fungal super infection.

412
00:49:39,950 --> 00:49:45,920
And immediately someone from somewhere would say, oh, yes, well, we've we've already reviewed this evidence.

413
00:49:46,250 --> 00:49:53,090
And we've also got some routinely collected data on 100 patients, and this is what it shows.

414
00:49:53,090 --> 00:49:56,659
And then people would have a confluence of we've got 100 patients and this happened.

415
00:49:56,660 --> 00:50:03,680
And so it was absolutely amazing to see these these questions being addressed in real time.

416
00:50:04,040 --> 00:50:11,720
Also, because the pandemic was hitting different countries at different times, you know, it was just amazing.

417
00:50:11,980 --> 00:50:17,360
So that email list was important, but also social media.

418
00:50:17,870 --> 00:50:19,580
You know, I've been on Twitter for a long time.

419
00:50:19,970 --> 00:50:27,740
I got a lot of followers, although my followers, I think, quadrupled in, you know, since the beginning of the pandemic.

420
00:50:27,740 --> 00:50:33,139
So I thought I'd love of over 40,000, you know, 160,000.

421
00:50:33,140 --> 00:50:40,190
But the point about it is people were following other people who they thought would be able to give them useful information.

422
00:50:40,190 --> 00:50:47,840
But what that meant was that if you had already curated your Twitter feed, you could immediately connect to, you know.

423
00:50:48,950 --> 00:50:55,390
The World Health Organisation, the Lancet. The some of the top people in the NHS.

424
00:50:55,670 --> 00:50:59,690
Who follows who on Twitter was really quite important.

425
00:51:00,220 --> 00:51:04,040
So. So it wasn't that Twitter was a distraction from my research.

426
00:51:04,130 --> 00:51:09,590
Twitter was my research. We recruited patients through it.

427
00:51:09,590 --> 00:51:13,160
We recruited staff, participants through it.

428
00:51:13,700 --> 00:51:17,690
And we got it all through the ethics committees. By the way, I think it's really important to say.

429
00:51:18,020 --> 00:51:25,730
My husband is a retired academic, sits on the Oxford Bee, I think it is Research Ethics Committee.

430
00:51:26,270 --> 00:51:28,610
And he was as busy as I was.

431
00:51:29,120 --> 00:51:43,010
His Research Ethics Committee were looking at these very rapidly put together protocols for clinical trials for other kinds of human research.

432
00:51:43,460 --> 00:51:51,550
And they were turning those very complex proposals around in 48 hours so that the

433
00:51:51,590 --> 00:51:57,500
the bureaucracy of getting research up and running didn't delay the research.

434
00:51:58,990 --> 00:52:02,840
So we'd already asked the Ethics Committee, please, can we recruit by Twitter?

435
00:52:03,380 --> 00:52:07,730
You know, they said, well, yes, so long as you do this, this and this. So we were doing all that.

436
00:52:08,720 --> 00:52:16,610
So in many ways it was quite exciting, although it was also quite scary.

437
00:52:17,420 --> 00:52:25,850
And you know, for example, when my trainees receptionists died, when my own son got COVID in March 20, 21 as a junior doctor.

438
00:52:26,880 --> 00:52:33,870
It was terrifying, to be honest. But that, I think, is why we were all working so hard.

439
00:52:37,760 --> 00:52:46,190
So let's move on to another area of your research that I just I just very quickly scanned some of your recent papers.

440
00:52:46,850 --> 00:52:54,980
And clearly something that's been preoccupying you a lot has been masks and airborne transmission.

441
00:52:56,130 --> 00:53:00,290
What when did you first decide that was something that really needed addressing?

442
00:53:02,150 --> 00:53:13,550
Um, again, early on and again through my contacts with the Chinese, we have to remember that songs and Murs were.

443
00:53:14,640 --> 00:53:21,030
A. They weren't pandemics. They were epidemics that affected certain Asian countries.

444
00:53:21,540 --> 00:53:31,200
And I think China, Japan, Hong Kong, Singapore, places like that that learned from those earlier epidemics.

445
00:53:31,410 --> 00:53:34,410
They knew coronaviruses were airborne.

446
00:53:34,410 --> 00:53:40,049
There was no doubt about that. In places like China and Japan, you know, it was just standard.

447
00:53:40,050 --> 00:53:50,850
It was just known. And I suppose because I was talking to the Chinese and through Floridians, COVID 19 researchers,

448
00:53:50,850 --> 00:53:56,940
email group, we were we were conversing with scientists around the world.

449
00:53:56,940 --> 00:54:11,520
We weren't just in our own little UK bubble. Another thing that happened really early in the pandemic, 8th of March 2020, there was a big concert,

450
00:54:11,720 --> 00:54:18,720
a big performance of the St Matthew Passion in a big concert hall announced to done.

451
00:54:20,100 --> 00:54:28,590
Pretty sure it's a boxing match of passion and of a choir of about 130 people.

452
00:54:28,830 --> 00:54:33,530
Something like 100 of them got sick. The conductor ended up on intensive care.

453
00:54:34,640 --> 00:54:43,820
And for me, that was incontrovertible evidence that this virus spreads through the air.

454
00:54:44,360 --> 00:54:53,360
It was simply inconceivable that every member of that choir had touched the same doorknob and then licked their finger.

455
00:54:53,420 --> 00:55:08,870
It just didn't hang together. Cheltenham races was followed very rapidly by a surge in cases of COVID because people were shouting and cheering.

456
00:55:08,870 --> 00:55:13,730
And again, you know, when you vocalise you generate aerosols.

457
00:55:14,030 --> 00:55:22,219
So from my perspective, I couldn't understand why everybody was on everybody.

458
00:55:22,220 --> 00:55:27,110
But but an awful lot of influential people, certainly all the leading policy makers in the UK,

459
00:55:27,800 --> 00:55:34,040
the W.H.O., were going crazy about hand-washing and scrubbing surfaces.

460
00:55:34,430 --> 00:55:36,680
It just didn't make sense.

461
00:55:37,490 --> 00:55:47,960
And very early in the pandemic, I got together with a couple of colleagues who died who had picked up on this email list, COVID 19 researchers.

462
00:55:48,470 --> 00:55:53,810
And we wrote an article for the British Medical Journal about the precautionary principle.

463
00:55:54,770 --> 00:56:05,329
Precautionary principle says when the risks of doing something massively outweigh the sorry,

464
00:56:05,330 --> 00:56:17,000
but the benefits of doing something massively outweigh the risks, you might want to act before you have definitive evidence, just in case.

465
00:56:17,300 --> 00:56:19,370
That's why it's called the precautionary principle.

466
00:56:19,970 --> 00:56:32,810
And we said we think introducing masks would be a good idea, even though we don't have incontrovertible evidence that they will benefit.

467
00:56:32,810 --> 00:56:37,340
Because if we're right, we could save hundreds of thousands of lives.

468
00:56:38,150 --> 00:56:42,350
If we're wrong, it probably won't matter. It just means that people will be wearing these things for no reason.

469
00:56:44,450 --> 00:56:51,980
What we had was Jenny Harries getting from Public Health England, getting up and saying masks could do enormous harm.

470
00:56:53,570 --> 00:56:58,670
I had the slogan, it's it's a piece of cloth, not a land mine.

471
00:56:59,240 --> 00:57:06,800
And yet the narrative from both the W.H.O. initially and from public health

472
00:57:07,100 --> 00:57:14,989
policymaking in the U.K. was that masks probably didn't benefit you very much,

473
00:57:14,990 --> 00:57:18,740
but they could do colossal harm. And.

474
00:57:20,240 --> 00:57:24,740
I knew this wasn't right. Like, where do you think that idea came from?

475
00:57:24,860 --> 00:57:30,120
Well, it's very interesting. I can tell you exactly where it came from, because we've done quite a lot of research on this.

476
00:57:30,190 --> 00:57:42,079
Now, the problem with airborne diseases is that they can spread like wildfire because airborne diseases come out when you breathe,

477
00:57:42,080 --> 00:57:46,220
when you talk, when you sing and before you are symptomatic.

478
00:57:46,790 --> 00:57:55,890
So very often in an infectious disease, you're actually most infectious the day before you get symptoms, you know, something like chicken pox.

479
00:57:56,540 --> 00:58:00,710
It's no good. By the time that kids come out in spots, they've already given it to all their friends.

480
00:58:01,050 --> 00:58:10,610
Grandmother. Yeah, exactly. Exactly. So. So we all know that with these able diseases, but airborne diseases for that reason,

481
00:58:11,780 --> 00:58:18,350
if you look at where the W.H.O. talks about airborne diseases, it's in its bioterrorism manual.

482
00:58:19,070 --> 00:58:29,480
And an airborne disease is one that you might use if you wanted to attack a country, you know, in a bioterrorist attack.

483
00:58:30,260 --> 00:58:42,260
So, of course, when you've got a worldwide shortage of high grade PPE and when you have got an escalating pandemic,

484
00:58:42,260 --> 00:58:48,800
which might not quite turn into a pandemic, you know, we it's something we're concerned about.

485
00:58:48,810 --> 00:58:54,350
But do you remember sales didn't and birds didn't. So you don't want to embarrass yourself too much.

486
00:58:55,370 --> 00:58:59,029
We don't really want to put out a message saying, oh, it's airborne.

487
00:58:59,030 --> 00:59:07,820
It's airborne because everyone's going to panic. And what was driving Tedros, the director general of the W.H.O.?

488
00:59:07,850 --> 00:59:16,490
What was driving him at the beginning was making sure people didn't overreact, making sure we didn't have mass panic.

489
00:59:17,360 --> 00:59:35,420
And the trouble is, in his attempt to quell the panic, he then backed the wrong horse in in, I think, a spectacularly naive and flawed move.

490
00:59:35,990 --> 00:59:42,900
But having done that. He and others in the W.H.O. didn't want to backtrack.

491
00:59:44,070 --> 00:59:50,879
And because they really wanted to reserve high grade PPE for people working in intensive care units,

492
00:59:50,880 --> 00:59:54,510
for example, and doing aerosol generating procedures and all that kind of thing.

493
00:59:56,850 --> 01:00:01,880
They stuck to their story. Which was just wrong.

494
01:00:02,510 --> 01:00:07,610
We know it was wrong now. And I think interesting, we're making this for future historians,

495
01:00:07,610 --> 01:00:16,879
but I think people will look back and be absolutely gobsmacked at how long it took

496
01:00:16,880 --> 01:00:25,430
the W.H.O. to put out a clear and definitive message that this virus is airborne.

497
01:00:25,760 --> 01:00:33,110
And we have to shift from what I call droplet theatre into airborne precautions.

498
01:00:34,100 --> 01:00:38,570
And I've spent an awful lot of time and lost an awful lot of sleep on that topic.

499
01:00:39,840 --> 01:00:47,250
Yes. And I interrupted you so we could go back to the point which so instead of talking about why they had that policy,

500
01:00:48,780 --> 01:00:52,620
you had become convinced very early on that it was airborne.

501
01:00:52,890 --> 01:00:59,459
Yeah. So how did you perceive that? Well, we read the paper for the British Medical Journal, and that was published on the 2nd of April.

502
01:00:59,460 --> 01:01:02,640
And I was cross because the BMJ had been sitting on it for three weeks because

503
01:01:02,640 --> 01:01:06,780
they wanted to get peer reviewed and all that kind of thing and that paper.

504
01:01:07,960 --> 01:01:15,430
Was very, very popular. It's been cited, I don't know, hundreds of times, but it didn't change policy straight away.

505
01:01:15,880 --> 01:01:32,080
Policy didn't change till July 2020. And I kept campaigning because I felt and I still feel that unless we wear masks in crowded indoor public places,

506
01:01:32,260 --> 01:01:39,730
particularly on public transport, we are not going to stop the spread of this predominantly airborne disease.

507
01:01:40,660 --> 01:01:46,959
So I suppose I put stuff out on Twitter and then I went on television.

508
01:01:46,960 --> 01:01:51,370
And then once you've been on television, once you get put on television again, you know,

509
01:01:51,370 --> 01:01:59,770
etc., etc. and I did a lot of radio on this single message about wearing masks,

510
01:02:00,340 --> 01:02:12,610
and I became rather unpopular in some circles because I did not realise that this was going to be a political issue and an ideological issue,

511
01:02:12,610 --> 01:02:18,280
and it was all about, you know, libertarian values and all the rest of it because it certainly isn't in Asia,

512
01:02:18,980 --> 01:02:28,930
but just put masks on and that's that it became heavily politicised, became linked to the Christian right in America, I think all that kind of thing.

513
01:02:29,650 --> 01:02:40,719
And I got some very rude messages, shall we say, extraordinary messages actually, from people who thought I should shut up.

514
01:02:40,720 --> 01:02:51,370
I also got an email actually from, um, I got the email from Peter Horby saying, look, you're wrong about masks, which is a bit odd really.

515
01:02:51,610 --> 01:03:00,250
So why do you them back? And I said, Look, I don't think I'm wrong about masks and I don't really like the way you phrased that.

516
01:03:01,330 --> 01:03:03,460
I think he was the chair of Nervtag.

517
01:03:03,670 --> 01:03:11,590
What he meant was there is not definitive evidence from randomised controlled trials so you should stop behaving as if there is.

518
01:03:12,410 --> 01:03:17,470
My response to him was I know there's not definitive evidence from randomised controlled trials.

519
01:03:17,650 --> 01:03:24,940
I am not pretending that there is. What I am doing is invoking the precautionary principle and I am saying even

520
01:03:24,940 --> 01:03:28,060
though there is not definitive evidence from randomised controlled trials,

521
01:03:28,240 --> 01:03:35,950
we should still bring in mask mandates because hundreds of thousands of people are going to die if we don't.

522
01:03:37,420 --> 01:03:42,249
And I think Peter will be still probably feels that I was I was jumping the

523
01:03:42,250 --> 01:03:46,030
gun on masks and I'd be very happy to have a conversation with him about it.

524
01:03:47,020 --> 01:03:56,919
So he wasn't the only researcher within Oxford who has published papers saying that not only that there is no evidence that masks work,

525
01:03:56,920 --> 01:04:00,910
but that there isn't evidence that the virus is airborne.

526
01:04:01,120 --> 01:04:09,010
Yes. Yes. So that's there's a group led by Carl Hennigan at the Centre for Evidence based Medicine in my department.

527
01:04:09,250 --> 01:04:20,500
I worked very closely with Carl's team. Initially we were putting out rapid reviews and I remember the rapid review where we basically parted company.

528
01:04:20,500 --> 01:04:25,570
So we had various medical students and relatively junior clinicians working on these reviews.

529
01:04:26,020 --> 01:04:34,000
And one of the questions that we'd been asked was, should we be social distancing at two metres or one metre?

530
01:04:34,360 --> 01:04:44,390
So we had a peak or two metres or one question mark. And if you assume that the virus is airborne, if you take on the evidence the virus is airborne,

531
01:04:44,680 --> 01:04:48,249
of course it doesn't really matter whether it's two metres a one.

532
01:04:48,250 --> 01:04:55,809
If you are sitting in a room breathing the same air with the windows closed and you've been there for a long time because you know,

533
01:04:55,810 --> 01:05:03,010
just like if someone's smoking or if they farted it, these things travel through the air.

534
01:05:03,550 --> 01:05:08,500
So yes, it is important to socially distance.

535
01:05:08,500 --> 01:05:18,579
And even with airborne viruses, the closer you are, the worse it is because airborne transmission happens at close contact as well as long distance.

536
01:05:18,580 --> 01:05:28,360
But it isn't. That's not the solution. And so the people came to me, the the junior academics came to me and said,

537
01:05:28,360 --> 01:05:32,499
look, we're struggling here because cold is not what we've done, basically.

538
01:05:32,500 --> 01:05:35,620
And I looked at what they did. They said, Well, you haven't gone far enough.

539
01:05:36,190 --> 01:05:42,340
What you need to do is link up with an expert in aerosol transmission.

540
01:05:42,610 --> 01:05:47,950
Now, experts in aerosol transmission do not assume that everything is an aerosol.

541
01:05:48,400 --> 01:05:51,850
What they're good at is deciding whether something's in aerosol or not.

542
01:05:52,330 --> 01:05:55,389
So I linked Nick Jones who was leading on that paper.

543
01:05:55,390 --> 01:06:03,130
I link to video for Webber, who is who studies the aerodynamics of coughs and sneezes.

544
01:06:03,610 --> 01:06:07,020
She's she's published a paper in the New England Journal. It's a.

545
01:06:07,150 --> 01:06:11,110
Sneeze and kind of films them, that kind of thing.

546
01:06:11,530 --> 01:06:19,540
And Lydia and various others not only do this in the Dumaresq here in Australia.

547
01:06:19,840 --> 01:06:24,340
There's Kimberley Prather and her team in America.

548
01:06:24,580 --> 01:06:31,090
There's host Jimenez, who's also in the different parts of America, and there's lots of aerosol scientists.

549
01:06:31,600 --> 01:06:38,460
And I linked my team with one of those aerosol scientists,

550
01:06:38,920 --> 01:06:48,970
and we produced a paper which brought in all this aerosol science that I hadn't really realised existed, interdisciplinary work again.

551
01:06:50,620 --> 01:06:59,169
And I then began to work with the aerosol scientists and I realised that the stuff they were doing was really pivotal.

552
01:06:59,170 --> 01:07:06,879
It was absolutely pivotal, but it was being ignored, completely ignored by Public Health England,

553
01:07:06,880 --> 01:07:11,830
by the W.H.O. and initially by the CDC in America, although they came around.

554
01:07:11,920 --> 01:07:15,670
Now, there was a meeting in October, I think.

555
01:07:17,250 --> 01:07:22,299
Well, actually, the aerosol scientist wrote to the W.H.O. on I think it was the 8th of July.

556
01:07:22,300 --> 01:07:25,690
They said an open letter to the W.H.O. say 2020.

557
01:07:25,690 --> 01:07:35,580
So yeah, we're still in 2020. So early July, 20, 27th, July, an open letter from over 200 aerosol scientists.

558
01:07:35,590 --> 01:07:39,999
And look, the evidence is overwhelming that this virus is airborne.

559
01:07:40,000 --> 01:07:48,880
It's overwhelming. Your key infection control committee does not include any expertise in aerosol science.

560
01:07:49,090 --> 01:07:52,060
Please, can we help? We are available.

561
01:07:52,540 --> 01:08:01,779
And the W.H.O. published two days later what they called a scientific brief, saying, well, we don't believe you, we don't value your evidence.

562
01:08:01,780 --> 01:08:05,940
We don't want you help. And I was gobsmacked.

563
01:08:05,950 --> 01:08:17,019
I was absolutely gobsmacked. I realised what was happening was and this sort of draws on my background as a social scientist who has

564
01:08:17,020 --> 01:08:25,630
read sort of critical sociologists like Pierre Bourdieu around the links between science and power.

565
01:08:26,680 --> 01:08:32,770
And again, I put out a tweet actually, anyone an expert in Bonjour,

566
01:08:32,980 --> 01:08:39,970
we need to look at this through the lens of critical sociology, critical philosophy of science.

567
01:08:40,600 --> 01:08:51,940
So a couple of people, one guy from Canada and another chap who I showed published with before Moustafa was Belgian and Damian contact droplets.

568
01:08:52,180 --> 01:08:56,470
So one sociologist, then a big sociologist really.

569
01:08:58,000 --> 01:09:05,559
And we did a deep dive into what was going on in key W.H.O. committees,

570
01:09:05,560 --> 01:09:15,580
Public Health England committees about how they had systematically dismissed and denied aerosol science.

571
01:09:16,650 --> 01:09:23,670
How, you know, the slogan I was using was Evidence is what powerful people say it is.

572
01:09:24,210 --> 01:09:31,470
And there were people who were on the key committees were saying, this evidence counts, that evidence doesn't count.

573
01:09:32,130 --> 01:09:36,240
And that needed to be analysed in an academic way.

574
01:09:36,930 --> 01:09:50,760
So we published a paper on Welcome Open Research all about orthodoxy and heterodoxy, which are these terms that both introduced the orthodox view.

575
01:09:50,790 --> 01:09:55,710
Code word is spread by droplets. Hand-washing is important. Scrubbing surfaces is important.

576
01:09:55,980 --> 01:10:00,360
Quarantining your post is important. Aerosol is an important.

577
01:10:00,360 --> 01:10:07,170
That was the orthodoxy. The heterodoxy was. Look, this is an airborne disease.

578
01:10:07,830 --> 01:10:10,980
How did all that? How did the choir get sick?

579
01:10:11,400 --> 01:10:18,840
You know, if it wasn't an airborne disease. And here is chapter and verse from aerosol science.

580
01:10:20,850 --> 01:10:25,050
But they weren't getting a look in because they weren't on the relevant committees.

581
01:10:25,500 --> 01:10:33,450
And so there were all these power plays from people who were on the committees and didn't want to backtrack on what they said.

582
01:10:34,320 --> 01:10:39,790
Because it would erode that power base. And that was happening internationally.

583
01:10:39,810 --> 01:10:49,290
The W.H.O. nationally in places like Public Health England and indeed in local public health departments and right down to schools.

584
01:10:49,290 --> 01:11:02,249
For example, I read only this morning of a nine year old child who had gone to school and said we really ought to

585
01:11:02,250 --> 01:11:09,809
still be wearing masks because the virus is airborne and the child being told off by the teacher saying,

586
01:11:09,810 --> 01:11:13,980
no, it's not. It's spread by droplets. You must keep washing your hands.

587
01:11:14,640 --> 01:11:18,510
And someone had tweeted me saying, Can you please help my nine year old?

588
01:11:19,140 --> 01:11:27,810
So I sent them a couple of things. But that is all about how the teacher can say to the child, I'm your teacher.

589
01:11:27,810 --> 01:11:30,990
Therefore, my science is more correct than your science.

590
01:11:31,680 --> 01:11:41,280
It's scary. It's really scary. So we unpacked quite a bit of that and I think it's probably by putting a marker down for another paper,

591
01:11:41,340 --> 01:11:48,059
probably the paper that has had the most influence actually. So I worked with Kim Prather with her, said Jimenez,

592
01:11:48,060 --> 01:11:55,860
with a couple of infectious diseases guys to write a piece for The Lancet called Ten Scientific Reasons Why.

593
01:11:55,860 --> 01:12:02,580
We Know that the SARS-CoV-2 virus is everyone. It was very derivative.

594
01:12:03,180 --> 01:12:09,970
It was summarising. Stuff that had already been published.

595
01:12:10,240 --> 01:12:14,700
Stuff that was bombed for obvious to aerosol scientists.

596
01:12:14,890 --> 01:12:23,250
So I don't take any credit for having done this work myself, but I could see that we needed to make a rhetorical move.

597
01:12:23,590 --> 01:12:31,660
We needed to do a power play, if you like. And that was publish something in one of the world's leading journals,

598
01:12:31,840 --> 01:12:37,930
which was short enough and punchy enough for people to get their heads around it

599
01:12:38,500 --> 01:12:44,020
because they were publishing in journals such as this journal called Indoor Air.

600
01:12:44,830 --> 01:12:49,750
Well, when did you last pick up a copy of Indoor Air to read it?

601
01:12:49,870 --> 01:12:57,780
It was too nice, you know. So we needed to shift the publications from even from places like science.

602
01:12:57,790 --> 01:13:02,919
Yeah. That's a pretty mainstream high impact journal actually, that I read those.

603
01:13:02,920 --> 01:13:08,110
But they do read The Lancet, they do read the British Medical Journal, so we needed to get stuff in there anyway.

604
01:13:08,260 --> 01:13:15,280
We constructed that paper and we lobbied and lobbied the editors of The Lancet and they said, Yeah, right.

605
01:13:15,280 --> 01:13:24,490
Will publish it. Will publish it as a comment. So it wasn't exactly in the front bits of the journal, and that was in April 21.

606
01:13:24,670 --> 01:13:34,520
It was in April 21. And one reason why we did that and we did it fast was that Carl Hennigan, his group who'd been funded by W.H.O.,

607
01:13:34,780 --> 01:13:39,519
this particular committee that didn't have any errors or scientists, they'd been published to do that.

608
01:13:39,520 --> 01:13:44,200
They're funded to do a systematic review which had just concluded that there was

609
01:13:44,380 --> 01:13:51,220
not really any there wasn't enough evidence of airborne spread to take any action.

610
01:13:52,420 --> 01:13:55,090
And I was still mourning the death of my mother.

611
01:13:55,930 --> 01:14:05,440
My mother had gone into hospital, having had a fall and having been completely isolated in the nineties,

612
01:14:05,740 --> 01:14:12,160
had spent while on a trolley in the A&E department and had come back and very quickly developed COVID.

613
01:14:12,370 --> 01:14:16,659
I jolly well knew she'd caught it through the air in the hospital.

614
01:14:16,660 --> 01:14:25,000
It was, you know, and I suppose that drove me to feel particularly passionate and to give this a particularly strong piece.

615
01:14:25,000 --> 01:14:29,980
But, you know, we had wave to wave two was worse than wave one, you know.

616
01:14:31,220 --> 01:14:35,080
Tens of thousands of people had died and was still dying.

617
01:14:35,090 --> 01:14:39,260
So that was the context of this. And then co-head and group having.

618
01:14:40,500 --> 01:14:51,180
Had a very narrow and a theoretical approach to the question of whether this this virus was airborne.

619
01:14:51,990 --> 01:15:02,640
They published this systematic review as a preprint, and it has actually failed peer review and still has failed peer review that it was.

620
01:15:02,760 --> 01:15:05,909
It was published on an open preprint server, open peer review.

621
01:15:05,910 --> 01:15:09,450
And three scientists said, this is flaky.

622
01:15:09,450 --> 01:15:13,200
This is not good science. Now, this is not something I would normally do.

623
01:15:13,530 --> 01:15:18,719
I do not go around disparaging other scientists, and I'm not disparaging the scientists.

624
01:15:18,720 --> 01:15:21,870
But that particular systematic review,

625
01:15:22,140 --> 01:15:34,260
which was the official W.H.O. funded review on which international guidance was going to be based, was scientifically flawed.

626
01:15:34,660 --> 01:15:41,610
We had to make noise about it. So within it took us ten days to pull together the evidence.

627
01:15:41,970 --> 01:15:50,910
And we published that paper in The Lancet ten scientific reasons why we know this and put on that paper.

628
01:15:51,780 --> 01:15:56,519
It's now it's still in the top 20 of our metric schools of all time.

629
01:15:56,520 --> 01:16:05,610
So out metrics is, you know what, how often is it tweeted about or how often is it on Facebook, you know, all those kind of social media outlets?

630
01:16:06,150 --> 01:16:11,220
It's also been cited hundreds of times and it was peer reviewed.

631
01:16:11,490 --> 01:16:24,210
It was independently peer reviewed. So I've never tried harder in my life to get a piece of a publication out there.

632
01:16:24,510 --> 01:16:31,710
We did loads of TV interviews all around the world and the W.H.O. took notice.

633
01:16:32,130 --> 01:16:37,620
So senior people in the W.H.O. contacted particularly Zeynep Tufekci.

634
01:16:37,620 --> 01:16:43,290
Actually, she's a social sociology professor, but she's also a leading journalist.

635
01:16:43,290 --> 01:16:46,290
She really understands how to play the media, and she co-authored that.

636
01:16:47,100 --> 01:16:55,800
And Zeynep actually worked with a couple of senior people at the show, and I think some of them.

637
01:16:57,290 --> 01:17:00,390
Said. You may be right.

638
01:17:01,260 --> 01:17:11,760
You may be right. And one or two publications from the W.H.O. started to acknowledge airborne transmission.

639
01:17:12,710 --> 01:17:23,870
But the relevant committee, the key committee, which was the one that puts out that scientific brief in July 2019,

640
01:17:24,440 --> 01:17:32,540
is still to this day saying that the virus is only situation of the apple,

641
01:17:32,540 --> 01:17:41,750
in other words, in aerosol generating procedures and in highly unusual settings where there's a high degree of crowding.

642
01:17:43,280 --> 01:17:48,600
And that is still something that I worry about and I'm cross about and I lose sleep about.

643
01:17:48,860 --> 01:17:59,690
But I think we did move the needle with that paper. Right now recruiting again.

644
01:18:03,950 --> 01:18:08,860
So, yes, just to sort of follow up on that, has the work you've done on area transmission,

645
01:18:08,870 --> 01:18:14,190
airborne transmission changed policy, for instance, in this country?

646
01:18:14,210 --> 01:18:16,070
You've told me what's happened in W.H.O.

647
01:18:17,030 --> 01:18:29,060
I think the work I did on masks, I think did have some influence on the policy decision to introduce masking in July 2020.

648
01:18:29,750 --> 01:18:38,690
I think the work I've done on airborne transmission has had some influence, but I think to be honest,

649
01:18:39,290 --> 01:18:45,890
what's happening in the UK at the moment, speaking in early November 21, is.

650
01:18:46,850 --> 01:19:00,110
We seem to have gone into a policy of relying on vaccination and assuming that we now can drop all other measures.

651
01:19:00,680 --> 01:19:06,730
So the question of whether this is an airborne virus or drops the virus has really

652
01:19:06,740 --> 01:19:14,390
been parked because it's now seen to be a virus that's controlled by vaccination.

653
01:19:14,870 --> 01:19:26,850
And there is a narrative that we have uncoupled the from the transmission of the disease from severe effects, the disease.

654
01:19:26,870 --> 01:19:30,080
That is not a view I personally hold.

655
01:19:30,350 --> 01:19:34,670
It's only a couple of days since we have 9300 deaths in this country.

656
01:19:35,090 --> 01:19:38,210
You know, we're regularly getting over 200 deaths a day.

657
01:19:38,990 --> 01:19:49,370
And yet it is assumed that because everyone is vaccinated or many people are vaccinated, it's not a serious disease anymore.

658
01:19:49,380 --> 01:19:55,610
We've kind of conquered it. That is highly, highly problematic.

659
01:19:56,100 --> 01:20:04,340
I am very, very troubled by this concocted truth in inverted commas.

660
01:20:06,380 --> 01:20:14,750
I wish the debate on the mode of transmission was front and centre, but it is not currently, which is a great shame.

661
01:20:20,400 --> 01:20:27,720
I think well, we talked about this a bit, but I just focus on why you think it's been so difficult for the medical science as a whole.

662
01:20:27,810 --> 01:20:32,210
Actually, there's another question on both of us. Evidence based medicine.

663
01:20:35,230 --> 01:20:41,709
I remember when the phrase kind of first came in and everybody thought, Oh, what a good thing would come from this time when it was all kind of stuff.

664
01:20:41,710 --> 01:20:50,470
You can see based on personal experience to it, to a time where treatments are all based on evidence, but the term always seems to have.

665
01:20:52,030 --> 01:20:56,260
Broken down in a way, because you have to question what is what is evidence?

666
01:20:56,270 --> 01:21:01,510
How is how do you decide what evidence to pay attention to what what's your view on that?

667
01:21:01,780 --> 01:21:08,950
It's very, very interesting, isn't it? I think evidence based medicine was a very clever piece of marketing.

668
01:21:09,370 --> 01:21:13,010
And actually Mayor Grey, who is a professor,

669
01:21:13,360 --> 01:21:22,990
claims to have developed the term evidence based medicine to kind of market the ideas of clinical epidemiology.

670
01:21:23,290 --> 01:21:33,250
And clinical epidemiology says if you want to make a treatment decision in an individual patient or indeed diagnosis decision,

671
01:21:33,520 --> 01:21:39,190
you should be taking account of research into populations.

672
01:21:39,190 --> 01:21:44,260
You shouldn't just be treating the patient on the basis of whether the previous patient got better on a particular drug.

673
01:21:44,680 --> 01:21:56,979
Now, I think we're all signed up to that, but that doesn't mean that the methods and evidence hierarchies that are appropriate

674
01:21:56,980 --> 01:22:03,940
for assessing the efficacy of drugs or the the accuracy of diagnostic tests.

675
01:22:05,550 --> 01:22:10,080
Applied to every aspect of anything health related.

676
01:22:10,530 --> 01:22:26,480
And I think the evidence hierarchy of evidence based medicine has been naively misapplied to dismiss aerosol science.

677
01:22:26,490 --> 01:22:31,260
And if you go back to what I was saying about interdisciplinarity and how my

678
01:22:31,410 --> 01:22:38,730
own personal doctoral work shifted from a biochemical focus to a much broader,

679
01:22:39,330 --> 01:22:51,620
you know, anthropological focus and. I think we need people who can change horses.

680
01:22:53,500 --> 01:22:59,830
Change disciplinary horses when it's needed. And the problem with evidence based medicine is.

681
01:23:01,150 --> 01:23:12,100
It's really just code for clinical epidemiology and it is a unique disciplinary perspective which favours epidemiology.

682
01:23:13,120 --> 01:23:22,570
And we don't need epidemiology, or at least it shouldn't have an exclusive or privileged position.

683
01:23:22,720 --> 01:23:30,340
I mean, the epidemiology of COPE is very important. But when what when the question is, is the virus airborne?

684
01:23:30,700 --> 01:23:37,240
You need aerosol scientists. You don't need clinical epidemiologists because they're not trained to do that.

685
01:23:37,570 --> 01:23:42,250
This seems to me to be such a basic thing.

686
01:23:42,850 --> 01:23:45,850
I honestly. Cannot.

687
01:23:47,110 --> 01:23:51,690
I can understand why people got it wrong, because it's all about the link between science and power.

688
01:23:51,700 --> 01:24:00,460
But. It's it's something I think future historians are going to look back and say, gosh, gosh.

689
01:24:01,590 --> 01:24:11,340
Even with so much research funding, so much scientific evidence, they still completely dropped the ball there.

690
01:24:15,040 --> 01:24:26,870
That's great. Thank you. I think, again, you mentioned this a bit that we can develop it a bit.

691
01:24:26,880 --> 01:24:34,500
To what extent have you personally felt threatened by the infection, either in the initial phase or more recently?

692
01:24:35,040 --> 01:24:38,370
I've taken this infection very seriously, and I haven't had it.

693
01:24:39,450 --> 01:24:42,930
I have you know, I'm a cancer survivor.

694
01:24:42,960 --> 01:24:46,860
I've been very sick with sepsis in the past.

695
01:24:47,220 --> 01:24:55,950
And I don't want to repeat that experience because I was convinced from an early stage that this virus was airborne.

696
01:24:56,160 --> 01:25:00,120
I have not been on public transport since the beginning of the pandemic.

697
01:25:00,480 --> 01:25:03,600
I have only been into my department three or four times.

698
01:25:04,860 --> 01:25:09,930
Every single time was on a Sunday or late at night when there wasn't anyone else in the building.

699
01:25:12,360 --> 01:25:20,700
And I have been to very, very few face to face meetings, maybe two or three since the beginning of the pandemic, because I don't want to catch it.

700
01:25:21,450 --> 01:25:27,990
So. You know, I have personally had it's as I said, my mother died of it.

701
01:25:28,010 --> 01:25:32,870
My son had what was actually pretty mild COVID.

702
01:25:32,930 --> 01:25:39,800
So it wasn't very nice at the time. But you know, ten days later with better and.

703
01:25:41,980 --> 01:25:54,640
I think the way COVID affected me, apart from losing my mother, was an awful lot of my staff were affected by lockdown and furloughed.

704
01:25:55,360 --> 01:25:58,719
You know, all were homeschooling their kids, that kind of thing.

705
01:25:58,720 --> 01:26:02,200
And I think I'm not alone in that, but certainly.

706
01:26:03,190 --> 01:26:07,570
It was a bit of a struggle. But, you know, that was a sort of indirect, really.

707
01:26:07,720 --> 01:26:20,470
You know, physically I've been completely unscathed. Again, you've answered this one that you could perhaps again say how it panned out later.

708
01:26:20,470 --> 01:26:24,160
Did you work longer hours than normal during the pandemic? No, crazy.

709
01:26:24,160 --> 01:26:29,080
I was absolutely crazy. I was. And in fact, someone asked me recently,

710
01:26:29,320 --> 01:26:36,250
what would you have done differently if you if you if we could kind of play that first few months of the pandemic again?

711
01:26:36,250 --> 01:26:47,920
And I said I would I would have taken more breaks because we were working at an extraordinary pace, an absolutely blistering pace.

712
01:26:48,190 --> 01:26:52,150
I've published more than 50 papers in 2020.

713
01:26:52,840 --> 01:26:57,430
You know, it's one week. It was crazy.

714
01:26:57,790 --> 01:27:02,430
And actually I published over 40 this year and it finished.

715
01:27:02,440 --> 01:27:12,790
Yes. Hadn't got much better. But actually, of those first 50 papers, you know, I'm talking to you about five or six of my papers.

716
01:27:13,060 --> 01:27:17,140
There were an awful lot of papers that weren't that good, actually, looking back.

717
01:27:17,680 --> 01:27:25,059
And although every single one of them was done in good faith, we tried hard.

718
01:27:25,060 --> 01:27:32,330
I think if we taken a step back, taken a weekend off from time to time,

719
01:27:32,350 --> 01:27:38,710
something like that, we may have done a few pieces of work, but done them slightly better.

720
01:27:41,890 --> 01:27:48,940
Having said that, I don't think we would have known at the time which ones we should have focussed on, which ones we shouldn't.

721
01:27:50,050 --> 01:27:54,040
Because that first masks paper, the one for the precautionary principle.

722
01:27:54,520 --> 01:27:59,170
It only took a couple of days to write. We didn't know it was going to go viral.

723
01:27:59,830 --> 01:28:05,350
We didn't know masks were going to be such a big thing. So it's all very well with the retrospective scope, isn't it?

724
01:28:05,410 --> 01:28:10,090
But in the in the fast unfolding of events, it was quite hard to know what to focus on.

725
01:28:10,600 --> 01:28:15,970
And I think, I mean, you said it was five months that you had this extremely intense period,

726
01:28:16,840 --> 01:28:21,669
the implication being that since then you haven't been getting it quite such a blistering pace.

727
01:28:21,670 --> 01:28:25,200
But on the other hand, you have produced you did produce a huge number of papers.

728
01:28:25,360 --> 01:28:30,700
Did you actually get a chance to take time off or did you institute a regime of regular breaks from that time?

729
01:28:30,970 --> 01:28:40,709
Um. I've had two weeks holiday in the last two years and I got another one the week after next month.

730
01:28:40,710 --> 01:28:44,520
She said that by three weeks in two years. So that's not very much.

731
01:28:46,470 --> 01:28:58,800
On the other hand, it's quite hard to go on holiday. I do stop now most evenings.

732
01:29:00,150 --> 01:29:05,710
I think. The pace of work.

733
01:29:07,680 --> 01:29:11,129
I think doing 16 hour days was crazy.

734
01:29:11,130 --> 01:29:18,730
So now I could do 12 hour days. But there's still plenty of work to do, actually.

735
01:29:18,970 --> 01:29:28,720
And also, although, you know, I'm working long hours, as I said, I don't feel particularly stressed by it now.

736
01:29:28,870 --> 01:29:34,480
It's quite fulfilling. I'm finishing off quite a lot of projects that have been running for a few months.

737
01:29:37,310 --> 01:29:41,600
I'm finding it quite sort of comfortable intellectually.

738
01:29:42,140 --> 01:29:47,180
There's some very, very interesting philosophical work I haven't talked about much, but for example,

739
01:29:47,180 --> 01:29:53,389
I've been linking up with some pragmatist philosophers because I think pragmatism is a really,

740
01:29:53,390 --> 01:29:58,820
really interesting theoretical lens to look at the pandemic through.

741
01:29:59,330 --> 01:30:03,740
So one of the papers I've got under review at the moment is around.

742
01:30:05,420 --> 01:30:08,780
Crisis policymaking through a pragmatist lens.

743
01:30:12,060 --> 01:30:20,580
That's almost like a hobby and it's very different from the kind of work I was doing much at the beginning of the pandemic,

744
01:30:20,580 --> 01:30:24,960
which was very much about how can we stop people dying today and tomorrow?

745
01:30:25,500 --> 01:30:30,720
I've now shifted gears a bit and started thinking.

746
01:30:31,970 --> 01:30:36,980
Wait a minute. What does this pandemic tell us about pandemics generally or crises generally?

747
01:30:37,370 --> 01:30:42,320
And that, I think, is is quite rewarding and productive.

748
01:30:43,340 --> 01:30:46,850
You know, you can see all the. Feel particularly stressed right now.

749
01:30:47,420 --> 01:30:53,120
Time to do this interview if you don't speak about this 18 months ago and I said sorry, ample time.

750
01:30:53,690 --> 01:30:58,010
So I think things are settling down a bit. Yeah, I do.

751
01:30:58,400 --> 01:31:03,830
Is there anything that you do within your group to support the emotional well-being of your colleagues?

752
01:31:05,870 --> 01:31:14,779
That's a really interesting one, isn't it? I am cynical about some of the emotional well-being stuff that goes around.

753
01:31:14,780 --> 01:31:20,929
So we have this email that comes around every Wednesday and the headline is Wellbeing

754
01:31:20,930 --> 01:31:26,090
Wednesday and it says things like Take 20 minutes away from your work or that kind of thing.

755
01:31:31,520 --> 01:31:35,580
It's too formalised, it's too technocratic.

756
01:31:35,600 --> 01:31:40,860
It's like going on a resilience course. I think the way.

757
01:31:42,120 --> 01:31:47,400
I have. Tended to do it is.

758
01:31:50,680 --> 01:31:57,670
Picking up a lot of bitty things that people weren't coping with.

759
01:31:58,210 --> 01:32:01,930
And so I would pick them up and.

760
01:32:03,230 --> 01:32:06,830
You know, help them with it. Various people,

761
01:32:06,830 --> 01:32:14,000
various of my early career researchers had been slogging away at a paper for months

762
01:32:14,000 --> 01:32:20,390
and not being very productive because all the stuff that was going on and I.

763
01:32:21,450 --> 01:32:25,649
Had more input to those papers than I would normally have had,

764
01:32:25,650 --> 01:32:30,750
but I've made sure that they got the paper finished, submitted and published, so they've got the line on the CV.

765
01:32:31,080 --> 01:32:37,650
I actually think that kind of input is a lot more helpful than let's all have a virtual coffee morning.

766
01:32:38,250 --> 01:32:43,230
Although we do do virtual coffee. It happens once a week.

767
01:32:43,320 --> 01:32:47,700
They tend to do it without me, actually. Some people find it very helpful.

768
01:32:47,700 --> 01:32:53,350
Some people don't. I've done. A couple of other things with my group.

769
01:32:53,980 --> 01:32:57,700
I'm friends with a Danish academic called Nina.

770
01:32:57,700 --> 01:33:01,540
Maya, and Nina has an interest in.

771
01:33:02,550 --> 01:33:05,790
The support of the and mid-career researchers.

772
01:33:05,790 --> 01:33:07,740
That's one of her research interests.

773
01:33:08,220 --> 01:33:19,530
And she was in a situation where she wasn't doing a massive amount of pandemic related work and she had a bit of extra time during the pandemic.

774
01:33:19,530 --> 01:33:24,480
And she said, Is there anything I can do? And I said, Well, can you do some sessions for my team?

775
01:33:25,020 --> 01:33:33,870
So she did some virtual sessions on academic writing and helped individual members

776
01:33:33,870 --> 01:33:39,750
of my team with some of their papers and gave them feedback on drafts of writing.

777
01:33:40,590 --> 01:33:43,890
And they found that enormously helpful.

778
01:33:44,460 --> 01:33:55,350
I think mainly because Nina is wonderfully gentle and slightly motherly and in a nice way, if I can say that.

779
01:33:56,070 --> 01:33:59,879
And it was because it wasn't me helping them.

780
01:33:59,880 --> 01:34:04,260
I think they were sort of saying interests kind of going off saving the planet.

781
01:34:04,800 --> 01:34:11,600
We've got this protected space with Nina who's not doing pandemic stuff.

782
01:34:11,610 --> 01:34:18,150
She is committed to us. And actually I use some of my pandemic money to.

783
01:34:19,450 --> 01:34:24,490
Pay her for that. Now, talking of pay and money.

784
01:34:25,730 --> 01:34:38,240
We also responded. We applied for University of Oxford Pandemic Funds to return people to work after the pandemic.

785
01:34:38,900 --> 01:34:44,420
Now we have lots of different people with different problems and challenges.

786
01:34:45,410 --> 01:34:57,350
But what I did was I helped, I think, seven or eight members of my team each to apply for £5,000.

787
01:34:58,100 --> 01:35:08,360
And we used that money to pay the salary of somebody who came in as a research assistant, and they used her time.

788
01:35:09,700 --> 01:35:15,790
Flexibly however they wanted. So they said, Please, I want you to help me do the background work for grant application.

789
01:35:15,790 --> 01:35:18,119
I want you to help me finish this paper.

790
01:35:18,120 --> 01:35:25,660
And it was good for the research assistant because that person would come to the end of the contract and would have been made redundant.

791
01:35:25,990 --> 01:35:31,110
But it was also good because I said to people, I don't care what you do, I don't want to.

792
01:35:31,120 --> 01:35:34,750
I don't even want to know. Here's an extra pair of hands.

793
01:35:35,170 --> 01:35:38,440
And people would say, Oh, that's brilliant. That's just what I need.

794
01:35:38,860 --> 01:35:47,230
And they would come up with an idea for using this person's time, which is far better than what I would have come up with.

795
01:35:47,710 --> 01:35:54,190
So practical help was important. Um, what else?

796
01:35:54,550 --> 01:35:57,640
Sounds like pragmatism again? Yeah, just. It was very pragmatic. But then.

797
01:35:57,640 --> 01:36:02,170
But then pragmatism. It's not just about being practical.

798
01:36:02,190 --> 01:36:06,339
It does have a kind of philosophical underpinning, which is.

799
01:36:06,340 --> 01:36:09,669
Which is something I'm getting quite interested in.

800
01:36:09,670 --> 01:36:14,410
But I didn't say onto this tape because I'm actually a novice on pragmatism and I probably get it wrong.

801
01:36:16,210 --> 01:36:20,860
So were you involved in your institution department's code safety regime?

802
01:36:21,340 --> 01:36:26,710
No, no, I offered to be, yes. But I was told that I wasn't needed.

803
01:36:27,640 --> 01:36:32,990
And what you satisfied with how it was implemented? No. There's droplets which are everywhere.

804
01:36:32,990 --> 01:36:40,670
But she's want to go in. I'm quite gobsmacked actually at the.

805
01:36:43,680 --> 01:36:48,540
The way in which job that theatre has.

806
01:36:49,450 --> 01:36:53,080
Dominated Oxford's response and the way.

807
01:36:54,100 --> 01:37:02,800
Airborne precautions have not been taken on. I'm just I think yesterday or the day before, we published a new paper.

808
01:37:03,220 --> 01:37:13,720
Peer reviewed and welcome. Open research. All about getting back to campus, you know, returning to on site teaching.

809
01:37:15,400 --> 01:37:19,900
It was a rapid, systematic review of the literature on what should be done.

810
01:37:20,500 --> 01:37:28,000
The most important thing is vaccinating staff and students and getting vaccination levels up to 90%, if we can.

811
01:37:28,570 --> 01:37:33,700
The next most important thing is instigating airborne precautions, including mosques, etc.,

812
01:37:33,700 --> 01:37:44,590
etc. and that we published it or a version of it through the U.S. you through universities and college union.

813
01:37:44,860 --> 01:37:52,000
It was sent to every member of U.S. U. And it's now being published as a peer reviewed journal with a few more references.

814
01:37:54,480 --> 01:38:00,240
But it hasn't kind of hit the desks of the people who are running the response.

815
01:38:02,300 --> 01:38:05,810
And my emails. I don't think I've had replies to them.

816
01:38:07,170 --> 01:38:10,800
So. Yeah, that sad. Sad.

817
01:38:12,630 --> 01:38:18,660
On the other hand, if we talk about emotional well-being, you know, in the end,

818
01:38:18,660 --> 01:38:23,880
you can only do your best in the end if they're not going to take any notice.

819
01:38:24,870 --> 01:38:29,509
I'm. I mean, I remember when I was a junior doctor,

820
01:38:29,510 --> 01:38:34,910
I used to cry myself to sleep when a patient died and someone took me aside and said, You never can survive in medicine.

821
01:38:35,690 --> 01:38:43,099
You did what you could do. And if someone came in with crushing chest pain and you gave them the right drugs and you got the drip into the vein,

822
01:38:43,100 --> 01:38:47,180
and you, you know, you would there and you put the monitor on and they still died.

823
01:38:47,990 --> 01:38:50,430
They were going to die. And it's not your fault.

824
01:38:50,450 --> 01:38:58,880
And I sort of take a bit of the same approach here, is that unless if you can't do that, you're going to go crazy.

825
01:38:59,660 --> 01:39:02,660
So I've done my best. I've made my offer.

826
01:39:03,020 --> 01:39:07,220
I've published these very high profile papers.

827
01:39:08,000 --> 01:39:11,640
And if they choose to ignore it. You know.

828
01:39:13,200 --> 01:39:20,270
I'm not going to beat myself up. You mentioned earlier that your public profile with you cannot tell you at all.

829
01:39:21,830 --> 01:39:28,490
How have you felt about that, that those environmental and social media you're you're now a name that's no much more like.

830
01:39:28,550 --> 01:39:32,210
Um. It was it's not something I was seeking out.

831
01:39:33,380 --> 01:39:37,370
I don't court the media. I don't have an agent.

832
01:39:38,030 --> 01:39:42,590
I say no to 90% of requests.

833
01:39:43,340 --> 01:39:47,479
And I've very narrow, very much narrowed down.

834
01:39:47,480 --> 01:39:51,620
So people have phoned me up. They will call my mobile number. They say, please, will you be?

835
01:39:51,950 --> 01:39:55,100
I got a phone call yesterday because you have Good Morning Britain tomorrow.

836
01:39:55,550 --> 01:40:00,490
And then you say, what's it for? And they'd say something.

837
01:40:00,500 --> 01:40:07,550
You think, Well, I could talk on that subject, but I'm not the world's expert on it, and it's not what I'm known for.

838
01:40:07,970 --> 01:40:11,600
So I will say, No, I'm not going to talk on that.

839
01:40:11,600 --> 01:40:15,620
I'll talk about masks and I'll talk about airport precautions, and that's it.

840
01:40:16,310 --> 01:40:22,610
And they'll talk actually about revoke, but they can go find someone else to talk about the other stuff.

841
01:40:23,180 --> 01:40:27,110
But actually, in recent weeks, I've refused all media.

842
01:40:29,100 --> 01:40:34,799
And that's partly because although I'm not feeling particularly stress did actually stresses my family

843
01:40:34,800 --> 01:40:41,840
it stresses my husband and it's often they want you at 10:00 at night and then they'll keep you waiting.

844
01:40:41,850 --> 01:40:48,500
So you're actually not on to a quarter to 11. And then it's actually quite hard to get to sleep after you've done live TV.

845
01:40:49,160 --> 01:40:52,370
So I've done quite a bit. It's.

846
01:40:55,290 --> 01:40:58,860
It's very time consuming.

847
01:40:59,340 --> 01:41:05,249
I don't like the attention. I don't like if I've done a TV appearance.

848
01:41:05,250 --> 01:41:09,360
I can get 20 emails from people saying, Can you do local radio tomorrow?

849
01:41:10,590 --> 01:41:17,520
And I don't like the abuse. I haven't talked much about the abuse, but I was going to ask you about gay rights.

850
01:41:17,880 --> 01:41:24,390
Yeah, I don't need explicit examples, but I mean, it's it's it's something that anybody with a high profile.

851
01:41:25,350 --> 01:41:29,450
Yes, I think so. I think the mosques thing has been the worst.

852
01:41:32,030 --> 01:41:38,230
People have. Systematically set up groups to attack me.

853
01:41:39,160 --> 01:41:46,240
There are the sort of dark Web sites of, you know, libertarian groups.

854
01:41:46,540 --> 01:41:49,180
I know that I'm on that list.

855
01:41:51,400 --> 01:42:01,810
So, for example, one person will put out a tweet or say, reply to one of my tweets, and within minutes there'll be 200 replies,

856
01:42:04,750 --> 01:42:10,510
all saying very much the same thing as if they've been told that this is the version to use.

857
01:42:10,510 --> 01:42:15,070
And sometimes it's identical text and you just think.

858
01:42:16,410 --> 01:42:20,430
I've got better things to do with my time than engage with that.

859
01:42:21,000 --> 01:42:26,700
And I go around knocking people. But this is this is not what I want to spend my time doing.

860
01:42:27,510 --> 01:42:32,790
It's time consuming. It's exhausting. It upsets my husband because he doesn't either.

861
01:42:32,940 --> 01:42:37,620
I mean, I was there was someone put out on Twitter the other day that I should be raped with a bayonet.

862
01:42:38,100 --> 01:42:43,740
Well, you know, that's all very well. I just think. Well, that's what 14 year olds say about women they don't like.

863
01:42:44,490 --> 01:42:49,510
It really didn't bother me that much. But, my goodness, you know, it upset my news to do so.

864
01:42:49,920 --> 01:42:55,740
And I don't really want to spend my time inviting that kind of thing.

865
01:43:00,260 --> 01:43:04,700
I don't lose a lot of sleep over it. I just try to avoid it.

866
01:43:05,200 --> 01:43:09,440
How did you find out in general, you have found Twitter useful?

867
01:43:09,580 --> 01:43:14,440
Yeah, because I because I control I block people.

868
01:43:14,450 --> 01:43:22,259
I use mass blocking tools sometimes to block everybody who follows a particular extreme libertarian thing.

869
01:43:22,260 --> 01:43:26,690
But if they're following that person, I don't want them to have anything to do with me.

870
01:43:26,690 --> 01:43:32,329
So I'll put 500 of them or something and then I have to apologise sometimes because sometimes people

871
01:43:32,330 --> 01:43:37,040
have followed them and then they've forgotten they're following them and they don't agree with them.

872
01:43:37,040 --> 01:43:40,730
So I have to kind of unblock people, but that's what you have to do.

873
01:43:42,470 --> 01:43:46,700
I said, okay, there will be one, right? Another 10 minutes.

874
01:43:48,080 --> 01:43:52,639
So how have you. I'll just just clarify this.

875
01:43:52,640 --> 01:44:01,070
I think we talked about a little bit earlier, but are you are you not associated directly with any policymaking body?

876
01:44:03,380 --> 01:44:13,400
Oh, goodness. Now, I'd better get this right at night. Until quite recently, I sat on a committee at the World Health Organisation.

877
01:44:14,270 --> 01:44:17,690
But it wasn't the one that was dealing with the current response.

878
01:44:17,990 --> 01:44:21,260
So it was the Alliance for Health Policy and Systems Research.

879
01:44:21,890 --> 01:44:27,680
I sit on, I think last count, about 13 national committees.

880
01:44:28,370 --> 01:44:37,310
I am on the long COVID National Task Force. I was on the nice oversight group for the long COVID guideline.

881
01:44:40,040 --> 01:44:43,070
I've done various pieces of work with the.

882
01:44:44,300 --> 01:44:49,910
What's it called? NHS England. Digital Primary Care.

883
01:44:50,950 --> 01:44:55,779
Primary Care Digital Transformation Team. That's what its primary care digital transformation team think.

884
01:44:55,780 --> 01:45:01,419
I'm an official advisor to them. So, you know, one one works with policymakers.

885
01:45:01,420 --> 01:45:12,420
Yes. But I'm not on any of the formal convened the ones that are.

886
01:45:13,830 --> 01:45:22,170
Should we say in the public eye like. In relation to Kobe, I'd say to say, I'm not on Sage, I'm not on Nervtag.

887
01:45:23,280 --> 01:45:28,290
I applied to be on the stage, actually, and I was told that my expertise wasn't appropriate,

888
01:45:28,290 --> 01:45:34,589
which I think is quite what the other ones I'm giving you.

889
01:45:34,590 --> 01:45:38,309
I'm not all any of those know, and I'm not even an independent sage,

890
01:45:38,310 --> 01:45:44,430
which is quite interesting because often when you've got a high profile scientist who's not on Sage, you'll find that they are on independent sage.

891
01:45:44,700 --> 01:45:52,500
But I have appeared on the Independent Sage, you know, that broadcasts because, you know, I've gone there as a guest.

892
01:45:53,730 --> 01:45:56,820
So I'm friends with them, shall we say.

893
01:45:58,470 --> 01:46:04,830
So has the work you've done raised new questions that you might be interested in exploring in the future?

894
01:46:05,220 --> 01:46:18,990
Yeah, I think all the stuff around pragmatism, I've just put in a grant to the MRC under No Child for funding to appoint a post-doctoral philosopher,

895
01:46:18,990 --> 01:46:29,459
to look at how pragmatist philosophy can help us in these very action oriented research approaches where you've got to generate stuff in real time,

896
01:46:29,460 --> 01:46:36,600
interpret it, apply it all in a big sort of unfolding jumble, if you like.

897
01:46:37,560 --> 01:46:43,560
And that's interesting. That is the thing that's most grabbing me at the moment, actually.

898
01:46:43,560 --> 01:46:50,270
Yeah. The last question Has the experience of Kogi changed your attitude or approach

899
01:46:50,270 --> 01:46:53,930
to your work and all the things that you'd like to see change in the future?

900
01:46:55,970 --> 01:47:02,930
Um. That's a really interesting question.

901
01:47:03,560 --> 01:47:10,670
And out of all the questions you've asked me, it's the only one I haven't got an immediate answer for.

902
01:47:12,530 --> 01:47:19,160
And I think it's because I'm still too close to it. I think if you asked me in a year's time, I would know.

903
01:47:19,820 --> 01:47:24,740
But it's because I'm still experiencing it, I think.

904
01:47:25,490 --> 01:47:29,680
What on earth is going to happen in the future? I don't know.

905
01:47:29,690 --> 01:47:35,629
I mean, I've got a, um, I've got an application which I doubt will be funded,

906
01:47:35,630 --> 01:47:47,240
which I'd put in about nine months ago for a leaf, a human senior fellowship to write a book about Wittgenstein.

907
01:47:48,020 --> 01:47:51,140
And there was a.

908
01:47:52,760 --> 01:47:59,960
A friend of Wittgenstein, who was a doctor who wrote a book called The Danger of Words is a chapter called Maurice Drury.

909
01:48:00,290 --> 01:48:04,610
But it's all about how some of Wittgenstein's insights are very relevant to medicine.

910
01:48:05,090 --> 01:48:06,920
I applied to Lever. HUME to.

911
01:48:07,940 --> 01:48:18,260
Right, a modern day version of that book, because actually it was written in the 1950s, early sixties, I think, and medicine's changed hugely.

912
01:48:18,270 --> 01:48:24,140
But actually some of the work of the later Wittgenstein would be incredibly relevant now.

913
01:48:25,190 --> 01:48:34,850
I put that in thinking I would if I got it, I could then spend three years writing a book and then retire because I'm 62 now.

914
01:48:35,300 --> 01:48:40,240
Would that be wonderful? And then I thought, would I actually do that?

915
01:48:40,250 --> 01:48:44,570
Because I would have thought when I wrote the application, I thought the pandemic would be over by now.

916
01:48:45,110 --> 01:48:50,569
Whereas actually with pandemics now grumbling along, there's all sorts of, you know, terrible things happening.

917
01:48:50,570 --> 01:48:56,059
I'd be dropping all precautions because of the, you know, the idea that we think we're vaccinated.

918
01:48:56,060 --> 01:49:02,420
So that's that can I really kind of just go and sit in the Bodleian and write a book about Wittgenstein?

919
01:49:02,420 --> 01:49:07,579
Even if I get funding, I'm not sure. I really don't know what the answer to that is.

920
01:49:07,580 --> 01:49:12,319
It'd be interesting, anyway, that that my hand would probably be forced because they probably won't fund it.

921
01:49:12,320 --> 01:49:17,240
But it would be it would be a big change. It would complete transformation if I did get it.

922
01:49:19,120 --> 01:49:22,270
Thank you very much. Oh, don't do that. Okay.