So first of all, could you just say your name and your current position and affiliation?
I'm Trish Greenhill, Shawn, professor of Primary Care Health Sciences in the Department of Primary Care Health Sciences at the University of Oxford.
Thank you. So, first of all, could you just tell me a little about yourself?
I mean, very briefly, but how you got to where you are now? I'm a medical doctor.
I'm trained initially in diabetes and then moved into general practice quite soon.
And I've also trained in social sciences and in public health.
So I spent most of my academic career at University College London brief period.
Queen Mary, University of London.
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.
Actually, we co-lead that team my job share the leadership of the research unit with Sara Shaw,
who's an associate professor with a social policy background.
So we have a we our approach is to bring people in from lots of different disciplines.
So we have philosophers, anthropologists, computer scientists, health economists, doctors, nurses, pharmacists, physiotherapists, paramedics.
And we do a very broad range of research basically at the interface between social sciences and medicine.
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?
The question that gets me out of bed. Currently we're talking November 2021 is how are we going to end this pandemic?
How are we ever going to get back to normal in inverted commas?
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?
We're going to get on code, obviously, but the nature of the questions I explore are like real world questions.
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,
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.
Oh, I think you've answered the next one. Yes. So you mentioned you've mentioned that your research unit is extremely interdisciplinary.
Why do you think that's important? Oh, I think I got into interdisciplinarity when I did my doctorate.
So as I said, I trained in diabetes and the topic that I was studying in my doctorate was unstable diabetes type one diabetes,
what we call brittle diabetes in those days, this was the mid 1980s,
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.
And over the couple of years when I was doing my field work,
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,
and more and more interested in the stories that people were telling me about that diabetes, about their marriage,
about their financial challenges, about trying to give their kids a good upbringing and how that's affected their diabetes.
Now, of course, that might well have been mediated through the molecules that I was studying, things like counter regulatory hormones.
But the thing that interested me most was the narratives themselves and the meaning systems of
different patients and how that seemed to have a real bearing on how their diabetes unfolded.
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.
And so I'd gone from collecting blood to collecting stories.
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,
which was stress and diabetes through different disciplinary lenses.
And I think the biochemistry of stress is hugely important, but so is the anthropology and the psychology of stress.
And then, of course, we get a very rich perspective on that kind of topic if we bring in lots of different disciplines.
I suppose the other thing that is worth saying about interdisciplinary work is it's inherently conflict ridden.
If you are feeling totally comfortable and on the same page as everybody you're working with, you're probably not doing interdisciplinary research.
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,
why are they looking at it like that? That's not the right way to look at it.
Then you are starting to get the kind of productive conflicts from which higher order interdisciplinary insights can come.
And I think that's what really excites me, too.
You're you're comfortable with dealing with conflicting ideas?
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.
Now, this isn't the topic of this interview,
but I think there are destructive forms of conflict in academia and there are constructive forms of conflict.
And I think the challenge when you're running an interdisciplinary research unit is to ensure that conflict is constructive and productive.
So can you remember when you first heard that there was a pandemic in the offing?
Yes, I can. Can you remember what you were doing this time? I was checking my emails.
I'm sure. So one of the things that I was doing back in 2019 and indeed for a couple of years before that,
was I was working internationally with Chinese academics and we had already brought a group of
Chinese professors over to Oxford for what was known as the Chinese Academic Medicine Course.
And I think I did one of those in 2019.
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
Oxford academics would would be arranged to give lectures and the Chinese would ask questions,
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.
And one of the things we were actually trying to do with the Chinese was was get them
to do more interdisciplinary research because they were a bit multidisciplinary.
And so that was one of the selling points of this particular project.
Anyway, we had a group from Guangdong on probably pronouncing that wrong and they had been planning to come over mostly cardiologists actually,
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.
And come about December 2019, I got an email from one of the Chinese saying, look, we may have to postpone our visit.
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.
So Guangdong is the second city in China to have to be hit by what we now call COVID 19.
And. I then said, oh, good gosh.
So this is a this is a serious one. Is it as bad as sales and murders?
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.
To try and prepare for what looked like it was going to inevitably hit Europe.
And indeed it did. So I think I was serendipitously forewarned, quite early that this was likely coming our way.
The other thing is, I'm a very keen social media person.
I do a lot on Twitter and I follow various people around the world.
There's one person I follow on social media, Dina Grayson from America, who mostly tweets about American politics, actually.
But but she had done her Ph.D., I think, on Ebola.
And she was very interested in pandemics.
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.
We need to prepare. And then I realised, I think that.
My life was going to be taken over by this pandemic quite early in 2020.
So how did you react? How did you go about organising your colleagues or discussing the colleagues?
What were the questions were that you could approach with the resources at your disposal?
Yeah. So one of the first things that was very, very clear was that this was a highly contagious disease.
You could see on the television, you could see by social media pictures.
But I also knew from the emails I was getting from my Chinese colleagues that the Chinese clinicians were wearing hazmat suits.
They were treating this as a very, very contagious disease, which needed the highest level of infection control and.
I thought. UK is not ready for this.
We. Years ago I applied for a job that I didn't get in an infectious diseases hospital in London.
I remember going and visiting it because I really wanted the job. This is when I was a very junior doctor.
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.
But I remember being shown the Lassa fever ward, which was a a very small room in the middle of a field.
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.
You went and dealt with them.
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.
And, you know, that is a metaphor for. Hang on a minute. COVID could affect huge numbers of people.
We don't have enough fields with hospital wards put in the middle of those fields.
We don't have enough hazmat suits.
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.
And so I very quickly realised that one of the things we were going to have to do was mobilise remote care, remote consultations.
Now, by happy coincidence, I have been doing research into remote consultations since about 2009.
And in fact, I've been writing grant applications since 2009.
We wrote to Grant. For what is now the National Institute for Health Research to look at video consultations in diabetes,
actually with those working in the east end of London. And this is all relevant.
I was working the east end of London and the did not attend rate for diabetes appointments was 50%.
Half the patients never showed up. And this was mainly because the patients were were in low status jobs, often in the deep economy,
and they couldn't afford to take time off to spend half a day going to their diabetes appointment.
But the consultant was very progressive and she said, Well, have you got a smartphone?
And they said, Yes. And she said, Well, why don't I Skype you on your phone?
And they said, That would be fine. I'll just take a break.
And that's how it started. Very adult, very informally.
And she said to me, maybe we could do some research on this.
So we put in a bit to the NIH as it is now and said, we'd like to research video consultations.
We got shortlisted and then we got turned down because they said this will never happen.
This will never become policy. So we got rather cross about this.
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.
So we put in the same grant application with literally no changes.
And we said, the only reason that you turn this down is you said it would never happen.
Well, it is happening. Please, with you. It.
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.
And over the next sort of nine or ten years we got lots of different contracts from governments, from charities.
We had a big study from the Health Foundation. We got funded by the NIH.
We've had some MRC money, so lots of different sources of our research and we did some theoretical or theoretical work.
On the challenges to moving video from a demonstration project.
Everyone can set up a demonstration project saying, Oh, look, isn't it pretty?
You know, it works on a small scale to something that is business as usual within the fabric of the NHS.
So we were particularly interested in the organisational changes needed to spread and scale
up video consultations and we're actually doing a piece of work for the Scottish Government.
I spent a couple of weeks in November 2019 driving around Scotland, which was lovely.
We have to go to all these remote areas like the Outer Hebrides and the Orkneys and things,
and see how people connected to the mainland through state of the art video technology.
So we've just done them just writing out that report and then bang the pandemic hit.
We got approached. I got approached by NHS England NHS Improvement to say, Trish, you've got to help us,
we need to change the NHS overnight to dealing with as many problems as possible by remote means.
And that meant digital trialists.
That was one of the things that everybody who wanted to see a doctor or nurse had to do.
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.
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,
and that is the only all nighter I did in the whole of the pandemic.
I stayed up all night to help write the initial briefing document for the total trials,
along with Minor Back I and a couple of others from NHS England and NHS Improvement.
Because GP practices needs guidance and a sort of standard operating procedures and all that kind of thing.
This was an academic was very much, you know, the kind of in the down and dirty of implementation.
And so that was a really major piece of work applying the insights that we had developed
over the last ten years at pace and scale to flip the NHS across into a remote by.
Fault service.
Except, of course, it was a remote by default.
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.
And you went on to look at how that works in practice as a research project, is that right?
Yes, we applied for them.
The interesting thing was that from about the beginning of March, know look, 11th of March is my birthday.
11th of March 2020 was the day the pandemic was declared.
And I also think that was the last day of any semblance of normality, because it was my birthday, my husband,
I went to Bletchley Park because I love going to Bletchley Park and looking around those old computers and things.
We were the only people wearing masks and we were a little bit nervous.
But we said, Well,
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.
To me, it's been very long inside and there weren't many people there.
We got there when it opened and I remember driving back and seeing the W.H.O. announcement that the pandemic had been declared.
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.
So after that. I don't think I left my desk apart from to take an hour's exercise every day.
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.
It was that for long.
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.
What then happened was. The pandemic hit.
And at the end of February 2020, maybe beginning of March, one of my trainees was a GP,
a part time GP in the part of London where the pandemic was hitting hardest and earliest.
And it affected her practice very, very dramatically.
She said to me at the beginning of the week, she said,
We're beginning to see one or two patients with what we think is covered by the end of the week.
Her receptionist was on intensive care and by the following Monday the receptionist was dead.
This was a 45 year old woman who had been completely well, was not overweight, had no risk factors.
And at that point, we thought, crikey. And it seems odd now when hundreds of health and care workers have died.
But then. It hit me like a cannonball.
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,
with that very routine, normal sort of thing, the person maybe hardly had any symptoms.
Maybe they didn't even have any symptoms. That receptionist who died of the disease.
This has never happened in my memory. And it didn't it hasn't happened in anyone else's memory either.
You know, this was something that nobody alive could remember.
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.
Because of the interactions. So this was beginning to be really, really scary.
And my trainee was saying that she I think she was pregnant at the time.
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.
And she said, Yeah, that's true. I'll try and volunteer for phone calls.
So that was on the Friday. And on the Monday, she said she took 100 calls from patients, 100 phone calls.
And by the Tuesday, she said, I know everything there is to know about this disease in terms of diagnosing it over the phone.
And I said, well, that's extraordinary, because only Friday you said you knew nothing.
So from taking a hundred calls, you now now know what it's like to have COVID.
You can diagnose it over the phone. You can decide who needs to go straight into an ambulance, she said.
Yet she said 100 calls with it. It's a very busy day.
So I said, That's extraordinary. We need to tap into your expertise.
So I said, Do you know anyone else who has been dealing with this amount of COVID?
She said, Yeah, I can find you ten more people. I said,
We need to set up some online focus groups and we need to capture that wisdom that
you have acquired because the Chinese data was based only on hospital patients.
So I should say that I've been liaising with my Chinese colleagues and they've been
sending me guidelines that even been translating them from Chinese to English.
And I was also working with people in this country who were Chinese by birth but were now, you know, academics in this country.
So we were trying to spark as much information as possible from China.
We've been through this a couple of months earlier, but the problem was that they didn't really have a primary care system.
The denominator population was people who'd been admitted to hospital.
So we didn't know anything about who should be admitted to hospital and who can be safely managed back in the community.
So going back to my trainee and and her colleagues, who had quite by chance received, if you like,
the first wave of patients or the the shoulder of the first wave, you know, that early shoulder.
I also put out some messages on Twitter and I said, is anyone actually seeing patients with probable COVID yet?
And we pulled together some online focus groups and we got 72 GP.
In fact, I think we got about about 65 of them with GP's.
And then there were a few, what we call advanced nurse practitioners who are basically doing the job of a GP,
one or two paramedics, but mostly of GP's.
And we got them to talk, we got them to tell us what their impressions were.
And just to give you an example, one of the things that we that we picked up from these discussions was.
The idea that patients were sometimes unaware of how sick they were,
and in particular that they didn't feel breathless when they should have felt breathless, happy hypoxia, happy hypoxia or silent hypoxia.
Now, a colleague of mine has a daughter who is a junior doctor, and this daughter said she described it as.
iPhone positive, oxygen negative.
What she meant by that was there would be an oximeter clipped to the patient's finger, which would show terrifyingly low oxygen levels.
But the patient would be sitting there oblivious to their own illness and playing on their iPhone.
And that was really odd because if you have a standard bacterial pneumonia and your oxygen levels with that low,
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.
COVID was giving people an odd mismatch between the level of sickness and the level of symptoms.
And that was picked up quite early on by some of the GPS who would tell quite horrific stories
of perhaps doing a video consultation with a patient who would say they felt all right,
but they would be noted to be deeply sore on those.
You know, they have blue lips and and yet the patient would not be aware of that anyway.
So we had a number of things followed from that.
I was asked by the British Medical Journal to write.
A rapid article on how to assess people in the community, mostly using telephone or video who might have COVID.
So I've pulled together all these Chinese guidelines which were, as I say, of limited use.
I talked, I pulled together some of the early data from the focus groups that we were doing,
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.
And we published that paper on the 25th of March.
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,
which had an infographic and one of those sort of arrow diagrams, if this,
then that and it was called something like assessing possible acute COVID, you know, remotely or something like that.
And in the next. Three weeks.
I think that article had a quarter of a million hits and it became the go to article as COVID rolled across the country.
People say, Oh yeah, there's not going to be MJ about that. And I was nervous about it because of the kind of.
Pulling together. It felt it felt very pragmatic.
It felt, look, this is as much as we know right now.
It may actually prove not to be 100% correct.
But this is as good as it's going to get right now.
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.
So that was a nice guideline. Well, give us the kind of the definitive truth on it.
And we don't want. You didn't have any formal responsibility to report to nice or no.
Any other advisory body. No, no. But when those guidelines came out, the section on assessing patients in the community just quoted our article,
and then suddenly it was sort of it set in stone.
This is what you do. And we thought, okay, but then the nice guy comes also quoting all sorts of other,
shall I say, cobbled together, kind of best guess perhaps his at the time.
So. We still didn't have any research money.
And I think it's probably worth saying. What happened to some of the big research projects at the beginning of the pandemic.
So. That's where to start.
First of all, the National Institute for Health Research, the Wellcome Trust, the MRC,
everybody puts out messages to their researchers saying, okay guys, we've got this pandemic.
Stop doing what research you're doing and start doing research on COVID just via the money across.
Redeploy your staff. Forget about the research questions you were pursuing.
There are more urgent ones right now and that was brilliant because it meant that those of our staff who could work and
many of them couldn't because they were locked down and they were looking after their kids or they was stressed out.
But the ones who were able to work could be immediately redeployed on the pandemic response, which was great.
You know, we started doing all sorts of literature reviews and publishing those very, very quickly on preprint.
So it's that kind of thing. But.
But actually I was coming towards an end of a grant, so I had to write a grovelling letter to the Wellcome Trust saying,
look, we've actually run out of this grant, but please, could you give me some more money?
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.
So there was a bit of that.
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.
But I didn't get round to writing that application until about May to do a study called Remote by Default.
That's now become a bit by default one because we got some more money to do it, but by default too quite recently.
But anyway, it was then remote by default.
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?
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?
And we use the case study approach we were looking at for localities across England and Wales,
and we also had a project which was funded separately by the Scottish Government to look at Scotland.
And we interviewed people remotely, we interviewed, you know, clinicians, patients, managers, policymakers,
technology suppliers and we pulled together stories within different localities of how people were responding to the pandemic,
but also an overarching story of the National Health Service.
And we've just published some of those actually.
But one of the things that I was. Fascinated by was balancing the risks of doing remote consultations with the benefits,
and conversely, balancing the risks of doing face to face consultations with the benefits.
And that required it required me to use all the different aspects of my training.
You know, I've trained as a GP, I'd trained as a hospital doctor, I've trained in social sciences,
I've trained particularly in the social science of new technologies and in innovation and in policy analysis.
And you know, in some ways I could say I was in the right place at the right time,
but but the remote beautiful study was the first funded study we had.
And one of the things we did was we retrospectively funded some of the people
who'd been working on those online focus groups of GPS to get that early data out.
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
a survey or several rounds of a survey where you have to get a sample of experts,
you have to get the right experts. Otherwise, you know, it's garbage in, garbage out.
But the idea is that we would have we'd have conditions, we'd have patients, we'd have call handlers,
we'd have people who deal with remote consultations in all sorts of aspects.
And then what you do is you make you give them a set of statements.
Here's 20 statements about, you know, what should happen or what have you, and then you ask them to rate those.
Do you agree with it? Do you agree broadly with it?
Would you like to change the wording? Would you like to improve the wording, etc.?
And then you do all that and you get the responses back and you change the statements, you send them out again, etc.
So we did a full round Delphi panel and we came up with.
A preliminary set of questions that you could ask someone over the phone to decide
whether or not you should send them to hospital or send them to a hot tub,
rush them in, in a blue ambulance and take them straight to intensive care.
You know, that kind of thing. What are the things that predict whether or not someone needs what we called escalation of care?
Because of course, the thing I haven't sent was because it's also so it's still so, so raw.
This was the time when the NHS was completely overwhelmed and you know, all routine work had stopped.
There was real problems with the back door because the question was how are we going to discharge people?
And there was all that stuff about discharging people back to care homes, which, you know, in retrospect was a bad idea.
But but the idea was that we needed to clear the hospital to make capacity for more people going in through the front door.
So people got sent out the back door, back to their care homes.
But but the other thing that was happening was we needed to control the front door by keeping people out of hospital.
It didn't need to be that. And so the slogan was Stay at home, protect the NHS.
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.
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.
So the other thing that the beautiful study did was it allowed us to do a big quantitative study on data linkage.
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.
Charcol Brendon Delaney from Imperial and some of those know from my department
in Oxford and we put together a component of what's called the RBD study,
where patients contacted the NHS by telephone, either by the GP or via the COBRA Clinical Advisory Service,
which was the special NHS one on one phone service for people who might have COVID and any body contacting those would get
these 1011 questions and then we would follow those patients up for the next few months to see who was admitted to hospital,
who was admitted to intensive care and who died. So we followed them up and followed up.
Off the top of my head, something like 12,000 patients using data linkage.
So we had the individual patient record in general practice, GP record and we through the patient's NHS number,
we would link that to what's known as hospital episode statistics and also to coroners.
Oh no, not coroners, sorry. Office of National Statistics Deaths.
And the idea was that the statisticians would produce kind of graphs and of.
Which of those questions best predicted whether or not the patient ended up dead or admitted to hospital,
etc., etc. And I've recently had a sneak preview of the results of that study,
which was very interesting findings that the early impressions of those GP's,
like my trainee who said after 100 calls I know who should go to hospital.
Well actually they were right.
They could predict with remarkable accuracy which questions to ask of patients in order to decide who needs to go to hospital.
And I suppose one bottom line thing that we've now demonstrated,
but which the GP's were saying with their hunches back in March 2020, patients need an oximeter at home.
That little thing that you click on your finger and with any luck it comes out to 98 per showing you your nascent health.
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.
Now. It's perhaps worth saying that.
We had that hunch earlier, but it took a very long time to demonstrate quantitatively just how important oximetry data was.
And just to give a personal aside, at Christmas time, my mother became ill with COVID,
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%.
And my mother was sitting in her rocking chair at home saying, I don't know, I don't feel all that bad.
Do you think I should call the doctor? And he said, Yes, I do think you should.
And I, in fact, contacted nine, nine, nine, and my mother didn't last much longer.
So this is all affecting me really quite personally.
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,
not feeling all that breathless but the oximeter reading showing that they had a red flag sign.
And the remote by default study has now shown that, you know, very conclusively, very decisively.
We haven't yet published, but we are about to by the time this is available, it will be you can look it up.
It's known as the recut study remote coded assessment in primary care that that substudy of remote by default.
So that that was all. If we come back to the theme of interdisciplinarity.
I had been very comfortable looking at the social science, if you like, of the introduction of remote services.
I was very comfortable running online focus groups, doing qualitative interviews.
Those are the kind of things that I'm good at, if you like.
I was not at all comfortable doing large scale data linkage studies across these different databases and
working with geeky statisticians to produce what's known as receiver operated characteristic curves.
But I knew that we had to prospectively test the hypotheses that we'd come up with with our qualitative data.
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.
But, you know, it was what was needed. Excellent.
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.
But I wondered whether your very rapid reaction and sense that something needed
doing and I suppose what you've said about the funding bodies partly answered this,
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?
Um, did did it feel collective? Did it feel as if you were really engaged in the collective?
Yes, but I think there's also the fact that we weren't allowed to carry on.
So I had one post-doc who was, I would say, just slightly sleepy about this,
that this person was not clinically qualified and was quite nervous about shifting everything across to COVID and wanted to
carry on studying a different project and then got an email to say all projects that are not to do with COVID are stopping.
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.
But now it wasn't because they were being lazy.
It was because they they felt they didn't have the skills to to contribute.
And I think a lot of people who were clinical felt, gosh, there's nothing for me to do.
You know, I might as well be furloughed if you like. But I said, look, there's plenty you can do.
Go and do X, you know, but they did need quite a bit of guidance.
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.
Were there other ways in which the lockdown impacted on what you were able to do?
Um. I think I was very lucky in my set up with lockdown in that my kids have grown up.
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,
immediately caught COVID and got better from it very quickly, went back home to the COVID board, you know, all that kind of thing.
So so he wasn't causing me any trouble. He was helping with the COVID response in another way.
And then my other sons living abroad. So we didn't have the kids to worry about.
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,
but my living room became my office and I had quite a comfortable setup.
I had wi fi at home. I could connect.
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,
which we couldn't access remotely, mainly because the person who gave out the passwords wasn't there.
So it was one of those things. So we had to use this slightly more.
What's the word? Generic piece of software. SurveyMonkey. But it works, right?
It works all right in the end. But apart from that, the kind of work that I personally was doing, the qualitative interviews,
the analysis of policy documents, the writing of policy advice could perfectly easily be done at my desk at home.
So I think I was quite lucky there. I'm also very lucky to live close to Port Meadows.
So, you know, the morning jogging or in the summer, the swimming all just happened, you know, perfectly easily.
I think that wasn't the case for many members of my staff, particularly the young academics who were living in small flats.
Perhaps two of them were sharing a desk and.
You know, having to take turns using one computer, you know, all those kinds of things.
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
actually getting the writing done was in some ways easier to do if you weren't in an office.
It was certainly no more difficult.
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.
But and so you have a nice window in my living room.
And I think when you say, you know, checking your email and turning off Twitter, look,
research at that time of the pandemic, Twitter was my data source and Twitter was my way of connecting to people.
That's really important to get across.
I got contacted early in the pandemic by a guy called Florian Stigler, who I think is Austrian, and FLORIDO met me once.
He reminded me that we'd met in a pub somewhere in London when he was doing an earlier piece of research,
but and he said, Would I join a COVID 19 researcher's email group?
And I thought, well, I got enough emails, but yeah,
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.
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.
This was real time research.
This was not something, this was not your conventional stuff.
We needed to generate and share knowledge in real time.
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.
It was called COVID 19 researchers. And people would come up and say things like, you know,
I've got a patient on a ward with seems to go fungal infection having been treated with antibiotics.
Should we start treating these patients with antibiotics when we know that this is a virus because maybe they'll get fungal super infection.
And immediately someone from somewhere would say, oh, yes, well, we've we've already reviewed this evidence.
And we've also got some routinely collected data on 100 patients, and this is what it shows.
And then people would have a confluence of we've got 100 patients and this happened.
And so it was absolutely amazing to see these these questions being addressed in real time.
Also, because the pandemic was hitting different countries at different times, you know, it was just amazing.
So that email list was important, but also social media.
You know, I've been on Twitter for a long time.
I got a lot of followers, although my followers, I think, quadrupled in, you know, since the beginning of the pandemic.
So I thought I'd love of over 40,000, you know, 160,000.
But the point about it is people were following other people who they thought would be able to give them useful information.
But what that meant was that if you had already curated your Twitter feed, you could immediately connect to, you know.
The World Health Organisation, the Lancet. The some of the top people in the NHS.
Who follows who on Twitter was really quite important.
So. So it wasn't that Twitter was a distraction from my research.
Twitter was my research. We recruited patients through it.
We recruited staff, participants through it.
And we got it all through the ethics committees. By the way, I think it's really important to say.
My husband is a retired academic, sits on the Oxford Bee, I think it is Research Ethics Committee.
And he was as busy as I was.
His Research Ethics Committee were looking at these very rapidly put together protocols for clinical trials for other kinds of human research.
And they were turning those very complex proposals around in 48 hours so that the
the bureaucracy of getting research up and running didn't delay the research.
So we'd already asked the Ethics Committee, please, can we recruit by Twitter?
You know, they said, well, yes, so long as you do this, this and this. So we were doing all that.
So in many ways it was quite exciting, although it was also quite scary.
And you know, for example, when my trainees receptionists died, when my own son got COVID in March 20, 21 as a junior doctor.
It was terrifying, to be honest. But that, I think, is why we were all working so hard.
So let's move on to another area of your research that I just I just very quickly scanned some of your recent papers.
And clearly something that's been preoccupying you a lot has been masks and airborne transmission.
What when did you first decide that was something that really needed addressing?
Um, again, early on and again through my contacts with the Chinese, we have to remember that songs and Murs were.
A. They weren't pandemics. They were epidemics that affected certain Asian countries.
And I think China, Japan, Hong Kong, Singapore, places like that that learned from those earlier epidemics.
They knew coronaviruses were airborne.
There was no doubt about that. In places like China and Japan, you know, it was just standard.
It was just known. And I suppose because I was talking to the Chinese and through Floridians, COVID 19 researchers,
email group, we were we were conversing with scientists around the world.
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,
a big performance of the St Matthew Passion in a big concert hall announced to done.
Pretty sure it's a boxing match of passion and of a choir of about 130 people.
Something like 100 of them got sick. The conductor ended up on intensive care.
And for me, that was incontrovertible evidence that this virus spreads through the air.
It was simply inconceivable that every member of that choir had touched the same doorknob and then licked their finger.
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.
And again, you know, when you vocalise you generate aerosols.
So from my perspective, I couldn't understand why everybody was on everybody.
But but an awful lot of influential people, certainly all the leading policy makers in the UK,
the W.H.O., were going crazy about hand-washing and scrubbing surfaces.
It just didn't make sense.
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.
And we wrote an article for the British Medical Journal about the precautionary principle.
Precautionary principle says when the risks of doing something massively outweigh the sorry,
but the benefits of doing something massively outweigh the risks, you might want to act before you have definitive evidence, just in case.
That's why it's called the precautionary principle.
And we said we think introducing masks would be a good idea, even though we don't have incontrovertible evidence that they will benefit.
Because if we're right, we could save hundreds of thousands of lives.
If we're wrong, it probably won't matter. It just means that people will be wearing these things for no reason.
What we had was Jenny Harries getting from Public Health England, getting up and saying masks could do enormous harm.
I had the slogan, it's it's a piece of cloth, not a land mine.
And yet the narrative from both the W.H.O. initially and from public health
policymaking in the U.K. was that masks probably didn't benefit you very much,
but they could do colossal harm. And.
I knew this wasn't right. Like, where do you think that idea came from?
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.
Now, the problem with airborne diseases is that they can spread like wildfire because airborne diseases come out when you breathe,
when you talk, when you sing and before you are symptomatic.
So very often in an infectious disease, you're actually most infectious the day before you get symptoms, you know, something like chicken pox.
It's no good. By the time that kids come out in spots, they've already given it to all their friends.
Grandmother. Yeah, exactly. Exactly. So. So we all know that with these able diseases, but airborne diseases for that reason,
if you look at where the W.H.O. talks about airborne diseases, it's in its bioterrorism manual.
And an airborne disease is one that you might use if you wanted to attack a country, you know, in a bioterrorist attack.
So, of course, when you've got a worldwide shortage of high grade PPE and when you have got an escalating pandemic,
which might not quite turn into a pandemic, you know, we it's something we're concerned about.
But do you remember sales didn't and birds didn't. So you don't want to embarrass yourself too much.
We don't really want to put out a message saying, oh, it's airborne.
It's airborne because everyone's going to panic. And what was driving Tedros, the director general of the W.H.O.?
What was driving him at the beginning was making sure people didn't overreact, making sure we didn't have mass panic.
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.
But having done that. He and others in the W.H.O. didn't want to backtrack.
And because they really wanted to reserve high grade PPE for people working in intensive care units,
for example, and doing aerosol generating procedures and all that kind of thing.
They stuck to their story. Which was just wrong.
We know it was wrong now. And I think interesting, we're making this for future historians,
but I think people will look back and be absolutely gobsmacked at how long it took
the W.H.O. to put out a clear and definitive message that this virus is airborne.
And we have to shift from what I call droplet theatre into airborne precautions.
And I've spent an awful lot of time and lost an awful lot of sleep on that topic.
Yes. And I interrupted you so we could go back to the point which so instead of talking about why they had that policy,
you had become convinced very early on that it was airborne.
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.
And I was cross because the BMJ had been sitting on it for three weeks because
they wanted to get peer reviewed and all that kind of thing and that paper.
Was very, very popular. It's been cited, I don't know, hundreds of times, but it didn't change policy straight away.
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,
particularly on public transport, we are not going to stop the spread of this predominantly airborne disease.
So I suppose I put stuff out on Twitter and then I went on television.
And then once you've been on television, once you get put on television again, you know,
etc., etc. and I did a lot of radio on this single message about wearing masks,
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,
and it was all about, you know, libertarian values and all the rest of it because it certainly isn't in Asia,
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.
And I got some very rude messages, shall we say, extraordinary messages actually, from people who thought I should shut up.
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.
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.
I think he was the chair of Nervtag.
What he meant was there is not definitive evidence from randomised controlled trials so you should stop behaving as if there is.
My response to him was I know there's not definitive evidence from randomised controlled trials.
I am not pretending that there is. What I am doing is invoking the precautionary principle and I am saying even
though there is not definitive evidence from randomised controlled trials,
we should still bring in mask mandates because hundreds of thousands of people are going to die if we don't.
And I think Peter will be still probably feels that I was I was jumping the
gun on masks and I'd be very happy to have a conversation with him about it.
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,
but that there isn't evidence that the virus is airborne.
Yes. Yes. So that's there's a group led by Carl Hennigan at the Centre for Evidence based Medicine in my department.
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.
So we had various medical students and relatively junior clinicians working on these reviews.
And one of the questions that we'd been asked was, should we be social distancing at two metres or one metre?
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,
of course it doesn't really matter whether it's two metres a one.
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,
just like if someone's smoking or if they farted it, these things travel through the air.
So yes, it is important to socially distance.
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.
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,
look, we're struggling here because cold is not what we've done, basically.
And I looked at what they did. They said, Well, you haven't gone far enough.
What you need to do is link up with an expert in aerosol transmission.
Now, experts in aerosol transmission do not assume that everything is an aerosol.
What they're good at is deciding whether something's in aerosol or not.
So I linked Nick Jones who was leading on that paper.
I link to video for Webber, who is who studies the aerodynamics of coughs and sneezes.
She's she's published a paper in the New England Journal. It's a.
Sneeze and kind of films them, that kind of thing.
And Lydia and various others not only do this in the Dumaresq here in Australia.
There's Kimberley Prather and her team in America.
There's host Jimenez, who's also in the different parts of America, and there's lots of aerosol scientists.
And I linked my team with one of those aerosol scientists,
and we produced a paper which brought in all this aerosol science that I hadn't really realised existed, interdisciplinary work again.
And I then began to work with the aerosol scientists and I realised that the stuff they were doing was really pivotal.
It was absolutely pivotal, but it was being ignored, completely ignored by Public Health England,
by the W.H.O. and initially by the CDC in America, although they came around.
Now, there was a meeting in October, I think.
Well, actually, the aerosol scientist wrote to the W.H.O. on I think it was the 8th of July.
They said an open letter to the W.H.O. say 2020.
So yeah, we're still in 2020. So early July, 20, 27th, July, an open letter from over 200 aerosol scientists.
And look, the evidence is overwhelming that this virus is airborne.
It's overwhelming. Your key infection control committee does not include any expertise in aerosol science.
Please, can we help? We are available.
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.
We don't want you help. And I was gobsmacked.
I was absolutely gobsmacked. I realised what was happening was and this sort of draws on my background as a social scientist who has
read sort of critical sociologists like Pierre Bourdieu around the links between science and power.
And again, I put out a tweet actually, anyone an expert in Bonjour,
we need to look at this through the lens of critical sociology, critical philosophy of science.
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.
So one sociologist, then a big sociologist really.
And we did a deep dive into what was going on in key W.H.O. committees,
Public Health England committees about how they had systematically dismissed and denied aerosol science.
How, you know, the slogan I was using was Evidence is what powerful people say it is.
And there were people who were on the key committees were saying, this evidence counts, that evidence doesn't count.
And that needed to be analysed in an academic way.
So we published a paper on Welcome Open Research all about orthodoxy and heterodoxy, which are these terms that both introduced the orthodox view.
Code word is spread by droplets. Hand-washing is important. Scrubbing surfaces is important.
Quarantining your post is important. Aerosol is an important.
That was the orthodoxy. The heterodoxy was. Look, this is an airborne disease.
How did all that? How did the choir get sick?
You know, if it wasn't an airborne disease. And here is chapter and verse from aerosol science.
But they weren't getting a look in because they weren't on the relevant committees.
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.
Because it would erode that power base. And that was happening internationally.
The W.H.O. nationally in places like Public Health England and indeed in local public health departments and right down to schools.
For example, I read only this morning of a nine year old child who had gone to school and said we really ought to
still be wearing masks because the virus is airborne and the child being told off by the teacher saying,
no, it's not. It's spread by droplets. You must keep washing your hands.
And someone had tweeted me saying, Can you please help my nine year old?
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.
Therefore, my science is more correct than your science.
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,
probably the paper that has had the most influence actually. So I worked with Kim Prather with her, said Jimenez,
with a couple of infectious diseases guys to write a piece for The Lancet called Ten Scientific Reasons Why.
We Know that the SARS-CoV-2 virus is everyone. It was very derivative.
It was summarising. Stuff that had already been published.
Stuff that was bombed for obvious to aerosol scientists.
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.
We needed to do a power play, if you like. And that was publish something in one of the world's leading journals,
which was short enough and punchy enough for people to get their heads around it
because they were publishing in journals such as this journal called Indoor Air.
Well, when did you last pick up a copy of Indoor Air to read it?
It was too nice, you know. So we needed to shift the publications from even from places like science.
Yeah. That's a pretty mainstream high impact journal actually, that I read those.
But they do read The Lancet, they do read the British Medical Journal, so we needed to get stuff in there anyway.
We constructed that paper and we lobbied and lobbied the editors of The Lancet and they said, Yeah, right.
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.
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.,
this particular committee that didn't have any errors or scientists, they'd been published to do that.
They're funded to do a systematic review which had just concluded that there was
not really any there wasn't enough evidence of airborne spread to take any action.
And I was still mourning the death of my mother.
My mother had gone into hospital, having had a fall and having been completely isolated in the nineties,
had spent while on a trolley in the A&E department and had come back and very quickly developed COVID.
I jolly well knew she'd caught it through the air in the hospital.
It was, you know, and I suppose that drove me to feel particularly passionate and to give this a particularly strong piece.
But, you know, we had wave to wave two was worse than wave one, you know.
Tens of thousands of people had died and was still dying.
So that was the context of this. And then co-head and group having.
Had a very narrow and a theoretical approach to the question of whether this this virus was airborne.
They published this systematic review as a preprint, and it has actually failed peer review and still has failed peer review that it was.
It was published on an open preprint server, open peer review.
And three scientists said, this is flaky.
This is not good science. Now, this is not something I would normally do.
I do not go around disparaging other scientists, and I'm not disparaging the scientists.
But that particular systematic review,
which was the official W.H.O. funded review on which international guidance was going to be based, was scientifically flawed.
We had to make noise about it. So within it took us ten days to pull together the evidence.
And we published that paper in The Lancet ten scientific reasons why we know this and put on that paper.
It's now it's still in the top 20 of our metric schools of all time.
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?
It's also been cited hundreds of times and it was peer reviewed.
It was independently peer reviewed. So I've never tried harder in my life to get a piece of a publication out there.
We did loads of TV interviews all around the world and the W.H.O. took notice.
So senior people in the W.H.O. contacted particularly Zeynep Tufekci.
Actually, she's a social sociology professor, but she's also a leading journalist.
She really understands how to play the media, and she co-authored that.
And Zeynep actually worked with a couple of senior people at the show, and I think some of them.
Said. You may be right.
You may be right. And one or two publications from the W.H.O. started to acknowledge airborne transmission.
But the relevant committee, the key committee, which was the one that puts out that scientific brief in July 2019,
is still to this day saying that the virus is only situation of the apple,
in other words, in aerosol generating procedures and in highly unusual settings where there's a high degree of crowding.
And that is still something that I worry about and I'm cross about and I lose sleep about.
But I think we did move the needle with that paper. Right now recruiting again.
So, yes, just to sort of follow up on that, has the work you've done on area transmission,
airborne transmission changed policy, for instance, in this country?
You've told me what's happened in W.H.O.
I think the work I did on masks, I think did have some influence on the policy decision to introduce masking in July 2020.
I think the work I've done on airborne transmission has had some influence, but I think to be honest,
what's happening in the UK at the moment, speaking in early November 21, is.
We seem to have gone into a policy of relying on vaccination and assuming that we now can drop all other measures.
So the question of whether this is an airborne virus or drops the virus has really
been parked because it's now seen to be a virus that's controlled by vaccination.
And there is a narrative that we have uncoupled the from the transmission of the disease from severe effects, the disease.
That is not a view I personally hold.
It's only a couple of days since we have 9300 deaths in this country.
You know, we're regularly getting over 200 deaths a day.
And yet it is assumed that because everyone is vaccinated or many people are vaccinated, it's not a serious disease anymore.
We've kind of conquered it. That is highly, highly problematic.
I am very, very troubled by this concocted truth in inverted commas.
I wish the debate on the mode of transmission was front and centre, but it is not currently, which is a great shame.
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.
Actually, there's another question on both of us. Evidence based medicine.
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.
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.
Broken down in a way, because you have to question what is what is evidence?
How is how do you decide what evidence to pay attention to what what's your view on that?
It's very, very interesting, isn't it? I think evidence based medicine was a very clever piece of marketing.
And actually Mayor Grey, who is a professor,
claims to have developed the term evidence based medicine to kind of market the ideas of clinical epidemiology.
And clinical epidemiology says if you want to make a treatment decision in an individual patient or indeed diagnosis decision,
you should be taking account of research into populations.
You shouldn't just be treating the patient on the basis of whether the previous patient got better on a particular drug.
Now, I think we're all signed up to that, but that doesn't mean that the methods and evidence hierarchies that are appropriate
for assessing the efficacy of drugs or the the accuracy of diagnostic tests.
Applied to every aspect of anything health related.
And I think the evidence hierarchy of evidence based medicine has been naively misapplied to dismiss aerosol science.
And if you go back to what I was saying about interdisciplinarity and how my
own personal doctoral work shifted from a biochemical focus to a much broader,
you know, anthropological focus and. I think we need people who can change horses.
Change disciplinary horses when it's needed. And the problem with evidence based medicine is.
It's really just code for clinical epidemiology and it is a unique disciplinary perspective which favours epidemiology.
And we don't need epidemiology, or at least it shouldn't have an exclusive or privileged position.
I mean, the epidemiology of COPE is very important. But when what when the question is, is the virus airborne?
You need aerosol scientists. You don't need clinical epidemiologists because they're not trained to do that.
This seems to me to be such a basic thing.
I honestly. Cannot.
I can understand why people got it wrong, because it's all about the link between science and power.
But. It's it's something I think future historians are going to look back and say, gosh, gosh.
Even with so much research funding, so much scientific evidence, they still completely dropped the ball there.
That's great. Thank you. I think, again, you mentioned this a bit that we can develop it a bit.
To what extent have you personally felt threatened by the infection, either in the initial phase or more recently?
I've taken this infection very seriously, and I haven't had it.
I have you know, I'm a cancer survivor.
I've been very sick with sepsis in the past.
And I don't want to repeat that experience because I was convinced from an early stage that this virus was airborne.
I have not been on public transport since the beginning of the pandemic.
I have only been into my department three or four times.
Every single time was on a Sunday or late at night when there wasn't anyone else in the building.
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.
So. You know, I have personally had it's as I said, my mother died of it.
My son had what was actually pretty mild COVID.
So it wasn't very nice at the time. But you know, ten days later with better and.
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.
You know, all were homeschooling their kids, that kind of thing.
And I think I'm not alone in that, but certainly.
It was a bit of a struggle. But, you know, that was a sort of indirect, really.
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.
Did you work longer hours than normal during the pandemic? No, crazy.
I was absolutely crazy. I was. And in fact, someone asked me recently,
what would you have done differently if you if you if we could kind of play that first few months of the pandemic again?
And I said I would I would have taken more breaks because we were working at an extraordinary pace, an absolutely blistering pace.
I've published more than 50 papers in 2020.
You know, it's one week. It was crazy.
And actually I published over 40 this year and it finished.
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.
There were an awful lot of papers that weren't that good, actually, looking back.
And although every single one of them was done in good faith, we tried hard.
I think if we taken a step back, taken a weekend off from time to time,
something like that, we may have done a few pieces of work, but done them slightly better.
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.
Because that first masks paper, the one for the precautionary principle.
It only took a couple of days to write. We didn't know it was going to go viral.
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?
But in the in the fast unfolding of events, it was quite hard to know what to focus on.
And I think, I mean, you said it was five months that you had this extremely intense period,
the implication being that since then you haven't been getting it quite such a blistering pace.
But on the other hand, you have produced you did produce a huge number of papers.
Did you actually get a chance to take time off or did you institute a regime of regular breaks from that time?
Um. I've had two weeks holiday in the last two years and I got another one the week after next month.
She said that by three weeks in two years. So that's not very much.
On the other hand, it's quite hard to go on holiday. I do stop now most evenings.
I think. The pace of work.
I think doing 16 hour days was crazy.
So now I could do 12 hour days. But there's still plenty of work to do, actually.
And also, although, you know, I'm working long hours, as I said, I don't feel particularly stressed by it now.
It's quite fulfilling. I'm finishing off quite a lot of projects that have been running for a few months.
I'm finding it quite sort of comfortable intellectually.
There's some very, very interesting philosophical work I haven't talked about much, but for example,
I've been linking up with some pragmatist philosophers because I think pragmatism is a really,
really interesting theoretical lens to look at the pandemic through.
So one of the papers I've got under review at the moment is around.
Crisis policymaking through a pragmatist lens.
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,
which was very much about how can we stop people dying today and tomorrow?
I've now shifted gears a bit and started thinking.
Wait a minute. What does this pandemic tell us about pandemics generally or crises generally?
And that, I think, is is quite rewarding and productive.
You know, you can see all the. Feel particularly stressed right now.
Time to do this interview if you don't speak about this 18 months ago and I said sorry, ample time.
So I think things are settling down a bit. Yeah, I do.
Is there anything that you do within your group to support the emotional well-being of your colleagues?
That's a really interesting one, isn't it? I am cynical about some of the emotional well-being stuff that goes around.
So we have this email that comes around every Wednesday and the headline is Wellbeing
Wednesday and it says things like Take 20 minutes away from your work or that kind of thing.
It's too formalised, it's too technocratic.
It's like going on a resilience course. I think the way.
I have. Tended to do it is.
Picking up a lot of bitty things that people weren't coping with.
And so I would pick them up and.
You know, help them with it. Various people,
various of my early career researchers had been slogging away at a paper for months
and not being very productive because all the stuff that was going on and I.
Had more input to those papers than I would normally have had,
but I've made sure that they got the paper finished, submitted and published, so they've got the line on the CV.
I actually think that kind of input is a lot more helpful than let's all have a virtual coffee morning.
Although we do do virtual coffee. It happens once a week.
They tend to do it without me, actually. Some people find it very helpful.
Some people don't. I've done. A couple of other things with my group.
I'm friends with a Danish academic called Nina.
Maya, and Nina has an interest in.
The support of the and mid-career researchers.
That's one of her research interests.
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.
And she said, Is there anything I can do? And I said, Well, can you do some sessions for my team?
So she did some virtual sessions on academic writing and helped individual members
of my team with some of their papers and gave them feedback on drafts of writing.
And they found that enormously helpful.
I think mainly because Nina is wonderfully gentle and slightly motherly and in a nice way, if I can say that.
And it was because it wasn't me helping them.
I think they were sort of saying interests kind of going off saving the planet.
We've got this protected space with Nina who's not doing pandemic stuff.
She is committed to us. And actually I use some of my pandemic money to.
Pay her for that. Now, talking of pay and money.
We also responded. We applied for University of Oxford Pandemic Funds to return people to work after the pandemic.
Now we have lots of different people with different problems and challenges.
But what I did was I helped, I think, seven or eight members of my team each to apply for £5,000.
And we used that money to pay the salary of somebody who came in as a research assistant, and they used her time.
Flexibly however they wanted. So they said, Please, I want you to help me do the background work for grant application.
I want you to help me finish this paper.
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.
But it was also good because I said to people, I don't care what you do, I don't want to.
I don't even want to know. Here's an extra pair of hands.
And people would say, Oh, that's brilliant. That's just what I need.
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.
So practical help was important. Um, what else?
Sounds like pragmatism again? Yeah, just. It was very pragmatic. But then.
But then pragmatism. It's not just about being practical.
It does have a kind of philosophical underpinning, which is.
Which is something I'm getting quite interested in.
But I didn't say onto this tape because I'm actually a novice on pragmatism and I probably get it wrong.
So were you involved in your institution department's code safety regime?
No, no, I offered to be, yes. But I was told that I wasn't needed.
And what you satisfied with how it was implemented? No. There's droplets which are everywhere.
But she's want to go in. I'm quite gobsmacked actually at the.
The way in which job that theatre has.
Dominated Oxford's response and the way.
Airborne precautions have not been taken on. I'm just I think yesterday or the day before, we published a new paper.
Peer reviewed and welcome. Open research. All about getting back to campus, you know, returning to on site teaching.
It was a rapid, systematic review of the literature on what should be done.
The most important thing is vaccinating staff and students and getting vaccination levels up to 90%, if we can.
The next most important thing is instigating airborne precautions, including mosques, etc.,
etc. and that we published it or a version of it through the U.S. you through universities and college union.
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.
But it hasn't kind of hit the desks of the people who are running the response.
And my emails. I don't think I've had replies to them.
So. Yeah, that sad. Sad.
On the other hand, if we talk about emotional well-being, you know, in the end,
you can only do your best in the end if they're not going to take any notice.
I'm. I mean, I remember when I was a junior doctor,
I used to cry myself to sleep when a patient died and someone took me aside and said, You never can survive in medicine.
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,
and you, you know, you would there and you put the monitor on and they still died.
They were going to die. And it's not your fault.
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.
So I've done my best. I've made my offer.
I've published these very high profile papers.
And if they choose to ignore it. You know.
I'm not going to beat myself up. You mentioned earlier that your public profile with you cannot tell you at all.
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.
Um. It was it's not something I was seeking out.
I don't court the media. I don't have an agent.
I say no to 90% of requests.
And I've very narrow, very much narrowed down.
So people have phoned me up. They will call my mobile number. They say, please, will you be?
I got a phone call yesterday because you have Good Morning Britain tomorrow.
And then you say, what's it for? And they'd say something.
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.
So I will say, No, I'm not going to talk on that.
I'll talk about masks and I'll talk about airport precautions, and that's it.
And they'll talk actually about revoke, but they can go find someone else to talk about the other stuff.
But actually, in recent weeks, I've refused all media.
And that's partly because although I'm not feeling particularly stress did actually stresses my family
it stresses my husband and it's often they want you at 10:00 at night and then they'll keep you waiting.
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.
So I've done quite a bit. It's.
It's very time consuming.
I don't like the attention. I don't like if I've done a TV appearance.
I can get 20 emails from people saying, Can you do local radio tomorrow?
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.
Yeah, I don't need explicit examples, but I mean, it's it's it's something that anybody with a high profile.
Yes, I think so. I think the mosques thing has been the worst.
People have. Systematically set up groups to attack me.
There are the sort of dark Web sites of, you know, libertarian groups.
I know that I'm on that list.
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,
all saying very much the same thing as if they've been told that this is the version to use.
And sometimes it's identical text and you just think.
I've got better things to do with my time than engage with that.
And I go around knocking people. But this is this is not what I want to spend my time doing.
It's time consuming. It's exhausting. It upsets my husband because he doesn't either.
I mean, I was there was someone put out on Twitter the other day that I should be raped with a bayonet.
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.
It really didn't bother me that much. But, my goodness, you know, it upset my news to do so.
And I don't really want to spend my time inviting that kind of thing.
I don't lose a lot of sleep over it. I just try to avoid it.
How did you find out in general, you have found Twitter useful?
Yeah, because I because I control I block people.
I use mass blocking tools sometimes to block everybody who follows a particular extreme libertarian thing.
But if they're following that person, I don't want them to have anything to do with me.
So I'll put 500 of them or something and then I have to apologise sometimes because sometimes people
have followed them and then they've forgotten they're following them and they don't agree with them.
So I have to kind of unblock people, but that's what you have to do.
I said, okay, there will be one, right? Another 10 minutes.
So how have you. I'll just just clarify this.
I think we talked about a little bit earlier, but are you are you not associated directly with any policymaking body?
Oh, goodness. Now, I'd better get this right at night. Until quite recently, I sat on a committee at the World Health Organisation.
But it wasn't the one that was dealing with the current response.
So it was the Alliance for Health Policy and Systems Research.
I sit on, I think last count, about 13 national committees.
I am on the long COVID National Task Force. I was on the nice oversight group for the long COVID guideline.
I've done various pieces of work with the.
What's it called? NHS England. Digital Primary Care.
Primary Care Digital Transformation Team. That's what its primary care digital transformation team think.
I'm an official advisor to them. So, you know, one one works with policymakers.
Yes. But I'm not on any of the formal convened the ones that are.
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.
I applied to be on the stage, actually, and I was told that my expertise wasn't appropriate,
which I think is quite what the other ones I'm giving you.
I'm not all any of those know, and I'm not even an independent sage,
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.
But I have appeared on the Independent Sage, you know, that broadcasts because, you know, I've gone there as a guest.
So I'm friends with them, shall we say.
So has the work you've done raised new questions that you might be interested in exploring in the future?
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,
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,
interpret it, apply it all in a big sort of unfolding jumble, if you like.
And that's interesting. That is the thing that's most grabbing me at the moment, actually.
Yeah. The last question Has the experience of Kogi changed your attitude or approach
to your work and all the things that you'd like to see change in the future?
Um. That's a really interesting question.
And out of all the questions you've asked me, it's the only one I haven't got an immediate answer for.
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.
But it's because I'm still experiencing it, I think.
What on earth is going to happen in the future? I don't know.
I mean, I've got a, um, I've got an application which I doubt will be funded,
which I'd put in about nine months ago for a leaf, a human senior fellowship to write a book about Wittgenstein.
And there was a.
A friend of Wittgenstein, who was a doctor who wrote a book called The Danger of Words is a chapter called Maurice Drury.
But it's all about how some of Wittgenstein's insights are very relevant to medicine.
I applied to Lever. HUME to.
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.
But actually some of the work of the later Wittgenstein would be incredibly relevant now.
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.
Would that be wonderful? And then I thought, would I actually do that?
Because I would have thought when I wrote the application, I thought the pandemic would be over by now.
Whereas actually with pandemics now grumbling along, there's all sorts of, you know, terrible things happening.
I'd be dropping all precautions because of the, you know, the idea that we think we're vaccinated.
So that's that can I really kind of just go and sit in the Bodleian and write a book about Wittgenstein?
Even if I get funding, I'm not sure. I really don't know what the answer to that is.
It'd be interesting, anyway, that that my hand would probably be forced because they probably won't fund it.
But it would be it would be a big change. It would complete transformation if I did get it.
Thank you very much. Oh, don't do that. Okay.