So can you just start by saying your name and your affiliation?
Yes. I'm Paul Harrison, professor of psychiatry at the University of Oxford and also a consultant, general adult psychiatrist.
And first of all, can you just tell me a little bit about yourself?
How did you briefly get to be where you are now?
So I had a fairly conventional academic medical training, so I trained in Oxford and in London,
had a welcome Sydney fellowship and was appointed my current chair, which is the reading positions country back in the early 1990s.
And I've been here ever since and until COVID came along,
my main research interest was into serious mental illnesses like schizophrenia, bipolar disorder.
And I've done a range of different sorts of research study broadly within the biological end of the psychiatric research field.
Mm hmm. And if there's one overarching question that gets you out of bed in the morning, what would you say it was?
I think it's trying to understand the the biological basis of serious mental
illness and how we can use that information to treat the conditions better. And so what techniques have you mostly used to explore that question?
And over the years, I've done everything from post mortem neuropathology,
structuring, function, brain imaging, experimental medicine, clinical trials.
So I've I've dabbled in a range of methodologies from the very basic mechanisms through terms like clinical trials of patients.
But it's very much at the biological end. Yes, it is like that.
You don't need the conventional picture of what people think, of what they think of the psychiatrists.
I suppose that's probably true. I think it gets down to remembering, of course, psychiatry's as much of medical speciality as haematology oncology.
I think you're right.
A lot of both Lay and some of the medical people think of us not really as doctors, but if you like, a psychologist or therapist.
I'm very much in the camp of first and foremost sees myself as a doctor and ascribe to the values and beliefs of doctors.
And I just happened to be applying it to conditions we call psychiatric. So moving on to Kobe itself.
Can you remember when you first became aware that there was a pandemic in the offing?
Yes, I do. I was skiing in northern Italy just at the time when the first case was okay.
I was there about four weeks before.
I think it got really serious on there because I remember talking to my from holidays thing goes to think this is going to spread.
Is this going to be another like a bird flu or a previous sort of virus to beat around?
But it was beginning to look worrying then. And then, of course, we had within weeks of being home,
we were into the full realisation what was going to happen and the Government deciding what it was or wasn't going to do about it.
And how soon was it before you thought, this is something I need to pivot my research towards?
And I mean, was that something? Was there an external push for that and that just come from talking to clients?
Yeah, I think my recollection of the course and prior to that time was, was just how are we going to cope with the pandemic and lockdown?
So I had both kind of coping with the practical restrictions that were being imposed on us as individuals and as members of university,
the labs, closing sector, etc. But my second main thought was as a doctor, how is this going to affect what I should be doing?
Because I think in the very early stages when the the fear that we were going to be completely overwhelmed and the NHS would be a number of us,
even a psychologist would think about should we begin offering services to the excellent department, should we be offering to go to another man?
Ventilators. Some fairly scary thoughts for us and for our potential patients, I can assure you.
But then whilst that was happening and as it became more apparent that level of and we can reposition or take away it wasn't going to happen,
we began to think more. How could we as psychiatrists help deal with the mental health consequences of lockdown as well as of COVID infection itself?
And so the work over the coming months and talking kind of spring to summer 2020,
our research saw clinical my clinical work very much moved in part to looking
after people that had COVID and dealing with their mental health separately,
but also thinking how can we use our research opportunities in the time that's been made free?
Because our previous previous studies offered to stop trying to use some of our academic
abilities to try and answer some of the important questions that were becoming apparent.
So let's just go back and unpack some of that.
So first of all, the impact of the measures that were taken, the closing of departments and so on, I mean, patients don't stop being ill.
How did you cope with that? Yes. So again, in the beginning,
I think we were unclear how much the mental health services are going to be overwhelmed and indeed how much the mental inpatients in the psychiatric
hospital here were going to be infected with COVID and we were going to be turned into almost a medical extension of the John Ratcliffe Hospital.
So I remember for about a six week period, we wrote daily calls with the hospital management looking at numbers of cases, how many stopped being sick?
How could you keep the wards open? How could we as as honorary consultants help the mental health trust efforts to keep clinical services going and
adapt them to what was thought to be a change in the kinds of patients and the kind of problems we're going to have.
So there was a lot of kind of detailed attention to try med plans were going to keep the service going under what were difficult circumstances.
And there were some fairly, you know, cataclysmic predictions of how bad it was going to get before we realised it wasn't to be quite that awful.
And then gradually over the months as the, the reality sort of settled down, it became clear what was a problem, what wasn't regrets.
We went back more towards our normal ways of working within the constraints of the pandemic.
Yes, it was. Was that much of a problem of infection in the.
In the patients in the room?
Yes, most I think all the wards had an outbreak, as you might expect, of some patients, and that the main problem was the staff going off.
And of course, this was before the vaccines were around and quite a lot of the staff this hospital were from the more vulnerable communities,
the population. So that was a real challenge, I think, for the for the hospital management to keep the wards open and, you know, safely staffed.
But that probably gradually got batteries as things settle down and as the vaccines came on.
And did you spend any of the second of what you said?
Did you experience an increase in people with mental health difficulties as a result of COVID infection?
Yes, but I think, again, less than we were expecting in the beginning,
and that was partly because, for example, the trust put in a 24 seven phone helpline.
So recognising the fact that most people couldn't or wouldn't come on site.
Nothing the pandemic has done for my area of medicine is has transformed the
views about the importance of face to face as opposed to remote assessments.
And that change happened really remarkably quickly and surprisingly effort,
not effort as it was a lot of technological questions, but it's been much less problematic,
I think both of us as practitioners and most of our patients, and I think we would have thought and kind of jump ahead to where we are now.
It's already leading to changes to think about how we envisage psychiatry being practised in the future
with an assumption that you need to be in the same room with someone every single time for a setting.
I don't think any of us think we can go back to that. We're trying to work out what's the right compromise, what flexibility should we offer.
So I think that be one of the more interesting positive outcomes of the pandemic forced change upon us,
which otherwise I think we'd have been screaming towards.
Actually, it's worked out for me in most respects, but what kind of problems did people who had the disease said?
Well, I mean, in the beginning, especially when case numbers were low,
it wasn't really people who's had COVID so much because they were so rare off that they were individual patients of interest that people noticed.
It was really how were the population coping with lockdown and the fear of illness?
And what was going to happen after lockdown was that would they have lost their job?
Would they lose their parents?
They couldn't visit all the kind of real stuff that we all went through, and it was really helping them, if not the worried, well, the people.
One of the implications of the pandemic, it was only later as the number of confirmed cases grew.
But the suggestion there might be a link between actually having the infection and getting mental health problems became more apparent.
And that's really where my particular research interest, the pandemic, developed from.
So how easy was it to identify the kinds of research questions you might explore and bring them into some kind of focus on I.
How did you know where to start? Okay. So in any parallel that you're trying to keep the clinical service going and all the other stuff within the
department here where there's a lot of academics and most of whose research I've seen since you stopped,
we had a number of Zoom meetings where we all kind of thought about where could be, where could we make a difference,
where are the opportunities that we can take advantage of whatever connections, skills we have.
And so a number of my colleagues really set off really, I think,
what have been leading programs in the kind of mental health of COVID in different areas.
My own interest was really fortunate.
I took advantage of a fortunate coincidence because my main work is a big lab based and that couldn't happen by chance.
A few months before the pandemic began, I'd started working on a big electronic health records network,
mostly in the U.S., but in other parts of the world as well. And I realised,
and I remember distinctly suddenly having thing on the light bulb that was in my head of there are 80
million patients in this dataset and their recording pretty much in real time diagnosis of COVID.
And the first time I went to this database, which must have been early summer 2020,
there already about 50,000 people there who had a diagnosis of COVID.
So what can you do? You have to be very bright. Now, I can use these data to say what risks of those 60 what it was 50,000 patients
packed in the coming weeks and months in terms of the mental health diagnoses.
I could compare the people who've had COVID with people who've had other health events like flu or broken leg.
And similarly, I can see to what extent does having a previous psychiatric history affect your risk of getting COVID?
So it was taking advantage of electronic health records, and the fact I had paid by chance started working with them.
That gave us the opportunity to say, okay,
let's try and get some robust real world data on the incidences and the risks of the common mental health conditions using this network.
So tell me a bit more about about the network.
I mean, I know about UK Biobank and that's half a million people, but we're talking about much, much larger numbers.
And how did that network. Well, so it's a it's sort of federated mental health network is Hamilton,
which has its proprietary name, which has become an index and gets everyone's interested.
And in fact, there are two or three of these in the states now particularly which between them cover the majority of the American population.
And they do it because that partly because they're collecting health data, because of the way that you pay for health care in the US.
So all the health care providers have to be fairly organised and about 60 or 70 of the big health care providers
scattered across the US should upload their data anonymized to these electronic health records network.
And the reason they set it up was to was because pharmaceutical companies wanted
to know where can I find the patients with the following characteristics?
Because I wanted a clinical trial of a new drug, for example, or whatever else,
and so they would pay the network for access to these data to find out where they would go to keep their patients.
A couple of years ago, the network realised that actually this kind of information could be quite useful academically for nothing.
I've got no interest in drug development in this regard at all. And so for reasons I can go into, if you're interested, I was, I think,
the first academic anywhere in the world to be given unrestricted and free access to this network.
Well, I think because the network saw the value of someone like me could demonstrate how useful their data were for academics.
They might, in the future, I imagine, want to make academics pay for access like you do from any other big data dataset.
And so we had been working with this network, and I kind of learned how to use it the full time it came along,
which is why I say I was very fortunate to then be in a position not only to know how to ask the questions,
but have access to what I think most of the time is the biggest single electronic health records in network in the world.
So what was the first question that you posed? Yeah.
So giving a talk every time.
And I should I should acknowledge this point that all the work, if we can talk about the work that's happened subsequently,
has really been driven by a junior psychiatrist called Max Tackett, who's a trainee who again happened to have an extraordinary skill set.
That meant he was able not only to interrogate this network like I could,
but he grew so much more sophisticated things and he's kind of managed to reverse engineer some analysis,
and he has enabled us to do quite sophisticated approaches rather than simply counting counting bodies, if you like.
So given the time we took in all summer 2020,
so the epidemic was kind of three or four months in and I say we had probably had 60 or so thousand patients COVID.
By the time we did the definitive analysis, we simply asked the question, in three months after diagnosis of COVID,
what percent of those patients have been given a diagnosis of any of the common psychiatric conditions depression, anxiety, psychosis and so on?
And similarly, what were your risks of COVID if you had a psychiatric diagnosis beforehand, then, if you didn't?
And so essentially that first paper was about the numbers, the percentages,
as well as the comparison with other health conditions to show that you were more
likely to get a psychiatric diagnosis after COVID than you were after anything else.
We compared COVID two, and importantly, having managed the patients for all that other characteristics.
So we did what we could to rule out the non-specific,
to allow us to answer the question How much of this is really about COVID itself as opposed to just being ill or indeed living through the pandemic?
And the numbers, the sheer numbers in this network? Yes, it gave us that all that was extremely reliable.
Yeah, exactly. It was very severe. The statistics, of course, you get statistics if you die for cancer, more samples.
And another way of saying is a composite was a very tight so we had they were very precise estimates so we could say I forget the exact numbers.
But for example, something like a first episode of depression occurred in 4.8% of patients and we were pretty sure it was between 4.7 and 4.9.
So these were really, I think, the first good data with the limitations of records data,
but they were about as good data as you could have had for that point of the pandemic.
And I think probably because of that, that paper got picked up again remarkably by the media in a way I've never experienced in research career,
not because it was spectacular research, but it was such a pressing question that the world's media wanted answers to.
And we gave some of the first answers.
And those answers presumably are highly relevant to how clinical services are delivered and what sort of care and health services are delivered.
And in the future, you would you would think so.
I mean, in the beginning, I'm not sure that was really the interest because again, the numbers of people who were getting COVID was so small,
people were still interested in what's the whole population's mental health going to be.
But yes, all data in the subsequent papers we've done, I think, do highlight that whatever the pandemic has done to all of our mental health,
it's done something worse or greater to the people who've been unfortunate enough to get COVID itself.
And that's become more apparent, I think, as the pandemic has progressed. So that was the first study and making a list here.
So I think oh yes. You said you were also interested in whether having a previous diagnosis of mental health difficulties increased your chances of.
Yes, I know that that was really very much a kind of perspective thing.
I remember just thinking, well, what are we doing? One question, what have we answer the other?
Because it's kind of a lot of the work is the same. I don't think we really had to predict a particular prediction hypothesis.
And we did find this paper that if you had had a previous diagnosis of something like depression or anxiety or schizophrenia,
you were almost two thirds more likely to go and covi by the time we did the study than matched people who didn't have a mental health disorder.
So even while it's quite striking, interesting, in the week before we published in another big electronic health records network,
some another group found exactly the same, if not even more striking effects of the time I've been picking about both.
The big studies were both agreeing that this there was a connection between your mental health and your risk of COVID.
Lots of speculation on what a mechanism might be. And I have to say we haven't really drilled down much further to that.
But certainly it was that that fact was one of the reasons, I believe,
why the government prioritised patients with serious mental illness in the original
vaccine rollout because of evidence it was presented at the House of Commons.
I believe that our data had suggested these were a vulnerable population, so that was quite a nice distraction.
Beyond the media interest which was found at its own challenges, it was actually making a difference,
at least to to some policies that would help one patient but one.
So what possible explanation was that? There are they are a vulnerable group, period.
They're going to be both vulnerable to mental health difficulties and vulnerable to cope.
It is that it's not necessarily that the mental health difficulties make them more vulnerable.
Well. You know, you're right. It absolutely could be either of those.
And so simplistic in one view is that whatever your biology is that gave you the mental health disorder vulnerable,
that the same biology might make you vulnerable to COVID.
So, for example, brain inflammation, to take a simple concept, if you like, a biological link between those two things.
On the other hand, you know that people with a particular serious mental illness have different lifestyles than as healthy generally.
They may have higher body mass index is, they smoke more, they may have more problems isolating, etc., etc.
So my own view is it was more likely to be something about the behavioural correlates of having a mental illness that really a direct biological link.
And then way the same question about is the link about biology or if you like,
sociology applies to the the fact you get a mental diagnosis after COVID.
Is it that the COVID virus has directly done something to you that has made you vulnerable to develop depression, anxiety, for example?
Or is it having had a what could have been a life in this,
has left you feeling traumatised in a psychological sense and this the diagnoses just reflect that.
So again, that's that of open question. Yes, it is.
There's data beginning to come through that may shed light on that.
But one of the limitations of electronic health records research, you can only really answer questions that have been coded in the medical records.
And I don't think we have we have yet worked out a way that we could do that.
And dissection of aetiology, of causes, effects.
So so another phenomenon that you've looked at, which, again, is being in the media a lot, is what's come to be known as long COVID.
The idea that people have impairments to their health that can hang around for a year or what.
What did your network studies show that?
Yes, that was a much more recent paper where we we looked at what were essentially a group of nine cardinal features of COVID.
One of the challenges of research on COVID is nobody knows what it is. It's sort of a rather circular argument.
But we captured nine we thought features and claims that captured most people's views about the common things and on COVID.
And the key ones were specifically looking at things like ongoing breathlessness, ongoing aches and pains, fatigue,
brain fog, etc. So we had nine things like that and again in the six months, particularly the 3 to 6 month period after.
So we're trying to now not look at the acute symptoms or the peak of three months later.
Then what happens in the next three months?
What percent of patients have been diagnosed with one or more of those nine core long tapered features with these people all hospitalised,
the way they know this is that everybody had had them. By this stage we talk about over a quarter of a million patients in COVID.
That's pandemic.
So due to your sample sizes, they come up every time you look in all in the network, they've all been working in sensitivity analysis.
We compared people who've been hospitalised of those who had patients and took it to or two, you and those who hadn't.
So we had measures of severity,
but the bottom line is we found quite high rates of one or more of the long COVID features in eight people due to COVID,
not just those who'd been ill enough to need hospitalisation or intensive care.
On the other hand,
we also found that we did the same comparison again after influenza to try and control for having a virus or being ill during the time.
And rates were pretty high after influenza. And so, you know, depending which statistic you pick on,
we found that roughly maybe just over half patients after COVID have one or more of these long term features.
But so did a record, almost, almost a third of people after flu.
And interestingly, by that, I mean this and this paper, again, generated lots of media interest.
Interest, and this time the thing most media picked up on was was the flu findings and started talking about the flu,
which is quite an interesting different take on long COVID,
because it just highlights that we've actually known that all viruses can lead to persisting physical event,
that there's been something called post-viral acoustic speech.
And yet somehow people thought Koby was was unique and long COVID was something we've never seen before.
Oh, oh, data. I think this is just well, the probably something a bit different about it.
On the other hand, there's also a lot with similar. And I think at that point you think it was the politics of long COVID and this kind of
it's because it's was being defined by the people who were experiencing the symptoms.
It's a user led movement that I think poses challenges for trying to do unbiased research.
When you don't have print and fixed views about what it is or what it isn't.
So we just in this paper,
Regis presented a lot of data in as neutral way as we could and almost leave other people to interpret what they want from our findings.
So you mentioned you were also looking at how simply living through the pandemic, whether or not you have the illness, affects people's mental health.
And what were the instances you looked at was eating disorders, but with others as well.
How Colin did this? Yes, sir. In terms yes, you're right. So we've done the two sources is the only completed study that we're now.
We're we're using the same health network, but we're now not looking at people particularly.
You've had to go and now look at the whole of the collection. So this is more of the question what is the pandemic done to everybody's mental health?
And the reason we picked eating disorders was because by the time we answered,
we decided to investigate this question, which was probably spring this year for spring 2021.
There was quite a lot of anecdotal evidence that eating disorders were becoming common and apparently worse.
So a lot of clinicians, both locally and in other centres, both in the UK and abroad, were reporting quite an epidemic of eating disorders.
But really a noticeable increase in some of the data coming through naturally was supporting it.
So again, thought we would look at this in our research by using this network.
So we looked at the rates of a diagnosis of different sorts of eating disorder through
20 essentially look back through the last four years and as you might expect,
until the pandemic came along, the numbers were pretty constant from one year to the next,
and they didn't really change from one month to the next through the year. And then as early 2020 began, suddenly we diagnosed.
This is now measuring first diagnoses of any sort. The numbers start to go up and they go up and up.
And so by the end of 2021, they're still going up. And by the end of 2020, 2021, it was almost double what it had been previous year.
And so that was that was you support from this real world data that the anecdotal
evidence was probably right there were more people being diagnosed disorders.
They did appear to be more severely ill in the high proportion of them or attempting suicide,
which is a quite a useful proxy for severity as you can imagine.
But also interesting, it wasn't just any eating disorders, particularly anorexia nervosa in a way, and in some ways the most serious form.
And also it was teenage girls, so other, other ages and men were much less affected.
So there was it would appear there was something that was affecting teenage girls with anorexia that was being most stirred up by the pandemic.
And again, you know, the data doesn't tell you why that might be what you need to do.
It does do a different kind of study. You do. And other people who are interested who are interested in this is also that I'm quite
interested in of the qualitative and quantitative studies trying to dig drill down into that.
And as you might imagine, my recollection, my reading the data is it's a mixture of things, everything from, you know,
the social isolation to the pressure to the need to retain control in one aspect of your life for the rest of your life, you've lost that.
You can imagine all sorts of plausible and probably correct mechanisms, but that's not something that studies have tried to answer.
So have the. We talked a little bit about this before,
but do you think the findings that have come out of the these big studies that you've done have already changed policy or practice?
Or do you think they will in the future? I mentioned example probably the privatisation of patients mental illness.
But beyond that, it's difficult to say.
I mean, we have been we have been told that a couple of papers have certainly been discussed possible by UK policymakers and in the US.
Interestingly, another study we did, which was about the risks of the nasty blood clots with the vaccines we got involved in just a little while.
So so that got us into a whole different interesting area where the different sort of vaccine manufacturers, obviously,
and different people were putting spins on the data because of course, let's go back and sort that out into do we go any further?
So this is this is. I can never remember what CBT stands for and empathy.
Sarah Silverman, CBS. Cerebral Venous Sinus Thrombosis, right?
Yes. Yes.
So this again, what's a time when this was very much in the forefront of the media, particularly concerns about the AstraZeneca Oxford vaccine.
So there'd been a small number of cases. That's right. There's been a blood clot, essentially.
Brain blood clot. Exactly. After the vaccination and as a result, various countries, including the UK,
were introducing considered introducing various restrictions on the use of the AstraZeneca
vaccine with obviously both the risks and the benefits that that slow down might produce.
And so, again, we thought, well, is this network the place to look at that now?
We couldn't redirect the Oxford-astrazeneca question because the Americans didn't and still haven't licensed that vaccine.
So it a later weeks, we really tried to ask the question, what was your risk of getting this nasty thrombosis if you happen to catch COVID?
And how did that compare to the estimates of the risk after the vaccine?
And we found and again, other people subsequently confirmed this. Your risk of one of these blood clots is markedly increased if you get COVID.
And that risk is greater than any of the estimates of how great the risk is after any of the vaccines.
Even amongst the young,
healthy people in whom there was greatest concern that the risk benefit equation might not be in the right direction for vaccines.
So our data got picked up, I think rightly to say, well, whatever you want as well, having the vaccine,
you should be wearing a lot more if you catch it and don't think just because you're
young and fit it wouldn't happen to you if you go COVID because it still might.
So that that was really the message of the paper.
But of course, as part of that, we also did report that, you know, in this period they said there were,
I think, a couple of cases where this particular sort of blood clot had been reported in,
people having had one of the American the MRA vaccine, the Pfizer vaccine and the Moderna vaccine,
and then got picked up because at the time the claim was those vaccines did not cause this block ever, essentially.
And so people got on this and it properly sort of focussed on that minor point in the paper,
I say, which which was translated into some sort of interesting conversations.
But I think now again, the data subsequently showed that, you know,
these things and anything can happen if you give 100 million doses of a vaccine to people.
And some things will happen that are very rare and the message remains the same.
It's COVID that is worse. People clots, not the vaccines. Yes.
And that is that is worse than pretty much anything different with it.
So so as an aside from this experience that was first of all, there were concerns that what is the what's what is the countries doing,
writing about it or opining about vaccines, which is a fair criticism.
There was also the suggestion in place explicitly that we, as Oxford researchers, were trying to defend the Oxford vaccine.
Now, I had at the time never spoken to anti-Ebola or anybody else in vaccine centres, but again,
it was a hard it was hard to prove that we were not in any way trying to, you know, defend the Oxford vaccine.
But again, that was all a storm and I think it really died away very quickly and.
So once again, coming to us before I ask these questions was whether you needed to raise funding for your research from new sources?
No, we didn't. The other traction, this was at least the first instance because I had access to this network anyway.
And really all it requires is that me and blacks and other people to spend their time sitting in
the terminal and downloading and setting research questions and downloading the data to them.
No, they require a penny in only funding, in a way is that Max is a who's an ICF Heads Research Time, funded by the online channel.
So we're able to use his research time for the purposes of research again within our biomedical research centre,
which is the nature of funded infrastructure,
that property that we were instructed to begin pandemic in a sense drop what you're doing if you can do something more valuable for the COVID fight.
So I think we were totally appropriate in, you know, decisions to kind of reroute his time and sort of mind to do these studies.
Mm hmm. So.
Yeah, we got a little bit of there. So don't just go back to the, the, the first lockdown.
How did it change? How did it impact on what you were able to do?
Did it did it change the way you worked? And were any of those changes positive?
You've already talked about how using remote consultation with patients was was something that you were probably going to do more of.
But whether other things that are there any anecdotes, remember? Well, I did those that changed my life.
And as people, I was always an academic away from and it's a late every day.
I do tend to work at home instead of coming to work so suddenly that I was at home.
Be grateful the broadband was okay for me and my wife and others.
So that was just so something I was doing. I like it when I was getting used to the zoom and the teams and getting used to
two dimensional images of people and all those joys that people loved to love.
I think seeing the same patient.
So my first experience of my first time doing clinic work through both phones or teams meetings was in the early stages.
Quite an eye opener because you thought this is going to be so difficult in some of the work.
But as I said earlier, that actually was okay, but that was a big change.
And of course the last thing was we were invited to had all the normal cancer research activities and then the normal teaching just stopped.
So instead we sort of filled the gaps with what we've been talking about to do with with COVID and different response.
So the students were sort of shocked to and stuck with it. Yes.
And so the medical sort of see this, just the students do this,
the country in their penultimate year of their medical course and pretty much that the the term that that particular medical school was enclosed to.
We also got involved in helping support if you remember the that the student the medical students were due to qualify in
August of 2020 and then go onto the wards as junior doctors because there was this desperate need for more personnel.
They had their finals essentially pulled forward. They lost all the usual bit of fun of the last months of being a medical student,
and they were being kind of giving and they were volunteering like people volunteering
with the front line to go and be sort of quasi junior doctors from the eighth,
I think, from the April onwards. And so lots of colleagues got involved and kind of mentoring and supporting the mental health
of these students who'd come both to experience before to deal with what was at the time,
frankly, the fear of going into an environment where nobody quite you just how did you disposables they'd imagine being imagining
themselves being a doctor from beginning of August suddenly four months earlier they were going to be pitched in.
So they had understandable concerns.
And so we tried to sort of mental and support them through that three month period before they then became like proper junior doctors in August.
So that was another interesting aspect of the early pandemic.
Was that something you had to do more broadly for colleagues at all levels to to be aware
that they they might be struggling a bit with their wellbeing and were being support?
Yeah. Yes, I suppose although it was very much the medical students we actively kind of sought out to get to try and offer them support.
And we had these regular zoom zoom therapy groups, but support groups like I think most of us, the more senior people there was in the beginning,
there was a certain sort of Dunkirk spirit, if you like, and it wasn't that it was the done thing to show you a strong commitment.
If you were, I think, maybe sort of looking after ourselves,
our own mental health came in later really when I think we realised how long this was going on for was going to,
I think in the beginning probably just speaking for myself. He was definitely an absolutely yes.
Yes. I do think that had a cost. Yes, I do.
I think I think, you know, as this pandemic has affected people within university,
very different from each other, like it has outside, and there's been some of us who've been very fortunate,
both in our physical mental health and on kind of a life on living circumstances that have enabled us to adapt remarkably well,
I think, and in some ways have benefited. I also know colleagues who, for one reason or another,
whether it's in where they live or childcare or physical health, where it's been, it's been a really tough period.
And I think every time we've sort of we have thought we're out of it. And then, of course, there's been another wave and it's all gone on longer.
I think it's been very difficult for people to to maintain. The sense we had of the beginning was this was an acute crisis and we just got
lucky to knuckle down and get through it and then it becomes a chronic thing.
And I think that's I think that transition is something that some people find quite emotionally hard
to cope with the now the the lack of certainty at all about when it's really going to be over.
And you are you being very third person is that do you think you cut yourself among those who are better perhaps than some of the others?
Yes, I yes, I do know what the inconvenience is for me, but I'm touching on many other people.
And I have had a much more difficult time. And did you hadn't actually had COVID yourself?
No, never had it. Have you felt threatened by that because of the possibility of catching and being a no?
To be honest, I mean, I was being in time.
I think knowing the statistics has been quite reassuring and just make it so well for a man of aged and weight and race, etc., etc.
My general health, what's my chance of getting really live?
I demonstrating it and it was sufficiently low that I was able to put it to the back of my mind.
I was much more worried about, you know, I might give it to an elderly parent or an elderly friend.
So, yes, of course. But and I never person felt vulnerable.
Maybe I should. So were you involved at all in your institution's COVID regulations or preparations and all safety regime?
Um, only as a member of the senior management team or the Parliament,
we had to get weekly support group meetings when the department regulations and guidelines were being agreed.
And what did we think was right for our staff? Because the university, I think having originally, I think we were expecting it to be like a central,
you know, dictated about what wouldn't wouldn't happen,
although the guidance it was left to departments to to tailor to their particular circumstances and we
like other medical departments have the particular complication with we're on an NHS hospital site,
even the university part and of course the regulations of university and NHS.
But times have been very different and we've tried to negotiate an appropriate balance
between following the different rules that we might be seen to be subject to.
And I think again, that's worked very well. We've got great department leadership in administration here.
I've I think most all the decisions I've been involved with, I think have been the right decision,
the right balance between being too cavalier and being too cautious.
And do you think that's a general feeling within the department or whether a conflicts and it's been surveyed in an anonymous survey at least twice,
I think during the pandemic. And as you might expect, there's a range of views from people.
We think we should be more cautious and nobody should have been under any pressure to come back into work ever
through to people who are just chomping at the bit and say it's bad for mental health to be stuck at home.
I want to come back into work. So I think on balance, I think we've got the right compromise.
And again, I think there's been a lot of flexibility in individual circumstances.
And from the cases I'm aware of, I think I think we when we look at the management team,
the department's in a pretty good job in trying to take on board individuals wishes and fears.
And so do you think the fact that you were able to work on something that affected everyone in the country,
helped to support your own wellbeing in any kind of way? I mean, you have you had a lot of purpose in your life?
I never thought about. I think you're absolutely right.
Yes, I do think so, because I remember again, beginning with this sense of guilt, the sense of as doctors and as academic doctors,
we should be contributing you doing something and having the opportunity to do it through this way.
And when it began occurred to me it was quite good to take off the way it did, and particularly for medical family.
My wife is a GP, for example, so I was, I was living at home with my wife,
going to CAMHS and basically telling these people they were going to die and the hospitals wouldn't take them.
I mean, she had she had and still has a far harder time of the kind of front line of this fight than I did.
So I've always felt fortunate that the other doctors.
I know so. And have you at any point throughout this ordeal, either before or since,
being directly involved in any kind of policymaking and around public health?
No, I say we've contributed our data. I've been involved in various as of seminars and meetings where all data, amongst others, have been discussed.
You know, for example, they don't have for example,
but I've never directly engaged in any specific policy that has come from any specific finding we've made.
It's been more just setting the scene of the kind of scale and nature of the problems that people might be anticipating.
Most likely never as to the people what they think about the government that they did.
Do you think the way the authorities, let's put it that way, have handled the pandemic as a whole, has made things easier or difficult?
It is hard not to be for this particular scope of this.
I think everybody would be judicious to say, I think we've done some things well, perhaps more through chance than just fine.
And I think clearly the rollout of the discovery of vaccines has been a spectacular success.
And we concluded a bit around the edges. But fantastic job how much the politicians should take credit for that, I don't know.
But that's been great. I think other things. It's very easy with hindsight.
For example, things like, you know, when the lockdown started,
I remember at the time not being aware of any evidence to know whether it was too soon, too late or about.
Right. So I think we've got to be careful.
We don't judge people against that with hindsight, against a pandemic where by its nature you have no idea really what's going to happen next.
I think I think there's other areas where the culpability has been greater.
You know, seeing people in the wards with no PPE because there was no PPE for a psychiatric hospital, for example.
And my daughter is a junior doctor again because nursing known to be patients with no PPE, because the hospitals didn't have to be.
She couldn't cope and she was fine. But, you know, that that to me was the was the bit that was always something really, really unnecessary.
If we planned for this, we hadn't got rid of all stocks of PPE, for example.
We could have done a better job probably having lower infection rates, particularly health staff,
catching it from one patient and therefore giving it to somebody else. It wasn't just the health care stuff you worry about.
It's there that was, you know, vectors of transmission.
So I think I think that that was I think the PPE and the whole thing about masks and the confused messaging that they gave.
But then I guess it is very easy to use hindsight and I was glad it was time for us to make those decisions to reduce going ahead and do nothing.
So so has the work that you've done just over the past year raised ideas for things you might want to explore in the future?
Yes. So we're involved directly and indirectly into the big now follow up COVID studies that have been funded in the UK.
There's one called coded and there's one called COVID CNS.
So the UK, the Ukrainian and German and also have funded these two big cohort studies were they follow people,
either people who were simply needed to be hospitalised that COVID and they're
following up for a year 5000 patients just to kind of see the natural history.
So we see UK bases again, these are not real, but UK patients and UK hospitals.
Yes, and that study is about six months in and with colleagues there's a the brain health working group as part of that.
So this was sort of measures of mental and brain health embedded in that big study.
And those findings are beginning to trickle out. And the bottom line is the data are quite similar to what we had reported in the US.
So in the British population generally a rather worrying proportion of patients who were months of COVID on what better than six months,
a significant number, both in terms of how they report themselves, but also objective measures of persistent dysfunction of one or other organ system.
Then there's another study with the COVID sickness,
which is a really focusing on patients who did have neurological psychiatric problems during their acute infection.
And we our data I think one of the things which helped inform what were the priorities for
measurements in that study and I'm not we know Oxfam one of the centres recruited to that study,
but again patients being followed up to see but what happens to the mental health of their neurological health,
what the brain scans show with the blood tests and to try and get a better understanding on the mechanism.
As we were talking about earlier, how much of this is a direct link to the virus, sometimes indirectly to inflammation?
How much is not the direct link to anything? And that study, again, is just it's just running through at the moment.
So those two studies have definitely, I think, followed on from work we did.
And then thirdly, some other funding we put in while we were approached by a charitable foundation in UK who'd seen our work and others and,
and said, you know, what could you do with another pot of money.
Nice. So it's related to the outcome of that. Yeah. They killed amongst other things we would do with that money is again to, to,
to explore more deeply into these and other health records networks to really try and produce even more big scale, robust and long term data.
Because I studies at the moment, having looked at the first six months after COVID,
we can now look at 12 in the 1970s, now almost a million people in this network.
So since this work that the results become quite outdated very quickly because it's possible that the numbers we found in our first study,
which was during the first wave, might be very different. Now the public's perception of what COVID means is different.
Maybe that your likelihood of getting long term problems is either gone up or gone down from the beginning,
because with the vaccine that the virus has changed at the end of the day.
One of these back to backs. Yes, yes, yes. In fact, on the latest that is still under review, we've looked around at two questions.
It does does if you catch COVID having been vaccinated, is your Koby different than if you catch it without being vaccinated?
Because that's another very topical question. And again, bottom, the headline of that study is we might look like everybody confirms it.
You're much less likely to get a bad COVID if you've had a vaccine than if you haven't.
However, your chance of getting the longer term consequences like long COVID symptoms in our study don't look any lower.
So you still seem to get those complications even though you'll keep COVID wasn't quite as bad.
It given the different interpretations of that which we need to drill down into. And have you used the UK Biobank tool?
I just got given that they've got that,
I don't know whether they've got a better level of baseline measurements than the the the American that no we haven't is Biobank and their
colleagues in the John Ratcliffe have looked particularly at how your brain how your brain changes because there were pre and post brain scans.
Oh, yes. Other people who are using Oxford are using some of the UK equivalents of the Met in that what we've used,
there's two or three big primary care databases.
One could open safely but has had a lot of publicity recently where people have sort of asked the same sort of questions using UK data.
And I think that the messages UK and US give you very good.
They have complementary strengths and weaknesses. The great thing in the UK of course is its its beauty.
The whole population was the US. The level of detail that we can access is greater than you can in some of the routine UK data centre.
But even that moving on from television, one thing that strikes me very much is that you've got an opportunity really to look at the
connections between mental and physical health in a way that you might not have done before.
Like you said, you had already started working with that. No, I think that's right.
And I think actually that one of the things Pandemic have done, again,
is has drawn his attention to this fact we talked about earlier that we've always known that
physical illness is a mental illness is connected to particularly people after viral infections,
for example, and yet is somehow an area that's that's quite fallen into disrepute.
I think people find it so difficult to unpack and make progress.
It's never really been given the attention it deserves. Well, a lot of people thought it wasn't real.
Well, the idea that we all have such strong views about what they think it is or it isn't.
I mean, we see, for example, in the recent and today's yesterday's changes to the nice guidelines about people with chronic fatigue syndrome,
where there are views that this is very, very physical and it's very it's it's caused by a specific thing.
And we must do must not do the following too.
If people who've got it and you've got other people have very different views about what it might be and what we should or shouldn't do about it.
And COVID, in a way, whether we like it or not, is is drawing renewed attention to that question.
And so I think it's a real opportunity to kind of reset things in how we do explore the relationship between mental and physical health.
Definitely, we looked into that, almost recapitulated the last question I was going to ask, which it says,
As the experience of COVID and doing all this research changed your attitude to your approach
to to the work that you do and other things that you'd like to see change in the future.
But, uh, I want to say this I think it is this integration of physical mental health care
and views about models of different types of disease is the biggest opportunity.
Now, whether that's really going to happen, what I think is unfortunately still a moot point for a number of other reasons.
One is that in this country we have a separation of physical and mental health care.
So most of the trusts where secondary mental health care is provided a second for separate from physical health care trusts.
And so getting good psychiatry done to hospitals and good gentlemen's name
psychiatric hospitals is much harder than I think everybody thinks it should be.
And trying to unpick that historical separation has proved problematic over many years, whether capable enough of a stimulus for that.
For example, in these long-covid clinics that are being set up, I think we all want it to be one, quite one.
Where the levers are that are needed to change it meaningfully is is is remains to be seen.
And I think from research point of view, again, it will be whether convincing research applications get funded that do manage to cross that boundary.
Too many of them seem to fall by the wayside because either the physical bit isn't done well enough or the mental bit isn't about enough,
or the funders don't like the combination. So I think it's those issues rather than anything more fundamental about the need to change
things and integrate these areas of research and clinical practice that we need to consider.
Thank you. So continuing to talk to Carson, you mentioned briefly that I rather ran over it at the beginning,
that you'd actually be involved in volunteering to carry out vaccine clinics.
And how did that come about? Yes. So early in the pandemic, when we're all looking at options, how how could we contribute?
And then vaccines came along and there was a big opportunity for doctors to get involved in vaccinating.
Now, as the countries that do very little in the way of practical procedures and not for many years but say through that and I trained
in giving the vaccines and I've been running towards participating in vaccine clinics in general practice since the first wave.
We're now running booster clinics, and that's that's been really rewarding.
So how much of your time? You know, we keep doing and doing clinics and instead, I mean, you tend to give a clinic every week, maybe every two weeks.
So that's 60, 70 patients usually in a batch.
And that's been very interesting, both in terms of, you know, face to face with people who are living through the pandemic and having the vaccines.
And you'd expect only the hopes and fears and the worries about people coming for vaccines,
everything from will this vaccine give me a blood clot to, you know, can can we can my friend have it?
Well, she's sitting in the waiting room. So there's all those kind of real life engagements of the boss,
which is much more it was actually it's actually been a very positive experience for me personally, again, feeling I'm doing something useful.
But also 99.9% of the people are so grateful.
They really understand what a triumph the vaccines have been.
They're very proud to be British and being on oxygen, they're very prone to forgetting you.
Also, I remember the first wave was we kind of have the oxygen is this the oxygen heats up?
It was 50% of time. It wasn't 5%.
I wasn't it was kind of random which got so that's been kind of sort of false and pride about being in a city institution that developed the vaccine.
Although of course I have no credit whatsoever for the vaccine itself. So that's been great fun together things seeing people appreciate it.
And then as people come back to the second dose and after booster,
you sort of see again how the population's views about this whole thing is evolving.
Like we talked about earlier, it's going from being is brand new, exciting but really scary thing through.
It's a bit of a booster and I'm hoping to go on holiday and can I have my passport and those sorts of things.
So again, seeing the evolution of, if you like,
the societal implications of the of the of the pandemic coming through and whilst doing something sort of proactive and appreciating.
So that's been I have the golden goose.