1 00:00:01,170 --> 00:00:04,320 So can you just start by saying your name and your affiliation? 2 00:00:04,710 --> 00:00:10,620 Yes. I'm Paul Harrison, professor of psychiatry at the University of Oxford and also a consultant, general adult psychiatrist. 3 00:00:12,090 --> 00:00:15,660 And first of all, can you just tell me a little bit about yourself? 4 00:00:15,870 --> 00:00:19,410 How did you briefly get to be where you are now? 5 00:00:20,820 --> 00:00:25,440 So I had a fairly conventional academic medical training, so I trained in Oxford and in London, 6 00:00:26,370 --> 00:00:33,179 had a welcome Sydney fellowship and was appointed my current chair, which is the reading positions country back in the early 1990s. 7 00:00:33,180 --> 00:00:36,690 And I've been here ever since and until COVID came along, 8 00:00:36,690 --> 00:00:40,980 my main research interest was into serious mental illnesses like schizophrenia, bipolar disorder. 9 00:00:41,670 --> 00:00:47,700 And I've done a range of different sorts of research study broadly within the biological end of the psychiatric research field. 10 00:00:47,970 --> 00:00:56,220 Mm hmm. And if there's one overarching question that gets you out of bed in the morning, what would you say it was? 11 00:00:57,810 --> 00:01:02,490 I think it's trying to understand the the biological basis of serious mental 12 00:01:02,490 --> 00:01:09,780 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? 13 00:01:10,430 --> 00:01:14,100 And over the years, I've done everything from post mortem neuropathology, 14 00:01:14,370 --> 00:01:18,000 structuring, function, brain imaging, experimental medicine, clinical trials. 15 00:01:18,630 --> 00:01:25,530 So I've I've dabbled in a range of methodologies from the very basic mechanisms through terms like clinical trials of patients. 16 00:01:25,770 --> 00:01:28,600 But it's very much at the biological end. Yes, it is like that. 17 00:01:28,620 --> 00:01:33,870 You don't need the conventional picture of what people think, of what they think of the psychiatrists. 18 00:01:34,410 --> 00:01:42,660 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. 19 00:01:43,080 --> 00:01:43,860 I think you're right. 20 00:01:43,880 --> 00:01:49,680 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. 21 00:01:50,340 --> 00:01:56,999 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. 22 00:01:57,000 --> 00:02:04,390 And I just happened to be applying it to conditions we call psychiatric. So moving on to Kobe itself. 23 00:02:04,600 --> 00:02:09,460 Can you remember when you first became aware that there was a pandemic in the offing? 24 00:02:10,750 --> 00:02:16,780 Yes, I do. I was skiing in northern Italy just at the time when the first case was okay. 25 00:02:17,680 --> 00:02:19,149 I was there about four weeks before. 26 00:02:19,150 --> 00:02:24,040 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. 27 00:02:24,040 --> 00:02:29,139 Is this going to be another like a bird flu or a previous sort of virus to beat around? 28 00:02:29,140 --> 00:02:33,219 But it was beginning to look worrying then. And then, of course, we had within weeks of being home, 29 00:02:33,220 --> 00:02:38,680 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. 30 00:02:40,330 --> 00:02:46,959 And how soon was it before you thought, this is something I need to pivot my research towards? 31 00:02:46,960 --> 00:02:51,740 And I mean, was that something? Was there an external push for that and that just come from talking to clients? 32 00:02:54,280 --> 00:03:00,550 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? 33 00:03:00,580 --> 00:03:07,690 So I had both kind of coping with the practical restrictions that were being imposed on us as individuals and as members of university, 34 00:03:07,730 --> 00:03:15,700 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? 35 00:03:16,120 --> 00:03:23,739 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, 36 00:03:23,740 --> 00:03:30,090 even a psychologist would think about should we begin offering services to the excellent department, should we be offering to go to another man? 37 00:03:30,100 --> 00:03:34,480 Ventilators. Some fairly scary thoughts for us and for our potential patients, I can assure you. 38 00:03:36,010 --> 00:03:44,410 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, 39 00:03:44,650 --> 00:03:52,870 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? 40 00:03:53,590 --> 00:03:59,200 And so the work over the coming months and talking kind of spring to summer 2020, 41 00:03:59,740 --> 00:04:04,299 our research saw clinical my clinical work very much moved in part to looking 42 00:04:04,300 --> 00:04:07,870 after people that had COVID and dealing with their mental health separately, 43 00:04:08,920 --> 00:04:12,969 but also thinking how can we use our research opportunities in the time that's been made free? 44 00:04:12,970 --> 00:04:17,380 Because our previous previous studies offered to stop trying to use some of our academic 45 00:04:17,830 --> 00:04:21,250 abilities to try and answer some of the important questions that were becoming apparent. 46 00:04:22,300 --> 00:04:24,790 So let's just go back and unpack some of that. 47 00:04:24,790 --> 00:04:32,590 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. 48 00:04:33,230 --> 00:04:37,510 How did you cope with that? Yes. So again, in the beginning, 49 00:04:37,510 --> 00:04:44,620 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 50 00:04:44,620 --> 00:04:50,350 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. 51 00:04:50,740 --> 00:04:59,229 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? 52 00:04:59,230 --> 00:05:09,730 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 53 00:05:10,090 --> 00:05:14,830 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. 54 00:05:15,550 --> 00:05:24,160 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. 55 00:05:24,160 --> 00:05:30,610 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. 56 00:05:31,180 --> 00:05:38,050 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. 57 00:05:38,080 --> 00:05:45,080 We went back more towards our normal ways of working within the constraints of the pandemic. 58 00:05:45,760 --> 00:05:48,820 Yes, it was. Was that much of a problem of infection in the. 59 00:05:49,040 --> 00:05:50,810 In the patients in the room? 60 00:05:51,410 --> 00:05:58,280 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. 61 00:05:58,280 --> 00:06:05,120 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, 62 00:06:05,120 --> 00:06:12,980 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. 63 00:06:14,450 --> 00:06:19,010 But that probably gradually got batteries as things settle down and as the vaccines came on. 64 00:06:20,270 --> 00:06:22,669 And did you spend any of the second of what you said? 65 00:06:22,670 --> 00:06:28,460 Did you experience an increase in people with mental health difficulties as a result of COVID infection? 66 00:06:29,360 --> 00:06:32,089 Yes, but I think, again, less than we were expecting in the beginning, 67 00:06:32,090 --> 00:06:36,440 and that was partly because, for example, the trust put in a 24 seven phone helpline. 68 00:06:36,440 --> 00:06:40,070 So recognising the fact that most people couldn't or wouldn't come on site. 69 00:06:40,830 --> 00:06:44,350 Nothing the pandemic has done for my area of medicine is has transformed the 70 00:06:44,360 --> 00:06:49,040 views about the importance of face to face as opposed to remote assessments. 71 00:06:49,040 --> 00:06:54,450 And that change happened really remarkably quickly and surprisingly effort, 72 00:06:54,590 --> 00:06:58,430 not effort as it was a lot of technological questions, but it's been much less problematic, 73 00:06:58,430 --> 00:07:05,719 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. 74 00:07:05,720 --> 00:07:11,570 It's already leading to changes to think about how we envisage psychiatry being practised in the future 75 00:07:11,570 --> 00:07:16,510 with an assumption that you need to be in the same room with someone every single time for a setting. 76 00:07:17,090 --> 00:07:23,240 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. 77 00:07:23,900 --> 00:07:28,790 So I think that be one of the more interesting positive outcomes of the pandemic forced change upon us, 78 00:07:29,480 --> 00:07:32,630 which otherwise I think we'd have been screaming towards. 79 00:07:32,720 --> 00:07:41,660 Actually, it's worked out for me in most respects, but what kind of problems did people who had the disease said? 80 00:07:41,660 --> 00:07:44,630 Well, I mean, in the beginning, especially when case numbers were low, 81 00:07:44,840 --> 00:07:50,840 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. 82 00:07:51,140 --> 00:07:56,299 It was really how were the population coping with lockdown and the fear of illness? 83 00:07:56,300 --> 00:08:00,290 And what was going to happen after lockdown was that would they have lost their job? 84 00:08:00,590 --> 00:08:01,760 Would they lose their parents? 85 00:08:01,760 --> 00:08:10,510 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. 86 00:08:10,540 --> 00:08:18,080 One of the implications of the pandemic, it was only later as the number of confirmed cases grew. 87 00:08:18,530 --> 00:08:26,419 But the suggestion there might be a link between actually having the infection and getting mental health problems became more apparent. 88 00:08:26,420 --> 00:08:29,660 And that's really where my particular research interest, the pandemic, developed from. 89 00:08:33,540 --> 00:08:42,800 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. 90 00:08:43,380 --> 00:08:50,970 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 91 00:08:50,970 --> 00:08:55,130 department here where there's a lot of academics and most of whose research I've seen since you stopped, 92 00:08:55,530 --> 00:09:00,509 we had a number of Zoom meetings where we all kind of thought about where could be, where could we make a difference, 93 00:09:00,510 --> 00:09:05,640 where are the opportunities that we can take advantage of whatever connections, skills we have. 94 00:09:06,090 --> 00:09:08,969 And so a number of my colleagues really set off really, I think, 95 00:09:08,970 --> 00:09:14,010 what have been leading programs in the kind of mental health of COVID in different areas. 96 00:09:14,790 --> 00:09:16,530 My own interest was really fortunate. 97 00:09:16,650 --> 00:09:26,219 I took advantage of a fortunate coincidence because my main work is a big lab based and that couldn't happen by chance. 98 00:09:26,220 --> 00:09:31,980 A few months before the pandemic began, I'd started working on a big electronic health records network, 99 00:09:32,490 --> 00:09:36,780 mostly in the U.S., but in other parts of the world as well. And I realised, 100 00:09:37,080 --> 00:09:41,950 and I remember distinctly suddenly having thing on the light bulb that was in my head of there are 80 101 00:09:41,950 --> 00:09:46,920 million patients in this dataset and their recording pretty much in real time diagnosis of COVID. 102 00:09:47,370 --> 00:09:51,600 And the first time I went to this database, which must have been early summer 2020, 103 00:09:51,900 --> 00:09:56,190 there already about 50,000 people there who had a diagnosis of COVID. 104 00:09:56,790 --> 00:10:04,449 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 105 00:10:04,450 --> 00:10:09,720 packed in the coming weeks and months in terms of the mental health diagnoses. 106 00:10:10,050 --> 00:10:15,030 I could compare the people who've had COVID with people who've had other health events like flu or broken leg. 107 00:10:15,780 --> 00:10:22,080 And similarly, I can see to what extent does having a previous psychiatric history affect your risk of getting COVID? 108 00:10:22,110 --> 00:10:28,469 So it was taking advantage of electronic health records, and the fact I had paid by chance started working with them. 109 00:10:28,470 --> 00:10:30,330 That gave us the opportunity to say, okay, 110 00:10:30,330 --> 00:10:39,210 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. 111 00:10:39,780 --> 00:10:42,290 So tell me a bit more about about the network. 112 00:10:42,300 --> 00:10:48,000 I mean, I know about UK Biobank and that's half a million people, but we're talking about much, much larger numbers. 113 00:10:48,020 --> 00:10:53,360 And how did that network. Well, so it's a it's sort of federated mental health network is Hamilton, 114 00:10:53,370 --> 00:10:57,390 which has its proprietary name, which has become an index and gets everyone's interested. 115 00:10:57,780 --> 00:11:03,630 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. 116 00:11:04,020 --> 00:11:10,620 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. 117 00:11:10,980 --> 00:11:17,820 So all the health care providers have to be fairly organised and about 60 or 70 of the big health care providers 118 00:11:17,820 --> 00:11:23,580 scattered across the US should upload their data anonymized to these electronic health records network. 119 00:11:24,210 --> 00:11:28,410 And the reason they set it up was to was because pharmaceutical companies wanted 120 00:11:28,410 --> 00:11:31,379 to know where can I find the patients with the following characteristics? 121 00:11:31,380 --> 00:11:36,000 Because I wanted a clinical trial of a new drug, for example, or whatever else, 122 00:11:36,360 --> 00:11:42,150 and so they would pay the network for access to these data to find out where they would go to keep their patients. 123 00:11:42,930 --> 00:11:49,090 A couple of years ago, the network realised that actually this kind of information could be quite useful academically for nothing. 124 00:11:49,140 --> 00:11:56,670 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, 125 00:11:56,670 --> 00:12:02,210 the first academic anywhere in the world to be given unrestricted and free access to this network. 126 00:12:02,220 --> 00:12:10,380 Well, I think because the network saw the value of someone like me could demonstrate how useful their data were for academics. 127 00:12:10,590 --> 00:12:17,580 They might, in the future, I imagine, want to make academics pay for access like you do from any other big data dataset. 128 00:12:18,210 --> 00:12:23,250 And so we had been working with this network, and I kind of learned how to use it the full time it came along, 129 00:12:23,250 --> 00:12:28,559 which is why I say I was very fortunate to then be in a position not only to know how to ask the questions, 130 00:12:28,560 --> 00:12:37,050 but have access to what I think most of the time is the biggest single electronic health records in network in the world. 131 00:12:38,350 --> 00:12:41,440 So what was the first question that you posed? Yeah. 132 00:12:41,450 --> 00:12:42,850 So giving a talk every time. 133 00:12:42,970 --> 00:12:47,680 And I should I should acknowledge this point that all the work, if we can talk about the work that's happened subsequently, 134 00:12:47,860 --> 00:12:55,150 has really been driven by a junior psychiatrist called Max Tackett, who's a trainee who again happened to have an extraordinary skill set. 135 00:12:55,510 --> 00:12:59,170 That meant he was able not only to interrogate this network like I could, 136 00:12:59,470 --> 00:13:03,340 but he grew so much more sophisticated things and he's kind of managed to reverse engineer some analysis, 137 00:13:03,340 --> 00:13:10,240 and he has enabled us to do quite sophisticated approaches rather than simply counting counting bodies, if you like. 138 00:13:11,290 --> 00:13:15,040 So given the time we took in all summer 2020, 139 00:13:15,490 --> 00:13:21,030 so the epidemic was kind of three or four months in and I say we had probably had 60 or so thousand patients COVID. 140 00:13:21,070 --> 00:13:27,700 By the time we did the definitive analysis, we simply asked the question, in three months after diagnosis of COVID, 141 00:13:28,270 --> 00:13:36,220 what percent of those patients have been given a diagnosis of any of the common psychiatric conditions depression, anxiety, psychosis and so on? 142 00:13:36,610 --> 00:13:41,620 And similarly, what were your risks of COVID if you had a psychiatric diagnosis beforehand, then, if you didn't? 143 00:13:42,520 --> 00:13:47,350 And so essentially that first paper was about the numbers, the percentages, 144 00:13:47,740 --> 00:13:52,569 as well as the comparison with other health conditions to show that you were more 145 00:13:52,570 --> 00:13:56,590 likely to get a psychiatric diagnosis after COVID than you were after anything else. 146 00:13:56,980 --> 00:14:01,840 We compared COVID two, and importantly, having managed the patients for all that other characteristics. 147 00:14:02,500 --> 00:14:05,469 So we did what we could to rule out the non-specific, 148 00:14:05,470 --> 00:14:11,650 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? 149 00:14:12,670 --> 00:14:18,640 And the numbers, the sheer numbers in this network? Yes, it gave us that all that was extremely reliable. 150 00:14:18,970 --> 00:14:24,940 Yeah, exactly. It was very severe. The statistics, of course, you get statistics if you die for cancer, more samples. 151 00:14:25,300 --> 00:14:32,920 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. 152 00:14:32,920 --> 00:14:41,260 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. 153 00:14:41,260 --> 00:14:46,419 So these were really, I think, the first good data with the limitations of records data, 154 00:14:46,420 --> 00:14:50,050 but they were about as good data as you could have had for that point of the pandemic. 155 00:14:50,680 --> 00:14:58,370 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, 156 00:14:58,480 --> 00:15:04,590 not because it was spectacular research, but it was such a pressing question that the world's media wanted answers to. 157 00:15:04,610 --> 00:15:06,070 And we gave some of the first answers. 158 00:15:07,000 --> 00:15:16,780 And those answers presumably are highly relevant to how clinical services are delivered and what sort of care and health services are delivered. 159 00:15:16,880 --> 00:15:20,170 And in the future, you would you would think so. 160 00:15:20,170 --> 00:15:26,559 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, 161 00:15:26,560 --> 00:15:30,220 people were still interested in what's the whole population's mental health going to be. 162 00:15:30,610 --> 00:15:37,569 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, 163 00:15:37,570 --> 00:15:43,450 it's done something worse or greater to the people who've been unfortunate enough to get COVID itself. 164 00:15:44,080 --> 00:15:52,810 And that's become more apparent, I think, as the pandemic has progressed. So that was the first study and making a list here. 165 00:15:53,200 --> 00:16:02,930 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. 166 00:16:03,110 --> 00:16:06,189 Yes, I know that that was really very much a kind of perspective thing. 167 00:16:06,190 --> 00:16:09,610 I remember just thinking, well, what are we doing? One question, what have we answer the other? 168 00:16:09,610 --> 00:16:14,890 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. 169 00:16:16,150 --> 00:16:22,270 And we did find this paper that if you had had a previous diagnosis of something like depression or anxiety or schizophrenia, 170 00:16:22,780 --> 00:16:30,580 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. 171 00:16:31,060 --> 00:16:37,750 So even while it's quite striking, interesting, in the week before we published in another big electronic health records network, 172 00:16:37,750 --> 00:16:43,420 some another group found exactly the same, if not even more striking effects of the time I've been picking about both. 173 00:16:43,420 --> 00:16:49,240 The big studies were both agreeing that this there was a connection between your mental health and your risk of COVID. 174 00:16:49,780 --> 00:16:54,849 Lots of speculation on what a mechanism might be. And I have to say we haven't really drilled down much further to that. 175 00:16:54,850 --> 00:16:58,839 But certainly it was that that fact was one of the reasons, I believe, 176 00:16:58,840 --> 00:17:03,069 why the government prioritised patients with serious mental illness in the original 177 00:17:03,070 --> 00:17:06,820 vaccine rollout because of evidence it was presented at the House of Commons. 178 00:17:06,820 --> 00:17:12,550 I believe that our data had suggested these were a vulnerable population, so that was quite a nice distraction. 179 00:17:13,450 --> 00:17:18,969 Beyond the media interest which was found at its own challenges, it was actually making a difference, 180 00:17:18,970 --> 00:17:22,710 at least to to some policies that would help one patient but one. 181 00:17:22,870 --> 00:17:28,480 So what possible explanation was that? There are they are a vulnerable group, period. 182 00:17:28,810 --> 00:17:32,920 They're going to be both vulnerable to mental health difficulties and vulnerable to cope. 183 00:17:32,920 --> 00:17:37,270 It is that it's not necessarily that the mental health difficulties make them more vulnerable. 184 00:17:37,270 --> 00:17:40,179 Well. You know, you're right. It absolutely could be either of those. 185 00:17:40,180 --> 00:17:46,160 And so simplistic in one view is that whatever your biology is that gave you the mental health disorder vulnerable, 186 00:17:46,180 --> 00:17:48,810 that the same biology might make you vulnerable to COVID. 187 00:17:48,820 --> 00:17:54,250 So, for example, brain inflammation, to take a simple concept, if you like, a biological link between those two things. 188 00:17:54,670 --> 00:18:00,729 On the other hand, you know that people with a particular serious mental illness have different lifestyles than as healthy generally. 189 00:18:00,730 --> 00:18:06,459 They may have higher body mass index is, they smoke more, they may have more problems isolating, etc., etc. 190 00:18:06,460 --> 00:18:14,560 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. 191 00:18:15,400 --> 00:18:19,750 And then way the same question about is the link about biology or if you like, 192 00:18:19,750 --> 00:18:24,130 sociology applies to the the fact you get a mental diagnosis after COVID. 193 00:18:24,370 --> 00:18:31,089 Is it that the COVID virus has directly done something to you that has made you vulnerable to develop depression, anxiety, for example? 194 00:18:31,090 --> 00:18:34,420 Or is it having had a what could have been a life in this, 195 00:18:34,600 --> 00:18:40,870 has left you feeling traumatised in a psychological sense and this the diagnoses just reflect that. 196 00:18:41,470 --> 00:18:45,010 So again, that's that of open question. Yes, it is. 197 00:18:45,010 --> 00:18:48,100 There's data beginning to come through that may shed light on that. 198 00:18:48,100 --> 00:18:55,809 But one of the limitations of electronic health records research, you can only really answer questions that have been coded in the medical records. 199 00:18:55,810 --> 00:19:00,310 And I don't think we have we have yet worked out a way that we could do that. 200 00:19:00,880 --> 00:19:04,270 And dissection of aetiology, of causes, effects. 201 00:19:05,470 --> 00:19:12,640 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. 202 00:19:12,650 --> 00:19:20,440 The idea that people have impairments to their health that can hang around for a year or what. 203 00:19:20,440 --> 00:19:23,469 What did your network studies show that? 204 00:19:23,470 --> 00:19:31,900 Yes, that was a much more recent paper where we we looked at what were essentially a group of nine cardinal features of COVID. 205 00:19:32,080 --> 00:19:36,280 One of the challenges of research on COVID is nobody knows what it is. It's sort of a rather circular argument. 206 00:19:36,730 --> 00:19:42,910 But we captured nine we thought features and claims that captured most people's views about the common things and on COVID. 207 00:19:43,500 --> 00:19:51,850 And the key ones were specifically looking at things like ongoing breathlessness, ongoing aches and pains, fatigue, 208 00:19:52,000 --> 00:20:00,160 brain fog, etc. So we had nine things like that and again in the six months, particularly the 3 to 6 month period after. 209 00:20:00,520 --> 00:20:05,259 So we're trying to now not look at the acute symptoms or the peak of three months later. 210 00:20:05,260 --> 00:20:06,910 Then what happens in the next three months? 211 00:20:07,360 --> 00:20:14,950 What percent of patients have been diagnosed with one or more of those nine core long tapered features with these people all hospitalised, 212 00:20:14,950 --> 00:20:19,810 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. 213 00:20:20,080 --> 00:20:20,970 That's pandemic. 214 00:20:21,010 --> 00:20:27,040 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. 215 00:20:27,040 --> 00:20:31,149 We compared people who've been hospitalised of those who had patients and took it to or two, you and those who hadn't. 216 00:20:31,150 --> 00:20:32,440 So we had measures of severity, 217 00:20:32,830 --> 00:20:40,900 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, 218 00:20:41,500 --> 00:20:46,390 not just those who'd been ill enough to need hospitalisation or intensive care. 219 00:20:47,530 --> 00:20:48,489 On the other hand, 220 00:20:48,490 --> 00:20:55,150 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. 221 00:20:55,690 --> 00:21:01,390 And rates were pretty high after influenza. And so, you know, depending which statistic you pick on, 222 00:21:01,900 --> 00:21:08,980 we found that roughly maybe just over half patients after COVID have one or more of these long term features. 223 00:21:09,250 --> 00:21:13,120 But so did a record, almost, almost a third of people after flu. 224 00:21:14,020 --> 00:21:18,069 And interestingly, by that, I mean this and this paper, again, generated lots of media interest. 225 00:21:18,070 --> 00:21:24,730 Interest, and this time the thing most media picked up on was was the flu findings and started talking about the flu, 226 00:21:25,330 --> 00:21:29,080 which is quite an interesting different take on long COVID, 227 00:21:29,080 --> 00:21:34,930 because it just highlights that we've actually known that all viruses can lead to persisting physical event, 228 00:21:35,050 --> 00:21:38,260 that there's been something called post-viral acoustic speech. 229 00:21:38,260 --> 00:21:43,420 And yet somehow people thought Koby was was unique and long COVID was something we've never seen before. 230 00:21:44,170 --> 00:21:49,149 Oh, oh, data. I think this is just well, the probably something a bit different about it. 231 00:21:49,150 --> 00:21:55,840 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 232 00:21:55,840 --> 00:21:59,709 it's because it's was being defined by the people who were experiencing the symptoms. 233 00:21:59,710 --> 00:22:05,770 It's a user led movement that I think poses challenges for trying to do unbiased research. 234 00:22:05,770 --> 00:22:11,350 When you don't have print and fixed views about what it is or what it isn't. 235 00:22:11,680 --> 00:22:12,729 So we just in this paper, 236 00:22:12,730 --> 00:22:21,070 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. 237 00:22:22,750 --> 00:22:31,329 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. 238 00:22:31,330 --> 00:22:37,060 And what were the instances you looked at was eating disorders, but with others as well. 239 00:22:37,760 --> 00:22:45,080 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. 240 00:22:45,090 --> 00:22:48,999 We're we're using the same health network, but we're now not looking at people particularly. 241 00:22:49,000 --> 00:22:55,840 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? 242 00:22:56,450 --> 00:23:00,219 And the reason we picked eating disorders was because by the time we answered, 243 00:23:00,220 --> 00:23:05,950 we decided to investigate this question, which was probably spring this year for spring 2021. 244 00:23:06,970 --> 00:23:12,790 There was quite a lot of anecdotal evidence that eating disorders were becoming common and apparently worse. 245 00:23:13,000 --> 00:23:21,219 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. 246 00:23:21,220 --> 00:23:25,570 But really a noticeable increase in some of the data coming through naturally was supporting it. 247 00:23:26,140 --> 00:23:30,730 So again, thought we would look at this in our research by using this network. 248 00:23:31,300 --> 00:23:35,500 So we looked at the rates of a diagnosis of different sorts of eating disorder through 249 00:23:35,500 --> 00:23:39,819 20 essentially look back through the last four years and as you might expect, 250 00:23:39,820 --> 00:23:43,149 until the pandemic came along, the numbers were pretty constant from one year to the next, 251 00:23:43,150 --> 00:23:50,560 and they didn't really change from one month to the next through the year. And then as early 2020 began, suddenly we diagnosed. 252 00:23:50,710 --> 00:23:57,310 This is now measuring first diagnoses of any sort. The numbers start to go up and they go up and up. 253 00:23:57,310 --> 00:24:05,860 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. 254 00:24:06,700 --> 00:24:12,009 And so that was that was you support from this real world data that the anecdotal 255 00:24:12,010 --> 00:24:15,580 evidence was probably right there were more people being diagnosed disorders. 256 00:24:16,510 --> 00:24:21,579 They did appear to be more severely ill in the high proportion of them or attempting suicide, 257 00:24:21,580 --> 00:24:24,730 which is a quite a useful proxy for severity as you can imagine. 258 00:24:25,480 --> 00:24:32,500 But also interesting, it wasn't just any eating disorders, particularly anorexia nervosa in a way, and in some ways the most serious form. 259 00:24:32,800 --> 00:24:39,129 And also it was teenage girls, so other, other ages and men were much less affected. 260 00:24:39,130 --> 00:24:47,740 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. 261 00:24:49,180 --> 00:24:53,380 And again, you know, the data doesn't tell you why that might be what you need to do. 262 00:24:54,100 --> 00:24:58,840 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 263 00:24:59,010 --> 00:25:03,339 interested in of the qualitative and quantitative studies trying to dig drill down into that. 264 00:25:03,340 --> 00:25:08,390 And as you might imagine, my recollection, my reading the data is it's a mixture of things, everything from, you know, 265 00:25:08,440 --> 00:25:14,930 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. 266 00:25:14,950 --> 00:25:20,950 You can imagine all sorts of plausible and probably correct mechanisms, but that's not something that studies have tried to answer. 267 00:25:24,810 --> 00:25:30,990 So have the. We talked a little bit about this before, 268 00:25:30,990 --> 00:25:38,879 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? 269 00:25:38,880 --> 00:25:46,390 Or do you think they will in the future? I mentioned example probably the privatisation of patients mental illness. 270 00:25:46,830 --> 00:25:50,960 But beyond that, it's difficult to say. 271 00:25:50,980 --> 00:25:58,570 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. 272 00:25:58,570 --> 00:26:06,370 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. 273 00:26:06,730 --> 00:26:12,520 So so that got us into a whole different interesting area where the different sort of vaccine manufacturers, obviously, 274 00:26:12,550 --> 00:26:18,230 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? 275 00:26:18,260 --> 00:26:24,820 So this is this is. I can never remember what CBT stands for and empathy. 276 00:26:25,210 --> 00:26:29,320 Sarah Silverman, CBS. Cerebral Venous Sinus Thrombosis, right? 277 00:26:29,350 --> 00:26:30,120 Yes. Yes. 278 00:26:30,430 --> 00:26:37,390 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. 279 00:26:38,020 --> 00:26:42,849 So there'd been a small number of cases. That's right. There's been a blood clot, essentially. 280 00:26:42,850 --> 00:26:48,069 Brain blood clot. Exactly. After the vaccination and as a result, various countries, including the UK, 281 00:26:48,070 --> 00:26:52,030 were introducing considered introducing various restrictions on the use of the AstraZeneca 282 00:26:52,030 --> 00:26:57,250 vaccine with obviously both the risks and the benefits that that slow down might produce. 283 00:26:57,850 --> 00:27:01,210 And so, again, we thought, well, is this network the place to look at that now? 284 00:27:02,320 --> 00:27:07,570 We couldn't redirect the Oxford-astrazeneca question because the Americans didn't and still haven't licensed that vaccine. 285 00:27:08,020 --> 00:27:16,390 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? 286 00:27:16,690 --> 00:27:19,690 And how did that compare to the estimates of the risk after the vaccine? 287 00:27:20,170 --> 00:27:27,010 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. 288 00:27:27,640 --> 00:27:33,460 And that risk is greater than any of the estimates of how great the risk is after any of the vaccines. 289 00:27:34,030 --> 00:27:35,469 Even amongst the young, 290 00:27:35,470 --> 00:27:41,260 healthy people in whom there was greatest concern that the risk benefit equation might not be in the right direction for vaccines. 291 00:27:41,830 --> 00:27:45,970 So our data got picked up, I think rightly to say, well, whatever you want as well, having the vaccine, 292 00:27:46,210 --> 00:27:50,560 you should be wearing a lot more if you catch it and don't think just because you're 293 00:27:50,560 --> 00:27:54,250 young and fit it wouldn't happen to you if you go COVID because it still might. 294 00:27:55,390 --> 00:27:57,250 So that that was really the message of the paper. 295 00:27:57,250 --> 00:28:02,590 But of course, as part of that, we also did report that, you know, in this period they said there were, 296 00:28:02,920 --> 00:28:06,909 I think, a couple of cases where this particular sort of blood clot had been reported in, 297 00:28:06,910 --> 00:28:11,920 people having had one of the American the MRA vaccine, the Pfizer vaccine and the Moderna vaccine, 298 00:28:12,610 --> 00:28:18,700 and then got picked up because at the time the claim was those vaccines did not cause this block ever, essentially. 299 00:28:19,330 --> 00:28:25,660 And so people got on this and it properly sort of focussed on that minor point in the paper, 300 00:28:26,290 --> 00:28:29,919 I say, which which was translated into some sort of interesting conversations. 301 00:28:29,920 --> 00:28:33,190 But I think now again, the data subsequently showed that, you know, 302 00:28:33,190 --> 00:28:38,170 these things and anything can happen if you give 100 million doses of a vaccine to people. 303 00:28:38,620 --> 00:28:42,790 And some things will happen that are very rare and the message remains the same. 304 00:28:42,790 --> 00:28:45,850 It's COVID that is worse. People clots, not the vaccines. Yes. 305 00:28:46,060 --> 00:28:50,410 And that is that is worse than pretty much anything different with it. 306 00:28:50,920 --> 00:28:58,780 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, 307 00:28:59,470 --> 00:29:02,830 writing about it or opining about vaccines, which is a fair criticism. 308 00:29:03,250 --> 00:29:09,760 There was also the suggestion in place explicitly that we, as Oxford researchers, were trying to defend the Oxford vaccine. 309 00:29:10,750 --> 00:29:15,969 Now, I had at the time never spoken to anti-Ebola or anybody else in vaccine centres, but again, 310 00:29:15,970 --> 00:29:23,340 it was a hard it was hard to prove that we were not in any way trying to, you know, defend the Oxford vaccine. 311 00:29:23,350 --> 00:29:27,650 But again, that was all a storm and I think it really died away very quickly and. 312 00:29:30,290 --> 00:29:37,940 So once again, coming to us before I ask these questions was whether you needed to raise funding for your research from new sources? 313 00:29:38,780 --> 00:29:43,729 No, we didn't. The other traction, this was at least the first instance because I had access to this network anyway. 314 00:29:43,730 --> 00:29:48,410 And really all it requires is that me and blacks and other people to spend their time sitting in 315 00:29:48,410 --> 00:29:53,059 the terminal and downloading and setting research questions and downloading the data to them. 316 00:29:53,060 --> 00:30:01,970 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. 317 00:30:02,420 --> 00:30:08,450 So we're able to use his research time for the purposes of research again within our biomedical research centre, 318 00:30:08,450 --> 00:30:12,200 which is the nature of funded infrastructure, 319 00:30:12,710 --> 00:30:18,860 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. 320 00:30:19,220 --> 00:30:26,060 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. 321 00:30:26,580 --> 00:30:31,330 Mm hmm. So. 322 00:30:33,680 --> 00:30:38,740 Yeah, we got a little bit of there. So don't just go back to the, the, the first lockdown. 323 00:30:41,500 --> 00:30:44,590 How did it change? How did it impact on what you were able to do? 324 00:30:44,770 --> 00:30:49,540 Did it did it change the way you worked? And were any of those changes positive? 325 00:30:49,840 --> 00:30:57,550 You've already talked about how using remote consultation with patients was was something that you were probably going to do more of. 326 00:30:57,880 --> 00:31:03,670 But whether other things that are there any anecdotes, remember? Well, I did those that changed my life. 327 00:31:03,760 --> 00:31:07,749 And as people, I was always an academic away from and it's a late every day. 328 00:31:07,750 --> 00:31:12,250 I do tend to work at home instead of coming to work so suddenly that I was at home. 329 00:31:13,330 --> 00:31:17,380 Be grateful the broadband was okay for me and my wife and others. 330 00:31:17,560 --> 00:31:22,900 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 331 00:31:23,140 --> 00:31:27,550 two dimensional images of people and all those joys that people loved to love. 332 00:31:28,540 --> 00:31:30,850 I think seeing the same patient. 333 00:31:30,860 --> 00:31:38,349 So my first experience of my first time doing clinic work through both phones or teams meetings was in the early stages. 334 00:31:38,350 --> 00:31:42,159 Quite an eye opener because you thought this is going to be so difficult in some of the work. 335 00:31:42,160 --> 00:31:45,190 But as I said earlier, that actually was okay, but that was a big change. 336 00:31:45,700 --> 00:31:52,420 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. 337 00:31:52,630 --> 00:31:58,420 So instead we sort of filled the gaps with what we've been talking about to do with with COVID and different response. 338 00:31:59,500 --> 00:32:02,530 So the students were sort of shocked to and stuck with it. Yes. 339 00:32:02,550 --> 00:32:05,680 And so the medical sort of see this, just the students do this, 340 00:32:05,680 --> 00:32:12,730 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. 341 00:32:13,330 --> 00:32:19,330 We also got involved in helping support if you remember the that the student the medical students were due to qualify in 342 00:32:19,330 --> 00:32:26,490 August of 2020 and then go onto the wards as junior doctors because there was this desperate need for more personnel. 343 00:32:26,500 --> 00:32:32,560 They had their finals essentially pulled forward. They lost all the usual bit of fun of the last months of being a medical student, 344 00:32:32,830 --> 00:32:36,100 and they were being kind of giving and they were volunteering like people volunteering 345 00:32:36,100 --> 00:32:41,130 with the front line to go and be sort of quasi junior doctors from the eighth, 346 00:32:41,140 --> 00:32:46,690 I think, from the April onwards. And so lots of colleagues got involved and kind of mentoring and supporting the mental health 347 00:32:46,690 --> 00:32:51,489 of these students who'd come both to experience before to deal with what was at the time, 348 00:32:51,490 --> 00:32:59,170 frankly, the fear of going into an environment where nobody quite you just how did you disposables they'd imagine being imagining 349 00:32:59,320 --> 00:33:04,150 themselves being a doctor from beginning of August suddenly four months earlier they were going to be pitched in. 350 00:33:04,540 --> 00:33:06,399 So they had understandable concerns. 351 00:33:06,400 --> 00:33:13,060 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. 352 00:33:13,780 --> 00:33:16,960 So that was another interesting aspect of the early pandemic. 353 00:33:17,620 --> 00:33:22,570 Was that something you had to do more broadly for colleagues at all levels to to be aware 354 00:33:23,020 --> 00:33:27,580 that they they might be struggling a bit with their wellbeing and were being support? 355 00:33:29,290 --> 00:33:35,439 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. 356 00:33:35,440 --> 00:33:44,259 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, 357 00:33:44,260 --> 00:33:50,000 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. 358 00:33:50,020 --> 00:33:53,110 If you were, I think, maybe sort of looking after ourselves, 359 00:33:53,120 --> 00:33:57,999 our own mental health came in later really when I think we realised how long this was going on for was going to, 360 00:33:58,000 --> 00:34:03,190 I think in the beginning probably just speaking for myself. He was definitely an absolutely yes. 361 00:34:03,220 --> 00:34:06,940 Yes. I do think that had a cost. Yes, I do. 362 00:34:06,940 --> 00:34:10,659 I think I think, you know, as this pandemic has affected people within university, 363 00:34:10,660 --> 00:34:15,010 very different from each other, like it has outside, and there's been some of us who've been very fortunate, 364 00:34:15,010 --> 00:34:22,719 both in our physical mental health and on kind of a life on living circumstances that have enabled us to adapt remarkably well, 365 00:34:22,720 --> 00:34:27,129 I think, and in some ways have benefited. I also know colleagues who, for one reason or another, 366 00:34:27,130 --> 00:34:33,850 whether it's in where they live or childcare or physical health, where it's been, it's been a really tough period. 367 00:34:34,120 --> 00:34:39,609 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. 368 00:34:39,610 --> 00:34:46,209 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 369 00:34:46,210 --> 00:34:49,840 lucky to knuckle down and get through it and then it becomes a chronic thing. 370 00:34:49,840 --> 00:34:53,739 And I think that's I think that transition is something that some people find quite emotionally hard 371 00:34:53,740 --> 00:34:59,299 to cope with the now the the lack of certainty at all about when it's really going to be over. 372 00:34:59,300 --> 00:35:06,670 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? 373 00:35:07,180 --> 00:35:12,520 Yes, I yes, I do know what the inconvenience is for me, but I'm touching on many other people. 374 00:35:12,520 --> 00:35:17,080 And I have had a much more difficult time. And did you hadn't actually had COVID yourself? 375 00:35:17,360 --> 00:35:24,910 No, never had it. Have you felt threatened by that because of the possibility of catching and being a no? 376 00:35:25,030 --> 00:35:27,429 To be honest, I mean, I was being in time. 377 00:35:27,430 --> 00:35:33,700 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. 378 00:35:33,700 --> 00:35:36,219 My general health, what's my chance of getting really live? 379 00:35:36,220 --> 00:35:40,300 I demonstrating it and it was sufficiently low that I was able to put it to the back of my mind. 380 00:35:40,380 --> 00:35:44,070 I was much more worried about, you know, I might give it to an elderly parent or an elderly friend. 381 00:35:44,790 --> 00:35:47,999 So, yes, of course. But and I never person felt vulnerable. 382 00:35:48,000 --> 00:35:59,130 Maybe I should. So were you involved at all in your institution's COVID regulations or preparations and all safety regime? 383 00:35:59,840 --> 00:36:02,819 Um, only as a member of the senior management team or the Parliament, 384 00:36:02,820 --> 00:36:09,320 we had to get weekly support group meetings when the department regulations and guidelines were being agreed. 385 00:36:09,320 --> 00:36:16,140 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, 386 00:36:16,620 --> 00:36:18,689 you know, dictated about what wouldn't wouldn't happen, 387 00:36:18,690 --> 00:36:24,330 although the guidance it was left to departments to to tailor to their particular circumstances and we 388 00:36:24,660 --> 00:36:29,130 like other medical departments have the particular complication with we're on an NHS hospital site, 389 00:36:29,640 --> 00:36:33,540 even the university part and of course the regulations of university and NHS. 390 00:36:33,660 --> 00:36:38,459 But times have been very different and we've tried to negotiate an appropriate balance 391 00:36:38,460 --> 00:36:42,360 between following the different rules that we might be seen to be subject to. 392 00:36:43,320 --> 00:36:47,330 And I think again, that's worked very well. We've got great department leadership in administration here. 393 00:36:47,360 --> 00:36:51,599 I've I think most all the decisions I've been involved with, I think have been the right decision, 394 00:36:51,600 --> 00:36:55,830 the right balance between being too cavalier and being too cautious. 395 00:36:56,430 --> 00:37:05,520 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, 396 00:37:05,520 --> 00:37:08,620 I think during the pandemic. And as you might expect, there's a range of views from people. 397 00:37:08,620 --> 00:37:14,220 We think we should be more cautious and nobody should have been under any pressure to come back into work ever 398 00:37:14,730 --> 00:37:18,690 through to people who are just chomping at the bit and say it's bad for mental health to be stuck at home. 399 00:37:19,260 --> 00:37:23,280 I want to come back into work. So I think on balance, I think we've got the right compromise. 400 00:37:23,550 --> 00:37:27,450 And again, I think there's been a lot of flexibility in individual circumstances. 401 00:37:27,450 --> 00:37:32,429 And from the cases I'm aware of, I think I think we when we look at the management team, 402 00:37:32,430 --> 00:37:38,249 the department's in a pretty good job in trying to take on board individuals wishes and fears. 403 00:37:38,250 --> 00:37:44,610 And so do you think the fact that you were able to work on something that affected everyone in the country, 404 00:37:45,510 --> 00:37:50,250 helped to support your own wellbeing in any kind of way? I mean, you have you had a lot of purpose in your life? 405 00:37:51,270 --> 00:37:53,190 I never thought about. I think you're absolutely right. 406 00:37:53,190 --> 00:38:00,659 Yes, I do think so, because I remember again, beginning with this sense of guilt, the sense of as doctors and as academic doctors, 407 00:38:00,660 --> 00:38:04,590 we should be contributing you doing something and having the opportunity to do it through this way. 408 00:38:04,980 --> 00:38:11,670 And when it began occurred to me it was quite good to take off the way it did, and particularly for medical family. 409 00:38:11,670 --> 00:38:15,360 My wife is a GP, for example, so I was, I was living at home with my wife, 410 00:38:15,360 --> 00:38:19,500 going to CAMHS and basically telling these people they were going to die and the hospitals wouldn't take them. 411 00:38:20,460 --> 00:38:25,410 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. 412 00:38:25,410 --> 00:38:29,219 So I've always felt fortunate that the other doctors. 413 00:38:29,220 --> 00:38:40,360 I know so. And have you at any point throughout this ordeal, either before or since, 414 00:38:40,990 --> 00:38:45,790 being directly involved in any kind of policymaking and around public health? 415 00:38:46,720 --> 00:38:54,310 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. 416 00:38:54,760 --> 00:38:56,829 You know, for example, they don't have for example, 417 00:38:56,830 --> 00:39:03,129 but I've never directly engaged in any specific policy that has come from any specific finding we've made. 418 00:39:03,130 --> 00:39:07,940 It's been more just setting the scene of the kind of scale and nature of the problems that people might be anticipating. 419 00:39:13,920 --> 00:39:17,840 Most likely never as to the people what they think about the government that they did. 420 00:39:18,090 --> 00:39:28,860 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? 421 00:39:30,600 --> 00:39:33,360 It is hard not to be for this particular scope of this. 422 00:39:34,920 --> 00:39:40,050 I think everybody would be judicious to say, I think we've done some things well, perhaps more through chance than just fine. 423 00:39:40,770 --> 00:39:45,719 And I think clearly the rollout of the discovery of vaccines has been a spectacular success. 424 00:39:45,720 --> 00:39:50,670 And we concluded a bit around the edges. But fantastic job how much the politicians should take credit for that, I don't know. 425 00:39:51,150 --> 00:39:54,690 But that's been great. I think other things. It's very easy with hindsight. 426 00:39:55,290 --> 00:39:57,690 For example, things like, you know, when the lockdown started, 427 00:39:58,170 --> 00:40:02,909 I remember at the time not being aware of any evidence to know whether it was too soon, too late or about. 428 00:40:02,910 --> 00:40:04,680 Right. So I think we've got to be careful. 429 00:40:04,680 --> 00:40:10,950 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. 430 00:40:11,970 --> 00:40:14,490 I think I think there's other areas where the culpability has been greater. 431 00:40:15,630 --> 00:40:21,540 You know, seeing people in the wards with no PPE because there was no PPE for a psychiatric hospital, for example. 432 00:40:22,170 --> 00:40:29,650 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. 433 00:40:31,290 --> 00:40:40,139 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. 434 00:40:40,140 --> 00:40:43,530 If we planned for this, we hadn't got rid of all stocks of PPE, for example. 435 00:40:44,010 --> 00:40:49,079 We could have done a better job probably having lower infection rates, particularly health staff, 436 00:40:49,080 --> 00:40:53,969 catching it from one patient and therefore giving it to somebody else. It wasn't just the health care stuff you worry about. 437 00:40:53,970 --> 00:40:56,280 It's there that was, you know, vectors of transmission. 438 00:40:57,030 --> 00:41:03,810 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. 439 00:41:05,340 --> 00:41:13,330 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. 440 00:41:14,520 --> 00:41:21,960 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? 441 00:41:23,250 --> 00:41:31,160 Yes. So we're involved directly and indirectly into the big now follow up COVID studies that have been funded in the UK. 442 00:41:31,170 --> 00:41:34,770 There's one called coded and there's one called COVID CNS. 443 00:41:34,770 --> 00:41:41,130 So the UK, the Ukrainian and German and also have funded these two big cohort studies were they follow people, 444 00:41:41,700 --> 00:41:45,149 either people who were simply needed to be hospitalised that COVID and they're 445 00:41:45,150 --> 00:41:49,700 following up for a year 5000 patients just to kind of see the natural history. 446 00:41:49,720 --> 00:41:53,280 So we see UK bases again, these are not real, but UK patients and UK hospitals. 447 00:41:53,280 --> 00:42:00,090 Yes, and that study is about six months in and with colleagues there's a the brain health working group as part of that. 448 00:42:00,480 --> 00:42:04,170 So this was sort of measures of mental and brain health embedded in that big study. 449 00:42:04,860 --> 00:42:10,290 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. 450 00:42:10,290 --> 00:42:17,490 So in the British population generally a rather worrying proportion of patients who were months of COVID on what better than six months, 451 00:42:17,870 --> 00:42:25,830 a significant number, both in terms of how they report themselves, but also objective measures of persistent dysfunction of one or other organ system. 452 00:42:26,850 --> 00:42:29,520 Then there's another study with the COVID sickness, 453 00:42:29,520 --> 00:42:35,400 which is a really focusing on patients who did have neurological psychiatric problems during their acute infection. 454 00:42:36,000 --> 00:42:40,170 And we our data I think one of the things which helped inform what were the priorities for 455 00:42:40,180 --> 00:42:44,370 measurements in that study and I'm not we know Oxfam one of the centres recruited to that study, 456 00:42:44,910 --> 00:42:48,900 but again patients being followed up to see but what happens to the mental health of their neurological health, 457 00:42:49,680 --> 00:42:54,120 what the brain scans show with the blood tests and to try and get a better understanding on the mechanism. 458 00:42:54,120 --> 00:42:59,400 As we were talking about earlier, how much of this is a direct link to the virus, sometimes indirectly to inflammation? 459 00:42:59,760 --> 00:43:04,740 How much is not the direct link to anything? And that study, again, is just it's just running through at the moment. 460 00:43:05,100 --> 00:43:08,970 So those two studies have definitely, I think, followed on from work we did. 461 00:43:09,540 --> 00:43:17,959 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, 462 00:43:17,960 --> 00:43:21,240 and said, you know, what could you do with another pot of money. 463 00:43:22,270 --> 00:43:28,440 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, 464 00:43:28,440 --> 00:43:36,180 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. 465 00:43:36,870 --> 00:43:40,050 Because I studies at the moment, having looked at the first six months after COVID, 466 00:43:40,470 --> 00:43:44,250 we can now look at 12 in the 1970s, now almost a million people in this network. 467 00:43:44,940 --> 00:43:55,319 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, 468 00:43:55,320 --> 00:44:00,090 which was during the first wave, might be very different. Now the public's perception of what COVID means is different. 469 00:44:00,180 --> 00:44:05,309 Maybe that your likelihood of getting long term problems is either gone up or gone down from the beginning, 470 00:44:05,310 --> 00:44:09,480 because with the vaccine that the virus has changed at the end of the day. 471 00:44:09,500 --> 00:44:15,600 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. 472 00:44:15,600 --> 00:44:22,170 It does does if you catch COVID having been vaccinated, is your Koby different than if you catch it without being vaccinated? 473 00:44:22,590 --> 00:44:31,620 Because that's another very topical question. And again, bottom, the headline of that study is we might look like everybody confirms it. 474 00:44:31,860 --> 00:44:36,060 You're much less likely to get a bad COVID if you've had a vaccine than if you haven't. 475 00:44:36,600 --> 00:44:42,180 However, your chance of getting the longer term consequences like long COVID symptoms in our study don't look any lower. 476 00:44:43,020 --> 00:44:46,920 So you still seem to get those complications even though you'll keep COVID wasn't quite as bad. 477 00:44:47,680 --> 00:44:54,209 It given the different interpretations of that which we need to drill down into. And have you used the UK Biobank tool? 478 00:44:54,210 --> 00:44:55,890 I just got given that they've got that, 479 00:44:56,100 --> 00:45:05,159 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 480 00:45:05,160 --> 00:45:13,260 colleagues in the John Ratcliffe have looked particularly at how your brain how your brain changes because there were pre and post brain scans. 481 00:45:13,290 --> 00:45:19,560 Oh, yes. Other people who are using Oxford are using some of the UK equivalents of the Met in that what we've used, 482 00:45:20,250 --> 00:45:22,650 there's two or three big primary care databases. 483 00:45:23,400 --> 00:45:29,970 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. 484 00:45:30,580 --> 00:45:33,740 And I think that the messages UK and US give you very good. 485 00:45:33,790 --> 00:45:38,790 They have complementary strengths and weaknesses. The great thing in the UK of course is its its beauty. 486 00:45:38,980 --> 00:45:47,450 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. 487 00:45:48,070 --> 00:45:56,080 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 488 00:45:56,350 --> 00:46:01,419 connections between mental and physical health in a way that you might not have done before. 489 00:46:01,420 --> 00:46:04,930 Like you said, you had already started working with that. No, I think that's right. 490 00:46:04,930 --> 00:46:07,389 And I think actually that one of the things Pandemic have done, again, 491 00:46:07,390 --> 00:46:12,990 is has drawn his attention to this fact we talked about earlier that we've always known that 492 00:46:13,000 --> 00:46:16,780 physical illness is a mental illness is connected to particularly people after viral infections, 493 00:46:16,780 --> 00:46:21,849 for example, and yet is somehow an area that's that's quite fallen into disrepute. 494 00:46:21,850 --> 00:46:25,510 I think people find it so difficult to unpack and make progress. 495 00:46:25,570 --> 00:46:29,860 It's never really been given the attention it deserves. Well, a lot of people thought it wasn't real. 496 00:46:30,080 --> 00:46:34,660 Well, the idea that we all have such strong views about what they think it is or it isn't. 497 00:46:35,290 --> 00:46:40,600 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, 498 00:46:41,410 --> 00:46:46,420 where there are views that this is very, very physical and it's very it's it's caused by a specific thing. 499 00:46:46,420 --> 00:46:48,630 And we must do must not do the following too. 500 00:46:48,850 --> 00:46:54,400 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. 501 00:46:55,120 --> 00:47:00,370 And COVID, in a way, whether we like it or not, is is drawing renewed attention to that question. 502 00:47:00,880 --> 00:47:09,970 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. 503 00:47:10,360 --> 00:47:15,560 Definitely, we looked into that, almost recapitulated the last question I was going to ask, which it says, 504 00:47:15,610 --> 00:47:21,700 As the experience of COVID and doing all this research changed your attitude to your approach 505 00:47:22,150 --> 00:47:28,360 to to the work that you do and other things that you'd like to see change in the future. 506 00:47:28,660 --> 00:47:34,600 But, uh, I want to say this I think it is this integration of physical mental health care 507 00:47:34,600 --> 00:47:38,410 and views about models of different types of disease is the biggest opportunity. 508 00:47:39,220 --> 00:47:47,680 Now, whether that's really going to happen, what I think is unfortunately still a moot point for a number of other reasons. 509 00:47:47,680 --> 00:47:51,910 One is that in this country we have a separation of physical and mental health care. 510 00:47:52,000 --> 00:47:58,300 So most of the trusts where secondary mental health care is provided a second for separate from physical health care trusts. 511 00:47:58,780 --> 00:48:02,049 And so getting good psychiatry done to hospitals and good gentlemen's name 512 00:48:02,050 --> 00:48:06,470 psychiatric hospitals is much harder than I think everybody thinks it should be. 513 00:48:06,490 --> 00:48:13,990 And trying to unpick that historical separation has proved problematic over many years, whether capable enough of a stimulus for that. 514 00:48:14,470 --> 00:48:19,660 For example, in these long-covid clinics that are being set up, I think we all want it to be one, quite one. 515 00:48:19,660 --> 00:48:25,750 Where the levers are that are needed to change it meaningfully is is is remains to be seen. 516 00:48:26,320 --> 00:48:33,880 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. 517 00:48:34,480 --> 00:48:40,660 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, 518 00:48:40,660 --> 00:48:50,049 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 519 00:48:50,050 --> 00:48:54,130 things and integrate these areas of research and clinical practice that we need to consider. 520 00:48:56,790 --> 00:49:06,689 Thank you. So continuing to talk to Carson, you mentioned briefly that I rather ran over it at the beginning, 521 00:49:06,690 --> 00:49:11,009 that you'd actually be involved in volunteering to carry out vaccine clinics. 522 00:49:11,010 --> 00:49:16,770 And how did that come about? Yes. So early in the pandemic, when we're all looking at options, how how could we contribute? 523 00:49:17,280 --> 00:49:21,480 And then vaccines came along and there was a big opportunity for doctors to get involved in vaccinating. 524 00:49:21,900 --> 00:49:29,850 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 525 00:49:29,860 --> 00:49:37,110 in giving the vaccines and I've been running towards participating in vaccine clinics in general practice since the first wave. 526 00:49:37,740 --> 00:49:41,160 We're now running booster clinics, and that's that's been really rewarding. 527 00:49:41,730 --> 00:49:50,010 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. 528 00:49:50,010 --> 00:49:52,410 So that's 60, 70 patients usually in a batch. 529 00:49:53,220 --> 00:49:59,400 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. 530 00:49:59,400 --> 00:50:04,049 And you'd expect only the hopes and fears and the worries about people coming for vaccines, 531 00:50:04,050 --> 00:50:09,570 everything from will this vaccine give me a blood clot to, you know, can can we can my friend have it? 532 00:50:09,570 --> 00:50:14,520 Well, she's sitting in the waiting room. So there's all those kind of real life engagements of the boss, 533 00:50:14,520 --> 00:50:19,620 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. 534 00:50:19,950 --> 00:50:23,130 But also 99.9% of the people are so grateful. 535 00:50:23,490 --> 00:50:26,160 They really understand what a triumph the vaccines have been. 536 00:50:26,490 --> 00:50:29,700 They're very proud to be British and being on oxygen, they're very prone to forgetting you. 537 00:50:29,700 --> 00:50:35,009 Also, I remember the first wave was we kind of have the oxygen is this the oxygen heats up? 538 00:50:35,010 --> 00:50:36,839 It was 50% of time. It wasn't 5%. 539 00:50:36,840 --> 00:50:44,040 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. 540 00:50:44,040 --> 00:50:49,950 Although of course I have no credit whatsoever for the vaccine itself. So that's been great fun together things seeing people appreciate it. 541 00:50:50,460 --> 00:50:53,040 And then as people come back to the second dose and after booster, 542 00:50:53,520 --> 00:50:57,089 you sort of see again how the population's views about this whole thing is evolving. 543 00:50:57,090 --> 00:51:02,670 Like we talked about earlier, it's going from being is brand new, exciting but really scary thing through. 544 00:51:03,000 --> 00:51:07,680 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. 545 00:51:07,680 --> 00:51:10,110 So again, seeing the evolution of, if you like, 546 00:51:10,140 --> 00:51:18,510 the societal implications of the of the of the pandemic coming through and whilst doing something sort of proactive and appreciating. 547 00:51:18,520 --> 00:51:21,840 So that's been I have the golden goose.