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Here we go. All right. Sure. So, weather.

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Sorry about that. Right. Okay. So, first of all, can you just say your name and your affiliations and title and so on?

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So I'm Sarah Walker. I'm a professor of medical statistics and epidemiology at the Nuffield Department of Medicine.

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Thanks very much. So, first of all, can you just tell me a little bit about yourself?

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I don't need your whole life story, but just the highlights of how you got to be where you are now.

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So interestingly, I'm actually a mathematician, so I started out in maths.

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Very quickly I realised that I wasn't really very interested.

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Georgina in the kind of traditional post maths rates, accountancy, actuaries, etc. And very fortunately I fell into medical statistics.

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And so that's the application of mathematics essentially to answer questions about health.

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So I then did an MSA and a Ph.D. in medical statistics, and I've really worked for the last 25 years in infectious diseases,

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which I find fascinating because they change so quickly and there's always something new.

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There's a lot of work in HIV, work in bacterial infections like C, different MRSA, work in hepatitis C,

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but very a broad range of stuff with applications both in the UK and abroad and running a lot of large scale,

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both observational studies but also randomised controlled trials who also have quite a strong track record, if you like,

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in the background operations that how do you even get the data, let alone when you've actually got the data?

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What do you do with that? And so that's really how I came to be involved in the COVID 19 Infection Survey.

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So what are the big questions that the statistical approaches allow you to address?

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So in the survey with us, let's not talk about survey.

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I'm still talking about your work, but before that, really?

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Yeah. So epidemiology is essentially the study of disease.

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So how many people have a disease? What are the risk factors?

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So who is more likely to get it and other people? And what happens to you?

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You know, what what are the long term outcomes? One of the short term outcomes, what are the best way to treat a disease?

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To manage a disease? Lots and lots of questions, essentially to tell people in the health service if somebody arrives with this.

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What kind of things should we do? How should we manage them? That's great.

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And so. I think we've covered all those questions.

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Right. So can you remember how you first became aware that there was a pandemic in the offing?

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Oh, very clearly. So actually one of my projects is actually a large randomised trial in Vietnam.

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And of course, you know, Vietnam being so close to China right from the start of 2020, we, you know,

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we were aware that there was this new infectious disease and that, you know, that it was causing a lot of challenges.

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There were a lot of discussions about the implications for Southeast Asia and a lot of the work we do.

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The people in Ho Chi Minh City were obviously thinking about the potential for spread.

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They're all infectious diseases. Physicians, many of them have worked in influenza for a long time.

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You know, the fear of a flu pandemic has really driven a lot of a lot of research.

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And so, you know. Right, I would say from the beginning of February 2020, we were acutely aware that there was a challenge in China.

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Of course, at the time, we thought it was going to be rather like the original source, which although, you know,

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it did spread to Canada in particular, you know, it was contained fairly quickly predominately because it isn't actually so transmissible.

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We were actually planning a meeting in Vietnam March the 16th to the 18th, 2020,

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and lots and lots of discussions about whether that meeting would come off.

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And they did in the end, presumably, you know, if you remember.

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And so March the 23rd, we actually went into lockdown.

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Yeah, England.

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But actually so the previous weekend we made the decision not to go and actually people were starting to think about doing trials of Homeworking.

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So Monday, the 16th of March, was actually the last day that I that I went into my office in London on the Friday before

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the last time I went into my office in Oxford because we were all trialling homeworking,

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you know, thinking that maybe, maybe this was going to turn into a big problem.

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And of course, a week later, we were in full lockdown. Mm hmm.

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So how did you and your colleagues sort out how you were going to keep working?

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Can you just tell me a bit about the kind of meetings and discussions that took place to enable you to arrive at the decision to work at home?

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And and how easy was that going to be? So I think there's a real challenge in in distinguishing between work that is

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predominately computer base and whether it's domain that faced uncertainly in,

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you know, in the group. Colleague in Oxford, we have a really large lab contingent.

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You know, we do a lot of work with bacteria, with viruses, microbiology, sequencing, and clearly that just can't continue in lockdown.

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So it was really more about thinking with people very quickly on that Friday,

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if you have to work at home for a week, what projects can you move forward?

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Because obviously people are still writing papers. People are thinking about, you know, designing experiments.

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And so even if you work in a wet lab, there is actually a lot that you can do remotely for the other staff.

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It was really more, well, if we have restrictions on the numbers,

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anyone who really can work from home should and there is just about network connectivity,

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is making sure that people have got actually laptops that they thought about taking monitors home,

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that they thought about making sure they had good connexion to the university networks,

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that all all, you know, big servers were properly hooked up so that if we weren't able able to come in,

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that that all that stuff was really rapidly facilitated and for us is particularly

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acute because our group is actually sited in the John Ratcliffe Hospital.

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We're actually right next to microbiology. We have, you know, we have academic offices right next to the main service microbiology.

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So we are right in the thick of it. And there was a cert,

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certainly a concern that essentially the whole hospital would be locked down and we wouldn't be able to access that space for a long time.

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And I mean, you are obviously you've been involved in infectious disease for a long time by this stage, the middle of March.

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How how I was going to say frightened.

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I mean, that sounds like a bit of a I mean, it's it's really difficult.

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I think I think the answer is at that time, no, not really.

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Because as I say, you know, Sars-Cov-1 had, you know, spread to Canada,

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but have actually been contained in the end and, you know, didn't go on to become a global pandemic.

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You know, just from that from the camels in Saudi Arabia, you know, has been infected humans in a limited way for a number of times.

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So so you're aware that these things have potential, but you're also aware that historically that that potential hasn't been realised.

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And as I say, it's the influenza that really everyone's always really worried about.

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So I think, you know, yes, concerned.

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But I mean, certainly no concept of actually what the next 18 months was going to hold.

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And I would actually stress I think that's that's actually true a lot later in 2020.

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So, you know, even by August 2020, you know, and I know we will talk about the survey,

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but, you know, in August 2020, we actually ramped up from around 35,

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40,000 participants a fortnight to 150,000 because people were worried about whether there would be a second wave and if there was a second wave,

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they wanted to know about it soon.

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So, you know, even then it was you know, the feeling was, well, if there isn't a second wave, then we're just going to stop it.

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So, you know, 18 months on, I think it's easy to forget, actually, that even in the first period,

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there was a lot of feeling that actually maybe this will all just die out and it will disappear very quickly.

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Right. And that that was fairly common amongst your colleagues, was it, that, you know, I think it was quite I don't think it's just my colleagues.

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I don't know. I think, you know, I think many people in August 20, you know, eat out to help.

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Oh, God. Yes. I remember a lot of people, you know, thought it could all be over.

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So how did you come to decide to pivot your research to or were you called upon to pivot your research to focus on this particular virus?

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Yeah, I think so. So I think there's two distinct there are two distinct sides, actually.

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Georgina So the group that I co-lead in Oxford is called Modernising Medical Microbiology.

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And it's a group that's co-led with a microbiologist and infectious disease physician.

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Derek. Yes, I spoke to him last week. So I have to say, I think from the lab side, there was a clear need for, you know,

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better assays for people really understood about how lab stuff works to to really shift their research into that direction.

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And so a lot of the group really moved very strongly down maths.

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And obviously you've talked about that with them.

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So I think my side of it was then a little bit different because actually it wasn't

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so much the groups that shifted as I shifted in the what happened was that,

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you know, for the first month I was really just carrying on with Non-Covid work, meeting people on teams,

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pushing these papers forward, thinking about everything we could do that didn't require the lab.

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And then because of this work that, you know, Derek and Tim were involved in around the essays,

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I got started getting asked for advice from the Department of Health,

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particularly around the, you know, the need for a very large seroprevalence study setting out.

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Can you just explain what that means? So I was going to say at the time, you know, lots of people come back from half term in really sick.

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And the feeling was that actually maybe 60% of people have had it already.

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And so what Seroprevalence means is in the population, so what is prevalent?

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How many people have got serological evidence meaning in their blood?

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You can see they make antibodies to COVID so that they've had it before.

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And so the real question was, well, if 60% of people have had it already, we don't need to worry.

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And but we had no idea, actually, in the general population how many people would show this evidence in their blood.

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And obviously, to do that study, you need a large scale design, you need sponsorship, you need ethical approvals.

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And so essentially it was actually on Tuesday, the 14th of April 2020.

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So, you know, three or four weeks after lockdown that I got pulled into a meeting to really talk about

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different designs for seroprevalence studies like that and how we can make that happen.

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And then actually, because the need was very, very great, it all happened very fast.

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So two days later, we got agreement from Department of Health that we should proceed and the Oxford would be the sponsor,

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because every big medical study like this that there's a system in the UK for how you set these things

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up and the approvals you need and you need somebody to act as a as a formal sponsor for the study.

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And I think it was only honestly just a case of stepping up.

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I remember I had a bit of time on Friday because a couple of meetings got cancelled.

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So I said, Well, I'll write a draw. Yeah. So I wrote a draught of the protocol on Friday and that was the first the first time for the study.

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And at the time, it was essentially taking blood.

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Because we were interested in how many people had antibody levels in their blood that showed that had it before.

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And we plan to do that every month.

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And because we were also looking for new infections, we were pairing that with nose and throat swabs because we were taking blood.

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We were restricting just to those who were 18 years and older and to try to get a rough estimate.

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The idea was we'll start with a thousand households.

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The reason for going for households is obviously that was there was knowledge at that time that it was being transmitted within households.

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There were lots of questions about whether just one person in the house household or everybody.

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So you start with a thousand households and then we'll do another 1000 households every month for a year.

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So you basically have this rolling design where you not only follow up the people you've got, but you continue to see actually people into the cohort.

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I know that that's a fairly basic seroprevalence study.

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But what was so interesting, Georgina, is is it then kind of gained a momentum of itself because I think as soon as you start to think,

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well, actually, we don't know how many people have had it before, let's set up a study to look at that.

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Then as soon as people find that out, a whole load, more questions come up.

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Because, yes, it's true. We don't know who's had it before, but neither do we actually know who's got it now.

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And it's all very well saying, you know, 18 class. But what about kids?

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So by Saturday, the 18th. So this is the day after the first protocol draught,

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it had already been dropped down so that we were going to recruit everybody who was 12 years and older.

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We would still only take blood if they were 16 years old, but we were actually going to try and get nose and throat swabs from teenagers.

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And because people were concerned about how quickly the infection might be burning through,

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we were actually going to do an extra maintenance swab at two weeks.

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So B, enrolment, a two week nose and throat swab and then multiplied and then.

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But but still only a thousand households. Yeah. And how did you recruit the households?

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Well, no, we haven't even got to the final study yet. Oh, right. Okay.

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Because by the Sunday so the day after it was up to 11,000 households, though ten times as many.

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And down to two years and extras.

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Right so 123 ways and and then the day after we submitted the protocol for ethics.

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So literally in three days we went from really quite small study to really quite

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large study and we actually recruited our first participant the Sunday after that.

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Now, how were the participants chosen? You know, at that time, as you said, there was a lot of uncertainty.

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Georgina And we really needed information fast.

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So actually in that first wave of recruitment, the Office for National Statistics have been running a number of all the surveys,

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and they asked people if they would be happy to be approached for future research.

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And so in that first wave, we actually went to households where somebody had said, I'm happy to think about doing studies again.

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There weren't that many households in that group. So by July we were we.

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And since July 2020, we've just recruited from address list.

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So Ordnance Survey hold lists of addresses across the UK and we just picked addresses at random

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because we are trying very much to get representative households across the UK and you know,

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particularly to make sure that we do include people from more deprived areas and rural areas, city areas everywhere.

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So, so people got a letter and within the letter there is a phone number and if you phone up we, we send a study worker to come to your house.

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They don't go into the house, but it's basically all done through through addresses and through households.

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And what's the level of acceptance that you get from the invitation letters?

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So from the first letters, we actually got about 40%,

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which isn't particularly surprising because they're a group of people who've said, yes, approach me before.

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So you have to assume that they're more interested in taking part from the general address, less samples.

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It's generally in the region of 10%, so it's around one in ten.

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So, you know, and that's the Office for National Statistics will tell you is fairly average for just just general sampling from an address list.

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It is a big ask. So I would stress this that, you know, all participants have a study worker come to their home every month.

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You know, they each do a nose and throat swab. About half of them now have blood taken.

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We're actually using a fingerprint now. We're all fine.

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But, you know, it's still a reasonable half and we do ask some questions every month.

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So and you know, the study work and I's where they live.

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So it is a pretty big ask. And I actually think getting 10% of households is is actually a really a really stunning achievement.

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Yeah, absolutely. So this was one of a number of ways that people tried to count the progress of the of the epidemic in this country.

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Can you just talk a little bit about the the pros and cons of the different methods?

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You know, so so a lot of information comes from from the national testing programme.

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So test and trace. So this is where, you know, if you think you've got COVID or you think you've been exposed, you know, you're a contact.

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You can go online and you can ask for a test. And so obviously those numbers are much, much, much bigger.

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The challenge is that the number of positives that you find reflects not just the number of positives that there are in the community,

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but how likely each one of those people is to get tested.

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So if actually. Everyone just has a 40% chance of being tested.

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If they've got COVID, it doesn't matter because the numbers that you get at the end,

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the positives will still reflect what's going on in the background.

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The problem is that we do, you know,

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suspect or know from indirect sources that there may be lots of reasons why people don't want to get a test because if they test positive,

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it has consequences which may affect their income or it may affect the things they want to do.

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And I would say that in my mind at least, that the biggest challenge with COVID is just that so many people have it without knowing.

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They've got it still possible. And it's this so-called asymptomatic infection.

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So infection where actually your nose and throat is stuffed for the virus, you'll breathe in and out all the time.

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You feel fine. That is the biggest challenge for this infectious disease, because obviously those people don't know they've got it.

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So they're never going to test. When we test everybody, every month we find about a third of infections.

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People genuinely have no symptoms, no idea they've got it at all.

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So that's a lot of people going round spreading it.

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And that was the challenge with the alpha wave.

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You know, at the end of November, beginning of December, that last year,

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you saw what happened to hospitals when actually then a small number of people who didn't get it really badly or the tip of the iceberg.

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But the iceberg has got this enormous number of people, you know,

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maintaining the epidemic and maintaining transmission and, you know, inadvertently passing the virus around.

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So, you know, the challenge with testing data is it only tells you about a bit of the problem.

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And then you have to make a lot of assumptions about the relationship between the best you can say and the iceberg bit under the water that you can't.

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So you talked about the sorry, you talked about the alpha wave.

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Let's just go back to the beginning of it and just can you just tell me a little bit about the

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kind of natural history of this virus and how you saw it evolving through the the programme?

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Yeah. So I mean, what came out of Wuhan was, you know, it was the, the found the virus and actually relatively quickly last year,

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I think they think probably by July or August it had already made one major change to its genetic material.

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So this is this mutation called the 614g, which really rapidly became the main population.

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So the way you see that viruses are more fact or transmit better is that basically they just take over.

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So if you have something that's got an advantage, you know, within a few months,

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you'll see it really becoming the majority virus in lots of different places.

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And so that already happened once. But this 614 DG was probably not super, super transmissible.

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What then happened in, you know, probably in September, early October,

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we'll never know exactly is that the virus found a new place to go and that's the alpha variant.

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So one of the challenges lots and lots of people having infections is that there's lots and lots of virus making copies of itself all the time.

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Every time it copies itself, it has the chance to to change one or more of the letters of the genetic code.

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And if that change really helps the virus, then that changed virus will just be the one that goes on and gets transmitted.

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It becomes more and more successful. And Alpha was probably at least twice as transmissible as the virus that it replaced.

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And then on to fight Delta, which rose early earlier this year, is probably at least twice as transmissible as again it is.

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I'm fight natural.

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The virus has never been in human beings before and there are lots of things about human beings that it will find ways to to adapt to.

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And the more infections you have, the more opportunities it's got to find those changes that give it an advantage.

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So it is expected, I think it will carry on.

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I think it's difficult to say whether the changes that it finds in future are going to be so big because,

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you know, to doubling transmission and then double again really in six months is pretty unusual.

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But I think we have to expect that it's going to continue to find ways to to be more transmissible,

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to adapt to humans over the next I know the coming months and years.

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So how much longer do you see the survey continuing?

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Well, it's we're funded until March next year. And I think it will you know, I think it will really depend how we get through this winter.

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As I say, you know, testing data has a lot of advantages.

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If you can see that it is a good reflection of what's going on in the general population.

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The survey is it does cost money and it's a balance then of how much extra information you get from the survey that you can't get from elsewhere.

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Obviously, vaccination is hugely successful. And you know, if you think about where we were a year ago, you know, we're in a so much better place.

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But, you know, whether or not we really will see challenges with waning immunity over this winter, that translates into increased hospitalisations.

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I think if we see really big health system challenges,

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then that's the kind of thing where it would probably be more useful to keep the survey in some form,

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to carry on monitoring how immunity is changing and what other interventions we might need in which population groups to try to keep hospitalisations.

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You know, low hospitalisations obviously are much lower than they were a year ago, but they're not zero.

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And of course, that they're extra compared to what we had two years ago.

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And there are a lot of people who really need NHS treatment now.

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So I think we have got to keep finding ways to keep the impact of COVID on the health system low.

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We aren't going to eliminate it. That's that's just not going to be possible.

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So apart from just tracking exactly what kind of what strain was infecting people and how many people were infected, what were the main finding?

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What have been the main findings so far from the survey?

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And is there anything that's come out of it that surprised you?

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So we've done a lot of work looking at vaccine effectiveness and particularly how long protection from,

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you know, protection from getting infected again, last with the different vaccines.

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I mean, I think one of the surprising things to me has been that although they are both, you know, very successful so that the M RNA vaccines,

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the Moderna and Pfizer and then the Adeno virus vaccine from AstraZeneca, they are both successful, but they are actually very, very different.

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And in particular, you do get much better protection, at least initially from the M RNA vaccines.

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But that changes reasonably fast.

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And what's also very interesting is it seems to change much faster in the people who are most at risk.

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So, you know, people who are older people have long term health conditions, have much faster declines in antibodies.

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And that's quite interesting because, you know, both of the vaccines are designed to stimulate the immune system,

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to give you protection, and they both do protect, but they're doing it in quite different way.

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And what that really does suggest is that these strategies where you give people

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different vaccines might actually be really effective at a population level.

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And obviously, we're currently conducting a huge natural experiment in that because, you know,

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people who had to isolate doses like I did will get Pfizer and all the people who had two Pfizer doses will also get Pfizer.

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So that's something that we're going to be looking more into in this survey over the next few months.

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I mean, I think that the finding that really so so many people have COVID without any symptoms at all was completely unexpected.

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We actually got a lot of challenge over it. And I think that that has actually been really important for just people getting their you know,

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getting their heads around what that means from a public health strategy.

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But but I mean,

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definitely I think the other thing that's really interesting is that increasingly the work we're doing is showing the importance of natural

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infection in terms of how you respond to vaccines and what that may mean subsequently and without a very large study like the survey,

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where you actually have a reasonably good idea about who's had it before,

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because obviously if you're testing people regularly, you find them when they don't know they've had it.

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Whereas if you just rely on them coming forward and getting tested through a national programme, you'll miss a lot of previous infections.

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And so, you know, those kind of those kind of answers to questions, what's the relative benefit of vaccination versus natural infection?

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What about being vaccinated and then getting it composed of being vaccinated twice

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and then getting a booster in terms of how we live with this over the coming years,

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answering those questions, which again is something that we're really focussing on over the next six months I think will be really important.

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And to what extent have your findings fed into policy on how the pandemic is managed?

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So we we actually report to government three times a week.

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So a Tuesday report, Wednesday report and Friday report.

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And we publish every weeks for positivity.

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We publish every two weeks information about antibody levels.

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And then at least two or three times a month we're publishing extra reports,

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whether that's on characteristics of people with positive information about symptoms.

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You know, we've done lots of work on Reinfections.

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We try to look at predictors of who is positive at the moment, know what are the current drivers of the epidemic.

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So, you know, I'm 100% confident that, you know, everything we've done has fed in and has affected,

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you know, decisions about lockdown, about plan B, and we'll continue to do so moving forward.

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And also to what extent do you interact with the people who are running the test and trace system,

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which is obviously, as you've explained, producing data that has some some benefits, but some.

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Yeah. Yes.

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So test and trace feed into government decision making through the Joint Biosecurity Centre, which is now called the UK Health Security Agency.

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So all the information does get does get fed in here.

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It comes together in in the Department of Health and Social Care.

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And then there is a summary that is written every week for ministers, basically summarising that the totality of the evidence.

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I think it's you know, so definitely it has a huge role to play and is also being used to look at vaccine effectiveness on a broader scale as well.

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Of course, where it where it gains is that you can look at much smaller, less smaller areas.

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Yet even with 150,000 people tested in the survey every fortnight, if you spread them across the UK,

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you know, or ability to look in small local area authorities is essentially zero.

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Whereas, you know, the national testing programme can do that.

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But equally is the fact that, you know, we then provide an unbiased estimate of, if you like, what's the,

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the underlying picture and then the testing pulls out specific areas and then you can kind of pull the two together to

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extrapolate and make some estimates about how much testing there is and think about what that could mean in terms of underlying,

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right? So that they're definitely complementary and they do all get pulled together.

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So just as as a kind of ordinary member of the public, I have the impression,

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certainly in the kind of newspapers I read, that the own survey data was regarded as very high quality.

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And so people would always say, oh, we'll have to wait and see what the UN says on Friday.

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So so all your data was being not just given to government but put into the public domain every week?

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Yes. What was that like for you to have that level of public exposure,

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which can't have been something to get me, but presumably wasn't happening previously?

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Well, I mean, because, you know, much research is on a much longer timescale and it's almost only the results at the end that matter.

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You know, particularly if you think about doing a trial, you know, you know,

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that results when you've only recruited 20% of the people are going to be extremely unreliable because,

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you know, you need the whole sample in order to get a reliable result.

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So, you know, the survey is just it's quite different to to a lot of academic research.

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I mean, I think I. It was a challenge.

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But it's also critically important because, you know, people are giving up a lot to help us out, our participants.

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And also the information is important for people to know.

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You know, it isn't it isn't just something for governments,

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not only the Office for National Statistics has an absolute mandate that everything they do has to be transparent and in the public domain and,

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you know, shouldn't just be reserved for policymakers. They aren't actually part of government.

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They are independent of government. And it's partly for those kind of reasons.

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So, you know, I think that it's actually been essential and it's been one of the one of the best things about the survey,

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the fact that people really have known what the data is saying and what we're doing with it.

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So I'm kind of poking for it. How did you personally feel about doing interviews and sharing in the media?

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I don't do a lot of it, but actually I don't I don't mind because I think, as I say,

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I think it's so important for me to be able to explain to people what we're doing and why.

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You know, I think, as I say, people give up their time and energy to give us answers.

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We have a responsibility as scientists to close the circle and to do the best we can, whether we feel comfortable with it or not.

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I don't do a lot of it because, you know, it's not my you know, it's not my real world expertise.

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There are people like David Spiegelhalter who has, you know, far more ability and natural, natural flair at communication.

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But I can talk about what we are doing and I and I'm happy to do that.

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I, I think you do it really well actually.

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So I don't know if you've had any training, but I think you're doing, you're doing from the evidence of this interview, you're good at it and.

331
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Right. So I've got a little list here of things that I picked up from your papers that we might just go into a little bit detail.

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So there's this question of viral load. What's that concept?

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What what does it mean and why is it important?

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So if you think about two people with infection, if one person has got 10 million viruses in their throat and one person has got 1 million viruses,

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and then you think about air coming out of their mouth.

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All the studies have shown that basically the more virus you put in your throat, more like you are to pass it on.

337
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And. The reason. So, so, so viral.

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Viral load, if you like. How much virus there is sitting in your throat is a key determinant to transmission.

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Now, where it would get interesting is if actually you thought that everybody ultimately had exactly the same amount of virus.

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It was just when you sampled them.

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So obviously when you first get to it, you won't have much virus and then it will all start making copies of itself.

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And then your immune system, all the vaccinations you could get in a national decline.

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And so if it's just about where in that kind of wave of virus you sample people,

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then it shouldn't matter and everybody should transmit the same amount.

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And that's not what you find.

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You find that actually the amount of virus when people take a test is strongly, strongly predictive of their chance of passing it on.

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So individual people clearly have very different amounts of virus and you can kind of see that from hospitalisation as well.

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You don't see any symptoms. Lots of people end up in hospital, so individual people respond very, very differently.

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And then we can use the amount of virus that we find in people to almost, if you like, track the predicted impact on transmission.

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We also use it to try to track where we think positivity will be going because obviously if if viral loads are very,

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very high, there's a good chance that a lot of it will be being passed on and next week positivity will be even higher.

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And that in reverse, if viral loads are very low, the lower chance of passing it on.

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So next week positivity will be lower. And so, you know that that's partly how we're using viral load, you know,

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also to look at things like vaccination and how how that's affected the amount of virus that people carry.

355
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And another study you've done, I think it is, is separate from the UN study is looking at health care workers.

356
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But I'm still, you know, through it through the work with the Oxford Group.

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One of the things that we've had for actually 15 years now is a very large warehouse

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of anonymized data from across the hospital that includes all the laboratory tests,

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but also the occupational infection data, which includes healthcare workers in particular,

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whether they're vaccinated or know the test results from the health care worker testing programme.

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And actually, that's been hugely important for for giving us the first evidence about things like the protection that you get from natural infection,

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because lots of healthcare workers were exposed very early on in the first wave.

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Lots of them were tested. They were vaccinated very early.

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And so that's been hugely helpful in trying to understand just how much protection

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you might get from both natural infection and then also from vaccination.

366
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So did that help you to design the onus study where you were already getting enough data to do that?

367
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No. So, I mean, in terms of the timing, you know that the health care worker testing was already being set up in April,

368
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May, June, July, a similar time to, you know, to the survey really ramping up.

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But just because, you know, the health care workers were being tested actually much more frequently, so many of them were being tested twice a month.

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You just get more data more quickly. And also the other thing is that they were being exposed more in hospital.

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You know, actually, hospitals still stayed, you know, of substantial place of risk all the way through to December last year.

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So again, the sense one gets as an ordinary member of the public is that that that there has been

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the the path from scientific data to policy has not necessarily been a smooth one.

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There has been there have been differences of opinion about what the best policy measures are.

375
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And clearly, our outcomes in this country have not been brilliant, except in the case of vaccination.

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Is that something you concern yourself with or do you just get on, collect the data and leave it to others?

377
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So, you know, to a degree, I leave it to others because I do think, you know, hindsight's always 2020.

378
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But at the time, you know, the health data is only one piece of the picture.

379
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And there are a lot of all the pieces of the picture that actually I don't think we will actually know the consequences of for a while,

380
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you know, educational attainment, you know, how mental health, how well, you know, all operations councils, you know, the impact on cancer care.

381
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And and, you know, there are there are a large number of dimensions.

382
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You know, it's a bit like one of those wobble boards. You know, there's so much going on.

383
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And I'm not an expert in all of that. I'm not sure that anyone is.

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But what I am an expert in is the health of.

385
00:41:14,890 --> 00:41:22,600
And so what I can do is I can make sure that my vision of what will board the data is as strong as possible.

386
00:41:25,000 --> 00:41:31,569
I'm not abrogating responsibility for the bigger decision, but my job at the moment isn't about the bigger decision.

387
00:41:31,570 --> 00:41:41,470
My decision. My job is about making my bed as tight as possible and being clear as possible about the consequences on what that means for my bit.

388
00:41:41,770 --> 00:41:48,730
And I do think people who think it's obvious or simple, you know, if I knew where to do this, it would have been completely different.

389
00:41:49,720 --> 00:41:56,530
I think there's a lot of just story going on there because it's not entirely clear that even had you done something different,

390
00:41:56,770 --> 00:42:00,430
it wouldn't have been bad in a different way that you just have not anticipated.

391
00:42:02,130 --> 00:42:10,590
Very diplomatic. And I've just got a few questions about the extent to which the pandemic affected you personally.

392
00:42:11,250 --> 00:42:17,280
I mean, you said at the beginning you thought it would probably you didn't think it would become as bad as it was.

393
00:42:17,280 --> 00:42:22,230
But at later stages, did you feel personally threatened, threatened by it?

394
00:42:23,550 --> 00:42:28,770
No, because I'm I'm so fortunate in that, you know, my job is flying from home.

395
00:42:29,340 --> 00:42:35,190
And so actually, you know, I haven't actually been into my office in Oxford for 18 months.

396
00:42:35,640 --> 00:42:42,120
And I also have a position in London, and I've been into that office, you know, two or three times.

397
00:42:42,450 --> 00:42:52,049
So I am incredibly fortunate that I'm actually I find interacting with people on on, you know, teams.

398
00:42:52,050 --> 00:42:57,110
All the reason be straightforward. I do force people to have cameras on.

399
00:42:57,120 --> 00:43:01,470
I think, you know, the being able to see somebody in the face is really important.

400
00:43:01,770 --> 00:43:06,900
But, you know, all of the work with Baroness, I've never met any of that face to face.

401
00:43:07,590 --> 00:43:13,680
And we have a great working relationship. So. So. But, you know, I accept that I'm very lucky in that regard.

402
00:43:13,680 --> 00:43:16,950
And that isn't the case for everybody.

403
00:43:17,340 --> 00:43:20,670
I have a long term health condition. I'm an insulin dependent diabetic.

404
00:43:21,420 --> 00:43:27,659
So, you know, I, I got my first vaccination in the middle of March, and I'm a booster next week,

405
00:43:27,660 --> 00:43:34,500
but I can't say I've ever I've ever really felt personally threatened because I've been able to control what I do.

406
00:43:34,500 --> 00:43:40,260
And I think that's what makes a huge difference, really. And it's for people to all table top flight control.

407
00:43:40,410 --> 00:43:45,390
I think it's been a particularly challenging and stressful time.

408
00:43:46,630 --> 00:43:50,880
And what about the workload? I mean, have you have you been working longer hours than you would normally?

409
00:43:51,210 --> 00:43:56,060
Yes. Yeah. Don't ask. No. It's been a long, hard.

410
00:43:56,370 --> 00:43:59,430
It's been a long, hard slog. And I'm still working very long hours.

411
00:44:00,900 --> 00:44:05,370
But it is my choice. No one's actually forcing me to do it.

412
00:44:05,400 --> 00:44:10,230
I'm doing it because I feel that it's something that I know I need to do.

413
00:44:10,870 --> 00:44:15,430
I want I want to see people get value from this survey.

414
00:44:15,450 --> 00:44:21,360
I feel that, you know, it does cost money and there are lots of calls for money at the moment.

415
00:44:21,750 --> 00:44:24,360
But, you know, what I can do is make sure that, you know,

416
00:44:24,960 --> 00:44:31,290
what's coming out of it is high quality and answers to questions that that people really want answered.

417
00:44:32,590 --> 00:44:39,910
And are there any steps you take, too? I mean, what do you do to maintain your well-being under such a pressured way of life?

418
00:44:41,080 --> 00:44:44,860
I am good at going to the gym. So I think that's very important.

419
00:44:45,720 --> 00:44:49,420
You know, and I'm already, you know, I have to take care of myself.

420
00:44:50,620 --> 00:44:53,890
Me being a diabetic, you get used to kind of monitoring.

421
00:44:54,650 --> 00:44:59,170
And so and I have fantastic friends. I think that's the other really important thing.

422
00:44:59,170 --> 00:45:07,149
And even though I haven't seen much of them, I speak to a lot of them, you know, on Zoom on teams and also my sister.

423
00:45:07,150 --> 00:45:17,920
So I think having those kind of connexions, even if they're not physical and that she prioritising and you know speaking to people is is essential.

424
00:45:18,130 --> 00:45:25,450
Otherwise you just descend into it. I'm actually having a lot of fun with the people that Christina I really can't

425
00:45:25,450 --> 00:45:31,000
stress enough how how fantastic the team are and how fantastic the team at Oxford.

426
00:45:31,330 --> 00:45:37,510
And actually in my, you know, my other job in London. And actually, people give you energy and.

427
00:45:37,590 --> 00:45:40,590
And I love working with people. Mm hmm.

428
00:45:40,800 --> 00:45:49,090
And I mean, all the broader steps that have been taken to maintain the that the wellbeing of the team as a as a as a whole.

429
00:45:49,780 --> 00:45:54,970
I think so. We I think we have all tried.

430
00:45:55,000 --> 00:46:04,720
I think everyone has been very busy. And I do also think it is it is about finding out where people are and what people want

431
00:46:05,290 --> 00:46:10,330
rather than making assumptions that people are struggling when actually for some people,

432
00:46:11,380 --> 00:46:21,220
it has actually improve things. So I think with everything to do with people, it is just about avoiding one size fits all policy.

433
00:46:21,670 --> 00:46:27,160
Some people want to go into the office and it's about facilitating that. Some people don't and it's about celebrating that.

434
00:46:27,580 --> 00:46:32,379
And as I say, it's about making sure the people have the right kit and that they know they can get it

435
00:46:32,380 --> 00:46:36,820
and that they know they've got someone to talk to and meeting people where they are.

436
00:46:37,170 --> 00:46:44,080
So to me, that that's been the approach we've taken and will continue to take because I don't think we're there yet.

437
00:46:45,190 --> 00:46:51,909
I think a lot of the general population have just felt a bit helpless and that there's nothing they could do to help the situation.

438
00:46:51,910 --> 00:46:56,620
Whereas you were obviously somebody who had a very clear job that you could get on with.

439
00:46:57,070 --> 00:47:05,020
Is that was that helpful? Do you think that it gave you a clear objective and something to get on with in terms of coping with the whole?

440
00:47:05,530 --> 00:47:09,820
But I think it's the uncertainty that people feel, so it's so difficult to do that.

441
00:47:10,510 --> 00:47:18,370
To be honest, Georgina, it's a bit hard because I have just literally worked all the time and so I haven't really had time to think.

442
00:47:18,370 --> 00:47:25,059
And I think that probably is, you know, the weeks just go by in a continuous blurb, always having many more things to do.

443
00:47:25,060 --> 00:47:31,840
And at least as long as my home and people shouting stuff on them. So you don't have a lot of time to think about it.

444
00:47:32,110 --> 00:47:35,620
I mean, I guess my only observation would be, I think in everything you do,

445
00:47:35,950 --> 00:47:39,730
you always have the opportunity to make someone else's life better or worse.

446
00:47:40,060 --> 00:47:44,680
Yeah. And so even if you even if you can't control the situation,

447
00:47:44,680 --> 00:47:51,900
you can control how how you interact with other people and how you make their day, you know, better day or worse day.

448
00:47:51,910 --> 00:47:57,879
And I guess, like always, you know, I've always believed in that kind of degree of control when you can't control events,

449
00:47:57,880 --> 00:48:04,660
but you can control how you how you respond to them and how you make meaning or sense out of them.

450
00:48:06,820 --> 00:48:15,070
So has on the last couple of questions, you. Has the work you've been doing raised new questions that you'd be interested in exploring in the future?

451
00:48:15,760 --> 00:48:20,740
Well, so, I mean, here 18 months ago, I didn't know anything about COVID. Yeah.

452
00:48:21,100 --> 00:48:31,390
So, I mean, I guess I am particularly interested in the interplay between natural and acquired, often via vaccination immunity.

453
00:48:31,960 --> 00:48:36,520
And because to me. That'll be all.

454
00:48:36,520 --> 00:48:43,170
All we really going to give people a boost every year? You know, she might be need to give me a boost as more than ever.

455
00:48:43,300 --> 00:48:46,580
Yeah. Yeah. And. And to whom and how.

456
00:48:46,770 --> 00:48:55,520
And so I think answering that question is really essential for thinking about a post-COVID world.

457
00:48:55,940 --> 00:49:04,570
I think the other question that I really think we need to answer, but I just don't know that we've got the right balance between deterrence.

458
00:49:04,690 --> 00:49:10,390
So let me explain is who is actually getting hospitalised despite vaccination?

459
00:49:11,750 --> 00:49:18,830
Is it fundamentally a challenge of co-morbidity that we can probably do very little about?

460
00:49:18,950 --> 00:49:23,900
That means they've already got some disease that makes them susceptible.

461
00:49:24,140 --> 00:49:27,410
Is it actually, you know, oh, they actually vaccine failures.

462
00:49:27,410 --> 00:49:34,310
We just don't know. So in the survey, we can work out these vaccine failures, but we just don't have that many people.

463
00:49:34,320 --> 00:49:38,360
So very, very few hospitalised in the national data set.

464
00:49:38,360 --> 00:49:42,380
They have a lot of you know, they have everybody because they do it on that linkage.

465
00:49:42,650 --> 00:49:48,709
And so, yes, you can see that it is people with co-morbidities in general that are hospitalised,

466
00:49:48,710 --> 00:49:54,470
but you don't know whether that's actually to do with vaccine failure or whether actually it's because there's something else,

467
00:49:54,770 --> 00:49:56,569
you know, challenging about their immune system.

468
00:49:56,570 --> 00:50:05,030
And it's how can we bridge that gap somehow in the middle to try to understand whether it's actually, you know,

469
00:50:05,030 --> 00:50:10,040
whether whether the vaccines are actually something which we can control and do something about,

470
00:50:10,430 --> 00:50:15,010
or whether there are groups of people in who we need to be more targeted,

471
00:50:15,380 --> 00:50:23,420
or we just need to be clear that, you know, this issue of risk and I think it's is this kind of personalisation of risk management

472
00:50:23,750 --> 00:50:28,670
and moving away from a one lockdown is a one size fits all policy everybody set home.

473
00:50:29,300 --> 00:50:35,870
But to say it's not right and it's not fair, but, you know, you may intrinsically have more risk.

474
00:50:36,740 --> 00:50:39,820
You can choose to do whatever you want.

475
00:50:40,430 --> 00:50:44,450
If you do these things, your risk will be lower. And that's your choice.

476
00:50:44,750 --> 00:50:52,540
And you're moving because, you know, before COVID, we all got colds and we just accepted it was part of life.

477
00:50:53,000 --> 00:51:04,309
And the cold didn't land you in hospital, but it's just moving to that understanding about what you can do, how your choice plays into that,

478
00:51:04,310 --> 00:51:10,490
without expecting there to be, if you like, a national response or that it's going to go away because it isn't.

479
00:51:12,560 --> 00:51:21,020
So the other question is related and you partly answered it. Just to ask you whether the experience of of COVID has changed your your attitude or your

480
00:51:21,020 --> 00:51:25,850
approach to your work and whether there are things you'd like to see change in the future.

481
00:51:27,760 --> 00:51:36,190
Um. I mean. I think I've I've always worked hard and I've always enjoyed working with people.

482
00:51:36,200 --> 00:51:40,990
So I'm not sure that actually from that point of view, it has really changed anything.

483
00:51:41,170 --> 00:51:43,400
I've always found medicine fascinating.

484
00:51:43,420 --> 00:51:49,690
I've always found infectious disease fascinated, who always wants to use maths to, you know, to find the stuff out.

485
00:51:50,080 --> 00:51:59,160
And I think. What it has made me aware of is the fact that, you know, I did spend 10 hours a week meeting before.

486
00:52:00,270 --> 00:52:05,010
I do now spend those hours working that you can all that it's not a good trade.

487
00:52:05,370 --> 00:52:13,499
But I think, you know, moving forward, I would like to see more recognition of the fact that for many people,

488
00:52:13,500 --> 00:52:20,040
commuting takes up a substantial amount of time is quite stressful and not very pleasant.

489
00:52:20,520 --> 00:52:27,240
And however much there may be benefits from working from home, there are also some advantages.

490
00:52:28,130 --> 00:52:35,910
You know, so it may be benefits from working in the office and it would just be about finding a better balance.

491
00:52:36,120 --> 00:52:43,050
I do think it's really challenging for people starting new jobs and I think it's very challenging for junior staff.

492
00:52:43,350 --> 00:52:49,030
So, you know, I'm not I'm not I'm not just, you know, prior to want to work from home because I think, you know,

493
00:52:49,110 --> 00:52:55,350
those years in your twenties when you're really trying to work out what you're doing, being around all the people is very important.

494
00:52:56,130 --> 00:52:59,700
So unfortunately, it's a question of balance, which is always tricky.

495
00:52:59,700 --> 00:53:08,159
It's not easy to make one thing or another thing, but that is something that I would like us to move towards a more nuanced and just

496
00:53:08,160 --> 00:53:12,630
caring less about where people are in the country or even necessarily the world.

497
00:53:13,200 --> 00:53:17,640
If you're a good person, does it matter if you're sitting in Romania?

498
00:53:19,140 --> 00:53:24,270
Yeah. If you're doing good work, that's really helpful and moving along.

499
00:53:25,140 --> 00:53:29,280
Why does your physical location matter? So I think that's something that I'd like to see.

500
00:53:29,580 --> 00:53:33,120
I mean, I understand there are tax implications and it all needs to be worked out.

501
00:53:33,420 --> 00:53:43,079
But I'd like to see more focus on on productivity or contribution and less on all you physically in the office,

502
00:53:43,080 --> 00:53:49,230
all, you know, in the town where we're employing you. And I think I think that could actually help us all.

503
00:53:51,130 --> 00:53:56,020
Great. I think that's fine. Is there anything obvious to you that I've left out?

504
00:53:56,380 --> 00:54:00,070
No. I have absolutely no expectations.

505
00:54:00,120 --> 00:54:05,380
I hadn't talk about. I can talk the hind leg off a donkey, to be honest.

506
00:54:05,590 --> 00:54:08,530
You know, that works out now. So I'm just going to stop recording. I'm.