I say to them that you need to turn that off.
So can you just, first of all, say your name and your current title?
Yep. So my name is Thomas Kirk and I am now a research fellow at the University of Nottingham in biomedical engineering, specifically imaging.
Terrific. Thanks very much. So without telling me every minute of your life story, can you just give me the headlines on your your career so far,
starting really from how you first became interested in And I don't know whether the life sciences or the engineering side of it came first,
but in those subjects. So I was I was always interested in engineering from from a relatively young age,
but not interested in the sense that I knew from a long way out, I want to go to university and I want to be an engineer.
I know some kids have not quite well formed life plan.
That wasn't the case for me. However, when it came down to applying for university,
I was at a very good school where pretty much everyone goes to university, so I was just going with the flow, as it were.
And but that's the that was the first time where I seriously considered that I could go to Oxford or Cambridge, and now I had the grades to do that.
I applied to Cambridge and again, actually I failed by interview and then I spent a year working as a maths teacher on
a teach first scheme and then I reapplied fogs at this time and did much better.
And I think the teaching experience I was doing probably helped a lot because my the interviewer at Trinity College,
where I played in Oxford, his wife is a teacher, so we did spend part of the interview talking about the challenges of teaching.
And I think that that probably helped put me at even. Anyway.
And Oxford is a is a special place to do engineering in the UK like Cambridge.
But not many other universities share this property of offering a general engineering course where you specialise as you go on.
And initially biomedical didn't feature on my radar at all.
I thought I'd probably end up as a civil engineer and then after having done one year of general engineering at Oxford,
realised I absolutely hated civil engineering engineering, I ended up quite liking electrical, which I never thought would happen.
And then that was the influence of one tutor in particular called Michael Chappell, who I remain working with now at Nottingham.
He supervised my PhD and now I work with him at Nottingham.
He is the person that steered me towards biomedical engineering as I went through my degree.
So in second year he started tutoring me for control and then he supervised me on a small summer
project in third year and then he supervised me for my Masters Year project in fourth year.
And then he invited me to apply for a PhD with him and so on and so on.
And here we are eight years later, and I'm still working with with Michael.
And the subject to be the subject of my PhD is.
So we work in the field of MRI imaging, which is a particular strong point of Oxford, particularly for the brain.
And my Ph.D. was working with new types of MRI, in particular one called arterial spin labelling.
And it's it's a very promising modality for investigating the function of the brain and moving towards neurodegenerative disease.
And this is because it's measuring entirely different properties of the brain compared to conventional MRI imaging.
So the image that you get out of the brain is very different. It tells you very different things compared to a normal MRI.
But it is a it is an image rather than a spectrum that you then it remains an image.
Yeah. The challenge is it's very noisy.
I mean, you get very low quality, very blocky, grainy, noisy images.
And therefore to get around that, you need to use sophisticated mathematics, in particular a framework called the variation or Bayesian framework.
And so that was the crux of my Ph.D. is applying variational Bayes to arterials and labelling MRI to improve the image quality that you get.
And here's a challenge for your teaching skills.
Is it possible to explain very simple Bayesian approaches in a way that somebody who doesn't have the maps would understand?
Yeah, it is, actually. It's an. How would you do it?
So. So the crux of Variational Bayes is.
There are good theoretical reasons why a Bayesian approach is the best strategy to use for this problem and for the problems of that statistic.
Piece of statistical terminology. How exactly guilty Bayesian stands in contrast to.
I might be scrambling my terminology here,
but it stands in contrast to likelihood based approaches so that generally people will adopt a maximum likelihood approach.
And a Bayesian approach is is similar.
There's a subtle difference, but in certain circumstances, a Bayesian approach ends up being the same as a as a maximum likelihood approach.
The difference is the Bayesian approach allows you to incorporate prior knowledge.
So before you've even image to the patient, there are certain things that we know to be true about what answer will come back.
And in particular outside of MRI measures, blood flow in the brain, we measure the rates of delivery of blood to different regions in the brain.
And therefore we know ahead of time that these values will never be negative.
And they could be zero. For example, a stroke would be an occlusion.
So therefore some regions of the brain would have zero flow, but they will never be negative.
And so you have this kind of private information of what is plausible from physiology.
And when you incorporate the this prior knowledge into the Bayesian framework, you will end up with answers.
That's a different. I knew you would obtain a few.
And if you didn't adopt the Bayesian approach.
If you use a likelihood based approach, what you're trying to achieve is some level of certainty about what you're looking at on the image.
Hmm. Or in fact, actually, you you qualitatively, you are correct.
But one of the really neat things about a Bayesian approach is not only does it give you
the estimates of the things you're looking for and allows you to quantify uncertainty.
So in the case of a particularly poor image, you might come back with an answer that says, okay, we believe the blood flow to be this value.
But the uncertainty on that is very wide, actually.
And that's the the maths telling you this was a very good acquisition, whereas in other cases you'll get a very tight uncertainty.
So that's also quite a nice property of it. So you were working away on this Dphil very worthwhile, useful thing to be doing.
And then at some point you will have heard that there was something going on in Wukan.
Can you remember I'm asking everybody this. Can you remember when you first heard about the outbreak of of COVID in Wuhan,
and how long was it before it became apparent to your group that actually this was something that you could jump in and and contribute to?
So. Now I can remember very well Christmas 2019, reading about it.
But even before that, actually, there's something interesting happened.
To this day, I do not have an explanation for. I was in Shanghai late November 2019.
Oh, really? Yeah. And I flew back with another Oxford Ph.D., actually.
And we we flew back to the UK, and I've only ever flown to the Far East.
That entire region of the world. I've only ever flown there once, which was this trip.
So I don't know if this is normal, but I'm told it's not normal. On the way back home, it was a British Airways flight.
At one point the cabin was sprayed down with a mist and all of the flight attendants put on respirators and masks,
but they didn't give us any notice of what was about to happen. They didn't give us any masks.
And then for about 20 seconds, the entire cabin was sprayed down with something.
And at the time, I assumed it was some sort of infection control, pest control measure.
Never has it been explained. I'm led to believe it's not exactly common on flights.
I've done a couple of long distance flights from the US, and that hasn't happened.
And we now know in hindsight that the first confirmed case in Shanghai was a few days after we left Shanghai.
Actually, they've managed to date the first COVID case in Shanghai. It's just afterwards.
So for all we know, while we were there, it already started spreading around South Korea spread.
And then when when it started gathering pace in the UK.
We never once did we discuss as a group whether we could contribute.
It's not really that's not really the way my group operates.
We're a computational group. We deal with quite hardcore imaging.
In particular, MRI is not going to be used in a COVID context.
It would never be used in an emergency situation. The doctors would always reach for X-ray C.T., things like that that are much quicker to operate.
And however, as it was becoming increasingly clear there would be a lockdown,
I did email the Jenner Institute, who were working in the floor above me.
I was based at the Old Road campus and the IBM,
so I emailed the Jenner Institute and said I'd be happy to help out for data analysis
because I presumed at some point they would have reams of data to be crunching through.
So they said they would bear the offer in mind and they added it to a list.
I believe they had a list of people who'd offered likewise and said, We'll get in touch if we need you.
But that never did happen. And then very soon after I made that offer.
Anyway, Oxfam's came in to my my path.
Right. So let's tell that story. So what?
Clearly, after looking at what happened in Italy, there was always concern in the UK about hospitals being overwhelmed,
a shortage of beds, shortage of personnel and and also, crucially, crucially, shortage of ventilators.
So how did colleagues of yours come to think that that was an area where they could make a contribution?
Are you on Twitter, by any chance? Yes. Yeah, I'm not.
Medical Twitter is is a very active subset of Twitter and medical.
Twitter, I believe, plays an important role in this question.
So the the person who really kicked off her was Robert Starrett, who is also a PhD.
He's is just about finishing his Ph.D. now, actually, and he's also a military medic.
Do you know any background about Robert or I did wait up a little bit about him as well.
Yes. So. So it was it was him who was looking at the news coming out of Italy.
And in particular, he's very active on Twitter and he's he's plugged into all the communities of health care, people on Twitter and.
It is my understanding he was the first person to join the dots and think this is going to hit the UK like it like a train.
This is going to be really, really bad. And so he started thinking about emergency ventilation.
And then I believe the next person he approached was Andrew Farmer.
Within anaesthetics. Yes. Correct. And Rob's wife and their stroke is a she's an a niece anaesthetist who works in intensive care as well.
So I believe she might have made the introduction.
I'm not sure on that.
But either way, Rob has this background in plastics and surgery and that his wife has the background in intensive care and certainly is more,
more familiar with that part of the medical world. And very soon after Rob started having these ideas, he was put in touch with Andrew Farmer,
I believe Andrew Farmer being the kind of person he is, which is to say is a wonderful free thinker.
Actually, he's he's an excellent person to to work with.
It's really good fun interacting with him. And because he he is just a curious experimental type of person, which is thrilling to be around.
So I suspect he was already having many of the same ideas anyway.
And then between the pair of them and my understanding is that a.
They quickly built a prototype and they looked at a few other people to this effort.
And then the prototype itself was assembled by the engineering workshop at the IBMA.
And particularly the two technicians whose names I'm struggling to remember right now.
I can pull them up later, if that would be important.
And what was the what was the I mean, clearly there are designs of ventilator that are out there already.
What were the advantages of this? Of the oxidant?
What became the oxidant? What was what were they kind of new challenges that it was trying to solve?
That's a good question. So I. Cheap and simple above all else is the is the mantra.
I presume that was the guiding principle from the off.
Cheap and simple. And the initial vision was that we would.
I was involved in the project at this point, but it would be designed and then the design would be open sourced and then it could
be assembled by anyone around the country who had a sufficiently equipped workshop.
And in particular they were thinking university workshops could probably channel these out,
which is why the two technicians at the IBM Me workshop, who are magicians, they have a long history of creating incredible apparatus.
It is why they were such a crucial part of this early effort.
And so the idea was that using their practical knowledge,
they could refine the design and then you chair anyone could start manufacturing from that point.
So it was simplicity all the way.
And around this time, news must obviously have been spreading internally within Oxford that some people were working on this project.
And then the next key persons come on board, in my recollection is Harrison.
Harrison Steele is called and Harrison is now an associate professor at the Department of Engineering.
He was not at the time. I don't believe he is another surgeon.
These people, he's he's a genius. And Harrison is probably the most capable individual on the entire project.
He really is operating at a level above everyone else.
And he. His expertise in controlling electronics.
And he approached Rob and Andrew Farmer and basically said, I will take care of whatever electronics and control is required for this,
and to which I think their response was along the lines of that's actually we hadn't really thought anything on that topic.
So if you're willing to just take care of that, that's great because that is not something they are familiar with.
And then my involvement at this point, I think I've been at home for.
Four or five days. The start of lockdown. And then, yeah, my involvement came in because I had previously imagined that's his name.
I had previously worked with Jim, the technician at the IBM workshop.
I'd done a few projects with him and I was once again, I don't know how Rob came to learn this,
but basically my name was thrown out as someone who would be a safe pair of hands to liaise with Jim because like many workshop technicians,
the world over and. There's a certain way of dealing with the people who own the workshop.
And in particular, at this point, the project was gaining momentum and lots of people were just agglomerated around the nucleus of the project,
but they were all congregating in the workshop. And so there were, you know, a dozen or two dozen people floating around the workshop,
getting in the way of the technicians and just generally asking difficult questions and not not being,
let's say, linearly minded in the way the workshop.
People like to be very linearly minded. And so my role, Rob approached me to basically say, look,
I need to get everyone out of the workshop and I need them to stop asking silly questions to the technicians.
And I need someone to be the liaison between the ideas people and the workshop people,
someone who can speak the right language to them and just insulate them from all the chaos.
And that was my role initially. Mm hmm.
I just wanted to say. Yeah. And you weren't the only graduate student involved in this project.
Oh, no. Very much. No. Yeah, Lots of others accumulated.
I'm happy to say quite a big chunk of them were Trinity.
As it happens at this point, I am now maudlin.
As a PhD student, I went over to modelling college, and that's where Rob was.
But by sheer coincidence, a lot of the key foods happened to be Trinity,
including the the student Andrew, or who was on the news report, which I hope is now in the archives.
When Sky News came in to film the prototype operating the ventilator,
it was Andrew or who was put forward as our representative to demonstrate the prototype working, and he started receiving fan mail.
I believe the various people managed to track him down and he received quite a lot of emails.
So see, I hope that piece of footage can be located and put in the archives is very entertaining.
So what was the how was the prototype being demonstrated?
So at this stage it hadn't actually been used on a on a patient, presumably.
No. And. To my knowledge, I don't think it ever was.
Yeah, at no stage. And the closest they got was either dummy patients or I'm not sure that's the correct term for it.
Now at this stage it was operating on an iron lung or a rubber lung, rather,
which is an ancient piece of apparatus that is covered in rust, but I believe dates from the fifties or sixties.
You'd have to ask an Andrew summary. It's my understanding, Andrew Farmer,
he has a collection of eclectic equipment and apparatus that should probably have been on the scrap heap a long time ago.
But he's here in the museum. Yeah, exactly.
And that he's somehow, you know, saved from the scrap heap.
So we were using this and yeah, it demonstrates the principles.
Which. Which are simply we should you know, I've been kind of assuming making assumptions that people would know what we're talking about.
But it it delivers oxygen to a patient who's not able to breathe for themselves.
Yeah. Yeah, well, no. Good point. So a crash course in ventilation and so.
Yeah, I actually just delivers air. That's the main thing.
It is compensating for the patient's inability to breathe in sufficiently under their own power.
It is common that you will also enrich it with oxygen.
But you probably wouldn't do pure oxygen and that would be a quite severe case if they were on pure oxygen.
I think for COVID, most of the time you could, you know, they just needed help breathing with a slightly enriched mix.
And there are different modes of ventilation. So the way our one operated is the most basic and called a volume controlled ventilator.
So the operator would set a specific volume of air.
Fernando, This will be about 400 millilitres and the ventilator will provide 400 millilitres
in one go at a certain frequency and the patient just has to get with it.
Here the patient has to sync themselves up with the right cause because the ventilator will do it no matter what.
It will deliver that 400 at that frequency. And there are more sophisticated modes.
So there is a mode that's called and pressure controlled,
and that's where the ventilator will provide the access sets and pressure, whereas in volume controlled,
the ventilator will basically provide that's not volume 400 millilitres, whatever pressure is necessary to get it in up to a certain point.
And the reason why pressure becomes so important is because in acute respiratory distress syndrome, AIDS,
which is the the and the state in which COVID patients end up in when they have difficulty breathing.
That was called ARDS respiratory distress syndrome.
And I believe there's there's a stiffening of the the respiratory organs.
And so to to inhale the same volume of air,
a much greater force is required from the patient because that their membranes and the lungs themselves have become stiffer because of this syndrome.
And so that's why the pressure's required to achieve the same volume might change during ARDS.
And then finally, the.
And the most sophisticated forms of ventilation will entirely remember how they work, to be honest, because it's not not at all my background.
And I suppose the key takeaway here is to note that the the ventilator was designed to capture
the the most basic end of the spectrum of patients that might plausibly be puts on it.
It was never designed to be a comprehensive ventilator that could handle every situation that was thrown into it.
It was designed to be a ventilator that could handle 80% of the bottom 80% of cases,
the simple ones, and therefore the top 20%, a complex that would require very advanced ventilation.
You'd be able to put them on the existing high standard ventilators and free up the capacity, basically.
So this was it was a deliberately simple design, and we knew that it would never be able to take care of all situations.
But the idea was that it would be implemented during this pandemic.
I mean, there was there was an urgency about developing it.
Absolutely. So. So this now leads into phase two of the project, the the ventilator challenge.
Does that ring any bells? It's yes, it's beginning to.
But talk me through it. So for posterity, for the future, people listening.
I will also say at this point that there was a lot of media coverage around the ventilator challenge and in particular towards the end of it,
I believe this would have been April, May, June of 2020.
And the Financial Times published quite a thorough investigation of behind the scenes in the Investigates ventilator challenge and.
To my knowledge, that was a very well resourced story because they were reporting things that I we knew to be true but were very much secret.
And B, they then reported a whole lot of things that we have no idea about ourselves.
So so for anyone looking in the future to, to understand the background to that F.T. article,
I don't know the name of the journalist, unfortunately, but it was very well resourced.
So I'm. So this was a this was a challenge that was thrown out by the government, was it to develop the.
Correct. So so coming late, late February, early March,
I'm not entirely sure the state of play was that in Oxford we had put together a benchtop prototype that was operating.
Very basic ventilator and we were thinking we could share it around the country and people could crank out a few hundred at a time.
And it would all be part of this wonderful grassroots effort.
And lots of other people had come up with similar ideas and in particular after after he went on Sky News.
And other people who'd had similar ideas started sending their ideas to us and saying,
Oh, maybe you could incorporate this, this and this, which was very nice.
But we ourselves, we didn't really have the capability to do anything with those ideas.
We weren't able to start manufacturing in large quantities ourselves.
And this is where the ventilator challenge came in.
So the government decided to launch this challenge and they called up all industry in academia to to respond to the ventilator challenge.
And they set out a specification. It was called the AR and the document, the rapidly manufactured ventilator specification.
And that sets out the requirements for a basic ventilator device.
They must provide at least this volume, at least this respiratory rate, and must operate for this length of time, etc., etc.
And then. Teams were called to basically submit their prototype designs to me, that specification, and then that would be a shortlisting stage.
And then that was a preparation for manufacture stage where ideas were assigned to to other.
Other companies who could help accelerate them. And I'm not really sure of all the the logistics anymore in anyway.
It doesn't really matter because the the whole thing constantly kept changing in motion anyway because it was such a stressed, rushed situation.
So I, I believe Oxford wasn't originally on the shortlist to go through,
but then after the Sky News report, I believe we were added to the shortlist at the last minute.
At this point I was still only vaguely involved in the project, so that's why I'm not entirely certain.
And then once we were on the shortlist, what then happened is Smith and Nephew take a medical manufacturing firm in the UK.
They had submitted their own idea to the ventilator challenge that was not shortlisted.
I can't remember the principles.
I think that has worked on negative pressure, which is logical for Smith and Nephew because they're their main product.
The thing that generates most of their revenue is it's called negative pressure therapy for wounds.
And it's a it's a way of keeping serious wounds clear while they heal and it dramatically reduces reinfection, etc.
So they've already mastered that technology for wound healing.
So it's quite logical that they approach ventilation in a similar manner.
And so Smith and Nephew had put that design forward.
It wasn't shortlisted and so they were then match made with us by the government, the powers that be.
So now the situation was we Oxford and King's College, London.
They were at this point a load of anaesthetists and intensive care.
People had come on board from King's College London.
We were matched up with Smith and Nephew to prepare the design for manufacturing.
And so around this time. Eight of us were.
We went drove up from Oxford to Hull, which is where Smith and nephew have their main UK manufacturing facility.
And yeah, we moved up there to prepare for the next phase of the project.
And your role was going to change then?
At this point you were no longer simply the gatekeeper of the workshop. You were.
Yeah. Yeah. So at this point I was Tim Dennison, who was one of the professors at the Oxford end of things,
who has a lot of experience and regulatory side of things.
He used to work in industry at Medtronic, which is a huge American medical devices fund.
He was taking on more of the sort of regulatory strategic direction of the project.
Yeah, I was never officially assigned a role, but Tim Dennison described me as systems integration lead.
Yes, I saw that. I saw that phrase. And I was going to ask you what it meant.
Yeah. So it systems integration is, you know, a little bit about everything and you make sure that it all fuses together.
So, you know a little bit about the control system, you know a little bit about the manufacturing side of things,
you know a little bit about the battery, the power, the sensors.
And your responsibility is to make sure everything matches up nicely.
So yeah, that's a very big responsibility, isn't it?
Yeah. Yeah, it is. And yeah, so I was I mean, I was quite pleased with that because I'm, I am a generalist.
I think that is, that is what I do best. So I thought it seems to me quite well.
But, and though that was the title that someone used to describe what I was doing, it was always very flexible.
Anyway, we didn't really ever have much time to sit down rigidly, define who was doing what with I.
You know, if we were doing things again, that would probably be a good thing to do.
But it was more to do with. Interpersonal relations management, then you weren't actually doing computation.
You weren't doing this. You weren't deploying your skills in maths and computation on this project yourself?
No. A lot of the time there were parts where I did need to do some certain maths, in particular around calibration,
so that that would be the most technical contribution I made was around the calibration.
But no, for for the most part you're entirely right. It was is it's a team management and common sense role.
So in particular, lots of troubleshooting if if a problem arises in a subsystem.
We had lots of issues with lots of issues with the electronics, the batteries, sensors, the things like this.
And so an important part of it is can we redesign around that problem?
Can we tweak the design such that that problem goes away and which more often than not is common sense as opposed to specialist knowledge?
And yeah, so, so off we went to Hull and at this point we were given letters by the engineering department and letters that very importantly stated,
you know, to whom it may concern this person is engaged in a mission of national importance.
You must let them pass, because we we didn't know if we'd meet police roadblocks and all of this we never did once made a police roadblock.
Never once did I have to use my my important letter or the whole of code, which is a shame.
And and the other people who came up that that initial.
Trip to Tahoe were key people and.
So she could. There was a project manager who might have to look her name up in a minute.
Actually, she was very important. She was one of Andrew family's trainee medics.
And I had previously had a career in the RAF working as an engineer and looking after helicopters and had made a change not late in life by any means.
She's only three or four years older than me, I think. But certainly she'd made a change too, to become a graduate doctor.
And so at this stage she was going through the first years of her medical training and Andrew Farmer, who was one of our tutors and.
So Tyler Edwards was the name I was looking for.
And yeah, she came on as an as project manager.
That was one of the few roles that we did properly defined, and that was a role.
She was magnificent and she was an excellent, excellent manager.
And her RAAF experience proved to be very handy because two times did we then draw on her RAAF contacts in the future.
So one of them was to activate this thing called the Civilian Air Corps.
Which is a network of volunteers who I presume live in way of the day that they will be called up,
is the kind of Thunderbirds situation that they've probably been waiting for their whole lives.
And The Cove, it was one of those times when you could activate the civilian echo and they yeah,
they are volunteers who will undertake missions at times of great need in the national interest.
And so one of the times we activated the civilian echo was to fetch Paul Gula, who is a professor in engineering at Oxford.
And we needed him up in Hull very, very short notice to to trouble fix some software issues we were having.
And so and I believe from the time that we decided we needed him in the hull to a taxi being sent for him to his house, only an hour elapsed.
You know, he got a phone call, pack a bag, a taxi. He's coming to get you.
He's driven to a field somewhere outside Oxford where there's a little propeller plane waiting for him.
And then about an hour and a half later, and he's told to pack light as well, because there's not much space in the cabin.
And if it's too heavy, the plane won't take off.
And then an hour and a half later, he's in Hull and a volunteer civilian volunteer who had no idea of their name or where they came from,
had just flown him up on his own initiative to Hull and deposited them for us.
So that was that was quite an interesting little vignette.
And the the other time in which her RAAF experience was very handy was obtaining the Queen's helicopter,
which I'm not sure if you'd heard of that either, and a similar situation.
We needed to move some circuit boards that had just been manufactured in Redding and by a by really fascinating British company.
I forget their name at the moment, but quite an innovative,
established company who manufacture printed circuit boards, custom custom interconnects, that sort of thing.
And, and that yeah, we needed these circuit boards to be with us in Hull as soon as possible so we could put them in
some ventilators that would then be sent out for evaluation testing by the healthcare regulator,
the MHRA. Once, once again, time was of the essence.
So through Chantelle's contacts and she managed to obtain permission for the Queen's helicopter to do the job.
And so it was dispatched off to Redding, picked them up and flew them up to Hull.
And we did all downed tools at that point and we all went to to the airfield by the helicopter was coming in and took some pictures.
I think all of the teams, about 50 of us in total,
went for that because that was partly things were no longer in the supercritical stage at that time.
So we just needed to plug the circuit boards in.
But a lot of the other work had been done and partly I think we all needed the morale boost at that moment in time because.
We'd been in the deep, dark tunnel for quite a while, which is something I will now loop back to, to explain.
So. So we arrived in.
How? Initially the eight of us who'd come up from Oxford and let's call them the the core eight.
We were the boots on the ground and the brief.
Was. Well, I guess the brief was never explained as clearly as it could have been to everyone.
My understanding was that the purpose of going up there was to hand over the project.
It was you guys have you you've done a lovely effort.
You've made your prototype design. Thanks very much.
We've teamed you up with some professionals now who know what they're doing.
So go up there, you know, explain it to them, hand it over, and just let them get on with it.
Now they'll do the rest. And.
I'm not sure what Smith and Nephew were expecting of from their side.
And at any rate. It wasn't quite.
But it wasn't quite that neat. Clean separation as this is now your project.
I hand it over to you. Thanks very much. Good luck. It didn't quite work out like that.
And.
So we and the reason why that's important is because we initially went up thinking we'd be there for two or three days and so had to act accordingly.
I remember I live quite close to the IBM at the time,
so I remember sprinting home and picking up two sets of underwear in a shot and not set thinking we'd only be there for a few days.
Of course, predictably we ended up staying for three and a half weeks, during which time I was still on massive underwear and t shirts and that's it.
And. Yeah, well, what happened?
The way things did play out was it was a handover, but it remained a much more collaborative effort.
And in particular. The the system needed major redesigns in pretty much every respect before it could be manufactured at scale.
However. Smith and nephew on their own would not have been able to achieve those redesigns in a quick enough timeframe.
Let's say so in particular, the thing that Smith and Nephew excelled at was designed for manufacture.
So that is, how can we redesign the device such that it becomes extremely easy to manufacture?
So one specific example of this was the case of the device, the physical enclosure.
And they very quickly through through what we'd done out the window,
and they went for a single sheets of thin steel that is cut with a laser and the template is scored into it using a laser,
and then it's robotically folded into a box.
And and so just like that, that single step, you've dramatically simplified the assembly of the whole thing and it can all be automated.
And that's it's a far superior solution.
And so that kind of knowledge was, you know, was invaluable.
And we would never have made those same decisions because we don't manufacture anything university engineering departments.
We sit around having ideas. We don't actually ever have to build anything ourselves.
With the exception of gym in the workshop. So so a lot of that design effort went into addressing those kinds of questions.
And that's something I was involved in a bit as well.
I remember we had. Quite a fun session in all of that boardrooms and where they had the heads of the manufacturing teams were all there.
Four or five people, very senior in manufacturing were there.
And then it was just me and one other from the Oxfam team.
And we we were basically taking apart the prototype device we had and then reassembling it in different orders.
So we kept taking apart and then trying to assembler in this order, in that order and, and time it how long it took each, each different route.
And that's the kind of basic hands on work that they do to work out what is the optimal route to, to assemble it.
And the reason that they were putting so much effort into this is because they'd already cleared out one of their
warehouses on the site and they'd started putting together a manufacturing line for it with I believe they're about.
That stations 30 or 40 stations on this manufacturing line.
They already had a team of volunteers who were going to work the line.
And so they were really pouring money and resources into this.
In total, they spent in excess of £6 million, I think, on the project.
Yeah. And they were really getting ready to to manufacture at scale because because
that was what we were led to believe was going to happen by the government.
But then for the other parts of the. Other aspects of the project in Oxford, it turns out, needed to remain much more involved,
and in particular, the thing that caused by far and away the most headaches was the control software.
So there's there's two types of software on the device.
There's a basic interface, which is to say there's a small screen that has buttons on it and there are menus and you
can scroll through the menus and you can change the settings and you do all of this.
And it also measures in reports key metrics about the patient so that oxygen saturation and things like this.
So that's one subset of the system of the system's software.
And then the other subset of the system software is the the control software.
So if the user has requested deliver 400 millilitres at 12 breaths per minute to this patient and do not exceed 25 centimetres of water pressure,
what software actually. Takes responsibility for ensuring that happens.
That's the control software. And unfortunately, it turns out the Smith and Nephew,
I think this was a learning experience for them that surprised that in-house software team, unfortunately,
just did not have the capability to address these problems at speed, and that particularly important in the context of a medical device because.
You know, universities these days, a lot of what we produce is we we churn out software.
A lot of my degree was churning out software algorithms that are now used in other universities,
but they are far from perfect and they have bugs in them. They have bugs that I don't know about.
And when a bug arises, someone can email me and hopefully they bring my attention to it and then I can fix it.
But the bugs are never safety critical because the software I have written is never
being used in a life or death situation to make a decision on someone's treatment.
A the software that goes into a ventilator when someone's in acute respiratory distress is 100% safety critical.
And therefore, there are extremely strict rules about how you can write software that goes on to such a device and how you have to test the software.
And they make and they make the process very slow and difficult.
It's a laborious process to write software in the correct manner in that kind of application.
And so that this is where that was a very unfortunate skills gap.
One would have assumed the Smith and Nephew in-house software team had the necessary skills, and they'd be able to do that quickly at speed.
And unfortunately, Smith and nephews in our software capability was just not very strong at all.
Largely, I think, because their existing product lines do not make heavy use of software.
It's just not something they've had to do very much previously.
And we Oxford people, we have a lot of capability in writing software, but we never have to do it in such a constrained safety critical manner.
And so this was by far and away the biggest problem we faced in that second phase of the project when we were preparing to manufacture is with Nephew.
We have continual issues with getting the software to work, verifying it was safe.
And being in regulatory compliance. And that's why we had to to fly up.
Paul Gula from Oxford, a very short notice. He was leading the control side of things.
And also special mention should go at this point to Michael Garcia, who is another Ph.D. student.
He was he's in Paul's group or was in Paul's group at the time, also at Trinity.
And he he was the the magician of get it's called get is a software tool.
And that in this context allows people to collaborate.
So get is a mechanism by which you can have ten people working on different aspects of the same project.
But I think it's GitHub. I've heard of GitHub. Exactly.
Yeah. Yeah. And it allows yeah,
you can have ten people working on ten different sections of the same project and get
is the mechanism that synchronises it all back together creates a centralised copy.
It's a fabulously powerful tool but is quite difficult to use, particularly the advanced features.
And Michael Garcia was a magician at this.
He he was coordinating everything from his kitchen table.
He never did come up to actually, he he was always remote,
but I only learned relatively late in the project he was the guy taking responsibility for that.
And in fact, in so doing, he inspired me after this to go out and don't get properly.
Because at that point, I'd only ever done in a very superficial manner by now.
And a bit better at that. But that's purely through having seen first hand what it's capable of in the hands of someone competent by Michael Gaskin.
So, yeah, I think. That surmises the the further development work we had to do and how.
And then the next the next phase.
And also just to say it was really fun working with the team at Smith and Nephew.
They. They were all volunteers.
They didn't have to do it. And. It's not staff members, but volunteers.
Yeah. Yeah. They were all stuff of Smith nephew, but.
But all of you know, all the Smith nephew stuff had been sent home at this point, all the non-critical stuff.
And so this was a group of people that had self-selected.
We want to keep coming in to work on this.
And there were there were lots of COVID controls on site, understandably so.
In particular, they they split up their team into two halves and kept them completely isolated from each others.
There was a design team and a manufacture team, and we only ever met the design team in person so we could interact physically with the design team,
but we'd never met the manufacture team physically for COVID safety, of course,
because we were worried that if COVID spread into that group, then they'd never be able to manufacture.
So. So even though we're all on the same side, we were in buildings next to each other.
We had to we had to video conference the whole time to the people next door, which which is a real pain when you're trying to.
Yeah. If you're trying to troubleshoot a problem, particularly a problem that has such a physical, tangible form.
For example,
there's not enough space in the box to put the battery here and then the circuit board is going to hit it at this kind of really basic issue.
Yeah, it's such a pain to have to be doing that over online the whole time.
It's just not how people are meant to work. And where were you living during this period while you were in the.
I think as a Holiday Inn Travelodge. Holiday Inn. Okay. So, yeah, a budget hotel?
Yeah, budget hotel. It's right next door. We had a fleet of minis.
I remember Mini Oxford gave us a load of minis too to run around in because I didn't have a car.
Only a handful of people on the project had a car, so that was nice.
Then we brought these minis out from Oxford. We were driving between the hotel and the.
And like the Italian job. Yeah, pretty much.
But I don't know why we would trade between those inside, because they're basically next door to each other as a five minute walk.
And then towards the end, I started. I started walking anyway, because I needed time out, because I've used the phrase long, dark tunnel.
I'm just waiting for it to get back to you. So to go to it. So, I mean, at this point, we're we're fairly in the tunnel because.
It was really punishing at that. The days were really, really long.
And we were regularly starting at seven or eight in the morning and regularly going past midnight.
And then as things reached the crunch time. Yeah.
The thing that I think really ramped up the pressure was when Boris Johnson went into
hospital and he went into Guys and Thomas's and he was in the intensive care ward.
And it so happened that because we had kings, people involved in the project and we,
we had inside knowledge from the, the ward guys and Thomas's of what his status was.
And it is my understanding that the news reports at the time, quite understandably,
were airing on the more catastrophic side of things compared to what his situation actually was.
It is my understanding, based purely on what I heard Second-hand from clinicians in the team, that he would probably be okay.
Nevertheless, it was at that moment that.
The yeah, the magnitude of things really started to sink in because the isolation was really kicking in at this point.
We'd been up there about a week and a half. You're working in a very small team of people.
You're not seeing the outside world. Your horizon has shrunk enormously.
Also, I happened to be reading a book at the time. That is an excellent book, but it was quite bad timing.
It's a sci fi book about the world ending in slow motion.
It's called 7/8 by Neal Stephenson. But I got to the bit where the world starts to end, just as COVID was really kicking off.
So I'm hoping it's out there reading this book before going to sleep, which probably wasn't helping my spirits enormously.
But when Boris Johnson went into hospital, really started to, you know, thinking, wow,
this could be much bigger than than we initially thought, because up to that point.
Probably naively, given that I was in a slightly privileged position with the information, I had access to.
The fundamental message that the government was still putting out was this will pass, will have quite a few difficult weeks.
Lots of people will go to hospital, but it will pass and in a few months time we'll be out of this.
And there's nothing, you know, nothing catastrophic is going to happen.
And it's at that point when the magnitude of things really started landing for me, that it could be quite catastrophic.
And then the thing that. The other important effect it had.
Boris Johnson going into intensive care was at this point the ventilator challenge became complete chaos.
Everything just the wheels came off at a national level.
And I remember one day we we had a call from.
I believe it's Lord Agnew. Phil Agnew. He was cool.
He was the person in the Cabinet Office who, along with Michael Gove, was sort of taking responsibility at Cabinet level for the ventilator challenge.
And in if we were waiting at this point for the go signal,
we'd been told and the government had placed an order for 6000 units minimum, that was an option for 6000 more.
And we'd been told to prepare to manufacture a rate of 5000 a week, I believe.
So. Yeah. We,
we've been told we we're going to need some upfront and we're probably going to need you to maintain a high rates of production for a period of time.
And, and so in response to that, Smith and nephew, you know, started spending a lot of money.
Getting hold of components became a huge challenge, which I'll also come back to in a minute,
because this was one of the most chaotic and poorly thought out aspects of the ventilator challenge.
It was shockingly coordinated.
But when Boris Johnson went into hospital, we we got a phone call and we were candidly told off the record.
While Boris is in intensive care, no one is going to make any decisions whether you should proceed or not.
Proceed. Decision making stopped. Everything stopped and it was Michael Gove or Theo Agnew who told us that.
And. And I think at this point, the politics becomes unavoidable.
Something that was said about Boris Johnson's cabinet from day one way before COVID started,
but something that was said about his cabinet was his cabinet of lightweights who have been put that because,
you know, they're not going to rock the boat. They don't stand up to him. They agree with him.
And yet we very clearly saw as soon as the man at the top was out of action, everything just grinds to a halt.
No one was going to make a decision until he was back in action.
And and that for me, and that's when I came to realise there are no adults in the room.
That was the. The main take home of COVID for me, which hit me really hard, actually.
But. Yeah, it was shocking. There's such chaos and there were no adults in the room.
You expect when things get really bad, you expect that someone somewhere is going to take the lead and make it okay.
This is a very childlike belief. It's very, you know, innocent belief.
And it's these moments like that, you come to realise, no, that is not how the UK operates.
I don't know about other countries. Very few countries came through COVID in a good way.
Certainly in the UK there were no adults in the room at this point. It was complete pandemonium.
And then. Because we had been led to believe we needed to manufacture thousands of units.
We started going through our supply chain.
So this was an exercise in contacting everyone who supplied components for the ventilator and and asking them how many parts have you got available,
how quickly can you provide them? And there were a few bottlenecks.
And were they all UK suppliers or was some of them overseas completely global?
So so in some respects we were quite innovative and resourceful.
So for example, our oxygen sensor that we used in us was a scuba diving oxygen sensor.
And I believe that we were the only people to use a scuba diving oxygen sensor.
But that was quite fortuitous for us because I was the one to actually make the call.
And I called the supplier up one morning and told them that will buy your entire stock place and put it on the Smith and Nephew credit card.
And that was half a million pounds of purchase in one go that I was making on behalf of Smith nephew.
And that was that was one of those moments where you it's a lot of responsibility that I'd never previously had before.
And you come to realise that, you know,
Smith and Nephew really taking a huge amount of trust on this because they're letting 20 year old PhDs call up and just spend money on their behalf.
And so that was something where the supply chain was good because no one else was using those devices.
And so therefore we had a free run at it. Great. One of the really horrendous bottlenecks was nest hoses that caused NIST and in any NHS hospital.
There's a when you need to access high flow oxygen or pressurised air,
that is a plug on the wall and it has a special type of sitting on it like a garden hose almost.
And you can just jam your pipe on the air and it will click and then you do whatever you needed to do.
And that fitting is called a nest fitting and it's standardised across all hospitals in the U.K. I don't know if it's used elsewhere.
I'm. And so therefore, for a ventilator, you need a hose to plug into the wall and then plug into the the device itself.
And. By.
But this is one of the lessons that we've learned globally since COVID is around
supply chain concentration and the fact that it turns out in in a few key areas,
the world is hugely dependent on the tiny number of supplies in the UK.
To my knowledge, there's only one supplier of doses.
And that's probably because day to day there is a tiny demand for nest houses.
There's only so many hospitals in the country. They only need so many houses.
Every now and then they probably break and replace them. But that's it.
And what was not planned for is that.
One day something like the ventilator challenge would come along.
And the government would go round to all of British industry and say.
And, you know, what's the maximum number of ventilators you can prepare?
And start buying the components to do so. And they gave the green light to many teams, and I believe.
I believe that the total demand for ventilators in the UK was projected at 50 or 60,000.
That was the number that was required to get through the first wave, give or take.
And how how many are then in normal times in operation in hospitals?
Probably down to ten or 20,000. I believe I am less certain on that particular figure.
And given it's not my not my day to day area of expertise.
There was this. But this fateful phone call that happened between all the teams,
the ventilator challenge with the Cabinet Office, I wasn't on the call, but then I heard about it.
And one by one, and the person hosting the call for the Cabinet Office went round all the different teams and said,
okay, how many ventilators can you produce? And the numbers that were coming back, I mean, for us, I think we we answered between ten and 15,000.
We were one of the bigger numbers. But all the the big companies that come on board, companies like Ford, I believe Ford were doing them at Dagenham.
Airbus had come on board. Dyson was still claiming that they would be able to manufacture lots.
But I'm firmly of the opinion Dyson was only ever a publicity stunt.
I do not believe that was ever a serious effort on that part.
And the problem is that the total number of ventilators that were claimed could be delivered, I believe came back over 200,000.
And so there was now this issue of we.
We've cried wolf.
We've got all of industry to put down their tools and focus on this problem all at the same time with zero coordination between the different groups.
We've put more headlong onto this, and now actually the number that they've come back with is way over what is required.
And yet they still weren't willing to coordinate the supply of resources.
And this comes into this becomes visible.
The morning I called the man who manufactures nest hoses in the UK, of which every single ventilator manufactured by any team would need a nest hose.
That is a party you absolutely cannot design around. And I asked him, How many hoses have you got?
How many can you supply? And he just broke down in tears.
And he said, you're the fourth call I've had this morning.
I've already been asked to provide tens of thousands.
I have a thousand in stock. There are none in coming any time soon.
And you guys keep calling me up and ordering tens of thousands.
And then I said, okay, this is you know, this is a huge issue.
Thank you for telling me. And I tried to find out more about the problem and what I was planning to do.
Was relayed back to the Cabinet Office because we'd been given instructions to go out and check your supply chain.
And if there are any issues, report them back to the Cabinet Office and we will try and coordinate centrally and try and get involved.
And I said this to the guy and I said, I will I will report this back to the Cabinet Office and hopefully they can tidy up.
And he said, The Cabinet Office have already called me and they just screamed at me and told me to, you know, make it happen, find a way.
So there was no I don't know who placed that call from the Cabinet office.
Maybe it was the Cabinet office, maybe it wasn't the Cabinet Office. Maybe it was someone trying to speak with the the authority of the Cabinet Office
because there were dozens of consultants involved in the project at this point,
unsurprisingly. Who knows what value they were adding?
Certainly the consultant that was added to our project by the Cabinet Office was largely useless.
Every morning they would tell us, Let me know whatever problems you have and I'll help you fix them.
And every time a problem was brought to his attention, he'd say, Coralie, I hope you're not one.
I'm afraid. So I don't know if this person who called up the next hose supplier was one of those consultants or not.
But at any rate, the guy was pretty much having a breakdown on the phone.
And all because. All because basically every team at this point genuinely thought they would be called on to deliver thousands of devices.
And so were double and triple booking the same hoses. There was no rationalisation, no coordination.
And then one of the final. Well, the final resourceful things we did in this phase to get hold of parts was.
The central component of our ventilator was a rubber balloon, effectively a glorified rubber balloon.
And when you squeeze that balloon, that's what pumps are into the patient.
And the balloons are manufactured in China.
And at this point, pretty much every country in the world had put down an export restriction on any medical product of any nature.
And so we had. I think it was 50,000 of these.
We managed to successfully buy 50,000 of them, and they were in Shanghai, in China,
but we couldn't get them out of Shanghai because of the export restrictions.
And so for a while, lots of lots of creative things were being looked at.
Someone I can't remember who, but someone even had a relationship to Richard Branson.
And so at one point we spoke to Richard Branson about could he send one of his jets over that to pick it up for us.
And in the end, that didn't come off the way we got them out.
This was Shontell as well. Johnson Edwards was doing a lot of this work.
I believe somehow we persuaded someone on the ground in China to label them as footballs.
And then Smith and Nephew were able to send one of their planes out to pick them up.
We managed to get them out, but it was purely through creative accounting, let's call it.
And so these are the kinds of issues that that were faced in trying to find enough components to to build tens of thousands of devices.
But it was it was complete chaos all over the world. Complete chaos.
So. Yeah. A very unusual way of spending what should have been the final year of your dphil?
And so, yes, you ended up spending, what was it, three and a half weeks in in Holland.
All that happened during that time? Yeah, it was very well, I mean, ultimately cut to the chase.
Ultimately, the 6000 audit were never made.
Is that is that correct? Yeah. So. So what happened is.
Oh, device was sent off for testing in Birmingham and the first batch of tests came back that the devices and now it's fundamentally operable.
The device broadly meets what it's required to do, but it's one or two areas require major improvement.
And could you also add this thing called respiratory controlled ventilation, which basically is a slightly different mode of operation?
Where the ventilator will wait for the patient to start breathing again.
And once it senses the patient has started breathing again, it will then help them along.
So. And all of this.
Came about what struck us as slightly odd.
We weren't surprised that one or two areas were quite improvement.
That was entirely predictable. But the fact that they the requirements had suddenly increased quite substantially to
we would now like it to be as an assisted ventilation where it assists the patient.
That was quite a big step up and had not previously been a requirement in the specification and it all was a little bit sneaky behind the back.
That's the first red flag in hindsight. We then went ballistic for four or five days.
Trying to trying to implement that change, which happily we could do that entirely in software.
It didn't require a physical redesign of the device.
It just required reworking the software quite substantially.
The problem with that, though, is, as I already mentioned, writing software for a medical device at high speed is extremely complicated,
let alone when you have a very, you know, stretched team in place to do it.
I never wrote any software for the device. It's not something that's in my skill set or already a handful of people that
were capable of doing so and they had already been worked to the to the bone.
You at one point I. I can't remember what Paul Goulart did,
but I effectively instructed Paul to leave his computer and go and sleep in the factory because he'd been at
his computer for 22 hours or something non-stop and was visibly trembling and he couldn't type any more.
So I noticed that on your CV you said that you had the title of Chief Morale Officer.
Yeah. That was that official? Or was that just a role you took?
It was. It was what? Someone described me as rich, which, yeah, I'm very proud of that.
So. Yeah. Yeah.
So anyway, we went to a great speed to do all of that.
And this was the point when. Tim Denison described it as a death march.
It was just a death march when you felt you knew the project was going nowhere?
Yeah, because we we were in limbo. We'd been told, you need to be ready for thousands of devices ASAP.
And the order never came in. We never got a go order.
And for the first part, it was what's happening to Boris Johnson.
No one's going to make a decision. So he comes out and then he came out and still no decision was coming.
And so we didn't really know what was happening and.
At this point, I think one or two people that had had to leave Hull and gone back to Oxford.
I just kept breaking down, crying at random moments.
I started walking in and out of the factory between the hotel just because I needed the time out.
But I remember just crying all the time. It was a very intense period and.
And and then we managed to get the device ready to go back for testing.
Second time in Birmingham, and this time they came back.
The test results came back. It met the requirements.
It was a sufficient device. I forget the exact terminology that was used on the report.
I have the report myself. We we all got a copy of the report, but it meets the requirements.
And then we got a letter signed by Michael Gove shortly afterwards saying, you know,
thanks so much for all the effort you put into it, but unfortunately your device is deficient.
It just doesn't meet the requirements and so you can all pack up and go home.
And that was that. And what effectively happened and this is why about that big article I mentioned earlier in the FT about the ventilator challenge.
What happened is the government got everyone really wound uptight about it.
Industry responded in a more forceful way than than was anticipated.
And to put it bluntly, I think the government didn't want the embarrassment of going around shutting people down.
And so they were doing it by the backdoor. By shifting the goalposts, they kept shifting the goalposts.
Such that they could find an excuse to then say, Oh, your device doesn't matter anymore.
And we were naive and stupid and we didn't read between the lines.
The actually, it didn't matter whether we kept meeting the new requirements,
the government would have just kept doing something to dismiss the whole project.
Then there was a brief moment when we.
I think Smith and Nephew were making the case that, look,
we've we've already sunk huge sums of money into this and we've already acquired thousands of parts to build.
Then let us build them and send them to India.
So then there was this phase of the project of looking for alternative markets.
So India was one of them. We looked into Mexico quite a lot.
Interestingly, A, it could have gone to Mexico,
but it would have struggled a little bit more because the the maximum volume that the ventilator can provide is 600 millilitres.
And by the volume of that, you need to provide scales with the body mass of an individual.
So you normally do a millilitres per kilogram of body mass figure.
Interestingly in Mexico that if needed a ventilator up to about 800 and because average weight
is higher in Mexico basically got heavier people so so it wouldn't have been so well suited,
but it could have been perfectly operable for India. And and that's where the the Oxford Foundation comes in.
It's effectively it's and people trying to find some use.
So it's come out of the device. It could you know, it could be relevant for a future epidemic.
Unfortunately, this is not going to be the last respiratory pandemic the world sees.
So so it could be used for that. And also the the other argument that we various people tried to make to the government is.
You could just spend the money now and buy 10,000 of them and stick them in a warehouse for the next time,
because there will be a next time and top 10,000 emergency devices would be quite handy.
To my knowledge. I believe at the time when the whole ventilator challenge disintegrated,
I'm not going to say it was shut down because it was never shut down properly.
It just disintegrated in a completely chaotic, uncontrolled fashion at that moment in time.
I believe Oxford with Smith, the nephew, was the project that had the capacity to manufacture the most ventilators.
It was the cheapest. It was about £1,000 per unit, whereas the cost of a typical ICU ventilator device is about £20,000.
So it's an incredibly cheap device. Smith and Nephew had managed to get the manufacturing time down to 90 seconds per unit.
And it was the only one that could be manufactured at thousands per week.
None of the others could do thousands per week. But according to Michael Gove doesn't meet requirements.
It was a deficient device according to him,
although he doesn't probably know that we we have the report from the regulator ourselves anyway, so we know that's complete nonsense.
Now you go and I mean, with hindsight, I mean,
I think I've heard it said that it actually turned out we didn't need so many ventilators
after all that that once they were redistributed from one hospital to another,
there were more or less enough to go round. I mean, like the Nightingale, all these Nightingale hospitals that were set up.
And in the end they turned out not to be needed. Yeah, no.
Broadly you are absolutely correct. I think, you know, moments in time it would have been useful.
Thompson Some more ventilators. I'm sure there were moments in time when.
Hospitals were uncomfortably tight on ventilators, capacity.
But broadly speaking, you are correct. We did not require tens of thousands of devices in the UK, thank God.
But that was more than anything. It just turned out that way.
With regards to the Nightingales, an interesting little fact about that is because we we designed our device for nightingales.
So during the design process we because we had loads of clinicians on the team, which is a fantastic attribute to have.
We were talking to the recently appointed heads of the Nightingales people setting them up and they were telling us what they wanted from our device.
So for example, a standard ICU ventilator comes on the stand.
It's got wheels, It's it is its own thing. Ours is a box that you can put on the floor.
You can clip it to a bed, you could clip it to another thing.
It's a big steel box so that if you walk into it, it doesn't matter.
A is designed to be left lying around in a completely chaotic environment
because that's what the heads of Nightingales that were calling us up saying,
I want this on, I want bats on it. And we were saying, Yeah, we can do that.
And interestingly with the Nightingales it is highly debateable whether they would, even if they had been required,
it is highly debateable if they would have ever been useful because they would
have been staffed by nurses who were already allocated to other hospitals.
Actually, they just weren't enough people to fill them. Yeah, yeah.
But in the meantime,
you and your colleagues have designed and prototyped and developed the manufacturing process for a device that sounds like a very good device.
And does it does oxidant still exist as an entity and what are its plans for the future?
So oxygen does still exist. It's a social enterprise.
I myself, I'm not involved in it running Oxfam.
I'm not involved in any regard. Actually in Oxfam, it's mainly it's mainly the professors who are involved in that.
And I believe they they envisage going into.
Other markets where ventilator capacity is more constrained.
So broadly speaking, there are many contacts in the developing world where it'd be really handy to have a ventilator.
So not just for respiratory disease, but, for example, in childbirth.
I believe under some circumstances, if there's a complication,
it can be very advantageous to have ventilator available and there's many aspects of the oxygen really nice.
You can run it on a compressor, an industrial air compressor, whereas a conventional hospital ventilator requires a medical grade.
Air supply is called. To put it simply, if you are in many regions of the world,
you're not going to find a medical grade air supply, but a little industrial compressor, no problem at all.
You'll be able to find that. So so that that's the vision for it.
But I don't know if they've made any great strides in that direction.
I believe not at this moment in time. So for you.
All that drama in Hull was over by, what, the end of May?
Yeah. Yeah. And then we. He came back down to Oxford.
My housemates had been. Having a great time that's watched every day.
Basically, they'd got baked part into the vernacular and been watching Lord of the Rings back to back.
And they they'd been having a lovely time because really Sunday it was a beautiful spring.
And it was a very jarring experience.
I. To this day, I've lived through lockdown.
Subsequently, of course, I have no idea what that first lockdown was like.
I hear so much has been written and said about that lockdown.
And people were wondering, Oh my God, the world could be different. The world could forever be different.
What will it be like when the dust settles?
There was a lot of curiosity and hope around that first lockdown, and I did not experience any of that because we were in the tunnel and.
Yeah. And it took a long time to. I didn't work again until.
So August that year. I mean, I was trying to work, but I wasn't really.
What did you have left to do? Well, you just writing up your thesis or did you still have my my final.
That was the start of my third year. So I was still about a year to go.
I finished in the end, I actually finished entirely on time.
And it just so happened that when COVID hit, I was ahead of schedule and then the effects of COVID wiped out that buffer.
So in the end, I finished June of 21 and.
I was very angry for quite a long time.
I still I'm quite angry at various bowlers. It comes and goes.
Yeah, just really, really angry. And I can't quite put my finger on why, but it is an incredibly demoralising experience.
But you were, you were taken advantage of. I mean, all of you were in a very cynical way, it sounds like to me.
Yeah, we were, you know, we were happy to do so.
And when the rest of you I mean, how did you share your feelings with the other seven people in the group who'd been through all the.
Yeah. I can't speak for everyone, but I know some people incredibly hard.
Mm hmm. Yeah, it hit some people incredibly hard.
Definitely. Yeah. Yeah.
And then. And then there was Kofi, project number two.
Yes. Which was a lot more fun and with a with a better outcome and lovely feedback from.
Yeah. So tell me about that. Probably it's a more it's a less rollercoaster story, but it's still you know,
it still unfortunately contains some pretty damning indictments of of the system.
So that one starts again on Twitter. And it's also Rob Starke because he just cannot get enough of Twitter though it's early 2021.
And the vaccination campaign is about to launch.
And. There were the nine priority groups that had been identified by the Joint Committee on Vaccination and Immunisation.
And I believe priority group number three or four was housebound individuals.
And so they would not be able to come to a vaccination centre.
The GP or nurse would need to go to the person's house and vaccinate them on site.
And. The the original target was that those top four priority groups, the high vulnerability people,
they had to be done within six weeks of the vaccination campaign starting.
That was the first objective. We need all of them done in six weeks.
And in order to incentivise GP's.
But I should say also that unlike the majority of the vaccination campaign where.
Individuals who could do so would go to a central vaccination site.
You know, one of the big massive vaccination centres and they were organised centrally.
And so. The NHS is all about layers of responsibility and who's looking after which patient.
And so for a lot of people they could go to a central vaccination site and so the authority lies with some central body within the NHS.
Housebound patients were only the responsibility of their local GP and there was no other way that they were going to be vaccinated.
It was purely the responsibility of the GP surgery to make sure that housebound patients were taking care of.
And. And that burden falls extremely asymmetrically.
So if you look at the number of patients that are assigned, talking about all patients here,
the number of patients assigned to each GP surgery in the country, I believe the figures range from about 1500.
In some regions to over 3000. In other regions.
So the density of patient to GP can vary by 100%.
And so you can imagine when it comes to that and treating housebound patients, some regions of the country, in particular the South-West,
Devon, Cornwall, the entire South-West region will have a much higher density of older patients who are frail and likely to be housebound.
And so and who probably also live further apart from the very rural area.
So there's this burden of you need to go and look after these patients is incredibly asymmetric.
And also, astonishingly, no one has any idea how many there are.
No one keeps the numbers I've made for Freedom of Information requests at this point.
Two different authorities within the U.K. for the total number of housebound patients.
The only figure I've been given that has any let's say credibility is a lower bound of 250,000.
I'm led to believe the number is probably about 500, but no less than 250.
But shockingly, no one actually has a number for it.
No one's keeping track of that.
And we've been told by someone at the Royal College of GPS that this this illustrates how the problem even exists in the first place,
because no one has responsibility for them in the central NHS.
And therefore, why would you count them? They're not my problem.
These are patients that consistently fall through the cracks of the system
because no one is charged with looking after them for essential points of view.
So. In order to incentivise GP's to get through vaccinating these people as quick as possible.
And they started putting incentives down. So there was a £10 uplift it was called.
So for every housebound patient a GP vaccinated, they would get an extra £10 on top of the existing right as an incentive for doing so.
The missing link was that there was no technology in place to do so.
You can throw money at the problem. You can tell people I'll pay you twice as much money to do it,
but unless you really give them the means to do so, that's not actually going to make the problem go away.
And this is what Rob became aware of on Twitter in particular.
There was one GP in Wales outside Merthyr Tydfil, who was.
He was tweeting about the challenges he faced and he managed to find a plug in
for Google Sheets whereby if he entered a list of postcodes into Google sheets,
it would automatically locate all of them on a map on Google Maps.
And then he could draw a line between the postcodes and he could make a route.
And then he knew, okay, to do these ten patients, this is the route I'll follow.
And he was very pleased with what he'd done and that he was tweeting about it so that he could share it with other GP's.
And it was a very labour intensive solution, but it was a very crude solution to the problem of how do you efficiently do this?
And so Rob brought this to me and said, surely we could automate this, surely we could do better.
It's a travelling salesman problem. Yeah, is exactly that.
Yeah. And, and because it's the travelling salesman problem solutions that exist, this is a trivial problem to solve.
Now there are many solutions out there. And so, so.
So I got on with that and 48 hours later.
I worked two days and two days, and then we put the basic version online.
And yeah, if it went, it gained a lot of use very quickly.
People started sharing it, word of mouth. So on Twitter and there's loads of WhatsApp groups for GPS.
So in particular someone would come across it and then they would put it on a WhatsApp group and they would share it on.
We kept the site free to use. So at no point have we charged for it and.
Partly because we. Partly because we didn't want to and partly cause it to set up a whole payments processing system, which is really complicated.
It's not the kind of thing you want to do at high speed, as much more interested in just solving the problem than getting it out there.
But that was in my rush to do so. That was one thing that would sting in the tail a little bit further on.
And so within. I think within two or three weeks we'd hit 100,000 patients had gone through the site.
You know, at one point about 10,000 patients a day were running through the service.
So how do you focus? Because people would upload their patients to the site so you could go out?
Yes. So the doctors. The patients, Yeah. The doctors would export an Excel spreadsheet and then you upload the Excel spreadsheet.
And so we can we can count. And all it was doing, it was an elaborate frontend to.
To Google Maps. Basically, I would take the patients.
And and the addresses and I would sort them into smaller groups.
So some of ized. Obviously you didn't have the names.
Yeah, no names and also postcodes, because postcodes are anonymized, you can't identify an individual from a postcode.
It's too broad. But these kinds of data questions just capturing that, unfortunately not in a constructive way.
And so say you upload 50 patients, you're not going to go off and vaccinate 50 at once.
You split them into five groups of ten, for example. So that's what the service does.
You can choose the group size, it splits them off into these clusters and then for each cluster, it goes off to Google Maps,
it gets Google Maps to do the travelling salesman for you, and then it sends the result back to the user.
This is incredibly simple and that's how it was able to be built so quickly.
Nothing in there is novel or unique.
It's just gluing together existing pieces of code already out there and it's going to give it its name.
So you've got it's got a name fancy map facts about.
Yeah. My name, actually. I thought I was quite loud and.
And then, yeah, we had 100,000 patients really quickly. The problem with this is it was all running on my credit card.
So the server costs you highly you pay to to have a server, but that's not actually that expensive.
It's about $7 a month. That's fine. The thing that racks up is API costs code and that's that's a fee.
You pay Google for every address that you look up and you route.
So you as an individual, when you go on Google Maps, they don't charge you.
But if you're starting to do large scale stuff programmatically, they start charging you for that.
And I believe I worked out the final figure at some point was about.
Is it? A couple of pennies per patient was the total cost we were paying.
But then when you consider that for some reasons, I'm not entirely sure.
There's really interesting usage patterns around it.
What people tend to do with Vaccine App is they tend to upload their patients and then they'll generate some routes.
They'll look at them, decide whether they like them or not, and then they'll change some settings and then they'll regenerate.
So they'll actually they'll run the same request we call it.
They'll run that four or five times before they're happy, and then they'll they'll save the final one and use that.
But it means that you've paid four or five times to generate the salaries.
And so long story short, very, very quickly, my credit card was £2,000 down in debt and.
And so the logical thing at this point is you think, well, you'd go to the NHS and say,
would you mind awfully just giving us a bit of money to cover this?
And they say, absolutely not. And they don't want to know.
And this. Just became a Kafkaesque mystery.
We were calling around anyone and everyone trying to persuade them to get involved.
So happily Modelling College said they would pay at least £2,000.
Ideally, could we find someone else as well to match them?
We spoke to Oxford University Innovation. The spin out of the uni.
They they loved it and they were happy to put in, I think up to 15, but that the problem with Oxford funding is it's mainly benefits in-kind.
So it's money towards lawyers fees and things like that. They don't really want to just give you a lump sum of cash and also.
The project and you could call it a spin out,
but it wasn't really a spin out in any meaningful sense of the word because we weren't really planning to monetise it in any sense.
It's a very time limited problem that, you know, it might be a useful service for a year or two, but then thereafter it's not.
You know, COVID vaccinations are not going to be going on large scale next year.
And so therefore. Is there a business case for it?
And we tried to get the news involved, you know, as if the news would publish some stories about it.
But, you know, they didn't they didn't want to take it at all. They didn't care.
They didn't even return emails, which I was quite disappointed about.
I thought it would have been a really nice, nice little thing.
And then at this point, we we had another really interesting idea.
This wasn't my idea, actually. Another individual got involved to this point.
A mutual friend of both myself and Robert called Adam Barker, and they had an idea together for.
A a service to reallocate spare vaccine doses at the end of the day.
So I don't know if you remember, people were queuing up outside GP's to try and get a spare shot and this was happening all over the world.
It's this basic principle of at the end of the day, we just need to get the vaccine in someone.
It doesn't matter who. And they quite, quite understandably had the idea.
Many other people around the world had the same idea of.
If you could make a system, an online website where you an individual member of the public at the end of the day, logs onto the website,
puts in their address and gets told there are three spare doses this GP or they are to over that as you could do this really short notice allocation.
If the people who are completely flexible on time, who are happy to just stop work whenever and walk out the door,
it would be an ideal system and it would avoid people having to queue for hours.
And so we we actually at this point started building a prototype of that, even though vaccine itself was still completely unfunded.
We started building a prototype of this other one. And we we spent a few days on that.
And then when we first brought it to the attention of the NHS, they basically said no,
it would require a level of coordination that is not possible in the NHS at this time, which is basically the answer that we got.
In particular, a company called Cure X were handling all the vaccine booking.
They are a private company and they want the contract to manage the vast majority of vaccine appointment booking.
And so I think for our system to have worked, it would have required a deal of integration with secure access.
That was just not going to happen.
Basically, it is a great shame it didn't happen because someone in France had the same idea and he built it and he's called David Meadows,
which means quickly my dose. And he was awarded the Order of Merit for it very soon afterwards.
So when I read that paper, then that was all right.
We wanted to do that anyway and seek some recognition for both your project.
So we should say that because it said a lot about compensation.
So far it's been a little on the downbeat side, but that there have been awards of that not that was an award for the Oxford U.S.
Institute of Engineering and Technology Global Challenge Grand Innovation Award.
I believe it was called which which was a lovely surprise because we, I myself did not know we were in the running for that.
So that was nice. And the vaccine at.
No, not to my knowledge. And I must have been thinking of the Austin fun.
Yeah, not to my knowledge. And so we were having these conversations with with different parts of the NHS.
This is a important aspect of the way the UK health care system is structured is, you know,
we talk about the NHS, but in reality there is no NHS, there is no monolithic NHS.
What there is, is a large number of closely related but slightly independent groupings.
So you have NHS England, for example, you have NHS Digital.
You'd have thought that that was a very obvious place for for this vaccine project to be parked.
NHS Digital, that was NHS X, which is the innovation section of the NHS and introductions were made for us.
Lots and lots of people were. Very generously exerting themselves on our part to try and get the powers that be to take notice of this thing.
And we weren't even trying to sell it to the NHS.
We were not trying to sell the whole system to them. We would have happily gifted it to them.
We were simply looking for a sum of around £10,000 to just cover the costs.
Because I did some calculations and I calculated the £10,000 would more than cover all the costs we could foreseeably hit.
And that's not even including any payment for the time that Rob and I put into it.
It just covers the actual costs of the running it and.
Eventually even. They went all the way to Patrick Vallance.
I have an email from Patrick Vallance on my phone that I got forwarded and forwarded saying,
look, can can vaccination not resource this and he just sent forwarded to vaccination needs.
Thanks for bringing my to my attention and unfortunately nothing ever came of that.
And in essence the way it went is every single conversation we had with people in the
NHS would be along the lines of This is lovely and we really should resource this.
But it's not in my purview to do so. No one was willing to take responsibility and I think a big part of that is because because conventionally
primary care is actually one of the bits of the NHS that is more privatised than the rest.
GP surgeries are actually independent businesses.
So when you have something that is very explicitly geared towards primary care but has this national level strategic value,
no one knows what to make of it and they don't know where to fit it in.
And it obviously it didn't make sense to go around asking individual GP's to pay for it on an individual basis because look, I'm not going to do that.
I'm not going to set up shop as an individual, calling around, making sales and booking all of it.
I've got better things to do. So that's why we just wanted someone in the middle to give us the lump sum of money.
And then then the more we spoke to the NHS, the more they started asking difficult questions around data security and and privacy.
And from the beginning, we've been very I had been very careful around the way I wrote the code.
At this point. I'd already had the experience with Oxfam, so I was much more aware of the,
the implications of writing code that is used in a large scale medical context.
So I believe we'd made many I had made many reasonable attempts to take care of the data privacy and the security aspects of it.
And furthermore, there is guidance online from from the Information Commissioner's Office that quite clearly states that there are no privacy
concerns around what we were doing because we were just using postcodes and postcodes and not regarded as identifying information.
The problem is again dealing with an organisation like the NHS.
You will get asked this question over and over and over again and people don't really they're not willing to take yes for an answer.
They'll take they'll ask the question because, you know, it is their responsibility to do so, which is understandable.
They must always be critical of a new technology that comes in front of them.
They must look at it quite carefully and you can understand that.
But none of them are really willing to take yes for an answer, because if you take yes for an answer, you're that implicitly taking responsibility.
You yourself, you are the person who said, okay, I believe this is acceptable and they don't really want that decision tied to them.
So I then spend hours joining phone calls with various information,
leads across different sections of the NHS, answering the same question again and again and again.
But they would never respond to my answers and say, okay, yes, I'm satisfied.
They would just. They basically just let the conversation die.
And that is why at no point did any section of the NHS ever encourage the uptake of vaccine out.
Never did they condone it, Never did they resource it?
Never. Did they recommend it to be used at primary care level?
Instead, we were adopted entirely by a grassroots effort, word of mouth.
And in the end the people who funded it were the UK Army.
The Ministry of Defence put the money in because they had seconded.
Military medics had been seconded to vaccination teams that were roving around the country.
That was it was called Operation Script was the the Army's contribution to COVID response.
And because all of the military vaccination teams had adopted vaccine, that they were all using it of their own initiative.
Eventually, the person who heads up medical innovation within the army,
it was him who he who took the initiative and he found the money for us because it was so useful to what the army were doing.
Mm. So if you want a decision taken, go to the army.
No, They are in the business of making decisions. Yes, indeed. Yeah.
No, he was. Who knows? Maybe I'll cross paths with him again.
But it was. He's one of the few people who is willing to stick his neck out and make a decision.
And it just baffles me. And by the time the money landed, I think I was close to £3,000 in debt.
Me as an individual, unpaid drawing.
No salary. Not having a job. Just having a stipend.
And I'm bankrolling part of the UK's vaccination effort.
And no one cares. No one wants to listen within the NHS.
No one wants to do anything. And the sums of money that are involved.
A trivial. Absolutely. And when you hear these two, it well,
it must make you absolutely furious when you hear these stories of multi-billion
pound contracts handed out to private companies of one kind or another.
So yeah, we spoke to there was an individual at the Royal College of GPS, the Informatics Lead at the Royal College of GPS.
And he he made some good efforts to help us. And it was very telling.
At one point he said, you know what, if you were a consultancy, we buy this off for you for 5 million.
But you're not a consultancy, so we're not going to buy off you and nor are we going to deal with you.
And the NHS just does not have the the processes are not in place for engaging.
Like that. They're very familiar with dealing with consultants.
They know how to do that. The commercial department will draw up a contract and legal will swing in and the
process is there and they do it all day long and they waste loads of money by doing so.
But as soon as there's any kind of grassroots innovation, particularly ironically,
given that Rob is a military medic, so Rob is half in the NHS anyway, that kind of process just does not exist.
They do not know how to comprehend it and how to engage with it.
Mm hmm. So now you're you've moved on to the next stage in your in your life?
Yes. Yeah. What are you working on now?
So now I am working with Michael Chappell, my supervisor from Oxford,
and we are in the process of spinning out a company, a medical imaging company, which is related to.
Well, part of the work I did during my Ph.D. will be in the company,
but what I did in my Ph.D. is just the latest in a long line of research efforts that have been made in the group.
And and it's that long line, that body of historical research that we've done that we're we're now looking to commercialised sites.
It is an imaging company mainly focussed on the brain at this moment in time.
But maybe we'll be able to spread out in the future and we will be addressing to, to areas of application.
So. One of them will be clinical trials.
So hopefully we believe our type of MRI can be very useful in drug discovery.
And in fact, the day we are recording this, the 6th of December 2022.
Just recently there's been a lot of discussion around the first Alzheimer's drug.
Yes. That has significant positive evidence behind it.
And and this is very interesting because Alzheimer's is one of the holy grails in disease research at the moment.
And. We hope.
And when I say we, we as the collective community of people around the world who work on asylum, because there are many, many, many of us.
And we hope that ESL will be extremely useful in the context of Alzheimer's and.
We hope that it will be very sensitive to the early signs of Alzheimer's.
And this this is quite interesting in the context of the drug that's just come
through because that drug has been entirely developed around pet pets imaging.
So the drug on emission tomography, I guess we should spell it out.
Yes. Yes.
It's a nuclear imaging techniques that involves the use of radioactivity and.
The the drug that's just been just been reported on.
I think it's called like minimap lacuna map. I'm terrible with drug names.
I'm glad I did. Memorable, aren't they?
Yeah. And there is a reason. And now there are monoclonal antibody.
That's. That's. Most of the new ones seem to do that right where you have that knowledge.
I did not notice that you will be able to qualify that in the debate of drug discovery myself.
And so the one that's just going through, it's it targets the the plaques, the amyloid plaque.
And and this is important because it fits under the amyloid hypothesis,
which is remains controversial, although now this is more evidence for I guess.
But the the amyloid hypothesis is one explanation of how Alzheimer's comes about.
And therefore, under the amyloid hypothesis, if your drug can remove the amyloid plaques from the brain,
that will alleviate the symptoms of the disease.
That's the thinking. And the drug does that and it reduces the amyloid.
And I think the figure they reported is about 27% improvement in cognitive function.
And the reason why this is all interesting in the context today is so the MRI we're working with is the missing link in all of this.
Good news is that for the treatment to be successful, it has to start early.
Yes, to start really quite early. And at the moment, there remains no good systematic way of screening for the early signs of Alzheimer's.
The way that they do it at the moment is either doing a CSF sample, which involves taking small amounts of fluid from the body.
So that's an invasive procedure. Or they do a pet image of positron emission tomography.
And that also involves injecting the body with a radioactive compound.
So these techniques are they're well understood that say they're not challenging per say,
but they're labour intensive and you could never run a screening program at national scale on that.
And they said it's just too much work. And so this is where the big hope is for MRI.
That MRI could hopefully be used to run a screening program to pick up the early signs of Alzheimer's,
and then you could put them on a treatment pathway using this new drug.
So so the fact that we now have a treatment in place or it looks like we have a fast treatment in place, Alzheimer's,
it may increase demand for the screening technology to then identify the patients, because at the moment,
one reservation that you hear in the UK, it's quite a cynical and depressing points of view,
but is understandable is there is no point screening for Alzheimer's because if we find it, we can't do anything.
Yep. So why would you bother? But now maybe the calculus has shifted in the other direction.
So this is an interesting project. Companies very small at the moment.
It's just me and the supervisor. We're applying for funding early next year, so if we get that, then the company will exist and.
And I think it will remain. Who knows?
I mean, maybe it will be very successful and take off very quickly.
But I think it will always remain quite a tight knit company, actually, because we have a company called Quantified Imaging.
It's the name of the company, but we haven't even registered yet. All right.
The company is just a twinkle in our collective eyes at this moment in time.
Yeah, it will be interesting to work in a team again and I do enjoy working in the same room.
That was definitely the upside of.
The upside of oxtail. And the upside of having done vaccine was that.
I gained ten years worth of career experience and three months.
The the level of work that I had to just suddenly jump up to.
I personally authored many of the reports that went to the MHRA regulator in the UK, and I did a lot of the data analysis.
I believe some of them went to an FDA submission in the US.
So yeah, I mean, in a very short period of time I gained ten years worth of career experience and.
I learned a lot about how much I'm worth, actually, as well in the context of work.
Not that I'm a millionaire at this instance. I'm definitely not that.
But yes, that. I'm sorry that I shouldn't use the word unique because it's probably not unique,
but being able to acquire that level of experience is what he had experience working in an academic context.
And then you had to liaise with both clinical researchers and then clinical practitioners, and then also with a medical device manufacturing company.
So you see something about the commercial world and then also with government and
regulatory bodies that that universe of experience must be extraordinarily unusual for,
as you say, a 20 year old in the second year of that field.
Yeah, I think I'm. You're right. It's not completely unique, but it's almost unique.
A few other individuals were in that similar situation.
There was undoubtedly there was a silver lining to go that for me.
I also I didn't get COVID and to Christmas of last year, actually, I managed to avoid it for almost two years before I finally got COVID.
Now, I usually ask everybody how frightened they were of getting it, and the onset tends to scale by age.
So obviously people who are older or who have co-morbidities are more likely to have been quite frightened about getting it,
but in younger people, less so. I don't know how you felt initially.
Yeah, initially I wasn't too frightened. So that really was the very first period.
And then and then by the time I was doing oxygen and stuff, I was like, Fair enough.
It doesn't look. It doesn't look as harmless as was initially made out.
And then by the time I did get it, I was I was vaccinated at that point.
And I almost certainly had I believe I was the data was the wave going through at the time.
And I was supposed to go to France for Christmas because I'm French.
Half of my family is in France and I was supposed to go out there and then just before going, I finally fell ill with it and.
I'm pleased that I didn't get it earlier because it definitely knocked me out for a few days.
It's not. Not a pleasant experience. Who knows?
Maybe on the very first wave. The severity would have been different.
But but by the time I was vaccinated and I had it, yeah, I really knew I had it.
Yeah. Did you have experience of friends, colleagues, or family members having it?
Having severe illness with it? Being badly affected.
I am. So I think.
Yeah. I believe my mum lost her sense of smell for a while.
And. I only know of one.
Person. Let's say an acquaintance who he was a model in college.
Who died. And. That was very sad, actually, because a.
He was a person. For which he reacted very badly to two lockdowns.
And I became incredibly anxious.
And didn't handle it well at all. And then he puts on a lot of weight.
We're talking 30, 40% of his body weight he gained in that period of time.
And then tragically, it was a week before his first vaccination was due April.
21 may be May 21.
He caught COVID, and by this point, I think he was so obese, you know, he'd taken on so much weight that he died very soon afterwards.
It's a classic case of the co-morbidity COVID and obesity is quite well established, I believe.
And I didn't know him as an individual in any meaningful sense.
I just knew him as someone around college. But.
Yeah I'm very much of the opinion he. He's one of those people that lockdown killed inadvertently.
Which is not. I'm not going to turn that into a broader argument of lockdown was the wrong course of action to take.
I genuinely don't know. That question is is too big of a question for me to to pronounce upon.
I'm not qualified that some he I firmly believe he's one of those inadvertent.
Costs of lockdown. So I think we really need to just think what in summary,
what would you say are the key lessons that you're going to take forward in in how you plan
your life and career in future from the time you spent working on these COVID projects?
I think the vaccine map taught me that nothing is ever so simple and so obvious.
That it hasn't already been tried. I unless Rob had been able to point to people on Twitter saying, I need help for this right now,
I would have never even started working on that because I would have thought, no, it's a solved problem.
It's done, not needed. But there you go.
Nothing is ever so simple and so obvious that it shouldn't be tried.
And from Oxfam's. Yeah.
From Oxford. There are no adults in the room. I firmly stand by that conclusion.
And in the future, I. I believe I want to leave the UK for a period of time and go and live and work abroad.
And. And experience something a bit different.
I don't think I'm going to find a utopia anywhere. I don't think anywhere is a paragon of that being well-run.
But I think the UK is afflicted by an inability to to critically look in upon itself and address the problems that are here,
where we're very good at deflecting and blaming everything but ourselves, I believe, and in COVID that really came home to roost.
Great.