1 00:00:01,290 --> 00:00:04,440 So could you start by saying your name and what your job title is? 2 00:00:05,280 --> 00:00:12,840 My name is Lizzie Stafford and I'm clinical research nurse manager with Oxford University, and I'm based off of the Job Market Hospital. 3 00:00:13,020 --> 00:00:17,130 Okay, that's great. So going back to how you first got interested in nursing. 4 00:00:17,310 --> 00:00:20,640 Can you just give me the main sort of milestones in your career so far? 5 00:00:21,180 --> 00:00:26,850 Well, it's rather boring, really. I was very clear from a young age I wanted to go into nursing. 6 00:00:27,330 --> 00:00:34,889 And I recall my wonderful mum making a little costume as a gift for a friend's birthday party. 7 00:00:34,890 --> 00:00:39,480 And I think we were probably seven. And the gift was this homemade nurse's outfit. 8 00:00:39,480 --> 00:00:42,030 And she modelled it on me because it would fit me. 9 00:00:42,030 --> 00:00:47,700 And I went off to the party, gave it away rather sadly, and came home to discover she'd made another one for me. 10 00:00:48,270 --> 00:00:55,709 And I think that confirmed it. And I yes, from a very young age, without any real understanding of what the profession was about, 11 00:00:55,710 --> 00:01:01,140 I had a strong sense that I wanted to be a nurse, and I continued in that pathway. 12 00:01:01,800 --> 00:01:05,670 And at the age of 18, I went off to study nursing at university. 13 00:01:05,820 --> 00:01:13,770 Where did you go? I went to reading and then on qualification, moved around quite a bit. 14 00:01:14,820 --> 00:01:26,040 I worked in Bristol and in Exeter and in London and now in Oxford and I in the middle of all that, trained as a midwife as well, 15 00:01:27,390 --> 00:01:34,380 and however have come back to nursing and found that there was more in nursing that I thought was suitable for me. 16 00:01:35,040 --> 00:01:42,029 So I found myself very much in acute sort of urgent care, 17 00:01:42,030 --> 00:01:47,249 emergency care intensive care environments all the way through until I got married and we moved 18 00:01:47,250 --> 00:01:54,870 to Oxford and I thought perhaps a bit less shift work and a bit less and weekends would be nice. 19 00:01:55,500 --> 00:01:58,590 And that's when I started exploring research. 20 00:01:58,830 --> 00:02:11,400 Mm hmm. And I was originally I came to Oxford to a post in Hepatology, which is the study of liver disease and was part of a team for over a decade, 21 00:02:12,510 --> 00:02:16,260 which started off with me and one colleague and then grew and grew. 22 00:02:16,650 --> 00:02:27,690 And we had one study beginning, which grew to a large portfolio of studies into all different liver diseases, and we had commercially sponsored ones. 23 00:02:27,690 --> 00:02:30,810 We had academically led ones with local Oxford studies. 24 00:02:32,040 --> 00:02:40,139 And we were by early 2020 a pretty big team with about, gosh, 25 00:02:40,140 --> 00:02:50,820 about six or seven nurses and other support staff running a portfolio of about 25, 30 research studies in the jail. 26 00:02:51,450 --> 00:02:54,660 So what this is a silly it's a simple question. 27 00:02:54,930 --> 00:02:58,410 I hope it's not a silly question, but what does a research nurse do? 28 00:02:58,530 --> 00:03:06,660 No, it's a very good question and it's one many people ask. So there are different types of role as a research nurse. 29 00:03:06,900 --> 00:03:11,640 There is the academic research nurses who are delivering their own research. 30 00:03:12,090 --> 00:03:18,510 These are nurses who have their own research question that they want to answer, just like any other medical professional might, 31 00:03:19,230 --> 00:03:25,110 and they will follow their own pathway through an academic route to answer that research question. 32 00:03:26,430 --> 00:03:35,070 The research nurses that I sit with in the campus of what we class as clinical delivery research nurses, 33 00:03:35,490 --> 00:03:40,950 and this is about the research nurses who enable large research projects to happen. 34 00:03:41,730 --> 00:03:54,270 So whether it be big commercial sort of sponsored studies that are global, whether it is even just a small single site, local, academically led study, 35 00:03:54,780 --> 00:04:03,269 if it involves the recruitment of patients and if it involves the management of those patients, you're going to need support staff to do that. 36 00:04:03,270 --> 00:04:08,970 And the person, often the researcher behind that research, isn't in a position to actually make that happen. 37 00:04:09,630 --> 00:04:22,320 So research delivery nurses very much take on the role of and understanding that the fullness of the study and then the responsibility of identifying, 38 00:04:22,320 --> 00:04:31,110 recruiting, consenting and managing the care of participants as they come through these research studies, sometimes for many, many years. 39 00:04:31,110 --> 00:04:36,030 Some of the studies can go on for even seven or eight years in chronic health conditions. 40 00:04:37,230 --> 00:04:40,730 The nurses are in a very privileged position then to build up a very nice rapport. 41 00:04:40,740 --> 00:04:44,310 They've become, much as you might, a specialist nurse with that. 42 00:04:44,610 --> 00:04:50,009 If these are chronic conditions that are being managed and you become a bit of an expert in 43 00:04:50,010 --> 00:04:56,070 that condition and also really build up a strong rapport with that participant or patient. 44 00:04:56,790 --> 00:04:59,850 And and you've got research now. 45 00:05:00,140 --> 00:05:05,300 You are managing emergency care work, people coming in to the emergency departments. 46 00:05:05,810 --> 00:05:10,850 There might be research going on into certain types of traumatic injuries, 47 00:05:10,850 --> 00:05:17,749 or there could be research going on to a stroke or heart disease or heart and myocardial infarctions 48 00:05:17,750 --> 00:05:24,560 and all different reasons why we need to understand better treatments and better management. 49 00:05:25,130 --> 00:05:27,770 All of which. And around the country, 50 00:05:27,770 --> 00:05:37,310 there will be researchers asking questions and then building projects to make sure that we try and understand these conditions better and better. 51 00:05:37,580 --> 00:05:49,010 But all of that takes a person behind the scenes. You could do it because of the large amount of and quite often it's the the paperwork and the 52 00:05:49,640 --> 00:05:54,680 the rules and the regulations that uphold all of these research practices are very detailed, 53 00:05:54,680 --> 00:05:59,170 They're very thorough, and they are different and not the same as normal clinical practice. 54 00:05:59,180 --> 00:06:06,680 It's not possible just to expect a nurse is caring for that participant or patient on a ward to carry on the research activity. 55 00:06:06,690 --> 00:06:10,010 It's too much and it's too expertise. It's too specialist. 56 00:06:10,700 --> 00:06:19,069 So over the last sort of 30 years, the role of the research nurse has grown and grown and is now a very diverse role. 57 00:06:19,070 --> 00:06:21,469 And I'm sure even in my explanation, 58 00:06:21,470 --> 00:06:30,240 I have probably made a terrible injustice by not including more of its breadth and and there will be colleagues that go, 59 00:06:30,240 --> 00:06:34,300 Well, hang on, what about what I did? And it does all come under the remit of research. 60 00:06:34,310 --> 00:06:38,180 Ms. And do you do that all the time? 61 00:06:38,270 --> 00:06:45,590 Excuse me. Yes. So you don't do shifts of just basic care on the wall. 62 00:06:45,600 --> 00:06:50,989 There are some roles that are what they call hybrid roles where you might have a nurse who a percentage 63 00:06:50,990 --> 00:06:56,240 of her working hours is allocated to the research and a percentage is allocated to clinical care. 64 00:06:57,140 --> 00:07:00,230 And there's lots of examples of excellent practice where that works. 65 00:07:00,230 --> 00:07:02,630 It's quite hard to manage because of the shifts, 66 00:07:03,110 --> 00:07:11,540 and so the majority of research roles tend to be full time or if not full time, then that's their only. 67 00:07:11,540 --> 00:07:20,570 Well, that's what they do. Yes. Yes. And because of, I think just the fact that often it's different line managers, it's different funding streams. 68 00:07:20,960 --> 00:07:27,710 It isn't funded out of the hospital budget. So it becomes in itself a slightly separate group. 69 00:07:28,130 --> 00:07:36,170 And even though we very much are working alongside our NHS colleagues who are in the wards and the departments sort of, 70 00:07:36,200 --> 00:07:39,560 you know, kind of doing the the core of the NHS work. 71 00:07:40,760 --> 00:07:44,000 So take me through I mean, I'm quite happy to expand it a little bit. 72 00:07:44,180 --> 00:07:47,120 You mentioned recruitment is one of the roles of the research. 73 00:07:47,300 --> 00:07:52,879 So so you will be the first person who actually speaks to a patient about the course often. 74 00:07:52,880 --> 00:07:53,959 So again, 75 00:07:53,960 --> 00:08:02,150 it depends on the nature of the study and whether it's an emergency or urgent care or whether it's perhaps a long term chronic health condition. 76 00:08:02,600 --> 00:08:08,780 So certainly in the emergency departments or critical care units, 77 00:08:09,620 --> 00:08:19,790 you will have certain doctors and certain research nurses who will be tasked with identifying suitable participants or patients. 78 00:08:20,150 --> 00:08:23,540 And it just depends kind of who spots them fast. 79 00:08:24,140 --> 00:08:31,160 But there's often a very short time window to recruit somebody into research because if 80 00:08:31,160 --> 00:08:36,020 it involves particularly a drug that is a comparison to standard of care treatment, 81 00:08:36,410 --> 00:08:41,720 then if they've already been started on a pathway of traditional treatment, then they're no longer eligible. 82 00:08:42,380 --> 00:08:49,250 So there is a very tight window of opportunity in these scenarios where so nurses do have to be on call. 83 00:08:49,250 --> 00:08:56,780 They are the research nurses quite often will work weekends, carry a bleep, and somebody will say, is somebody arrived, we think is suitable. 84 00:08:57,560 --> 00:09:05,870 You've also then got the vast majority of research in hospital probably falls under the remit more of your outpatient and chronic care management. 85 00:09:06,290 --> 00:09:08,390 Now that could be in it. 86 00:09:08,450 --> 00:09:17,060 You've got a huge amount of work going on in cancer and haematology and once somebody comes under the radar and they know about them and a diagnosis, 87 00:09:17,900 --> 00:09:25,580 then it's very much the role of that. The clinical team will say, well, flagged them to the research team and say somebody we think might be suitable. 88 00:09:26,870 --> 00:09:31,459 And then you very much often all the research nurse is often the first person to approach them, 89 00:09:31,460 --> 00:09:37,100 whether that's directly face to face in a clinic appointment, whether you call them up at home and have a conversation, 90 00:09:38,390 --> 00:09:45,110 and you then would be discussing it often with considerable sensitivity, if it's a new diagnosis, 91 00:09:46,430 --> 00:09:51,800 that what it is that you think is unique about them that might work for this study. 92 00:09:52,040 --> 00:09:59,810 You tell them about the study and you have to be incredibly careful to remain an advocate because you do not want to be persuading. 93 00:09:59,870 --> 00:10:05,780 Or showing any bias towards the correct answer for them, whether it's to take part in the study or not. 94 00:10:06,080 --> 00:10:13,070 And it's really vital that they know that they can answer as many questions as they like and can walk away, that, you know, this isn't to me. 95 00:10:14,060 --> 00:10:19,400 But at the same time, you obviously are wanting to promote taking part in research. 96 00:10:19,400 --> 00:10:23,510 We know that the value of research participation is immense, 97 00:10:23,770 --> 00:10:28,849 and it's only because of people volunteering in research that we develop our understanding and 98 00:10:28,850 --> 00:10:35,150 can produce more and more amazing medicine and science to manage people's health conditions. 99 00:10:35,630 --> 00:10:41,000 So it's a fine balance and you have to sometimes walk quite firmly in the middle, 100 00:10:41,000 --> 00:10:49,040 and particularly if there's pressure on recruitment and pressure from and whether it be the company that 101 00:10:49,040 --> 00:10:53,870 is running the research or whether it's even just the investigator locally who's responsible for it, 102 00:10:54,350 --> 00:10:57,020 you know, there is targets and you do have to meet them. 103 00:10:57,560 --> 00:11:04,490 So often the role of advocate for the research nurse is crucial in making sure that none of that pressure gets passed on to the patient. 104 00:11:05,660 --> 00:11:15,380 Mm hmm. And what are some of the ethical issues that arise in whether or not a patient is willing to go ahead? 105 00:11:15,590 --> 00:11:22,850 Well, gosh, I mean, there's huge things. I mean, you might have even just in that conversation at the outset could be language barriers. 106 00:11:22,850 --> 00:11:30,290 That could be comprehension barriers that would prevent them from fully understanding what the risks of participation in research are, 107 00:11:30,290 --> 00:11:39,859 which are always very well spelt out. You know, we have strong standards and the ethics committees that review all clinical research are really, 108 00:11:39,860 --> 00:11:44,360 really very careful and very strict about what documentation is produced and how it's produced. 109 00:11:45,260 --> 00:11:52,610 But you've got to be able to read that and then to stand it. So you don't want there to be any misunderstanding at the outset. 110 00:11:53,270 --> 00:11:58,310 You also recognise that quite often, particularly in the context of a new diagnosis, 111 00:11:58,520 --> 00:12:03,260 people might be very scared, vulnerable, not necessarily hearing all the information. 112 00:12:03,680 --> 00:12:08,240 So you've really got to reassure yourself that they have made an informed consent. 113 00:12:09,380 --> 00:12:15,020 And that's the difference between just consent and and informed consent and really being confident. 114 00:12:16,370 --> 00:12:21,049 But then equally, as I say, is got to be that they feel that there's a real choice, 115 00:12:21,050 --> 00:12:27,320 that they fully understand what the alternative would be, that they don't think that taking part in research is the only treatment. 116 00:12:27,320 --> 00:12:35,030 But actually there is other treatment pathways and and all of them are equally available to them. 117 00:12:37,100 --> 00:12:40,549 And yeah, I mean, that's just the sort of the beginnings really. 118 00:12:40,550 --> 00:12:45,100 And then of course, it's absolutely paramount that somebody might decide to take part. 119 00:12:45,110 --> 00:12:48,740 And just like everything else and perhaps even consumer laws, 120 00:12:49,100 --> 00:12:54,560 there's a it's perfectly okay to turn around, say I've changed my mind and that people can willingly. 121 00:12:55,250 --> 00:12:59,510 Having gone through the process of signing a consent form and saying they'll take part in a study 122 00:12:59,510 --> 00:13:05,610 and setting up those initial appointments and screening appointments to turn around and go, 123 00:13:05,870 --> 00:13:08,870 you know, I think I don't want to do this, and that's okay. 124 00:13:09,290 --> 00:13:13,130 And they mustn't feel that there's any pressure on them to do otherwise. 125 00:13:14,660 --> 00:13:23,180 So the research nurse holds a very important role in that area, I think, of conducting research, making sure we have time to give them, 126 00:13:23,180 --> 00:13:30,919 because quite often the investigators, the the doctors who are running the studies simply do not have the privilege of time. 127 00:13:30,920 --> 00:13:32,030 They're incredibly busy. 128 00:13:32,540 --> 00:13:41,359 So we need to make sure that we have given time to that patient to ask questions and to really make them comfortable and at ease. 129 00:13:41,360 --> 00:13:46,339 And and if actually we have questions that we think need to be discussed, investigated, 130 00:13:46,340 --> 00:13:50,900 and we can encourage them and take them to them and and sort of get that addressed. 131 00:13:52,190 --> 00:14:03,110 But, yes, there is lots of areas where managing ethically, you know, the participation of a patient in the study is very much a priority. 132 00:14:03,130 --> 00:14:09,140 And and even just that, the whole idea that each time they attend the appointment, 133 00:14:09,590 --> 00:14:13,520 you're gaining their verbal consent, that they're still willing to take part. 134 00:14:13,940 --> 00:14:23,150 There's no assumed assumptions. And you know that you're always being very transparent with them about what you're doing and why you're doing it, 135 00:14:24,440 --> 00:14:32,330 where this information is stored or going, or how it's going to be analysed or used in a way just complete transparency. 136 00:14:33,080 --> 00:14:39,379 This set me obviously many years back in the past have been some really poor handling 137 00:14:39,380 --> 00:14:46,250 of people's personal data on health data and we are very careful to avoid that now. 138 00:14:46,670 --> 00:14:53,360 Mm hmm. So you would typically a study is investigating a new drug or a new intervention of some kind? 139 00:14:53,390 --> 00:14:58,250 Yes. I mean, it might be it might be to do with it could be a new drug. 140 00:14:58,250 --> 00:15:08,640 It could be a new. It could be sort of a scanning or radiology related investigation for detection of things. 141 00:15:09,780 --> 00:15:19,500 It can also be non interventional, as we call it. So it is observational and that can produce huge amounts of understanding. 142 00:15:19,860 --> 00:15:30,209 And by observing a cohort of people who have a specific disease or capability and watching them over prolonged periods of time to 143 00:15:30,210 --> 00:15:40,980 understand better the pathway and and to sort of be able to observe patterns which then can obviously identify research questions. 144 00:15:41,160 --> 00:15:46,229 But that observation might include collecting data through taking bloods or other kinds of things. 145 00:15:46,230 --> 00:15:53,549 Yes. Yes, absolutely. So it's very much a they engage in that project and they are willingly giving consent. 146 00:15:53,550 --> 00:16:00,660 And often it's data and samples at the same time repeatedly and are often followed up for many, many, many years. 147 00:16:00,990 --> 00:16:09,030 And actually, if that weren't, you know, those sources of of data can be and sampling can be hugely informative in understanding 148 00:16:09,030 --> 00:16:15,090 progression of disease and identifying why some people progressed differently. 149 00:16:16,050 --> 00:16:21,720 And then obviously you might go back and you might be looking at the genetics of the individuals 150 00:16:21,720 --> 00:16:27,600 involved or you might be looking at the environment of people involved and all of these things. 151 00:16:27,600 --> 00:16:35,220 So there's huge amounts of of work that go into those projects as well that are not interventional, Right? 152 00:16:35,460 --> 00:16:40,320 Well, I think it's time we got to go it can you remember where you were or what you were 153 00:16:40,320 --> 00:16:45,720 doing or how you first heard that there was something a bit worrying going on in China? 154 00:16:47,010 --> 00:16:51,389 I tell you, if I can remember a specific time, I do. 155 00:16:51,390 --> 00:17:02,940 I do remember certain key things on the news when following the development of the outbreak in Wuhan. 156 00:17:02,940 --> 00:17:06,989 I mean, I was I've always been somebody who follows current affairs closely. 157 00:17:06,990 --> 00:17:15,750 So I was definitely very aware of what was going on and I was watching it. At what point I started to sort of realise it's coming our way. 158 00:17:16,080 --> 00:17:18,120 I'm not quite clear. I mean, 159 00:17:18,120 --> 00:17:30,060 I think probably it was in the February of 2020 when Italy was really struggling and I think as soon as we realised what was going on in Italy, 160 00:17:31,140 --> 00:17:35,970 then there was a sort of okay expectation of this is not going to be possible to contain. 161 00:17:36,960 --> 00:17:41,010 I don't think any of us could have imagined what turned out to be the reality. 162 00:17:41,880 --> 00:17:43,709 I certainly wasn't imagining it myself, 163 00:17:43,710 --> 00:17:51,720 and I do remember quite vividly when I think I must have heard something on the radio one day and they were obviously contemplating lockdown. 164 00:17:51,730 --> 00:17:56,790 So this would have been in the march and there was somebody talking about schools shutting. 165 00:17:57,390 --> 00:18:03,300 And I think I had presumed they might shut for a couple of weeks in the run up to Easter or something. 166 00:18:03,750 --> 00:18:12,270 And I heard this presenter saying about the only way for the school lockdowns to be effective was if they were at least 12 weeks. 167 00:18:12,840 --> 00:18:19,139 And I, I just remember stopping and sort of staring at the radar going, you can't be serious. 168 00:18:19,140 --> 00:18:23,460 You can't stop the schools functioning for 12 weeks. What will we do? 169 00:18:23,970 --> 00:18:32,820 And and just this sort of absolute heavyweight reality check kicking in and going, oh, I haven't thought this through. 170 00:18:33,420 --> 00:18:41,760 And so so just really sort of So that was outside of work, obviously, that was very much sort of recognising the impact on home life. 171 00:18:43,170 --> 00:18:49,710 And I do remember a distinct and now and I look back and I laugh at myself now thinking, gosh, if it was only just 12 weeks. 172 00:18:50,790 --> 00:19:00,990 But, but do you I do remember distinctly that feeling of what being really surprised and sort of I think that was a defining moment 173 00:19:01,500 --> 00:19:10,889 and I think work wise it's a strange thing and I'm sure other people you've spoken to have probably described something similar, 174 00:19:10,890 --> 00:19:26,250 but there was a strange the early part of 2020 when the as it became apparent that we were coming into a strange and unknown time in our lifetimes, 175 00:19:28,740 --> 00:19:36,809 there was a strange feeling within life in the hospital of, well, yes, sort of battle readiness, 176 00:19:36,810 --> 00:19:41,460 I suppose, and and getting ready for this arrival of something that was unknown. 177 00:19:42,240 --> 00:19:50,700 And none of us really knew what it was going to do. And my from my point of view personally, because I was working in research on liver disease, 178 00:19:52,290 --> 00:19:55,500 they quickly made the decision that all research studies would have to stop. 179 00:19:56,700 --> 00:20:01,500 It was obvious that, particularly in our case, outpatients. Coming in was just totally inappropriate. 180 00:20:02,160 --> 00:20:06,150 They were starting to really point heads and say these things are just not going to be possible. 181 00:20:07,440 --> 00:20:19,200 So we quite quickly in. Must have been early March realised that our research activity was being paused and we needed to sort of safely shut it down. 182 00:20:20,730 --> 00:20:27,690 And and some research had to continue because for some people their research activity is actually their drug treatment and their management. 183 00:20:28,050 --> 00:20:30,780 So it was important that these people were provided for, 184 00:20:30,790 --> 00:20:36,270 but majority of our research activity seemed right down and we kind of got right down to a very small core. 185 00:20:36,720 --> 00:20:42,600 And that meant the team of nurses that I was managing were freed up to be redeployed, myself included. 186 00:20:43,260 --> 00:20:47,130 But the ones who did need to continue, did you have to deliver them their drugs at home? 187 00:20:47,160 --> 00:20:50,340 So, yes, we had some provision for delivering drugs at home. 188 00:20:51,120 --> 00:20:55,139 We had some drive by pick ups of pharmacy medications, 189 00:20:55,140 --> 00:21:03,209 literally kind of making arrangements to meet people in the car parks so that you could just drop a window down, check who it was. 190 00:21:03,210 --> 00:21:10,110 You were passing the medication through to make sure it was the right person check they were okay and and dropping it through the window. 191 00:21:11,310 --> 00:21:18,780 Not many. Mostly we had a sort of combination of home delivery set ups. 192 00:21:20,670 --> 00:21:24,030 And thankfully, we it wasn't too many patients who were dependent on that. 193 00:21:24,030 --> 00:21:31,320 So that was good. So we had some staff who remained perhaps a day or two days a week focussed on their research. 194 00:21:31,650 --> 00:21:36,240 But then the other days, the week they were deployed to another department and then we had others who were fully deployed. 195 00:21:37,650 --> 00:21:45,480 We had some who were shielding or for personal medical reasons, weren't able to be patient facing. 196 00:21:45,530 --> 00:21:53,370 So took on different roles and so everybody started doing different things, but we had to sort of physically shut down. 197 00:21:53,370 --> 00:21:57,329 And what literally happened was the the space where we saw our participants, 198 00:21:57,330 --> 00:22:03,750 our patients were was a case area that the trust told us was going to be redeployed and used for COVID. 199 00:22:03,750 --> 00:22:13,410 So we had to literally empty everything out. So the consulting rooms, the storage cupboards, lab area where we processed all the blood samples, 200 00:22:13,830 --> 00:22:17,730 all of that had to be packed away in boxes, in cages and parked away and moved. 201 00:22:18,210 --> 00:22:22,680 And and so it was a huge amount of work, actually, and it was very stressful. 202 00:22:22,680 --> 00:22:26,760 It was very unknown purely from that perspective. 203 00:22:27,330 --> 00:22:35,309 And then we sort of did finally reach a point where all of that was packed away and each of the staff in my team had been allocated a new bone. 204 00:22:35,310 --> 00:22:41,940 But that was complicated from a management point of view, handing over their management to a new temporary manager, 205 00:22:43,020 --> 00:22:49,110 getting them arranged on rosters and etc. And for many of us it meant really updating our skills 206 00:22:49,110 --> 00:22:56,909 because as research nurses you might be experts at phlebotomy or taking bloods or pretty good at EKGs, 207 00:22:56,910 --> 00:23:00,750 but it might well have been a long time since you were working on the wards. 208 00:23:01,080 --> 00:23:05,340 And so for most of us there was certain skills that needed refreshment. 209 00:23:05,880 --> 00:23:15,360 And if for me, the biggest challenge was updating myself to use all of the digital software that's now required. 210 00:23:15,360 --> 00:23:23,070 So everything is electronically recorded. And and I was familiar with certain areas of the electronic records that we used in our work, 211 00:23:23,580 --> 00:23:27,990 but there's so much more that is required if you're managing the care of a patient who's an inpatient. 212 00:23:28,530 --> 00:23:32,100 So they have everything on iPads, everything is on computers. 213 00:23:32,220 --> 00:23:37,379 I mean, it's literally complete. They have these mobile computers moving around the woods and everything. 214 00:23:37,380 --> 00:23:46,500 Your drug delivery, all of your care management, all of your Nate and every request that's made for them or investigation, etc., all held in that. 215 00:23:46,830 --> 00:23:55,170 So to find the plan, you need to be able to find it. But to document and and report what you've been doing, you need to do all of that digitally. 216 00:23:55,470 --> 00:24:02,130 So all of that I need to see get updated on and learn and various other e-learning requirements. 217 00:24:02,520 --> 00:24:07,170 So having sort of packed away everything alongside that, everybody was busy updating, embedding. 218 00:24:07,740 --> 00:24:15,060 And then it was about the middle of March when I was finally on a roster and then redeployed to a ward. 219 00:24:15,310 --> 00:24:16,410 And what kind of world was that? 220 00:24:16,680 --> 00:24:25,570 Well, I was moved to we had a set up in Oxford where they tried to keep the Churchill Hospital, as they called it, the clean Hospital. 221 00:24:25,590 --> 00:24:27,060 In other words, no COVID cases. 222 00:24:27,660 --> 00:24:38,399 So our gastroenterology ward at the John Radcliffe had been relocated over there, and I was allocated to it with that because of the link. 223 00:24:38,400 --> 00:24:45,270 A lot of hepatology research. If our patients were ever inpatients, they came in under that department, the gastroenterology department. 224 00:24:45,870 --> 00:24:50,190 So there was already a link and so we put that. 225 00:24:50,400 --> 00:24:54,660 So I was allocated to go and work that up at the Churchill. 226 00:24:55,050 --> 00:24:59,610 And and it was a strange, really strange time because. 227 00:25:00,060 --> 00:25:11,010 By this point, You know, the schools had shut and the sun was blazing and we had this surreal lockdown world that no one understood. 228 00:25:11,010 --> 00:25:14,460 And at that early point, most people were tolerating very well. 229 00:25:15,960 --> 00:25:22,920 And and I think I have this and there was this strange well, this is what we've been trained for. 230 00:25:23,400 --> 00:25:26,250 This is this is why we came into these professions. 231 00:25:26,760 --> 00:25:35,730 And there was a really I think I can speak for most colleagues, there was a really determined sense of we sleeves up, get stuck in. 232 00:25:36,330 --> 00:25:44,190 Some colleagues were terrified, but majority just wanted to help and do what they could and and be wherever was helpful to be helpful. 233 00:25:44,550 --> 00:25:51,750 And there was a really amazing kind of camaraderie and atmosphere. 234 00:25:52,020 --> 00:25:58,079 And of course, at the same time, the strangest scenario was that where they had stopped all of the outpatient 235 00:25:58,080 --> 00:26:02,490 appointments and where they had stopped people coming into hospital routinely, 236 00:26:03,570 --> 00:26:07,200 the only thing coming through the doors was really urgent and emergency care. 237 00:26:07,500 --> 00:26:10,560 So we actually sort of saw this drop of workload. 238 00:26:10,590 --> 00:26:18,300 So you had an excess of staff because there was no annual leave, there was no study leave, or the research staff had been brought in. 239 00:26:18,570 --> 00:26:25,200 And in a place like Oxford, you've got a huge amount of academic staff that are clinical that can be redeployed. 240 00:26:25,950 --> 00:26:32,700 So we really were very well staffed overall and actually with very few patients. 241 00:26:32,910 --> 00:26:37,290 And in the early days when there was just the COVID patients that were coming 242 00:26:37,290 --> 00:26:41,820 in were very much being contained in the intensive care unit on a specialist, 243 00:26:41,850 --> 00:26:47,879 Omarion Ward. And I do remember in those early days, you know, sort of people asking about what's the daily numbers? 244 00:26:47,880 --> 00:26:56,430 And, you know, it was it was just low and and yet that's the point when we all got into lockdown and none of us knew what was coming. 245 00:26:57,120 --> 00:27:04,980 And so there was this sort of strange anticipation in the air, not really knowing where this was going or what was going to happen. 246 00:27:05,310 --> 00:27:10,080 But at the same time with that, I did, you know, I felt very much like, oh, no, this is important. 247 00:27:10,080 --> 00:27:14,100 I'm glad I can help. I would hate to actually be stuck at home in the lockdown. 248 00:27:14,430 --> 00:27:21,180 I think your children have key work at school. Well, he did It didn't really work, actually. 249 00:27:21,180 --> 00:27:25,980 So my husband in the end was furloughed and the first lockdown. 250 00:27:26,460 --> 00:27:34,200 And partly because unfortunately, obviously in the first lockdown, none of the schools were prepared and had no experience of how to manage it. 251 00:27:34,890 --> 00:27:43,830 So it was tricky. My youngest was only, gosh, what was he five at the time, and would he just turn six maybe? 252 00:27:44,550 --> 00:27:55,650 Yes. Four years ago he must have just turned six. And he therefore, you know, homeschooling that age is really tricky anyway. 253 00:27:56,430 --> 00:28:00,390 And then my older daughter would have been in the year for that time. 254 00:28:01,320 --> 00:28:06,180 But there was there was a suggested work coming home and lots of it. 255 00:28:06,510 --> 00:28:10,080 And and yet they weren't doing any of it with the key worker kids in the day. 256 00:28:10,440 --> 00:28:15,480 So I was feeling under pressure to then try and complete all this work. 257 00:28:15,750 --> 00:28:23,159 But in the evenings, which felt ridiculous with such children and yet you'd send them in in the day and they just played or coloured in. 258 00:28:23,160 --> 00:28:26,459 They didn't do any teaching or work with them at all. 259 00:28:26,460 --> 00:28:28,770 They didn't follow what they were sending home for children to do. 260 00:28:29,220 --> 00:28:36,120 So it was a bit tricky and so that was quite stressful and, and was certainly quite concerning. 261 00:28:36,390 --> 00:28:39,870 And they said we thought that didn't really work. 262 00:28:39,870 --> 00:28:42,810 And in the end my husband was, well, I didn't and we kept them home. 263 00:28:43,350 --> 00:28:46,770 There was also only, I think, two other children who were keyworkers in the school. 264 00:28:46,770 --> 00:28:51,989 So that was literally just these four children and two of whom were at odds. 265 00:28:51,990 --> 00:28:55,890 And I think we just felt like, oh gosh, this is not really very helpful for the school. 266 00:28:56,190 --> 00:29:04,410 So we saw the first lockdown that was was not straightforward or particularly easy to juggle. 267 00:29:05,550 --> 00:29:07,290 But I had this escape. 268 00:29:07,290 --> 00:29:15,270 I could jump on my bike early in the morning and cycle off to do my shift and leave my husband and children at home to worry about that stuff. 269 00:29:16,470 --> 00:29:20,040 And and I quite enjoyed being back on the wards. 270 00:29:20,040 --> 00:29:27,689 I very much enjoyed it actually, and sort of going back to my roots in nursing, not having been in that kind of role for over a decade. 271 00:29:27,690 --> 00:29:31,320 And I really enjoyed the opportunity to to refresh these skills. 272 00:29:31,740 --> 00:29:35,340 Almost what sort of level? Because, I mean, you've been you do a fairly management role. 273 00:29:35,340 --> 00:29:37,250 Elizabeth Yes, absolutely. So no, 274 00:29:37,290 --> 00:29:44,670 that was quite strange in the sense of they they they were obviously very aware of the fact that I was in an ordinary world I was normally managing, 275 00:29:45,000 --> 00:29:48,810 but I wouldn't have taken on that position at all. 276 00:29:49,650 --> 00:29:56,850 So now I was very much sort of considered one of the staff nurses on shift and I made sure that I wasn't cheated in any other way. 277 00:29:57,600 --> 00:30:03,590 And actually the teams I worked with were lucky. Many of whom I knew sort of had worked alongside. 278 00:30:04,760 --> 00:30:11,089 And and, you know, they were all fantastic and patient with me because I had a lot of questions and didn't know where things were. 279 00:30:11,090 --> 00:30:17,659 And, you know, it was from that point of view, but they were great. So that was all a sort of strangely quite nice. 280 00:30:17,660 --> 00:30:23,930 And I think all of that management responsibility gone when you're used to carrying that. 281 00:30:24,410 --> 00:30:31,190 It was it was actually very liberating to just go to work and do a job and come home and not have to 282 00:30:31,190 --> 00:30:35,960 feel responsible for a team of people or the delivery of a project or the delivery of a programme. 283 00:30:36,740 --> 00:30:44,030 So it was very strange and very surreal and quite refreshing in a funny way. 284 00:30:45,170 --> 00:30:50,150 And and then within a few weeks of being on that board, 285 00:30:50,690 --> 00:31:02,570 I got a phone call from my line manager to ask me if I'd come back to oversee some research at the and based at the John Ratcliffe for Pavitt. 286 00:31:03,650 --> 00:31:07,459 And it wasn't part of the main COVID response taskforce, 287 00:31:07,460 --> 00:31:13,010 which was a huge effort that the trust put in place where they took most research nurses 288 00:31:13,010 --> 00:31:18,830 from a certain funding stream and put them together to form this incredible taskforce, 289 00:31:19,190 --> 00:31:23,480 which was wonderful. And I do hope you've spoken to people who worked on that, 290 00:31:23,900 --> 00:31:33,800 but they there was a particularly a group of doctors, including Alex MENSAH, who you've spoken to, 291 00:31:34,220 --> 00:31:42,860 who were recognising an opportunity to capture data on samples from staff who tested 292 00:31:42,860 --> 00:31:49,999 positive for COVID and that we would really value collecting that information. 293 00:31:50,000 --> 00:31:53,030 And most of those staff were keen and saying, Can you take my blood? 294 00:31:53,030 --> 00:31:54,080 Can you do something with it? 295 00:31:56,000 --> 00:32:02,960 So a project was hastily assembled and I was asked if I would come and help deliver on it alongside other people, colleagues. 296 00:32:04,550 --> 00:32:09,440 And so by the middle of April 2020, that's what I was doing. 297 00:32:11,510 --> 00:32:16,310 And then that and ironically, I'm still doing that today. 298 00:32:16,970 --> 00:32:29,750 Really. So what was a temporary measure and a redeployment as the summer of 2020 progressed and we realised 299 00:32:29,750 --> 00:32:38,120 the sheer scale of this pandemic and that obviously by then vaccines were busily being trialled. 300 00:32:38,750 --> 00:32:44,840 We had set up this amazing cohort of we had to think about, oh gosh, 301 00:32:44,840 --> 00:32:52,340 over 150 staff had donated samples to us repeatedly that had tested positive for COVID. 302 00:32:53,150 --> 00:33:00,050 We'd make them aware that we were doing this research project and asked if they would take part once they were well enough to be back at work, 303 00:33:00,560 --> 00:33:07,550 and then they would come and see us at regular time points for us to take blood samples from them. 304 00:33:07,880 --> 00:33:10,720 So you didn't take the samples until after they'd recovered? No. 305 00:33:10,820 --> 00:33:15,230 So they would have had a positive swap result done through the staff testing programme, 306 00:33:16,160 --> 00:33:20,360 which is an incredibly efficient service and and really, really well managed. 307 00:33:20,810 --> 00:33:24,889 And they as part of their feedback of the results, 308 00:33:24,890 --> 00:33:30,740 we had a process where they also told them about this research and said if you're interested, you contact this email address. 309 00:33:32,840 --> 00:33:37,909 So we had these people volunteer and then the idea being we ran clinics five days 310 00:33:37,910 --> 00:33:43,430 a week in the mornings and these were people who worked in a hospital somewhere, 311 00:33:43,490 --> 00:33:45,290 Churchill or the John Ratcliffe. 312 00:33:45,890 --> 00:33:54,530 And we ran clinics on both sites so that they could pretty much nip out from their shift whatever it was they were doing 313 00:33:55,070 --> 00:34:01,220 and come for a 15 minute appointment with us where we would just update the data and collect a blood sample from them. 314 00:34:03,290 --> 00:34:10,820 And we realised that actually building up this bank of samples and data was a really precious commodity. 315 00:34:11,390 --> 00:34:17,180 We were able to use those samples as control samples in the Oxford vaccine study. 316 00:34:17,180 --> 00:34:21,740 So where they were busy trialling their vaccines, they helped, 317 00:34:22,520 --> 00:34:29,420 they were able to take from us equivalent timepoint samples from people who'd had natural infection as opposed to vaccination protection. 318 00:34:30,830 --> 00:34:38,960 And we were able to, you know, sort of match that time points and provide that sampling data, which was really helpful, I think, for them. 319 00:34:39,230 --> 00:34:44,930 So you could look at the antibodies and see how they played, differed between them and, and, 320 00:34:44,950 --> 00:34:53,809 and we were the programme that we're involved in is very much looking at your T-cell immune response rather than your antibody response. 321 00:34:53,810 --> 00:34:58,970 But we work closely with colleagues who do work very much on the antibody response and. 322 00:34:59,760 --> 00:35:01,830 And other areas of our immune responses. 323 00:35:03,090 --> 00:35:13,110 And so we have taken what was this very willing group, some of whom still come and see us regularly now and and kept following them through. 324 00:35:13,920 --> 00:35:22,380 And we now have this large project known locally in Oxford as Optic, but we are part of a national consortium called Pitch, 325 00:35:23,010 --> 00:35:29,130 which stands for Protective Immunity T cells in healthcare workers from COVID. 326 00:35:29,760 --> 00:35:36,030 And the idea is we are alongside collaborators around the country. 327 00:35:37,530 --> 00:35:41,490 Everybody is is working towards the same scientific aims and goals. 328 00:35:42,960 --> 00:35:46,650 And there is still funding a little bit going into that. 329 00:35:47,010 --> 00:35:48,270 So it continues. 330 00:35:48,930 --> 00:35:59,880 And with colleagues around the country, we're still addressing the questions of our immune responses to both vaccinations and different variants. 331 00:36:01,080 --> 00:36:07,409 And again, we remain useful controls because there's lots of research looking at drug therapies 332 00:36:07,410 --> 00:36:11,130 for the immunosuppressed or immunocompromised groups who are most vulnerable, 333 00:36:11,850 --> 00:36:16,950 obviously, and are often least protected from our vaccines. 334 00:36:18,300 --> 00:36:21,150 And so we can provide control samples for that. 335 00:36:21,920 --> 00:36:34,500 And so we are also recognising that this, you know, impacts on other respiratory viruses, the influenzas, and that are also problematic. 336 00:36:35,160 --> 00:36:40,950 And the fact that we can really broaden out our research so that we can look at other things as well alongside COVID. 337 00:36:41,730 --> 00:36:47,640 COVID is here to stay and we need to make sure we keep abreast and ahead of it if we can. 338 00:36:49,200 --> 00:36:55,680 And although it's lost its way, it's not really what anyone wants to talk about anymore. 339 00:36:56,850 --> 00:37:07,170 We recognise the need to keep understanding it, making sure that we don't let it get the better of us again and and other viruses like it. 340 00:37:07,320 --> 00:37:14,760 So I think what was established as a group of a work package that was established in 341 00:37:14,760 --> 00:37:19,800 2020 and the value of that continues even though it's slightly changed its direction. 342 00:37:21,480 --> 00:37:25,620 And so when funding became available for paste in it, 343 00:37:26,490 --> 00:37:33,570 I decided to apply and and then make the transition from my former team into staying in this role. 344 00:37:34,020 --> 00:37:35,910 And that's right. Mm hmm. 345 00:37:36,300 --> 00:37:43,390 And so you've not been working on projects that involve taking samples from patients who came into hospital a little bit at the beginning. 346 00:37:43,410 --> 00:37:51,420 So we we did support and some of our participants were inpatients only a handful, 347 00:37:51,420 --> 00:38:02,030 mostly because there was so much amazing research going on for them that these patients were already being offered opportunities to take part in it, 348 00:38:02,040 --> 00:38:09,930 sort of two or three other research studies. And it felt probably unnecessary to add another one into the mix. 349 00:38:11,160 --> 00:38:14,490 And when there was so much excellent research going on with patients. 350 00:38:15,030 --> 00:38:23,280 So we very much focussed on providing because there was so much research looking at those hospitalised with COVID, 351 00:38:23,490 --> 00:38:28,980 whereas we were able to provide the answers about people's immune response to COVID 352 00:38:29,220 --> 00:38:34,800 when they were not hospitalised and they managed it mildly in a sense at home. 353 00:38:35,880 --> 00:38:38,580 And actually that is the majority of the population. 354 00:38:38,620 --> 00:38:42,990 Yeah, and of course the rest of the population was in lockdown and we couldn't do any research on them. 355 00:38:43,000 --> 00:38:48,329 So the health care workers coming in to work with this incredibly valuable resource to 356 00:38:48,330 --> 00:38:55,200 understand what's a healthy immune response to COVID might look like and to provide that data. 357 00:38:56,190 --> 00:39:02,729 So it was so very much we sort of although there was some patient involvement at the beginning, 358 00:39:02,730 --> 00:39:09,270 we quickly shifted our focus to be purely healthy volunteers, or in this case, 359 00:39:10,110 --> 00:39:14,430 co-workers in a health care environment who were willing to participate. 360 00:39:15,960 --> 00:39:26,880 And thankfully, I think in our case and all of our recruits were, although at times poorly with COVID or made good recoveries. 361 00:39:28,500 --> 00:39:33,290 So what's it been, as you say, the study still ongoing, but there have been some publications. 362 00:39:33,300 --> 00:39:36,660 What what have been the main conclusions? Well, 363 00:39:36,660 --> 00:39:41,610 we've had there was a very interesting study in the early days which caught the headlines 364 00:39:41,610 --> 00:39:46,940 because we looked at the differences between the vaccines and we looked at the durations. 365 00:39:46,950 --> 00:39:57,959 And I don't know if you recall, but there was a little bit of a outcry when the government decided that rather than having three weeks between doses, 366 00:39:57,960 --> 00:39:59,300 we were going to get 12 weeks in. 367 00:40:00,860 --> 00:40:07,230 This came out of the news very quickly and all of the trials had obviously looked at three week intervals in these vaccines. 368 00:40:07,560 --> 00:40:11,160 But here we were in the real world being told, no, you're going to have to wait. 369 00:40:11,910 --> 00:40:16,710 And but because of the way that that was decided in the timing of that decision, 370 00:40:17,430 --> 00:40:26,100 there was a we started vaccinating healthcare workers in early to mid December of 2020. 371 00:40:26,760 --> 00:40:35,190 The decision came late December, so there was already a several weeks worth of staff who'd been vaccinated, 372 00:40:36,300 --> 00:40:39,720 who the trust decided locally in order to manage it, 373 00:40:40,080 --> 00:40:44,280 that they would honour people up to the end of December who'd already had a first vaccine, 374 00:40:44,280 --> 00:40:50,190 would still only get the three week interval, and then anybody vaccinated from that point on would would have to wait 12 weeks. 375 00:40:50,490 --> 00:40:55,319 So we ended up with these two wonderfully comparable groups to be able to 376 00:40:55,320 --> 00:40:59,190 compare then long term what the difference was between their immune responses. 377 00:41:00,690 --> 00:41:08,430 And it was, you know, in theory, we were providing the research that supported the government's decision. 378 00:41:08,440 --> 00:41:18,329 You could argue, and the government were fortunate that the research went in their favour and the 12 week interval was seen to be I mean, 379 00:41:18,330 --> 00:41:27,210 there was no question it was very there was differences, but in fact memory responses or t cell responses on the longer duration were better. 380 00:41:28,140 --> 00:41:36,030 And although the antibody responses with the short duration peaked higher, the sustainability of them was better with the longer duration. 381 00:41:36,030 --> 00:41:42,030 So so we were able to answer that question that had obviously had to be made for 382 00:41:42,030 --> 00:41:47,400 practical reasons and with strong scientific reason to believe it would be effective. 383 00:41:47,930 --> 00:41:53,370 And we were able to quickly get that evidence together and and monitor those participant, 384 00:41:53,370 --> 00:41:59,040 those people over those sort of next six months and see what happened on that paper was able to support that decision. 385 00:42:00,780 --> 00:42:07,920 And we're also very keen not just in looking at blood samples, we also collect from our participants a little thing that we could do some strep, 386 00:42:08,280 --> 00:42:11,370 which is a little cotton swab that sits inside your nose for a minute and you 387 00:42:11,370 --> 00:42:15,360 just press and hold on your nostril while it just absorbs what's in your nose, 388 00:42:15,750 --> 00:42:29,760 because there's obviously big questions about nasal and mucosal immunity and how much people's people might be protected from underlying immunity, 389 00:42:29,940 --> 00:42:35,940 might be from other coronaviruses that they've previously had, or it could be having had COVID infection. 390 00:42:36,000 --> 00:42:42,120 This then gives them an extra level of immunity to protect them from further reinfection. 391 00:42:43,260 --> 00:42:51,360 So we also collecting those samples and although we haven't had a huge ongoing work on that at moment, 392 00:42:52,020 --> 00:43:00,700 and there will be I think we'll see more and more of that recognising that, you know, we want to look at alternative vaccination methods. 393 00:43:00,720 --> 00:43:06,270 Nasal vaccines are very common now in flu viruses, particularly of with children. 394 00:43:07,230 --> 00:43:13,559 So I think we'll see more and more work like once. But really I think what we've also looked at is then the booster regimes, 395 00:43:13,560 --> 00:43:19,320 because health care workers get boosted or offered a booster vaccine regardless of their age. 396 00:43:19,800 --> 00:43:26,160 And again, we've been able to look at the difference that makes on people's immune responses. 397 00:43:26,730 --> 00:43:32,910 So being able to gather that evidence in and have large numbers of people who have received a 398 00:43:32,910 --> 00:43:40,080 third and a fourth booster has been really useful in comparing that to people who haven't. 399 00:43:41,520 --> 00:43:45,090 And and as I say, health care workers are a natural group of people who can do that. 400 00:43:46,470 --> 00:43:56,879 And then lots of people in the sense of are often our samples get requested to be followed by other groups who are doing particular things, 401 00:43:56,880 --> 00:44:02,500 whether it be to do with the vaccine and whether it be to do with the variants of concern. 402 00:44:03,330 --> 00:44:07,739 There's lots of work going on here in Oxford and Gavin's speech and Zapp have worked on this a 403 00:44:07,740 --> 00:44:15,150 long time through this and are very keen to borrow samples from us or have samples from us. 404 00:44:15,570 --> 00:44:23,430 And when we have got somebody who we know who have sent a variant of what we do now is now that all the testing has stopped and it's 405 00:44:23,430 --> 00:44:30,540 very hard for us to know what variant of COVID people had because that's something you detect through processing their PCR swab. 406 00:44:31,170 --> 00:44:37,229 So our cohort will have at home little PCR kit that they have ready should they test positive 407 00:44:37,230 --> 00:44:43,709 on the left to then do on this themselves and pace back and for us to get the sequence of the 408 00:44:43,710 --> 00:44:48,600 virus off it so that we can match their samples with a virus sequence at some point down the 409 00:44:48,600 --> 00:44:57,780 road and just keeping up that information so that we've we've got access to current samples is, 410 00:44:57,780 --> 00:45:03,640 is really quite important now in the. So they are going on a national level. 411 00:45:04,630 --> 00:45:11,230 So yeah, that's sort of what we're doing. So how much longer do you think the study will be funded for? 412 00:45:11,290 --> 00:45:17,230 Well, we've got we've just been given some funding to keep it ticking along for another just shy of two years. 413 00:45:17,560 --> 00:45:23,400 That doesn't fund everything. Funds elements of the what ifs and buts. 414 00:45:23,410 --> 00:45:29,300 This there's plenty of grant writing going on to get the rest of the money to try and fill the gaps. 415 00:45:30,930 --> 00:45:42,729 And and I think probably it will now probably become something that extends to be more respiratory viruses than just COVID. 416 00:45:42,730 --> 00:45:49,120 And I think it will broaden slightly to allow it to be other pathogens that health care workers are exposed to, 417 00:45:49,930 --> 00:45:53,500 particularly those that we get, you know, vaccinated against. 418 00:45:54,460 --> 00:46:00,040 But yes, we might want to do studies looking at RSV, which has been particularly problematic this year. 419 00:46:01,110 --> 00:46:05,860 And and but also the other respiratory sensitive virus. 420 00:46:06,120 --> 00:46:16,269 That's very. Yes, Yes. So we see I think probably what will happen is it will become a little bit broader and a bit more diverse, 421 00:46:16,270 --> 00:46:26,440 but just really recognising what a valuable cohort of these amazing volunteers who are all busy 422 00:46:27,700 --> 00:46:33,459 medics and nurses and administrators and porters and they're all busily doing their jobs and, 423 00:46:33,460 --> 00:46:41,620 and through their volunteering, we've been able to get really valuable and quite rich data from them and sampling from them. 424 00:46:42,100 --> 00:46:48,010 That's really useful in on understanding and answering important scientific questions. 425 00:46:48,310 --> 00:46:56,980 And does that include looking at how much people vary in their genetic susceptibility or their the degree of their immune response? 426 00:46:57,160 --> 00:47:03,370 Yes, I mean, it does. I think it's more about what matters because we know these huge viruses happen. 427 00:47:03,370 --> 00:47:06,729 So so then it's about matching up with the clinical story. 428 00:47:06,730 --> 00:47:10,840 So a lot of what we're doing at the moment now is focusing on people who think they've never had COVID. 429 00:47:11,380 --> 00:47:17,890 We obviously all believed that vaccination would mean, you know, great protection and not many people would get COVID. 430 00:47:17,890 --> 00:47:23,830 And of course, the inverse of that is true. Most of us get COVID despite vaccination. 431 00:47:24,070 --> 00:47:28,210 We don't. Thankfully, most of us get poorly enough to require hospitalisation. 432 00:47:28,630 --> 00:47:37,600 So the vaccines are working. But we're looking at those people who believe they've never had a COVID infection that knowingly had it. 433 00:47:38,740 --> 00:47:41,860 And you know, whether they're testing or not, they might not have been symptomatic. 434 00:47:42,160 --> 00:47:49,899 So they've become a group of really interest to us now. So we've been busy recruiting in people that fall into that category and getting 435 00:47:49,900 --> 00:47:55,629 them in for sampling and then sort of we will follow them up to see what happens, 436 00:47:55,630 --> 00:48:02,890 whether they do in fact, still get COVID. Some, of course, already have, because there's high levels of COVID now. 437 00:48:04,150 --> 00:48:07,990 So we're very much focusing as well on them. 438 00:48:08,410 --> 00:48:13,960 And the question is, though, does it does does it matter if they've had COVID and not known about it? 439 00:48:14,530 --> 00:48:17,730 How much? Because that's an important question to answer. 440 00:48:17,740 --> 00:48:23,860 How much transmission is unknown, How much is out there without people having any idea that they've they've even had it. 441 00:48:24,310 --> 00:48:28,840 So if we can sort of get a better sense of that or be part of answering that question, 442 00:48:29,350 --> 00:48:36,009 that also helps in sort of this very much a sense of future preparedness, 443 00:48:36,010 --> 00:48:41,380 future pandemic preparedness and recognising we've got so much we can learn from the COVID pandemic. 444 00:48:42,370 --> 00:48:49,510 So many great collaborations and institution sort of developments have occurred because of it. 445 00:48:51,190 --> 00:48:54,670 And having put these really excellent working practices into place, 446 00:48:55,000 --> 00:48:59,590 it's important we take that knowledge and we use it to our benefit in the future because there 447 00:48:59,590 --> 00:49:08,350 will be future viruses that are going to cause concern and some may be on the scale of COVID 19, 448 00:49:08,350 --> 00:49:16,300 others may be more sort of remote, probably from the UK, but therefore a geographical region of the world. 449 00:49:16,540 --> 00:49:19,659 But the knowledge gained here can be just as useful. 450 00:49:19,660 --> 00:49:26,020 And and I think we all recognise that just because the problem may be occurring 451 00:49:26,020 --> 00:49:29,260 on the other side of the world doesn't mean it can't become a problem for us. 452 00:49:29,650 --> 00:49:40,240 So there's a really amazing sense, I think, that of learning how to work together, how to work remotely together, how to collaborate. 453 00:49:40,750 --> 00:49:46,780 And so many things changed during COVID on that level that were just really quite liberating. 454 00:49:47,650 --> 00:49:57,280 And I think people are keen to try and keep that behaviour and practice where possible to enable it. 455 00:49:57,280 --> 00:50:09,179 Just a really good sort of shared. Knowledge for the future so that we can hopefully improve upon and manage more efficiently should it happen 456 00:50:09,180 --> 00:50:18,120 again and and and be able to really be proud of that work that so many in Oxford and other cities achieved. 457 00:50:19,620 --> 00:50:26,370 Should it come again? You obviously love being involved in research. 458 00:50:26,370 --> 00:50:34,050 I just wondered if there are any issues that sometimes arise in working with academic researchers who don't have the clinical experience. 459 00:50:35,430 --> 00:50:45,210 I mean, I'm sure the older ones, because I mean, Alex was incredibly complimentary and was very anxious that I should promote the well, 460 00:50:45,270 --> 00:50:48,239 recognise the importance of the role of the research team. 461 00:50:48,240 --> 00:50:56,850 But I wonder if perhaps some of the more junior researchers have to be educated also about what's involved in. 462 00:50:56,880 --> 00:51:02,810 Well, I think maybe I've been rather fortunate because I think once. 463 00:51:03,690 --> 00:51:14,010 I can't say I've ever worked in my years here in Oxford in research, which is now it must be around 14 years. 464 00:51:14,130 --> 00:51:15,900 I've never encountered that. 465 00:51:16,440 --> 00:51:29,370 I have worked with and, you know, senior medics of of different years in the sense of their age and and they all have their different ways of working, 466 00:51:29,370 --> 00:51:34,680 but they've all been very respectful, actually, towards the role of the research nurse. 467 00:51:35,070 --> 00:51:40,920 And now we might be fortunate. I think Oxford is particularly ahead of the game. 468 00:51:41,250 --> 00:51:48,420 I think that, you know, there's been a lot of research nursing going on here for a reasonably long time and I think therefore exposure is good. 469 00:51:50,490 --> 00:52:00,510 So I don't think actually the the academic population are particularly unaware of what we do. 470 00:52:00,930 --> 00:52:09,540 I certainly but then equally I recognise we I'm really talking about senior clinical researchers who I'm directly working with. 471 00:52:09,540 --> 00:52:16,560 So, you know, certainly the clinicians have been fabulous and, and I think we've been really fortunate to have such a. 472 00:52:20,040 --> 00:52:25,020 Just a real team spirit. There is not a lot of hierarchy in that environment. 473 00:52:25,890 --> 00:52:30,510 Everybody recognises the strengths of each other's roles and the need for each other's roles. 474 00:52:30,960 --> 00:52:36,130 And and I've been very fortunate to work in teams where that's been very paramount. 475 00:52:36,150 --> 00:52:44,910 So I'm maybe I've just been very lucky. So I'm just going to go a little bit onto how the pandemic impacted on you personally. 476 00:52:44,910 --> 00:52:53,790 You've talked a little bit about the homeschooling issues and so on, but how threatened did you feel by the possibility of becoming infected yourself? 477 00:52:54,270 --> 00:53:05,430 It's really strange, and I think I remember talking to a colleague quite early on in the pandemic as we were all preparing to be deployed. 478 00:53:06,090 --> 00:53:09,899 And I've been talking to a nurse in the team. 479 00:53:09,900 --> 00:53:13,590 He was very nervous and very anxious and very scared that day. 480 00:53:13,590 --> 00:53:17,309 And and in a conversation with one of my seniors later that day, 481 00:53:17,310 --> 00:53:21,690 I was sort of recounting the conversation and she looked at me and she said, Are you scared? 482 00:53:23,220 --> 00:53:27,060 And I said, No, I'm not. I said, I don't know why. 483 00:53:27,060 --> 00:53:30,060 I don't think I'm invincible. But I did feel scared. 484 00:53:30,810 --> 00:53:34,980 And and I and I just said, I don't know why. 485 00:53:34,980 --> 00:53:43,800 I just don't. And and I just had a sort of it doesn't feel like this is going to be a threat to me. 486 00:53:44,820 --> 00:53:50,340 And I had no reason to believe that because clearly many amazing health care workers 487 00:53:50,340 --> 00:53:56,230 who were infected and subsequently got very sick and some of them very sadly died. 488 00:53:56,250 --> 00:54:00,540 So it wasn't through anything I had any knowledge of. 489 00:54:00,540 --> 00:54:05,940 It was purely just a feeling in my gut that I thought I was going to be okay with that. 490 00:54:06,990 --> 00:54:08,940 I therefore, I wasn't overly worried. 491 00:54:09,540 --> 00:54:19,230 Of course I was worried about people I cared for, you know, elderly parents and vulnerable parents and and recognising their vulnerability. 492 00:54:20,580 --> 00:54:24,360 And that was definitely a concern. But for myself directly. 493 00:54:25,020 --> 00:54:35,759 No, I didn't. And, and I think I recognise in hindsight when we were first sampling our cohort, when they were first returning to it, 494 00:54:35,760 --> 00:54:43,200 we had a very different policy that they had in the early days that they could come back to work after seven days and we didn't 495 00:54:43,200 --> 00:54:50,490 have allergies and and they could come back to work if they felt well enough and didn't have a temperature up to seven days. 496 00:54:50,520 --> 00:54:57,990 Now, in hindsight and at this point, we weren't even wearing masks like it was before we fully understood the need for mask wearing. 497 00:54:58,770 --> 00:55:08,249 And I remember somebody taking I was taking bloods of a young nurse one morning and she said to me, Aren't you wearing a mask? 498 00:55:08,250 --> 00:55:13,590 And because I think at that point we that the policy was with known private participants or patients in the hospital, 499 00:55:13,590 --> 00:55:18,210 you obviously will PPE, but not with each other in the common areas and staff rooms and stuff. 500 00:55:18,810 --> 00:55:23,820 And I said, and she thought you were rich and she'd just a week ago tested positive. 501 00:55:24,090 --> 00:55:26,390 Now, in hindsight, of course, we now think, yes, 502 00:55:26,400 --> 00:55:33,360 you probably Western Infectious and the knowledge we have acquired means that I now realise that I was putting myself at risk. 503 00:55:33,840 --> 00:55:42,389 But at that point we didn't have the knowledge, we didn't understand the duration really of viral transmission, 504 00:55:42,390 --> 00:55:45,600 and we didn't realise how long people were going to test positive for. 505 00:55:47,040 --> 00:55:55,890 So yeah, those first few weeks probably I did encounter some risk on knowing that I was and, 506 00:55:56,000 --> 00:56:01,979 and I was obviously fortunate, but, but now I didn't ever particularly feel at risk. 507 00:56:01,980 --> 00:56:02,910 And I think, you know, 508 00:56:02,910 --> 00:56:12,209 I was encountering mostly people who'd had COVID and returned to work and were well and we very quickly were wearing masks and gloves, 509 00:56:12,210 --> 00:56:17,370 obviously, and and being a bit more careful about all sort of PPE questions. 510 00:56:19,020 --> 00:56:22,710 And so I didn't feel the need to have you know, I didn't feel particularly vulnerable. 511 00:56:23,970 --> 00:56:34,440 And so that wasn't too bad. And I think the impact on the home was more just I could see what a lot of stress it was placing on my 512 00:56:34,440 --> 00:56:41,310 husband and trying to juggle in a we were in a much smaller house before we were here with no garden. 513 00:56:41,980 --> 00:56:54,930 And so juggling an energetic six year old and nine year old and not being really allowed out and was no fun and and it was really, 514 00:56:54,930 --> 00:57:05,430 really tough on him. So I think that was my biggest stress was sort of concern for their welfare and mental health in that time. 515 00:57:06,450 --> 00:57:09,450 And I think all of us were just very grateful for the long, 516 00:57:09,450 --> 00:57:18,060 sunny days that bathed that sort of early lockdown period and what you were able to work fairly normal hours. 517 00:57:18,580 --> 00:57:21,610 Just like the you talked about, where you had to keep everything. 518 00:57:21,610 --> 00:57:26,860 Exactly. So we did. We did. For a while, I was doing shifts, long days. 519 00:57:26,860 --> 00:57:28,030 I didn't have to do any nights. 520 00:57:29,050 --> 00:57:37,210 And so that was different for them, you know, in the sense of I've normally been there more part time of the two of us. 521 00:57:37,870 --> 00:57:44,500 So there was definitely a lot more responsibility on, you know, sort of my husband to provide all things domestic. 522 00:57:44,980 --> 00:57:49,300 And he was amazing. You know, he stepped up to the challenge fabulously, but was also still, 523 00:57:49,570 --> 00:57:54,820 despite being furloughed from his role, there was still activity that needed to happen. 524 00:57:55,390 --> 00:58:01,630 And it was just a lot of responsibility. So that was yeah, that was a bit tricky. 525 00:58:01,840 --> 00:58:12,190 But we we got through that and and I think everybody quickly found little things to be sort of grateful 526 00:58:12,190 --> 00:58:19,079 for or thankful for as that summer unfolded and the promise of vaccines that's on the horizon. 527 00:58:19,080 --> 00:58:23,950 And and we all hoped that it would get better. 528 00:58:23,950 --> 00:58:28,270 And of course 2021 was a tough year and actually it wasn't much better. 529 00:58:28,420 --> 00:58:30,010 In fact, for many it was probably worse. 530 00:58:31,720 --> 00:58:38,150 And thankfully, I think the thing that was different for us by then was we had moved because in the middle of yes, 531 00:58:38,260 --> 00:58:40,810 in the summer of 2020, we moved house to a bigger house. 532 00:58:41,290 --> 00:58:48,849 So by the time the second lockdown occurred in 2021, and not only were we better catered for space wise, 533 00:58:48,850 --> 00:58:54,940 but the schools had developed much more robust home learning setups. 534 00:58:55,870 --> 00:58:59,350 So we were much more catered for in providing sort of structure. 535 00:58:59,710 --> 00:59:02,950 And it also meant that on the days when our children went in as key worker days, 536 00:59:03,790 --> 00:59:08,980 they were actually being taught something of what was in the proposed framework. 537 00:59:09,010 --> 00:59:17,220 So, so it felt like they weren't having quite such a loss of education in that second lockdown that, well, 538 00:59:17,260 --> 00:59:22,570 there was more educational provision for them and support for us as parents trying to educate them. 539 00:59:24,430 --> 00:59:30,400 And my I by that point I'd shifted to this role full time anyway. 540 00:59:30,610 --> 00:59:36,970 So I was this was my my new world was catered and and and that's where it has sort of stayed. 541 00:59:38,140 --> 00:59:45,910 And did you think the fact that you were able to work on something that was important over and beyond what you do all the time, 542 00:59:45,910 --> 00:59:50,160 which is important, help to support your wellbeing through those difficult times? 543 00:59:50,200 --> 00:59:58,749 Oh, it's unbelievable the difference it makes, because I remember cycling home and literally cycling down streets of people bashing saucepans like, 544 00:59:58,750 --> 01:00:04,989 you know, 8:00 on a Thursday night or whatever it was and cycling through and they had no idea where I'd come from. 545 01:00:04,990 --> 01:00:10,240 Like I was just a cyclist passing by, but I knew why they were doing it. 546 01:00:10,780 --> 01:00:15,729 And, and it was just the most incredible feeling to think these people are really grateful. 547 01:00:15,730 --> 01:00:23,860 And, and it's this it's a sad state that I, I remember very distinctly, despite always knowing I wanted to go into nursing. 548 01:00:24,520 --> 01:00:33,429 I remember my secondary school, which is not in the area, had sort of dismissed me when I said I want to go into nursing. 549 01:00:33,430 --> 01:00:41,020 It wasn't academic enough for them, and they therefore said, Oh, good luck to you if you go and there was no support, careers, advice or anything. 550 01:00:41,680 --> 01:00:50,200 It sort of gave me the distinct impression at the age of 17 that nurses weren't valued and nursing certainly wasn't valued. 551 01:00:50,800 --> 01:00:58,660 So I think you don't realise you carry that now once you work in hospital and once you start working in the NHS, 552 01:00:58,660 --> 01:01:03,610 you realise that as a group of professionals, each of you values each other very highly. 553 01:01:04,330 --> 01:01:10,450 So you get great support from peers and a lot of respect from peers, and you knew what each other were doing. 554 01:01:10,450 --> 01:01:13,800 And you know what an amazing provision is happening in now. 555 01:01:14,290 --> 01:01:20,770 And obviously patients who encounter that, hopefully they taste and experience that they're able to understand it. 556 01:01:21,040 --> 01:01:30,549 But there is just this constant sense of the general public doesn't appreciate or understand quite how hard everybody 557 01:01:30,550 --> 01:01:36,730 in that place is working as a team with different skill sets to deliver the best care possible for those people. 558 01:01:37,510 --> 01:01:43,870 And so being able to suddenly have a sense of now the world is appreciating the 559 01:01:43,870 --> 01:01:48,969 value of this and how important this is was definitely a huge morale boost. 560 01:01:48,970 --> 01:01:50,860 And of course, that's what's so hard. 561 01:01:50,860 --> 01:01:57,909 Now when you look at the state we're in with nurses having to strike because conditions and pay are so awful and so poor. 562 01:01:57,910 --> 01:02:05,260 And and if you allow yourself to read, you know, kind of comments, particularly in social media, 563 01:02:05,260 --> 01:02:12,970 that can be so dogged about nursing as a profession and you just have to just you can't read it, you can't think about it. 564 01:02:13,240 --> 01:02:18,440 It's it's cruel but basically generally nurse. 565 01:02:18,520 --> 01:02:30,579 Singh is not a respected profession, but briefly there for a time and covered we were and then and that definitely helped him and has anything about 566 01:02:30,580 --> 01:02:38,830 working through the pandemic changed your attitude or your approach to your work or how you think about your career? 567 01:02:40,030 --> 01:02:47,770 Well, obviously it's actually changed my job, so I suppose in quite profoundly I'm now doing a different, very different line of work. 568 01:02:48,130 --> 01:02:55,000 And that opportunity only arose because of the pandemic, I think. 569 01:02:56,510 --> 01:03:05,000 I think it makes you I mean, I was very fortunate. We were very fortunate that we didn't lose anyone close to us because of COVID. 570 01:03:05,600 --> 01:03:08,660 We didn't suffer personal loss as a family. 571 01:03:09,260 --> 01:03:22,999 And and I'm very grateful for that. I loved being part of the the sense of providing for the world, in the sense of knowing that in some small, 572 01:03:23,000 --> 01:03:28,819 tiny way, the work we were doing was supporting other really important research groups, 573 01:03:28,820 --> 01:03:30,230 particularly the Oxford Vaccine Group, 574 01:03:30,950 --> 01:03:40,940 and knowing that all of these vaccines that have been delivered and that have saved lives has come from the most incredible collaboration of people. 575 01:03:41,630 --> 01:03:46,580 And that in a tiny, tiny, tiny way, I was part of that. That's amazing. 576 01:03:46,790 --> 01:03:52,819 You know, that's that's a real accolade and and something I'm deeply proud of. 577 01:03:52,820 --> 01:03:55,940 So. So I think it kind of has helped me. 578 01:03:55,940 --> 01:04:04,819 I think I am. Yeah. I'm keen to stay in the working world. 579 01:04:04,820 --> 01:04:12,620 I mean, right now, because I do see that there is a real sense of this hasn't just gone away, it's gone quiet. 580 01:04:13,400 --> 01:04:17,090 People are less interested, but there might be another one. 581 01:04:17,240 --> 01:04:20,390 And if that's in my working lifetime, 582 01:04:20,630 --> 01:04:27,800 I would like to think that we can take all our knowledge and experience and I can be part of a response to that and again in the future. 583 01:04:28,310 --> 01:04:34,010 So. So yes, I suppose, whereas I probably wouldn't have even thought about it, you know, three years ago. 584 01:04:34,820 --> 01:04:47,750 So I think in that sense it's changed a little bit. Um, but mostly I think probably and I've just made sure that we have more toilet 585 01:04:47,750 --> 01:04:51,079 roll in the house because the world went out and bought all the toilet Well, 586 01:04:51,080 --> 01:05:01,830 and we couldn't buy anything. So probably my, my, I have learnt a lot about making sure we have a few spare toilet rolls, but otherwise, um, 587 01:05:02,090 --> 01:05:10,100 I think it's for me been in many ways I'm a situation that's provided lots of opportunity and I'm very grateful for that. 588 01:05:10,280 --> 01:05:18,259 And it's highlighted what Oxford has to offer space academically and in its health 589 01:05:18,260 --> 01:05:23,300 care workforce here and the amazing collaborations that exist between these groups. 590 01:05:23,720 --> 01:05:26,960 Um, and I just feel very privileged to have been able to be part of it, really. 591 01:05:28,040 --> 01:05:28,970 Thank you very much.