So could you start by saying your name and what your job title is?
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.
Okay, that's great. So going back to how you first got interested in nursing.
Can you just give me the main sort of milestones in your career so far?
Well, it's rather boring, really. I was very clear from a young age I wanted to go into nursing.
And I recall my wonderful mum making a little costume as a gift for a friend's birthday party.
And I think we were probably seven. And the gift was this homemade nurse's outfit.
And she modelled it on me because it would fit me.
And I went off to the party, gave it away rather sadly, and came home to discover she'd made another one for me.
And I think that confirmed it. And I yes, from a very young age, without any real understanding of what the profession was about,
I had a strong sense that I wanted to be a nurse, and I continued in that pathway.
And at the age of 18, I went off to study nursing at university.
Where did you go? I went to reading and then on qualification, moved around quite a bit.
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,
and however have come back to nursing and found that there was more in nursing that I thought was suitable for me.
So I found myself very much in acute sort of urgent care,
emergency care intensive care environments all the way through until I got married and we moved
to Oxford and I thought perhaps a bit less shift work and a bit less and weekends would be nice.
And that's when I started exploring research.
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,
which started off with me and one colleague and then grew and grew.
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.
We had academically led ones with local Oxford studies.
And we were by early 2020 a pretty big team with about, gosh,
about six or seven nurses and other support staff running a portfolio of about 25, 30 research studies in the jail.
So what this is a silly it's a simple question.
I hope it's not a silly question, but what does a research nurse do?
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.
There is the academic research nurses who are delivering their own research.
These are nurses who have their own research question that they want to answer, just like any other medical professional might,
and they will follow their own pathway through an academic route to answer that research question.
The research nurses that I sit with in the campus of what we class as clinical delivery research nurses,
and this is about the research nurses who enable large research projects to happen.
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,
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.
And the person, often the researcher behind that research, isn't in a position to actually make that happen.
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,
recruiting, consenting and managing the care of participants as they come through these research studies, sometimes for many, many years.
Some of the studies can go on for even seven or eight years in chronic health conditions.
The nurses are in a very privileged position then to build up a very nice rapport.
They've become, much as you might, a specialist nurse with that.
If these are chronic conditions that are being managed and you become a bit of an expert in
that condition and also really build up a strong rapport with that participant or patient.
And and you've got research now.
You are managing emergency care work, people coming in to the emergency departments.
There might be research going on into certain types of traumatic injuries,
or there could be research going on to a stroke or heart disease or heart and myocardial infarctions
and all different reasons why we need to understand better treatments and better management.
All of which. And around the country,
there will be researchers asking questions and then building projects to make sure that we try and understand these conditions better and better.
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
the rules and the regulations that uphold all of these research practices are very detailed,
They're very thorough, and they are different and not the same as normal clinical practice.
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.
It's too much and it's too expertise. It's too specialist.
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.
And I'm sure even in my explanation,
I have probably made a terrible injustice by not including more of its breadth and and there will be colleagues that go,
Well, hang on, what about what I did? And it does all come under the remit of research.
Ms. And do you do that all the time?
Excuse me. Yes. So you don't do shifts of just basic care on the wall.
There are some roles that are what they call hybrid roles where you might have a nurse who a percentage
of her working hours is allocated to the research and a percentage is allocated to clinical care.
And there's lots of examples of excellent practice where that works.
It's quite hard to manage because of the shifts,
and so the majority of research roles tend to be full time or if not full time, then that's their only.
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.
It isn't funded out of the hospital budget. So it becomes in itself a slightly separate group.
And even though we very much are working alongside our NHS colleagues who are in the wards and the departments sort of,
you know, kind of doing the the core of the NHS work.
So take me through I mean, I'm quite happy to expand it a little bit.
You mentioned recruitment is one of the roles of the research.
So so you will be the first person who actually speaks to a patient about the course often.
So again,
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.
So certainly in the emergency departments or critical care units,
you will have certain doctors and certain research nurses who will be tasked with identifying suitable participants or patients.
And it just depends kind of who spots them fast.
But there's often a very short time window to recruit somebody into research because if
it involves particularly a drug that is a comparison to standard of care treatment,
then if they've already been started on a pathway of traditional treatment, then they're no longer eligible.
So there is a very tight window of opportunity in these scenarios where so nurses do have to be on call.
They are the research nurses quite often will work weekends, carry a bleep, and somebody will say, is somebody arrived, we think is suitable.
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.
Now that could be in it.
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,
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.
And then you very much often all the research nurse is often the first person to approach them,
whether that's directly face to face in a clinic appointment, whether you call them up at home and have a conversation,
and you then would be discussing it often with considerable sensitivity, if it's a new diagnosis,
that what it is that you think is unique about them that might work for this study.
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.
Or showing any bias towards the correct answer for them, whether it's to take part in the study or not.
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.
But at the same time, you obviously are wanting to promote taking part in research.
We know that the value of research participation is immense,
and it's only because of people volunteering in research that we develop our understanding and
can produce more and more amazing medicine and science to manage people's health conditions.
So it's a fine balance and you have to sometimes walk quite firmly in the middle,
and particularly if there's pressure on recruitment and pressure from and whether it be the company that
is running the research or whether it's even just the investigator locally who's responsible for it,
you know, there is targets and you do have to meet them.
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.
Mm hmm. And what are some of the ethical issues that arise in whether or not a patient is willing to go ahead?
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.
That could be comprehension barriers that would prevent them from fully understanding what the risks of participation in research are,
which are always very well spelt out. You know, we have strong standards and the ethics committees that review all clinical research are really,
really very careful and very strict about what documentation is produced and how it's produced.
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.
You also recognise that quite often, particularly in the context of a new diagnosis,
people might be very scared, vulnerable, not necessarily hearing all the information.
So you've really got to reassure yourself that they have made an informed consent.
And that's the difference between just consent and and informed consent and really being confident.
But then equally, as I say, is got to be that they feel that there's a real choice,
that they fully understand what the alternative would be, that they don't think that taking part in research is the only treatment.
But actually there is other treatment pathways and and all of them are equally available to them.
And yeah, I mean, that's just the sort of the beginnings really.
And then of course, it's absolutely paramount that somebody might decide to take part.
And just like everything else and perhaps even consumer laws,
there's a it's perfectly okay to turn around, say I've changed my mind and that people can willingly.
Having gone through the process of signing a consent form and saying they'll take part in a study
and setting up those initial appointments and screening appointments to turn around and go,
you know, I think I don't want to do this, and that's okay.
And they mustn't feel that there's any pressure on them to do otherwise.
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,
because quite often the investigators, the the doctors who are running the studies simply do not have the privilege of time.
They're incredibly busy.
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.
And and if actually we have questions that we think need to be discussed, investigated,
and we can encourage them and take them to them and and sort of get that addressed.
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.
And and even just that, the whole idea that each time they attend the appointment,
you're gaining their verbal consent, that they're still willing to take part.
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,
where this information is stored or going, or how it's going to be analysed or used in a way just complete transparency.
This set me obviously many years back in the past have been some really poor handling
of people's personal data on health data and we are very careful to avoid that now.
Mm hmm. So you would typically a study is investigating a new drug or a new intervention of some kind?
Yes. I mean, it might be it might be to do with it could be a new drug.
It could be a new. It could be sort of a scanning or radiology related investigation for detection of things.
It can also be non interventional, as we call it. So it is observational and that can produce huge amounts of understanding.
And by observing a cohort of people who have a specific disease or capability and watching them over prolonged periods of time to
understand better the pathway and and to sort of be able to observe patterns which then can obviously identify research questions.
But that observation might include collecting data through taking bloods or other kinds of things.
Yes. Yes, absolutely. So it's very much a they engage in that project and they are willingly giving consent.
And often it's data and samples at the same time repeatedly and are often followed up for many, many, many years.
And actually, if that weren't, you know, those sources of of data can be and sampling can be hugely informative in understanding
progression of disease and identifying why some people progressed differently.
And then obviously you might go back and you might be looking at the genetics of the individuals
involved or you might be looking at the environment of people involved and all of these things.
So there's huge amounts of of work that go into those projects as well that are not interventional, Right?
Well, I think it's time we got to go it can you remember where you were or what you were
doing or how you first heard that there was something a bit worrying going on in China?
I tell you, if I can remember a specific time, I do.
I do remember certain key things on the news when following the development of the outbreak in Wuhan.
I mean, I was I've always been somebody who follows current affairs closely.
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.
I'm not quite clear. I mean,
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,
then there was a sort of okay expectation of this is not going to be possible to contain.
I don't think any of us could have imagined what turned out to be the reality.
I certainly wasn't imagining it myself,
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.
So this would have been in the march and there was somebody talking about schools shutting.
And I think I had presumed they might shut for a couple of weeks in the run up to Easter or something.
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.
And I, I just remember stopping and sort of staring at the radar going, you can't be serious.
You can't stop the schools functioning for 12 weeks. What will we do?
And and just this sort of absolute heavyweight reality check kicking in and going, oh, I haven't thought this through.
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.
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.
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
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,
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,
there was a strange feeling within life in the hospital of, well, yes, sort of battle readiness,
I suppose, and and getting ready for this arrival of something that was unknown.
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,
they quickly made the decision that all research studies would have to stop.
It was obvious that, particularly in our case, outpatients. Coming in was just totally inappropriate.
They were starting to really point heads and say these things are just not going to be possible.
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.
And and some research had to continue because for some people their research activity is actually their drug treatment and their management.
So it was important that these people were provided for,
but majority of our research activity seemed right down and we kind of got right down to a very small core.
And that meant the team of nurses that I was managing were freed up to be redeployed, myself included.
But the ones who did need to continue, did you have to deliver them their drugs at home?
So, yes, we had some provision for delivering drugs at home.
We had some drive by pick ups of pharmacy medications,
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.
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.
Not many. Mostly we had a sort of combination of home delivery set ups.
And thankfully, we it wasn't too many patients who were dependent on that.
So that was good. So we had some staff who remained perhaps a day or two days a week focussed on their research.
But then the other days, the week they were deployed to another department and then we had others who were fully deployed.
We had some who were shielding or for personal medical reasons, weren't able to be patient facing.
So took on different roles and so everybody started doing different things, but we had to sort of physically shut down.
And what literally happened was the the space where we saw our participants,
our patients were was a case area that the trust told us was going to be redeployed and used for COVID.
So we had to literally empty everything out. So the consulting rooms, the storage cupboards, lab area where we processed all the blood samples,
all of that had to be packed away in boxes, in cages and parked away and moved.
And and so it was a huge amount of work, actually, and it was very stressful.
It was very unknown purely from that perspective.
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.
But that was complicated from a management point of view, handing over their management to a new temporary manager,
getting them arranged on rosters and etc. And for many of us it meant really updating our skills
because as research nurses you might be experts at phlebotomy or taking bloods or pretty good at EKGs,
but it might well have been a long time since you were working on the wards.
And so for most of us there was certain skills that needed refreshment.
And if for me, the biggest challenge was updating myself to use all of the digital software that's now required.
So everything is electronically recorded. And and I was familiar with certain areas of the electronic records that we used in our work,
but there's so much more that is required if you're managing the care of a patient who's an inpatient.
So they have everything on iPads, everything is on computers.
I mean, it's literally complete. They have these mobile computers moving around the woods and everything.
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.
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.
So all of that I need to see get updated on and learn and various other e-learning requirements.
So having sort of packed away everything alongside that, everybody was busy updating, embedding.
And then it was about the middle of March when I was finally on a roster and then redeployed to a ward.
And what kind of world was that?
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.
In other words, no COVID cases.
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.
A lot of hepatology research. If our patients were ever inpatients, they came in under that department, the gastroenterology department.
So there was already a link and so we put that.
So I was allocated to go and work that up at the Churchill.
And and it was a strange, really strange time because.
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.
And at that early point, most people were tolerating very well.
And and I think I have this and there was this strange well, this is what we've been trained for.
This is this is why we came into these professions.
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.
Some colleagues were terrified, but majority just wanted to help and do what they could and and be wherever was helpful to be helpful.
And there was a really amazing kind of camaraderie and atmosphere.
And of course, at the same time, the strangest scenario was that where they had stopped all of the outpatient
appointments and where they had stopped people coming into hospital routinely,
the only thing coming through the doors was really urgent and emergency care.
So we actually sort of saw this drop of workload.
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.
And in a place like Oxford, you've got a huge amount of academic staff that are clinical that can be redeployed.
So we really were very well staffed overall and actually with very few patients.
And in the early days when there was just the COVID patients that were coming
in were very much being contained in the intensive care unit on a specialist,
Omarion Ward. And I do remember in those early days, you know, sort of people asking about what's the daily numbers?
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.
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.
But at the same time with that, I did, you know, I felt very much like, oh, no, this is important.
I'm glad I can help. I would hate to actually be stuck at home in the lockdown.
I think your children have key work at school. Well, he did It didn't really work, actually.
So my husband in the end was furloughed and the first lockdown.
And partly because unfortunately, obviously in the first lockdown, none of the schools were prepared and had no experience of how to manage it.
So it was tricky. My youngest was only, gosh, what was he five at the time, and would he just turn six maybe?
Yes. Four years ago he must have just turned six. And he therefore, you know, homeschooling that age is really tricky anyway.
And then my older daughter would have been in the year for that time.
But there was there was a suggested work coming home and lots of it.
And and yet they weren't doing any of it with the key worker kids in the day.
So I was feeling under pressure to then try and complete all this work.
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.
They didn't do any teaching or work with them at all.
They didn't follow what they were sending home for children to do.
So it was a bit tricky and so that was quite stressful and, and was certainly quite concerning.
And they said we thought that didn't really work.
And in the end my husband was, well, I didn't and we kept them home.
There was also only, I think, two other children who were keyworkers in the school.
So that was literally just these four children and two of whom were at odds.
And I think we just felt like, oh gosh, this is not really very helpful for the school.
So we saw the first lockdown that was was not straightforward or particularly easy to juggle.
But I had this escape.
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.
And and I quite enjoyed being back on the wards.
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.
And I really enjoyed the opportunity to to refresh these skills.
Almost what sort of level? Because, I mean, you've been you do a fairly management role.
Elizabeth Yes, absolutely. So no,
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,
but I wouldn't have taken on that position at all.
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.
And actually the teams I worked with were lucky. Many of whom I knew sort of had worked alongside.
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.
And, you know, it was from that point of view, but they were great. So that was all a sort of strangely quite nice.
And I think all of that management responsibility gone when you're used to carrying that.
It was it was actually very liberating to just go to work and do a job and come home and not have to
feel responsible for a team of people or the delivery of a project or the delivery of a programme.
So it was very strange and very surreal and quite refreshing in a funny way.
And and then within a few weeks of being on that board,
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.
And it wasn't part of the main COVID response taskforce,
which was a huge effort that the trust put in place where they took most research nurses
from a certain funding stream and put them together to form this incredible taskforce,
which was wonderful. And I do hope you've spoken to people who worked on that,
but they there was a particularly a group of doctors, including Alex MENSAH, who you've spoken to,
who were recognising an opportunity to capture data on samples from staff who tested
positive for COVID and that we would really value collecting that information.
And most of those staff were keen and saying, Can you take my blood?
Can you do something with it?
So a project was hastily assembled and I was asked if I would come and help deliver on it alongside other people, colleagues.
And so by the middle of April 2020, that's what I was doing.
And then that and ironically, I'm still doing that today.
Really. So what was a temporary measure and a redeployment as the summer of 2020 progressed and we realised
the sheer scale of this pandemic and that obviously by then vaccines were busily being trialled.
We had set up this amazing cohort of we had to think about, oh gosh,
over 150 staff had donated samples to us repeatedly that had tested positive for COVID.
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,
and then they would come and see us at regular time points for us to take blood samples from them.
So you didn't take the samples until after they'd recovered? No.
So they would have had a positive swap result done through the staff testing programme,
which is an incredibly efficient service and and really, really well managed.
And they as part of their feedback of the results,
we had a process where they also told them about this research and said if you're interested, you contact this email address.
So we had these people volunteer and then the idea being we ran clinics five days
a week in the mornings and these were people who worked in a hospital somewhere,
Churchill or the John Ratcliffe.
And we ran clinics on both sites so that they could pretty much nip out from their shift whatever it was they were doing
and come for a 15 minute appointment with us where we would just update the data and collect a blood sample from them.
And we realised that actually building up this bank of samples and data was a really precious commodity.
We were able to use those samples as control samples in the Oxford vaccine study.
So where they were busy trialling their vaccines, they helped,
they were able to take from us equivalent timepoint samples from people who'd had natural infection as opposed to vaccination protection.
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.
So you could look at the antibodies and see how they played, differed between them and, and,
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.
But we work closely with colleagues who do work very much on the antibody response and.
And other areas of our immune responses.
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.
And we now have this large project known locally in Oxford as Optic, but we are part of a national consortium called Pitch,
which stands for Protective Immunity T cells in healthcare workers from COVID.
And the idea is we are alongside collaborators around the country.
Everybody is is working towards the same scientific aims and goals.
And there is still funding a little bit going into that.
So it continues.
And with colleagues around the country, we're still addressing the questions of our immune responses to both vaccinations and different variants.
And again, we remain useful controls because there's lots of research looking at drug therapies
for the immunosuppressed or immunocompromised groups who are most vulnerable,
obviously, and are often least protected from our vaccines.
And so we can provide control samples for that.
And so we are also recognising that this, you know, impacts on other respiratory viruses, the influenzas, and that are also problematic.
And the fact that we can really broaden out our research so that we can look at other things as well alongside COVID.
COVID is here to stay and we need to make sure we keep abreast and ahead of it if we can.
And although it's lost its way, it's not really what anyone wants to talk about anymore.
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.
So I think what was established as a group of a work package that was established in
2020 and the value of that continues even though it's slightly changed its direction.
And so when funding became available for paste in it,
I decided to apply and and then make the transition from my former team into staying in this role.
And that's right. Mm hmm.
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.
So we we did support and some of our participants were inpatients only a handful,
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,
sort of two or three other research studies. And it felt probably unnecessary to add another one into the mix.
And when there was so much excellent research going on with patients.
So we very much focussed on providing because there was so much research looking at those hospitalised with COVID,
whereas we were able to provide the answers about people's immune response to COVID
when they were not hospitalised and they managed it mildly in a sense at home.
And actually that is the majority of the population.
Yeah, and of course the rest of the population was in lockdown and we couldn't do any research on them.
So the health care workers coming in to work with this incredibly valuable resource to
understand what's a healthy immune response to COVID might look like and to provide that data.
So it was so very much we sort of although there was some patient involvement at the beginning,
we quickly shifted our focus to be purely healthy volunteers, or in this case,
co-workers in a health care environment who were willing to participate.
And thankfully, I think in our case and all of our recruits were, although at times poorly with COVID or made good recoveries.
So what's it been, as you say, the study still ongoing, but there have been some publications.
What what have been the main conclusions? Well,
we've had there was a very interesting study in the early days which caught the headlines
because we looked at the differences between the vaccines and we looked at the durations.
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,
we were going to get 12 weeks in.
This came out of the news very quickly and all of the trials had obviously looked at three week intervals in these vaccines.
But here we were in the real world being told, no, you're going to have to wait.
And but because of the way that that was decided in the timing of that decision,
there was a we started vaccinating healthcare workers in early to mid December of 2020.
The decision came late December, so there was already a several weeks worth of staff who'd been vaccinated,
who the trust decided locally in order to manage it,
that they would honour people up to the end of December who'd already had a first vaccine,
would still only get the three week interval, and then anybody vaccinated from that point on would would have to wait 12 weeks.
So we ended up with these two wonderfully comparable groups to be able to
compare then long term what the difference was between their immune responses.
And it was, you know, in theory, we were providing the research that supported the government's decision.
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,
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.
And although the antibody responses with the short duration peaked higher, the sustainability of them was better with the longer duration.
So so we were able to answer that question that had obviously had to be made for
practical reasons and with strong scientific reason to believe it would be effective.
And we were able to quickly get that evidence together and and monitor those participant,
those people over those sort of next six months and see what happened on that paper was able to support that decision.
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,
which is a little cotton swab that sits inside your nose for a minute and you
just press and hold on your nostril while it just absorbs what's in your nose,
because there's obviously big questions about nasal and mucosal immunity and how much people's people might be protected from underlying immunity,
might be from other coronaviruses that they've previously had, or it could be having had COVID infection.
This then gives them an extra level of immunity to protect them from further reinfection.
So we also collecting those samples and although we haven't had a huge ongoing work on that at moment,
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.
Nasal vaccines are very common now in flu viruses, particularly of with children.
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,
because health care workers get boosted or offered a booster vaccine regardless of their age.
And again, we've been able to look at the difference that makes on people's immune responses.
So being able to gather that evidence in and have large numbers of people who have received a
third and a fourth booster has been really useful in comparing that to people who haven't.
And and as I say, health care workers are a natural group of people who can do that.
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,
whether it be to do with the vaccine and whether it be to do with the variants of concern.
There's lots of work going on here in Oxford and Gavin's speech and Zapp have worked on this a
long time through this and are very keen to borrow samples from us or have samples from us.
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
very hard for us to know what variant of COVID people had because that's something you detect through processing their PCR swab.
So our cohort will have at home little PCR kit that they have ready should they test positive
on the left to then do on this themselves and pace back and for us to get the sequence of the
virus off it so that we can match their samples with a virus sequence at some point down the
road and just keeping up that information so that we've we've got access to current samples is,
is really quite important now in the. So they are going on a national level.
So yeah, that's sort of what we're doing. So how much longer do you think the study will be funded for?
Well, we've got we've just been given some funding to keep it ticking along for another just shy of two years.
That doesn't fund everything. Funds elements of the what ifs and buts.
This there's plenty of grant writing going on to get the rest of the money to try and fill the gaps.
And and I think probably it will now probably become something that extends to be more respiratory viruses than just COVID.
And I think it will broaden slightly to allow it to be other pathogens that health care workers are exposed to,
particularly those that we get, you know, vaccinated against.
But yes, we might want to do studies looking at RSV, which has been particularly problematic this year.
And and but also the other respiratory sensitive virus.
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,
but just really recognising what a valuable cohort of these amazing volunteers who are all busy
medics and nurses and administrators and porters and they're all busily doing their jobs and,
and through their volunteering, we've been able to get really valuable and quite rich data from them and sampling from them.
That's really useful in on understanding and answering important scientific questions.
And does that include looking at how much people vary in their genetic susceptibility or their the degree of their immune response?
Yes, I mean, it does. I think it's more about what matters because we know these huge viruses happen.
So so then it's about matching up with the clinical story.
So a lot of what we're doing at the moment now is focusing on people who think they've never had COVID.
We obviously all believed that vaccination would mean, you know, great protection and not many people would get COVID.
And of course, the inverse of that is true. Most of us get COVID despite vaccination.
We don't. Thankfully, most of us get poorly enough to require hospitalisation.
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.
And you know, whether they're testing or not, they might not have been symptomatic.
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
them in for sampling and then sort of we will follow them up to see what happens,
whether they do in fact, still get COVID. Some, of course, already have, because there's high levels of COVID now.
So we're very much focusing as well on them.
And the question is, though, does it does does it matter if they've had COVID and not known about it?
How much? Because that's an important question to answer.
How much transmission is unknown, How much is out there without people having any idea that they've they've even had it.
So if we can sort of get a better sense of that or be part of answering that question,
that also helps in sort of this very much a sense of future preparedness,
future pandemic preparedness and recognising we've got so much we can learn from the COVID pandemic.
So many great collaborations and institution sort of developments have occurred because of it.
And having put these really excellent working practices into place,
it's important we take that knowledge and we use it to our benefit in the future because there
will be future viruses that are going to cause concern and some may be on the scale of COVID 19,
others may be more sort of remote, probably from the UK, but therefore a geographical region of the world.
But the knowledge gained here can be just as useful.
And and I think we all recognise that just because the problem may be occurring
on the other side of the world doesn't mean it can't become a problem for us.
So there's a really amazing sense, I think, that of learning how to work together, how to work remotely together, how to collaborate.
And so many things changed during COVID on that level that were just really quite liberating.
And I think people are keen to try and keep that behaviour and practice where possible to enable it.
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
again and and and be able to really be proud of that work that so many in Oxford and other cities achieved.
Should it come again? You obviously love being involved in research.
I just wondered if there are any issues that sometimes arise in working with academic researchers who don't have the clinical experience.
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,
recognise the importance of the role of the research team.
But I wonder if perhaps some of the more junior researchers have to be educated also about what's involved in.
Well, I think maybe I've been rather fortunate because I think once.
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.
I've never encountered that.
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,
but they've all been very respectful, actually, towards the role of the research nurse.
And now we might be fortunate. I think Oxford is particularly ahead of the game.
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.
So I don't think actually the the academic population are particularly unaware of what we do.
I certainly but then equally I recognise we I'm really talking about senior clinical researchers who I'm directly working with.
So, you know, certainly the clinicians have been fabulous and, and I think we've been really fortunate to have such a.
Just a real team spirit. There is not a lot of hierarchy in that environment.
Everybody recognises the strengths of each other's roles and the need for each other's roles.
And and I've been very fortunate to work in teams where that's been very paramount.
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.
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?
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.
And I've been talking to a nurse in the team.
He was very nervous and very anxious and very scared that day.
And and in a conversation with one of my seniors later that day,
I was sort of recounting the conversation and she looked at me and she said, Are you scared?
And I said, No, I'm not. I said, I don't know why.
I don't think I'm invincible. But I did feel scared.
And and I and I just said, I don't know why.
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.
And I had no reason to believe that because clearly many amazing health care workers
who were infected and subsequently got very sick and some of them very sadly died.
So it wasn't through anything I had any knowledge of.
It was purely just a feeling in my gut that I thought I was going to be okay with that.
I therefore, I wasn't overly worried.
Of course I was worried about people I cared for, you know, elderly parents and vulnerable parents and and recognising their vulnerability.
And that was definitely a concern. But for myself directly.
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,
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
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.
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.
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?
And because I think at that point we that the policy was with known private participants or patients in the hospital,
you obviously will PPE, but not with each other in the common areas and staff rooms and stuff.
And I said, and she thought you were rich and she'd just a week ago tested positive.
Now, in hindsight, of course, we now think, yes,
you probably Western Infectious and the knowledge we have acquired means that I now realise that I was putting myself at risk.
But at that point we didn't have the knowledge, we didn't understand the duration really of viral transmission,
and we didn't realise how long people were going to test positive for.
So yeah, those first few weeks probably I did encounter some risk on knowing that I was and,
and I was obviously fortunate, but, but now I didn't ever particularly feel at risk.
And I think, you know,
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,
obviously, and and being a bit more careful about all sort of PPE questions.
And so I didn't feel the need to have you know, I didn't feel particularly vulnerable.
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
husband and trying to juggle in a we were in a much smaller house before we were here with no garden.
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,
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.
And I think all of us were just very grateful for the long,
sunny days that bathed that sort of early lockdown period and what you were able to work fairly normal hours.
Just like the you talked about, where you had to keep everything.
Exactly. So we did. We did. For a while, I was doing shifts, long days.
I didn't have to do any nights.
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.
So there was definitely a lot more responsibility on, you know, sort of my husband to provide all things domestic.
And he was amazing. You know, he stepped up to the challenge fabulously, but was also still,
despite being furloughed from his role, there was still activity that needed to happen.
And it was just a lot of responsibility. So that was yeah, that was a bit tricky.
But we we got through that and and I think everybody quickly found little things to be sort of grateful
for or thankful for as that summer unfolded and the promise of vaccines that's on the horizon.
And and we all hoped that it would get better.
And of course 2021 was a tough year and actually it wasn't much better.
In fact, for many it was probably worse.
And thankfully, I think the thing that was different for us by then was we had moved because in the middle of yes,
in the summer of 2020, we moved house to a bigger house.
So by the time the second lockdown occurred in 2021, and not only were we better catered for space wise,
but the schools had developed much more robust home learning setups.
So we were much more catered for in providing sort of structure.
And it also meant that on the days when our children went in as key worker days,
they were actually being taught something of what was in the proposed framework.
So, so it felt like they weren't having quite such a loss of education in that second lockdown that, well,
there was more educational provision for them and support for us as parents trying to educate them.
And my I by that point I'd shifted to this role full time anyway.
So I was this was my my new world was catered and and and that's where it has sort of stayed.
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,
which is important, help to support your wellbeing through those difficult times?
Oh, it's unbelievable the difference it makes, because I remember cycling home and literally cycling down streets of people bashing saucepans like,
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.
Like I was just a cyclist passing by, but I knew why they were doing it.
And, and it was just the most incredible feeling to think these people are really grateful.
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.
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.
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.
It sort of gave me the distinct impression at the age of 17 that nurses weren't valued and nursing certainly wasn't valued.
So I think you don't realise you carry that now once you work in hospital and once you start working in the NHS,
you realise that as a group of professionals, each of you values each other very highly.
So you get great support from peers and a lot of respect from peers, and you knew what each other were doing.
And you know what an amazing provision is happening in now.
And obviously patients who encounter that, hopefully they taste and experience that they're able to understand it.
But there is just this constant sense of the general public doesn't appreciate or understand quite how hard everybody
in that place is working as a team with different skill sets to deliver the best care possible for those people.
And so being able to suddenly have a sense of now the world is appreciating the
value of this and how important this is was definitely a huge morale boost.
And of course, that's what's so hard.
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.
And and if you allow yourself to read, you know, kind of comments, particularly in social media,
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.
It's it's cruel but basically generally nurse.
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
working through the pandemic changed your attitude or your approach to your work or how you think about your career?
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.
And that opportunity only arose because of the pandemic, I think.
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.
We didn't suffer personal loss as a family.
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,
tiny way, the work we were doing was supporting other really important research groups,
particularly the Oxford Vaccine Group,
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.
And that in a tiny, tiny, tiny way, I was part of that. That's amazing.
You know, that's that's a real accolade and and something I'm deeply proud of.
So. So I think it kind of has helped me.
I think I am. Yeah. I'm keen to stay in the working world.
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.
People are less interested, but there might be another one.
And if that's in my working lifetime,
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.
So. So yes, I suppose, whereas I probably wouldn't have even thought about it, you know, three years ago.
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
roll in the house because the world went out and bought all the toilet Well,
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,
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.
And it's highlighted what Oxford has to offer space academically and in its health
care workforce here and the amazing collaborations that exist between these groups.
Um, and I just feel very privileged to have been able to be part of it, really.
Thank you very much.