Medicine and wellbeing
Time to do things differently
I’m a creature of habit, but on 11 March 11 2020 everything changed.
I had just returned from a collaborator meeting in Sao Paulo, and I was in London giving a talk about the role of integrins in Covid-19 and discussing the management of Idiopathic Pulmonary Fibrosis.
Social distancing was an abstract thought, although the London underground was uncharacteristically quiet. Lockdown was predicted at some point in the future although handwashing was on everybody’s minds. Meetings meant to be focused on pulmonary fibrosis instead discussed the surge of Covid-19 observed in Italy and was being anticipated in London.
I had spent two weeks speaking to senior physicians from across the world and the one thing we all had in common was we really didn’t know what to expect but we would have to learn quick and do things differently.
At least I felt somewhat prepared.
I had been following the development of the pandemic from early January when descriptions of a Severe Acute Respiratory Syndrome had been described in Wuhan. I had been surprised by the severity of the lung injury given the relative lack of SARS-CoV-2 receptors in the regions of the lung affected in severe forms of the disease.
I had developed a hypothesis based around integrins, proteins that are recognised viral receptors, which are found at high levels in the lung. I had put in a grant application [in February] to form a team capable of exploring this hypothesis, and quickly.
This is all fairly standard in the academic world, formulate an idea, develop a team, submit a grant and wait for a funding decision. However, when I submitted the grant in the middle of February, I didn’t think the surge would be at the end March. Given the timescales involved, it was clear my research strategy going forward would need to be different.
"Whilst academic scientists are by their nature competitive it was clear that we would have to behave differently to come up with answers to mitigate the pandemic, and collaboration would be key. "
A week later the UK was in lockdown and all travel was cancelled. My diary, which for March and April had been rammed, was now suddenly open. This was fortunate because my hospital needed me back on the front-line seeing patients on the newly adapted Covid wards. The University closed its labs with exceptions made for Covid-19 research regarded as essential. Fortunately, I had secured funding for my hypothesis and my lab remained open, staffed by lab members who volunteered to be part of the ‘war effort’.
Another, more optimistic, feature relating to Covid-19 was emerging; people want to do something to help, and collectivism seemed to be trumping individualism. Whilst academic scientists are by their nature competitive it was clear that we would have to behave differently to come up with answers to mitigate the pandemic, and collaboration would be key.
We approached this by developing a website (www.nottinghamcrg.info) where we post our work as we generate results, and then use social media, especially Twitter, to promote the content as we deposited it on the website. The idea was to update the community in real-time rather than to wait for the complete work-packages to be published in peer review journals as this would lead to considerable delay in the dissemination of new information.
I approached this with trepidation as this kind of real-time data release can sometimes lead to over interpretation and error and there is also the possibility that somebody might ‘steal’ your hypothesis. However, we state that the data are not peer reviewed (in the conventional sense) and the response has been very rewarding. It has facilitated unofficial peer review with scientists asking questions on Twitter and via e-mail which has led to new lines of enquiry, improved experiments and new collaborations.
The peak is now receding, and the landscape has very definitely changed. It is clear that clinical practice is going to be done differently for some time to come. I understand new words like fomite and furlough, and I understand that goggles, face masks and a two-metre distance might just save my life, and that of many of my colleagues. The infection control policies will need to change and things that were routine will now become exceptional, such as routine lung function clinic visits, and things that were exceptional will become routine such as teleconsultations and FFP3 face masks. As a creature of habit, I will need to adapt.
However, I hope that we will all learn from what has happened and move forward with some of the silver linings from this crisis. More people are cycling, remote monitoring and teleconsultations might improve care for hard-to-reach communities, videoconferencing might reduce our carbon footprint, and the collegiate and collaborative approaches adopted by the scientific community might lead to real and rapid advances in the fight against Covid-19.
Gisli Jenkins is a National Institute for Health Research Professor and Professor of Experimental Medicine in the School of Medicine.