Leading cardiovascular researcher, physician and pharmacologist awarded CBE

Professor David Webb is Christison Professor of Therapeutics and Clinical Pharmacology. He is based in the Centre for Cardiovascular Science at the University of Edinburgh and is also Lead for Hypertension and Renal Theme (HART) at QMRI and for the Lothian ESC Hypertension Excellence Centre.

Professor Webb works in the field of hypertension and kidney disease. His research on blood pressure, arterial stiffness and endothelial function has contributed to the development of renin inhibitors, phosphodiesterase inhibitors and endothelin antagonists as new medicines for the treatment of heart disease.

On October 10 2020, Professor Webb was awarded Commander of the British Empire (CBE) in the Queen’s Birthday Honours, for services to Clinical Pharmacology Research and Education. We spoke to Professor Webb about receiving the award and his career to date.

“I was personally delighted to be awarded a CBE in the 2020 Queen’s Birthday Honours and also that my award recognised my ‘services to Clinical Pharmacology Research and Education’, which is where I have centred my medical career, and which I think remains one of the most rewarding medical disciplines” says Professor Webb.

 

Establishing new centres and new medicines

In his 30 years based in Edinburgh, Professor Webb has made a huge impact, not only in the fields of cardiovascular medicine and clinical pharmacology, but also wider clinical research.

“I have had the pleasure of living in a wonderful city and collaborating with a a fantastic set of trainees, colleagues and collaborators in cardiovascular medicine and clinical pharmacology.

I have had the chance to establish the University’s first Clinical Research Centre, the University’s Centre for Cardiovascular Science (and acting as its first director), the Queen’s Medical Research Institute on the Little France site (a team effort) and develop several cardiovascular medicines that are now in common use,” he says.

 

A team effort

Discussing his recent royal recognition, Professor Webb is extremely keen to acknowledge the contributions of colleagues to the success of the work he has led and collaborated on.

“I have had the pleasure of seeing some of my trainees become research leaders in their disciplines within the University. These include Dr Bean Dhaun, Professor James Dear, Professor Michael Eddleston and Professor David Newby” says Professor Webb.

“I have also worked with Professor Simon Maxwell and others to establish a Hypertension Excellence Centre in Edinburgh and also, with Simon as clinical pharmacology lead, to create the Prescribing Safety Assessment, an examination now taken by all 8000+ UK medical students before graduation, and which they must pass for career progression,” he explains.

The establishment of the PSA with Professor Maxwell was accompanied by both professors lobbying the General Medical Council and persuading them to increase the undergraduate medical focus on prescribing skills and in doing so, improving patient safety.

“Beyond Edinburgh, I have been involved in regulating medicines through work as a non-executive director (and Deputy Chair) of the MHRA (the UK regulator for drugs and devices) and as Chair of the Scottish Medicines Consortium. I have also held the Presidency of the British Pharmacological Society and will be President of the World Congress of Pharmacology in 2022.”

Wishing many congratulations to Professor Webb on his recognition in the 2020 Queen’s Birthday Honours.

Find out more about Prof Webb’s research in CVS

Pandemic insights: Animal care under lockdown

Many of us have been working differently since the lockdown began earlier this year. In this post, we are highlighting staff from Bioresearch and Veterinary Services, who have been helping to keep our research running and ensuring the health and welfare of our research animals during the pandemic.

Animal technician cleans a mouse cage

The Bioresearch & Veterinary Services (BVS) team is responsible for the housing, care and management of animals used in biomedical research at the University. 

The team provides veterinary and technical support for scientific staff to ensure high quality research and optimal animal welfare. 

During lockdown, the team were given ‘essential worker’ status to allow them to continue caring for the animals and for essential research to continue.  We spoke to members of the BVS team to find out how the pandemic affected their usual ways of working.

One of the BVS vets, Nacho, explained the immediate impact on their work: “The main challenge was not to be present in the animal units for a while. We had to cease all training and assessment of trainees and most of the experimental work stopped. Our technical staff continued to do the husbandry and look after the colonies, so we were reassured that the welfare of the animals was never compromised. Whenever there was a concern about specific animals, which was very rare, the techs were able to show us through webcams installed in all units and we would discuss the best course of action with them. Once we were able to resume some experimental work, the vets played an important role in the discussion around what studies should be prioritised and what controls should be in place to ensure that, as always, the welfare of the animals was a priority.”

As with many areas of the University, some staff were required to shield during the lockdown period while others faced childcare challenges. Researchers were not permitted into the units, so the technical team were required to step up and carry out additional duties to ensure the continuity of ongoing research.

Animal technician with a mouse on flat palmKyle, one of the technical assistants in the team, said: “Working through Covid-19 has definitely had its worries. Thankfully at my place of work, the team I work with have all pulled together and tackled the stresses, strains and worries head on. Although work had quietened down, there was still animal care and facility cleanliness to deal with. We were also working on short 4 hour shifts, with fewer staff members due to shielding and the merging of two facilities. It has been strange with fewer procedures taking place, not seeing the researchers and work load at a minimum but we got there. My co-workers pulled together and were there for each other, which made the working environment less stressful.  Steps were also taken to ensure the chances of transmission were minimum and the staff felt safe.” 

Roy, who also works in one of the facilities, added: “Mostly this has been a challenging but positive experience. Although at times a bit of a slog, the techs, cage washers and managers have all pitched in and we helped each other without complaint. The availability of staff from other facilities and research groups has been invaluable and all of them have also been willing to pass on knowledge.”

The team’s efforts have not gone unnoticed by our research community.

Dr Elisa Villalobos, a postdoctoral researcher in the Centre for Cardiovascular Sciences, recently highlighted the team’s work with a ‘Good Citizen’ nomination for the CVS newsletter. She said: “As researchers, most of our work relies on the use of animal models. During the lockdown this work was severely restricted, in some cases BVS staff were relied upon entirely to look after animals and carry out experiments for us. From a personal standpoint they have been excellent in not only looking after the wellbeing of my animals but also, they are always very kind and happy to help us to get the work done through colony maintenance, feeding mice with special diets, or carrying out specific procedures. All things that during regular, everyday, non-COVID times I and countless others do by ourselves. I am very grateful to the BVS team for helping to keep our science moving forward.”

You can find out more about animal research at the University, including how it is regulated, on our website here.

Our Pandemic Insights series aims to highlight the experiences of staff during the Covid-19 pandemic. If you would like to highlight a specific team to thank them for their efforts during the pandemic, please message CMVM.communications@ed.ac.uk.

Science Insights: the pupils’ perspective

Sixty fifth year pupils from schools all over Scotland spent a week online in July on the Science Insights Online work experience programme. Students usually join us on campus but life is a little different this year. Gracie Taylor from Firrhill High School and Evie Tynan who attends James Gillespies High School tell us how they got on with the first foray into work experience delivered online.

 

Gracie Taylor 

Pupil Gracie Taylor taking part in a Zoom sessionI first came across the Science Insights programme around a year ago when I was frantically searching for biomedical work experience. I applied in February when the week was still set to happen in person, on campus at various research institutes across the university. Then, obviously due to the pandemic, the programme was moved online. Even though I knew that I wouldn’t get the hands-on lab experience I had hoped for, I was still super-excited to get stuck in.

I thoroughly enjoyed the whole week but for me the highlights were the MS clinical trials ethics workshop and the Meet the Scientists sessions that we took part in at the end of every day. As someone who is hoping to be involved in medical research, understanding some of the ethical dilemmas around clinical trials was very interesting and a side of my future career that I hadn’t ever thought about before. The sessions were nerve-wracking at first but as we went through the week, I became more confident in asking questions. It’s not very often that you have the opportunity to interact with that many scientists who are all incredibly passionate about their work so I fully embraced this opportunity. I knew that science was broad and multi-disciplinary but I had no idea of just how much potential and flexibility there was. It has made me excited more than anything just to get stuck into my scientific career.

Another highlight of my week was Dr Katie Baines’ talk about her research into equality, diversity and inclusion in STEM. I’m a young leader at my local Brownies, so empowering young girls and women so that they feel capable in STEM careers is really important to me. Katie really inspired me because she came from a scientific research background but then used her experience to drive more of a social change, something that I had no idea you could do with a science degree. Our generation more than ever is likely to completely change career paths multiple times – this is something that used to scare me but now I’ve realised how exciting this is. I honestly couldn’t tell you where I’ll end up but Science Insights has shown me that there’s a world of opportunity that is waiting for me.

I feel like not only have I gained so much insight through the programme, I’ve also grown in confidence. I’ve found that meeting like-minded people has really helped me as I now know people who are passionate about similar things and we can bounce ideas off each other. My one piece of advice to any prospective Science Insights applicants is just apply! I got so much out of the week and I know that anyone who gets a place, even if it’s online next year, won’t be disappointed.

 

Evie Tynan

Pupil Evie Tynan taking part in a Zoom sessionI was introduced to the Science Insights online programme when my biology teacher showed it to me at the start of lockdown. I knew after a little research that it would be beneficial to a keen biology student like myself who was still unsure of what to study at university so I sent in my application. I was super-excited upon receiving my acceptance email, especially having spent lockdown doing lots of uni-related research. I knew this was going to be a great opportunity for me.

I had doubts knowing that it was going to be online and thought it was a shame that we wouldn’t get the practical or social aspect as other years did, but after the first day I was pleasantly surprised. After the initial introductory session where we met the organisers and our sub-groups, we took part in a webinar about where biology can take you and why science is for everyone. I loved hearing from Generation Scotland about their work and the TeenCovidLife survey where they shared the results and how they compared with adults. It showed that lockdown impacted teenagers just as much despite being excluded from many studies outwith this one.

During the week, I enjoyed speaking to different scientists about their various research projects and learning all about life as a scientist through talks and as part of ‘meet the scientist’ sessions at the end of the day.  We heard from scientists working in developmental biology, cancer research, science communication, bioethics and much more and spoke about their careers and current work. I had no idea that a career in scientific research had so many travelling opportunities. It makes me very excited about my future.

We also listened to a few talks about animal research, its importance and the ethics involved, which sparked some very interesting questions and discussions over how you measure an animal’s sentience and why one animal is preferred for research over another. I loved hearing from Cameron Wyatt about the use of zebrafish as a model organism and the process of keeping and looking after these as well as the benefits of using them over other animals.

We also took part in other ethics discussions about multiple sclerosis and the stakeholders in a clinical trial. In small groups, we talked about informed consent and the risks involved at the different stages of a trial. It was very thought provoking but difficult to put yourself in the shoes of a patient.

On one day we managed to get hands-on from home with some practice suturing using string and plastic bands. I think I speak on behalf of all participants when I say it was very difficult! I managed to complete mine after a little trial and error.

On the final day, we took part in a webinar about the current pandemic that spoke in depth about the science behind this virus and its relatives as well as simple epidemic modeling and the use of phylogenetic trees to track how the virus has spread. I loved being able to see how my knowledge from school applied to this area and others. We also heard from Martin Reijns about testing for the virus and how they get from sample collection to results. Hearing about the pandemic from experts in the field was incredible, especially how the technologies have developed in the few months since the pandemic began. It was also brilliant hearing their professional opinions on future predictions of the virus, potential for second waves and overall how we have handled it. I felt much better hearing it directly from scientists rather than rumours circulating the media.

I loved my week with Science insights and it really highlighted to me the diversity of options both in degrees and further down the line. Having previously been concerned I wouldn’t get the same opportunities to meet new people online, the platforms we used allowed us to connect with other participants and I’ve come out with many new friends, some of which I’ve already gotten the chance to meet and I hope to be able to meet the rest in the near future. I was heavily encouraged throughout the week to keep asking questions and I’m glad I did. I learnt so much because of it and I would ask more if I could do it again. I’m so inspired by all of the scientists I was lucky enough to meet and the week has sparked many new interests I previously knew little about.

Overall, Science Insights Online was completely worth it and I’d urge any S5 pupils considering a science career to apply in coming years. The discussions that arose from all the talks I took part in were truly eye-opening and showed me a whole new side to science. I learned so much, not just about different scientific areas but also navigating a science career, which you don’t often get at school. It was a truly amazing experience and I’m very grateful that I had the opportunity to take part.


Spotlight on the Global Health Governance Programme

The Global Health Governance Programme researches how global institutions, finance and rules can better serve the needs of people across the world. The programme is based in the Usher Institute within Edinburgh Medical School.

Professor Devi Sridhar, Personal Chair in Global Public Health is the founding director of the programme and she is joined by staff and student researchers from across Edinburgh Medical School.

Members of the GHGP team have been conducting and sharing much research during the last several months of the Covid-19 pandemic. We caught up with a few of them to find out about their most recent work.

Genevie Fernandes – PhD student researcher

PhD student, Genevie Fernandes
Genevie Fernandes

Genevie Fernandes is a public health researcher interested in policy and practice for advancing maternal and child health (MCH) especially in developing countries.

In her most recent article Genevie calls for the strengthening of health care systems as countries’ first line of defence against Covid-19.

She highlights how the global pandemic has highlighted several already well known and deeply persisting inequalities including:

  • The disproportionately higher risk of Covid-19 complications for those with comorbities and who are socioeconomically disadvantaged.
  • The higher risk of domestic violence for women during quarantines and lockdowns.
  • The inequality between the healthcare systems of rich and poor countries.

Genevie also mentions that whilst the next pandemic might strike at any time, so might other events such as extreme weather, natural disasters and recurring economic crises.

“During all of these natural and human-caused crises, it is a country’s health system that is the first line of defence, and if the system is not resilient, it will be overwhelmed and collapse, exacerbating the health impact and adding to inequality” Genevie states.

Read the full article in the International Monetary Fund

Follow Genevie on Twitter

Joey Brooke – medical student researcher

Medical student, Joey Brooke
Joey Brooke

Joey became involved with the GHGP after attending the inaugural lecture of Prof Devi Sridhar, Director of the programme.

“The areas they worked on and the themes they delved into really resonated with me, and I wanted to help in any way I could” explains Joey.

Since the start of lockdown, Joey has been assisting the programme on an array of COVID-19 related research.

“Initially I looked into what the North American response to COVID-19 had been so far, covering Canada, Mexico and the US. I was then asked to compile a short brief of country exit strategies, and to update it as more countries announced plans to scale down lockdown. Google Translate was probably my ‘most visited’ page during this period! I then spent some time researching countries who had ‘successfully’ eliminated COVID-19, like the Faroe Islands, Iceland, New Zealand and Fiji. Since then I have investigated the effect of populist leaders on the COVID-19 response in Brazil, tracked the evolution of PCR testing, and looked into our current knowledge surrounding immunity and coronaviruses.

As I start to go back to clinical work and medical studies, doing this research alongside my studies helps me remember the bigger picture, and the interconnected nature we now practice medicine within.”

Follow Joey on Twitter @JoeyBrooke

Lois King – PhD student researcher

PhD student, Lois King
Lois King

Lois King is a PhD student with the Global Health Research Unit on Respiratory Health in Asia (RESPIRE) at the University of Edinburgh.

Lois King is a member of the Data Evaluation and Learning for Viral Epidemics (DELVE) group, the Royal Society’s research action team collecting emerging data to produce rapid reviews to aid national response to the COVID-19 pandemic.

She contributed to a recently-published DELVE report on mask use for the general public, which was provided to the UK government’s Scientific Advisory Group for Emergencies in April 2020.

Lois has co-wrote articles with Prof Devi Sridhar about the importance of wearing a mask to slow community transmission of the virus (published in The Scotsman) and about Trump wanting to withdraw the US and its funding from the WHO (published in the BMJ). She is currently working on a DELVE report on the effect of COVID-19 in Black and Minority Ethnic (BAME) populations in the UK.

“It’s been amazing to be a part of all this research in real-time as the situation develops and we gain a better understanding of how COVID-19 is being managed and how to minimise its impact on our health. I find global health governance and policy fascinating as people who make decisions can have the greatest impact on public health, so producing research to inform policymakers has been very rewarding for me.”

Read the BMJ editiorial piece on Trump and the WHO
Visit the DELVE reports page
Follow Lois on Twitter

Visit the Global Health Governance Programme website


But they said we wouldn’t find it here: Racism, discrimination and Covid-19

Dr Gwenetta Curry
Dr Gwenetta Curry

I have only been in the UK for a little over a year, and one thing that has become abundantly clear is that there needs to be an increased focus and understanding of the impact of racism on the conditions of Black, Asian, and Minority ethnic groups.

Most people are very comfortable addressing issues concerning the disadvantages created through poverty and what that means for upward mobility. But what about the minorities who have checked all of the boxes for educational attainment and employment? Previous studies have shown that after controlling for socioeconomic status, ethnic minorities suffer from more comorbidities than their white counterparts.

In the United States, the research is well established around the impact of racism on health outcomes, with various states naming racism as a Public Health concern. The experience of racism and discrimination is more than a simple annoyance or an inconvenience.

Racism and health outcomes

Experiencing racism, whether overt or covert, has significant implications on health outcomes for ethnic minorities. As research by David Williams has shown through his Everyday Discrimination scale, the experience of discrimination can cause an increased risk of hypertension and poor mental health.

Arline Geronimus created the term “weathering” to describe the process for which ethnic minorities experiencing racism and discrimination lead to high-stress levels, which damage organs and cause accelerated ageing. As a result, ethnic minorities suffer from comorbidities at a much younger age than their white counterparts. For example, Type 2 diabetes usually occurs in populations over 40, but in Southeast Asians and African Caribbean populations, this appears after 25 years of age.

Access to healthcare and education

Block of city centre flats
Block of city centre flats

A couple of weeks ago, I presented a paper outlining the relationship between structural racism and poor health. Current structures throughout the UK have relegated ethnic minorities to the more deprived area and created challenges for them to have equal access to quality health care and education. According to the Office of National Statistics, Black African (20%) and Arab (17%) groups had the lowest rate of home-ownership compared to white British (63%) populations. In the US, “redlining” has left Black family’s homes uninsured and limited federal funding in Black neighbourhoods by labelling them as risky areas.

While the UK has not had the history of redlining like the US, there have been reports of discriminatory practices in the UK dating back to over 60 years. According to the Politics and Policy Racial Discrimination report Black, Asian, and Minority ethnic groups were more likely to wait longer for a housing offer, to be offered poor quality homes and flats rather than houses. The report also states that “housing officers were seen to be steering BAME applicants away from white neighbourhoods based on judgements about social class as well as racial grounds.” For many minorities from America, this is a well-known tactic to maintain the property value and predominantly white spaces.

The impact of racism must be addressed in the UK

Previous studies have demonstrated that where we live can be a clear marker for life-expectancy and opportunities. In the UK, ethnic minorities are over-represented in overcrowded or deprived areas, and these conditions are linked to higher COVID-19 incidence and death. As researchers continue to investigate the factors that have contributed to the disproportionate number of deaths among ethnic minorities in the UK, the impact of racism must be addressed. The predominate trend in current research analysing COVID-19 mortality by ethnicity and race, presupposes a cultural deficient and higher risk behaviours of groups rather than exploring the sociologically obvious fact that UK society is structurally and culturally racist.

The insistence that the UK be framed as an egalitarian society where racism does not, can not, and should not, explain health disparities forces Black researchers to dismiss obvious trends in data as anomalies and contrary to fact.

Dr. Gwenetta D. Curry is a Lecturer of Race, Ethnicity, and Health at the University of Edinburgh. Her research interests are Racial & Ethnic Health Disparities, Critical Race Theory, & Black Family Studies. Her present research analyses racial disparities in treatment and infection rates of Covid-19. She coauthored UNCOVERed’s “What is the Evidence on Ethnic Variation on Covid-19 Incidence and Outcomes,” and “Sharpening the global focus on ethnicity and in the time of COVID-19.”

Read Gwenetta’s ResearchGate profile


Tropical livestock are key to help feed the world

Professor Appolinaire Djikeng, Director of the Centre of Tropical Livestock Genetics & Health (CTLGH
Professor Appolinaire Djikeng

My name is Appolinaire Djikeng and I am the Director of the Centre of Tropical Livestock Genetics and Health (CTLGH), based at the Roslin Institute.

I am a livestock genomics scientist and have spent more than 20 years leading multi-disciplinary, multi-institutional and global research and development programmes focusing on agricultural development and human health.

Tackling hunger

As the global population grows, demand for animal protein, including milk and eggs, is increasing. It is estimated that the world will need to produce 70 per cent more food by 2050.

The World Hunger Organisation reported last year that one in nine people in the world does not get enough to eat, not only because of lack of food, but because there are no robust systems allowing people access to food. Some 151 million children are stunted owing to malnutrition, four out of five of whom live in south-east Asia or sub-Saharan Africa.

Ethiopian girl drinking milk (copyright ILRI/Apollo Habtamu)
The requirement for animal protein like meat, milk and eggs is increasing as the global population grows

If livestock in places such as sub-Saharan Africa can sustainably produce more meat, milk and eggs, and have less impact on the environment, it will help improve both the nutrition and income of millions of smallholder farming families who rely on them.

In order to do this, agriculture has to be more efficient. The industry has to be strong enough to meet the needs of a growing global population, and ensure enough food for all.

Sustainable systems

The Covid pandemic has highlighted how fragile the global food system is. Here in the UK, we suffered from empty supermarket shelves as processing in plants and distribution networks were interrupted. However, for millions of people in low- and middle- income countries, who rely on visiting markets daily to buy food, Covid has been devastating. People have been unable to buy food and farmers have been left with food they cannot sell.

So, as well as developing a resilient and sustainable agricultural industry in tropical countries, we must work to strengthen the global agri-food system to be resilient to threats like Covid in the future.

Personal mission

Appolinaire and Bill Gates
CTLGH receives significant funding from the Bill & Melinda Gates Foundation

I have always wanted to try to improve the quality of the lives of people who are exposed to many externalities. For millions of smallholder farmers in tropical countries like Africa and south and south-east Asia, livestock are their only source of income and food. These people have no safety net so are, by definition, quite vulnerable.

It’s a very personal mission for me. I know first-hand the challenges that smallholder farmers in Africa face and the fragility of their livelihoods as my parents were pig and poultry farmers in Cameroon. Growing up, I realised that our livestock not only gave us the security of food, but their sale paid for my siblings and myself to go to school and become educated.

Huge potential

CTLGH Vision 2030 front page
The Vision 2030 document highlights strategic goals of CTLGH for the next 10 years

Although the agricultural industry in Africa is weak, the continent, like many tropical countries, has huge potential for producing more food. Africa has 60 per cent of the world’s uncultivated arable land and the livestock have been selected over generations by farmers to survive disease prone environment, challenging temperatures and marginal food accessibility.
But there is a definite trade-off – tropical livestock are not as productive as those in developed countries. For example, a typical dairy cow in Africa produces one-tenth of the milk of a typical dairy cow in the UK.

Improving genetics, improving productivity

I joined CTLGH in 2017 and lead the Centre in their mission to drive and support research to develop solutions to help improve the productivity, sustainability and resilience of livestock in low- and middle- income countries.

The Centre’s goal is to tailor and apply advanced breeding technologies routinely used in the West to livestock in Africa, South, South East and East Asia, in order to improve the health, welfare and productivity of animals, while retaining their ability to survive in challenging conditions and minimising their impact on the environment.

I joined the Centre because I was keen to work somewhere that has a direct impact on improving human health and agriculture in Africa and other low- and middle- income countries, and I am immensely proud of what CTLGH researchers and their collaborators across the globe have achieved since it was established in 2014.

The Centre is a strategic alliance between the University of Edinburgh through the Roslin Institute, Scotland’s Rural College (SRUC) and the International Livestock Research Institute (ILRI) in Kenya and Ethiopia. Together, the Centre’s researchers have already developed important tools to support genetic improvement in tropical livestock and, through training and research placements, have enhanced the scientific capacity of researchers in sub-Saharan Africa.

I am very excited about the future of the CTLGH. We recently launched our 2030 Vision document, which highlights the Centre’s key strategic objectives and focus for the next 10 years. I look forward to seeing how the Centre can work with others to improve tropical livestock genetics in the future.

Working together

I believe that everyone is equipped to contribute, innovate and to make a difference. By working together, through international collaborations and partnerships, we can tackle the huge challenge of global food security.

Together, we can make a change and improve the lives of millions of people living in hunger and poverty.

Appolinaire Djikeng was recently awarded the International Nelson Mandela Justice Award by the UNESCO Center for Peace in recognition of his work to make a difference in the lives of others.

View the CTLGH 2030 Vision document

Learn more about Appolinaire’s International Mandela Justice Award

Follow CTLGH on Twitter

Find CTLGH on linkedin


COVID-19 test facility built from scratch at IGMM

Dr Martin Reijns is a senior research fellow working in the Medical Research Council Human Genetics Unit. He was part of a team of university and NHS scientists who set up a COVID-19 diagnostics lab from scratch. Martin tells us how they did it.

Dr Martin Reijns in the lab
Dr Martin Reijns in the lab

Dr Martin Reijns is one of the scientists who took on a huge challenge at the start of the COVID-19 pandemic – to transform university labs normally used for scientific research into a COVID-19 testing facility and to develop an accurate test. With NHS Lothian and his colleagues at the Medical Research Council Institute of Genetics and Molecular Medicine, they created capacity for 1,000 COVID-19 tests a day for NHS patients in Scotland.

“It all started with my boss, Professor Andrew Jackson, realising at the start of the pandemic that the countries performing the highest numbers of COVID-19 tests also had the lowest infection and death rates,” says Martin. “We wanted to help increase testing capacity for Scotland. Because a test for presence of a virus is based on techniques we normally use in our molecular biology lab, he felt that we should be able to set up COVID-19 testing fairly quickly and easily. Well, it wasn’t quick or easy, but we did do it; from scratch.”

“Everyone in the world was looking for the reagents to do COVID-19 testing so they were in short supply. At the beginning I was sitting in my living room phoning companies and sales reps and saying ‘we are setting up this facility, we will be doing lots of testing, what can you provide at what cost and how quickly?’”

One of the robots used for testing
Introducing Eve, the robot

Robots

Martin and his colleagues built a COVID-19 diagnostics lab in a space usually busy with genetics researchers. Labs from all over the University of Edinburgh lent them the robots and machines they needed to create capacity for around 1,000 COVID-19 tests a day for NHS patients in Scotland. The team of volunteer scientists that set up the testing lab agreed that robots need names, they settled on characters from the film Wall-E and named them EVE, WALL-E, AUTO, BURN-E and GO-4.

Before commercial tests were available, countries all over the world shared their in-house testing protocols on the World Health Organisation website. This info helped the team build an accurate test that could be used locally, giving NHS staff and patients test results within 24 hours.

“You can do tests where you look for a single target in the virus genome- the genetic information that tells us if a person is infected – but to be more confident, it’s best to try to detect more than one target within the viral genome. So that’s what we did – our test seeks multiple targets in a single reaction. This really helps with speed and cost, and means we can be really confident in the test result,” says Martin.

The robots and machines helped speed the whole testing process up. EVE arrived in the lab first.

Lab tools included tube holders, pipette tips and 96-well PCR plates
Every-day lab equipment played an essential role in testing.

In addition to the robots and machines, there were everyday lab tools at the heart of the COVID-19 test. These simple circles are tube holders, pipette tips and 96-well PCR plates. Scientists use pipettes to move precise volumes of liquid from one tube to another. The tubes and 96-well plates they move them into carry the patient sample from test start to finish. Bar codes keeps track of which patient’s test is where.

Working with samples

Martin describes what happens when the patient samples arrive: “A sample arrives as a swab in a liquid, and then a scientist from our team of volunteers carefully takes some of this liquid and inactivates the virus to make the sample safe to work with. We’ve developed a test ourselves that looks for multiple targets in the coronavirus’ genetic material, reducing the chance of false negative results. Also, we can be more confident that when there is virus in the sample, we actually get a positive test result.”

“The first step of taking it out of the swab tube has to be done by a person. It takes quite some time because it has to be done safely and of course it is crucial that the sample is linked to the correct patient and the clinician who submitted it.”

Once the sample is safe to handle and logged into an IT system, a purification step (using a robot) takes place to isolate genetic material from any virus present. Then it’s run through a procedure called RT-qPCR, which stands for reverse transcriptase quantitative polymerase chain reaction. It means making lots of copies of the genetic code the virus carries in a continuously repeating cycle.

“One big benefit of the RT-qPCR machines is that they show how much virus is present in the sample in real time; the more there is, the quicker you will see it. Another plus side is that once the sample is in the machine it needs no further handling; the machine does everything else. It sends results to a computer programme that then allows a scientist to see if there is virus in the patient sample,” says Martin.

The testing team was staffed by volunteers from the University of Edinburgh –  a call went out at the start of lockdown and more than 1,000 scientists responded immediately.

“There were a lot of people who wanted to help, but it was decided to invite people already familiar with our building, some of whom even had previous experience of handling infectious disease samples. We now have a team of about 25 scientists supported by our local NHS colleagues who’ve been working throughout the pandemic to run COVID-19 tests for the NHS,” says Martin.

“We have capacity to run 1,000 tests a day, but so far the most we’ve needed to do in one day was around 300. In the vast majority of cases, we have results back with hospital staff within 24 hours.”

Researcher at Medical Research Council Unit The Gambia.
Researcher at Medical Research Council Unit The Gambia.

Sharing test protocols

The team developed an accurate test that could show whether there was actually virus in patient samples. This test can be used alongside similar tests that have since become available commercially. They have also shared the test protocol and even reagents with their colleagues at another Medical Research Council funded lab in The Gambia, Africa, and are hoping to share the methodology more widely by publishing it.

Martin says: “The first thing we did was send our colleagues in The Gambia enough reagents for 5,000 COVID-19 tests, as they were struggling to get hold of the reagents they needed. As demand is still increasing for them, they asked if we can provide kit for another 20,000 tests. We can help them without having any impact on our own testing capability so I’m trying to organise that now. About 2.5 million people live in The Gambia, so it’s about half the size of Scotland. With our help they can further expand their COVID-19 testing capabilities, by creating capacity at the MRC Unit The Gambia. It’s quite gratifying to know that the test we are sharing with them is going to help people in a whole other country.”

“Although it was hard under the circumstances, developing this test was absolutely the right thing to do, so I’d do it again. I’m happy that I was able to contribute.”

>Visit the website of MRC Human Genetics Unit

> Visit the website of the MRC Unit The Gambia



Raj Bhopal on COVID-19

Professor Raj Bhopal on why ethnic and racial minority groups are seemingly being disproportionately affected by COVID-19.

 

Professor Raj BhopalMy name is Raj Bhopal and I am Emeritus Professor of Public Health at the Usher Institute. I officially retired in 2018, having held the John Usher Chair of Public Health for 19 years.

I have devoted much of my academic career to studying public health epidemiology with special reference to ethnic and racial variations in health and healthcare outcomes. I have, for example, been studying for 35 years the approximately 1.5 and three-fold increased incidence of heart disease and diabetes, respectively, among Asians.

Now the Covid-19 pandemic has brought me out of retirement and I have been working with colleagues including Dr Gwenetta Curry to review why ethnic and racial minority groups are seemingly being disproportionately affected by this virus. Our work is focussed on UK South Asian and Black (African origin) and African-American populations.

 

Inequalities

The pandemic has sharpened the focus on structural and societal inequalities that have long existed in the UK, the USA, and other countries. In our view, the ethnic variations we’re seeing in hospitalisations and death is largely due to socioeconomic and environmental factors, rather than biological explanations.

For example, many people from minority ethnic groups, especially those who are also recent migrants, hold essential jobs in health and social care, retail, public transport, and other sectors, putting them on the front line and at risk of exposure to the SARS-CoV-2 virus.

Ethnic and migrant minority groups are more likely to live in overcrowded urban housing centres, the conditions of which can make physical distancing and self-isolation difficult.

 

Raj with his son Sunil
Me and my son Dr Sunil Bhopal

Health disparities

We know that chronic conditions, especially diabetes, are more common in migrant and ethnic minority groups in Europe and the USA. These co-morbidities are contributing to comparatively adverse outcomes for those people who develop COVID-19.

Healthcare disparities are also likely to have a role. For example, in the USA, Black or African American minorities and Hispanic groups are less likely to have health insurance, with consequent reduced health-care access and use.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31102-8/fulltext

What can we do?

We urgently need political action to tackle xenophobia, systemic racism, and individual level prejudice and discrimination with concerted efforts to resolve long-standing societal inequalities globally.

I have been contributing to many papers and articles and working with fellow academics and the media to raise awareness of these issues.

Recently, I informed MPs and the BBC about the existence of a report that was denied by ministers in Parliament. This information persuaded the UK Government to release the report containing vital recommendations of measures to protect ethnic minority groups during the pandemic.

I am particularly concerned about the worldwide impact of COVID-19 on immigrant populations, specifically failed asylum seekers and undocumented immigrants. Equally, failing to attend to such populations is a risk to all of us. This was demonstrated recently in Singapore, where the pandemic was controlled except in the hostels housing migrants. This led to a second wave of infections emerging from these hostels.

I have written to the UK and devolved governments to urge them to remove the ‘no recourse to public funds’ condition, which prevents people who don’t have permanent leave to remain in the UK from accessing state benefits.

Many of these individuals contribute significantly to frontline public services, such as the NHS, and fulfill key-worker positions maintaining the nation’s infrastructure, cleanliness and sustenance supplies. Yet these workers do not have access to the same state rights and support as their friends, neighbours and colleagues. This includes rights such as child tax credit for those in employment and for those who have lost their jobs due to COVID-19, who were already engaged in precarious self- or zero-hour contract employment. There is no safety net or furloughing or state support.

I believe this is an unjustifiable denial of the human rights of some workers, students and others, who are not being treated on an equal basis with other citizens as a result of their nationality. This is particularly egregious at a time of national crisis, such as we are facing right now.

https://www.bmj.com/content/368/bmj.m1213/rapid-responses

Children enjoying ice cream
Children from the carefree days we now yearn for.

Effects on children and young people

Another major concern of mine is the impact of the pandemic on babies, children and young people across health, education, social care, justice and poverty. With my son Sunil, a a lecturer and specialist trainee in paediatrics, I am helping to set out the risks of COVID-19 in children in the context of other problems we have. We have found that less than 0.4% of deaths in children are caused by COVID-19, fewer than by influenza and road traffic accidents. The bottom line for me is that my children and grandchildren are far more important than I am. I don’t want them to be disadvantaged to try and prevent me getting COVID-19.

The different policies of European countries, and indeed even within the UK, in relation to children returning to school are an example of confusing variability that could have major impact on the future livelihoods of our children.

To help provide some context for parents, teachers, clinicians and policymakers grappling with this, we have examined age-specific mortality data across several countries which shows that deaths from COVID-19 fortunately remain very infrequent in children and young people.  Results are similar for each country.

We are making this data freely available through a  table published online, which includes deaths by age-categories and by country and is regularly updated with the latest data (https://tinyurl.com/child-covid) .

Given these data, we think the medical community should be upfront with parents, carers, teachers, clinicians and decision-makers that the direct impact of COVID-19 on children is currently small in comparison with other risks that children face in everyday life, and that the main reason we are keeping children at home is to protect adults. This conclusion may change as the pandemic evolves, and the epidemiology of COVID-19 in children should be closely monitored.

https://www.bmj.com/content/369/bmj.m1669/rr-4

Raj's parents
My parents shortly after arriving in UK.

A bit about me

Many of us who come from abroad have unusual histories and I would certainly say this about my own family. I was born in Moga, a town in Punjab in the fifties and we moved to the Gorbals, Glasgow when I was two years old. The Gorbals was the most notorious slum in the whole of Europe. Many immigrants in Scotland started their lives there.

My mother’s side of the family were in the tailoring business that supplied uniforms for the British army in India. My father was also a tailor. A few years after arriving and saving some money in Glasgow, my father started a wholesale and retail clothing shop called Moga Trading Company in Norfolk Street, which was on the A1 leading from Glasgow to London. I would consider myself both Punjabi and Scottish in a 50-50 ratio but I didn’t become a tailor. Like many traditional Indian families, we were all encouraged to become professionals and I became a doctor.

Related titles by Professor Raj Bhopal

>> Migration, Ethnicity, Race, and Health in Multicultural Societies

>> Epidemic of Cardiovascular Disease and Diabetes

Blog written by Professor Raj Bhopal and edited by J Middleton and J Durkin


Pausing the PhD to understand Covid-19

Dr Clark RussellClark Russell is a medical doctor training in infectious diseases and microbiology. Prior to the COVID-19 pandemic, he was undertaking scientific training through a PhD in immunology as part of the Edinburgh Clinical Academic Track.

 

Understanding the immune system

Pre-pandemic, Clark was working in the Dockrell Laboratory in the Centre for Inflammation Research. Using a combination of a cell culture model and genomics, Clark would investigate the ways in which bacteria that are unusually virulent have evolved to avoid being killed by immune cells called macrophages.

 

Clark is interested in using examples of bacterial adaptive evolution to understand more about the human immune system, particularly which immune responses have successful pathogens evolved to evade?

 

Pausing the PhD 

At the end of January, Clark decided to put his PhD project on hold to allow him to work full-time on COVID-19 with Dr. Kenneth Baillie.

“I’m very grateful to my PhD supervisors and Wellcome for allowing me to do so,” he says.

Clark currently works on a clinical characterisation study of COVID-19 and a scientific study of COVID-19 pathogenesis using tissue obtained from fatal cases of the disease. “I usually work in the hospital once a month, helping to look after patients with infectious diseases, which of course recently has become almost entirely COVID-19” explains Clark.

 

Multiple studies

Dr Clark Russell in PPE at workAs part of the ISARIC clinical characterisation group, Clark works with clinical researchers worldwide on modifying a research protocol for studying emerging infections for COVID-19.

The research protocol is available open-source for anyone anywhere to modify and use, aiming to facilitate harmonised research during outbreaks to generate answers more quickly.

“I am part of the ISARIC Coronavirus Clinical Characterisation Consortium in the UK where we are using a version of this research protocol to collect clinical data and serial biological samples from hospitalised patients with COVID-19 to describe clinical features and investigate disease mechanisms,” explains Clark.

In Edinburgh, Clark is involved in a study collecting and analysing tissue from patients who have died due to COVID-19. “The mechanism of lung and other organ injury in COVID-19 remains incompletely understood and obtaining tissue samples post-mortem provides an opportunity to study pathogenesis in a level of detail not possible during life,” says Clark.

Additionally, Clark also works with a group of biologists and bio-informaticians in the Baillie Lab at the Roslin Institute, generating a list of human genes with pre-existing biological evidence to suggest a role in susceptibility to coronavirus disease that can be investigated further.

 

Inspiring colleagues

Clark says it has been a privilege to be working with ‘inspirational and brilliant people’ from around the UK and around the globe.

“I have learnt a huge amount from them in the process. So from the perspective of scientific training this has been incredibly valuable,” he says.

“Observing these traits in colleagues responding to COVID-19 has been very gratifying. It has also been inspiring to see nursing, medical and laboratory colleagues in the Infectious Diseases Unit and diagnostic lab rise to the challenge of COVID-19. They have been working flat-out on this disease since January.”

 

Not so great at hairdressing

Outside of work, Clark enjoys running a bit more, while he has also had an  unsuccessful venture into hairdressing.

“Since I haven’t been able to get a haircut due to the lockdown I tried my hand at cutting my own hair recently, which went very badly indeed” he says.

Probably best to stick with the medicine then.

Find out more about the ISARIC clinical characterisation group 

Find out more about the ISARIC Coronavirus Clinical Characterisation Consortium in the UK 

Visit the Baillie Lab web pages


Engineer, scientist then surgeon – now 3D printing PPE

Aidan Roche
Aidan Roche

Hi I’m Aidan and I’m an ECAT SCREDS Clinical Lecturer at the University of Edinburgh and a Plastic and Reconstructive Surgery Registrar within NHS Lothian.

I’m working with Dr Adam Stokes (School of Engineering) and colleagues on the rapid 3D printing of personalised protective face-masks and visors. These face-masks are made to World Health Organisation standards and for healthcare workers treating COVID-19 patients. We were recently awarded £84,000 from the Chief Scientist Office Rapid Research in Covid-19 Programme.

First things first, what are ECAT and SCREDS?

ECAT SCREDS clinical lectureships are highly competitive joint academic and clinical training positions between the University of Edinburgh and the NHS.

ECAT (Edinburgh Clinical Academic Track) is a flagship Wellcome PhD programme for clinicians. It is open to both medics and vets who have demonstrated the potential to pursue a career as an academic clinician.

SCREDS (The Scottish Clinical Research Excellence Development Scheme) provides an integrated training and career development pathway enabling clinicians to pursue concurrently or sequentially academic and clinical training within the NHS.

How does it work?

A SCREDS clinical lectureship allows trainees like me to progress with both medical/surgical training at the same time as their academic training. Usually, we spend 80% of our time doing clinical work (operating, clinics, ward work, etc.) and 20% academic work (managing projects, writing papers, presenting at conferences, etc.).

It’s a really enjoyable job, as no two days are ever the same. In the clinical world, I can help a few patients directly, while with my academic hat on, my impact can be global.

The important point being: as academic clinicians we can identify problems in the clinical world firsthand, then devise a solution to them. I used to be an engineer… first training as a mechanical engineer, then as a scientist by obtaining my doctorate in bioengineering, before training as a surgeon…so finding solutions to problems like this are enjoyable for me.”

Poorly-fitting face masks

The project came out discussion with clinical colleagues in A&E and ITU who had noted that not all FFP2/FFP3 masks available were fitting sufficiently to prevent transmission of infection. I work with Ken Stewart who is a Consultant Plastic Surgeon, and one of the collaborators involved.

I looked into these issues a bit further with Occupational Health at St John’s Hospital. The data confirmed that with the stock available, not all staff were safely passing the required respirator “fit-test” – a measure of how well the mask is filtering out aerosolised particles, thus preventing transmission.

As such, these valuable staff members cannot safely work in areas where Covid-19 patients are present. We realised this is due to the generic nature of available masks, so we proposed adapting 3D scanning technology we already use for facial reconstruction surgery to generate an exact 3D model of a healthcare worker’s face.

From this model, a personalised 3D printed mask could then be printed, which conforms to each individual’s unique features. This can all be done within a matter of hours and locally, important points in a global pandemic when supply chains are strained.

The 3D printing solution

As such, I developed the proposal and protocol, and collaborated with Dr Adam Stokes (Principal Investigator) of the Soft Systems Group in the School of Engineering as a cross university CMVM/CSE project. We are aiming to use the CSO’s funding to develop and validate our designs by using the same respirator fit-tests used in NHS hospitals.

We are also working with Professor Paul Digard of the Roslin Institute to investigate which materials are best to prevent viral contamination and can be easily disinfected in line with NHS protocols, so that these masks can safely be re-used (thus becoming a more sustainable, long-term solution).

While we appreciate this is a research project at the moment, we hope by testing the masks in participants’ homes and in simulated clinical scenarios (e.g. in the simulation suite where management of simulated cardiac arrests or big burns can be trialled in teams) we can gain quantitative data of how well the masks perform and importantly, how clear communication is through them, and how comfortable they are during long wear and stressful environments.

Why did I get involved and what are my hopes?

Simple – I have useful skills that I want to apply to help during a global crisis. If we all do our bit, it makes it more manageable for everyone.

I would hope that by validating the use of 3D face scanning and 3D printing together in a rigorous study we would be able to provide a blueprint for rapid production of locally produced PPE that help support the existing NHS response.

The goal would be to fill any gaps in stock, particularly for staff whose generic supplies do not fit safely, whether that is here in Scotland, the UK, or perhaps further afield. Ideally, I would like to support local industry to develop sustainable PPE using materials in a way that previously might not have been considered, thereby avoiding over-reliance on global supply chains that are clearly being strained.

> Learn more about ECAT