A little slice of me for LGBT+ History Month

StevenMention Stonewall, Marsha P Johnson or Harvey Milk, Terence Higgins, Peter Tatchell or Allan Horsfall in the presence of some ‘BabyGays’ (a term used for the younger LGBT+ community) and they’ll all say ‘who?’ Which is a shame. Or is it?

Those many fearful but brave souls who stood up for their rights and the rights of their community ‘back in the day’, paved the way for recent generations of LGBT+ to exist a little more easily, to come out a little less scarily and express themselves a little more courageously.

We older ones tend to say things like “It was never like that in my day” or “the young uns get it too easy these days. They haven’t had to hide or fight to be who they are.” We look at Pride marches and see it more as a carnival nowadays, a celebration if you will and not so much a protest march, but isn’t that what we wanted back then? I know I did. I dreamed of a time when acceptance was automatic, that my sexuality wasn’t an issue in my connections with other human beings.

I would have loved LGBT+ orientated support services or a helpline or just something to help me realise that I was not on my own. I knew I wasn’t ‘the only gay in the village’ but there was nothing offered when my parents and I approached the social services when I was forced out of the closet at age 15.

Picture this, raised in a small town in Fife (and discovered sex with men at too early an age some would say) and at 15 yrs old I had a boyfriend who was 9.5 years older than me. We went off on a little 4 day break having told millions of lies to my parents so I could go and of course, I was found out. After quite a long interrogation when I got back, I blurted out I was gay and had been away with my boyfriend. My Bi-polar mother hit the roof – no surprise there and my step-father just said “I knew it.”

My mum fled to the neighbours to call the police (we didn’t have a phone) and she was calmed down and we were advised to go to social work the next day. When we did, we were then informed that as I was still a minor (under 16) there had been a criminal offence committed even though I was consenting. Back then, the age of consent was 21 and the police would still have been called – so either way I was screwed (pardon the pun).

The police were duly called and I had to undergo a highly embarrassing medical examination and then two policemen (one of them a neighbour) had to sit and take my statement. All this without my mum or step-father present and no-one to support me. It seemed to be ok for social work to treat me as a minor in one respect but then not do all they can to help or protect me in the other.

To cut a very long story short, it was kept out of the papers and thankfully, my boyfriend got a small fine on the strength of my statement. We lasted another 5.5 years after that. School had no idea how to cope with this either and again, there was nothing in place from social work or the school to help me cope with all the bullying, beatings and humiliation I suffered throughout that academic year.

Maybe that’s why I side with the underdog and get too easily frustrated often when things like the Pride rainbow flag is usurped by the NHS and the like….
And then I check myself, think back and remember and smile. I’m glad that the generations who’ve come after me have it a little easier (the fight’s still not over, I know that) and that they can truly express who they are in the workplace in any way they choose and that they are also supported and encouraged in that expression.

For some, it will still be a struggle but at least these days, we definitely know We Are Not Alone.

Steven, Clerical Officer, NHS Lothian

Being my true self and not my censored self at work in the NHS

Gordon at PRIDEHi I’m Gordon and I’ve been an openly gay man for nearly 20 years now. I’m a nurse and have been for 17 years, and I’m also a Trade Union Shop Steward and UNISON Lothian Health Branch’s LGBT+ Officer.

It is only in the last year or so that I have been out to my patients and their visitors and tried to raise LGBT+ visibility and awareness in NHS Lothian and UNISON Lothian Health Branch. Being a gay man is part of my identity and something I’m proud of, and human rights and LGBT+ rights are things that I campaign for in my personal and professional life.

It has been through my post-graduate study of person-centred practice that I have realised that in order to be truly authentic and in turn effective in the workplace I need to be my true self not my censored self at work. Don’t get me wrong, that doesn’t mean I don’t have a private life and professional boundaries.

If I’m not visible as an LGBT+ NHS employee, how can I expect other employees to be, let alone patients or their visitors who are so often in a vulnerable and distressing situation in our healthcare environment?

I felt conflicted, I am different, we’re all different but we’re not all treated the same – should we be . . . ? Then I had my light bulb moment, what mattered to me wasn’t in fact equality it was equity. I didn’t want to be treated the same, I wanted to be treated fairly. I wanted my diversity not to be celebrated but to be embraced.

For me it’s not about “We’re here! We’re queer! And we’re here to stay!” or in your face demonstrations or protests. It’s about “I’m a person, I’m a gay person and I will be treated fairly like all people.”

Irrespective of sex, gender identity, gender expression, sexuality and/or any other protected characteristic we should all be treated fairly. In terms of being visible and raising awareness, the NHS can keep the “Covid rainbow” because I’m going to be rocking the progressive pride flag!

Gordon.

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

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

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

Sequencing the virus from Covid-19 patients

Dr Thomas Williams
Dr Thomas Williams

Thomas Williams is a respiratory paediatrician undertaking a Wellcome Trust funded PhD in Basic Science.

When the first Covid-19 case was recorded in Scotland, Thomas was invited to help set up a nanopore sequencing programme aiming to track the spread and diversity of the virus UK wide.

Clinician turned PhD student

Thomas was a paediatric registrar at the Royal Hospital for Children and Young People and the Neonatal Intensive Care Unit at the Royal Infirmary of Edinburgh before commencing his PhD at the MRC Institute of Genetics and Molecular Medicine in 2016.

In his PhD, Thomas looked at how DNA (the instructions for all of our cells) copies Tom in the labitself, and how mutations might occur during this process. Part of this involved a process called nanopore sequencing- where you take DNA and put it in a sequencer attached to a laptop, and get the results back within a few hours.

Thomas is also involved in research related to respiratory syncytial virus (RSV), which causes a disease called bronchiolitis in young children. He has been part of a large World Health Organisation program which is planning to sequence RSV samples from around the world to better understand the disease. RSV, like the novel coronavirus, is an RNA virus.

A typical day pre-pandemic

A typical day for Thomas would involve growing yeast cells (a good model for how DNA copying- replication- works) or human cells to look for mutations in the lab plus some nanopore sequencing at a laptop at his bench. The rest of his PhD time would be spent doing computational analyses of the data.

A typical day now

Rebecca Dewar, Clinical Scientist
One of Thomas’ fellow team members, Rebecca Dewar

When the first coronavirus case was recorded in Scotland Thomas was invited to help the Royal Infirmary of Edinburgh Laboratory team set up nanopore sequencing for the novel coronavirus.

Using reagents and equipment donated by the University of Edinburgh, the team successfully demonstrated study feasibility in just over a week, and then started sequencing samples from all coronavirus positive patients in NHS Lothian.

Within two weeks, Thomas’ team were part of a large UK Government funded scheme (the Covid-19 Genetics UK Consortium) looking at viral spread and diversity in real time across the whole of the United Kingdom.

Aims of the project

The project aims to sequence many viral samples (over 10,000 so far) from across the United Kingdom to use their genetic code to:

  • work out where and when different lineages of the virus were introduced into the UK
  • see how clusters of disease are spreading across the UK
  • check that the testing performed for the virus (part of the government’s 100,000 tests a day strategy) will pick up all the different virus lineages
  • help to inform our understanding of what happens after the lockdown is lifted.

Team work

Stefan Rooke
Another team member, Stefan Rooke

Thomas works in a split team, in case anyone is affected by Covid-19. This means he spends half the week in the laboratory sequencing, and the rest working remotely helping with tasks related to ethics, education, and data analysis.

In a truly cross-College effort, Thomas works with a post-doc and PhD student from King’s Buildings, a post-doc from QMRI, a PhD student from the Roslin Institute, and two clinical scientists from NHS Lothian who already worked at the NHS laboratories.

“The team is enthusiastic, diverse, highly skilled and motivated, and it has been a real pleasure working with them” says Thomas.

Contributing both locally and nationally

Thomas adds: “It’s been great to work on this project which has taken a group of people- from the University and NHS- with a wide variety of skills and built a service that contributes both to the national response to the pandemic, and also gives us a clearer picture of how the virus is spreading in Edinburgh and in Lothian.

We can also use viral sequences to look at outbreaks within particular contexts to help to understand these better.”

Post pandemic

In August, Thomas will return to shifts and clinics as a respiratory paediatrician in the Royal Hospital for Children and Young People, while also continuing his RSV work with the World Health Organisation.

“It is likely that there will be a vaccine for RSV soon and the work we are doing will be important in guiding implementation of this vaccine,” he says.

Final thoughts

Dr Thomas Williams
Thomas checking data

“This pandemic has highlighted the importance of research and scientific data in driving the clinical response to the pandemic. I hope it will encourage clinicians to become involved in research, and reinforce to policy makers the importance of investing in research and public health” says Thomas.

>> Recent RSV paper

> COG UK website

>> Follow Thomas on Twitter