Good afternoon everyone and welcome to
the first public engagement lecture from the faculty
of Medical Sciences here at University College London.
Thank you for joining in and the producer told me
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Normally we would have liked to welcome you to one
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we selected the topic for the first lecture
around COVID-19 which is affecting a lot of our friends
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moment but moving forward you could help us select the
future talks presentation title so do feedback
to us. My name is Doctor Zahra Mohri I'm from
the Division of Surgery and Interventional Science, one
of the module leads in the Medical Sciences and Engineering degree programme
and it brings me great pleasure
to introduce today's speaker, Professor Mervyn Singer.
Thank you very much for joining us
us today. The title of this talk tells it all
so I don't need to read it again but I just would like to tell
you he's a Professor of Intensive Care Medicine at
UCL and he's the Chair of the International
Sepsis Forum. He has written a number of textbooks
around critical care so do lookout for them and read
them if it's the area that you're interested in
and his area of expertise
and interest in terms of research is to
take the medical innovations from the lab to
- from the bench to the bedside from the lab and the laboratory environment
to actually helping the patients in the hospital so
without any further ado I'll pass on
on my virtual microphone to Mervyn and thank you for joining us.
Lovely thank you very much indeed Zahra.
I'm just going to hopefully get my talk up and running.
So sorry about that light right I hopefully
everyone can see that. Hi my name is Mervyn Singer and
it's a great pleasure to chat to you today so I'll
talk for about 20 minutes or so and then please feel
feel free to ask questions and I'll try my best to answer them so.
Covid is in the news, has been for the last few months
so I'll talk about something that we did at UCL and at
University College Hospital.
Covid is a horrible disease
and the likes of which we've not seen before so the way
it attacks the body was completely
different and so there was very much a learning curve to
to how to manage these patients and you
can see these are chest X Rays
x rays that came from China, and you can see.
The lungs usually appear in black on an X
ray and you can see day by day there's
increased fluffiness which is indicative of severe
inflammatory response in the lungs and many of the
patients in Wuhan initially and then in Italy
taly, and then traveled to Spain, UK, etc.
Suffered a severe drop in oxygen levels in their
blood which needed them to become
hospitalized and about 15% of these patients
couldn't cope with just an oxygen mask alone, it
wasn't sufficient to get enough oxygen into
their bloodstream so they needed more respiratory support.
And the traditional way of doing that is to use the
ventilator so this is where the patient is heavily sedated paralyzed and then a tube is
put through the mouth into the trachea, the windpipe
that's then connected to a bellows,
a mechanical ventilator that pushes air in and out.
The problem was in Wuhan and then it got replicated
in Italy was that there was such a sudden rush of these
critically ill patients that it overwhelmed
the resources available. The critical care resource and the ventilator resource.
We had a bit of warning in the UK so
the first 100 confirmed cases
were reported from China on the 20th of
January, Italy towards the middle-end of February
and the UK around the six/seventh of March.
So we have a little bit of time to prepare.
Unfortunately I think it's fair to say we were a bit
slow to react and we didn't
actually take on board the lessons that China
and Italy had learned the hard way
 
There's a little clip I'll show you which
came from a BBC television series in the
1980s called Yes Minister and I hope the sound
carries through. "In Stage One, we say nothing is going to happen.
"In Stage Two, we say something may be going to happen but we should do nothing
about it. In Stage Three, we say that maybe we should do something about it, but there's nothing we can do.
Maybe there was something we could have done, but it's too late now."
So unfortunately I think that was
a bit of the story of what happened in the UK
and the penny dropped at least publicly
on the 13th of March when Boris Johnson
announced that there would
be Unfortunately many many deaths in the UK and that's unfortunately being
being born out.
And then in the next few days television and newspaper headlines kept appearing.
The modelling suggested huge
numbers of patients would end up in hospitals in the United Kingdom.
And because of the lack of
critical care beds there may have to be rationing.
Unfortunately in terms of resource United Kingdom lags
behind other developed countries in the number of critical
care beds we have so you can see compared to
the United States which has about 35 we
have 6.6 so in
total in the UK there's about 3,500 intensive care
beds and by using anaesthetic
machines, borrowing ventilators from the private
private sector the capacity could be increased up to
about 8000, however the modelling
suggested we would need potentially up to
40000 ventilators. Yet as you can imagine the
whole world was crying out for ventilatand there was a worldwide shortage. They weren't available.
And we were starting to get these reports from
Italy about the terrible situation that they were facing and
you can see here in the top right corner a
picture of patients not on ventilators but having
what's called noninvasive respiratory support so the patients are
awake and their breathing in as shown here in
these hoods, these helmets. They're called
Bubble CPAP.
And what do I mean by CPAP? CPAP stands
for continuous positive airway pressure
So in patients in whom an oxygen mask isn't good
enough but perhaps you don't want to fully ventilate them
it offers a nice halfway house.
And this positive pressure
splints the lungs open and improves
oxygenation of the blood and that obviously helps the body get more oxygen.
So the positive pressure,
without the CPAP the alveoli
at the basis of the lungs collapsed down but with CPAP it splints
the alveoli open and it helps
the matching of blood flowing through the lungs and its ability to pick up oxygen.
And so the patient wears a tight fitting mask.
And an air oxygen mix pass
through at very high flow across the mask
and the patient breathe out through a valve
and this valve was called a peep valve
allows the patient to breathe out against the resistance
so rather than breathing out against atmospheric pressure there's
a little bit of positive pressure that keeps the lung splinted open.
And the masks that the patient can wear can either
be a tight mask covering the nose and mouth, one over
the nose, a whole face mask
 
or this bubble helmet, hood type of approach
so it's sealed to allow
a good flow of air under pressure.
However, there was a lot of worry about CPAP. The World Health Organization, many
national guidelines including the UK because of the fear of transmission of the COVID virus.
Through aerosolisation because of the high flow
and therefore a risk to health care workers,
However, needs must. And despite these guidelines doctors in China and Italy had turned to CPAP
because they didn't have the ventilators
they didn't have the intensive care beds and they wanted to spare these for the most needy.
and this is an example of a guideline from Italy and
you don't have to know Italian to see the word CPAP there so
it figured quite prominently in their
guideline and a friend of mine who was one of the leaders of
the emergency response in the Lombardy region, That's round Milan, told me in early March "I don't
have any hard data but I am absolutely sure
CPAP is the answer."
And I have many friends and colleagues in China
in Italy and they said that about 30 to
70% of patients managed with CPAP
could be kept off a ventilator thus reserving
that resource for those who really really needed it.
Importantly there were no reports of
serious infection in health care workers, doctors,
nurses, caring for these patients. Yes we were
wearing PPE and they were wearing PPE
but these patients were attending Intensive care patients themselves.
And there were no issues with oxygen supply
because they use more oxygen than a standard oxygen mask
but the hospitals were coping.
So at University College Hospital and with
the buy-in of frontline doctors, the nursing staff
and the hospital management, we started from
the very beginning to use CPAP to
try and spare intensive care beds and
Ventilators for those who really needed it And that wasn't
what the Department of Health were recommending at the time
But we thought the lessons from Italy and China were so compelling,
this made sense to us.
And we developed an algorithm so commencing at the front door
of the hospital the emergency department we
assessed whether the patients needed CPAP or not.
There was this rapid intensive training programme
for patients outside intensive care to learn how
to use CPAP.  Doctors, nurses, physiotherapists
and so forth. And we look to buy more machines.
We only had 12 stand alone machines in
the whole hospital and we were anticipating many many more patients.
 
However, none were available so we had a problem.
 
So I'd now to talk to you about our little
CPAP project and the journey we went on.
So as I mentioned earlier by early March, we'd identified
that we needed more CPAP devices to help our patients and the projected need.
On the 16th of March Boris Johnson
announced that he was asking UK industry
to help make ventilators. There was a shortfall of
about 30000 ventilators so he appealed
to companies Dyson, Rolls Royce, Airbus,
big companies to make ventilators to try and fill the gap.
In my humble view, this was completely misguided
for two reasons. Firstly,
these are very sophisticated machines and
to ask companies who had no experience
in making ventilators to make them from scratch
in a few weeks was an impossibility.
These machines take months, years to develop so to get
it done in weeks would be, to my mind anyway,
an impossible ask. And secondly, with the anticipated rush of patients, there wouldn't
be the beds and the intensive care staff who could look
after mechanically ventilated patients. You do need special training because without that, that can endanger the patients' lives.
So I had a thought that, well, can we make CPAP machines?
And there was this very old device that had
been invented by a small company in Britain in the early
1990s called the whisper flow and it was a purely mechanical
device with three knobs. There was an on off button.
There was a button to adjust how much oxygen was
coming from the wall oxygen supply and also a
button to adjust the flow rate and that's
all there was to it, purely mechanical.
No electrical bits, no moving parts, very simple device.
It was no longer being made. It actually had come out of patent
we found a few months later, so we were free to copy it.
As I mentioned it was simple to make but it's simple to operate too
so it doesn't need much in the way
of training and because it was based on
an existing device hopefully it would be easy to get
regulatory approval because clearly you can't
use something that you make in your garden shed and
then try it on patients. You have to make sure it's not going to harm the patient.
Simpler to make but clearly important questions:
Could it be made quickly and at scale
for the thousands of patients who would potentially need it?
And we had the other added problem of a global lockdown so
many factories were now closing.
So Boris Johnson announced
his request for ventilators to be built
on the 17th of March on 16th and some
of our engineers at UCL were asked to help with forming
consortia and the two people
shown here Professor Becky Shipley, who's the Professor
of Healthcare Engineering at UCL, and Professor Tim Baker,
who is a Professor of Mechanical Engineering,
they asked me about this and I gave them my views that
no, we didn't need ventilators, we needed these CPAP devices
and we met
the day before at the senior common room at University
ty College London was locked down and we talked about what we needed.
So that was the 17th of March. Let's see if we can make it.
How are we going to make it at scale?
Enter Mercedes Formula One Racing team.
So Tim,
the Professor of Mechanical Engineering in an earlier life,
had worked designing and building engines for Formula One teams
and so he had many strong connections, one of whom was the chief engineer at Mercedes AMG HPP.
The high-performance powertrain factory
in Northamptonshire that made the engines for Formula One cars.
And this is a big factory, 800 people work there,
really skilled engineers and technicians
and you can see there right at the front The guy on the right
you might recognize somebody called Lewis Hamilton and the guy
next to him is the managing director who is also an
engineer called Andy Cowell.
So Andy
was contacted that evening. Can Mercedes help? And his answer was an immediate yes.
So the following day he dispatched 4 of his top engineers down to
UCL to work with the engineers there.
And they were amazing. They did CT scans
of the whisper flow. They found one themselves on eBay. There were computed
aided designs. They looked at the flow through the machine and
they built some prototypes so you can see here from
blocks of steel. They engineered Precision engineered
them and you can see here how beautifully made they were. And this was the final product.
And they did this in just 100 hours after
our first meeting on the 17th of March.
Amazing speed.
So in 0-100 hours from the original,
we found one in our hospital museum, they found one on eBay, to this device.
And it even had a UCL logo
imprinted on it.
So they brought it up to me on the Saturday so we first
talked about this on the Tuesday. They brought it up on the Saturday
and there I am holding the very first prototype and
what do you do when you get a new toy you want to try it.
So here it is with me trying it out and it worked.
And there's Andy Cowell. He came up with his chief
engineer and you can see him there fiddling with the flow rate
so very very rapid achievement.
As I mentioned before we had to get regulatory
approval and the MHRA, the Medicines and Healthcare Products Regulatory Agency, were incredibly helpful.
So you can see here on the 20th of March,
Neil McGuire said he's very happy to help.
On the 25th of March we sent in
a huge dossier with all the technical spec,
the manufacturing, I tested it with
some colleagues on ourselves that we had some validation data
and you can see that we were given approval to use it
on the 27th of March so the MHRA responded in just 36 hours.
So that was the 27th of March and then the UCL Comms team went into action and the BBC were
really keen to highlight this and Fergus Walsh,
the medical correspondent came and filmed on the 27th of March. He cut it over the weekend
and it was announced on the BBC website and I'll play you a little bit of BBC Breakfast:
"Delivers oxygen to the lungs without the need for a ventilator. Here's our Medical Correspondent Fergus Walsh.
"It's a small device that could make a big difference
known as continuous positive airway pressure or CPAP. It pushes oxygen into the lungs keeping
them open making it easier to breathe. They're already used in the NHS but are in short supply so
a team modified and improved an existing
design in less than a week which has now been approved for use by health regulators."
And this story went
global so you can see all over the world people were
really interested in what we've done and they were interested to hear more. So it was quite a
busy time, as you can imagine.
We even had the ultimate accolades, tweets
from Gary Lineker and Lewis Hamilton. What more could you ask for?
And Mercedes, just to show how impressive they were,
so we then were asked by the UK government to build 10000 of these and
by the 15th of April less than a month from when we first sat down and had the idea they produce 10,000 devices
which is quite a remarkable feat and I'm full of admiration for them.
And I won't go into the detail now
but they, together with our engineers, improved on the design and so a mark 2 device came
out as the 10000 devices which was actually up to 70% more efficient in oxygen use
use than the original device.
Let's go back a step to the other thing we thought was really
really really important was not just to look after
the UK but to think about the rest of the world because
clearly everywhere else has been suffering from Covid and
many countries aren't as rich and developed as the UK so what we did
was on the 6th of April, we made the designs freely available for anyone
in the world. So anyone in the world could access
the designs, the manufacturing package, what materials were used. We had training
videos educational brochures etc. And provided you are legitimate
organization, the government, a healthcare provider,
a research institution, a manufacturer you could have the
designs and in fact we gave over
1800 design packages to
different groups and so far 105 countries have expressed interest.
And the devices are now being made locally, being donated or being purchased at cost. We don't want to make any
profit from this to loads and loads of countries around the world where they're being used.
I just like to finish off by thanking, I mentioned Becky and Tim earlier. My lovely
colleague, another intensive care consultant doctor David Brealey,
here wearing a mask, who was also hugely
instrumental in helping me with getting the clinical evaluations done
and helping the engineers optimize the
device and the other gentleman is Professor David Lomas, who is
the Vice Provost of the university. He's a respiratory physician as well, and so he immediately
saw the need for the device and helped
open doors, not only in UCL
to get the funding streams and the bureaucracy swept away,
but also with the government in the Department of Health.
And I'd also just briefly like to acknowledge the many many other people in UCL.
The engineers, Mercedes, everyone
who made this possible. On that note thank you very much indeed for listening and I'll hand you back to Zahra. Thank you.
 
Thank you Mervyn, that
was really interesting. I have read about this stuff on
the university UCL's website but I really wanted to
to hear it from somebody who was in the front line and
it's really interesting to hear about CPAP, how it went from this
sort of from the labs of the engineers to the actual
patients in the hospital and the fact that you mentioned the
collaboration between various departments, between engineers, your
colleagues in the hospital, between Professor Shipley
and Professor Brealey. That's amazing that just to show to our young audience here,
students of the high school that this is
the future of the research and the future of the world that we all collaborate together. There's a large number of questions.
Obviously, I must tell the audience, we've got the producer
told you got over 800 of you tuned in which
is fantastic so I'm now under pressure to try
to choose some of those questions and read out
to you so I'll try not to repeat And I've tried to we
with my colleagues were trying to put them into groups so that we follow the same type of questions,
rather than jumping.
That clip from Yes Minister was really funny so that's great. There's a lot of questions
around that from the from the audience. Obviously around the reactions
of the government about this event and
there's a few questions around the actual
virus and so I think maybe I'll start with the virus itself.
So what are your opinions Professor Singer in terms of how this virus differs from the previous ones
that we've come across in many years back, SARS, etc.
How is this one different compared to the previous?
It caused... so SARS was something that
happened at about 2002 to 2004 and
the patients there had severe respiratory
symptoms but they presented quite quickly.
With Covid because it takes about five days or so for the patient to become
symptomatic, it meant it could be very easily spread without often people realizing
that they were transmitting viruses and then it
took a further 5 days from the patients becoming symptomatic to pitching up in hospital and needing
to be admitted. And so there was this long running period and again many patients had relatively mild
symptoms or even no symptoms
and unfortunately, a proportion was very severely affected and one of the things that has shocked the
the medical community, is how
different it is from other viral pneumonia.
It does behave differently and so we had to learn how to manage it very quickly.
Yes I agree with you.
I've heard that from other colleagues who work in the hospitals
and we hear that viruses can mutate very rapidly so do you think a mutated
strain would have the same severity? What's your thoughts on that?
Well mutation basically going either direction.
It might either become mild or it can even go away
or it may potentially become more severe. So we talked about SARS,
essentially disappeared after 2004.
We don't know why but
it came, affected a few big cities,
Toronto, Singapore, Hong Kong and then went
away so hopefully, it'll be the same for COVID but unfortunately,
there's no guarantee. It may come back
with a vengeance in the next few weeks, months,
years, as mutated COVID or as a completely new virus may
also, unfortunately, hit the planet.
Sure, I think I agree on that
with you I said we don't know how the virus is going to respond. Which way
it's going to go. We hope it's going to go to
the milder version that we can then cope with better.
How about your thoughts on herd immunity? What are your ideas on that?
 
In the normal process, there are lots
of viruses, measles, mumps, chickenpox, where the idea
is that immunities gained across
the population. So if there is an outbreak most
people are already immunized and you can achieve
that through either lots of people catching it and then developing
their own immunity or vaccination so
what the government are busy working on and
many countries around the world, there are two vaccine trials going on in the UK,
trying to develop vaccines to try and
improve herd immunity so
clearly we hope it will work. There's no guarantee
and maybe even if it doesn't work fully it may
modify the symptoms so that the patients may get COVID infection
but they won't get it to the severe degree that we've been seeing in the last few months.
Great, so you mentioned the vaccine and
some sort of antiviral drug
and so a member of the audience is asking what is
specifically about this structure, the molecular biology of the virus itself,
that makes it so hard to develop a vaccine or antiviral drug?
Unfortunately, COVID19 belongs to a group
of viruses called Corona viruses and the best known coronavirus is the common cold.
And unfortunately for 30, 40 years people have tried to come up with vaccines against the
common cold and have failed miserably for two reasons.
a) the virus mutates and changes
but also even if you do get immunity it seems
to be relatively short lasting a
year two years maximum so by and large
for Coronaviruses, vaccines have
not been shown to be terribly effective and not long-lasting
so yes if a vaccine is developed and
huge efforts are going into trying to do so
there may be the need to have repeat vaccinations every year.
Right so you've answered another question that actually had been asked, if we had a vaccine how long would
would we be immune to COVID19 in terms of the lifetime. So you've already covered that.
I'm going to move on to another question. In terms of the populations that get affected,
why is it that the elderly get affected from a scientific point of view
Why elderly are more prone to COVID-19?
Lovely question.
The brutal answer is we don't know, clearly people or
certain groups, population groups have been identified as being high risk so elderly,
men more so than women,
black and asian minority ethnic groups
had been identified, people who have underlying
diabetes, hypertension, heart failure, so all of these groups have been identified. The big big big
question is why? It may be that
if you have underlying health care problems,
if your immunity is impaired to some degree
as you get older your immunity changes. So the immune function
of a 20-year-old is very different from a 70-year-old so that might be important.
People have queried vitamin D levels, environmental pollution,
Yeah humidity and cold weather at night,
lots and lots of theories are abounding but unfortunately, we still don't know the answer.
Right, so, again you answered a couple of other
questions about BAME, are they the only ones affected?
Obviously, the audience can now hear Professor Singer's answer.
It's not just the BAME,
other sectors have been affected as well so it's not what we hear in the news.
So there is a variety and there is no real
answer to who is going to get it or not but there are
certain groups of the population more prone to it so
I was gonna move into the CPAP.
There is a question about the negative pressure in the room.
Would the CPAP patient be kept in a negative pressure room to maximize airflow or
are these rooms limited in the hospital environment?
They are limited in hospital. So intensive
care units, you can modify the flow because obviously
if a patient is infectious you don't want them
coughing out their bugs around the room or you can
have other areas or rooms where
the flows in the opposite direction So you've got somebody who's
immunity is compromised, a leukaemia patient,
for example, where you don't want them to catch bugs
so intensive care units are well equipped for this,
but general wards aren't, so what we did was
we found that our hospital and other hospitals did the same,
We cohorted patients together
so we managed to look after CPAP patients in
the operating theatre area and one of the wards which we turned
into a respiratory high dependency unit
and the staff looking after these patients wore PPE.
The good thing was that Public Health England did environmental air sampling and they couldn't find virus circulating in the air
in these patients so the good news was, it didn't seem to be aerosolising at any greater risk to
somebody wearing a straightforward oxygen mask.
So we were encouraged by that and as I mentioned
earlier in Spain, Italy, France, UK, China, we haven't had reports of doctors, nurses,
looking after these patients ending up as patients themselves.
Great, thank you, Mervyn.
Could negative pressure ventilators, such
as the ones used during early polio epidemic,
be used to help COVID patients?
It's a really nice question. So just to give a little bit of
a historical perspective in the early 1950s before polio vaccines came along there were outbreaks, epidemics
of polio, and that caused paralysis of patients
and it could paralyze respiratory muscles so they
couldn't breathe and in Copenhagen
or even beforehand they were using
some sort of iron lungs so the patients sat in a rigid iron box and instead of the air
being pushed in as I described now with a ventilator
here the air around the patient there was a
vacuum which sucked the air in the opposite
direction, creating a negative pressure to make the lung
expand from outside rather than
air being pushed from inside through
the windpipe.
And there are in fact people are trying to re-look at these devices. The only problem is with COVID,
especially early on, the patient taking a deep breath wasn't a problem and these
patients were taking sometimes massive tidal
volumes, massive deep breaths, but they weren't
still able to get the oxygen into their lungs. So when you and I breathe we're breathing
negatively. We're sucking the air in like a vacuum cleaner into our lungs.
So adding a negative pressure
ventilator to our already large negative pressure breaths probably wouldn't help.
It may potentially cause harm because if
you overinflate the lungs just like a balloon
keep blowing blowing blowing blowing and then the lungs go pop
and then the lungs can burst and so there's this
balancing act between helping the patient but not overdoing it
with your ventilation, both negative and
and positive pressure ventilation, to cause damage.
I think that's really interesting to hear so that's
makes CPAP quite exciting. It does what
you're actually explaining it to do.
Since you are still talking about patients and the hospital environment,
Someone was asking your thoughts on chloroquine and hydroxychloroquine.
What are your thoughts on those drugs?
Lots and lots and lots of drugs are
being used or put forward where the evidence wasn't
that particularly strong and hydroxychloroquine was
one very good example. There was a little bit
of data in mice
models of being given a virus. A little bit in
malaria because obviously, that's where the use is of hydroxychloroquine.
It's a standard drug used for malaria and that was extrapolated to maybe it could work in
viral illnesses and so there was a lot of excitement.
You remember President Trump promoting it very vigorously.
Personally, I never believed in it from the
first and so we never actually used it in any of
our patients and my view was vindicated because subsequently
there had been large trials to show it
doesn't work unfortunately so it was an idea.
Lots of ideas are being put forward. You may have heard on the news last week about low dose steroids
being effective so that was one idea. That's the first study that's
actually been shown in a randomized control trial where
patients either get the drug or don't get the drug to have a benefit.
So at least we had something now that will help.
For every six patients ventilated it will save one life, which is clearly a benefit.
Great, and just to continue from what you said, are you aware of any research in UCL?
Or perhaps you're involved in terms of finding
new medications or support for COVID19 now that we have a large
number of patients and access to samples? Are you involved in anything?
Could you share a bit for us?
We still don't understand fully the mechanisms,
the pathology of how the virus causes
this exaggerated response within the body especially
affecting the lung and there
are loads and loads and loads and loads of treatments being
suggested or being trialed I was sent to list a couple of weeks ago with 132 different ideas which is a lot.
And it's difficult to know which one will
work especially as we don't fully understand the disease so we're
doing at UCH, and like most hospitals around the world, are participating in trials
to try and see which of these ideas do work. 
At the same time we're actively
doing research to try and understand the mechanisms by
which it causes disease much better
For example, the inflammation caused by COVID,
seems to generate an exaggerated thrombosis response.
So yes we used to seeing patients
with blood clots in the arteries or
their veins or what are called pulmonary emboli, blood clots in the lung. 
But the number we've seen
with COVID is around 6, 7, 8 times higher than what we are usually used to so
again the contribution of these blood clots to the disease process we still don't know but again,
that's an avenue for research.
Great, thank you.
And so how do you deal with the stress of tragic diseases? The line of work you
are in obviously you see a lot of things on a
daily basis and with COVID-19 probably on a very sort of enlarged factor,
how do you deal with the tragedy? I assume the question is probably from one of the young members of the audience.
It is hard. I'm not, unfortunately,
you've seen on the television I'm sure all of the television clips
and interviews of people who work in intensive care.
So to give you an example we have a 35 bed in intensive care unit but many of
these patients are relatively well. They've had a big operation,
we're just waiting for them to recover. So at any one time will have
5 to 10 very unwell patients
and the others are unwell but not to the same degree.
With COVID, at its peak, we had 62 really sick patients so the scale of
the severity and the number of patients was just something we've never experienced before
so usually we have one nurse trained intensive care nurse to one patient who is very unwell.
With COVID, in our hospital we had
one trained nurse to four patients.
Some hospitals in London, it was one trained intensive care nurse to six patients so it put a huge strain on the hospital system.
Yes we had lots of support from the anaesthetic department, from the respiratory department,
other doctors who were not intensive care doctors came to support us but it was very
very stressful and wearing that PPE is horrible.
You get hot. You get sweaty. You can't hear
people talking to you and it takes a long time to put on and put off
and obviously, there was this
hidden fear of perhaps I might catch this horrible disease myself. So you had all of these stressful factors
all combined at once especially in dealing with the disease
we'd never come across before.
Yes and for that reason I
thank you once again with those claps that we did on the Thursday.
Originally was Wednesday. I did clap from my
window and so did my neighbourhood so thanks to you and your colleagues for putting
up with all these stresses and all these worries in the back of your mind to help us and all the
other medical profession doctors around the world so
there is a question from the audience, do you think the intensive care unit will be given more priority in terms of
funding and research and I'll add to that being a researcher.
How about just the general research around vaccines and antibodies and immunity etc.?
Do you think it's about time that the government will provide a bit more support for the
research groups across the world and within UK?
Yeah. Great question and certainly in terms of
intensive care beds I think it's embarrassed the government
how few beds we have relative to other countries
that I showed that slide earlier and so I know in London
there's a big push to double the number of
beds that are available but clearly it's not just having the beds,
you need to have the staff as well and there's a shortage of trained doctors and nurses and physios
and so forth. So there's got to be not just the machines and the beds, but the staff.
And completely agree with you Zahra, wouldn't it be nice if the government puts a lot more money into
research so that we're better able to understand diseases not just COVID
but diseases in general
and come up with better ways of identifying them early and
and treating them more effectively.
Great, thank you.
In terms of the PPE I heard myself
and I know some people are asking as well, was there really a shortage of PPE in the hospital? At least in University College London where you are working?
Well we were lucky and just about managed to cope
and we were getting to points where we were running out of gowns and things like that and
we had a shipment from China and Chinese people
are generally shorter than people in the UK and so the arms came up to about here.
Some of my colleagues are very tall and
the sleeves were rather short and so there was a lot of hairy arm being exposed but
you make do with what you have and obviously
hopefully, if there's another surge we'll be
better prepared in terms of masks and gloves and hoods and so forth.
Did you and your colleagues try to
get access to the PPE that the researchers have in university
just alone in UCL I know in our labs
we have. Was there initiative on that?
Unfortunately I think the NHS, I heard a figure
and I can't remember the exact figure but it was something like
three million bits of PPE were being used per day.
So if this was this huge turnover because every time you went to
see a patient unless they were cohorted together, you had
to put on new PPE kit and wearing PPE the nurses could only do 2-hour shifts because
it was so uncomfortable. We had to have a
huge number of patients -
sorry - disposable. So we created a huge
huge environmental mountain of PPE that
the planet will now have to get rid of.
So I'm just, thank you very much Meryvn
It's time up, it's one o'clock but just
one quick question. Lots of people are asking about the
social distancing, the two-metre distance apart, the face masks,
the ease of lockdown on the 4th of July and if you think that COVID19 is dangerous,
why the government is then asking us to ease down on the lockdown and so
what are your views on all these suggestions that the government
is giving us in terms of coping with this?
Yeah, that's a horrible question. I'm glad I'm not a politician.
On the one hand, you've got the doctors quite rightly
saying there is a risk that you might get an increase in cases.
On the other hand, the economy has
suffered really really really badly and that means and
you're hearing the news that many people will be made unemployed and
if you can't have a healthy economy you can't
then provide funds for the health care service
cancer operations new treatment lots of other things So you've got to
reach this sensible balancing act between
restarting life but doing it in a sensible way and hopefully
controlling the non-lockdown, the return to normality, that we don't get a second surge.
Thank you very much, Professor Singer, for your time.
Thanks to the audience, I heard that is over 900 of you tuned in.
Thank you very much, I apologize I could not read
everybody's questions because there's so many of you but I tried to read the ones that
are more relevant and we will receive this
session in a recorded format through an email maybe sometime
during next week with the feedback form if you could please fill the
feedback form and let us know how we did and how
can we improve moving forward and what other topics would you like to hear.
Thank you for tuning in. Goodbye from University College London. 
Bye bye.
