Medicine and Science from The BMJ

Lockdown lessons from an Antarctic winter

Anne Hicks, is an emergency medicine consultant in Plymouth, and for 16 years was the medical director for the British Antarctic Survey (she stepped down last year).
The British Antarctic Survey operates all through the antarctic winter - where for 90 days, the sun sets and plunges their base into cold and darkness. So who better to give us some advice on coping with the strict covid-19 rules during our winter period.
Anne talks to Cat Chatfield about the ways in which structure, even the seemingly small and arbitrary, can help, how to spot signs of someone struggling, and how the lack of daylight affects teams working at the bottom of the world.
https://www.bmj.com/wellbeing

Corona virus second wave - Fears for tiers

As the first vaccine for corona virus is approved, and England joins the other nations of the UK outside of full lockdown, we are all entering tiers of restrictions - variable across the country, which will continue until that vaccine coverage is enough to slow transmission in the community.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and are re-joined by Karl Friston, neurologist and member of iSAGE.
They discuss what we know about the efficacy of these tiers, and how they interact with things like track and trace, and the mass testing taking place in Liverpool.
For more of The BMJ’s covid-19 coverage.
www.bmj.com/coronavirus

Calum Semple - the efficacy of mass testing in Liverpool

The government has decided to pursue a strategy of mass-testing in Liverpool, in a pilot to see what effect that has on containment of corona virus.
A lot of criticism has been levelled at the scheme, from the sensitivity of the lateral flow test used, to whether this is screening and should be referred to the national screening committee to be evaluated.
Calum Semple, professor of child health and outbreak medicine at the University of Liverpool is evaluating the project, and joins us to explain what we can understand from this - how initial data shows the new testing regime is reaching more of the population, and why he thinks this is a public health intervention, not a personal screening test.
www.bmj.com/coronavirus

Why the government is being sued over PPE contracts

The BMJ is a champion of openness and transparency in research, in clinical practice and in health policy.
However, if you’ve kept and eye on the journals recently, you’ll have seen that governments have been less diligent about keeping an eye on competing interests than they should be.
In this podcast we’re joined by Jolyon Maugham QC - one of the founding members of the Good Law Project, who have successfully litigated against the government on Brexit, and are now turning their eyes to procurement during the pandemic.
Jo talks to Kamran Abbasi about how big the contracts have been, how the UK’s system lacks the checks and balances to prevent a government from forging ahead, and if cronyism and corruption have damaged the pandemic response
www.bmj.com/coronavirus

Coronavirus second wave - recentring patients in our covid-19 response

As further promising news emerges of vaccine effectiveness, although still with no data published, and as plans emerge for the return home of university students and limited festive winter celebrations.
But as we talked about in the last podcast, there needs to be a concerted effort to re-centre patients and the public within the decisions made about how the NHS will treat covid patients and those with continuing healthcare conditions impacted by the pandemic.
National Voices, a coalition of charities that stands for patient centred care, have been talking to patients about what matters to people during COVID-19 and beyond, and have written a report with some clear recommendations to health and care leaders and professionals.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Charlotte Augst, Chief Executive of national voices to talk about that report; why some patients have felt abandoned; how covid has accelerated the conversation about rationing; and why now is the time to rebuild services around patient needs.
www.bmj.com/coronavirus

Talk evidence covid-19 update - uncertainty in treatment, uncertainty in prevention

Uncertainty abounds - even as we get better data on treatments, with the big RCTs beginning to report, and new trials on masks, the evidence remains uncertain, in both the statistical realm (confidence intervals crossing 0) and in what to do in the face of that continuing lack of clear effect.
As always Helen Macdonald and Duncan Jarvies are looking at the evidence, and this week are joined by John Brodersen, professor of general practice at the University of Copenhagen.
Helen talks to Bram Rochwerg, methodology lead on the WHO treatment guidelines for covid, about why their latest review has stopped recommending remdesivir for covid-19 treatment.
John tells us about the Danmask study - what question it was actually trying to answer.
We also discuss the ways in which there is a tendency to express certainty where there is none, and why distrusting simple solutions to complex problems is a good rule of thumb.
Reading list:
A living WHO guideline on drugs for covid-19
https://www.bmj.com/content/370/bmj.m3379
Covid-19’s known unknowns
https://www.bmj.com/content/371/bmj.m3979
Effectiveness of Adding a Mask Recommendation to Other Public Health Measures to Prevent SARS-CoV-2 Infection in Danish Mask Wearers
https://www.acpjournals.org/doi/10.7326/M20-6817

Wellbeing - What we’ve learned from treating doctors

Clare Gerada and Zaid Al-Najjar have been treating doctors for a while now, through the NHS Practitioner Programme.
In that time they have noticed some themes in the issues that bring doctors to them, from isolation to stress.
In this podcast they reflect on what they've learned about the problems that affect doctors, and how covid-19 has exacerbated some, and surprisingly reduced others.
Their book Beneath the White Coat: Doctors, Their Minds and Mental Health is out now
https://www.routledge.com/Beneath-the-White-Coat-Doctors-Their-Minds-and-Mental-Health/Gerada/p/book/9781138499737

Coronavirus second wave - vaccines, how ready is the needle to hit the arm?

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Matt Morgan, a consultant in a intensive care medicine in Cardiff, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Katrina Pollock, senior clinical research fellow in vaccinology at Imperial College London, to talk about: the three vaccines in the news; why different groups may require different vaccines; and how to choose who to get the vaccination first.
www.bmj.com/coronavirus

How well did hospitals perform for their staff during covid?

In the first wave of covid-19, hospitals started to reconfigure space and services, to provide rest areas and food for staff, to help them cope with the surge in patients.
Michael West, professor professor of work and organisational psychology at Lancaster University Management School, returns to the podcast to talk about how well those changes helped staff - and what needs to be done, now that a second wave is hitting, to make sure those essential services don't disappear.
www.bmj.com/wellbeing

Coronavirus second wave - viral transmission and a vaccine announcement

Covid-19 continues its grip on the Northern Hemisphere alongside news of a vaccine trial showing real success at first glance. In this second wave update, we explore the latest issues with healthcare professionals from primary care, secondary care, and public health, and discuss what is happening in their field, and put their questions to experts.
In this podcast, Fiona Godlee, editor in chief of The BMJ, talks to Alison Pittard, a consultant in anaesthesia and intensive care medicine in Leeds, and Helen Salisbury, GP in Oxfordshire, and Nisreen Alwan, associate professor in public health at the University of Southampton.
They are joined by Müge Çevik, an infectious diseases researcher at the University of St Andrews, to talk about: what’s happening with track and trace and how to make it work better; transmission and asymptomatic spread, in particular hospital-acquired infections; views on the news of Pfizer’s vaccine; and reaction to US presidential election.
www.bmj.com/coronavirus