Medicine and Science from The BMJ

Coronavirus second wave - Should we cancel Christmas?

As London and some neighbouring counties move up to tier 3, and Germany, Italy and The Netherlands impose tighter restrictions over over the coming days of Christmas, in this podcast we ask - should Christmas gatherings be cancelled?
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.
They're joined by Mike Tildesley, reader in mathematics at Warwick School of Life Sciences, who models infectious disease spread.
They discuss why the key to controlling is pruning network connections - but why that concept hasn't been well explained to the public, what's happening in Cardiff, where ICU is running at 120% capacity, and how the vaccine roll out is being coordinated in primary care.
For more on the pandemic
www.bmj.com/coronavirus

Inside a vaccine trial

The last few weeks we’ve been feverish in our coverage of vaccines - the evidence base for them is, how they’ve been evaluated and licensed, and who’s going to get them first.
But what we’ve not covered much is what it’s like to do, and take part in, a vaccine trial.
In this special podcast, we’re going to hear from John Wright, director of the Bradford Institute of Health Research. He’s been keeping a “doctors diary” for BBC radio, and in this podcast we’re doing a deeper dive into that - and finding out about the people working on, and volunteering to test, a corona virus vaccine.

Talk evidence covid-19 update - poor public messaging, and vaccine approval data

The vaccines are being rolled out - but approval is still on an emergency basis, and the evidence underpinning those decisions is only just becoming available for scrutiny.
In this podcast we talk to Baruch Fischhoff, professor at Carnegie Mellon University and expert on public health communication about how that messaging should be done.
Peter Doshi, associate editor at The BMJ, and vaccine regulation researcher also joins us to talk about the data now released on the vaccine trials - what questions does it raise, and what are the next steps for researching safety.
For more on The BMJ's covid-19 coverage www.bmj.com/coronavirus

Coronavirus second wave - the vaccine’s here, but the pandemic isn’t over

As the first people outside of a trial have started receiving Pfizer's sars-cov-2 vaccine, including Matt, but that's not the end of the story for the pandemic, there are still logistics of rollout, plus treating those who have already contracted the disease.
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.
They discuss why it's impossible to get the vaccine into care homes, because of the need for very low temperature storage, why the survival rate in ICU has gone down, and how messaging on the non-vaccine ways of preventing spread need to be tightened up, especially now.
For more of The BMJ’s covid-19 coverage.
www.bmj.com/coronavirus

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