The BMJ Podcast

This week we're focussing on what kind of information we need to be able to collect and use as the country transitions out of lockdown - and why local lockdowns may be here for some time. We also hear about the new antibody tests which are available in the UK - are they actually a game changer? (2.00) Helen explains what some new evidence says about hydroxychloroquine (spoiler; don’t take it for covid-19) (6.40) *Non covid alert* - Carl tells us about new research on compressions stockings for thromboprophylaxis, and the importance of doing research on non-pharmacological interventions (10.30) David Nabarro, Special Envoy of WHO Director-General on COVID19, (28.00) Helen goes back to Jon Deeks, professor of biostatistics at Birmingham, to find out more about these “accurate” tests for covid, endorsed by the government this week. Reading list: Clinical efficacy of hydroxychloroquine in patients with covid-19 https://www.bmj.com/content/369/bmj.m1844 Hydroxychloroquine in patients with mainly mild to moderate covid-19 https://www.bmj.com/content/369/bmj.m1849 David Nabarro’s website, with daily briefings https://www.4sd.info/ News Covid-19: Two antibody tests are “highly specific” but vary in sensitivity, evaluations find https://www.bmj.com/content/369/bmj.m2066

With COVID-19 still ongoing, and at the forefront of the minds of doctors, patients and members of the public alike, difficult conversations are taking place - GPs are encouraged to talk about death with those who might not be ready to discuss it, and families are losing loved ones without being able to say goodbye. In this episode, we also look at survivor guilt, the range of emotions that grieving encompasses, and how to address the potentially thorny subject of advance care planning with COVID-19 patients. Our guests: Katherine Shear, internist and psychiatrist, is Director of The Center for Complicated Grief at Columbia University’s School of Social Work. She has been involved in research into treatments for grief for over 20 years. Scott Murray, a recently retired GP, has key interests in disease trajectory and advance care planning. He led the first Primary Palliative Care Research Group and he chairs the International Primary Palliative Care Network. He advocates high-quality palliative care for everyone. This week's deep breath out is the Viral Counterpoint of the Coronavirus Spike Protein (2019-nCoV) - https://soundcloud.com/user-275864738/viral-counterpoint-of-the-coronavirus-spike-protein-2019-ncov

Does history count as a non-pharmaceutical intervention? Much of our view on what to do in this pandemic has been influenced by the 1917 Spanish 'flu outbreak - even though covid-19 seems to be acting differently. In this podcast, we talk to Howard Markel, a professor of pediatrics at Michigan, as well as professor in the history of medicine. He's written books on quarantines and epidemics, and was part of a team that did the medical and historical work that first showed the value of flattening the curve. This is the first of 4 podcasts from our US colleagues, looking at the disease in that country, which will be published over the next 2 months. For more on covid-19 www.bmj.com/coronavirus

Hydroxychloroquine is in the news again - as Trump and some news organisations are pushing it as a treatment, despite evidence (published in The BMJ) showing it lacks efficacy, and has a load of potential negative effects - including arrhythmias. We know that kind of information spreads online - particularly through social media, but how does it do that? In this podcast we talk to Adam Kucharski, and epidemiologist from the London School of Hygiene and Tropical Medicine, who has used disease modelling tools to look at fake news spread, and has some ideas about creating an online social distance. For more covid coverage www.bmj.com/coronavirus

Big data is being crunched to help us tackle some of the enormous amount of uncertainty about covid-19, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. In these podcasts, we're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week. (3.10) Calum Semple, professor of outbreak medicine at the University of Liverpool talks about the ISARIC project - predesigned research brought off the shelf and deployed during a pandemic. (14.20) Ben Goldacre, doctor, researcher and director of the EBM datalab at the University of Oxford, joins us to talk about how his team have managed to pull together records from 40% of NHS patients to look for patterns in covid-19 morbidity and mortality. Reading list OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1 Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1

If you’re a regular listener to our podcasts, you’ll have heard how Covid is exposing the cracks in our systems of healthcare - from showing how poorly provisioned elderly social care is, to how antibody testing issues have exposing how innovation is uncoordinated and driven by the worst bits of the free market. In this podcast we talked to Soumya Swaminathan, the WHO’s first Chief scientist, and ask about how the world’s foremost normative body for health tackle some of this issues. We talk about agenda setting - and how the WHO is trying to prioritise neglected areas of research, how they’re starting to set standards for evidence driven by public rather than commercial priorities, and how, if and when a vaccine for corona virus is finally created - they can help it be distributed equitably, rather than to those with the most money to spend.

The first peak of the pandemic has passed, the situation in hospitals is more manageable. While healthcare workers are preparing for the long haul, Abi and Cat discuss how to deal with this period of post-crisis crash. In this podcast, we speak to Ali Milani, a former Labour politician who ran against Prime Minister Boris Johnson in his London constituency during the 2019 election. How might Milani’s experience of a year-long campaign and fallout compare to the current post-emergency stage of Covid-19? www.bmj.com/wellbeing www.bmj.com/coronavirus

We’re at the point in the pandemic that restrictions on the way people live and work are being relaxed around the world, but how that changes safety for the population is very different depending on your demographic - will you have to work with other people, will you have to take public transport to work, and can you wear a mask in public safely? To talk about the importance of not neglecting those most affected by covid-19 we’re joined by Kathleen Bachynski, assistant professor of public health at Muhlenberg College and Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London For all The BMJ's covid coverage www.bmj.com/coronavirus

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (1.20) Carl gives us an update on the England and Wales admission data. (3.00) Helen talks about ways in which spread and severity of infection amongst household contacts. (8.20) We talk natural history of covid-19, and Harlan Krumholz, cardiologist at Yale, tells us what we know, and why it's difficult to have a full picture at the moment. (15.10) Helen picks up on a study from Tim Spectre and colleagues using an app to track cases. (20.00) Henry Scowcroft, one of The BMJ's patient editor, who also works for Cancer Research UK, joins us to talk about patients who are taking part in clinical trials, and how this is affecting them. He also touches on the thin patient participation in the design of covid treatment guidelines. (24.10) Carl talks rapidity of publishing, and where researchers should most target their evidence outreach. Reading list: Reducing risks from coronavirus transmission in the home https://www.bmj.com/content/369/bmj.m1728 Rapid implementation of mobile technology for real-time epidemiology of COVID-19 https://science.sciencemag.org/content/sci/early/2020/05/04/science.abc0473.full.pdf The BMJ Public and Patient participation twitter chat https://twitter.com/hashtag/BMJdebate

We are more than six weeks into the lockdown and if you were to gauge the mood of the nation, it would be one of fatigue. It started as an all-hands-on-deck emergency situation, but it now transpires that the current work situation for healthcare professionals is not going to change any time soon. This is a marathon rather than a sprint. So how can we better look after ourselves to cope with this new realisation? In this podcast we speak to Dr Caroline Walker, an NHS-based psychiatrist and therapist. Wait til the end for Caroline's simple technique she uses to help when feeling overwhelmed. Read Caroline and Clare Gerada's opinion piece https://blogs.bmj.com/bmj/2020/03/31/extraordinary-times-coping-psychologically-through-the-impact-of-covid-19/

In this week’s episode, we discuss bystander guilt, convergence, brain hacks and “how you can sneeze on someone’s brain from anywhere in the world”. How can GPs cope with the myriad worries around treating patients during the current pandemic, both on the frontline and in general practice? How do we recognise and break unhelpful anxious behaviour habits and stop fixating on the news? Our guests:
 Monica Schoch-Spana is a medical anthropologist and a Senior Scholar at Johns Hopkins Center for Public Health. She specialises in crisis and risk communication, community resilience to disaster, public engagement in policy-making and public health emergency preparedness. Jud Brewer is an addiction psychiatrist and neuroscientist, specialising in anxiety and habit change. He is the Director of Research and Innovation at Brown University’s Mindfulness Center, an associate professor of behavioural and social sciences at the School of Public Health at Brown, as well as of psychiatry at the university’s medical school. Reading list:
 Monica's blog on the psychological impacts of covid-19
 https://blogs.scientificamerican.com/observations/covid-19s-psychosocial-impacts/ Jud's article in the New York Times
https://www.nytimes.com/2020/03/13/well/mind/a-brain-hack-to-break-the-coronavirus-anxiety-cycle.html GP course: https://drjud.com/health-care-provider-course/ Youtube animation of the NYTimes article: https://www.youtube.com/watch?v=900cOKCADIk&feature=youtu.be Youtube coronavirus daily videos: https://www.youtube.com/watch?v=w4NwsyXRbNw&list=PL6sRqjtLfiTTni7oXKpSj2cQ9290lkpKH

As the pandemic plays out - hospitals are reconfigured to increase critical care capacity, outpatient clinics become virtual, and elective procedures delayed. How are these affecting care for those who are in hospital but don't have covid-19? In this podcast, Matt Morgan,honorary senior research fellow at Cardiff University, consultant in intensive care medicine and Partha Kar, consultant in diabetes and endocrinology in Portsmouth, join us to discuss how their working week is changing. Read the BMJ's columns https://www.bmj.com/uk/news/views%20%26amp%3B%20reviews

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you some insight into these issues. This week: (1.10) Carl gives us an update on the UK's figures, and how deaths outside are now being counted. (2.10) When the pandemic slows down, and normal services resume - what should we start doing first? Helen picks up some evidence on what they might be. (6.05) There's a signal that covid-19 may be causing coagulopathies in some patients, and Helen picks up on a listeners request for more information. (11.22) John Deeks, professor of Biostatistics at the University of Birmingham, is leading a Cochrane initiative into examining the evidence around testing, and rivals Carl's rant when he explains how some research is being done behind a veil of confidentiality. (35.27) When there's a lot of uncertainty, and the stakes are very high, then tempers can flare. Vinay Prasad, hematologist-oncologist in the US, and host of Plenary Sessions podcast, joins us to talk about having a good, respectful, scientific debate.

How can we help frontline clinicians? Sometimes medics may feel uneasy or even guilty and that they could be doing more. That was what a junior doctor in Abergavenny in Wales felt and she did something about it. In this podcast, we speak to Josie Cheetham about how she started her initiative to provide support boxes in hospitals for her colleagues working at the frontline, and how that initiative inspired others and mushroomed across the UK.

Around the world, as the covid pandemic plays out, and some countries are starting to ease their restrictions, this narrative of the economy and public health being opposing weights on a set of scales keeps returning - they need to be balanced. But before this, a healthy population is very much seen as being supportive of the economy. So is a pandemic different, or is that dichotomy false. Joining us to discuss are; Martin Mckee, professor of european health at LSHTM Kathleen Bachynski, assistant professor of public health at Muhlenberg College Sridhar Venkatapuram, associate professor global Health & philosophy at King's College London