Coronavirus

While I wanted people to know more about what microbiologists and virologists do, and for our infection expert colleagues to have a higher profile with the public, this is really not what I had in mind. Anyone, anywhere in the world, with internet, radio or newspapers, will have heard of the new coronavirus SARS-CoV-2 that causes COVID-19. We have seen lots of coverage of the science and the biology of the virus, and many of our members have made a tremendous contribution in interviews in print, radio and television media, despite the massive pressures on everyone. 

Finally, journalists seem to be getting the hang of the difference between a bacteria and a virus and hopefully the days of ‘flesh-eating superbug’ headlines are now in the past. Much of the coverage has been helpful in bringing information and advice to everyone. We still have a way to go on the use of antigen testing instead of virus testing, but we are working on it.

We are all acutely aware of the massive workload that this new virus has brought to our microbiologists, virologists, infectious disease and infection control teams, as well as all the biomedical scientists and laboratory staff at this time, in every country. We are also all aware of how this load is likely to grow significantly. You are all very much appreciated for all the additional, critically important work you are coping with at this time. 

The rapid sequencing and development of testing for SARS-CoV-2 is a tribute to the power of our current molecular genetic techniques and the skills and expertise of those developing the testing for this new agent. Public health organisations all over the world have done amazing work in developing tests in short order. While the validation and adoption has caused short-term pain, the relief to laboratory teams of rolling testing out to many other centres will be helpful in reducing the workload from send-away tests, and shortening turnaround times for patients. The pressures on the volumes of testing continue everywhere. Global shortages of consumables are themselves consuming huge amounts of time and effort, and restricting the numbers of tests we can offer in many countries.

Initial development of vaccines has already commenced, as has drug and other therapy development, fueled again by molecular genetic technology. Our virologists, together with the pharmaceutical and diagnostic industries, are providing tremendous support and impetus towards this. Governments have made significant funding available for rapid development of therapies and diagnostics, and I have spent several long nights, along with colleagues, helping with an application for one such call. This coming together of colleagues in joint endeavours to accelerate key developments is one of the few silver linings of this epidemic, as is our close and highly pressured work with government to help deliver the services and developments needed. 

Looking back on the week as I update this article, I have had 32 different meetings (all virtual now) just on the governmental aspects of the UK’s national response related to the epidemic, and we are liaising with colleagues all over the world. Our expertise as pathologists is much in demand and, after some initial concern, I believe that we are being listened to on key aspects of the approach. Governments now understand the key importance of the national health services as the central touchstone for testing and developments. I attend ministerial meetings where progress and challenges are being addressed, and senior College members are also being consulted in other nations. 

We have tried to ensure that not only do the immediate solutions proposed meet the need, but where possible they leave health services in a better place for the long term. One such example is our request for interoperability and connections between laboratories (a key part of our workforce plan), which is now an urgent national priority. It is being rolled out rapidly, with 60 labs across the UK already linked, with more following weekly. Similarly, rapid work on simple coding changes is also going on and, once again, thanks and great credit to all those involved in this informatics work.

Our expert groups have done outstanding work in bringing together the guidance relating to this pandemic at such speed, and to such high standards. We know that our guidance is being used all over the world. The COVID resource hub on the website (www.rcpath.org/coronavirus) has been in constant demand, with more than 30,000 hits in just over a month. It is not just our pathologist experts that have been working all hours and all weekends, but also the College’s Communications team who, with support from colleagues, have been superb in getting the guidance published and the hub up and running and updated. Thank you all.

We have issued updated guidance directly related to suspected COVID-19 for autopsy practice, immunology guidance related to serology, updated home working and digital pathology guidance, and many others. More are in preparation and may be on the site as you receive this Bulletin. Our Vice Presidents, Specialty Advisory Committee Chairs, advisory groups and all their members have been fantastic in advising on and preparing these. Twitter is an extremely helpful medium to get information out quickly and for us to send news of updates, new guidance and government advice, so do consider using this (not just for cat videos). The College account is @RCPath and mine is @JoMartin_path.

Our work with other organisations has been similarly frantic but very productive. I prepared a list of tests we might defer or deprioritise, to free capacity for COVID-19 work. This was refined by colleagues and it has been used as national guidance in association with NHS England, the Association for Clinical Biochemistry and Laboratory Medicine, the Association of Clinical Pathologists and the Institute of Biomedical Science. We have formed a coalition with many of the infection organisations to bring together knowledge and support each other. We have worked with public health bodies to help validate and quality improve methods and prepare guidance on procedures such as those used in cell culture in genomics, the use of personal protective equipment, vacuum tube use and many others.

Our Learning team has been extremely busy liaising with trainees and examiners over the need to defer the running of exams. This was a very hard decision, and not one taken lightly. We have enormous sympathy for the candidates who are affected by this, and are supporting them. We are working with other Colleges, educational bodies and regulatory bodies to explore ways to help mitigate the effects of this. We are also exploring how we may be permitted to use modifications to examination methods. Thank you to our Learning team, examiners and the Trainee Advisory Committee, who have all been superb in this difficult work. 

Our Events team has also been extraordinarily busy, looking at converting to a virtual method of operation for our conferences, and making more materials available online. We are looking at a series of regular virtual short learning events, and hope to have news of these shortly.

Being kind

We have seen some fantastic initiatives at this time in support of each other. There is a strong evidence base about how courtesy and kindness can have a really positive effect on team productivity and patient safety. At this time in particular, as pressures mount, the kindness afforded to each other has been really impressive. This has been seen across our teams, disciplines and multiple nations, and is truly heartwarming. 

We’re seeing WhatsApp groups of consultants keeping in touch and keeping each other’s spirits up while they are separated, and the platform is being used to keep in touch with sick colleagues. Social media groups have been set up to support each other, and there are email threads of colleagues asking questions across nations as to how best to deal with really complicated issues, or sometimes apparently simple issues that turn out not to be so simple. Sometimes people are just sharing something that made them smile. (My favourite is an exponential graph: x axis with dates from the beginning of January to the end of March, and the y axis ‘time spent looking at exponential graphs’.) These interactions have been so important in maintaining a sense of positive community and human contact when we are physically separated.

Haematology and workforce

We are delighted to have published the UK haematology workforce briefing. This publication followed the survey we sent to all departments a short while ago. The Workforce team are to be congratulated on the rapid turnaround of this key piece. It is a really important document for us to use to help influence national workforce investment in this key area, and to help advocate for departments to receive the support from haematologists that they need. Do also use this to help support your own job planning and business cases locally.

Our wider effort on workforce for the future has continued with great support from Cancer Research UK and other patient charities. We have continued our work with Health Education England and other national education groups to try to rapidly increase training numbers in some of our most stressed disciplines. This may not be seen as a priority in the context of the pandemic, but without future planning and input into national training planning, we will lose out. 

This time it’s personal

So, I’ve spoken about the pandemic and how we are responding, and about the truly great things we have been doing. I have mentioned how we can support each other under stress. I have also told you about some of the work we are continuing to do to make patients safer and the future better. 

I am all too aware that we are also coping with this pandemic on a very personal level. We have all got friends, family and colleagues who have been affected. We have lost great pathologists, and some of us have lost people very dear to us. We worry about those we love who might still be affected. We worry about not being able to visit our elderly parents, or our children. We also worry about going into work and bringing the infection back to those at home. Many of us have had to change what we do and how we do it completely; some of our colleagues have already gone from the laboratory back to direct patient care. 

It is very unsettling at the moment at so many levels, but you are not alone in this. Do reach out and speak with colleagues as they are a great source of support. Do feel free to contact me. From the very depths of my heart I wish you all the very best.