Well, I think everyone is in from the waiting room and it's gone 7:01 according to my clock. So let's begin. Welcome, everyone. Thanks so much for attending our vaccine information and question and answer Webinar today. My name is Sara Brylyn, and I'm a librarian for Stockport. And I'm a librarian for health and well being, It's wonderful that you're all here with us tonight. We've all been asked on the panel to share something interesting about ourselves. So I will be-- if I have a free moment-- crocheting along while we're having our meeting tonight. So that's going to be on my lap off camera. But also tonight we will be recording the session. So just to let you know, your screen nor your microphone nor your screen name will be recorded. But if you want to put a question in the chat, I will be saying Charles has asked a question. If you'd like your question to be anonymous, that's not a problem. Just direct message the host--that's me, Sara--in the chat and just let me know you'd prefer to not have your name spoken out loud and be part of the recording, Just let me know and I can ask your question anonymously. But if you do have a question, please put it in the chat. I'll be collecting the questions throughout the session so you can start putting questions in now, if you like, and we'll be presenting those to the panel after they've each given us a bit of insight for the evening. That's my bit. I'm your technical host for the evening. I'm going to be handing over to James Ryan, who's going to be your host host for the evening. So, James. James Ryan: Brilliant. Thanks for the intro, Sara, that's great. So I'm James Ryan. I'm the Assistant Librarian at Stepping Hill Hospital, and I'm gonna be quite boring and be a typical librarian like one of my passions is reading and books, and I'm going to do a bit of a plug here. So we've actually started a podcast in the library. So that's one of my, one of the kind of projects we're working at the moment, and it's something I'm really passionate about. So for the session tonight, one of the motivations behind the session is to share reliable, authoritative vaccine information and experiences from a diverse range of trusted people. We wanted to have staff from Stepping Hill Hospital and Public Health England, and to show the extraordinary work that has gone behind the scenes in not only researching and developing Covid vaccines, but also in its rollout. Furthermore, I think some of the speakers today also worked on the frontline during the first wave of the pandemic. I think that's something that was really important. And obviously it's something that we have huge respect for. And also the hope is that some of the stories shared tonight will read some of those people who still may be a bit hesitant and taking the vaccine. So that's kind of our motivation behind organising the event tonight. So without further ado, I'm going to introduce our first speaker. Who is Dr Baxter. So he's our Director of Medical Education at Stepping Hill. And we can share your screen brilliant. Dr. David Baxter: Come back. Okay. Good evening, Manager David Baxter. I've worked in vaccinations, probably for 30 years. I'm here because I've done some work with a large number of people on getting them a vaccine called Novavax licenced, and we're also currently doing another study on Cov boost. I've only got eight minutes, which I've just forgotten to start. I want to start it now. And so I'm happy to take questions, but I prefer possibly to leave it to the end. if that's, if you're okay with that. So, human beings have been we've had pestilence and plague since time immemorial and one of the approaches that we've developed to deal with pestilence are vaccines. And this was probably the first vaccine. Um.. this is the first vaccine that appeared probably about 300 AD. It's against smallpox. And the child on the left is being vaccinated. And the man on the right is blowing crusts of smallpox. The lesions. You you take the lesions, you powder them up and then you blow them up the nose. And that, that was the first approach to vaccination. We've come some way since then, and this would be a modern vaccine. And basically, we You generally inject the vaccine mainly because the skin a mucous membranes are so good and preventing infection. You inject them to get into cells. The white cells recognise the, in this case, the vaccine and produces antibodies against, uh, against the pathogen. It's not limited to antibodies. There are other aspects of the immune response. But if we focus on antibodies, that's pretty reasonable. This lady is an incredible woman, Lady Mary Jane Wortley Montagu. She was the ambassador. She was the wife of the ambassador to Constantinople. She went over to Turkey and she came across this approach. But instead of blowing it up the nose, what they were doing by the time she got to Turkey is they were injecting it, scratching it into the skin. And she introduced this into the UK in about 1715. And she she had her own. It was called Variolation, and she had her own daughter variolated when she came back to the UK. I was asked to talk about the process of a vaccine being licenced. And this is Newgate Prison. This was about 1720 and this was the site of the first clinical trial. Six prisoners were promised their freedom if they were, if they had the variolation process that Lady Mary Jane brought back from Turkey. And if they.. they were told if they survived that was it. If they were fine, that they could go, Okay. And that was the very first clinical trial. Probably wouldn't get through an ethics committee these days, but nevertheless, it was It was the first one. We moved from that. We don't just give one group of people the vaccine. What we do now is something called a randomised trial. Ideally, where half the group who are in the study get the vaccine and the other half get the current treatment or some sort of a placebo, which basically means something that's inert. You then follow them forward in time and you see what happens to them in terms of how, in this case, the vaccine, how the vaccine protect or doesn't, as the case may be. Now, the Novovax study that we've just done we had 15, just over 15,000 people of whom we recruited 768 in Stockport. About 380 got the vaccine. The other 380 got, uh a A vaccine that protected against a completely different disease. We then followed them forward in time and they were walking around living in the community and we saw how many people got disease in the vaccine group. How many people got disease in the in the other vack- The meningococcal vaccine, which would protect. And it was on that basis that we're able to say that this is a high efficacy vaccine. About 90% of people were protected against, were protected against these. Good vaccine. This is more detail. What a vaccine trial will look at, how it will be organised. There are four phases: 1, 2, and 3. And Phase 3 is the one that we just talked about. Um, it's what is called an efficacy study. Where half the people get vaccine, half the people get placebo and you simply follow them forward in time and see how many get disease. At this stage you then.. you then apply to what is called the M.H.R.A. The Medicines and Healthcare Products Regulatory agency for a licence. And we Novavax Novavax was licenced about three weeks ago. And then the vaccine now is used in the general population. Okay, so those are the phases of a clinical trial. And this is... This is doing our clinical trial in Stockport. Our Phase 3 study. Big room. Ee used, uh, actually we used Manchester Rugby Club. And around here, around here, we've got all the vaccinators. This is our equipment in the middle, and we would have a team of probably... I don't know... 12 to 16 groups, people at the table who would be vaccinating or giving placebo. We ran that for about eight, about 16 months. And in fact, uh, Dr Jackson, Matt here was was one of our team. Our team we had about 150 people. So, that was our clinical trial. This is where we are now. This is where we are now. We have more than 300 vaccines in development. Pre- clinical is where you do it. You give the vaccine, you try it out in animals or in the laboratory to see if it's... to see if it works in a laboratory situation. If it works in the laboratory situation, you do what is called a Phase 1 study. In a Phase 1 study, you'll give it to 10 people 15, 20 probably at most. And that is to see whether the vaccine actually works. This is proof of principle and this is effectively your first time you're doing it in humans. This is an experiment to see does the particular vaccine work? So we've currently got 40 vaccines in Phase 1. We've got... Phase 2 is basically an extended Phase 1 where you're giving it to larger numbers of people. And we've got 44 vaccines and when I say we, we globally we've got 44 vaccines. And then... And then the Phase 3 is the randomised trial, and this is pivotal to getting a vaccine licence. So you can see we've got 194 based pre-clinical --animals, 40 in Phase 1, 40 for Phase 2 and 40 in phase 3. So a lot of vaccines are in development. Currently, we've got 23 being used, and these are just different types of vaccines. I won't go into the different types. I'm not sure how how relevant that is, but I think that's it. So thank you very much indeed. This is... this is what we all aspire to. So the skillful doctor cures illness when there's no sign of disease, and thus the disease never comes. Much better to prevent. It's incredibly important that we have very effective clinical services, but it's equally important that we prevent disease. So I think that's me finished. Thank you. James Ryan: Perfect. Thanks so much, Dr Baxter. That was fascinating. Especially the even early history of the vaccine. And also how you're helping with the Novavax research as well. Really interesting. So our second speaker tonight is going to be Dr Matt Jackson. He's a Clinical Director for the ICU here at Stepping Hill. Matt Jackson: Are you able to show my slides, Sara? Or do you want me to do it? So as James said, my name is Matthew Jackson, and I'm the Clinical Director for Intensive Care at Stepping Hill Hospital. So next slide, please. So who am I? This is a bit of my background and also the declaration of other interests as well. So I'm a father. Husband. Um, I like riding my bike. I tend to ride my bike as much as possible, trying, trying to as few journeys in the car as possible. Musician feels like it's stretching it a little bit too much, but I enjoy... enjoy playing folk music. So I play mandolin and Irish whistle. While being an intensive care, doctor, I've kind of ended up sliding into novel infections. Partly because each year we're... in intensive care we're assaulted with various, uh, flu strains on an annual basis. And I think this became most clear to me earlier on in my training when we had Swine Flu and that... that caused quite a real swell in the number of beds we needed to provide on Intensive Care. That was my first real experience of a novel infection. We then kind of moved on to have, as I developed an intensive care saw yearly flu surges. And, you know, rehearsed using using PPE, isolating patients and dealing predominantly with respiratory failure from those. During 2014/2015, I became a little bit more interested in novel infections and became involved in the research project in West Africa, looking at novel treatments for Ebola. And then kind of used those experiences over the last few years, as I've lead the ICU effort at Stepping Hill to look after the sickest patients infected with Covid-19. Alongside being a clinical doctor, I'm a researcher as well. And I suppose that sort of expresses my my desire and my belief that with rigorous scientific studies, we can find new ways of treating and preventing disease. Uh, so there's a few a few things I just need to here... mention here just as conflicts of interest. So I was a paid consultant on the interest trial, which was a study looking at severe, new treatments for severe respiratory distress syndrome. I was a team leader on the Ebola Rapide trial, which was also a paid position. And I've worked with Dr Baxter on the Novavax trial, which I had a small amount of paid money for my time back. Unpaid work at Stepping Hill: I've also been the principal investigator for the genomic study, which is a study looking at genetic trends in people who have the worst, the worst outcomes from from Covid-19 and end up on intensive care. Next slide, please. So, hopefully over the next few minutes, I want to just briefly talk about what is intensive care. What's Covid-19 on intensive care looked like. In truth, you don't really want to meet me in a professional capacity. So what sort of things can you... Can you try and do to avoid meeting, meeting me on our intensive care unit at Stepping Hill? And finally, just just a brief acknowledgement of the thanks for everyone who supported us over the last two years the next night. So intensive care is a specialist unit in hospitals, and it's where we look after the sickest patients. These are patients whose bodies are failing them, and we have a variety of specialised machines and drugs to, to essentially take over the functions of the failing parts of the body. We have really high staffing ratios. So, we typically have one nurse looking after one patient because the workload in looking after someone that sick requires real, really intense workload. And we tend to have more doctors on on the unit than you'd see on a normal non-shop floor. So these are two pictures of intensive care units we built during the Covid-19 pandemic. As you can see, um, each bed space is surrounded by lots of equipment, lots of machines. So these pictures were taken just as we'd set the bed areas before we before we commissioned them and got patients in and the next slide. Working during the pandemic. So we suddenly needed to swell the... our workforce because we ended up looking, uh, looking after four times as many patients as we normally look after. You've seen all the pictures of the PPE. So we had to learn to dress up in PPE to keep ourselves safe and try and prevent cross infections between between patients. And we had to move into areas of the hospital. But we don't normally work in for additional space. And we had to recruit staff to work on intensive care who who don't normally work on intensive care. And it was, you know, it was It was a hard period where we saw multiple waves coming to us. And at the peak of the first few waves, we were seeing four times as many patients as we as we usually see. Next slide, please, Sara. So, what were the patients like that came to came to us? Well, by definition, they were all in severe respiratory failure. So they had, they were really struggling with their breathing. Their breathing was so bad that they were unable to cope by themselves. They were unable to cope with the basic ward care that we could do on general wards. So they needed to come to intensive care for high levels of a breathing support, of respiratory support. The graph in the bottom corner there just shows a number of patients we had on intensive cares over time. So the first wave, which is this this first peak here that happened sort of the beginning springtime of 2020. Um, those patients were characteristically overweight, generally diabetic, hypertensive, predominantly male. And that was, you know, that's something that when you look at the data, that's very clear, but also, you know, sort of a more subjective take on that is, when we hand our handovers, they, you know, every patient had a very similar story: struggling with their breathing, overweight. and you know, these patients were often spending 2 to 4 weeks with us. As things progressed, so onto the 2nd and 3rd waves that we had in the in the Northwest, the patients became a little bit predictable. So we were seeing all types of all types of patients coming in. It was no longer the overweight, middle-aged man with diabetes and hypertension. We were seeing quite young people. We were seeing older people. We were seeing a little bit of everything. And then towards Easter 2021 we stopped seeing... admission is coming in waves, and it's kind of just stuck at a constant grumble. And that that was largely due to the advent of widespread, widespread vaccination. And then if you just see towards the bottom part of the graph of the most recent data, we've had a real fall in in admissions. And that seems to be because Omicron is not affecting in the respiratory system as as bad as the other strains had earlier on. Next slide, please. So just thinking about that that data from after Easter 2021 once vaccination was was a lot... It was a lot more common in the population, there was a real sense that the admissionswe were getting to ICU were predominantly unvaccinated. And this data is from from the National ICNARC data set. So that's all the intensive care units submit data to, uh to to this data set. You can see quite strikingly those yellow bars are the predominant number of people that have been have been admitted to intensive care. And they're all unvaccinated patients. Next slide, please, Sara. Intensive care, because because the patients are so sick, we unfortunately see quite a high mortality rate. We tend to see only 70% or so of our patients survive. About 30% of our patients die. And what this graph is showing is, you know, for a typical patient who is admitted to intensive care with Covid-19, how long they tend to survive and and what you can see on this graph is we're seeing. Initially, we were seeing about 57% of patients surviving. And as we've got more treatment options available, thanks to the research that's been done, we've, we're seeing slightly better survival rates. So about 66% of patients are now are now surviving on intensive care. Next slide, please. So, I guess the big question at the moment that we're all facing is What next? This picture was taken, um, I think summer of 2020. So we had the first few waves and suddenly we have no cases on, no Covid cases on ICU. We were able to clear it out, and this was just after we'd fumigated the place. And we were all really excited about that. Things didn't last and we ended up converting this unit back to a Covid intensive care unit again. Just this week, we have again cleared out ICU, and we no longer have any Covid patients on the Stepping Hill ICU. And we're using it just as a non-Covid ICU at the moment. But what's the future? It's difficult to say. We've been here before. Hopefully, I'd like to think that we've seen the end of Covid. But I think, you know, a more sober position is we really just don't know what the future holds in terms of the pandemic. Next slide, please. So I don't know who's going to end up in intensive care. We've seen people who have very poor health coming on to intensive care. We've seen people with really good baseline health handing a ended up on intensive cat. I do know the sort of things you can do, though, to improve your chances of not ending up in intensive care. And they are the public health messages that you have heard time and time again, about healthy diet, good amount of activity, maintaining a healthy weight, having healthy rest, avoiding smoking and alcohol, good personal hygiene. And, you know, particularly for infectious diseases, getting vaccinated against conditions that are going to bring you into intensive care. So Can I just have my last slide, Sara? So I just want to say a big thank you to ICNARC who have provided the graphs that I presented in this presentation. So that's national data from across across the UK. Big thanks to everyone at Stepping Hill, who's worked on the unit during the pandemic. And then people and businesses of Stockport for following the rules and mitigations that have been been around for the last two years. It's really, really helped reduce admissions into the hospital and intensive care. And, you know, thanks for all the support that we've had from people, you know, sending us well wishes and gifts. That's been really much appreciated. Thank you. James Ryan: Thanks. Very much. Matt, that was absolutely fascinating. And itwas so good to just get an insight into what's actually happening in theICU. Really interesting. So our next speaker is going to be Ben Fryer, who is a Consultant in Public health in Stockport. Ben Fryer: Thank you. Let's just see if I can manage to share my screen. Has that worked for everybody? James Ryan: It's all good. Ben Fryer: Lovely, Thank you. So I'm just going to similarly start by introducing myself. So I'm Ben and as well as being consulted in Public Health, I'm a father, husband and also a keen cyclist. So, Matt and I find new things about each other this evening that we didn't know before. You can see, I've chosen to put a photo with my two little girls and my wife in, and also one of the mad contraptions I use for dragging them around behind a bicycle. So, I don't know how clearly that's coming across, but there's a kind of two kids seats there on a trailer that I tow behind the bike. And that's how we get around at the moment. They love it. Well, they love it in good weather. Like the lovely weather in that photo. Not so much at the moment--they prefer to go in the car. So I'm a Consultant in Public Health. When this pandemic started, I was a Public Health Registrar, training in public health. I've therefore worked in a few different organisations during this pandemic. I was working for NICE when the pandemic started. I then started working for Public Health England and had some involvement in interviewing the first few cases. The skiers returning from Italy, they mostly were and then have kind of followed the pandemic through its local authorities. So I now work in Stockport Council but also work with the CCG and the rest of the NHS. I'm currently the main lead for Stockport's vaccination programme in the primary care system. So I'm going to show one very, very complicated graph and I wanted to show this graph not because it's the easiest graph to explain--though I'm going to have a... make an attempt at explaining it-- but because this graph for me tells the story of the pandemic. This graph... I'm just going to introduce how to read the graph first and then I'll talk you through the story that this graph tells. So on the left hand side is the number of cases reported in Stockport. It's a rate so it's per 100,000 people and it's the number of cases reported in a week per 100,000 people. And that's the two blue lines. You can see the solid line, which is the everybody and the dashed blue line, which is just for those over 60. On the right hand side, we have the number of beds occupied in Stepping Hill Hospital. So it's not just the ICU beds that Matt supervises, but all the hospital beds that have got Covid-19 patients in them at any given time. And the brown line is people who have died within 28 days of a positive test. And when you look at this graph, you see that there are kind of distinct waves to it, and those are the waves of infection that we all experienced, and the shape of those waves is given by lots of different things, both what's happening in the community and how able we are to detect it and measure it. So right at the start of the pandemic on the left hand side, you see that the highest wave is the number of people who are in beds in hospital. And that's because right at the start of the pandemic, we didn't have the testing capacity under NHS Test and Trace that we're now very used to having. And so we actually saw lots of people going into hospital. And we only tested them when they got into hospital to find out that it was Covid-19 that they had. We didn't know in advance of their admission. And then over subsequent waves, from sort of July 2020 onwards, we started to have the testing data to understand the cases that were out there. We still only detected maybe a third to a half of the total number of cases because lots of cases never got any symptoms and never went through a test. But testing became much, much better. During the first phase, I was working with Public Health England. A lot of the work we were doing was advising the care homes who were having a really difficult time because most of the care homes had lots of cases in and unfortunately, we saw quite a lot of deaths in the early wave of the pandemic. And what you see there is that the deaths actually exceeded the hospital admissions for a very brief period at the start of the wave that we saw in Stockport. So a really unusual circumstance that you wouldn't expect to see. But we saw it and it was very much real, very much affected people, particularly living in care homes. And many of the people, the older males with obesity with hypertension that Matt described earlier. As the pandemic went on, we had good access to testing, but in the only, well, the late 2020 wave, we didn't have a vaccination programme, or we didn't have a large, widespread vaccination programme because at that time we were just starting to vaccinate the first few people. So what you start to see in December is the waves of cases in the community. Firstly, the two blue lines very much follow each other about, so there's no difference between what the older population are experiencing and what the rest of the population are experiencing. And those waves of infection in the community translate very directly into additional admissions to hospital. But what you start to see from around this point, which is around June 2021 onwards, as we went into what was nationally described as the Third Wave-- and for those in Greater Manchester, it really felt like a Fourth wave-- What we saw was the lines suddenly all moving apart and that moving apart is what we had hoped we would achieve through vaccination and, at the population level, looking at the data for all of the residents of Stockport, what we're seeing is that this very much happened. If you recall, by June we had vaccinated the vast majority of older people, but were only just starting on the under fifties healthy population. And so you see the dotted line-- which is for older people-- very much about half the rates of the solid blue line, which is for the population as a whole. So demonstrating the protective effect. This is protection against initial infection that the older group are getting from the vaccination. But even more importantly, you see that the hospital admissions are lower still and not showing the same steep peaks that we see even for the over sixties. And so that's demonstrating the second effects of vaccination, which is that even though some people who are vaccinated will get symptoms, will get ill, they're protected from severe disease and protected from needing to go into hospital. And then the brown line at the bottom, again, stays quite low during this period. There are some deaths, but not nearly as many as in the previous waves. And again, even for those who become seriously ill, the vaccine continues to have a really strong protective effect at this point, reducing the impact of death. And you could obviously draw another line, which would be somewhere between the orange and the ground line. It's in most cases for ICU admissions. So what this graph shows, in summary, is that, at the population level, vaccines have worked. They have completely transformed how we can manage this disease and given us a way of starting to release some of the really strict lockdown measures that we were living under while enabling, so enabling life to go on really, while allowing the number of people dying and the number of people who are seriously ill to be vastly reduced from what would have previously happened without the vaccine. And other things have contributed to this as well. The new drugs that we now have in hospital makes some difference to the gap in deaths, that reduction in deaths. They don't make a big reduction in numbers of cases, and they don't have a big impact on the number of hospitalizations. But they do have some effect. But by and large this effect is driven by vaccination. So there's lots of different things that we can do to stop a disease causing harm. And what I've done here is just kind of put those things in a hierarchy. We make choices as individuals and as a society about how we're going to try and minimise harm. But in general, what we're trying to do is to choose the interventions that are most effective and cause the minimum of health, social and economic harms. Interventions at the top of this list at the top of the hierarchy are the really effective ones that don't cause too much harm but also tend to enable individual choice. And the interventions a bit lower in the list, perform less well in that regard. And at the moment for Covid-19, vaccination is the thing that has the biggest impact for the lowest harm. All the interventions have some harm, and we'll never get away from there being some harm associated with almost everything we do. But the vaccinations are as close to the optimal way of dealing with Covid-19 as we can get at the moment. The next thing on the list is very much those healthy, active lifestyles that Matthew Jackson talked about earlier. After that, the medical treatments that I mentioned that we we now have in hospital and we now have in primary care, which makes some difference but not nearly as big a difference as vaccination has made. Social distancing, good hand hygiene and face coverings make some difference They're still effective, they're still worth doing. But we we know from the fact that we've had to have a series of lockdowns that on their own, they're not enough. Testing. Contact tracing and self isolation have had some effect, but again, they're not enough on their own. And lockdowns and other interventions are very effective at controlling viruses, but have an incredibly high cost. And that's the reason why we really need to try and avoid using those measures. We often use an analogy to a Swiss cheese model. The idea that all of these measures have holes in them and if we use multiple measures together, we're able to stop the disease getting through and causing the effects that it sometimes can, and that model is very relevant, particularly for the people who are the most vulnerable to Covid-19. Uh, it feels less relevant to perhaps the youngest children for whom the impact on them of the virus are relatively slight. Most young children, if they get Covid-19, are not severely affected by it, although a small minority, will be. In Stockport we're really lucky to have phenomenal vaccine uptake. We've had a brilliant team of professionals delivering this vaccination process, uh, programme from the hospital professionals you've already heard from through to doctors in our GP surgeries through to pharmacists through to St John's Ambulance volunteers through to Council and CCG staff. So literally thousands of people have been involved professionally in delivering the vaccine programme. And the public have responded brilliantly to that vaccine drive. We've given, I think, over 500,000 vaccines in Stockport so far. So a really phenomenal number of doses and the vast majority of people are now deriving at least some protection from the vaccines that they've had. There's still work to do, and we continue to offer vaccines and continue to work to reach the people who are still undecided and who still want to find out more about vaccines. That's part of what this is about. Vaccine uptake isn't equal. And what we normally see in public health is that the people who have the greatest advantages in life-- people who have more money, the people who have more power, the people who have more influence-- tend to have better health outcomes than those who have less access to those resources. And what we see in Stockport in terms of vaccine uptake. Well, I guess the first point is vaccine uptake is strong. It's over 75% in every small area of Stockport, which is brilliant and really good to see. But the people who have had less vaccine are concentrated in particular areas and they tend to be the slightly less affluent areas of Stockport and there is a real inequality here. And we know that when people who have less time, less resource, less ability to look around and look at all the information that's available, are asked about vaccine, they have more doubts and they have more concerns about it. And it's a really important part of our job to make sure that everybody has equal chance to have their questions answered, and have access to information that might help them to address some of the doubts that they have. And I share this graph not to kind of pick out different areas that have low uptake, but just to make the point that it is really important that we make sure everyone has the access that they are entitled to, to make a decision for them about whether the vaccine is the right thing for them to proceed with. And then finally, every time we have a vaccination information session or a similar event, I always want to make sure people are aware of where they can go to get the vaccine if they want to do so in the next few days. This week we're doing, well. we've been doing 10 different pop-ups in 10 different locations. And anyone who's age 12 plus who is eligible for a vaccine is welcome to come to any of these locations on the next three days to get a vaccine. We are open from 10 o'clock till 2:30 each day at each of these six locations. So a clinic in Heaton Mersey, one in Woodley, one in Reddish, one in Shaw Heath, one in Adswood, and one in Offerton. So those clinics are mostly concentrated in the areas where we know there were lots of people who haven't had the vaccine yet. But anyone from anywhere in Stockport, or even further afield, is welcome to come along. There's no booking required for those clinics. And that's it for me. James Ryan: Brilliant. Thanks so much, Ben. So hopefully with those wall-in centres, we will get over 75%. That would be amazing. So our next speaker is going to be Wie Woodyatt. So she is our research and innovation manager here at Stepping Hill. Wie Woodyatt: Hi. And Sara, you alright to share my slides? Please. Sara Brylyn: Just one second. Wie: Thank you very much. So Hi, I'm Wie Woodyatt. I'm the Research and Innovation Manager at Stockport. And I'm going to take you on a little journey of what happened to me and my team during the last 18 months. Go to the next slide, please. Thank you. So just a little bit about me to start. I absolutely love working in clinical research. It's pretty much what I've donesSince leaving university. I've worked at various Trusts across the NHS, and I've ended up heading up the research service at Stepping Hill for the last five years now. It's been an awful lot of project management over the last 12 to 18 months. And my little team, we support research projects in the NHS, and we helped develop, hopefull,y a strong evidence base behind what does and doesn't work for lots of different treatments, interventions, etcetera, that we see used in the NHS. And when I'm not project managing at work, I'm also doing lots of project management at home. I've had quite busy year. We've moved house and we then decided to get married in November, and we get married next week. We made the decision to get married in November, and we booked it for a few weeks time. So it's been busy busy for me. If I'm not at work and working on pretty much vaccine...well vaccine trials have been my life, probably the last 12 months, I'm usually out and about with my lovely lassie dog. Okay, so I'll take you on to the next slide. So why I'm here. So I'm just going to talk a little bit quickly about the Covid research journey for me and my team at Stockport. And then I'm going to finish with a real account from one of our research nurses who worked on the front line at the start of the pandemic and hopefully will provide a little bit of context as to why research is just so important in the NHS and certainly has been during this pandemic. So back in February 2020 we were tootling along our little team of 12, business as usual. We had about 50 or so research projects going on in lots of different areas from children, gastroenterology, cancer, you name it. I think we were working in about 20 different specialties. And then it felt like a wrecking ball hit us in March 2020 and everything that we normally did literally went on pause. So all of our normal business as usual just halted and we were looking after our patients that we had already enrolled into research, keeping them safe and follow up. But everything else then got thrown into making sure we could focus on Covid studies, and just trying to understand what was happening with the virus. And that was our very first project in research for Covid back in March 2020. Which is this World Health World Health Organisation ISARIC study that's mentioned on my little slide. So this study is... we always can know it as CCPT, which is a clinical characterisation protocol, and it's been around for ages. It's a sleeping study in essence, and we bring it out of hibernation for pandemics epidemics. So we did some work on it for the swine flu and things like that. And obviously when Covid hit, it came out. Today we've enrolled about 1800 patients on it at Stockport and that's mirrored across all the different hospitals in the UK. And all, all we're doing with this study is collecting data. We're collecting data on the signs, the symptoms, looking at blood results for every single patient that's been admitted into our hospital with a Covid positive status confirmed. What this has meant, if you think about that 1800 times by how many hospitals there are in the NHS across England and beyond, that gives us an awful lot of data. And it's provided us with lots of information on how we understand this virus and how we can better treat patients. So the next natural thing that came along because then our treatment trials. So the first one that were involved in was recovery, which was, again, a study that was run across all of the UK. And it involves lots of different arms of treatment. So Dr Baxter mentioned that before different arms of the vaccination studies, and this study has literally had tens. Can't remember we might even get it up to maybe 100 different combinations of arms on this study since we first started. We've tried all different types of drugs on this study to see actually what works well in helping to treat patients. And we found out things like, you know, some simple steroids are nice and cheap to get hold o.f They've been absolutely instrumental in helping to reduce deaths of people who have been hospitalised with Covid. And something as simple as a drug called Dexamethasone, which has been around a long time, this steroid has helped save a million lives globally, and we've also found out what doesn't work as well. So again, that's been really important. And then as Dr Baxter and Matt have mentioned earlier in the evening, We've also been working really hard on some large scale vaccine studies, which is where our journey went in September '20 and then again in May '21 when we took on a booster vaccine study as well. So it really has been very much that the vaccination programme in itself we feel really privileged to be able to work on that our little team in Stockport, but also it's helped us get back tentatively now, as I said, my little circle goes full journey and that we're hopefully back tentatively to business as usual. So that's where we're at. Can I have the next slide, please, Sara? Thank you. And there's an awful lot of work that goes behind the scenes in vaccine research. So we've got here our team. We're small but mighty. I always say that. We're trained, we're experienced. Our core team is 12 to 15 at any point in the pandemic. But I think what has to be really emphasised here is that we had about 180 staff that were pulled all from Greater Manchester, all the different hospitals that all came together to help deliver those one to two vaccine studies. So you'd never normally have that level of resource and to pull on to make sure that a study was successful and run very quickly to get the data that we needed to help with those regulatory applications, to say, to add another vaccine to the population and again, having that huge staff contingency to pull on really made sure that we could see a lot of patients really quickly to keep people safe, but also produce some really good data that's helped inform those regulators, like the MHRA, in making informed decisions about which vaccines work and don't work. So it really is. It's a team that's been behind it, that's been the secret to the success. I'm just going to finish one final side on an account from one of my research nurses. A lady called Bex. If you can just move to the next slide, if that's okay, Thank you. So Bex is shown in the pictures here, and she would have presented this herself. But her experience as a front... she was on the front line at the height of the pandemic, and the experience did leave her with PTSD. And she was, She's happy for me to share that. And she was really wanting this story to be shared tonight, to highlight why research and the vaccination programme has been so important because it has really helped us move on from where we were at the start of this pandemic. So I'm going to read this exerpt, and it is in Bex's words. So I said, I'll read it word for word. I remember I was on a night shift, and my first insight into Covid was when we heard a doctor we knew who contracted it in the hospital, and we knew it was finally here. We were a small unit and we were putting measures in place to make make theatres into Covid ICU as well. We had training on PPE and education on what to expect. I and some of the other nurses weren't scared at the time as we knew what challenges we might come across in ICU, as we've been through challenges like this before. Or so we thought. most recently, the Manchester bomb. February 2020 was when Covid hit our unit, and it was nothing as to what we expected it to be. The admission was fast, and I saw some of the sickest patients I had ever come across my whole career as an ICU nurse. Obviously, we couldn't continue with this by ourselves. So we brought in nurses from all other areas, alongside theatre staff and medical students. A huge number of health care professionals with different knowledge and experiences all came together, but were all so clueless to this new virus. Patients were admitted at all ages, some in their twenties and some in their sixties. There was no significant age group, and how it affected people in different ways was mind boggling. This pandemic was out of control. There were many nurses in tears because they were trying to do their very best in a situation that was literally out of control. But they felt that they couldn't give the standard of care they always normally gave because of the stretched nurse to patient ratios. Usually we work one to one, but this increased to one to four at our busiest. Even for the most hardened ICU nurse, walking onto a unit and seeing so many people who are that acutely sick was overwhelming. It was a really an emotional response, and every one of us really struggled with it. We didn't know the patient, and we didn't even know them through their family in these circumstances. We all found this really tough. The fact that someone was... the fact that everyone was all geared up in PPE made this even more complicated because you couldn't see their faces. But you could tell how someone was doing by their eyes. I made sure I looked at people's eyes to see how they were coping. Some nurses collapsed with exhaustion because of the business on the unit and the PPE was so hot. The masks also made a lot of us, ended up with black eyes and pressure sores on the bridge of our noses due to the pressure of the masks. This included myself. But we had to carry on. The constant sanitising of the equipment with cloroclean smells burnt our noses. And at one point we had to sanitise and share equipment because we had run out. On top of all of that, there was a guilt about your family and loved ones. I was getting home so late that I decided to stay away from home for a week, and then I felt guilty for not being at home. But when I was at home, I felt guilty for not being at work because all the medical staff were feeling the pain. There's a huge guilt for nurses around all of this, and it felt like a no win situation. There was a guilt of not being at the hospital, and then there was a guilt of being there, but not being able to do your best. On top of that, when we were in the thick of it and I was exhausted both emotionally and physically, I convinced myself irrationally that I had Covid all the time and I was taking it home to my family. I just had it constantly in my mind that I was putting them at risk and until I actually contracted it myself and then ended up being an impatient and then got to see all sides from the family, the patient and the health care workers. It was a scary time, but I made it through but felt so guilty for all the patients I cared for who didn't make it. And that always plays on my mind. The clap for carers. Every Thursday I could hear my neighbour banging on pans. I got presents. I got praise and such kind words, but I'm not a hero. I don't like the word heroes. The nurse is battling this crisis, a real people who are working incredibly hard day and night in extraordinary circumstances. It was our job simply at the end of the day, I can only dream of Covid now. I wake up in the night thinking of Covid. All the nurses are the same. Their minds are completely occupied by what had happened. The job I want to love turned into my nemesis, my kryptonite. I couldn't face going back. I still suffer nightmares and the dread of going back to ICU sends shivers up me. Now I'm a clinical research nurse. And even though I did my best to look after the patients in ICU I do feel like my new role has given me an insight on how I can help people further to reduce hospital admissions. Okay. That.. that's it. James Ryan: Wow, that was... Wie Woodyatt: Quite difficult, difficult to read, actually, even though it was not my account. James Ryan: Yeah. Kind of speechless here. I guess I just wanted to thank Bex for just writing that testimonial. And I mean, there's not really much words to kind of to say, really. But thanks for sharing your research journey as well, Wie. And we're going to go on to our last speaker this evening. And last but not least, we got Jan Sinclair. So Jan is one of our Senior Health Care Public Health Nurses. Jan Sinclair: Thanks very much, James. Hopefully you can hear me sorry for the connectivity problems earlier, but hopefully it will all go smoothly. I'm the last one in the in the lineup and and hopefully it will just be a whistle stop whistle stop tour from me. James quite rightly said my role over the Trust is Senior Health Care Public Health Nurse. I've actually been a nurse for far too many years than I care to remember, So it's well over 40 so we'll forget the rest. Um, I also have a secondary job working for a OHID, which is the Office of Health Improvement in Disparities, which was the old PHE. And I work on the physical activity Clinical Champion Programme as the lead nurse for that and have done over the last five years so small introduction as well for me. I'm a mum of five daughters Grandma to 8, great Grandma to one. Have lots and lots of hobbies, which generally are sort of physical activity type hobbies. So running, dancing, Zumba, bit of gym. My very, very happy place that I try and get to whenever I can. And it's a lovely, lovely place called Sirmione in Lake Garda. So if none of you have ever been there, you need to get there. It gives you that good old serotonin levels. So what I'm going to talk to you about this evening, very, very informally, so there's no slide set with my talk, I'm afraid. Consider it is a bit of a nighttime story for you all. It's an experience of a vaccinator based at Stepping Hill Hospital. So my involvement in the vaccination programme here at Stepping Hill started on the first of December 2020. We were one of the first vaccination centres allocated over in the Northwest and in Greater Manchester. So very, very pleased to see us actually being highlighted as one of the big centres. At the time I was part of quite a large team. So when we first started doing the vaccination, the vaccination here, there were 10 vaccination stations, each with a qualified nurse on them, lots and lots of managers. We had lots and lots of training to do before we even started to do the vaccination programme. Our population who were being vaccinated in Stockport at the time were all our staff, or as many as we could get during the first dose of vaccinations. We actually vaccinated at the time quite a wider community of our population in Stockport and that included lots of the specialist school staff. We had lots of care home staff at the time. People like taxi drivers. We had paramedics. So a huge, huge cohort of people all from cross Stockport. So it was a very, very busy time for us. The busiest time we had was a day where we actually vaccinated 600 people. I think that was a bit of a manic day, if I can be perfectly honest with you. But that was a really good thing, and obviously it set a bit of a precedent. So anything that we scored less than that was maybe people thought we were being a bit lazy. But 600 is a little bit too many, I think, for one day, and the other cohort of patients that people we we found was the patients. And the time there was a cohort of sort of elderly care patients who were attending our outpatient departments in Stepping Hill. So I was very honoured to be proud and proud to be part of vaccination inpatients as well as the outpatients at that time. So lots and lots of different cohorts who were lookig out to vaccinate at that time. What it meant for me. Personally, I have to say I felt a really big sense of belonging to something really special, and it was really groundbreaking, wasn't it?, You know, doing the vaccinations for something that was just, you know, for a pandemic was incredibly fascinating to be part of so very, very proud of that. So personally felt very proud. Um, I think my family felt very proud of me. My husband even painted a picture of me vaccinating, took a photograph of me in all the gear, you know, protective gear. And he actually painted a picture of me. And, uh, needless to say, that definitely isn't going on the wall in my house. But he was so proud of me, And, uh and that was something that was quite special. Lots of excitement. Lots of buzz in the vaccination hub when I was first starting doing this. And it wasn't only staff as well being so excited to do it. It was very exciting for the patients as well. So all our staff who were coming in and say the wider community, lots and lots of emotions, lots of people with tears, actually, but tears of happiness. I have to say people were so grateful for actually getting that first vaccination. It was really that honour to be vaccinating people who were really, really grateful and wanting to be vaccinated. I have to say there's lots of self is as well. I think as the programme's gone on, we've not seen too many people doing the selfies in vaccination two and the boosters, but at the time, people having those first vaccinations all wanted selfies, so many selfies taken. So we found that quite amusing but a really positive thing, that people actually want to have their picture taken for prosperity. To have to have that as a as a history sort of and a story to tell people in the future. Obviously, it didn't go without its challenges. And some of the key challenges that we found as vaccinators--while it was obviously a new process for everybody so we had to do lots of training before we were vaccinating in the first place. Lots and lots of questions, some questions we knew. A lot of questions that were probably straight to Dr Baxter, to be perfectly honest, He probably was with the key man to go to for any of our queries. Lots and lots of reassurance needed, Obviously, which goes along with those questions are people wanting reassurance that they felt that you know, they feel like they're doing the right thing, but wanted just to ask lots of queries that they had. Of course, the other thing that goes along with something new was lots of documentation. So lots and lots of time consuming documentation, documentation to take part in, and particularly with each member of staff and any of the other patients that came through. Lots and lots of tick list, wasn't there? Had to ask loads of people questions, lots of questions. So that actually is something that was fairly new to us. And again, coping with the elderly patients was again something quite, quite an honour to be proud of. I have to say, obviously the middle of winter, you don't get somebody just with one layer clothing, which when you're vaccinating them, what you need is just somebody with a short T-shirt on. That definitely didn't happen. There was layers and layers of clothes with some of these people. And I have to say, for some patients, particularly the elderly ones, it was the first time they've been out for months and months, and they were so grateful to actually be coming ou--t coming out and getting the vaccinations. I think some of them actually dressed up to do that vaccination process. So that was actually, you know, something that was quite funny. What's changed? I think, over the period of time that we're doing these vaccinations. Of course, Uh, there's lots of... a lot less of us actually doing the vaccinations. Now our programme at Stepping Hill is just on a Monday and Tuesdays at the moment. And predominantly we are just vaccinating our own staff. Although we have had quite a lot of Dr Baxter's Novavax patients coming through. And so that's been really good that they kept us really busy. We actually now have a lot more efficient processes in place, for us doing the vaccinating nowadays, and what used to be sort of quite time consuming.with us not only doing the tick list, but also inputting data-- that's all changed. We're now doing that electronically, and we also have assistants to help us with that that process of data inputting. So that's an awful lot less paperwork than we had. Of course, as you can imagine, staff are an awful lot more confident in the processes. So, over time we've got used of conversations. We've got used to a lot of the questions that people are asking. So it doesn't seem to be that we were clueless anymore. We've got an awful lot of information stored in our heads nowadays. Of course, isn't there waiting time? So some things have changed in terms of the processes. It's people who have had the first two doses of vaccination, generally we're not having to keep those people around. So again, it's a lot more straightforward for the people coming through. And just a couple of amusing stories, I suppose, from me. For some reason, I'm named JJ, and that stands for Javelin Jan and I wasn't quite sure whether I should be proud of that name. Javelin Jan, Really? But I'm guessing that's because people thought it was quite slick at doing the vaccinations more than that being something of a sport, shall we say. The other thing was on a couple of occasions, and on one particular day, I did actually get it quite wrong that couples who were together were not actually, um, either wife and son or husband and daughter. It was actually that there were couples so embarrassingly enough I got a bit of a nickname of getting really, really wrong when people are coming together as couples. And, uh, yeah, I have to say that was something that I wasn't particularly proud of at the time. But fortunately, people do have a bit of a laugh at these things, don't they? So yes, some amusing stories along the way. But I have to say it's something that I've been really honoured to be part of at Stepping Hill Hospital. And I know the vaccinators who were part of that programme with me have all felt the same thing, really, that we felt like we've been doing the right thing. We felt that it's, you know, it's been really good for Stockport. And as Ben said before, you know about the fact that we've we've actually conquered so many vaccinations during the time that we've that we've been doing them is it just felt so you know, such a good thing to be doing so So that's just a little bit of a whistle stop tour from my perspective of a vaccinator at Stepping Hill. So I hope that I hope you've enjoyed that. Thanks very much, James. James Ryan: Thanks so much, Jan. It's always great to hear from you. And it's always great to get those personal stories as well. And Right. So we've had a few questions submitted before this session today, so hopefully we can get through a few of them. Um, there's not too many questions in the general chat as of yet. Have you received any private, questions, Sara? Sara Brylyn: I've had a question submitted by my daughter so I'll add that one to the list if that's okay. James Ryan: Brilliant. Right. So I guess we'll try and get through a few questions. So, the first one: If the first doses lasted 20 weeks, the boosters 10 weeks. How long will the next booster last? And will we have to get a fourth one? so I guess I'll kind of open this out to anyone who would like to answer whoever's willing, Ben Fryer: Shall I start then? James: Yeah. Perfect. Yeah. If you wouldn't mind. Ben Fryer: Others can add in their thoughts afterwards. Um, the first dose and the booster times. That's how long roughly--and it varies from person to person-- the booster and the first dose have prevented infection. And we have to recognise that vaccines work on a number of different levels. for kind of quite complicated reasons about how the immune system works, that I don't think it's helpful for us to go into here unless people really want us to, Um, and the vaccines have much longer lasting effects against really serious illness, hospital admission and death than they have against infections. So while they in fact resistance to infection is measured in tens of weeks, we think the resistance to death and serious infection will last a good deal longer. But as for will we need to have a fourth dose? We are planning as a country on the assumption that there will be a fourth dose for at least some members of the population. So for the people who are most vulnerable to Covid-19, which are the people who were vaccinated first, the people who are in the older age groups the people with multiple long term health conditions, we do expect we'll be offering a further vaccination. That could be around the Autumn time, and this might be a little bit like the flu whereby we offer an annual booster to vaccinate people against the flu. We think we probably will need to do that for Covid-19. But all of those things have to have a bit of a caveat associated with them. This is still a really new disease. We're still learning about it. We've seen new variants emerging every so often up till now. The disease might settle down soon, or it might continue throwing surprises at us. And we'll have to be adaptable and react to what the disease presents to us. And we can plan on an assumption about what we need to do. So probably boosters for at least some of the population in the autumn. But we remain ready to change our plans if we have to do that in order to prevent serious illness. James Ryan:Great. I'm a bit conscious of time, and we have a few questions to go through. Would anyone else like to jump in or... A shake of heads. That's.. I think you understand. Really well, actually, I'm happy with that. Um, So the second question: A family member who has a history of strokes and cardiac arrests due to the vaccine. What is the likelihood it could happen to myself? Ben Fryer: So, I don't have the precise numbers available. When something horrific, like a stroke or cardiac arrest happens, then our natural instinct is to think about what, what happened at that time and what could have caused it. And my sympathies to whoever it is that asked that question. Who had to cope with the horrendous experience of having a family member seriously unwell with cardiac arrest. When we think about those sorts of quite common events, strokes and cardiac arrests happen all the time to different people in the population They're not as rare as we'd like them to be. We have to reflect that if we're vaccinating everybody in the population, then inevitably some people are going to have strokes and cardiac arrests very soon after they have the vaccine, just through the sheer number of vaccines we're giving and the fact that these things do happen and we can't say without looking into the details of the individual case that that vaccine will necessarily have caused the stroke or the cardiac arrest. What we can say is that through all of the work that Dr Baxter talks about with the clinical trials that we do for any vaccine, before they have approved and through the monitoring that's in place to the MHRA and its yellow card scheme, severe and potentially lethal side effects like those are incredibly rare and affect tiny, tiny numbers. I'm sure it will be a fewer than one in a million people when they have a Covid vaccination. For the family member... If you've had a family member who has had a stroke or cardiac arrest, there are some genetic reasons to think you might be more at risk of those things happening, but not necessarily in a way that's linked to the vaccine. And so actually, what we've highlighted earlier, those various ways of keeping yourself fit and active and making sure that you've in tune with your heart health, making sure you have a healthy diet, making sure you exercise, making sure that you manage your cholesterol, all of those things, having a really big impact on strokes and cardiac arrest, and we'd advise those sorts of preventative measures. But if you have a family member with and have that family history of stroke or cardiac arrest, then you know it's appropriate that you think about your own health and how to prevent similar things happening and address those. I don't know how old the person asking the question is or what their status is. But there are plenty of things that we can do to try and reduce the risk of stroke and cardiac arrest through general prevention and through the various medical approaches that are available through GPs. James Ryan: Would anyone else want to jump in on that one? Dr. Baxter: Yeah I'd like to come in. Is the person on the call? No, it was a question submitted before the session this evening. Dr. Baxter: So the... I think Ben's comment is fine. For an individual, though, we can be a bit more precise than at a general population level. The best thing to do would be tell him to make contact with his GP, and then let's have a chat with his GP and the individual themselves. And perhaps somebody like me. We've done this quite a lot over the last 12 months, trying to individualise risk, and that's one of the approaches that we found that we found useful: asking to speak to his GP. Get to speak to somebody with experience around using Covid vaccine, and then we can we can make it. We can individualise the risk, and it generally works out quite well. I agree with quite a lot of things that Ben said then about low risk and things like that. But it's... you can get more useful information to the individual. James Ryan: Right. I might move on to the next question. Why is the number of deaths with only Covid listed on the death certificate so very low compared to number of deaths within 28 days of a positive test? Ben Fryer: Again, I don't mind attempting to answer this question. When a death certificate is completed, the doctor who has completed that death certificate has to have a reasonable level of confidence that something that they list on the death certificate has actually caused that death. And so while lots of people have died within 28 days of having a positive test, very regrettably, many of those people will have had long term conditions which will be at least equally responsible for their death. Covid-19 has killed people who have no pre-existing conditions, but very often there are other things that are equally, if not more important, to list on somebody's death certificate. Increasingly, because we see, and particularly in the last wave, the Omicron wave because we've seen such large numbers of infections, many people have died with coronavirus rather than from coronavirus. So that gap between the number of people who have Covid listed on their death certificate and the number of people who die within 28 days of a positive test is really growing as death with Covid starts to become considerably more common than death from Covid. James Ryan: Anyone else want to jump in? Matt Jackson: I've just put a link on the chat, to the Office of National Statistics' answer to the question, which is very, very simple. Well, almost identical to what Ben was saying. It's just a different way of looking at things, you know. The question is, has someone died of or died with? So there's that link to the Office of National Statistics. It's...the answer is about nine months old, so it doesn't have more recent Omicronn experience that we're having at the moment, outbreaks. It's a really good, really good a little article just looking at the background. James Ryan: I think like the Covid, it's the answers are complex. They're never quite black or white. So I'm going to ask our last question that was submitted earlier, and hopefully we'll be able to get to Anthony's question as well. So the last question we've been submitted is: What is Stockport doing to make the vaccine programme accessible for people with special needs who have severe needle anxiety? My autistic son wants to have the vaccine to protect him and others, but all he's been offered so far is a quiet room with staff who would treat him patiently or an application for medical exemption certificate, neither of which meet his needs. Ben Fryer: So I think again, that's probably a question that I should answer. So Dr. Baxter: Can Ianswer that Ben, rather? Ben Fryer: You can certainly start with that, David. Dr. Baxter: So is the person on? James Ryan: No, again, it was a pre-submitted question, but if they're on the call, I mean, I'm sure they can put some contact details in the chat if they're comfortable doing that. Dr. Baxter: Okay, so we actually have a service in Stockport that's run by Carrie Heal, h e a l And she's a paediatrician. She works in Paediatric Unit. She runs a clinic and she does see children with severe needle anxiety. We also have a really good play scheme team, that are very helpful in this situation. I probably want to know: Has the son here been referred to a service like that? Because it does run well and Carrie is an excellent paediatrician. And I used to see a lot of children with autism in my clinic, and it really is quite a... It can be quite disabling, but in appropriate hands, with people like our play specialists, a consultant who knows how to deal with children with autism, you can actually deliver a service which is both effective, and hopefully it should enable the autistic-- I don't know whether it's his or her-- autistic son to have the vaccine, but that service is there. Sara Brylyn: I've been in contact with the parent, and I've said I would pass along the details if they weren't able to be here tonight, so I'll be sending that along. They'll be happy to hear it, I hope. Dr. Baxter: well, Sara, it should go through the GP. And it should then go to Carrie Heal c-a-r-r-i-e h-e-al Sara Brylyn: Thank you. I'm sure that will be very welcome. Information. Those were the questions that we had received ahead of time. But we have had a few that have come through the chat. So the first one was from Anthony, and he say:, Hi. My brother has lymphoma. Very ill. Still up and about, though chemo is finished, I see him three or four times a week. I go in his home, observed social distance and in a bubble. I've started doing daily lateral flow tests on myself. Am I wasting tests? Or is it a reasonable precaution to protect my brother? Dr. Baxter: So Is Anthony on? Sara Brylyn: He he did put the question in the chat. I don't know if he's still on, but he was here this evening. Yes, I see. I think, I see an Anthony on the list. So I think he's here. Dr. Baxter: So there's I don't know if, Matt, you want to say anything first, because I'm sure you have more more familiarity with lymphoma, and seriously ill patients that I have, But is there anything you want to say or do you want me to sort of give a sort of view about how you might manage? Matt Jackson: I was going to leave it to you actually, David. I can can say a few things after you if you want. Dr. Baxter: Okay. Okay. So, Anthony, I think, right, what you're doing seems very appropriate to try and protect your brother. I'm assuming that you've been vaccinated. Um, I wonder if your brother has been vaccinated. I'm assuming that everybody in the local family has been vaccinated and that you're all protected and everybody knows that they shouldn't be turning up to your brother if they're symptomatic. I'm rather hopeful that your brother has actually been vaccinated and I was listening to Ben's response about vaccines and boosters and actually, we do have a fourth vaccine programme. But it's only for people with who are severely immunocompromised. Which again Ben mentioned. But I think it's, it really is appropriate that if and when he can have a vaccine, he is vaccinated and that everybody that comes into contact with him is advised about infection control and is also appropriately vaccinated because again, as was mentioned, the vaccine is... the vaccines, because there are several vaccines, are really good at both preventing hospitalisation and death but also reducing transmission. So are you wasting to test? No. Is it a reasonable precaution to protect my brother? I think it's one of the things you should be doing, but it's not the only one. Don't know if there's anything you want to add to that, Matt. Matt Jackson: No, I completely agree with what you've said there, David. I guess my perspective is thinking of the analogous situation we have in intensive care where we have relatives visiting desperately sick patients with compromised immune systems. And those are exactly the sort of precautions that we're advising encouraging people to be vaccinated, reducing social contacts, maintaining social distancing, good hand hygiene, wearing masks in public places. And I suppose you know something that strikes me within the home environment is just trying trying to maintain ventilation. I know it's not very, very easy at this time of year with the cold, but just, you know, keep trying to keep the distance and ventilation as well. Dr. Baxter: And last thing Anthony, If there's very, very little influenza in this country, please make sure everybody's vaccinated against influenza as well, even though there's very little around, it's well worth it to. All those measures are incremental, but they should hopefully protect your brother. And, yeah, I trust I trust you or someone spoken to his oncologist about him being vaccinated as well. Sara Brylyn:Were there any other answers that people wanted to say anything for Anthony's question? Ben Fryer:I just, uh I guess I should just add a testing is one of my other lead areas. I would absolutely agree with what Matt and David have said. And just another note to add. There's going to be lots of changes to the testing that's available to us all as members of the public as part of the government's living with Covid strategy that is currently pencilled in for publication next week. And one of the things I'll be looking for when I see that strategy is how we continue to make sure that testing is available to support people in your situation who are using tests to try and protect somebody who is particularly vulnerable. And that, in my view, is the most important use of testing that we have and something that I'd like to see continue. Sara Brylyn:Okay, Thank you Dr. Baxter:Just to say Anthony's actually responded, so thank you. All vaccinated. Follow good practise. Thank you. So what I get from that, Anthony, is that you and the family are vaccinated. Excellent. I'm not going to ask you if your brother's been vaccinated, but I'm sure if you're speaking to his oncologist, they will be giving him the appropriate advice. And then you've also got there. You're following. He's been vaccinated. Great. Okay. And he should have a fourth dose and keep in touch with his oncologist about future doses because we're while hard, While four billion people in the world remain unvaccinated, there's going to be variants popping up on a regular basis that will potentially lead to perhaps very restricted outbreaks and more extensive outbreaks. I think we... this disease isn't going anywhere. It's now part of what we call our endemic viruses and viruses that now transmit all the time. It's part of that programme, not programme is part of that environment, and we're going to have to be, we're going to be living with this for a number of years before we get under the sort of control that Ben was... that Ben mentioned but I'm sure we will get there. Uh huh. Yes. That's a plea for a more equitable distribution of vaccine on a global level. Sara Brylyn: Great. Thank you. I am conscious of the time. I don't feel like we have time to give any more questions a full, a full answering. There are a few that were submitted that we didn't get to tonight. So if that was one of your questions, I will be sending it out to the panel and requesting a typed answer, if that's okay, panel? If we can just get answers out to people who asked a couple that we couldn't speak to tonight. But on behalf of myself, Stockport Libraries, James, I'm sure you agree, everyone from NHS thank you so much for being here tonight and everyone who's stuck with us through the evening. Thank you for being with us. I hope you found some fascinating information. I certainly did. I hope you got some answers to questions that you had. And thank you so much for being here. And panel-- Thank you so much for your time and willingness and your energy and your evening that you've invested with us. And you've been willing to share your personal stories and your knowledge and your professionalism. So on behalf of myself and the libraries and everybody tonight, thank you and good night. Everyone joining in: Thanks very much. Thank you. Everyone. Have a nice evening, everyone. Bye!