10:50:56 From Michael Trimble : Great introduction. I'm off to an NI regional ethics forum. Will hopefully re-join later. 11:15:55 From Julie Stone : Presumably we can speed up the process side, but can we speed up how fast clinical responses show up and that the response is due to the intervention? 11:17:17 From Pirashanthie Vivekananda-Schmidt : There have also been recently concerns that people who have just had the vaccine are tested and test positive,,,,,,but it isn’t recognised that this is because of how recent their vaccinations is. 11:19:21 From Pirashanthie Vivekananda-Schmidt : Sorry I appreciate not the current focus of session. 11:20:50 From Julie Stone : We need to be honest, and govts need to be honest about what is evidence and what is political decision making. If we are shortcutting length to observe side effects, for example, this should be part of open debate 11:21:37 From chantalpatel : my mother in law has tested positive despite having the vaccine.. she has not been able to take up the second dose as she has been very unwell..she is slowly on the mend 11:24:43 From Suzanne Shale : Do we know how long the vaccine protection exists for, as it hasn’t been possible to trial this for any length of time. Anyone know if there are scientific answers to this that don’t rely on time to test empirically? 11:28:10 From Julie Stone : Has there been coproduction and community engagement in spreading available vaccine to move to single dose? 11:32:09 From Julie Stone : Part of 'the problem' is that there is diminished trust about the government basing policy on 'the evidence' e.g. David Nutt, Misuse of Drugs 11:35:32 From Bryan Vernon : On Suzanne Shale’s point, yesterday PHE said there was evidence for 5 month protection. 11:38:20 From Paquita de Zulueta : Re mRNA vaccines (Pfizer/Moderna) I quote the Lancet 13th Jan Cavaleri et al”: “No clinical data at present that would confirm prolonged protection after first dose beyond the intervals studied in clinical trials” [19-42days]. “Additionally, the levels of neutralising antibodies elicited by the first dose of these vaccines is low, which would call for caution with respect to the possibility of reduced protection the longer the second dose is delayed and given the possible rapid emergence of vaccine escape variants of SARS-CoV-2”. These concerns are echoed by virologists/infectious disease specialists. The short term gain of prolonging booster dose may be outweighed by the development of a ‘vaccine resistant’ virus mutant &/or vulnerable believing they are protected but actually getting secondary serious infection in the interval leading to overall more disease/deaths. Any comments? 11:38:49 From Hugo Wellesley : Is there evidence of a reduction in people volunteering for research after high profile problems - eg in Frimley Park with the biological agents? 11:39:34 From Dita Wickins-Drazilova : It seems to me that the approved COVID-19 vaccines are presented by the UK government and mainstream media (BBC etc) as having no or tiny risks and huge benefits. People who have doubts are being ridiculed. But it seems to me that this is all still very uncertain. Is there thorough research following long-term side effects etc? 11:40:22 From Julie Stone : Paquita, yes, a comment - where is the strength of holding truth to power over this? Where is the voice of ethicists and, significantly, a unified clinical voice? 11:41:52 From Jo : i thought there had been a rise in volunteering for research trials after Northwick Park https://www.bbc.co.uk/news/health-22594635 11:41:54 From Pirashanthie Vivekananda-Schmidt : I especially like th epoint about being weary about leaning too much towards paternalism @ Miike Parker and thee complexities around establishing acceptable boundaries off risk. 11:42:31 From Bryan Vernon : In a situation of uncertainty, we can’t demand a unified clinical voice 11:43:16 From Pirashanthie Vivekananda-Schmidt : Fair point Bryan. But I agree wtiih Julie that there is a lot of populism that is damaging confidence? 11:44:06 From charlotte :D : I seem to remember, after the Frimley park, volunteering for research participation went up (because people became aware that you could get 'paid' to participate in medical research) 11:44:15 From Suzanne Shale : Mike’s last point on slow vaccine development - we’ve only got this vaccine now because it was widely tested in global south among very unequal populations - the BBC podcast ‘How to vaccinate the world’ had some very moving interviews with South African test volunteers. We owe them a lot. I think we should find ways to make people, especially in BAME communities, aware of how they took this risk on behalf of us all. 11:45:07 From mekber : Interesting ethical question about vaccines is whether individuals get a choice between the three vaccines we now have in the UK?? 11:45:43 From Julie Stone : A unified clinical voice THAT THERE IS UNCERTAINTY, but that the govt's political choice is outside protocol. Trust feels in short supply. And yes, Suzanne, sharing benefits and burdens... 11:45:50 From Berenike Baechle : @mekber: as far as I know, we do not get a choice. 11:46:46 From Bryan Vernon : Yes, agreed Julie 11:46:47 From Dita Wickins-Drazilova : The only choice we have is that we can refuse the vaccine that we get offered. 11:52:19 From Raanan Gillon : major ethical concerns as Maarion says about the potential biases built into AI derived 'data' 11:52:59 From Julie Stone : https://cybernews.com/news/chinese-tech-patents-tools-that-can-detect-track-uighurs/ 11:53:50 From Paquita de Zulueta : Yes there is data that the longer interval may be OK with the AZ vaccine but not the unstable mRNA vaccines. Even if the vaccines can be ‘tweaked’ the billions already manufactured could then be of reduced/no efficacy before this can be done. The flu vaccine - I believe- is changed on an annual basis. My understanding is that a shortage of vaccines is driving this regime change, but we are not being told by the government what exactly are the ‘distribution problems’. In my view, there is an opacity and paternalism that is definitely not in the spirit of co-production and community engagement. 11:54:50 From Julie Stone : Can we circulate the chat after the event please 11:56:41 From M Oswald : If interested in data-driven approaches to Covid-19, please do get in touch: marion.oswald@northumbria.ac.uk @omddac @Marion_InfoLaw 11:56:53 From Suzanne Shale : agree with Mike strongly 11:58:11 From John Chisholm - British Medical Association to Phil Greenwood(Direct Message) : Mike is absolutely right about the UK's obligations to ensure fair international distribution of vaccines - despite the context of the shameful decision to reduce UK overseas aid. 11:59:38 From Silvia Camporesi : Thank you for some great chairing Emma! 11:59:47 From Suzanne Shale : Agree, great session. 12:00:02 From Julie Stone : Thanks very much to all. 12:00:08 From Bryan Vernon : If anyone is unhappy for the chat to be shared, can you indicate this and we can edit your comments out. I hope an implied consent process will be forgiven! 12:00:17 From Freddie Stourton : What Mike says about “take the once you’re offered” is quite interesting - I know a lot of people, mostly HCP’s, who are very keen to only take one particular vaccine. 12:00:36 From Michael Parker : I’m very happy for my slides to be shared 12:02:53 From Suzanne Shale : Given that HCPs already have to have some compulsory vaccination what do people think about covid (or indeed flu) being mandatory? 12:03:50 From Silvia Camporesi : Same about my slides. 12:05:44 From John Chisholm - British Medical Association : I too am happy to share my slides, and the text of my talk, which will include some material that I omitted when speaking. Phil has the slides and I will send him and Bryan, today or tomorrow, the text. 12:05:59 From Michael Parker : I’m personally not against mandatory vaccination. However, the main priority has to be which approach is going to lead to the biggest uptake. I wonder whether a concerted co-produced campaign emphasising the value might work best. Also, would compulsion impact trust longer term? 12:06:40 From Dita Wickins-Drazilova : Freddie, do you know which vaccine people usually prefer and why? 12:08:22 From M Oswald : the potential biases built into AI derived 'data' that Raanan mentioned in the chat is something that we're very interested in, particularly around potential applications like cough detection apps that might in the future be incorporated into screening processes, based on machine learning research 12:09:53 From Paquita de Zulueta : I agree with Mike but note that there are religious objections to some vaccines which were articulated by the chaplain in our clinical ethics committee. 12:10:20 From Freddie Stourton : To be honest Dita, the vast majority of people have been jumping at the chance to get a Pfizer jab (I certainly did!). However there’s been significant discussion where people would prefer the Oxford AZ jab. There’s been a lot of discussion about various side-effect of Pfizer, not least questions about fertility 12:12:16 From Dita Wickins-Drazilova : Thank you, Freddie 12:13:16 From zareen : Participants in the Oxford trial once unblinded have expressed a preference to have the oxford vaccine if they were in the control group (meningistis vaccine). A number of Oxford participants were healthcare professionals who had to be unblinded as part of the national/trust guidelines to get vaccinated. some of the thoughts from participants once they have been unblinded (and found to be in the control group) is that the effort they put in for the trial would colour thier preference to have the oxford vaccine. 12:13:53 From Freddie Stourton : The “no information about effects on fertility” has had a huge effect on people’s perception of the vaccine. I was discussing it yesterday and was told by someone they didn’t want the vaccine as they wanted to get pregnant and the vaccine can cause placental abruption, which I don’t think is a known side effect of the vaccine but can be caused by thrombotic effects of COVID!! 12:14:41 From Julie Stone : The question of mandatory vaccination is really interesting, especially as no other vaccines in the UK are mandatory. Restrictions on travel/employment without having been vaccinated may be the preferred route. But we do have to factor in and address the relative lack of trust in government now v. previously when mass vacc projects were initiated. 12:15:19 From Freddie Stourton : Thanks Miranda for a fantastic talk! I don’t think the impostor syndrome goes away when you qualify unfortunately, it certainly hasn’t for me just yet! 12:17:16 From John Chisholm - British Medical Association : Freddie and Miranda - the imposter syndrome indeed never goes away. All of us find ourselves in situations where others have far more knowledge than we do and we wonder what we are doing there - and in situations where the reverse is true. And thank you, Miranda and Hasnain, for your contributions. 12:18:04 From zareen : would making vaccine mandatory alienate the the pockets of people who already have a distrust of research? A number of people won't even wear masks despite the evidence- making vaccine madandatory when a non-invasive intervention is not being adhered to would serve to create further lack of compliace. 12:18:32 From Pirashanthie Vivekananda-Schmidt : Only mandatory to HCPs Ii think. @Zareen. 12:20:05 From Kathryn Mannix : I am so proud that young people like these want to join the medical profession. Wow. 12:21:50 From Richard Huxtable : Brilliant, thanks Miranda and Hasnain, for your presentation and all your contributions (also: lovely slides!) 12:21:52 From Julie Stone : Fabulous presentations. Having to leave conference for a meeting, but incredibly inspiring. Thank you. 12:22:27 From Pippa Sipanoun : All credit to you both! You are amazing! 12:22:46 From Bryan Vernon : Mandatory vaccination seems harsh, but the un-vaccinated can reasonably be deprived of certain privileges, like where they are employed. 12:22:47 From Suzanne Shale : Fantastic dual presentation, thank you. I’d be interested to hear what you would like to tell the GMC in light of your experiences (I’m a member of council) 12:48:40 From Berenike Baechle : @Bryan - didn't someone say earlier that some vaccinated tested positive after the first shot and that we do not know at this moment in time that this is definitely not related to the vaccination? So until we know that that the vaccine definitely has nothing to do with it, that clean air might not be provided by vaccinations yet.. ;-) 13:02:28 From Agastya : Still considering the huge population of India with diversity, India did remarkably well in terms low infectivity and deaths... Dr Amit Patil 13:08:04 From Bryan Vernon : https://www.nature.com/articles/s41591-020-1015-0 13:08:45 From Agastya : What happened to Non-COVID patients especially suffering from end stage malignancy or kidney diseases etc, amidst COVID pandemic?? Were they ignored from right to treatment? 13:13:09 From Suzanne Shale : Absolutely fascinating - thank you! 13:13:17 From Pirashanthie Vivekananda-Schmidt : Thank you for sharing your experiences so Frankly. @Mary Matthews 13:15:07 From Mary Mathew : My email should you wish to contact me 13:15:40 From Mary Mathew : mary.mathew@manipal.edu 13:24:23 From Silvia Camporesi : International perspectives on covid-19, Journal of Bioethical Inquiry Symposium: https://bioethicalinquiry.com/symposium-social-and-ethical-implications-of-the-covid-19-pandemicpart-1/ (disclaimer: it includes also a view from lockdown in Northern Italy) 13:36:23 From Paquita de Zulueta : Thank you both for really interesting and thoughtful talks. 13:36:54 From Pirashanthie Vivekananda-Schmidt : Thank you. Good to have the opportunity to hear your experiences. 14:11:48 From Pirashanthie Vivekananda-Schmidt : Your slides are not being moved down? 14:11:58 From Richard Gibson : Not sure if it's just me, but the slides haven't moved on from the first one. 14:12:03 From Pirashanthie Vivekananda-Schmidt : Yes correct. 14:19:58 From Suzanne Shale : I work in a mental health trust. Might be worth summarising what we’re seeing. Acuity of people who had eg psychosis appears worse, so our inpatient mental health wards are very stressed environments. Our community mental health teams are getting fewer referrals than this time last year. Our CAMHS teams are close to getting overwhelmed. On the plus side MANY patients have really appreciated getting remote treatment, either video or more likely phone. DNAs are down c.62% A lot of young people prefer remote consultations. Digital poverty is an issue though. 14:20:55 From Suzanne Shale : And the people seeing a lot of the mental wellbeing concerns are GPs, they’re not getting to secondary care. 14:22:42 From emily holmes, Uppsala University : thank you for the comments. As my slides disappeared, paepr is here: Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science, in The Lancet Psychiatry https://doi.org/10.1016/S2215-0366(20)30168-1 14:23:37 From Bryan Vernon : Everyone apart from Kath needs to mute! 14:23:47 From Miri MacFarlane : Thanks Emily, that was really interesting, particularly re: scale and tolerance to current interventions. 14:24:38 From Harleen Johal : To add to Suzanne Shale’s comments, I’m currently working as a junior doctor in an ICU and over the summer, we saw a huge number of patients presenting with deliberate self-poisoning, attempted suicide or alcohol/drug related issues (acute withdrawal, seizures, pancreatitis). ICU staff were managing patients with mental health problems, with limited support from a stretched liaison service, when they were still dealing with their personal psychological trauma of the first wave. We’ve referred to acute deterioration in mental health as the ‘other pandemic’ within our unit. 14:26:33 From Suzanne Shale : That’s really interesting Harleen. Where in the country do you work? 14:27:01 From Harleen Johal : Great Western Hospital in Swindon 14:38:00 From Freddie Stourton : Harleen we’ve seen a lot of similar presentations in paediatrics for the last few months. All the RSV bronchiolitis and D&V that we expected hasn’t happened because of lockdowns, but instead we’ve had a significant number of suicide attempts in teenagers who say it’s been triggered by lockdown 14:38:44 From Zareen : Thank you so much for this presentation. 14:39:41 From Richard Huxtable : Thank you all for great presentations. Prompted by Kath’s reference to the 4 principles, I wonder if we need to debate where the balance should fall between clinical ethics concerns (individual focus) and public health ethics concerns (population focus). It strikes me many C19 responses understandably try to address both, but I wonder where the tipping point should be? Answer might inform our approach to many of the dilemmas? 14:39:56 From John Chisholm - British Medical Association : Thank you, Kathryn, for a very thoughtful, reflective, caring and sensitive presentation. 14:41:38 From Miranda Clarke : Agree with all the above comments. Your book and BBC videos have been hugely influential for so many of us medical students (as well as to signpost friend’s and family to) so it was wonderful to hear you speak today. Thank you! 14:47:26 From Bryan Vernon : Scotland does it, Tom - as Kenneth and Alastair will remind us! 14:48:58 From Alastair : Thanks Bryan, you saved me from saying it!! 14:55:54 From Richard Huxtable : Very sad to leave you all for a meeting - thanks to all speakers, so much to think about. Take care all, and thanks 14:57:26 From Paquita de Zulueta : So glad that you bring these issues up Tom including the importance of touch. I have written about the importance touch in general and in the context of general practice. https://bjgp.org/content/70/701/594 14:58:37 From Pippa Sipanoun : I also need to leave, sadly. Thank you for a fascinating day. All very pertinent, thought provoking and sensitively presented. Take care everyone 14:59:09 From Bryan Vernon : Abraham Verghese has a brilliant Ted talk on touch in medicine. 15:02:44 From Thomas Curtis : Absolutely echo this, we’re seeing a lot more very difficult discussions regarding the end of life, in people we would never have thought we would have to have them with. Have been learning lots of skills ( communication and clinical) that have probably been underdeveloped for a while! 15:02:52 From Bryan Vernon : Please can I reiterate the plea I made at the outset for feedback and tips about how IME can improve future Zoom events. 15:03:08 From Zareen : THanks for saying this Tom 15:03:22 From Suzanne Shale : Completely agree with Tom. 15:04:26 From Paquita de Zulueta : Obesity is an ‘underlying condition’/risk factor - that includes many people in the UK… 15:04:31 From Agastya : Many doctors and residents working in the COVID ICU suffered from mental breakdown and have to counseled and treated by Psychiatrists Dr Amit Patil 15:04:55 From Alastair : A splendid meeting! To improve future ones, PLEASE give more time to the group sessions!! 15:05:18 From John Chisholm - British Medical Association : Tom is so right. Those who have died are all valued as human beings. The discourse from commentators such as Julia Hartley-Brewer and Toby Young that dismisses the deaths of those with underlying conditions is truly appalling - lacking in humanity and empathy and sensitivity. 15:05:58 From Chantal Patel : Thank you for a fantastic conference even if I had to miss a couple of hours to attend to work matters.. I really enjoyed Tom's talk.. much to think about .. 15:07:02 From Miri MacFarlane : I think this is where nuance around death and dying really falls down; social media/broadcast media tends to equate acceptance of death with permissibility/minimising of value of remaining life. Brilliant presentations, thank you! 15:08:01 From Paquita de Zulueta : I agree with Tom re dismissing people with ‘underlying conditions’. Awful 15:08:06 From Suzanne Shale : So sorry that I have to leave to go to a meeting, I have to say this has been hugely more invigorating than a trust board meeting! Anyone interested in mental health ethics or moral leadership I’m at suzanne.shale@nhs.net and @ethicsconsult Thanks to all presenters, and organizers. Great day. 15:08:46 From Paquita de Zulueta : Really interesting meeting with rich and varied perspectives - thank you! 15:09:15 From Zareen : When will the recording of this conference available? Thank you so much for the amazing presentations and talks 15:09:53 From Phil Greenwood : The recording should be online on Monday if not before. I will email all registered delegates with a link when it is live. 15:10:04 From Pirashanthie Vivekananda-Schmidt : Particularly the importance of continuing too work to reduce inequity across the globe! 15:11:33 From Michael Trimble : In past times there was a more general recognition of the need for individuals to prepare for death. In our more materialistic age I think, especially in medicine, we have lost sight of mortality. Death is seen as medical failure. A regaining of the spiritual side of life might help prepare for death. 15:16:12 From Kathryn Mannix : Students, and junior docs whose placements have been changed and progression in training has been impeded, have played a major part in the NHS response to the pandemic. Fantastic work by them all. So much responsibility at a time of very little control. 15:16:45 From Anne Slowther : Thank you for an excellent conference Very thought provoking. I agree one of the best IME conferences 15:17:10 From emily holmes, Uppsala University : thanks for the super summary and organising such a useful Conference . i have learnt so much 15:18:04 From Harleen Johal : Thank you to the organisers and speakers! 15:18:17 From Agastya : Thank you for an interesting conference. 15:18:34 From Berenike Baechle : Thanks for a lot of food for thought and reflections - it was very interesting! :-) 15:18:38 From mekber : Huge thanks to everyone. I have to leave now. Enjoy the weekend. Merryn 15:18:42 From Anna Hutchins : Thank you for a fantastic conference! 15:18:47 From Miranda Clarke : THANK YOU!! 15:18:52 From Rose Clout - GMC : Thanks to all the speakers 15:18:55 From M Oswald : Thanks so much everyone 15:19:28 From Raanan Gillon : let me add that Zoeand Caqth were highly commended in the BMA's justice and health care competition and were published in the J