COVID-19: Beyond the Virus

28 April 2020
Presented by Chris Smith, Adam Murphy
Production by Adam Murphy.

CORONAVIRUS

An artist's interpretation of a coronavirus particle.

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This week, we’re looking at the impacts of coronavirus beyond the virus: how is it hitting economies, universities and our mental wellbeing? Plus, researchers come up with a way out of the lockdown, how people who’ve recovered from coronavirus can help save the lives of those infected with it, and how the lockdown is offering one scientist a unique mass participation research opportunity...

In this episode

A woman wearing a blue facemask.

To wear or not to wear a facemask
Julii Brainard, University of East Anglia

“To Wear, Or Not Wear” THAT is the question. A face mask that is. Have you got one? Have you been using one when you’ve been out shopping? Have you been cutting up old t-shirts to make your own? Or are you a nurse or doctor worried that supplies are going to run out if everybody leaps on to the face mask bandwagon? It’s a tough call and it’s perhaps an understatement to say that the advice on whether we should all wear facemasks has been a little confusing. In some countries, mask-wearing is compulsory; in others it’s not. So let’s try and cut through to the scientific evidence. A team at the University of East Anglia have gone through all the research we have for airborne infections like coronaviruses. Basically, they’ve found that there is a protective effect, but, it’s small and, like all things coronavirus, the science isn’t straightforward and it depends on the context. Adam’s been speaking to Julii Brainard, one of the team behind the study...

Julii - The methods we used is something called a systematic review. And you look at all the primary research studies that have been done by other investigators, looking at real people wearing face masks, and being exposed to an environment where something like influenza is circulating. And you compare the people who wore face masks and the people who didn't, who got more flu.

Adam - And then what kind of things did you find at the end of this review?

Julii - What we found is the evidence is a little complicated. So one thing that had happened is in the previous literature summaries, the science tended to look only at what are called randomised control trials. And that's where people are given the masks. And often it's known who they're being exposed to. And in those situations you've got a group of people who've been asked to please wear a mask, and you've got another group of people who've been asked, please don't wear a mask. And the first thing you find out is that people didn't follow instructions. So you have people who were supposed to wear masks who maybe only wore them half the time or less, and people who weren't supposed to wear masks who wore them some of the time. So then when you compare the results at the end, we might find a small protective effect, but you’re thinking that's probably underestimating the true protective effect.

So that was a problem with those trials, which should be the very best quality evidence. They were often very small trials so you couldn't sort of adjust for other factors, other hygiene awareness. The other type of observational study that can be done, you look at people who've had say, influenza, and you compare them to people who didn't and you compare their habits to see which hygiene habits might be the most protective. And the problem with that is, you know you've never captured all the variables. And in that second type of study, which is called a case control, you typically find much stronger evidence in favor of face masks. But you don't really know. Is it the face mask or is it something I haven't observed? So I think what we found was the evidence is complicated. That said, on balance, we all concluded that there is some protective effect going on most of the time, in the groups that wear the face masks, but it's a small protective effect.

Adam - So what does that mean as a recommendation? Does that mean with coronavirus we all should wear facemasks?

Julii - No, but see that's complicated too because we don't want the public to be competing with healthcare professionals. You have to think how can a face mask protect you? It's going to protect you because somebody put, well, to be crude about it, they've put a little bit of spit into your environment, probably directly onto your face, because they've been talking to you or they've coughed near you, and the people who are going to most benefit from having the face mask are the healthcare professionals. So if us in the public start wearing these masks, are we going to actually deprive them of that protective equipment? The other thing is there's a lot of the time we don't really know what kind of masks people were wearing. So in those observational studies, people were asked did you wear a mask? But they weren't usually asked what kind of mask. So we don't know enough about how protective cloth masks might be for instance. In the deliberate experiments, people were always given surgical masks and we know a lot about their properties and why they could keep viruses out. So in terms of should we all wear masks?

Well they're not very practical because they're uncomfortable. They can cause skin reactions, you have to take them off to eat and clean your teeth, and they usually impede breathing to some extent. So should we all wear a mask? I think the conclusion we came up with is that if people want to wear masks, they've got good evidence that they're giving themselves some protection, but no mask is as good as getting two metres away from someone. So the social distancing where we just don't have that opportunity to pass material, little saliva material between us, is much better than wearing a mask. And it's much more practical a lot of the time. So where would we wear a mask, where would we suggest it? It would be in crowded environments where you can't avoid being close to someone. So the typical example would be on the tube, other types of crowded public transport and possibly crowded shops. Although, where I live right now, there's, there's no such thing as crowded public transport or crowded shops.

A locked chain holding together an orange metal door

An exit strategy for COVID-19
Miquel Oliu Barton, Paris-Dauphine University

Scotland’s Nicola Sturgeon was first out of the blocks on Thursday with some proposals for lifting the Scottish lockdown. Her government’s “Framework for Decision Making” came a day after Professor Chris Whitty, England’s Chief Medical Offices, made it plain that we are all going to have to live with disruptive social measures for at least the rest of the year, and perhaps until a vaccine can be mass produced. It’s also clear that there needs to be a huge amount of testing, tracing of contacts, and isolation of symptomatic individuals. So how might all this work? One strategy, from mathematicians in France, is to divide countries up into lots of small "cells". These are colour-coded "red" when the virus is actively spreading in that area - and people there stay in lockdown; or "green" when the virus is under control, and people there can go about their business largely as usual. Green areas are allowed to interact freely with other green areas, but not with red areas. This, the creators say, could get us back to normal in about 5 or 6 months. Miquel Oliu Barton from the Paris-Dauphine University told Chris Smith more...

Miquel - We're interested in how to safely and efficiently transition back to a new normal. The idea would be to partition the country into separate components such as counties, towns or suburbs. And then each area would then be labeled red or green. Red, meaning that the virus is not under control and the strict lockdown measures need to remain in place. While green means that the growth rate of infections is low and the future risks appear manageable. So first thing is you need to map the country into little cells, and each of which has a label, red or green.

Chris - And how big are those cells? When you say little cells, what are we talking?

Miquel - About a couple of thousand per country. But we need to bear in mind that all these things are very flexible. For instance, the European Union is already partitioned into countries, and each country is already partitioning to regions and each region is already partitioned into smaller and smaller regions. So the definition of these cells, which should have between 5,000 to 100,000 inhabitants depending on the density, should be left to politicians and epidemiologists and doctors to know what is possible to really enforce, and what makes sense in economic terms.

Chris - And the idea is that if I'm in say, region one, and you're in region two, we would not meet. There's no way that I can have contact with you and give you my virus. So I'm in a green area, you're in red, you can't transmit to me.

Miquel - Yeah. So the idea is some intermediate situation as we are facing today, instead of everyone is locked down in his place. If we identify areas where the virus is under control, we could allow people in the same area, let's say area A which is green, to interact in a more normal way while people in a zone, which is red, B, will stay in lockdown.

Chris - And how long, because this is a critical question, how long would say your red area stay red? So you've got some cases in your area this week. I'm in a green area next door. How long do you stay red?

Miquel - So this is a good question. So far we, based on what we observed very informally from the media, we are assuming that a zone is remaining red for between 14 to 35 days, which can depend on the country or the area's hospitals.

Chris - Right. And you'd reinforce this. So you keep testing the red areas and the green areas for surveillance purposes. As long as you keep not detecting virus circulation. After that time had elapsed, a red area becomes a green area.

Miquel - Yes. So after one cell, which is a small zone, has been proved to be handling the virus, then you could give it a label green.

Chris - Can we talk about the practicalities of this just for a minute? How feasible is this? Because of course we've got very used to the fact that some parts of the country are nice to live in and other bits are nice to work in. So we commute between the two. There are many people who will end up then entrapped still in a green area, where they live, but work is in a red area and they won't be to go to work.

Miquel - Yes. So that's a very good question, and that's why it is very important in defining these zones, these predefined zones, before we go into the labels, to take into account these commuting zones. We would like, first of all, to open commuting zones. So make sure that one big area, let's say the metropolitan area surrounding London, if the whole area was green, that would be a very good news. And we could open the economic and social interactions within this zone. Even though the whole UK is not having a control of the virus. We need to define these areas in a way that is both enforceable and meaningful in terms of economic and social interactions.

Chris - And if you run your model, how long does it predict it will take for a country on the scale of the population of the UK or France, in order to end up with the entire country being green, wall-to-wall green, back to business as usual.

Miquel - Yeah. We ran a simulation on a very simplified mathematical model. We imagine that the country is divided into cells like a chessboard. What is interesting is that we get something between two to five months for a country like the UK or France, and actually it depends on a very critical parameter, which is; what's the probability that at any point in time a green zone becomes red again, if it's slow enough, then we're driven by these exponential growth to a big green zone. If this parameter is big, then of course we go from red to green and to green to red forever.

Man giving blood

13:32 - Convalescent serum for Covid-19

Using convalescent plasma to bolster immune defences against Covid-19

Convalescent serum for Covid-19
Robert Lechler, King's College London

Here in the UK, the National Health Service have begun asking coronavirus survivors to donate blood plasma, to see if it can be used to treat those who currently have the infection. "Convalescent plasma" trials like these are also being carried out in other countries too. But does this work? Robert Lechler is an immunologist at Kings College London and is part of the UK initiative. He spoke to Chris Smith about the plan...

Robert - Good evening. Well, as you imply, this is a very simple concept really. It's taking plasma, which is the liquid component of blood, from patients who have recovered from Covid-19, and donating that or transfusing that into patients grappling with the virus, but failing to clear it.

Chris - Why do you think that will be useful?

Robert - The theory here is that a key component of clearing the virus is the part of the immune response called antibodies. These are circulating proteins that bind to foreign particles like viruses and help the immune system clear them. And one of the features of making an immune response against the virus is that, almost always, you do make antibodies and those, if you transfer them, they circulate in plasma. If you can transfer those into a patient who's grappling with a virus, those donated antibodies will help the patient to clear the virus.

Chris - Are there enough people who have actually caught and recovered from coronavirus to make this practical though? Because we estimate that the number of people in the population, in percentage terms, who have had it and recovered is still quite low.

Robert - Well, that's a fair point. Depends very much on how you choose to apply this treatment, which patient population you donate the plasma to, and there are three options. One is patients in intensive care, ventilated at risk of losing their lives; the second option is patients who are ill enough to be in hospital but not yet ventilated, and you're aiming to help them clear the virus in order to prevent them needing ventilation. The third option is that you go into care homes for an elderly person who tests positive even before they're ill, you try to prevent the development of the disease. Now I would say based on prior experience, probably the second of those three options is the most attractive. And in that case then the numbers I think work because we do now have hundreds of patients who have recovered around the country and in the hospitals that I worked with, at Guys and St Thomas' and King's College Hospital, we have well over a hundred patients who are, in theory, eligible to donate plasma.

Chris - So how does it work? What's the nuts and bolts? A person comes in and does, to all intents and purposes, the same thing as we would do when we do a blood transfusion donation. You would take the donation of blood and then skim off the plasma, which has got the antibody in it?

Robert - Roughly speaking, yes. I mean one way to do it is literally to take a pint of blood and then spin the cells out and give the plasma. Probably more appropriate is to use a technique called plasmapheresis; when the blood is taken out of a vein through a machine that spins out the cells, returns the cells to the donor, and the plasma then is taken and transfused into another person.

Chris - One consideration with these coronavirus infections though is that we think it falls into a range of different phases, where the initial phase is the virus growing in the patient's lungs and doing damage to the lung tissue, and then there's a second phase, which some people tend to develop. I don't think it's fair to say, we really don't understand why that happens, but in that second phase, we think the immune system is doing more damage. So is there not a risk that if you give people more immune factors you could actually intensify this? It would be almost like pouring oil on the fire.

Robert - You're quite right that it does look as though some of the terminal phases of this illness are, if you like, an over-exuberant immune response causing collateral damage. The point I'd make however is that antibodies are not really an important part of that collateral damage - that's much more driven by things called cytokines, which are like circulating immune hormones, and I don't think there's a risk of it causing greater inflammation in this way. The other point I'd make is that, as you implied in your introduction, this approach, it was used in China. In fact in some Covid patients, hundreds of patients have now been treated in the US, they really shot off and got into gear to do this, and talking to my American colleagues they haven't seen adverse effects of the kind that you are alluding to.

Chris - That's reassuring. And just to finish, Robert, is it clear when we need to intervene with this therapy? Or is that what the trial is going to help us to understand: whether it's good to give this therapy early on in the disease course or do you wait for someone to be extremely unwell and then you try this as a rescue therapy?

Robert - You wouldn't, I think, do this on every patient who gets the virus. Because for many people it is a relatively mild or moderate illness. No, this would be for patients who are ill enough to be in hospital, maybe their oxygen saturation levels are dropping a little bit, but they're not compromised enough to need ventilation. So you're trying to help them turbo charge their immune system to clear the virus before they reach the point of needing ventilation. I think that's the attractive moment to intervene.

Polluted sky, silhouettes of trees and electricity pylons

18:50 - Air pollution and coronavirus

How might air pollution impact coronavirus?

Air pollution and coronavirus
Marco Travaglio, University of Cambridge

Scientists looking for an explanation as to why some people develop more severe coronavirus disease have identified air pollution as one possible cause. A preliminary study from a group at the University of Cambridge shows that Covid-19 death rates tally with bad air hotspots. Marco Travaglio is one of the PhD students conducting the research, and he spoke to Chris about his findings, which are currently on the "medRxiv" platform awaiting peer review...

Marco - What we did was to use publicly available data to look at air quality across different regions in England and what we tried to do was to find an association between air quality and the severity of coronavirus in England.

Chris - When you say air quality, who's making those measurements and how?

Marco - The measurements were made by the European Environmental Agency and they are measurements made according to international standards of air quality.

Chris - And you're asking, I know what the air quality is doing in a given area and I know what the death rate is from coronavirus infection, Covid, in that area. Is there any kind of relationship?

Marco - That is precisely what we did. We tried to investigate if there is any association between deaths and cases from coronavirus and the air quality in that specific area in England.

Chris - Was it retrospective air quality measurements? Because of course at the moment with the lockdown and everything and people changing behaviour because of coronavirus, air quality is changing quite a bit at the moment.

Marco - That is a very good point. We wanted to look at retrospective air quality for precisely this point. We cannot rely on air quality after the outbreak of the virus because we know that with the lockdown measures that have been in place, the air quality has significantly improved. So we only looked at data prior to the outbreak. So this is data for the year 2018.

Chris - And what did you find? Is there a relationship?

Marco - Yes. So we found a significant relationship between air quality measures in England and coronavirus deaths and cases. And again, this is only preliminary and more research needs to be done, but the association was significant at this stage

Chris - And what, the interpretation is if you breathe bad air, you're more likely to die of coronavirus if you catch it?

Marco - Yes, that's, that's the conclusion of the study. The conclusion is that there might be a link between air quality and coronavirus. And the reason for that is because some particles in the air can cause damage to certain organs in your body. This includes the lungs and of course if the function of the lungs is compromised, knowing that the virus attacks precisely these parts of your body, you can imagine that the virus can have a more detrimental effect on your health.

Chris - And can you be reasonably confident that it's not just that where you have lots of people, you therefore get lots of pollution. But if you've got lots of people catching coronavirus, you're going to get lots of deaths as well. There's definitely a relationship there involving the pollution.

Marco - So this is something that we haven't looked at, so I'm not overly confident that if you go to an area with a higher number of people, there could be lower levels of air pollution, but this is something that would be interesting to investigate in the future.

Chris - And of course one other side effect of the lockdown, with people staying at home, is that air quality is stupendously good compared to, you know, a year ago. So has an indirect effect of the lockdown been improved air quality, and therefore could part of the reduction in numbers of cases and deaths be because the air quality is better?

Marco - This is something that's been going around in the news and I think it's very interesting to look at. Air pollution levels have been going down as part of the measures implemented by the government. I think it would be interesting to see if this can have any impact on the possibility of a second wave. If there is a strong association between air pollution and number of deaths, and cases from coronavirus, you would imagine that long term decrease in air pollution could lead to potentially better defense mechanisms being applied by our immune system to respond to a potential second wave. Of course, it's too early to make any conclusion, but this is something that could be potentially interesting to look at in the future.

woman being reflective

Teenagers and social isolation
Sarah-Jayne Blakemore, University of Cambridge

There are many ways of looking at the lockdown. Generally it’s seen as a sensible way of slowing the pandemic and a buffer for healthcare systems. The downside is it’s a huge disruption to people’s lives and a big shock to the economic system. For some psychologists however, the lockdown is a vast experiment that could never be copied in the lab. And Sarah-Jayne Blakemore, who normally looks into how the brain develops during adolescence, is going to do just that. From her sunny Hertfordshire garden, with birds in the background, she explained what she’s got in mind to Phil Sansom...

Sarah-Jayne - We had been planning to start a study next academic year looking at the effects of social isolation on adolescent development and adolescent mental health. We also wanted to know how social media affects social isolation; are the damaging effects of social isolation mitigated by interacting with people online? Anyway, so that was a study that we were actually planning to do next year anyway, and then suddenly COVID-19 happened and the social distancing measures came into place all around the world. And we thought, "this is a very unfortunate natural experiment."

Phil - If it's a natural experiment, how do you go about studying it?

Sarah-Jayne - So we're going to look at this by using people's mobile phones. So asking people to log on to a mobile phone app, which then will ask them questions every few days about things like how they're feeling, whether they're happy; but we'll also be able to ask them questions about their situation, for example how many people they're living with, whether they get on with the people they're living with, whether they have outdoor space. Because if you get on with your family, then you might have a very different experience of social distancing than someone who doesn't really get on very well with their family, and has no garden and lives in a very small flat for example. But also because we're using an already established mobile phone app, we'll be able to measure things directly like what social media apps they use, their movement, their physical exercise, their sleep.

Phil - Based on what you know already, what are you expecting?

Sarah-Jayne - Well, it's such an interesting question. When we first started out planning a study, we thought, "oh my God, this is going to be terrible for young people's mental health!" But then we started to think, "well hang on a minute, young people are the biggest users of social media." So maybe use of social media apps like, you know, the apps that allow you to communicate with your friends; both in text like Snapchat, but also in video like Houseparty or Facetime or whatever it might be; maybe that will really be beneficial to young people in this time of social distancing.

Phil - Is that the case for social media generally? Because... I don't know, in my brain social media often is a contributor to worse mental health.

Sarah-Jayne - That is really interesting. So it's much more complicated than that, and it really depends on how people are using social media, how much they're using it, what apps they're looking at. I mean, I think all you have to think about is: I was a teenager 30 years ago. Imagine if there was this pandemic and social distancing 30 years ago. As teenagers we would have had no way of communicating with our friends other than a landline phone, which only one person in a family can use at any one time, and I remember that it was really expensive when we were growing up to use a landline. We would have had no other way of communicating with our friends. And that has got to be... I mean, the hypothesis is that that would have been much more harmful than now, when adolescents do have the possibility of keeping in contact. One consequence is that we really need to worry about young people who don't have access to social media, whose families can't afford WiFi, and who can't afford a mobile phone contract. And there are a lot of families in that situation in this country, and of course all around the world it's the case for most young people. Sorry about this, I'm just rescuing my chicken.

Phil - From what?

Sarah-Jayne - From the fence. Well... I mean retrieving one from the hedge.

Phil - It's like Chicken Run.

Sarah-Jayne - Oh my God, it so is like Chicken Run.

A woman with her back to the camera in a lab, using scientific equipment

28:37 - What are some coronavirus worries?

What does a former UK science minister make of this crisis?

What are some coronavirus worries?
Lord David Willetts, Resolution Foundation

Lord David Willetts, former UK minister for Universities and Science, joined Chris Smith in the studio, and started off by putting health impacts aside for a moment, and told Chris what worried him the most at the moment from where things stand...

David - Well in terms of how people are affected in Britain, there are two groups who are clearly most affected. There's about 8 million or so people who, key workers, who are out and about in the health service, delivery drivers, they're the ones who are most exposed to the virus, and then there's about 6 million people who have worked in sectors that are now completely shut down. Those are the ones most affected and our work at Resolution shows, sadly those people are disproportionately low paid, they tend to be young, they tend to be female. So some of our more vulnerable groups, who are ready below average on income for example, are the ones who are most heavily affected by this crisis.

Chris - And tell us about Resolution cause you mentioned that. What's that?

David - Well, that's the think tank of which I'm President and we have been doing a lot of economic analysis of the effects of the virus, and we can see how at the moment it looks as if the people who are best protected from it, people who can, for example, work from home, who have preserved jobs, tend to be by and large, older and better paid. So it looks as if the economic effect of the virus is it's, sadly it's hitting hardest, some of the people who are most vulnerable.

Chris - So when Boris Johnson said this is an equal opportunities virus, in some respects it is because it takes no prisoners. It will infect you. But in terms of its repercussions, reverberations and ramifications, it certainly isn't then?

David - Yeah. At the moment, the way it's playing out, sadly, is that the economic effects are not evenly distributed. Of course, thank heavens we've seen interventions by the government to help fund people on furlough scheme, things like that. But as we look ahead, the danger is that this virus makes life tougher for the most vulnerable people. Then there's another group we need to think about, which is people leaving education, be they leaving school, college or university, who will be heading out into a labor market, that's incredibly difficult at the moment. So another issue coming down the track is; should we be providing them with further educational opportunities rather than expecting them to graduate from school or university in the next couple of months, and try to find a job? Because it's going to be a very hard time to find a job. And if they don't find a job and they're unemployed, there are longterm scarring effects.

STOCKS

31:32 - COVID-19 and the economy

What has coronavirus meant for job losses

COVID-19 and the economy
Christopher Rauh, University of Cambridge, Lord David Willetts, Resolution Foundation

Our lives have been turned upside down in the last few weeks, and the economy is no exception. Many people have been furloughed or have lost their jobs. What kind of impact is this having short and long term? Christopher Rauh is an economist from the University of Cambridge, and he spoke to Adam Murphy about this impact. Then Lord David Willetts, former Minister of State for Universities and Science, and President of the Resolution Foundation shares his thoughts with Chris Smith...

Christopher - So most of the government data is released with a lag. And at the moment there was nothing available. So we thought, let's go out and collect our own data.

Adam - And what have you found? What is the impact going to be in terms of job losses?

Christopher - So I can only second what David said. So we actually were interested in the inequality of the impact and before we go into the inequality, just the aggregate impact was huge. So already 15% of workers have lost their job, of those that were working four weeks ago. And this number is even more shocking if you think about that usually in the recession, mass layoffs are not what are driving increases in the unemployment rate. Usually they're coming from people having problems finding jobs. So that makes these numbers ever more shocking.

Adam - So who is it that's most affected? Who stands to be hit hardest?

Christopher - First are those in precarious work arrangements, they were the ones that lost their jobs first. So zero hour contracts, temporary contracts, variable hours. We see that all those people were the first to lose their jobs. Then those that work from home, they are are protected quite well because they can continue to do their job and these jobs tend to be held by those that are more educated and also have higher incomes. What is really different though, from other recessions, is that this time women have been more likely to also lose their jobs. So usually it's men that are more likely to lose their jobs in recessions. Now, one could think that this is because women are more likely to work in services or in face to face jobs, but we find that it's above and beyond that. So even if you control for their work arrangements, individual characteristics and occupation, women have been more likely to lose their jobs.

Adam - Do you know what's driving that difference then?

Christopher - We don't. So we have some time-use data and this is really only suggestive. We have no causal evidence for this, but we find that those women that are still working from home, they spent more time on homeschooling and taking care of their children than men that are working from home and have children. So one could think about maybe this plays a role in the decision employers make.

Adam - As you mentioned, this is a very different kind of recession. Does that mean the way out is going to be different? Will it be short term? Once we've got a vaccine or are we in this for the long haul?

Christopher - So I think we're in this for the long haul, but how long will depend on some of the government schemes. So I think the furloughing scheme is going to be key here. If firms have to go back and hire lots of workers, number one they wouldn't want to do this because of the uncertainty involved. Number two, the whole process is costly. You have to screen people, meet them, make decisions and make good matches. And then the other problem is that if you work for someone over time you're accumulating something that is like an employer-employee specific human capital. You know how that firm is run. The firm knows how you work. So you are more efficient together. Now if all these people are being separated from their firms, you lose all of this. So through furloughing a lot of this can be preserved.

Adam - And as we've said, this is different from previous recessions, but is there anything we can learn from those recessions and take forward into this one that might help us?

Christopher - You know, if we had had a furloughing scheme in place already here, that would have helped a lot. You have the self employed that wouldn't be receiving payments until June. That creates a lot of uncertainty. People can not cover their bills. So we find that more than one third of the people are already having problems covering their bills and these things create domino effects. So looking back, we should have learned from the past recessions, that we should have policies to adapt to these short term or medium term drops in demand and production.

David - Well, I would say that the initial reaction from the chancellor and the prime minister was pretty bold. And also we were able to coordinate that, sort of the fiscal response, the public spending announcements, and the monetary response, the bank of England's announcements, in a way that was harder in Europe because of the structure of the Eurozone. So I would say the initial response was bold and effective, but there's still a lot more to do as we've just been hearing. There's a real danger of viable companies going under and the scarring effects bringing down our long-term economic performance and lowering our productivity.

Chris - What is the level of debt that we're accruing? I mean, as a country, so when the government is doing the various initiatives that we just heard about, how much is this costing per week? What will the level of debt burden be by the time we, you know, best case scenario, get out of this lockdown and get the economy rebooted?

David - Well, we started with our national debt standing at about 80% of our national income. Now, who knows where it'll be at the end of it, but it's going to be, I think very probably over a hundred percent, could be significantly higher than that. So it will be a big increase in the national debt. But at the end of the second world war, the national debt was over 200% of GDP. So that puts it into perspective, but nevertheless, we will be operating with higher levels of national debt. However, on the other hand, interest rates are very low. That means that at the moment, the cost to the government of paying the interest on its borrowings is surprisingly modest. It's a peculiar combination, very large amounts of debt, relatively low cost of actually paying the interest on it.

Chris - And you made a sort of reference to the second world war, which we only just stopped paying off in relatively recent years. I suppose the differences comparing then to now is that with things like the furlough scheme and keeping businesses intact albeit not producing anything for the short term is that we're sort of hot loaded and ready to go as soon as things can reboot. Which after a war of course that wouldn't have been the case. There would have been more of a lag.

David - Yeah, that is true and the logic from the Treasury's point of view, looking at it from the economic perspective, is absolutely that they want companies to be back and viable and functioning. They're trying to keep them going - a sort of short term blip. I think the interesting parallel with the second world war is of course there hasn't been the physical destruction. On the other hand, if railway carriages and tube trains all have to have every other seat blocked off so that we're not too close to other people, if you have to redesign the way that your workplace functions so that people are always two meters apart, then actually that is a very big hit. That means that your capital stock can't work as well as it used to. That's a massive investment challenge to reboot and reorganise the way we do things.

Chris - And just briefly, David, people are talking about what globalization might look like in future. We've been hooked on a supply of very cheap mass manufactured goods from the far East for a long time now, for example. People are saying that's all going to have to change. What's your view? How is it going to change and will it?

David - I think there will be changes, partly in the way we lead our lives. I suspect there'll be less air travel for a very long time, and there will be national attempts to create the new industries that you need to tackle the problem. However, the one optimistic sign on globalization in this terrible crisis is that this is a common enemy. It isn't something that should divide nations. This is an enemy that we can all see and where there can also be very high levels of international collaboration. And what I hope comes from this is a greater sense that we're all in this together. Just as with the challenge of climate change.

Schoolchildren writing on a blackboard

39:48 - Universities and coronavirus

How will universities cope in the current crisis?

Universities and coronavirus
Stephen Toope, University of Cambridge, Lord David Willetts, Resolution Foundation,

Across the world, universities have been closed, researchers sent home and many classes are either not taking place or they’ve shifted online; so how does that impact the way universities are operating, and what’s been the financial and scientific impact. Chris Smith spoke with Stephen Toope, Vice Chancellor of the University of Cambridge, and was then joined by Lord David Willetts, former Minister of State for Universities and Science, and President of the Resolution Foundation for his expert opinion...

Stephen - We have to be frank that a lot of this depends upon the extent and duration of the economic downturn. We certainly estimate the potential for hundreds of millions of pounds of lost income over the course of the next couple of years, but there are upsides and there are downside scenarios and you know at this point it's really hard to tell exactly what number might be right. It does represent the potential for fee income to go down, particularly if there is a smaller cohort of international students. It also represents a loss of income for rental of accommodation for the colleges of Cambridge and other universities would experience a similar loss of income. In our case, we're fortunate enough to have an endowment, so it's also contemplating a reduction in the payout from the endowment.

Chris - At the moment, obviously institutions like Cambridge rely very heavily on an overseas trade in students. Education is a major export success for the UK. How is that going to change?

Stephen - Well, I hope it's too early to say how it's going to change, quite frankly, but there's certainly a likelihood in the short term that there will be a reduction in the number of international students traveling anywhere in the world. This is not just a UK phenomenon. I'm aware, for example, that there's a perception fair or not in other parts of the world that the UK was slow in its response to coronavirus and therefore we've got families saying, "is the UK a safe place to go?" So one of the things that we're going to have to do is make sure that our public communications around how the country is going to deal with the virus going forward is communicated as clearly as possible even outside the borders of the UK. Of course in the longer term, we don't know whether this will play out as a changing dynamic fundamentally, or whether this will turn out to be a more temporary pause in what has been an extraordinary growth in international students all around the world.

Chris - With a place like Cambridge, one of the world's best research centers for science, how on Earth are we going to carry on doing cutting edge research when laboratories are shut, people are having to do science at their kitchen table?

Stephen - We do have to find a way as quickly as possible to get people back into labs and libraries because if we don't, we're going to have a real pause on absolutely fundamental research. I mean think about research related to cancer for example, that is largely not happening in the same way that it was previously. Again, I know people are going online and doing as much as they can and sharing data, but we've got to get people back into the lab and so we've already started looking very, very carefully in a detailed way at how we can open up labs as soon as social distancing rules shift and the lockdown is no longer fully in place. But we're going to have to do it carefully and with absolute precision in thinking about the health and wellbeing of our staff members. We are going to be part of the solution to the re-booting of the UK economy, which is going to have to focus on research and innovation. I think we've learned that in this crisis. And if our teams are already degraded, we're not going to be able to make the contribution we need to make.

The good news here I think is that the government had previously committed to a very dramatic expansion of research funding over the course of the next few years. And in a sense I think all the government has to do is front end load some of that funding to make sure that we hold this infrastructure together so that it can really be up and running and deployed as quickly as possible when we're out of the immediate elements of this crisis.

David - Well, you're right, I mean one of the big elements is that flow of overseas students that's so important for British universities. And the estimate is they bring about 7 billion pounds into our universities, students from China and from around the world. And if they don't travel to the UK, that's a big hit. So yes, there are massive economic risks for universities. That was a fantastic interview from Stephen too, but I, I think the other point is that this crisis is reminding us of how important and valuable universities are. There are medical students being graduated from university early so they can go straight into the hospitals to help out with the crisis. And similarly for nurses. You know, the research that's going to be necessary on vaccines and what you were hearing earlier in the programme from Robert Lechler at Kings College London where I'm a visiting professor. This is reminding people of the value of the university and what they stand for. And universities have had a bit of kicking in the media in the last few years. I hope this is a reminder that they are absolutely crucial for our recovery from this.

Chris - Is there not a danger though that with universities nursing these kinds of revenue hits, that they'll look to make savings and they'll do it by looking at head count, they're going to be looking to take jobs away and this could fragment research teams that take years to assemble and that will actually impact on the research trajectory.

David - Yes. And look, part of the dirty secret of this flow of overseas students is one of the uses of the revenues that universities get from overseas students is to help cross-subsidise their research activities. So one of the pressure points is what happens to their research. So that's why people are looking at that urgently to see if there are ways in which university research activities and R&D across the country can be supported. And of course there was an  announcement from the chancellor on that last week of some help, particularly for innovative R&D intensive companies. So yeah, there is a danger. But again, the paradox is that this terrible crisis it is bringing home to us how important and how significant the scientific research is. Unlike school science, which is sometimes yes, telling people what we know and what the rules and observations of science are, this is cutting edge science. This is people seeing science played out day by day in the media, dealing with uncertainty, dealing with different accounts of what's happening, comparing them, trying to collect new evidence in real time. I think there's going to be a surge of young people who want to be doing scientific and medical research as a result of this, and we will need them.

Sad man 2

Mental health during COVID-19
Daisy Fancourt, University College London, Rory O'Connor, University of Glasgow, Lord David Willetts, Resolution Foundation,

How are people coping with the COVID-19 pandemic, both overall and on a week to week basis. To find out, Adam Murphy spoke to Daisy Fancourt at University College London, who's looking at people's mental health week-by-week, and with Rory O'Connor from the University of Glasgow, who in conjunction with the Samaritans is conduction a longer term study. Then, Chris Smith spoke with Lord David Willetts, former Minister of State for Universities and Science, and President of the Resolution Foundation about how we can help people struggling...

Adam - In the midst of social isolation and the constant threat of illness, it's important to keep an eye not just on the physical health of people, but on their mental health. How are we all doing? Well Daisy Fancourt from University College London is part of a team that's doing a weekly checkup, as it were; asking people to go online each week to answer questions about what they're up to and how they feel.

Daisy - So far we've been looking particularly at how people's depression and anxiety levels are affected during the pandemic. And we know that prior to lockdown coming in, a lot of people got very worried about the virus and we saw that this had a negative effect on people's mental health. Since lockdown came in we've seen that this seems to have stabilised for a lot of people; we've even seen some slight decreases in things like anxiety. Now this is still above the normal levels for people, but it's promising to see that many people are managing to adapt. That said, we are also seeing that certain people are finding this time much tougher than others, particularly people who have a previous existing mental health condition, people who are living alone, people who have got lower levels of household income, and also younger adults for whom this might be making a greater change day to day than for people who are older.

Adam - This weekly approach is great for pointing out trouble spots - immediate issues like people being scared of food availability. But does it help longterm?

Daisy - Yes, and it's relevant to keep tracking this as well; because for now, people have started to get more confident about having access to food so we've seen those hoarding behaviours decreasing, but it's important to see what happens over the coming weeks as well because if there start to be more concerns again, then we might see these worries starting to go up in people. And this is really helpful to know because it means that we know what kinds of reassurances that people need, and we also know what kinds of things people are worried about which might be triggering behaviours like panic buying.

Adam - At the University of Glasgow, in conjunction with Samaritans, a new study is starting that compliments this weekly approach. There they've gathered a representative group of 3,000 people and are checking with them every few weeks to see how they're feeling, especially in terms like how 'entrapped' do they feel, and how 'defeated' do they feel. This will measure how we're dealing with this pandemic and what might keep us safe for the next one. Rory O'Connor is part of the team there at Glasgow.

Rory - We've already completed the baseline assessments. And the baseline assessment, we have asked a whole range of questions which tap into people's mental health and wellbeing, but also investigates their experience of coronavirus/COVID-19; what they're doing, activities that they're engaging in; as well as a range of other factors which we know are associated with mental health and wellbeing like entrapment, this notion of defeat. We've also looked at health anxiety, trusting government, a range of social support and resilience measures. We're following people up at least six times in total, but five times after baseline over the next six months. And we're also planning a longer-term 12 month followup. So we'll be able to not only understand in real time how people's feelings of entrapment are associated with depression or anxiety or suicidal thinking, but over time we'll be able to understand, do these things predict in the longer term as well as the short term. So what we're looking to do in this study, in addition to looking at more negative mental outcomes, we're also looking at positive wellbeing. And the key question we're trying to determine or answer is, "what are the things that people do; what activities, both physical activities or the way that they think, or doing things differently... is that associated with more positive wellbeing in terms of resilience, or in terms of feeling better about the world?" And crucially if we can understand these more positive outcomes, it helps us move forward; especially for example if there's a second outbreak, we'll know how to better respond so that people's mental wellbeing... it's not just that it's not adversely affected, but crucially that their mental wellbeing can be boosted.

Adam - And how important will considering mental health be, as we come out of this?

Rory - I think that protecting and responding to our mental health should be central to the pandemic response. We have to be vigilant and we have to be really, really protective of those who are losing their jobs, sadly, or are experiencing other difficulties; especially if maybe your mental health has been really affected during lockdown, we have to make sure that we do as much as we can to mitigate that risk in the longer term as well as the short term.

David - Well fortunately this is an interest where there's been a massive increase in research over the past 10 years. And the Office of National Statistics actually began tracking wellbeing back in 2010, it was a subject that David Cameron was very interested in. So we have got a long time series now of asking people how overall satisfied they are in their lives, what levels of anxiety they've got; so together with these extra research projects, I think we will get a pretty good picture of how the virus affects people, and then of course most importantly be innovative in how we help people.

Chris - And what do you think the government have in mind in that regard? What are they going to do? Because mental health and wellness and wellbeing, et cetera, has not been well-funded hitherto, in the UK at least, but that's echoed in many countries.

David - Yeah, and it clearly does require a higher priority. I know that Matt Hancock personally is very aware of the importance of it, and I thought what Sarah-Jane Blakemore was saying earlier in the program was very important. It is just possible that some of the innovative technologies we've got, the creation of online communities, is going to enable us to help some people better than we could in the past. Just like with education and Stephen Toope's interview, we may find many more people are able to learn more online. So it's a terrible crisis, but as with war it's also going to drive innovation at a speed we've not seen before, and let's hope that it really helps people who are finding this psychologically a challenge.

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