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Recruitment for the study began in March. Photograph: Richard Adams
Recruitment for the study began in March. Photograph: Richard Adams

ScienceOctober 23, 2020

My life as a human guinea pig on the Oxford Covid vaccine trial

Recruitment for the study began in March. Photograph: Richard Adams
Recruitment for the study began in March. Photograph: Richard Adams

At the forefront of the race for a coronavirus vaccine are researchers at Oxford University, who are working ‘with great care and due haste’. Six months ago, several hundred volunteers began participation in a clinical trial of the vaccine. Among them was UK-based NZ journalist Richard Adams.

I can’t talk now, I told the caller, because I’m about to go into a hospital. Since it was April 2020, telling anyone that you were at a hospital required more explanation than usual, so I told him: I was about to be injected with the new Covid-19 vaccine being developed by Oxford University.

Oxford’s vaccine trial had started four days earlier, when the first two human subjects were injected and filmed and broadcast across the world. Two days later, two more were injected. And two days after that, there was me, lost in the carpark of the Churchill hospital.

“You’re very brave,” my caller said. But up until then, bravery had nothing to do with it. To be honest, I signed up more in fear of boredom than anything else.

The Oxford vaccine trial launched with little publicity, because it began so early, at the height of international panic but before the reality of the long and debilitating nature of the Sars-CoV-2 virus had emerged. I only heard about the vaccine trial through my colleague, Hannah Devlin, the Guardian’s science correspondent.

For anyone who lives in Oxford and is feeling brave: the first UK vaccine trial is now recruiting,” she tweeted on March 27. Lockdown in the UK had begun the week before. All but essential staff were working from home. Schools and universities had emptied, conferences and exams were cancelled, meaning that, as the Guardian’s education editor, I (temporarily) had not much to do.

So I followed the link on Hannah’s tweet, expecting a grand scheme. But this was very local: volunteers had to live near Oxford, be aged between 18 and 55, and healthy. And not have had Covid-19. So I filled in an online form with the usual stuff. Medical history. Allergies. Contact details. No, I’d never taken part in a paid medical trial before – wait, we get paid?

“Volunteers will be required to make multiple visits over several months and must commit to remaining in Oxford for that time …” Well, I wasn’t going anywhere, and neither was anyone else. The railway line to London runs close to my house, and entire inter-city trains – normally carrying hundreds of commuters at rush hour – were going by with hardly a soul on board.

But then things moved quickly: the next day an email invited me to a screening. When was I available? I looked at an empty calendar and replied: anytime. An hour later another email arrived telling me to come the next day, for two and a half hours. And in another sign of seriousness, there would be free carparking, an unheard of event in Oxford.

Help protect the world from a health crisis, and get free parking, too. Photo: Richard Adams.

By this point in April, the centre of Oxford was deserted. The students and tourists had gone, the hotels, museums, colleges and restaurants all closed. Without any traffic the drive across the city took just minutes, meaning I arrived very early. The carparks were all but empty anyway, Oxford’s hospitals having cancelled appointments and barred visitors. Ambulances were the only things on the road, and the few people around were fully gowned and visored.

But not at the the Centre for Clinical Vaccinology and Tropical Medicine, where screening was to take place. Outside were some nervous young interns with lists of names. No masks or gowns for them, or us, or even hand sanitiser, unsurprising given the severe national shortage in England at the time.

I was given a sticker with the number 5 on it and taken to see a socially distanced video of Adrian Hill, the director of Oxford’s Jenner Institute, explaining what was happening. There were then legal documents to be signed disclaiming any liability on the part of the University of Oxford for eternity, and a form for bank details. So we did get paid.

Oxford, emptied by coronavirus. Photo: Richard Adams

Then there were interviews, physical examinations, tests and more tests, including blood tests, the first of many, increasingly painfully. But I didn’t know that then, thankfully. That day around 700 people in the UK died from Covid-related causes.

Some phone calls followed with questions – I’d been to Italy in February, where had I gone exactly? – and finally another email inviting me to be vaccinated, on Day 0 in group one of phase one of the trial.

Perhaps because things had moved so quickly I hadn’t really thought about the dangers until that carpark phone call on Day 0. It was a university vice-chancellor. “You’re very brave,” he said, “I couldn’t do it.” I laughed it off, saying that after all the things I’d written about the University of Oxford it only seemed fair they should have a shot at killing me. But for the first time I felt properly nervous.

Adrian Hill had explained that because this was the first human trial, and the usual testing had been sped-up, there could be unexpected side-effects. And in some earlier cases, animals injected with experimental Sars vaccines had more severe symptoms when they were later infected than those that hadn’t been vaccinated.

I remembered that I’d posted a link to the trial sign-up on the local parents WhatsApp group, which was full of eager messages from parents wanting to support the NHS. No one replied.

But this was a randomised controlled trail – meaning that 50% of the volunteers would receive the officially titled ChAdOx1 nCoV-19 vaccine, the other half would get an unrelated meningitis vaccine, and no one would know who got which until the trial ends in six months. And Sarah Gilbert, Oxford’s professor of vaccinology, had told journalists she was 80% confident of success. So I figured that a 50% chance of an 80% chance was pretty good odds. 

Now the interns were gone, replaced by security guards outside the clinic. Inside I glimpsed Professor Gilbert, who’d been in the media since the first injections four days earlier. A doctor took me off for more tests. “Your blood pressure is very high,” she said. I admitted being nervous. Don’t worry, she said, they’ve injected five chimpanzees with the vaccine and four of them are fine.

Despite the high blood pressure, finding my veins proved difficult until a passing paediatrician helped me fill up the six vials of blood required. Meanwhile nurses cursed the flimsy aprons they had to wear, which ripped too easily. “There are meant for hairdressers,” one said in disgust.

Then after more blood came the vaccine itself, which looked and felt like a flu jab. I was ushered off to an observation room for an hour, “just in case”. Then more tests, and another zip home through the empty streets. I felt fine but tired, I told the follow-up phone call that evening, and started filling in a web diary every day for a month to come.

The next day I felt very tired indeed but there was none of the swelling or redness at the injection site that we had been warned to watch for, and by day three when I returned for more tests, everything seemed back to normal.

Except for my veins, which refused to give up their blood without a struggle. The same happened again on day seven and day 14, by which point my arms had seen more needles in three weeks than the rest of my life put together. One nurse said my vein went flat as soon as the needle went in, so nothing came out. Another doctor said my vein jumped about, causing some very painful attempts to pin it down.

So I learned that some people are much better at taking blood than others. And I learned that before a blood test it helps to eat lots of food and drink lots of fluids – coffee is not so good but tea is fine. Also, I’d be a rubbish heroin addict.

Then things slowed down, the diary became a depressing weekly record of lockdown life. “How many times did you go to the pub/club/theatre this week?” – zero didn’t even come close to the truth. Every sore throat or runny nose in my household had to be recorded, followed by “outcome of illness”: recovered or died.

Each visit to the CCTVM saw it grow and become more professional. The flapping paper signs with directions were replaced with laminated logos. A vast mobile building was unfolded on one edge of the car park, and became the new centre for testing. The building was normally trucked around to music festivals like Glastonbury, a nurse told me, but they had all been cancelled.

A mobile building trucked in to house researchers. Photo: Richard Adams

As summer passed, the trial expanded from Oxford to other cities and countries. People like Boris Johnson have buoyantly talked up its chances. The US government bought hundreds of millions of doses in advance. Newspapers wrote articles about “the race for the vaccine” as if it was an inevitable success.

Those articles were usually illustrated by scientists in gleaming labs, and maybe there were some, but from outside it wasn’t obvious. The Jenner Institute building itself is modern. But around it on the sprawling hospital campus are derelict buildings, smashed glass, collapsing roofs, broken furniture. The staff carpark is dirt and gravel, dusty in summer and muddy the other three seasons. The hopes of the world and billions of dollars might be resting on it, but within sight of the centre are abandoned offices with blinds poking out of broken windows – another side of the UK’s  health system exposed by this pandemic.

Soon I’ll be making a final visit for the Day 182 tests, when the trial ends. It doesn’t seem like six months have passed since Day 0. Maybe that’s because as I write this, Oxfordshire has recorded 100 new infections in a day, Oxford’s hospitals seen their first Covid-related death since mid-summer, and most of the UK and Europe are being locked down again. I still don’t feel brave.

Keep going!
Toby Morris for The Spinoff
Toby Morris for The Spinoff

ScienceOctober 22, 2020

Siouxsie Wiles & Toby Morris: Covid-19 and the Swiss cheese system

Toby Morris for The Spinoff
Toby Morris for The Spinoff

The effort to defeat the coronavirus relies on many layers of defence. Or, let’s call them, slices of cheese.

One thing that has really irked me during Covid-19 has been the labelling of any mistake in our systems or any unexpected transmission of the virus as a failure. Yes, I understand that the media and the opposition have a responsibility to hold the government and our public services to account, but screaming FAILURE from the rooftops has everyone looking for someone to blame and massively undermines public trust in New Zealand’s pandemic response. It’s also completely out of all proportion. If you want to see failure, look to countries like the US or the UK. Identifying mistakes or holes in our response is really important as it allows us to learn and adapt our processes, something that has been key to New Zealand’s success in managing Covid-19 so far.

Twenty years ago, James Reason, a professor of psychology at the University of Manchester in the UK, published a paper in the British Medical Journal in which he described what he called the “Swiss cheese model of system accidents”. Reason was trying to move people’s thinking from treating mistakes as individual errors by “bad” people to a systems approach that accepts that humans are fallible and mistakes are to be expected. Rather than blaming individuals for failure, we should try to understand how and why the failure happened to prevent it from happening again.

But what has Swiss cheese got to do with all this?

The idea behind the systems approach is to build in layers of barriers and safeguards. In an ideal world, each of these defensive layers would be impenetrable. But in the real world, they aren’t. So Reason likened each layer to a slice of Swiss cheese – it has holes in it. To be fair to the Swiss, they have lots of different cheeses, many of which don’t have holes, so it’s probably more accurate to call Reason’s model the “Emmental Model”.

Back to the holes. They can happen for many reasons. Slips, fumbles, mistakes. People not following procedure. Or they can even be built into the system. A hole in one layer of defence isn’t necessarily a disaster if there are lots of other layers to fall back on. Then its only when all the holes line up that the defences are breached. Reason’s model is now used all over the place including in medicine, engineering, and the aviation industry.

Applying the Swiss Cheese/Emmental Model to Covid-19

I’ve seen several excellent applications of the Swiss Cheese/Emmental Model to Covid-19, like this one by virologist Ian Mackay or this one by sketchplanations. They represent each of the different public health interventions we have for Covid-19 as layers of cheese. I love how they show that we actually have quite a few defences against Covid-19 but that none of them is impenetrable.

We have the use of border controls and putting travellers into isolation/quarantine to stop the importation of cases into a country or between regions. We also have the crucial package of rapid testing, contact tracing, and isolation of infectious people and their close contacts. This test-trace-isolate strategy can be used very effectively to stop the spread of the virus. Then there’s limitations on gathering sizes or the movement of people, or on high-risk activities or places.

We also have all the things we can do as individuals. Things like physical distancing, washing our hands, practising safe cough and sneeze hygiene, wearing a mask, using contact tracing apps to keep a track of where we’ve been and who with, staying home when sick, and getting tested if we have symptoms. And, finally, there’s cleaning and ventilation. Hopefully we’ll be adding vaccination next year.

New Zealand’s swiss cheese/Emmental model for managing Covid-19

Around the world, countries are applying different layers of cheese depending on the strategy they are following to deal with the pandemic. Herd immunity? What cheese? Flatten the curve? Some slices. Elimination? All the cheese!

Here in New Zealand, at the beginning of the pandemic we applied border controls as our first slice of cheese, along with physical distancing, handwashing, and cleaning. It was soon clear these weren’t going to be enough and the virus was way ahead of us. That’s when the alert levels were brought in, a framework of escalating restrictions on movement and activities.

A good way of thinking about the different alert levels is as slices of cheese with fewer and fewer holes as you move from level one to level four. We soon applied the slice with the fewest holes, backed up by managed isolation and quarantine of travellers as well as physical distancing, handwashing, and cleaning. That minimised importation of the virus into the country, and massively restricted community transmission of the virus. It also bought us time to ramp up the country’s testing and contact tracing capabilities, including the development of an app.

Applying all those slices of cheese got us to elimination. But then one by one we started stripping back the layers as we became more and more complacent. Until all that was really left were the border controls and managed isolation and quarantine. Those slices have worked fantastically well, but we know they aren’t impenetrable.

Fast forward to August, when someone in the community with no links to the border tested positive for Covid-19. Quickly many of the slices of cheese we’d used before were applied, as well as a new one, masks. And they worked, again. We’re back to no cases of Covid-19 in the community. It’s looking like we’ve eliminated the virus again.

Elimination is something we have to keep working at

As long as people continue arriving in New Zealand from countries with widespread community transmission of Covid-19, we’re going to need to keep working at elimination. Because our systems are so good now, we are able to track rare transmission events in ways other countries can only dream of. We’ve had what seems to be transmission in managed isolation from a bin lid and a lift button. Then we’ve just had the port worker who picked up the virus despite wearing PPE.

And now we’ve had several new arrivals in Christchurch test positive in managed isolation at their routine day three test. They are from a large group of workers from Russia and Ukraine who have recently flown to New Zealand on a charter flight to take up jobs on fishing boats. They all tested negative before flying. The first thing this highlights, yet again, is that just because people test negative before they board a flight doesn’t mean they aren’t a risk. They could have taken an unreliable test, or could be incubating the virus, or could have become infected on the journey. It’s just more evidence for why our border controls and managed isolation and quarantine facilities need to stay in place. And why we need to keep using all the slices of Emmental at our disposal.

No room for complacency

I’m noticing that complacency is starting to creep back in again. The number of people using the contact tracing app is dropping, just like it did before our second outbreak in August.

At the very least, we must keep up with washing our hands, practising safe cough and sneeze hygiene, wearing a mask, using the contact tracing app, staying home when sick, and getting tested if we have symptoms. That way, if the virus does get through our managed isolation and quarantine system, we’re far less likely to need to move up the alert levels to stamp it out again. Instead we can use testing, contact tracing, and isolation.

We’re in this for the long haul, and it’s up to all of us to play our part.