Talking Points: Deepti Gurdasani on COVID-19

With COVID-19 still affecting the scientific community and society at large, further actions are needed to tackle this and future pandemics.

The COVID-19 pandemic has resulted in hundreds of thousands of deaths around the world and has left millions of people with long COVID. Deepti Gurdasani (@dgurdasani1), an epidemiologist at Queen Mary University of London with more than 140k followers on twitter, has used social media to inform both the public and other scientists about the pandemic. Here, Gurdasani discusses the impact of pandemic on the scientific community, the lessons that can be learned for the future, and how the UK government is failing to respond to "really terrifying legacy of COVID-19".

Deepti Gurdasani

Over the past two years, you have been using Twitter to inform and educate the public about the pandemic. How would you describe your experience doing this, and what have you learnt?

It's been a mixed experience. It's been absolutely great to be able to communicate science and reach people, and it's been rewarding to know that a lot of people have been acting on the information I'm communicating to keep their families and communities safe. It's also been disappointing to realise that many proponents of misinformation and pseudoscience are colleagues within the scientific community. Combatting this misinformation on social media, where algorithms facilitate spread, has been a huge challenge.

The experience has also given me a lot of insights into the culture within the scientific community. Much of the misinformation I challenge, and the bullying and harassment I've faced, has come from colleagues. It's become very clear that the scientific community isn't above ideology and bias, and often, instead of humility in the face of new evidence, we see scientists becoming more and more entrenched into positions they have taken even as they are proven wrong.

The bullying, misogyny and racism have also been striking. This isn't new to me, being an outspoken brown woman, without a lot of power in academia, but it's interesting to see it out there in the public. It's very much an amplified version of the racism and misogyny I've experienced in academia, but out there for everyone to see.

Do you think that the pandemic has affected the role that social media will have in the future in terms of discussing and disseminating public health measures and scientific information?

Yes, absolutely. In many ways, I feel social media is very good for quick communication of new science. It's one of the reasons I stay on social media, to keep myself up to date with new information and evidence. It has been a great tool for quick dissemination of what new studies mean, and their implications for the pandemic, and for policy. It's also clearly one of the ways that many non-scientists, who want to stay informed, get information and translate it into day-to-day practice. So many community efforts and networks have emerged through these people! There are also amazing citizens' data science efforts on social media – collating data and creating easily interpretable resources for others to use. Often, these efforts are not spearheaded by scientists, but by motivated members of public, who are very well informed and want to facilitate research and situation awareness.

I think social media also provides an important tool to understand the lived experience of often marginalised groups. Reading and sharing the experiences of those within the long COVID and the ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) communities really help people understand what living with these conditions is like – including scientists and clinicians, who have often been sceptical about giving importance to the lived experience of people suffering from conditions they don't fully understand. It's also been a great tool for advocacy for parents, teaching staff, long COVID patients and the clinically vulnerable community. I see it as an important avenue for social change, and change in the scientific and medical community, which is necessary.

COVID-19 has led to many scientists working from home, labs having stricter rotas, mask-wearing becoming compulsory in many labs, and so on. Do you think the research community will ever go back to how it was before the pandemic? If not, what do you think the biggest lasting changes will be?

I honestly hope that it doesn't go back to how it was. I think the pandemic has really shown us what kind of work actually requires people to go into offices and labs, and for how much of their working week. It has also made clearer what aspects of work environments are valuable, such as the social aspects of being in a team, and we can think of ways to keep these without having people in work environments all week. Equally, it has also made clear the importance of workplaces for some people, whether it be for dedicated time and space, respite or, sadly, even safety. I think the key change we need is greater flexibility in working arrangements to accommodate different needs.

From my point of view, working from home is great, and it has really increased productivity, especially if you have long commutes into work. This becomes even more important if you're disabled, chronically ill, or juggling childcare. The flexibility really helps, and in my case, I really feel it has improved, not reduced, productivity, and made it much easier for me to do what I do. As someone who is chronically ill and disabled, having to commute every day is very hard. Working from home has not only freed up time, but also the limited energy reserves I have, so I can spend them more productively on work, rather than commuting. It has improved my quality of life considerably.

I think universities have fared differently on safety measures over time. Earlier on, I think there was a greater focus on these, but in my view these have been dropped far too quickly, even in academic centres. While I'm sure many of us really like working from home, it is important for universities to be inclusive spaces. This means careful attention to masking policies, ventilation, air-cleaning and air-sterilisation. I think this could be done better. It's not only about COVID, but we've learned that these simple steps can massively reduce airborne infection, and good ventilation is important for concentration and cognition. We've focused for decades on clean water, clean food – it's time that clean air became a focus in workplaces.

The pandemic also disrupted many research projects, with many scientists being unable to keep working consistently and many funding lines failing to be extended. How do you think this will impact scientific output in the long term? And how will it affect early-career scientists who had their work interrupted?

This is a serious problem and requires careful consideration by funders. I do worry about this, because I think the impact will be greater on early-career researchers and particularly on women and other minoritized groups. I've had international projects that became impossible to deliver because of a state of emergency in the country the work was planned in. And unfortunately, even with extension, it could not be completed, because of barriers due to COVID-19.

I think there needs to be more of an understanding from funders, and evaluators about outputs during COVID-19. It's been a challenging period for many reasons. Scientists have had work interrupted not only because in-person research became very hard during these periods, but also due to the personal cost many would've faced – including a greater burden imposed by childcare during school closures, mental health impacts of the pandemic, losing family members, developing long-term illness/disability from long COVID themselves, and the impacts of societal disruption.

The academic system is archaic and unforgiving. It only rewards a very narrow view of what is considered being productive. I think that view needs to be challenged. By its nature, the system is structurally discriminatory, cruel and non-meritocratic. It is discriminatory to carers who are often women. Those with families. Those with disabilities. And early-career researchers who need support.

During the pandemic, many scientific conferences and events became hybrid or went entirely online. What has been the impact of this? Do you think the online option for conferences will continue to grow in the coming years?

I hope so. I think it's one of the inclusive ways moving forward, given that conferences have been superspreading events, and generally safety measures in-person have been found wanting at most conferences. It also makes it much easier for people with families and childcare responsibilities, and those with clinical vulnerabilities, chronic illness or disability to attend. This should’ve happened ages ago!

Do you think that, for the general public, life will ever go 'back to normal'? What do you think will be the biggest long-term impact of COVID-19 on our societies? And on our health?

I don't think so. I think there is a pretence of normal, but the reality keeps breaking through, which makes it hard to keep up. We're facing a huge impact of chronic illness due to long COVID on the workforce, and there is mass societal and educational disruption due to continuing transmission of SARS-CoV-2. While isolation is no longer mandatory, the disruption seems to be caused by illness now, which isn't something that can be 'policied' away. I think there will be a massive impact on long-term health and the economy. We're already seeing this in many countries now. In the UK, we have more people out of the labour force with chronic illness than we've ever had, and long COVID is leading to labour force shortages in the US. And this is just two and a half years down the line. It's going to get worse.

For me, part of the terrifying legacy of COVID-19 will be the normalisation of mass death and disability, and the ableism, racism and social inequality within policies that sacrificed the vulnerable, the poor, the disadvantaged, the elderly, and had disproportionate impacts on ethnic minorities. I never thought I'd live in a time where so much suffering was normalised by governments, media, with complicity from some in the scientific community. The denial of reality and the success of misinformation campaigns aided by vested interests to support this has been eye-opening. Unless we find a way to combat this, the future looks bleak, not only in terms of public health and pandemics, but also tackling huge problems like climate change.

Do you think the vaccination campaigns for COVID-19 have improved or decreased the public's trust in science, and specifically in the effectiveness of vaccines?

I think vaccine campaigns initially did increase public trust and uptake was good in many places. Unfortunately, overreliance on vaccine effectiveness, and a blinkered approach to new variants, has somewhat undermined that trust as, over time, the virus has increasingly escaped vaccines developed against the original strain. This could've been prevented with strong messaging around a 'vaccine-plus' or multi-layered approach: presenting vaccines as an important layer, but one of several – including masks, ventilation, air cleaning, testing and supported isolation to protect communities. For many, the earlier optimism and complete reliance on vaccines meant that when breakthrough infections started happening commonly with new variants, trust was lost. Had vaccines been presented as one tool of many, with an additional focus on protecting vaccine efficacy by suppressing transmission to reduce the rate of evolution of variants, we may have done better.

I also feel very little was done to address vaccine hesitancy in ethnic minority communities, where there is legitimate distrust of the medical and scientific community due to historical and continuing structural violence. This was never acknowledged, nor addressed, with vaccine hesitancy widely treated as ignorance or an information problem, rather than a legitimate issue with trust.

Undermining the messaging around childhood COVID vaccines, like the UK did, made vaccine hesitancy worse. I worry that this will have impacts beyond COVID. Unhelpfully, the void left by governments and scientific committees on vaccination has been filled by disinformation campaigns by lobby groups that are often supported by vested interests. These campaigns have been vastly successful in undermining trust in vaccines, and governments and social media platforms have done very little to combat them. Again, the impacts of these campaigns will be felt well beyond COVID – and will likely extend to the political domain as well as climate change.

How has the pandemic affected scientific literacy among the public?

This is a hard one to answer. I think there are certain aspects of scientific literacy that have likely improved, in that people are more aware of certain concepts and areas of information that they may not have had a lot of knowledge about before. However, given how widespread and successful misinformation and disinformation campaigns have been in the media and within government, it is difficult to get a sense of what the general public's understanding is. When we talk about scientific literacy we often think mainly about knowledge, but a key aspect of such literacy is the ability to critically examine information. This is much harder to do, especially when 'trusted' sources of information, like governments and public health agencies, are not reliable.

The UK government regularly said it was "following the science" during the pandemic: do you think it did?

No. There is so much evidence against this. The UK has been an exception on policy in so many aspects, defying evidence-based policy, or even the precautionary principle that was followed in many other countries. The result is one of the highest death rates per capita in Western Europe, and even globally.

The list of the UK government's failures is a very long one. Delayed action again and again, leading to tens of thousands of deaths, and millions with long COVID. Delayed lockdowns despite scientists advising this was urgent. Overzealous messaging on hand hygiene over airborne precautions. Very confused messaging on masking, including messaging from scientific advisors that masking was ineffective, or even harmful. Delayed policies on masking, and even then, a lack of messaging on the utility of well-fitting high-quality masks. Discharging infected care home residents without testing back into environments where infection spread, killing many vulnerable people. Pretence that airborne transmission doesn't happen within school walls (England possibly had one of the poorest policies of masking in schools, and also one of the highest rates of educational disruption across Western Europe). Lack of preparation when schools were closed to put in place ventilation, air cleaning that would reduce school outbreaks. Lack of any consideration of long COVID in policy, which is now coming to bite the government on the economy. 'Eat out to help out', which facilitated infection and no doubt cost lives. Delayed vaccination for children again and again. Lack of any protections for the clinically vulnerable. Extremely poor support for isolation, which now, of course, has been stripped altogether. Spending billions on testing, while having the lowest sick pay across the OECD, which meant that most people couldn't afford to isolate, even if testing was free.

The government say they went first on vaccines, and have rested on those laurels, but the truth is vaccine roll-out in the UK was overtaken last year by many other countries in Western Europe as the UK stalled on vaccinating children.

It was absurd to make pandemic control a personal responsibility to avoid putting in the infrastructural, financial and practical support needed to contain the pandemic. The result has been mass death, disability, and huge impacts on public health, NHS, society and economy.

Do you think the UK has learnt lessons that will make it better prepared for future waves of COVID-19 and/or future pandemics? If not, what does it need to do?

No, not at all. I think the government has learned that, with the right voices from the scientific community standing complicitly by them – and being rewarded – and with a deeply complicit media, they can get away with not doing anything to protect the public. The government has used this crisis to distract, grab power, and benefit their donors. The corruption evident in PPE procurement contracts, and the private test and trace system has been astounding.

The lessons from the pandemic are very clear. Dr Mike Ryan – the executive director of the Health Emergencies Programme at the World Health Organization, responsible for the containment and treatment of COVID-19, said in the first few weeks of the pandemic: "Be fast, have no regrets. The greatest error is not to move", and "speed trumps perfection" when it comes to dealing with an outbreak.

The precautionary principle is key. Do not assume the best. Prepare for the worst. Decentralise response, because local authorities are experienced with working with the communities they serve. Do not try to 'tech' your way out of it. Basic public health principles of infectious disease should apply while we learn more. Many countries did this successfully, even when we knew very little about the virus. For example, South Korea and Japan were using excellent contact tracing and airborne precautions to contain spread to the point of not needing national lockdowns. Meanwhile, in the UK, basic public health measures were completely ignored, using emergency lockdowns as the primary means of containment when spread got out of control again, and again, causing an unacceptable toll in mortality and chronic illness.

The WHO has had an important role in coordinating the response to the pandemic. Do you think they managed this role well? Have the measures taken by the WHO against COVID-19 better prepared the world for future pandemics?

No. While their earlier messaging on acting urgently was good, they completely failed on messaging around airborne transmission – a mistake that very likely cost lives and has still not been acknowledged by the WHO. It seemed that at many points (including airborne transmission, and childhood vaccination for COVID), the WHO were fitting policy to perceived resource, rather than to science, which really undermined trust in them, and had lasting impacts on responses in many countries. I think the WHO need to reflect on their failures and understand how they were allowed to happen. They need to openly and transparently acknowledge failures and learn from them. This is essential to be able to rebuild trust.

Deepti Gurdasani was interviewed by Helena Pérez Valle, Associate Features Editor, eLife.