What is Covid-19 and how should we respond to Coronavirus as healthcare professionals?

"With so much hysteria, misinformation, and click bait out there in the media, we're going to try and have an objective and balanced conversation with a subject expert and see what we can learn."

In this conversation with Liam, infection control expert, Josie Winter, cuts through the hysteria to explain what a Coronavirus is and how we can respond to Covid-19 as healthcare professionals.

Click play to listen to the audio of this conversation

Topics covered in this podcast

0.33 Introduction

4.42 How Josie's scrubbed role as an ODP lead her to a deep understanding of infection control

8.03 Moving from the public to the private sector

9.23 Josie set up her own consultancy around infection control and clinical practice

14.13 How infection occurs - the 6 links in the Chain Of Infection

19.56 What do we know about the Coronavirus family of viruses?

23.48 Flattening the curve - how can we stop the spread of Coronavirus?

26.23 What is the impact of our immune system on the spread of Coronavirus?

29.15 Adaptive immunity and antibodies - a big factor in why some people get sick from Coronavirus

33.28 The key Infection Control Precautions

38.08 Summary

0.33 Introduction

Liam Palmer

Hello, everyone. It's Liam Palmer here on the Care Quality Podcast. Meet the leaders and the innovators. This is a special episode with Josie Winter. Josie is a leading authority on infection control and prevention.

She brings an expert perspective on how we can respond to this virus as healthcare professionals. I wrote an article recently on the impacts of the virus for the social care sector. I've noticed that managers were becoming powerless through fear and anxiety.

It was a call to action to be confident and to lead. I think having reflected on that, the missing part is the science. It's science and biology that's going to give us the strategy to win the war against this outbreak.

How a virus spreads: The 6 Links In The Chain Of Infection

This episode doesn't present all the answers, but it's an informed view with science, which may help you determine which are the right questions. Josie was very generous to be so patient with me. I'm not that strong on science. She had to tutor me along the way. I hope you enjoy.

This is a special episode in regards to the COVID-19 pandemic.

I've got a very special guest with me, Josie Winter.

Josie is an expert in infection control, and we're going to be taking an infection control perspective to take a look at the virus.

With so much hysteria, misinformation, and click bait out there in the media, we're going to try and have a fairly objective and balanced deep dive conversation with a subject expert and see what we can learn.

So, Josie, without any further ado, pleasure to meet you, and would you like to tell us a bit about what you're doing right now?

Josie Winter

Josie Winter, Founder and Clinical Director of Advanced Clinical Solutions Ltd - a professional services provider of patient safety, regulatory compliance, and quality improvement support to private healthcare organisations

Thanks, Liam. Great to be here. I run a clinical consultancy called Advanced Clinical Solutions. We support independent healthcare providers with patient safety, compliance, quality improvement and clinical governance. We have a particular interest in infection prevention and control.

Liam

Obviously, we met through Tim Dallinger (our podcast conversation with Tim, Registered Manager, is here). Tim, thanks for the introduction. And, we just thought that it would be helpful to speak to an expert in this area because obviously technically it's an outbreak. It's something that's actually covered within the sort of infection control methodology.

We thought it'd be useful to kind of hear your perspective as an expert in this area to see if with the information that's out there, the experience and knowledge you've got, if we could get a more kind of objective narrative to look at this virus, see where the threats are, see where the concerns are, and see what we can do to sort of protect ourselves. So, that's a sort of broad brief of this episode.

4.42 How Josie's scrubbed role as an ODP lead her to a deep understanding of infection control

Liam

So, let's go back a bit more into a little bit about your career trajectory and sort of what brings you to be running this specialist company. So, do you want to sort of take us back to maybe perhaps when you started work and where your interest was, and how you got from there to here? Would that be okay, Josie?

Josie

Yeah. Thanks, Liam. So, I've always had a keen interest in the STEM subjects, science. I knew from a very early age that I wanted to be involved in healthcare. So, at 16, after I left school, I went to work in our local hospital in their bioscience lab. I stayed there for about a year and saw an advert to train to become an ODP, which is an operating department practitioner.

Liam

Do you want to just explain what that is in the context you're working in, Josie?

Josie

Yes. So, an ODP specializes in operating theatres. So, we go through a degree level program just like a nurse, but we specialize specifically in operating theatres. We would do scrub, which means working in the surgical field in the aseptic field, assisting surgeons. We would do anesthetics and recovery, as well.

Liam

I mean it's probably obvious, but in terms of scrub and stuff like that, so is that related to infection control? Is it about keeping people safe, or what's the purpose of that role?

Josie

Absolutely right. So, the scrubbed role is you really need to have an acute understanding of how important sterility and surgical aseptic are. We don't want to be giving patients surgical site infections, so it's important that things are kept as sterile as possible.

Liam

Excellent. So, it's now making more and more sense how that you've worked in different parts of the healthcare chain, I suppose, and how that's given you that deep understanding and caused you to become the expert that you are now.

So, okay, so you started in the labs, did the ODP, trained in that, so you're a professional clinician, worked in the NHS in hospitals there until 2007. So, you moved in 2007, moved to the private sector. Do you want to just explain a little bit about what that was about?

8.03 Moving from the public to the private sector

Josie

So, I left the NHS in 2007 and made quite a bold move to go and work in the private sector. So, I spent a couple of years providing clinical support services to various medical tech companies. It was a big change going from public sector to private.

I had to learn very quickly new skills like how to write emails and Excel spreadsheets. But, still very much in and around healthcare, supporting where I can from a clinical viewpoint. I did this for a couple of years. I didn't really have a lot of sort of focus on any particular specialist area at that point. I worked in diabetes for a little while. But, I still had this keen passion to get back to infection control.

Liam

I guess I have some parallels in moving into healthcare seven or eight years ago, and it's a big pond, isn't it? And there's so many specialties, there's so many different angles, so many different types of services. And I think it takes a while, doesn't it? You have to try out a few different things to sort of work out where you fit.

So, you said after those clinical support roles, you then got a major break. Do you want to tell us about this move into a big... It was a big tech company, wasn't it? Do you want to explain a bit more about that?

Josie

Yes. So, in 2011, I went for a clinical specialist role for one of the top five med tech companies in the world, and fortunately, I was success in my interview.

Liam

Josie, do you want to tell us about the breadth of that role because it was quite broad, wasn't it? So, what did that role entail?

Josie

It was, yes. So, the company in particular had quite a breadth of specialty areas from infection control to bio sciences to pathology. It looked at lots of different areas of healthcare. So, I was originally tasked with training and developing RN tutors, which would be healthcare staff, NHS staff, nurses, doctors, et cetera.

Liam

So, as I understand it, that involved you doing educational programs, clinical audit programs. So, you're working with a company that's providing products and services to the NHS, and you're working with the NHS with these educational programs, clinical audit program.

So, I guess when you add that to the work you'd done as an ODP and the labs and the clinical support roles, I can see how you then, during that time, actually got a pretty broad perspective about private healthcare, how it interacts, working within the NHS as a clinician and how to sort of manage services and products with the NHS. So, quite an interesting perspective. Now, I remember when we spoke before that this sparked a deeper interest in infection control. Do you want to tell us a bit more about that?

Josie

Yes. So, I was very fortunate that the company heavily invested in staff development. So, by the time I left this company, they had paid for me to do additional higher education in infection control. They paid for me to my education and training award, and they also paid for me to get a clinical audit qualification. So, in that sense, I was very lucky, and they were very supportive.

9.23 Josie set up her own consultancy around infection control and clinical practice

Liam

So, from there you went to create your own business as an entrepreneur, is that right?

Josie

I did. In 2017, I left the comfort of the big med tech company. I gave myself six months to do something. I didn't really have any idea what I would do. So, I decided to set up my own consultancy with my husband based on all the previous clinical experience that I gained, so it just seemed logical to go towards quality improvement, clinical skills training, and general clinical support works.

Liam

Yeah. It makes sense. As we talked about when we were not recording, I've been really fortunate to meet some extraordinary people on the Podcast, and there are a few sort of patterns that are starting to emerge. So, for example, I'm coming across people that sort of see themselves as almost accidental entrepreneurs.

They'd been working in the area about 15 to 20 years. They've had a couple of steps that sort of fed into each other, not necessarily planned. But, they find themselves 15 to 20 years in actually subject experts with deep knowledge, and just decide to take the plunge. Tell us a bit about how you felt when you did make that move because it's a big step, isn't it?

Josie

Oh, absolutely petrified. I had no idea whether it would work or not. We had interest from day one of my specialist area of infection prevention and control. We were approached by a major university, the University of Lincoln.

We were given a blank canvas to develop a post graduate module, so a level seven module around infection control for clinical practice. So, this would be training up sort of key nurses, other allied healthcare professionals with both practical and informative information around infection prevention and control that they could take away key transferable skills and knowledge in the area.

Liam

Yeah. Perfect. Thanks for explaining that. I mean I hope the listeners enjoy this little detour, but it was a deliberate one. I think what I've learned from working in healthcare over the last seven or eight years is that no one knows it all, and everyone has got a slightly different angle, a slightly different set of experiences. And those experiences clearly sort of inform their perspective. So, I wanted to get to know you a little bit better professionally, Josie, so that we could kind of understand where you're coming from when you are talking about infection control matters. So, thanks so much for that.

14.13 How infection occurs - the 6 links in the Chain Of Infection

Liam

Right. We're going to move on now to some of the meat, if you will, of this episode with Josie. We're going to talk about infection control at the chain of infection, and I think this is a framework model, a way of looking at things that's going to be really really helpful when we go in a bit more detail about how this particular virus works and how we can protect ourselves from it. So, Josie, do you want to explain, give us a top line of what these six links are in the chain of infection?

>> Explainer - The Chain Of Infection <<

1. Infectious agent (germ)

2. Reservoir

3. Portal of exit

4. Mode of transmission

5. Portal of entry

6. Susceptible host

Josie

Yes. So, to understand how an infection occurs, it's useful to think of it as a chain. It's just like a chain on a bike. If the chain were to break, the bike would no longer work. And the same is true for the chain of infection. So, each link must be present and in the correct order for an infection to occur. There are six links in the chain of infection, which are an infectious agent, or the germ, a reservoir, a portal of exit, a mode of transmission, portal of entry, and then the final link is a susceptible host.

Liam

Alright. So, do you want to take us from the top, then, talking about the infectious agent?

Josie

Okay. So, there are different categories of microorganisms. So, as the name suggests a microscopic organism that is too small to be seen with the naked eye. And these can cause illness and disease. For most infections in humans, they are caused by either a bacteria or a virus.

Liam

All right. Thank you. So, we'll move on now to the reservoir.

Josie

So, link number two, or reservoir. So, reservoir is just another name for, kind of like a place to live. Microorganisms do not survive for long in the world on their own. They need a nurturing environment, somewhere they can grow, live, and multiply. A reservoir is any place where there are lots of different types of reservoir, so people, the environment, healthcare equipment, animals and food can all act as a reservoir. The human body is probably the biggest and best reservoir for some of these microorganisms, and it's also the most common source of infection to others.

Liam

So, that's the infectious agent, we've done reservoir. So, moving onto the portal of exit.

Josie

So, these microorganisms need a way to leave the body before it can present a risk of infection to somebody else, so before it can be passed on. And there's a number of ways that they can leave the body. So, they can come out through the respiratory system like sneezing or coughing. They can come out in blood and other bodily fluids, as well. So, the common cold, for example, exits the body through the respiratory tract, usually on droplets when you sneeze or cough.

Liam

Okay. So, without trying to sound like the 12 days of Christmas recapping things, we've got the infectious agent, the reservoir, the portal of exit. So, we're moving on now to the mode of transmission.

Josie

Link four is the mode of transmission. So, this is the route by which the microorganism can pass from one person to another. And there a couple of different ways that it can do this. So, the key ones are probably direct contact, so from person to person. Airborne is another way, so some microorganisms can be easily carried through the air.

Liam

Right. So, we've done mode of transmission. We're moving on now to portal of entry.

Josie

Okay. So, link number five is the portal of entry. So, to infect someone new, the microorganism needs a way of getting into the next body or the next person.

"The portal of entry will vary for different infections. For example, the respiratory tract is the entry point for microorganisms causing the common cold or flu."

The portal of entry will vary for different infections. For example, the respiratory tract is the entry point for microorganisms causing the common cold or flu. So, the virus can be breathed in through the mouth or nose. Another common portal of entry is the digestive system. So, if we eat contaminated food, for example. Another portal of entry could potentially be an open wound.

Liam

So, we're moving onto the sixth one, which is susceptible host.

Josie

Yes. So, the final link in the chain, or link number six is a susceptible host, or a willing victim. So, the human body has lots of defense systems, but in some people these can become weakened from a variety of reasons. For example, AIDs, underlying health conditions and pregnancy, as well.

Liam

Okay. So, I'm going to summarize that as well, in that 12 days of Christmas manner. So, the six links to the chain of infection, and I thought that was really helpful, you explaining that they've all got to be present and coexisting for the infection to occur, is the infectious agent, the reservoir, the portal of exit, the mode of transmission, the portal of entry, and the susceptible host. So, all those things need to work together in a chain for the infection to occur. So, thank you very much, Josie for explaining that. We took our time because it's quite technical, but I think it's very relevant in regards to the virus. So, thank you.

19.56 What do we know about the Coronavirus family of viruses?

Liam

So, we're going to move on now to sort of add another layer of detail. So, we want to ask you about the science behind the common cold and flu and the coronavirus family of viruses, I guess. Do you want to talk to us a little bit about that, and go into the science a little for us.

Josie

Yeah. Sure. So, I don't know if you've ever met a scientist before, but they are highly organized analytical type people. And they like to classify and sort things into orders.

So, this is true with viruses.

So, with a virus, they are generally classified or sorted into different types of families. And they sort them by like or similar characteristics and traits. This could be anything from shape, structure, genetic information, even down to what type of disease they could cause.

So, the coronavirus is a large family of viruses. So, in humans the coronavirus family tends to cause respiratory infections, and these can be relatively mild infections such as a common cold. But, then on the other end of the spectrum, there are more severe ones such as SARS, MERS, and more recently as we know COVID-19.

So, we've known about human corona viruses for a while, and they identified the first one in the 1960s, but more recently there have been at least six new human corona viruses identified since the early 2000s including SARS. So, SARS stands for severe acute respiratory syndrome. So, under an electron microscope, so an electron microscope is a really powerful microscope that allows us to see really small things.

So, corona viruses have this crown like appearance, and corona is actually Latin for crown. So, that's where the name originates from. The crown appearance is caused by spike proteins, or S proteins, that sort of protrude out of its surface. So, we know COVID-19 is related to other human corona viruses, such as the SARS and MERS that we've heard about before. And they share a similar genetic footprint, but they're not exactly the same.

Our scientists have been doing lots of genetic testing and genetic sequencing tests. So, the corona viruses have these S proteins or these spikes sticking out its surface, so to be able to enter a human cell, the spikes need to dock with a receptor on a human cell. So, they need to come together.

The one COVID-19 likes is a receptor called ACE2, so it's kind of like a doorway into our cells. These are particularly common in the lungs, so they're particular cells found in the lungs.

This docking - the spike and the receptor coming together - is a crucial step for the virus to enter into our cells. It's not technically a virus until this has happened.

So, once that happens, the virus will inject its genetic information into our cells, and the genetic information is essentially instructions on how to make clones of itself.

23.48 Flattening the curve - how can we stop the spread of Coronavirus?

Liam

Alright, Josie. So, thanks for that. We've talked about the science of cold and flu and the coronavirus family, as it were, a family of viruses. So, going to add another layer of detail here. We want to ask you about the virus in terms of how it's evolving. We talked offline about the spread, about contagion, and also about how the healthy body responds to the virus. So, do you want to talk to us about the flattening the curves, and the significance of that with this virus?

Josie

Yeah. Absolutely. So, we keep hearing the term flatten the curve. The curve is essentially a scientific model that predicts the effectiveness of different interventions to try and limit the spread of the virus. So, we need to look at how infectious COVID-19 is. So, by infectious we mean this is the number of people infected by each person infected. So, compared to the seasonal flu, approximately for one person who has the flu, they will then go onto infect a further 1.3 people. What we know about COVID-19 is that for every one person that has COVID-19, they will then go onto infect another two to 2.5 people.

Liam

And the significance of that is...

Josie

Just sheer numbers. So, it just spreads much more quickly.

Liam

And that's the reason for the lock downs, et cetera.

Josie

Yeah. For social isolation.

26.23 What is the impact of our immune system on the spread of Coronavirus?

Liam

All right. Okay. So, that's clear. So, I'm asking you to now more clearly explain this point that I got quite excited about when we first talked. And in my simple speak, it was this idea that what determines whether people will get seriously ill is something to do with their immune system and something to do with how their immune system responds. Can you sort of more properly explain that, and then what that would mean?

I mean these are only sort of assumptions based on things we're looking at, as we said to the listeners in the intro. We're not giving medical advice. We're not saying take these interpretations at face value. We're just looking at what we know today, and we're just trying to make sense of it. So, with that in mind, do you want to explain about the impact of the immune system, Josie?

Josie

Okay. So, the immune system is basically our body's own defense system. It's like our very own personal unique army we use to fight infections. So, within the immune system, it has lots of different components. So, there will be white blood cells. There'll be antibodies and lymph nodes. The immune system essentially is split into two lines of defense.

So, the first line of defense is what we call our innate immunity. It's our first line of defense against the virus, if you like. And this will be sort of things like the mucosal linings in our respiratory system, so you know the sticky mucus that you get in your nose. It will help to trap particles. Your body's innate immune system is absolutely incredible, and on its own can probably prevent most infections that you'll come across in your life. However, if there's a pathogen it can't destroy or it doesn't recognize, it will send a chemical signal to our second line of defense, so sort of a signal to say that they need a bit of backup.

So, the second line of defense we have, it's a bit more sophisticated, and we call it our adaptive immune system. The adaptive immune system is responsible for recognizing and remembering different types of viruses. Adaptive immunity gets its name because it can adapt and change. As you go through life and you're exposed to different types of microbes or pathogens, so if your innate defense can't fight them, your adaptive immunity is much more targeted and a bit more accurate. So, the adaptive immunity usually takes four to seven days to kick into action.

The other thing adaptive immunity does, which is really, really incredible is that it produces specific antibodies to fight an infection. And once it produces this antibody, it kind of stores it away in a memory bank. So, sometimes you get an illness only once in your life, and then you'll never get it again. It's because your body has produced this antibody, and it has this memory.

So, it can recall this memory, fire the antibody down to the pathogen, and deal with it quite effectively. So, you can see why keeping our immune system and our general health in really good condition is so important at the moment.

29.15 Adaptive immunity and antibodies - a big factor in why some people get sick from Coronavirus

Liam

Yeah. That just sounds amazing. Yeah. I mean I think... Yeah. Well, let's try and break that down for me, and for the listeners a bit. So, Josie, so are you saying that people who've gotten a weaker immune system are more susceptible to get ill? Are you saying that the main thing determining whether people get very ill from this virus is the condition of their immune system?

Josie

Yeah. That just sounds amazing. Yeah. I mean I think... Yeah. Well, let's try and break that down for me, and for the listeners a bit. So, Josie, so are you saying that people who've gotten a weaker immune system are more susceptible to get ill? Are you saying that the main thing determining whether people get very ill from this virus is the condition of their immune system?

Liam

Yeah. Okay. Well, let me explain what I think that means, as in what you've just said. Right?

Josie

Okay.

Liam

And we might leave it, or we... So, what stands out for... Okay. So, you've got two lines of defense. The first one is innate. The second one is adaptive. The adaptive is the interesting one that creates the antibodies.

Josie

Yep.

Liam

And the antibodies has got the memory, and the antibodies is the one that healthy people will have that will stop them getting sick, or could well stop them getting sick from this virus, which is why the vulnerable people with compromised immune systems are the ones we're protecting and stuff like that. So, to me... Is that it, or is that not it?

Josie

Well, kind of. If you think of the immune system as a whole system, anybody with an underlying healthcare condition, the majority of their immune system will be going towards supporting whatever that underlying health condition is. So, a big chunk of their immune system is already working hard on that underlying health condition. So, if you then go and put another pressure on it like COVID-19, for example, it's just not going to be as effective.

Liam

So, what I think you're saying is if someone doesn't have a serious health condition, and their immune system is working properly, it means that when the virus comes, that they've got all their power, all their energy, it's working at 90 to 100%, and they can sort of fight the attacker off relatively easily. If they've got some relatively serious health conditions, their immune system might be working at 50%, 60%, something like that because as you said, it's too busy dealing with another health condition. So, when the virus comes to them, they struggle to fight it off. That's the simple...

Josie

Yes. In very simple terms, yes.

Liam

It has to be simple for me, unfortunately. Brilliant. Brilliant. Okay. I think that kind of narrows that point because we're just trying to sort of draw out meaning from some of this science, quite honestly. And I know we're hacking it for simplicity, but it's to try to give some meaning, isn't it? Do you know what I mean?

Josie

Yeah.

Liam

Because it's not the place to get into too much detail. Otherwise, we lose the meaning in a nutshell. All right. So, let's move on, then, to... We can just do a quick summary there. So, we've got a good sense of who you are, Josie, in terms of your career story, your interests, and how you developed this sort of deep knowledge of your subject area both through practical work in the NHS employment sector and also studying it, studying the subjects formally. We've looked at the infection control and the chain of infection. We've looked at the science of cold and flue and the coronavirus family. We've looked at what we know about the virus today. We've looked at the levels of infection. You've also clearly explained the sort of relationship between the immune system and how that can have a bearing on whether people get very ill from this virus or they don't, and how that could be a significant factor in how this plays out with the population.

33.28 The key Infection Control Precautions

Liam

So, we want to kind of draw all of that together, all of that learning, all the sort of layers of information we've got there, and sort of end on a pretty practical note in terms of pulling all that stuff together and say, okay, so in terms of what we do know, based on your experience in infection control and knowledge about this virus, so what sort of tips or reminders would you give listeners in regards to protecting themselves from the virus?

Josie

Okay. So, I guess the important thing to remember is that COVID-19 is an infection. Most health and social care workers at some level, albeit basic, will have had some kind of infection control training. And this will be part of their mandatory training schedule. So, if I were to give a list of things to go and refresh yourself on, one of them would be the standard infection control precautions. And there are 10 of them, but I think there are a few that we need to pay particular attention to. We've seen quite a lot of them on the news, and this is the advice that's coming out from the government, and the NHS and Public Health England, and all of those bodies.

1. Hand washing

So, number one, standard infection control precaution would be increased hand hygiene. I'm not going to go over it. We all know we need to washing our hands for at least 20 seconds.

2. Cough hygiene

The next thing, and again, this has been highlighted across the news, is our respiratory and cough hygiene. The phrase, "catch it, bin it, kill it," we're seeing that everywhere. So, number two, practice good respiratory hygiene.

3. Keep your environment clean: cleaning and disinfecting

Number three, I would say, and this is quite an important one, but it hasn't been covered as extensively as some of the others, would be around managing our environment. So, really rigorous cleaning and disinfecting.

Now, I say those two things separately because they are two separate processes.

Cleaning is removing of visible dirt, and disinfecting is a more sophisticated process using chemicals.

So, we would normally clean first, and then disinfect after. And it is absolutely pointless disinfecting unless you've cleaned away the dirt first.

So, a lot of the common disinfectants, I think the one most people are using are sodium hypochlorite, or bleach. So, cleaning and disinfecting, really really important. And I cannot stress enough please do not overlook your cleaning up tips. They are an essential part of your infection control team. And just up skilling them around the difference between cleaning and disinfection, and they will be so important in drawing up and maintaining your cleaning schedules.

4. Personal Protective Equipment (PPE)

The thing I'm getting asked a lot about at the moment is what PPE we should be using. So, we've all got our basic PPE. We've got our aprons. We've got our gloves. But, the one I'm getting asked about all the time is face masks. So, I just want to provide a little bit of clarity around the face masks and when to use them. So, there are essentially two types. We have the normal surgical face mask, and then we have a more sort of sophisticated face mask, which you would have seen them on the news. They have sort of a filter device on the front of them. So, the surgical face mask is worn for droplets. The filtering device face mask is worn whenever there's a risk of airborne transmission. So, there is a helpline. So, if any providers are really struggling to get hold of supplies, there is a helpline they can ring. It's called the National Supply Disruption Line, and they can be called on 0800 915 9964.

38.08 Summary

Liam

Okay. Perfect. Is there anything else? I mean we've had a vere wide ranging conversation, and I'll sort of reflect on it, and sort of wrap it up a bit later. It's quite a lot to take in. Is there anything else that you want to tell us about the original brief which was to take the infection control sort of framework and models, apply it to this virus so that we could have a way of getting our heads around it, how to approach it, how to think about it, how to respond to it? Is there anything else that you'd like to add, Josie?

Josie

Yeah. I think just to summarize really. We need to take a sensible, rational approach. We need to listen to the guidance that's coming out, and it is changing by the day. So, keep yourself up to date with reliable scientific evidence and guidance. If you can, knock out the chain of infection, and then correlate your infection control precautions to each link in the chain of your infection. You've got to draw it out on a big bit of paper or something, do that. Just really think about how you're applying your standard infection control precautions to break the chain of infection.

Liam

Brilliant. And we've got those six that you talked about earlier. So, we can all certainly do that. All right, thank you. Josie, this was quite a difficult brief, but I think we've done it justice. We've probably put about a total of probably six to eight hours into it, I would have thought, maybe a bit more, maybe 10 hours. I hope the listeners enjoy. Our original brief was to have an intelligent, informed conversation about this difficult subject. We haven't shied away from it, and I hope you've, in some ways, enjoyed the experience. It's certainly been a pleasure to have you on the Podcast.

Josie

Thank you so much. I guess, like the rest of the country, I'm remote working. So, if anybody needs any advice, just give me a call.

Liam

Wonderful. And how would they find you, Josie?

Josie

I'm very active on LinkedIn. We have a website, Advanced Clinical Solutions. So, just look us up.

Liam

So, there you have it. Again, very many thanks to Josie Winter for this special episode. What did you think? Did you get something from it?

For me, it was a timely reminder about the importance of the chain of infection. I found that really helpful, as was reflecting on the mode of transmission. Is it airborne or through droplets only?

There's no clear answers here yet, but I think it's a good question, as that informs of which type of protective equipment is needed. Really important.

The other point that really stood out for me was talking about the immune system and how the virus is likely to have an adverse impact to those whose immune system is impaired.

That gave me something important to think about because prior to that, I was thinking that it was the severity of the virus that was causing these terrible illnesses for people.

And the idea that the reason why they're becoming so sick is because their immune system is compromised, and because they don't release the antibody that fights the virus. I found that really helpful, kind of reassuring, actually. I hope I've understood and quoted that correctly.

Inevitably, just to close then, I mean with such a broad and complex subject, I wonder if this was helpful.

I wonder if I achieved my modest goal.

Josie and I put about nine hours into creating this episode. We made sacrifices in the evenings and weekends to do it. I think if it's made things a little bit clearer for you, it's certainly worth it.

So, I'm going to close now, and I really hope that helps. Stay safe, everyone.