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From the Desk of the NNEdPro Chair

PANDEMIC TO PANDORA – Two months, Two Lessons and Ten Thanks


Since our last newsletter sent in early February all our lives have changed in ways that we could not even have conceived just a couple of months ago!




THE PAST TWO MONTHS

Rewinding back to the beginning of February, the NNEdPro Global Centre Regional Networks programme ran a series of bi-annual workshops and fieldwork across the India network with activities spanning five states. This was followed through the rest of February by planned soft launches of three important network hubs in Switzerland, Italy and Mexico bringing the total number of network hubs to ten across the globe. Over the 2020/21 this leaves two more regional networks to be launched – one in Canada where this will consolidate our longstanding collaborations since 2014 and another in the Middle East where we have developed very promising new connections – additionally some of our existing networks are to be expanded to cover a wider geographical reach such as within the African continent. Attainment of these three remaining milestones will mark the completion of the roll-out of strategically placed regional networks linked with our vision of an International Knowledge Application Hub in Nutrition by 2025 (I-KANN-25), serving the needs of nutrition and health professionals across all of these regions. Within each regional network we will prepare to implement our two cross-cutting models: Nutrition Education policy for Healthcare Practice (NEPHELP) at the level of professionals and policymakers, as well as the Mobile Teaching Kitchen (MTK) interfacing with both professionals and the public. Back at base, in the first week of March we delivered a very well attended webinar on Nutrition and Cardiovascular Disease to our healthcare colleagues down under via the Australasian Society for Lifestyle Medicine followed by key note talks and a key presence at the hugely impactful inaugural annual conference of Nutritank at the Royal Society for Medicine. Do visit our past events page to have a look at the action packed weeks of from late January to early March.

And then just over a month ago the tide turned dramatically as our colleagues in Italy went into lockdown. By the second week of March, COVID-19 had gone from being a public health emergency of international concern (which we had alluded to with all humility in our January newsletter!) to an omnipresent pandemic permeating every facet of our global centre and leading to the cancellation of our showcasing event in the Cambridge Science Festival and subsequently the entire festival itself! As things in Italy and neighbouring countries began to spiral uncontrollably, the UK began to grapple, prevaricate and ultimately realise that a tidal wave was about to hit in the form of SARS-CoV-2 and the deadly disease that is COVID-19. As we cross Easter, the UK will have been in lock-down for three weeks and it is barely a month since our face to face activities were in full swing. Yet it feels like another era already. Many of us have spent much of March and now part of April working remotely and living in relative isolation (or in some cases completely so!) attempting wherever possible to maintain some semblance of normality for those of us lucky enough to do so whilst countless others either fall victim to COVID-19 or indeed battle bravely on the front-line of this invisible war and possibly the greatest generational challenge that most of us will experience in our lifetime as well as one that generations to come will mark in the books of history. Against this surreal backdrop of a world that will possibly never be quite the same again – a world where all borders and divisions, both natural and man-made, have been relentlessly permeated without discrimination – we are also witnessing an increasing number of small miracles in the form of the human spirit striving to combat COVID-19, ranging from selfless acts of kindness through to the prowess of science working for society, as well as the unshakeable resolve of healthcare and key workers who are putting their own lives on the line to serve others. I feel inspired to see that the NNEdPro Virtual Core as well as the wider membership is full of such miracle-makers including those members who are at the frontline in both clinical and societal settings as well as others who form part of the scientific and public health response. It is a real privilege to be working with such outstanding individuals!

Whilst COVID-19 has been a threat like no other it has also ignited our will and skill to play a key role in rapidly pulling together as an organisation but also robustly pooling together scientific knowledge that might be of help. By mid-March we activated crisis management processes within the NNEdPro Global Centre to develop an organisational response appropriate to our position of being headquartered in the UK but with widespread central as well as regional networks. Whilst recognising that the dynamic needs of individual regions would differ, we established a centrally positioned Taskforce co-led by a front-line medical doctor with formal training in ‘Global Health and Catastrophe Medicine’ to help guide our activities through these disrupted and uncertain times. Following our initial Taskforce meeting we prioritised the safety of all members across our regional networks. In order to ensure this, ALL NNEdPro operations were moved online with immediate effect and indefinitely, in line with measures advised by the World Health Organization. This was roughly a week ahead of the UK at large, enabling us to gear up and continue current operations through virtual methods. Fortunately, in the Autumn of 2019 ahead of the current crisis, we transitioned to predominantly virtual operations and therefore had some lead time on this front. In addition, we immediately enacted several changes to our calendar of events including transitioning to virtual platforms wherever possible including our flagship summer school and summit. Despite best efforts there will still be cancellation of some events where conversion to online is not feasible but as far as we can see these will not impede our overall scientific and strategic goals for the year ahead. Our Directors and Governors have also rallied around all efforts which have benefited from the much more frequent counsel of the Directors in particular. Aside from considerations of safety, our Medical Director specialised in Occupational Medicine, has also been running a twice weekly online ‘Wellbeing Café’ to help the NNEdPro Virtual Core keep good spirits during this unprecedented time.

Invariably, all our University lab-based as well as field-based activities across the board were suspended in mid-March until further notice and roles have been rapidly repurposed. Due to our wide-ranging activities worldwide, we have been monitoring the development of the pandemic and seeking expert advice to enable dynamic risk management across our central and regional networks. However, perhaps the most challenging part of this has been to remotely guide the risk management of field activities in lesser resourced settings such as our work in urban slums and rural villages in India. Whilst we were able to act very early to mitigate exposure to our researchers and participants/beneficiaries and this will hopefully save lives for now, it remains that saving livelihoods is a greater challenge, as is ensuring food security in the medium term. To this effect we have re-purposed our crowdfunding campaign for our champions in urban slums of Kolkata to help towards their survival but of course recognising that this is a tiny tip of a gigantic iceberg and we are therefore collecting insights from the field and attempting to pass these on to those concerned with mitigating the effects of acute food insecurity arising from the COVID-19 crisis.

The efforts of our Taskforce (and particularly our science comms and digital leads) have led to the development of a dedicated Microsite collating useful resources for our members and stakeholders on COVID-19: https://www.nnedpro.org.uk/coronavirus. Within this Microsite we have specifically created a set of resources and information around COVID-19 and Nutrition: https://www.nnedpro.org.uk/nutrition-resources and our rapidly synthesised original blog bringing together a 10-point summary on diet, nutrition and the role of micronutrients has now been viewed online by over 2K people and is being translated and adapted for multiple regions. Also in production is an evidence-informed practice guidance piece in Complete Nutrition which is expected to reach well over 10K health professionals. Additionally, working closely with our journal BMJ Nutrition, Prevention and Health we launched a special collection on Nutrition and COVID-19 Interactions in which we are calling for guiding evidence that might help us in this unprecedented global crisis. I am delighted that we already have several pieces in various stages of genesis that multiple authors around the globe are working on towards strengthening or collating the existing evidence we have on COVID-19/immunity/infection and its connections with nutrition as well as looking at the acute impact of COVID-19 measures on food security. As these outputs emerge over coming weeks our science comms team will have much to do towards disseminating key messages for potential uptake. We have also managed to quickly input to the design of an acute London-based study in a hospital intensive care unit looking at how nutritional status/intervention might be correlated with clinical outcomes in COVID-19. We hope that through these efforts we will soon understand more clearly where Nutrition is positioned both in the realms of prevention as well as intervention in relation to COVID-19. I am immensely thankful to all contributors and the Taskforce which has been working tirelessly towards enabling us to make a humble contribution of one more piece towards the jigsaw puzzle that we are all living. The members of the Taskforce are below:

NNEdPro COVID-19 Task Force

  • Co-Chairs – Dr Dominic Crocombe (Exec) & Prof Shumone Ray (Ex-Officio)

  • Attending Members – James Bradfield Education/Events), Dr Luke Buckner (Key Projects), Emily Fallon (Public Health), Dr Lyn Haynes (Networks), Shane McAuliffe (Science Comms) & Sucheta Mitra (Secretariat)

  • Corresponding Members – Matheus Abrantes (Digital), Martin Kohlmeier (BMJ NPH) & Pauline Douglas (also on behalf of Prof Dan Del Rio, Dr Celia Laur & Dr Minha Rajput-Ray)

TWO LESSONS LEARNED

Reflecting on these two tumultuous months, highlights two key lessons for me personally, which I would like to share. The first one stems back to 2009-10 when I was an NIHR Public Health Fellow in the East of England and visited the WHO HQ in Geneva to witness the global response to the H1N1 (Swine Flu) pandemic which was estimated to have led to about 575,000 deaths at that time after which it continues to add to the overall burden of seasonal influenza which continues to kill half a million people annually. This pandemic just over a decade ago also challenged global public health systems quite significantly but of course was in many ways less lethal both in terms of its transmissibility as well as its case fatality in comparison to the agent of the current pandemic. However, the lesson from 2009/10 was one of PREPAREDNESS along the lines of the old adage of failing to prepare being equivalent to preparing to fail! By 2010 public health agencies all over the world had actually prepared for an even worse viral pandemic and the WHO had defined a multistage process to help with a coordinated and timely response. But processes are only as good as the people who discharge them and with the passage of time this lesson had perhaps faded from many a memory both at the level of individuals but also organisations. COVID-19 reminds us once again in a manner that cannot be ignored that we must prepare for a future in which there may be other unprecedented global challenges whether this takes the form of pandemics or the effects of climate change. We cannot control nature but we can curb some of our own actions that contribute towards the precipitation of calamities and we can certainly train ourselves to be better prepared and not take for granted the liberties that we have all been afforded to date.

There is also a second lesson that I learned five years ago. At the time of the H1N1 Pandemic as part of the healthcare workforce I felt at arm’s length from the disease itself. But ironically in January 2015 I suffered from a particularly severe case of ‘Swine Flu’ myself. As an H1N1 survivor I remember being isolated in a high dependency unit running an unbelievably high temperature for days and ultimately having convulsions as well as being unconscious. I developed pulmonary haemorrhage, couldn’t breathe and felt like I was drowning on dry ground and from needing oxygen I was soon on positive pressure ventilation. In short, I went in days from having no underlying health conditions to being so extremely ill that I was certain it was the end and so were a number of others. However, despite the severity of illness I bounced back just as dramatically, thanks to modern healthcare and perhaps a competent immune system. It has been five years since then that I have perhaps been on borrowed time. My lungs underwent all the classical pathological changes associated with severe viral and recurring secondary pneumonia taking three years for me to recover fully. Despite the setback in early 2015, the past five years has brought a sense of urgency whereby I have attempted to utilise as much time as possible towards facilitating a small but tangible contribution to the mission that underpins the work of our Global Centre. The lesson I learned in this process was that of GRATITUDE. To appreciate all that we have and not take for granted the most important gift of all and that is to be alive and have time on our side! Many of us will not only be alive and well but we are also well positioned with opportunities to make contributions to science and society which look beyond immediate or individual returns and convert the power of privilege into priority actions that are needed to collectively address the global challenges of our time and beyond. The COVID-19 pandemic once again reminds us that we are all susceptible but also that we are all connected and that those of us who are fortunate enough to be spared can express gratitude in innumerable ways, even incognito, for the benefit of those who are most affected or at risk across the populations that we serve.

TEN TOKENS OF THANKS

If we all look, I am sure we can identify at least ten things for which we can give tokens of our thanks. My own heartfelt thanks (in no particular order and all with equal emphasis!) at this time go to: (1) Healthcare professionals and key workers the world over for saving lives every single moment and keeping things functioning across society; (2) Policymakers and those who hold the power to intervene at population level whilst maintaining law, order and decorum; (3) Scientists – both in biomedical/health as well as social/behavioural sciences – particularly those contributing to guiding prevention as well as intervention; (4) Our members, collaborators, stakeholders and beneficiaries for being such a source of inspiration and dedication as we try to do our little bit; (5) Family, friends and immediate colleagues who are all affected but never hesitate to think of others before themselves; (6) Teachers and educators who have found ways to ensure that the pursuit of learning can continue no matter what; (7) Innovators in all sections of society who are using ingenious ways to help us all retain the modern amenities that we have all become so used to; (8) The media and other forms of communication which have enabled us to stay excruciatingly up to date but also digitally more connected than perhaps ever before; (9) The supply of good food, clean water, comfortable accommodation and the economic as well as intellectual privileges which many not be available to so many when they need it the most; (10) The unique opportunities which both I and the NNEdPro Global Centre are continually presented with to make a positive difference in the world through our concerted efforts. I can also think of many more as I have had five years before this to reflect on the role of both preparedness as well as gratitude!

THE PANDEMIC AND PANDORA’S BOX

As we live through this pandemic, finding ways to not only survive but ultimately thrive, I cannot help but draw a metaphorical analogy to the well-known idiom of Pandora’s box. As most will know the box symbolises a source of great and unexpected troubles. The mythological story behind this described the box as containing sickness, death and despair which were released into the world. However, the one thing that was left behind was the most important attribute of all, the power of HOPE. This pandemic is of course very real, and it really is unimaginably bad. But this is not the first pandemic to have swept the world and it may not be the last. So as we all go through this together it is important that we continue to hold on to hope in all its forms which will help us persevere as well as preserve the momentum of our efforts to overcome this pandemic and any further challenges that the future may hold!

I wish you all the very best of health whilst I offer my thoughts and prayers to those who have very sadly suffered loss already. I would like to close by lighting a ‘candle of hope’ which is something that has always guided me personally even at the most challenging of times so I would invite you to pass this message to one and all envisioning an increasingly brighter road ahead of us and one where we all walk together in solidarity


HAPPY EASTER WITH HOPE FOR HAPPIER HORIZONS!

Professor Sumantra (Shumone) Ray

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2016 Finalist & Runner-Up: BMJ Education Team of the Year Awards

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