'Statistics Are Vital' is a joint campaign by the Royal Statistical Society and Significance magazine, celebrating the work of statisticians during the Covid-19 pandemic.
The RSS spoke to Thomas Jaki, programme leader at the MRC Biostatistics Unit, Cambridge and professor of statistics at the University of Lancaster, about his work during the pandemic on the RECOVERY trial and other platform studies.
'Statistics as a whole has been phenomenal in doing what it does best – trying to interpret information in a meaningful way.'
How have you been involved in the response to Covid?
I was involved in the Covid response very early – from around 10 January 2020. Professor Sir Peter Horby (Professor of Emerging Infectious Diseases and Global Health at Oxford University), who I had collaborated with in the past, asked for help in designing a Covid clinical trial in Wuhan. We quickly set up two studies investigating different anti-virals, but the situation improved in the region, and we ran out of Covid patients to be able to complete the study. As it became apparent that the disease was spreading further afield, we turned our thoughts to what we could do in the UK and had discussions with the World Health Organisation (WHO). We quickly submitted the application for what became known as the RECOVERY trial. I have also been involved in the AGILE, an early phase clinical trial platform, which tests multiple Covid treatments in parallel and HEAL-Covid, a study into the effects of long Covid.
When did you realise Covid was going to have a massive impact on both your work and home life?
It became apparent from the initial discussions in January around the trials in Wuhan, that any delay in our work would potentially have a detrimental impact for those in the region and lives would be lost. Having been involved with outbreak responses previously I knew we had to act fast and the first patient for the trial was recruited in a few days. I didn’t have much time to concentrate on anything else – evenings got very long and weekends very short. It dawned on us in March, when a substantial number of cases emerged outside of China, that it was going to be much longer term than we first thought.
The support around me helped massively. My wife has been fantastic in allowing me to spend the necessary time to deliver the work needed. My colleagues both at Cambridge and Lancaster were also a great help in stepping in to cover parts of my day job. I would like to give special thanks to Dr Pavel Mozgunov, Prof Andrew Titman and Dr Helen Barnett who played a crucial role in the work on the AGILE platform. Additionally, Dr Barnett stepped in with covering some of my teaching commitments.
How did you cope with the sudden interest in your work?
It was great to see statistics in the spotlight and a great opportunity to show the world the importance of them. However, this interest did involve some additional pressures on my time, including various media requests and invitations to give public lectures, but I think it’s important to spend time on these activities. It’s given us a great opportunity to raise the profile of statistics. Having had a bit of media training helped me to find a way to engage which was beneficial rather than just leading to uninformative soundbites.
How did you and your colleagues stay motivated?
There were always ups and downs, but at the end of the day it was rewarding to see the difference we were making. With the RECOVERY trial, we were able to quickly identify an effective treatment for patients and also identified a treatment being given which was ineffective, which was discontinued as a result. Having these outcomes early on really helped us stay motivated. Now further on, there is a huge need for treatments for long Covid. Master protocol approaches have been around before but are now much more frequently used and have proved really valuable in their ability to assess multiple treatments at the same time. Now, at this stage, I am looking at and am motivated by how we can use the learnings from the ongoing Covid studies and transfer them to other diseases and situations.
What’s the greatest challenge you have faced during the pandemic?
The biggest challenge was around collaborations and the overlap between different trials. For example, the WHO Solidarity trial was investigating some of the same treatments as we were with the RECOVERY trial. There were also around 100 trials investigating the effectiveness of hydroxychloroquine as a potential treatment. It would have been better if we had all worked together rather than replicating efforts. When we did reach out to other groups it wasn’t always as easy as we would have liked.
Going back to our work in Wuhan in January, when we ran out of patients to trial there, it would have been beneficial if we were able to recruit patients from other regions, but frustratingly this wasn’t possible. It was also difficult once we had the results from the studies: the review process is slow – it can take a couple of weeks – so because of this we decided to release some of our results via press releases as a way to get them out more quickly. This caused controversy as people were only seeing the headline figures and weren’t able to fully assess the quality of the data. However, we felt it was the right thing to do given the review process was slow and would often only lead to minor changes. Time was of the essence and people’s lives were on the line. Nevertheless, it was difficult receiving criticism from others in the scientific community.
What aspects of your work are you most proud of and what positives do you take from this difficult period?
I’m proud of our work on the AGILE study, for which the study design, unlike other studies, was constructed completely from scratch and in only six-to-eight weeks.
While I have said collaboration was sometimes an issue, at the same time huge collaborative efforts were made which prior to the pandemic we wouldn’t have thought possible. It shows that under pressure we can work together effectively and efficiently. It was also good to reevaluate some of the working practices we have never previously questioned: for example, it wasn’t necessary for us to be in the office five days a week and we were able to hold scientific conferences remotely.
What’s likely to change in your role as we move out of the pandemic?
I’m hopeful that the intense focus on Covid is slowly and surely stopping, which gives me the opportunity to do other things again. Fundamentally, my role won’t change but I would like to put more focus on statistical communication and public outreach. Pre-pandemic, I knew this was important but it was low down my priority list. The pandemic has made it clear to me that it’s an essential part of my work.
How would you summarise the contributions made by statistics and statisticians in tackling this global health emergency?
I have no doubt the contribution has been very large, simply because of the nature of statistics in trying to make sense of information and data. As a consequence, being able to interpret results from observational studies and clinical trials requires a statisticians’ insight. I think another key contribution has been statisticians engaging in public discussions and tackling misconceptions on platforms such as Twitter – often in their own free time in a way that’s not been done before. Statistics as a whole has been phenomenal in doing what it does best – trying to interpret information in a meaningful way.
Read more about the RECOVERY trial, the AGILE trial and the HEAL-COVID trial