In the heady adrenaline-infused days of early lockdown, time stood still, and the layers of our lives were stripped back. For health systems, the virus stuck, like a stick into a beehive.
As lead research midwife, I was reeling from 13 March 2020 scattering of our team of 21 clinical research staff at Imperial College. Some of whom were headed for home and some of whom were headed for the so-called ‘frontlines’ of maternity services. Since then, I've thought about the concept of the frontline in relation to a global pandemic.
The so-called ‘frontline’ of a pandemic conjures images of a health system on the brink of collapse, hospital corridors laden with the ill and the sainthood of healthcare workers. But, I'm uncomfortable with the metaphor of war. Wars are the place of soldiers, victims and heroes. All of which presume there to have been a known battle line, along which the war would be fought. But, the coronavirus hasn't revealed itself in such a way as to have geographical certainty.
The battle of the pandemic, rather, has been set against blurry, political, racial, economic and shifting lines. Throughout this time, those of us in health systems, clambered to react, respond and regroup. In midwifery, a war zone image is not the scene that I have seen, anyway. What I have seen is a health system in a steady state of dismantlement, redesign and rebuilding.
The place of clinical research in health systems has always claimed a complex intersection across clinical care and academia. In the context of the pandemic, our place was no less complex. The reconfiguration of my clinical research team along the shifting lines of the pandemic came without instructions. There were no lines to this script. In a fleeting mid-March exchange in a corridor, just when our hospital had been emptied to become something new, my doctor colleague said, ‘…It would be a mistake not to maintain a research infrastructure. We will need to be ready to respond to this with research’.
Working through the weeks of early lockdown, it became known that the virus wasn't necessarily affecting the pregnant population in the way that had been feared. I, and midwives within my team, had nevertheless, ‘stepped up’ to the frontline of labour ward, antenatal care and maternity triage; ready. We swapped our research files for scrubs, theatres and IV lines of oxytocin, pushing birth itself forward through the pandemic. However well we shored up our defences, though, the real remedies and victories were always going to be born along research lines.
The term ‘urgent public health study’ became my rallying cry. The frontline work that I had stepped into on labour ward was soon traded for the frontline of coordinating the launch of a global research registry looking to better understand COVID-19 in pregnancy and babies. The foot soldiers of this were research midwives, research and development teams, data managers, ethics committees and pregnant women themselves, all driven by a collective sense of purpose, rather than conscription.
The word ‘research’ comes from old French meaning ‘to go about seeking’. In a pandemic, conducting research is akin to conducting a search party in a storm. No one is quite sure what they will find or even how to look but they are, nevertheless, programmed to seek. The usual bureaucracy of research was shelved for an emergency version of itself, fuelled by the moral imperative to mobilise our ability to understand the coronavirus and attempt to keep pace with it.
The virus, of course, skips, obliviously, across lines of latitude. The pandemic has spared few corners of the globe and a handful of island nations that are shielded by the sea. Daily, I work with those lines of latitude as the project manager of the PAN-COVID global study (www.pan-covid.org). We're looking to help identify just a sliver of our understanding of the virus in pregnancy and babies in relation to preterm birth, stillbirth and transmission from mother to baby. Speaking to women about their experience of pregnancy and birth during the pandemic is the richest part of this uncertain time. Their stories of the virus will act as a compass to help navigate the future through research.
Without question, research is a key part of disaster relief and it sits on the frontline. Florence Nightingale didn't wield only a lamp to do wound dressings in the war. She armed herself with data to provide the statistical basis for health improvement, hospital organisation and social reform. In other words, research doesn't come after the storm, war or pandemic. It's right there with it and goes out searching with a lamp. The doctor in the corridor was right about getting ready with research. On the brink of further lockdown, this continues to be sage advice.