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“The lives of anyone involved with clinical trials, including the clinical trial pharmacy team, changed forever.”

Kathryn Murray is Lead Clinical Trials Pharmacist at Cardiff and Vale University Health Board. She has been a registered pharmacist since 1992 and has worked in hospitals and as a clinical pharmacy lecturer in the UK, and New Zealand.

What were you working on before the COVID-19 outbreak?

Prior to the COVID-19 pandemic the majority of the clinical trials running in Cardiff where outpatient trials investigating new treatments for a variety of conditions within haematology, nephrology, endocrinology, neurology and cardiovascular diseases, and in the majority of trials the investigational treatment was being compared to the current gold standard therapy.

However, with the arrival of COVID-19 in Cardiff in March 2020 all this changed. For the first time in my career, health care professionals were faced with a new virus that was rapidly spreading, had no known treatments and the intensive care units were filling up with critically ill patients who were dying when the only treatment available at that time, ventilation, failed to help. Enrolment in clinical trials investigating potential treatments for COVID-19 (SARS-CoV-2) was potentially their only way of survival, and the lives of anyone involved with clinical trials, including the clinical trial pharmacy team, changed forever.

How has your focus changed since the global pandemic began?

The pharmacy clinical trials teams across the UK were deluged with new COVID-19 clinical trials and because the drugs in the early COVID-19 trials were the only potential treatments, we could not follow our existing methods of setting up trials (which may take up to two months from initial contact to patients receiving treatments) because this would mean intensive care units would continue to fill and patients would die.

We received the RECOVERY trial protocol in mid-March 2020. At that time the protocol included hydroxychloroquine, lopinavir-ritonavir and dexamethasone and as these were oral drugs that did not require any complex processes for storage and dispensing, I confirmed that pharmacy would have the capacity and capability to perform the trial within 24 hours of receiving the protocol.

I decided to supply the COVID-19 wards (at that time we had 3 ITU and 6 COVID-19 wards) whole boxes of all the drugs in the RECOVERY trial to use as stock. We placed the first order for RECOVERY trial drugs on a Friday and I spent the whole weekend worrying whether I was making the right decision – it seemed that most pharmacists in the UK had decided not to supply stock and the RECOVERY trial pharmacy manual had the rather unclear statement ‘do not dispense whole packs’. I felt that we were not dispensing to individual patients but supplying stock to the ward so were not going against this advice. After having sleepless nights over the weekend worrying about whether I was doing the right thing, I spoke to the Directors of Pharmacy and R&D and my colleagues within the clinical trial pharmacy team and we decided that the only way we could guarantee access of trial drugs to patients was to supply the original packs. We received the stock from PHE on the Monday morning and issued the first packs to the wards before 2pm and patients were recruited to these treatment options before the end of the day. Because of the decisions the pharmacy clinical trials team made when setting up the RECOVERY trial Cardiff was one of the first sites in the UK to open the RECOVERY trial.

As more becomes known about COVID-19, it is clear that the patients are dying from a hyper-immune response and not from the initial coronavirus infection. So, the trials we were sent started to include immune modulating agents that had the potential to stop the development of the hyper-immune response or reverse this response in patients in ITU. Yet again the pharmacy trials team needed to set trials up rapidly to enable patients to receive these potentially lifesaving treatments. We recruited the first patient to the TACTIC-R trial within 3 weeks of initial contact and 24 hours after receiving sponsor green light, but this only happened because I spent the Friday everting and Saturday morning finalising the pharmacy procedures. This speed of trial set up and recruitment never happened prior to COVID-19 and has put an incredible amount of pressure on myself and the other members of the pharmacy clinical trials team.

Please tell us about how you usually manage your wellbeing.

I suffer from severe recurrent depression and anxiety, and over the last 10 years have had three major episodes of depression where I have been unable to work for a total of 9 months. I have learnt that work pressure and worrying about what has happened at work increases my anxiety levels, and the potential for the downwards spiral of increased anxiety, self-doubt and descent into depression occur. However, with the help of a psychiatrist and clinical psychologist during my last episode of severe depression in 2017 I learnt how to reduce worry and manage anxiety. My self-care armoury consists of exercise, mindfulness, gardening, listening to classical music, singing, taking regular breaks at work, talking to people in person and on social media, and going on holiday.

How have you managed your wellbeing since the start of covid-19?

When lockdown started, I was often the only person cycling along the River Taff to and from work so I could slowly on the way home and take notice of the beautiful surroundings around me. I recognized if I’d had a bad day if, at the end of my 3-mile ride home, I hadn’t relaxed and left all my work troubles behind me. The pressure of rapidly setting up trials meant that by mid-April I was finding it incredibly difficult to switch off, and despite my bike ride I was not sleeping. I knew that I needed to add something else in to help me survive.

What extra steps did you take to counteract the increased worries and anxieties?

Starting small, I planted bulbs and seeds and I have spent many hours pottering around ‘mindful gardening’ and talking to my plants. My garden has never looked better!

Going bigger, I have always sung in choirs and find this an incredible way of switching off from the world around me. Since the face-to-face meetings have stopped, several organisations created virtual choirs where you learn a piece at home, record a video of you singing and submit this video so it can be put together with a multitude of other singers. I was one of 14,000 singers from around the world to submit a video for Eric Whitacre Virtual Choir 6 in April and have since joined the NHS Chorus-19 and Stay at Home Choir. I’ve also found that listening to music while I work helps me focus on the task I’m working on and not think about anything else.

I started running in 2017 while recovering from my last major episode of depression and know how beneficial it is for my mental health. So, to push myself even further, I decided that I would run a marathon over 10 days to fundraise for Pharmacist Support, as they had helped me in the past.

I did most of my runs during my lunch break and found I was more able to cope with the challenges I faced at work after the run. I completed my marathon in ten days and did my last run around the UHW campus dressed as Wonder Woman. When I finished the 2.6 challenge I realised that I needed to have something else to motivate me because it was just too easy to get home and stew over what had happened during the day.

It occurred to me in May that we would be unlikely to be able to do the French road trip that we had planned for my 50th birthday in July. So, I decided to virtually travel to the Loire Valley by running, cycling and walking 500 miles around Cardiff in the 10 weeks running up to my 50th birthday in July and the #500at50 #COVID19 #lockdownchallenge to fundraise for Pharmacist Support was born. I’m due to finish my challenge on my 50th birthday on 9th July and have 47 miles left.

Over the last 9 and a half weeks I’ve found having a reason to exercise by running and going for walks with my husband extremely beneficial for my mental wellbeing and talking to my husband while walking about what has happened during the day helps reduce worrying.

Pharmacist Support is extremely proud and grateful for everything Kathryn has done and continues to do for our pharmacy family. To follow her #500at50 challenge, visit her Twitter profile  @kmmurray97 . You can also support our pharmacy family who are facing challenging times by donating to Kathryn’s fundraiser on Just Giving.

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