Coronavirus (COVID-19): National Clinical Director Jason Leitch interview

Transcript of a question and answer session with Professor Jason Leitch.

Professor Jason Leitch is Scotland’s National Clinical Director.

In July 2021 we asked people on the highest risk list to send us their questions about Covid. 

This is a full transcript of the Q&A session where he answers some of the most common questions that were sent in. You can also watch a video of the session.


Jay Crawford (host): We​​ll hello and thank you very much for joining us for this question-and-answer session about Coronavirus, with National Clinical Director Jason Leitch. I’m Jay Crawford I’m going to put your questions to Jason today, there’s been a fantastic response we’ve had over 250 submitted, and given our time constraints we’re obviously not going to be able to answer them all but we’ll do our best to try and get through as many as we possibly can, covering a popular and broad range of topics.

Now we’ve specifically chosen ones that directly relate to the highest risk list, we’ve also received some questions relating to people’s individual medical circumstances which unfortunately Jason can’t answer, so please speak to your clinician or your health board if you’ve any concerns at all or if you’ve any questions about your own treatment or suitability for the vaccine.

Jason on behalf of everyone who’s asked a question, thanks very much for taking the time out of your extremely busy schedule to respond to some of the queries and the concerns, especially from those at highest risk about COVID-19, and I should say that of course we’re doing this remotely rather than in person which I’m sure everyone has got used to over the last year and a half.

How has Jason navigated the pandemic?

Jay: I’d like to start by asking you personally, how you’ve coped with the last eighteen months because along with our NHS frontline workers, you’ve probably been one of the busiest people in Scotland over the last year and a half, how have you managed to cope with it?

Jason Leitch: Well, Hi Jay thanks for having me, it’s nice to be with you and it is such an important subject so it is worthy of the time both you and I will give it and I hope some help to those who perhaps submitted these questions but also those who have these questions themselves. Well, the first thing to say in answer to your question is a bit cliched, but I’ve not had the hardest of this period, lots of people have worked harder than me, have been more affected by the virus in their families than me, the latest research suggests that nearly twelve million people have died of this disease globally, and there’s two hundred and twenty million have had infections. But that doesn’t mean it hasn’t touched my family, it hasn’t touched my loved ones, and it hasn’t made my job just a little bit more crazy perhaps than it was before, and it has been high stakes it has been very busy, but - to anybody who knows me the only thing worse than having a big role in the pandemic would have been for me not to have a role in the pandemic. Sitting on the side-lines of this, the greatest public health crisis the world has known in a hundred years would have been frankly more difficult Jay than being involved and I’ve got a fantastic team of people, a fantastic family who keep my feet very firmly on the ground, so when my mum watches this back, she’ll ask about my hair and my shirt and why I’m not wearing a tie like the questioner rather than the content of my answers, so I’ve got a very good support team. And it’s been hard, there have been moments where it’s been tough, but nothing like people who have lost family and close friends to this disease.

Jay: Has the responsibility of all of this advice Jason, has it weighed heavily on your shoulders?

Jason: Yes, it has, and it can do nothing else. If you don’t take that seriously then I think you’ve misunderstood. What is helpful though is that you don’t do it alone, even in the big room, let’s call it the big room, there are a number of others. So once a week the four UK clinicians meet in the evening, initially we were meeting twice a week late into the night, with the CMOs of the four countries, the people who do my job in the four countries and the CNOs in the four countries, and we still meet every Tuesday night and we discuss what testing we’re going to advise or what are we going to do with the clinically extremely vulnerable group advice, but we also support each other. So, you’re not by yourself if these jobs, even though one of the things I have done prominently whether you like it or not is a little more TV and radio than perhaps I would have been predicted to have done in the last little while, so sometimes that’s a little bit lonely, a little bit exposed. But it’s also, I’ve quite enjoyed learning a bit of a new world, your world, the world of journalism and communication and how all of that works and it turns out there’s some things you can learn in there just like there’s things you can learn everywhere.

Jay: Well we’ve all learned a great deal from you of course over the last eighteen months and how try and deal with all of this, so let’s get on to some of the questions that are still perplexing people today.

Current restrictions and those at risk

Jay: And the first question is: Why given that the highest risk group was asked to shield during the early stages of the pandemic, are they now being asked to follow the same restrictions? Elizabeth said, “I will always be grateful to have been shielded, however I feel the risk has certainly not gone, and it’s now left mental and physical marks. Never before have I been so anxious or physically deconditioned. Would it not be more prudent to have special measures in place for those at the highest risk, perhaps introduced over a longer time frame than for others.”

Jason: Elizabeth is of course right, it’s been a really, really difficult period for everybody, but principally and for our purposes today that that group at highest risk of this version of infectious disease. But the pandemic has changed, it’s changed a number of times, there’s been phases there’s been periods, and globally looks different than it did three months ago, and Scotland looks different from how did it three to six months ago. The principal change is vaccination. Vaccination has changed the equation of case to hospital and harm, and what we’re trying to prevent here is harm, we’re not just trying to prevent infection what we’re really trying to prevent is people being harmed by the disease, now there are lots of diseases in the world, and in Scotland, and in every season, and people live with them, manage their own risk around them and that’s where we’re headed to with COVID. Where the levers of government have less of a role and individuals will have more of a role. Now we’re not there yet, we haven’t broken that chain completely, but the reason we’ve gone back to more normality is because it is the right period for that to do. Now that will worry some people of course, but let’s remember the millions of others who have not been working, who have lost out economically, who are lonely socially, and so all of that together is a very very difficult balance to strike, we call it the four harms: The harm from COVID, the other health harms, mental health etc, the social harm, so loneliness and older people perhaps, care homes, and the economic harms, and when we give advice and then when the decision makers decide we have to do it in the round, we have to do it not just from straight COVID harm. Initially, when we didn’t know what we were dealing with, when we didn’t really know who it affected, when we had no medicine, when we had no vaccine, the only option was to lock the country down and shield the vulnerable. Now it’s much more elaborate and it’s a much more complex set of decisions frankly.

What is the clinical evidence on which lifting lockdown decisions are made?

Jay: The second follow up to that is from Alan and he’s asked, “what the strong clinical evidence is on which the decisions on lifting restrictions are being made?”

Jason: We touched on that a little bit and what Alan seeks may not be fully available, I wish there were a folder on the wall here that you could bring down and you could say if you get to a two this is what you should do and if you get to a five this is what you should do, it’s unprecedented. I know that’s an overused expression during this isn’t it? But nobody has ever had to do this, it is a new Coronavirus, it causes a new disease called COVID-19, and every single day we learn more about who it hurts, how you manage it, what the vaccines can do, and therefore in the round you have to find that clinical advice as best you can. What we know for certain is that there is less harm from this virus now, than there was in wave one and wave two. So, for example, one example is that about ten percent of people were being admitted, so about one in ten of people were being admitted after they were infected, before the vaccine, now it is about two to three percent, so it’s less than a third of what it was before. And you can see that in the hospitalisation numbers now down below four hundred, ICU numbers down below fifty, when we had thousands of people in hospitals in wave one and we had to double and treble intensive care capacity just for COVID, never mind people with heart attacks and strokes, and post-operative cancer surgery. So, we know for certain that things are moving. What I can’t tell you is that on Tuesday night, when it gets to two hundred cases, this is what we’ll do with pubs. That’s the judgement piece, and that’s really frustrating for people I understand, but if it were easy, then you wouldn’t need all these advisors and all these decision makers, because it would just be a formula. It’s not a formula and that I understand can be frustrating for hospitality owners or people on the high risk group who are worried about how they should go about their lives.

Is there an increased risk being around non-vaccinated people compared to those that are vaccinated?

Jay: We’ve got a question that’s come in on a number of occasions from various people asking, “is there an increased risk being around non vaccinated people than those fully double vaccinated, for example do unvaccinated people harbour more potential spread if they are say asymptomatic compared to double vaccinated people who the virus is less likely to affect?”

Jason: It’s a great question. It’s quite difficult on an individual level to give advice on who you should spend time with and who you shouldn’t, but at a population level we know that double vaccinated people have less disease, so less harm, so they get hospitalized less often, they die less often, I’m sorry to be so blunt, and they also spread the disease less well. And that makes perfect sense if you just think about it, if you get COVID you cough and splutter for lack of a better expression, if you get it seriously you cough and splutter more, if you get it asymptomatically you cough and splutter less. Therefore, if you can get people down that line, there’s going to be less virus in the room, in the hospital room or in the pub, or in the place of worship, wherever you happen to be and therefore less risk to those around you. So, it is safer around doubly vaccinated people, but that’s a little bit harsh because some people either can’t get vaccinated, they choose not to get vaccinated, we haven’t done them yet because they’re fifteen years old. So, I wouldn’t tell you to put a sign up at your door to say, “only vaccinated people allowed”, but you should encourage those around you to get vaccinated, particularly if you’ve got young people in your house or in your circle, I would ask you to persuade them, cajole them, send them to Young Scot Online to look at the right information and get them vaccinated.

What evidence is there that being vaccinated stops the virus being transmitted to those at the highest risk?

Jay: The next question kind of follows that up, and perhaps you’ve already explained it in that answer but “what evidence is there that even the public being vaccinated stops the virus being transmitted to those at the highest risk?”

Jason: This comes from a little bit of difficulty with the science, some of the, some of the stuff online confuses this, nobody ever said vaccination was a light switch, that if we just vaccinated you, you would have no risk, COVID would be gone, and if we got up to a certain level within the population, the COVID risk would disappear, that’s now how vaccines work. We’ve only eradicated one disease with vaccination and it’s smallpox, it took decades. We’ve almost eradicated measles, almost eradicated polio, but they still come back every so often. But vaccination is the single most important protection against serious disease and harm, and increasingly we think, against transmission. And that’s whoever is going to be infected, so that can be the five-year-old at no risk of serious disease or the seventy-year-old who’s in the clinically vulnerable group and has been shielding for months. So, whoever they are the risk is reduced if we vaccinate the population, and their risk is reduced if they get vaccinated, now we’ll come onto more individual questions about the nature of vaccination for those vulnerable individuals I imagine, but we know the vaccine works. What we don’t know, and can’t know hugely frustratingly is this, did you get, did you get a four or did you get a seven from the vaccine, there’s just no scientific way of working out how protected you are, but it is your best hope. And my slightly flippant line, to all groups who ask about the vaccine, and I’ve done quite a lot in the past few days with young people about vaccination, is it’s better than COVID. So I don’t mean that to sound overly flippant, but it is better than COVID.

Jay: There have been a lot of questions, Jason, submitted around the importance of those who spend a lot of time with people on the highest risk list getting their vaccination.

Encouraging those unvaccinated to get the jab

Jay: Morag said, “my son lives with me and we do not agree about a good few things the main one being that he will not have any jabs, and I’m worried for both him and for myself, I’ve spoken to him about how I feel especially as I’m in the highest risk category, he won’t change his mind, is there anything I can say to make him change his opinion then I can relax a little bit.”

Jason: That’s so difficult isn’t it, what a difficult situation. I feel for that family, both sides of it actually and the challenge. There is a lot of misinformation online and that will be where the young man is almost certainly getting his information, he won’t be I imagine listening to the Today programme or reading NHS inform where we’ve got our NHS Scotland web presence. I would ask her to try and push him towards trusted sources, now that might not be government or it might not be me the fifty-two-year-old guy, but it might be Young Scot who have got a fantastic track record of being very accessible to young people and translating into language and sources that people can understand, that people access. Well just this morning I was at Capital radio recording a podcast with the Young Scot health panel who are a group of teenage and early twenties, who have educated themselves, who have looked into it, and they do the kind of outreach to the young people, not me I just provide some content for them. And so there’s podcasts there, we’ve just answered a load of questions this morning and that will be going up online quite soon, Young Scot have a lot of information available from trusted sources, government and non-government, so that’s where I’d ask him to go. If he wants to get really interested, then there’s a thing online called the vaccine confidence project, and the vaccine confidence project is all about how you deal with vaccine hesitancy, not anti-vax, not the extreme version of microchips and conspiracy theories, the advice for that world is to ignore it. But vaccine hesitancy is a thing and is a good thing, people should ask questions they shouldn’t just accept what they’re first told, and that’s about surrounding people with the correct information and the correct science. His peer group are the most likely to influence him not his mother, it comes as a great shock to parents, but that’s where he’s most likely to be influenced.

Jay: That’s a great answer thank you very much for that.

Efficacy of the vaccine

Jay: Another topic for those at highest risk who are very interested is the effectiveness of the vaccine, particularly those with immunosuppression. Now Catherine asked, “I understand that the octave study is not reporting until the end of the year so people who are immunosuppressed are left wondering what protection we can have when we’re double vaccinated?” Can you give any advice at all on that Jason?

Jason: Well, the reality is that that is no different for non-immunocompromised people than it is for immunocompromised people, none of us know how protected we are by the vaccine, we can’t know it is impossible. The only thing we could do, is do an antibody test, now antibody tests have become a little bit aethereal or a little bit like the magic answer, they’re not the magic answer, all they tell you is the test found antibodies, it doesn’t tell you if it found five million or four, it doesn’t tell you if it found enough to combat the disease or not. So, we don’t have science available that grades your antibody response I’m afraid, and that’s true for me not in the clinically extremely venerable group and true for those in it, so therefore we can’t help you, other than at a population level we know that vaccines work because we’re seeing it in the data. We’re seeing it in less people being admitted to hospital, less people dying, in all categories, in all ages. So, we started with the clinically vulnerable and the elderly, and the numbers in those groups of COVID harm and death fell, so we know it works. Now the difficulty then is if you ask Frank or Jane or Margaret, what’s my individual risk? And I understand why people ask that and they want to know, I can’t help you, all I can do is tell you the protection measures gathered together of vaccination, testing, and following the rules is your best way to avoid harm from COVID.

Any planned antibody testing?

Jay: There’s a follow up to that, which it comes from a slightly different angle Jason and this is Ian’s question, he says I am immunosuppressed like many others we even after two vaccines don’t actually know how protected we are, and you’ve just explained how we don’t know that of course, but is there any planned antibody testing that can be done to check, a time limit on this is you know is there any way that we’ll know how long this vaccination is actually going to last before we require a booster?

Jason: That’s a great question we’re doing that in trials, so what you do with that is not necessarily antibody testing, antibody testing remember is yes/no, antibody or not, doesn’t tell you about disease response, doesn’t tell you how good your antibodies will be, and immunity response is very complex, it’s about cells and antibodies and all kinds of things working together, so it doesn’t give you the full answer, and vaccination and previous disease all build that immunity together. What we’re doing in trials is we’re doing serial tests on people and we’re following whether they get infections, so the most likely thing to happen is as immunity wanes, as it wears off, infection rates will go up in the vaccinated, that doesn’t take a genius scientist to work out. So, we follow the disease in the vaccinated, and we do that globally, though one of the places we’ve seen that happen is Chile. So, Chile had a fantastic vaccination programme, rolled it out very quickly, but did a thing that we didn’t do, they used a very short gap between dose one and dose two. You’ll remember the controversy in the UK about that eight-to-twelve-week gap between the doses, and our boffins said in order to get a long immune response the science is suggesting put in a bigger gap than you would expect to do. Chile and some other countries didn’t do that, they did a three-week gap, they’re now beginning to see immunity wane at the other end of that, and we know that because they’re getting infections in vaccinated individuals, we are not. We’re getting some, but it’s stable. It’s not like vaccine is suddenly wearing off and everybody’s getting infected. So, I can assure you we’re doing lots of trials both in the UK and around the world on vaccine longevity, how long it lasts, and we’re ready for booster doses whenever they are required, the joint committee on vaccines, the vaccine boffins, have said get ready for September, so be ready, but they haven’t given us final advice about whether we should do it and when we should do it.

Jay: Right, that explains it for us all I think.

Different types of vaccine

Jay: Mimi has a follow-up question, she says that according to the blood cancer charity, double doses of AstraZeneca’s vaccine do not provide a high percentage of efficacy compared to Pfizer for blood cancer patients. Now is this true and is it possible for people to choose a different vaccination when the booster programme begins this Autumn, is it wise to mix them?

Jason: So, Mimi’s partially right, there have been some trials that suggest in some specific conditions the vaccine response is perhaps not as high as it is in some others. Remember that’s the population level vaccine response, that’s not some kind of measure of your specific protection as an individual remember we discussed already you can’t really do that, but at a population level. The joint committee on vaccination again looks at all of that globally, trials all over the world, and decides which vaccine to use for which groups, and you’ve seen us do that for young people, where we’ve said Pfizer or Moderna not AstraZeneca, we’ve made some adjustments to how we use those vaccines and those specific types of vaccines in individuals. What we can’t do, for obvious reasons of supply is we can’t give personal choice, we can’t just if you don’t fancy the Pfizer vaccine, we can’t let you choose another one, because we’ve got very very strict supply, because we’ve got to vaccinate India, and Uganda, and Canada as well, so the global supply is a problem. Now the second part of that question is what to do with mixing vaccines, now normally we don’t care, if you go abroad and have a typhoid injection to go to India or Africa you don’t look up the manufacturer, it’s just that we’ve played this out in real time on the telly, so people know there are different manufacturers. And typhoid is usually a single dose and then a booster and we don’t care which company made it, in fact you can have two different ones, in the end that is what will happen with COVID, we will mix the vaccines and we’re doing trials just now to see if that’s acceptable and safe and works, and everything so far says it does. In fact, there’s some early data that suggests mixing them might be a good thing because you might get a slightly different immune response. I Imagine that the booster doses will probably be the supply we can get and that might be Pfizer at that stage, and there’ll be advice from the joint committee about what that booster dose and booster set of responsibilities should be.

Jay: Thanks Jason.

High risk teachers - is it safe to go to school?

Jay: We’ve also received a number of questions looking to the future and returning to work, and there’s been quite a bit in the media about that over the last few days, people being asked to return to work they’re very nervous about it. Kirsty wants to understand how immunocompromised teachers and school staff can be kept safe if there’s an outbreak at school. Teachers, school staff, who don’t have a choice to work from home obviously and on top of that young children can’t socially distance themselves from staff, it’s been one of the key questions of the whole pandemic hasn’t it? And it’s been quite controversial how we’ve dealt with schools, how we’ve dealt with the teachers, how the unions have responded and so on, so what’s the advice looking forward now?

Jason: It’s a very important question, not just in schools, but in civil service buildings and in radio studios and any kind of workplace all over the world, and what we’re asking people to do is use their common sense. Of course, people have been working in Asda and Sainsbury’s throughout, you can’t do Asda customer service desk from home, or the checkout, or the hospital or the social care environment. And schools, my wife’s a high school teacher, and she’s been at work the whole pandemic except when she was having to home school when they were closed, so it’s very important that we do that gradually, we try and do it in a way that is, let’s call it person centred, so that the individuals don’t feel overly pressurised, don’t feel at risk, and we do it with mitigations in place, it’s not a free for all, it’s not back to normal. We’re still expecting extra hygiene, we’re still expecting extra ventilation, we’re still expecting face coverings in secondary school environments, so those are in place to protect everybody, of course the clinically extremely vulnerable but also everybody else. Still distancing between adults, still distancing as much as possible between adults and the young people who are there. So, we have to move, we have to progress because kids have lost so much and have paid a very very deep price for this pandemic, so I’m very keen that we get those young people back in a full-time education environment, but I want to do it in a safe way both for them and for those who serve them and that makes it a little bit difficult for some, because they will have to go back, they will be nervous about that. And the slightly unsatisfactory advice is to speak to your employer, to speak to those who look after you, and in the vast majority of cases the employers are sympathetic, they’re doing it in a gradual way, they’re not forcing anybody back in a hurry and they’ll think about what, whether that’s the civil service building, or the high school or primary school round the corner.

Concern about following the same advice

Jay: Well that leads us on to this question very nicely from Anna, who emailed in with her question, “how can I follow the same advice as for the rest of the population and not put myself at risk? My concern is that my employer, they can make the workplace as safe as they can, however, my job involves attending meetings in schools and other buildings and also visiting children and their families in their homes, and I must say up to date my employer has been fantastic and allowed me to work from home but I’m not sure how long that’s going to last now. I’ve been told I have to follow the same advice as everyone else.”

Jason: So, Anna is in that same transition that a number of the questioners have been in isn’t she? I do feel, I do have sympathy for that position, but that transition is coming, that transition will be different for Anna than it will for me or for you Jay. I mean my 81-year-old parents, are beginning to re-emerge, so they’ve been in my house, they’ve been out for dinner, they’re back at Church, they’ve been in a garden centre for coffee. Now three months ago, my mum in particular didn’t want to do any of that, and as she has re-emerged, she’s taken alcohol gel with her, she’s taken a face covering with her, she speaking to her neighbours a little bit more, Church is a safer environment than it was a few months ago, they’re vaccinated, those who are around them in the main are vaccinated, so their transition looks a little bit different from mine. I’ve been on the train relatively often because I commute between Glasgow and Edinburgh, so my transition and Anna’s are going to be different. So, the individual advice is to do that in a way that is appropriate to you in consultation with your employer. This might sound a little bit harsh, and I don’t mean it to sound harsh, we live with infectious disease all the time, we always have, so Anna probably if she gets symptoms of the flu two years ago probably doesn’t go to work, that’s the right thing to do, stay off don’t spread the disease. But now we’ve got this new infectious disease, that has been the front story on the news for eighteen months, has dominated many of our lives for that period, now we have to transition to a space where we can live with it, and living with it for Anna will be slightly different from living with it for me. But we all have to get to a point where we can live with it.

Jay: And just one of the, one of my pet hates to be honest Jason is people not always washing their hands, you know if you go to a public toilet and someone doesn’t wash their hands before they leave, or you’re in a restaurant you see that happening its always been a pet hate of mine and at least we’ve got to that point now where I think you know that’s one of the key principles of hygiene when it comes to this pandemic isn’t it?

Jason: And I think we’ll keep some of that going forward, I mean I think the COVID police at the front door of the restaurant making sure that before you go in they see you use the alcohol gel, that’s no bad thing for flus and colds and norovirus and COVID frankly, and the little cartons of alcohol gel you can carry yourself in your pocket or your bag, I think we might keep them for some time going forward, I certainly do it much more often, I think it makes sense to do it. Dropping our guard, thinking it’s over, is one of the things that will make this go wrong again, and looking at other people and blaming them for the disease, so look after your own version of it, so protect yourself, your family, your loved ones, but don’t lock the door and hide away, because loneliness and isolation is as much of a problem sometimes as some of the infections we’ve been causing. So I don’t want people to feel they can’t come out, and my parents again are a good example of that, they were pretty isolated for a number of months, but now, have re-emerged, with their alcohol gel and with their face coverings, and with their vaccinations, and it feels good, it feels possible, and it feels safe.

Mental health advice

Jay: There’s been a lot of discussion of course about mental health during this pandemic, and what advice would you give to people like your parents, what have you said to them about how you deal with that, because people have actually been extremely anxious about going out, I’ve felt it myself sometimes just going out and suddenly there’s a crowd of people walking along the pavement towards me and I don’t know whether to step off into the traffic is less dangerous or walking through a crowd of people. And we all saw what happened at the Euros and at the Olympics and elsewhere where there’s a big crowd of people, what’s your advice there?

Jason: You must have dealt with that, crowds of fans coming towards you for decades Jay, that must be, that can’t be an uncommon occurrence?

Jay: Well unfortunately there’s no video available of that so I can’t prove it.

Jason: The advice of course it comes in a spectrum. At one end of that is professional help, genuinely, we have mental health services, they are very good, they get a bit of a bad press sometimes, but they are superb. So if you think you need professional help then you talk to professionals, it’s like getting any professional help, and your first port of call should probably be your general practitioner. You can phone NHS 24, you can go to NHS inform, which is our web presence for NHS Scotland which has fantastic resources for mental health and for diagnosis of many other illnesses, advice about what to do if it’s one of the kids in your family who are struggling, or if it’s one of your elderly relatives who’s struggling, so lots of things in there. So professional help at one end, and you should absolutely do that if that’s something you feel as though, you’ve reached the point where you require it and we’d be delighted to see you, and then as you come down, I think it becomes about resilience and support, personal support, so that’s about family and loved ones, third sector organizations, organizations at your door step who might run cafes, or drop in centres, or whatever it might be, it might be, it might be a running club, it might be knitting, I don’t know what it is for you. For me, it’s three meals a day, sleeping for eight hours, and running 5K, and if I do those three things along with keeping in touch with my family, I’m pretty stable in the main. But that might be different for some, Tom Daley likes to knit, so if it’s knitting, then knit. But there’s something about human interaction isn’t there and my mum and dad got fed up with, slightly fed up with zoom calls every couple of nights to make sure everybody was still okay, but that’s important I think, It’s important to stay In touch with family, work I think is quite important, I’ve always found purpose to be quite an important thing, and having a purpose in the pandemic whatever that might be, whether you’re the Uber driver or the clinical director of the system, then I think it’s important we help people with that return to work and that purpose that they might have.

Jay: Jason, I’d just like to take this opportunity to say thanks very much indeed for today’s session, for answering all those questions and queries that we’ve had, as I say, over two hundred and fifty of them have come in and I’m sure there are many more questions from people out there that we’ll get to eventually, but thank you very much for today’s session. And if I may, thank you very much for the last eighteen months because it’s been very reassuring having you come on TV and radio over the last eighteen months to give us the advice, which I’m sure the majority of people have been following to the letter, so thank you very much indeed.

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