Respiratory consultant Dr Eleanor Mishra is responsible for managing a drug trial at the Norfolk and Norwich University Hospital (NNUH) that reduced Covid-19 mortality rates by one third. Find out how her work is helping to contain the virus.
Each month, those working at the pioneering heart of Norwich Research Park tell us how their work is shaping the world we live in. Read their stories here.
You are a respiratory consultant – what does that involve?
I look after people’s lungs. My work mainly focuses on outpatients and diagnosing lung cancer, but I am also interested in pleural disease – when fluid builds up between the lung and chest wall. At the Norfolk and Norwich Pleural Unit we ultrasound patients, drain the fluid, conduct advanced procedures to find out what the underlying causes are and treat them.
How did the Covid-19 pandemic impact your work?
I stopped my outpatient work and started focusing entirely on inpatients on Covid wards. It was quite stressful at first – being the consultant responsible for patients with a disease that none of us had ever seen before. Everyone was very anxious: staff were frightened of getting infected and patients were worried about high mortality rates.
At the beginning there was no specific treatment. It was really a case of supporting and monitoring patients closely until they got better. What is unique about Covid is that oxygen levels drop without any breathlessness, so patients are actually much sicker than they look. But as we gained more experience we became more confident with treatment, largely thanks to drugs trials.
What are the RECOVERY trials and what was your involvement?
The Randomised Evaluation of Covid-19 Therapy (RECOVERY) trials are conducted by the University of Oxford and funded by the National Institute for Health Research (NIHR), with more than 170 hospitals participating across the UK. I am the principal investigator at NNUH and the trials involve testing different drugs and their effectiveness in treating Covid-19.
Drugs trialled include azithromycin (an antibiotic), dexamethasone (a type of steroid), hydroxychloroquine (a malaria treatment), lopinavir-ritonavir (an HIV drug), and tocilizumab (an anti-inflammatory). We are also trialling convalescent plasma collected from people who have recovered from coronavirus and contains antibodies to fight against it.
Dexamethasone is the only drug so far that has been proved to enhance survival. The great thing about dexamethasone is that it is cheap and readily available. It suppresses the overactive immune response which causes low oxygen levels and it has been shown to reduce mortality in patients who go to intensive care by a third for patients on ventilators and by a fifth for patients on oxygen. It is going to save a lot of lives and it is only because of the RECOVERY trials that we discovered this treatment.
Did you always want to work in the health sector?
When I was young, I wanted to be a librarian because I thought they spent their time reading books. Aged 15 I read The Man Who Mistook His Wife for a Hat by Oliver Sacks. It really fascinated me – the idea of patients with diseases being this puzzle that you could work out. That is what inspired me to become a doctor.
How did you end up in Norwich?
I grew up Stockport and attended Cambridge University, then did my clinical training and PhD at Oxford. I spent a year in Australia at Nambour General Hospital on the Sunshine Coast before returning to the UK.
My first job was in Norwich but I went back to Oxford to develop my specialism in pleural disease and learn the skills to run research trials. When I qualified as a consultant it was a natural progression to move back to Norwich as it was somewhere I really enjoyed.
What advice do you have for young people considering a career in health or science-based research?
It is so important to gain experience. Before I started out on this career path, I worked in a nursing home as a care assistant and volunteered in a research lab to get an idea of what was involved before committing to it.
It’s a great area to work in: it’s always fascinating, there’s a huge amount of variety and lots of opportunity to travel, but it is also difficult because you have to be prepared to go the extra mile – particularly when caring for patients. You have to work hard to progress and you must be prepared to relocate.
What’s the best thing about working at Norwich Research Park?
The community. There’s so many academics with different backgrounds, which means we are able to work together to develop new ideas and research projects that would not have been possible on our own. And of course the world-class facilities which enable us to do the research.
What do you get up to when you are not working?
I like running and generally trying to keep fit. I’ve got two young children – a five-year-old and a nine-year-old – and we love living in Norwich, so we spend our time enjoying the attractions nearby. We like exploring the north Norfolk Coast, Eaton Park and the Forum. We recently went to Pensthorpe Natural Park and Felbrigg Hall for the first time.
Reducing plastic use is important to me so I love shopping at the zero-waste stores, independent retailers and the market. Norwich is great.
Dr Eleanor Mishra is respiratory consultant at Norfolk and Norwich University Hospital (NNUH). You can follow her on Twitter @EleanorKMishra.
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