The COVID response: Did we get it wrong?

The COVID-19 pandemic is in the rear-view mirror, so what did we learn about mask wearing, vaccines and prevention? And how can we stay healthy to face a future pandemic? 

We’ll reflect on ZOE’s role - collecting data from millions of people on their symptoms, identifying COVID hotspots and shaping the public understanding of the virus.

Then we discuss the possibility of the next pandemic, and how we can individually protect ourselves against it. By the end of this episode, listeners feel more equipped to stay safe in the face of another global pandemic and that ZOE members who used the COVID app contributed to valuable science.

Make smarter food choices. Become a member at zoe.com - 10% off with code PODCAST

Try our new plant-based wholefood supplement - Daily 30+

*Naturally high in copper which contributes to normal energy yielding metabolism and the normal function of the immune system

Follow ZOE on Instagram.

Transcript

Jonathan Wolf: I know, no one wants to talk about COVID anymore. Who wants to live in the past? The thing about the past is, we can learn from it. 

When COVID-19 started spreading across the world, ZOE dropped everything to help. My co-founder Tim Spector was in the thick of it. Tim kept us all informed through updates from the ZOE COVID study. He received an award from the Queen for helping keep the public safe. 

These dark days are behind us but what we learned could help us improve our day-to-day health. And could another pandemic be around the corner? Studies suggest that pandemics are becoming increasingly frequent and severe. So are we prepared for the next one?

Today, we learn lessons from the past to help us plan for the future. Tim is one of the world's top 100 most cited scientists, a professor of epidemiology, and my scientific co-founder at ZOE. He will break down what really happened during COVID, and the things we got right and wrong. You'll leave this episode feeling more confident and equipped for any future virus.

Jonathan Wolf: Tim, thank you for joining me today. 

Prof. Tim Spector: Great fun. I'm looking forward to it. 

Jonathan Wolf: Well, you know how it goes. We always start with a quick-fire round of questions. Are you ready to go? 

Prof. Tim Spector: I'm all in, as always. 

Jonathan Wolf: All right. Did ZOE members save lives during COVID? 

Prof. Tim Spector: I think they did. 

Jonathan Wolf: Are there ways to reduce the symptoms of long COVID?

Prof. Tim Spector: Some of them yes, not all of them. 

Jonathan Wolf: Did you take the COVID vaccine yourself? 

Prof. Tim Spector: I did, at least three times. 

Jonathan Wolf: Can certain foods reduce your risk of getting COVID? 

Prof. Tim Spector: Yes. 

Jonathan Wolf: Do you think that you'll see another global pandemic in your lifetime? 

Prof. Tim Spector: 50-50. 

Jonathan Wolf: Thank you, Tim. And then finally, what's the biggest misconception about the COVID pandemic, do you think?

Prof. Tim Spector: Oh, there's so many. But I think the global one was that it only affected old people. Young people didn't have to worry about it. And that's really before we all knew about long COVID.

Jonathan Wolf:  So what lots of listeners will know, but also lots of listeners to this podcast won't know is that ZOE was actually very involved in COVID during the pandemic.

And so I think that's another reason that I'd love to look back. So for example, the reason that we started doing anything on YouTube is that we actually uploaded a video to explain to people how to use our brand new free COVID app, and this was sort of the introduction, right, Tim, for you doing what became regular weekly videos and then made us think, well, we should really go and do a podcast.

Prof. Tim Spector: Yeah, absolutely. We had no idea then what we'd be doing now or that anything we were doing during COVID would have any relevance afterwards. And I think it's only with hindsight looking back that we see all the amazing things, in this time of disaster, how some things really worked. 

And not only changed how ZOE works, but also how we changed a lot of the face of research as well, and also interacting with the public. So lots of things, I think, came out of the interaction between this terrible virus. Public reaction and companies like ZOE and working with academia and Kings.

There's so many lessons, I think we learned from it that were very hard to learn at the time because it was at a frenetic pace. 

Jonathan Wolf: And Tim, can you take us back to that time almost five years ago? What were we doing at that point before COVID hit, tell us about that lead-up to this conversation, which I remember very well, where you gave me a call and said, Hey, we need to go and do this thing.

Prof. Tim Spector: So in March 2020, ZOE had actually been in existence for nearly three years, which many people don't realize they think we only started during COVID. 

So we were doing this study to see if by giving a thousand people identical meals, whether there was enough difference in their response to these to make a difference, and then we could then predict how people responded differently.

This is all in order to get a way of measuring personalization so that we could give people personalized advice, given the fact that people respond very differently to foods. So this was totally new territory. It was a theoretical idea that we had. 

There was some very little bit of data out there, but no one had done this for blood sugar, for blood fats, and gut microbes altogether, and it was by far the biggest study ever done.

Huge risk, but it paid off, and we were able to estimate from these results with our clever computer scientists, algorithms that could be used in an app that would then allow people to give personalized scores for their food. 

So that was where we were and we were just starting to get the app together and then suddenly everything came crashing down and we're told in the U.S. and the U.K. on virtually the same day, everything had to stop, everywhere. 

So science was suddenly on hold, and, you know, science is my life. So, it was a terrible feeling, and I suddenly felt very depressed and rather lonely, as I cycled home and everyone was either very frightened or sad, anxious, depressed, you know, all kinds of emotions going on. But by the time I cycled home, half an hour, I'd said, well, there must be something we can do. 

My initial idea was to use our twins that we have this huge twin collection in the U.K., 15,000 twins all over the country that could be used like canaries, if you like, beacons for this pandemic so that we actually work out what's going on.

And the idea was to use an app that the team at ZOE had been developing for nutrition and swap it out for COVID. And so this suddenly transformed me from being super depressed to being energized. And I remember ringing you when I got home, I said I got this crazy idea and far from you dismissing it, which I was expecting, you said, that's great, but we don't have to do just twins. If it's an app, anyone can download it. We can use it far wider. So you had an even bigger vision of it. 

Jonathan Wolf: I remember this incredibly well because I was in my study, which I spent much of the following two years in, right? Like people who, I'm not a doctor, right? So you were going into hospital and I wasn't.

I remembered this call because I think I also felt this is awful what's going on and I really wanted to be able to do something and I felt really helpless and useless, which I know talking to lots of people was one of the very common feelings for people who weren't medically trained. 

You came up with this idea about how we could use a lot of the technology we've been developing over the last three years and it felt like we should. It felt like this was really important and we should stop the business that we were doing and just focus on this pandemic.

Prof. Tim Spector: Yeah, and it was great. So getting that positive feedback and our other co-founder, George, was in agreement, and then you got the approval of the investors, didn't you? It was their money after all. 

Jonathan Wolf: Correct. And I think they deserve a shout-out, actually, because, often people think about these investors as only caring about making money.

And actually we basically said to them, we want to stop doing everything that we're doing on this nutrition science research. I know we said we're about to go and turn it into a first product. We want to stop all of that and get everybody in the company, all the engineers, everybody else to work full-time on a completely free app for the pandemic, which has no commercial purpose.

We just think it's really important and we need to work on it. And amazingly, they just instantly said, Yes, that sounds like the right thing to do. You should just do it. We've got your back. 

I would actually like to say I'm immensely grateful because I think that they didn't have to say that. And it made me feel really good over the next year when I think we then went on to work ridiculously hard.

Didn't we? 

Prof. Tim Spector: Yeah, we seemed like we were doing about five jobs at once rather than, you know, a lot of people just went home to do the gardening. 

Jonathan Wolf: Do you want to talk through what happened over the next five days? 

Prof. Tim Spector: Yeah, I think there were about 30 people in ZOE at the time. Everyone was super energized by this idea and it, you know, like everyone During that time, it was so good to have a purpose.

And the team basically worked night and day, at least 20-hour days for five days to get this app up and running. Because we realized it was totally time-critical. There'd be all kinds of other things going on and distractions and surveys. And the government was saying that we're going to do stuff, basically if you wanted to have an impact. It had to be early. 

So I couldn't believe that it was ready. And there it was. Okay, it had bugs, it had clunks, it had all kinds of things, but we got it out there and then with our social media contacts, got lots of celebrities to retweet the link to the app. We had a million downloads in the first 24 hours, which completely crashed all our rather puny systems and amazed us.

But I remember the night we launched there was a little ticker we had on it just showing the number of people on it and it was super exciting and the feedback was immensely positive. People just wanted to be doing something because they were just to remind people that maybe they didn't see this in other countries.

We were asking people to report their state of health. How are you today? Do you have any of the following symptoms? Have you had a COVID test and then giving them feedback about their area, about how many people in their area were reporting the similar. 

So it was it was very much like the the sort of canary in the coal mine. But with a million people reporting. And it turned out to exceed our wildest dreams about how popular it was. 

Jonathan Wolf: I would add that it was built on the technology that we've been working on for the last three years. So we'd been doing what in science were like huge remote clinical trials, right? A thousand people is enormous for like human trials historically.

And so we built these apps to be able to collect very large amounts of data remotely. In fact, nothing was down for more than a few minutes, and we were able, in fact, to support a million people at the end of the first 24 hours, and there were four and a half million people after about a month, a lot in the U.K., but also in Sweden and in the United States, and that basically we sort of had this back end infrastructure.

We also understood how to do stuff that was going to be compliant for clinical trials, for clinical research. You were in the right place, right? We'd built this understanding, but then we needed to know how to use it and I think we had this amazing support from you and a lot of scientists and doctors at King's College London, right, to understand what were the right questions and problems.

There will be a lot of listeners who participated in what ended up being called the ZOE Covid Study. What did we get out of this? And in retrospect, as we look back, was there participation? Many people sort of shared their symptoms every day for a couple of years. Was this worthwhile and valuable?

Prof. Tim Spector: It turned out to be immensely valuable in many different ways, ways that we hadn't predicted. So the first of all, the thing that people still come up to me in the street and say, thank you for everything you did in COVID, was a psychological effect that none of us even thought about, that just by getting people to participate as a giant community, they were helping their own state of mind.

This idea of participating and being part of something bigger than just at home isolating had a real bonus on their mental health. That psychological impact was probably the most important to the people doing it. 

Then there was the idea of the things we were doing for the country and the world. And I think the first thing we were noted for was picking up these new symptoms. Initially, we were told the only two symptoms, definite about COVID were a persistent cough and shortness of breath. We were asking about other symptoms and we very quickly picked up this loss of smell, that about one in five people were getting. 

Jonathan Wolf: And Tim, for people listening to this, who will never have used this app during the time.

Why were we able to pick up symptoms in a way that there were hundreds of thousands of scientists around the world suddenly thinking about COVID that they weren't able to? 

Prof. Tim Spector: Because we were getting daily updates from a million or so people on their current state of health in real-time, and no one else was doing this.

Others were depending on slow surveys, still using even questionnaires. Nothing like this had ever been attempted before. I think there'd been some sort of community studies about people looking at stars and reporting what they were, but nothing in the health sector at all. 

So this is by far the biggest mass community study in real-time. And it was the idea that every day we were collecting data that was telling us what was happening in every region of these countries, that not only gave you an idea of the state of the pandemic. So we were able to pick hotspots, which areas were going up, which were going down, how the disease was changing and how the symptoms were changing and how they were linked to people of different ages and vulnerabilities, et cetera.

So that was really quite key and no one else had that data. And that's why the loss of smell for everybody. And we've found different symptoms in children and different symptoms in the over 80s with delirium and other things that weren't at all noted. We were the first to point those out. 

It changed the WHO criteria of the symptom lists, and most countries changed their criteria based on those ZOE results.

Jonathan Wolf: Based really on all these 4 million people participating in this app, just sharing their symptoms each day and whether or not they got sick. 

Prof. Tim Spector: Exactly. And instantly people saw the scale of what we were doing and the fact we were reporting it very transparently in real time. There was no fiddling of results, it was just these are the data and that's pretty much it. 

That’s why these major health organizations very rapidly change their criteria and then change their public health departments to say this is what to look out for. You know, it's not just a cough and shortness of breath. There are these other features.

It's rather sad that the English government, English NHS, were the last to actually approve these, rather ironically. 

Jonathan Wolf: We were more than frustrated, I remember we were really angry at the time. Because we felt people were dying as a result of it.

Prof. Tim Spector: Yeah, because they're still going to work, or going to parties, or meet old people with having completely lost their sense of smell, with a government saying, oh, well, we don't believe these results, we're waiting for our own ones to confirm it.

Jonathan Wolf: And I remember when we were doing this, now this all seems a bit obvious, but it was very radical, right? And you know, my background was sort of big data and internet and stuff like this but I'd never done anything in health. 

And you're one of the top scientists in the world Tim I don't need to tell you that and you'd been used to doing what seemed like very large data within science But very large data few for you was you might have twelve thousand twins and get a thousand people in studies.

So this was something really radically new and I remember there was a lot of debate about when we were starting ZOE, was it possible to do real science where you just did it remotely so people weren't coming into a lab or a hospital and where, if you could get to millions of people, you could get, discover all sorts of science. It's just not possible with a thousand people coming into a clinic, even though of course you're always having better medical devices in the hospital, but the trade-off is you get so many more people.

Prof. Tim Spector: Yeah, there was a lot of skepticism at the time and a lot of critics in academia didn't like what we were doing. They said many things, people will lie to you if you're not seeing them face to face, so they're not going to tell you the truth, which turned out not to be true. The other thing was they said no one over 60 is going to use an app.

That's what the medical profession generally think of the intelligence of over 60-year-olds, that they're incapable of using apps. And we blew that out of the water completely. But that was at the time, it seems mad now, but actually that was the sort of status quo of the reasoning. You don't do studies in older people with technology. 

Jonathan Wolf: And I think they also said you'll never be able to do proper quality science. So did we manage to get proper quality science that was peer reviewed out of this? 

Prof. Tim Spector: Well, we ended up being probably the leading research group in COVID and the number of high-quality papers we got with a number of people.

So I think it was over 40 peer-reviewed papers in the very top journals, from New England Journal, Lancet, and Nature. These are still very highly cited papers today. 

One of the most important ones I was looking up the other day, I think, the most highly cited is an early one that showed the infection rates of COVID in people who were working in hospitals compared to the community. We showed a tenfold increased risk in the U.S. and the U.K. and people were one of the very first ones to show the risks of waking in hospitals and it was also correlated with how well staffed they were with equipment. You could look at the geography of saying this state or this state had very little PPE and didn't give its staff proper masks and therefore the rates were even higher.

So we were great on symptoms, and as the variants changed, so the symptoms changed, and we had this big debate about it switching to be more like a really starting like a cold, and we spotted that several weeks before any of the other systems because ours was always much faster. 

The other thing I think with these hot spots we were finding in the early stages before there was any testing, we also found a lot about vaccines. So we had over a million people reporting what happened when they took those first vaccines, because there was a lot of anxiety about vaccines at the time, a lot of misinformation. 

And so we obviously were able to give independent information about not only what were the side effects of those first vaccines, but how effective they were.

And we were the first to confirm in very large numbers what the smaller clinical trials had shown, that these vaccines were protecting people between 70 and 85% compared to not having it, and they were reducing severe COVID in big ways. 

So I think they were the sort of things that I remember as the major things, but there were so many other aspects that also were fascinating about the spread and the infection rates and then we were first really to write about long COVID as well.

And I wish we'd been able to do more on long COVID, but we weren't able to access the people with severe long COVID because they'd gone to hospital and people in intensive care are obviously not filling in their app. 

So we always were focusing on the milder cases. And I think that wasn't appreciated by everyone at the time. So we could talk about long COVID in the community, but we couldn't talk about those really severe cases. So I think they were the major achievements. As well as we did do stuff about diet and supplements. 

Jonathan Wolf: I'd like to take the opportunity just to thank everybody who participated. There were millions of people in the U.K., in Sweden, in the U.S. who did this selflessly and contributed, and I think you just hear the amount of impact, I think that's amazing. I'd also like to thank everybody at ZOE who worked incredibly hard to make this happen, and it was really, really intense. 

I remember juggling this and looking after my then not-yet-one-year-old with no childcare for the first four months. My wife's a doctor, so she was very busy. So it was a mad time. 

On the other hand, it certainly gave me purpose and I think got me through that actually in a way that was much better than many people as I discovered subsequently because I felt like I was very busy and I had a lot of purpose.  And so I think actually it was very good for my mental health to feel that in a time that's difficult.

But i'd love to look back now at the pandemic and understand, you know, what did we get right across the world?

There were obviously very different reactions in different countries and we got wrong. And actually, I'd love to start with something that at the time I remember was viewed as complete conspiracy theory, which is where did the virus start and how did it spread. But I understand Tim that there's been more real examination.

So can we start with that? 

Prof. Tim Spector: Yes, so, I don't think there's any doubt that this virus emanated in China, in a place near Wuhan. And the question is, did this come from bats? Did it come from a lab that was working on this virus and manipulating it to make it grow faster? Or was it a totally artificially generated virus to cause harm that they then didn't control?

The initial ideas and the government's official response was that this was related to bats and was a natural phenomenon that came out of this market in Wuhan. 

And it's looking increasingly like that was a bit of a cover-up and that the most likely source of this was a lab leak from Wuhan and there've been a lot of U.S. congressional hearings talking about how there'd been work between U.S. labs and Wuhan labs to basically look at the infectiousness of these viruses and how you might control them or speed them up. 

Jonathan Wolf: You said it very calmly, but it sounds quite radical. You're saying genuinely when you look at the data trail and the science now that you think there is quite good evidence to suggest that it might actually have come out of a lab rather than just somehow transferred from an animal to a human being in China completely accidentally.

Prof. Tim Spector: That seems to be the most likely scientific answer for what went on that explains both the epidemiology, the timing. Also, the trail of shredded documents and email exchange between the U.S. and China at the time. And it's also, there was a very obvious cover-up very early on by various governments saying we have to get a report out there saying this is all down to bats so people aren't going to blame labs and scientists to keep that credibility going. 

So that's my personal view and there are views on all sides of this. I don't think the idea that someone built a virus from scratch would be very easy to do. So I think it's more likely that was a mistake rather than anything deliberate, but I think these were people working with hazardous viruses that got out of control rather than it being a plot.

Jonathan Wolf: It's slightly terrifying. I mean, you say that very calmly, but it's slightly terrifying because it does suggest, in a way, it makes it feel more risky that something like this might happen again. 

Prof. Tim Spector: I think particularly if this cover-up continues and people don't admit that it actually happened, at least in the U.S., is quite open.

It's interesting in the U.K., there's very little coverage of this going on. And I think it'd be better to be more transparent and say, are there labs around that should be controlled like you would control nuclear threats or anything else that's extremely deadly. 

So I do think we need more oversight on this because if that is the most likely solution, well that could happen again in another lab if we're not careful.

So let's just keep our eyes open about this and I think like many things that happened in COVID, there were some things that governments did as if they were in a war situation and they had to take control of everything and make these decisions. And some of them were good and some of them were bad.

I think we just got to be honest about that. And I think some of these decisions just need to be now looked at again, and perhaps with greater transparency going forward so we can make sure it doesn't happen again. 

Jonathan Wolf: Well, you slightly shocked me with this one, Tim, so I think I'm going to go on to the next list, which is really about protective measures.

I guess the things that when we think about COVID that we'd never heard of before, but then we got really used to, was mask-wearing on one side, which, you know, for some people in Asia, they'd obviously been used to, but for the rest of the world, we'd never been used to wearing masks. 

The other one is sort of shutting down interactions within society, whether they are So, You know, they were called lockdowns in various countries or school closures that we saw across the world.

What have we learned about the effectiveness of those protective measures? 

Prof. Tim Spector: Well, mask-wearing was very controversial and basically most countries divided into two groups of people, the sort of really pro or against a bit like religion. 

The early studies didn't show much benefit for masks and partly that was because people weren't wearing them properly, had them around their chin most of the time, or they were very flimsy cloth ones. But the latest summary of all the studies shows that proper mask-wearing does reduce risk of infection significantly, and the better the mask, the better the protection. 

So I think now we know that masks do have some benefit if worn correctly, And a lot of the studies included people who weren't wearing them properly at the time and it, we didn't really know exactly what was going on.

So, that's a good lesson for the future that if you want to stop a virus that's airborne, make it really hard for that virus to get into your mouth and nose, which is where they get into the body. It makes sort of sense. 

The other measures we had on lockdowns, the data is not so clear. I think some countries were able to survive without lockdowns because they had very good medical facilities and the hospitals weren't overrun.

And so in that first wave, they didn't have to stop the whole of society and cause massive economic problems. They had enough hospital beds and doctors and nurses to treat that first wave. 

For countries like the U.K. and many states in the U.S., they weren't able to deal with the huge wave of respiratory problems. And so, without having people dying in the streets, some lockdown was necessary. 

Now, whether subsequent lockdowns were effective or not is somewhat debated. I think it's very hard to generalize across every country about whether they are effective or not. We were advising number 10 at one point, a group of epidemiologists about whether there should be another lockdown or not, looking at all the data. 

What prevented the virus was the amount of movement of people. And there are these scales for measuring movement. And we were down about 70 or 80% for most of the time during these crises. So if you see people coughing and, going to hospital all around you, it's going to change your behavior, whether the government tells you to do things or not.

And you would often get these peaks proceeding before the lockdown happened. And so actually people were deciding themselves to self-isolate and do the sensible thing. So it's not really clear that governments need to take this action. It could be that the more vulnerable people made their own decisions to isolate and they didn't need government to do that for them.

Jonathan Wolf: And what about school closures? 

Prof. Tim Spector: School closures were pretty much a disaster. I think that was one thing got very wrong. I don't think we really thought through the consequences of stopping children going to school, meeting other kids, and interacting with huge mental health sequelae after it.

And we got it wrong. We thought that children were at risk of the virus themselves. It turns out, we were wrong. It was just very much like a common cold for the vast majority of them, or they had nothing at all. 

I think in retrospect, we should have produced different rules for children because we had this obsession with if we locked down until they were vaccinated, then they wouldn't carry on infecting other people.

It turned out that even after vaccination, they were still able to infect people. And so that was a real fallacy and so they're the ones I think who suffered the most during this. We're seeing this epidemic of mental health issues around the world from this group and who also suffered educationally retrograde back a year or so in their education.

So that's one thing we got wrong and the epidemiology expected that children would act the same way as adults and I think this is something we need to learn for the future, that there is this payback and that the people who aren't suffering the consequence of it shouldn't pay the most of the penalty.

Jonathan Wolf: It reminds me a little bit, interestingly, of the day-to-day experience that I have at ZOE around extending your healthy years versus disease and being sick. 

It feels to me that it's very in line with healthcare in general, which is very, very focused on avoiding somebody dying. And therefore we put this enormous amount of our resources right into the last six months of someone's life and spend almost nothing trying to actually improve people's health before they're really sick and giving them many healthy years. 

ZOE is all about understanding how you can feel better now and you can live more healthy years. And you have people saying, well, aren't you just looking after people who aren't sick yet? And I'm like, yes because getting many more healthy years is great. And somehow it feels similar, it's very focused on people who might die from COVID, which is awful and of course should be avoided.

And I think very much about my parents, but not really measuring very much the sense about the harm that it was doing to our children and other people who are locked down and all those mental health problems. Because it's that very measurable death seems to get such a high weighting, I see that in nutrition.

 But do you think that played into this as well do you think?

Prof. Tim Spector: Hugely yes, and you can imagine it from a politician's point of view. Are you going to say Okay, we'll allow schools to carry on and there's a risk that some of those kids will go and infect their grandparents, and those 85-year-old grandparents are going to die maybe a year or two before they would normally die, and all of those kids can go to school.

So that's not something that's easy for any politician or anyone public to say.

Jonathan Wolf: It's an incredibly difficult choice, isn't it? Because I think one of the things we all felt was our relatives are really important to us, right? And I think one of the things we discovered is we're willing to put up with a lot in order to protect them.

It just feels like we created a lot of harm here with children that I think we weren't really aware of. I think you're saying if we were to redo this, we could have let them go to school and not really affected the death rate very much. 

Prof. Tim Spector: Yeah, absolutely. And I think this is a debate every country needs to have about what is the price of each year of life. Is an 85-year-old living to 86 more important than some child losing a year or two of education and having mental health problems the rest of their life? 

These aren't easy things to talk about. But I think in health care, the U.S. is even more extreme, about a third of all the U.S. healthcare goes in the last three months of life. I think we have to start re-evaluating this really, moving forward as we start putting money into preventive health. 

The other element that comes in we haven't really discussed is economic and these lockdowns had huge economic costs and epidemiologists know there's a clear link between the economy and health and long-term health outcomes.

So I think in the future we also need to be modeling saying well for every dollar we're losing that's going to cause more suffering, more health issues as well. 

So it's a much tougher, holistic experiment than we've realized. And I think next time around, we want to be more prepared to say, well, this is the things that make sense. We know these factors are important. Let's have a much more grown-up debate about it rather than just reacting to things. 

Jonathan Wolf: And it sounds like you're saying that in particular, the schools is a thing that you really feel we should have done differently across the globe. 

Prof. Tim Spector: Yes. And it's also how we treated the children. We know in certain states in the U.S. they really sort of picked on kids and said, Well, you know, even five-year-olds are going to be vaccinated otherwise they can't go to nursery school. And there was no science backing this up. And I think we just have to realize where we made mistakes and where we did really well.

And the vaccine story was an incredible success story overall. 

Jonathan Wolf: I was going to say, can we talk about that now? Because when we were asking for questions on this episode, we had a lot of questions about the potential side effects from vaccines, and we also had questions about whether the risks of vaccines actually outweighed the benefits.

Have any studies been looking into this and what is the the verdict now looking back? 

Prof. Tim Spector: Huge amounts of studies looking into this. So for adults the vaccine prevented 70 to 85% depending on the vaccine and the timing of COVID infections. It was even slightly greater for severe COVID and it also reduced long COVID.

So you're four or five times less likely to die if you had, you had been vaccinated than if you hadn't, so there were huge differences. 

Jonathan Wolf: And so just to make that really clear, your view today, if advising an adult about whether or not they should take the vaccine, is… 

Prof. Tim Spector: Well, I mean I took the vaccine and I was very glad I took it. Obviously, you're reducing your risk of getting that infection and if that infection is like we have a risk of death, then you're going to reduce that equally.

As each phase of COVID gets weaker, it’s more infectious. So what's happened is exactly as predicted. Each variant of the virus has become clever at evading our immune systems and it's kept mutating, so it's even more infectious than it was right at the beginning, but it's much less likely to harm us severely or kill us. 

So this is what happened to the original Spanish 1917 influenza pandemic, it took about seven or eight years for it to blend into the background.

So when we talk about vaccines now, it is different from what it was in 2020 when the mortality rate was huge. Still, we think about 20 million people worldwide have died of COVID so I'm not trivializing this any way. 

Jonathan Wolf: Which is an enormous number of people right from something that didn't exist six years ago. 

Prof. Tim Spector: Correct, and just seemed to come out of nowhere. But it would have been many more if we hadn't had the vaccine. 

Jonathan Wolf: And there's lots of people who talk about side effects, and focus on those side effects. As a doctor and a scientist looking at the data now, how would you help someone who's worrying about that and trying to understand, did they do the right thing and indeed, if they are thinking about vaccines today? 

Prof. Tim Spector: These COVID vaccines do have side effects. And because this is probably the most studied vaccine in history, even in our ZOE survey, we had over a million people we were looking at, we could see these rare side effects quite well. 

You can get problems with the heart, myocarditis, and pericarditis. Occasional brain problems, but you get 10 or 20 times more if you get the infection. So, yes, there are side effects of the vaccine, which is giving you the virus in a mild form. 

But if you have the virus in the full form, the wild form, you're going to get many times more. So that's why for adults, the risk-benefit ratio is for the vast majority of people, always positive.

For children, it wasn't the case. So they didn't get the same advantages, because they were relatively protected against the virus. 

Jonathan Wolf: What you're saying is, if they got the virus, they weren't likely to be sick? 

Prof. Tim Spector: Much less likely to be sick or have major heart problems, or die. And therefore, in many cases, the risk of the side effects was as great as the risks of the actual virus itself.

So I think most countries moved away from vaccinating children fairly early, but some stuck with it, particularly some U. S. States. So I think that's where a lot of this controversy lies. But there's a big difference between talking about children and talking about the average 50 to 70-year-old person.

And everyone's got their own personal story. These vaccines wane after time, so it depends when you're taking it.

When people are listening to this podcast, there might be a vaccine that's just come out that's, that's really good against the latest variant, and it's just coming up to winter, and you want to be protected, that's when it happens. You're offered another one that's just about to go out of date. It's really good against the old variant, and that's changed, and actually, you're coming up to summer, and there's not much going on, and therefore you're better off waiting. 

So it's become slightly more subtle in terms of what we do, but I don't think because of these subtleties on these rare side effects, we should in any way think that vaccines in general are problematic. 

Because of COVID, there's been this terrible anti-vax movement that's thrown out everything. And so suddenly saying, well, we can't believe anything these guys are telling us and therefore kids are now dying of measles, really important cervical cancer vaccines are not being taken up. 

And we're not using this incredible technology that was developed that the whole world got together to fight cancer and things like this. So, let's be sensible about these things.

In general, follow the advice because the value of vaccines is huge. 

Jonathan Wolf: Got it. And here what you're saying is, overall the vaccines were great, but in children, when we look at the risk-reward, particularly, I think you're saying for younger children, the risks from COVID were really overstated. They were very low. 

Therefore, when you look at these rare side effects, those risks are as high or higher than COVID. So it doesn't make sense there, but I'm nearly 50. Or I think about my parents in their seventies. You're saying it was a very different calculation. 

Prof. Tim Spector: Yes, and as you get older, or you have a medical condition, then that ratio changes.

Jonathan Wolf: And what about today, Tim? Because I'm really struck how much COVID is still going around, right? I sort of had the thought, oh, everyone's got a vaccine, it'll disappear, you'll never hear about it ever again. And I'm struck by how many people say, Oh, I can't come to this event. I'm really sick and my whole family's sick and we've got COVID.

And some people are getting really sick with it. I noticed some people feeling really unwell for long periods of time. What does that mean about people thinking about vaccination today as opposed to presumably already having had previous vaccines during the pandemic? 

Prof. Tim Spector: Yeah, I think the big worry now is not so much death it's more about long COVID. The current estimates are that around 10% of the people who are being affected are going to have some degree of long COVID, which means it's going to last at least three months. And that means many people are left with all kinds of weird configurations of symptoms that is going to impair their life.

We do know that vaccines reduce the risk of long COVID, estimates are something about 50 and 80%. So that's probably the main reason to be taking it. And strangely, we would have thought that if you had COVID multiple times, Oh, well, you're not at risk of long COVID. But actually, the more times you've had it, it slightly increases, so it doesn't disappear.

People would assume that, oh, I've had it once and I didn't get long COVID, I'll be fine. 

Jonathan Wolf: You've incredibly depressed me because I had assumed until 30 seconds ago, I've had COVID after my vaccine, and I didn't get long COVID, so I'm totally fine. And now you're pulling the rug out from underneath me, Tim. 

Prof. Tim Spector: I believed that as well. I thought, oh, I'll be fine. But I think there is still this risk of long COVID, which is probably the major one that's still hanging over us and has a major psychological, financial, economic, everything component. 

Everyone who's been through long COVID or is still suffering knows how important it is. So, I think that's the main consideration that we shouldn't just completely ignore these new variants and these threats. We're not out of the woods yet. 

Jonathan Wolf: And are a lot of people getting long COVID? 

Prof. Tim Spector: There are, yes. So those numbers haven't really dropped and it's not in the news and they don't get the attention they deserve.

As yet, we haven't really found a cure for long COVID. So there have been lots of trials done and we're getting better at spotting the symptoms, but there's no magic test. 

It's not been easy for the medical profession to try and work out what's going on. Some signs we can deal with, some of these symptoms, but the ones with tiredness, et cetera, we've made lots of mistakes.

We used to tell people with long COVID to exercise more. Just get out there and pull yourself together and go for a long walk. 90% of people got worse when you did that. So actually, that was the wrong advice. The advice is really to rest. 

So we still got a long way to go in dealing with long COVID and the results of that. So,there are millions of people around the world who are still suffering. I think we shouldn't forget them because as people like ourselves are trying to move on, there are many people who can't, and I think that's very important. 

There are a few promising drugs around, but they seem to be treating individual symptoms rather than the whole thing.

Jonathan Wolf: Well, I think it makes you realize just how terrible a virus this is and has been, doesn't it? Because there will be lots of people listening to this who lost loved ones during COVID. I know many people who lost parents and other relatives. Many people obviously who suffered really significant mental health issues, but then people still living with long COVID but still getting it now.

And it makes you realize the world is a worse place as a result of COVID being out there than it was. This is really depressing. And I guess it's a good transition to the final things I'd like to touch on really, which you mentioned in the quick-fire at the beginning about the risk of another pandemic, that this might not be the only time this happened.

You said it was 50-50 in your own lifetime, whether we had this again. And I know the team shared some research showing that these pandemics are getting more frequent and severe if you look across history. 

I'd like to focus on what people can do to prepare. I think there's a whole other podcast about what governments might be able to do, but what can people do? 

Given that this is ZOE Science & Nutrition I'd maybe like to come back to that quick-fire answer question right at the beginning where you said well actually, there's things you can do with your diet that can really reduce your chance of getting COVID and reduce the severity. Because I think some people listen that will be like well that sounds totally crazy, like total quackery. I think the first time I heard you talk about this I was like, surely not.

Prof. Tim Spector: Obviously the last thing most doctors talk about is diet. That's why, we tested about a hundred different drugs for COVID and people are still obsessed with the anti-worm drug, ivermectin,  as being useful although 14 randomized trials have proven it doesn't work.

But we did a study of a million people, followed them up and worked out how severely they got COVID. There was a clear relationship that was the strongest factor after age was the quality of their diet.

If they had a high ultra-processed food diet, high inflammatory-causing diet, lack of fiber, all these things had a surprisingly high impact on their risk of having severe COVID. 

I think it didn't so much stop you getting it, but it stopped it being really bad. So the first thing anyone listening to this can do about preventing any sort of nasty illness that's going to impact your immune system is to build up your immune system.

How do you do that? Improving your gut microbiome, and how do you do that? Through your diet. People going through the ZOE nutritional program will know exactly what I'm talking about. It's basically this idea of more plants, diversity, high fiber, feeding your gut microbes in a way that is going to help your immune system. So that's number one.

The other is try and keep your weight under control. So obesity turned out to be quite a major factor. There's some evidence that people taking metformin, interestingly, which is a drug that's been around for 30 years treating type 2 diabetes and is being researched now as an anti-aging drug, can actually reduce risk of infection.

But we don't know whether that would work for Avian flu or anything else, but there's an interaction between some of the drugs people commonly take and our immune system that we still don't understand much about. 

Jonathan Wolf: If someone's listening to this, they might well have the same response that I had originally, which is, I understand how eating food can affect my weight, I can sort of understand how it affects my mood now because you sort of talk about the bacteria making things. I can get there

But the preventing me getting really sick with a virus, it sounds like a crazy stretch. How does this work? 

Prof. Tim Spector: To understand how you might fight off an infection or keep it minimal under control through your diet, you've got to understand the link between the food you eat and your gut microbes and your gut microbes and your immune system.

We now know that most of our immune system is in our gut, 70-80% of it. The way it gets its signals and it understands what's going on around it is through the gut microbes, most of which are in our lower intestine. There are a hundred trillion of them, the same number of cells in our body. And we all have very personal, different ones.

You can change them rapidly within a few days by altering your diet. The more healthy your gut microbes, the more diverse they are, the more good ones the less bad ones, the better you're going to be able to control your immune system. 

If you control your immune system, this means it's going to react appropriately to say a virus, it's able to fine-tune your defenses and it's not going to waste lots of energy.

So, people eating a junk food diet, very little fiber, and you know, typical American diet, is going to have an inflamed gut microbiome that's going everywhere, it's all distracted. It's trying to put out fires all over the place. So, when a real virus comes along, it's not able to really pin it down.

So that's why our immune system, keeping our immune system in perfect health is really crucial. Not only is that good for infections, but that's also good for aging and also fighting cancer. It's the same principle. That's why microbiome and diet keep coming up in all these diseases. So if you want to have the best immune system, you need to make sure your gut health is in the best possible way.

And as our members know, yes, it's plant diversity, it's fermented foods, which we now know are really good for the immune system, and this means foods with probiotics in them, live microbes, and it also means not having ultra-processed foods, and getting plenty of fiber in there. 

So, I can't stress enough, that's the reason that we saw these big differences in social class effects on severity as well. It's all linked to diet as much as anything else. 

Jonathan Wolf: And so, does that mean that when I'm feeling sick, the way I historically would have responded to that was, Oh, I'm just gonna eat loads of junk because I'm not feeling very well, so I think just indulge myself. I, historically, thought that seemed perfectly reasonable.

After all, you're not sick most of the time, so it's a time to throw anything you might think about healthiness away. Is that fine, or actually, when you're sick, should you almost be doubling down on making sure that you're eating these foods that are supporting your good microbes? 

Prof. Tim Spector: No one's done the study of suggesting that people like you go and divide into two groups. But all the evidence suggests that we should be really focusing on immune-boosting nutrition when we're sick and not going for comfort food. 

Jonathan Wolf: I definitely think a lot more now about like, okay, am I still eating sort of good food that is supporting my microbiome in that situation that I would have done?

It's one of the things I think I've really changed. So I understand you saying there's not the proof, but it's definitely changed my mind. So I've got this idea I want to keep the microbes helping me out. I don't want to, because I can tell I'm in an internal battle. 

Prof. Tim Spector: You know, we're getting this evidence from our studies, like in sleep, and if you have a poor night's sleep, you feel terrible and your brain sort of picks the wrong foods for you to make you carry on feeling even more terrible. 

So I think we've got to start realizing there is this really close link between our brain, how we're feeling, our immune systems and the diet, but let's not lose track of what our gut microbes need in order to keep the immune system going is even more crucial.

There was some tentative evidence that things like probiotics could help artificial versions of fermented foods. And so, yeah, if next time I get COVID, and I have done the last few times, I am really hitting the fermented foods and making sure I'm getting plenty of fiber.

Jonathan Wolf: Tim, many more questions, but we’ve definitely hit time. Thank you.

I'm going to try and do a quick summary across this as always. So, I think we started by saying that there's been an opportunity to reassess everything because we have distance and data, and this is one of the most studied virus ever.

There's a set of things that I think we've come through and we feel really good about. So you said we feel really good about the vaccines. They've turned out to be safe. They saved many, many lives. 

There's things like masks where you're saying, now that we've been able to examine this clearly, it is clear that if you wear the mask correctly, it can really reduce your risk of infection but a lot of people were failing to do that.

But other things you said you've really rethought and that particularly you feel that our approach with children was wrong. That closing schools was wrong and that indeed that the balance of risk for young children on vaccination was also wrong because their risk of getting COVID and being hurt was so low that actually were at the same level of risk as a vaccine.

Then we talked a bit about long COVID and the fact that not only is this real, but it's continuing. And one of the things that is a negative surprise is even people like me or you who've had COVID, we aren't guaranteed to be safe from long COVID and from a future infection, which makes you think you'd really rather not get it, but it's going round and round.

Future vaccination, for people who've already had vaccines can make sense, but you need to be in an at-risk group and you'd really like to be having the vaccination that's actually well targeted to the current version of the vaccine, not the one from five years ago. 

And then I think we got onto this really interesting topic about what can you do to protect yourself from infections in the future, whether that is a future pandemic or just flu, you know, COVID, any of these sort of things.

And this amazing data that the food you eat is one of the biggest things that could change your risk of getting really sick with COVID because we now understand that the food we eat has this profound impact on our gut microbes that then has this profound impact on our immune system. 

So by eating the food that is really going to support the right microbes, we can actually really improve our immune system. And I think you said it doesn't guarantee we won't get sick, but it basically means that we're much less likely to get severely sick. 

Prof. Tim Spector: Yeah and prolonged infections or, and hope, there’s some evidence, but preventing long COVID as well. 

Jonathan Wolf: So the message as is so often here and with Tim is what you eat is centrally important.

And that somehow the more we study it, the more we understand how much it impacts every aspect of our health. 

Prof. Tim Spector: Absolutely. 

Jonathan Wolf: Tim, thank you so much. And I will wrap up again, as I said at the beginning to thank so many people, both listeners and non-listeners who participated in everything during COVID five years ago.

And I would just say I feel very proud, actually, of my part in this. I think when I look back on the whole ZOE story, it's a thing I'm going to feel proudest about by far and I think everyone listening who took part in in those studies or frankly did anything during COVID that was helping other people should feel really proud. Because I think it was a very difficult time and I hope you're wrong Tim and that there will not be another pandemic in your or my lifetime.

Prof. Tim Spector: I very much hope so too but yes everyone it was fantastic and very emotional really to revisit those times and realize what an amazing team we and the millions of other people were. It just shows what you can achieve when we work together 

Jonathan Wolf: I love that Tim. Thank you so much I really loved having Tim on the podcast as always.

And my biggest takeaway is that we really need to learn the lessons from the COVID pandemic because there's a very real risk that there will be another pandemic in our lifetime. One of the big lessons is that the food we eat is one of the most important things we can do to improve our health and make us better at fighting the next virus.

And that's where ZOE membership can help you. Each day, more than 100,000 people rely on our personalized nutrition program to make smarter food choices, to feel better in weeks, and be on track for more healthy years. 

So how does it work? ZOE membership starts with at-home testing to understand your unique body. Then ZOE's app is your health coach using weekly check-ins and daily guidance to help you shift your food choices to steadily improve your health. I rely on ZOE's advice every day. And truly it has transformed how I feel. 

Will you give ZOE a try? The first step is easy. Take our free quiz to find out what ZOE membership could do for you. Simply go to zoe.com/podcast, where as a podcast listener, you'll get 10% off. 

As always, I'm your host, Jonathan Wolf. ZOE Science & Nutrition is produced by Julie Pinero, Sam Durham, and Richard Willan. The ZOE Science & Nutrition podcast is not medical advice, and if you have any medical concerns, please consult your doctor.

See you next time.

Have feedback or a topic you'd like us to cover? Let us know here.

Episode transcripts are available here.