It’s OK to Mourn the Small Stuff Before You Move On: How riding the emotional wave has benefits in developing who you are

girlymicro General , , , , , , , ,

I suspect that many people opening this blog may be thinking that I’m going to write something about loss, and I am, but not necessarily about the loss of a person. So bear with me whilst I explain why I wanted to write this today, as it isn’t the post is I meant to write this evening.

This post was inspired by the re-emergence in my life of a giant Eeyore that my sister brought me when my mother in law sadly passed away. He’s almost the same size as me and gave me huge comfort on my first encounter with significant grief. Then my sister passed away unexpectedly and he came to represent a lot of loss I couldn’t process. That was over 15 years ago, and today he has finally come out of the attic to live under my desk, regaining his position of comforter. I’m not over what happened to my sister, but I’ve finally reached a place where the things that I associate most strongly with her are things I want in my life, rather than being a trigger for trauma. How does this connect to a post about wider emotional processing? It struck me when he gained his new position that we make time and allow for grief about the big things, but the need to go through similar, shorter, processes for other scenarios is seldom acknowledged.

I’ve posted before about how important it is to celebrate, both the big and the small things, and today has made me think about how the converse is probably true, do we need to acknowledge and make room for grief and mourning in response to less dramatic changes in our lives? Often we are told to ‘buck up’ or ‘pull it together’ but for specific, delineated time frames, should we actually just hand each other a box of tissues and some ice cream and accept the benefits of a good wallow?

I think there is a certain amount of social acceptance of loss related to people and the grief associated with it. It strikes me, however, there is much less acceptance of loss related to other things. Loss that occurs to all of us during our lives and can impact how we see ourselves or the world. Missing out on our dream job, drifting from a close friendship, or even the loss of a favourite pair of shoes. These things may  sound small, but variations of them will impact us all, and if we save permission to feel sad and grieve only for the big things we may not deal well with the impact of routine losses that end up hitting us just as hard because we’ve ignored processing them. So in contrast to celebration, I thought I would talk about the moments that I consider ‘wallow worthy’ and encourage us all to allow space for a little mourning.

The Power of Celebration: Why we should see celebration as essential and not a selfish act

Mourn a vision of the future that will no longer be

In my post about losing my sister I talk about the loss of the idea of being a mother and developing that new family unit. There are plenty of other ways this form of loss can hit however, all of which are still valid.

There are many things in life that we can sometimes take for granted when we are younger. The fact that we will find Mr/Mrs/They right and will have companionship. That we will have a permanent home that we enjoy. That we will have a sense of community and a way to express ourselves. Things that are just assumed will happen at some point, but in some cases, and for some people, never quite arrive. It doesn’t mean that not having those things will make you unhappy. I know many people who are content without some or all of those things. That doesn’t mean, howver, that there won’t be moments, days, or even weeks, where you don’t mourn the fact that some things that are just considered ‘a given’ haven’t been given to you. Contentment does not rule out a sense of loss at what might have been and it is OK to recognise that and mourn it for a while, despite acknowledging that you are still content with your lot. In fact, going through the acknowledgement and mourning process may be the only way that you truly come to terms with the reality of your life.

Mourn the loss of your sense of identity

There are numerous points in our lives when we change how we view ourselves. When you become parents and leave behind a phase when you can focus entirely on yourself. When you retire, and have to discover who you are when you no longer have the structure and identity of yourself as part of an organisation by which to define yourself. There are many reasons why your sense of identity could shift, and many of them are actually positive. The positive direction of travel may not however mean that you don’t mourn and miss who you were before. In fact, this is one where acknowledging the change may be a really important health and wellbeing piece to ensure success in your future identity.

We all know those people who cling tightly to who they were in their twenties, even though decades have passed, or the people that retire who can never really step away from their old place of work. Denying that our identities are rooted in both time and place, and that letting those go requires a level of emotional processing, can lead to less healthy long term outcomes. This one can be especially tricky as we are often expected to enter new phases of our lives with unconditional joy, and being sad or worried about what you are leaving behind is often taboo. It is essential to acknowledge the complex emotions linked to these transitions however, in order to make them well.

Mourn the loss of an aspiration unfulfilled

There is never enough time. Long and short, time is a limiting factor. You may not be able to get onto that PhD that spoke to you, write the book you’ve been talking about down the pub for years, or give a key note speech at a conference. Aspirations are tangible goals that are possible to achieve, and therefore it can sometimes hit even harder when you stop to reflect 20 years on and you haven’t managed to tick a box on your list that you’ve been hanging onto for years.

There are all kinds of reasons why an aspiration may not occur. Sometimes, life takes us in a different direction. Sometimes, you don’t manage to make the time or succeed in the steps that lead up to the final goal end point. The fact that it should be achievable can make the lack of fulfillment hurt even more. It can often feel within reach, and yet keep slipping away.

Without being able to reflect, and experience the emotion linked to the loss, it can be challenging to decide if the aspiration is still important enough that it is worth trying to achieve. Without looking into the face of it and mourning how the loss feels, you can’t decide how much you are invested in the outcome. Feeling the loss is crucial in determining fresh priorities for the future.

Mourn the loss of a dream

For me, the difference between a dream and an aspiration is the likelihood of it happening. Dreams are less based in reality. There is often not a tangible 10 step plan you are following to get from point A to point B. It doesn’t mean that you will be any less emotionally invested in them. In fact, we are often more invested because we are aware of the challenge that dream will face from others.

I’ve known multiple people who were exceptional dancers who had their dreams of dancing professionally taken away by injury. I’ve known wonderful writers, who have given up on their dreams because they had families to support and the jobs required to do so meant they let go of their dreams to focus on their reality.

Dreams also form a part of self identity, and letting go of a dream can, therefore, cause us to be confronted with the reality of who we are and what we can actually achieve. This process can be incredibly painful and letting go of that hope for the future requires going through a grief process. People will often say that you should just get a new dream, but to actually do that requires you to truly process the loss of the old. So, no matter how much the dream felt like a work of fiction, its removal is something that needs grounding in emotional processing in order to move forward.

Mourn the loss of an ideal

This one I find particular interesting at the moment. I work for an organisation I love, but because of system changes outside of any of our control, it no longer feels like the place that I have loved and been invested in for over 2 decades of my life. It is still there, but feels tarnished somehow. The same can happen with people you love and respect. There is, after all, the famous saying that you shouldn’t meet your idols, and that is often because they often won’t live up to the ideal we have set for them.

I still love the place I work, but I am seeing it through a lens right now where I am confronted with sides of it that don’t look the same now I have removed my rose tinted glasses. It doesn’t mean it’s bad, it just means that to be able to continue to work there and maintain my commitment, I need to acknowledge the difference and mourn the loss of the ideal I used to hold.

There are so many examples of this right now, from how I feel about the political scenario in the US, to the disappointment I experience at the reported behaviours of some of my favourite writers or directors. It does no one any good to pretend that the complexity of the world do not exist, but I sometimes mourn the loss of my naivety. It may that being more enlightened is a good thing, but a period of mourning to move on is still required to help me process and plan for my new reality.

Mourn the loss of an opportunity

This is one I’ve talked about before, in talking about my process for handling failure whether linked to papers, grants, or other things. It is not possible to be 100% successful, in fact within the failure is the learning that is so important to succeeding in your eventual outcomes. I’d be lying if I said that failure is fun though. Even with a growth mindset, where you embrace the positivity of failure, it can still get to you.

I allow myself a short defined period of mourning and wallowing when I am confronted with failure, in order to allow me to take the next step bravely. This kind of mourning of the loss of opportunity can link to everything from job applications, to trying to get tickets to Glastonbury. You may learn from the process to be able to increase your chances of future success, but if you don’t process the failure you may be too disappointed to try again or approach the next chance with the learning necessary to increase subsequent chances.

For me, a great example of this is when I need to respond to reviewers about a paper. If I haven’t stepped away from the reviewers comments in order to just mourn and be irritated in response to their criticism, when I come back I will respond from that emotional space instead of from one of balanced logic. This is likely to make the response less well balanced, and possibly lead to additional unnecessary failure. Allow myself 48 hours to step away and wallow however, and I’m good to go with the next step.

Mourn the loss of a connection

Someone recently said to me that friendships are for a season, and it’s really stuck with me. My life has diverted substantially from the lives that some of my close friends lead. They have gone on to have families, which are understandably a large focus of their time. There are parts of their lives and conversations linked to their day to day realities that I simply can’t partake in. When I have been surrounded by a group of friends who are all young mothers, I simply don’t have the context to discuss the best cream to deal with nappy rash or the latest school communication on head lice. You therefore become less and less present within their lives.

They also probably don’t understand my joy at getting 5000 words down for my book on a weekend, or how excited I’ve been to record a specific podcast. It’s not that I love them any less, or they me, we’ve just lost some of the grounds for connection that we previously had.

It’s OK to feel sad and mourn the change, but it is part of life, and so acknowledging the way you feel is important, otherwise it can actually get in the way of friendships and lead to them ending when they could otherwise continue, just in a different form.

I have to be honest here, and say I have been with the amazing Mr Girlymicro for over 20 years so I don’t have good experience, but I imagine the same is true with dating and other forms of connectivity. To develop a new type of connection, you need to acknowledge the loss/change of the old, in order to build new foundations.

Not all loss is big but it’s OK to recognise what it means and why before you move on

Many of the things I’ve talked about are big things, but I just want to throw in a call here for being able to grieve for the loss of the little things (in a proportionate little way). The loss of you favourite dress because it has finally fallen to pieces through excess use, or because someone down the pub spilled red wine all over it. In my case, often the loss of a favourite teapot or piece of china, that holds emotional meaning for me and I’ve dropped on the floor.

Not everything has to be big. Some days, it’s OK to acknowledge that something sucks, and spend the time it takes to watch a weepy movie to help you process it. I embrace the fact that we support each other by trying to cheer each other up, especially as these mourning periods should have a time limit, but we should also allow a certain amount of ‘wallow window’ to let people truly process in order to make the most out of their lives.

Mr Girlymicro and I call this visiting the pit of despair. The pit of despair is filled with cushions, tea, and chocolate, but not so comfortable that you can move in there. So allow yourself to visit the pit when you need to, but make sure you keep the rope ladder to hand for when you need to climb out. It is a place to visit and come out renewed, not to exist within.

All opinions in this blog are my own

How to Review a Scientific Paper: Top tips to avoid becoming like the meme of reviewer 2

girlymicro General, Microbiology (Research), Research/Academia , , , , , , ,

It’s been a little while since I posted some academic tips, I think mostly because I spent a lot of last year in that space whilst writing It Shouldn’t Happen to a PhD Student. I’ve been speaking to a few people recently, however, who have shown an interest in how the review process works for scientific papers and how they could get started. It felt timely, therefore, to put some of what came to mind down in a blog.

It’s probably worth bearing in mind when you are reading this that every journal is slightly different, some will require very long discussion sections, some will prefer word count to be focused on results sections. This blog will cover the points that are generally important to consider as part of a review, but there will always be journal specific factors that you need to take into consideration. Hopefully it will still act as a helpful starting point.

What are the benefits of undertaking peer review?

There are many benefits of being a reviewer for scientific journals, but let’s get this out of the way at the start, money is not one of them, no you do not get paid. You don’t even get a discount to publish in the journals you review for. What you do get is a lot of experience of seeing papers going through various levels of development. You get to spend time reflecting on your reaction to manuscripts and exploring what leads to the reaction of ‘this paper is amazing’ or ‘this paper is wrong somehow’. Time is one of the things that is limited for almost everyone, and so having a reason to carve out time for this type of reflection is beneficial for both you and the wider scientific community. After all, papers don’t get published if no one takes the time to participate in peer review.

The thing that I personally have found most valuable after over a decade of doing this, is learning to the look at the bones and structure of a paper and being able to provide supportive feedback on how some changes to that structure could make the end result better. Going through this process has allowed me to learn so much, so that when I am developing the structure and content for my own papers I apply the lessons I have learnt from reflecting during reviewing papers for others. I hope this makes the review process for those looking at my own papers easier, as I’ve already acted as my own reviewer with a critical eye before I even submit a paper, but it definitely helps me reduce the number of drafts I produce.

One final, very unique opportunity you get as a reviewer, is that you get to see the reviews that others provide. Once all the reviews are in you will be able to access the reviews that others provide, either online or in the email sent out. This is always very interesting as it is the only circumstance where you can see what others have taken away from reading the same manuscript. It is fascinating to see whether others come to the same conclusions vs acceptance etc, and also to see what points they’ve noted. This is a great learning opportunity, and even after all this time I make sure to look, reflect, and learn from what others have said.

How to get involved?

Once you begin to publish your own scientific papers you will tend to quite naturally end up being involved as a reviewer, because of the fact that your details and expertise will then be part of the database that editors from a journal will select reviewers from. There are other ways to get involved however:

  • Email an editor to volunteer
  • Become part of journal junior editor programme
  • Ask your supervisor to put you forward when they received review invitations they can’t accomodate
  • Ask your supervisor/mentor to send you articles so that you could review in parallel and compare comments
  • Join a journal club, not quite the same but a similar experience that will help
  • Present at conferences, as editors may remember your name
  • A more recent route in is also to review Pre Prints, where you leave your name and comments which may be picked up by an editor further down the line

The more reviews you do, the more you will be asked to do, and so the main thing is to just start and more opportunities will follow.

Principles for reviewing

There are a number of principles or considerations that I try and stick to that I have listed below, but there is one that I think is worth talking about before I discuss the others. This one is simple. Don’t be a jerk. Peer reviews are usually anonymous but this isn’t a license to say anything you wouldn’t say to someone’s face.

Now that’s done, onto some other points to consider:

  • Don’t be ‘that reviewer’ who tells authors to reference your papers, that’s not really the point of peer review
  • Remain impartial, it doesn’t matter if the author is your best friend, a complete unknown, or a star of their field, everyone is entitled to the same level of review. If you can’t be impartial then decline the invite
  • Don’t accept review requests that you know you won’t be able to fit into your diary, it just delays things for everyone
  • Reflect on whether you have the skills and knowledge to fulfil a review request. Over time I have been asked to review in all kinds of areas and I deliberately ask myself every time whether I am the right person to undertake the review
  • Focus on communication, both to the editor and the author. Make your points concise and structured in the way you would like to receive them as an author (often in a bullet pointed list, with a single comment per bullet point). If you are going to be delayed in returning your review let the editor know
  • Rarely, I have reviewed papers where I felt the conclusions or practice was actually unsafe. This has only happened a couple of times, but when it has I have communicated with the editor as well as adding comments, as it had patient safety implications. Often these papers won’t reach review but if they do, it is key that they are escalated
  • Be aware of whether you should be commenting on how well written the article is. Language should be accessible, but it is wrong to discriminate against authors who may not be writing in their first language, and your main purpose is to review the science, not to mark an English essay

Available tools

It can be a bit intimidating reviewing papers when you start, and it can be difficult to know where to begin. There are some tools that can help make this a little easier. My two favourites are ORION and CONSORT. ORION is linked to outbreak papers, and CONSORT is linked to randomised clinical trials. ORION is quite old now, but CONSORT was updated last year (2025).

Orion statementDownload

ORION exists to help authors put together papers that are linked to outbreaks and infection control, and most helpfully comes with a checklist. This checklist can also be really helpful during a review to help you frame your response and pin down things that might be missing. Not all points will be suitable for all papers, so bear that in mind, but as a tool to assist you it is a helpful starter for 10.

orion-checklistDownload

CONSORT is a very similar tool for randomised trials. Again, even if you are looking at a paper that is not randomised but has another form of clinical trial, it can be a useful aid to help your thinking and a framework to support your review.

Consort 2025 statementDownload

CONSORT, similar to ORION also has a checklist, which can be a useful tool to enable you to make notes when reviewing papers.

CONSORT 2025 editable checklistDownload

My review process

Once you have accepted an invitation to be a reviewer for a scientific paper you will get a link to log in and download the article. You will then have a period, usually two weeks, to submit your review.

Once I have the paper downloaded, I initially read it for an overview to get a feel for the article prior to reviewing each section in detail. I then consider which of the available options for outcome I think it might fall into:

  • Reject
  • Accept without changes
  • Accept minor revisions
  • Accept major revisions

Bear in mind when you go in to review in detail you may change your mind, and you need to remain open, but the reason I do this general overview is because the level of feedback I give, and thus the level of note taking required, will depend on the likely outcome. In general, I will provide more detailed notes for ‘accept with major revisions’ than I will for a reject, as I want to support the authors in having the best outcome possible and that requires a more in depth response.

From these general notes I write an opening review summary, which will includes which gaps I think the paper addresses, the benefits to the academic specialty, and my overall comments about what is good, and where it could be improved. I then move on and makes notes on each manuscript section in detail; which I use to formulate a more detailed list of reviewers comments point by point in order to make it easier for the authors to respond.

How to review a scientific manuscript and get creditDownload

Title

My main focus when looking at the title is whether it accurately reflects what is in the paper. I enjoy a fun title, but there are some articles where titles act as the equivalent of ‘click bait’ and can lead the reader in a way that is not reflective of the data. Most of the time the title is fine, but I have had a few occasions where I’ve had to feedback that it needs to be better reflect the outcomes and research question based on the evidence presented.

Abstract

Whilst I have written this section at the top of the sections, because I’ve covered them in order, I always review the abstract last once I’ve got a full understanding of the rest of the paper.

The abstract should act as a stand alone summary, as many readers will read it alone and without additional context prior to decided whether to down load a paper. It should clearly communicate the research question, important components of the methodology, and accurately summarise the results. There can sometimes be a tendency for abstract to over call the results and conclusions so that people engage with the paper, and so this is something I give a lot of consideration to when reviewing.

I personally love an abstract with clear sub-headings as I find this makes them easier to read and review, but bear in mind that the format is based on the style of the individual journal, so don’t feedback on components like this without understanding the journal guidance. It is one of the benefits of reviewing for journals that you know well, or have submitted to yourself, that you are more aware of their editorial style requirements and so won’t need to research this as part of the review process.

Introduction

An introduction should introduce the relevant literature that the reader needs to understand the context of the rest of the paper.

When looking at an introduction I will consider:

  • Do the authors introduce concepts in other sections that they haven’t covered for understanding in the introduction?
  • How balanced are the references included, are they presenting significant bias by the papers they’ve chosen to include? (NB every paper is telling ‘a story’ and so there will always be some of this but it needs to not be extreme)
  • Are the references included suitable, relatively recent, and from peer reviewed journals?

The introduction is the foundation of the paper and so this needs to be right to support the reader in being able to fully access the content that follows it. It also needs to fully articulate the research question that is being addressed.

Methods

For a scientific paper, the main question to evaluate the methods is whether from reading them you could reproduce the paper. Do the authors list all the pertinent details? I often read methods sections and take myself through how they are laid out step by step to decide whether I could actually do that experiment myself. You’d be amazed at the number of times this isn’t possible. Often authors have such an understanding of their work that they make assumptions about what the reader will know, and therefore need to be asked to add in further details. For outbreak papers, authors will often assume you know something about their hospital or patient population, which is often not the case. The method section is somewhere where a CONSORT or ORION checklist can really help you to ensure that all the key components are there.

The methods should also include statements linked to ethical requirements for the study. There is also sometimes a specific ethics statement at the end of the paper, so it is worth making sure that you review both together if present. Again, not method specific but something I tend to take into account as part of method review, are disclosures. Was the study funded by a manufacturer or supplier who is listed in the method section? It is not wrong to undertake sponsored work, and often great science comes out of collaboration, but knowing this is the case and taking it into account when you are reviewing and understanding how it may or may not have impacted how the study was undertaken is important.

The other key thing to reflect on when reading the methods is whether the method chosen is actually the most appropriate method for addressing the research question asked. There are often many different ways to approach a question, and so there be many suitable method approaches meaning it’s important to not be prescriptive, but not all methods may appropriate. This is a point where you need to walk a fine line. You can’t ask someone to completely change their research method as even with major corrections you can only ask for clarifications or some amount of additional work, so if the flaw is fundamental this is one of the reasons I would reject a paper.

Results

The overarching question when looking at any results section is do the findings directly answer the research question posed in the introduction. Sometimes authors can end up answering a different question to the one originally posed, as their results lead them in a different direction, but this isn’t really acceptable in a paper where you have to have a thread through each section that makes sense to the reader.

The other things that are worth paying attention to in a results section include:

  • Are the figures and tables appropriate?
  • Do the figure and/or table legends permit them to be reviewed in isolation from the text?
  • Are error bars or other components to aid interpretation present?
  • Is all data represented i.e. data doesn’t feel cherry picked from what was stated in the methods?
  • Has statistical analysis been undertaken when it should have?
  • Is any statistical analysis undertaken appropriate?
  • Is the full dataset available in an appendix or public access database (if appropriate)?

Discussion

The main thing I am looking for in a discussion is that the authors have undertaken a thorough critique of their results in the context of the available literature and related it back to their original research question. This means that I don’t expect them to have just quoted a lot of their own previous work in order to support their interpretation of their current results, as this can introduce unnecessary bias. I expect a range of references to be used, most of which I would expect to be recent, rather than from the 90’s. As I said previously, every paper will be telling a story, but I don’t expect it to be sales pitch. I want to see the results interpreted within the context of relevant literature, and thought demonstrated about discrepancies and findings that may look like outliers.

I also expect authors to have highlighted limitations of their study and their interpretation. If there is potential bias I would like it acknowledged here alongside how easy the results may be to generalise. All studies will have limitations and it is important for the reader that these are clearly stated in order to reduce over stating the outcomes, but also so that other studies can build upon the current work.

Conclusion

Conclusions are key, and also where some authors fall into the trap of trying to overly dramatise what they have achieved. It can be tempted to over state your results and your impact, everyone wants to think that their work matters, and this is the key area where reviewers can support when looking at conclusions. It is crucial that the conclusion are representative of the work and stated within the context of the research question asked. This section is often quite small, but it is however incredibly important to get right, and reviewers can really help support authors in making sure this happens.

Owning your feedback

You will often be asked if you are happy to have your name associated with your review. I always say yes. Saying yes keeps it present within your mind that you are reviewing the work of people who will have worked hard to create what is in front of you. I never write something in a review that I wouldn’t be happy saying to the authors face if I met them at a conference.

Feedback should always be constructive. It should always be helpful. It should always be kind. Too often I’ve seen reviews that do not keep to these three rules and it makes me both sad and angry. Don’t be lured into taking a different approach because the review is online and feels anonymous. Character is who we are when no one is watching.

Using the learning

If you are just starting out undertaking peer review, make sure you capture what you learn from the process so that you can use it when you are next sitting down to write your next manuscript. Make notes for yourself, as well as the editor. What did you like? What worked well? What are the common errors that you are seeing? How would you correct that in your next work?

Reviewing is a unique opportunity, both to give back to your profession, and to make your own work better. Make sure you maximise this opportunity and when you’ve learnt how to do it well…pay it forward for others to benefit.

Other resources

https://authors.wiley.com/Reviewers/journal-reviewers/how-to-perform-a-peer-review/step-by-step-guide-to-reviewing-a-manuscript.html

https://www.britishjournalofnursing.com/content/top-ten-tips/essential-principles-for-peer-reviewing

https://www.elsevier.com/en-gb/reviewer/how-to-review

ethical-guidelines-peer-reviewers-copeDownload
A Guide to an Effective Peer ReviewDownload

All opinions in this blog are my own

If you’d like more academic tips, think about checking out my book on thriving in the world of academia:

Heat Delays Programming

girlymicro General

Hi Everyone

Massive apologies but there is no blog this week, for two reasons:

One, IT’S SO HOT and I have a normal heat comfort range of no more than 23 degrees. I’ve struggled to be able to work on the central line as it has been hitting over 40 degrees, and frankly I become non-functional:

Shel Silverstein

Secondly, I’ve been busy trying to finish the notes for book number 2, and this has now happened! 70,000 words of printed notes have arrived to try and turn into an 80,000 word book. Wish me luck! It will probably be available between Halloween and Christmas 2026, depending on how the conversion goes and if the temperature becomes less like a volcano. I post weekly updates linked to this on my Instagram stories under Girlymicro, so drop in there if you want more regular information.

Normal service should hopefully resume next week

All opinions in this blog are my own

Guest Blog from Anthony De Souza: 2015 Ebola Response Deployment to Sierra Leone – A Personal Reflection

girlymicro Guest blog, Microbiology (Clinical) , , , , , , , , ,

Last week I wrote about the challenges of the current Ebola virus outbreak, talking about some details linked to the virus itself, and also some challenges that mean this outbreak may be more challenging to manage. I was involved in previous outbreaks, but definitely in a peripheral support capacity, because of my underlying autoimmune condition I did not travel to Sierra Leone. Context and learning from previous events is important however, so I tapped my good friend and colleague Ant De Souza, who was directly involved in supporting diagnostics, to write me a guest blog of his experiences.

Everyone Keeps Saying the E Word: Why there are so many news reports talking about Ebola, and why we should pay attention

Anthony De Souza is an award-winning Healthcare Science educator with over a decade of experience as Biomedical Scientist in microbiology. He was the first Healthcare Scientist to gain a permanent Practice Educator post, a post he has only continued to develop and expand since its inception. Ant’s transition into strategic education leadership has empowered the Healthcare Science workforce to improve patient outcomes based on his approach; which links strengthening multidisciplinary collaboration, expanding clinical capabilities, and elevating the profile of the healthcare science workforce to ensure they are invited to have a seat at the table. The impact of this has been recognised not just by me, but by him being named on The Pathologist’s Power List for his outstanding contributions to the field.

Ebola Deployment, Sierra Leone – A Personal Reflection

In 2015, when an urgent appeal was issued by Public Health England (now UKHSA) for scientists to support the Ebola crisis in West Africa, I didn’t hesitate—I knew I had to go.

In the past, I’d seen similar calls for volunteers and questioned whether my skills were enough to make a meaningful contribution. The last thing I would ever want was to become a burden on a mission of such importance. But this time felt different. For the first time, my experience, confidence, and mindset aligned with what was needed. I was working as a Band 6 Biomedical Scientist at Watford General Hospital, in a busy microbiology department delivering a 24/7 service. I was used to working under pressure, and I felt ready to contribute.

Before committing, I spoke with my colleagues. A five-week deployment would mean they would take on additional workload, and it was important to me that I had their full support. With their encouragement, I signed up.

Preparation and training

Preparation for deployment was thorough and, at times, intense. I travelled to Porton Down in Salisbury for specialist training, where we learned how to work safely with high-risk pathogens such as Ebola. This included simulation exercises in a laboratory environment designed to mirror the Kerrytown facility, where we practised managing realistic scenarios, including equipment failures and power outages.

We also completed security awareness and hostage survival training, alongside a series of vaccinations for diseases such as yellow fever, cholera, and typhoid. Anti-malarial medication was essential. The preparation highlighted not only the scientific challenges ahead, but also the environmental and personal risks we would face.

The journey

Getting to Sierra Leone was a journey in itself. We travelled by plane, transferred in Morocco, then boarded another flight to Freetown. From there, the journey continued by minibus to a port, a boat crossing, and finally another minibus to the site.

It was a strange experience travelling with a group of people I had never met—yet over the course of five weeks, these individuals would become a close-knit team.

Arrival and first impressions

On arrival, small behavioural changes immediately became part of daily life. Handshakes were replaced with elbow taps, a simple but important measure to reduce transmission risk. Regular temperature checks became routine, particularly at checkpoints when travelling to and from the treatment centre.

We were based at the Ebola Treatment Centre (ETC) in Kerrytown, outside of Freetown—a facility built by the British Army Royal Engineers and funded by the Department for International Development. The scale of the operation was impressive, and there was a strong sense of shared purpose. People from different organisations and backgrounds worked together with a single goal.

The ETC was divided into zones based on risk, from green (low-risk areas) to red (high-risk patient areas). Full personal protective equipment (PPE) was mandatory in higher-risk areas.

Working in the laboratory

Our laboratory was located centrally within the site, shared with the Ministry of Defence. After donning PPE, we met the outgoing team and received a rapid but essential handover. For a few days, we worked alongside them before taking full responsibility.

Our role was to test blood and swab samples from individuals suspected of having Ebola. We operated six days a week, with two teams of six covering shifts from 06:00 to 22:00.

Many samples came from community settings, including remote villages. A significant proportion were post-mortem samples, taken to determine whether Ebola had caused the death. The high number of samples from children and infants was particularly difficult to process emotionally.

Specimen reception took place outside the lab. Samples were placed into chlorine solution for decontamination before being handled further. Wearing full PPE in the heat of the sun was physically exhausting, and the need for constant vigilance—checking for incorrectly packaged samples or hidden sharps—added to the pressure.

Inside the lab, resources were basic but functional. The space had sealed cement benches, limited air conditioning, and no negative pressure system. Testing was carried out using PCR techniques for Ebola, alongside POCT testing for malaria. A flexible film isolator was used to safely inactivate the virus before analysis.

Life beyond the lab

Outside of the laboratory, the scale of the public health response was visible everywhere. Posters, radio messages, and community outreach efforts aimed to educate people about Ebola transmission, safe burial practices, and how to protect themselves.

Strict measures were in place:

  • Large gatherings were prohibited
  • Schools and religious services were disrupted
  • Curfews were enforced
  • Checkpoints monitored movement and health status
  • Movement restrictions between districts

Daily life, as it once was, had largely come to a standstill.

Cultural challenges and adaptation

One of the most striking aspects of the outbreak was its impact on traditional burial practices.

In Sierra Leone, burial rituals are deeply rooted in cultural and religious beliefs. Traditionally, families wash, dress, and physically say goodbye to loved ones. However, in the context of Ebola, these practices posed a significant risk, as the virus remains highly infectious after death.

To reduce transmission, specially trained burial teams were introduced. These teams worked closely with communities and religious leaders to adapt traditions safely. While physical contact was removed, efforts were made to preserve dignity—allowing families to view the body from a distance, limiting attendees, and involving community leaders in the process.

This collaboration was essential. Without it, there was a real risk that families would carry out burials in secret, increasing the spread of the virus.

Reflections

There is much I could say about my time in Sierra Leone—far more than can fit into a single blog. The work was challenging, both physically and emotionally. There were moments of exhaustion, uncertainty, and sadness.

But above all, what stays with me is the resilience of the people.

In the face of immense hardship, communities adapted their traditions, supported one another, and worked alongside international teams to combat the outbreak. It was a powerful reminder that effective public health is not just about science or medicine—it is about trust, collaboration, and cultural understanding.

This experience reshaped my perspective on global health, teamwork, and the role we each play in times of crisis. It remains one of the most challenging and meaningful periods of my career.

All opinions in this blog are my own

Everyone Keeps Saying the E Word: Why there are so many news reports talking about Ebola, and why we should pay attention

girlymicro General, Microbiology (Clinical) , , , , , , ,

Infectious diseases have been in the news a lot over the last few months, between Hantavirus, Listeria and raw milk, and even Screwworm in cattle, it is hard to ignore the headlines, and after the pandemic it feels like every news article declares a risk to all human life. Ebola is, however, an incredibly difficult virus to manage, with devastating consequences for both countries and communities and so despite the instinct to hide from the reporting we need to continue to engage with the information that is coming out.

From an infection point alone this outbreak is worth discussing, but it is especially pertinent because aside from the impact it has locally, is the fact that the number of people currently dying and infected has likely been directly impacted by global policy choices linked to de-funding United States Agency for International Development (USAID). Combine this with the US decision to pull out of the World Health Organisation (WHO) reducing funding for international health responses, has resulted in a public health emergency that took longer to detect, and now requires managing with both less resources, and less available expertise of previous pandemics. All of which lead to making an already difficult and dangerous situation considerably more challenging.

We live in a global community, and the idea that you can step away from global responsibilities without consequence is more than delusional, it is dangerous, so ‘sorry, not sorry’ for the politics in this one, I think it’s too important to ignore.

Previous outbreaks

There have been a number of Ebola outbreaks since the Ebola virus was first identified in 1976. The initial outbreak included two near-simultaneous outbreaks in Central Africa: one in Yambuku, Zaire (now the Democratic Republic of the Congo), near the Ebola River, and the other in Nzara, Sudan (now South Sudan). The largest outbreak, and the one many of us will remember due to both the substantial media coverage and global health response, occurred in and around Sierra Leone. This 2014–2016 outbreak had more than 28,600 cases reported.

https://www.cdc.gov/ebola/outbreaks/index.html

The Centres for Disease Control (CDC) figure show these outbreaks, and the causative Ebola virus (see Ebola virus section below for more details on viral species).

The key takeaway is that the virus causing this outbreak, the Bundibugyo virus, is a rare cause of Ebola virus outbreaks, with considerably less know and understood about how the virus is transmitted, and how it can be detected and managed. This leads to an even greater need for a rapid global response, both in terms of public health, but also in terms of research focus. Making the delay in both even more impactful, and the need for us to get on top of it even more urgent. Some of our prior learning can be ported, but so much of it cannot.

The current outbreak

On the 17th May the WHO declared the current scenario in the Democratic Republic of the Congo (DRC) and Uganda a public health emergency of international concern, but what does this mean? Well, the WHO defines it as of an extraordinary, sudden, or unexpected public health event with a risk to other countries through the international spread of disease, potentially requiring a coordinated global response.

On the 5th June the African Centres for Disease Control and WHO launched a joint Ebola continent preparedness and response plan of $518 million to support African countries to prepare for, rapidly detect, and respond to the outbreak.

WHO update 8th June – https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON606

Ebola virus has a number of different variants, and the current outbreak is caused by the Bundibungyo virus. As of the 6th June there have been 515 confirmed cases, with 91 deaths (17.7%). Uganda has 19 confirmed cases and 2 deaths (10.5%). It is worth considering that these numbers are likely to be a significant under estimate, as laboratory backlogs, plus some level of distrust in healthcare systems, are likely to lead to a reduction in confirmed cases, but I’ll discuss the difference between confirmed, probably, and possible cases later. At the moment, all onward cases are still linked with travel to DRC, but patients are currently being treated or followed up in a number of countries outside of Africa, including in Brazil, Germany, and Italy.

https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON606

What is Ebola virus?

Well, the first thing to realise is that it is not a single virus. Ebola viruses are part of the filoviridae family, most commonly referred to as Filoviruses. They are zoonotic pathogens (associated with animals) that survive in what are known as reservoir species. These are non-human reservoirs, possibly bats, where the virus can circulate without harming the host and leads to occasional spillover into humans where disease is then detected. Ebola disease (EBOD) is a rare and often severe illness in humans that is frequently fatal.

Ebola disease is caused by a group of viruses that belong to the Orthoebolavirus genus of the filoviridae family. Six species of Orthoebolaviruses have been identified to date,with 4 causing disease in humans, three of which are known to cause large outbreaks: Zaire Ebola virus, Sudan virus and Bundibugyo virus. The zoonotic reservoirs are not well understood for Ebola viruses, unlike those for Marburg viruses where a host reservoir has been established by direct isolation from bats.

NB Marburg disease (MARD) caused by Marburg virus was the first filovirus to be discovered in 1967 and also causes disease in humans, but is not an Ebola virus. Ebola Reston virus (RESTV), is another Ebola virus that has been detected in humans but appears to infect them sub-clinically i.e. with no symptoms, and so transmission routes and impacts are not well understood. It does however cause EBOD disease in non-human primates and has been detected in animals such as pigs in the Philippines and China, so there may be a zoonotic reservoir for this virus similar to other members of the genus. This is the virus that featured in The Hot Zone book by Robert Preston, based on the New Yorker article Crisis in the Hot Zone (1992).

https://www.nejm.org/doi/full/10.1056/NEJMra1901594

Filoviruses are enveloped, non-segmented, negative-sense RNA viruses. The genomes between Bundibugyo and Zaire Ebola species differ by about 30%, and the pathogenesis and clinical outcomes also appear to differ, but there is still limited information regarding the viral mechanism/s that lead to these differences. Importantly, it is worth noting that the cause of the current outbreak, Bundibugyo Ebolavirus, behaves differently in terms of mortality than the more commonly detected outbreak species. Vaccines and other targeted therapy are also not yet established, as the virus has been seen much less frequently.

What are the symptoms?

Patients usually have an initial non-specific presentation which includes fever with malaise (discomfort/unease), fatigue, and myalgia (muscle pain). A few days after this, patients may develop gastrointestinal infections that can include anorexia (loss of appetite), nausea, vomiting, and diarrhoea. Although many people associate EBOD with haemorrhagic fever (i.e. temperatures and bleeding), bleeding abnormalities actually occur in less than half of patients. If bleeding is present, it is usually linked to bleeding from the gums, subconjunctival haemorrhage (broken blood vessels in the eye), and blood in vomit and stool.

The incubation period is between 2 to 21 days (typically, 6 to 10 days) and probably depends on the Ebola virus, as well as the exposure dose and route.

Diagnosis and patient management

Diagnostic testing for Ebola is mainly via reverse transcription–polymerase chain reaction (RT-PCR) targeting the RNA of the virus, but it is made more challenging because it can only be detected in blood once symptoms appear. It is also possible to use Antigen-Capture Enzyme-Linked Immunosorbent Assay (ELISA) tests, these are often less sensitive but easier to implement. Point of care tests, finger prick tests, can also be used but they again have much lower sensitivity than PCR. Many of these tests have been designed for the main outbreak strains of Ebola, and so modification may be needed to allow detection of the Bundibugyo virus, or test sensitivity may be further reduced.

Once patients have developed symptoms, especially during this outbreak as there is a lack of specific treatment options, the main response is linked to supportive care:

  • Fluid & electrolyte resuscitation as patients have severe fluid loss from diarrhoea and vomiting
  • Cardiovascular support as patients frequently go into shock
  • Respiratory support, as patients enter respiratory failure, using equipment such as ventilators
  • Symptom management as patients may end up needing dialysis for renal failure

Most of which require complex medical equipment which may not be available, or available in large enough numbers within local treatment centres. Lack of equipment availability and access to supportive treatments directly impacts clinical outcomes. The mortality (death) rates without treatment also show a great disparity between Ebola viruses:

  • Ebola Zaire: 90% (20 – 40% with early treatment and supportive therapy intervention)
  • Sudan virus: 50% (no approved vaccines or specific antiviral therapeutics available)
  • Bundibugyo virus: 30% (no approved vaccines or specific antiviral therapeutics available)

Although there isn’t currently an established treatment for Bundibugyo virus, Peter Stafford, the US doctor who contracted Ebola in DRC and was flown to Germany, has been treated with an experimental antibody MBP-134. The BBC has also reported that three vaccines are currently in development which would target the glycoprotein of the Bundibugyo Ebola virus.

Each vaccine aims to train the body to spot the same structure on the surface of the virus but each uses a different technology in order to support an immune response. All three still require testing using clinical trials, and so although it is good that vaccines are being developed, their ability to influence the outbreak is currently still unknown.

For patients that recover, post infection morbidity (long term effects) have not always been well captured due to the devastating impacts of the outbreaks themselves, but during the 2014–2016 EBOV epidemic caused by Ebola Zaire, musculoskeletal pain, headache, encephalitis, and ocular problems were noted in survivors and were referred to collectively as the “post-Ebola syndrome.” Recovery, therefore, can be a protracted process and is likely to vary by causative species.

How does it spread?

One challenge for outbreaks on this scale, and for Ebola viruses in particular, is the fact that cases occur throughout communities as well as in healthcare settings. Some of the people most needed to stop spread and to care for patients are the ones at the highest risk of acquisition. Those caring for the living, and the dead, as well as those who are going into homes and other environments to make them safe again for others. The level of selflessness required is huge, especially when you are having to step up knowing that the equipment and support you need to keep you safe may not be there.

During this outbreak there have been numerous reports of people putting themselves at risk to do their roles as items like personal protective equipment (PPE) are just not available. This happens because, although Ebola is spread by close contact with blood and bodily fluids, those infected produce significant amounts of excretions that are also likely to be heavily viral loaded. I talked in the patient management section that one of the biggest challenges is fluid loss via diarrhoea and vomiting and all of those fluids contain risk for those caring for them, or their environment.

Some of the additional challenges that occur during Ebola outbreaks are linked to how it impacts communities. Traditional burial practices often require kissing or interacting with the dead. In many Congolese communities, physical contact with the body is seen as a vital, respectful “final farewell”. This isn’t just a ‘nice to have’ it’s part of embedded in ritual and is highly significant as a way of saying goodbye to loved ones. There are also components that include family members washing the deceased. This is obviously a significant risk moment for transmission.

During significant outbreaks bodies may be disposed of using safe and dignified burial protocols, meaning funerals are undertaken using no touch protocols (the family cannot see or touch the body), bodies are sealed and specially transported, and bodies are buried in deep graves of at least 2 meters deep. Funerals themselves are events where people gather, which may be impacted public heath regulations, so at a time where people are most vulnerable they may expected to manage without support of friends and family, or the rituals traditionally used to help process loss. This can cause to distrust of authority and can lead to clashes between communities and those enforcing the protocols.

On final thing to consider for filovirus spread is that they have been detected in multiple body fluids, including breast milk and semen, in survivors of infection. The persistence in semen, with the potential for sexual transmission has been noted for more than 500 days after disease onset, amd is a serious concern for recovering individuals. However, onward transmission this long after disease onset is very rare with undetermined effects. Even so, this means that survivors and communities may need to consider transmission for protracted periods post recovery and it can represent a source of anxiety.

How is it managed differently?

Ebola is classified as a Risk Group 4 (or Biosafety Level 4, BSL-4) pathogen, meaning that is requires the highest level of biological containment This impacts everything from the way patients are diagnosed and managed in clinical environments, to what kind of laboratory facilities are required to work in developing vaccines and other treatments.

Within the UK it is referred to as a high consequence infectious disease (HCID) which is defined based on the following criteria:

  • Requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely
  • Acute infectious disease
  • Typically has a high case-fatality rate
  • May not have effective prophylaxis or treatment
  • Often difficult to recognise and detect rapidly
  • Ability to spread in the community and within healthcare settings

Local guidelines for those managing these kinds of outbreaks evolved a lot as a results of the 2014 – 2016 Ebola Zaire outbreak, where the CDC modified guidance, in part due to the number of healthcare worker acquisitions early in the process.

As it is not just those in hospitals that require PPE to protect staff, the WHO have also released guidance to aid decision making about what kind of PPE is needed for different workers and interactions across the patient pathway. This obviously has a caveat that if the PPE is not available you are not able to wear it.

Key infection prevention and control measures in the World Health Organization (WHO) guideline for Ebola Willet V et al. BMJ 2024; 384 :p2811 

There are also some fantastic design solutions that can enable patients to be cared for in a way that limits the exposure of those undertaking that caring. These solutions also support patients having continued access for families, where they can be seen and communicate. This is also important as families may be expected to continue to provide food, even during hospitalisation, meaning they need to ve able to visit safely.

From the videos that I have seen, these facilities do not seem to be widely accessibly within the DRC, but the scenario might quickly change with the increasing recognition of the need for a global response to the outbreak.

https://www.bbc.co.uk/news/articles/cgepl7ler5eo

Although it would be nice to imagine that everyone is being cared for in facilities, like those pictured above, many of the reports I have seen are much more similar to the New York Times video pictured below, which is really night and day to what we would wish for patients, staff, and families in terms of infrastructure access.

What does this mean for returning travelers?

The world cup has just started. People are travelling from all over the world to the USA, Canada, and Mexico. The report below shows some of the challenges that this kind of travel can lead to.

Events like these have led to places like the European Centres for Disease Control (ECDC) to issue guidance on what to think about if a passenger develops symptoms on a flight. This is so crucial because, as discussed, the initial symptoms are pretty non-specific, and if someone has a possible contact history it can be difficult to separate EBOD from a number of other infections that could initially present the same way.

They have also issues guidance about who might need to be followed up after an exposure event. Anxiety can drive extreme responses to having a probable/confirmed case, and so having guidance in these circumstances is key. As Ebola is transmitted by direct contact it is important to be able to differentiate those who are contacts from others who will have just been in the same space but are not at minimal to no risk (contact free exposure has a risk if <1%).

Terminology is key

As I’ve been talking about possible/probably/confirmed cases I thought it was important to include what those definitions actually mean within the UK health setting at least:

Confirmed case

An individual (alive or dead) with a positive laboratory test result (real time polymerase chain reaction (PCR)) from a blood or other body fluid sample.

Probable case

An individual for whom no laboratory results are available (for example waiting for testing or results), who meets both of the following criteria:

Clinical illness compatible with EBOD including any of the following symptoms:

  • fever (temperature greater than 37.5°C)
  • severe weakness
  • severe headache
  • myalgia
  • abdominal pain
  • sore throat
  • vomiting
  • diarrhoea
  • unexplained haemorrhage

PLUS

Contact with an Ebola virus in one or more of the following ways in the 21 days before the onset of symptoms:

  • contact with an identified potential source of EBOD (for example, direct contact with a probable or confirmed case without wearing adequate PPE or where there were breaches in PPE
  • exposure to an Ebola virus-infected body fluids or tissues without wearing adequate PPE or where there were breaches in PPE
  • direct handling of bats, antelopes or primates, from Ebola affected areas without wearing adequate PPE or where there were breaches in PPE

Possible case

A possible case is a deceased individual with epidemiological risks for EBOD 

OR

An individual for whom no laboratory results are available (for example waiting for testing or results), but who meets both of the following criteria:

Clinical illness compatible with EBOD including any of the following symptoms:

  • fever (temperature greater than 37.5°C)
  • severe weakness
  • severe headache
  • myalgia
  • abdominal pain
  • sore throat
  • vomiting
  • diarrhoea
  • unexplained haemorrhage

PLUS

One or more of the following epidemiological criteria in the 21 days before the onset of symptoms:

  • history of travel to EBOD affected areas
  • direct contact with a confirmed case of EBOD,
  • or their body fluids (including laboratory staff), but trained and wore appropriate PPE, and had no known breaches in PPE
  • direct contact with a confirmed case of EBOD, or their body fluids (including laboratory staff), but trained and wore appropriate PPE, and had no known breaches in PPE

For someone arriving into the NHS, the application of these terms in linked to the flow chart below (https://www.gov.uk/government/collections/ebola-virus-disease-clinical-management-and-guidance) with the guidance last updated 4 September 2025. This also helps to remind people to go through steps such as ruling out other possible causes for the symptoms present, such as malaria.

Being able to use precise case definitions means that healthcare staff can ensure that the level of PPE and other protections are matched to the likelihood of risk being present.

https://assets.publishing.service.gov.uk/media/695e899311989e7ef067195e/vhf-risk-assessment-algorithm-october-2024-updated-january-2026.pdf

Global health matters

As discussed at the start of this post, returning travelers or healthcare workers are already being monitored in numerous countries outside of the outbreak zones, and this is only likely to increase within the next 21 days, linked to the incubation period of the virus.

Until the infrastructure is present to support prevention of onward transmission the risk of global spread will continue to be present. Let me be honest here, I don’t think this is turning into a pandemic. I think there may be risk of acquisition to a small number of healthcare workers if for any reason communication linked to prior travel history fails. This isn’t the point though. We should not just mount public health responses because of a fear that they may impact us personally. I think we have an obligation to utilise the knowledge, experience, and resources available to help save, potentially, thousands of lives.

BBC News – Ebola: Brazil monitors two patients for possible infection – BBC News
https://www.bbc.co.uk/news/articles/cy72z48zd7po

The time of it taking months of sea travel to get from point A to point B are far behind us. You can be anywhere in the globe in 24 hours, far shorter than the shortest incubation period for most infectious diseases. If the COVID-19 pandemic taught those of us working in the world of infection anything it was that global networks can make a real difference. A difference is the time it takes to recognise that there is a problem to be addressed. A difference in the number of people who are impacted. A difference in the time it takes to take a possible solution to an infectious problem, like vaccines, to a state where they are ready to be implemented.

We cannot live in a world where we think in terms of them and us. Where we think something isn’t happening in our back yard and therefore we don’t need to get involved. The truth is so far from this. Global health has the word global in it for a reason, and the eco systems we live in are global. We need to make networks and connections stronger, not let them be degraded.

So let’s put the pressure on where we can, use what influence we have, and try to ensure that the outcome of this outbreak is not determined by what resources are lacking and who makes the expertise available to help. Let’s behave as we hope someone else would in return, step up and be counted in order to save lives. Let’s be the global family that the pandemic showed us we could be if we tried.

All opinions in this blog are my own

Cruise Ship Outbreaks and How Disney Cruise Line Changed My Mind on Cruise Infection Risks: What can infection control on cruise ships look like?

girlymicro General, Microbiology (Clinical), Science Communication , , , , , , , , , ,

Cruise ships and cruise ship outbreaks have been in the news a lot this month. So much so, that I’ve already posted about the Hantavirus outbreak that was associated with a cruise ship in South America:

An Unusual Cause for Concern? A Hantavirus outbreak associated with a cruise ship

There have also been headlines, however, linked to 48 passengers displaying symptoms consistent with gastrointestinal illness, as well as one crew member, that has led to another cruise ship asking passengers to isolate.

BBC News – More than 1,000 passengers held on cruise after gastrointestinal illness outbreak – BBC News
https://www.bbc.co.uk/news/articles/cn5pe4yel1ko?app-referrer=deep-link

This second kind of cruise ship outbreak isn’t all that unusual, and I wonder if it would even have reached the headlines if it hadn’t happened during the same month as everyone was talking about Hantavirus. Cruise ships are mobile cities, with large numbers of people confined within a limit space, usually drawn from all over the world. Places where everyone is outside of their ‘normal’, eating different food together, spending time in close quarters with strangers, and sometimes reticent to lose holiday time if they start to feel unwell. That’s without throwing in sea sickness as an alternate reason for nausea and vomiting, which may mean people don’t realise they are ill with something infectious as early as they may do at home.

I’ve always sworn, for all of these reasons that I would never go on a cruise. I’ve spent way too many hours in lectures listening to outbreak stories related to ships, and yet, due to a birthday surprise, I went on my first ever cruise in 2025 and it surprised me, so I thought I would spend this week talking about a few of the reasons why, but first some outbreak context.

Multi-Year Outbreak Comparison (2019–2026)

According to historical Centres for Disease Control (CDC) data tracking of official gastrointestinal outbreaks across major cruise lines, the frequency of notable incidents varies dramatically by cruise line brand:

  • Princess Cruises: Highest frequency with 14 outbreaks
  • Holland America Line: 13 outbreaks
  • Royal Caribbean International: 10 outbreaks
  • Celebrity Cruises: 6 outbreaks
  • Carnival Cruise Line: 2 outbreaks
  • Disney Cruise Line: 1 outbreak

It’s worth noting, however, that different cruise lines not only have very different numbers and types of ships, with wildly different passengers numbers, but they also have very different passenger profiles. Some, like Virgin, host adult only cruises. Others, like Viking, serve older passenger demographics and undertake river cruising rather than ocean based cruising. Then you have lines like Disney, that focus on family centered cruising, and so will have a high proportion of families and young children as part of their passengers. Some cruises are also much longer than others, with cruises over six months becoming more common, and some cruise ships now consisting of passengers who have permanently brought cabins as their primary homes. All of which is to say, that numbers alone may not tell the whole story, and it is probably important to compare like with like.

NB Interestingly, as the recent Hantavirus outbreak did not impact 3% of passengers, I don’t know believe it would be reported via this system, and I suspect that they only manage US related outbreak numbers.

Outbreak Organisms (CDC list 2023 – 2026)

When you are training in microbiology, virology and infection prevention and control, you study A LOT of outbreak scenarios. Some of theses are almost always linked to outbreaks on cruise ships and/or navel carriers. Studies of re-supply and bringing in vegetables used for salads that took down 2/3 of the ship cohort with multiple organisms. I thought it might, thereofore, be interesting to look at the CDC data related to some recent outbreaks and see what the causative organisms actually are.

From 2023 – 2026 (to date) there were 54 reported outbreaks on the CDC website reaching the 3% of total passengers threshold. The causative organisms, where known, included:

  • Norovirus
  • Salmonella
  • E. coli
  • Combined Salmonella and E. coli

Now, I’ve previously posted about Norovirus, and how difficult it can be to control, especially the challenges of getting it out of environmental reservoirs (carpets, curtains, bedding) and so I’m not surprised that it is on the list.

Tis the Season to Talk Noro: What is norovirus and why does it cause such issues?

I was interested to see how dominant norovirus was compared to other causes. When you look at the numbers it shows that norovirus really does seem to be as dominant as I was taught, with nearly 90% of outbreaks due to noro:

  • Norovirus: 48 outbreaks
  • E. coli: 4 outbreaks
  • Salmonella: 1 outbreak
  • Combined Salmonella and E. coli: 1 outbreak

Whilst noting that this feels like a lot of cases, it is also worth considering that the CDC states that cruise ship outbreaks account for just 1% of all reported norovirus cases globally. The other interesting thing is that the numbers seem to be pretty stable year on year, whereas out in the community I would expect there to be a significant rise in norovirus cases every 2 – 3 years, as strains change due to mutation, this doesn’t seem to be the case within the cruise data available.

Disney cruise line specific outbreaks

Having noted that Disney had only 1 outbreak listed recently on the CDC site, I thought I would investigate a little further. Disney Cruise Line has had two major officially documented gastrointestinal illness outbreaks that reached the CDC mandatory reporting threshold of 3% or more of passengers or crew, one in 2016 and one in 2002, each on a different ship:

Disney Wonder:

April–May 2016 (Official CDC Outbreak): During a 4-night Bahamian itinerary heading into a Panama Canal cruise, 131 of 2,680 passengers (4.89%) and 14 of 991 crew members (1.41%) fell ill with laboratory-confirmed norovirus.

Disney Magic:

November 2002 (Official CDC Outbreak): A total of 175 passengers and crew members out of 2713 passengers and ~950 crew, contracted norovirus during a Bahamian voyage. Disney temporarily pulled the ship from service for a week to break the infection cycle through a deep chemical sanitation.

Not all ships are equal

Something that struck me, is the outbreaks listed for Disney are to do with the two older ships in the Disney Cruise Line fleet, as they are both part of the Classic Class. This is interesting for 2 reasons:

  • Is there an accumulation of outbreak risk due to age? Especially for organisms like norovirus which can be linked to environmental reservoirs
  • The oldest 2 Disney Cruise Line ships were not a custom Disney build and so lack some of the specific design features that may support risk reduction on the newer ships

To aid with understanding this, it is noteworthy Disney has built a number of custom ships since the production of the Classic Class, and therefore have had the opportunity to include many more custom features in the later classes of ships.

The Classic Class – purchased by Disney but not a custom Disney design

  • Disney Magic (1998) ~2700 passengers
  • Disney Wonder (1999) ~ 2700 passengers

The Dream Class – commissioned by Disney for Disney

  • Disney Dream (2011) ~4000 passengers
  • Disney Fantasy (2012) ~4000 passengers

The Wish Class – commissioned by Disney for Disney

  • Disney Wish (2022) ~4000 passengers
  • Disney Treasure (2024) ~4000 passengers
  • Disney Destiny (2025) ~4000 passengers

The Global Class – purchased by Disney but part built before acquisition

  • Disney Adventure (2026) ~6700 passengers

One thing I didn’t realise, until I started to investigate this area more, is that cruise ships need to go into dry dock at least twice in every 5 year period by maritime law. Obviously mostly this is to do with safety, linked to the hull etc, but most cruise lines will use this opportunity to re-fit and manage any fittings and soft furnishings, which can aid with managing ongoing outbreak risk.

Why does Disney Cruise Line have to do things differently?

Full disclaimer here, I haven’t been on cruise lines with anyone else, but I have done a lot of talking to people and watching videos to enable some comparison, but my only first hand knowledge is from what I have experienced. I have only been on the Fantasy, and there are other classes of ships, obviously if Disney Cruise Line would like me to travel on them all to do an infection control audit, I’d be happy to, they wouldn’t even have to pay me.

I think, from my experience, one of the reasons that Disney Cruise Line is different, and has to be different, is because of the passenger demographic they serve. Their passenger number contain a huge amount of children under the age of ten. Children who may be shedding high viral loads, and carrying asymptomatic infection. Children who may also be too small to be able to communicate how they are feeling when symptoms come into play, and who may also not be compliant with hand and other hygiene practices, and are likely to be in close contact with others when playing etc. The ships are therefore at higher risk, potentially, than other cruise lines of having significant spread once a virus is onboard. It is also much harder to be able to isolate small children, and they are much more likely to need clinical support if they become unwell, which is a risk to the child and logistically complicated to manage. It is therefore much better to invest in steps to prevent infection spread.

What does Disney Cruise Line say they do to prevent the transmission of infectious disease?

Disney consistently ranks in the top five cleanest cruise lines globally. Their fleet frequently achieves perfect 100 scores during unannounced CDC sanitation inspections. They also have an advantage as they are an independent fleet, they don’t rent their ships out to others for events or specialist cruises, where they would have periods of time where they couldn’t control their risk. This allows them to maintain control of their fleet, what activities are undertaken, and ongoing control methods. The ships are also on the smaller size in terms of passenger numbers compared to some of the very large cruise ships managed by other companies (~2,700 to ~6,700 guests compared to ~5500 to ~7600 on some other lines).

Below is what Disney Cruise Line states about how they control their infection risks:

Key Quarantine and Isolation Protocols

  • Mandatory Isolation: If you test positive for COVID-19 or another contagious illness during your cruise, you and your stateroom occupants will likely be required to isolate in your stateroom or a specially designated, safer area of the ship.
  • Medical Evaluation: Shipboard medical centers are staffed with experienced doctors and nurses to provide care, and you may be required to quarantine at the sole discretion of the shipboard physician.
  • Disembarkation/Evacuation: If necessary, you may be required to disembark early for medical reasons, which could occur in a foreign port.
  • Pre-Boarding Screening: While pre-boarding testing is not always required, all guests must complete a mandatory health questionnaire before boarding, which includes screening for symptoms like fever, cough, vomiting, or diarrhea.
  • Compliance: You are required to abide by all health safety protocols, which can change without notice, and failure to comply may result in denied boarding or forced disembarkation.
  • Stateroom Support: If you are required to isolate, Disney provides necessary support, including food delivery and medical check-ins.
  • Illness Prevention: The crew conducts extensive cleaning and sanitization of common areas and staterooms

Now, luckily for me, I didn’t experience any sickness onboard and so I can’t testify to the accuracy from all of these portrayals. I can, however, attest to many of other aspects, such as pre-screening, cleaning, and hand hygiene support.

Operational approaches

There were some brilliant operational choices that made me both happy and also surprised me. There were also some really simple design decisions, which now I’ve seen I don’t understand why they aren’t present everywhere. The best example of this was the way that plates on the buffet were stored upside down. This means that no one is in contact when taking a plate with the surface that someone else will then eat off. This is such a simple change but makes so much sense in terms of infection control I can’t believe I have neither thought about it myself or seen it elsewhere.

Other simple things included the fact that all cutlery was left fully wrapped, and so no one was touching the implements that anyone else was going to eat with. This fully enclosing, rather than just wrapping, is another easy way of prevention cross transmission routes, as asymptomatic, or even symptomatic excreters, are not in a position to pass on their organism to others. It also prevents deposition on cutlery from other routes, such as when people sneeze, effectively providing a protective barrier.

Self serve vs cast member led

Another key thing, on some ships, is that the buffet is served by cast members rather than self serve. This means that the food is kept behind screens and significantly lowers contamination risk. All main meals are served plated by cast members, which also reduces reduces the risk. Even self serve items, have guidance linked to risk reduction. For instance the fizzy drink dispensers advice people not to use reusable cups, so that the dispenser outlet does not risk re-contamination after someone has drunk from the cup.

Keeping hand hygiene easy

Something else, that is very prominent, is the emphasis placed on hand hygiene wherever you go onboard. Hand hygiene stations are conspicuously present with both adult and child height basins. Special sinks are also present in all the child specific areas that can help children with hand hygiene, as all they have to do is submerge their hands and the sink itself undertakes the agitation. This helps hygiene efficacy for children who younger or less engaged.

Multiple hand hygiene stations are available at the entrances to the buffet, and there are enough of them that no one should skip unintentionally because they haven’t seen them, or because people are off-put because of queues. Making hand hygiene easy and visible has been found to be key from healthcare studies, and I imagine cruise ships are no different.

Gatekeeping

At main dining room meals, in the evening, hand hygiene is actively enforced. As there are too many people entering the dining rooms at each sitting (as everyone eats at either early or late dining) Disney enforce hand hygiene by having crew members physically hand out hand sanitising wipes directly to each passenger as they enter the dining room. The same happens at the buffet at busy times. This is very different (from what I can tell) to other cruise lines and definitely contributes to risk reduction. Having these multiple points, every day, where hand hygiene is enforced really helps to impact the collective risk level onboard.

Bathrooms

Even the bathrooms pleased me, and not just because of the Mickey shaped mirrors. Having a feature that attracts people towards the sink does help with hand hygiene compliance, however. They also have signage on how to wash your hands by every sink, to encourage that it is done appropriately. Additionally, many have access to hand hygiene in areas after you have exited the bathroom door, to manage any exit contamination risk, as an additional option.

Domestic cleaning

Cleaning is obvious everywhere you go. I may have been the only person on that cruise who spent time photographing the cleaners trolley rather than the ‘big five’. All rooms got cleaned at least once a day, but in my experience many rooms got cleaned twice a day, as they get a morning clean and an evening turn down. Eating areas are also rotated and open at different times which allowed cleaning to be supported. Spending so much time auditing, I am often super aware of environmental grime, and no once was I brought out of the magic of being onboard by seeing anything that triggers my IPC brain.

Cleaning trolleys have freshly made up cleaning solution, alongside cleaning wipes. Fresh cloths and easy access to gloves. The level of cleaning we experienced was immaculate, and this does seem to align with the CDC audit scores.

Pre boarding

There are steps taken to reduce risk, however, before you even get on board. Disney Cruise Line requires all guests to complete a mandatory, online health questionnaire on the morning of embarkation, typically arriving via email between 5:00 a.m. and 6:00 a.m. The is pretty brief and asks a series of “Yes/No” questions regarding recent fever/respiratory symptoms, gastrointestinal issues, and pregnancy status (specifically for those 24 weeks or more). Although not infection related the pregnancy question is an interesting one and often catches people out. Disney, like many cruise lines, won’t let women sail if they are over 24 weeks pregnant. This appears to be standard across the industry because , if a medical emergency or preterm labour occurs, ships do not carry the specialized equipment or staff required to safely manage delivery or provide neonatal care for a premature infant.

If you reply in the positive to any question, other than the pregnancy question which is an immediate no board, then you will usually be reviewed prior to boarding and a risk assessment performed.

During cruising

If you develop symptoms of any kind, once you are onboard, there is support available from the medical team. It may be hard to distinguish between gastrointestinal symptoms and sea sickness, and everyone is encouraged to flag anything in order to ensure the right risk review is undertaken. If it is felt to be an infectious cause, passengers will be asked to isolate, and enhanced cleaning is undertaken.

Not only is hand hygiene reinforced during signage, by telling you not only how but when to wash your hands, it also clearly flags that you should contact medical support staff if you experience symptoms, and helpfully even flags what they are. All of this means that they are multiple contact points every day where passengers can access information that may be helpful in reducing infection risk (also, how clean are those tiles).

During excursions

Hand hygiene is also enforced after excursions before you get back onboard the ship. Alcohol gel dispensers are brought out by the crew, and cool towels, as well as water, are available to aid passengers stay cool and hydrated. I’m sure if you were in colder climes these would be aimed at warming you up.

Signage is also placed outside of disembarkation points that can help guide whether special measures may be needed or advised before you start on excursions. I think most people are more concerned with COVID still than norovirus, whereas I am very much concerned about diarrhoea and vomiting as part of my ship board experience.

Visible prioritisation

In general the communication of the need for hand hygiene is ubiquitous onboard. The signage below was part of the display in the lifts on the Fantasy. Embedding this guidance, and having it reinforced by cast members, means that for the most part everyone just complies without the need for prompting. I suppose it should be no shock that Disney do communication well, so much so I think there are some things we could learn in hospitals about how it is approached.

Design led solutions

The other area that healthcare could learn from is some of the design based solutions. We obviously have a lot of hands free options in healthcare but it was great to see these design points across the ship to minimise areas where hand contact is concentrated by needing to touch single points. A lot of thought has been given to pinch points in the system, and actions like manually supporting hand hygiene using wipes really also helps to address these.

Things I still can’t get over

Having talked about everything I loved, there is one thing that I don’t think I’ll ever get over, the people soup that are shared spa pools. The idea of sharing warm bubbling water with strangers and imagining our shared bacteria growing is something I can’t get passed. Also, I need to see the Pseudomonas testing certificates. This isn’t a Disney specific aversion, I just don’t think I can get my head around them anywhere. Nothing is perfect.

Where can I learn more?

I was taking on my cruise as a surprise, but Mummy and Mr Girlymicro has done a LOT of research before we want, so much so they even had to delete their YouTube histories so I wouldn’t notice. All lines have different risks, so I would advise doing some research to see which ones have risks that you are prepared to engage with. For me, I’m a Disney girl and I’m yet to see information from any other cruise line to temp me into doing something different. What can I say, I’m a convert to cruising, but only under a very specific set of parameters, and if Disney ever need infection control support, all they have to do is call me.

If you want to learn more, or check out your own cruise line of choice, the CDC website that contains a lot of info:

https://www.cdc.gov/vessel-sanitation/cruise-ship-outbreaks/index.html#

All opinions in this blog are my own

An Unusual Cause for Concern? A Hantavirus outbreak associated with a cruise ship

girlymicro General, Microbiology (Clinical), Science Communication , , , , , , , , , , ,

Content warning – this one is long, and is heavier on the detail than usual. It kind of needed to be as people have died. However, if you want the Cliff Notes version, no, there is no need to panic as Hantavirus is not going to be the cause of the next pandemic.

Everyone seems to be talking about Hantavirus right now, well they were, now people are also talking about Ebola and meningitis. It does rather feel like the infectious disease of the week right now. Despite a lot of effort by scientists and healthcare professionals there seems to be an appetite for panic linked to this. It is worth knowing that although Hantavirus is considered to be a high consequence infectious disease (HCID), that is mainly because it is linked to a potentially severe outcome for an individual if infection is confirmed, rather than potential for wide scale spread.

As I’m being asked about this by everyone from cab drivers to healthcare professionals, and faced with panicked social media commentary about whether this is going to be another pandemic, I thought I should share some of the information that is out there in order to support the ‘don’t panic’ key messaging. I think it is important to note, however, that I am not a Hantavirus expert, just your standard infection prevention and control professional, but having studied zoology in a previous life I couldn’t miss the opportunity to talk about a zoonotic (linked to spread from animals) infection.

What is the current scenario?

The cruise ship (MV Hondius) that is making headlines departed from Ushuaia, Argentina, on April 1, 2026, and traveled across the South Atlantic Ocean, stopping at several remote locations that including excursions and the opportunity for passengers to get off the ship, standard cruise fare but with more unusual destinations. These included Antarctica, South Georgia Island, Tristan da Cunha, Saint Helena, and Ascension Island.

The ship itself carried 147 people (86 passengers and 61 crew) from 23 different countries, so small for a cruise but still a sizable mix of people to have in one space.

BBC News – Three dead in suspected virus outbreak on Atlantic cruise ship – BBC News
https://www.bbc.co.uk/news/articles/cy0294829ndo

The extent of their contact with wildlife before or during the expedition is either unknown or disputed, although there are plenty of rumours linked to bird watching etc.  The importance of all of which will become apparent when we talk more about the virus and it’s standard transmission routes.

It is also worth noting, that unlike many cruises which have a curcular route with all passengers embarking and disembarking at the same point, with this cruise a number of passengers departed at various points as part of planned departures, therefore dissemination of some people involved had already occurred before any clinical symptoms were understood.

Headlines began to appear linked to a possible outbreak onboard in early May, with the outbreak developing, and more information gradually becoming available, as so often happens during any outbreak situation.

What are Hantaviruses?

First let’s start with the fact that Hantaviruses are very different from the viruses that we have seen causing pandemics over the last century. Although all three are RNA viruses, Hantaviruses are different in structure, transmission and disease presentation to both coronaviruses and influenza viruses. They demonstrates low comparative rates of mutation and very limited person to person spread, so the same epidemiological principles do not apply.

Hantaviruses are RNA viruses that are part of the genus Orthohantavirus. They were named after the Hanta river in South Korea in 1978 (originally called the Hantaan virus) and consist of a family of viruses rather than one single disease, with over 20 species known. As a viral group they have since been split into Old World Hantaviruses and New World Hantaviruses, with viruses found to circulate not just within rodents but also within moles, shrews and other animals. They circulate asymptomatically within their natural zoonotic reservoirs without causing symptomatic infection. When humans are exposed, and infection caused, it is typically due to spread from their normal reservoir with exposure due to interaction with bodily fluids, such as dried urine and droppings.

https://www.ecdc.europa.eu/en/infectious-disease-topics/hantavirus-infection/factsheet-orthohantavirus-infections

Different Hantavirus species are associated with different animal reservoirs and their associated geographical territories, as well as leading to different clinical presentations in human infection. Old World Hantaviruses are linked with hemorrhagic fever with renal syndrome (HFRS) and are geographically associated with Africa, Asia, and Europe. New World Hantaviruses are associated with hantavirus cardiopulmonary syndrome (HCPS) have a geographical and have a distribution across the Americas, sometimes also called hantavirus pulmonary syndrome (HPS). As the cruise exposure focus is mostly linked to South America, due to both cruise stops and clinical HCPS presentation, the main animal reservoirs of interest are:

  • Long-tailed Pygmy Rice Rat (Oligoryzomys longicaudatus)
  • Pygmy Rice Rats (Oligoryzomys species)
  • Vesper Mice (Calomys species)

Although there have been a number of cases in the current cluster confirmed as positive for the Andes virus, for context, in Europe (according to ECDC), just under 1,900 cases were recorded in 2023 across all different strains/species of Hantavirus. In the Americas, 8 countries reported 229 cases in 2025. There are, therefore, cases of Hantavirus infection detected annually across the globe, and although not huge numbers the impacts on individuals can be significant. The number of cases that are currently being observed linked to the cruise are therefore considered to be an outbreak, but the risk is mainly due to how individuals that will need to be repatriated to their native countries will be managed and how to ensure the best possible outcomes for those exposed.

What are Zoonotic infections?

A zoonosis (or zoonotic infection) is an infectious disease that can jump from a non-human animal to humans. Traditionally it will have no, or limited, ongoing human to human spread. Transmission can be:

  • Direct – touching, petting, biting, leading to direct contamination by saliva, blood, urine, or other bodily fluids
  • Indirect – exposure to saliva, blood, urine, or other bodily fluids via indirect routes such as contamination linked to food, contaminated environments where animal reservoirs live (soil, water etc), contaminated objects
  • Vector borne – not linked to Hantaviruses, but for other organisms can be spread linked to insect carriage and transmission via insect bites

I’ve talked about the fact that Hantaviruses have animal reservoirs. But which animal, depends on the Hantavirus species, which then impacts where there is a risk of acquisition, as you can’t be exposed if the animal doesn’t live there.

Old World Hantavirus animal reservoirs:

  • Apodemus (Wood Mice / Field Mice) – Dobrava-Belgrade virus (DOBV)/Hantaan virus (HTNV)
  • Rattus (Rats) – Seoul virus (SEOV)
  • Myodes (Bank Voles) – Puumala virus (PUUV)
  • Microtus (Voles) – Tula Virus (TULV)

New World Hantavirus animal reservoirs:

  • Deer Mouse (Peromyscus maniculatus) – Sin Nombre virus (SNV)
  • White-footed Mouse (Peromyscus leucopus) – New York virus (NYV)
  • Cotton Rat (Sigmodon hispidus) – Black Creek Canal virus (BCCV)
  • Marsh Rice Rat (Oryzomys palustris) – Bayou virus (BAYV)
  • Long-tailed Pygmy Rice Rat (Oligoryzomys longicaudatus) – Andes virus (ANDV)
  • Pygmy Rice Rats (Oligoryzomys species) – Andes virus (ANDV)
  • Vesper Mice (Calomys species) – Laguna Negra virus (LNV)

The cruise had been visiting remote wildlife areas, so a passenger could have come into contact with the virus then, or before boarding the ship, as the incubation period is prolongued. This can make contact tracing and understanding the epidemiology more challenging, at least initially, and it is possible that the initial transmission event will never be well understood. The animal reservoir associated with the identified Andes virus, the causative agent of the outbreak, long-tailed pygmy rice rat (Oligoryzomys longicaudatus) and Pygmy Rice Rats (Oligoryzomys species) which can help to pin down broad areas, but not precise transmission route.

Transmission

Transmission linked to zoonotic infection happens in two main ways, transmission within the animal reservoir where infection is usually without any symptoms (asymptomatic), and exposure to humans to the virus circulating within the animal reservoir.

Within the animal reservoir transmission can be linked to moments like aggressive acts, such as biting and scratching where saliva or bodily fluids may be transferred. This is probably one of the primary mechanisms. Animals may also share environments leading to close contact, such as sharing nests, and viral transmission can be linked to exposure in close quarters.

This transmission linked to close contact is also an unusual feature of the Andes Hantavirus and can occur in humans and not just within the animal reservoir. Even so, human to human transmission is relatively rare, but can occur when individuals have prolongued close contact with someone who is symptomatic, especially if exchange of bodily fluids can occur via kissing or other close contact. There is also believed to be an airborne transmission route for the Andes virus, although the route by which this occurs is not well understood. This is addition to the transmission routes from the animal reservoirs that can be due to a number of exposure routes:

The initial clinical presentation of the 70-year-old Dutch passenger, who developed a fever, headache, and diarrhea day 6 of the cruise, five full days after boarding, and who then died on day 11. This timeline means the passenger is unlikely to have acquired Hantavirus onboard as the minimum Hantavirus incubation is believed to be 7 days, meaning that the exposure was likely to have occurred before the passengers even boarded the ship. Ongoing transmission onboard is therefore unlikely to have been point source from an animal exposure, and is more likely to have been linked to close contact of human passengers.

Clinical presentation

Initial presentation of HCPS is pretty generic, and could easily be hard to recognise as Hantavirus infection without a string travel or exposure history. The prodrome phase, or early onset phase is usually 1 – 5 days long and can occur 4-42 days after exposure. Symptoms can be confused with many other viral illnesses and include:

  • High fever, chills, and profound fatigue
  • Severe myalgia (muscle aches), particularly in large muscle groups like the thighs and back
  • Prominent gastrointestinal symptoms: nausea, vomiting, diarrhea, and abdominal pain
  • Headaches and dizziness

One to two days after the initial phase patients can enter a cardiopulmonary phase where patients can become critically unwell:

  • Rapidly progressive dyspnea (shortness of breath) and hypoxia
  • Noncardiogenic pulmonary edema (fluid in the lungs) and coughing
  • Hypotension, tachycardia, and cardiogenic shock
  • Potential myocardial depression and acute metabolic acidosis
Vial P, Ferrés M, Vial C et al.
Hantavirus in humans: a review of clinical aspects and management
The Lancet Infectious Diseases, 2023; 23, e371-e382

This is different to the progression of HFRS, which typically has five phases:

  • Febrile Phase (3–7 Days)
  • Hypotensive Phase (Hours to 2 Days)
  • Oliguric Phase (3–7 Days)
  • Diuretic / Polyuric Phase (Days to Weeks)
  • Convalescent Phase (Weeks to 6 Months)

The initial febrile phase is still pretty non-specific in terms of presentation, but tends to include high fever, chills, intense headache, severe backache, and abdominal pain. Mortality rates vary by causative species, but range from 1 – 15%.

Vial P, Ferrés M, Vial C et al.
Hantavirus in humans: a review of clinical aspects and management
The Lancet Infectious Diseases, 2023; 23, e371-e382

Transmission control

Within the UK, Hantavirus infection caused by Andes virus is classified as a high consequence infectious disease (HCID). HCIDs are defined based on the following criteria:

  • Requires an enhanced individual, population and system response to ensure it is managed effectively, efficiently and safely
  • Acute infectious disease
  • Typically has a high case-fatality rate
  • May not have effective prophylaxis or treatment
  • Often difficult to recognise and detect rapidly
  • Ability to spread in the community and within healthcare settings

Interestingly, only the Andes Hantavirus is listed as a HCID, due to the risk of airborne human to human transmission. Once an HCID is confirmed or highly probable based on a combination of exposure history, symptoms, and diagnostic testing outcomes, the patient will be transferred by specialist transport teams to a designated HCID Treatment Center or High-Level Isolation Unit (HLIU). There are 7 adult and 5 paediatric Airborne HCID Treatment Centres in England, all of whom will hold specialist isolation facilities.

Early diagnosis of Hantavirus infection can be difficult, especially within the first 72 hours of symptoms, before the virus can be accurately detected in body secretions and excretions. Repeat diagnostic testing is often done 72 hours after symptom onset. As the initial presentation is fairly generic, it can take some time to realise what additional testing is required, and a good travel and activity history is key to informing diagnostic steps.

Within the UK, diagnostic testing options include:

  • Serology (Blood Tests): This is the primary diagnostic method. Laboratories use Enzyme-Linked Immunosorbent Assays (ELISA) or immunoblot assays to detect hantavirus-specific Immunoglobulin M (IgM) which looks for recent infection and IgG antibodies which looks for more established immune response, both by testing blood serum samples.
  • Molecular Testing (RT-PCR): Reverse transcription-polymerase chain reaction (RT-PCR) is used to detect hantavirus viral RNA in acute blood or blood samples during the viraemic phase, when the virus is present within the blood stream.
WHO update 6th May 2026

Internationally, one of the challenges for control in this specific outbreak, was that this wasn’t a point source exposure where everyone is incubating according to the same time frame, as people left the ship at different times, and were also isolating onboard the ship over different time periods based on the level of contact with the initially cases. This made initial components of contact tracing challenging, which then led to further possible exposures as some of the initial passengers returned to their home countries before the extent of the outbreak was understood.

Clinical management

There is no specific antiviral treatment option for Hantavirus so management focuses on supportive therapy, respiratory support (often in intensive care), fluid management, and for HFRS dialysis. Among patients who have severe respiratory symptoms as part of HCPS, the case fatality rate has been estimated to be approximately 38%.

As part of the follow up for this current outbreak, UK nationals, once repatriated have been taken to an isolation facility where they will be kept for up to 72 hours and initial clinical review and testing will be undertaken. As part of this clinical teams will then assess whether contacts who are not displaying symptoms can isolate at home or at another suitable location based on their living arrangements. Exposed individuals are generally being advised to self-isolate for up to 45 days from their last known exposure, but this self-isolation is voluntary. During the isolation period clinical networks will maintain daily contact to check for potential symptoms and undertake regular testing.

The World Health Organization (WHO) has recommended a 42-day quarantine period for the cruise passengers from their last exposure, although within the UK this has been extended to 45 days. Cases are managed, if symptoms develop using the following case definitions:

  • Confirmed Case: A patient with positive PCR testing for hantavirus in clinical samples, combined with travel on the MV Hondius from 1 April 2026 or contact with a passenger within 45 days of symptom onset.
  • Probable Case: A patient with compatible symptoms (e.g., fever, respiratory distress) and no other identified pathogen, linked by travel or close contact to the MV Hondius outbreak.
  • Possible/Suspected Case: A patient with compatible symptoms and no other identified pathogen, who had contact with a MV Hondius passenger within 45 days of symptom onset.

Previous outbreaks

Although all of this information seems rather intense and it is easy to see why the new media are trying to make a big story out of it, apart from those exposed we do need to put this outbreak into context. Outbreaks of Hantavirus happen with relative frequency, probably more than we know as diagnosis can be difficult identification may be underestimated, and some local outbreaks are probably under reported. To help demonstrate this I’ve put together a list of previous, easy to find, outbreaks along with their case numbers:

  • Argentina Regional Outbreak (Late 2025 – Early 2026)
    • Cases: A spike in localized regional cases with the NEJM reporting 34 cases from a single event.
    • Deaths: Up to 20 deaths.
  • Germany Voles-Linked Surge (2025)
    • Cases: 55 cases in the first half of the year (predominantly in Bavaria)
    • Driven by an ecological spike in the local bank vole population.
  • Brazil Farmland Outbreak (September 2022)
    • Cases: 22 cases.
    • Deaths: 10 deaths.
    • Traced to wood and rice mice exposure on agricultural properties.
  • Episodic Outbreaks in Los Santos, Panama (2022)
    • Cases: 29 cases recorded over nine months.
    • 16 manifested as severe HCPS; no fatalities reported.
  • Argentina Andes Outbreak (2018)
    • Cases: 34 confirmed cases.
    • Deaths: 11 deaths.
    • Someone sick with ANDV attended a birthday party with 100 people; 5 people who were seated close to the individual later developed symptoms
  • Yosemite National Park, USA (2012)
    • Cases: 10 confirmed cases.
    • Deaths: 3 deaths.
    • Contracted by visitors staying in signature tent cabins infested with deer mice.
  • Chili (1997 – 1998)
    • Cases: 25 cases were officially recognized as part of the primary outbreak wave from July 1997 to January 1998.
    • When expanding the surveillance period from October 1995 through January 22, 1998, a total of 33 cases were confirmed nationwide
    • Epidemiologists verified human-to-human transmission across two out of three family clusters identified during the outbreak
  • The Korean War Epidemic (1950–1953)
    • Cases: 3,000+ UN soldiers infected.
    • The landmark historical event that first clinically defined Hantavirus Hemorrhagic Fever with Renal Syndrome (HFRS)

What is currently happening with this outbreak?

As this post has taken me a couple of weeks to pull together, I thought it was worth ending with the latest update I have available from the European Centre for Disease Prevention and Control (ECDC) on 24 May. At this point 12 cases have been reported in total, including 10 confirmed and 2 probable cases. One new case and no new deaths have been reported since the previous update (unclear when the last update was).

ECDC update on 24th May

The cruise ship M/V Hondius has had all passengers and crew disembarked and is currently docked in Rotterdam, the Netherlands, undergoing sanitation procedure.

https://www.nejm.org/doi/full/10.1056/NEJMc2606496

Do I need to be concerned?

The short answer is no, I don’t believe so and neither do many people who are far more expert than I that you will hear write and talk on this subject. This scenario has got me thinking though, if this outbreak hadn’t impacted European and US passengers whether we would have even heard about this outbreak at all. As you’ve seen in the outbreak section, Hantavirus outbreaks are not that uncommon. Was it because of passenger social media that it made headlines, because the cruise industry is big business, or because it impacted audiences because they saw passengers as being ‘like them’ and worrying that they too could be impacted on a holiday?

I think, whatever the reason, that this should be used as a wake up call for all of us to realise that infection diseases are global, and that we ignore infections that we don’t consider to impact ‘us’ at our risk. With global travel, with climate change, with changes in health surveillance due to certain US policies, the old way of looking at infectious diseases may not be fit for purpose. Too much of the world is in pandemic denial, and just doesn’t want to think about infection risk. We either experience coverage that induces panic, or ostriching where we don’t talk about it at all. Neither of these approaches are going to lead to the best outcomes or knowledge sharing in the face of a changing infection landscape. What needs to happen is for global networks to be built, for infrastructure to be invested in, and for communication to occur in a way that supports surveillance and knowledge acquisition. I don’t believe that Hantavirus is a risk for developing a new pandemic, but if we don’t take the time we have available to invest in planning, we won’t be as prepared for the next outbreak that could be.

Reading you might find interesting

https://asm.org/articles/2026/may/how-does-andes-hantavirus-spread-between-people?fbclid=Iwb21leAR_9pVleHRuA2FlbQIxMQBzcnRjBmFwcF9pZAwzNTA2ODU1MzE3MjgAAR5YsP6VyODOW7LaM47kpl__ECZ7fgHiAcPymHPd5HvAKzUj6GHfYSQgSpw5SA_aem_YWdncwDbsPWxAcsw50hsWWdn6Odm&brid=YWdncwHt62falu6GnVxUGBdWXpcB

Curr Treat Options Infect Dis. 2020 Oct 29;12(4):410–421. doi: 10.1007/s40506-020-00236-3

What is hantavirus? How is it transmitted and what are the symptoms?

BBC News – Hantavirus may have spread between passengers on cruise ship, WHO says – BBC News
https://www.bbc.co.uk/news/articles/cm2p186gyp2o

BBC News – Cruise passengers tell of life on board stranded ship after hantavirus outbreak – BBC News
https://www.bbc.co.uk/news/articles/clype7ededzo

BBC News – Hantavirus: Race to trace passengers who left MV Hondius at St Helena – BBC News
https://www.bbc.co.uk/news/articles/cnvpzgn26edo

BBC News – Hantavirus strain that spreads between humans found in cruise ship passengers – BBC News
https://www.bbc.co.uk/news/articles/ce8pypvjx1ko

BBC News – Britons on hantavirus cruise ship face 45 days of self-isolation – BBC News
https://www.bbc.co.uk/news/articles/c9wepl8we90o

BBC News – British passengers on virus-hit cruise ship to isolate on Wirral – BBC News
https://www.bbc.co.uk/news/articles/c2029r42w8wo

BBC News – Tourist hotspot at ‘end of the world’ denies causing hantavirus outbreak
https://www.bbc.co.uk/news/articles/cx21ej471g2o

https://www.england.nhs.uk/long-read/ipc-measures-asymptomatic-contacts-cases-hantavirus-healthcare-settings/

All opinions in this blog are my own

The Pygmalion Effect: Why choosing who we have in our lives matters

girlymicro General, Leadership , , , , , , ,

This blog post is delayed as I’ve been away stuffing my face with seafood, staring at the ocean, and taking a much needed break. I’m back now though and I have an event tomorrow (Monday, so probably today when you see this), that I’m both excited about and super nervous for. I’m giving a talk for Pint of Knowledge linked to research I’m doing for my new book on infections in movies and TV. Now, I give lots of talks, on average a couple a month, but this one is different. For one, people are paying to see it (I’m not getting paid or anything, I’m assuming it covers venue costs), which means there is an extra obligation that it is both entertaining and worth the entrance fee. It is also a public talk, anyone can buy a ticket, which means that the audience is hard to guess and it is difficult to predict what their expectations are, or if I will be able to meet them. All of which mean I’ve managed to get myself into a bit of a tizz about the whole thing.

Whilst I’ve been having my existential crisis of confidence however, Mr Girlymicro has, as always, been an absolute rock. He’s let me talk through ideas for presentation structure for hours on our holiday, supported me taking my laptop away so I could practice my slides on him, and provided me confidence and reassurance when my courage to try something new took its own holiday and left town. I’ve been thinking a lot, therefore, about the roles those close to us play in the success and outcomes of our lives. Mr Girlymicro, for instance, has both given up a lot of quality time to support my goals, but also carried a lot of emotional burden to get me through tough times. The same is true for Mummy Girlymicro, and my key close friends. Success may appear to be a solo effort, but in reality it’s always a team sport. What I hadn’t realised until recently is how much this is recognised and that there is even a term that really encapsulates this reality, it is known as the Pymalion Effect.

What is Pygmalion?

Pygmalion was originally a figure from Greek mythology who fell in love with an ivory statue that he sculpted of his ideal woman, who was then brought to life by Aphrodite. My knowledge, however, comes from my A-level drama days and my love of George Bernard Shaw as a playwright, who wrote a play called Pygmalion in 1912, which was first performed in 1913. The plot centers around a phonetics professor, Henry Higgins, who places a bet that he can transform a flower girl, Eliza Doolittle, into a refined lady, that no one will be able to guess the origins of, within a matter of months. After a period of intense training, Eliza succeeds in high society but as a consequence of her development journey asserts her independence, leaving the inconsiderate Higgins at the end of the play to establish her own life based on her new self-worth.

The play was then turned into a musical, My Fair Lady, by Lerner and Loewe in 1956, and then captured as a film staring Rex Harrison and Julie Andrews in 1964, which went on to win the Academy Award for Best Picture.

What is the Pygmalion Effect?

The Pygmalion Effect is a psychological phenomenon where high expectations lead to improved performance. This is born from the fact that the expectations of Higgins for Eliza drives her to change and develop (although it must be said he is not kind), because he holds a belief in what she can become. The idea behind the Pygmalion effect, therefore, is that surrounding ourselves with people (and leaders) who have increased expectations of our capacity for success (whatever that means for us) will result in better outcomes.

The effect was first described in 1968 by researchers Robert Rosenthal and Lenore Jacobson who shared it within their book ‘Pygmalion in the Classroom’. The book described an experiment in schools showing that teachers’ positive expectations of “bloomer” students led to higher IQ scores, although it is worth noting that subsequent experiments have not always replicated the original data described. That said, the concept holds a certain amount of internal logic. If you are the target of positive comments and supportive behaviour, you are likely to internalise those comments and respond to that behaviour. It is known that those with internalised positive labels succeed accordingly, this is something that also links to privilege. A similar process works in the opposite direction in the case of low expectations, where low expectations can lead to worse performance and the inclusion of negative external commentary into sense of self.

What does it mean for us as individuals?

What this means for us as individuals is that the people we choose to keep closest in our lives matter, as do the leaders we choose to follow, as their voices will impact how we see ourselves for good or for ill. They can either enhance our resilience, and enable us to be braver and take appropriate risks, or they can be the voices that enforce our pre-existing self doubt causing us to fall into a fixed rather than growth mindset. It’s not just about support and reinforcement, it is also about the ‘why don’t you just give it a go’ and ‘of course you should’, the push to take steps and constructive risk that you would not have considered or been brave enough to voice otherwise.

Getting distracted by the noise

There’s so much noise in our day to day lives. There is so much distraction. If you look at LinkedIn or social media, it is easy to become overwhelmed and to question whether we are enough. When you are on a clinical career pathway which lasts years, it can be challenging to maintain your motivation, and to manage the challenges involved, in a set of career steps that require focus over more than a decade.

For me, I needed to take a lot of risks and steps into the unknown if I was to achieve the career I envisaged. I knew, for instance, that I wanted to become an Infection Control Doctor but there were no other scientists in that role. I knew I wanted to maintain an interest in education, when I didn’t know anyone who held an education qualification, and include that within my Healthcare Scientist role. I knew that I wanted to have equivalent qualifications to my medical colleagues to help establish my professional credibility, but didn’t know anyone who had succeeded at FRCPath whilst working solely within a specialist setting. There is no bench mark for knowing whether you can succeed in goals where there is no established pathway, or whether you are ready to take the next step. At key decision points, therefore, those that surround you can be a key influence into whether you saddle up and ride out, or hunker down and wait.

Using those close to us to find the signal

Sometimes, what we need is to have someone who helps us cut through all that noise. Someone who can be a sounding board for processing our thoughts. To aid us in deciding whether the goal we are considering is the one that we really want to follow, or is it just the one that is most visible, most accessible, or most acceptable to those around us. To think about whether it is something we want, or something we are doing for others. To help ask us ‘what is it that you want?’ ‘what is the end game?’ ‘what could your next steps be?’. They can also help us respond to the doubters, the critics, and those who ask ‘why would you want to do that?’. To help us ensure that we listen to the right voices in our lives, rather than the ones that might just be the loudest. Not everyone will see your vision, but having the right people in your life means that there will be people who can validate your vision, even when they can’t quite picture it with you just yet, because they have trust in you, your ability, and your decision making.

Actively choose who you pay attention to

This only works, however, if you listen to the right people, and spend time with the people that ask you the right questions. The people who ask ‘what will your next step be?’ rather than ‘why would you want that?’. This means that you need to choose who you surround yourself with and pay attention to the signals that the way they speak to you send. The people who, when you say ‘I need to skip tonight and revise’, say ‘sure, shall we lock something in the diary to help you celebrate when it’s done’ rather than pushing the ‘one night won’t hurt’ commentary.

NB there are definitely times when pushing someone who is going too hard into a night off to recover is the right move, here I’m talking about the repeat pushes that mean the focus never happens

Many of us drift through relationships in our lives, and I’m not just talking romantic encounters. As I’ve gotten older, especially since the pandemic, I think I’ve realised the importance, and joy, of being more selective in those who I keep really close and those voices that I listen to most. Not all conversations hold the same weight, not all opinions have the same value, and I am now just more conscious of the ones that I let engage with my own self talk.

Find people who will push you to do the hard stuff

When I was having a wobble, and seriously questioning whether I had it in me to face my fear of failure and sit an exam, I once called my sister and said ‘I need you to motivate me’ and she replied with ‘do you want fries with that?’. She didn’t mean that being in the service industry was bad, nor was she making commentary on career choice. She was making commentary on my ability to choose what my aspiration was. I could choose a route by which I knew I could succeed. One of no risk, with no need to confront my fears. Or I could choose to roll the dice on myself, put in the work, live within my fear, and aim for the thing that I did not know if I could achieve, and decide that the aspiration was worth the risk.

My privilege is that I have had multiple people in my life who pushed me to do the thing I didn’t know I could achieve. Who pointed out that failure is learning, and that to have it within my life was not a source of shame but a source of strength. I am very aware of how fortunate that makes me. I also had a mentor in my career who told me it was OK to try, who had my back when I wanted to be the first at trying something that was not traditional for a scientist. I have even been fortunate enough that support has been demonstrated in concrete ways, such as when Dr Walker undertook organising so many guest blogs for me last year to enable me to focus on getting my first book out (It Shouldn’t Happen to a PhD Student). Things that don’t just change your internalised view but also help you to achieve in practical ways.

Keep people in your life who have faith in you when you don’t have faith in yourself

The people I keep close now are all ones who whose opinions I trust. The ones that will tell me the hard stuff as well as the good, and because of that I hear and take onboard when they tell me the positive in a way I wouldn’t if they didn’t also call me out when I’m being a less good version of myself. Mr and Mummy Girlymicro will often be the voice of reason when I’m lighting myself on fire with self imposed deadlines. They are also the ones who will push me to be braver, and as Mr Girlymicro say ‘JFDI’ or ‘just f*****g do it’ when I’m prevaricating and letting fear make my decisions, rather than knuckling down to the job in front of me.

To have trust, you need to know that they will do what is needed in the moment. If they tell me this may be a stretch, but even if I fail I will get through it, I believe them because they acknowledged the level of challenge I am facing. Sometimes, you need a cheerleader in the room. Sometimes, you need the honest truth. Be aware of your needs in the moment and go to the right people to address what is actually required. You will likely have more people that can act as your cheer squad, than the number who will sit with you in the truth of the challenge that you face. One may sometimes look like the other, but they are actually entirely different roles.

Beware your Dunbar number

The reason why awareness of the roles you need playing, and who can play them in your life, is valuable is that we are only able to maintain relationships at specific levels with set numbers of people. If you choose to have those closest to you as the ones that magnify your self doubt, rather than pushing you to be greater, then you are using up a finite resource without maybe recognising it as such.

I’ve talked about the Dunbar Number before, but it’s the concept that, because maintaining relationships requires input and resource, you can only maintain a limited number of close relationships at any one time.  The number of people closest to you, often your direct family, is usually limited to about 5. Beyond this you have your super family, that slightly wider circle of close friends but not necessarily the people you would call at 3am, which is still limited to about 15 people. The choice of the people we include in these small, but highly impactful groups, can therefore have exponential impacts on us individuals, especially for an area of our lives where we may not undertake conscious review of its influence. Choosing who sits within those categories wisely can literally be a life changer.

Celebrate those who you choose to keep close

Now, I’ve talked a lot about how other impact us, but relationships and leadership roles are bi-directional. You are not just on the receiving end of positive or negative reinforcement, you will also be the instrument of delivery. It is crucial, therefore, to consider who we want to be on the other side of this equation. To think about our word choice, motivations, and actions towards others. To consider our opportunity for impact, not just for our close family and friends, but those team mates and mentees who are within our sphere of influence. Small actions and word choice can really impact, without our conscious awareness, especially if they are undertaken over a period of time.

So my final thought is that we should not just choose who we want in our close circle with purpose, but be aware of and choose which inner voices we want to support in others, the one that makes them doubt and fear, or the one that enables them to take their next steps bravely and grow into spaces they never believed had room for them. Everything is a choice, whether made conscious or not, let’s choose to raise others not amplify their fears.

All opinions in this blog are my own

Talking About Tiara Syndrome: Why you may be waiting some time for anyone to give you the crown you deserve

girlymicro General, Leadership , , , , , , , , ,

I’ve been thinking a lot about social contracts lately, the unwritten rules by which groups, systems, and even cultures run. The things that often no one explicitly says, but that end up in your brain as frameworks by which you function. One of the dangers of these social contracts, is that because they are unwritten, individuals can have different understandings of what they mean, and there can be drift across groups and generations, leading to upset or unease without it being easy to pin down.

One of the ones that sticks out to me a lot at the moment is around recognition and promotion. There is a real imbalance that I keep encountering about whether reaching the next step on the career ladder is about achievement or loyalty linked to time served. What is the best way to be recognised enough to receive the crown of acknowledgement? That moment when you receive recognition and the reward for all you’ve done. Is is given more readily to the people who work hard, go out of their way, and tick all the boxes to thus get the promotion? Is it, or should it be, about recognition of spending time in role and thus demonstrating loyalty to a particular organisation or system? The disconnect between these two approaches is something I observe causing a lot of distress, especially with trainees and those early in their career journeys who are trying to make decisions in order to further their careers.

The truth, I am realising, is that success probably isn’t about either of those things, or at least neither of those things alone. The social contract linked to recognition probably isn’t, and never has been, about time vs input. What never gets discussed, and the thing that strikes me as making the biggest difference, is advocation, either for yourself or someone on your behalf, and this is probably not linked to social contracts at all. This is about group behaviour and how we are seen, not even necessarily about the reality of what we achieve in role. For today’s post, therefore, I thought I would explain why my thinking has changed, and how we might be able to do more to help and empower ourselves once we are more aware of the game we actually playing.

Before I go on however, just because I want a pick me up this Friday (miss you sis), I thought I would share my favourite ever tiara based scene. Whenever I hear the term Tiara Syndrome, this is the visual that comes to my mind, and I’m not sad about that.

The meritocracy suggestion

I was always taught that if I worked hard enough I could achieve anything. If I put in the hours and experienced the grind, then my reward would be in the recognition I received as a result. I spent years putting in the extra hours, missing key life events and prioritising work, believing I was fulfilling my side of a social contract. Work hard, be seen, be recognised. I was fortunate enough that in many ways the social contract was delivered for me, but it was not for the reasons that I thought. There was a key piece that I didn’t recognise. I had a wonderful boss who was the one who both pushed and saw me. He believed in what I was trying to achieve, and when he had the opportunity he provided what recognition he could. My work hard ethos aligned with his and I was therefore both seen and rewarded. Since his retirement, I’ve been able to understand how much of a difference that positioning made. I’ve also come to recognise that some of that ‘be seen, be rewarded’ was because of the alignment in our ethos, and that others who aligned differently did not get seen in the same way. In many ways this is human nature, but it also means that you can’t rely on A leading to B, in reality it is much more complex than that.

When I first saw the video below from Barack Obama, it spoke to me, it aligned with what I had always been taught. It’s not true though. It’s only true in certain circumstances, for certain people, and that means it relies on privilege. If you are in the wrong place, if alignments don’t fit, if you have people who don’t want to see you, then you can solve all the problems you want and A will not lead to B, you won’t be ‘seen’, you will work hard and things will improve for the system as a result, but that doesn’t always equate to your aspirations being met as a result.

The truth about the meritocracy myth

The reason that point A doesn’t always lead to point B, is because what counts as ‘merit’, not only counts as different things to different people (loyalty vs going above and beyond for instance), but also the benchmarks for achieving those merits varies. Some people are running a flat race, whilst others are running the hurdles. Loyalty in role could be 2 years to some people and 20 to others. Going above and beyond could be being willing to stay an extra 30 minutes to one boss, and being prepared to work every weekend to another. The Obama idea of being the person who turns up with solutions, or fixes problems that are not seen by others, requires you to have a boss who doesn’t just take that fix and present it to a room without mentioning where it originated. If a problem is fixed that isn’t seen by others, is the solution going to be as valued, can you be too efficient to be ‘seen’?

Having the space and capacity to be the ‘fixer’ also has privilege associated. Many studies have shown that, in places like academia, women take on a lot of the ‘soft’ skill work, mentorship, outreach, committee membership etc, which means they have less time to tackle the ‘reward’ associated tasks, such as publishing, funding applications etc. Not only do you have to go above and beyond, but you have to go above and beyond in the right tasks, that are valued by the right people. This is before you even get onto whether going above and beyond is the right marker. For instance, if someone can’t go above and beyond by extending hours because they have caring commitments, but they are excellent in the contracted time available, why should they be disadvantaged? All of which is a long way of saying, that the system doesn’t reward ‘merit’, as it is often unclear what ‘merit’ is. Even if ‘merit’ is made clear the system often doesn’t reward ‘merit’ in all cases for all people, much of it is circumstance dependent. If you are lucky like I was to have a boss that aligned and saw me, great, but can success really be so dependent on luck or can we make our own?

What constitutes ‘merit’ isn’t universal

Even if the gateways were the same, along with the resources, there would still be differences and challenges linked to performance in the work place, often based on misinterpretation or a lack of strategic understanding of the unwritten rules of the system, and it is by enhancing our understanding of these rules that we can make our own ‘luck’.

In 2013, Sheryl Sandberg published “Lean In”

Women, she wrote, apologize constantly—for things that don’t warrant apology, to people who didn’t request one, in situations where men would never dream of saying sorry.

They face what researchers call the “likability penalty” When men are successful, they’re liked more. When women are successful, they’re liked less. Success and likability are positively correlated for men, negatively correlated for women.

This means women face an impossible choice: be liked but not respected, or respected but not liked. Men often don’t face this trade-off.

The gap isn’t in competence. It’s in permission.

Men are frequently given implicit permission to take up space, to speak with certainty, to disagree openly, to advocate for themselves. Women must constantly negotiate that permission—softening, qualifying, apologizing, making themselves smaller to avoid backlash.

That’s not a personal failing. That’s adaptation to a rigged game.

That brings us to Tiara Syndrome

Tiara Syndrome describes the professional tendency, often seen in women, where they wait to be noticed and rewarded rather than actively advocating for themselves. The belief that if they undertake diligent, excellent work, it will automatically be noticed and rewarded with promotions or raises, like a fairytale princess receiving a crown. They see the process of recognition as passive, linked to how impactful they are in role, rather than requiring active self-promoting or negotiation for advancement. Coined by Carol Frohlinger and Deborah Kolb, it highlights how quiet competence can lead to being overlooked in favour of more vocal colleagues. All of this means that if you have something you want, you can’t be a passenger in how you get it. It is the very epitome of ‘if you don’t ask, you don’t get’. The skill, therefore, is in learning how and when to ask.

How can this play out in the work place?

Apart from the impacts on career progression, one further issue with Tiara Syndrome is that, due a lack of self advocation, we can fall into an even worse trap, that of performance punishment. If you are the one who always stays late, or steps in to fix the small mess before it becomes something big that will impact others, that is the standard that gets set. Stay late on a Friday night frequently enough when dealing with Friday dramas, it will become assumed that whenever a Friday drama occurs you will be the one who stays late. It stops being a request and becomes an assumption. This leads to the benchmarks moving, and suddenly you need to do even more to be seen as going over and above. Therefore you are even less recognised than before. Completely the opposite to what you were trying to achieve. You work harder hoping to have that work recognised, but what happens is that your hard work gradually leads to decreased recognition and makes the situation worse. The solution is not to work harder, the solution is to advocate better.

So what can we do about it?

Part of the observations made by Sheryl Sandberg in Lean In, was that she noted that women often attribute success to external factors (luck, help from others, timing) while men attribute it to their own skills and efforts. This means that women can frame their career progression differently and feel less empowered to make changes that lead to different outcomes. If we think that our career progression is down to luck, then it makes sense that you are less likely to make active changes, but it is these active changes that truly make the difference.

So what can we do, irrespective of gender, to take control of our route to coronation? The first thing I would advocate for is having a plan. Reflect enough to know where your aspirations lie. You don’t need to know every step of the way, but you need to know where you are aiming for, what you next step is, and a rough road map in-between. Then develop some solid actions against it. Draw up a plan, and some way of measuring, like success criteria, to help you know how far you’ve come.

Instead of going with the flow, take some time to reframe and record your activity in light of your aspirations. Think about the skill and knowledge gaps you need to fill, develop evidence as you complete them by thinking broadly and including things like testimonials so you can provide external assurance. Whilst you are doing all of this, make a conscious decision to change your language. Think about using words that empower, rather than disempower, when you are talking about your work. Recognise the input and aid of others without dismissing your own contribution. Know when to use the term ‘we’ and when it would be more impactful (and honest) to use the word ‘I’. You can advocate for yourself whilst still being a team player and acknowledging the contribution of others. Step out of your comfort zone and practice how to take ownership of your successes. I mean this literally, as I found it was a skill I needed to actively practice, otherwise in the moment I would (and sometimes still do) default to how lucky I am. Now, don’t get me wrong, I am lucky, but it isn’t luck that got me to where I am, that was a lot of hard work, late nights, and too numerous a list of sacrifices to count.

Another thing I learnt is the importance of expending my energy wisely. There will be people who will never see you, or acknowledge your worth/work, no matter how much you advocate for yourself or put the evidence in front of them. These are battles that are not worth fighting. Invest your energy in those discussions and encounters where you can influence or change the conversation. If you can’t find the right people straight away, build your networks until you can. Find your people, find the person who can mentor and advocate for you in order to lighten the load. This doesn’t remove the responsibility and need to do it for yourself, but means that you will feel less alone whilst doing so. Use those people you find to practice the discussions you’ll need to have with people who may not be so aligned. Use them, and the safe space they provide, so that you can be more effective when you have to step into more uncertain territory.

Know that it’s OK to change and set boundaries

One of the key things that I’ve learnt, rather late in life, is the need to set boundaries, both for myself and others. This is something that I’m still working on, but has made a huge difference to how I see both myself and the world. One of the dangers of being a people pleaser is that you take on the agenda of others as if it is your own. You take on the extra work, and the extra projects, in the mistaken belief that this will be recognised, ease your pathway to success, but also make others happy. The reality is that it can just distract you from the things that you want to achieve, and often, it is neither noticed or rewarded. Transitioning away from this ‘of course’ behaviour can be both challenging and unsettling. It can really impact your identity, how you see yourself, and how you fear others may see you.

Living in that fear does not make the behaviour itself either healthy or meaningful, however. It just provides a comfortable delusion that in the long term doesn’t pay off. I’m not saying that you should suddenly say no to everything. Nor am I saying you shouldn’t be a team player. What I am saying is that you need to face the role you are playing in the scenario and be prepared to live in the discomfort in order to change things for the better in the long run. Say yes to things but in a strategic way. Look at your skill and knowledge analysis, and say yes to things that help address the gaps. Say yes to things that bring you joy. Otherwise, if you say yes to everything you end up, by default, saying no to others unintentionally. By taking a pause to think before you say yes, it means that the yes you say is about moving forward not just filling time or making others happy.

Find a team that crowns you

Finally, I talked about finding your people, and I have to say this is the thing that has made the biggest impact on both my life and my career. My team last year made me a swab tiara, and crowned me ‘The Swab Queen’. All of which is to say, if you find the right people and the right place, you won’t have to find a way to be crowned, your people will do it for you. A word of warning to finish on, however, make sure that once you have your regalia you take the time to make sure you find those who you can pass it onto. Crowns are about legacy after all, no one keeps the same crown forever.

All opinions in this blog are my own

The Next Chapter: Don’t Open That Door! A Microbiologist’s Guide to Infection in Movies and TV

girlymicro General, Healthcare Science, Microbiology (Clinical), Science Communication, Writing , , , , , , , , , , ,

You may have noticed that I’ve been a little poor at keeping up with the Girlymicrobiologist site admin, and missing the odd weekly blog post. This isn’t because I’ve been slacking, honest, it’s more because I may have become a little distracted by a new project. I promise to get back on top of things soon, but in the meantime I thought I owed you an update.

Many of you have been kind enough to support last years project, which was a book aimed at supporting people to engage with research and research degrees, and I couldn’t be more grateful for your cheer leading. This new project, however, in the words of Monty Python could be described as ‘and now for something completely different’. It couldn’t be further from a book about academic study. This one is all about something else I love passionately, movies and TV.

I finished and launched the last book last October, and to be honest it hadn’t occurred to me, prior to letting it go into the wild, that I would write anything else till my retirement – when I’m planning to write some pathology based murder mysteries. It was never the plan to do something again, at least so soon. Frankly though, my brain tends to disrupt all my best laid plans, and ideas come meaning I just can’t help myself but get swept up. I’m blaming Ian McKellen inspiring me to ‘practice any art’.

Despite having no plans to do more, I have to say that I really enjoyed writing the first book, and I found the process of being able to write in a different way very fulfilling. I love writing this blog, and the first book is based on a lot of the pieces I have written for here, but it was nice to see them come together and take on a new and different life of their own. I also enjoyed mixing up the writing of something on a single theme with writing blogs on different topics for here, although I did rely a lot on Dr Claire Walker bringing together many guest blogs to allow me some writing time. It was lovely to see what those guest blogs brought to the site, and I really enjoyed seeing how including those voices really makes this feel even more like a community space. Without realising it, I think I caught ‘the bug’. Now, I’ve always enjoyed writing, this is my happy space, but I had never seen myself as an author, having held a book I’d written in my hands though, I can see how it could become a little addictive.

As I was sitting watching horror movies as part of my post release recovery, and researching for my 2025 Halloween post, I suddenly realised what I’d like to do next. I really wanted to write about some duel loves of mine, movies and TV plus infection.

Halloween 2025: Let’s talk all things vampirism and infection

Without any expectation of writing another book, all of a sudden I had a structure in my mind, and Don’t Open That Door had began…

You all know how much I am a movie and TV buff, everything from guilty pleasure reality TV, like The Secret Lives of Mormon Wives, to documentaries, and all genre of film (with the exception of torture porn horror movies, I’m a Blumhouse girlie). Whilst enjoying some down time with Mr Girlymicro, I realised how widely infection is featured in all kinds of different genera settings, some of it was actually pretty good, whilst some of it was really poor. So the first step was to do a whole bunch of research about what kind of examples were out there, by hitting up a bunch of different lists that have been collated by others, internet searches, and sourcing opinions from my movie loving friends. All of which led to the creation of a list of 138 options that needed a review to see if if they were actually linked to infection, and if they were infection based….was the infection content any good.

If you follow me (Girlymicro) on Instagram, you will have probably seen a number of stories that I’ve posted recently linked to movies I’ve been watching with some Infection Prevention and Control/micro commentary:

These have come about whilst I’ve been watching the 138 films/series with Mr Girlymicro to decide which ones make the cut to be included. I’ve watched some awesome films, some like Sinners, weren’t based on infection so couldn’t be included. I have also watched some truly bad movies, I even gave Resident Evil another go, and have spared you all by making sure that it is not included on the list. One of the considerations was that, even if the science wasn’t dreadful, I haven’t included anything that I or Rotten Tomatoes include as being truly horrible. I’m not just saving you on this, but also myself, as I’m having to watch included examples many times as part of the writing. I also felt it was really important to cover infections linked to viral, fungal, parasitic, and bacterial causes, just because they behave so differently and the interventions needed are so different. So the final list for inclusion involves movies and TV series that sit across infectious agents, although viruses are more represented than any other cause.

There are plenty of horror movies on the list, purely because they represent A LOT of the infection genera, but I was surprised at how many options there were outside of horror movies. I also tried to mix up certifications where I could, so that there are some options that everyone might enjoy.

Not everything could be included however, and there were also some exclusion criteria that impacted what I could include. Exclusion criteria included factors such as availability – no point including things that people can’t access, language options – I sadly only speak English so it needed at least English subtitles, and most importantly not based on real life events – this is about fiction.

For inclusion examples also needed to have infection as a central theme. This meant that health dramas could not be included as they only feature infection in some episodes, but at some point I do really want to write something that compares different medical dramas (House, New Amsterdam, Holby City etc) and maybe do a ranking scale….let me know if you think that would be a fun blog post.

Image credit The Red Dress

The reason it felt timely to talk about this today, is that the Biomedical Scientist magazine has been kind enough to do a whole feature on what the new book will look like, with a bit more detail, and some examples of what chapters will look like. It dropped on the 27th March and you can check it out the link here: https://thebiomedicalscientist.net/2026/03/24/infections-films. Also, how awesome is the art work they’ve done, can’t say enough how awesome The Red Dress are.

Whilst writing the article for the Biomedical Scientist and watching the example movies, I couldn’t happen but note how many weird and wonderful things are included as part of the science representation. Things that in my scientific career I rarely if ever encounter, but seem to crop up time and time again in Hollywood depictions of scientific life. I’m collating these for one of the final chapters in the book called ‘Science House of Horrors’ as I find them a bit fascinating. I’ve included some of the ones in the Biomedical Scientist article that I noticed, as well as those sent through as responses from social media, but I’d love to know if you have any others that I should include.

There are other opportunities to get involved though, I have 23 films and series examples, but there is room in the book to cover 25. I’m really keen to get other examples that include fungi, but if there is just something brilliant I haven’t included please let me know. There will also be a chapter called ‘Hall of Fame’ that covers both amazing movies that just don’t have enough infection in them to be included, or ones that were great but not quite as good an example of an infection characteristic as the ones already included. There is also the ‘Hall of Shame’ for examples, such as the TV series The Rain and Resident Evil, where the science is so bad that it is note worthy in itself.

Anyone who drops me an email to elaine@girlymicrobiologist.com and inputs into the House of Horrors, volunteers film examples I’ve missed, or suggests contenders for the ‘Hall of Fame’ or ‘Hall of Shame’, will get their name included in the list of contributors at the back of the book. Science takes a village, so does pulling together a book, and I’m really keen that this feels like it comes from our community. I hope you enjoy the article and I can’t wait to hear from you about your suggestions.

All opinions in this blog are my own

Actions Speak Louder Than Words: How people showing up unprompted makes a difference that words cannot convey

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It has been an amazing week (despite this post being late as I was unexpectedly struck down unwell). Last week, I was fortunate enough to attend the Academy for Healthcare Science Honorary Fellowships and Chair Celebration, which was a joyous way to celebrate the contribution that Healthcare Scientists make to the Academy, but also to acknowledge the impact that Healthcare Scientists make across the healthcare landscape. This week has been Healthcare Science week, and it’s been a delight to see the posts shared, and hear about the great work and impact of Healthcare Scientists.

It’s been especially poignant for me personally, as the AHCS had also been liaising with me to support my book, It Shouldn’t Happen to a PhD Student. They were generous enough to allow me to share copies of the the book as part of the goodie bag for their Fellowship event, as well including an article about why I felt it necessary to write the book within the Spring 2026 edition of the HCS Leadership Journal.

All of which got me thinking…it got me thinking about how it feels to have people step up to support you. It got me thinking about privilege and the importance of knowing where you have it, and where you may lack it. Finally, it got me thinking about the importance of using that privilege recognition to actively engage with others, and decide how to utilise it both for impact and the benefit of others.

Awareness of privilege

We all have privilege, even if it doesn’t always feel like it. If you are reading this blog you have some form of privilege, even if that is just that you aren’t in digital poverty. I have privilege. I am white, middle class, European, and in a heterosexual marriage. I also lack privilege in some ways, being a woman who came from a state education background, and work in a professional structure that is dominated by my medical colleagues. Organisations are the same, they will have spheres of influence, and areas where they are trying to expand that influence.

It is obviously helpful to know where you have influence, and where you may lack it. This is essential to allow informed decision making about where to devote your energies, but more than that, it is important to know where you can expend energy for the benefit of others. There is more danger than we sometimes acknowledge in not understanding, and spending time reflecting on, our privilege. Not doing this can result in making assumptions that can harm ourselves and others.

Awareness of the priviledge gap

What does that privilege awareness look like? I am never going to be able to run an invite only event for 200 people. I have a fair level of of influence, due to you lovely people reading this blog and interacting with me on social media, but I am only one person. I will never have the influence, impact or resources of an organisation or group. Therefore, the privilege I am able to harness for the benefit of others will also be limited. This is why I want to discuss the importance of gestures, such as those made by the AHCS. I am able to reach a certain percentage of Healthcare Scientists that I’m personally connected with across platforms. The Academy in contrast has thousands of members across their registers. They have thousands of followers across social media platforms, and they also have reputation impact, as they are have intrinsic legitimacy due to their role providing professional accreditation.

The AHCS supporting me, by allowing me to share my book and by including an article in their journal, substantially increases my reach, and the chance of something I hope to have impact, getting into the hands of someone who may find it useful. It also lends their validation to that reach as, I hope, they wouldn’t support sharing details of the book if they thought it was rubbish. It gets my book into the hands of people who may never have picked it up otherwise, from students to senior leaders. I’m so grateful to them for using their privilege to support something that means so much to me, and that I hope will support the profession I love. Gestures can be big or small, but the impact of them should never be underestimated.

Support without asking

Now, I’ve talked about the fact that I do have privilege. That said, I don’t have the kind of privilege I’ve seen in some of my academic or medical colleagues. The kind of privilege where doors are just opened, or barriers are just removed. I don’t have a problem with this, I feel like I have proven myself every step of the way. Every promotion I’ve had has been a competitive process. Every committee I’ve sat on I’ve either had to apply for or prove my credentials as part of joining. The support for my book is the first time ever that someone has come to me and asked how they can help. Not just the Academy, but places like Applied Microbiology International. The Academy really followed through, and did not just ask the question, but helped me work out ‘the how’. They don’t know this, but when I got off the call, and recovered from the shock of their kindness, I actually had a little happy cry. There is nothing like people stepping up and showing their faith in your by offering the kind of support you would never have asked for. It is a rare event, and it’s made me determined to do what I can for others in order to make it a little less rare.

Support without conditions

Often when people have offered support for me in the past there has been a certain level of quid pro quo. A level of you scratch my back and I’ll scratch yours. If you’ve followed this blog for any length of time, you’ll know that my leadership style is much more around authentic leadership than transactional leadership. There is nothing wrong per se, with transactional leadership, there is definitely a place and time, but it doesn’t feel the same as someone offering their support with no ties or limitations. There is something special about someone offering unconditional support, support that you don’t feel like you have to pay back or pay off. Now having said that, I’m not saying you shouldn’t try to live up to the generosity being offered you, just that it’s different when that’s a decision you make rather than one that is a condition of the support to begin with.

Support without comeback

The other interesting form of support is that type that comes freely at early stages of your career, but has ramifications later on. I think many of us have probably experienced this one, where you have had mentors or supporters who offered great support, until the point at which you reach a similar level of career progression. At this point the support becomes more transactional, or worse, relationships become less constructive and more distant. Opportunities taken can be greeted with commentary, or judgement. This can be a very confusing scenario if you haven’t encountered it before, or seen it happen to others.

People who offer support irrespective of career stage, or perceived risk to position, are worth their weight in gold. Those individuals and organisations who support others, not for benefit to themselves, nor affected by positionality, are both investing in relationships for the long term and build trust based on consistency. This is one of the best ways to maximise impact over time, both for the person supporting, but also for those offering aid.

Acceptance without doubt

This isn’t just about those offering the support however, no matter how wonderful. It is also about how we receive the support and opportunities that we are offered. It can be easy to question whether to accept unconditional support by wondering what’s the catch? If you have been submerged in a culture where you are surrounded by transactional relationships, or where cultures have become challenging due to resource scarcity, it is both understandable and predictable to question support when offered. It is essential however that we get out of our own way. This can be a challenge if you are in a position where you lack privilege. When working with, and offering support to others who have dealt with a lack of privilege long term, building trust may be a required step prior to acceptance of any support offered.

We can all have a tendency to say ‘why me’ for both good and ill. This can obviously be context dependent, as well as depending on whether we are in a place of pessimism or optimism when the offer is made. It is important to have the self awareness to know when we are drifting to skepticism when we should be embracing opportunity. When we are driven by factors from our past instead of embracing our future.

Acceptance with gratitude

Instead of questioning when we are offered support, it is important to move to a space where we accept with gratitude rather than anxiety. I think it’s key to talk about what I mean by gratitude, I’m talking about gratitude without submission. I have a tendency to over correct on this one. I tend to be so grateful for the support that I can come across as sycophantic, without meaning to. I think the best way you can be grateful however, is to make sure you learn the lessons from being offered the support and ensure that you incorporate it into your practice by role modelling that behaviour yourself. As you are being supported without conditions, you should be thankful and stop looking for some unwritten cost that doesn’t exist. Embrace the opportunity and then make sure you do the same for others.

Delivering on the commitment

The biggest demonstration of gratitude you can give, I believe, is by delivering on the faith that others have placed in you. If someone goes out of their way to show you support, then deliver. Deliver on whatever that may be. It could be by putting in the work to achieve a goal. It could be by working to ensure that the advantage they’ve given you isn’t wasted and allows a next step to be taken. It could just be by embedding the same values in your leadership to benefit others. Actions speak louder than words, and so if given an opportunity act to maximise the outcome.

Paying it forward

I’ve mentioned the importance of making sure that you increase the legacy of any kindness you are shown by role modelling that moving forward, but it’s so important that I wanted to state it again. Not all gestures require large resource or commitment. It can be as simple as stating someone’s name in a room that they are not in, or passing on an opportunity that you may believe would be of benefit. Knowing where our privilege and influence lie, not taking it for granted, and utilising it for the benefit of others in whatever way we can, is such an important part of how we move forward as a profession and lift people up as individuals. Especially at the moment, when resources are limited and times are hard, it can be easy to forget what is in our gift to do, and I think now more than ever it’s crucial to realise that we all still have the capacity to positively impact on others.

A final thank you

So, I wanted to end by saying thank you again to the Academy of Healthcare Science. Not only have they really impacted me by showing such by in with a book that means a lot to me, but they were also kind enough to present me with an extra surprise, the Chair’s Award for Excellence. It’s made a real impact on me, and now all I can hope to do is pay it forward and show the same faith and impact in others.

All opinions in this blog are my own

Holding Up a Mirror to Perfection: Why I’m finding LinkedIn can impact how I view myself

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This is not the post I’d planned to write this week. I don’t think it had really been on my mind. That’s often the way of these things however, thoughts that have been lingering without notice sneak up on you and call for attention.

Last week, I had a meeting with the wonderful Vicky Payne and talk came around to blog writing, but also to how much we both missed the twitter communities we used to have. The supportive space, where you felt like you could share in an authentic way, and how the community really felt like it was there cheering you on. This blog was built in that community space, and it probably wouldn’t be what it is now without the support and positive reinforcement that that community gave it.

We then moved onto where we tend to post and share now, and this led us inevitably to LinkedIn. I felt like I had to share how LinkedIn feels like a very different space. That makes sense. It is a professional platform that was developed as a way of people connecting to find roles, form business connections and turn those into opportunities.

Let me start by saying this isn’t an ‘I hate LinkedIn post’. I’ve been a member on LinkedIn for years, it’s more about the change that occurred in our terms of reference, and I for one did not notice.

Like most people I used to post now and again. I’d use it as a nice way to keep up with colleagues and those in similiar specialisms. Then the decline of Twitter happened, and the ethical challenges of that meant that we all left in droves. There was a social media and connectivity hole that needed to be filled. Many of us tried alternate spaces such as Bluesky and Mastadon, but after a promising start they stalled, as many of these things do.  To me, that during this time it appears that the way people use and access LinkedIn also changed. Its use expanded and changed in order to somewhat address this need. The problem is that many of us shifted our use without really taking the time to realise that it was in no way a like for like switch.

After a conversation that triggered a lot of thinking and then logging in this evening and consciously monitoring my responses and feelings linked to what I saw, I had somewhat of an epiphany about one of the reasons I’ve been struggling lately. LinkedIn makes me feel bad. With this in mind I thought I’d write about why I think that is and what I think I’m going to do about it.

How does it make me feel?

As someone who needs to be pretty active on social media, not just linked to this blog and book writing, but also because I believe that visibility and public engagement matters, I’ve not been feeling great lately and some of that is definitely driven by the social media space I inhabit. I don’t feel enough right now. I don’t feel like I achieve enough. I feel like I’m like the last runner in a race I didn’t know I’d signed up for.

To have things seen by others on LinkedIn you have to log in, react and post regularly, otherwise your content just doesn’t get shared and seen by others. The algorithm rewards engagement. My use of LinkedIn has therefore increased. This is, in itself, not a problem. The problem is that that means everyday I see a stream of amazing achievements. People knocking it out of the park. Everyone doing more. Achieving more than I could dream of doing. When I say that that is a problem, it isn’t really. I love the people that I’m seeing achieve and have such impact. It is inspiring. At the same time there is no balance to the constant stream of highlights. It triggers the ‘must work harder’ ‘must achieve more’ part of my brain, and I have to say that those parts of me are not the healthiest parts. Those are the parts that respond to emails at three in the morning, that didn’t have a weekend off in three years. The parts that lead to a world of well being challenges as I fail to sleep or eat properly.

Bear in mind I acknowledge that this is a me problem, not an issue of the platform or those posting.

There’s a lot of uncertainty around

It is important to acknowledge that some of this response is highly likely linked to the uncertain times we are living in. For the first time in my career of over 2 decades the NHS is undertaken wide scale job cuts, with pushes for voluntary redundancy, and the previously unheard of compulsory redundancy processes. The need to show value, to show that you are ‘good enough’ is very much in my mind at least. The self doubt and questioning that working in such an uncertain space brings on is even more amplified when you see and inevitably benchmark yourself against others.

For me, as an over thinker, that makes me feel even more at risk and unsettled, which then drives the spiral to continue. Nothing happens in a vacuum. Some of the posting of the good stuff I see from others, I suspect is also driven by the need to be ‘seen’ to be enough. Thus we all stay on the carousel and it spins again.

Portrayal through a singular lens

All posting on social media is biased, I’m not saying it’s not. What I am saying is that because LinkedIn is a platform that is basically set up as CV sharing, there is a string tendency to only share things that would be seen as CV candy. This understandably removes the balance of some posting that is undertaken on other platforms. I don’t see a lot of posts about people, the focus tends to be on events and milestones, and those events and milestones are almost always achievements, rarely do you see failures. It’s a world that feels, to me right now, that functions on toxic positivity. Once you become more aware of that posting bias it is probably easier to navigate, but as someone who wasn’t paying enough attention to notice the drift, I also wasn’t looking out for the impacts.

Everything is polished for public consumption

Due to this positivity, and I suspect in response to the tone of posts that are generally shared, everything is not just positive but dressed in a way to support branding. As someone who is known by more people as Girlymicro these days than Elaine I am in no way averse to people having a personal brand, I think it’s the world we now live in, but I think it’s the nature of that branding can be challenging. Branding that is all about surface or positivity does not feel, to me, that it can also be authentic.

It feels like it’s tick boxing, and worse than that, deliberately manipulating perceptions to cause us to be drawn into some form of unwinnable race where everyone is perceived as winning, but in reality we’re all drowning and not forming the real connections that could throw us a life line. I’m not talking about this at a person based level, but at a platform level. I just think it’s easy to get caught up without even realising, and to think that everything you are seeing is an accurate portrayal of the reality without undertaking the necessary sense checking on what is in front of you.

About perceptions rather than dialogue

One of the biggest changes that this type of posting leads to, is that it feels much more like shouting into a void. It’s about putting success out there, rather than leading to greater dialogue, or focusing on connection. Although it feels straight forward to gain a larger and larger following, I’m not sure how well I could say I know most of that following, outside of the ones that I also know in real life. This is in contrast to how I used to feel about Twitter, where I had connections that I formed and felt like I got to know really well, who I never met in person. Everything feels more superficial, although I have to say there are a few exceptions to this, it is far from universal.

Don’t get me wrong, there are benefits to forming these larger networks, but as Dunbar says, you can only maintain deeper connections with a small number of these contacts without deeper dialogue. These networks maintain a purpose, just not the same one that I originally felt that they would have. They are less about support and more about linkage for the purpose of opportunity sharing. Valuable, but different.

Being different is not a risk free strategy

The other big challenge, which I’m only just now getting my head around, is that LinkedIn is always fundamentally linked with my job. My job title and employer are front and centre on my profile. I have always tried to maintain my social media separate from my work. There is a reason every blog post finishes with ‘All opinions in this blog are my own’. They are my thoughts, my opinions. This is an important separation for me, and yet this separation isn’t easy to achieve now this platform switch has occurred. Now, don’t get me wrong, it’s not like I ever want to post things that are unprofessional, I don’t think that I post things that will impact my role, but I also have always appreciated the voice that independence allows me.

It is also true that, in a world where your posts are always linked to your CV, that posting outside of the norm could have an impact but not in the way that I would hope. It could be that posting holistically could be perceived as weakness and failure, rather than growth and learning. I have also encountered a few instances recently where personal opinions have landed on professional pages, because profiles were being utilised similar to twitter, which led to confusion of aims and muddying of the terms of reference for those pages. This has negatively impacted not just the page, but the person and project linked to it. There is a possibility, therefore, that getting this wrong is not a risk free challenge.

I am more than my job

As profiles are linked so tightly to roles, it is also no surprise that the sharing and posting tends to be much more job orientated. The thing is, and I know this may shock you, I am much more than my job. I have interests and experiences that exist outside of my role, many of which I have shared across other platforms as I think it is so important for public engagement that people see who scientists are outside of the day job. People talk about the fact that you can’t be what you can’t see, and that isn’t just about the role. It’s about seeing that people like you occupy those roles. In my case, it’s about seeing that someone who didn’t go to private school, someone who didn’t always achieve academic success, someone with chronic illness, and who isn’t only interested in intellectual pursuits, can still succeed. By only posting about the role, we miss out on the fact that success means different things to different people, and not all of that is about the job. It limits the success that we share, and I’m not sure that that is a beneficial thing for those that aim to follow us.

Failure is learning

Another danger linked to only sharing successes is that the journey from point A to point B appears straight forward from the outside. This can mean that those attempting to follow a similar pathway can end up feeling like failures when they encounter a route that is less straight forward. It could mean that they give up because they lose confidence in their ability to complete the journey, when the journey may have been that difficult for others, they just aren’t talking about it. Rather than raising others up therefore, it can, as an unwitting consequence, result in discouraging others from following.

The other thing to note here is that I have learnt so much more from my failures than from my successes. My failures have taught me about who I really am, what really matters to me, what drives me, as well as how to do things better in the future. No matter how challenging, they have made me both better at my job and better as a human being. By not sharing our failures, it means they are almost seen as an embarrassment, when far from a source of shame, in many ways mine are a source of pride. Without them I wouldn’t have achieved, and so I think that learning is more worthy of discussion than any of my tick box moments.

Rest isn’t failure

I have always struggled with workaholic tendencies. The need to work harder in order to feel like I’m keeping up and the resulting abandonment of self care. I’ve had to work really hard to attempt to put boundaries in place in order to maintain both my physical and mental health. I have a tendency to feel like I’m falling behind and that I achieve little in comparison to others. A lot of this is seated in having had to fight to keep up my whole life, whilst managing being unwell. I know that this is not anyone else’s problem, this is very much a me thing, that I am aware of and need to counter. I do however, miss the parts of twitter where we would celebrate rest time with others. Liking posts where people talked about what they were reading, going for drinks with friends, cooking, and spending time not being on the productivity treadmill. Now that success is re-focused on productivity I find it harder to remember that resting is not failure. I need to remember that rest is productive in it’s own way, and that my life is should not, and cannot, always be measured by how productive I am against a single given matrix. I miss seeing what people enjoyed doing outside of their role productive spaces.

Remembering that I’m running my own race

That has all been a lot about what I miss and what I’ve found challenging, but what am I doing about it now I’ve had some time to think? Well, first I am looking at LinkedIn a little less, and when I access it I’m acknowledging the success of others but trying to not get overwhelmed by what I’m seeing. I love cheer leading others on, but I need to find a balance. I’m learning to love Instagram a little more, not that I really understand that either, but it means I get to still see sides of people that are about rest and joy, not just a CV (I’m Girlymicro there if you want to look me up).

The biggest thing however, is that I now understand my responses to what I am seeing, and so instead of self flagellation, I am able to remind myself that I am just running my own race. I am pleased for others, but I am intent to only bench mark against myself. What do I want to achieve? What can I do this year that I could not do last year? Where is my learning? What am I doing to become a better scientist and human being? Worrying and giving head space to the self doubt just makes me anxious and achieves little, so I need to actively focus on taking my next steps uninfluenced by others.

Bringing authenticity back

As well as changing my approach when reading others peoples posts, I am also going to deliberately take some risks and makes changes in some of what I post. Instead of only sharing the shiny bits, I am going to share posts like this but also ones like the one below, that don’t disguise the fact that I find some days, some challenges, some moments, just hard. I think being aware that the platforms we use have different unwritten rules is the first step to understanding what is possible, and I am happy to push the boundaries of that, without acting like it is something it is not. LinkedIn has a lot of benefits, so I plan to embrace it for what it is, rather than pretending it is something it isn’t, but I intend to do that by sharing more of my authentic self when appropriate.

Reflecting on the dangers of comparison

This whole process has reminded me of how dangerous it can be to compare ourselves to others. There are many benefits to using others to inspire us, to see and understand the possible. Maintaining these benefits without letting comparison start to limit or impact our sense of self is something that I think we all need to be aware of. This could just be because I’m a peri-menopausal 40 something who has lost a lot of her confidence after the pandemic, but the brain weasels are real, and being aware of triggers is an important part of stopping spirals before they begin. Knowing how much is enough, knowing my purpose, and what I am aspiring to achieve, are important aspects to keeping me centered and in a good place. I’m focused on the vision, not the comparison right now.

Loving my imperfect self

Most important of all, I am reminding myself that I am enough. So what if I don’t publish as much as I’d like to. So what if I haven’t found time to write the grant applications I’d wish. So what if I don’t feel like I’m always impactful enough, or accepted for my expertise without constantly fighting to be visible. At the end of the day I come home to Mr Girlymicro who loves this flawed human for who she is. He loves me irrespective of my successes or failures. He loves me despite the fact that I fall flat on my face and throw food down myself on a regular basis. He loves and believes in me when I have no ability to do those things for myself. So I am taking a leaf out of his book and trying to see myself through his eyes. I am trying to love all of me and not place caveats upon that love. To know that my value is not based on what I’ve achieved, but who I have achieved it with and the relationships that got me there.

No matter what social media you use, or how you use it, always remember that if you can return to a place of true connectivity where you are seen and loved for all you are, it doesn’t matter how you are seen out there. You are always doing better than you perceive, and are almost inevitably loved more than you know. Keep the faith, and treat yourself as kindly as you would treat others in a similar boat.

All opinions in this blog are my own

Guest Blog by Dr Claire Walker: Can artificial intelligence pass your Genetics exam? Not this one

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Everywhere I look at the moment people are talking about ChatGPT and artificial intelligence (AI). On LinkedIn this week everyone was sporting ChatGPT produced images, and I have to say I felt completely out of things as I’d have no idea where to even start. The challenge is, the same cannot be said for our students. As an external examiner I see how the AI creep is really beginning to impact on assessments, so I reached out to my great friend and educationalist Dr Claire Walker, who is actively working to think about how we can respond to the AI challenge when it comes to our assessments.

Dr Walker who is a paid up member of the Dream Team since 2013, token immunologist and occasional defector from the Immunology Mafia. Registered Clinical Scientist in Immunology with a background in genetics (PhD), microbiology and immunology (MSc), biological sciences (mBiolSci), education (PgCert) and indecisiveness (everything else). Now a Senior Lecturer in Immunology at University of Lincoln. She has previously written many great guest blogs for the Girlymicrobiologist, including Exome Sequencing and the Hunt for New Genetic Diseases.

Blog by Dr Claire Walker

So, there’s a new problem in higher education. The elephant in the room that we’re all talking about, or sometimes pretending doesn’t really exist: our chatty friend, generative AI. When I first encountered it, I suspected the impact might be overstated. Students do not come to university simply to cheat; they come for authentic learning experiences and to gain transferable skills. I mean, they want real jobs eventually, right?! But the reality facing educators is more complicated. Alongside the rise of AI, we are also facing another persistent challenge: do more with less. Larger cohorts, less time, fewer staff and an increasing pressure to design assessments that genuinely measure skills rather than copy-paste ability. Many of our classic approaches to assessment – lab reports, literature reviews, and even theses can be generated with just a few of the right kind of prompts.

Our chatty friend or the nemesis of lecturers everywhere

So how can we create authentic learning experiences that are difficult to outsource to AI while still being practical to run and mark? At the University of Lincoln in our Genetics and Bioethics module, we have developed one approach: AI-supported patient roleplay combined with pedigree analysis and ethical reflection. One of the long-standing challenges in genetics education is giving students meaningful practice in family history taking and pedigree construction. Traditional simulated patient encounters are highly effective but expensive and logistically demanding, often requiring trained actors and significant coordination. As a result, many students learn pedigree analysis primarily through static textbook cases. I can’t say this isn’t useful, but it’s pretty far removed from the realities of genuine clinical conversations.

Our solution was to create interactive patient roleplay scenarios in which students interview a simulated patient using Claude.AI during a live teaching session. The students interact with a “patient” presenting with features of the genetic condition hereditary haemochromatosis. They gather the relevant family history by asking structured clinical questions of our AI bot pre-programmed with a real clinical case. The information they need does not exist in advance as a written case study; it emerges through the interaction, requiring students to listen carefully, probe appropriately, and adapt their questioning strategy in real time. This immediately changes the learning dynamic. Students are no longer passively interpreting a pre-constructed pedigree; they must build the dataset themselves by asking the right questions. Mistakes become learning opportunities, and repeated questioning helps them to refine both clinical reasoning and communication skills. Following the roleplay session, students translate the collected information into a formal pedigree diagram using a clinical pedigree-drawing software fortunately available for free online. This requires them to apply standardized genetic notation accurately while organizing complex family information into a clear visual representation that can be assessed objectively, and delightfully quickly. Most importantly – right now ChatGPT can’t draw this from a script. Maybe one day, but for today this assessment is one step ahead.

A medical family history drawing tool from Health Education England

The assessment does not stop at technical skills. Students are also asked to reflect on the family scenario and the issues raised during the session to consider a realistic counselling question: would they personally choose to undergo testing for a variably penetrant mutation associated with hereditary haemochromatosis? The genetic test used in the module looks for two common changes in the HFE gene known as C282Y andH63D. In simple terms, the test examines a person’s DNA to see whether they carry gene variants that can affect how the body regulates iron absorption. Certain combinations, particularly inheriting two copies of the C282Y variant, increase the likelihood of developing iron overload, but they do not guarantee disease. Many individuals with these genetic results remain healthy, illustrating the concept of variable penetrance; genetic changes that influence risk rather than determine destiny. Environmental and lifestyle factors such as diet, alcohol intake, blood donation habits, and biological sex also affect whether symptoms develop and how severe they become. Students are therefore encouraged to reflect on how genetic risk, environmental influences, and personal values shape decisions about predictive testing taking into account what they learnt from their virtual patient experience. At the end of the module, they are offered the opportunity, within the academic teaching setting, to undergo testing themselves so they can engage directly with the ethical, psychological, and practical considerations that accompany real-world genetic screening decisions.

Instructions to Claude.Ai for how to behave as a patient and a excerpt of the transcript of the interview

An additional advantage of this approach is assessment authenticity. Because the key information is generated dynamically during a live interaction, the task cannot easily be completed using generative AI alone. Students must attend, participate, and apply lecture knowledge in context, meaning the assessment evaluates what we actually want to measure: their ability to gather relevant genetic information, interpret it, and think critically about its implications. Equally important, the approach remains scalable and low-cost. No actor recruitment is required, sessions can be delivered across large cohorts, and students can practice interviewing skills in a structured but flexible environment. What once required substantial logistical planning can now be implemented with minimal additional resources. Moreover, all modules must have some laboratory component, and this one falls into a middle of our usual price point.

I’m not offering a complete solution to this huge challenge facing higher education, but it is a step toward something we increasingly need: assessments that measure real skills, encourage real engagement, and prepare students for the complex clinical and ethical conversations they will eventually have with real patients.

TL/DR – If AI can take the assessment, change the assessment.

All opinions in this blog are my own

Miss Piggy is My Hero: Why we should all be a little more Muppet

girlymicro General, Leadership , , , , , , , , , , ,

I’ve always been a massive Muppets fan, from their original films through to one of my favourite films of all time, The Muppet Christmas Carol. It’s a family tradition and you all know how much I love Christmas. Picture my joy then when the news was released that this week there would be a new, original, episode of The Muppet Show released on Disney+.

Watching it gave me such joy. Miss Piggy is, after all my hero, but I started to try to think why? Why do The Muppets bring me such joy? What is it about them and their interactions that really speaks to me? Especially as I’ve been writing about the role of women in the work place recently, what is it about how Miss Piggy functions that I admire and wish I could channel more? Then I found this quote below and it felt so genuine to me.

When thinking about their traits more, I couldn’t help but come up with a fairly substantial list that made me want to be ‘more Muppet’ and I thought that in honour of their new moment in the sun I would share the list with you in case you want to join me on a Muppet adventure.

Self advocacy

I don’t care what you think of me unless you think I’m awesome. In which case, you are right

As a female scientist there have been more times than I can count when I wish I’d had the courage to speak up, be seen, and be heard. In fact this is one of my themes and aspirations to be braver about in 2026. Miss Piggy is never afraid to stand up and be counted. She knows her value, and she knows what she brings to the table. More than that she’s not afraid to let others know it and to hold them to account when they under value or under estimate her.

We are often trained that it isn’t a good look to be too confident, or come across as too challenging. That it is better to fit in then to stand out, and that standing out will only cause us trouble. Miss Piggy stands out proudly and isn’t afraid of the consequences of making her presence known. I wish that I too could hold my space without being worried about how others see me for doing so, and I too should maybe care a little less what others think of me.

Boundaries

One of my favourite parts of The Muppet Christmas Carol is when Kermit negotiates for Christmas Day off work:

Mr Cratchit (Kermit): Mr Scrooge it appears to be closing time.

Mr Scrooge: Very well. I’ll see you at 8.00 tomorrow morning.

Kermit: Tomorrow’s Christmas.

Mr Scrooge: 8.30 then.

Kermit: If you please Sir. Half an hour off hardly seems customary for Christmas Day.

Mr Scrooge: How much time off is customary Mr Cratchit?

Kermit: Uh. Why. Um. The whole day.

Mr Scrooge: The whole day! – The entire day?

Kermit: If you please Mr Scrooge, why open the office tomorrow? Other businesses will be closed. You’ll have no one to do business with. It’ll waste a lot of expensive coal for the fire.

Mr Scrooge: It’s a poor excuse for picking a man’s pocket every December the 25th. But as I seem to be the only person around who knows that… Take the day off.

There are moments like this time and time again in The Muppets, be they in the movies or on the small screen. Moments where they gently but firmly set boundaries. Boundaries on good behavior. Boundaries for each other. Boundaries linked to kindness, both to themselves and others. Kermit holds a quiet confidence that permits him to set boundaries that protects both himself and others, without making drama or conflict out of the act. As someone who struggles to say no, and protect her well being on occasion I admire this so much.

Loyalty

The Muppets are a family. They have disagreements. They consist of very different personalities. Yet they love each other unconditionally, and always turn up for each other when it matters. Their love and loyalty isn’t transactional. It’s not performative. It’s the kind of loyalty I look for in those people who are my ride or dies. The ones who would take a call from you at 3 in the morning, just because you need to make it.

They have the kind of loyalty to each other in a work space that allows them to disagree, to argue about the order of the set list, but also lets them arrive at a moment where they all pull together for the absolute best they can achieve as a group, which is always better than any of them could achieve alone. I count myself so lucky to have an IPC team where I feel like we are always there for the finale together.

Respect without hierarchy

I don’t do hierarchy, I don’t do respect just for the sake of it. For The Muppets, Statler and Waldorf are the epitome of that approach, they are there to remind people that there is always a reason to laugh at ourselves, and not to get too caught up in position or reputation.

Waldorf: Well, you gotta give them credit
Statler: Why’s that?
Waldorf: Well, they’re gonna keep on doing it till they get it right

Although The Muppets have big personalities, and a leader in Kermit, that leadership is quiet and is not based on titles. It’s based on respect for how he handles situations and the relationship capital he has built. Miss Piggy may run wild, but always pulls back just in time because of her respect and love for him. Mr Girlymicro is very much a Kermit like personality, and it’s one of the many reasons why being married to him makes me a better person. He knows when to call me on my shit, and I respect him enough to hear it.

Living in the moment

I’m a planner. I have a ten year plan. I have a plan for the next 10 minutes. All of that planning can mean that I lose sight of the now. I can struggle to ever truly be in the moment. I love the fact that no matter the chaos that features in a Muppet episode, they can come together in the moment to experience the true joy of achieving a goal or being in each others company. They are aware of the challenges that the future holds, but are able to still live in the moment and enjoy the now. Be that for a musical number, or to cheer each other on. It is so easy to let the now pass whilst aiming for a better future, when really there is a lot to be said for enjoying the moment that you are in.

Appreciation of the good things

Living in the moment brings me onto appreciating the good things. One of my very early experiences as the UK Ambassador for the Society of Healthcare Epidemiology of America was to attend a conference held in, of all places, the Contemporary Hotel at Disney World in Florida. I’d never been to Disney before. In fact I’d never considered going, but I was paid to go and that meant I could also take Mr Girlymicro, and Mel (my science work wife).

It happened to be Star Wars weekend, and I had a whole day where I could explore and make memories with people who mean a lot to me. In those days a mock up of The Muppet Theatre was there, along with The Muppet courtyard. The three of us made some wonderful memories, and had so much fun. That ride is no longer there, and there has not been another conference held there. If I hadn’t decided to try something I’d never done before I would never have become the Disney fan I am today. If I hadn’t been on that ride and to that place, I would never have had the opportunity, as I’ve not been back to Florida and The Muppet Theatre closed last year. The Muppets embrace all there is in life, and sometimes I have to remind myself to do the same.

Give permission to feel

One of the other things that I love about The Muppets is that they express all of the emotions. Miss Piggy expresses both love and rage. Kermit exhibits leadership and frustration. Fozzy expresses bravery and self doubt. None of them are perfect, nor do they try to be. They have songs about joy, but they also have songs about heartbreak and sorrow, and don’t try to hide from either. They travel the gamut of human emotions and don’t try to claim that one is more valuable than another. I think sometimes it is important to be reminded that it is OK to not be OK. We can’t have it together all the time. Occasionally it is alright to sit on your lily pad in a state of ennui, as long as you also know that at some point you have to get up, dust yourself off, and get back in the fight.

Embrace complexity

Born out of that acceptance that all emotions matter, or maybe because of it, is the fact that The Muppets accept and demonstrate complexity. Miss Piggy is a strong independent pig who still loves a frog with all of her heart. Kermit has a quiet confidence that emanates, but is still easily overwhelmed and loses that central calm. They show that none of us is just one thing, nor should we aim to be.

I may be the person who has published >40 scientific papers, but I’m also the person who got locked in her own bedroom recently as she couldn’t get the door nob to turn. Competence in one area does not equal competence in another. I can be someone who loves reading about the history of the Silk Road, and also someone who enjoys watching Below Decks or Love is Blind. No person is all good, or all bad, and this is especially important to remember in a leadership context. There may be people that we don’t understand how they think, or their processes, but that doesn’t make them bad it people, it just makes them different, and we should embrace that difference as variety makes the whole better.

Fearless in response to challenge

Every Muppet episode or film is always centred around challenge, there would probably not be much plot otherwise. The challenge is often insurmountable, or at least incredibly intimidating. There’s a reason they will all need to come together to overcome it. The amazing thing, to me, is that they never waste a lot of time bemoaning the challenge, they just get on with it. They don’t ever really consider what will happen if they don’t succeed. They don’t waste energy on fear or overwhelm. As someone who wastes a LOT of energy in catastrophising, and in fearing failure, I really do think this is an area where I need to be more Muppet. They have such faith in each other to carry them through, even when they lose faith in themselves. Being a little more task rather than ‘what if’ focused would certainly help me.

Refuse to be defined by others

One of the reasons The Muppets weather any storm is that they know who they are and don’t let others define them. It is so easy to be a passive passenger in our own lives. Humanity works based on silo’s and putting each other in boxes, and it is sometimes easy to go along with those definitions that used by others for us. One of the things this blog has gifted me, is that I feel much more comfortable defining myself and my own narrative than I did for the first decade of my career. Finding your voice may not be the easiest process, but it one that is worth investing in as early as you can. Define yourself so that others have a harder time doing so on your behalf.

Defy convention

When we let others define us, we also let them limit us. The Muppets defy convention. They say that you can be anything you want to be. The Muppet Babies encourages you to dream. The Muppet Christmas Carol encourages you to be kind and to value things outside of the conventional, and a Muppet Treasure Island tells you it’s OK to be a pirate. All joking aside, Miss Piggy shows that ambition is not a dirty word. Why not dream of being a pop star? Why not aim to win an Academy Award? Why not dream bigger than we’ve been told we are allowed, rather than believing being told to think small. Aspirations are not a bad thing. Miss Piggy works hard towards her dreams, even if they never fully happen. It shows us that it is the journey rather than the gateway or the destination that is most important. Judging ourselves on what we learn rather than attaining tick boxes is something that we could all benefit from embracing.

Anyone can be a scientist

Finally, I wouldn’t be me if I didn’t mention how much joy Bunsen and Beaker bring me. No, I don’t ever want to work in their lab. No, I’m not sure they comply with any health and safety guidance ever written. They do however completely change how people normally see scientists. They are not distant. They are not ‘other’, other than being puppets. They have joy in their work. Things go wrong, regularly, and yet they are always there the next week trying something new. They embody the joy of exploration, well at least Bunsen does, I think Beaker probably needs some time off to recover. In a world where science is either vilified or portrayed as being undertaken by people so intellectual we can’t envisage knowing them, The Muppets still being me joy by offering a grounded view of the joyful chaos that being a scientist can bring.

The truth of it all, even if we learn nothing else from them, is that The Muppets tell us that if you are doing what you love everything will find a way to being OK.

As for Miss Piggy, I salute you! Let me know how I can be as stylish as you!

All opinions in this blog are my own

More Than a Piece of History, a Lot About Impact: Why I became a Liveryman of the Worshipful Company of Plumbers

girlymicro General, Leadership , , , , ,

The start of 2026 has me thinking a lot about perceptions of women in science, and after my dive into women in the workplace and the importance of female visibility last week, I thought I would write something on a related topic, both in terms of London history and in terms of relatively recent changes to reflect the diversity of the city in which it is based. So today I’m talking about how I became a member of the Worshipful Company of Plumbers, what Worshipful Companies are, why they still matter, and why I decided to become involved. It felt timely to write this off the back of the one about the Lady Mayor’s parade, as it is the Worshipful Companies that elect the Lord/Lady Mayor and so it may also help you enjoy that post more.

Lead WITH Us: Why making history is important, and not just about walking in a parade

What are the Worshipful Companies?

To start, a little bit of history…

There are 113 Livery Companies as of 2026. The term livery originated in the designed form of dress worn by retainers of a nobleman and then by extension to special dress to denote status of belonging to a trade. They are unique to London and began to be established in the 12th century as a way to guarantee that those who members hired were qualified and the goods they produced were reputable. Not only this however, being a Liveryman offered protection and had added benefits, such as the right to trade within the City of London, now commonly described as the Square Mile, an area of central London around Chancery Lane. The reason that Livery Companies are also known as Worshipful Companies, is because early companies also had religious ties, with a chosen Patron Saint and association with a local church/monastery.

Due to the reason for their creation, most of the Ancient Livery Companies are associated with specific crafts, and were formed from ‘mysteries’ or fellowships of craftsmen. For this reason they also had a role in training, where they oversaw the progression of pathways from apprentice to master craftsman. They also always had a charitable arm, where they cared for members in sickness and old age by providing alms (money, food, clothing, or other necessities given as charity to people in poverty or need, often considered a religious or moral duty).

Ancient Livery Companies continued to be established until the 17th century (1848) when a combination of civil war and growth of trade outside of the Square Mile meant creation of new companies became less viable. A number of companies have been created subsequent to 1926. The term used for these newer Livery Companies is Modern Companies, and their precedence starts with the Worshipful Company of Master Mariners (granted Livery in 1932). The newest Livery Company is the Worshipful Company of Communicators, and was granted livery status in March 2025 making it the 113th City livery company in order of precedence.

The Great Twelve Livery Companies

The Great Twelve Livery Companies were the ones that were considered the most prestigious, ancient, and historically wealthy trade guilds in the City of London, when they were ranked by the Mayor of London in 1515. At that time there were 48 companies and ranking was mostly based on both levels of wealth and level of influence.

The Great Twelve in Order of Precedence:

  1. Worshipful Company of Mercers: General merchants established 1394.
  2. Worshipful Company of Grocers: Originally spice/pepper merchants 1345.
  3. Worshipful Company of Drapers: Wool and cloth merchants 1361.
  4. Worshipful Company of Fishmongers: One of the oldest, dating to 1272.
  5. Worshipful Company of Goldsmiths: Bullion dealer, Regulates gold/silver (hallmarking) 1327.
  6. Worshipful Company of Skinners: Fur traders 1327.
  7. Worshipful Company of Merchant Taylors: Tailors 1327.
  8. Worshipful Company of Haberdashers: Dealers in small wares and fabrics. 1448
  9. Worshipful Company of Salters: Originally traders in salt/chemicals 1394.
  10. Worshipful Company of Ironmongers: Originally iron dealers 1463.
  11. Worshipful Company of Vintners: Wine merchants 1164.
  12. Worshipful Company of Clothworkers: Originally finishers of cloth 1528.

One of the most interesting things about the order of precedence of the Great Twelve, is that numbers 6 and 7 alternate each year. Both the Worshipful Company of Skinners and the Worshipful Company of Merchant Taylors were incorporated in the same year (1327) and grew to be among the most powerful “Great Twelve” guilds. This led to intense rivalry over which should be ranked higher in civic processions and violence broke out in 1484 during the Lord Mayor’s river procession. In order to resolve the dispute, the Lord Mayor (Lord Mayor Robert Billesden) who was a Haberdasher, settled the dispute by requiring that the companies alternate their positions each year, traditionally at Easter. This is supposed to be where the term ‘at sixes and sevens’ originates.

History of the Livery Companies and the Royal Family

The British Royal Family maintains close, historical ties with the Worshipful Companies, with many members serving as Royal Patrons, Liverymen, or Honorary Freemen of these ancient trade guilds. These, often ceremonial, relationships involve Royal charters of incorporation, attendance at banquets, and support for the City of London’s philanthropic and civic initiatives. The relationship between the Liveries and the Royal Family date back to their creation and were an important component of the the Crown interacted with craftsman at the time.

Worshipful Companies with Royal Family Members:

  • Worshipful Company of Shipwrights: King Charles III is the Patron, succeeding the late Queen Elizabeth II in 2024. The Permanent Mastership is also merged with the Crown.
  • Worshipful Company of Brewers: King Charles III is a Liveryman of this company.
  • Worshipful Company of Butchers: The Princess Royal (Princess Anne) is a Past Master.
  • Worshipful Company of Carmen: The Princess Royal is also a Past Master of this transportation-focused guild.
  • Worshipful Company of Saddlers: The Princess Royal holds the unique status of Yeoman.
  • Worshipful Company of Fan Makers: Queen Camilla was clothed as an Honorary Liveryman in 2024.
  • Worshipful Company of Basketmakers: The Duchess of Gloucester serves as an Honorary Liveryman.
  • Worshipful Company of Coachmakers and Coach Harness Makers: The Duchess of Kent is a Liveryman. Historically, this company has included the late Duke of Edinburgh (Prince Philip) and Prince Michael of Kent as Royal Liverymen.
  • Worshipful Company of Drapers: This company has a long history of royal members, including King George VI and King William III.
  • Worshipful Company of Mercers: Liverymen include various members of the royal family, continuing the tradition of the company that ranks first in the order of precedence.
  • Worshipful Company of Master Mariners: King Charles III is the Patron, and the late Duke of Edinburgh served as Admiral and Past Master.

Her Majesty The Queen (formerly HRH The Duchess of Cornwall) was admitted to the Worshipful Company of Plumbers on 26th January 2017.

Worshipful Company of Plumbers

As I said, there are a total of (as of 2026) 113 Worshipful Companies within London, with the Worshipful Company of Plumbers sitting at number 31 in the order of precedence. For interest to see the scope of crafts included, here is the list of the 48 Ancient Livery Companies by Precedence. excluding the Great Twelve:

  • 13 Dyers
  • 14 Brewers
  • 15 Leathersellers
  • 16 Pewterers
  • 17 Barbers
  • 18 Cutlers
  • 19 Bakers
  • 20 Wax Chandlers
  • 21 Tallow Chandlers
  • 22 Armourers and Brasiers
  • 23 Girdlers
  • 24 Butchers
  • 25 Saddlers
  • 26 Carpenters
  • 27 Cordwainers
  • 28 Painter-Stainers
  • 29 Curriers
  • 30 Masons
  • 31 Plumbers
  • 32 Innholders
  • 33 Founders
  • 34 Poulters
  • 35 Cooks
  • 36 Coopers
  • 37 Tylers and Bricklayers
  • 38 Bowyers
  • 39 Fletchers
  • 40 Blacksmiths
  • 41 Joiners & Ceilers
  • 42 Weavers
  • 43 Woolmen
  • 44 Scriveners
  • 45 Fruiterers
  • 46 Plaisterers
  • 47 Stationers and Newspaper Makers
  • 48 Broderers

The company was formed in 1365 in order to regulate plumbers in London and to ensure the quality of the crafting linked to cisterns and sanitation in order to support public health. It was subsequently granted a royal charter in 1611. As well as ensuring quality by providing oversight, and by punishing poor work and ‘unruly behaviour’, it also had an educational role in overseeing the 7 year term of apprentices.

As it is Worshipful Company, it is associated with St Michael as its patron Saint and the St Magus the Martyr church. It retains a focus on charity and education. There are five major committees that form the work of the company: Education & Technical, Finance, Freedom & Livery, Membership, and Social, each chaired by a Court Member

Homepage

Like most Livery Companies, the Plumbers’ Company has a number of different levels of involvement, consisting of:

  1. Freemen – this category recognises that some individuals may not be able to make a full commitment to become a Liveryman when they initially apply. The Freeman membership category limits the functions you can attend, however it gives a good insight into being a full Liveryman and Freeman are encouraged to become a full Liveryman at an appropriate time. Freeman can attend all visits and activities, but not the formal Company functions, unless invited as a guest by a Liveryman. They also cannot vote in the City of London elections.
  2. Liverymen – there are ~three hundred and fifty members of the company, the vast majority of whom are Liverymen. About 70% are connected with the plumbing craft and allied disciplines. The remaining members cover a wide spectrum of interests and professions including engineers, scientists, architects, builders, accountants, lawyers and many others.
  3. Court of Assistants – drawn from within the Livery, it reflects in its membership those disciplines which are needed for the Court to advise and help the Officers of the Company to run its affairs
  4. Officers of the Company – the Master, Upper Warden, and Renter Warden are installed annually in October and serve for one year
  5. Stewards – led by the Senior Steward, they help to ensure the smooth running of functions and organise Company visits. Stewards serve initially for three years, and then either stand-down, or continue on to become Senior Steward.

Although traditionally London based, a third of Liveryman live over 100 miles from London, and charity work is undertaken globally.

There are a number of routes to admission:

  • Redemption: The most common method for new members, where an application is made followed by an interview.
  • Patrimony: If a parent was a Freeman at the time of the applicant’s birth.
  • Young Entry Scheme: Discounted rates (50% off) for those aged 21–40.

Applying involves being proposed and seconded by existing Liverymen, and potential members must be involved in or connected to the plumbing industry. Applications can be made online via the Company website.

How and why did I get involved?

I have been involved in looking at the role of the built environment in transmission of infection, mainly in healthcare, since before doing my PhD. In recent years I’ve been actively involved in writing a number of pieces of water based national guidance, as well as running the Environment Network and associate courses. You can see some of the papers that have come out of this work on the publications page. I also get to put some of this theory into practice by being involved in providing guidance about the design and commissioning of new buildings (hence the delightful cover picture :).

Despite working in this area for over two decades I hadn’t really heard of any Worshipful Companies, let alone the plumbers specifically. I had done a few internationally webinars for the Royal Society of Public Health and linked to this I was fortunate enough to be invited to an awards ceremony, where I met Elaine Waggott, who had just become a Liveryman herself. We started talking and she told me about the Worshipful Company of Plumbers, the work they were doing, and their ambition to get more women involved. The company was one of the first to admit women, and there has been an active push to recruit women from a variety of backgrounds. Elaine talked about the Women in Livery and Diversity (WILD) team as a determined group of members leading a drive to improve the gender balance and increase diversity in the Company, and across the Livery. As someone who cares deeply about female representation this aspect of the company really resonated. This plus both their charitable and education focus really spoke to me and so I decided to throw my name into the hat.

Stages of involvement

Once I decided to get involved there were a number of stages that I needed to progress through in order to become a Liveryman of the Worshipful Company of Plumbers.

First I needed to apply to be a Freeman, have the support of several Liverymen, and go through an interview process. After which I swore the Oath of the Freemen.

Once I became a Freeman, I then had to apply and be awarded Freedom of the City of London. The Freedom of the City of London is a symbolic honour dating back to 1237, originally granting citizens rights like trading within the City and freedom from feudal service. Today, it is a largely ceremonial title recognizing high achievements, contributions to public life, or association with the City (such as being part of a Worshipful Company), and is granted by the City of London Corporation to nearly 2,000 people annually.

This was such fun, the ceremony felt really meaningful, and Mr Girlymicro and I even got to hang out with Florrie the sheep. Recipients are often humorously cited as having the right to drive sheep across London Bridge, carry a sword in public, or be “drunk and disorderly” with safe passage home. The main thing is that being granted Freedom of the City of London is a requirement before being accepted as a Liveryman for a Worshipful Company.

The Freedom process involves completing paper work that is included in the National Archives, as well as agreeing to follow a set of rules of conduct. Both of which give it a very historic feel.

Once all of the prior stages are completed you can then be invested as a Liveryman of the Worshipful Company of Plumbers.

Women in the Livery

By 2020, all City Livery Companies and guilds opened their membership to women on equal terms with men, you read that right, 2020.

Like many surprising parts of the history of women at work I discovered as part of my Lady Mayor’s post, the first female Master was not elected until 1983 (Sylvia Tutt, Chartered Secretaries & Administrators). It feels like the 80’s were the beginning of a watershed change. Another milestone was passed around 2015 when the association of Female Past Masters achieved 100 members – significant because progression to Master often takes 20 years in a Livery Company (irrespective of gender), so these women started their journey to the chair of their respective companies well before the topic of gender inclusivity among the Livery Companies was widely understood or recognised.

There have been three female Masters in the history of the Worshipful Company of Plumbers in the 650 years since its charter. The first of which came into place in 2015:

  • Erica Stary (2015–2016): The first woman to serve as Master of the Company
  • Dame Fiona Woolf (2018–2019): The second female Master; she also served as the second female Lord Mayor of the City of London
  • Sandra Raine (2025–2026): The current Master of the Company

Additionally, Janet Rivers is presently serving as the Upper Warden for the 2025–2026 term, and so is a candidate for election as the next Master,. Every woman makes it easier for the one to follow. As with the Lady Mayor, progress is happening, but the fact that much of this change has happened in the last decade just goes to show both how recent this change in approach has been, and also how far we have left to go.

So why does any of this matter?

Institutions that go back, and are as part of the cultural structure of places like London matter. They matter because they have influence. They matter because they have the capacity to drive change. As organisations with such history are often the slowest to change, the fact that change is now occurring is significant. These groups are involved in electing roles, such as the Lady Mayor, they have the capacity to drive inclusion via their education and charitable work, and they lend legitimacy to wider changes in attitude and position. Being visible matters, being accepted matters. Being both of those things in an organisation that has established links to other established institutions, such as the Royal Family, can only help to move dialogue forward.

I am probably not your typical member. I don’t have a private school education. I am not associated with the armed forces. I am not a lawyer. Yet I have been welcomed. I have been especially welcomed by Sandra Raine both before and now she is Master, who has taken such a lot of time to help me network, to include me, to help me feel like I fit in. There is a lot we can learn from the mentorship and support offered. Having Liverymen who do not fit the mold is important. Changing perceptions of what a Liveryman looks like is key to ensure that the company continues to support the workforce as it looks like now, and that it’s charity and education work remain fit for purpose.

It is easy to think that these types of organisation are not for us. To think of them as part of an establishment that doesn’t have room for someone who looks different, or who comes from a different place. There are however people working actively, passionately, to change the trajectory, whilst still maintaining the history and values that drove the organisation to exist. I for one count myself lucky to have met some of those individuals, and hope to build on the legacy they are putting in place.

All opinions in this blog are my own

Lead WITH Us: Why making history is important, and not just about walking in a parade

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On 8 November 2025, 200 women from across the worlds of tech and health walked together in the Lady Mayor’s Show answering Dame Susan Langley’s 697 call for change. They formed part of 697 women walking to support the historic shift that Dame Susan is introducing as the 697th Lord Mayor of London.

This post was just going to be about the privilege of being involved in walking in such an amazing historic event, but then an article was published by the New York Times on the 6th November which both changed what I wanted to say, the context of why I think the walk was important, and also required a few weeks of calm reflection before I felt I was ready to write it.

The article was called “Did Women Ruin the Workplace? And if So, Can Conservative Feminism Fix It?” Needless to say it garnered quite the response on social media and across the internet:

If you, like me, don’t have a New York Times subscription, this article summarises it pretty well: https://www.glamourmagazine.co.uk/article/conservative-feminism-new-york-times

Reading and processing my response to both the article and the coverage led me down a number of rabbit holes, both about the history of women in the work place, and women’s right to equality linked to both work and the money acquired as a consequence of that work. Some of which shocked me.

History is important, as it leads us to the present. It also means that we acknowledge the fight it took to get to our current ‘normal’ and prepares us for the role we need to play to make the changes for those that will follow. So, before I talk about how this ties into the Lady Mayor of London and the Lead WITH Us movement, I thought it was important context to share.

Why does having women in the workplace matter?

Access for women to work has not been an easy path, many women had to stand up, be seen, and be counted in order for progress to occur. In my mind, most of this change happened when Queen Victoria was on the thrown, but that assumption was far from correct. Here are some key points of that history:

  • Elizabeth Garrett Anderson was the first female doctor allowed to train and become legally qualified in 1865, no British hospital would accept her qualifications however and so she studied in Paris to gain her formal degree and was eventually admitted to the British Medical Register in 1870. She then worked to bring in the Medical Act of 1876 to formally open the medical profession to women, and co-founded the London School of Medicine for Women which now forms part of UCL
  • The first female MPs were permitted following the Parliament Qualification of Women Act in 1918. The first woman elected was Constance Markievicz, but she didn’t actually take her seat. The first woman to actually sit as an MP was Nancy Astor. Despite this, women could not sit within the House of Lords until after the Life Peerages Act 1958 that permitted Baroness Swanborough, Lady Reading and Baroness Wooten to take their seats
  • Women were not allowed to serve as magistrates or on juries until 1919. Even when the law changed however, juries remained predominantly male for another 40 years. The same act permitted women the right to undertake professional careers, such accountant, or vet, but women did not have protection for the income they earned until much later
  • Women were not allowed into ground combat roles in the UK military until 2016, with the RAF opening up roles in 2017, and the wider military 2018. Women had served in combat prior to this, but were banned from serving in front line military units

Unless you have women in the rooms where decisions are made the voices of women will never truly be heard. This is why the role of women in the workplace is so key. Much of the change that has occurred has been incremental, as it was only when women made it into positions where they could influence change, that that change occurred for the wider population. Even when laws change, culture change takes longer, and so embedded change requires conscious effort for decades after the first shift occurs. We have all seen recently how quickly rights can disappear that had been considered to be part of day to day life, and so there is a continuing need to not take rights that were hard earned for granted.

Why is women working important for both them and society?

Access to work supports both financial and societal freedom, supporting autonomy and decision making. When looking into the history of how work placed change impacted on financial autonomy I was pretty shocked by the fact that the timeline for some of these changes occurred within my lifetime.

  • The first petition for women’s suffrage in parliament was in 1867, but it wasn’t until Parliament Qualification of Women Act of 1918 (the same act that permitted female MPs) that eligible women were granted the right to vote. It wasn’t until 1928 that the Equal Franchise Act passed that gave women equal voting rights to men, making 15 million women eligible to vote
  • The Married Women’s Property act passed within the UK in 1870, which allowed women to become the legal owners of any money they earned. Women could not however inherit property on the same terms as men until 1922, when a property act change meant that that a husband and wife could inherit each others property. Prior to this, women had to give up all rights to their property when they married
  • Women had no legal right to equal pay until the 1970 Equal Pay act which came into being after 850 female workers went on strike at Ford Motor factory in Dagenham. Even so this allowed men to be paid no more than 15% more than women. The Equal Pay amendment act (1983) allowed women to be the paid the same as men for equal work – the pay gap however remains ~15%
  • It took until 1975 for women to be allowed bank accounts in their own names with no counter signatories (when the sex discrimination act came into law). Before then, although no law forbade women from having their own accounts, but many banks and financial institutions still required a male guarantor to open accounts, access credit, or get a mortgage
  • It was not until 1982 that the law changed to mean it was illegal to refuse to serve a woman a drink if she was unaccompanied by a man
  • Statutory maternity introduced in 1987 permitted eligible women to have 6 weeks leave at 90% of their usual earning. This wasn’t expanded to all working women until 1993 as a result of a European directive

It is no coincidence that the right of women to work in professional spaces changed alongside the right of women to have representation and the right to vote. Change often comes with privilege, and not everyone benefits from the changes initially, this can be seen in some of the step wise changes above. It is beholden on those who have access via that privilege to continue the work to ensure that access is widened and available to all, rather than a select few.

What’s the Lady Mayor’s Show and how does this tie in?

The role of Lord Mayor of London has been in place since 1189 when Henry Fitz-Ailwyn first took it up, although the holder wasn’t referred to by the title of Lord Mayor until 1354. Since then there have been 697 Lord Mayors, of which only three have been female.

The first two were:

  • Dame Mary Donaldson, in 1983, who famously fined people for referring to her as Lady Mayoress
  • Dame Fiona Woolf, in 2013, who focused on trying to promote women into senior roles within the City of London

The role of Lord Mayor, these days, changes annually and is based upon an annual election held by the Liverymen (more on that in a separate post to come) who are members of the City of London’s Livery Companies. The process involves Aldermen presenting two candidates, followed by a vote by Liverymen to select the new Lord Mayor, who then serves a one-year term as an ambassador for UK financial services. Only sitting Aldermen are eligible for election, and so even to even be in a position to be nominated is a feat within itself, especially when many Livery Companies are still male dominated. In 2025, Dame Susan Langley was elected at the third ever female Lord Mayor.

It took until my lifetime to have a woman serve as Lord Mayor, and until 2025 to have a Lord Mayor who was happy to represent female visibility enough to call herself Lady Mayor, and set out to embrace difference in order to increase visibility and impact. The parallels between this change and some of those linked to female autonomy and role acceptance have not been lost on me. This change was celebrated as part of the annual parade at the start of the Lord Mayors term, when the parade was renamed the Lady Mayor’s Show.

As part of the principles of her term Dame Susan has focused on something called the “697 call for change” which refers to the fact that she is the 697th person to hold the office of Lord Mayor of the City of London, and the first to use the title “Lady Mayor”. This call includes:

  • Adopting the Title “Lady Mayor”: While she is the third woman to hold the post, she is the first to be officially known by the title of “Lady Mayor”. This decision reflects a commitment to modernising the role and promoting diversity and inclusion within the City’s traditionally male-dominated institutions.
  • The “Lady Mayor’s Show”: In another historic first, the traditional Lord Mayor’s Show was renamed the “Lady Mayor’s Show” for her procession in November 2025.
  • Inclusion in the Parade: The show included 697 women from various City sectors walking in the parade with her, symbolically representing her position as the 697th holder of the office and highlighting women’s roles in the City.
  • “Modern Mayoralty” Initiative: Dame Susan is committed to introducing a “Modern Mayoralty” initiative, a long-term vision to ensure the role’s ongoing relevance and to “un-square the Square Mile” by championing innovation, prosperity, and inclusion. 

Having talked about historically why having women visible and in positions of influence matters to supporting changes and improvement for women more widely, the shift to clearly embracing diversity and incorporating female visibility, feels like an important declaration. It should not be a news worthy moment to include reference to Lady rather than Lord within a title, but it is indicative of a wider agenda which is significant for a role that has existed for 836 years.

Why does it matter?

We may say, well why does this matter? I certainly don’t face the same barriers as a woman of my grandmothers generation, or even those that impacted my mother. I have never been stopped from having a bank account, no one has ever stopped me having a drink in a pub. Those barriers were present in my lifetime however, and just because they are gone does not mean that other barriers do not exist. Within STEM (science, technology, engineering and maths) careers women are still under represented at senior levels, with women making up only 28% of the overall workforce in 2024. Women are still on average paid ~15% less than colleagues for the same job, and so the pay gap is certainly still present and there is still work to do.

Even in my career I have encountered numerous incidents where being a woman was included as part of a value judgement of my career trajectory, including a male colleague congratulating me when they discovered I couldn’t have children as it meant that ‘they could continue to invest in my career’ as I wasn’t going to disappear off and have children. There have been decades of my career where I was utilised to write grants and other work for my male professors, and my name was never included. Some of this is earning your way, but I am aware that there was a definite difference between how some of their male students were treated in comparison. This isn’t whinging, I found my own way. I learnt lessons. I also had the privileged (if you can call it that) to not be managing a family or caring issues which would have meant that life was harder.

This attainment difference due to lack of recognition in science linked to gender is so common that it even has a name, the Matilda Effect. This makes it even more important that women are represented at senior positions within science and tech, not just to show that it is possible, but also to change the dynamics so that some of the embedded cultural norms are subject to change.

Why did I think it was important to walk?


All of this brings me onto why I believed it was it important to walk as part of the 200 women representing science and technology. As the wonderful guys at Lead WITH Us state:

‘This isn’t just a float. It’s a signal. A collective act of visibility. 200 women. One shared purpose. Infinite possibility. A reminder that leadership takes many forms and that women are already leading, shaping, coding, building, healing, innovating, and challenging systems in ways that often go unseen.’

That was the reason that I chose to walk, but the experience was so much more than I had predicted. We walked for 3 miles along a route that was lined with people of all ages, backgrounds, and reasons for being there. The smiles of the children we encountered, the number of high fives requested and given. Walking as a group of women in science and tech, flying my geek flag proudly, being surrounded by a wonderful group of women who shared a goal and were there to support each other. Role modelling leadership in action. Hearing the cheers and feeling the welcome was an amazing reminder of the difference that science makes and how much it is appreciated.

Representation matters

The other great thing about walking with this group of women, was that the group itself was as diverse as those who lined the streets. People brought their parents, sisters, children, friends. I even brought Mr Girlymicro to help with tech and take some photos.

We come from different disciplines and backgrounds:
Some of us are Healthcare Scientist, Allied Health Professionals, nurses and clinicians working in the NHS.
Some are immersed in data and code.
Some lead strategy or drive system change.
Others are disrupting the infrastructure across delivery and design.
And some are just starting out but already creating waves.


We were walking to be visible, but more than that we were walking so others can re-imagine the future. We walked standing on the shoulder of giants who came before. Those who created a momentum. A momentum we want to continue. So much of what we do builds upon the work of those who came before.

There is still change that needs to be made. Representation still needs to be improved so that it leads to real change and that the barriers faced by those that come after us are different again from the ones that we are overcoming.

What will the legacy be?

Plenty of work will be ongoing in 2026 during this one year term and it is well worth keeping an eye on the City of London website. More than that though, there is a real hope that the 697 will become a movement and a legacy of this year. Certainly the 200 of us who walked are still linking in and a community is forming. From Whatsapp groups to a LinkedIn page, spaces are being made where we support each other, share successes, and form connections that will help everyone in their roles and ambitions. If you know a woman in Tech or Health who’s made a difference in your life or career, or if you would like to be involved yourself, then follow the links and get involved. Change can happen, but it happens best and last longest when we make it together.

All opinions in this blog are my own

Looking Back and Looking Forward: A Girlymicro 2025 year in review and looking forward to 2026

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This week is the first ‘return to normal’ back at work week for many people, and the reality can hit hard. I’ve been reading articles about how to get over this particular speed bump, mostly because they are everywhere you look right now. Many of them talk about how important reflection is to re-centre yourself and adjust to the change of pace.

Now, I haven’t been off in quite the same way as many but doing a bit of reflection to process 2025 and set up 2026 seemed like not a bad way to manage some of my thoughts that I hadn’t made time to investigate in the chaotic world of the Christmas build up. Doing a bit of mental spring cleaning felt timely. So, in case it helps, I thought I would share the questions I asked to structure my thinking, as well as the answers in case you fancy doing something similar as a way to enter 2026 in a positive mindset.

One thing I’ve learnt

I wrote last week about my journey redefining who I am post pandemic. The thing that triggered this, that maybe everyone but me already knew, is that redefining identify requires work.

Roll on 2026: Being intentional about finding my way back to my full authentic self

The need for redefinition to be an active process that requires purpose, energy and focus, was something I just hadn’t realised. I’d been waiting for it to ‘just happen’, for me to snap back into my pre-pandemic self like some kind of human rubber band. I think I’ve spent some time quietly baffled about the fact that wasn’t happening and questioning how long it would take. After all, as teenagers we don’t define ourselves with purpose, we try on identities like clothes, and finally one sticks.

The same does not seem to be true as a woman in your 40s. In hindsight, having had this revelation, I am glad for the requirement to be purposeful about getting back to the new me, rather than defaulting to the old.

The thing I’m proudest of this year

This year I really feel I rolled the dice on myself. I put something out there which made me both visible and vulnerable, without any idea of how it would be received. I had an idea. I committed. I took that idea and made it into a reality I could hold in my hands. I wrote a book that went out into the world, where I gave up all control of how it would be received, and how those who read it might view me.

The book is called ‘It Shouldn’t Happen to a PhD Student‘ and it is very deliberately not the kind of academic book I have been previously involved in writing. Much to the horror of some of my academic colleagues it is not referenced. It is a practical guide to your PhD journey, everything from what you need to take to your first conference if you are presenting a poster, to how to build confidence in public speaking. It also contains a lot of me, acknowledgement of how I got things wrong in my own PhD and supervisory experience, as well as the things that went well.

I’m so proud of myself for taking the risk. I’m proud of myself for taking some of the commentary in my stride. I’m proud of myself for trying to make a difference, so that others have a better experience when they are taking on a new challenge.

I’m also grateful to everyone who has stood with me, shared, brought, and supported me. It’s when you put yourself in a vulnerable position and see everyone come out to cheer lead that you are reminded of quite how fortunate you are in life.

Something I am still working on

One thing that I am still making very slow progress at, and requires conscious effort, is managing the need for external recognition in order to feel validated. Sometimes, I think that I am something of a Golden Retriever, with a love of people tapping me on the head and telling me I’ve done a good job. In my defense it be because positive reinforcement is not exactly a feature in my day job, I am, after all, often the bearer of bad news, but as a people pleaser this lack of acknowledgement can make it hard to feel safe and heard.

This lack of positive feedback/reinforcement is also a feature of seniority. As you move up the ladder competence is assumed. No one is going to say well done just for doing your job. There is a need to go above and beyond in order to gain that recognition. A lot of my above and beyond is linked to our wider community, and therefore pretty invisible to my day job, or not considered relevant. It’s not a surprise therefore that it doesn’t feature. Building on my own internal capacity for reflection and acceptance is an important way to manage my people pleasing tendencies. I suspect I need to be less dog and more cat, in terms of independence, moving forward in my working life.

A reflective tool to structure my 2026 learning

Towards the end of 2025 I found this reflection tool online which I have found quite useful as a way of entering 2026. Leadership can be a lonely space, and having a structured way to process and explore events that arise can be really beneficial, both for well being, but also for learning.

A lot of the ways I want to approach 2026 are linked to being more targeted and defined in terms of the impact I want to make. I have been fortunate to have this amazing community support me and let me grow, and now I want to think about moving it forward, rather than just drifting and responding. Understanding challenges and moments that I could improve is the first step, alongside reflection on what fulfills me and brings me joy, in making sure that I move forward with purpose. Challenge and conflict are not dirty words in the Girlymicro world, they are opportunities for growth, even if living those moments brings discomfort. Rather than denying they have happened, I would rather be a better person, scientist, and leader as a result.

Three words to carry me forward

The inspiring Tara Birch made this post on LinkedIn before Christmas and it really resonated with me. I knew that I didn’t want to make a standard January post, but instead make some promises to myself, using words which will help keep me on track linked to my aims, values, and passions.

My words for 2026 are Creative. Brave. Redefined.

Creative – as I want to still be writing, writing blogs here, writing to support others, and writing for another project. Science is also a creative endeavour, and it can be hard to be truly creative when tired or overwhelmed. I’m putting things in place to ensure that I can flex my science muscles and re-fill that particular creative cup to allow 2026 to be a launch pad for new scientific projects

Brave – because I want to continue to speak and be heard, whether the message I have is digestible to others or not. Being visible will always come with critics and commentary. Despite the challenges of that I want to maintain being brave enough to stand up and be counted, and hopefully walk even a little taller when owning my space

Re-defined – it is all too easy to let other define us, or for others to speak their truth and get swept up in it. It is also easy to lose sight of who we are in the rapid, challenging, and responsive world we live in. To drift rather than standing firm and looking inside because we are too scared to see ourselves for all we are. I both love and have hope for myself, and I am surrounded by people who see me for all I am and love me anyway. In 2026 I want to use these positive motivations to ensure I can continue to move forward, growing into my future self, rather than a 2019 echo

https://www.linkedin.com/posts/thetarabirch_i-ditched-new-years-resolutions-years-ago-activity-7408770886821941248-xtEg?utm_source=share&utm_medium=member_android&rcm=ACoAAAZjGL0B8K0ce1stGHZAPTgt9H7tGgWKQ8s

One aspiration to keep me focused

The NHS, the world, and science in general, is going through a difficult time right now, so I’ve been thinking what it is that I can do about it. It is easy to feel powerless, but I really do believe we have more power than we acknowledge.

Large scale systematic change is happening all around us, which can be unsettling, and lead to destabilisation of how we feel, as well as the system we sit within. Even if we are not directly impacted, we see how this impacts friends, colleagues, and family. It can make us want to keep our heads down and just keep going. The thing about this kind of change however, is that it is also an opportunity. If we are brave enough the system itself can emerged changed, but hopefully better. If we don’t engage however, the change will lead to the new system looking surprising similar to the old system, and a lot of the discomfort experienced will therefore have had limited value. This is the time, no matter how it feels, to engage rather than withdraw if you can face it, to make all of the disruption worth while.

The rise of science denialism is also everywhere I look. For instance, the impact of the US administration on organisations I’ve liaised with all of my working life, such as the CDC, have made it very clear that none of us can stand by and not challenge this type of commentary when we encounter it. When I say ‘challenge’ I mean it in the sense of questioning, trying to understand drivers, and building of bridges, rather than trolling people on the internet or engaging in insult slinging. I’m talking about getting out there and sharing evidence, and tackling mis-information when it comes in front of you. I acknowledge that there can be a lot of ‘why me’ and ‘surely someone else can do it’. People who are paid science communicators. People who have more time. People who have more strategic power. I feel you, and I’m not saying we should take this on like it’s our full time roll. The thing is, science deniers often have high visibility. They are easy to find. It is often not so easy to find a friendly scientist who will provide the counter position. So this year I will try to be more visible, to be the science ‘phone a friend’ for people who find it helpful. Most of all I will not make myself small for the comfort of others, especially for those who wish there was less diversity in science. Now is the time to stand up and be seen.

A manifestation to work towards

So………I mentioned I had my first book come out in 2025, and despite the fact that it may have been madness to commit to getting a book out in 4 months I’ve rather caught the bug. I have plans to have another book out early October, launching before Halloween. It’s called ‘Don’t Open that Door: A microbiologists’ guide to infection in movies and TV’.

It contains a whole lot of chapters on infection prevention and control, alongside 23 chapters based on a different films or TV series where infection is key to the core theme of the work, split into sections on viruses, fungi, parasites, and bacteria (and other causes). Most of the end of last year was about getting the list of options down from 136 to 23, although I could still do with 2 more fungal examples if any exist, so give me a shout if you have any ideas. It has been so much fun so far, but now the work really begins. I’m really excited about this one, and Mr Girlymicro and I are planning to pick up the mics and also do some podcasting as we go along, so keep an eye out and maybe subscribe to the Girlymicro podcast so you are the first to hear.

A gratitude to end on

One of the things that is always a feature of the Girlymicro community is how grateful I am for all of your support. I feel braver and more creative because I know you all support my endeavours. Everything that I, and this blog, accomplish is because you take the time to read it. In 2026 I am looking for more ways for us to support each other. If you have ideas how please let me know. Whether that is writing me a blog post on something you are passionate about, having a catch up at a conference or event, or that you are starting a new project that you would like support with and you think I can help. Let’s enter 2026 with an ambition to connect and support each other even more than we did in 2026.

For all of you still struggling with the pressure and darkness of January I leave you with this:

All opinions in this blog are my own

Roll on 2026: Being intentional about finding my way back to my full authentic self

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It’s the Sunday between Christmas and New Year. In theory it was supposed to be a chilled out, relaxed and refuelling week off work. Instead, due to no fault of anyone, it’s been a week full of chaos, and disruption linked to illness, house moves and life changes. All of which will fade into memory but for now are quite at the forefront of my thinking. Subsequently this means that I am entering 2026 less rested and more discombobulated than I had hoped, feeling very much like a Gemma Correll picture.

For full disclosure, it’s not just 2026 I have entered this way. It feels like every New Year since 2020 I have become less and less likely to greet it with joy and moved more and more towards greeting it with a timid ‘hi’ from behind the curtains. It feels like we’ve all been bitten once too often by providing an optimistic welcome and seeing the resulting 12 months turn into another year of trial and trauma, whilst our resilience is no longer worth writing home about.

Add to this the ever present commentary on all social media platforms, where my professional and social peers list all of their successes, the languages they’ve learnt, the places they’ve been, and the skills they’ve picked up, whilst I rot with unwashed hair and wallow in exhaustion. Life can start to feel hard or like you’re failing in comparison, all of which can make it feel difficult to roll out the red carpet to another New Year.

In order to centre myself and navigate through the triggering level of self proclaimed positivism out there I thought that this year I would not focus on making a list of New Years resolutions, but reflect on what went well in 2025. The aim of this is not to make life worse for others by screaming about my successes, but to remind us all that progress is more impactful than tick boxing, and that the small things count, some days even more than the big things. Fair warning, this post contains a lot of ‘I’s, as it is about how I see the world. I hope that despite this it may still be useful to you all.

My big aim for 2025 was to try and feel more like the 2019 version of me. Someone who had hobbies, friends, and could even find time to spend with them, as well as family. To feel like a whole person, and not just a professional avatar, so this is the benchmark I shall be measuring 2025 success against.

I spent time with Mr Girlymicro and my wider family

This sounds like a basic thing, but I had gotten into the habit of working every weekend, catching up on emails or catching up on work in general. I began to have a lot of anxiety if I didn’t, in case there was something life/job ending between Friday night and Monday morning. This has been the year that I deliberately faced that anxiety and forced myself to work through it by not reacting to it, and allowing it to drive me to work more. It’s meant that I have had to find coping mechanisms. At the moment they could be healthier as they involve doing work adjacent things, such as book writing, but they have enabled me to step away. I have also been forced to accept that things will happen, but that I can’t work 24/7, and attempting to do so was leaving me in a very unhealthy place.

The payoff for this has been being able to spend more time with my family. Now, some of this is because Mummy Girlymicro and my brother moved in with us (hence the Xmas house moving chaos as they moved out) but a lot of it was me prioritising spending time on non-work. Mr Girlymicro and I have been able to have, at least, protected movie time on a Sunday, and we’ve even managed some date nights. I need more of this in 2026, just spending time together is healing and I can’t wait to spend more and improve on my 2025 efforts.

I managed to finish a non-work based project (Mr Girlymicro would scream work adjacent at this header)

Talking about that work based distraction and anxiety management, I decided to do something for me, based on my passion. Now, I acknowledge that deciding to write a book in 4 months may not be the healthiest of anxiety managing techniques, but it enabled a fire break, where I could focus that anxiety on something productive and was sufficiently distracting to allow a re-focus away from work. It was also nice to be able to visualise something productive coming out of that anxiety, seeing the word count increase little by little. A lot of my day job is responsive or constantly writing and changing written guidance, it can sometimes be hard to see what you’ve achieved at the end of a day, week, month, and so to see a book come together from a concept felt incredibly validating.

(if you haven’t seen the book, take a look at the Girlymicrobiologist book page, or the Amazon webpage for more details)

The other opportunity that writing the book gave me, was that it started, alongside spending time with family, to allow me to form a new identity. I’ve been in work mode for 5 years, and have become so locked in that I almost couldn’t remember the pre-pandemic me. Developing a project that wasn’t directly linked to work allowed me to ask questions like ‘what brings me joy?’ and ‘what message is it that I have to share?’, ‘what can I add?’, ‘what can I do to make the world easier/better?’. This book on a small scale was the answer to those questions. More to follow though, this was a starter for ten.

I acknowledge that I will not return to who I was before

A key part of building a new identity is acknowledging change and letting yourself grieve for your previous one. 2025 was the year that I finally acknowledged that those of us who worked through the pandemic, lost loved ones and colleagues, probably do carry a certain level of trauma with us. I probably don’t see the world the same way now as I did before. The circle of friends that I hold close is much smaller than before, and they have seen all the sides of me. They are the people I trust to always take a 4am call from me. To let me come and crash at their place with 30 minutes notice, just because I need to escape. They are my ride or dies, and I value them so much.

I think I will be sad for the loss of some of the innocence I had before the pandemic, some of the faith and trust in systems. I think I will continue to miss the naivety. I believe I have emerged on the other side better at my job however, and for those I’m close to a better friend. I see the change as an opportunity to re-define who I want to be and where I want to go. It’s hard to know how much of this is truly pandemic, or just hitting peri-menopause and realising I need to be better at setting boundaries. Either way, although I have moments where I reminisce about hopeful past me, I think I am a better person for the journey. I still have hope, it just lands differently.

I spent time focusing on re-connection

Having said that my world had grown fairly small over the past 5 years, and my social circle really limited to those who I knew love all the sides of me, I’m fortunate in my pre-pandemic life to have had a wide circle of lovely people who occupied all kinds of different hobby/interest spaces. All of whom challenged me, cheered me, and helped me grow as a human being. It felt important to saunter back into those spaces, especially as they would be useful in discovering the new me.

I did things that are probably normal for most of you reading. I went out for drinks. I met people for dinner. I even returned to conventions and shared spaces, which have been triggering for me having spent so much time avoiding crowds for the last several years. I remembered that, although these activities and spaces can make me feel anxious at times, the pay off is so very worth it. I’m not sure I will be returning to hosting afternoon tea for 30+ people any time soon, but I’m certainly up for small group activities and have committed to not defaulting to no or an excuse. I also discovered that many lovely people had kept a door open for me to return, and that was a really meaningful thing to discover.

I returned to some pre-pandemic activities

On the back of this re-connection, I also went back to some of the activities that I used to take for granted pre-pandemic. I went to a literary festival, I went to science events, and I even returned to a gaming convention. These events reminded me of how much joy I find in learning, being intellectually curious and exploring. They reminded me of why I became a scientist in the first place, because even when not science related they reminded me of the joy of being inspired by others.

Being at a gaming convention was both so much scarier, and so much more fun than I remembered. It was lovely to take off my head, my identity, my thought processes, and step into those of someone else. I played a modern day police office in the Rivers of London universe, a teenage aristocrat in musketeers France, and a political leader in 1930s Europe. I dealt with murders, magic, and revolution, and not a single virus or infection was in sight. The experience reminded me that it was OK to prioritise both breaks and escapism, and of the benefits they can lead to in terms of reflection and re-fuelling.

I gave myself permission to feel

Speaking of gaming, it’s a great sandbox to explore emotions and feelings in response to stimuli for you character. It’s a safe space and time limited, so anything you dive into can be dropped at any point, and you will move onto a new character in 4 hours anyway. Life isn’t quite like that and exploring emotions, be they positive or negative, can take its toll. In 2025 I specifically gave myself permission to feel. To stop saying ‘I’m fine’ to those close friends and family who I know would be there come what may.

Sometimes the best way forward is through, and I found that being in responsive mode for so long at work had meant I had stopped processing a lot of the emotional side of what had gone on. I’m normally pretty optimistic and I know that things will be fine, but in 2025 I gave myself permission to acknowledge that the route to fine sometimes sucks, and that that is OK. I reminded myself that it’s OK to just acknowledge the moment and have a good weep, before getting it together and moving on.

BTW it appears that Taylor Swift songs are my favourite weeping companions, for both sad and happy tears, according to Spotify in 2025.

I started to try and look forward

Acknowledging that I have work to do in my emotional processing also enabled me to start to look forward, rather than being stuck in a loop. It enabled me to think about what I want, and where I want to be. What fuels me rather than draining me. I am fortunate enough to have the most amazing husband who will always pick me up, dust me off, and put me back together. So these considerations were mostly work related.

I know it’s a shocker, at least it was a surprise to me, but I’m getting older. I turned 46 this year, which is no age, but as I’m planning to retire and explore new directions at 55 that is an ever shrinking time period to make change and have impact. Don’t worry, this blog, my writing, public engagement and microbiology are going nowhere. I still want to work post NHS retirement, but maybe not the 12 hour days that add to my current exhaustion.

A dear colleague passed away just before Christmas and that brought this message home to me even more strongly.  We can often approach all aspects of our lives as if we have all the time in the world. The reality is that that is never true, and a lot less of it is in our control than we believe. So, I’m giving some time to thinking what is on my list to accomplish and trying to make sure that it doesn’t just drift because of competing demands. This is a newer focus, but one that will definitely continue in 2026.

I expended effort in trying to find my joy

This has all sounded a bit bleak but the truth about authenticity is that includes sharing all aspects of the truth. even those that are not full of pep. The reality is not as bleak as all that, by doing this hard work I have been able to find true unadulterated joy in a number of moments in 2025. Joy I haven’t been able to feel for a long time. Joy so strong that it made me cry happy tears. Joy so real it reminded me why it is important to connect and follow your passions.

The move from survival mode into engaging with life has not been an easy one. There is still a lot of work to be done, and space for recovery needed. The joy however reminds me of why all of that work is worth it, and at a time when working within the NHS can feel even more challenging than during the pandemic, that joy is needed. So give yourself the gift of compassion you would give others. Offer yourself the space you need to heal, and then be brave about stepping into the world as the new (possibly wiser) version of you. I hope the rest of 2025 is kind to you, and that you too will be able to find joy as we enter 2026.

All opinions in this blog are my own

If you are finding this time of year difficult, and you are in the UK, here are some contact details that I hope may help. No one should need to struggle on their own:

Merry Christmas One and All

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Scrooge was better than his word. He did it all, and infinitely more; and to Tiny Tim, who did not die, he was a second father. He became as good a friend, as good a master, and as good a man, as the good old city knew, or any other good old city, town, or borough, in the good old world. Some people laughed to see the alteration in him, but he let them laugh, and little heeded them; for he was wise enough to know that nothing ever happened on this globe, for good, at which some people did not have their fill of laughter in the outset; and knowing that such as these would be blind anyway, he thought it quite as well that they should wrinkle up their eyes in grins, as have the malady in less attractive forms. His own heart laughed: and that was quite enough for him.

He had no further intercourse with Spirits, but lived upon the Total Abstinence Principle, ever afterwards; and it was always said of him, that he knew how to keep Christmas well, if any man alive possessed the knowledge. May that be truly said of us, and all of us! And so, as Tiny Tim observed, God bless Us, Every One!

A Christmas Carol by Charles Dickens

Merry Christmas everyone, wishing you all love and laughter and excessive amounts of good cheer!

All opinions in this blog are my own