Creating a COVID-19 risk prediction model
Professor Julia Hippisley-Cox, of the University of Oxford’s Nuffield Department of Primary Care Health Sciences, led the development of a risk assessment tool to identify people at highest risk of serious illness from COVID-19.
The risk prediction model, called QCovid, was developed using anonymised data from more than 8 million adults. The researchers found that there are several health and personal factors which, when combined, could mean someone is at a higher risk from COVID-19. These include characteristics like age, ethnicity and BMI, as well as certain medical conditions and treatments.
NHS Digital has now used this model to develop a population risk assessment. The risk assessment predicts on a population basis whether registered patients with a combination of risk factors may be at more serious risk from COVID-19, enabling the government to prioritise them for vaccination, and provide appropriate advice and support.
Investigating the long-term impacts of COVID-19 on multiple organs
Prof Stefan Neubauer and Dr Betty Raman, from the BRC’s Imaging theme, led the C-MORE study, which found that a significant proportion of COVID-19 patients discharged from hospital reported symptoms of breathlessness, fatigue and depression and had limited exercise capacity several weeks after leaving hospital.
The researchers used advanced state-of-the art imaging to investigate the impact of the virus on patients’ organs, and to assess its effects on exercise tolerance, quality of life and mental health. They found that at two to three months after the onset of the disease, 64% of patients continued to experience breathlessness and 55% reported fatigue. MRI scans revealed abnormalities in the lungs of 60% of participants, in the hearts of 26%, in the livers of 10% and in the kidneys of 29% of patients.
The C-MORE study is a key part of the national PHOSP-COVID platform, led by the University of Leicester, which is investigating the long-term effects of COVID-19 on hospitalised patients. Around 10,000 patients are expected to take part, making it one of the largest comprehensive studies in the world to understand and improve the health of survivors after hospitalisation from COVID-19.
The STOIC study: Treating COVID-19 with asthma inhalers
Researchers led by Professor Mona Bafadhel, from the University of Oxford’s Nuffield Department of Medicine, found that early treatment with a common asthma medication appears to significantly reduce the need for urgent care and hospitalisation in people with COVID-19. The STOIC study found that inhaled budesonide given to patients with COVID-19 within seven days of the onset of symptoms also reduced recovery time. Budesonide is a corticosteroid used in the long-term management of asthma and chronic obstructive pulmonary disease (COPD).
The trial was inspired by the fact that, in the early days of the pandemic, patients with chronic respiratory disease, who are often prescribed inhaled steroids, were significantly under-represented among those admitted to hospital with COVID-19.
Development of a COVID-19 vaccine
When the new SARS-CoV-2 virus emerged in China at the end of 2019, the BRC Vaccines theme was already working on human coronavirus vaccines and was in a unique position to respond rapidly to the pandemic. The Oxford team – led by Prof Sarah Gilbert, Prof Andrew Pollard, Prof Teresa Lambe, Dr Sandy Douglas and Prof Adrian Hill – identified a vaccine candidate and began testing in human volunteers in April 2020. In December 2020, the vaccine was found to be safe and effective, according to the peer-reviewed findings of the Phase III trial. The efficacy data were based on 11,636 volunteers across the United Kingdom and Brazil who took part in the trial.
In January 2021, the NHS launched a roll-out of the Oxford AstraZeneca vaccine, with patients at Oxford University Hospitals NHS Foundation Trust the very first to get the life-saving jab. The Oxford team has now launched the first study to assess the safety and immune responses in children and young adults of the vaccine.
The University of Oxford is working with the UK-based global biopharmaceutical company AstraZeneca for the development, large-scale manufacture and distribution of the COVID-19 vaccine.
The RECOVERY Trial
The Randomised Evaluation of COVid-19 thERapY (RECOVERY) Trial is identifying treatments that may be beneficial for people hospitalised with COVID-19. The trial has proceeded at record speed, with the first patient enrolled just nine days after the protocol was first drafted. Over 10,000 patients were recruited over the following 8 weeks, and the first result was announced by 12 weeks. This is a truly national effort involving 176 acute hospital trusts (including all of the NIHR Biomedical Research Centres) across the four UK nations.
The trial is testing treatments which have been recommended by the Department of Health and Social Care and its preliminary results have informed treatment guidelines around the world. Most notably, the researchers have found that dexamethasone, a cheap and widely available steroid, cuts the risk of death by a third for COVID-19 patients on ventilators.
The Trial is led by Professor Peter Horby and Professor Martin Landray, who is theme lead for Clinical Informatics and Big Data. The RECOVERY platform will continue to test potential COVID-19 treatments throughout the pandemic. It could also provide a suitable basis for future trials in other acute infections.
Development of a high-throughput COVID-19 antibody test
Professor Derrick Crook from the Antimicrobial Resistance and Modernising Microbiology theme co-led the development of a high-throughput test to detect COVID-19 antibodies from blood samples. The test which was initially developed in Professor Gavin Screaton’s lab is based on the commonly used enzyme-linked immunosorbent assay (ELISA) and uses a COVID-19 specific protein to capture COVID-19 antibodies that are present in the blood. A positive result indicates that an individual has likely come into contact with the virus previously and developed an immune response.
The assay has been used in a number of studies to determine levels of exposure to COVID-19 across the UK population, including the Office of National Statistics infection survey and samples from UK Biobank. The test has also been used by the COVID-19 vaccine development effort and to carry out surveillance testing of staff at Oxford University Hospitals NHS Foundation Trust.
Remote GP consultations during the pandemic
Prof Trish Greenhalgh, lead for the Oxford BRC Partnerships for Health, Wealth and Innovation theme, had been doing research into alternatives to face-to-face clinical consultations (especially via video) for 10 years prior to the pandemic. While randomized controlled trials have shown face-to-face alternatives like video consultations to be acceptable, safe, and effective in selected conditions and circumstances, her team have addressed why this model has rarely been mainstreamed and sustained across real-world healthcare settings.
In May, Prof Greenhalgh was awarded £750,000 from the Economic and Social Research Council (ESRC) for a new study entitled ‘Remote-by-Default Care in the COVID-19 Pandemic.’ The study aims to address the technological tools that GP surgeries use to interact with patients (such as phone and video consultations, text messaging, and telephone triage); the organisational and wider infrastructure changes that might be required to scale up and deliver better remote care; and what insights we can glean from this time of crisis that will help build a more resilient NHS.
Using wearable technology to monitor COVID-19 patients
Wearable technology that monitors patients’ vital signs is being used with COVID-19 patients on an isolation ward at the John Radcliffe Hospital in Oxford. The Technology and Digital Health theme, led by Prof Peter Watkinson and Prof Lionel Tarassenko, had been developing and testing the concept of a virtual High-Dependency Unit (vHDU) for 18 months before the onset of the COVID-19 outbreak in the UK. A vHDU is a general hospital ward in which high-risk patients are monitored using wearable sensors that measure pulse rate, respiratory rate and blood oxygen saturation, combined with Bluetooth-linked tablet computers and smart alerting algorithms. The system was adapted for the COVID-19 isolation ward and went live with its first four patients on Monday 23 March.
The vHDU system allows patients to remain mobile and to be monitored continuously. The aims of this are to reduce the burden on nursing staff, allowing them to perform vital-sign observations for high-risk patients at the same rate as for lower-risk patients, and to improve early detection when a patient’s vital signs become abnormal.
The research team are currently working on optimising the vHDU system design for ambulatory patients on (non-Covid) general wards, and planning a clinical study to evaluate the impact of the system on patient and clinical staff outcomes.