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. The results of the Phase I/II trial indicate no early safety concerns and show the vaccine induces a strong immune response. The potential vaccine entered Oxford’s Phase III clinical trials, led by Professor Pollard, in May across 19 trial sites in the UK, and sites in South Africa and Brazil.
The University of Oxford is working with the UK-based global biopharmaceutical company AstraZeneca for the further development, large-scale manufacture and potential distribution of the Covid-19 vaccine, with plans for clinical development and production of the Oxford vaccine progressing globally. Oxford and AstraZeneca are collaborating with clinical partners around the world as part of a global clinical programme to trial the Oxford vaccine, adding trials in the US, Japan and Russia led by AstraZeneca.
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.