Researchers supported by the NIHR Oxford Biomedical Research Centre will play a crucial role in tackling the current COVID-19 pandemic, ranging from the development of a new vaccine to developing the most effective drug treatments for people who have contracted the virus.
A team from the Oxford Vaccine Group and the University of Oxford’s Jenner Institute have identified a vaccine candidate for COVID-19, a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The virus was officially named COVID-19 on 11 February 2020 and declared a pandemic by the World Health Organisation on 11 March, the first time a coronavirus has led to a pandemic.
The Oxford team – led by Prof Sarah Gilbert, Prof Andrew Pollard, Prof Teresa Lambe, Dr Sandy Douglas and Prof Adrian Hill – started work designing a vaccine on 10 January, have identified a vaccine candidate and are working towards the first clinical testing phase.
The chosen vaccine is one that is regarded as being the most suitable for SARS-CoV-2 as it can generate a strong immune response from one dose and it is not a replicating virus, so cannot cause an ongoing infection in the vaccinated individual. This also makes it safer to give to children, the elderly and anyone with a pre-existing condition such as diabetes.
Coronaviruses have club-shaped spikes on their outer coats. Immune responses from other coronavirus studies suggest that these are a good target for a vaccine. The Oxford vaccine contains the genetic sequence of this surface spike protein. After vaccination, the surface spike protein of the coronavirus is produced, which primes the immune system to attack the coronavirus if it later infects the body.
Prof Gilbert and her team have previously developed a vaccine for another human coronavirus disease, Middle East Respiratory Syndrome (MERS), and this has shown promise in early clinical trials.
Recruitment for the COVID-19 vaccine clinical trial has not yet started. The team are very busy with vaccine development, so prospective participants should not contact the team at the moment. Please keep checking the Jenner Institute website for updates, including a link to sign up for the trial, once it is open.
At the same time as preparing for and conducting the first clinical trial, production of the vaccine is being scaled up ready for larger trials, and potentially, future deployment.
Oxford BRC-supported researchers at the University of Oxford’s Nuffield Department of Population Health and Nuffield Department of Medicine are working closely with clinical and infection control teams from Oxford University Hospitals (OUH) NHS Foundation Trust as part of a major national multi-centre clinical trial to test the effects of potential drug treatments for patients admitted to hospital with COVID-19. The first patients have now been recruited.
There are currently no specific treatments for COVID-19. It is possible that some existing drugs usually used for other conditions may have some benefits – but they may not. The Randomised Evaluation of COVid-19 thERapY (RECOVERY) trial will provide doctors and the health service with information they need to determine which treatments should be used.
The treatments initially included in the study have been recommended by an expert panel that advises the Chief Medical Officer in England. These are Lopinavir-Ritonavir, normally used to treat HIV, and the steroid dexamethasone, which is used in a wide range of conditions to reduce inflammation. The safety and side effects of both drugs are well known. In the future, the RECOVERY trial will be expanded to assess the impact of other potential treatments as they become available.
The chance to join the trial will be offered to adult inpatients who have tested positive for COVID-19 in NHS hospitals, and who have not been excluded for medical reasons. All patients will receive the usual standard of care. Patients joining the trial will be allocated at random by computer to receive one of the two drugs being studied or no additional medication. This will enable researchers to see whether any of the possible new treatments are more or less effective than those currently used for patients with COVID-19.
Peter Horby, Professor of Emerging Infectious Diseases and Global Health in the Nuffield Department of Medicine, University of Oxford, and Chief Investigator for the trial, said “There is an urgent need for reliable evidence on the best care for patients with COVID-19. Providing possible new treatments through a well-designed clinical trial is the best way to get that evidence. Adults admitted to hospital with COVID-19 should be offered the opportunity to participate in this trial and contribute to improving care for everyone. All patients will receive the standard full medical care, regardless of which treatment group they are placed in.”
Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health, and the Oxford BRC’s Theme Lead for Clinical Informatics, is the Deputy Chief Investigator on the RECOVERY trial.
He added: “The streamlined design of this clinical trial allows consenting patients to be enrolled in large numbers easily and without compromising patient safety or adding significantly to the workload of busy hospitals and their staff. In this way we can rapidly assess the value of potential treatments for COVID-19 and provide reliable information on the best ways to treat patients with this disease.”
The new trial has been classed as an Urgent Public Health Research Study. Chief Medical Officer Professor Chris Whitty and NHS England Medical Director Professor Stephen Powis have written to NHS trusts in England asking them to fully support the new trial.
The Oxford BRC’s Co-theme Lead for Gastroenterology and Mucosal Immunity, Prof Paul Klenerman, is leading Oxford’s immunology research relating to COVID-19, looking for antibodies and other immune responses.
He said: “We are rapidly developing tests to better understand why some patients do well and others suffer severe infection and what type of immunity is protective in different age groups.”
Others within the theme working on this include Prof Graham Ogg and the MRC Human Immunology Unit, Prof Philippa Matthews and Prof Ellie Barnes. They are all coordinating closely with colleagues from Vaccines, Respiratory and Infection.
The COVID19 crisis is driving changes in healthcare practice, including how clinicians carry out consultations remotely with patients.
The Oxford BRC’s Theme Lead for Partnerships for Health, Wealth and Innovation, Prof Trish Greenhalgh, had a paper published in the BMJ last week on the appropriateness of using video consultations for dealing with the coronavirus crisis, and whether they could be scaled up quickly enough.
Her research has shown that clinical consultations conducted through a video link tend to be associated with high satisfaction among patients and staff; no difference in disease progression; no substantial difference in service use; and lower transaction costs compared with traditional clinic-based care.
However, most of this evidence pertains to highly selected samples of hospital outpatients with chronic, stable conditions, and so there are questions over its relevance to the current escalating situation involving patients with an acute and potentially serious illness.