COVID-19: Research

Our staff are involved in a wide range of research studies looking at potential treatments, strategies, risks and consequences of the coronavirus pandemic.

Prevention

Novavax vaccine trial at the Royal Free Hospital

Clinical staff at the Royal Free Hospital in London have been working on the Novavax vaccine trial.

The trial was featured on "Hospital" on BBC Two on 7th December 2020. You can watch a short clip, including an interview with Dr Fiona Burns, on YouTube.

Diagnosis and Prognosis

Systematic evaluation of 22 previously reported candidate prognostic models

Rishi Gupta led a systematic evaluation of 22 previously reported candidate prognostic models, and found that none of these performed any better than simple individual predictors to predict in-hospital deterioration or death. None of the evaluated prognostic tools were therefore considered suitable for clinical implementation.

Read the paper in the European Respiratory Journal

Predicting the risk of requiring ventilatory support or critical care, or dying, following hospital admission

Following his systematic evaluation (see above), Rishi contributed to development, in collaboration with the ISARIC4C investigators, of the 4C Mortality Score before leading development and validation of the 4C Deterioration prognostic model, which predicts the risk of requiring ventilatory support or critical care, or dying, following hospital admission.

The model was based on a cohort of ~75,000 hospitalised adults and was found to perform well across England, Scotland and Wales. It has now been released online for routine clinical use.

Developing and validating blood transcriptional biomarkers

Rishi Gupta is also working with the ISARIC4C and COVIDsortium investigators to develop and validate blood transcriptional biomarkers for COVID-19 diagnosis and prognosis.

British HIV Association (BHIVA) COVID-19 Registry

The potential impact of HIV on the outcome of COVID-19 infection is unknown, with published reports documenting inconsistent findings. The COVID-19 Registry, run by Caroine Sabin and team, collects detailed information about people with HIV attending HIV services in the UK who are known to have acquired COVID-19.

Association of HIV with outcomes of COVID-19 hospitalization outcomes

To characterize the presenting characteristics and outcomes of COVID-19 related hospitalization in people with HIV relative to those without HIV in the UK, a team including Caroine Sabin analyzed data collected within the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) World Health Organization (WHO) Clinical Characterization Protocol (CCP), the largest prospective observational study of patients admitted to hospital with COVID-19 worldwide.

Findings from the study were published as evidence by SAGE with both Professor Sir Patrick Vallance and Professor Sir Chris Whitty commenting on the importance of the findings.

Clinical Research

SAFER study: healthcare worker risk of SARS-CoV-2 acquisition: Members of our Centre for Clinical Research in Infection and Sexual Health (CRISH) have mobilised to assist UCLH on a study looking into healthcare worker risk of SARS-CoV-2 acquisition. The CRISH team is running recruitment and follow-up care for the SAFER study (SARS-CoV-2 Acquisition in Frontline Health Care Workers – Evaluation to Inform Response).
Symptoms among ICU admissions: Shortness of breath (dyspnoea) is the only symptom of COVID-19 that is significantly associated with severe cases of the disease and admission to intensive care units (ICU), according to a systematic review and meta-analysis led by Vageesh Jain.
COG-UK Hospital Onset Covid-19 Infection (HOCI) Study: The Centre for Pragmatic Global Health Trials is collaborating with UCL Comprehensive Clinical Trials Unit to deliver the COG-UK Hospital Onset Covid-19 Infection (HOCI) Study, an interventional cohort study to evaluate the benefit of rapid COVID-19 genomic sequencing on infection control in preventing the spread of the virus in United Kingdom NHS hospitals. The PI is Prof Judy Breuer based at UCL and within IGH Andrew Copas, Oliver Stirrup and Fiona Mapp are contributing their time and expertise.

Treatment

Efficacy of tocilizumab: a study in northern Italy

Alessandro Cozzi-Lepri and partners from University of Modena, northern Italy, conducted a study in patients hospitalized with severe COVID-19 disease, showing that “…Treatment with tocilizumab, whether administered intravenously or subcutaneously, might reduce the risk of invasive mechanical ventilation or death in patients with severe COVID-19 pneumonia. Although these results are encouraging, they should be confirmed in ongoing randomised studies.” Their findings were published in The Lancet Rheumatology.

The data were subsequently confirmed by the REMAP-CAP trial and tocilizumab is now recommended in the UK for use in the critically ill.

Ethnic Group Analysis

Mortality rates are 2-3 times higher among BAME groups

Delan Devakumar, Anne Johnson, Ibrahim Abubakar and their co-authors discovered that the likelihood of death from COVID-19 is two to three times higher among England’s Black, Asian and Minority Ethnic (BAME) groups than the general population.

Their findings were widely reported in the UK media including on ITV's Good Morning Britain and the BBC World Service's Newsday (from 14 minutes 48 seconds).

Risks for BAME healthcare workers (UK-REACH)

Ibrahim Abubakar is among investigators working on UK-REACH, a major study study looking at COVID-19 risks for BAME healthcare workers, funded by NIHR and UKRI.

Incidence, severity and risk factors in the BAME and Migrant groups to inform public health action

Delan Devakumar is working on a related study, ‘Investigating incidence, severity and risk factors for COVID-19 in BAME and Migrant groups to inform public health action’, which is being led by the UCL Institute of Health Informatics.

BAME young people's experiences of COVID-19

Rochelle Burgess is working in partnership with Wandsworth Community Empowerment Network (WCEN) on a project which aims to understand the specific impacts of COVID-19 and related public health response and government advice on the wellbeing of young people aged 16-25, from Black, Asian and Minority Ethnic Backgrounds (BAME) in London.

Gender Analysis

Global Health 50/50's sex-disaggregated data tracker

Data suggests men are more likely than women to die from the virus. Understanding why could alter the way we administer treatment to vulnerable groups, as explained by Sarah Hawkes on CNN and in the BMJ.

Global Health 50/50 have launched a live data tracker which monitors the sex-disaggregated data on COVID-19 as reported by countries. At present, this covers the 25 countries with the highest number of cases but will be expanded to further countries over the coming weeks. To date, this is the only tracker that compiles sex-disaggregated data on COVID-19.

GH5050 are also conducting a review of academic literature to assess sex-disaggregated data on COVID-19. They are looking at the role both sex and gender may be playing in the pandemic.

Comparing the risk of invasive mechanical ventilation (IMV) and mortality by sex: exploring potential mechanisms leading to the observed higher risk in males

Alessandro Cozzi-Lepri co-authored a paper in Clinical Microbiology and Infection which confirmed a higher risk of COVID-19 clinical complications in males and showed a predominant role of CRP to mediate the difference in risk by sex.

Modelling

Using PHE and Transport for London data to model the virus' spread in London

Lara Goscé built a model for the spread of the new Coronavirus in London calibrated to COVID-19 London data released by PHE.

At the same time, Lara collected data from TfL to study the levels of contact between the different London boroughs. This data allowed Lara and her team (Ibrahim Abubakar, Andrew Phillips, Rishi Gupta and Paula De Souza Leao Spinola) to analyse the spread on the smaller scale and test multiple scenarios of control strategies.

Lara also studied transmission in Nigeria - see "Evidence to Inform Policy & Mitigate the Impact in Nigeria" below.

Predicting the spread of the virus in KwaZulu-Natal, RSA

Guy Harling has been working with the Africa Health Research Institute (AHRI) and Massachussets General Hospital on mathematical models requested by the KwaZulu-Natal government to predict the epidemic trajectory of the virus in the South African province. The models were then adapted for colleagues working with governments in Botswana, Malawi and Eswatini.

The models helped KwaZulu-Natal officials make early decisions regarding social distancing. The team has since collaborated with colleagues in the United States on ongoing, more complex models to understand the options for prevention, treatment and care provision in the province.

Predicting the scale and appropriate responses in Malawi

Tim Colbourn and Andrew Phillips are part of a team who are to trying to estimate the appropriate scale and type of responses needed in Malawi, given unknowns the country may face on comorbidities such as HIV, TB, Malaria and malnutrition common in lower-income countries, as well as the key COVID-19 comorbidities such as diabetes, CVD and COPD that are also prevalent in wealthier countries.

Tim has also been reviewing modelling papers for The Lancet and Nature, and is involved in expert forums in the UK, in Malawi, and globally.

Evidence to Inform Policy & Mitigate the Impact in Nigeria

This work, led for UCL by Lara Goscé, supported, as part of the Evidence Synthesis Group advising the Presidential Task Force in Nigeria, a series of position papers addressing questions arising during the current COVID-19 emergency.

See also the "Diagnosis and Prognosis" section above for Rishi Gupta's model which predicts the risk of requiring ventilatory support or critical care, or dying, following hospital admission.

Observational Studies

Assessing the impact of lockdown on sex and service use among MSM in the UK (RiiSH survey)

Cath Mercer, Alison Howarth and colleagues from the NIHR-funded Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections (BBSTIs) at UCL, in collaboration with Public Health England, have completed data collection for the first and second waves of the "RiiSH" survey (Reducing Inequalities In Sexual Health).

They conducted rapid risk assessment online surveys in June-July and November-December 2020. They recruited two thousand cisgender men, trans and gender diverse people who have sex with men from across the UK into the first wave, and one and a half thousand into the second.

Preliminary findings were presented as part of an HPRU session at vBASHH 2020 (the annual conference of the British Association of Sexual Health and HIV). The paper, “Stay at home …”, assessing the impact of lockdown on sex and service use among MSM in the UK, won the Prestigious STI Award for the presentation with the best potential for publication.

The team will run a third wave of the survey and the results will inform public health messaging, support needs assessments for future public health planning and help mitigate risks to health among a population group disproportionately burdened by sexually transmitted infections and HIV.

The impact of the pandemic on sexual and reproductive health (Natsal-COVID study)

Nigel Field, Cath Mercer, and Pam Sonnenberg, together with colleagues from the Natsal team have undertaken a Natsal-COVID study, funded by a UCL Covid-19 rapid response award, to understand the impact of the pandemic on sexual and reproductive health, as well as the impact of sexual intimacy needs on population-level adherence to public health control measures.

The team presented preliminary results to the research community in a webinar on 30th November 2020, and a recording is available to watch on YouTube.

The impact of COVID-19 on the care of young children in informal settlements in Nairobi

Zelee Hill is working on a panel study exploring how the care of young children has been affected by Covid in informal settlements in Nairobi. The team will be conducting phone interviews with carers.

The effects of social distancing in the USA

Guy Harling and partners at Massachusetts General Hospital posted a pre-print on the effects of state-wide social distancing policies in the United States. Their analysis suggested that these measures may have had an impact on the epidemic curve, with a significant fall in the growth rate.

How the COVID-19 economic impact has reduced condom use among Dakar sex workers

Aurélia Lépine and Sandie Szawlowski found that the COVID-19 crisis has severely reduced earnings of female sex workers in Dakar, Senegal. You can watch a short video on YouTube about the study.

Survey evidence suggests that a significant proportion of female sex workers have resorted to unprotected sex, which is more lucrative, as a response to this economic shock.

The decline in condom use is particularly marked among poorer female sex workers. Policies targeting sex workers to dampen the adverse economic impact of the COVID-19 crisis should urgently be considered as a strategy to pre-empt the development of sexually transmitted infections and HIV/AIDS.

The impact of Covid-19 on behaviour and socio-economic wellbeing in rural South Africa

Guy Harling and colleagues at AHRI and other research sites in SAPRIN in South Africa have been conducting continuous, phone-based surveillance since April 2020. Initial work highlights high levels of compliance with government non-pharmaceutical regulations despite the threat of substantial social, economic and health repercussions during South Africa's first Covid-19 epidemic wave. This project will continue in 2021.

Changes in social contact patterns due to Covid-19 in rural South Africa

Guy Harling led a telephone-based interview project at AHRI in rural South Africa to collect detailed data on the social interactions and movements of adults between June and September 2020 as the first wave of Covid-19 peaked in South Africa. Comparing these data to others collected in the same area in 2019, the team showed a 75% reduction in contacts outside the household, leading to a 42% reduction in the potential reproduction number for the disease in this area. This project plans to conduct further data collection in 2021.

Strategic Input

South Africa Health systems group: As part of her role at AHRI in South Africa, Maryam Shahmanesh chairs a KwaZulu-Natal, South Africa Health systems group with all the key active research groups in KwaZulu-Natal. The aim is to bring together researchers and implementers to 1) Share evidence that emerges to rapidly inform policy and 2) Define the evidence gaps to inform the research agenda.

Many other IGH staff members are working closely with local, national and global bodies to assist with their COVID-19 strategies; more detail on this is on the Engagement page.

Social Sciences

Private sector contact tracing apps

Since the start of the COVID-19 pandemic, a steady stream of propositions from tech giants and start-ups alike has furnished affected states and populations with the idea that GPS- or Bluetooth-enabled contact tracing apps are a vital part of the pandemic response.

Stephen Roberts and colleagues considered these apps as ‘corporate contact tracing’, emphasizing the private-sector role that such developments imply. Their article discusses corporate contact tracing’s potential to de- center the power of public health authorities and question its capacity to address structural inequalities and to foster a social justice vision of public and global health, and call for a discussion of this technology beyond questions of privacy and efficacy.

Environmental factors and the spread of COVID-19 in Italy

Francesco Salustri has co-authored two papers on the spread of the virus in Italy. The first analyses the role of the environment on coronavirus cases and deaths. The second looks at the contagion in Italian municipalities located in protected regional or national parks.

The authors' findings were widely reported in the mainstream media, in Italy and internationally, and were presented at the Italian Economic Association and the Economy of Francesco international seminars.

Frontline staff perceptions and experiences of COVID-19 in 11 countries (RREAL)

Nehla Djellouli and UCL colleagues from the Rapid Research, Evaluation and Appraisal Lab (RREAL) are working with UCLH and international partners to capture frontline staff perceptions and experiences of COVID-19 in 11 countries: Australia, Brazil, Chile, Italy, Mexico, Pakistan, Spain, South Africa, Switzerland, UK and USA.

The RREAL group is also expanding their work to explore the impact of COVID-19 on non-COVID-19 healthcare delivery through a global survey (currently focused on chemotherapy treatment for cancer patients).

PDF icon See an infographic summary of the COVID-19 methods used undertaken by UCL RREAL (pdf)

PDF icon See an infographic summary of RREAL's emerging findings (pdf)

Diplomatic and environmental research effects of COVID-19 (Ilan Kelman)

Ilan Kelman has been examining how and why the pandemic is unlikely to foster new, lasting diplomatic or peace initiatives. Ilan has also been working with a global team to determine the impacts of COVID-19 on people involved in Antarctic research. Ilan participated in "A Think-Tank on Civilization Resilience Post Covid" which can be viewed on YouTube and several other online talks including Creating Catastrophe: Pandemics and Beyond.

More detail on Ilan's research can be found in his blogs for Polar Connection and Nautilus; his papers on COVID-19 for Greenland and as a disaster; and his comments in, among other media, the Telegraph and the New York Times.

The Good Work Monitor: inequalities in England and their effects on health outcomes

Jolene Skordis and Lu Gram co-authored “The Good Work Monitor: A Framework for Action”, an interactive report produced in collaboration with the Institute for the Future of Work and Opinium Research. They found that inequalities in good work are related to poorer health and worse COVID-19 outcomes.

Previously-existing inequalities increased further through the pandemic, and lower-performing areas on the Monitor on average suffer from higher COVID-19 mortality rates and worse employment outcomes.