At the Institute for Global Health, we are immensely proud to have our staff actively engaged in the fight against the coronavirus/COVID-19 pandemic. Examples of some of this work are compiled below.
Our teaching team responded to the crisis by ensuring the remainder of the academic year could be completed offsite. Systems are in place to ensure that students are contacted regularly by their personal tutors and supervisors to check on their wellbeing and provide guidance.
Course leaders are finding innovative ways to engage with their students, such as the new COVID-19 seminar series that has been established by the MSc Applied Infectious Disease Epidemiology (AIDE) tutors.
The COVID-19 pandemic has emphasised an urgent need for strong public health leadership able to synergise across disciplines. The IGH MSc AIDE provides world class training in stats and epidemiology together with training across a range of allied disciplines. The innovation and ideology behind this programme is described in this article in The Lancet Infectious Diseases.
Public Engagement and Advice
Guy Harling answered listener questions on BBC Radio 5’s ‘Nihal Arthanayake Show’ (from 16 mins 13 secs), and the next day appeared on BBC Breakfast, providing a brief overview of the epidemic and giving advice on how to minimise risk of catching the virus and spreading it to others.
Therese Hesketh took part in a debate for the Economist's weekly podcast, on the subject "What can countries do to prepare for covid-19?".
Chikwe Ihekweazu wrote for The Conversation about steps Nigeria is taking to prepare for cases of coronavirus, incorporating knowledge gathered and systems put in place following the Ebola outbreak.
Lara Gosce's research on how influenza-type illnesses are spread on the London Underground was widely quoted in the media as the UK began to increase containment measures. Lara was interviewed by various outlets including on BBC London News.
Anne Johnson and Graham Hart took part in the UCL Minds podcast series in the episode "What can we learn from the history of pandemics?" The panel discussed outbreaks through history, including HIV/AIDS in the 1980s and the Black Death in the 14th century. Anne's expertise has been called on by a wide range of media outlets, such as for this New Scientist article on lockdowns.
A subsequent episode in the series discussed the subject "How has the pandemic highlighted BAME inequalities?" and featured Delan Devakumar. Delan also spoke to LBC Radio and Euronews TV about his research (see "Ethnic Group Analysis" below). Ibrahim Abubakar was a guest on the episode asking what we can learn from the African response.
Lu Gram was interviewed for Yahoo! News about experiences of racism towards people of east and south-east Asian heritage. Lu and his fellow campaigners are fundraising to launch the UK’s first non-profit organisation dedicated to addressing racism faced by people of east and southeast Asian heritage.
Other UCL staff have been interviewed by the mainstream press. The resulting articles are too numerous to list comprehensively, but a few are highlighted here:
- What can Britain learn about containing Covid-19 from countries that got it right? (The Guardian, quotes Anne Johnson)
- Face masks could give false reassurance (The Sun, quotes Ben Killingley)
- Scientists warn Britain to step up coronavirus testing (Financial Times, quotes Tim Colbourn)
- Coronavirus: Government releases official advice to protect your mental health (Yahoo! Style, quotes Rochelle Burgess; Rochelle was also interviewed for BBC World Service's Newshour talking about mental health and community psychology)
- Should employers be preparing now for further waves of the Covid-19 virus? (Employee Benefits website article by Ilan Kelman)
Along with their UCL colleagues from other departments, all 37 of IGH's clinical academics have been released to work on frontline NHS duties.
These academics are applying their practical knowledge and experience to test and treat patients, not only close to our London base but nationally and internationally.
Marie Francis and Julian Surey, based at the Mortimer Market Centre, have teamed up with Find and Treat and NGOs to visit London's homeless population and arrange accommodation in hotels. The specialist nurses, who usually work on outreach screening services such as HepCare, are testing this vulnerable population for COVID-19 and ensuring they are treated and housed accordingly.
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.
Rochelle Burgess wrote about causes and consequences of mental health and COVID-19 for Nature magazine; "COVID-19 mental-health responses neglect social realities." Rochelle's commentary piece calls for mental health services to do more to support people during the pandemic.
Rochelle is also working with Hertfordshire County Council on their COVID-19 public mental health strategy (see "Strategic Input" section below), and took part in UCL's podcast "Coronavirus: The Whole Story - How is it affecting our mental health?" and on BBC World Service's Newshour speaking about mental health and community psychology (from 19 minutes 10 seconds).
Ethnic Group Analysis
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.
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.
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.
IGH staff have been instrumental in ensuring the inequalities in the impact of Covid-19 are prominently featured in the UK’s mainstream and academic press. Letters and publications in The Lancet (April 2020 and June 2020) and the Journal of the Royal Society of Medicine (June 2020) have helped to maintain nationwide focus on racism and discrimination.
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.
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).
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.
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.
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 is now adapting the model to study transmission in Nigeria.
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 officals 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.
Tim Colbourn has been reviewing modelling papers for The Lancet and Nature, and is involved in expert forums in the UK, in Malawi, and globally.
Tim and Andrew Phillips are also 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.
Support to Humanitarian Programming
Naomi Saville, who is based in Kathmandu and has 25 years' experience in Nepal, is working with DFID to provide thematic advice on food security and nutrition during the country's COVID-19 response to inform programme interventions and delivery.
Naomi will be working with the Nepalese government, local partners, UNICEF, the UN World Food Programme amongst others to support efforts to maintain food and nutrition security throughout the outbreak.
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 wave of the "RiiSH" survey (Reducing Inequalities In Sexual Health). They conducted a rapid risk assessment online survey in June-July 2020 and recruited two thousand cisgender men, trans and gender diverse people who have sex with men from across the UK.
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 second and 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.
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 will present preliminary results to the research community in a webinar in the afternoon on Monday 30th November 2020.
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.
Guy Harling and AHRI colleagues are supporting the work of South Africa's Human Sciences Research Council (HSRC) in building a knowledge base around the national public's understanding of COVID-19, and its impact on their lives.
Guy is also working with AHRI on their longitudinal population surveillance to ascertain incidence of COVID-19 in a rural South African setting among residents in the AHRI surveillance area. Regular (weekly for a sub-cohort) telephone interviews with household heads will screen for symptoms of the virus and the impact of related social distancing policies on residents. Those screening positive will be followed-up for testing, referral for care if needed and contact tracing-based on government protocols.
Guy and partners at Massachusetts General Hospital have 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.
Researchers from across our Institute have been prominent advisors and commentors, often helping to shape government policy using their expert knowledge.
Ibrahim Abubakar supports the House of Lords Science and Technology Committee as a Scientific Adviser. On 23rd July, the Committee wrote to the Prime Minister and summarised their recommendations for urgent action needed before the winter. The recommendations drew on tesimony from witnesses including Anne Johnson (who is cited multiple times in the letter).
IGH staff have been contributing as members of DELVE (Data Evaluation and Learning for Viral Epidemics), a multidisciplinary group convened by the Royal Society to support a data driven approach to managing the COVID pandemic. Anne Johnson and Nigel Field (as Chair of the DELVE working group) sit on the DELVE committee.
Anne Johnson and Guy Harling were recently part of a team who wrote a wide-ranging report identifying the potential for Testing, Tracing and Isolation to help control the UK COVID-19 epidemic, as part of a wider package of interventions.
By reviewing successful programmes internationally, conducting modelling exercises and drawing on experiences from multiple academic fields, the team highlighted the importance of speed, compliance and coverage for TTI to be effective, and the need for integration with the wider response.
The DELVE group subsequently published highly influential reports on COVID-19 infection in hospitals, preparing the NHS for winter and the impacts of school closures and plans for their reopening.
Lucy Irvine is currently on secondment to the SAGE International Team, where she is synthesising international evidence and identifying innovative research for the GSCA and SAGE. Lucy is also helping to coordinate research projects at the Government Office for Science and the British Academy into the impact of Covid-19 on vulnerable populations and BAME communities.
Anthony Costello was interviewed by various national media outlets including the BBC's Newsnight, Channel 4 News and The Independent regarding early measures by the UK and other national governments to prevent the spread of the virus. Tim Colbourn also provided commentary in specialist publications such as The Lancet Public Health and via mainstream media including the BBC's Jeremy Vine show (from approximately 15 minutes).
Prof Costello also gave evidence to the UK Government's Health and Social Care Committee for their inquiry into the country's management of the coronavirus outbreak.
Rochelle Burgess is contributing to the development of Hertfordshire County Council's COVID-19 public mental heath strategy. Rochelle has been advising on a socially informed public health response that responds to a range of socio-political drivers of mental ill health linked to the outbreak (including food insecurity, poverty and violence) and developed the structure for a stepped care intervention to provide mental health and wellbeing supports across the county, which has over a million residents.
Rochelle is working in partnership with Wandsworth Community Empowerment Network and their Black Minds Matter collective, to understand how young people from Black, African, Caribbean, Asian and other minority backgrounds in South London are coping with COVID-19.
The study focuses on young people's accounts of coping and survival, to understand what is going well, and what can be improved. The team will also work with young people to design new public health messaging that takes into account successes and challenges, to help promote better wellbeing for their communities in coming weeks and months
Rochelle also wrote about causes and consequences of mental health and COVID-19 for Nature magazine; "COVID-19 mental-health responses neglect social realities."
Delan Devakumar provides scientific evidence on child and adolescent health policy advice on behalf of the REACH-WELL group. Delan has also advised a group of London boroughs on their COVID strategy in respect of the increased mortality in BAME groups.
Rochelle and Delan sit on the Society and Mental Health COVID-19 Expert 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.
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.
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.
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).
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.
Other COVID-19 work at University College London
The above are all examples of work carried out by staff at the UCL Institute for Global Health. You can see examples of COVID-19 research, advice and expert comment across the wider university on the main UCL website.