IHI response to the COVID-19 pandemic
Harnessing health data to address key clinical questions to help save lives has never been more urgent. In a global public health emergency such as the one we are currently facing, rapid and safe access to UK health data is vital to be able to undertake research that will inform government policy around public behavior and clinical guidelines to treat patients.
UCL IHI researchers and clinicians are working closely with key partners within NHS, the university sector, healthcare and data providers, funders, industry and with patients and the public to help understand and tackle the COVID-19 infection, while ensuring safe access to data is maintained.
This vital work includes:
- Informing Government guidance on people with underlying conditions to improve understanding of who is most vulnerable to COVID-19 and providing scientific and technical advice to support government decision-makers
- Establishing a comprehensive, open-access catalogue of codes that can be used for defining COVID-19 related phenotypes in UK electronic health record (EHR) data for use by the research community
‘DECOVID’: Establishing a national COVID-19 datamart for research to improve patient care during the pandemic
Exploring use of natural language processing to analyse free text information within health records of COVID-19 patients in order to gain insights into the disease
- Understanding the spread of the virus including seasonal trends in COVID-19 across the UK, risk of infection and use of public spaces, and how COVID-19 spreads in hospital to and support efforts to prevent transmission
- Working with patients and the public to inform and co-design key aspects of our endeavours
Our coordinated response and research findings are being shared with the scientific community through the HDR UK COVID-19-challenge Slack channel. Sign up to the Slack channel
Our most recent work on COVID-19
Investigating incidence, severity and risk factors for COVID-19 in BAME and migrant groups to inform public health action
A team led by Dr Robert Aldridge has been awarded £1.4m to recruit about 12,000 people from BAME groups to add to the 25,000 already in the Virus Watch study, previously funded by UKRI and NIHR. It will examine infection incidence among BAME communities and the contribution of factors such as overcrowding, migration status and occupation.
DECOVID: Using high resolution real time data from digitally mature NHS Trusts to improve patient care during the COVID pandemic
IHI researchers including Prof Spiros Denaxas and Maxine Mackintosh are among the first to be involved in the DECOVID project, a collaboration led by UCLH and the Alan Turing Institute to establish a national COVID-19 datamart for research. DECOVID will create a scalable data repository and data analytics centre providing clinicians with real-time actionable intelligence into patient care and operational planning during the COVID-19 pandemic. DECOVID aims to address urgent questions defined by clinical staff in order to produce rapid insights which are actionable on the frontline at a local level. This will support proactive care and management during the COVID-19 pandemic, with learning facilitated across the NHS through the insights of robust data science modelling, without placing a burden on front line staff.
The initiative will bring real-time EHR data from UCLH, University Hospitals Birmingham and King’s College Hospital in London (in the first instance) and analyze the data to directly inform care. The resource will be used to answer clinically pertinent questions on the acute management of inpatients who are at risk of, or are suspected or confirmed to have COVID-19. For more information, contact Prof Spiros Denaxas (firstname.lastname@example.org).
Government policy on easing COVID lockdown does not include people with common underlying health conditions and may lead to significant increased risk of death
Vulnerable people, including people aged over 70 and those who have high blood pressure, heart disease or asthma, make up 20 per cent of the British population. Previous models of population mortality during the COVID pandemic have not included information on such common high-risk conditions or their longer-term pre-COVID-19 mortality. IHI researchers, led by Dr Ami Banerjee, together with researchers at UCL, Oxford and Cambridge estimated the excess number of deaths over one year under different COVID-19 incidence scenarios based on varying levels of transmission suppression and differing mortality impacts for different relative risks for the disease. The study used linked electronic health records of 3.8M people from England and the Health Data Research (HDR) UK–CALIBER open online portal to define underlying conditions at different ages in women and men. Findings, published in The Lancet show that the risk of death from COVID-19 for someone with heart disease is five times higher than a healthy person and 10 times higher for someone with heart disease and diabetes. For more information, contact Dr Ami Banerjee (email@example.com ).
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Association between angiotensin converting–enzyme (ACE) inhibitor and angiotensin-receptor blocker (ARBs) medication on incidence of Flu
As the number of COVID-19 cases continue to rise, we urgently seek effective medication to treat the disease, especially with older patient with co-morbidities who are at higher risk of poor outcome. In early March, there was speculation on the safety of use during the pandemic for two commonly prescribed medications for hypertension and heart failure, the angiotensin converting–enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs). Research, published in the New England Journal of Medicine), analysed the clinical information of 5.6 million people in the UK to investigate the association between use of ACE inhibitor and incidence of influenza. Results showed that use of ACE inhibitors and ARBs was associated with either no effect on the incidence of influenza or a lower incidence, depending on the duration of use. While the association between the use of ACE inhibitors/ARBs and risk of contracting COVID-19 remain unclear and future virology studies are needed, these findings may inform the safety of ACEI/ARB use regarding susceptibility to respiratory infection. For more information, contact Dr Sheng-Chia Chung (firstname.lastname@example.org).
BAME groups two to three times more likely to die from Covid-19 than the general population
International and UK data suggest that Black, Asian and Minority Ethnic (BAME) groups are at increased risk of infection and death from COVID-19. We aimed to explore the risk of death in minority ethnic groups in England using data reported by NHS England, a study led by IHI's Dr Rob Aldridge has found. The analysis, published in Wellcome Open Research, used NHS data of patients with a positive Covid-19 test, who died hospitals in England from March 1 to April 21 this year, which included data on age, region and ethnicity. For more information, contact Dr Rob Aldridge (email@example.com).
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Estimating Excess Mortality in People with Cancer and Multimorbidity in the Covid-19 Emergency
IHI-led research, led by Dr Alvina Lai, along with DATA-CAN: The Health Data Research Hub for Cancer used data from hospitals in London, Leeds and Northern Ireland and the health records of nearly 4 million patients in England (CALIBER) to look at changes in cancer service provision and model excess deaths in the COVID-19 emergency in patients with cancer and other underlying health conditions.
Researchers estimated there could be 6,270 more deaths among newly diagnosed cancer patients over the next year – a 20% increase in deaths among people newly diagnosed with cancer. This number could rise to an estimated 17,915 additional deaths if all people currently living with cancer are considered. More than three quarters of these excess deaths will occur in people who are also suffering from one or more other underlying health condition, including cardiovascular diseases, hypertension, obesity and diabetes.
The research team, consisting of biostatisticians, clinicians and scientists, also analysed weekly returns for chemotherapy attendances and urgent cancer referrals based on data from hospitals in Leeds, London and Northern Ireland, and observed worrying, major declines in admissions for chemotherapy (60%) and urgent referrals for early cancer diagnosis (76%) compared to pre-emergency levels. ResearchGate For more information, contact Dr Alvina Lai (firstname.lastname@example.org).
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Informing Government policy on people with underlying conditions who are most vulnerable to COVID-19
IHI rapid-response research led by Dr Ami Banerjee along with researchers and clinicians at UCLH, the University of Cambridge and Health Data Research UK (HDR UK) presented new estimates of excess mortality from COVID-19 among people with underlying conditions including coronary heart disease, kidney disease and diabetes. Current models to predict deaths from COVID-19 have ignored underlying conditions or underlying risk of death, which means that they may not be accurately predicting the number of deaths, and they do not look at excess deaths over a 1-year time frame. The team analysed data from 3.8 million adults in England using UK primary care EHR to estimate the excess number of deaths over 1 year under different COVID-19 incidence rates and differing mortality impacts in relation to underlying medical conditions and age.
Findings being published in The Lancet suggest that people with multiple underlying diseases are extremely vulnerable and stronger suppression measures, which aim to reverse epidemic growth, may be required in the UK to avoid excess mortality from COVID-19. The data show that the UK government’s strategy could lead to between 35,000 and 70,000 excess deaths over the next year, and measures do not go far enough in stopping the spread of the disease or identifying the most high-risk groups. For more information, contact Dr Ami Banerjee (email@example.com).
‘MyRisk’ online risk calculator for patients and the public
In response to the UK Government Chief Medical Officer’s announcements on 16 and 22 March 2020 on underlying conditions we wanted to identify an individual’s risk of dying based on their underlying conditions using the best possible evidence. This is important to help people understand how government policies around ‘social distancing’ affect them. We also wanted to find out how COVID-19 will affect the health system by estimating the number of excess deaths which might occur due to COVID-19. Working closely with patients and members of the public, we developed the MyRisk calculator - an online tool to help patients and the public understand their risk of death, in the context of current guidelines, over the next year, and to facilitate people’s conversations with their family and health professionals. For more information, contact Dr Ami Banerjee (firstname.lastname@example.org).
Open-access catalogue of COVID-19 coding
In order for research into COVID-19 to be carried out consistently across the whole of the UK, it is important that the research community is open and transparent about how the condition has been defined for research. We are establishing a comprehensive, open-access resource providing the research community with information, tools and phenotyping algorithms for defining COVID-19 related phenotypes in UK EHR data. This resource contains information on controlled clinical terminology codes used to record COVID-19 related events (ICD-10 and ICD-11, Clinical Terms Version 3 (CTV3), EMIS, Vision, UK SNOMED-CT, International SNOMED-CT, LOINC and openEHR), reporting templates and proformas, prevalence estimates and information about the Public Health England high risk definition or populations at increased risk of severe illness from COVID-19. For more information, or to contribute to the resource, contact Prof Spiros Denaxas (email@example.com).
Understanding seasonal trends in COVID-19 across the UK
A team of researchers led by Dr Rob Aldridge used historical data to study three common coronaviruses to understand whether there were greater numbers of infections caused by these coronaviruses in the winter or summer. The study found that the levels of infection from the three coronaviruses appear to have followed a seasonal pattern in England, with peaks occurring in the winter at approximately the same time as influenza. The research team also studied whether people became infected with these common coronaviruses more than once to try to understand whether people developed immunity to the virus. The study found that only small amounts of the virus were transmitted in the summer months, a finding that may also be applicable to COVID-19. For more information, contact Dr Rob Aldridge (firstname.lastname@example.org).
Risk of coronavirus infection and use of public spaces
This important study was the first to investigate the impact of a range of public activities on the risk of acquiring respiratory tract infection in a population-based cohort using data from the Flu Watch study (a community study of respiratory infection occurrence and risk factors which followed households across England and Wales through the winter seasons of 2006/7-2010/11). This Wellcome Trust funded research found that time spent in public spaces, including supermarkets, eating out, socialising, shopping and using public transport, significantly raises risk of contracting respiratory illnesses. Contact with someone who has a cold also significantly increases the risk of contracting a respiratory illness. These findings support intensive physical distancing and isolation measures in all countries with community transmission of COVID-19 to slow the spread of the virus, save lives and reduce the intense pressure that health services will face. For more information, contact Prof Andrew Hayward (email@example.com).
Burden and impact of COVID-19 in care homes
COVID-19 causes significant mortality in elderly and vulnerable people and spreads easily in care homes where one in seven individuals aged > 85 years live. However, there is no surveillance for infection in care homes, nor are there systems (or research studies) monitoring the impact of the pandemic on individuals or systems. This one-year ESRC UKRI funded study, to commence on 1 May 2020, will build on an existing collaboration with Four Seasons Healthcare (FSHC), and will extract weekly data on COVID-19 cases, hospital admissions, deaths and the use of disease control measures across 200 UK care homes. Findings will be shared with FHSC, GPs and Public Health England, patients and the public, and support the national response to COVID-19. For more information, contact Dr Laura Shallcross (firstname.lastname@example.org).
More COVID-19 research and activities
Redeployment of staff to COVID-related clinical duties
We are extremely proud of all our staff who have moved to working on the NHS front line and volunteering to help wherever needed. We are delighted that Dr Ami Banerjee has been appointed Deputy Chief Clinical Informatics Officer at the new Nightingale Hospital, London.
Informing Government policy
• Scientific Advisory Group for Emergencies (SAGE): COVID-19 response
SAGE provides scientific and technical advice to support government decision-makers during emergencies. IHI researchers are working alongside other experts to provide advice and expertise during the COVID-19 outbreak, for example as part of the Independent Scientific Pandemic Influenza Group on Behaviours (SPI-B) SAGE subgroup
• Evaluating and improving communication with the public during a pandemic, using rapid turnaround surveys
IHI researcher Dr Henry Potts and colleagues are analysing polling data on the public's attitudes, knowledge and behaviours around the coronavirus pandemic in collaboration with the Department of Health and Social Care, Public Health England and the Government Cabinet Office in order to inform government policy. This project, funded by the National Institute for Health Research, are informing guidance around how best to communicate with the public during this pandemic.
Hospital onset COVID infection
The UK Government has launched a new alliance to sequence the genomes of SARS-CoV-2, the virus responsible for the current COVID-19 pandemic. Dr Laura Shallcross is working with Prof Judy Breuer (UCL Division of Infection and Immunity), the UCL Comprehensive Clinical Trials Unit and Imperial College London to evaluate the impact of feeding back viral sequencing data to infection control teams in hospital (doctors and nurses responsible for preventing transmission of covid-19 between patients and/or healthcare workers) during the pandemic. The project will run at four sites (Imperial, Glasgow, Sheffield and Guy's and St Thomas' NHS Foundation Trust) and will test whether provision of sequencing results can help to identify the source of COVID-19 infection and whether it can help detect cases of hospital acquired COVID-19 infection (when patients catch COVID-19 from other patients or from healthcare workers whilst in hospital). The impact of this work will be to improve our understanding of how COVID-19 spreads in hospital and support efforts to prevent transmission.
Treatment with ACE-inhibitors and early severe SARS-COVID-19 infection
IHI researcher Prof Richard Dobson alongside colleagues at King’s College London carried out a study among acute inpatients with COVID-19 at King’s College Hospital and Princess Royal University Hospital in London to understand whether ACE-inhibitor use is associated with increased risk of severe COVID-19 infection. The team did not find any evidence for ACE-inhibitors increasing the short-term severity of COVID-19 disease and concluded that patients on treatment with ACE-inhibitors should continue these drugs during their COVID-19 illness.
Working with patients and the public to help tackle the coronavirus pandemic
Patients and the public remain at the core of all research activities carried out within our Institute. During these unprecedented times, our patient and public community have quickly risen to the challenge to get involved in our activities. For example, patients and the public are working closely with us to develop the ‘MyRisk’ calculator by feeding in to the design and functionality of the tool and design of the website. As always, we are extremely grateful to our patient and public community for their valuable input and insights. For more information, contact Natalie Fitzpatrick (email@example.com).