Oxford 2020: Meeting the Pandemic Challenge
The vaccine hunt begins...
On 31 December 2019, China reports a mysterious cluster of pneumonia-type cases in Wuhan, Hubei Province. On 2 January an Oxford team begins work on the new disease, building on decades of research into vaccine technologies for just this type of crisis. China publicly shares the genetic sequence of the virus on the morning of Saturday, 11 January. Within hours the team around Professors Sarah Gilbert and Andrew Pollard begin work on a vaccine candidate: ChAdOx nCoV-19. By the end of 2020 they will have an approved vaccine for the world, completing what normally takes around fifteen years in just ten months.
...and another hunt for immediate treatments
Oxford’s Medical Sciences Division organises a large-scale information sharing exercise about the new disease. The next day, a global federation of health bodies hosted by Oxford, the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), launches a plan drawn up previously for exactly this scenario – a global pandemic requiring rapid enrolment of patient volunteers within strict ethical guidelines, to help assess new clinical treatments. The virus remains unnamed – it will be another 10 days before the World Health Organisation calls it ‘COVID-19’.
Genome sequencing is a key weapon
Dr Moritz Kraemer sets up a large collaboration to map the spread of COVID-19, launching an interactive global map backed by open-access epidemiological data. Meanwhile Professor Oliver Pybus leads analysis for a ‘virus genome sequencing alliance’ to unlock the secrets of the disease, with its importance noted by Government Chief Scientific Adviser Sir Patrick Vallance. This particular UK and Oxford initiative will become critical later in the year as COVID variants begin to emerge.
Imaginative start-ups race to help
Oxford has been a hotbed of innovation for centuries but the pandemic acts as a fresh spur to finding creative solutions. Based at Oxford Foundry (OXFO) and led by Dr Alexander Finlayson, digital health care start-up Nye Health dramatically scales up its remote health consulting tool, allowing 10 million patients to consult with doctor. Dr Kyle Grant, founder of another start-up OxWash, applies a revolutionary green solution to NHS needs across several cities, collecting and returning laundry by electric cargo bike.
The world’s largest clinical trial begins
Professors Peter Horby and Martin Landray start the Randomised Evaluation of COVID-19 Therapy (RECOVERY) Trial, which will become the world’s largest clinical trial for COVID-19 treatments. In March 2020, nobody knows whether existing drugs used to treat other conditions might also benefit COVID-19 patients. The trial begins as a collaboration with the UK’s National Health Service, enrolling 37,000 hospital patients, later becoming international.
Racing towards new solutions
As the crisis gathers pace, there are a flurry of initiatives across the University. Ideas for a contact tracing app, a rapid coronavirus test and a rapidly manufacturable ventilator all gain traction. The ventilator is a collaboration between Engineering Science, Anaesthetics and King’s College London. Within one week a small group of academics and students led by Professor Mark Thompson build a working prototype and win a place on the UK Government’s Ventilator Challenge. OxVent becomes a social venture supporting deployment of innovative low-cost ventilators across the world. The UK goes into lockdown on March 23.
The university adjusts to lockdown
Day after day in March, the UK sees bright sunny days of almost perfect spring weather, but the atmosphere remains uneasy. On 13 March, two days after the World Health Organization calls a global pandemic, Oxford University advises all students to return home where possible. On 23 March the Prime Minister instructs the British public to ‘stay at home’, except for ‘shopping for basic necessities’, and when travelling to and from work is ‘absolutely necessary’. However, technology and rapid planning allow many of Oxford’s key and most distinctive activities to keep going. This includes online tutorials for undergraduates.
Helping parents help their children
Now it’s late March. Lockdowns are everywhere, 1.5 billion children are at home and parents are feeling the heat. An Oxford team led by Professor Lucie Cluver and Dr Jamie Lachman launch positive parenting resources including tipsheets, comic strips and audio packs. These resources are based on evidence-based, open-source parenting programmes across Africa, Asia and Europe, disseminated by the World Health Organization, UNICEF and others. Translated into over 100 languages by volunteers, the tips went on to be used by 33 national governments and have reached over 150 million families in 198 countries.
Towards a wearable tech revolution
Professors Lionel Tarassenko and Peter Watkinson have already pioneered a system for recording nurse observations, but now they rapidly deploy a Coronavirus Health Monitor consisting of wearable technology for hospitalised COVID-19 patients – a wireless pulse oximeter and a chest patch connected wirelessly. Used on patients on Oxford’s main COVID-19 isolation ward from April 2020, it reduces staff exposure to viral infection while allowing patients to walk around, critical in fighting a respiratory infection. By the end of the year it will have been used for the real-time monitoring of 164 patients for 8,000 hours during the first two waves of the pandemic in the UK.
The humanities bring a sense of perspective
The humanities play a significant role in the University’s COVID response. Dr Stuart Lee leads Lockdown2020, crowdsourcing students and staff for lockdown testimony, often submitted via Twitter. Word analysis reveals the popularity of ‘exercise’, ‘nature’, ‘Zoom’, ‘breathe’, ‘nature’ and ‘family’. Elsewhere in the University the entire, public-facing Humanities Cultural Programme goes online almost over night, while on 15 April the Ten-Minute Book Club is set up, later achieving international traction as far afield as India. It is led by Dr Alexandra Paddock, Professor Kirsten Shepherd-Barr and Dr Erica Lombard, and features book snippets readable in ten minutes.
The museums donate their protective equipment
The pandemic is now a worldwide healthcare crisis with over 1 million cases of COVID-19 declared globally. The Bodleian Libraries, Ashmolean Museum, History of Science Museum and Museum of Natural History all answer a call to donate their Personal Protection Equipment (PPE) to key workers and frontline healthcare professionals. Conservators often use hazardous substances in their work, meaning that boxes of nitrile gloves, disposable aprons, sleeve protectors, protective masks and antibacterial wipes can all be given to the NHS.
The case for better animal welfare
Oxford has several programmes in conservation science. Professor E J Milner-Gulland, with colleagues Doctors Hollie Booth, Lauren Coad and Stephanie Brittain, issues a powerful statement on the need of humanity to rebalance its relationship to nature, accepting that the suspected zoonotic (animal to human) source of COVID-19 is not proven. They call for an evidence-based approach to risk management within global food systems, and scrutiny of both intensive livestock rearing and the trade, hunting and consumption of wildlife. They also call for prioritising better welfare standards for domestic and wild animals, recognising that this approach also reduces human risk of disease.
The principle trial begins
Managed by the University’s Primary Care Clinical Trials Unit and led by Professors Chris Butler and Richard Hobbs, Oxford launches another major national treatment trial called PRINCIPLE. Whereas RECOVERY is hospital-based, this trial is focused on at-risk COVID-19 patients in the community and applies common drugs to test their effectiveness in halting the disease and preventing hospitalisation. The trial is conducted through GP surgeries and will later be expanded to include more drugs and a wider age-range of patients.
A unique summer term unfolds
The University’s summer (Trinity) term is unlike any other in its 800-year history. All in-person teaching and exams are replaced by online learning, assessment and support. Teaching and professional support staff work tirelessly to move tutorials, seminars and lectures to online formats. Tens of thousands of exams are delivered online. Student support moves to online delivery, from counselling to careers. It is a challenging time but according to a subsequent survey two-thirds of both staff and students will say that they were satisfied overall, paying testimony to the collegiate University’s response to the challenges it faces.
A big announcement
The month ends with a very significant partnership announcement between the University of Oxford and the UK-based global biopharmaceutical company AstraZeneca for the further development, large-scale manufacture and potential distribution of the COVID-19 vaccine candidate. The agreement includes working with many global partners on the international manufacture and distribution of the vaccine, and particularly working to make it available and accessible for low- and medium-income countries. Both partners agree to operate on a not-for-profit basis for the duration of the coronavirus pandemic.
Mental health matters
Oxford researches mental health and wellbeing issues among many populations, both locally and globally. The month begins with the launch of an international mental health survey of adolescents (Oxford ARC Study), led by Professor Elaine Fox and designed to determine what promotes or hinders resilience. A few days later an interim report is published on a family mental wellbeing survey (Co-SPACE). Co-led by Professor Cathy Creswell and Dr Polly Waite, it highlights the enormous pressure lockdown has placed on the parents of children, particularly children with special education needs and/or neurodevelopmental differences and those from lower income households.
A special Oxford report is published: Will COVID-19 fiscal recovery packages accelerate or retard progress on climate change? Professor Cameron Hepburn has led a global survey of over 700 economic stimulus policies, sent to 231 global experts, and they conclude on average that a ‘green’ route out of the COVID crisis will also be highly effective economically. Co-authored by Professor Joseph Stiglitz and Professor Lord Nicholas Stern, the report highlights the economic and green benefits of renewable energy, building retrofit, clean infrastructure and natural capital investment for ecosystem resilience and biodiversity. Fossil fuel subsidy and airline bailouts are by contrast the worst sort of stimulus.
COVID mortality risks shared
Collaborating with the London School of Hygiene and Tropical Medicine, Oxford publishes the largest COVID-19 risk survey yet seen, considering 17.4 million UK adults between 1 February and 25 April 2020. The survey reveals that ethnicity is a factor in COVID risk (and contrary to prior speculation, only partially attributable to pre-existing clinical risk factors or deprivation); that social deprivation is a source of risk, and that in general, older males or patients with underlying diabetes or severe asthma are at greatest risk.
COVID-19 and inequality
Research fellows Victoria Nash and Rebecca Eynon report that the move of 1.3 billion children to home schooling has resulted in exaggerated inequalities, primarily related to digital access and affluence. 4 June will see the publication of Gender inequalities: changes in income, time use and well-being before and during the UK COVID-19 lockdown. This major report, led by Professor Man-Yee Kan, will highlight that women have suffered twice in the face of lockdown and COVID-19. Gender inequality at home has continued, while 80% of frontline health workers are women, disproportionately exposing them to COVID risk.
The history of pandemics
Members of the History Faculty publish widely in the public domain about the lessons of previous pandemics. Dr Helen Lacey writes about the economic consequences of the Black Death and Professor Lyndal Roper considers the plague in the Reformation. 22 May sees Professor Mark Harrison publish COVID-19, the aftermath: insights from history, in which he notes that all previous pandemics resulted in racial and class-based divisions, economic strife, extreme politics and prolonged civil unrest, as suffering populations and authorities sought answers and scapegoats for their plight.
A remarkable donation to the university
Reuben College had been established in May 2019 as Oxford University's 39th college, and is dedicated to graduate study with a focus on interdisciplinary research addressing 21st-century challenges. Right in the middle of the COVID pandemic, the Reuben Foundation makes a transformational gift of £80 million, endowing the college. The college’s focus remains interdisciplinary research addressing future global challenges including cellular research, environmental change and Artificial Intelligence. The first of those includes vaccine research.
The life-saving properties of dexamethasone
The RECOVERY trial begun in March yields a big result. An instantly available and affordable steroid treatment, dexamethasone, shows a clear benefit to patients severely ill with COVID-19. The survival rates for patients with severe respiratory complications improve by one-third. Professor Peter Horby describes it as ‘…an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients.’ It did. By early 2021 the drug is estimated to have saved over 1 million lives worldwide.
The university continues to reach out
Oxford’s outreach programme to potential new students is a vital part of its mission. A new digital learning resources hub is launched and video presentations engage potential applicants. The University’s flagship free residential access programme for UK state-school students, UNIQ, moves entirely online, as does its graduate counterpart UNIQ+. The annual University-wide undergraduate Open Days go virtual, and the launch of Opportunity Oxford, the University’s major new access initiative, go to plan. All participants complete an online study module and 100 go on to attend a September residential stay in Oxford, designed to conform to social-distancing regulations.
Air quality and COVID-19
By now the world has registered 10 million cases of COVID-19. On this particular day the first lockdown in the UK ends. Air quality has improved in most places where there has been a lockdown, with traffic volumes down 60% in Oxford in April. But what exactly is the relation between a disease with respiratory symptoms and air pollution? Early July sees Oxford researchers led by Professor Felix Leach win funding to extend the existing air quality sensor network to 16 city locations, taking a measurement every ten seconds. The OxAria programme includes noise measurement and will accelerate into 2021.
The call for face coverings
Professor Melinda Mills publishes a major study on face masks, noting, ‘The evidence is clear that people should wear face coverings to reduce virus transmission and protect themselves, with most countries recommending the public to wear them. Yet clear policy recommendations that the public should broadly wear them has been unclear and inconsistent in some countries such as England.’ Until this point there has been marked reluctance to wear face coverings in some countries including the UK, but from this point on the debate shifts in their favour and the UK introduces face covering regulations in late July.
Oxford’s vaccine produces a strong immune response
In a big milestone for Oxford’s vaccine programme, the result of the Phase I/II trial is published in the scientific journal, The Lancet, and indicates no early safety concerns and strong immune responses in both parts of the immune system. The vaccine provokes a T-cell response within 14 days of vaccination (white blood cells that can attack cells infected with the SARS-CoV-2 virus), and an antibody response within 28 days (antibodies are able to neutralise the virus so that it cannot infect cells when initially contracted).
AI COVID-19 test breaks new ground
Oxford champions collaborative work across departmental boundaries. A classic example is the partnership between a leading clinician, Dr Andrew Soltan, and two professors respectively of Artificial Intelligence and Big Data, David Clifton and David Eyre. Out of their discussions comes an algorithm to detect COVID-19, ‘trained’ on the real data of 115,000 emergency hospital visits by patients. The astonishing result is accuracy of over 90% in screening patients for COVID-19, and no need for an expensive laboratory. It is fast, cheap and accurate and perhaps a glimpse at what AI might be able to do for healthcare in the future.
Don’t underestimate long-COVID
The term ‘long COVID’ originated in a tweet in May, but it received clinical validation in Oxford when alumnus and Consultant Physician with Oxford University Hospitals NHS Foundation Trust Dr Rajarshi Banerjee sat down with his team at the company Perspectum to study scan data from former COVID-19 patients. What they saw greatly troubled them: multi-organ damage in as many as a quarter of patients, which tallied with a rich stream of anecdotal evidence suggesting that for many patients the initial end of symptoms definitely didn’t mean the end of COVID-19.
The risks of opening up
Led by the Blavatnik School of Government, Oxford’s COVID-19 Government Response Tracker publishes The Risk of Openness Index which seeks to provide information on the risk that a country faces if the government adopts an ‘open’ policy stance – which means no policy measures aimed at containing the virus through reducing physical interaction. The index makes it possible to see how risk has changed over time, showing how the risk of openness has increased across much of Europe – a point that will unfortunately be borne out grimly in the months to come.
The healthy perspective of centuries
The University’s Bodleian Library hosts a landmark conference – online of course – to celebrate the 700th anniversary since the first steps towards a central university library had been made by Thomas de Cobham in 1320. The new library in the University Church developed over a century but set out the principle of preserving knowledge while supporting learning. The conference carries a special air, as Bodley’s Librarian Richard Ovenden notes the importance of this knowledge as the basis of the vaccine and countless other pandemic discoveries. It is also recognised that the University has seen many previous pandemics come and go, including the Black Death.
Another rapid test breaks cover
In a multi-party collaboration between Oxford University, government agencies, other universities and company Oxford Nanopore, a big test programme yields a big result, namely that Oxford Nanopore’s sequencing technology offers diagnostic sensitivity of 99.1% in analysing COVID-19 samples from suspected patients, and the potential for thousands of tests a day, hugely speeding up the process. Led by Professor Derrick Crook, Oxford’s expertise in clinical microbiology and pathogen sequencing is once again evident, but so too its broader ability to collaborate with industry.
Long COVID presents worrying symptoms
Led by Dr Betty Raman and Professor Stefan Neubauer, the C-MORE study finds that three months after the onset of COVID-19, 64% of hospitalised patients experience persistent breathlessness and 55% complain of significant fatigue. Whole body MRI scans indicate abnormalities in the lungs of patients (60%), kidneys (29%), hearts (26%) and livers (10%). A month earlier, the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC), based at Oxford University, launches a large study to measure prevalence and risk factors of long-term health and psychosocial consequences of COVID-19. Oxford is now the leading authority on Long-COVID, partly because of a pre-existing excellence in medical scanning technology.
The infodemic laid bare
The Royal Society publishes a study by Oxford’s Professor Melinda Mills on vaccine deployment, exploring misinformation and policy. Prof Mills supports dialogue with local communities around the vaccine rather than a one-way stream of official information, to combat mistrust of authority and science and general vaccine hesitancy. Oxford’s Reuters Institute surveys COVID-19 misinformation in six countries covering March–April, finding that misinformation consists of 87% manipulation of true stories and 13% pure fabrication, typically on social media. The term ‘infodemic’ provides a powerful framing tool for health authorities.
The beginning of the end?
Before any vaccine’s effectiveness is announced, historian Dr Erica Charters looks ahead to the successful containment of COVID-19 and seeks an interdisciplinary framework for the ‘end’ of the pandemic, informed by history. ‘Epidemics end once the diseases become accepted into people's daily lives and routines, becoming endemic – domesticated – and accepted.’ But, she says in a co-authored paper How epidemics end, while the formal end signals a return to normality it is typically an uneven process, proceeding at different speeds in different places. Pandemics are socially, politically and economically negotiated, not just bio-medical events.
The university ramps up its own COVID-19 testing
A joint venture with life science company Thermo Fisher Scientific allows a steep increase in testing capacity to 50,000 a day. By quantifying antibodies in blood serum, the ELISA (enzyme-linked immunosorbent assay) is a serologic test that could also provide critical feedback on vaccine effectiveness, so this is a major step towards unlocking the pandemic both locally and globally.
The arrival of the lateral flow test
The University has a large population of staff and students for whom COVID-19 testing might allow face-to-face work to continue. In a collaborative research programme with Public Health England, Oxford professors led by Richard Hobbs had previously begun to pilot COVID-19 lateral flow tests among different volunteers at the University, to measure accuracy and usability, and as a ‘DIY’ alternative to the laboratory. The results now suggest a big advantage in their use to fight transmission of the disease. Regius Professor of Medicine Sir John Bell says of the discovery that if used systematically the tests might reduce infection rates by 90%. Within weeks lateral flow test kits will become common in homes across the UK and beyond.
The mental health benefit of going to school
More than 12,300 parents have now taken part in the Co-SPACE (COVID-19 Supporting Parents, Adolescents, and Children in Epidemics) survey co-led by Professor Cathy Creswell and Dr Polly Waite. The findings strongly show the mental health benefit of attending school, and conversely, the difficulties faced by primary age children during the first lockdown of 2020, and how they alleviated when schools went back. The survey also highlights the suffering of children with special education needs and/or neurodevelopmental differences and those from lower income household, all of whom displayed consistently elevated behavioural, emotional and attentional difficulties over the course of the pandemic.
Oxford’s vaccine announces phase iii results
On a very significant day in the history of the University, and in collaboration with its partner AstraZeneca, Oxford announces successful interim trial data from its Phase III vaccine trials. They show that the ‘Oxford Vaccine’, ChAdOx1 nCoV-2019, is effective at preventing COVID-19 while offering a high level of protection. There were no hospitalised or severe cases in anyone who received the vaccine, and over 24,000 volunteers had been drawn from clinical trials in the UK, Brazil and South Africa, providing a large safety base. The Oxford vaccine is noteworthy for being easily stored at ‘fridge temperature’ (2–8 °C) and distributed using existing logistics, while large scale manufacturing is already ongoing in over 10 countries to support equitable global access at cost-price.
Oxford’s vaccine is approved for use
On a landmark day for the University, the UK Government accepts the recommendation from the Medicines and Healthcare products Regulatory Agency (MHRA) to authorise the emergency use of the ChAdOx1 nCoV-19 coronavirus vaccine in the UK. Professor Adrian Hill, Director of the Jenner Institute, says, ‘For the past 25 years, staff at the Jenner Institute have worked to develop vaccines using novel technologies to protect people around the world from diseases that claim many lives each year. The work on ChAdOx1 nCoV-19 builds on many years of research by a dedicated team of vaccinologists, and we are delighted to see the first emergency use licensure.’
A knighthood for a professor
From early 2020, under the leadership of Professor Dave Stuart, the University, Diamond Light Source and the Rosalind Franklin Institute, coordinated their expertise and facilities to create a unified team that has been producing and distributing the virus’ proteins and host factors, studying their structures and interactions and screening them for possible drug therapies. They led the structural analyses work using protein crystallography. Dave was knighted as recognition of his work on December 31st.
The first Oxford-Astra vaccine is administered
The first doses of the Oxford-AstraZeneca vaccine are administered on this day, Jan 4th, 2021. But the implications of the vaccine are far greater than its first dose. From the start it was designed for the world. Distribution at cost meant that by late-April AZ had produced about a third of the world’s 1.47bn administered doses, with the widest distribution both geographically and across global income groups. As of mid-2021, 98% of vaccine supplies to Covax, the COVID-19 Vaccines Global Access initiative, are the Oxford-AstraZeneca vaccine.
More details and information about the University’s Coronavirus research can be found at Coronavirus Research | Research | University of Oxford
Find out more about the University's year in the 2020 Annual Review.