Much has changed since the beginning of the year, when University of Oxford researchers first started coming together to fight the novel coronavirus outbreak.
But as Charvy Narain from the Radcliffe Department of Medicine outlines, what has remained consistent is that the University of Oxford remains at the forefront of global efforts to combat the SARS-CoV-2 virus and mitigate its many effects: medical students have been stepping up, researchers with clinical skills are returning to front-line clinical roles, and others are offering up equipment and materials, as well as their laboratory skills to help the NHS respond to the crisis.
The University is also working directly with Oxford University Hospitals NHS Foundation Trust to reduce clinical research activity, and instead prioritising research on COVID-19.
Immunity as the key
One such researcher is Professor Tao Dong, a Professor of Immunology at the University, as well as the Oxford Director of the Chinese Academy of Medical Sciences Oxford Institute (COI). The Institute, a collaboration between the University of Oxford and the Chinese Academy of Medical Sciences, has turned out to be particularly well-placed to respond to the coronavirus crisis: its main aim is to deliver innovative ways of managing cancer as well as infectious diseases, and it has close links to clinicians as well as researchers in China.
Professor Dong says: ‘We started prioritising research on COVID-19 back in January 2020. In March, the COI has already provided funding to seven separate research projects unpicking the immunobiology of the SARS-CoV-2 virus, helping Oxford-affiliated researchers to get research started at record speed.’
Professor Dong’s own research group is currently testing samples taken from COVID-19 positive patients in hospital, taken at different time points in their illness. She says: ‘Some people with a COVID-19 infection are able to fight it off successfully, while others get really ill. We are analysing immune markers in patients to see if we can identify markers that predict how a patient is going to respond, and also to identify targets for drugs to make things better.’
Professor Dong does think that understanding the immune response to COVID-19 is going to be key to defeating it. She says: The immune response to this novel coronavirus is quite unusual. Some of the immune responses it appears to be triggering may actually be making things worse, and if we can predict who is going to respond this way, or even better, find ways to change it, we might be able to help patients.’
The immune system is also the focus of the Oxford Vaccine Group and the Jenner Institute, who are veterans when it comes to combating epidemics: in 2014, the Oxford team helped develop a vaccine for the Ebola epidemic in West Africa. The team are about to start trials in healthy young volunteers in the Thames Valley region, to test the new ChAdOx1 nCoV-19 vaccine.
The new vaccine is already in production but not ready yet. Dr Sandy Douglas, who is leading on the vaccine manufacturing scale-up project, says: ‘The scale of this epidemic poses a huge challenge for vaccine manufacturing. We need to follow rigorous safety standards and that takes time. By starting work on large-scale manufacturing immediately, we hope to accelerate the availability of a high quality, safe vaccine.’
Technology to the rescue
Large-scale usage would also be the key to the success of a mobile contact tracing app, developed by researchers at the Big Data Institute, Nuffield Department of Medicine, that could potentially help slow COVID-19 infection rates, and support countries to emerge from lockdowns safely. But civil liberty issues and ethics were also central to this proposal: researchers from the Wellcome Centre for Ethics and Humanities at Oxford University co-authored this study, and point out that both ethical oversight and public and user engagement would be essential to the app’s potential success.
The idea of an app is one of many emerging at break-neck speed as researchers focus their combined efforts to combat COVID-19.
Looking to the future
Some researchers are looking at what happens to COVID-19 patients over the longer term: Dr Betty Raman says: ‘We know from the previous SARS epidemic that coronavirus infections can have long-term effects on lung function, exercise capacity and quality of life. Tracking the long term effects of SARS-COV-2 may therefore be important and could highlight the need for ongoing medical surveillance and follow-up.’
Recent studies suggest that COVID-19 can affect other organs besides the lungs. So together with Professor Stefan Neubauer, Dr Raman is leading the C-MORE study, which assesses the effects of COVID-19 on multiple vital organs including the lungs, heart, brain, liver and kidneys (as assessed by magnetic resonance imaging) for up to twelve months. The study will also explore the impact of COVID-19 on functional capacity and quality of life for people who are affected by the illness.
Professor Neubauer said: ‘This research will be important to understand the long-term impact of SARS-COV-2 infection on a holistic level. The results will be important to assess the long-term consequences for healthcare resource planning and to guide development of new therapies.’
These researchers are also collaborating with others at Oxford, including Professors Clare McKay and Peter Jezzard at the Wellcome Centre for Integrative Neuroscience, to assess the impact of SAR-COV-2 on neurological and mental health, along with infectious diseases experts (such as Professor Brian Angus) and others.
Researchers at the Departments of Experimental Psychology and Psychiatry are looking at the longer term, and have launched a study to track young people’s and children’s mental health through the COVID-19 crisis. The study came together in record time. Dr Polly Waite, who is co-leading the study, said: ‘Schools closed in the UK on Friday 20th March, we had the idea for the study on Sunday 22nd March, and we had the survey out on following Monday, on 30th March.’
Dr Waite is a working clinical psychologist, and her research is usually focussed on managing anxiety in young people known to have anxiety disorders. “But the closure of schools and nearly all families having to stay at home is quite unprecedented, and we know that many young people already struggle with general anxiety, depression and OCD,” says Dr Waite. So the survey aims to identify what factors might protect children and young people from worsening mental health, what particular stress points there might be, and how this might vary according to factors specific to the child and family.
Professor Cathy Cresswell, the study’s other co-leader, says, “We hope to have more than 10,000 parents and carers across the UK complete the new online survey. Their responses will help us really understand how families are coping and what support could make all the difference to children, young people and their families at this time.”
The research team hope to track families over the next twelve months, including when children might return to school. “That may bring a whole new set of challenges for a family, but children are generally quite resilient,” says Dr Waite. “But again, what we want to do is try and track why and how some children have an easier time readjusting compared to others.”
In collaboration with the World Health Organization and UNICEF, the University of Oxford has also launched a parenting resource for self-isolating families.
During this challenging time, some of the world’s brightest minds are coming together, working in unprecedented ways to deliver world class research with global benefits and to make an impact on the frontline of this crisis. Oxford is made of its people, and these achievements are a result of contributions on all levels as we continue to face this global challenge, together.
Find out more about the University of Oxford’s coronavirus research.