The NIHR Oxford Biomedical Research Centre (BRC), which is hosted by Oxford University Hospitals, has allocated funding to three new COVID-19 research projects in an attempt to improve treatment, understand how the virus interacts with chronic diseases, and the longer-term effects of infection on organs. The Oxford BRC’s Director, Prof Helen McShane, said: “The researchers we support are already at the forefront of national efforts to find a vaccine for COVID-19, and effective treatments for patients – both in hospitals and general practice – who have contracted the virus. “Such is the breadth of expertise in our BRC – whether in immunology, technology, big data or imaging – that we are especially well placed to address many different aspects of this pandemic, from developing treatments in the short-term, to looking at the longer-term impacts of the virus. “For this reason, we have released funds to get these projects up and running as quickly as possible so that as many patients can benefit as possible.”
COVID-19 (Novel Coronavirus-induced disease 2019) can induce severe disease in 30 percent of hospitalised patients. Progression from a mild fatigue, fever and cough, to severe respiratory failure requiring mechanical ventilation typically happens one to two weeks into the disease.
This provides a window of opportunity to provide disease-modifying treatment. One candidate is Azithromycin (AZM), a commonly used antibiotic. AZM, used for a range of common infections, is safe, inexpensive and available worldwide. It also has broad antiviral properties and has been used against a wide range of inflammatory lung diseases and viruses. The ATOMIC trial, led by Dr Tim Hinks of the Experimental Medicine Division of the Nuffield Department of Medicine, will test the efficacy of 14 days of once-daily AZM tablets in preventing progression from moderate disease to severe respiratory failure in patients who present to hospital with COVID-19, but who are suitable for initial management as outpatients.
Another research project, jointly led by Prof Peter Watkinson of the Nuffield Department of Clinical Neurosciences and Professor Julia Hippisley-Cox of the Nuffield Department of Primary Care Health Sciences, will use national databases to understand whether drugs commonly taken for chronic conditions such as hypertension or diabetes may exacerbate or reduce the severity of COVID-19 disease. It is hoped this study will be able to identify alternative drugs for patients with chronic conditions, as well as possible drugs to treat COVID-19; and identify high-risk patients in primary care. The Intensive Care National Audit and Research Centre (ICNARC) is already providing up-to-date information on the admission characteristics and outcomes of all patients with severe COVID-19 infection treated on an ICU in England, Wales and Northern Ireland.
The new study will seek to match this against data on prior long-term medication and chronic disease, information contained in the QResearch databases derived from the anonymised general practice health records.
The third project, the C-MORE study, led by Dr Betty Raman of the Radcliffe Department of Medicine and the Oxford BRC’s Imaging Theme, is looking at the longer-term impact of the virus on patients’ organs. Previous studies have suggested that the effects of corona virus infection can carry on for months after the acute infection. Six months after infection, SARS survivors exhibited persistent impairment in lung function, exercise capacity and quality of life compared to a normal population. Using Oxford’s advanced state-of-the art imaging facilities, Dr Raman’s group will assess what the long-term effects of COVID-19 infection are, not just on the lungs, but also the heart, liver, kidney and brain.