COVID-19 priority research: a call to action

An understanding is growing that although the ongoing COVID-19 shutdown is vital to contain the coronavirus, putting society into a suspended animation is only a stop-gap measure. Any effective and sustainable exit plan relies on various research strands coming to fruition with all possible speed. Exit strategies must also be designed to avoid sliding into a roller-coaster of recovery, breakouts, lockdowns and social distancing.

One immediate research priority is to develop effective and efficient treatments for those infected, particularly targeting those individuals who react to the virus with life-threatening symptoms. Many research authorities are applying fast-track processes to speed the approval times of COVID-19 research, be it for novel drug discoveries or drug re-purposing.

Global open data is the default position in a global health pandemic. To have the greatest positive impact, vaccines must be urgently developed, financed, manufactured and fairly distributed in parallel on a global level.

A sound exit plan in an infectious disease global health crisis also rests on developing and allowing global access to diagnostic tests that can identify those with past and current infections. One can hope that in the longer term some level of global herd immunity will eventually be acquired. 

In addition to the critical work being done by medical researchers, the input needed from the social sciences must not be overlooked. We have all come to understand that ‘health’ depends on a range of determinants, and attention is increasingly being given to the socioeconomic and socio-cultural profile of COVID-19 victims. Data regarding England indicates that the number of those admitted to ICUs coming from black and minority backgrounds is disproportionate to their presence (circa 14%) in society.[1], [2] The existence of some correlates and causalities between socio-economic factors and the prevalence of COVID-19 surely comes as no surprise, although this approach must go hand-in-hand with conducting genetic and genomic analysis. The COVID-19 virus is said not to discriminate; however, societies do. 

The UK’s four chief medical officers, and NHS England and Improvement’s National Medical Director, issued on 3rd April a letter to every NHS Trust to encourage efforts to enrol patients into nationally prioritised clinical trials on COVID-19. This research program covers the whole disease spectrum and is located in primary care, hospital and ICU settings. The letter stresses that patients need to be recruited as quickly as reasonably possible: ‘the faster that patients are recruited, the sooner we will get reliable results’.

However, the complexity of organising clinical trials in a context of global pandemic should not be underestimated. In a recent COVID-19 webinar at the Royal Society of Medicine, Professor Hugh Montgomery asked for support in ensuring that recruitment in critical COVID-19 clinical trials progresses with all possible speed, expressing concerns that recruitment could meet with obstacles.

The repercussions of trial recruitment problems will be dire. Let us all therefore add to our COVID-19 priority ‘to-do’ list the duty to promote participation. Ideas of how we can act would be welcome. 

References

[1] Intensive Care National Audit and Research Centre (ICNARC). Reports (https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports; accessed 17 April 2020). 

[2] Butcher B, Massey J. Are ethnic minorities being hit hardest by coronavirus? BBC News (https://www.bbc.co.uk/news/uk-52219070; accessed 17 April 2020). 

 

Comments (3) Add yours ↓
  1. Roger Kirby President-elect RSM

    Nicola is right – correctly performed, properly randomised trials are the only way to get reliable information about what does and what doesn’t work in COVID-19 patients. The NHS is arguably the best place in the world to conduct these important studies: https://www.nihr.ac.uk/covid-19/urgent-public-health-studies-covid-19.htm – so Nicola’s “call to action” should resonate with us all.

    April 17, 2020 Reply
  2. Brian Dye Lawyer

    Thank you to the OP for a great contribution. The referenced correspondence below by Peto proposes that the present policy of suppressive semi-lockdown measures could be replaced by universal repeated weekly testing of the population, with home quarantine of positive testers. Home quarantine being lifted when a whole household simultaneously tests negative. Everyone, other than pro-team positive test households can resume normal life, if they wish to, and still hold R0 down.

    Locally operated, a real-time system such as this, assuming a UK population of 66 million and 90% compliance, would need a capacity of maybe 8,500,000 million tests per day, harnessing a lot of lab facilities (including new ones) up and down the country. It seems to me the cost of this could be cheap compared to lockdown. The benefit of a real time system is that it could enable us to get a grip on the disease and put the public back in control of their own futures.

    Here’s the paper:

    Peto J. Covid-19 mass testing facilities could end the epidemic rapidly. BMJ 2020;
    368: m1163.

    https://www.bmj.com/content/368/bmj.m1163

    April 17, 2020 Reply
  3. Dr Stephanie Barrett Consultant Rheumatologist

    The awareness and recruitment to properly conducted randomised, controlled trials, with significant numbers will make all the difference in controlling the pandemic.
    Patient awareness of the relative safety of these interventions in the trials, is key to recruitment. Many of the drugs have been used for many years in other diseases such as those seen in rheumatology and HIV, and therefore there is a good safety record.

    April 20, 2020 Reply

Your Comment

All comments are moderated. Trends in Urology & Men’s Health reserves the right not to publish material we deem inappropriate.

Web design and marketing agency Leamington Spa