From harnessing the computing and modelling expertise of scientists nationwide, overseeing the reorganisation of Royal Papworth and Addenbrooke’s Hospitals, preparing for clinical trials, and analysing national and international data to advise the UK government on its pandemic strategy, Trinity Fellows are contributing to the national response to COVID-19 and its consequences.
As President of the Royal Society Dr Venki Ramakrishnan has convened a multi-disciplinary panel to analyse the wealth of data emerging from the pandemic to determine the effects of various measures on a range of public health, social and economic outcomes.
The Data Evaluation and Learning for Viral Epidemics (DELVE) panel will include in its work consideration of how the UK can emerge from the current lockdown.
‘We are also looking at how different countries have adopted different strategies, for example, is the use of masks by everyone in public spaces useful in reducing transmission, when they have opened schools, how much testing they have done, what is the percentage of asymptomatic carriers and the percentage of asymptomatic transmission, how long would you be immune to this virus if you have recovered from an infection,’ Dr Ramakrishnan said.
As a member of the DELVE steering committee, Professor Sir Tim Gowers, a Fellow in Mathematics at Trinity and Fields Medallist, will help oversee the detailed work and communicate the panel’s findings to government. He said:
‘As a country we have to make some very important decisions without much time to think about them. Doing a cost-benefit analysis is hard, especially given the many uncertainties about the effects of various measures, both on the economy and on the virus itself, and raises many mathematical questions, so I hope that my perspective – which is just one of many in a highly interdisciplinary committee – will be helpful.’
With experts in epidemiology and pandemic modelling working round the clock, the skills of the wider scientific community are in demand. Trinity Fellow and Lucasian Professor of Mathematics, Mike Cates is spearheading another Royal Society initiative, the Rapid Assistance in Modelling the Pandemic (RAMP) taskforce, alongside Professor of Mathematical Biology, Julia Gog (of Queens’ College).
They are coordinating offers of expertise from a remarkable array of disciplines, including scientists in academia and industry working on urban traffic planning, financial market modelling, data flow optimization across communications networks, and individualized marketing on social media.
Professor Cates says it is the first time that he has encountered such an urgent call to arms for mathematicians and scientists to help save lives. The fact that expertise from such a wide range of areas can help is testament to the effectiveness and interconnected nature of mathematics.
One of RAMP’s key aims is to understand how possible exit strategies from the lockdown conditions currently in place in the UK, and around the world, could work. RAMP is coordinating the efforts of this new volunteer workforce to build the computing and modelling capacity needed to explore possible exit strategies, refine the predictions of these models in response to live data from around the world, and try to understand our best way forward, says Professor Cates.
The response has been overwhelming with hundreds of researchers offering their services so far. It shows that we are all humans first and mathematicians or scientists second – faced with a human catastrophe, everyone’s first instinct is to do whatever they can to help out. The goal of RAMP is to marshal this goodwill into the most productive channels possible.
Meanwhile, biochemist Sir Gregory Winter, former Master of Trinity, believes the humanised antibody-based drugs his research enabled could help COVID-19 patients, particularly those whose immune system goes into overdrive in response to the virus. He said:
For reasons that are not yet clear, the immune system can over-react, leading to serious inflammation and collateral damage to healthy tissues, particularly the lung, including leakage of blood vessels and formation of blood clots, and a downward spiral to death. This is sometimes referred to as a “cytokine storm”.
Clinical trials in the UK for antibody drugs such as tocilizumab and eculizumab are urgently needed, Sir Gregory said, to assess their efficacy against this inflammatory reaction.
‘It is all too easy to be cautious – we need to find out, and to run these and similar medicines in clinical trials as soon as possible. We cannot assume that we will have a vaccine any time soon.’
Understanding the immune system response to the coronavirus, and why some people become very ill and others do not, is vital, according to Patrick Maxwell, the Regius Professor of Physic & Head of the School of Clinical Medicine.
Professor Maxwell has helped to oversee the reorganisation of Addenbrookes and Royal Papworth Hospitals to increase capacity to treat patients with severe COVID-19 and to separate the hospitals into areas for patients who might have coronavirus and those who do not.
We have greatly increased the capacity to treat patients who have severe Covid19 disease. This has meant increasing the number of intensive care beds, increasing the number of ventilators and retraining lots of staff. It has also meant stopping things that can safely wait – for example elective surgery. And in Papworth it has meant greatly increasing the capacity for extracorporeal membrane oxygenation (ECMO) which is what can be done when the lungs are so badly affected that putting them on a ventilator will not get enough oxygen into the lungs.
Professor Maxwell said as much activity as possible had been moved out of the main site at Addenbrookes. ‘Many outpatient consultations are now being done remotely. This is very challenging for some specialties where physical examination or tests are important.’
Meanwhile the Clinical School has been ramping up COVID-19 testing capacity in two ways: a test with a 90-minute turnaround to clarify if patients have the virus or not; and testing of frontline hospital staff.
The rapid point-of-care test would save 24-48 hours of uncertainty, Professor Maxwell said. ‘This is called SAMBA II and is made by Diagnostics for the Real World, a Cambridge spinout. The machine was made for HIV testing in Africa, and has been adapted to test for SARS-CoV2. The aim is to use it to test patients when they are triaged so that we really know if they have COVID or not.’
Professor Maxwell said the testing of NHS staff was vital, particularly because the virus affected people in very different ways.
‘We are finding some staff who carry the virus but are completely asymptomatic. Getting them to stay at home and self-isolate immediately protects patients and other staff. From the genome of the virus we will be able to understand whether it is spreading from one patient to another in the hospital, and from patients to staff and vice-versa.’
One consequence of the pandemic is that many diagnostic tests for suspected cancer have been put on hold.
Professor Rebecca Fitzgerald, Interim Director of the MRC Cancer Unit, and an Honorary Consultant in Gastroenterology and Cancer Medicine at Addenbrooke’s has sought to tackle this issue for patients with symptoms related to the oesophagus.
‘I realised we could use the Cytosponge – given this is a crisis situation – and provide some diagnostic assessments for those with worrying symptoms when most cancer testing, which relies on endoscopy, is on hold,’ she said.
Professor Fitzgerald’s Cytosponge – the ‘pill on a string’ – has been progressing through clinical trials to show that it can detect pre-cancerous cells. This week, for the first time it was administered to patients at Addenbrooke’s to detect cancer as part of a new clinical service in response to COVID restrictions in endoscopy.
Compared to an endoscopy, which requires three medical staff, the Cytosponge is less invasive for patients and safer for medical staff because fewer aerosols are released.
Read the latest Reflection by a Trinity Fellow: Sir Gregory Winter on the use of antibody-based drugs in the fight against COVID-19.
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