Responsive Research

COVID-19 Pandemic Response 

Our remit includes a responsive research capacity in the event of a major health protection incident. Our work on the COVID-19 pandemic is a model of policy-relevant responsive public health research. This led to the recruitment of the globally unique cohort, the Integrated Network for Surveillance, Trials and Investigations into COVID-19 Transmission (INSTINCT). The success of this enterprise was recognised by the award of a Chief Medical Officer-commissioned grant, Assessment of Contagiousness of COVID-19 Contacts (ATACCC), to recruit a parallel sister cohort of newly-exposed COVID-19 contacts to address key public health knowledge gaps in household transmission and infectiousness.

Integrated Network for Surveillance, Trials and Investigations into COVID-19 Transmission (INSTINCT)

Coronavirus disease 2019 (COVID-19), caused by a new human virus, SARS-CoV-2, has quickly spread to cause a global health emergency yet we know very little about how the virus spreads in households, the immune response to it and why different people experience such diverse outcomes after infection. We therefore address these fundamental questions:

1. What proportion of household contacts get infected?

2. What proportion of cases are symptom-free? How many are infectious?

3. Which initial immune responses protect against (a) infection and (b) symptomatic COVID-19 disease? 

4. How long does immunity last?

We collect throat swabs (for virus) and blood samples (for immune responses) from adults and children over 5-yrs with newly diagnosed COVID-19 and their household contacts. Samples are taken at 5 time-points over 6 months to understand the evolution and durability of immune responses. Alongside laboratory samples, we collect daily information on participants’ symptoms and health which will then be linked to laboratory sample results, including immune responses, to answer the above questions and identify which immune response are protective. Our findings will inform exit strategies from lockdown, guide longer term control of infection beyond lockdown and accelerate development and evaluation of vaccines.

Assessment of Transmission and Contagiousness of COVID-19 in Contacts (ATACCC)

Coronavirus disease 2019 (COVID-19), caused by a new human virus, SARS-CoV-2, has quickly spread to cause a global health emergency yet we know little about how the virus spreads in households. On 31st December 2019, the first cases of infection with a novel coronavirus, subsequently designated SARS-CoV-2, emerged in Wuhan, China. A global pandemic was declared by the World Health Organisation (WHO) on 12th March 2020. The NHS Test and Trace (NTAT) system was launched in England on 28 May 2020. This system requests that those who develop COVID-19 symptoms notify National Test and Trace, isolate and undergo PCR testing for SARS-CoV-2. If SARS-CoV-2 infection is confirmed by PCR testing, the individual declares their contacts and NTAT gets in touch with those contacts and instructs them to self-isolate for 14 days.  If a contact goes on to develop symptoms, anyone they live with must then self-isolate and the individual must report their symptoms and get tested.

As we emerge from lockdown, a rise in transmission is expected and we therefore need urgently to improve our understanding of household spread. Therefore, in this Chief Medical Officer commissioned observational longitudinal cohort study, we will determine (a) the PCR-detectable SARS-CoV-2 secondary attack rate (stratified by symptomatic vs asymptomatic index cases) and the time to first PCR-positive nose/throat swab; (b) viral shedding (peak and duration) in symptomatic and asymptomatic PCR-positive contacts and (c) size and longevity of antibody and cell-mediated immune responses to SARS-CoV-2 in symptomatic vs asymptomatic PCR-positive contacts and the proportion of PCR-negative individuals deemed infected based on positive immune responses.

We visit the households of adult consenting COVID-19 contacts newly identified by the national test and trace system to collect information on daily symptoms, daily self-administered nose/throat swabs (for virus) and blood samples (for immune responses) while they self-isolate for 14 days. Our findings will inform government test, trace and isolation strategies to control infection in the UK.