The NIHR HPRU and COVID-19

Dr Jesus Rodriguez Manzano, HPRU lecturer has redeveloped a suite of novel rapid point-of-care diagnostics for the management of COVID-19

Members of the HPRU in HCAI and AMR have been doing their bit to help address the Covid 19 pandemic along with the clinical and research community

In February our Director, Professor Alison Holmes was an invited international expert at the WHO convened ‘Global Research and Innovation Forum: Towards a Roadmap for the 2019 Novel Coronavirus’, which shaped WHO Country and technical guidance. Since then she continues to support the WHO as a member of WHO COVID related panels and groups including the WHO Health Emergencies Program (WHE) Ad-Hoc Advisory Panel of Infection Prevention and Control Experts for Preparedness, Readiness and Response to COVID-19 (WHE-IPC-AP).In the UK she serves on a Scientific Advisory Group for Emergencies (SAGE) Coronavirus Response working group on nosocomial transmission.

Our close links with Imperial College Healthcare NHS Trust have enabled staff and students from the HPRU to work collaboratively with the Trust’s Hospital Epidemiology team, to model and forecast local figures every 48 hours. This work, which was shared with the Northwest London Clinical Commissioning Groups is further supported by HPRU collaborators in the Department of Mathematics led by Mauricio Barahona. The local forecasting was used to support bed capacity management and forward planning across the sector. This existing established collaboration is also facilitating the analysis and mapping of potential transmission pathways and the targeting of interventions. Interestingly, the systems our NHS service had developed and established to track and trace AMR, particularly for carbapenemase producing Enterobacterales (CPE) was effectively and rapidly deployed for COVID.

Our Medical Research Foundation PhD student Ashleigh Myall is undertaking further mathematical modelling of COVID-19 to look at its impact on antimicrobial resistance. Two of the Trust’s consultant microbiologists, Dr Satta and Dr Davies, who are conducting their MRC Clinical Academic Research Partnership awards under the auspices of the HPRU are, in addition to providing frontline clinical support, initiating research projects to examine the microbiology of COVID-19 and the impact of the pandemic on healthcare associated infections, respectively. The two projects will address key evidence gaps.

Other members of the Unit are repurposing their work on AMR to address the management of COVID-19. Dr Jesus Rodriguez Manzano, Lecturer with the HPRU, and Dr Pantelis Georgiou, a collaborator in the Department of Engineering and theme lead in our next HPRU, redeveloped their suite of novel rapid point-of-care diagnostics for the management of COVID-19 in collaboration with the National University of Singapore and Public Health England. Funding has been awarded by Imperial College to provide the first sample-to-result proof-of-concept data using this novel diagnostic platform. Once clinically validated, there is also an opportunity to integrate the diagnostic with a wearable monitoring system to enable real-time case reporting for epidemiological surveillance. 

Meanwhile, Dr Tim Rawson, an Honorary Clinical Research Fellow with the Unit, and post-doctoral researcher Bernard Hernandez Perez (Engineering) with NHS colleagues, are further developing our Clinical Decision Support System for antimicrobial prescribing, developed as part of an NIHR i4i award, to see if its case-based reasoning algorithm can be specifically adapted to help antibiotic management in the context of COVID19.  The importance of antimicrobial use and stewardship, to improve patient care and reduce the drivers of drug-resistant was highlighted in our recent paper “A rapid review to support COVID-19 antimicrobial prescribing” in Clinical Infectious Diseases. 

Funding has been awarded to the HPRU by the UKRI to fund a collaboration with UCL and the Sanger to sequence SARS-CoV-2 positive samples, and explore the utility of whole genome sequencing to understand local transmission and target interventions. Work is also in progress to examine the role of environmental transmission in collaboration with Prof Wendy Barclay.

A range of other clinical members of staff have been helping NHS colleagues wherever they can. Members of the team have supported the co-ordination of PPE production in collaboration with the Trust and Imperial College’s Hackspace. Dr Esmita Charani, the HPRU Senior Research Pharmacist, is currently supporting the Trust’s staff testing programme and also working at Chelsea and Westminster to better understand symptoms associated with COVID-19. She has also been involved in work validating POC serological assays for SARS-CoV-2 in a UK hospital population, trying to independently validate three of the available test kits.

Richard Wilson, who was previously the lead pharmacist for critical care at Imperial College Healthcare NHS Trust has put his research on hold in order to return, working in the General ICU at Hammersmith Hospital. Others clinicians refreshed their critical care training and are working in ICU.

Finally, clinical colleagues in China with first-hand experience of the pandemic and its management in Wuhan make contact to offer a webinar to interested staff.  The meeting, co-ordinated by the HPRU team, took place by video-conference on Friday 3^rd April and provided insight into a range of topics from recommendations for management of severe COVID-19, to Community infection control including the issue of care homes.