Imperial academics have received funding from the National Institute of Health Research (NIHR) to support new research into long COVID.

Three Imperial projects are among 15 UK-based studies to be backed by £19.6 million in government funding through the NIHR. The research programmes will help to better understand long COVID, improve diagnosis and find new treatments for the condition.

Long COVID can have serious and debilitating long term effects for thousands of people across the UK, which can make daily life extremely challenging Health and Social Care Secretary Sajid Javid

Recent findings suggest that although many people make a full recovery following COVID-19, a significant proportion of people continue to experience chronic symptoms for months. This is commonly referred to as long COVID, or post-COVID-19 syndrome.

The condition is still poorly understood and is associated with a myriad of symptoms, including fatigue, shortness of breath, chest pain or tightness and problems with memory and concentration.

Advancing long COVID diagnostics

A new project led by Imperial’s Professor Danny Altmann and Professor Rosemary Boyton will seek to better understand the mechanisms underpinning long COVID and its wide-ranging symptoms.

Some of the biggest hurdles faced by people with long COVID is a lack of recognition and being unable to get a specialist referral Professor Danny Altmann

To do this, the team will analyse blood samples from non-hospitalised long COVID patients and compare these to control groups. Researchers will then aim to identify relevant biomarkers which could be used to optimise treatment approaches and develop diagnostic tests for the condition.

Professor Altmann explains: “We will be working with volunteers from the community who are experiencing persistent long COVID symptoms, and looking at some of the current hypotheses which might explain why this is happening.”

“Our intention is to identify biomarkers to pave the way for clearer diagnostic tests and to inform the development of new therapies.”

“Some of the biggest hurdles faced by people with long COVID is a lack of recognition and being unable to get a specialist referral. Developing a more definitive diagnostic test would help to overcome these challenges.”

Creating a “gold standard” approach for long COVID treatment

Working with collaborators at the University of Leeds and Leeds Community Healthcare NHS Trust, Imperial’s Professor Brendan Delaney will jointly lead a £3.4 million research project to identify the best way to treat and support the one million people in the UK living with long COVID.

The diagnosis and management of long COVID is a huge challenge for doctors as it presents with a large array of symptoms which evolve over time Professor Brendan Delaney

The LOCOMOTION study aims to create a “gold standard” approach for the treatment of the condition. The team will work to identify best practices in providing services, ensuring people are supported quickly and receive the right treatments from the right healthcare professionals, in their own home, through their GP or at specialist long COVID clinics.

The project will also investigate how many people are unable to work due to long COVID and look at developing a vocational rehabilitation programme to support them back into employment.

To identify the best ways to support and treat patients, researchers will investigate the experiences of staff and patients at ten NHS sites, which collectively treat over 5,000 patients from a range of cultural and socio-economic backgrounds.

Dr Manoj Sivan, Associate Professor in the School of Medicine at the University of Leeds, Consultant in Rehabilitation Medicine at Leeds Teaching Hospitals NHS Trust and Leeds Community Healthcare NHS Trust, explains: “Long COVID is a significant challenge facing the NHS. It is a debilitating condition that has turned the lives of a large group of people upside down, with many unable to work or carry out activities that were possible before they became ill.”

“The purpose of this project is to optimise the way we organise services and enable evidence based and cost-effective treatments to be made available to everyone in a timely manner.”

Professor Delaney, Chair in Medical Informatics and Decision Making at Imperial’s Department of Surgery and Cancer, added: “The diagnosis and management of long COVID is a huge challenge for doctors as it presents with a large array of symptoms which evolve over time and there is potential for missing serious conditions, whether directly related to COVID-19 or not. We need to learn rapidly what works best from the existing services.”

“Imperial College is well placed to lead this work with Leeds, having one of the earliest established long COVID services and the capability to conduct research at scale. In North West London, researchers have access to a population-wide collection of health data from all GP and hospital sites covering 2.5 million people.”

Measuring improvement in long COVID

Imperial’s Dr Daniel Munblit will collaborate with researchers at King’s College London and the University of Liverpool to develop a unified approach to measuring improvement in long

COVID patients, bringing together perspectives from researchers, clinicians, patients and other key stakeholders.

Currently, treatment trials for long COVID use different methods to measure improvement among participants, making it difficult to compare results across studies. Developing an agreed framework will help to overcome this problem, while also aiding clinicians in measuring the aspects of long COVID that matter the most to patients and other healthcare professionals.

We have brought together experts from across the UK to work with international colleagues from the World Health Organisation and large international COVID studies Dr Daniel Munblit

To do this, the project team will create Core Outcome Sets (known as a ‘COS’) which specify what measurements should be taken in all patients. The researchers will build on the existing ‘COMET’ (Core Outcome Measures in Effectiveness Trials) framework to assemble global experts from relevant areas of research and medicine, as well as patients and other stakeholders, to compare perspectives and agree on an approach.

The NIHR-funded study will primarily focus on determining how to measure these core outcomes and which assessment methods should be used. The team will then share the agreed COS with key groups including healthcare professionals, researchers, long COVID patients and the public.

Dr Timothy Nicholson, Clinical Lecturer at King’s College London, said: “During this project, we will be developing a Core Outcome Set (COS) for long COVID. This is an important step in deciding best how to measure improvement in this disorder and optimise the ability to combine and compare data across research studies.”

Paula Williamson, Professor of Medical Statistics at the University of Liverpool, added: “We will be using robust methodology to achieve this, as recommended by the COMET Initiative, using surveys to achieve consensus between clinicians, researchers, patients, carers and other key stakeholders on how to measure this complex disorder.”

Imperial’s Dr Munblit, Honorary Senior Lecturer at the National Heart and Lung Institute, said: “We have brought together experts from across the UK to work with international colleagues from the World Health Organisation and large international COVID studies, such as the ISARIC consortium, to achieve consensus on the design of research studies addressing this disorder with a major global impact.”

Accelerating life-changing research

The new funding follows the four studies announced by the NIHR earlier this year, backed by £18.5 million, to help better understand the causes, symptoms and treatment of long COVID.

This package of research will provide much needed hope to people with long-term health problems after COVID-19 Professor Nick Lemoine Chair of NIHR's Long COVID funding committee

Health and Social Care Secretary, Sajid Javid, said: “Long COVID can have serious and debilitating long term effects for thousands of people across the UK, which can make daily life extremely challenging.”

“This new research is absolutely essential to improve diagnosis and treatments and will be life-changing for those who are battling long-term symptoms of the virus.”

“It will build on our existing support with over 80 long COVID assessment services open across England as part of a £100 million expansion of care for those suffering from the condition and over £50 million invested in research to better understand the lasting effects of this condition.”

Professor Nick Lemoine, Chair of NIHR’s long COVID funding committee and Medical Director of the NIHR Clinical Research Network (CRN), said: “This package of research will provide much needed hope to people with long-term health problems after COVID-19, accelerating development of new ways to diagnose and treat long COVID, as well as how to configure healthcare services to provide the absolute best care.”

“Together with our earlier round of funding, NIHR has invested millions into research covering the full gamut of causes, mechanisms, diagnosis, treatment and rehabilitation of long COVID.”

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This article has been adapted from press releases by the National Institute of Health Research and the University of Leeds