COVID-19: six months on the frontline
On 31 December 2019, an outbreak of "pneumonia of an unknown cause” was declared in Wuhan, a city of more than 11 million people in the central Chinese province of Hubei.
Six months later, life across the globe has become unrecognisable. Travel has halted, entire nations have entered lockdown, and hundreds of thousands of lives have been lost. The virus behind the outbreak, which causes the disease COVID-19, has spread to at least 188 countries and territories.
Imperial College London has played a key role in tackling the virus. Let us take you on a walk through some of the defining moments.
January
Sounding the alarm
1 January 2020: Chinese officials close the Hunan Seafood Wholesale Market, suspected to be the source of the mysterious illness. Like many ‘wet markets’ in China, it sells fresh produce, meat, poultry and seafood alongside live animals, including wild game- which have been linked to previous viral outbreaks. Although the cause of the outbreak has not yet been confirmed, speculation of a SARS-like virus begins to take hold on Chinese social media.
9 January: The World Health Organisation (WHO) confirms that a novel coronavirus has been identified by Chinese scientists and implicates it as the cause of the outbreak. Coronaviruses are a large family of viruses, which cause both mild illnesses – like the common cold – and serious illnesses, such as SARS and MERS. Some transmit easily between people, while others do not. Chinese authorities initially believe that the new virus can cause severe illness in some patients but does not transmit readily between people.
Almost immediately, researchers at the MRC Centre for Global Infectious Disease Analysis (GIDA) and the Jameel Institute (J-IDEA) at Imperial begin working to track and model the spread of the virus. The Centre, one of the largest of its kind in the world, brings together scientists from fields such as statistics, mathematical modelling, epidemiology, genetics, intervention science and health economics to understand and predict the spread of infectious disease. The team, led by Professor Neil Ferguson, comes to be known as the Imperial College COVID-19 Response Team.
The team’s first report on 17 January comes as 41 cases, including two deaths, are confirmed in Wuhan with three confirmed cases in travellers detected in Thailand and Japan. But the researchers, using population and flight data, calculate that the true number could be in the thousands. Some of these cases seem to have had no direct exposure to the implicated market in Wuhan, and the researchers warn that human to human transmission should not be ruled out.
Less than a week later, as confirmed cases in China rise tenfold and ever greater numbers are being reported outside of the country, Imperial’s COVID-19 Response Team update their estimate to 4,000 cases.
Report 3, released on 25 January, confirms that human-to-human transmission is the only possible explanation for the scale of the outbreak in Wuhan. The epidemic is “a clear and ongoing global health threat” they warn, and controlling the outbreak will depend on successful detection, testing and isolation of suspected cases, even those with only mild symptoms.
Meanwhile a separate Imperial group, including Professor Robin Shattock and Dr Paul McKay from the Department of Infectious Disease, are already turning their attention towards vaccine development for the new disease, based on years of research by Professor Shattock into self-amplifying RNA technology. When injected, their proposed vaccine will deliver the genetic instructions to muscle cells to make the ‘spike’ protein on the surface of the SARS-CoV-2 virus. This should provoke an immune response and create immunity to the virus.
28 January: COVID-19 gene fragments arrive at the Shattock lab. Within days the team generates their novel coronavirus vaccine candidate and it is ready for first animal trials. It is just 14 days after scientists in China first sequenced and shared the genetic code of the virus, a speed unprecedented in vaccine development.
By the end of the month, the virus has arrived in the USA and Europe, with France, the UK, Spain and Italy reporting their first cases. The World Health Organisation declares COVID-19 to be a Public Health Emergency of International Concern.
February
A crisis looms
10 February: The COVID-19 Response Team releases estimates that one percent of people will die from their infection. This is lower than the death rate for SARS or MERS - although COVID-19 is much more widespread - but considerably higher than that of seasonal influenza. But they warn that a lack of data means that the estimates should be interpreted cautiously.
“Assessing the severity of an emerging disease is always challenging,” says report co-author Professor Azra Ghani. “This is because we generally detect those that are most ill first and only later get a sense of how many people may have milder disease or carry the infection but not have any symptoms."
Later in the month a concerning finding comes to light. As of 20 February 2020, more than 74,000 cases of COVID-19 are reported in China, with 2121 deaths, and more than 1000 cases are confirmed in 29 regions and countries outside mainland China. But the COVID-19 Response Team’s latest report estimates that two thirds of COVID-19 cases exported from mainland China have remained undetected worldwide. This potentially leaves sources of human-to-human transmission unchecked.
Professor Neil Ferguson warns: “It is highly likely that some of these undetected cases will have started chains of transmission within the countries they entered.”
In the Shattock Lab, researchers begin animal trials of their vaccine candidate. The Imperial team is one of several research groups around the world currently working to create a viable vaccine.
According to Professor Robin Shattock, the difference between this vaccine effort and that of previous outbreaks, such as the SARS outbreak in 2002, is that a vaccine could potentially be produced much faster than conventional methods. “We have the technology to develop a vaccine with a speed that’s never been realised before,” he explains.
March
Britain enters lockdown
6 March: The UK records its first death from COVID-19 - a woman in her 70s with underlying health conditions. One hundred and sixteen people in the country have now tested positive for the virus.
A few days later, Nadine Dorries, a junior health minister, becomes the first MP to test positive, prompting speculation that the disease might have spread through the Houses of Parliament. On 11 March, COVID-19 is declared a pandemic by the WHO.
The UK government advises everyone to work from home where they possibly can, along with other social distancing measures to control the spread of the virus. On 16 March, Imperial begins a transition to remote operations.
At the same time, the COVID-19 Response Team releases its landmark ninth report, modelling the impact of multiple public health measures on slowing and suppressing the spread of coronavirus. The report suggests that large-scale social distancing measures are necessary to reduce further spread and prevent the NHS being overwhelmed.
“The world is facing the most serious public health crisis in generations,” says Professor Neil Ferguson. “Here we provide concrete estimates of the scale of the threat countries now face.
“It is likely such measures – most notably, large scale social distancing – will need to be in place for many months, perhaps until a vaccine becomes available.”
The report, which is reinforced by similar findings from separate groups of infectious disease modellers worldwide, is followed by further findings from the team a few days later, which reveals that while the vast majority of the UK public are following advice to wash their hands more regularly, only half are adhering to social distancing guidance to avoided crowded areas and social events.
Professor Azra Ghani discusses what the MRC GIDA team does day-to-day, including information gathering, tracking cases and scenario planning. “We now have over 50 scientists working on COVID-19 [within the Centre] just to get the best possible sense of all the scientific information out there,” she says.
A week after Report 9, on 23 March, Prime Minister Boris Johnson orders the country into lockdown. People can only shop for necessities, exercise is limited to one form a day, and travel is allowed only to and from essential work. While not as tight as lockdowns in China, Italy and Spain, the UK is told in no uncertain terms to “stay at home”.
As Britain enters lockdown, China begins to ease restrictions. The COVID-19 Response Team researchers find encouraging evidence of initial success for China’s social distancing policy. For the first time since the outbreak began, in China there have been no new confirmed cases caused by local transmission reported for five consecutive days.
Professor Steven Riley, report co-author, says: “Although we do not know what will happen next in China, this report shows that very stringent social distancing can be relaxed after containment has been achieved without transmission returning in the short term."
The COVID-19 Response Team publish two more important findings on global deaths. They estimate that the outbreak of COVID-19 would likely have caused 40 million deaths this year worldwide in the absence of any preventative measures, infecting 7 billion people. In Europe, strong social distancing measures to slow and suppress the spread of the virus may have already averted up to 120,000 deaths in 11 countries, including the UK, Italy and Spain. Dr Samir Bhatt, report author and Senior Lecturer from the School of Public Health, says: “There is sound evidence that these [measures] have started to work and have flattened the curve.”
The self-amplifying RNA vaccine candidate being developed by Professor Robin Shattock’s lab produces encouraging results in animal trials. The team could be ready to start human trials in June, they say.
Meanwhile, Professor Peter Openshaw is helping analyse thousands of samples from COVID-19 patients across the country, providing insights into the disease including who seems to get it worse, and how the disease progresses.
As the race to tackle the new coronavirus ramps up, Imperial launches a COVID-19 Response Fund following a groundswell of offers from alumni and members of the public to help speed up the College’s work. In under a week, more than 250 alumni, philanthropists and friends of the College back the fund with over £600,000 of new gifts. Imperial’s President’s Excellence Fund also allocates £1 million to support COVID-19 work.
Over the coming months, the COVID-19 Response fund goes on to support scores of projects, including rapid coronavirus tests, low-cost ventilators and projects exploring the effectiveness of face masks.
26 March: Millions of people around the UK are beginning to take to their front doors and windows, gardens and balconies, to applaud those working on the frontline of the fight against coronavirus.
April
Community efforts
The number of cases worldwide passes the one million mark. In the UK, 10 days after first self-isolating following a positive test for coronavirus, Downing Street announces that Prime Minister Boris Johnson is taken into intensive care on 7 April.
Imperial researchers, students and staff come together to join the global fight, finding ways to use their expertise, time and resources to combat coronavirus.
More than one thousand members of staff and hundreds of students volunteer to support the NHS. Two hundred and eighty final year medical students join the NHS frontline months early, having taken their final assessments remotely for the first time in Imperial’s history.
Help comes from unexpected places. London gin distillery Sipsmith donate thousands of litres of alcohol to bolster the efforts of a team from Imperial’s Department of Chemical Engineering who are making medical grade hand sanitiser for nearby hospitals.
Many academics turn their attention to testing. Retrovirologist Professor Myra McClure converts her lab for NHS COVID-19 testing, able to handle 1,500 samples per day. Meanwhile, Professor Chris Toumazou redeploys his DnaNudge consumer DNA testing technology into a rapid, lab-free test that can detect COVID-19 and deliver results in just over an hour. In early April, it begins large-scale clinical testing on patients with a view to extensive national roll-out, as part of the drive to meet the UK government’s testing targets.
A major programme of home testing for COVID-19, led by Professor Paul Elliott, begins to track the progress of infection across England. The Real-Time Assessment of Community Transmission (REACT) programme, sponsored by Professor Ara Darzi, involves testing 100,000 people in the UK to determine the prevalence of coronavirus infection in the community. It is also assessing the feasibility of mass home antibody testing which could indicate how many people have been infected and recovered since the outbreak began. These tests could identify individuals who may have some immunity to the virus and help plan services for those who do not.
17 April: Imperial’s vaccine receives government backing, as Matt Hancock announces £22.5m to fast track its development in the daily coronavirus briefing. The University of Oxford, developing a different vaccine, also receives £20 million.
Imperial joins the Oxford-led clinical trial and begins testing the Oxford vaccine, known as ChAdOx1 nCoV-19, as the teams continue to share data. Dr Katrina Pollock leads the work at Imperial, one of several UK sites carrying out trials of the vaccine.
Two studies towards the end of April reveal unsettling findings.
- Professor Azeem Majeed, Head of the Department of Primary Care & Public Health at Imperial, finds that the UK’s policy for shielding older adults from COVID-19 overlooks 7.3 million adults aged 60-69, placing them at increased risk of death. Currently, the UK government’s age threshold for isolation is 70 years and over. But the researchers say that while this group is at a lower risk of severe illness compared to those aged 70 years or older, their risk is still considerable.
- The COVID-19 Response Team finds that Black patients may be at increased risk of poorer health outcomes from COVID-19, in an analysis of patients hospitalised in London. The findings reveal that over a five-week period, a large proportion of patients admitted were from ethnic minority groups when compared with last year’s admissions at the same hospital Trust. In addition, compared to white patients, Black patients admitted to hospital with COVID-19 tended to be younger, have fewer pre-existing health conditions, and have worse health outcomes.
As April comes to an end, the number of people who have died with coronavirus in the UK passes 26,000, as official figures include deaths in the community, such as in care homes, for the first time. The month also sees reports emerging of a rare Kawasaki-like inflammatory syndrome in children, linked to exposure to COVID-19.
May
Analysing the global impact
The COVID-19 Response Team turns its attention to experiences of the pandemic worldwide, releasing reports on the potential impact of COVID-19 on malaria in Sub-Saharan African countries and HIV, TB and malaria in low- and middle-income countries. The team reports that some regions may see deaths related to HIV, TB and malaria increase by up to 10, 20 and 36% respectively over five years. They also find disruption to health services in low- and middle-income countries could cause significant rises in cases and deaths from these diseases.
One of the report authors Professor Timothy Hallett, from the School of Public Health, says: “The COVID-19 epidemic might be an even bigger threat to public health than we have been thinking.”
Subsequent reports focus on particularly impacted countries:
- Reducing lockdown measures in Italy could lead to a larger spike in coronavirus deaths than previously seen in some regions.
- COVID-19 cases and the reproduction number are estimated in Brazil, and the direct and indirect impacts on disadvantaged and vulnerable populations in low- and lower middle-income countries.
The team warns of a 32% increase in the probability of death in the poorest fifth of the population compared to the wealthiest fifth, based on how handwashing access, occupation and hospital access varies with respect to wealth status.
Early in the month, the government publishes the list of academics advising them as part of the Scientific Advisory Group for Emergencies (SAGE). The list features many experts from Imperial, including virologist Professor Wendy Barclay whose work looks at how respiratory viruses like influenza spread.
At the College's White City Campus, volunteers begin work to make more than 50,000 disposable visors for staff on the frontline in Imperial College Healthcare NHS Trust hospitals, transforming an entire floor of Imperial’s Translation & Innovation Hub (I-HUB). They are supported by Rolls Royce Motor Cars who provide kits for the team of Imperial volunteers to assemble the first 7,000 visors.
Millions of donations continue to be made to support Imperial's COVID-19 vaccine work, including a landmark £2 million donation from the Partners of Citadel and Citadel Securities. Later in the month, the team receives further funding of £18.5 million government support which it will use to launch phase three clinical trials of its new COVID-19 vaccine later in the year.
18 May: It is announced that Imperial's COVID-19 Response team will advise the state of New York as they look to re-open following lockdown. The team will work with the state to provide technical advice and analyse data and metrics throughout the state's reopening process and help track the state's progress. A few days later, the latest report from the COVID-19 Response Team reveals that increased mobility in the United States as lockdown measures lift could result in a surge of coronavirus infections and deaths.
On the hospital wards, an Imperial-led project introduces mixed-reality headsets on COVID-19 wards to keep doctors safe as they help patients with coronavirus. Staff at Imperial College Healthcare NHS Trust wear the Microsoft HoloLens headsets which use Microsoft Teams to send a secure live video feed to a computer screen in a nearby room, allowing healthcare teams to see everything the doctor treating COVID-19 patients can see, while remaining at a safe distance.
By the end of the month, the rapid COVID-19 test developed by Professor Chris Toumazou rolls out in urgent patient care settings across London hospitals following successful patient trials.
June
A vaccine offers hope
The number of recorded deaths passes 40,000. Britain’s lockdown begins to show the first signs of easing
- The Government announces that up to six people from different households can gather outdoors, provided that social distancing is maintained.
- Car showrooms, outdoor sports amenities, and outdoor non-food markets may reopen, along with primary schools.
- Imperial looks to the future, announcing that the Autumn term will begin on schedule and campuses will be reopened, as the College prepares to offer a combination of in-person and online learning, adhering to social distancing at all times.
At the start of the month, Imperial’s COVID-19 Response Team publishes the script to reproduce its high-profile 16 March coronavirus report, as it passes a codecheck. The code, script and documentation, which is available on Github – with refactored code there since April – is subject to an independent review led by Dr Stephen Eglen, Reader in Computational Neuroscience in the Department of Applied Mathematics and Theoretical Physics at the University of Cambridge. The results confirm the quality of the original report’s code, despite high-profile criticism from self-described 'lockdown sceptics' and commentators. The Imperial team's code continues to hold-up when subject to expert scrutiny.
Professor Neil Ferguson gives evidence to the House of Lords Science and Technology Committee, saying the UK must keep transmission reduced by 65% to control the pandemic, noting that transmission has already been reduced by about 80 per cent: “So we have a little bit of wiggle room, but it will be a learning experience as to how we allow society to resume while maintaining control of transmission.”
7 June: The College forms a new social enterprise called VacEquity Global Health (VGH) to bring its COVID-19 vaccine to the world. For the UK and low-income countries, Imperial and VGH will waive royalties and charge only modest cost-plus prices to sustain the enterprise’s work, accelerate global distribution and support new research.
Meanwhile, the COVID-19 Response Team publishes several findings in new reports.
- Lockdown works: The first, on 8 June, concludes that lockdown and school closures in Europe may have prevented 3.1m deaths by successfully reducing the transmission levels of the virus. In the UK though, they find that while COVID-19 transmission has slowed, the epidemic remains likely to continue for months, even if lockdown controls and social distancing remained unchanged. According to the researchers, easing social-distancing restrictions should be considered very carefully as small increases in contact rates are likely to risk resurgence of the disease.
- No sign of herd immunity: There is no evidence that declines in the transmission of COVID-19 are linked to “herd immunity”, the researchers say. They conclude that the decline in cases and deaths is a result of lockdowns, behavioural shifts, social distancing and other interventions. This means that the epidemic is still at a relatively early stage and that a large proportion of the population in these areas remain susceptible to the virus.
- “As the world copes with the coronavirus pandemic, many countries have achieved control through great effort and cost,” says study author Dr Samir Bhatt. “Only a small percentage of people have been infected, the infection fatality rate is higher than seasonal flu, and this terrible disease is unlikely to go away on its own. Claims to the contrary, suggesting that we have already reached herd immunity, can be firmly rejected by independent, credible data from around the world. In short, the pandemic is far from over.”
Professor Neil Ferguson tells MPs attending the Science and Technology Committee that introducing lockdown measures in the UK a week earlier would have reduced deaths by at least half.
A new study led by Imperial College Academic Health Science Centre (AHSC) researchers confirms that the Kawasaki-like syndrome linked to COVID-19 in children is a new condition. The condition, which the researchers name Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS), is studied in 58 children admitted to eight hospitals in England. The condition is believed to be extremely rare, but there are concerns about long-lasting coronary damage. Less than 200 cases have been reported in England with a range of symptoms and severity and most children have already recovered.
15 June: Non-essential shops can re-open for the first time since lockdown began, as well as farms, zoos, safari parks and places of worship for private prayer. This is welcome news for many, as the ONS reveals the UK economy shrunk by 20.4% in April, the largest monthly contraction on record.
16 June: Human trials begin for Professor Robin Shattock and his team’s vaccine candidate COVAC1, led by Chief Investigator Dr Katrina Pollock. The study is the first time the vaccine has been trialled in humans and will test whether it is well-tolerated and produces an effective immune response against COVID-19. The vaccine has undergone rigorous pre-clinical safety tests and in animal studies it has shown to be safe and produced encouraging signs of an effective immune response. Over the coming weeks, 300 healthy participants will receive two doses of the vaccine.
Throughout June, philanthropy continues to drive forward COVID-19 research. A new donation from Community Jameel helps to establish the £1 million Community Jameel Imperial College COVID-19 Excellence Fund, which will sit alongside the College’s existing COVID-19 Response Fund, providing grants of up to £200,000 to rapidly scale up high-impact projects. £5 million in philanthropic donations was key to getting Imperial's COVID-19 vaccine to clinical trial.
What's next?
By the end of June, more than 10 million confirmed cases of the novel coronavirus had been counted worldwide and the WHO warns that the worst could be yet to come in some regions. As the UK and other European countries enter the next stage of the pandemic, warily easing lockdown, with shops opening, sports matches beginning and pupils going back to school, many eyes are on Imperial, as Imperial’s COVID-19 vaccine trial progresses.
COVID-19: six months on the frontline
Words: Deborah Evanson and Joanna Wilson
Photography: Thomas Angus, Imperial College London | Giles Duley, Imperial College Healthcare NHS Trust (image of intensive care unit).
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