How research is showing us the way out of the global pandemic
Research has played a pivotal role in every aspect of the fight against Covid-19, and the Trust, in partnership with Imperial College London, has been at the forefront of research into learning about and treating this new disease. Consultant in intensive care medicine and chief investigator in the UK for the international REMAP-CAP Professor Anthony Gordon and clinical research nurse Dorota Banach explain.
Scientific research will always be vital to medicine, because there is always more to learn and improve that could make a difference to outcomes for patients. At Imperial College Healthcare NHS Trust, research is integrated into everything we do – from cutting edge medical treatments to being at the forefront of the latest healthcare innovations, and our leadership of national and international clinical trials.
When the Covid-19 pandemic hit, it was immediately clear that restrictions and lockdowns alone could not be the whole answer. Research would have to help shape our route out. The virus was new and we knew almost nothing about how it progressed, how it was transmitted, its biology and structure or how we could treat it effectively. Increasing knowledge and understanding, finding effective treatments and developing a vaccine were going to be crucial.
A national and local collaborative approach
When coronavirus first took hold in the UK, the National Institute for Health Research (NIHR) asked NHS Trusts, universities and other research organisations to prioritise particular studies and trials that would help support the global response to Covid-19. Known as Urgent Public Health Studies, more than 80 have been initiated across the UK since the start of the pandemic. The Trust is involved in over 30 of these and, to date, we’ve recruited nearly 5000 patients to Covid-19 studies.
The focus of nearly the whole scientific community for the last year has been on the response to Covid-19. Time and resource has been dedicated to studies that could help the most people in the shortest space of time. In some cases, this meant redirecting resource from research that had been unavoidably halted and may otherwise have gone to waste. This national, co-ordinated and collaborative approach has been vital for some of the scientific breakthroughs in the last year, which have translated into new treatment options, better outcomes and, ultimately, lower mortality rates. With studies focused under one aim, researchers could better utilise networks and partnerships.
The importance of partnership cannot be overstated – nearly all Covid-19 research studies span NHS and university sites across the country, with each organisation able to contribute individual expertise and experience to the collaborative effort. Much of the research at the Trust is made possible by the NIHR Imperial Biomedical Research Centre, a research partnership between the Trust and Imperial College London, which provides infrastructure to help scientific breakthroughs translate to clinical care. The Trust is also part of an Academic Health Sciences Centre which brings together NHS partners in north west London with Imperial College to turn scientific advances into new ways of preventing and treating disease. Bringing academic excellence together with clinical expertise and experience is vital, and these partnerships have been more important than ever.
Internal partnership is equally important. Without the dedication of clinical teams, who may not even have a formal research role themselves, many studies would not be possible. At a time when clinical staff were already stretched and working in challenging circumstances, doctors and nurses made time to understand key studies, as well as to put forward eligible patients, discuss with families and implement study protocols. The whole Trust united under one main aim – to beat the pandemic.
Breakthroughs need patient involvement
Without the involvement of patients in trials, treatments that are now saving lives and improving recoveries simply could not be possible. Patients and families continue to be a crucial foundation for Covid-19 breakthroughs. We rely on patients who consent to provide samples or try a drug that hasn’t been used in this way before when they are going through an already difficult time. While it’s understandable that not all will want to be involved, we find many patients just want to do their part to make things better for others.
Teams of dedicated clinical research nurses work closely with patients and families to answer questions and ensure they understand the requirements of studies. Very unwell patients in intensive care cannot provide consent, so it’s vital that families understand the study and feel reassured their relative will receive the best possible care at such an uncertain time. This trust and understanding has been integral to the incredible work that have been achieved as a result. We remain forever grateful to all patients and families who make such difficult decisions to help others.
For most of our patients, the key motivation for taking part is to help make sure other people do not go through the same difficult experience they have. But it’s worth noting that for some studies there are added benefits of access to a groundbreaking treatment, regular check-ups and the opportunity to find out more about Covid-19 from conversations with clinical researchers.
Real time changes to medical care
During the pandemic, most changes in healthcare have moved at significant speed, and that’s certainly been the case at the Trust, too. Whether it’s changing the layout of our hospitals to accommodate an influx of patients, setting up a staff testing programme or implementing large-scale vaccination programmes, these things have been possible because we adapted to allow rapid responses to the ever-evolving situation.
New treatments for Covid-19 have come in to use at a similar speed. This has only been possible because of the national focus on, and co-ordination of, Covid-19 research studies. For both research and clinical staff, it is motivating to see the tangible impact of the work in clinical practice in just a few months. Processes that previously happened in sequence could happen in parallel to reduce delay. Data has been gathered and analysed quickly, and national research networks have allowed this to be reviewed, regulated and implemented without unnecessary delay or compromising on safety.
Studies at the Trust as part of the national REMAP-CAP trial are investigating the benefits of various existing drugs traditionally used for other conditions as treatments for severe Covid-19 requiring ICU admission. Outcomes of these studies for two commonly available rheumatoid arthritis drugs (tocilizumab and sarilumab) meant they could become a treatment option in a matter of days, once data began to show a significant benefit. More than 7,000 patients across the UK have benefited from treatment with these drugs since the start of 2021.
Each study is adding to a knowledge pool around Covid-19 that grows every day. Results from RECOVERY, another national trial at the Trust, which is investigating treatments, first showed that dexamethasone improved outcomes and then supported the REMAP-CAP findings around the use of tocilizumab.
Enhancing pandemic successes for the future
Looking forward is just as important as reflecting back. We’ve learned so much, not just about Covid-19, but also how to effectively collaborate, focus and utilise the collective strength of scientific research for the benefit of patients. It’s vital to consider what we’ve learned and how we can ensure these lessons carry through beyond the pandemic.
For the scientific community to be united under one main aim is unlikely ever to occur to quite the same extent again in our lifetimes. Clearly, once the dust of the pandemic settles it will be vital for all health research to continue, not least to help with responding to the significant backlog of care for those patients we could not treat while the pandemic was ongoing. But we must remember that our impact is far greater when we work together.
We have continued to see the power of research embedded in clinical care. Rather than an occasional add-on, research is even more part of our everyday NHS work, allowing us to learn more quickly and improve care for patients. In the UK we are fortunate to have key research organisations, such as the National Institute for Health Research (NIHR), integrated within the NHS through partnerships such as our Imperial NIHR Biomedical Research Centre and Academic Health Science Centre.
Clinical research has always been vital to medicine, and that role has been felt acutely during the pandemic. We must build on the positive steps we had to take in response to Covid-19 to ensure the systems we created remain in place and continue to develop. It simply would not be possible to work at the pace of Covid-19 for the longer term, particularly as elective care and other research streams restart. We must implement learnings, avoid unnecessary delays and ensure that the improved focus and collaboration across the country continues to yield significant impact that quickly benefits our patients.