During the COVID-19 pandemic, our members are developing research to address COVID-19 related challenges. New projects are described in summary here. Further details will be published as soon as possible.
Meanwhile our staff have taken on extended clinical roles. See this post for details.
New COVID-19-related research at the Unit
1. Using linked primary care and viral surveillance data to develop risk stratification models to inform management of severe COVID19.
Research Group: Cardiovascular Group
Project Description: This project is being led by Dr.Rupert Payne (Bristol). The proposed research aims to 1) establish a new dataset to facilitate COVID19 epidemiological analyses, linking primary care (CPRD), routine hospital data (SUS), and the Public Health England COVID19 surveillance data (CHESS); 2) develop a risk stratification tool to determine which patients in primary care are at highest risk of admission to critical care and which pre-morbid factors predict survival.
Collaborators: Universities of Bristol & Manchester
2. ACE-Inhibitors/Angiotensin Receptor Blockers and risk of death for people infected with COVID-19: a prospective cohort study.
Research Group: Prevention Group, Primary Care Unit
Project Description: Analysis of RCGP Research Surveillance data of routinely collected GP records from May to August 2020 covering 530 practices.
In the UK, as of 24th March 2020, there were 8077 cases and 422 deaths from COVID-19. This figure is predicted to rise. Globally, mortality rates and severe complications have been high amongst those with hypertension (23.7%), cardiovascular disease (8%) or type 2 diabetes (16.2%). (Guan et al., 2020; Wu et al., 2020; Yang et al., 2020)
Reports from the COVID-19 epicentre in China and a recent letter in the Lancet noted that amongst those with severe complications including death, ACE-I and ARBs were frequently prescribed. (Fang, Karakiulakis and Roth, 2020)
COVID-19 binds to target cells through angiotensin-converting enzyme 2 (ACE2) which is expressed by epithelial cells in the lungs, kidneys and blood vessels. ACE-I and ARBs are thought to increase the expression of ACE2.
It is hypothesised that these medications, therefore, make people more susceptible to COVID-19 and could also increase the severity of the infection leading to ARDS and death.(Patel and Verma, 2020) (Jia et al., 2005)
This has caused some concern amongst prescribers and is leading to non-compliance amongst patients such that the British and Irish Hypertension Society, European Hypertension Society, Renal Association have released position statements calling for urgent evidence.
While a mechanistic link is plausible, to date, there are no studies in human subjects, while animal models show mixed results. Given that 65 million prescriptions of ARB/ACE-I have been issued by GPs in the UK in the last year alone and the COVID-19 epidemic is close to reaching its peak, it is essential and timely that this hypothesis is tested.
Collaborators: Dr Hajira Dambha-Miller, Prof Paul Little, Dr Beth Stuart, Dr Simon Fraser (University of Southampton), Prof Julia Hippisley-Cox, Prof Simon de Lusignan, Dr Ali Alrasbi, Mr William Hinton (University of Oxford), Prof Simon Griffin.
3. Addressing the challenges of End-of-Life Care prescribing in the community during the COVID-19 pandemic
Research Group: Palliative and End of Life Care Group, Primary Care Unit
Project description: Led by Dr Stephen Barclay (University Senior Lecturer) the group are addressing the considerable challenges for prescribing for people at the end of their lives with both COVID-19 and other conditions. A UK-wide survey of clinicians concerning changes in medications prescribed and the involvement of family caregivers in medication administration is to be published shortly; an Editorial in the British Medical Journal https://www.bmj.com/content/369/bmj.m1615 has been published, and prescribing guidance https://www.cambridgeshireandpeterboroughccg.nhs.uk/health-professionals/prescribing-information/controlled-drugs-and-palliative-care/palliative-care-prescribing/ has been provided for several Clinical Commissioning Groups across the UK and taken up by the Royal College of General Practitioners. This group are also collating publications at the intersection of Coronavirus and End-of-Life Care https://www.phpc.cam.ac.uk/pcu/palchase/coronavirus-and-palliative-care/
4. Estimating delayed cancer diagnosis and impact on the NHS in England following lock-down due to COVID-19
Research Group: Cancer Group, Primary Care Unit
Project Description: Aims: To model accumulating demand for primary and secondary care diagnostic tests and 2WW pathways and consequences for stage at diagnosis, emergency admissions and deaths, in order to estimate NHS capacity and diagnostics requirements as the immediate impact of COVID-19 settles into routine care.
Collaborators: This is a collaboration between the Cancer Research UK-funded CanTest Collaborative and the NIHR Cancer Policy Research Unit, led by Fiona Walter (Cambridge) and Richard Neal (Leeds). Other collaborators include Greg Rubin (Newcastle), Yoryos Lyratzopoulos (UCL), Stephen Duffy (UCL), Willie Hamilton (Exeter) and the National Cancer Registration and Analysis Service (NCRAS).
5. A rapid evidence review of interventions to reduce social isolation and/or loneliness during COVID-19 self-isolation measures.
Research Group: Prevention Group, Primary Care Unit
Project Description: A rapid evidence review of interventions to reduce social isolation and/or loneliness during COVID-19 self-isolation measures
Collaborators: Juliet Usher-Smith is supporting the group of medical students undertaking this work, led by Chris Williams.
Contact: Lucy Lloyd, communications manager, Primary Care Unit