A woman in a laboratory next to a microscope
Research
A woman in a laboratory next to a microscope

COVID research in the UK

The UK is leading the world in COVID-19 research thanks to our national networks that link all of the hospitals in the NHS together, so that skills and training can be shared across the country. This is a big advantage of the NHS and many other countries around the world are treating their patients using the results from UK trials.

 

What kinds of research are going on?

Lots of different trials are going on across the country, these might be;

  • Trials collecting information during and after COVID infection.

or

  • Trials in which people with COVID can receive one or more treatments that might help to fight the infection.

or

  • Trials of vaccinations to stop people from getting the infection. These are usually tested on people who have not had the virus, unlike you, so we will not discuss these trials here.

 

Trials collecting information

Research trials in which samples (like blood tests) or information are collected at different times, without giving any medicine, are called observational trials.

International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) is a very large trial running across the country, looking at which factors might make people more at risk from COVID infection, like age or race.

Studying the disease in a large number of people means that the results are more likely to be reliable.

You might have been asked to give blood samples as part of this trial, or to let the research team look at your medical records to collect information about your symptoms and background health.

Other clinicians and scientists want to understand in detail the way that the virus affects our bodies at the time of infection. You might have been asked to have special tests to help with this.

There are other national trials collecting information about COVID infection in more specific groups, including pregnant women and new born babies.

Now that lots of people are recovering from COVID infection it is important to understand whether the virus has any longer term effects on people’s health. Another group of trials will focus on collecting information about this. These will be discussed further down the page.

 

Treatment trials

Another type of research trial in which a medicine or treatment is used against the virus is called an interventional trial.

To choose a medicine or treatment we need to have a good reason to think it might work based on scientists studying the disease.

Researchers have found that COVID can make people ill because of;

  • The direct effects of the virus on the body.
  • The body’s immune system over-reacting. When this happens, lots of inflammatory chemicals are produced to fight the virus, but these can have some harmful effects like making the lungs wet, or the blood sticky and more likely to clot.

Some medicines that are tested will target the virus, while some will target our body’s immune response.

When we think we have a medicine that might work, we also need to be able to compare it to what we already do to treat the infection, to make sure it gives an added benefit. This includes giving extra oxygen to those with low oxygen levels, paracetamol for a high temperature and blood-thinning injections to protect people from blood clots. For people who are more poorly and need oxygen, doctors will use the steroid, dexamethasone, and in some cases, an anti-inflammatory drug called tocilizumab.

If research trials show that a medicine can be given safely and definitely helps, everyone would have the chance to receive this, even if they are taking part in another trial.

 

What are the bigger studies that are happening in the UK?

The largest trial to find medicine to treat COVID infection in hospital is the RECOVERY trial. This is being run in 179 hospitals across the UK and a small number of hospitals in Asia, with more than 39,000 people having taken part so far.

People like you with definite or suspected COVID infection are randomly assigned to different medicines used to treat other health conditions, like psoriasis or arthritis. At some hospitals, you could also receive man-made antibodies designed to fight the virus.

Some of the medicines are tablets and others are injections.

The medicines being tested in this trial are:

  • Monoclonal antibodies – there is more information about this further down the page.
  • A once-daily, anti-inflammatory tablet called baricitinib – already used to treat arthritis.
  • Dimethyl fumarate – a tablet used to treat psoriasis and the nervous system illness, multiple sclerosis (MS).

 

Are there different trials for people with more mild or more severe infection?

A national trial testing medicines for people with COVID illness who are treated at home is the PRINCIPLE trial. This is being run in health centres and GP practices across the country and is trying to find out if any treatments might help people to get better more quickly, or stop people needing to go into hospital. The medicines being tested in this trial include:

  • Colchicine – an anti-inflammatory tablet used for gout.
  • Favipiravir – an anti-viral tablet.

People with more severe COVID infection might need treatment on the Intensive Care Unit (ICU). One large ICU trial is the REMAP-CAP trial. Patients can receive combinations of different kinds of medicine in this national trial including:

  • A drug that affects the body’s immune response.
  • Treatment with high dose vitamin C.
  • A drug commonly used for high cholesterol called a ‘statin’.
  • A drug commonly used to treat high blood pressure.
  • Medicines that prevent the blood from becoming sticky, like aspirin – these medicines can sometimes be offered to patients on a normal hospital ward. It is important to know that this doesn’t mean the doctors think you will need to go to the ICU in future.

The people on ICU are the most severely affected by the virus, so there are other trials offering small numbers of people stem cell treatment to help the lungs repair.

What is convalescent plasma?

This was offered earlier in both the RECOVERY and REMAP-CAP trials. It was a type of blood transfusion, and involved giving a part of the blood donated by people like you who had recovered from COVID infection. Plasma contains antibodies, and scientists thought these might help to fight off the infection. Unfortunately, results showed that although plasma transfusions were safe, they didn’t make people better, and so they are not being used to treat patients in hospital anymore.

Man-made copies of these helpful antibodies, produced in a lab, are still being tested as a possible treatment – this is called ‘monoclonal antibody treatment’ and is given as an injection.

Blood donation services have now stopped collecting convalescent plasma for use in COVID infection, although they still need people to donate blood to treat other health conditions.

 

What about trials of treatments that aren’t medicines?

Other treatments used in COVID infection include things like oxygen. Oxygen can be delivered to a patient’s lungs in different ways, including through a normal face mask, using a tight-fitting mask called CPAP or using tubing that fits into the nose.

CPAP stands for continuous positive airways pressure, and is a type of breathing support. A bedside machine blows oxygen and air into the lungs through a tube at high pressure to stop the lungs from getting wet and collapsing. Special equipment can also be used to give oxygen through the nose at high pressure. We call this ‘high flow nasal oxygen’.

The RECOVERY-RS trial compares these three ways of giving people oxygen.

In a similar way, doctors on ICU are running trials to find out the best way to use a ventilator to help peoples’ lungs recover, including in the REMAP-CAP trial that was discussed higher up the page.

 

Why wasn’t I asked to take part in this research when I was in hospital?

There are a few reasons why you might not have been offered some of the trials mentioned on this website.

Some of the trials will only include people who meet certain criteria, for example, you would not be offered a medicine that might make any of your background health conditions worse.

Another reason is that a hospital can only offer a few trials at the same time because there is a lot of organisation that has to happen behind the scenes for a trial to work well. New research trials are starting all the time, so some trials might not have started when you were in hospital.

Finally, some of the trials change to keep up-to-date. Trials that can change over time are called adaptive trials. When a trial changes it can be quite confusing but the research team can always be contacted to help explain any questions that you or family members and friends might have.

 

Are there any results so far?

Lots of really good research trials have been done since the pandemic started, and we now have much more information about what medicines work and which ones don’t. Some of the major results are shown in the table below. Treatments that help are in green boxes, treatments that don’t help are in red boxes and treatments that we are less sure about are in orange boxes.

 

Dexamethasone

How it works and what it was used for before

A steroid tablet that works as an anti-inflammatory – steroids are used a lot for different health conditions e.g. in asthma or joint problems. 

Effects in COVID infection

Several trials, including the RECOVERY trial, showed that steroid tablets help to treat infection in people needing oxygen or who are on the intensive care unit. 

They don’t help in people with mild illness.

 

Inhaled budesonide (steroid inhaler)

How it works and what it was used for before

Steroid inhalers are used in common breathing conditions like asthma and COPD to stop inflammation in the lungs. The dose of steroid is lower in an inhaler than in a tablet. 

Effects in COVID infection

In the PRINCIPLE trial, GPs gave normal steroid inhalers to people who didn’t need to go to hospital but were at high risk because of their age or other health conditions. Using the inhaler meant people recovered more quickly. 

If you have a steroid inhaler for another health condition and test positive for COVID infection, it is really important that you speak to a healthcare professional before making any changes to how you use your inhaler.    

 

Tocilizumab

How it works and what it was used for before

An anti-inflammatory injection given as 1 or 2 doses – used already to treat types of arthritis.

Effects in COVID infection

The RECOVERY and REMAP-CAP trials showed that this medicine was really helpful in people who need oxygen or are on intensive care. 

It wasn’t tested in people who didn’t need oxygen. 

 

Anticoagulation

How it works and what it was used for before

Blood thinning injections given into the tummy every day. These are already used to stop people in hospital from getting blood clots in the legs or lungs.

Effects in COVID infection

We know that COVID infection can make the blood sticky and put people at higher risk of blood clots – a big trial has showed that giving blood thinning injections is helpful.

 

Beta-interferon

How it works and what it was used for before

This medicine is breathed in through a nebuliser mask and has been used in the past to treat some conditions of the nervous system.

Effects in COVID infection

This had really promising effects in a small trial – a bigger trial is going on now to help researchers be more certain about the effects.

 

Remdesivir

How it works and what it was used for before

An anti-viral medication.

Effects in COVID infection

This might have a small effect in some people but hasn’t been studied in a really large trial so we are less certain about when to use this.

 

Convalescent plasma

How it works and what it was used for before

Part of the blood containing antibodies, donated by people who have recovered.

Effects in COVID infection

The RECOVERY and REMAP-CAP trials showed that this didn’t help to treat infection in people who needed hospital care. 

Donations of plasma are no longer being collected for treatment of COVID.

 

Hydroxychloroquine

How it works and what it was used for before

An anti-malarial tablet – one of the first treatments suggested for COVID infection.

Effects in COVID infection

This did not help to treat COVID infection in or before hospital but importantly, is still safe to use if your doctor prescribes it for another reason – like rheumatoid arthritis.

 

Lopinavir-ritonavir

How it works and what it was used for before

An anti-viral medicine used to treat HIV infection.

Effects in COVID infection

This did not help to treat COVID infection. 

 

Azithromycin and doxycycline

How it works and what it was used for before

Both of these are antibiotics commonly used for lung conditions.

Effects in COVID infection

Azithromycin did not help to treat COVID infection in hospital. Both azithromycin and doxycycline were tested in people with more mild illness. They didn’t speed up recovery and didn’t stop people from needing to go to hospital. 

 

If you have concerns that you have experienced side effects from a research medicine or want to find out more about this, you should contact your local research team.

 

What if I am not sure what research I have taken part in during my hospital stay?

  • COVID infection affects people in different ways. If the illness is mild, it would probably not stop someone from deciding whether they wanted to take part in research trials.
  • On the other hand, some people might have felt too unwell to think about research when they were in hospital, or might have been sedated on the intensive care unit.
  • If this is the case, the research team try to consult family members or ask the doctor looking after the patient to decide whether they think it is in that person’s best interests to take part in research.
  • Once people recover and are well enough to understand what has happened, either in the hospital or back at home, the research team make contact to explain what has happened, and make sure the patient is happy for information to be collected about their recovery.
  • If you think that you have been involved in a research trial but are not sure of the details, you can contact the research team at your hospital for more information.
  • If you are not happy about the way you have been treated by the research team, you can contact them directly to discuss this too. If you do not feel comfortable doing this, you can raise your concerns with the complaints team at your local hospital. Contact information for both the research team and the complaints team can usually be found on the hospital’s website or through the hospital switchboard telephone number.

 

What research trials could I be asked to take part in after going home from hospital?

COVID infection affects people in different ways. You might feel completely back to normal, or you might still have some symptoms, for example, shortness of breath or tiredness. Because COVID is a new infection, we don’t really know how long symptoms like these might go on for, or why they affect some people but not others.

This means it is really important to check on you after you have been ill, to collect information about the longer term effects of COVID infection on physical and mental health. Many hospitals are inviting people, like yourself, to take part in follow-up studies for this reason.

One large, follow up study that you might be invited to take part in is called PHOSP-COVID. This study will collect information from 10,000 people across the country who needed to be admitted to hospital because of COVID infection. You can be involved in this trial in different ways. You can simply let researchers find out about your background health, illness and recovery from your medical records, along with giving a saliva sample for DNA testing, using a kit that is sent to you in the post. If you have more time, you might agree to complete a set of special tests, for example, blood tests and walking tests, at different time points after you go home from hospital. Early results from this trial have shown that more than half of people who needed to go to hospital for treatment of their infection still had some symptoms 5 months after they went home.

Some hospitals will run their own follow up studies that collect other kinds of useful information.

Lots of people have taken part in a medicine trial, like the RECOVERY trial, when they were in hospital. If you would like to take part in a follow up trial as well, this is usually fine, but let your research team know which trials you are taking part in and they can check for you.

 

Is there anything I can do to help?

You might already be taking part in a research trial or decide that you would like to take part in a follow up trial. Clinicians and scientists are so grateful to you for this, as it is the only way to learn more about treating COVID. This information will help many more people in the future.

If you are keen to do more, then you can talk to your friends, family and colleagues about your positive experiences taking part in research, as this may encourage other people to do the same in future.