Five COVID-19 questions we’re trying to answer

27 Apr 2020, 10:03 a.m.

Our army of researchers at GOSH and the UCL Great Ormond Street Institute of Child Health (ICH) are supporting scientific studies aimed at understanding, tracking and even stopping COVID-19. Several studies employ the expertise of intensive care researcher Professor Mark Peters, pictured above in 2017.

Our approach to research has always involved global collaboration. Pooling knowledge and sharing resources help us find answers more quickly and be more certain they’re the right ones.

Right now, collaboration is more important than ever. We’re tapping into our links with scientists and clinicians around the globe and working alongside key health organisations like the National Institute of Health Research (NIHR) and Public Health England (PHE), to support research into COVID-19 in any way we can. Here are some of the research questions we’re helping to answer.

1. How does the virus affect different groups of people? 

We know that some people are more severely affected by COVID-19. The Government has advised these vulnerable groups to take extra precautions to protect themselves from infection.

But there’s still a lot to learn. We don’t know why some groups are more affected than others.

The World Health Organisation (WHO) has launched a worldwide study to track the health of people with severe COVID-19 infections as their illness progresses. They’ll look at how symptoms change over time, and whether they respond to different treatments.

This will help us understand how and why the virus affects different groups of people, arming doctors with vital information on how best to advise or treat them. It could also help Governments and authorities decide how to manage the spread of the infection, for example giving certain groups special protection.

With the support of our patients and families, GOSH is contributing to the study by providing samples from children diagnosed with COVID-19, including blood samples and swabs taken from the nose or throat. Experts Dr Quen Mok and Dr Alasdair Bamford are leading this work, alongside a team with a unique skillset – carrying out research in intensive care units, as well as other clinical areas at GOSH.

“These studies present unique challenges,” says Lauran O’Neill, a Senior Research Nurse involved in the project. ”Intensive care units are high-pressure environments where decisions must be made quickly and families are under a great deal of stress. With the consent of families, our incredible nursing team will collect samples from patients at key points during their illness and recovery.”

2. How does the virus affect children with complex health conditions?

The evidence to date suggests very few children will develop severe symptoms of COVID-19, even if they have an underlying health condition. But our clinical teams are going the extra mile to keep our patients safe, including providing specialty guidance for patients who may be considered part of a vulnerable group. GOSH staff have also worked with teams around the UK and the Royal College of Paediatrics and Child Health (RCPCH) to produce guidance for doctors caring for children with COVID-19.

Meanwhile, GOSH researchers are looking at how COVID-19 affects different groups of children and young people, including those whose immune systems are less able to fight off infection, and those who have had bone marrow transplants. We also hope to soon launch a study looking at any links between kidney damage and COVID-19.

This work could help doctors identify the best treatments for different groups of patients, as well as giving families more information about how to protect their child.

In another study, Professor Mark Peters’ team is looking at how a child’s DNA – their body’s built-in instruction manual – is linked to the way they respond to COVID-19.

He says: “We’re studying DNA from children in intensive care, looking for key differences in people who are more able, or less able, to fight off the infection. Understanding how genetic characteristics are linked to the body’s ability to fight off COVID-19 could help us protect those most at risk, or even develop new treatments.”

Professor Mark Peters (also pictured above in 2017) and Lauran O'Neill are working on studies aimed at understanding how COVID-19 affects children. 

3. Could we control the spread of infection? 

As the UK’s biggest city and the main entry point for travellers, London is ‘ahead’ of the rest of the nation in terms of number of people with COVID-19. That gives us an opportunity to learn about the virus and try to reduce the impact on the rest of the UK.

Public Health England (PHE) are coordinating a nationwide effort to collect and compare samples from COVID-19 patients, looking for key characteristics and patterns in how the virus spreads. This could help to identify geographical hotspots - areas where the virus is likely to spread quickly of affect many people. It might be possible to put additional protective measures in place to reduce the impact on vulnerable communities.

GOSH virology expert Professor Judith Breuer and her team are contributing to this study by providing a large number of patient samples from London. Work to analyse these samples will take place in our brand-new research facility, the Zayed Centre for Research into Rare Disease in Children, a partnership between GOSH, UCL and Great Ormond Street Hospital Children’s Charity.

The project will also look at how the virus is passed on within hospitals, helping authorities decide on the best approach to infection control in healthcare environments.

4. Are there any treatments that could help children with COVID-19?

As part of an existing UK-wide collaboration, Professor Peters and his team are on the hunt for the best approach to treating children and young people with COVID-19. They’ll study the effects of different treatment combinations given to patients at GOSH, including existing drugs and new ones.

By monitoring how children respond and whether they make good recoveries, the team hopes to pinpoint treatments that will give the best outcomes.

Meanwhile, as part of their contribution to another nationwide study, Professor Breuer’s team is looking at the genetic material contained inside the COVID-19 virus. This genetic material – just like the DNA inside our own bodies – contains instructions that determine how the virus behaves. These instructions can change over time, as the virus continuously makes copies of itself. Sometimes, new instructions can change the virus enough that existing treatments stop working. This is known as resistance.

Using state-of-the-art facilities at the Zayed Centre for Research, Professor Breuer’s team will study the genetics of COVID-19 from seriously ill children who have been treated with new drugs. They hope to see how the virus is responding to drugs over time, including whether it develops any resistance to treatment. This will be vitally important to ensure any effective treatments keep working.

5. Can we develop tests to help children with COVID-19?

When children are admitted to intensive care with severe lung infections, medical teams need to rapidly determine whether it is caused by a virus – such as COVID-19 – or bacteria. Each requires a different treatment approach and any delays in diagnosis can affect the child’s chances of making a full recovery.

GOSH researchers are planning to join an existing project, led by the University of Cambridge, to find new ways of testing for the presence of bacteria and viruses in a child’s blood. Developing rapid testing approaches will help intensive care teams quickly provide the best treatment for children with lung infections, including those caused by COVID-19.

Two female hospital staff sitting at a desk

As well as playing a vital role in running COVID-19 research studies, Senior Research Nurse Sophie Foxall and Healthcare Assistant Anastasia Rousou are asking families to become 'sample superstars' by donating any leftover samples to the GOSH Sample Bank.

Celebrating our sample superstars

Expert teams across GOSH are collecting various samples as part of vital COVID-19 care and research. As part of this, we’ll be asking some families if they’d like to sign up for the GOSH Sample Bank. This initiative allows us to use patients’ leftover samples in child health research, instead of them being thrown away.

We want to extract all the knowledge we can out of every precious sample of urine, blood, faeces or biopsies of skin or other tissue. After a child undergoes tests, whether as part of their routine treatment or a research study, any leftover samples are usually thrown away safely. Patients and families who sign up to Sample Bank are helping us extract even more vital information out of their samples. They’re allowing us to carry out even more cutting-edge research into COVID-19, as well as other complex childhood conditions that affect our patients.

We’d like to say a big thank you to those who have already signed up – you’re our ‘sample superstars’!

Research at GOSH is underpinned by support from the NIHR Great Ormond Street Biomedical Research Centre (BRC) and GOSH Charity. We’d also like to thank the wonderful staff across GOSH who make this research possible, including the NIHR Clinical Research Facility team.

The Zayed Centre for Research was made possible thanks to a transformative £60 million gift from Her Highness Sheikha Fatima bint Mubarak, wife of the late Sheikh Zayed bin Sultan Al Nahyan, Founder of the United Arab Emirates, in 2014. The Zayed Centre for Research is a partnership between Great Ormond Street Hospital (GOSH), UCL and Great Ormond Street Hospital Children’s Charity.

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