Covid-19 projects

From launching new funded projects to collaborating on studies led by other instituions, the School of Medicine is engaged across a range of disciplines to reduce the impact of the Covid-19 outbreak.

RECOVERY Trial

RECOVERY is now the world’s largest clinical trial of Covid-19 treatments, having reached over 10,000 cases. Many trials examine the impact of therapies retrospectively, once the time has passed. There are significant drawbacks with such an approach, with chance findings of results more likely to occur. It is understandable why clinicians start unproven therapies when faced with someone unwell with Covid-19, but looking back at the results is not the best way of assessing their impact. Instead, a trial that is 'prospective, where a pre-set protocol and pre-defined objectives are made clear from the outset, is much more reliable. Moreover, where the treatment is 'randomised’, an allocation of a specific treatment given by a computer 'at random’, the chance finding of benefit of any one treatment above usual care is much less likely. RECOVERY is the largest prospective randomised trial of Covid-19 treatments in the world, and is being led by researchers in Oxford working alongside the NHS.

Four major treatment options are being tested, and compared against usual care. These treatments include steroids, an antibiotic (azithromycin), an anti-viral (lopinavir/ritonavir) and hydroxychloroquine (anti-viral and anti-inflammatory). There is an additional monoclonal antibody therapy that is offered in those who become critically ill.

We are supporting this trial in NHS Fife, having been the 3rd site to be recruited in Scotland.

Provisional results will be expected this summer.

Identifying community Covid-19 cases and exploring differences with patients diagnosed in healthcare settings

How Covid-19 spreads within the community and individual households remains uncertain as current data is based on people who receive medical care. A Covid-19 tracker app allows people to share data on the members of their household including symptoms. This research applies computer techniques to extract key information from text and will then link this with medical records to get a better idea of the true number of people with the disease. We will also look to see whether the clinical or demographic features of people who stay at home with Covid-19 differ from those who need medical help or are admitted to hospital. 

Multiscale mathematical model to simulate Covid-19 infection

Multiscale mathematical model to simulate Covid-19 infection Mathematical models are vital in advising government strategy during pandemics. The way infectious diseases transmit, and spread is different depending on where individuals live and, on their movements, and interactions. This means that epidemic models must take spatial features into account for accurate predictions, which currently they do not do effectively. We also must consider how infections affect individuals differently, e.g. weaker immune systems, gender and age. We will create a spatial mathematical model for Covid-19 that simulates infection in the body and the spread of disease from person to person. This multiscale model will be capable of robust predictions.

To develop evidence-based interventions to support doctors well-being and promote resilience during Covid-19 related transitions (and beyond)

The Covid-19 pandemic has resulted in a sudden and major disruption to the working practices and working environment of medical students, recent graduates, trainees, career grade and retired/returning doctors involved in the healthcare response. Our study will focus on understanding the experiences and effects of transitions in the workplace, from familiarity to unpredictability, for these groups.

With these insights we will develop and test interventions to support doctors’ wellbeing. Normality after the crisis will be different. Our study will help the National Health Service and Scottish Government ensure that doctors’ wellbeing will continue to be supported in order to enable the ongoing delivery of high quality healthcare to all.

Protecting population physical & mental health during the coronavirus pandemic: A representative national weekly survey to understand changes

Protecting population physical & mental health during the coronavirus pandemic: A representative national weekly survey to understand changes We will investigate whether people are adhering to coronavirus guidelines, how this impacts their mental & physical health and what triggers changes in adherence and health (e.g. worries, trust, Covid deaths).

Over 4 months we will conduct nationally representative surveys to assess changes and possible explanations in 8000 people. Each month we will report changes and explanations so the government and health officials can rapidly act to protect the public and prevent ill-health during the pandemic.

Primary care research priorities in Scotland after the coronavirus pandemic

High-quality primary care is underpinned by high-quality research. Research priorities set by generalist healthcare professionals, patients and carers reduces the risk of the production of redundant and irrelevant research that is of little clinical merit or value to patients and carers.

The aim of this project is to reach a consensus for primary care research priorities in Scotland where uncertainties remain and set a research direction that will be relevant for patients, carers and generalist healthcare professionals in the aftermath of the coronavirus pandemic. As such, extensive stakeholder engagement has occurred to help achieve a consensus of what the priorities should be.

This research prioritization exercise for Scottish Primary Care follows the James Lind Alliance (JLA) methodology and is led by the Scottish School of Primary Care.

Validation of an antibody test for Covid-19 St Andrews

The Coronavirus disease 2019 (Covid-19 ) is an infectious disease caused by a virus. The current way to find out if someone has the infection is to detect the virus in an antigen test ( nose swab, throat swab or spit sample). Until recently, there were no accurate antibody tests which could identify if someone has had an infection. Prof. Randall and colleagues are developing antibody tests using a variation of membrane bound and soluble forms of Covid-19 spike protein to determine antibodies in the blood.

Knowing if someone has had the disease will allow that person to know if they have had exposure to Covid-19 and have an immune response to the virus. The accuracy of the test is being checked using blood samples from 20 participants diagnosed as having Covid-19 and 20 healthy participants who have not displayed any symptoms of Covid-19. 

Where is the emergency exit? – co-creating appropriate and clear Covid-19 messages for the most vulnerable

‘Wash your hands’ and ‘stay inside’ - two messages that have played a central role in managing the Covid-19 outbreak. However, the scale and nature of the pandemic means that messages have not been universally successful. While high-risk individuals who are advised to ‘shield’ receive targeted information, central resources are lacking for others who are also at risk. Within communities, voluntary groups often have an insight into needs and ways to offer support.

The proposed work aims to develop methods for 1) co-developing effective messages with community groups and 2) identifying channels to ensure these messages reach the intended groups. Such methods will be essential to support the rapid development of relevant, clear messages to support all.

This work is a partnership between University of St Andrews, NHS Fife Public Health, Health Promotion Services, Fife Council and Fife Voluntary Action.

Covid-19 Autopsy Study

As a collaborative project with NHS Lothian and University of Edinburgh we established a research autopsy service for Covid cases, focussing on tissue processing, histopathology, identification of viral RNA and protein in tissue, and collection of fresh tissue under category 3 conditions. This project was entirely dependent upon the support of relatives having to make very difficult decisions and give permission for autopsy under the most difficult of circumstances.

In a separate project in St Andrews, in collaboration with a pharmaceutical company, we have examined the potential in cell culture experiments to repurpose a phosphoramidated nucleotide from use in cancer to disease modification in Covid-19. The candidate is the same family of drug as remdesivir, an anti-Ebola drug which recently received clearance for use against SARS-Cov2.

A paper related to the study has been published called "Tissue-specific tolerance in fatal Covid-19".

Identifying T cell epitopes from Covid-19 patient blood

An effective vaccine for Covid-19 will generate not only a good antibody response, but also the production of killer CD8 T cells that will target and eliminate virally infected cells.

The Powis lab is searching for the small antigenic viral peptides that are recognised by these killer CD8 T cells by extracting the peptides directly from the blood of Covid-19 patients, where such antigenic peptides are frequently released bound to HLA class I molecules either in a soluble form or on small extracellular vesicles (EV).

By sequencing the extracted peptides using mass spectrometry and mapping them to the known protein sequence of the SARS-CoV-2 virus, we can determine exactly which parts of the virus are being seen by the immune response, in each individual patient. We can then ensure that future vaccines include all the key parts of the virus that will generate useful killer T cells.

This work is now being supported by a Medical Research Council UKRI Covid-19 project grant awarded to Dr Powis and Dr Sally Shirran (School of Biology). 

Characterisation of Covid-19 outcomes in a high-risk cohort: Assessment of background levels of autoantibodies as a prognostic marker for severe Covid-19 infection

The recent emergence of SARS-coronavirus 2 (SARS-CoV-2) has developed into a global health emergency. Older adults and those with underlying health conditions, for example cerebrovascular disease, diabetes, hypertension, coronary heart disease and diabetes appear to be most at risk of dying from SARS-CoV-2 infection. However, we do not yet have a comprehensive understanding of all of the risk factors that contribute to poor outcomes from coronavirus disease 2019 (Covid-19).

Of significant interest is the overactivation of the immune system in patients with severe Covid-19, which leads to harmful tissue damage and is associated with poor clinical outcomes. It is not yet clear if patients who exhibit such robust immune response to SARS-CoV-2 have higher background antibody and autoantibody levels in general when compared to patients who develop mild disease.

We propose to investigate whether the production of high levels of autoantibodies, as measured by the EarlyCDT-Lung test in the ECLS trial, leads to more severe disease in patients who then develop a SARS-CoV-2 infection.

Social Processes and Well-being of Runners Within the UK During the Covid-19 Lockdown

As a result of the Covid-19 pandemic, gyms, running or jog groups, and other forms of collective exercise were abruptly brought to a halt. Our study looks to understand how the lockdown period within the UK affected runners physical and mental well-being. Our 1st survey: Running During a Lockdown: A Survey of Experiences, was completed during the initial lockdown period. This survey asked about the participant’s current physical activity level, subjective well-being, strength of identity with fellow runners and/or running group members, running motivation levels, and any changes the participant had experienced so far in their running and overall exercise routine.

As the UK reopens, and group running restarts, we would like to facilitate qualitative interviews to dive deeper into concepts addressed in the survey and tease apart some of our current findings. When running groups, jog groups, and collective exercise starts to occur with pre-lockdown regularity, we would like to send participants a follow-up survey for longitudinal comparison.

Does inhaled corticosteroid use impact on clinical outcomes in COPD and asthma patients with Covid-19 infection in real life?

People with respiratory conditions such as cystic fibrosis, asthma and COPD are at a higher risk of severe illness from Coronavirus (Covid-19). Inhaled corticosteroids (ICS) are widely used in the treatment of asthma and COPD, and have known benefits, including decreasing airway inflammation. They, however, have also been shown to promote bacterial growth, and patients with COPD may be more prone to develop pneumonia when taking these medications. Studying the safety of ICS in this group of patients is therefore vital to inform appropriate, safe, management decisions.

This study will provide invaluable, unknown information, on the impact and safety of ICS use in asthma and COPD patients during the Covid pandemic and will hopefully provide reassurance to patients and prescribers. Our data may also generate a hypothesis to support using ICS as a novel treatment for early Covid-19 infection in patients without airways disease.

Lived experience of long term Covid-19 on NHS workers in health care settings in Scotland: a longitudinal mixed methods study

Many NHS workers have greater occupational risk of exposure to Covid-19 than the general population, and UK studies have found a seven-fold risk of healthcare workers testing positive for Covid-19. Scotland healthcare workers and their households represent a sixth of cases admitted to hospital.

This study aims to establish the nature and extent, and lived-experiences of Long Covid-19 on the health and well-being on a self-identified cohort of professional and ancillary staff in NHS Scotland. We plan to use a longitudinal mixed methods approach, collecting data over a one-year period. We will develop an online questionnaire survey to examine self-reported health status, and the impact of long Covid-19 on health, quality of life, and working ability and patterns. Subgroups of NHS workers will be invited to take part in qualitative interviews designed to capture their narrative accounts of living with Long covid. Stakeholder workshops, where we will share emerging findings, will engage with occupational health and human services, professional bodies and training establishments. The findings will help to inform policy, practice and research recommendations, including NHS workforce planning needs.

The study has been funded by Scottish Government Chief Scientist Office. 

Covid-19 And Lingering symptoms In Primary care patients: CALIP study

Most people with Covid-19 experience mild (40%) or moderate (40%) symptoms and recover with symptomatic treatment without the need of hospital treatment. Some patients experience lingering/long-lasting symptoms after Covid-19, with 15% of patients still experiencing symptoms after 4 weeks. Most evidence about long covid has been generated from hospitalised cases, with a more severe course of disease. Little is known regarding disease trajectory of Covid-19 in milder community cases, including risk factors for long Covid-19.

This is the first, international study to explore the course of disease over a one year period and describe lingering symptoms and their impact on well-being and daily activities in adult non-hospitalized patients with confirmed Covid-19 infection, recruited from primary care.

This is a European collaboration, which will seek to prospectively enrol 300 patients from 15 participating countries.

Antibiotic use in patients which chronic respiratory disease during the Covid-19 pandemic

The Covid-19 pandemic is putting health systems worldwide under major strain, due to a rapidly increasing demand of health services and workers, which has translated into an urgent need of service reorganisation, having moved into a mixed service delivery, with consultations being increasingly delivered remotely. Telephone consultations may result in greater clinical uncertainty, due to inability to examine patients and perform investigations during telephone appointments, potentially leading to higher ‘just in case’ antibiotic use, as precautionary measure in cases of possible infection, and there is some early evidence of increased antibiotic use since the emergence of Covid-19. Patients with chronic respiratory disease (such as asthma and COPD) experience frequent exacerbations of their condition, particularly over winter months, and likely more exposed to antibiotics.

The main aim of this study is to examine antibiotic use in NHS Tayside and Fife during the Covid-19 pandemic, overall and by specific patient groups, such as in those chronic respiratory disease.