Behind enemy lines
“It’s being described by some as a ‘war pandemic’, and it is to some degree,” says Dr Brian Burns, the chair of Northern Beaches Hospital’s Research Governance Committee.
“It’s about getting intelligence on your enemy.”
The work of Dr Burns and numerous other researchers across our hospitals and medical facilities is going a long way to unmasking this foe, with several clinical trials and studies moving us ever closer to treatments and, maybe, even a cure.
Towards herd immunity
At Northern Beaches Hospital, local recovered COVID-19 patients have been turning out to offer their blood samples for research in the race to develop a vaccine.
Back in March, the area had one of the highest number of cases in NSW, and Dr Burns says most of these patients have returned to the hospital to participate in a pioneering study.
The study, called the Collection of Coronavirus COVID-19 Outbreak Samples in NSW (COSiN), is a collaborative effort by researchers across the state to determine immunity to COVID-19 in recovered patients.
Researchers analyse participant’s antibodies to see how long they stay protected from COVID-19, before the data will be reviewed for trends in the immune response of patients that have long-term immunity.
The goal is to use the knowledge to assist in the creation of a vaccine and/or treatment options for the virus.
“It may allow us to determine what kind of immune system do people who have an immunity [have] – how their white cells deal with this infection, which help you target either treatment or a vaccine,” Dr Burns explains.
Dr Burns says the hospital has also been approved for two other studies, one looking at immunity in children with the disease and the other trialling treatment options in critically ill patients.
“There’s also an observational trial on all the patients who were positive in the Northern Sydney Local Health District,” Dr Burns explains.
“We want to know about those patient populations because we’re trying to figure out who is more likely to get it, and that may change what you do in your everyday life. Who you let back to the officer, versus who should be semi-isolated.
“There’s a long way to go. This is one of the most difficult viruses that this country, or the globe, has ever had to face.”
At St Leonards’ Royal North Shore Hospital (RNSH), Professor Carol Pollock believes she may be on to something ‘life changing’.
As a chief investigator of the CLARITY study, the Kolling Institute researcher is investigating whether everyday blood pressure medications could reduce the risk of acute COVID-19.
The study will research whether a particular type of common blood pressure medication can improve outcomes for COVID-19 patients at risk of severe disease by interfering with the virus’ attempts to enter the cells.
It will also look at whether the medications, which have already been shown to reduce inflammation, reduce swelling of the tissue and fibrosis in the lungs.
If found effective, Professor Pollock says these medications could be rapidly used in the clinical care of COVID-19 patients across the world, potentially saving thousands of lives.
“It’s a cheap drug off patent, so there’s no barriers to using it. We think it likely doesn’t matter which type of the medication is used, so there’s half a dozen at least available in Australia made by different manufacturers,” she explains.
“In Australia, they’re [the medication] $5 for a month’s treatment and we’re only treating for a month. So, as you can imagine it could be a highly cost-effective solution.”
With the study now running trials across Australia and India, Professor Pollock says an added benefit of the medications is their proven safety.
“Blood pressure medications have been used widely in the treatment of various chronic diseases for more than 30 years. The risks are low,” she says.
“This could represent a major breakthrough in the management of COVID patients. If it works, it will be a huge benefit.”
Showing heart to save Aussies
Down the hallway, you’ll find North Shore’s leading cardiologist, Professor Ravinay Bhindi, hard at work on another ground-breaking study.
The head of the hospital’s cardiology department is leading one of the largest observational studies in the country, the AUS-COVID study.
As Professor Bhindi explains, the purpose of AUS-COVID is four-fold.
Firstly, the professor and his colleagues want to find out whether reports suggesting those with underlying cardiovascular disease may be at higher risk of death from COVID-19 are true.
“One in six Australians have cardiovascular disease and we are an ageing population, therefore, if the preliminary data suggests a higher death rate in these patients, we really want to understand this,” he tells North Shore Living.
“From a health policy point of view, we could shelter these patients… have a more aggressive strategy to say, ‘You have to wear masks and you have to avoid going out in public’.”
The study is also investigating whether having cardiac disease is itself a predictor of having heart complications from COVID-19.
“If this is true, we can then identify those people that you wouldn’t send back to their homes [after contracting COVID-19] and you’d keep in the hospital and monitor,” Professor Bhindi says.
The rate at which COVID-19 causes cardiac issues, as well as the correlation between common heart medications and death from coronavirus will also be investigated as part of the trial.
Professor Bhindi says this is a vital area of research, as some heart disease and blood pressure medications work by increasing the protein in the body that COVID-19 latches to.
“Researchers from hospitals across Australia have been quick to get involved and support the study, demonstrating the urgent need for more information about the implications of COVID-19 on this group of patients and the best treatment options.”
Nosing out COVID cases
Imagine this, you’re an aged care worker on the way to starting another long shift. Before you head on into the facility, you’re stopped, handed a piece of blotting paper and asked to identify the smell.
One problem, you can’t smell it, even after three attempts. Three strikes, you’re out, and you’re sent off for a COVID-19 test at the local provider.
This is the vision of Kolling Institute’s Associate Professor Rory Clifton-Bligh, who is investigating the correlation between COVID-19 and anosmia, or loss of smell.
“If you ask people, ‘Have you lost smell?’ about 30 per cent of COVID positive patients across the board say they’ve lost smell,” he says.
“Interestingly, in our study and other studies, if you directly assess is the loss of smell is actually 80 per cent.
“If you can create a test to reliably identify that, then I think you would go a long way to eliminating COVID from inadvertent hospital, educational facility or aged care transmission.”
Currently, the associate professor and his team are using the widely validated University of Pennsylvania Smell Identification Test (UPSIT) to assess how early loss of smell occurs in COVID patients and whether particular smells are lost due to the disease.
“We’ve learned from this smell test it [losing smell] is not a late manifestation, in fact, it’s quite an early manifestation of it.
“There is [also] strong evidence that some smells are more commonly lost in COVID, but equally some smells appear not to be lost.”
Once the findings are in, the endocrinologist will work with scientists at the CSIRO to develop a cheap point of care test to screen people coming into critical facilities for the disease.
“So long as it’s cheap, reliable and quick, you could do it on a daily basis to people coming into work,” Associate Professor Clifton-Bligh says.
“For people who are otherwise asymptomatic, this test is going to be extremely helpful.”