Application for Investigation into Prolonged COVID and Recurrent COVID Infections

Application for Investigation into Prolonged COVID and Recurrent COVID Infections

Standing Committee on Health, Aged Care and Sports

16 November 2022

The Peter Doherty Institute for Infection and Immunity (Doherty Institute) is an unincorporated joint venture between the University of Melbourne and the Royal Melbourne Hospital, combining research, teaching, public health and reference laboratory services, diagnostic services and clinical care in infectious diseases and immunity. .

Mainly Terms of Reference 3: We provided input and comments on research on the potential and known effects, causes, risk factors, prevalence, management and treatment of prolonged COVID and/or recurrent COVID in Australia.

Our presentation consists of three parts:

  1. Doherty Institute Capacity
  2. General recommendations
  3. Long COVID-Specific Recommendations

1. Doherty Institute Capacity

The Doherty Institute has long and recurring research expertise and established relationships used to address COVID through the leadership and involvement of a number of current projects. Some of these projects and their contributions to the understanding of long and recurrent COVID include:

  • Associate Professor Vicki Lawson He develops preclinical animal models for COVID-19 with experience in assessing the neurological impact of SARS-CoV-2 infection. In particular, he is leading an MRFF grant investigating the neurological and brain effects of related SARS-CoV-2 variants. The project will develop new, sensitive and specific biomarkers of virus-induced brain injury (Goal 1) and identify viral markers of neurovirulence (Goal 2) to predict the neurological impact of emerging VOCs (Goal 3). Collaborators include researchers from the Doherty Institute and La Trobe University.
  • Professor Stephen Kent, Doctor Adam Wheatley and Dr Jennifer Juno He has a longstanding collaboration with UNSW to investigate the immunological consequences of SARS-CoV-2 infection and contributed to the comprehensive analysis of immune responses eight months after SARS-CoV-2 infection. This analysis using samples from the ADAPT cohort and published at: Nature Immunology¹ showed that innate immune cells are highly activated in people with prolonged COVID-19 with a lack of naive T and B cells and elevated type 1 and type 3 interferons. They are now looking at the B cell response in more detail. The analyzed ADAPT cohort included 147 individuals, 31 of whom had long-term COVID.
  • Katherine Gibney He is principal investigator (with Professor Margaret Hellard of the Burnet Institute) in the Optimize Study, a research survey created in 2020 to monitor the Victorian COVID-19 response. Approximately 700 high-risk and COVID-affected participants were recruited with ethical approval for further communication. A rapid survey of long-term COVID was conducted in August 2022 and the report was available on the study website². Survey findings include support for ongoing public health measures to prevent long-term COVID, a significant proportion of people with prolonged COVID-19 without any formal diagnosis, and the widespread effects of prolonged COVID on participants’ daily lives. The Optimize work interacts well with the Victorian Department of Health and produces bimonthly reports.
  • Dr. Irani Thevarajan Established the Research Readiness Platform for Pre-COVID Sentinel Travelers and Emerging Infectious Diseases (SETREP-ID), which was enabled in 2020 to collect biological samples from hospitalized SARS-CoV-2 cases. but in modest numbers). Dr Thevarajan, Assoc. The SETREP-ID cohort also supports research looking at clinical sequelae in the context of the treatment and immunization of adults and children who develop long-term COVID.
  • this Australian Partnership for Communicable Disease Emergencies Preparedness Research (APPRISE) It is based at the Doherty Institute. APPRISE is an NHMRC-funded Center of Research Excellence that has received additional grants to continue through the Commonwealth Department of Health. Professor Sharon Lewin is the chief investigator and several other Doherty staff members are also involved. The additional grant will fund two major national projects, including one on long-term COVID. APPRISE is also enhancing platform capabilities for infectious disease research, including the establishment of a virtual biobank to connect diverse collections of biological samples for search in one place (including ADAPT and SETREP-ID).
  • via APPRISE, Professor Jodie McVernon In 2020, he established the Australian «First Few X» (FFX) study, including biological sampling and detailed household transmission analysis within the first 28 days following COVID infection, with longer-term follow-up for many participants. The study is currently recruiting in Victoria through the Royal Children’s Hospital and the Walter and Eliza Hall Institute. FFX data includes detailed vaccination history, symptom and household contact data in acute COVID, predominantly Omicron cases, and can be adapted for home checkups and extended COVID research.
  • virologist Dr Sarah Londonrigan Royal Melbourne Hospital has a longstanding collaboration (and approved protocol for research) with Associate Professor Daniel Steinfort, respiratory physician – with the capacity to sample airway epithelium and immune cells from vulnerable patients, including those with long-standing COVID.
  • Professor Jodie McVernon has links to the Patron research program at Melbourne Medical School, a platform capability for primary care surveillance led by Professor Lena Sanci – this platform can be enabled to study long-term COVID, including rural and remote areas.

2. General Recommendations

  1. Programs that promote collaboration and interagency relationships should be prioritized and openly funded because established research collaborations can be adapted to address new disease challenges and questions.
  2. Funding and grant programs and internal Institutional review, promotion and rewards programs should develop strategies to measure and reward collaboration as an important contribution to preparedness for future infectious disease challenges.
  3. Research platform capabilities spanning disease domains (and institutions) including physical infrastructure (eg PC3 laboratory and animal facilities, biobanking facilities, etc.) and digital/administrative infrastructure (eg data link arrangements, Electronic Medical Record systems, research governance strategies) should be developed. are constantly strengthened and prioritized for investment.
  4. Successful multidisciplinary disease responses (e.g. Hepatitis B and HIV responses in Australia, clinical research and integration of biobank into standard clinical care in the UK) should be explored and studied to provide guidance and inspiration for new disease responses. This includes relationships not only between different academic disciplines, but also with community and lived experience organisations, governments and healthcare providers.

3. Long COVID-Specific Recommendations

  1. Understanding and characterizing long-term COVID in Australia will be an important contribution internationally, as most infections are SARS-CoV-2 Omicron (and its subvariants) and are largely found in a vaccinated population.
  2. This will require larger, representative and well-characterized cohorts to facilitate understanding and study of all long-term COVID outcomes, including:
    • Prevalence and incidence in Australia
    • Clinical symptoms of acute and prolonged COVID
    • SARS-CoV-2 variant details
    • Vaccination status
    • biological sampling
  3. The need to develop long-term animal models of COVID to test interventions, conduct behavioral studies, and better understand the pathogenesis of infection, including biomarker identification.
  4. The need to understand effective care models, including action research, to identify and strengthen care pathways that link primary care with specialist services.
  5. Consider strategies and frameworks to enable the collection (and research access) of post-mortem tissue, including brain tissue, from people who died after severe acute and prolonged COVID.

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