My post-doctoral training was completed at the Centre for Immunology and Inflammatory Disease, Massachusettes General Hospital and Harvard Medical School, where I developed an intravital microscopy model of viral encephalitis to image leucocyte migration into the brain in real-time.
I have received the Royal College of Physicians Linacre Lecture Award (2022), Liversage Award for Neurology and the British Medical Association Vera Down Award for Neuroscience, and for my neurological education work in Africa, I am Honorary Faculty for the Royal College of Physicians. My team were the 2020 finalists for the Royal College Awards for Excellence in Education.
I have an h-index of 26, an i10-index of 42, with more than 160 publications, and 4,300 citations, primarily on neurological infection and inflammation.
My grant income is approximately £4.3 million as PI and also £7 million as Co-I from the MRC, Wellcome, NIHR, and Academy of Medical Science.
COVID-19 research areas
- Zoonotic infection
- Pandemic infection
- Immune networks.
Why working towards tackling COVID-19 inspires me
Medics have known for more than 100years that respiratory and/or gastrointestinal pandemic infections can result in brain complications, but we have limited understanding of why some people develop these. Does the virus enter the brain? Is it the immune response? Is there genetic risk? Is it prior exposure to other pathogens? Or something else not yet elucidated?
This pandemic has resulted in immeasurable human suffering, but if there can be any silver lining, it is undoubtably that this represents humanity’s first chance to understand the impact of pandemic infection on the brain, not just clinically, but also at an immunological, virologic, genetic, and neuroimaging level. This is not humanity’s first pandemic, and it will not be our last. The lessons we learn from this are needed now and will also be pivotal in our capacity to face the next.
Von Economo wrestled with the pathology, Menninger with the psychiatry, and Sacks described transient improvement with dopamine in some. However, these questions remained unanswered, in part because the work was siloed between different medical specialities and skill sets.
In January 2020 I organised a consortium of the UK’s major professional neuroscience bodies spanning not just neurology but also acute medicine/stroke, ITU, psychiatry, and paediatrics. We received ethics in February, our rapid-reporting platform was live in March, we submitted our manuscript on the first 153 patients in April, and this was published in May (Lancet Psychiatry 2020). We demonstrated that, after stroke, the next most common complication was alterations in mental status spanning those conditions traditionally through of as ‘neurological’, e.g. encephalitis, and those thought ‘psychiatric’, e.g. psychosis. Crucially, these patients were younger, with half being under 60 and a quarter being in their 20-40’s.
These findings led to me being awarded funding (£2.3m-UKRI) to study the clinical features and biological mechanisms, the COVID-19 Clinical Neuroscience Study. Early we identified that even in young patients with COVID-19 strokes, potentially treatable risk factors, including hypertension and diabetes are key (Brain Comms 2021). We also identified the impact of ethnicity on CNS complications in children and adolescents (Lancet Child Adolesc Health).
What it means to be part of the University of Liverpool at this time
Working for the University and with the WHO, our finding that a quarter of patients are asymptomatic for COVID-19 and a further quarter have recovered from COVID-19 symptoms, informed the WHO Screening Checklist and the Scientific Brief. Now, as Director of the WHO Clinical Exchange Platform, we disseminate emergent observations and guidance to physicians in more than 80 countries. Global connectivity has advanced data assimilation but requires internationally agreed approaches. With the WHO and World Federation of Neurology I am leading the global inter-observer study to validate both case definitions and neurological assessments performed by non-clinicians, who are the backbone of health care in LMICs.
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