COVID-19 patients frequently suffer brain problems during the infection and can be left with symptoms of brain injury. Similar problems have been seen in previous pandemics, including Spanish influenza over 100 years ago, but how and why this occurs is poorly understood.
We have already been notified of 800 UK patients with these complications due to COVID-19. We have a unique opportunity to understand how these problems occur and develop strategies to prevent and treat them.
The questions we will ask include in whom does COVID-19 cause injury? Does it do this by invading the brain? Or by triggering excessive immune responses or interfering with the blood supply to nervous tissue?
We will answer these questions through in depth clinical, laboratory, and imaging studies of these 800 patients in comparison to 500 control patients (hospitalised during the pandemic with COVID-19 or without COVID-19).
Without this understanding, we cannot determine whether anti-viral medication, or treatments that modulate the immune system or that improve blood supply will help, and if so in which patients.
We will apply this understanding through our World Health Organisation-commissioned Task Force (co-Chair Michael) to develop clinical care guidelines, identify patients for targeted clinical trials, and ultimately improve patient outcomes.
Our consortium, is led by NIHR HPRU for Emerging and Zoonotic Infection (Michael) and King’s College London (Breen) and spans England, Scotland, Wales and Northern Ireland, building on existing collaborations:
- CoroNerve (Michael), a multi-specialty registry of COVID-19 brain complications.
- The Wellcome Trust/industry NIMA consortium (Bullmore) provides established protocols for multisite MRI.
- The Neuroimmunology groups at Oxford (Irani) and Cambridge (Menon) have established platforms for assessing autoantibody and brain injury markers.
- KCL Maudsley BRC (Breen, Hotopf) and NIHR BioResource (Bradley) (n>24,000) provides online tools.
COVID-CNS leverages existing infrastructure, often led by consortium investigators: NIHR BioResource (Bradley, Chinnery), NIHR HPRU in Emerging and Zoonotic Infections (Solomon), NIHR BRCs (KCL, Oxford, Cambridge, Sheffield, Birmingham, Newcastle), MRC Virology Centre (Patel) and UK Brain Bank Network (Shaw).
COVID-CNS allows investigation of phenotype and mechanisms by integrating expertise:
- Neurology (Liverpool; Cambridge; UCL; Oxford; KCL; Sheffield;Newcastle)
- Infectious diseases (Liverpool; Belfast; Cardiff; Glasgow)
- Immunology (KCL; Liverpool; Belfast; Birmingham; Glasgow, Cambridge, Oxford)
- Genomics (KCL; Cambridge; Edinburgh; Oxford; UCL)
- Cognition and neuropsychiatry (Edinburgh, Oxford; Cardiff, KCL, Belfast, Liverpool).
Our outputs have immediate potential to impact service resource allocation, brain infection guidelines, to direct rational use of existing therapies, identify targets for therapy development, and clarify nature and burden of residual disability for neurorehabilitation resources.
For further information please contact Dr Benedict D. Michael
Without understanding how the virus causes brain injury or dysfunction, we are not able to know which existing medications to use or to develop new medications directed against inflammation targets to treat these neurological effects.Dr Benedict D. Michael
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