Reflections on a year of fighting COVID-19

In January this year, I was contacted by my research collaborators in China about a newly-identified coronavirus that was causing a serious respiratory illness in patients. They told me about the clinical and infection control challenges they faced, and the draconian public health measures imposed by the government in an attempt to control the spread of the virus.

On 30 January 2020, the World Health Organisation named the illness '2019-nCoV acute respiratory disease' – now known to us all as COVID-19 – and declared it a public health emergency of international concern. (The virus was later named SARS-CoV-2.) By then, there were 7,818 reported cases in 18 countries.

The following day, the UK saw its first two cases, both travellers who had been to China.

In March, I visited Singapore, a country that had experienced the devastating impact of the previous SARS epidemic, which had emerged in 2002. I was immediately struck by how seriously they were already taking infection control measures.

On arrival at Changi airport I was screened with a symptom and travel questionnaire and had my temperature checked before being allowed to enter the country. Everyone who had arrived from a high-risk country was being instructed to quarantine as well as being tracked using an electronic app, telephone calls, and in-person visits.

It was not uncommon for Singaporeans to wear face coverings as they went about their daily lives. The Singapore government was already issuing daily on-line COVID-19 situation reports.

During my stay I visited the National University Hospital where standard personal protective equipment (PPE) was being worn for contact with all patients, and enhanced PPE for patients with suspected or confirmed COVID-19, who were also isolated in individual negative pressure rooms.

When I returned to the UK a week later, the contrast between the public health responses in the two countries could not have been more different. On arrival at Heathrow, I was handed a COVID-19 information leaflet, and advised to self-isolate and to call the NHS 111 helpline if I developed COVID-19 symptoms.

At this point the UK was reporting over 1,000 cases a day - many more than in Singapore.

Whilst I was away, I contemplated what I could do to help with the local response to COVID-19. My clinical expertise is in infectious diseases and microbiology, and I also had research experience in clinical trials and microbial genome sequencing. I knew I could help.

I initially volunteered to help with recruitment of patients to the RECOVERY trial at Addenbrooke’s Hospital. This is a UK multicentre clinical trial, led the University of Oxford, which aims to evaluate potential treatments for COVID-19. To date, the study has recruited over 20,000 patients from 176 NHS hospitals across the UK - an extraordinary achievement. It has so far discovered that the steroid dexamethasone reduces mortality in hospitalised patients with COVID-19 who are receiving oxygen therapy or mechanical ventilation. It has also found that two other treatments (lopinavir-ritonavir and hydroxycholoroquine) do not reduce mortality in hospitalised patients with COVID-19.

My second opportunity arose through contact with Ian Goodfellow, Professor of Virology at the University of Cambridge, who was the local lead for the COVID-19 Genomics UK Consortium. This is a partnership of NHS organisations, academic institutions, and public health agencies that was established with the aim of sequencing SARS-CoV-2 rapidly and at scale across the UK. I was able to use my clinical and research experience to streamline the collection of clinical data and samples for sequencing in Ian’s laboratory, and built a team of people to analyse the epidemiological and genomic data. Every week we presented our findings to the clinical, infection control and hospital management teams, helping them investigate and manage suspected outbreaks of COVID-19 in the hospital. More recently, we have used similar methods to investigate COVID-19 outbreaks in care homes in the East of England. We have also developed a web-based app that we hope will help clinicians and researchers to conduct similar analyses in the future.

In May, I was invited to participate as a principal investigator in the Oxford COVID-19 vaccine trial, which is evaluating the safety and efficacy of a novel coronavirus vaccine (ChAdOx1) in over 10,000 adults in the UK (with parallel studies in Brazil, Kenya and South Africa). In very challenging circumstances, I was able to assemble an outstanding team of over 70 staff across three NHS Trusts in Cambridgeshire that vaccinated over 300 volunteers in a matter of weeks. This was an extraordinary team effort – setting up and delivering a clinical trial often takes many months, if not years. The preliminary results of the phase 3 trial showed 70% efficacy overall, and 90% efficacy with one of the dosing regimens.

COVID-19 is a global public health emergency that requires local, national and international collaborative efforts to tackle it. It has already claimed over 1.5 million lives.

I feel fortunate to have been able to use my clinical and research skills to contribute towards the UK’s response. I have been highly impressed by the willingness, energy and enthusiasm of my clinical and academic colleagues to work together, for long days over several months without a break, to deliver national research studies in addition to clinical care. Many of us had never even met or worked together before, but we were all united in a common endeavour. I am extremely grateful to each and every one of them for their support, and for their friendship, during these challenging times.

From a personal perspective, it was difficult as I was separated from my children for several months during the first lockdown and had to cancel my wedding in June. I did manage to organise a small civil ceremony (restricted to six people) in September between the two lockdown periods and am hoping to have a larger celebration next year.

Nevertheless, I shall remember the past few months as one the most demanding - and yet one of the most fulfilling - periods of my professional life. As we head towards 2021, we are in a much better place than we were at the start of the year, thanks to the dedication of so many people across the country and around the world. But even with the prospect of a vaccine on the horizons, there is much still to do.

Dr Estée Török is an Honorary Consultant in Infectious Diseases & Microbiology at Addenbrooke's Hospital, Cambridge University Hospitals, and an Honorary Senior Visiting Fellow at the University of Cambridge.

Main image by Anastasia Taylor Lind