September 3, 2021, by School of Medicine
50 at 50: Reflections on a year of Covid-19 from a clinical academic perspective
A new disease…, a new patient group…, new clinic requirements … and of course new opportunities for clinical research…, there is nothing like a pandemic to jolt a clinical academic who had been focusing primarily on one long-term lung disease and thought she had the next few years worth of research mapped out.
Whilst the onslaught of severely ill patients with Covid-19 admitted to hospital demanded immediate attention from Spring 2020 onwards, the subsequent tsunami of those presenting with on-going symptoms has been a great challenge to those personally affected and to clinicians in supporting them. A vast number needed careful assessment, information and treatment for a new condition about which we did not know the timelines, weren’t clear on the mechanisms and, indeed, for whom there was initially no clinical service.
Alongside supporting the frontline clinical service, work set out to instigate new multi-disciplinary post-covid assessment clinics – across respiratory medicine, critical care teams, allied healthcare professionals, nursing and other specialties. The collaborative nature of the interdisciplinary working was unrivalled, with the teams going the extra mile to follow up thousands of patients who had been discharged. We learnt that some who had not initially required hospitalisation still had persisting breathlessness after Covid-19 that needed assessment.
Developing a platform for robust and meaningful translational research was essential. The persisting, overwhelming symptoms encountered by thousands of local people, many of whom were previously fit and well was staggering. As clinicians, we were delivering the best management strategies we could and drawing up guidance documents, in the face of little medical evidence.
Through several of our clinical research programmes, set up last summer, we are beginning to understand the mechanisms behind the persisting and debilitating symptoms, including fatigue, cognition and breathlessness, that those who are recovering from Covid-19 infection can experience. This is essential so that targeted therapies can be developed.
Nottingham is centrally involved in the Urgent Public Health P-HOSP (Post-Hospitalisation Covid-19) study. In studies in our Nottingham Recovery from Covid-19 Research platform, funded by NIHR Nottingham Biomedical Research Centre (BRC) and Nottingham University Hospitals and co-led by Prof Ian Hall and myself, those attending the persisting breathless clinic provide further vital data to increase understanding of the outcomes and health burden of Covid-19.
Expertise in respiratory medicine, muscle physiology (Prof Paul Greenhaff) and the Sir Peter Mansfield Imaging Centre (Prof Sue Francis), has been harnessed in the mechanistic study DYNAMO (DYNamic Assessment of Multi-Organ damage following Covid-19) which has recently received further funding with the generosity of donations and fundraisers from the Nottingham Hospitals Charity, University of Nottingham alumni appeal and from the UK’s Research Councils (UKRI).
New research and a group of new participants demanded new clinical space. Thanks to the Faculty and the School of Medicine, the Nottingham Health Recovery Research Centre was formed. Equipping the area was made possible with thanks to the Nottingham Hospitals Charity, the NIHR Nottingham BRC and the Trust.
Across clinical practice and academia in Nottingham, colleagues have pulled together in such uncertain times to deliver Covid-19 research, with acute intervention clinical trials, vaccines research, behavioural research, systematic reviews, studying big data and mechanistic research of both acute and persisting injury.
Meanwhile, we are working with our clinical academic colleagues in Nepal – a low income country with a fragile healthcare system and where vaccine provision has, so far, been limited. We have been partnering on air pollution and lung health projects, with support from the Global Challenges Research Fund. Whilst the immediate needs of building wards, setting up basic medical provision and delivering acute care have understandably predominated, community clinical research, assessing lung health, restarted when it was safe to do so. Further, reviewing Covid-19 patients after discharge from hospital to assess the extent and nature of symptoms and the functional impact has commenced.
Trying to draw positives from this last 18 months is a challenge. As I write this, in Summer 2021, the pandemic is far from over. Collegiality across department teams to meet the needs in new ways has been amazing. The importance of both the need to study recovery after acute respiratory admission has been exemplified in a way that was only just bubbling under the surface before and the need for multi-morbidity research to provide a personalised approach to clinical care have shone through. Coming out of this, there needs to be a greater focus on chronic disease management and return to full health after any acute illness.
Key lessons that I learnt during this period – look after yourself, look out for one another, work collaboratively, be prepared to adapt.
My thanks extend wide and include those who recognised the need to get clinics and research projects up and running and with pace; those who facilitated new research space; fundraisers and donors; collaborators who helped turn ideas into research proposals; the research team and PhD students; the patients who willingly shared their experience of recovery after Covid-19 and volunteered for the studies. Last, but not least, those people, both in and out of work who have walked some of the tough and uncertain times alongside.
By Professor Charlotte Bolton, Clinical Professor of Respiratory Medicine
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