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Blog COVID-19 Research Summaries

COVID-19 fatality: Invader vs the immune system

Written by Rebekah Penrice-Randal

COVID-19 fatality may be associated with damage caused by our immune system as opposed to direct damage from the virus. Dexamethasone, a drug that has recently proved to reduce fatality in severely ill COVID-19 patients, suggests that inflammation plays a direct role in patient outcomes.

Is the inflammation caused be the virus itself, or the body’s immune system? Currently, this is unknown.

For a quick recap on the immune system: visit our infographic here.

The ICECAP consortia have released a preprint in MedRxiv that may hold the answer to this question. Tissues from 12 individuals who have died from COVID-19 in hospital were analysed by a team of pathologists, clinicians and virologists to determine where the virus was found and whether this corresponded to where inflammation was found.

Who are ICECAP?

ICECAP: Inflammation in COVID-19-Exploration of Critical Aspects of Pathogenesis.

“ICECAP was established as a rapid response to the COVID-19 pandemic. We collect and analyse tissue samples to understand COVID-19 and other fatal diseases, contributing to finding tests and treatments for these conditions.”

Tissue-specific tolerance in fatal Covid-19 is the first research output from this consortia.

Definitions of key words:

  • Inflammation: a local immune response to cellular injury.
  • Post-mortem: the study of the deceased.
  • Immune system: a system of the body that fights off infection and disease, including white blood cells, antibodies and the organs that produce these cells.
  • Macrophage: a specialised immune cell involved in the innate immune response.
  • Plasma cell: an immune cell that produces antibodies that make up the adaptive immune response.
  • Pulmonary: relating to the lungs.

Key findings

The Coronavirus was found in multiple organs within patients who died from COVID-19.

Most commonly in the lungs but also in other parts of the body, such as the heart, muscle and the gastrointestinal tract. In some cases, virus was detected in the liver, kidney and other organs.

Inflammation was not observed in non-pulmonary organs

Interestingly, virus that was detected outside of the lung, was usually not associated with local inflammation, despite frequent detection of viral RNA and protein. This was the case for tissues such as the intestine, liver and kidney.

Inflammation was identified in lung tissue

Lung damage consisted of significant injury to the alveoli (the part of the lung involved in uptake of oxygen), the identification of blood clots and inflammation of pulmonary blood vessels. Interestingly again, there was not a consistent association between the presence of viral RNA and either the presence or nature of the inflammatory response within the lung.

Abnormalities of the blood and the immune system

Abnormalities were found in the blood and immune system; two key cell types are discussed:

  • Macrophages – an immune cell that is involved in sensing and responding to pathogens and tissue repair.
  • Plasma cells – cells involved in producing antibodies.

Abnormal macrophages and an increased number of abnormal plasma cells were identified in the organs of the immune system. Within damaged lung tissues, the researchers identified that macrophages and macrophage-like cells were in high numbers.

The consequence of these abnormalities is currently unknown; however, this finding provides a direction for COVID-19 researchers and future studies.

Conclusions

The take home message from this research is that different tissues appear to have a different tolerance to the virus. Inflammation and damage to organs are likely to be extensively mediated by the body’s own immune system, and drives outcome from disease.

A note on preprint and peer review:

This research has not gone through the peer review process yet – visit our posts on peer review here.

Interested in communicating your research to a lay audience? Get in touch at info@thesciencesocial.com

Thank you to Dr Chris Lucas, an ICECAP investigator and co-author of the original article for permission to write this blog, and for the valuable comments.

Blog COVID-19 Guest Blog Research Summaries

Back to school. What do the students think? 49% of students say no.

Freya is a year 12 student A-level student who has recently conducted her first research project.

“This is the first research project I have conducted, and I did it because I want to advocate for young people. I think it is important that young people have a say in the decisions which impact them. They do not vote, and it seems unfair that their thoughts and valid contributions are not taken into account by the Government. I hope that through this research project I can provide some insight into what young people are saying and so that their concerns with returning to partial schooling can be addressed.”
Written by Freya Semple

Back to school

On May 10th, 2020 the UK Government announced that Secondary Schools, Sixth Forms and Further Education Colleges could provide some face-to-face support for year 10 and year 12 students after June 1st 2020. This was subsequently deferred to start on 15th June (1). Students in these year groups have national exams in Summer 2021. This means this time in year 10 and year 12 is critical as the bulk of the curriculum is delivered.   

To reduce the spread of COVID-19 in schools on the return of students, the government has advised the  regular cleaning of frequently touched surfaces, changing classroom layouts to reduce student contact and to stagger timetables (2). However, what are the students’ views on returning to school?

It was important to me to get this question answered, so I designed a study in aim to voice the views of students.

Why is this research important?

It is not apparent that the Government has engaged with the school students affected most by this decision. Students have not been given a platform to raise their concerns about returning to education. Their views have not been heard.

This motivated me to conduct a prospective study to collate the views of young people and publicise their concerns. It is important to involve young people in decisions that affect their situation so that they engage with the policy (3). Year 10 and year 12 students are also of an age where their opinions should be taken into account.

Aims of the research project:

This study was conducted to explore the opinions of year 10s and 12s concerning returning to partial school after the first wave of the covid-19 outbreak in June 2020. The aim was to provide a voice to young people on returning to partial schooling in June 2020.

Students were invited to express:

  • Their preferences on returning to school
  • Their views about safety with respect to government guidance on return to school
  • How they feel COVID-19 will impact on their future
  • How COVID-19 has impacted on their education

This study will inform members of the public and policy makers about the opinions of year 10 and 12 students returning to school in the UK at the end of the first wave of the SARS-CoV-2 outbreak.

How the research was conducted:

The aims of this study were addressed with qualitative research using a prospective survey conducted from the 20th to 27th May 2020. Participants were year 10 (age 14 to 15 years old) and year 12 (age 16 to 17 years old) school students in the United Kingdom.

A 12-question survey was compiled on Google Forms™ with 9 close-ended questions and 3 open-ended questions. The survey was distributed to the students via two online Facebook™ forums specific to their year groups: The A level Forum (6,500 members) and a GCSE forum (36,000 members). The survey was accessible on multiple platforms (computers and smartphones) and multiple web browsers.

The 3 open ended questions were subject to Braun and Clarke themed analysis. Thematic analysis is a method for identifying and interpreting patterns of meaning across qualitative data. This meant recurring themes in the written data could be addressed and the reasons behind students’ answers could be found without influence. Braun and Clarke analysis provides a qualitative six phased method of thematic analysis. Firstly, I familiarised myself with the qualitative data and noted general ideas. NVIVO (v12) software was used to group the qualitative data into codes (similar patterns in the data). Themes were then put together by grouping the codes. I then reviewed and defined each theme in relation to the research measures.

The results:

There was a rapid uptake from students with 1534 responses in 7 days.

An infographic breaking down the key findings in "Year 10 and 12 school students' opinions on returning to partial schooling during the COVID-19 pandemic: an action research prospective survey" DOI: 10.31235/osf.io/mdjsn

Conclusions:

Year 10 and 12 school students are evenly divided in opinion about whether they should return to school on 15th June. This uncertainty appears based on the majority of students having concerns about schools’ ability to comply with government guidance, particularly around social distancing and the risk of transmission. Some students recognised a need to return to education despite this perceived risk. This uncertainty could be addressed by better engagement from policy makers with school students. School students expressed desire that their students’ concerns are addressed by the Government and better explanation of the reasoning behind returning certain students to school at this time whilst other members of the community continue to isolate.

Policy makers should standardise remote learning. This will ensure all students receive some educational support during pandemics, ensuring the educational divide caused by a lockdown is minimized.

If you would like to read the full report click here! https://osf.io/preprints/socarxiv/mdjsn/

Reference list:

1. Actions for schools during the coronavirus outbreak [Internet]. GOV.UK. 2020 [cited 2020 Jun 9]. Available from: https://www.gov.uk/government/publications/covid-19-school-closures/guidance-for-schools-about-temporarily-closing

2. Coronavirus (COVID-19): implementing protective measures in education and childcare settings [Internet]. GOV.UK. 2020 [cited 2020 Jun 9]. Available from: https://www.gov.uk/government/publications/coronavirus-covid-19-implementing-protective-measures-in-education-and-childcare-settings/coronavirus-covid-19-implementing-protective-measures-in-education-and-childcare-settings

3. Mitchell C. “The Girl Should Just Clean Up the Mess”: On Studying Audiences in Understanding the Meaningful Engagement of Young People in Policy-Making. Int J Qual Methods [Internet]. 2017 Dec 1 [cited 2020 Jun 6];16(1):1609406917703501. Available from: https://doi.org/10.1177/1609406917703501

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