One of the main areas that the Cambridge Institute for Therapeutic Immunology and Infectious Diseases (CITIID) was set up to address was the area of future epidemiology.
Of course, no one expected that after institute staff and researchers began moving into their home at the brand-new Jeffrey Chah Biomedical Center in October and November of 2019, a new virus would emerge and spread around the world like wildfire.
As we know, the SARS-CoV-2 virus emerged in Wuhan, China, where the first cases were traced to early December 2019.
The virus spread rapidly from China to various other countries, which led to the World Health Organization (WHO) declaring the outbreak a Public Health Emergency of International Concern on January 30, 2020, and subsequently, a global pandemic on March 11, 2020.
As its raison d’être is the focal point of research for immunity and infection within the University of Cambridge, CITIID has quickly gone from being the newest institute on the university’s biomedical campus to the only research facility at the university allowed to remain fully open during the UK lockdown.
Although they “were not quite ready,” said Institute Director Professor Dr. Ken Smith, all of the CITIID researchers quickly and subtly shifted their work to focus on Covid-19 and SARS-CoV-2.
Professor Smith added that, as many of the researchers are also clinical professionals, they quickly realized that they could not do purely academic research.
This was particularly so because such work would require assistance from clinical staff — in obtaining patient samples, for example — and add to an already overburdened workload on the front lines.
“So our initial priority was to try and do research that would help in the immediate response to the epidemic,” says the university’s chief of medicine, a consultant nephrologist, and a clinical immunologist.
Quick test results
One of the first things they did was develop and create the first point of care for Covid-19 testing.
When the pandemic began, every patient who came to Addenbrooke’s Hospital – the main teaching hospital and research center of the University of Cambridge – had to wait more than 24 hours before knowing the results of a Covid-19 test.
All of these patients will be placed in a waiting area during this period.
“Instead of suspected patients spending a day in a mixed ward with non-Covid patients, waiting for their results, we will have their results within 10 minutes,” says Professor Smith.
This has enabled patients to be quickly separated and separated in Covid-19 and non-Covid-19 areas of the hospital in order to get the care they need.
The institute has also set up the UK’s first healthcare worker screening programme, in which Addenbrooke’s healthcare staff are screened after work every night.
“This means that we have been able to send infected people home, and that the hospital, which has been the largest source of infection in the community during the lockdown, can stop being a source of infection.
“We’ve been able to virtually eliminate infections inside hospitals,” he says.
Both programs are made possible by the rapid development of a PCR-based high-throughput assay for SARS-CoV-2 screening at the Institute.
The high-throughput screening assay allows the automated and rapid testing of a large number of samples for specific biological properties, such as genes, antibodies or active compounds.
In this case, it was allowed to examine the genes of the SARS-CoV-2 virus.
Professor Smith shares that this is made possible by the experience and expertise of his colleagues, molecular microbiologist Professor Dr Stephen Baker and Deputy Head of the Department of Pathology (Research) Professor Ian Goodfellow.
“Ian set up a field-testing system for Ebola in West Africa, using very rudimentary technology.
“He used this experience to prepare our rapid employee screening test.
“Because, of course, we weren’t able to get most of the reagents we wanted due to a short supply of them, so he created an alternative type of crude system, but it’s very effective.”
Because this test used different reagents than the rest of the world was competing with, the CITIID team was able to quickly get the supplies they needed in the quantities needed to set up both screening programs.
Another important contribution made by researchers at the institute is the creation of the Covid-19 Genomics UK Consortium (COG-UK).
Initiated by Professor of Public Health and Microbiology in the Department of Medicine Dr. Sharon Peacock and Associate Senior Investigator Dr. Ewan Harrison, this was an attempt to sequence viral samples collected by the institute.
Starting at CITIID, he soon moved on to the Wellcome Sanger Institute – a non-profit research institute in genomics and genetics located outside of Cambridge – and eventually took up sites across the UK.
“At their peak, they were sequencing 60,000 viral samples a day, which allowed us to track outbreaks and monitor new variants that come in and explore their spread across the country, and start to get those things under control,” Professor Smith shares.
For example, although much of the media attention at the time was on travelers coming from China and attending Austrian skating parties that produced Covid-19 kits, the sequencing program found that most of the initial British Covid-19 cases were in fact. It was brought from Italy, France and Spain.
“Obviously this provides you with a policy on how to control travel (to reduce transmission of the virus).” notice.
On a more local level, sequencing software allowed six apparently unrelated Covid-19 patients living around Cambridge with the exact same viral strain to be traced back to a shared minibus they were all boarding to go for dialysis at the same time.
This alerted local authorities to this mode of transport and allowed for stricter control of public or shared transport.
As the institute continues to work on SARS-CoV-2 and Covid-19 – including monitoring vaccine efficacy on viral variants and leading the UK-wide study on long-running Covid – work on their other major goals is slowly gathering strength again.
As Professor Smith shares: “Our strategy has been to think a lot about the problems that will happen in 20 years.
“And we thought it would be epidemics (and) it would be antimicrobial resistance – both of which would be affected by climate change.”
And while the timeline for pandemics certainly arrived much earlier than expected, in some ways it was a blessing in disguise.
“It was a great way to start a new institute, because everyone is forced to work together.
“We met every day at 5 p.m. to discuss strategy for the next day,” he said.
“The other thing is that we needed to significantly increase staff numbers to deliver things like screening health care workers.
“And we were able to do that because all the other scientists on campus had been sent home, so we had hundreds of volunteers who showed up to transport samples, to help out in the wards and lead a lot of the artwork.
“So we weren’t alone, it just became kind of a misery for the massive amount of volunteer activity around the campus,” he adds.
They even “adopted” three or four other research groups who were also researching Covid-19, but whose buildings were closed at the time.
Another benefit of the pandemic that Professor Smith shared was that “officials got out of our way.”
“Usually, when you want to conduct an experiment, there are a series of bureaucratic hurdles you have to cross that delay you for months.
And those things that used to take months were suddenly cut into days or weeks, and reasonable decisions were made very quickly.
“I was imagining this situation would continue after the pandemic, but I was wrong,” he says with a smile.
“But the speed with which we got it running when we were focused was very impressive,” he adds, noting that part of it was also due to “the perfect building being built and opened eight weeks before the outbreak.”
Aside from CITIID, Jeffrey Cheah Biomedical Center also includes the Wellcome-MRC Cambridge Stem Cell Institute, the Milner Therapeutics Institute and the Cambridge Myelin Correction Center.
It also has the largest biosafety level 3 laboratory in academia in the UK, according to Professor Smith.
Biosafety Level 3 laboratories are used to study infectious agents or toxins that can travel through the air and cause fatal infections.
Professor Smith met with the media recently when he was in town to give a lecture on “The Jeffrey Chiah Biomedical Center and Cambridge Rapid Response to the SARS-CoV-2 Epidemic” at Sunway University as part of the Jeffrey Chiah Distinguished Speaker Series.