ISARIC - Coronavirus Clinical Characterisation Consortium (ISARIC-4C)

Lead Research Organisation: University of Edinburgh
Department Name: UNLISTED

Abstract

In 2019 new virus emerged(SARS-CoV-2) that causes a disease termed COVID-19. This
may be mild but can also be severe, leading to viral pneumonia; about one in 100 infected
people are expected to die of it. There are many urgent questions that need answering to
help control the outbreak and treat patients in the UK:
• how long are people infectious, and what body fluids are infectious?
• what puts people at higher risk of severe illness?
• what is the best way to diagnose the disease?
• who should we treat early with drugs, and which drugs cause harm?
• does the immune system in some patients do more harm than good?
• what other infections(such as pneumonia or flu) happen at the same time?

The UK needs a coordinated response to answer these questions as quickly as possible.
Over the last 8 years we have been preparing for such a major outbreak; our expert team
is ready to immediately deploy and has already started collecting data and samples from
UK cases.
The ISARIC-4C study will provide a foundation for other studies, such as clinical trials of
new treatments, to help better understand the best way to use interventions.
We will provide real-time information about the course of COVID-19 while studying and
the underlying biology that explains illness severity with the goal of controlling spread and
better treating those who contract it.

Technical Summary

This COVID-19 Rapid Response award is jointly funded (50:50) between the Medical Research Council and the National Institute for Health Research. The figure displayed is the total award amount of the two funders combined, with each partner contributing equally towards the project.

It seems highly likely that SARS-CoV-2 will cause disease and mortality unprecedented in
modern times. Despite rapid publication of data from China, many unanswered questions
remain that have immediate bearing on control and treatment of COVID-19:
• Pathogen: how does transmission occur and over what period? What features of
the virus drive transmission and severity?
• Host: How can diagnosis be improved? How can severity be predicted? Does prior
immunity to other viruses worsen disease severity? How does (non)pulmonary organ
injury occur? Can therapy be tailored according to disease mechanisms? Which bacterial
or fungal co-infections contribute to critical illness?
This is a new disease. There is a high chance that clinical trials will fail to detect
therapeutic effects, by enrolling at the wrong time, or missing key subgroups or endpoints.
Deep biological phenotyping can mitigate these risks, providing rapid, efficient clinical
evidence.
Our response has been planned and tested over the past 8 years within the International
Severe Acute Respiratory Infection Consortium (ISARIC). We will recruit at least the first
1300 consenting UK patients, and 1000 suspected cases, as the base of a coordinated
national response, using our established, internationally-harmonized protocol (ISARIC
Clinical Characterisation Protocol) to:
• Provide a unified foundation for clinical trials, enriching design and interpretation
• Provide an open-access platform for evaluation of diagnostics and therapeutics
• Establish a sample repository with independently-managed availability to
researchers and to industry.
• Use real-time data to inform the response by funders, public health and hospitals
ISARIC-4C is a consortium of experts with a proven track record of high-quality outbreak
research.
We have already recruited 87% of cases reported in the UK.

People

ORCID iD

Publications

10 25 50

 
Title Dawn, on the Morning After the Storm 
Description Dawn, on the Morning After the Storm, is a new work by composer Zakiya Leeming, who has been collaborating with health data researchers since 2018 to create music informed by their work. All performances were recorded independently in lockdown conditions and then compiled by the composer. The piece is a result of discussions with UK members of the global International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) and COVID-19 Clinical Information Network about their experiences working through the COVID-19 outbreak. ISARIC4C, led by investigators from the University of Edinburgh, University of Liverpool and Imperial College London, is recognised as the sovereign COVID-19 research programme to meet urgent public health needs for the UK. It is a collaboration of over 200 scientists from 11 institutions and NHS teams from 350 hospitals. Outputs from the project have informed the UK's response to the current pandemic, based on data and biological samples from patients in hospitals across the UK, and it is one of the largest COVID-19 projects in the world. When Leeming asked ISARIC4C Chief Investigator, Professor Calum Semple OBE, what a piece about his experience should describe, Semple replied, 'Like Dawn, on the morning after the storm'. For Semple, it was about coming together to play, in the same way the consortium came together to respond to the challenge of the virus. The performance was followed by a recorded discussion between the composer and ISARIC performers. 
Type Of Art Performance (Music, Dance, Drama, etc) 
Year Produced 2021 
Impact 637 views and was streamed live from the Royal Northern College of Music on 17 Jun 2021 
URL https://youtu.be/e0l3S04TfFY
 
Description Citation in the Green Book Chapter 14a
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact Have provided early observational data about the first 20,000 UK patients in hospital with COVID-19 (https://doi.org/10.1136/bmj.m1985) and clinical characterisation of children and young people admitted with COVID-19 in the UK (https://doi.org/10.1136/bmj.m3249).
URL https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1057...
 
Description Contributed regularly to Scientific Advisory Group for Emergencies (SAGE) COVID-19 Response from meeting 20 in March 2020 to Meeting 105 in February 2022
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a guidance/advisory committee
Impact Targeted improvements in Infection prevention control Optimised roll out of vaccination Identified people most at risk of severe disease, likely to deteriorate and die. Explored impact of co-morbidity. Studies associations between ethnicity and outcome.
URL https://www.gov.uk/government/collections/scientific-evidence-supporting-the-government-response-to-...
 
Description Discussion at SAGE of therapeutic implications fo genetics
Geographic Reach National 
Policy Influence Type Participation in a guidance/advisory committee
Impact The TYK2 association in our first critical covid genetics paper, in addition to other clinical evidence, led directly to the inclusion of baricitinib in the RECOVERY trial. Baricitinib was shown to be effective for the treatment of Covid-19 by RECOVERY in March 2022.
URL https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/9269...
 
Description Member of NERVTAG
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact Our analysis informed vaccine prioritisation schedules, with two citations in Chapter 14A of The Green Book "Coronavirus (COVID-19) vaccination information for public health professionals." See Docherty AB et al BMJ 2020 and Swann OV et BMJ 2020 We developed the most widely used risk stratification tool to better identify those people at risk of death and deterioration. We allowed target intervention at sites where nosocomial infection rates were high.
URL https://www.gov.uk/government/publications/covid-19-the-green-book-chapter-14a
 
Description Two of the research team are represented on two Department of Health Advisory groups. The New Emerging Respiratory Viral Threat Advisory Group (MGS on NERVTAG) and the Antimicrobial Resistance Modelling Group (MGS & PM)
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a guidance/advisory committee
Impact Identification of risk groups and their prioritization for vaccination.
URL https://www.gov.uk/government/publications/technical-report-on-the-covid-19-pandemic-in-the-uk
 
Guideline Title Interim Clinical Commissioning Policy: Antivirals or neutralising monoclonal antibodies for non-hospitalised patients with COVID-19
Description Use of antivirals or neutralising monoclonal antibodies for non-hospitalised patients with COVID-19
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Citation in clinical guidelines
Impact antivirals or neutralising monoclonal antibodies (nMABs) are recommended to be available as a treatment option through routine commissioning for non-hospitalised adults with COVID-19 treated in accordance with the criteria set out in the policy. Hospitals were strongly encouraged to submit data through the ISARIC4C Clinical Characterisation Protocol (CCP) case report forms (CRFs).
URL https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2021/12/C1603-interim-ccp-antivir...
 
Description A UK underpinning platform to study immunology and immunopathology of COVID-19:The UK Coronavirus Immunology Consortium
Amount £6,552,119 (GBP)
Funding ID MR/V028448/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 08/2020 
End 12/2021
 
Description Clinical Characterisation of COVID-19 admitted to hospitals in the United Kingdom
Amount £8,948,758 (GBP)
Funding ID CO-CIN-01 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2020 
End 11/2021
 
Description ISARIC Clinical Characterisation Protocol UK (CCP-UK) - a companion study for patients with Cancer and COVID-19 (CCP-CANCER-UK)
Amount £344,930 (GBP)
Funding ID MR/V028979/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 08/2020 
End 03/2022
 
Description Non-hospitalised Children & young people (CYP) with Long Covid (The CLoCk Study)
Amount £680,000 (GBP)
Funding ID MC_PC_20052 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 02/2021 
End 02/2024
 
Description OpenSAFELY, ISARIC, PHOSP: tracking consequences of COVID-19 infection across UK primary and secondary care.
Amount £613,528 (GBP)
Funding ID MR/W016729/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 02/2021 
End 08/2022
 
Description PHOSP-COVID Post-hospitalisation COVID-19 study: a national consortium to understand and improve long-term health outcomes
Amount £8,532,684 (GBP)
Funding ID MR/V027859/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 07/2020 
End 08/2022
 
Description The UK Interstitial Lung Disease Long-COVID19 study (UKILD-Long COVID): understanding the burden of Interstitial Lung Disease in Long COVID.
Amount £2,014,983 (GBP)
Funding ID MR/W006111/1 
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 02/2021 
End 08/2022
 
Title 4C Deterioration Score 
Description A new risk-stratification tool which can accurately predict the likelihood of deterioration in adults hospitalised with COVID-19.The tool assesses 11 measurements routinely collected from patients, including age, gender, and physical measurements (such as oxygen levels) along with some standard laboratory tests and calculates a percentage risk of deterioration, known as the '4C Deterioration Score'. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2021 
Provided To Others? Yes  
Impact The online tool, has been made freely available to NHS doctors to support clinicians' decision making - helping to improve patient outcomes and ultimately save lives. 
URL https://isaric4c.net/risk/
 
Title 4C Mortality Score 
Description Using data from 57, 824 hospital admissions, we developed and validated an easy-to-use risk stratification score based on commonly available parameters at hospital presentation. The 4C Mortality Score outperformed existing scores, showed utility to directly inform clinical decision making, and can be used to stratify patients admitted to hospital with covid-19 into different management groups 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2020 
Provided To Others? Yes  
Impact The 4C Mortality Score has been extensively validated in independent studies across the world. The 4C Mortality Score has also been used to inform clinical practice in the UK and to guide inform national prescribing guidance for Remdesivir. 
URL https://isaric4c.net/risk/v2/
 
Title GenOMICC sample repository 
Description A sample repository comprising DNA from GenOMICC cases 
Type Of Material Biological samples 
Year Produced 2021 
Provided To Others? Yes  
Impact Discovery of 41 genetic associations with critical Covid-19. Prediction of therapeutic efficacy for barcitinib. Inclusion of baricitinib in RECOVERY trial, leading to new effective therapy for Covid-19 
URL http://genomicc.org/data
 
Title ISARIC4C Tier 1 and 2 Biological Samples 
Description Any investigator with the resources and capability can apply to access ISARIC4C biological materials. Access to samples obtained using the Clinical Characterisation Protocol (CCP) can be requested and includes the following: Serum (Clotted) Plasma (EDTA tubes) Cell pellets (extracted immediately for genotyping) Blood in blood RNA tube (extracted immediately for RNA seq) Combined nose and throat swab, otherwise a throat swab or nasopharyngeal swab alone Nasopharyngeal aspirate (NPA) Urine Rectal swab or stool specimen Samples/swabs from infected sites or sores 
Type Of Material Biological samples 
Year Produced 2020 
Provided To Others? Yes  
Impact The ISARIC4C sample access request process allowed rapid sample sharing with the Oxford COVID Vaccine Trial Group (https://doi.org/10.1016/S0140-6736(20)31604-4) and has led to the incorporation of several new research groups into the consortium. This includes lipidomics and urinary and faecal metabolomics. The sample access process also allowed sample sharing with several other consortiums including HICC and CiC, and high-impact projects including COVID-CNS and COVIRNA. 
URL https://isaric4c.net/sample_access/
 
Title Comparative evaluation of ten lateral flow immunoassays to detect SARS-CoV-2 antibodies 
Description Background: Rapid mobilisation from industry and academia following the outbreak of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to the development and availability of SARS-CoV-2 lateral flow immunoassays (LFAs). High-quality LFAs are urgently needed at the point of care to add to currently available diagnostic tools. In this study, we provide evaluation data for ten LFAs suitable for use at the point of care. Methods: COVID-19 positive patients (N=45), confirmed by reverse transcription - quantitative polymerase chain reaction (RT-qPCR), were recruited through the International Severe Acute Respiratory and Emerging Infection Consortium - Coronavirus Clinical Characterisation Consortium (ISARIC4C) study. Sera collected from patients with influenza A (N=20), tuberculosis (N=5), individuals with previous flavivirus exposure (N=21), and healthy sera (N=4), collected pre-pandemic, were used as negative controls. Ten LFAs manufactured or distributed by ASBT Holdings Ltd, Cellex, Fortress Diagnostics, Nantong Egens Biotechnology, Mologic, NG Biotech, Nal von Minden, and Suzhou Herui BioMed Co. were evaluated. Results: Compared to RT-qPCR, sensitivity of LFAs ranged from 87.0-95.7%. Specificity against pre-pandemic controls ranged between 92.0-100%. Compared to IgG ELISA, sensitivity and specificity ranged between 90.5-100% and 93.2-100%, respectively. Percentage agreement between LFAs and IgG ELISA ranged from 89.6-92.7%. Inter-test agreement between LFAs and IgG ELISA ranged between kappa=0.792-0.854. Conclusions: LFAs may serve as a useful tool for rapid confirmation of ongoing or previous infection in conjunction with clinical suspicion of COVID-19 in patients attending hospital. Impartial validation prior to commercial sale provides users with data that can inform best use settings. 
Type Of Material Database/Collection of data 
Year Produced 2021 
Provided To Others? Yes  
URL http://datadryad.org/stash/dataset/doi:10.5061/dryad.brv15dv8h
 
Title Outbreak Data Analysis Platform 
Description Unique research data assets generated from COVID 19 pandemic that have enabled critical discoveries and shaped the COVID 19 response in the UK and globally, including ISARIC4C/CO CIN data, GenOMICC data, and other study data, linked together with routine health data and viral genomic data. Data Access Governance Model with support from the data controllers will be in place to review access requests to the datasets included. The platform will be able to inform COVID-19 recovery and provide the necessary infrastructure for addition of datasets in the future to support other pandemics / epidemics. 
Type Of Material Data handling & control 
Year Produced 2022 
Provided To Others? Yes  
Impact To facilitate vital research on the impact of SARS CoV 2 genetic and phenotypic variation on disease severity and vaccine efficacy by creating additional data linkages, automating data flows and analyses, and democratising access to research datasets with full agreement from the contributing studies. 
URL https://isaric4c.net/analysis-platform/
 
Description CCP-Cancer-UK 
Organisation The Clatterbridge Cancer Centre NHS Foundation Trust
Country United Kingdom 
Sector Public 
PI Contribution Patients with Cancer have been severely affected by COVID-19. Vaccination means that the risks from COVID-19 have decreased for many people. But patients with cancer sometimes do not respond to the vaccine in the same way as other people due to the powerful anti-cancer treatments that these patients need to take and its effect on their immune system. This study is a multi-disciplinary project involving experts in cancer medicine, infectious disease, critical care, patient representative and data scientists. ISARIC4C will work with CCP-Cancer UK to collect more detailed data on cancer patients. ISARIC4C has recruited nearly a quarter of a million patients across the UK admitted to hospital with COVID-19. CCP-UK collects data and where possible samples from these patients.
Collaborator Contribution The purpose of CCP-CANCER UK study is to obtain additional data from patients with cancer who were/are recruited into ISARIC4C study which is the key national protocol for characterising COVID19 in the UK population. This study is designed to supplement, not replace. CCP-Cancer UK, will collect additional information about their cancer type, when the cancer was diagnosed, and treatments. The CCP-Cancer UK study will also do some work in the laboratory with the biological samples collected by the national study to answer cancer specific questions.
Impact This study is a multi-disciplinary project involving experts in cancer medicine, infectious disease, critical care, patient representative and data scientists. Data was presented at the European Society of Medical Oncology (ESMO) conference in 2021, showed that, although there has been a steady decline in mortality rates for people with no history of cancer since January 2020, the same is not true for people with a history of cancer. Furthermore, the gap in mortality between people with a history of cancer and those with no history of cancer widened between February 2021 and July 2021.
Start Year 2020
 
Description ISARIC4C/BHIVA 
Organisation British HIV Association (BHIVA)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Data from 47,539 people with laboratory confirmed or highly likely COVID-19 from the ISARIC CCP-UK study was used to define how HIV influences COVID-19.
Collaborator Contribution Our collaborators at the British HIV Association provided technical skills in analysing the data and expertise in explaining the results in the wider context.
Impact Outcomes of COVID-19 related hospitalisation among people with HIV in the ISARIC WHO Clinical Characterisation Protocol UK Protocol: prospective observational study. (https://doi.org/10.1093/cid/ciaa1605)
Start Year 2020
 
Description NHS Digital - NCCID/ISARIC4C 
Organisation NHS Digital
Country United Kingdom 
Sector Public 
PI Contribution The National COVID-19 Chest Imaging Database (NCCID) is a centralized database containing mainly chest X-rays and computed tomography scans from patients across the UK. The objective of the initiative is to support a better understanding of the coronavirus SARS-CoV-2 disease (COVID-19) and the development of machine learning technologies that will improve care for patients hospitalized with a severe COVID-19 infection. ISARIC4C collaborated with the study team to provide data to the project.
Collaborator Contribution The NCCID is a growing resource that provides researchers with a large, high-quality database that can be leveraged both to support the response to the COVID-19 pandemic and as a test bed for building clinically viable medical imaging models (https://doi.org/10.1093/gigascience/giab076).
Impact An overview of the National COVID-19 Chest Imaging Database: data quality and cohort analysis (https://academic.oup.com/gigascience/article/10/11/giab076/6437679). Multi-disciplinary - clinicians, radiographers, and scientists.
Start Year 2020
 
Title Diagnostic Evaluation Platform 
Description We proposed and established a Diagnostic Evaluation Platform at the University of Oxford (led by Dr Alex Mentzer) which was used to provide evidence to the UK government about the performance of new diagnostic and antibody tests. 
Type Support Tool - For Medical Intervention
Current Stage Of Development Small-scale adoption
Year Development Stage Completed 2020
Development Status Closed
Impact The results from the Diagnostic Evaluation Platform was used to provide evidence to the UK government about test performance (https://doi.org/10.12688/wellcomeopenres.15927.1) 
URL https://isaric4c.net/sample_access/
 
Title ODAP Flexible Compute Space 
Description The Flexible Compute Space for the Outbreak Data Analysis Platform is a suite of software systems, network and high-performance computing hardware which creates a "safe setting" for approved research with linked medical and genomic data. The hardware for the FCS is provided by the Edinburgh International Data Facility, but this grant has enabled the building of the software and security environment necessary to support analysis by the ISARIC4C, GenoMICC and PHOSP trials. 
Type Of Technology e-Business Platform 
Year Produced 2021 
Impact The FCS provides greater computational capability (access to high-performance computing) and a richer analytical software environment than the conventional National Safe Haven. The FCS has enabled research with linked medical, genomic and trial data for ISARIC4C, GenoMICC and PHOSP and has become the core of the Outbreak Data Analysis Platform, a proposed new UK Trusted Research Environment for the analysis of emerging or re-emerging pathogens of public health concern. 
URL https://isaric4c.net/analysis-platform/
 
Description Alastair Stewart & Friends; Guest Interview on 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Discussion on COVID-19 impact on society
Year(s) Of Engagement Activity 2021
URL https://www.imdb.com/title/tt14844278/?ref_=nm_flmg_slf_1
 
Description Kay Burley Sky News: Interview 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Updates on science of COVID-19 and impact of medicines, vaccinations, behavioural change
Year(s) Of Engagement Activity 2020,2021,2022
URL https://www.imdb.com/name/nm11426855/?ref_=nv_sr_srsg_1