Spread of COVID-19 mapped in hospitals to ‘break the chain’ of transmission
The trial will evaluate the effectiveness of rapid sequencing and analysis of SARS-CoV-2 genomes in reducing hospital outbreaks
A first-of-its kind clinical trial, led by scientists at UCL, will evaluate the use of ‘real time’ viral genomic data to reduce the spread of COVID-19 within hospitals. The study’s findings could help the NHS reduce further transmission of the virus by determining if an individual caught the virus from someone else within the same hospital.
The trial, led by Professor Judith Breuer, Director of UCL/UCLH/GOSH Biomedical Research Centres funded Pathogen Genomics Unit (PGU/UCLG), together with the UCL Comprehensive Clinical Trials Unit (CCTU), forms part of the Government’s £20 million COVID-19 Genomics UK Consortium (COG-UK) – which has established a network of rapid genome sequencing centres across the UK – allowing scientists to map the virus’ spread across the country.
“Spread of COVID-19 infections in hospitals is now recognised to be a major problem for both healthcare workers and patients, and ‘breaking the chain’ of these transmissions is critical.
“Tried and tested procedures to minimise infection spread in hospitals are already in use, including separating COVID-19 infected patients from uninfected patients, extensive cleaning, the use of PPE, and continual hand washing.
“Despite these measures, COVID-19 transmission to patients and staff is still occurring and has sadly proven fatal. So it is essential that we try out new tools such as viral sequencing to find out why this is happening and to help reduce hospital spread.”
Professor Judith Breuer, an expert in the use of genomics for tracking hospital infection
The importance of this research area has been recognised by the National Institute for Health Research (NIHR). This study is one of a number of COVID-19 studies that have been given urgent public health research status by the Department of Health and Social Care.
The COG-UK Hospital Onset COVID-19 Infection (HOCI) trial has been developed with the NIHR UCL/UCLH BRC supported Pathogen Genomics Unit at UCL in collaboration with Imperial College Healthcare Trust, Sheffield Teaching Hospitals NHS Foundation Trust with The University of Sheffield, and the Glasgow Royal Infirmary with the MRC-University of Glasgow Centre for Virus Research. COG-UK HOCI will involve over 15 hospitals linked to COG-UK sequencing hubs across the UK.
Each site will analyse the COVID-19 sequences in nasal and throat samples from all known COVID-19 patients in the hospital, along with newly infected hospital patients and frontline NHS staff. The trial will evaluate whether results from whole virus genome sequencing of all COVID-19 samples (now available within 24-48 hours) reduces the number of hospital outbreaks compared with standard methodologies. Specifically, the genomic data is likely to enable clinical teams in each hospital to see if newly infected patients have picked up the virus from a known positive COVID-19 patient within the hospital, or from outside the hospital.
There is already evidence emerging from COG-UK that COVID-19 sequences can help teams to control hospital infections better. The COG-UK HOCI trial will quantify by how much sequencing helps, how important it is to return results rapidly, what is the best way to implement COVID-19 sequencing across the NHS, and how much it costs. This information will help to make more precise plans as to how to use COVID-19 sequencing in the future.
“We already know that comparing the sequence of letters that make up one COVID-19 virus genome with the sequence of letters from COVID-19 in another sample, can tell us whether the two viruses are the same or different.
“Therefore by sequencing COVID-19 viruses rapidly, we hope to establish how hospital staff and patients became infected. This will allow hospitals to put effective measures in place faster, to try to interrupt onward transmission of the virus and reduce the number and size of outbreaks. Such measures might include more regular deep cleans, checking and double-checking the effectiveness of PPE equipment, and moving other vulnerable patients out of the hospital entirely to another setting.”
Professor Judith Breuer
COVID-19 viruses that are closely related (transmitted from one patient to another or to a healthcare worker) will have the same sequence, while COVID-19 viruses from two people that have different sequences will rule out the possibility of COVID-19 transmission between patients or healthcare workers.
“The understanding and prevention of hospital onset COVID-19 infections will be an important aspect of any recovery strategy for hospitals.
“Established infection prevention methods and surveillance approaches used to track and trace infections and antimicrobial resistance will be applied, but now supported with the additional information provided by genetic fingerprinting.”
Professor Alison Holmes, Director of the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, based at Imperial College London
The COG-UK project is made up of NHS, Public Health Agencies and academic institutions – including UCL and UCLH – and will deliver large scale sequencing of COVID-19, and intelligence sharing with hospitals, regional NHS centres and the government. In COG-UK samples from patients with confirmed cases of COVID-19 are being sent to a network of sequencing centres all over the UK.
“Using viral genomics we can now track how COVID-19 spreads in hospitals as well as in national and international settings. Our trial will hopefully provide valuable information for the hospitals involved revealing the chains of transmission that must be stopped in order to control COVID-19.”
Professor Judith Breuer
The following NHS Trusts have confirmed they are participating in the HOCI trial:
- Imperial College Healthcare NHS Trust
- Sheffield Teaching Hospitals NHS Foundation Trust
- NHS Glasgow and Greater Clyde
- NHS Lothian
- Guy’s and St Thomas’ NHS Foundation Trust
- Manchester University NHS Foundation Trust
- University College London Hospitals NHS Foundation Trust
- Royal Free London NHS Foundation Trust
- University Hospital Southampton NHS Foundation Trust
- Newcastle Hospitals NHS Foundation Trust
- Royal Devon & Exeter NHS Foundation Trust
- Norfolk and Norwich University Hospitals NHS Foundation Trust
- Liverpool University Hospitals NHS Foundation Trust
- Leeds Teaching Hospitals NHS Trust
UCL is in discussion with a further six NHS trusts about participating in the trial.
UCL is a diverse community with the freedom to challenge and think differently.
Our community of more than 41,500 students from 150 countries and over 12,500 staff pursues academic excellence, breaks boundaries and makes a positive impact on real world problems.
We are consistently ranked among the top 10 universities in the world and are one of only a handful of institutions rated as having the strongest academic reputation and the broadest research impact.
We have a progressive and integrated approach to our teaching and research – championing innovation, creativity and cross-disciplinary working. We teach our students how to think, not what to think, and see them as partners, collaborators and contributors.
For almost 200 years, we are proud to have opened higher education to students from a wide range of backgrounds and to change the way we create and share knowledge.
We were the first in England to welcome women to university education and that courageous attitude and disruptive spirit is still alive today. We are UCL.
The current COVID-19 pandemic, caused by the SARS-CoV-2 virus, represents a major threat to health. The COVID-19 Genomics UK (COG-UK) consortium has been created to deliver large-scale and rapid whole-genome virus sequencing to local NHS centres and the UK government.
COG-UK is made up of an innovative partnership of NHS organisations, the four Public Health Agencies of the UK, the Wellcome Sanger Institute and over twelve academic partners providing sequencing and analysis capacity. A full list of collaborators can be found here: https://www.cogconsortium.uk/about/
COG-UK is supported by £20 million funding from the UK Department of Health and Social Care (DHSC), UK Research and Innovation (UKRI) and the Wellcome Sanger Institute, administered by UK Research and Innovation. For more information, visit: https://www.cogconsortium.uk
The National Institute for Health Research (NIHR) is the nation’s largest funder of health and care research. The NIHR:
- Funds, supports and delivers high quality research that benefits the NHS, public health and social care
- Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
- Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
- Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
- Partners with other public funders, charities and industry to maximise the value of research to patients and the economy
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR supports applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.
Please visit https://www.nihr.ac.uk/covid-19/ to learn about other studies that have been given urgent public health status and the single, national prioritisation process that has been established to prevent duplication of effort and to ensure that the resources and capacity of the health and care system to support COVID-19 research are not exceeded.
Related News and Blogs
The COVID-19 genome
Information from the genome sequences will help track the spread of the coronavirus in the UK and support public health planning and clinical decision making
COG-UK preliminary analysis reveals the frequency and source of virus introductions into the UK
The latest analysis of the COVID-19 epidemic in the UK combines large-scale data and genomic sequencing to provide a detailed picture of the number and sources of SARS-CoV-2 introductions into the UK
Asymptomatic screening and genome sequencing help Cambridge understand spread of SARS-CoV-2 among its students
Since the start of the academic year in October 2020, the University of Cambridge has been offering regular SARS-CoV-2 tests to all students living in its Colleges, even if they show no symptoms. Initial results suggest that the screening programme, together with the University’s public health measures and responsible student behaviour, has helped limit the spread of the virus.
‘World-class’ CLIMB project receives £1.2 million funding boost from UKRI
As part of a wider £213 million investment to expand and upgrade ‘world-class’ research infrastructure, the Cloud Infrastructure for Microbial Bioinformatics (CLIMB) project — the ultra-high performance computing infrastructure which has supported the COVID-19 Genomics UK (COG-UK) consortium throughout the pandemic — has received a £1.2 million funding boost from UK Research and Innovation (UKRI).