Setting up a COVID-19 diagnostics and translational research group

Identifying behavioural success factors

Everyone contributed their time, expertise, and resources to that single purpose, working in the same laboratories, offices, or e-mail groups, helping each other outside their usual domain whether that was supporting research, diagnostic development, or service delivery. Three principles emerged:

What progress has been made in the first 4 months?

Our assessment highlights (at least) 4 areas of thriving translational research: (1) ‘delivering and adapting the clinical service’—caring for COVID-19 patients on an infectious diseases ward whilst providing a consult and infection prevention and control service across the hospitals. This gave visibility of core and rapidly changing clinical needs; (2) ‘developing laboratory diagnostic capability’—setting up a new COVID-19 diagnostic expansion laboratory embedded within academic research facilities at Guy’s Hospital introducing novel accredited pipelines; technologies; PCR or serological tests; and COVID-19 or metagenomic sequencing for clinical service, infection control, and public health asymptomatic screening [5–8] (we named this new laboratory in recognition of June Almeida who discovered coronaviruses by electron microscopy at St Thomas’ Hospital in 1966 [9]); (3) ‘conducting fundamental research’—comprehensive immunophenotyping to understand correlates of disease/protection and to inform novel therapies; virus culture to dissect viral replication and support preclinical drug discovery; and viral sequencing to inform transmission networks, immune escape, and persistence [10–12]; (4) ‘supporting therapeutics and vaccine research’—recruiting patients into nationally coordinated clinical trials of new therapies (e.g., convalescent serum, vaccines, and biologics) and participating in cohort-based and population studies to explore, inter alia, rates of infection, disease severity risk factors, and renewed or persistent COVID-19 infection [13].

It is premature to reach conclusions on the impact and outputs of these new working arrangements, although 2 early examples are worth mentioning. First, within 3 months we moved from investigating antibody responses to COVID-19 infection and the evaluation of over 10 different diagnostic technologies to setting up a first pilot patient serology service to identify the clinical benefit of antibody detection for managing suspected post-COVID-19 syndromes and persistent infection [7,8,10]. This would have been inconceivable before COVID-19: a single team worked across the pathway from start to finish including, e.g., university scientists being on the daily serology service rota. Second, our King’s College Hospital laboratory was at the forefront of NHS community screening in testing all residents and staff in 50 care homes across South East London boroughs and formed much of the basis for a submission of a large KHP bid for scaled up and linked hospital, key worker and community (symptomatic and asymptomatic) testing, and surveillance capability in South East London.

Forces likely to drive us apart when this pandemic is over

As society and healthcare institutions tentatively seek to return to normality, we can see that this new way of working is fragile with forces pulling us back. First, furlough, national underwriting of resources required to fight the pandemic and the willingness of finance in each organisation to temporarily accept the clinical need, meant financial incentives aligned with the partnership approach. This will not last when organisations start to realign around their previous funding models. A new more integrated strategic business plan will be required to keep this together, demonstrating convincingly to many stakeholders why this is better than past financial and strategic models that have engendered a siloed outlook.

Secondly, the parallel professional hierarchies within and between academic research, clinical service, and laboratory service: between research and healthcare scientists, full-time clinicians, and academic clinicians. These were exposed when we came together requiring some honest and sometimes difficult conversations to build mutual respect. The creation of a local multi-professional grouping committed to a shared endeavour with daily interactions felt like the primary delivery vehicle for diagnostic translational researchers taking innovation through to patient impact. Without continued support working across professional boundaries, including more flexible career paths and an integrated professional framework for healthcare and research scientists, articulated through a more realistic set of metrics of success and performance, the forces of familiarity will take us back.

Thirdly, wet laboratory consolidation strategies have dominated the direction of travel for the past 30 years often built around large technology platforms, be that for NHS pathology services, discovery science, public health, or national centres of excellence such as for genomics. This introduces additional geographical boundaries between members of a multi-professional team. Our ability to respond to this crisis would have been much harder had our diagnostic laboratories not been embedded in our clinical services, and we reflect on what more might have been achieved if university scientists had also been colocated.

National initiatives often within 1 professional body typically endorse the establishment of large consortia, national sample collections, centralised pathology, or public health laboratory hubs as well as small numbers of nationally commissioned centres of laboratory research excellence as lead delivery vehicles, including in this crisis. This approach clearly works as a model for advancement in therapeutics, vaccines, and human genetics. Yet the challenge translating novel diagnostics into NHS service has been noted for many years, and the UK SARS-CoV-2 testing response has attracted considerable criticism, in both cases comparing unfavourably with advancement in therapeutic innovation. The successful translational research model may be different for diagnostics, and additionally so for infectious diseases, with a need for a centre of gravity closer to the front line. With the frequent waves of new and emerging infections, now is as opportune time to evaluate how better to prepare for future onslaughts.

In summary, a new multidisciplinary translational research partnership emerged at KHP in response to the SARS-CoV-2 pandemic, where university and diagnostic laboratories combined with clinical academic, research and healthcare science, and service delivery teams to create a single delivery unit. It highlighted important but renewed questions about the optimal model for diagnostic innovation; laboratory configuration; and professional working linking service, research, and public health. The agenda is not new and colleagues around the world will have their own rich and recent experiences to share, no doubt with a range of views on where next? It is an open question whether our experience in South London can inform future organisational realignments, or whether it is a temporary aberration with lessons relevant only to a pandemic? For the former to be considered, we need support from the top of our structures to help capture the identity and vibrancy of these newly formed partnerships and implement positive change before things return to familiar ways.

Acknowledgments

To all the scientists, medics, nurses, pharmacists, and our managers and support service teams who came together during the pandemic to develop and deliver SARS-CoV-2 diagnostic services for our hospitals and the South East London community. The observations in this Opinion are based on their hard work, good humour, and professionalism throughout this challenging time.