The effectiveness of hydroxychloroquine as a coronavirus treatment and the Māori response to the pandemic are among the subjects of a slew of new NZ studies into Covid-19 and its impacts. Mirjam Guesgen reports.
Studies designed to aid the national and global fight against coronavirus – including three clinical trials – are set to get underway in New Zealand, thanks to more than $3.8m in funding from the Health Research Council of New Zealand and the Ministry of Health.
The 13 studies cover aspects of the coronavirus pandemic including diagnostic testing, genetic sequencing of the virus, treatment, addressing social inequality throughout the lockdown and beyond, and the role of kaumātua in pandemic responses.
The funding was awarded after an urgent callout for research proposals was made by the Health Research Council at the beginning of March. The council’s chief executive, Sunny Collings, is hopeful these studies will fill big gaps in our understanding of the pandemic.
“This research has the potential to contribute answers to questions the world is grappling with, especially those concerning treatment options for Covid-19,” Collings said.
Nearly half the funding (around $1.3m) has been allocated to studies investigating possible treatments for Covid-19.
One, the Australasian Covid-19 Trial (ASCOT) lead by Middlemore Clinical Trials, will assess how effective two antivirals (lopinavir/ritonavir and hydroxychloroquine) are in treating hospitalised patients. The study will investigate whether one or both drugs can reduce the need for ventilator support or reduce the risk of death.
“The people who have coronavirus who have to be admitted to hospital are the sickest ones. They’re the people we’re most worried about. We want to try and prevent the need for those people to go into intensive care. That’s the primary aim of this study: preventing death or admission into ICU,” said study lead and infectious disease physician Susan Morpeth.
Lopinavir/ritonavir is currently used to treat HIV and hydroxychloroquine is used for malaria. The drugs, particularly hydroxychloroquine, are attracting a lot of attention because they can be repurposed to treat a range of diseases including inflammatory and immune diseases and arthritis. The hope is that drugs that are already available could be used against coronavirus too.
“There’s been a lot of speculation about these drugs and people are interested to know, should they take these drugs if they get coronavirus. We need to know whether are effective and safe,” said Morpeth.
Because they’re already used to treat other illnesses, the drugs can jump straight from being tested against coronavirus in the lab to being tested in sick people, she explained. “They’re the obvious first two agents to test because they’re ready to get tested and they’re available,” she said.
Part of the funding will also go to extend a trial already going on at intensive care wards around New Zealand and overseas. The REMAP-CAP study, with the New Zealand component led by the Medical Research Institute of New Zealand (MRINZ), evaluates treatments for severe pneumonia – the main cause of coronavirus-related deaths.
REMAP-CAP will again test lopinavir/ritonavir and hydroxychloroquine as well as drugs that help the body’s immune system (anakinra and interferon beta 1-alpha). The trial has the potential to rapidly churn out treatment options because it is multinational and researchers will be sharing results as soon as they have them.
“It will be reassuring for New Zealand Covid-19 patients to know we are part of this trial and that they’ll get treated with what is more likely to be effective, with less time wasted on things that aren’t,” said Colin McArthur, MRINZ researcher and senior intensive care specialist at Auckland City Hospital.
The final clinical will test hydroxychloroquine as a preventive treatment for frontline healthcare workers. It would see a range of frontline healthcare workers get a low weekly dose of the drug to test whether it can reduce the risk of infection from constantly being exposed to the virus.
“In Italy we’ve seen Covid-19 completely overwhelm the healthcare system,” said Paul Young, MRINZ researcher and senior intensive care specialist at Wellington Hospital. “Once infected, not only are healthcare workers off work and their colleagues also forced into self-isolation, but they may have transmitted the virus to vulnerable patients in their care.”
Aside from clinical trials, several of the newly-funded studies deal with socioeconomic impacts of the virus. One, led by public health professor Michael Baker of the University of Otago, will provide the Ministry of Health with information about how individuals and their whānau experience the pandemic – not just the disease itself but isolation due to lockdown and economic effects.
“The study does almost everything,” said Baker. “New Zealand has taken a unique approach so we want to document that. New Zealand may have got by because we’ve got a nimbler society and we’ve responded with amazing leadership but those things can’t be guaranteed. We have to learn as much as possible from this so we can prepare our society for future events.”
Two other studies, one from Massey University and the other from the University of Otago, will address how people respond to quarantine and lockdown. Particularly, the researchers want to understand how ethnic and socioeconomic inequality affect people’s ability to follow lockdown rules. The Massey University study will also try to understand the social, cultural, political and racial factors that shape people’s attitudes towards pandemic diseases.
Both are vital, the researchers say, for building solidarity among New Zealanders when combatting infectious diseases.
The impact of the pandemic on Māori and other vulnerable groups is another big focus. Part of the funding goes towards a study measuring the economic risk to Pacific countries, while the other study will speak to kaumātua and kuia about their concerns and reactions to the pandemic, especially in regards to personal distancing (harirū, hongi and hau), self-isolation and gatherings.
Marama Muru-Lanning, an anthropologist from the University of Auckland, is leading that research. Her team will speak to communities in Ngātiwai and Waikato, who, Muru-Lanning said, are finding the pandemic difficult.
“A lot of their wellbeing comes from being with one another. Now that you’ve got to be in your own bubble they can’t meet and do their kapa haka and they can’t meet at the marae. They can’t be themselves at the moment,” she said.
The pandemic has also highlighted inequalities that already exist in those communities. “There were a number of people who didn’t have a car and relied on family members to drive them around. They were living in remote communities where it’s not easy to get to the hospital or anywhere,” she said.
The remaining studies focus on improving diagnosis of coronavirus including developing rapid diagnostic tests that take 15 minutes or less, genome sequencing and finding ways to screen people at the point of care (eg, doctors’ clinics or airports). One will also model the spread of the disease in close to real-time using machine learning and genetic, human movement and location data.