Alan Turing was a brilliant mathematician, theoretical biologist and codebreaker. He led the team that deciphered the German Enigma Code in 1943, a feat that probably shortened the war by two to four years and saved countless lives in the process. This was achieved at the now famous Bletchley Park, an 18th-century mansion set in the rural environs of leafy Buckinghamshire.
Over the past two weeks, a new generation of codebreakers has been assembling, not at Bletchley Park but at Charterhouse Square, a secluded tree-lined pentagonal enclave in central London. This is the campus for Barts and the London School of Medicine and Dentistry, part of Queen Mary University of London, and here the task being undertaken is just as critical as Turing’s was nearly 80 years ago. It is part of a national effort to help save the country from an assault that, once again, is threatening our way of life.
This new invader, a silent and merciless enemy, is the most virulent and deadly the country has faced in living memory – the Covid-19 virus.
Thus far, its attack strategy – the way it debilitates, then kills some of those who contract it, but barely touches others – remains a mystery. Why the impact of infection is so variable for different people is something still to be understood. A proportion will suffer no more than a sniffle or a cold, while a significant minority will suffer rapid respiratory collapse leading to general organ failure and death.
We know that the elderly are more susceptible than the young, that men are more likely to suffer than women and that those with certain existing medical conditions can be more vulnerable. But these predispositions are not hard and fast and the correlations are far from exact.
Charterhouse Square will be a key operational centre for a novel investigation into Covid’s dark secrets. This will be done through a specialist team of volunteer researchers who will delve deeply into the pandemic’s microbiology. Drawn from Barts Health, Queen Mary University of London and Genomics England, the team is headed by Sir Mark Caulfield.
The professor of clinical pharmacology, knighted for his work on cardiovascular and rare disease genomics, has personal as well as professional reasons for wanting to suppress Covid-19. In 1920, his great-grandparents were killed by the Spanish flu pandemic. Between 1918 and 1920 that virus infected 500 million people worldwide (a quarter of the world population at the time) and by some estimates killed up to 100 million. Significantly Sir Mark’s great-grandparents were not killed by the initial outbreak of infection, but by the second or even third wave that proved even more virulent.
Described as ‘one of the most influential researchers in the world’, Sir Mark has a very particular view of Covid-19. ‘On the one hand this virus is a massive threat to us all but it is also a unique opportunity,’ he explains.
‘It is only in the midst of a pandemic that you can really begin to understand it and how to combat this type of disease. We have to grab this chance with both hands now in case there are subsequent waves of the infection that could, through mutation, be even more lethal than what we are faced with now.’
The first thing Sir Mark and his team of medical codebreakers will need is data – and lots of it. To this end a small army of outreach volunteer researchers is being recruited and trained to gather the information required across Britain.
The first tranche of volunteers reported for duty two weeks ago. Among them were medical professionals including research trained nurses, clinical and academic doctors, clinical scientists, specialists in infectious diseases, administrators and disaster relief specialists.
They were ushered into the Derek Willoughby Lecture Theatre, which has a capacity of more than 200, but the requirement for everyone to keep two metres apart meant that only 30 people were allowed in to the auditorium at a time. For this reason registration, induction and training is being spread over some weeks.
Despite the inability to interact normally – these days even elbow bumps are considered a greeting too far – there was a genuine sense of excitement on that first day; a real buzz in the air.
Sir Mark welcomed everyone with genuine warmth and appreciation but was quick to follow up with an inspiring ‘call to arms’. He added that understanding how to defeat this infection was their professional opportunity to help not only British patients, but others worldwide.
‘We have to get this right,’ he beseeched. ‘This might be our major chance to understand and defeat Covid-19 and get insights into how to prevent future pandemics.’
So what is the battle plan? In short it is to search for patterns in the way the infection invades a population at the viral level. The teams will test specific treatments in nationally prioritised trials using, among other drugs, the hydroxychloroquine so favoured by President Donald Trump.
The volunteers, once trained, will enter and work alongside those in the red zones of intensive care units and already some have taken up residence at London’s Nightingale Hospital, as well as the vastly expanded intensive care units of The Royal London, Barts, Whipps Cross and Newham.
Their job will be to collect blood and detailed demographic details, and offer trial opportunities to as many patients as possible. Those well enough can sign a consent form, others, less well, may nod their agreement. Some, ventilated, cannot, so consent has to come from close family members.
Many of the blood samples for analysis are to be taken from the ‘waste blood’. Modern analysers only test microlitres of blood, so the bulk of a good quality sample is normally kept for a few days then discarded. Now routine samples taken from all Covid-19 patients every day can be intercepted before destruction, collated, separated and analysed.
It is an enormous logistical challenge but one way or another sufficient data has to be collected for the code-breaking, and other trials, to proceed.
The key is to decrypt the biomarkers in the human cipher in order to understand the way Covid-19 invades the human body and damages the host, who then multiplies its number and then transmits it within populations. The response to this virus depends on variations within humans, variations within the virus and variations in the way they combine.
By decrypting these features it may be possible to avoid future similar pandemics, but it will involve some major number crunching of billions of data points derived from each patient’s blood samples.
The variations and combinations involved far exceed even the coding possibilities of the Enigma machine, which itself ran to about 10 to the power of 23. We are talking an unimaginable number of possible combinations.
On the face of it the virus seems almost indestructible, but there will be underlying patterns to its behaviour, however, as well as weaknesses in its propensity to contaminate and infect.
It is hoped that studies such as the half million people in the UK Biobank study and the Covid-19 sufferers will now pay rich dividends.
The Daily Telegraph
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