Periodic Reporting for period 2 - EuCARE (European Cohorts of Patients and Schools to Advance Response to Epidemics)
Reporting period: 2022-10-14 to 2024-04-13
The EuCARE project aims at unveiling the impact of SARS-CoV-2 variants on key sectors of public health. To this end, it gathers a comprehensive multidisciplinary team of clinicians, virologists, epidemiologists, statisticians and top experts in artificial intelligence from strategic areas across 4 continents.
The four project’s cohorts - Hospitalised patients, Post Acute Sequelae of Sars-Cov-2 infection (PASC) patients and Health Care Workers (HCW) and Schools - are the basis of several different observational studies.
The overall aims are:
● To elucidate the relations among different circulating variants, available vaccines and host immune response.
● To analyse the clinical course of COVID-19 in patients in relation to the circulating variants of concern in order to deliver recommendations for optimized clinical management and treatment.
● To deliver recommendations on the best strategies to control viral spread with specific reference to the school setting, in relation to the circulating variants of concern.
To deal with complex interactions among many variables, EuCARE harnesses the power of artificial intelligence.
In the longer-term, EuCARE is committed to maintain active cooperation beyond the duration of the project with a dedicated task in the project.
The four project’s cohorts - Hospitalised patients, Post Acute Sequelae of Sars-Cov-2 infection (PASC) patients and Health Care Workers (HCW) and Schools - are the basis of several different observational studies.
The overall aims are:
● To elucidate the relations among different circulating variants, available vaccines and host immune response.
● To analyse the clinical course of COVID-19 in patients in relation to the circulating variants of concern in order to deliver recommendations for optimized clinical management and treatment.
● To deliver recommendations on the best strategies to control viral spread with specific reference to the school setting, in relation to the circulating variants of concern.
To deal with complex interactions among many variables, EuCARE harnesses the power of artificial intelligence.
In the longer-term, EuCARE is committed to maintain active cooperation beyond the duration of the project with a dedicated task in the project.
Supported by a strong legal, ethical and IT infrastructure, EuCARE set-up four retrospective-prospective cohort studies and one cluster randomised controlled trial.
As of April 13 2024, a total of 48,781 patients have been enrolled in the HOSPITALISED cohort, 1,646 patients have been enrolled in the PASC cohort studying long COVID, 1,662 healthcare workers have been enrolled in the HCW cohort, 437 school classes and 3,373 individuals (students, teachers, non-teaching personnel) have been enrolled in the SCHOOLS cohort and randomised study, and 8,908 biological samples are registered in the EuCARE Virtual Biobank.
Demographic, clinical, laboratory, sequence data as well as answers to the studies questionnaires are collected in the EuCARE centralised data collection platform. Data are standardised according to major standards and available for research studies, under approval procedure and regulatory constraints.
A library of 60 live viral variants is also available on request for scientific studies.
Based on these assets, the project has contributed to the elucidation of COVID-19 and SARS-COV-2 variants impacts on several aspects, from clinical outcome, including long term, to the psychological impact of containment measures in schools.
As of April 13 2024, a total of 48,781 patients have been enrolled in the HOSPITALISED cohort, 1,646 patients have been enrolled in the PASC cohort studying long COVID, 1,662 healthcare workers have been enrolled in the HCW cohort, 437 school classes and 3,373 individuals (students, teachers, non-teaching personnel) have been enrolled in the SCHOOLS cohort and randomised study, and 8,908 biological samples are registered in the EuCARE Virtual Biobank.
Demographic, clinical, laboratory, sequence data as well as answers to the studies questionnaires are collected in the EuCARE centralised data collection platform. Data are standardised according to major standards and available for research studies, under approval procedure and regulatory constraints.
A library of 60 live viral variants is also available on request for scientific studies.
Based on these assets, the project has contributed to the elucidation of COVID-19 and SARS-COV-2 variants impacts on several aspects, from clinical outcome, including long term, to the psychological impact of containment measures in schools.
Our study on in-hospital mortality in relation to viral variants shows that in-hospital mortality rates decreased over the course of the pandemic, particularly since the emergence of the Omicron variant. This is suggested to reflect a combined effect of immunity from vaccinations and previous infections, although it cannot be excluded that differences in virulence between SARS-CoV-2 variants may have contributed too.
Our blind test quality control procedure on 12 different diagnostic platforms commonly used showed that all of them successfully identified Alpha, Beta, Gamma, Delta and Omicron (B.1.1.519) variants, without false positive results.
Our study on post-COVID condition (PCC) shows a lower risk of PCC with Omicron variant vs wild type (WT), and a higher PCC risk with Alpha and Delta variant vs WT. However, the WT effect vs Omicron on PCC risk appeared to be mediated by intensive care unit admission. Thus, the observed reduction of the PCC-burden over time may be partly due to a reduced risk of acute severe disease associated with Omicron infections in patients with immunity or prior infections.
Also, our artificial intelligence models showed that invasive ventilation is a predictor of PCC.
Our study on data from Italy, Germany and Portugal in autumn 2022, when the Omicron variant was prevalent and limited preventive measures were implemented in schools, found no evidence of a causal relationship between school reopening in autumn 2022 and Omicron SARS-CoV-2 transmission, with lower case reproduction number (Rc) (Italy and Germany) or Rc decreasing trend (Portugal) associated with school opening.
Our studies in schools, although still ongoing, showed significant psychological impact associated with preventive measures, with significant differences among primary and secondary school students, males and females. For example, in secondary schools, at the beginning of the study, females reported higher levels of symptomatology compared to males, more peer relationship problems and emotional symptoms. At the end of the study, adherence to distancing measures was associated with more peer relationship problems.
The IMMUNITY-01 study has been designed to compare immune response to recent variants compared with the ancestral Wuhan (B.1) strain. Samples from different centres in the consortium have been shipped and are under analysis at projects’ laboratories.
Our blind test quality control procedure on 12 different diagnostic platforms commonly used showed that all of them successfully identified Alpha, Beta, Gamma, Delta and Omicron (B.1.1.519) variants, without false positive results.
Our study on post-COVID condition (PCC) shows a lower risk of PCC with Omicron variant vs wild type (WT), and a higher PCC risk with Alpha and Delta variant vs WT. However, the WT effect vs Omicron on PCC risk appeared to be mediated by intensive care unit admission. Thus, the observed reduction of the PCC-burden over time may be partly due to a reduced risk of acute severe disease associated with Omicron infections in patients with immunity or prior infections.
Also, our artificial intelligence models showed that invasive ventilation is a predictor of PCC.
Our study on data from Italy, Germany and Portugal in autumn 2022, when the Omicron variant was prevalent and limited preventive measures were implemented in schools, found no evidence of a causal relationship between school reopening in autumn 2022 and Omicron SARS-CoV-2 transmission, with lower case reproduction number (Rc) (Italy and Germany) or Rc decreasing trend (Portugal) associated with school opening.
Our studies in schools, although still ongoing, showed significant psychological impact associated with preventive measures, with significant differences among primary and secondary school students, males and females. For example, in secondary schools, at the beginning of the study, females reported higher levels of symptomatology compared to males, more peer relationship problems and emotional symptoms. At the end of the study, adherence to distancing measures was associated with more peer relationship problems.
The IMMUNITY-01 study has been designed to compare immune response to recent variants compared with the ancestral Wuhan (B.1) strain. Samples from different centres in the consortium have been shipped and are under analysis at projects’ laboratories.