Dr Susil Pallikadavath and Dr Anvesha Singh discuss the impact of Covid-19 on clinical research – both negative and positive…

Introduction

The Covid-19 pandemic has changed clinical research. Here, we explore how clinical academics have had to adapt to the challenges posed by the pandemic. We offer two views, one, from a newly graduated junior doctor on a clinical and academic programme and second, from an Associate Professor, at a more advanced stage of her career.

The experience of a junior clinical academic

Graduating as a doctor into a global pandemic has been a challenging experience, not least as I have tried to balance clinical duties with my academic aspirations. The pandemic has posed unexpected pressures and I have had to adopt unfamiliar techniques to kick start my academic and clinical careers.

One of the early goals for young investigators is to demonstrate our ability to plan, synthesise and conduct research studies. Establishing new projects in a pandemic has come with novel challenges. Physical distancing laws and reprioritisation of research funding have meant that academics have had to develop new techniques that replace traditionally patient-facing practices. For example, strategies incorporating electronic recruitment and data-gathering have come into focus. These offer the opportunity for research to continue in some capacity and have offered flexibility to both investigators and participants. Whilst these practices may be seen as transient, they have provided us with new skills that we can take forward into post-pandemic practice. They may be a long-term, cost-effective method that investigators can continue to adopt, particularly as participant hesitancy to enter clinical environments may remain for some time.

The structure of clinical research has meant that individuals are often competing to produce outputs. Whilst competition can drive excellence, it can also thwart collaboration. We have seen the value of collaboration during the pandemic through the RECOVERY trial which was the first to report dexamethasone as a therapy for severe Covid-19 infection. At one stage, 10% of all patients who were hospitalised with Covid-19 in the United Kingdom were enrolled into the trial. This would not have been possible without collaboration across multiple centres and research teams across the country. Collaboration on this scale has shown direct benefit for patients, and so it is in the best interests of healthcare that we continue with these relationships into the future.

The perspective from a senior clinical academic

Whilst many challenges posed for senior clinical academic have been similar to those seen by our junior colleagues, the biggest impact of the pandemic was the pausing of on-going research studies, often funded by competitive external research grants. Funding bodies had to recognise these delays and in some cases revaluate if studies could be supported or provide no-cost extensions. This also impacted many student projects (e.g., PhD) that had to be adapted or changed completely to allow completion. Restarting these projects required novel approaches, such as electronic consent and alteration of patient visits to reduce face-to-face contact, that would not have implemented prior to the pandemic.

While these novel techniques have optimised research during the pandemic, we must be mindful that overreliance on technology does not contribute to further inequality. Several studies have demonstrated an unequal burden of Covid-19 related morbidity and mortality associated with socio-economic and ethnic status. Disparity has also been shown in the uptake of vaccination. Individuals at risk of the worst outcomes are often those least likely to present to healthcare. Similarly, groups that already have the lowest representation in clinical research may be less likely to engage with clinical research going forward, further exacerbating the underrepresentation of minority groups within evidence bases. New ways of working, such as online recruitment, may be harder for some groups to access and engage with. How the clinical research communities respond is extremely important. There is a need more than ever to engage with these groups and strive to improve representation in clinical studies.

The shortcomings in equality do not lie alone with patient outcome and engagement, but extend to clinical academic staff. Female staff have borne the greatest burden of increased childcare needs with closure of schools and need for isolation. This has subsequently led to less academic time, leading to a disproportionate effect on the productivity and outputs of female academics, and may have a lasting impact on representation and progression to senior positions. Of course, these failings are not exclusive to the pandemic, and have been present far before it, however, the pandemic has brought them into focus, whilst exacerbating them for many.

Conclusions

The pandemic has given clinical and research teams the opportunity to put into practice many strategies that would not have otherwise reached priority. Novel technology may increase scope and access for participation in research for many, whilst widening the gap for others. The pandemic has rewarded collaboration and re-focused the attention to inequality and inequity that plagues both patients and staff. It is important, even more than before, that we engage with minority groups to reduce the burden of inequalities.

Dr. Susil Pallikadavath is an Academic Foundation Doctor in cardiology at Glenfield Hospital and the University of Leicester in the United Kingdom.

Dr. Anvesha Singh is an Associate Professor, NIHR Advanced Fellow and Honorary Consultant Cardiologist. Her research interests include using imaging and blood biomarkers to improve risk stratification in asymptomatic aortic stenosis, with a special interest in cardiac magnetic resonance imaging.