SARS-CoV-2 has emerged as a global pandemic in 2020. There are no effective treatments and an effective vaccine has not been developed. Whilst many patients recover without need for hospitalisation, a small proportion go on to develop severe disease. A better understanding of the natural history of this disease will facilitate improved clinical management with the potential to identify options for intervention. This proposal is for the formal collection of characterisation data for patients tested for and/or admitted with a confirmed diagnosis of SARS-CoV-2 infection. This study responds to the need for a clear understanding of the natural history of this novel, emerging pandemic. Specifically phenotypic characterisation may enable application of personalised medical approaches, based on clinical course, to aid earlier identification of patients at risk of severe disease, and facilitate identification of potential targets for novel treatments. The collection and characterisation of these patients reflects a strong partnership between NHS and academic critical care and respiratory medicine in Southampton that acts as both a secondary and tertiary centre, with support from the digital experimental cancer medicine team at the University of Manchester.

SARS-CoV2 is the virus which causes COVID-19, the form of coronavirus which is now a global pandemic. The gene ACE2 is involved when SARS-CoV2 infection occurs and the eye is an important possible place of entry for the virus to get into the body. It is thought that the virus enters the eye through ACE2, but this remains unclear. We will look at gene expression in eye tissue to identify whether ACE2 is important in the eye and generate a picture of biomarkers of the eye which may predict disease severity. This will help in understanding the first steps in the mechanism of infection and potential targets for therapies. We will be using excess surgical tissue from the eyes of non COVID-19 patients undergoing surgery for other reasons.

Primary Immunodeficiencies (PIDs) are rare inherited diseases of the immune system that may lead to recurrent infections, malignancy or autoimmunity, all with a significantly impaired quality of life. There are currently over 200 different PIDs with approximately 250 different genes linked to these disorders. Through the NIHR/Wellcome Trust Southampton Clinical Research Facility for Experimental Medicine and Translational Medicine Laboratory, we will perform deep-phenotyping (detailed examination of possible pertinent findings of gene tests) of 20 patients with PID to gain additional understanding of the cause each patients’ rare immunological disease. This greater understanding will hopefully identify novel therapeutic targets and the initiation of personalised treatments. Previously at our centre we have shown that, by this approach, we can commence precision therapeutics for patients with PID that substantially reduced morbidity and mortality.