New Zealand hospitals are hosting three clinical trials exploring potential treatments – including much-touted hydroxychloroquine – for Covid-19.
The trials are among 13 new studies, also exploring point-of-care testing and self-isolation, just awarded nearly $4 million through an urgent Health Research Council (HRC) funding round.
One trial, led by Auckland City Hospital intensive care specialist Dr Colin McArthur, will test immune modulation treatments as well as anti-viral drugs for their effectiveness in critically ill Covid-19 patients.
The anti-virals include hydroxychloroquine, used to treat autoimmune diseases like rheumatoid arthritis and lupus, or malaria, and lopinavir-ritonavir, used to treat HIV.
McArthur's study is an extension to a wider international study, REMAP-CAP, that's been recruiting patients with severe community-acquired pneumonia – the main cause of death from Covid-19 – for the past three years.
New Zealand, through earlier HRC funding, was already part of the wider study which was pre-designed to adapt when a pandemic occurred.
With 10 of New Zealand's intensive care units already taking part in that study, they're now set up and ready to test a range of treatments for Covid-19 patients.
McArthur said clinicians and researchers learned from 2009's H1N1 (swine flu) pandemic that a clinical trial must be in place and operating before a pandemic, to allow effective interventions.
Another clinical trial, led in New Zealand by Middlemore Hospital clinical microbiologist and infectious diseases physician Dr Susan Morpeth, will test the use of those same anti-virals in people unwell enough to need admission to hospital, but not so unwell that they need intensive care.
The study will be carried out at multiple sites across Australia and New Zealand to see which treatment, or combination of treatments, will reduce the risk of death or needing ventilator support among patients.
The third trial, led by Wellington Regional Hospital physician and Medical Research Institute of New Zealand director Professor Richard Beasley, will test the use of hydroxychloroquine in front-line healthcare workers.
In other work, University of Otago molecular biologist Associate Professor Jo-Ann Stanton is working with a team to develop a test to screen patient samples for Covid-19, whether at a GP clinic or an airport.
"At the moment, swabs are taken and sent to a central laboratory for testing," Stanton said.
"This is really robust and the most cost-effective way of doing things. What we are looking to do is move the test so it is closer to the patient.
"If you live in the provinces there is currently an average three-day wait for test results. That may not be an issue for some people in some scenarios, but in other cases it can be and we are looking to be able to produce the test result a lot quicker."
Stanton and her team have been working for several years on developing hand-held diagnostic technology which can be used as point-of-care testing devices.
"We are looking at taking laboratory-based tests, particularly those specific for DNA and RNA, repackage and reformat them, so we can take them out of the laboratory and put them in the hands of people who need the answers quickly – people like emergency care first responders."
Another Otago researcher, prominent epidemiologist Professor Michael Baker, is leading a collaborative project that aims to guide an effective and equitable response to Covid-19, and ensure New Zealand is better prepared for the next pandemic.
Baker said New Zealand's strategy of "elimination" might appear unique in the western world, but was similar to one several Asian nations had effectively adopted.
"We know this approach is tough, but it offers many advantages in terms of health and equity and hopefully allows us to emerge sooner from the grip of the pandemic than other strategies," he said.
"There is huge international interest in what New Zealand is doing and the benefits and costs of different responses to the pandemic.
"Unfortunately, the world is becoming a more dangerous place for emerging infections and we need to learn as much as possible about how island nations can protect themselves from pandemic threats."
A third Otago project, led by senior lecturer Lesley Gray, aimed to build a comprehensive picture of how Kiwis were self-isolating.
"Self-isolation and physical distancing are critical parts of Aotearoa New Zealand's all-of-government pandemic response. However, the effectiveness of this strategy is highly dependent on individual compliance," she said.
"While research has identified factors that may affect individuals' intentions to self-isolate, less is known about what people actually do or did in the face of a disease outbreak and the factors that help or hinder those actions.
"This research seeks to provide some statistically significant answers to these questions."
The HRC's chief executive, Professor Sunny Collings, said the studies would contribute to global research efforts to manage Covid-19 while meeting evidence gaps specific to New Zealand, with careful consideration to health equity for Māori and Pacific groups.
"This research has the potential to contribute answers to questions the world is grappling with, especially those concerning treatment options for Covid-19."