Your Contribution to COVID-19 Research

10th February 2022 – By Aaruthy Suthahar

Woman holding beaker and notepad

In October 2020, the National Core Studies commenced as part of the UK’s response to the COVID-19 pandemic. The National Core Studies are using health data to rapidly inform policy to help us get through the pandemic. 

TwinsUK is closely involved in the Longitudinal Health and Wellbeing National Core Study, which aims to understand the health, social and economic impacts of the pandemic. We are one of many UK longitudinal population cohorts taking part in the project.  

This large, multi-institution team is working together to answer key questions across several different areas. Current priority research questions include: how was healthcare disrupted by the pandemic; did government schemes such as furlough help; how was mental health impacted by the pandemic; how well do vaccines work; and what are the short and long-term consequences of infection on health.  

The team has prioritised questions that harness the unique aspects of cohorts like TwinsUK, such as extensive pre-pandemic data. By working together and triangulating analysis in longitudinal health cohorts and electronic health records, we can provide robust evidence to inform policy. 

Findings are regularly reported to the government’s Scientific Advisory Group for Emergencies (SAGE) and the Cabinet and have influenced NICE guidelines, which dictate how to treat medical conditions.  

Results and impact so far 

Every day we are learning more about COVID-19 and its impact, thanks to our TwinsUK members taking part in studies and questionnaires and our researchers rapidly analysing all the data coming in. Below are some key examples to date that TwinsUK was involved in: 

Society and Health: The coronavirus job retention scheme was associated with the preservation of health behaviours (eating, drinking, smoking, sleeping habits) similar to those remaining in employment, and more favourable to those who become unemployed. Also, while mental and social wellbeing declined in those furloughed, the effects were far less than those who lost their jobs. This suggests that social protection policies should be implemented in the post-pandemic recovery period and during future economic crises.  

Healthcare Disruption: The pandemic led to unequal healthcare disruptions. Females, ethnic minorities, and disadvantaged people were most affected. Action is needed to prevent the widening of existing health inequalities, and efforts to ensure continuity of care during pandemic-related disruptions may need to be more clearly targeted to those who most need that care.  

Mental Health: People with prior mental ill-health were hit harder by pandemic disruption. Inequality between those with and without mental health problems should be considered when provisioning current and post-pandemic health, economic, and well-being support. Also, a substantial deterioration in mental health seen during the first lockdown did not reverse when lockdown was lifted, suggesting that lockdown alone was not responsible for the decline in mental health. There is a need for investment in mental health support to address all underlying causes.  

Long COVID: We found that long COVID is associated with women, middle age, and pre-existing health factors, including asthma. Understanding why different groups of people have different levels of risk could both identify high-risk groups and help us understand how best to prevent and treat long COVID.  

What are we working on now? 

We are currently working with collaborators at University College London (UCL) to carry out a detailed study of how COVID-19 affects the body. This will help us understand long Covid, which is when infected individuals continue to experience symptoms for many weeks and even months after infection.  

This study will recruit people with a range of COVID-19 experiences, and participants will be invited to UCL’s clinic in London for a full day of checks and health tests, including an MRI scan. TwinsUK is the first cohort to recruit participants to CONVALESCENCE, which aims to recruit 800 participants in total. We have recruited more than 150 twins to take part, mainly in twin pairs.  

A big thank you 

We would like to take this opportunity to thank our twins for everything they have contributed to this vital research, both by taking part in sample collection and questionnaires during the pandemic, but also for all of the data they have previously provided to TwinsUK, which is essential to understand how the pandemic has affected health.  

TwinsUK’s Dr. Claire Steves is a senior researcher working across the National Core Study and CONVALESCENCE. Dr. Steves explained: 

“There is a wealth of data in the UK’s population cohort studies and linked health records. The pandemic has shown the importance of using these unique resources to answer key questions about public health and inform policy as quickly as possible.”

“I would like to thank each and every one of our twins for the vital role they are playing in defeating COVID-19.” 

If you would like more information on our COVID-19 research, please click HERE.  

How do hormones affect women’s experience of COVID-19?

13th October 2021 – By Aaruthy Suthahar

Two women sitting on a bench looking at the ocean

Post-menopausal women have lower levels of the female sex hormone oestrogen and appear to be at higher risk of developing serious complications of COVID-19, according to research from the COVID Symptom Study app.

Pre-menopausal women who took the combined oral contraceptive pill were less likely to develop COVID-19 and had a lower rate of admission into hospital. However, this was not the case for post-menopausal women taking hormone replacement therapy (HRT).

On the one hand, the team identified that the use of hormone replacement therapy was linked to an increased rate of predicted COVID-19. On the other hand, the HRT results need be considered with caution due to the lack of information about HRT type, route of administration and duration of treatment.

Over the COVID-19 pandemic, widespread research has detected that adult men of all ages have higher chances of developing serious complications compared with women. In addition, post-menopausal women who contract COVID-19 have been shown to have more severe complications.

The team analysed the link between COVID-19 and its severity in women taking oestrogen in the form of the combined contraceptive pill and in menopausal women undergoing hormone replacement therapy. 

The researchers analysed information supplied by hundreds of thousands of women logging their symptoms on the Zoe COVID Symptom Study app between May and June 2020, including members from the TwinsUK cohort. The team also used further health information collected through TwinsUK in their analysis.

Joint first author Dr Karla Lee explained:

“We hypothesised that pre-menopausal women with higher oestrogen levels would have less severe COVID-19 when compared to women of the same age and BMI who had been through the menopause, and our findings supported this. Additionally, when we compared a younger group of women on the combined oral contraceptive pill (COCP) with a similar group not taking the COCP we saw less severe COVID amongst those taking the COCP, suggesting hormones in the COCP may offer some protection against COVID-19. More research is certainly needed to further our knowledge.”

Joint first author Dr Ricardo Costeira said:

“Thanks to women of the COVID Symptom Study app we were able to show, with relatively large numbers, the significance of studying the sex hormone oestrogen in relation to COVID-19. We hope that results from our study can help inform ongoing biomedical research and clinical trials in the field.”

Senior author Dr Jordana Bell said: 

“We would like to thank all of the women who participated in the COVID Symptom Study app and our TwinsUK members for their contributions towards this study, and would encourage everyone to keep logging on the app.”

Costeira et al. (2021) Estrogen and COVID-19 symptoms: Associations in women from the COVID Symptom Study. PLOS ONE.

Use loss of taste and smell as key screening tool for COVID-19, researchers urge

5th June 2020

King’s College London researchers have called for the immediate use of additional COVID-19 symptoms to detect new cases, reduce infections and save lives.

In a letter published in The Lancet, the team discussed how loss of taste and smell – anosmia – should form part of screening measures for the virus.

They said:

“As countries slowly emerge from lockdown measures, it is imperative to correctly contact-trace infected individuals. We believe that having added loss of smell and taste to the list of COVID-19 symptoms is of great value as it will help tracing almost 16% of cases that otherwise would have been missed.”

The team, led by Professor Tim Spector, previously reported that loss of smell and taste is a key predictor of COVID-19 in addition to the most established symptoms of a high temperature and a new, continuous cough. The relative importance of the extra symptom was however disputed by sections of the UK government when it announced it was including the extra symptom. This additional analysis of the COVID Symptom Study app data and its 3.7 million users sought to quantify the clinical value of recording loss of smell in the population.

From 76,260 people with symptoms who tested positive for COVID-19 up to 19 May, 28.5% never reported any fever or cough and 16% reported loss of smell but not fever or cough. The prevalence of loss of smell and taste was three-fold higher in individuals testing positive (65%) than in those testing negative (22%), the strongest single predictor of being infected, suggesting that people with loss of smell and taste should self-isolate for at least seven days or until they can be tested.

Professor Spector said:

We believe that loss of smell and taste is a very common COVID-19 symptom and in fact, occurs more often than fever and lasts longer (5 days on average compared to only 2 for fever). Infections could be reduced, and lives saved now that this non-flu-like symptom is widely recognised, and actions are taken.

The researchers suggest that policymakers should consider these findings and their implications for mass screening as part of other public health measures in key areas such as schools, hospitals, airports and care homes.

Professor Spector said:

“Our data suggests that low-cost so-called ‘smell the difference’ screening tests, that are already being used in some workplaces to screen people has they enter buildings, would capture a larger number of positive cases than temperature sensors do. We therefore feel that it should form part of a wider public health approach to reducing the infection rate.”

King’s College London Pioneers Symptom Reporting App to Slow Spread of COVID-19

24th March 2020

King’s College London is launching a COVID-19 symptom tracking app in the UK, allowing anyone to take 1 minute to self-report daily. Around 5,000 twins and their families across the UK have been recruited from the TwinsUK cohort study to trial the app, which tracks in real time how the disease progresses. The aim is to help slow the outbreak by helping researchers identify:

  • How fast the virus is spreading in your area 
  • High-risk areas in the UK
  • Who is most at risk, by better understanding symptoms linked to underlying health conditions

Twins using the app will record information about their health on a daily basis, including temperature, tiredness and symptoms such as coughing, breathing problems or headaches. 

The aim is to send participants COVID-19 home testing kits to better understand which symptoms truly correspond to coronavirus infection. This is an urgent clinical issue given the current limits on testing.

The app will be also available to the general public without the home testing component of the study. It can be downloaded for free from covid.joinzoe.com

Comparing genetically identical twins with non-identical twins, who are as related as regular siblings, enables researchers to separate the effects of genes from environmental factors such as diet, lifestyle, previous illnesses and infections, and the microbes within the gut (microbiome).

Samples taken from the twin group will be used to generate a biobank for use in future research projects investigating infection and immune responses.

The data from the study will reveal important information about the symptoms and progress of COVID-19 infection in different people, and why some go on to develop more severe or fatal disease while others have only mild symptoms. 

The study will support the urgent clinical need to distinguish mild coronavirus symptoms from seasonal coughs and colds, which may be leading people to unnecessarily self-isolate when they aren’t infected or inadvertently go out and spread the disease when they are.

Led by Professor Tim Spector, professor of genetic epidemiology at King’s College London, TwinsUK is a scientific study of 15,000 identical and non-identical twins, which has been running for nearly three decades. At least 5,000 members of the existing twin cohort and their families are expected to sign up for this new COVID-19 sub-study. 

This unique twin group has been studied in unprecedented detail over many years, with most already having taken part in comprehensive genetic analysis and immune profiling, as well as detailed gut microbiome profiling. 

The free monitoring app has been developed as a partnership between researchers at King’s College London and health data science company ZOE – itself a spin-out from King’s College London – and will also be widely available to health staff and the general public who wish to contribute to this vital research. It will also be used by other large population studies in the UK and US.

Professor Spector says,

“These are worrying times for everyone. Our twins are a fantastically committed enthusiastic health research participants who have already been studied in unprecedented detail, putting us in a unique position to provide vital answers to support the global fight against COVID-19. The more people who use the app, the better the real-time data we have to combat the crisis in this country.” 

The TwinsUK COVID-19 research study is funded by King’s College London, ZOE Global Ltd, the CDRF charity, and the National Institute of Health Research Guy’s and St Thomas’ Biomedical Research Centre. Any data gathered from the app and study will be used strictly for public health or academic research and will not be used commercially or sold. 

TwinsUK to start COVID-19 research

20th March 2020

At TwinsUK we are making urgent preparations to set up a study to test and track twins for COVID-19 symptoms, caused by the ongoing coronavirus pandemic.

The health data we have already collected and our committed participants means we are in a unique position to research this condition and join in the fight against COVID-19.

This study will be funded by King’s College London, charity CDRF, tech company Zoe Global Ltd and Guy’s and St Thomas’ Biomedical Research Centre, National Institute of Health Research.

We will be working in collaboration with a number of other research teams and organisations, including tech company ZOE Global Ltd, who are rapidly building an app that will enable us to track coronavirus symptoms in our twins, and King’s College London Professor Michael Malim’s group. We will also consult with the TwinsUK Volunteer Advisory Panel throughout.

TwinsUK statement on coronavirus (COVID-19)

13th March 2020

Dear TwinsUK members, 

The government has announced that the country will be moving to the “delay” stage of the plan to fight coronavirus in the UK. 

We have taken the decision to cancel twin visits for the next month, in order to protect our twins and our staff alike. Our other research studies that require sending samples in the post will also be put on hold, and our staff will be working from home.  

Please be aware that we are unable to take calls to our usual number, so please contact us over email at twinsuk@kcl.ac.uk if you need to reach us.  

We are sending to you and your families and friends our very best wishes at this time, to keep yourself and others safe and strong. Of course, now is a good time to make plans to ensure you, your family and your friends will be ready and able to support each other should the need arise to self-isolate for an extended period of time. We know it is particularly important that older individuals have support networks in place, not forgetting that tools like Skype and Facetime can keep us all connected while minimising close contact.  

Please keep an eye on the NHS webpage for the most accurate information, and use the NHS 111 online service or call the 111 helpline if any coronavirus symptoms you experience worsen and you need additional support 

All our best, 

The TwinsUK Team 

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