Clinical academic research in the time of Corona: A simulation study in England and a call for action

OBJECTIVES: We aimed to model the impact of coronavirus (COVID-19) on the clinical academic response in England, and to provide recommendations for COVID-related research DESIGN: A stochastic model to determine clinical academic capacity in England, incorporating the following key factors which affect the ability to conduct research in the COVID-19 climate: (i) infection growth rate and population infection rate (from UK COVID-19 statistics and WHO);(ii) strain on the healthcare system (from published model);and (iii) availability of clinical academic staff with appropriate skillsets affected by frontline clinical activity and sickness (from UK statistics) SETTING: Clinical academics in primary and secondary care in England PARTICIPANTS: Equivalent of 3200 full-time clinical academics in England INTERVENTIONS: Four policy approaches to COVID-19 with differing population infection rates: "Italy model" (6%), "mitigation" (10%), "relaxed mitigation" (40%) and "do-nothing" (80%) scenarios Low and high strain on the health system (no clinical academics able to do research at 10% and 5% infection rate, respectively MAIN OUTCOME MEASURES: Number of full-time clinical academics available to conduct clinical research during the pandemic in England RESULTS: In the "Italy model", "mitigation", "relaxed mitigation" and "do-nothing" scenarios, from 5 March 2020 the duration (days) and peak infection rates (%) are 95(2 4%), 115(2 5%), 240(5 3%) and 240(16 7%) respectively Near complete attrition of academia (87% reduction, <400 clinical academics) occurs 35 days after pandemic start for 11, 34, 62, 76 days respectively-with no clinical academics at all for 37 days in the "do-nothing" scenario Restoration of normal academic workforce (80% of normal capacity) takes 11, 12, 30 and 26 weeks respectively CONCLUSIONS: Pandemic COVID-19 crushes the science needed at system level National policies mitigate, but the academic community needs to adapt We highlight six key strategies: radical prioritisation (eg 3-4 research ideas per institution), deep resourcing, non-standard leadership (repurposing of key non-frontline teams), rationalisation (profoundly simple approaches), careful site selection (eg protected sites with large academic backup) and complete suspension of academic competition with collaborative approaches