Virus Watch V1
Research type
Research Study
Full title
Virus Watch: Understanding community incidence, symptom profiles, and transmission of COVID-19 in relation to population movement and behaviour.
IRAS ID
281933
Contact name
Andrew C. Hayward
Contact email
Sponsor organisation
University College London
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Research Summary -
Virus Watch Lay Summary
The Coronavirus (COVID-19) Pandemic has caused large numbers of deaths and severe societal disruption worldwide. To respond and support the NHS and public health decision makers, we need to know how many people become infected, how many of them become ill, what their symptoms are and how many seek health care. We also want to learn how commonly infected people transmit the virus to their household contacts, what proportion need hospitalisation and what proportion die. We need to understand how the population responds to this virus in terms of hand washing, behaviours during and after coughing, sneezing or nose wiping, and whether people restrict their movements and social contacts.
Since many of those infected will have relatively mild symptoms and not seek medical advice the only way to accurately obtain this information is to conduct large scale community studies. We will follow up members of the public and contacts of cases using regular online surveys of symptoms and behaviours, secure tracking of participant movements, and testing for COVID-19 and other respiratory infections to build a detailed picture of how the virus spreads and the population responds. We will share this data with participants, health service and public health planners and the general public to help minimise the impact of the virus.
Lay Summary of Results -
Virus Watch is a national community cohort study of COVID-19 in households in England and Wales, established in June 2020.
Why was the research needed?
During the early stage of the COVID-19 pandemic in the UK, data on COVID-19 were largely collected in hospital settings. There was a need to better understand COVID-19 incidence, symptom profiles and transmission in relation to population movement and behaviour within the community. As a result, Virus Watch was set up by an experienced team of respiratory infectious disease epidemiologists at University College London (UCL).What were the main questions studied?
Our study focused on answering several key questions about COVID-19. We looked at the symptoms of COVID-19 and similar illnesses, as well as the factors that increase the risk of infection and how people’s behaviours, such as their movements, travel, activities, and social interactions, play a role. We also wanted to understand how these factors might differ by ethnicity, migration status, and levels of deprivation and what might explain those differences.Another focus was on COVID-19 vaccines. We studied how well the vaccines work in preventing both symptomatic and asymptomatic infections and their impact on stopping the spread of the virus. We compared vaccine effectiveness across different groups of people and looked at how long protection lasts, what factors contribute to immunity, and how well vaccines work against new virus variants.
Finally, we investigated long COVID, specifically how the risk of developing long COVID varies by virus variant, deprivation levels, migration status, and ethnicity, as well as in children. We also examined how antibody levels change over time in people with long COVID.
Who participated in the study? Where and when did the study take place?
The study was established in June 2020. As of March 2022, when recruitment ended, 58,628 participants living in England and Wales aged 0–98 years from 28,527 households had enrolled into Virus Watch. The study concluded in April 2025.What happened during the study?
We recruited participants between June 2020 and March 2022 in various ways, such as postcards, leaflets, newspaper and TV advertisements, social media (Twitter, Facebook, WhatsApp), and letters or text messages from general practitioner clinics.Once enrolled, each household completed a baseline survey. After that, households were sent an online illness survey every week, as well as occasional in-depth questionnaires about pandemic-relevant demographic, clinical and psychosocial factors.
Within the entire cohort, there were several smaller groups (subcohorts) focusing on different aspects of COVID-19:1) Laboratory subcohort – Participants provided blood samples twice (between October 2020 to January 2021 and May to August 2021) to check for COVID-19 antibodies. From October 2020 to May 2021, if they had symptoms like fever, cough or change/loss of taste/smell for two or more days, they sent in nasal swabs for polymerase chain reaction (PCR) testing.
2) Vaccine efficacy subcohort – Participants sent in finger-prick blood samples monthly from February to August 2021 and then every other month between September 2021 and March 2022. This allowed us to track immunity after COVID-19 vaccination.
3) ArcGIS tracker subcohort – Participants shared location data for up to a year to help understand movement patterns during the pandemic between September 2020 and February 2021.
4) Genomics subcohort – Participants sent in nasal swabs if they had a fever, cough or change of taste or smell and/or if they tested positive on a lateral flow test (LFT). These swabs were analysed to identify which COVID-19 variant they had.In addition, for participants living in England, we also linked participant data to NHS health records, including hospital visits, COVID-19 tests and vaccinations, and death records.
In April 2023, Virus Watch joined the ENDing COVID-19 Variants Of concern through Cohort studies (END-VoC) consortium. As part of the consortium, we set up a long COVID advisory group, which consists of people living with long COVID, carers, clinicians, policy makers, and researchers from the UK, India, Brazil, Mozambique and Palestine. This allowed us to carry out patient and public involvement and engagement to shape ongoing and future long COVID research within our study.
Detailed information on all the variables collected in Virus Watch is provided here: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Facademic.oup.com%252Fije%252Farticle%252F52%252F5%252Fe263%252F7205483%2FNBTI%2Fmvu8AQ%2FAQ%2F1d38fca3-3a4f-4a74-85b3-7e73ee4f08a4%2F3%2F6TMo31KIwc&data=05%7C02%7Champstead.rec%40hra.nhs.uk%7C923706005fbd4a96b54a08dd866ccace%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638814523999609721%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=oPKHzXYj8iK4S944iCC50OBDFOZQO3LAd14udWu1iVo%3D&reserved=0
What were the results of the study?
These are described on the Key Findings section of our study website: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fucl-virus-watch.net%252F%253Fpage_id%253D1323%2FNBTI%2Fmvu8AQ%2FAQ%2F1d38fca3-3a4f-4a74-85b3-7e73ee4f08a4%2F4%2FFiJxS2XxFR&data=05%7C02%7Champstead.rec%40hra.nhs.uk%7C923706005fbd4a96b54a08dd866ccace%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638814523999624806%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=WNpzjrm8BUV8SKn02utSn4eOd%2FiAYwa4z8BsWJEhel4%3D&reserved=0How has this study helped patients and researchers?
Overall, Virus Watch has provided valuable insights into understanding many aspects of COVID-19. Particularly, by investigating anti-spike (S) antibody levels among vaccinated participants, we gain key insights into how antibody levels decrease over time and protection against breakthrough infections. This provided evidence for the importance of booster doses and the need for ongoing protection against COVID-19.The study’s findings on vaccine efficacy, symptom profiles, and impact of deprivation have been shared with key decision-making groups, such as UK Health Security Agency, the Joint Committee on Vaccination and Immunisation (JCVI), and the Scientific Advisory Group for Emergencies (SAGE). These insights likely influenced policy decisions, such as the timing and prioritisation of booster vaccines, and helped shape strategies to protect clinically vulnerable populations.
In partnership with The Race Equality Foundation and Doctors of the World, we launched a report focusing on the disproportionate impact of the COVID-19 pandemic on disempowered ethnic minority and migrant communities. The report highlighted the urgent need for evidence-based policies and practices that prioritise the needs of Black, ethnic minority and migrant communities. It called for a comprehensive and inclusive approach that addresses the systemic barriers to healthcare access, ensures equitable distribution of resources, and tackles the underlying social determinants of health. The report can be found here: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fraceequalityfoundation.org.uk%252Fhealth-and-care%252Fnot-by-choice-the-unequal-impact-of-the-covid-19-pandemic%252F%2FNBTI%2Fmvu8AQ%2FAQ%2F1d38fca3-3a4f-4a74-85b3-7e73ee4f08a4%2F5%2F6NSeh56ms4&data=05%7C02%7Champstead.rec%40hra.nhs.uk%7C923706005fbd4a96b54a08dd866ccace%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638814523999638285%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=veY9y%2F%2FnXkHa34X5VNzOLzOoe2luz3flfJyA4FhVgGo%3D&reserved=0
Our analyses regarding occupational exposure and risk of infection were provided to government and official advisory bodies, including the UK Health and Safety Executive, the New and Emerging Respiratory Viral Threats Group, and the Scientific Advisory Group for Emergencies Environmental Modelling Group to inform evidence about occupational risk and work-related mitigations during the pandemic. They were also included as an important evidence source in a report by the Industrial Injuries Advisory Council recommending policy change making public-facing transport workers eligible for industrial injury compensation following severe complications of COVID-19. This was also presented to the parliament by the Secretary of State for Work and Pensions. Previously, only health and social care workers were eligible for similar compensation. The council also looked at risk in education workers, but there was not enough consistent evidence to make a recommendation. This is a step forward in terms of recognising the risk to public-facing workers – such as transport workers – from pandemic viral infections such as COVID-19. Virus Watch participants have played an important role in generating this evidence. Additionally, work on occupation and COVID-19 from Virus Watch was submitted to the COVID-19 inquiry.
Our work on Long COVID has been shaped by a patient and public involvement approach led by Virus Watch researchers, in which we recruited an international group of patients, carers, healthcare workers and health policy makers - including those from the UK - as part of our involvement in the END-VoC consortium. The advisory group provided input into important research questions and interpretation and communication of findings in order to address the needs of patients and other key stakeholders in our research. We have provided our findings around Long COVID to the European Commission, including through regular contributions to the EU Cohort Coordination Board working group on Long COVID as well as via reports and ongoing policy activities. Results from Virus Watch have also contributed an important evidence source around the impact of variant in the modelling of the global burden of Long COVID by the Global Burden of Disease Study, which involved direct collaboration between this group and the Virus Watch study team.Details of any further research planned
While the acute phase of the COVID-19 pandemic has passed, respiratory viruses continue to present a significant health threat by causing widespread days off work, hospitalisations, and the potential for long-term complications. Consequently, we are developing further research into acute respiratory infections, including COVID-19, influenza, and respiratory syncytial virus (RSV), based on our experience from Virus Watch. We are in the process of securing further funding for research into rates of infection, long-term impacts, and vaccine-related uptake and attitudes for acute respiratory infections in at-risk groups, including older adults.A full list of publications and pre-prints is available on our study website at https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fclick.pstmrk.it%2F3ts%2Fucl-virus-watch.net%252F%253Fpage_id%253D1388.%2FNBTI%2Fmvu8AQ%2FAQ%2F1d38fca3-3a4f-4a74-85b3-7e73ee4f08a4%2F6%2F5H3-XdLRH0&data=05%7C02%7Champstead.rec%40hra.nhs.uk%7C923706005fbd4a96b54a08dd866ccace%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638814523999651928%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=PR6FiRjiwA8aKCr%2BXv0NoC%2F0srLgQ4F7wSy%2FilAEnL0%3D&reserved=0
Funding
The United Kingdom Research and Innovation (UKRI) Medical Research Council (MRC) and the Department of Health and Social Care National Institute for Health and Care Research (DHSC NIHR) funded Virus Watch in April 2020 under the COVID-19 Rapid Response Call 2. Additional funding was awarded in August 2020 by the DHSC/UKRI to recruit larger numbers of minority ethnic and migrant populations when it became more apparent that these groups were under-represented in research studies, although experiencing greater risk of hospitalisation and death from COVID-19. The PROTECT COVID-19 National Core Study on transmission and environment, managed by the Health and Safety Executive on behalf of HM Government, funded Virus Watch research related to occupation. In May 2022, Virus Watch received funding from the European Union as part of the END-VoC consortium.Competing Interests
A.C.H. serves on the UK New and Emerging Respiratory Virus Threats Advisory Group. A.M.J. is Chair of the Committee for Strategic Coordination for Health of the Public Research.REC name
London - Hampstead Research Ethics Committee
REC reference
20/HRA/2320
Date of REC Opinion
21 May 2020
REC opinion
Further Information Favourable Opinion