CRUSH COVID: new research collaboration

12 October 2020

View of Uppsala, Upplandsmuseet by the river Fyris.

The purpose of the CRUSH COVID project is to detect local outbreaks in Uppsala County at an early stage and thereby succeed in stopping transmission at as early a stage as possible.

Uppsala University and the Uppsala Region are launching a joint research project aimed at surveying, preventing and reducing the spread of COVID-19 infection in Uppsala County. Using sources including data from the 1177 healthcare helpline and viral measurements in wastewater, the researchers aim to rapidly detect local outbreaks and thereby lower the transmission rate of the disease.

“It’s important for Uppsala University to contribute research on an issue that’s so important in society, and to be able to do it jointly with the regional authorities,” says Mats Larhed, Vice-Rector of the Disciplinary Domain of Medicine and Pharmacy at Uppsala University.

The Public Health Agency of Sweden predicts that, over the coming autumn and winter months, COVID-19 will spread in the form of local (cluster) outbreaks. The infection is currently being detected only when patients need to seek medical care, or get a test, because of their symptoms. Since one to several weeks have often, by then, passed since the person became infected, both tracking transmission of the virus and preventing it from spreading even more are difficult.

Detect local outbreaks

The purpose of the CRUSH COVID project is to detect local outbreaks at an early stage and thereby succeed in stopping transmission at as early a stage as possible.

“We’re currently seeing a rise in the number of cases in Uppsala County. This research project can provide valuable knowledge of how we can effectively fight the spread of infection,” says Johan Nöjd, an Uppsala Region doctor specialising in infectious diseases.

Tove Fall, Professor of Molecular Epidemiology.
Photo: Mikael Wallerstedt

In CRUSH COVID, researchers at Uppsala University will use information technology (IT) to combine data from several sources to facilitate early identification of geographical areas with signs of increased transmission. Anonymised data from the 1177 Care Guide helpline, for example, are combined with virus measurements in wastewater and information on the number of people needing inpatient care owing to COVID-19. Another key data source will be symptom data from the COVID Symptom Study (CSS) in Sweden.

Tove Fall, Professor of Molecular Epidemiology and senior researcher in both CRUSH COVID and CSS Sweden, reports on progress and plans.

“We’re now working intensively to compile information from several different sources. This should enable us to identify signals of increasing infection transmission at an early stage. We’ll then evaluate how well the method works. If it proves successful and beneficial, it can then be used in other regions as well.”

Researchers in different fields

Uppsala University participants in the CRUSH COVID project carry out research in general medicine, molecular and medical epidemiology, IT, environmental microbiology, statistics, and media and communications. The Uppsala Region provides experts in testing strategy and infection tracing, and in the statistics of testing.

Since COVID-19 is a novel disease, there are few scientific studies about which testing strategies are most effective and best in slowing down the spread of infection (“flattening the curve”) in the community. Among different demographic categories, there are also marked local variations in the proportion of people who get themselves tested in the event of suspected symptoms.

Mats Martinell, Senior Medical Advisor at the
Uppsala Region’s Testing Unit.
Photo: David Naylor

The survey results make up a supplementary database for the Uppsala Region’s Infection Control Unit, enabling the staff to prioritise where, and in which population groups, to expand testing for ongoing COVID-19 infection. In CRUSH COVID, evidence-based evaluation of which actions and targeted measures appear to be most effective will also take place.

“We need to understand how to focus the testing to find as many cases, and as early, as possible. CRUSH COVID will enable us to target measures earlier on to stop the upward trend. That way, we hope to minimise the impact of the pandemic and get valuable information on how to combat it and future pandemics too,” says Mats Martinell, Senior Medical Advisor at the Uppsala Region’s Testing Unit, who is the researcher in charge of the project.

Facts about CRUSH COVID

CRUSH COVID is funded partly by Vinnova, Sweden’s innovation agency. In the project, a method of picking up early signals of increased local transmission of infection in real time, by combining information from a number of different data sources, is being developed.

These data sources include:

  • The COVID Symptom Study (CSS) Sweden, a separate research study run by Uppsala University and Lund University in collaboration with King’s College London and ZOE Global Ltd. Everyone in Sweden aged 18 and over can volunteer for CSS Sweden and report daily, using the COVID Symptom Tracker, a mobile app, whether they have symptoms of the disease or not.
  • The 1177 Care Guide telephone helpline, which many residents in Sweden call if they have COVID-19 symptoms.
  • Measurements of the SARS-CoV-2 virus in wastewater from various parts of the county, with support from SciLifeLab (Science for Life Laboratory). The SARS-CoV-2 levels are an indication of where the spread of infection appears to be increasing or decreasing.
  • Group-level information from the Uppsala Infection Control Unit about the number of people testing positive, and seeking help at hospitals, from individual postcode areas in the Uppsala Region.
  • Deidentified information from the questionnaires filled in by CRUSH COVID respondents.

In addition, CRUSH COVID will continuously collect information about the proportion and number of residents testing positive for ongoing COVID-19 infection in the Uppsala Region; how many have been admitted to hospital; and the number of deaths resulting from COVID-19. The aim is to be able to investigate and evaluate different testing strategies and targeted measures.