The ORCHESTRA-PODCAST: Presenting ORCHESTRA
Episode 1 presents ORCHESTRA and gives an overview of the project and its mission. Nobody knows ORCHESTRA better than Prof. Evelina Tacconelli. She talks about benefits, challenges and how her team convinced her to apply for the European cohort research project on COVID-19. Evelina Tacconelli is the head of ORCHESTRA, professor of infectious diseases at the University of Verona and director of the infectious diseases section at Verona University Hospital. She is a consultant on infectious diseases research of the University of Tübingen, DZIF, the German centre for infection research. She leads several international projects, targeting epidemiological and clinical aspects of antibiotic-resistant infections. Evelina initiated the ORCHESTRA project with her team from the University of Verona.
Marlene Nunnendorf: Hello – and welcome to the ORCHESTRA podcast. ORCHESTRA is a large-scale European and international cohort research project on COVID-19. It is designed to find rigor scientific evidence on treatment and prevention measures, and provides a research infrastructure that contributes to a pandemic-preparedness for the future. ORCHESTRA is part of the HORIZON 2020 programme and receives funding from the EU.
This is episode number 1 and we will be presenting ORCHESTRA and give you an overview of the project and its mission. Nobody knows ORCHESTRA better than Evelina Tacconelli. She is the head of ORCHESTRA, professor of infectious diseases at the University of Verona and director of the infectious diseases section at Verona University Hospital. She is a consultant on infectious diseases research of the University of Tübingen, DZIF, the German centre for infection research. She leads several international projects, targeting epidemiological and clinical aspects of antibiotic-resistant infections. Evelina initiated the ORCHESTRA project with her team from the University of Verona and leads 37 partners from 15 countries, managing international and multidisciplinary teams within the network. Evelina why did you choose the name ORCHESTRA?
Evelina Tacconelli: Thank you – The idea was to put together data, experience, culture related to the COVID-19 pandemic within the European countries, that were not really talking to each other. We wanted to collaborate and create one melody that would be able to provide precise and accurate information about prevention and management of COVID-19.
Marlene Nunnendorf: Evelina, tell us a little bit about the general and overall objectives.
Evelina Tacconelli: The idea was that the existing platforms and data sets of information all across Europe in particular, were created for the SARS-CoV-2 pandemic. Imagine the power when we would bring it all together. We are still linking together all these pieces of information to have a sample size that will be big enough for specific data analysis (using e.g. machine learning or any new possibilities of big data analysis), in order to understand the impact of variants for immunity – and the factor vaccination with a specific care of the fragile population. We defined fragile population as children, pregnant, oncological, haematological patients. So, this is very much the idea of ORCHESTRA: try to link together what is already existing and giving feedback to the population and the major stakeholders.
Marlene Nunnendorf: ORCHESTRA has been building up a research infrastructure: we have 37 partners from 15 countries (European and non-European countries). The idea is to join talents and skills from the different countries, take the patient data from these different international cohorts and bring them together to create an extra-large cohort that represents different countries, patients with different comorbidities, social background, age etc. The aim is to get a great and representative number of patients to participate in the study, in order to get a clear picture of the disease. Evelina, would you please explain what cohort-research is about?
Evelina Tacconelli: Cohort-research means that we follow-up from one starting point that is defined in the same way for all participating countries at a specific population (e.g. children or pregnant women or people with Parkinson). We define specific points, where these people visited clinics (clinical evaluation of the patient). Then we assess the immunity to a blood sample, we check, if they are infected with SARS-CoV-2 and which type of variant they have. We follow up the patient at 6, 12 and 18 months after the SARS-CoV-2 infection or after starting the vaccination procedure. We are very much linked to many other European projects: e.g. there are people working on the side-effects of vaccination, while in other projects, there are colleagues working on epigenetic, neurological aspects… So, it is very much teamwork, trying to reduce as much as possible the duplication of efforts.
Marlene Nunnendorf: Evelina, what is the greatest challenge about cohort research right now?
Evelina Tacconelli: The problem we had in the big populations is the time it took to organize the work to link all the countries – and we are still not done. The legislation, and the distribution of the virus are constantly changing. So, we had to understand how the second vaccination had an impact, and at the same day we started, they introduced the third vaccination. That is completely changing the plan and the organization of the work. When we went back and reorganized the workload to understand the third vaccination, in some countries they started to get the fourth vaccination. So, just to give you an idea how difficult the pandemic time is: to keep everything transparent, following all the legislations in each country can take much of the time that should be invested in the research. How can I answer the pandemic with seven months of delay just to start looking at the data…?!
Marlene Nunnendorf: If we talk about ORCHESTRA being a research infrastructure, we should take a brief look at how ORCHESTRA is being organized. ORCHESTRA consists of 11 work packages (WPs):
WP1 is the ground control of the project. It is the project management unit. The team is doing an incredible job in coordinating all the WPs, communicating with EU organs and all stakeholders, organizing all the ORCHESTRA meetings etc. WP11 is linked to WP1. WP11 is responsible for the ethic requirements. WP2 is also led by Evelina and her team. They research the different long-term consequences and provide extensive and detailed mapping of data from existing and new cohorts. The goal is to set up predictive models for clinical decision-making for follow up and to assesses the risk of re-infection. Please, tell us a little bit more about the clinical background, Evelina.
Evelina Tacconelli: That is very interesting because we are now realizing how many consequences we have after COVID-19 – not only in the fragile population, where we were expecting it, but surprisingly also in the younger population without comorbidities. They are experiencing long-term consequences psychologically, cardiovascular etc., long after the COVID-19 hospitalization. We have several women of mid-age without previous issues of any disease, who need a lot of ambulatory checking. Unfortunately, it is also starting now with children. But the vaccination is reducing the number of sequelae, and I think this the good message for us in order to share the information with the population and contributing this way with the support of the vaccination strategy in different European countries.
Marlene Nunnendorf: Let me continue with WP3: the population-based cohorts. They research changes of serological immune response in vaccinated and non-vaccinated individuals, consequences of preventive measures (e.g. lockdown) on health, infections in between doses and the vaccinated, and the zero-prevalence and risk indicators for infection. Evelina, world you translate zero-prevalence for us, please?
Evelina Tacconelli: They try to define if we have protection from infection and re-infection. The real issue today is that this protection from infection may be based from the type of variant you have been in contact with. That is still an open question today, where I hope ORCHESTRA can give an important answer.
Marlene Nunnendorf: WP4, the fragile population cohorts, represent HIV-infected individuals, children and neonates, pregnant women, Alzheimer diseases, oncological- and transplanted cystic fibrosis patients and haematological diseases. They are researching the clinical presentation, medium- and long-term consequences, vaccination efficacy, prevention strategies and transmitting ways.
WP5 is the healthcare workers cohort. This is interesting as the healthcare workers represent the working groups of society, which are very exposed to the virus. They research occupational and non-occupational determinants of infections, long-term effects of exposure to COVID-19 (e.g. burnout or mindfulness), changes of serological immune response in vaccinated and non-vaccinated individuals).
WP6 deals with the laboratory aspects of the disease: bio-banking and bio-samples such as blood, urine and swaps. It conducts genomic and viral analysis, it assesses viral variants and their impact on viral phenotypes and clinical outcome, and it assesses the molecular changes that explain when to expect the severe or non-severe outcome.
WP7 deals with all aspects of data within the project, storage safety, data harmonization, data coding… a quite large task in the project.
WP8 is responsible for statistical cost-analysis modelling and assesses the impact of interventions and vaccination strategies and explores socioeconomical aspects.
WP9 is the global COVID-19 guidance. It assists the other WPs with reviews of internal protocols, translates results into scientific recommendation and produces public health recommendation.
WP 10 is responsible for dissemination and communication (such as producing a podcast…). It also provides statistics for the internal and external use and provides the ORCHESTRA-suite which is a data management cloud for collaboration.
You can tell by the time that it took time to explain the project – if you would like to find out more about the project and its partners, please visit our website on: www.orchestra-cohort.eu
This was the ORCHESTRA podcast – thank you for listening and enjoy your day!
Podcast by Marlene Nunnendorf, ORCHESTRA’s Science Communication Officer, University Hospital of Cologne.