When COVID-19 hit, hospitals across the UK faced an unprecedented challenge: large numbers of critically unwell patients, no proven treatments, and immense pressure on staff and health systems. The RECOVERY trial was set up at pace to test treatments at scale and provide results to inform clinical practice.
Its streamlined design and integration with the NHS were key to its success, as were the many thousands of hospital staff who recruited and cared for participants. We spoke to four of them at the first in-person collaborators’ meeting in the UK in October.
Collaborators reflected on the unprecedented scale of the study, the lessons learned during the first five years of the trial, and how these are being applied to the search for definitive evidence on treatments for other types of pneumonia.
Collaboration across the whole hospital
RECOVERY succeeded because it embedded research into clinical care. Emergency departments, wards, intensive care units (ICUs), and research teams worked together, ensuring patients were identified quickly and not “lost” as they moved through the hospital system.
‘I think RECOVERY has been a massive success because of the collaborations we have with other departments – from emergency to medical wards to ICU.’ said Ada Ukaulor, a research nurse involved in the trial at Royal Berkshire NHS Foundation Trust.
When every ward is full of COVID patients, you don’t get a choice — you all collaborate.
added Louise Mew, now an orthopaedic advanced nurse practitioner. Reassigned to lead COVID-19 research at Milton Keynes Hospital, she worked across wards where almost all patients were infected. Mew went on to recruit more than 500 patients to the study, making her hospital one of the highest recruiting hospitals nationally.
Professor David Chadwick, a consultant in infectious diseases at South Tees Hospitals NHS Foundation Trust, became involved in RECOVERY at the start of the pandemic in early 2020. He credited having the support and buy-in of research nurses, junior doctors and hospital research and development teams for enabling rapid recruitment.
Quick communication between teams meant eligible patients could be randomised without delay, keeping the trial moving at pace even during peak pressure. ‘Being able to reach clinicians easily and let them know a patient was eligible made everything move quickly and smoothly.’ said Ada Ukaulor.
Simple design that made participation possible
RECOVERY was designed to be easy to deliver. It requires minimal training and simple processes, allowing doctors and nurses to get involved rapidly. This simplicity translated directly into high recruitment numbers and sustained engagement across multiple sites.
‘It’s one of the simplest trials I’ve ever been involved in.’ said David Chadwick, adding that its straightforward design made it easier for busy clinical teams to take part. ‘It’s probably the easiest study I’ve ever worked on in terms of delivering.’ added Louise Mew.
Research infrastructure and hidden heroes
Behind the scenes, governance teams, trial managers, and technical teams ensured the study ran safely and efficiently, even at speed. ‘The research governance and technical teams enabled us to deliver the study as effectively as we could.’ said Louise Mew.
‘We’re supported by a clinical research unit – research nurses and trial managers who actively work on recruitment.’ said Dr Michael Boswell, a virology and infectious diseases registrar in Cardiff and Associate Principal Investigator.
Hospital staff valued the chance to share practical solutions to common challenges, from recruitment strategies to workflow improvements. Dr Boswell added that large multi-centre trials like RECOVERY benefit from shared experience. ‘You can learn from each other,’ he said.
'When you've got larger, multicentre studies, it's good to get to know other people that you are working with on the same trial, to see if you can learn from each other, to see if shared experiences can help solve some of the problems that you have.'
Rapid results that changed practice
One of RECOVERY’s most powerful features was how quickly results changed patient care, by identifying effective treatments and those that should be stopped.
Research is not just about what works – it’s about knowing what doesn’t, so we stop using it.
said Ada Ukaulor.
Clinicians could see the real-world impact of their efforts. ‘It’s good to see how many lives have been saved and how important the trial has been.’ said David Chadwick. ‘Seeing patients’ care improve drastically because of the results makes it incredibly important to be part of.’ added Ada Ukaulor.
A model for the future
RECOVERY has reshaped expectations of what clinical research can achieve – not just for COVID-19, but for flu, community-acquired pneumonia, and other respiratory infections.
‘It’s proven that research can be done quickly and effectively when it really needs to be.’ said Louise Mew.
'There’s a huge gap in evidence for respiratory viruses – RECOVERY is helping to fill that.' said Michael Boswell.