Urgent research and surveillance on Covid-19 using the new OpenSAFELY secure platform across 55 million patients' full linked primary care records

我们正在提供一个分析医疗数据的平台，目前包括2700万名患者的全科医生记录（已删除可识别信息），很快将扩展到5500万。要在2019冠状病毒病期间迅速取得成果，需要这种前所未有的规模。opensafety采用了一种新的模式，以最大限度地提高效率和隐私：我们没有将GP记录中的大量信息复制到另一个地方（这涉及安全风险），而是在GP记录已经存在的数据中心内建立了一个安全的分析平台，并与所有相关的Covid-19结果数据（如死亡记录和重症监护）相关联。我们已经迅速建立了这个系统，我们的第一次分析已经完成。我们现在迫切需要资金来维持该平台，并加快和扩大我们在以下三个工作流程方面的工作：1)进一步研究，确定哪些患者因Covid-19而入院、通气和死亡的风险更高，为管理、隔离建议、服务规划和这些发现背后的潜在机制提供信息（例如，BAME群体是否仅仅因为以前的医疗条件而风险更高？）；并探索某些药物的假设，这些药物有助于保护人们免受不良后果的影响，包括布洛芬、哮喘药物、抗凝血剂和其他治疗方法。2)通过建立疾病传播模型，将“疾病动力学”方法与每个地区Covid-19流行率和风险人群的详细临床数据相结合，预测当地的传播和服务需求，并评估封锁后的退出策略。3)衡量和减轻Covid-19对健康的间接影响，例如癌症诊断和转诊、心血管管理、疫苗接种等，并确定国家和较小地区的紧急必要行动。

We are delivering a platform for analysing healthcare data, currently including 27 million patients' GP records (with identifiable information removed), soon expanding to 55 million. This unprecedented scale is needed for rapid results during Covid-19.OpenSAFELY uses a new model for maximum efficiency and privacy: rather than copying large volumes of information from GP records into another location, which involves security risks, we have instead built a secure analytics platform inside the data centres where GP records already reside, and linked to all relevant Covid-19 outcomes data such as death records and intensive care.We have set this up rapidly and our first analyses are already complete. We now urgently need funds to sustain the platform, and to accelerate and expand our work on the following three workstreams:1) Further research to identify which patients are at higher risk of admission, ventilation and death from Covid-19, to inform management, seclusion advice, service planning, and underlying mechanisms behind these findings (e.g. is there higher risk among BAME groups simply because of previous medical conditions?); and to explore hypotheses on certain drugs helping to protect people against poor outcomes, including ibuprofen, asthma drugs, anticoagulants, and other treatments. 2) Predicting local spread and service need, and evaluating exit strategies from lockdown, by creating models of disease transmission which combine "disease-dynamics" approaches with detailed clinical data on Covid-19 prevalence and the population at risk in every local area.3) Measuring and mitigating the indirect health impacts of Covid-19 on, for example, cancer diagnosis and referrals, cardiovascular management, vaccinations, etc, and identifying urgent necessary actions both nationally and in smaller regions.