**Understanding COVID-19 Infectivity and Update from CCP-Cancer** [Watch the talk here][1] Dr Lance Turtle is a senior clinical lecturer and an honorary consultant in infectious diseases at the University of Liverpool’s Institute of Infection and Global Health and the Royal Liverpool University Hospital Tropical and Infectious Disease Unit. In his talk, he outlines the findings from ISARIC CCP-UK, an observational study examining hospitalised COVID-19 disease in the UK. • ISARIC (International Severe Acute Respiratory and Emerging Infections Consortium) is a “network of networks”, designed to allow a rapid response to emerging infections. It arose out of the failure to conduct rapid response clinical trials during the 2009 Influenza A H1N1 pandemic. • The ISARIC Clinical Characterisation Protocol UK (CCP-UK) was approved as a sleeping protocol in 2013 in anticipation of a future pandemic. It was activated on January 17th 2020 in response to the emergence of SARS-CoV-2. • Operating at 260 sites, CCP-UK is a prospective cohort study which characterises the clinical features of patients hospitalised with confirmed or suspected COVID-19 in the UK. As of September 28th 2020, 80,428 patients have been recruited to the study. • During the first wave, hospital admissions peaked during April 2020. The majority of patients hospitalised with COVID-19 were aged over 40. More men than women were admitted, accounting for 56% of all admissions. • Intensive care unit (ICU) admissions occurred in 14% of patients, with the majority of these admissions occurring in patients below the age of 60. Patients receiving non-invasive ventilation (15%) and invasive ventilation (8%) also tended to be younger, although this pattern was less pronounced in those receiving non-invasive ventilation. The proportion of patients receiving high-flow oxygen (65%) was consistent across age groups. • During the first wave, the mortality rate for patients hospitalised with COVID-19 was 29%. The strongest driver of mortality was increasing age, with male gender and co-morbid disease, including malignancy, also being associated with increased mortality rates. • The mortality rate for patients aged over 60 has steadily fallen since April 2020. This is the subject of investigation but is thought to be related to a greater understanding of how to manage the condition and more resources per patient being available as hospitals became less overwhelmed with admissions. Professor Carlo Palmieri is a professor of translational oncology at the University of Liverpool’s Institute of Translational Medicine and a consultant oncologist at the Clatterbridge Cancer Centre. In his talk, he uses data from ISARIC CCP- UK to summarise the impact malignancy has had on COVID-19 management and outcome. • As of 17th August 2020, 78,603 patients were enrolled in CCP-UK, of which 7026 (10.5%) had a history of malignancy. Of these 7026, 1680 were noted to be on active treatment. The true number of those on active treatment is likely to be higher as the initial case report form did not discern between a historical cancer diagnosis and those on active treatment until it was amended in April 2020. • There was no clinically significant difference in COVID-19 presentation between cancer patients and non-cancer patients, although the incidence of the most common COVID-19 symptoms (cough, fever and dyspnoea) was slightly lower in cancer patients than non-cancer patients. • In an unadjusted analysis, critical care escalation was higher in non-cancer patients (14.6%) than cancer patients (7.6%-9.5%). After adjusting for age, sex and comorbidities, cancer patients were still significantly less likely to be escalated to critical care than non-cancer patients. • In hazard ratio analysis, 30-day mortality rates in patients with a history of cancer (44.3%) and those on active treatment (42.3%) were higher than those without cancer (29.5%). However the impact that cancer had on mortality rate decreased with increasing patient age - the hazard ratio for cancer patients under 50 years of age was 4.09, compared to 1.17 in patients over 80. This trend persisted in multivariable analysis. • Funding has been approved for CCP-Cancer UK, a companion study in which data pertaining to tumour type, treatment, timing of treatment in relation to COVID-19 diagnosis and long-term outcomes will be collected from the over 7000 cancer cases in CCP-UK. • CCP-Cancer UK aims to understand the impact these cancer-related factors have on COVID-19 outcome and escalation of care, as compared to a group of non-cancer matched controls. This will allow medical teams to give more accurate information regarding the risks of COVID-19 in cancer, thus allowing patients to make better informed decisions regarding treatment and the extent to which they interact with society. [1]: https://osf.io/v2mp8/