Office of Research & Development |
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COVID-19 FACT SHEETFor VA investigators: Please check our funding page for news about new funding opportunities relating to COVID-19. |
In response to the COVID-19 pandemic, VA Research has undertaken a wide array of activities to support and advance VA's clinical and research missions and help Veterans affected by the disease. These efforts have spanned biomedical research, therapeutics and vaccine clinical trials, and data analyses that leverage VA's rich electronic health record system. VA Research has coordinated closely with internal VA and external partners—such as the National Institutes of Health and other federal agencies, and pharmaceutical companies—to identify the areas in which VA's nationwide research capacity, resources, and infrastructure could make the greatest contribution.
On this web page, we summarize recent and current COVID-19 research across the VA system.
VHA COVID-19 Research Dashboard
This interactive map shows active VA studies on COVID-19. Use the search bar or menus on the left to find studies on specific topics or locations. View larger version
VA hospitals had lower COVID-19 mortality rates than community hospitals
Iowa City VA Health Care System researchers learned that Veterans hospitalized for COVID-19 in VA hospitals were less likely to die than those treated in community hospitals. The study included data on nearly 65,000 Veterans 65 years old or older who were hospitalized with COVID-19 between March 2020 and December 2021. Veterans in community hospitals had a 27% risk of death within 30 days of hospitalization, compared with an 18% risk for those admitted to VA hospitals. However, about 74% of Veterans were admitted to community hospitals rather than VA hospitals. The results show that quality of VA health care compares favorably to non-VA care, but more efforts may be needed to ensure Veterans receiving care in the community get the best quality care. (JAMA Network Open, May 1, 2023)
Risk of death from COVID-19 decreased, still higher than flu risk
St. Louis VA researchers learned that the risk of death from COVID-19 is still higher than the risk of death from the flu despite a decreasing COVID-19 mortality risk. The researchers analyzed VA hospital admissions between October 2022 and January 2023. Death rates for patients admitted for COVID-19 were 6%, while death rates for flu patients were 4%. In 2020, 17% to 21% of patients hospitalized with COVID-19 died, compared with 4% of patients hospitalized for the flu. The researchers attribute the decreased COVID-19 death rate to vaccinations and improved clinical care, as well changes in virus variants. (JAMA, April 6, 2023)
Suicidal ideations among Veterans fell during pandemic
Despite concerns that Veterans would be at a high risk of suicide because of the COVID-19 pandemic, a recent study by VA Connecticut researchers found that rates of suicidal thoughts in Veterans actually decreased after the onset of the pandemic. The study included more than 2,000 Veterans assessed for suicidal thoughts. In this group, 9.3% reported suicidal thoughts pre-pandemic in 2019, which dropped to 6.8% in 2020 before increasing slightly to 7.7% in 2022. Only 0.4% of participants attempted suicide during the pandemic, a rate consistent with pre-pandemic numbers. The factors most associated with new suicidal thoughts were higher education, lifetime substance use disorder, pre-pandemic loneliness, and lower pre-pandemic purpose in life. (JAMA Psychiatry, April 5, 2023)
Paxlovid lowers risk of COVID post-conditions, hospitalization, death
A study by VA St. Louis researchers found that the antiviral drug Paxlovid lowers the risk of long COVID and death. The researchers looked at outcomes of more than 280,000 high-risk VA COVID-19 patients, nearly 36,000 of whom had been prescribed Paxlovid (generic name nirmatrelvir). Patients who were given the medication within five days of a positive COVID-19 test had a 26% lower risk of developing post-COVID conditions, a 47% lower risk of death from the disease, and a 24% lower risk of needing hospitalization. Paxlovid reduced the risk of long COVID symptoms in people who were unvaccinated, vaccinated, and boosted, and in people with their first infection or a reinfection. Study author Dr. Ziyad Al-Aly said the findings support using Paxlovid for high-risk patients both to treat acute COVID-19 and to lower the risk of lasting effects. (JAMA Network Open, March 23, 2023)
VA tablet program increased Veterans’ telehealth use during pandemic
The VA Office of Connected Care widely expanded its video-enabled tablet program at the onset of the pandemic, increasing the number of Veterans who received tablets nearly six-fold. When VA Palo Alto researchers and colleagues compared pandemic access numbers to those from 2019 and 2020, they found that Veterans who received tablets during the pandemic were more likely to use video care, and they did so more frequently than those who received tablets before the pandemic. However, older Veterans, or those unstably housed, were less likely to use video visits than other groups. The researchers concluded interventions may be needed to improve telehealth access for Veterans with unstable housing or who are less familiar with technology. (Journal of Medical Internet Research, Dec. 20, 2022)
Clinical Trials
Core warming of coronavirus disease 2019 patients undergoing mechanical ventilation: A pilot study . Bonfanti NP, Mohr NM, Willms DC, Bedimo RJ, Gundert E, Goff KL, Kulstad EB, Brewry AM. This pilot study suggests that core warming of patients with COVID-19 undergoing mechanical ventilation is feasible and appears safe. Inducing fever has potential to improve respiratory physiology in patients with COVID-19. Ther Hypothermia Temp Manag. 2023 Aug 2. Online ahead of print.
Intravenous aviptadil and remdesivir for treatment of COVID-19-associated hypoxaemic respiratory failure in the USA (TESICO): A randomised, placebo-controlled trial . Brown SM, Barkauska CE, Grund B, Sharma S, Phillips AN, Leither L, Peltran ID et al. Among patients with COVID-19-associated acute hypoxaemic respiratory failure, aviptadil did not significantly improve clinical outcomes up to day 90 when compared with placebo. Lancet Respir Med. 2023 Jun 19. Online ahead of print.
Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial . Bramante CT, Buse JB, Liebovits DM, Nicklas JM, Puskarich MA, Cohen K, Belani HK, Anderson BJ et al. Outpatient treatment with metformin reduced long COVID incidence by about 41% compared with placebo. Lancet Infect Dis. 2023 Jun 8. Online ahead of print.
The effect of povidone-iodine nasal spray on nasopharyngeal SARS-Co-V-2 viral load: A randomized control trial. Zarabanda D, Vukkadala N, Phillips KM, Qian ZJ, Mfuh KO, Hatter JN, Lee IT et al. Dilute versions of povidone-iodine nasal spray are safe for topical use in the nasal cavity, but the spray does not demonstrate virus-eliminating activity in COVID-19 positive patients. Laryngoscope. 2022 Nov;132(11):2089-2095.
Efficacy and safety of ensovibep for adults hospitalized with COVID-19: A randomized controlled trial. ACTIV-3/TICO Study Group et al. Compared with placebo, the medication ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 standard care, including remdesivir. No safety concerns were identified. Ann Intern Med. 2022 Sep;175(9):1266-1274.
Laboratory Studies
Comparison of virus aerosol concentrations across a face shield worn on a healthcare personnel during a simulated patient cough. Pratt AA, Brown GD, Perencevich EN, Diekema DJ, Nonnenmann MW. Face shields reduce virus and particle concentrations. However viable viruses were still measured on the inside of a face shield in the breathing zone of the health care worker during simulated coughing. Other exposure control methods need to be used to prevent transmission from virus aerosol. Infect Control Hosp Epidemiol. 2023 Aug 23;1-6.
Oxylipin concentration shift in exhaled breath condensation (EBC) of SARS-CoV-2 infected patients . Borras E, McCartney MM, Rojas DE, Hicks TL, Tran NK, Tham T, Juarez MM et al. Monitoring exhaled breath concentrations of oxylipin and other compounds presents an interesting opportunity to monitor key indicators of COVID-19 disease progression and severity. J Breath Res. 2023 Aug 7;17(4).
NK cells from COVID-19 positive patients exhibit enhanced cytotoxic activity upon NKG2A and KIR2DL1 blockade. Lee G, Schauner R, Burke J, Borocz J, Vasana S, Sobieraj L, Giraudo M et al. This study reveals new insights into Natural Killer cell phenotypes during SARS-CoV-2 infection and suggests a therapeutic approach worthy of further investigation to enhance NK cell-mediated responses against the virus. Front Immunol. 2023 Jul 7;14:1022890.
Vascular and non-HLA autoantibody profiles in hospitalized patients with COVID-19. Lichtenstein B, Zheng Y, Gjertson D, Ferbas KG, Rimoin AW, Yang OO, Aldrovandi GM et al. Patients hospitalized with COVID-19 demonstrate evidence of auto-reactive antibodies targeting endothelial cells, angiotensin II receptors, and numerous structural proteins including collagens. Front Immunol. 2023 Jun 15;14:1197326.
Honokiol inhibits SARS-CoV-2 replication in cell culture at a post-entry step . Salago-Benvindo C, Leijs AA, Thaler M, Tas A, Arbiser JL, Snijder EJ, van Hemert MJ. Honokiol, a molecule from the magnolia tree, inhibits replication of the virus that causes COVID-19. Microbiol Spectr. 2023 May 22. Online ahead of print.
Data Analysis/Review
Frailty as a risk factor for post-acute sequelae of COVID-19 among US veterans during the Delta and Omicron waves . Hammel IS, Tosi DM, Tang F, Pott H, Ruiz JG. Frailty was associated with an increased risk of developing post-acute sequelae of COVID-19 infection. Vaccination was associated with a decreased risk of sequelae, further reduced by booster doses. J Am Geriatr Soc. 2023 Sep 19. Online ahead of print.
Vaccination status and trends in adult coronavirus disease 2019-associated hospitalizations by race and ethnicity: March 2020-August 2022 . Ko JY, Pham H, Anglin O, Chai SJ, Alden NB, Meek J, Anderson EJ et al. Race/ethnicity disparities in COVID-19-associated hospitalizations declined but persisted in the era of vaccination. Clin Infect Dis. 2023 Sep 18;77(6):827-838.
Nirmatrelvir/ritonavir use and hospitalizations or death in previously uninfected non-hospitalized high-risk population with COVID-19: A matched cohort study . Butt AA, Yan P, Shaikh OS, Talisa VB, Omer SB, Mayr FB. Nirmatrelvir/ritonavir is associated with a significant reduction in 30-day hospitalization or death among previously uninfected, non-hospitalized individuals. J Infect Dis. 2023 Sep 15. Online ahead of print.
Growing deficit in new cancer diagnoses 2 years into the COVID-19 pandemic: A national multicenter study . Englum BR, Sahoo S, Mayorga-Carlin M, Hayssen H, Siddiqui T, Turner DJ, Sorkin JD, Lal BK. Disruptions in new diagnoses of four common cancers (prostate, lung, bladder, and colorectal) seen early in the COVID-19 pandemic have persisted for two years. Ann Surg Oncol. 2023 Sep 11. Online ahead of print.
Characteristics and outcomes of US Veterans with immunocompromised conditions at high risk of severe SARS-CoV-2 infection with or without receipt of oral antiviral agents. Gentry CA, Nguyen PN, Thind SK, Kurdgelashvili G, Williams RJ. Use of molnupiravir or nirmatrelvir-ritonavir was associated with lower incidence of hospitalization or death within 30 days of diagnosis in Veterans with immunocompromised conditions, regardless of vaccination status. Clin Infect Dis. 2023 Aug 24. Online ahead of print.
Other Research
Modifying Whole Health services for successful telehealth delivery: Lessons from Veterans Health Administration’s rapid transition during the COVID-19 pandemic . Wu J, Bolton R, Anwar C, Bokhour BG, Khanna A, Mullur RS, Taylor SL, Hyde J. The COVID-19 pandemic catalyzed tele-Whole Health service implementation, utilization, and sustainment. The challenges faced and modifications made during this transition provide lessons learned for other health care systems as they attempt to implement telehealth services. J Integr Complement Med. 2023 Sep 1. Online ahead of print.
Development and cross-sectional evaluation of a text message protocol to support mental health well-being . Whealin JM, Saleem JJ, Vetter B, Roth J, Herout J. The Coping During COVID text messaging protocol can successfully support users’ self-care efforts during the COVID pandemic. Psychol Serv. 2023 Aug;20(3):657-667.
Loss during COVID-19: Moderating effects of meaning and romantic relationships on anxiety and depressive symptoms . Gold AI, Ryjova Y, Corner GW, Rasmussen HF, Kim Y, Margolin G. Cumulative pandemic-related loss is associated with anxiety and depressive symptoms, and meaning in life and romantic relationships may be promising interventional targets. Psychol Trauma. 2023 Jul 31. Online ahead of print.
Pandemic-related posttraumatic psychological growth in U.S. military Veterans: A 3-year, nationally representative, longitudinal study. Kang H, Na PJ, Fischer IC, Tsai J, Tedeschi RG, Pietrzak RH. Results suggest that psychosocial interventions to bolster posttraumatic growth in relation to early life traumas may help facilitate posttraumatic growth in response to the pandemic and related crises. Psychiatry Res. 2023 Jul 24. Online ahead of print.
COVID-19-related media consumption and posttraumatic stress symptoms in U.S. military Veterans: A nationally representative, longitudinal study. Whealin JM, Fischer IC, Na PJ, Pietrzak RH. COVID-19 media consumption is independently linked to a greater likelihood of pandemic-related posttraumatic stress symptoms in Veterans. Psychiatry Res. 2023 July 18;326:115354.
Commentary
Global vaccine inequality threatens to unleash the next COVID-19 variant. Oehler RL, Vega VR. The emergence of COVID-19 variants from under-vaccinated regions is a direct consequence of the virus replicating unchecked through an unprotected population. Much more needs to be done to address global vaccine inequities and prevent the next devastating variant. Int J Infect Dis. 2022 Aug 18. Online ahead of print.
Estimated impact of the US COVID-19 vaccination campaign-Getting to 94% of deaths prevented. Jones M, Khader K, Branch-Elliman W. Substantial investments into national data infrastructure and research are needed to increase vaccine uptake and prevent more COVID-19 deaths. JAMA Netw Open. 2022 Jul 1;5(7):e2220391.
Approaches to long COVID care: the Veterans Health Administration experience in 2021. Gustavson AM, Eaton TL, Schapira RM, Iwashyna TH, Adly M, Purnell. Even well-resources health care systems such as VA are grappling with how to best address long COVID care. BMJ Mil Health. 2022 Jul 1;e002185.
Leveraging anthropological expertise to respond to the COVID-19 global mental health syndemic. Azevedo KJ, Riendeau RP, Sweet PA, Holmes SM. Anthropologists collaborating directly with mental health clinicians and the public can contribute to solutions to improve mental health issues exacerbated by the COVID-19 pandemic. Am Anthropol. 2022 Jun. Online ahead of press.
Awakening: The unveiling of historically unaddressed social inequities during the COVID-19 pandemic in the United States. Andrasik MP, Maunakea AK, Oseso L, Rodriguez-Diaz CE, Wallace S, Walters K, Yukawa M. Long-standing inequities paved the way for the disproportionate burdens of COVID-19 among people of color across the country. Infect Dis Clin North Am. 2022 Jun;36(2):295-308.
As of November 2021, nearly 70 VA medical centers are involved in one or more COVID-19 clinical trials. Below are several examples. A full list of COVID-19 Clinical Trials in VA is also available.
NIAID provides COVID-19 antiviral drug for VA’s Veteran patients
VA research spells out COVID's down-the-road risks for cardiovascular and mental health
VA official encourages minorities to make educated decisions about participating in COVID-19 trials
For a concise overview of current VA Health Services Research and Development (HSR&D) efforts on COVID-19, visit COVID-19 Efforts.
To rapidly stand up new research and optimize resources during the COVID-19 pandemic, the VA Office of Research and Development (ORD) has coordinated with the National Institutes of Health, the Department of Defense, the Department of Energy, other federal agencies, and several industry partners—namely, pharmaceutical companies. Further, as part of the larger Veterans Health Administration system, ORD has supported other VHA offices by providing research expertise and personnel to assist with public health and informational demands.
Prior to the pandemic, ORD had been pursuing three strategic priorities: enhancing Veteran access to clinical trials; putting VA data to work for Veterans; and increasing the real-world impact of VA research. These priorities continue to guide ORD’s efforts and have positioned the program to quickly respond to COVID-19 through the creation and expansion of research partnerships; optimization of resource allocation; and streamlining and modernization of processes and policies. Part of this effort has involved creating new ways to rapidly support VA investigators eligible for VA research funding, and quickly evaluating research ideas proposed by VA scientists.
ORD is engaged in a wide array of research activities on COVID-19, with the support and cooperation of many internal VA and external partners. These activities encompass a range of studies, as well as innovative approaches to planning, coordinating, and expediting research:
To help prevent the spread of COVID-19, reduce exposures among both research staff and patients, and decrease the burden on the health care system, ORD instituted an administrative hold that stopped non-critical, in-person research contacts for all VA-funded research. (Some of this activity has begun to resume as of June, depending on local conditions.) Additional guidance was issued to ensure the safety and protection of all those involved in research. To ensure communication and understanding, ORD has developed a common communication platform for providing written guidance and sharing resources and tools, issued FAQs for field staff, and conducted a series of informational webinars for VA research personnel.
As protective measures were implemented for personnel, ORD recognized the importance of continuing research when possible, given the public investments made to date. In this context, regulatory guidance was issued on options and requirements for conducting research through alternative methods. Additionally, ORD worked with the VA Office of Information Technology to issue guidance on the use of communication technologies for research purposes. A field operations workgroup was also set up to examine ongoing research challenges and to develop more uniform guidance for all research programs.