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
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)
COVID-19 reinfection increases risk of death and health problems
COVID-19 reinfection increases the risk of death and health problems, found a VA St. Louis study. Researchers used VA’s health care database to compare health outcomes of nearly 444,000 Veterans who had COVID-19 once, nearly 41,000 who had it two or more times, and over 5 million who never had it. They found that those who had multiple COVID-19 infections were at higher risk of death and hospitalization than those who only had COVID-19 once. They were also at higher risk for a variety of health problems, including lung and heart problems, diabetes, and mental health disorders. The risk was highest when people were first sick, but many still had elevated risk six months later. Risk of death and health problems increased with the number of infections. The results show that strategies are needed to prevent COVID-19 reinfection to protect against additional health risks, say the researchers. (Nature Medicine, Nov. 10, 2022)
Clinical Trials
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.
A pilot randomized controlled trial of supervised, at-home, self-administered transcutaneous auricular vagus nerve stimulation (taVNS) to manage long COVID symptoms. Badran BW, Huffman SM, Dancy M, Austelle CW, Bikson M, Kautz SA, George MS. Supervised, self-administered stimulation of the vagus nerve to relieve mental fatigue symptoms related to long COVID is safe and feasible. Larger studies can safely investigate the effectiveness of this treatment. Bioelectron Med. 2022 Aug 25;8(1):13.
Randomized trial on metformin, ivermectin, and fluvoxamine for Covid-19. Bramante CT, Huling JD, Tignanelli CJ, Buse JB, Liebovitz DM, Nicklas JM, Cohen K et al. Metformin, ivermectin, and fluvoxamine did not prevent low blood oxygen, emergency department visits, hospitalizations, or death associated with COVID-19. N Engl J Med. 2022 Aug 18;387(7):599-610.
Baricitinib versus dexamethasone for adults hospitalised with COVID-19 (ACTT-4): a randomized, double-blind placebo-controlled trial. Wolfe CR, Tomashek KM, Patterson TF, Gomez CA, Marconi VA, Jain MK, Yang OO et al. In hospitalized patients with COVID-19 requiring supplemental oxygen, baricitinib plus remdesivir and dexamethasone plus remdesivir resulted in similar mechanical ventilation-free survival by day 29, but dexamethasone was associated with significantly more adverse events. Lancet Respir Med. 2022 May 23. Online ahead of print.
Laboratory Studies
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.
Inflammatory and mental health sequelae of COVID-19 . Loftis JM, Firsick E, Shirley K, Adkins JL, Le-Cook A, Sano E, Hudson R, Moorman J. People with COVID-19 tested worse on a measure of anxiety and depression compared with uninfected people. Changes in neuropsychiatric symptom severity were accompanied by alterations in immune factors and higher biomarkers of inflammation. Compr Psychoneuroendocrinol. 2023 May 18. Online ahead of print.
Maternal transfer of IgA and IgG SARS-CoV-2 specific antibodies transplacentally and via breast milk feeding. Sajadi MM, Shokatpour N, Purcell M, Tehrani ZR, Lankford A, Bathula A, Campbell JD et al. Vaccination of mothers after childbirth followed by breastfeeding appears to be the best way to provide SARS-CoV-2 antibodies to infants. PLoS One. 2023 Apr 6;18(4):e0284020.
Synergistic detrimental effects of cigarette smoke, alcohol, and SARS-CoV-2 in COPD bronchial epithelial cells. Muralidharan A, Bauer CD, Katafiasz DM, Strah HM, Siddique A, Reid SP, Bailey KL, Wyatt TA. With pre-existing chronic obstructive pulmonary disease, short exposure to alcohol or cigarette smoke is sufficient to exacerbate COVID-19 infection and associated injury, impairing lung defenses. Pathogens. 2023 Mar 22;12(3):498.
Serum neutralizing antibody titers 12 months after coronavirus disease 2019 messenger RNA vaccination: Correlation to clinical variables in an adult, US population. Zhao M, Slotkin R, Sheth AH, Pischel L, Kyriakides TC, Emu B, McNamara C et al. Multiple clinical factors affect the strength and duration of primary series vaccination, but not post-booster dose strength. Malignancy was associated with lower booster-dose response regardless of prior COVID-19 infection. Clin Infect Dis. 2023 Feb 8;76(3):e391-e399.
Data Analysis/Review
Adverse outcomes of SARS-CoV-2 infection with delta and omicron variants in vaccinated versus unvaccinated US veterans: Retrospective cohort study . Hohnert AS ,Kumbier K, Rowneki M, Gupta A, Bajema K, Hynes DM, Viglianti E et al. In Veterans with high health care use and high occurrence of multi-morbidity, vaccination was robustly associated with lower odds of 30-day morbidity and mortality compared with no vaccination among patients infected with COVID-19. The vaccination type and number of doses had a significant association with outcomes. BMJ. 2023 May 23;381:e074521.
Excess mortality among patients in the Veterans Affairs health system compared with the overall US population during the first year of the COVID-19 pandemic . Weinberger DM, Rose L, Rentsch C, Asch SM, Columbo JA, King J Jr et al. Active users of the VA health system had similar relative increases in mortality compared with the general U.S. population during the first 10 months of the COVID-19 pandemic. JAMA Netw Open. 2023 May 1;6(5):e2312140.
Mortality among US Veterans admitted to community vs Veterans Health Administration hospitals for COVID-19 . Ohl ME, Richardson Miell K, Becks BF, Mecham B, Bailey G, Mengeling M, Vaughan-Sarrazin M. Among VA health care enrollees, most older Veterans hospitalized for COVID-19 were in community hospitals, and Veterans experienced higher mortality in community hospitals than in VA hospitals. JAMA Netw Open. 2023 May 1;6(5):e2315902.
Hospital catchment areas characteristics and geographic regions associated with higher COVID-19 Veterans Health Administration hospitalization during the Omicron surge. Wong MS, Frochen S, Steers WN, Washington DL. Within VA’s health care system, areas serving a larger high-risk patient population had more Omicron-related hospitalizations, while areas with more fully vaccinated and boosted patients and new VHA users had lower hospitalizations. J Public Health Manag Pract. 2023 April 27. Online ahead of print.
Molnupiravir and risk of post-acute sequelae of COVID-19: Cohort study . Xie Y, Choi T, Al-Aly Z. In people with SARS-CoV-2 infection and at least one risk factor for progression to severe COVID-19, molnupiravir use within five days of infection was associated with reduced risk of post-acute symptoms in people who had and had not received a vaccine and in those with a first infection or reinfection. BMJ. 2023 Apr 25;381:e074572.
Other Research
COVID-19 and lifetime experiences of trauma, moral injury, and institutional betrayal among healthcare providers . DeBeer BB, Mignogna J, Nance M, Bahraini N, Penzenik M, Brenner LA. Findings indicate that trauma exposure was a work hazard for health care providers during the pandemic, which could result in negative long-term mental health outcomes. J Occup Environ Med. 2023 May 24. Online ahead of print.
Factors related to COVID-19 vaccine hesitancy among middle-income and low-income adults in the USA. Nguyen VT, Huang Y, Huang M, Tsai J. In an online survey, the three main vaccine concerns were side effects, safety, and mistrust of vaccine distribution. Factors influencing vaccine acceptance included age, education, children, region, mental health and social support, threat perception, opinion of governmental response, risk exposure and prevention activities, and rejecting COVID-19 vaccine concerns. J Epidemiol Community Health. 2023 Mar 8. Online ahead of print.
Moral injury and psychosocial functioning in health care workers during the COVID-19 pandemic. Weber MC, Smith AJ, Jones RT, Holmes GA, Johnson AL, Patrick RNC, Alexander MD et al. Moral injury is prevalent and impairing for health care workers, which establishes a need for interventions with health care workers in organized settings. Psychol Serv. 2023 Feb;20(1):19-29.
The impact of the COVID-19 pandemic on eating disorders in U.S. military Veterans. Mitchell KS, Smith BN, Masheb R, Vogt D. Early pandemic mental health symptoms were associated with changes in Veterans’ eating disorder diagnoses one year later. Mental health symptoms increased eating disorder diagnoses via their impact on social and health satisfaction, as well as physical health impacts of the pandemic. Int J Eat Disord. 2023 Jan;56(1):108-117.
Airflow patterns in double-occupancy patient rooms may contribute to roommate-to-roommate transmission of severe acute respiratory syndrome coronavirus 2. Cadnum LJ, Jencson AL, Alhmidi H, Zabarsky TF, Donskey CJ. Airflow patterns in double-occupancy patient rooms may contribute to risk for COVID-19 transmission between roommates. Keeping curtains closed between beds may be beneficial in reducing risk. Clin Infect Dis. 2022 Dec 19;75(12):2128-2134.
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
Former Navy Surgeon General wants Veterans to know that vaccines are safe and effective for most
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.