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VA research during the COVID-19 pandemic

VA COVID-19 research volunteer list

As one of the nation's leaders in health research, VA is working to find ways to prevent and treat the coronavirus disease (COVID-19). Visit the website of VA's COVID-19 research volunteer list to learn how you can be part of these efforts and what to expect if you volunteer.

Photo: ©iStock/licsiren

Photo: ©iStock/licsiren

Photo: ©iStock/licsiren

Overview

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 focused on establishing and taking part in clinical trials and data analysis projects aimed at understanding and treating the disease. VA Research has coordinated closely with internal VA and external partners—such as 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.

Rapid mobilization, innovative approaches


VA Research has taken these actions while working to ensure and promote the safety and well-being of all those involved in research. The program has also been enabling continuity of operations to the extent possible across the entire VA research portfolio, all of which is aimed at improving Veterans’ lives. 

On this web page, we summarize key COVID-19 research activities currently underway across the VA system, and provide background information on how the VA Office of Research and Development has rapidly mobilized the nationwide VA research community and resources to contribute to the national response to the pandemic. The information below is current as of August 18, 2020, and will be updated regularly.

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Active research

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Below are examples of COVID-19 research underway in VA.

Clinical trials

As of August 2020, some 50 VA medical centers are participating in clinical trials for COVID-19. Below are several examples.

  • Testing prostate cancer drug—VA is funding a phase 2 clinical trial exploring whether degarelix, an androgen suppressor treatment used in prostate cancer, may be effective for men with COVID-19.
  • VA CURES—The wide-reaching “VA CURES” master protocol,  launching in August 2020, will enable a series of clinical trials across VA, the first one involving some 700 Veterans who are hospitalized for COVID-19. The study will examine the effects of convalescent plasma. VA CURES stands for “Coronavirus Research and Efficacy Studies.” The initiative aims to give Veterans faster access to potential COVID-19 treatments and to test their effectiveness. As a master protocol, VA CURES will offer a standardized framework for studies on many potential treatments for COVID-19, without the need for a new study design and protocol each time.
  • VA is part of two major national research initiatives on COVID-19 vaccines and therapeutics: Operation Warp Speed (OWS) and the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) initiative.
    • As of mid-August 2020, a number of VAMCs are preparing to become activated as “vanguard sites” in ACTIV-3, a trial of a monoclonal antibody.
    • One VAMC is set to take part in an OWS vaccine trial.
    • Additional VA sites are being recruited for other OWS and ACTIV trials.
  • Trials with industry—VA is taking part in a number of industry-sponsored studies of promising medications for COVID-19. These include, for example, studies of the drug tocilizumab with Hoffman-La Roche, and sarilumab with Regeneron. Both drugs are used in arthritis care and block an inflammatory protein known as IL-6.
  • Remdesivir trial with NIH—VA sites have been taking part in a randomized, placebo-controlled study of remdesivir and other medications for hospitalized patients with COVID-19, sponsored by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.

Observational studies

  • Natural history study—VA is collaborating with the Department of Defense on an observational, natural history study of COVID-19 illness titled “Epidemiology, Immunology and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential” (EPICC-EID). Researchers will collect data and biospecimens from volunteers for up to two years to better understand the clinical course of COVID-19.

Data analysis projects

  • COVID-19 Insights Partnership—VA is a key partner in the COVID-19 Insights Partnership, along with the departments of Energy (DOE) and Health and Human Services (HHS). The initiative aims to coordinate and share health data as well as research and expertise to aid in the fight against COVID-19.The Partnership creates a framework for VA and HHS to use DOE’s world-leading high-performance computing and artificial intelligence resources to conduct COVID-19 research and analyze health data.
  • Million Veteran Program—VA’s Million Veteran Program (MVP) has deployed a COVID-19 questionnaire to participants to collect information about their experience with COVID-19. In addition, MVP has prioritized a series of research questions to examine the genetic basis of infection by SARS CoV-2; complications of infection; disease severity and outcomes; and response to various medications. MVP will also seek to identify disease mechanisms and new treatment targets for COVID-19. Given MVP’s racially and ethnically diverse participant population (~ 20% African American and 7% Hispanic), the influence of race and ethnicity on disease susceptibility, severity, and outcomes will be an integral part of the analyses.
  • Synthesizing evidence from publications— Researchers from VA’s Evidence Synthesis Program are working with the World Health Organization and the VA RAPID/biosurveillance group to help synthesize publications about the novel coronavirus and COVID-19, and to translate that information into usable guidance for clinicians. Recent ESP rapid reports in this area include: “Risk of Transmitting COVID-19 During Nebulizer Treatment”; “Intensive Care Unit Length of Stay and Ventilation Days”; and “Corticosteroid Therapy & ARDS for COVID-19 Infection.” More are in the works. These reports can be found at covid19reviews.org.
  • International collaboration—Researchers with the VA Informatics and Computing Infrastructure team are participating in the Observational Health Data Sciences and Informatics (or OHDSI, pronounced "Odyssey") program, an international, interdisciplinary collaborative to maximize the value of health data through large-scale analytics.
  • Examining off-label use of existing approved drugs— Drugs that are already FDA-approved for other health conditions are being used to treat COVID-19. VA Research is contributing to the understanding of whether these drugs are safe and useful by helping to track data on prescriptions, side effects, and outcomes; and working with VHA Public Health Surveillance and Research and Pharmacy Benefits Management on longitudinal tracking of data on COVID-19 patients, including those prescribed off-label drugs. 
  • Dementia patients—VA researchers in Providence have funding from the National Institute on Aging to study COVID-19 risk factors and outcomes among Veterans with dementia who live in VA community living centers.

Other research activities

  • Facilitating access to investigational drugs under the FDA’s expanded access, or “compassionate use,” program—VA Research has streamlined and organized a central assistance process for VA medical centers seeking expanded access (a.k.a. compassionate use) under FDA rules to investigational drugs for COVID-19 treatments. One treatment being used under this program is transfusions of blood plasma from patients who have recovered from COVID-19. This “convalescent” plasma contains antibodies that researchers believe may help other patients. As of mid-August 2020, some 80 VA sites have treated more than 500 Veterans with convalescent plasma as part of the Mayo Clinic’s “expanded access” study of this therapy for COVID-19.
  • COVID-19 and mental health—In addition to studying how to prevent or treat COVID-19, VA is examining the mental health impact of the pandemic. As of mid-August 2020, VA had funded 18 studies looking at mental health and COVID-19. Some are new projects focused wholly on COVID-19, whereas others are supplements to existing projects that are broader in scope. The following study titles indicate some of the themes being explored:
    • Inflammatory and Mental Health Sequelae of COVID-19 in Veterans
    • An Integrative Technology Approach to Home-Based Conjoint Therapy for PTSD  
    • Impact of COVID-19 On Mental Health, Relationship Functioning and VA Telemental Health Service Use in a Longitudinal Cohort Study    
    • Impact of COVID-19 and Social Distancing on Mental Health and Suicide Risk in Veterans
    • Piloting a Self-Help Intervention to Improve Veteran Mental Health During the COVID-19 Pandemic
    • Mixed-Methods Pilot Study of the Impacts of Telemental Healthcare for High-Risk Veterans with Opioid Use Disorder During COVID-19
    • Adapting Caring Contacts to Counteract Adverse Effects of Social Distancing among High-Risk Veterans During the COVID-19 Pandemic
    • Virtual Pain Care for High-Risk Veterans on Opioids During COVID-19 (and Beyond)
    • Changes in the Delivery of Evidenced-Based Psychotherapies for Depression and PTSD as the Result of the COVID-19 Pandemic
    • Impacts of COVID-19 on African American Veterans with Chronic Pain
  • Biomedical studies—VA biomedical researchers are part of the fight against COVID-19. The following project titles illustrate the scope of the VA lab studies being conducted to better understand how the virus works, and to identify new ways to keep it from spreading and causing disease.
    • 3D-Printed Respirator Mask Performance with and without Virus Inactivation 
    • A Safe Validation to Test the Efficacy of Disinfectants on Reusable 3D-Printed Face Masks During the COVID-19 Pandemic 
    • Leukocyte Rewiring as a Mechanism of COVID-19-ARDS 
    • Viral and Immune Dynamics of Sars-Cov-2 Infection in Moderate and Severe COVID-
    • Predictive Immune and Airway Monitoring in Healthcare Workers and Hospitalized COVID-19 Patients 
  • Boosting the VA supply chain—Rehabilitation researchers are helping to build a more resilient supply chain for VA. Researchers from several centers are involved, such as the Human Engineering Research Laboratories (HERL) in Pittsburgh; the Center for Limb Loss and Mobility at the Puget Sound VA; the Minneapolis Adaptive Design and Engineering Program; and the Advanced Platform Technology Center in Cleveland. Partners in this effort include the VA Innovation Ecosystem, the U.S. Food and Drug Administration, the National Institutes of Health, and America Makes. These researchers and their colleagues have been designing, fabricating, and evaluating personal protective equipment (PPE) and other supplies to support VA’s response to this pandemic, such as masks, face shields, desk shields, nasal testing swabs. In many cases, 3D printing is involved.

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Selected Scientific Articles by VA Researchers

Laboratory Studies

Platelet gene expression and function in patients with COVID-19. Manne BK, Denorme F, Middleton EA, Portier I, Rowley JW, Stubben C, Petrey AC, Tolley ND, Guo L, Cody M, Weyrich AS, Yost CC, Rondina MT, Compbell RA. Patients infected with SARS-CoV-2 show altered platelet gene expression and functional responses. Blood. 2020 Sep 10;136(11):1317-1329.

Neutrophil extracellular traps contribute to immunothrombosis in COVID-19 acute respiratory distress syndrome. Middleton EA, et al. Researchers explored how substances called neutrophil extracellular traps are involved in the clinical presentation of COVID-19, and show that these substances may represent targets for new treatments. Blood. 2020 Sep 3;136(10):1169-1179.

Inactivation of SARS-CoV-2 and diverse RNA and DNA viruses on 3D printed surgical mask materials. Welch JL, Xiang J, Mackin SR, Perlman S, Thorne P, O’Shaughnessy P, Strzelecki B, Aubin P, Ortiz-Hernandez M, Stapleton JT. Several decontamination approaches effectively disinfect 3D-printed mask material. Infect Control Hosp Epidemiol. 2020 Aug 12:1-26.

Characterization of heparin and severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) spike glycoprotein binding interactions. Kim SY, Jin W, Sood A, Montgomery DW, Grant OC, Fuster MM, Fu L, Dordick JS, Woods RJ, Zhang F, Linhardt RJ. This article provides the groundwork for biological evaluation and design of glycosaminoglycan-based COVID-19 therapeutics. Antiviral Res. 2020 Jul 9;181:104873.

Evaluation of an electrostatic spray disinfectant technology for rapid decontamination of portable equipment and large open areas in the era of SARS-CoV-2. Cadnum JL, Jencson AL, Livingston SH, Li DF, Redmond SN, Pearlmutter B, Wilson BM, Donskey CJ. Wheelchairs, portable equipment, and waiting room chairs are frequently contaminated with potential pathogens. Application of a dilute sodium hypochlorite disinfectant using an electrostatic sprayer provided rapid and effective decontamination and eliminated the benign virus bacteriophage MS2 from inoculate surfaces. Am J Infect Control. 2020 Jun 6. Online ahead of print.

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Identification of potential natural inhibitors of SARS-CoV2 main protease by molecular docking and simulation studies. Gupta S, Singh AK, Kushwaha PP, Prajapati KS, Shuaib M, Senapti S, Kumar S. A protein was identified that may be an effective drug target for future COVID-19 treatments. J Biomol Struct Dyn. 2020 Jun 1:1-12. Online ahead of print.

Evaluation of ultraviolet-C light for rapid decontamination of airport security bins in the era of SARS-CoV-2. Cadnum JL, Li DF, Jones LD, Redmond SN, Pearlmutter B, Wilson BM, Donskey CJ. UV-C light administered in proximity to a plastic bin reduced contamination. Pathog Immun. 2020 May 22;5(1):133-142.

TMPRSS2 and TMPRSS4 promote SARS-CoV-2 infection of human small intestinal enterocytes. Zang R, Gomez Castro MF, McCune BT, Zeng Q, Rothlauf PW, Sonnek NM, Liu Z, Brulois KF, Wang X, Greenberg HB, Diamond MS, Ciorba MA, Whelan SPJ, Ding S. The intestine is a potential site of SARS-CoV-2 replication, which may contribute to local and systemic illness and overall disease progression. Sci Immunol. 2020 May 13;5(47):eabc3582.

Data Analysis/Review

Geographic variation of racial disparities in health and COVID-19 mortality. Parcha V, Malla G, Suri SS, Kalra R, Heindl B, Berra L, Fouad MN, Arora G, Arora P. Racial disparities in COVID-19 are largely driven by higher cumulative incidence of infection in Black patients. There is a discordance between the geographic dispersion of COVID-19 mortality and the regional distribution of health factors. Mayo Clin Proc Innov Qual Outcomes. 2020 Oct 6. Online ahead of print.

Temperature screening for SARS-CoV-2 in nursing homes: Evidence from two national cohorts. McConeghy KW, White E, Panagiotou OA, Santostefano C, Halladay C, Feifer RA, Blackman C, Rudolph JL, Mor V, Gravenstein S. A definition of 38.0°C for fever in nursing home screening tools should be lowered to improve predictive accuracy for SARS-CoV-2 infection. J AM Geriatr Soc. 2020 Oct 9. Online ahead of print.

The ten reasons why corticosteroid therapy reduces mortality in sever COVID-19. Arabi YM, chrousos GP, Meduri GU. This article summarizes the current understanding of the effect of corticosteroid therapy in severe COVID-19, which appears to reduce mortality. Intensive Care Med. 2020 Oct 7;1-4.

Long-term hydroxychloroquine use in patients with rheumatic conditions and development of SARS-CoV-2 infection: A retrospective cohort study. Gentry CA, Humphrey MB, Thind SK, Hendrickson SC, Kurdgelashvili G, Williams RJ 2nd. Hydroxychloroquine was not associated with a preventive effect against SARS-CoV-2 infection in a large group of patients with rheumatological conditions. Lancet Rheumatol. 202 0Sep 21. Online ahead of print.

Seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among VA healthcare system employees suggests higher risk of infection when exposed to SARS-CoV-2 outside of the work environment. Dimcheff DE, Schildhouse RJ, Hausman MS, Vincent BM, Markovitz E, Chensue SW, Deng J, McLeod M, Hagan D, Russel J, Bradley SF. Prevalence of SARS-CoV-2 among VA employees was not significantly different among those who provided direct patient care and those who did not. Employees who reported direct personal contact with COVID-19-positive persons outside of work were more likely to have virus antibodies. Infect Control Hosp Epidemiol. 2020 Sep 23:1-25.

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Patterns of COVID-19 testing and mortality by race and ethnicity among United States Veterans: A nationwide cohort study. Rentsch CT, Kidwai-Khan F, Tate JP, Park LS, King JT Jr, Skanderson M, Hauser RG, Schultze A, Jarvis CI, Holodniy M, Lo Re V 3rd, Akgün KM, Crothers K, Taddei TH, Freiberg MS, Justice AC. Black and Hispanic individuals are experiencing excess burden of SARS-CoV-2 infection not entirely explained by underlying medical conditions or where they live and receive care. PLoS Med. 2020 Sep 22;17(9):e1003379.

Utility of repeat nasopharyngeal SARS-CoV-2 RT-PCR testing and refinement of diagnostic stewardship strategies at a tertiary care academic center in a low-prevalence area of the United States. Lepak AJ, Chen DJ, Buys A, Stevens L, Safdar N. Repeat inpatient testing after initial negative COVID-19 result with the RT-PCR test failed to demonstrate negative-to-positive conversion, suggesting that sensitivity of the test may be higher than previously believed. Open Forum Infect Dis. 202 0Aug 27;8(9):ofaa388.

Endocrine significance of SARS-CoV-2’s reliance on ACE2. Lazartigues E, Qadir MMF, Mauvais-Jarvis F. This review discusses the rapidly evolving knowledge of the potential role of the ACE2 enzyme and coronaviruses in the development of diabetes, hypogonadism, and pituitary and thyroid diseases. Endocrinology. 2020 Sep 1;161(9): bqaa108.

Angiotensin converting enzyme inhibitor and angiotensin II receptor blocker use among outpatients diagnoses with COVID-19. Bae DJ, Tehrani DM, Rabadia SV, Frost M, Parikh RV, Calfon=Press M, Aksoy O, Umar S, Ardehali R, Rabbani A, Bokhoor P, Nsair A, Currier J, Tobis J, Fonarow GC, Dave R, Rafique AM. Among patients diagnosed with COVID-19, ACE inhibitor/ARB use for high blood pressure was not associated with increased risk of hospital admission. Am J Cardiol. 2020 Jul 12. Online ahead of print.

Income disparities in access to critical care services. Kanter GP, Segal AG, Groeneveld PW. A large gap exists in access to ICU beds based on income: 49% of the lowest-income communities had no ICU beds, whereas only 3% of the highest-income communities had no ICU beds. Health Aff (Millwood). 2020 Aug;39(8):1362-1367.

A case for targeting Th17 cells and IL-17A in SARS-CoV-2. Orlov M, Wander PL, Morrell ED, Mikacenic C, Wurfel MM. This review describes evidence linking risk factors for critical illness in COVID-19 with increased Th17 cell activation and IL-17 signaling that may lead to increased likelihood for lung injury and respiratory failure. J Immunol. 2020 Aug 15;205(4):892-898.

AGA Institute rapid review of the gastrointestinal and liver manifestations of COVID-19, meta-analysis of international data, and recommendations for the consultative management of patients with COVID-19. Sultan S, Altayar O, Siddique SM, Davitkov P, Feuerestein JD, Lim JK, Falck-Ytter Y, El-Serag HB; AGA Institute. Gastrointestinal symptoms are associated with COVID-19 in less than 10% of patients. Further studies are needed to standardize GI symptom questionnaires and liver function tests on admission for COVID-19. Gastroenterology. 2020 Jul;159(1):320-334.

Characteristics and quality of US nursing home reporting cases of coronavirus disease 2019 (COVID-19). Chatterjee P, Kelly S, Qi M, Warner RM. Rates of failure to meet or allegations of noncompliance with federal requirements were higher in nursing homes that reported COVID-19 cases. JAMA Netw Open. 2020 Jul 1;3(7):e2016930.

Decontamination methods for reuse of filtering facepiece respirators. Su-Velez BM, Maxim T, Long JL, St John MA, Holliday MA. UV light, steam, low-dry heat, and commercial sterilization methods with ethylene oxide or vaporized hydrogen peroxide appear to be viable options for successful decontamination of N95 masks. JAMA Otolaryngol Hed Neck Surg. 2020 Jul 2. Online ahead of print.

COVID-19, mast cells, cytokine storm, psychological stress, and neuroinflammation. Kempuraj D, Selvakumar GP, Ahmed ME, Raikwar SP, Thangavel R, Khan A, Zaheer SA, Iver SS, Burton C, James D, Zaheer A. COVID-19 can induce mast cell activation, psychological stress, cytokine storm, and neuroinflammation. Neuroscientist. 2020 Jul 10. Online ahead of print.

Investigation of nosocomial SARS-CoV-2 transmission from two patients to health care workers identifies close contact but not airborne transmission events. Bays DJ, Nguyen MH, Cohen SH, Waldman S, Martin CS, Thompson GR, Sandrock C, Tourtellotte J, Pugashetti JV, Phan C, Nguyen HH, Warner GY, Penn BH. At least in a health care setting, a majority of SARS-CoV-2 transmission is likely to take place during close contact with infected patients through respiratory droplets, rather than by long-distance airborne transmission. Infect Control Hosp Epidemiol. 2020 Jul 3:1-22.

Use of baricitinib in patients with moderate and severe COVID-19. Titanji BK, Farley MM, Mehta A, Connor-Schuler R, Moanna A, Cribbs SK, O’Shea J, DeSilva K, Chan B, Edwards A, Gavegnano C, Schinazi RF, Marconi VC. In a small uncontrolled cohort of patients with moderate-severe COVID-19, treatment with baricitinib plus hydroxychloroquine was associated with recovery. Clin Infect Dis. 2020 Jun 29. Online ahead of print.

Review of viral testing (polymerase chain reaction) and antibody/serology testing for severe acute respiratory syndrome-coronavirus-2 for the intensivist. Motley MP, Bennett-Guerrero, Fries BC, Spitzer ED. This review details the strengths and weaknesses of various testing methods for the SARS-CoV-2 virus. Crit Care Explor. 2020 Jun 15;2(6):e0154.

Clinical outcomes in COVID-19 patients treated with tocilizumab: An individual patient data systematic review. Antwi-Amoabeng D, Kanji Z, Ford B, Beutler BD, Riddle MS, Siddiqui F. Following tocilizumab treatment in COVID-19 patients, interleukin-6 levels elevate and C-reactive protein levels dramatically decrease, suggestion an improvement in the hyperinflammatory state. J Med Virol. 2020 May 21. Online ahead of print.

Differences in race and other state-level characteristics and associations with mortality from COVID-19 infection. Sehra ST, Fundin S, Lavery C, Baker JF. States with a greater proportion of African American residents report a higher death rate from COVID-19 despite adjusting for case rates and state-level factors. J Med Virol. 2020 May 30. Online ahead of print.

Survival after in-hospital cardiac arrest in critically ill patients: Implication for Covid-19 outbreak? Girotra S, Tang Y, Chan PS, Nallamothu BK. In a cohort of critically ill patients on mechanical ventilation, survival outcomes following in-hospital resuscitation were not uniformly poor. Circ Cardiovasc Qual Outcomes. 2020 Jul;13(7):e006837.

AGA Institute rapid review of the GI and liver manifestations of COVID-19, meta-analysis of international data, and recommendations for the consultative management of patients with COVID-19. Sultan S, Altayar O, Siddique SM, Davitkoy P, Feuerstein JD, Lim JK, Falck-Ytter Y, El-Serag HB. Gastrointestinal symptoms are associated with COVID-19 in less than 10% of patients. Further studies are needed with standardized GI symptoms questionnaires. Gastroenterology. 2020 Jul;159(1):320-334.

Systematic review and meta-analysis on the value of chest CT in the diagnosis of coronavirus disease (COVID-19): Sol Scientiae, Illustra Nos. Adams HJA, Kwee TC, Yakar D, Hope MD, Kwee RM. Chest CT scans have relatively high sensitivity to infections in patients with COVID-19 symptoms, but studies on the testing suffer from quality issues. AJR Am J Roentgenol. 2020 Jun 1;1-9. Online ahead of print.

Chloroquine and hydroxychloroquine in the context of COVID-19. Shukla AM, Archibald LK, Shukla AW, Mehta HJ, Cherabuddi K. Pending the availability of confirmatory studies, the use of chloroquine and hydroxychloroquine in COVID-19 should be viewed as experimental at this stage, and it should adhere to local, regional, or national ethics and research guidelines. Drugs Context. 2020 Apr 28;9:2020-4-5.

Other Research

Successful transfer of anti-SARS-CoV-2 immunity using convalescent plasma in an MM patient with hypogammaglobulinemia and COVID-19. Luetkens T, Metcalf R Planelles V, Zheng Y, Larragoite ET, Spivak ES, Spivak AM, Steinbach M, Blaylock RC, Avila SV, Hankey KG, Martins TB, Slev PR, Mannuel HD, Sajadi M, Rapoport AP, Atanackovic D. A severely immunocompromised patient with multiple myeloma and COVID-19 who received a convalescent plasma product showed SARS-CoV-2 clearance. Convalescent plasma immunity against SARS-Co-V-2 proteins was successfully transferred to the patient. Blood Adv. 2020 Oct 12;4(19):4864-4868.

A rapid mobilization of ‘virtual’ primary care services in response to COVID-19 at Veterans Health Administration. Reddy A, Gunnink E, Deeds SA, Hagan SL, Heyworth L, Mattras TF, Nelson KM. VHA has rapidly expanded virtual health care visits in response to COVID-19, primarily by accelerating use of telephone visits. Healthc (Amst). 2020 Dec; 8(4):100464.

Modeling suicide risk among parents during the COVID-19 pandemic: Psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide. Crasta D, Daks JS, Rogge RD. The findings highlight the value of targeting psychological inflexibility as an important strategy to reduce suicide risk during the COVID-19 pandemic. J Contextual Behav Sci. 2020 Sep 8. Online ahead of print.

Suddenly becoming a ‘virtual doctor’: Experiences of psychiatrists transitioning to telemedicine during the COVID-19 pandemic. Uscher-Pines L, Sousa J, Raja P, Mehrotra A, Barnett ML, Huskamp HA. The COVID-19 pandemic has driven a dramatic shift in how psychiatrists deliver care. Although there are some concerns about quality of care, the transition has been largely positive for both patients and physicians. Psychiatr Serv. 2020 Sep 16. Online ahead of print.

Assessing COVID-19 transmission to healthcare personnel: The global ACT-HCP case-control study. Lentz RJ, Colt H, Chen H, Cordovilla R, Popevic S, Tahura S, Candoli P, Tomassetti S, Meachery GJ, Cohen BP, Harris BD, Talbot TR, Maldonado F. COVID-10 transmission to health care providers was associated with medical exposures currently considered lower-risk and exposures outside work. Exposures associated with proper use of appropriate personal protective equipment were protective. Infect Control Hosp Epidemiol. 2020 Sep 9;1-22.

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The impact of COVID-19 on access to Parkinson’s disease medication. Cheong JL, Goh ZH, Marras C, Tanner CM, Kasten M, Noice AJ. Access to Parkinson’s diseases medication is likely to have been affected by COVID-19 and result in deterioration of patients’ symptomatic control. Move Disord. 2020 Aug 28. Online ahead of print.

The COVID-19 telepsychology revolution: A national study of pandemic-based changes in U.S. mental health care delivery. Pierce BS, Perrin PB, Tyler CM, McKee GB, Watson JD. Although there has been a remarkable increase in telepsychology use during the COVID-19  pandemic, individual and practice characteristics affect psychologists’ ability to adopt telepsychology. Am Psychol. 2020 Aug 20. Online ahead of print.

When to rule out COVID-19: How many negative RT-PCR tests are needed? Isikbay M, Henry TS, Frank JA, Hope MD. This case study presents a framework for how to weigh repeatedly negative test results in clinical decision-making when there is ongoing concern for COVID-19. Respir Med Care Rep. 2020 Aug 18. Online ahead of print.

A SARS-CoV-2 prediction model from standard laboratory tests. Bayat V, Phelps S, Ryono R, Lee C, Parekh H, Mewton J, Sedghi F, Etminani P, Holodniy M. A machine-learning model was able to predict the results of SARS-CoV-2 tests with 86% accuracy from standard laboratory results. Clin Infect Dis. 2020 Aug 12. Online ahead of print.

A model for treating COVID-19-related guilt, shame, and moral injury. Haller M, Norman SB, Davis BC, Capone C, Browne K, Allard CB. Trauma-informed guilt reduction therapy is a brief intervention that helps people accurately appraise their role in a stressful event, such as those experienced during the COVID-19 pandemic, and find positive ways to express important values going forward. Psychol Trauma. 2020 Aug;12(S1):S174-S176.

Reinventing palliative care delivery in the era of COVID-19: How telemedicine can support end of life care. Ritchey KC, Foy A, McArdel E, Gruenewald DA. The work identified the need for system innovation in palliative care and a quality improvement approach to structure telemedicine palliative care. Information gleaned from a patient’s family in a case study helped bedside staff to tailor care toward aspects meaningful to the patient. Am J Hosp Palliat Care. 2020 Nov;37(11):992-997.

Is increased sleep responsible for reductions in myocardial infarction during the COVID-19 pandemic? Advani I, Gunge D, Banks S, Mehta S, Park K, Patel M, Malhotra A, Crotty Alexander LE. Changes in subjects’ sleep patterns due to the pandemic led to longer sleep duration, which may impact the rates of heart attack. PLoS One. 2020 Jul 27;15(7):e0236554.

Automated EHR score to predict COVID-19 outcomes at US Department of Veterans Affairs. Osborne TF, Veigulis ZP, Arreola DM, Röösli E, Curtin CM. VA’s Care Assessment Need (CAN) score, an existing risk assessment tool, is well-positioned for broad use across the VA to enhance clinical decision-making about COVID-19. PLoS One. 2020 Jul 27;15(7):e0236554.

Coronavirus disease 2019 (COVID-19) catheterization laboratory survey. Banerjee S, Tarantini G, Abu-Fadel M, Banerjee A, Little BB, Sorajja P, Shishehbor MH, Brilakis ES. Invasive heart procedure rates have reduced significantly. There is near universal adoption of personal protective equipment; however, COVID-19 pretesting and access to N95 masks is suboptimal. J Am Heart Assoc. 2020 Aug 4;9(15):e017175.

National geriatric network rapidly addresses trainee telehealth needs in response to COVID-19. Nearing KA, Lum HD, Dang S, Powers B, McLaren J, Gately M, Hung W, Moo L. The Veterans Health Administration rapidly identified and responded to telehealth training needs of geriatrics trainees to optimize care for rural older adults as part of a rapid response to COVID-19. J AM Geriatr Soc. 2020 Jul 8. Online ahead of print.

Combating heightened social isolation of nursing home elders: The Telephone Outreach in the COVID-19 Outbreak program. Van Dyck LI, Wilkins KM, Ouellet J, Ouellet GM, Conroy ML. A telephone outreach program achieved initial success and promotes the social well-being of nursing home residents. Am J Geriatr Psychiatry. 2020 Jun 5;S1064-7481(20)30365-1.

Establishment of a COVID-19 recovery unit in a Veterans Affairs post-acute facility. Sohn L, Lysaght M, Schwartzman WA, Simon SR, Goetz MB, Yoshikawa T. Researchers report on a novel approach of utilizing long-term care beds at a VA health care facility for managing recovering COVID-19 patients. J AM Geriatr Soc. 2020 Jun 18. Online ahead of print.

Global impact of the COVID-19 pandemic on endoscopy: An international survey of 252 centers from 55 countries. Parasa S, Reddy N, Faigel DO, Repici A, Emura F, Sharma P. A substantial reduction in endoscopy procedures has been noted globally in light of the COVID-19 pandemic. Gastroenterology. 2020 June 11. Online ahead of print.

Veterans’ response to an automated text messaging protocol during the COVID-19 pandemic. Saleem JJ, Read JM, Loehr BM, Frisbee KL, Wilck NR, Murphy JJ, Vetter BM, Herout J. Veterans responded well to automated text messaging about COVID-19 from the VA app “Annie.” J Am Med Inform Assoc. 2020 May 29. Online ahead of print.

Commentary

Implementation of infection control measures to prevent healthcare-associated transmission of SARS-CoV-2. Lepak AJ, Shirley DK, Buys A, Stevens L, Safdar N. Adoption of the infection control bundle described may be helpful to prevent SARS-CoV-2 spread within health care institutions. Infect Control Hosp Epidemiol. 2020 Oct 12:1-13.

Aging veterans’ mental health and well-being in the context of COVID-19: The importance of social ties during physical distancing. Marini CM, Pless Kaiser A, Smith BN, Fiori KL. During the COVID-19 pandemic, aging Veterans may benefit from having an array of socially supportive network ties. Psychol Trauma. 2020 Aug;12(S1):S217-S219.

Financial strain and risk of suicide in the wake of the COVID-19 pandemic. Elbogen EB, Lanier M, Montgomery AE, Strickland S, Wagner HR, Tsai J. The current pandemic and the financial strains it causes foreshadow a spike in suicide in upcoming months and years. Am J Epidemiol. 2020 Jul 22. Online ahead of print.

Aging veterans’ mental health and well-being in the context of COVID-19: The importance of social ties during physical distancing. Marini CM, Pless Kaiser A, Smith BN, Fiori KL. During the COVID-19 pandemic, aging Veterans may benefit from having an array of socially supportive network ties. Psychol Trauma. 2020 Aug;12(S1):S217-S219.

Mental health ramifications of the COVID-19 pandemic for Black Americans: Clinical and research recommendations. Novacek DM, Hampton-Anderson JN, Ebor MT, Loeb TB, Wyatt GE. Race-conscious and culturally competent interventions that consider factors such as discrimination, distrust of health care providers, and historical and racial trauma as well as protective factors including social support and culturally sanctioned coping strategies are needed. Psychol Trauma. 2020 Jul;12(5):449-451.

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Mental health ramifications of the COVID-19 pandemic for Black Americans: Clinical and research recommendations. Novacek DM, Hampton-Anderson JN, Ebor MT, Loeb TB, Wyatt GE. Race-conscious and culturally competent interventions that consider factors such as discrimination, distrust of health care providers, and historical and racial trauma as well as protective factors including social support and culturally sanctioned coping strategies are needed. Psychol Trauma. 2020 Jul;12(5):449-451.

Toward nanotechnology-enabled approaches against the COVID-19 pandemic. Weiss C, Carriere M, Fusco L, Capua I, Regla-Nava JA, Pasquali M, Scott JA, Vitale F, Unal MA, Matteyi C, Bedognetti D, Tascotti E, Yilmazer A, Gogotsi Y, Stellacci F, Delogu LG. Nanotechnology is critical in counteracting COVID-19 and will be vital when preparing for future pandemics. ACS Nano. 2020 June 23;14(6):6383-6406.

Potential novel role of COVID-19 in Alzheimer’s disease and preventative mitigation strategies. Naughton SX, Raval U, Pasinetti GM. J Genetic and socioeconomic factors influencing the rates of Type 2 diabetes, Alzheimer’s disease, and COVID-19 severity may create an exceptionally high-risk profile for certain demographics. Alzheimers Dis. 2020;76(1):21-25.

Challenges in the interpretation and application of typical imaging features of COVID-19. Hammer MM, Raptis CA, Henry TS, Shah A, Bhalla S, Hope MD. CT remains a powerful diagnostic tool in the context of COVID-19 and should be used to trouble-shoot problematic cases. Lancet Respir Med. 2020 Jun;8(6):534-536.

Mitigating the effects of a pandemic: Facilitating improved nursing home care deliver through technology. Edelman LS, McConnell E, Kennerly SM, Alderden J, Horn SD, Yap TL. Investing in and adapting technology can help mitigate workforce stress and improve the quality of nursing home care during and after the COVID-19 pandemic. JMIR Nursing. 2020 May 26;3(1):e20110.

Flattening the curve by getting ahead of it: How the VA healthcare system is leveraging telehealth to provide continued access to care for rural Veterans. Myers US, Birks A, Grubaugh AL, Axon RN. The rapid expansion of telehealth in response to COVID-19 within VHA and subsequent refinements to the system can be used to more immediately improve the health and well-being of Veterans facing ongoing access to care barriers, such as those residing in rural areas. J Rural Health. 2020 Apr 13;10. Online ahead of print.

Preventing suicide in rural communities during the COVID-19 pandemic. Monteith LL, Holliday R, Brown TL, Brenner LA, Mohatt NV. Individuals in rural communities may be disproportionately impacted by the COVID-19 pandemic. Ensuring that rural communities are adequately equipped to prevent suicide while managing the spread and impact of COVID-19 is critical. J Rural Health. 2020 Apr 13;10. Online ahead of print.

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VA COVID-19 Research Volunteer List

Department of Veterans Affairs Public Health

Centers for Disease Control and Prevention

COVID-19 Reviews [maintained by VA ESP]



Infectious disease specialist consultation improves long-term <em>S. aureus</em> outcomes - Photo: ©iStock/South_agencyPhoto: ©iStock/South_agency

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.

Contributing to understanding COVID-19 and potential treatments

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:

  • Working with industry partners to include VA sites in clinical trials for new treatments. In one case, through a coordinated effort, VA was able to get a trial started in under a week—a dramatic reduction over the usual timeframe.

  • Coordinating with other federal agencies on national-scale studies on understanding the natural history of and treatments for COVID-19 or specimen collections from patients with COVID-19, to aid in vaccine and therapeutics development.

  • Facilitating expanded access (a.k.a. compassionate use) of investigational medications pending FDA approval. Efforts have included establishing a regulatory and pharmaceutical support team consisting of more than 80 VA research field staff for helping facilities obtain approvals for use of these medications.

  • Creating opportunities to rapidly fund VA investigators with meritorious research proposals on COVID-19.

  • Quickly evaluating research ideas proposed by VA scientists, in large part through a steering committee composed of leading VA experts in virology, infectious disease, and epidemiology.

  • Using data and informatics expertise to create common elements for harmonizing research and examining off-label use of approved medications.

  • Rapidly synthesizing evidence from the available scientific literature, and translating this evidence into usable guidance for clinicians in VA and beyond.

  • Coordinating the establishment of a central VA COVID-19 registry and biorepository.

Ensuring the safety and well-being of research personnel and study participants

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.

Enabling continuity of operations

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.

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