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VA research during the COVID-19 pandemic

COVID-19 FACT SHEET

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For VA investigators: Please check our funding page for news about new funding opportunities relating to COVID-19.

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 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.

News Briefs

Genetic links between severe COVID-19 and other diseases
A VA Million Veteran Program study identified genetic links between COVID-19 severity and certain serious medical conditions. Researchers analyzed genetic and health record data on more than 650,000 Veterans who volunteered for MVP. They compared gene variations previously found to be linked severe COVID-19 risk with gene variants connected to other conditions. The analysis showed that gene variants linked to severe COVID-19 are also linked to medical conditions known to be COVID-19 risk factors. The strongest links were found for venous embolism and thrombosis, as well as type 2 diabetes and ischemic heart disease. The study also showed genetic links between severe COVID-19 and neutropenia—low white blood cell count—in Veterans of African and Hispanic ancestry. This link was not seen in Veterans of European ancestry. Conversely, gene variants associated with severe COVID-19 were associated reduced risk of immune-related conditions such as lupus and rheumatoid arthritis. The findings shed light on genetic risk for COVID-19 and could lead to paths for new treatments, say the researchers. (PLOS Genetics, April 28, 2022)

Older and underweight Veterans at higher risk of death from COVID-19
Older and underweight Veterans had a higher risk of death from COVID-19, in a study by Salt Lake City VA researchers and colleagues. Researchers studied data on more than 400,000 Veterans who tested positive for COVID-19 in 2020 and 2021. Those 65 and older and those who were underweight were more likely to require mechanical ventilation and die in the hospital, compared with younger Veterans and those with normal weight. Veterans 85 and older had an almost five times greater rate of death. Asian and American Indian/Alaska Native Veterans also had higher risk of ventilation and death compared to white Veterans. Black Veterans had a 31% higher risk than white Veterans of hospitalization, but did not have a higher risk of death. Hospitalization, ventilation, and death rates decreased for all groups over time. The results show that age and weight are important variables to consider in COVID-19 risk, say the researchers. (Annals of Epidemiology, April 21, 2022)

Similar rates of moral injury in pandemic health care workers and combat Veterans
Potential for moral injury is as high for health care workers during the pandemic as it is for combat Veterans, according to a study by VA Durham researchers. Moral injury refers to feelings of guilt or shame when a person’s values or beliefs conflict with their actions or the way they see others acting. The researchers surveyed nearly 2,100 health care workers during the COVID-19 pandemic, along with more than 600 military Veterans who had deployed to combat zones. About 46% of Veterans and 51% of health care workers had potential moral injury related to the actions of others. Self-induced moral injury was seen in 24% of Veterans and 18% of health care workers. Moral injury was linked to higher depression symptoms and worse quality of life. Among health care workers, moral injury was tied to burnout. These feelings could stem from being unable to provide adequate care to dying patients and seeing others around them refuse to take steps to slow the spread of the virus, according to the researchers. Interventions related to moral injury in Veterans may be useful for health care workers in the aftermath of the COVID-19 pandemic, they say. (Journal of General Internal Medicine, April 5, 2022)

Video enabled tablets could decrease suicide in rural Veterans
Giving rural Veterans tablets for telehealth reduced suicidal behavior and increased mental health care use during the pandemic, found a VA Palo Alto study. Many fear that the COVID-19 pandemic has intensified suicide risk factors for people in rural areas. Researchers looked at mental health care use for more than 13,000 rural Veterans who were given video-enabled tablets. They compared this group to more than 458,000 Veterans who did not receive tablets. Those with tablets had an average increase of 1.8 in-person psychotherapy visits and 3.5 video visits per year. Tablets were linked to a 22% reduced likelihood of suicidal behavior. The tablet group had 20% lower odds an emergency department visit, and 36% lower odds of a suicide-related emergency room visit. The findings suggest that VA and other health systems should consider using tablets to increase access to mental health care via telehealth, say the researchers. (JAMA Network Open, April 1, 2022)

COVID-19 increases diabetes risk
COVID-19 increases the risk of developing diabetes, found a VA St. Louis study. Researchers studied data on more than 180,000 VA patients who had recovered from COVID-19. They compared these patients to over 4 million people who did not contract COVID-19 and over 4 million controls from before the pandemic. Those who had COVID-19 were at a 40% higher risk of being newly diagnosed with diabetes at least 30 days after infection, compared with controls. Odds of being prescribed medication for glycemic control were also increased. Diabetes risk was increased even in patients with mild COVID-19. More severe COVID-19 symptoms were linked to greater risk of developing diabetes. The results show that diabetes should be considered a facet of long COVID, and that strategies to address rising diabetes cases are needed, say the researcher. (Lancet Diabetes and Endocrinology, March 21, 2022)

View all studies

Selected Studies by VA Researchers

Clinical Trials

A multicenter evaluation of the Seraph 100 microbind affinity blood filter for the treatment of severe COVID-19. Chitty SA, Mobbs S, Rifkin BS, Stogner SW, Lewis MS, Betancort J, DellaVolpe J et al. Findings suggest that broad spectrum, pathogen agnostic blood purification can be safely deployed to meet new pathogen threats while awaiting targeted therapies and vaccines. Crit Care Explor. 2022 Mar 25;4(4):e0662.

Efficacy and safety of baricitinib plus standard care for the treatment of critically ill hospitalised adults with COVID-19 on invasive mechanical ventilation or extracorporeal membrane oxygenation: An exploratory, randomised placebo-controlled trial. Ely EW, Ramanan AV, Kartman CE, de Bono S, Liao R, Piruzeli MLB, Goldman JD et al. In a small exploratory study of critically ill, hospitalized COVID-19 patients on ventilation or extracorporeal membrane oxygenation, treatment with baricitinib reduced mortality. Lancet Respir Med. 2022 Feb 3. Online ahead of print.

The effect of povidone-iodine nasal spray on COVID-19 nasopharyngeal viral load in patients: A randomized control trial. Zarabanda D, Vukkadala N, Phillips KM, Qian ZJ, Mfuh KO, Hatter M, Lee IT et al. Data suggest that dilute version of povidone-iodine nasal spray are safe for topical use in the nasal cavity, but that the spray does not demonstrate virucidal activity in COVID-19 positive outpatients. Laryngoscope. 2021 Nov 1. Online ahead of print.

Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): A randomised, double-blind, parallel-group, placebo-controlled phase 3 trial. Marconi VC, Ramanan AV, de Bono S, Kartman CE, Krishnan V, Liao R, Piruzeli ML et al. Although there was no significant reduction in the frequency of disease progression overall, treatment with baricitinib in addition to standard of care (including dexamethasone) had a similar safety profile to that of standard care alone, and was associated with reduced mortality in hospitalized adults with COVID-19. Lancet Respir Med. 2021 Aug 31. Online ahead of print.

Baricitinib plus remdesivir for hospitalized adults with Covid-19. Kalil AC, et al. Baricitinib plus remdesivir was superior to remdesivir alone in reducing recovery time and accelerating improvement in clinical status among patients with COVID-19, notably among those receiving high-flow oxygen or noninvasive ventilation. N Eng J Med. 2021 Mar 4;384(9):795-807.

Laboratory Studies

Severe acute respiratory syndrome coronavirus 2 viremia is associated with coronavirus disease 2019 severity and predicts clinical outcomes. Jacobs JL, Bain W, Naqvi A, Staines B, Castanha PMS, Yang H, Bolts VF et al. Levels of virus particles detected in the blood correlate to COVID-19 disease severity. Clin Infect Dis. 2022 May 3;74(9):1525-1533.

Prospective validation of a rapid host gene expression test to discriminate bacterial from viral respiratory infection. Ko ER, Henao R, Frankey K, Petzold EA, Isner PD, Haehne AK, Allen N et al. A host response bacterial/viral test accurately discriminated bacterial from viral infection among patients with acute respiratory illness with fever. JAMA Netw Open. 2022 Apr 1;5(4):e227299.

T-cell expression of angiotensin-converting enzyme 2 and binding of severe acute respiratory coronavirus 2. Welch JL, Xiang J, Chang Q, Houtman JCD, Stapleton JT. T-cells exposed to SARS-CoV-2 demonstrate reduced proliferation, indicating that direct interaction of the virus with T-cells may alter T-cell growth. This may contribute to impaired T-cell function observed in patients with severe disease. J Infect Dis. 2022 Mar 2;225(5):810-819.

Effect of monoclonal antibody therapy on the endogenous SARS-CoV-2 antibody response. Kim PS, Dimcheff DE, Siler A, Schildhouse RJ, Chensue SW. Passive immunization therapy may cause immunologic interference. Clin Immunol. 2022 Feb 24;236:108959.

Genome-wide characterization of SARS-CoV-2 cytopathogenic proteins in the search of antiviral targets. Zhang J, Li Q, Cruz Cosme RS, Gerzanich V, Tang Q, Simard JM, Zhao RY. Genome analysis identified a protein that could be a target for new antiviral treatments for COVID-19. mBio. 2022 Feb 15;13(1). Online ahead of print.

Data Analysis/Review

Relative vaccine effectiveness of a SARS-CoV-2 mRNA vaccine booster dose against the Omicron variant. Butt AA, Talisa VB, Shaikh OS, Omer SB, Mayr FB. While the relative vaccine effectiveness of an mRNA booster vaccine dose in preventing infection against the Omicron variant is low, the effectiveness is substantial in preventing hospitalization and high in preventing the most severe COVID-19. Clin Infect Dis. 2022 May 3. Online ahead of print.

Psychiatric disorders newly diagnosed among Veterans subsequent to hospitalization for COVID-19. Chen JI, Hickok A, O’Neill AC, Niederhausen M, Laliberte AZ, Govier DJ, Edwards ST et al. Eight percent of VA patients developed a new mental health diagnosis following COVID-19 hospitalization. The most common diagnoses were depression, anxiety, and adjustment disorders. Psychiatry Res. 2022 Apr 22. Online ahead of print.

Risk prediction for acute kidney injury in patients hospitalized with COVID-19. McAdams MC, Xu P, Saleh SN, Li M, Ostrosky-Frid M, Gregg LP, Willett DL et al. Researchers developed and externally validated a model to accurately predict acute kidney injury in patients with COVID-19. Kidney Med. 2022 Apr 8. Online ahead of print.

Association of the COVID-19 pandemic with rates of prostate cancer biopsies and diagnoses in Black vs white US Veterans. Klaassen Z, Stock S, Waller J, De Hoedt A, Freedland SJ. During the COVID-19 pandemic, prostate biopsy and prostate cancer diagnosis rates decreased, but there were no statistically significant changes in rates by race. JAMA Oncol. 2022 Apr 7. Online ahead of print.

Association of psychiatric disorders with incidence of SARS-CoV-2 breakthrough infection among vaccinated adults. Nishimi K, Neylan TC, Bertenthal D, Seal KH, O’Donovan A. Psychiatric disorders were associated with increased incidence of SARS-CoV-2 breakthrough infection among VA patients. JAMA Netw Open. 2022 Apr 1;5(4):e227287.

Other Research

Communications to promote interest and confidence in COVID-19 vaccines. Thorpe A, Fagerlin A, Drews FA, Butler J, Stevens V, Riddoch MS, Scherer LD. Messages with information on the benefits of vaccination, reframing the likelihood of side effects, and emphasizing that post-vaccine symptoms indicate the vaccine is working increased vaccine interest. Veterans were more interested and confident in vaccines than non-Veterans. Am J Health Promot. 2022 Apr 12. Online ahead of print.

An assessment of Veterans attitudes and willingness to receiving the COVID-19 vaccine: A mixed methods study. Gardner J, Brown G, Vargas-Correa J, Weaver F, Rubinstein I, Gordon HS. The study illustrates the complexity of patients’ deliberation about COVID-19 vaccination and may help physicians and other health care providers understand patients’ perspectives about vaccination. BMC Infect Dis. 2022 Mar 29;22(1):308.

Cognitive and functional abilities in an older adult Veteran before and after contracting COVID-19. Okolichany R, Padala PR, Mooney S. No patterns of cognitive changes occurred in a 76-year-old Veteran before and after he contracted COVID-19. High levels of resilience, social support, and exercise, coupled with lower levels of perceived stress and loneliness may protect against cognitive and functional decline in older adults who contract COVID-19. J Alzheimers Dis Rep. 2022 Mar 25;6(1):115-120.

Home health aides’ increased role in supporting older Veterans and primary healthcare teams during COVID-19: A qualitative analysis. Franzosa E, Judon KM, Gottesman EM, Koufacos NS, Runels T, Augustine M, Hartmann CW, Boockyar KS. Home health aides played a central role in coordinating care during the COVID-19 pandemic, providing hands-on functional, medical, and emotional support. J Gen Intern Med. 2022 Mar 22. Online ahead of print.

Worse sleep, worsening post-traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID-19 pandemic. Straus LD, Dolsen EA, Nishimi K, Neylan TC, O’Donovan A. Poor sleep quality may enhance vulnerability to later PTSD symptoms during the pandemic, particularly among those who perceived the pandemic as threatening for their future. J Sleep Res. 2022 Feb 23. Online ahead of print.

Commentary

Smoking enhances suicide risk—A significant role in the COID-19 pandemic? Sher L. Tobacco smoking cessation may be needed to reduce suicidal behavior during and after the COVID-19 pandemic. QJM. 2022 Jan 5;114(11):767-769.

Chasing the storm: Recruiting non-hospitalized patients for a multi-site randomized controlled trial in the United States during the COVID-19 pandemic. Hu K, Tardif JC, Huber M, Daly M, Langford AT, Kirby R, Rosenberg Y et al. Researchers share difficulties and strategies for recruiting participants to COVID-19 trials during the pandemic. Clin Transl Sci. 2021 Dec 24. Online ahead of print.

Suicide prevention in the COVID-19 era. Rothman S, Sher L. With the COVID-19 pandemic affecting mental health and creating social isolation, preventative measures need to be implemented universally. Prev Med. 2021 Nov;152(Pt 1):106547.

Conquering COVID-19: How global vaccine inequality risks prolonging the pandemic. Oehler RL, Vega VR. Wealthier countries must do more to eliminate the inequality that exists in COVID-19 vaccine availability in less-developed nations. As long as the pandemic rages in any corner of the globe, the world will never be truly rid of COVID-19. Open Forum Infect Dis. 2021 Sep 9;8(10):ofab443.

Addressing and inspiring vaccine confidence in Black, indigenous, and people of color during the coronavirus disease 2019 pandemic. Marcelin JR, Swartz TH, Bernice F, Berthaud V, Christian R, da Costa C, Fadul N et al. This article explores the impact of inequities on vaccine acceptance and ways to establish trustworthiness in health care institutions; increase vaccine access in minority communities; and inspire confidence in COVID-19 vaccines. Open Forum Infect Dis. 2021 Aug 0;8(9):ofab417.

Active and Recently Completed Research

Clinical trials

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.

  • VA CURES—The wide-reaching VA CURES master protocol, launched in August 2020, enables a series of clinical trials across VA. The initial study examined 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 offers 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 CURES now serves as a partnering network for trials and VA trial sites.
  • VA has been 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.
    • Through OWS and other efforts, VA was an active participant in several clinical trials designed to evaluate potential COVID-19 vaccines. These trials have included:
      • The Moderna/COVE trial, which took place at one VA site. In December 2020, Moderna obtained an emergency use authorization for its vaccine from the FDA.
      • The AstraZeneca trial, now closed to enrollment.
      • The Janssen ENSEMBLE trial, which included 17 VA sites and is now closed to enrollment. The vaccine received FDA emergency use authorization in late February 2021.
      • The Pfizer trial, now closed to enrollment. In December 2020, Pfizer obtained an emergency use authorization for its vaccine from the FDA.
      • The Novavax trial, now closed to enrollment in VA.
    • ACTIV, led by the National Institutes of Health, brings together multiple groups within VA, the Department of Health and Human Services, and the Department of Defense, as well as outside organizations, to conduct large-scale clinical trials. VA is participating in two ACTIV protocols:
      • ACTIV-2 is a trial platform for outpatients with mild COVID-19 with risk of worsening illness. It is investigating multiple new drugs for potential COVID-19 treatment through clinical trials. ACTIV-2 has completed studies on six monoclonal antibodies, an antiviral, and an immunomodulator, and is currently studying multiple other possible therapeutics. Six VA sites have participated in ACTIV-2.
      • ACTIV-3 is a trial platform for inpatients with COVID-19. It is designed to test neutralizing monoclonal antibody and antiviral treatments in rapid succession. ACTIV-3 has completed trials of four monoclonal antibodies and one antiviral, and is enrolling participants for testing of a new antiviral. ACTIV-3 trials are also investigating patients with severe COVID-19 pneumonia, the drugs aviptadil and remdesivir alone or in combination as a COVID-19 treatment, and strategies for post-COVID-19 illness vaccination. Twenty VA sites have enrolled patients in ACTIV-3 studies.
  • CDC SUPERNOVA—In partnership with the Centers of Disease Control and Prevention, VA has undertaken the Surveillance Platform for Enteric and Respiratory Infectious Organisms at the VA (SUPERNOVA) project. A network of five VA medical centers is conducting active and passive surveillance for acute gastroenteritis, a symptom of COVID-19 and other illnesses. Monitoring includes both laboratory-confirmed testing for SARS-CoV-2 and norovirus, as well as electronic health system data from patients’ charts. The project will help track pathogen distribution over time.
  • Trials with industry—VA took part in a number of industry-sponsored studies of promising medications for COVID-19. These included, 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 took 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.
  • PURIFY blood filter technology—Scientists with VA, DOD, and partner institutions are testing a new technology called the Seraph 100 blood filter that may be able to filter out viral particles and harmful molecules from the bloodstreams of COVID-19 patients. The PURIFY program is a four-part, multi-site clinical evaluation that involves 13 participating sites across the U.S., including one VA medical center. Preliminary data suggests that severely ill patients treated with the Seraph filter had lower mortality rates than other patients.

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 COVID-19” (EPIC3). Researchers are collecting data and biospecimens from volunteers for up to two years to better understand the clinical course of COVID-19. The study also aims to establish repositories of clinical data and specimens, along with a participant registry, to support future studies of COVID-19 and other health conditions. Recruitment at up to 16 sites began in July 2020.
  • COVID-19 and cancer—The National Cancer Institute COVID-19 in Cancer Patients Study, or NCCAPS, is a natural history study of COVID-19 in people with cancer. In a natural history study, researchers follow people and collect medical and other information about them over time to learn more about how a disease and its symptoms develop and change. Diagnosis and treatment of a disease are not part of natural history studies. The knowledge gained through this study will help doctors better manage treatment for people with cancer and COVID-19 in the future. As part of the NCCAPS study, researchers will collect blood samples, medical information, and medical images from 2,000 people with cancer who also have COVID-19. Each person will be followed for up to two years to help doctors understand how cancer affects COVID-19 and COVID-19 affects cancer. The study is recruiting volunteers nationwide, including at 11 VA locations.

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 is working 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 is an integral part of the analyses.
  • VA SHIELD—The VA Science and Health Initiative to Combat Infectious and Life-Threatening Diseases (VA SHIELD) is a comprehensive, secure biorepository of specimens and associated data related to COVID-19 and other emerging diseases. The specimens and data are available to authorized investigators to advance scientific understanding and support of developing diagnostic, therapeutic, and preventive strategies for use in clinical care.
  • VA SeqCURE—VA SeqCURE, short for VA Sequencing Collaborations United for Research and Epidemiology, is a network of VA research labs funded by the American Rescue Plan of 2021. Five VA sites are included: Cleveland, Durham, Iowa City, Boise, and Temple. The network will generate genetic sequencing data for public health surveillance. Projects under VA SeqCURE will include studying the effectiveness of COVID-19 vaccines, analyzing antimicrobial-resistance organisms, and working with VA SHIELD to establish protocols for handling biospecimens.
  • Synthesizing evidence from publications—Researchers from the HSR&D Evidence Synthesis Program are working to help synthesize publications about the novel coronavirus and COVID-19, and to translate that information quickly into usable guidance for clinicians. The ESP’s completed reports can be found here.
    Additional evidence reviews can be found at www.covid19reviews.org. The goal of this resource is to capture the work of evidence synthesis groups, like VA’s, around the US and the globe, and thereby avoid duplication of effort and maximize the contribution of these researchers. The catalog is maintained by the VA ESP Coordinating Center in Portland, Oregon. New evidence reviews and reviews in progress are identified through literature searching and correspondence with colleagues and content experts. The team has also set up a listserv to facilitate collaboration among systematic review researchers.
  • 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.
  • COVID-19 Observational Research Collaboratory (CORC)—A VA research initiative is bringing together VA experts to analyze the use and effects of COVID-19 drugs with clinical partners interested in the safety and efficiency of these therapies. VA’s Health Services Research and Development ServiceClinical Science Research and Development Service, and Cooperative Studies Programestablished the collaboratory soon after the pandemic took hold earlier this year. CORC is conducting a national three-year study of VA inpatients and outpatients diagnosed with COVID-19, compared with matched controls. The study will use electronic health record data and surveys to assess risk factors and long-term symptoms.
  • 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

  • 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. To date, ORD has funded nearly 30 studies looking at mental, behavioral, and social 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 already completed or 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.

COVID-19 work highlighted on HSR&D site

For a concise overview of current VA Health Services Research and Development (HSR&D) efforts on COVID-19, visit COVID-19 Efforts.




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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