Office of Research & Development
Office of Research & Development
COVID-19 FACT SHEET
For VA investigators: Please check our funding page for news about new funding opportunities relating to COVID-19.
In response to the COVID-19 pandemic, VA Research has undertaken a wide array of activities to support and advance VA's clinical and research missions and help Veterans affected by the disease. These efforts have spanned biomedical research, therapeutics and vaccine clinical trials, and data analyses that leverage VA's rich electronic health record system. VA Research has coordinated closely with internal VA and external partners—such as the National Institutes of Health and other federal agencies, and pharmaceutical companies—to identify the areas in which VA's nationwide research capacity, resources, and infrastructure could make the greatest contribution.
On this web page, we summarize recent and current COVID-19 research across the VA system.
VHA COVID-19 Research Dashboard
This interactive map shows active VA studies on COVID-19. Use the search bar or menus on the left to find studies on specific topics or locations. View larger version
VA 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)
Paxlovid lowers risk of Long COVID
The medication Paxlovid lowers the risk of Long COVID, according to a VA St. Louis study. The study included more than 56,000 Veterans with a positive COVID-19 test. Those given Paxlovid—an oral antiviral medication that has been shown to reduce the risk of severe COVID-19 and hospitalization—had a 25% decreased risk of developing 10 of 12 different Long COVID conditions studies. The decreased risk was found regardless of whether it was a participant’s first COVID-19 infection or a reinfection, and regardless of whether the participants were unvaccinated, vaccinated, or boosted. Paxlovid could be an important asset to address the serious issue of Long COVID, said the researchers. The study was released as a pre-print in the interest of public health. (medRxiv, Nov. 5, 2022)
COVID-19 increases risk of neurologic disorders
COVID-19 increases the risk of long-term neurologic disorders, according to a VA St. Louis study. Researchers compared data on over 150,000 VA patients who contracted COVID-19 with more than 11 million people who had not had COVID-19. A year after recovering, COVID-19 patients had higher risk of a wide array of neurologic conditions, including stroke, memory disorders, nervous system disorders, migraines and seizures, Guillain-Barré syndrome, and sensory disorders. COVID-19 patients had elevated risks and burdens even when they did not require hospitalization during their illness. The results highlight a need for health care system planning to address the potential long-term consequences of COVID-19, say the researchers. (Nature Medicine, Sept. 22, 2022)
New prediction model to estimate risk of COVID-19 death
VA researchers developed a new prediction model to estimate the probability of death from COVID-19. The mathematical model, called PDeathDx, uses diagnostic codes from medical records to survey all of a patients’ preexisting conditions to estimate the risk that COVID-19 poses. Starting with data from 1997, the researchers used diagnoses from the first time a patient sought care until 14 days before a positive COVID-19 test, then compared that to COVID outcomes for nearly 350,000 patients treated in VA. They found that the new model outperformed other conventional prediction models. The study also showed that certain underlying conditions—such as neurological diseases, dementia, and severe disability—are much more likely to result in severe COVID or death. The approach used here could be adapted to predict outcomes for other diseases and conditions, say the researchers. (Biological Methods & Protocols, Aug. 4, 2022)
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.
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.
Association between SARS-CoV-2 viral load and patient symptoms and clinical outcomes using droplet digital PCR. Hastie E, Amogan H, Looney D, Mehta SR. Viral load in the upper throat was not a strong predictor of moderate-to-severe COVID-19 in the pre-Delta and Delta phases of the pandemic but was predictive of symptomatic diseases and in-hospital mortality, providing support for the idea that early viral control prevents the progression of the disease. Viruses. 2023 Feb 5;15(2):446.
Blood-brain barrier penetration of non-replicating SARS-CoV-2 and S1 variants of concern induce neuroinflammation which is accentuated in a mouse model of Alzheimer’s disease. Erickson MA, Logsdon AF, Rhea EM, Hansen KM, Holden SJ, Banks WA, Smith JL et al. The SARS-CoV-2 virus can cross the blood-brain barrier and cause inflammation in the brain, a major mechanism behind central nervous system and cognitive impairments. The Delta and Omicron variants cross this barrier faster than other variants. Brain Behay Immun. 2023 Jan 19. Online ahead of print.
Anti-membrane antibodies persist at least one year and discriminate between past coronavirus disease 2019 infection and vaccination. Amjadi MF, Adyniec RR, Gupta S, Bashar SJ, Mergaert AM, Braun KM, Moreno GK et al. After COVID-19 infection, antibodies persist for at least one year and can be used to differentiate between people who have been infected, vaccinated, or neither. J Infect Dis. 2022 Nov 28;226(11):1897-1902.
SARS-CoV-2 anti-spike IgG antibody and ACE2 receptor binding inhibition levels among breakthrough stage Veteran patients. Chensue SW, Siler AF, Kim PS, Dimcheff DE, Daghfal DJ, Prostko J, Frias E et al. Antibody levels declined significantly 150 days after initial two-dose COVID-19 vaccination, while vaccination after resolved infection and booster vaccination conferred longer immunity. Microbiol Spectr. 2022 Nov 21. Online ahead of print.
Rates of primary care and integrated mental health telemedicine visits between rural and urban Veterans Affairs beneficiaries before and after the onset of the COVID-19 pandemic. Leung LB, Yoo C, Chu K, O’Shea A, Jackson NJ, Heyworth L, Der-Martirosian C. Despite initial telemedicine gains at rural VA health care sites, the pandemic was associated with an increase in the rural-urban telemedicine divide across the VA health care system. JAMA Netw Open. 2023 Mar 1;6(3):e231864.
Validation of a predictive model for hospital-acquired acute kidney injury with emergence of SARS-CoV-2 variants. McAdams MC, Xu P, Li M, Gregg LP, Saleh SN, Ostrosky-Frid M, Willett DL et al. A model for predicting hospital-acquired acute kidney injury remained accurate in different COVID-19 variants, suggesting that risk factors for the kidney injury have not substantially evolved across variants. J Investig Med. 2023 Feb 14. Online ahead of print.
Inflammatory biomarkers differ among hospitalized Veterans infected with Alpha, Delta, and Omicron SARS-CoV-2 variants. Park C, Tavakoli-Tabasi S, Sharafkhaneh A, Seligman BJ, Hicken B, Amos CI, Chou A, Razjouyan J. Veterans infected with the Omicron variant showed milder inflammatory responses and lower mortality than other variants. Int J Environ Res Public Health. 2023 Feb 8;20(4):2987.
Palliative care in a pandemic: A multicenter cohort of critically ill patients with coronavirus disease 2019. Kodadek LM, Moore MS, Miller SM, Schneider EB, Ahuja V, Maerz LL, Davis KA. Mortality among critically ill patients with COVID-19 has remained constant across two pandemic waves with no change in use of palliative or end-of-life care. Surg Infect (Larchmt). 2023 Feb 8. Online ahead of print.
The impact of COVID-19 on trends in alcohol use disorder treatment in Veterans Health Administration. Perumalswami PV, Kilpatrick S, Frost MC, Adams MA, Kim HM, Zhang L, Lin LA. Despite increased telehealth use, the percentage of VA patients with an alcohol use disorder diagnosis receiving treatment declined during the COVID-19 pandemic, mainly because of a decrease in psychotherapy use. Addiction. 2023 Feb 3. 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.
Real-world evidence on the effectiveness of plexiglass barriers in reducing aerosol exposure. Cadnum JL, Jencson AL, Memic S, Osborne AO, Torres-Teran MM, Wilson BM, Deshpande A, Donskey CJ. In real-world settings, plexiglass barriers vary widely in effectiveness in reducing staff exposure to aerosols, and some barriers may increase risk for exposure if not positions correctly. Pathog Immun. 2022 Nov 4;7(2):66-77.
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
Amid shortage of face masks, researchers explore 3D options to guard against COVID-19, other infectious diseases
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.