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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.
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 January 11, 2021, and will be updated regularly.
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Below are examples of COVID-19 research underway in VA.
As of early January 2021, some 60 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.
COVID-19 protein can enter the brain
A study by VA Puget Sound and University of Washington researchers showed that the virus causing COVID-19 may be able to enter the brain. Researchers found that the spike proteins, protrusions on the surface of the virus, can cross the blood-brain barrier and enter the brains of mice. The blood-brain barrier is a border of cells that usually prevents harmful compounds from moving from the blood to the central nervous system. The fact that the spike proteins can cross this barrier on their own suggests that the full virus may be able enter the brain as well. The results add to the understanding of how COVID-19 can affect the central nervous system, and could help scientists develop treatments to counter its damaging effects. (Nature Neuroscience, Dec. 26, 2020)
COVID-19 patients at higher risk of death, health problems than those with flu
COVID-19 patients are at much higher risk of health problems and death than those with the flu, showed a study by St. Louis VA and Washington University researchers. Researchers looked at VA data on more than 3,000 COVID-19 patients and more than 12,000 flu patients. COVID-19 patients were five times more likely to die than flu patients. COVID-19 patients were also four times more likely to require breathing machines and almost 2.5 times more likely to be treated in the intensive care unit. COVID-19 patients were hospitalized for an average of three days longer than flu patients. Compared with flu patients, COVID-19 patients were also at higher risk of developing diabetes, acute kidney damage, and other medical conditions. (BMJ, Dec. 15, 2020)
First 10-days after hospitalization high-risk for COVID-19 patients
COVID-19 patients are at the highest risk of ending up back in the hospital or dying in the first 10 days after leaving the hospital, according to a VA Ann Arbor and University of Michigan study. In the first 10 days after leaving the hospital, COVID-19 patients had a 40% to 60% higher risk of returning to the hospital or dying, compared with patients with heart failure or pneumonia. Risk of readmission or death after 60 days was lower in COVID-19 patients than in patients with these two conditions. The results highlight a need for “special vigilance” in the first days after hospital discharge, say the researchers. (JAMA, Dec. 14, 2020)
Nurses at higher risk of COVID-19 than other health care workers
Nurses are more likely than other health care workers to test positive for the virus causing COVID-19, found a study including an Edward Hines, Jr. VA Hospital researcher. Researchers looked at COVID-19 test data for more than 6,500 health care workers. Nearly 2,000 of those were nurses. About 5% tested positive for the virus. Nurses had nearly twice the odds of testing positive, compared with other health care workers. Administrators who worked in hospitals but did not interact with patients were the least likely to test positive. Nurses who saw patients receiving high-flow oxygen therapy had a 45% higher risk of contracting the virus, and those treating patients receiving kidney dialysis had 57% higher odds, compared with other nurses. The results show that health care workers who spend more time around COVID-19 patients, such as nurses, are at increased risk from the virus, say the researchers. (Open Forum Infectious Disease, Dec. 9, 2020)
Race-based COVID-19 disparities
African American and Hispanic populations have higher rates of COVID-19 infection and death compared with other ethnic groups, according to a VA Portland review. Researchers reviewed 37 studies on COVID-19 data. They found that African American and Hispanic patients had disproportionately higher rates of virus infection, hospitalization, and death from COVID-19, compared with white patients. While these groups had a higher proportion of deaths from COVID-19, they did not show a higher risk of death in confirmed COVID-19 cases. Asian patients had similar COVID-19 rates as white patients. Not enough data exist on other racial groups to draw conclusions. The higher COVID-19 rates appear to be due to differences in health care access and exposure risk rather than any biological disposition, according to the researchers. (Annals of Internal Medicine, Dec. 1, 2020)
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Elevated immune response leads to more severe COVID-19
Elevated immune response is associated with more severe COVID-19 and death, found a review led by a Michael E. DeBakey VA Medical Center researcher. The review analyzed 16 previous studies. Researchers found that COVID-19 patients with higher levels of interleukins, proteins secreted by the immune system, were more likely to have worse symptoms or die, compared with patients with lower levels. Conversely, high levels of a different type of immune proteins (CD4 and CD8) were linked to better prognosis in COVID-19 patients. The results suggest that medications that block interleukin production could be a useful treatment for COVID-19, say the researchers. A number of interleukin blockers are already being tested as possible treatments. (Diabetes and Metabolic Syndrome, November–December 2020)
Blood pressure medications not linked to worse COVID-19
Common blood pressure drugs are not linked to worse COVID-19 outcomes, according to a review by VA Portland researchers. Researchers reviewed 17 studies on how angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) interact with the SARS-CoV-2 virus. Both types of drugs are used to treat high blood pressure and heart failure. Evidence suggests that taking ACE inhibitors or ARBS does not lead to more severe COVID-19. The drugs also were not linked to positive SARS-CoV-2 test results. The researchers found four studies looking at ACE inhibitors or as COVID-19 treatments, but results from these studies are not yet available. (Annals of Internal Medicine, Aug. 4, 2020)
VACO Index can accurately predict COVID-19 mortality risk from health data
The VA COVID-19 (VACO) Index can accurately predict risk of COVID-19 mortality using demographic and health data, according to a VA study. Researchers used VA medical administrative data to develop a tool to assess who is at highest risk of dying from COVID-19 within 30 days of infection. The VACO Index takes into account demographics such as age, sex, and race/ethnicity, as well as pre-existing medical conditions. To validate this measure, the researchers assessed more than 13,000 people who tested positive for COVID-19. Older age, multiple health conditions, and a history of heart attack or peripheral vascular disease were all associated with increased risk of death from COVID-19. The Index accurately predicted higher likelihood of death. The VACO Index could provide a timely, quantifiable, and individualized risk estimate of COVID-19 mortality risk, say the researchers, which will aid in social distancing and treatment decisions. (PLoS One, Nov. 11, 2020)
COVID-19 has five times higher in-hospital death rate than flu
Patients with COVID-19 hospitalized in the Veterans Health Administration had a more than five times higher risk of death than patients hospitalized with the flu, found a CDC study including VA researchers. Researchers looked at electronic health records data from nearly 4,000 patients with COVID-19 and more than 5,000 with influenza. Those hospitalized for COVID-19 had a much higher death rate. COVID-19 also carries a significantly higher risk of both respiratory and non-respiratory complications, compared with flu. Risk of COVID-19 complications was higher in Black and Hispanic patients, compared with white patients. (Morbidity and Mortality Weekly Report, Oct. 23, 2020)
Testing for virus presence after COVID-19 infection
Researchers from the San Francisco VA and University of California San Francisco studied how long it took health care workers with COVID-19 to test negative after initial infection. They tested 12 employees with reverse transcriptase polymerase chain reaction (RT-PCR). RT-PCR measures the amount of a specific type of RNA (genetic material). It can be used to test for the presence of the virus that causes COVID-19. The time between initial COVID-19 infection and a negative test ranged from seven to 57 days. The average time was 34.5 days. Understanding this time range could help institutions make decisions on when it is safe for employees to return to work, say the researchers. (Journal of Occupational and Environmental Medicine, Aug. 13, 2020)
COVID-19 fever screening criteria lack accuracy in older patients
A new approach to temperature screening for COVID-19 is needed in nursing homes, according to a Providence VA Medical Center study. Current guidance for COVID-19 screening in nursing homes includes checking for fever, defined as at least 38°C. However, many older patients may not reach this temperature threshold even when infected. Researchers studied SARS-CoV-2 screening data on more than 7,000 residents of VA community living centers. They found that, while SARS-CoV-2 positive patients did show rising temperatures, only 27% met the fever threshold of 38°C. Repeated temperature measurement with a patient-specific baseline could improve screening efforts in older patients, conclude the researchers. (Journal of the American Medical Directors Association, July 2020)
Universal COVID-19 testing needed in community living centers
VA Greater Los Angeles Healthcare System researchers discovered the benefit of universal COVID-19 testing and daily screening for all staff and residents in community living centers. After identifying two cases of COVID-19 testing, all staff members and residents were administered RT-PCR testing. They found 14 of 19 residents who tested positive showed no symptoms of infection. Half of the eight staff members who tested positive were also asymptomatic. The researchers concluded that universal and repeated lab-based testing for the virus was an effective strategy to curb the spread of COVID-19. (Morbidity and Mortality Weekly Report, May 29, 2020)
Clinical Trials
A neutralizing monoclonal antibody for hospitalized patients with Covid-19. ACTIV-3/TICO LY-CoV555 Study group, Lundgren JD, et al. Monoclonal antibody LY-CoV555, when coadministered with remdesivir, did not demonstrate efficacy among hospitalized patients who had COVID-19. N Engl J Med. 2020 Dec 22. Online ahead of print.
Laboratory Studies
Flow-mediated susceptibility and molecular response of cerebral endothelia to SARS-CoV-2 infection. Kaneko N, Satta S, Komuro Y, Muthukrishnan SD, Kakarla V, Guo L, An J, Elahi F, Kornblum HI, Liebeskind DS, Hsiai T, Hinman JD. Brain endothelial cells are susceptible to direct infection by the COVID-19 virus, which could cause cerebrovascular events such as stroke. Stroke. 2021 Jan;52(1):260-270.
Spike glycoprotein and host cell determinants of SARS-CoV-2 entry and cytopathic effects. Nguyen HT, Zhang S, Wang Q, Anang S, Wang J, Ding H, Kappes JC, Sodroski J. Researchers identified key structural features of the SARS-CoV-2 virus that could be useful in vaccine and other treatment development. J Virol. 2020 Dec 22. Online ahead of print.
The S1 protein of SARS-CoV-2 crosses the blood brain barrier in mice. Rhea EM ,Logsdon AF, Hansen KM, Williams LM, Reed MJ, Baumann KK. The SARS-CoV-2 virus was able to enter into the brain tissue, in a mouse model. Nat Neurosci. 2020 Dec 16. Online ahead of print.
Lower respiratory tract myeloid cells harbor SARS-CoV-2 and display an inflammatory phenotype. Bain WG, Peñaloza HF, Ladinsky MS, van der Geest R, Sullivan M, Ross M, Methe B, McVerry BJ, Morris A, Watson AM, Watkins SC, St Croix CM, Stolz DB, Bjorkman PJ, Lee JS. Lower respiratory tract cells can harbor the SARS-CoV-2 virus, and show signs of inflammation. Chest. 2020 Nov 17;S0012-3692(20)35157-6.
A high-throughput assay for circulating antibodies directed against the S protein of severe acute respiratory syndrome coronavirus 2. Weiss S, Klinger J, Hioe C, Amanat F, Baine I, Arinsburg S, Kojic EM, Stoeyer J, Liu ST, Jurczyszak D, Bermudez-Gonzalez M, Simon V, Krammer F, Zolla-Pazner S. J Infect Dis. 2020 Oct 13;222(10):1629-1634. Researchers developed a new SARS-CoV-2 test that is accurate and requires only 2.5 hours for results. J Infect Dis. 2020 Oct 13;222(10):1629-1634.
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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.
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
End-of-life care in the time of COVID-19: Communication matters more than ever. Ersek M, Smith D, Griffin H, Carpenter J, Feder SL, Shreve ST, Nelson FX, Kinder D, Thorpe JM, Kutney-Lee A. Effective remote communication with the patient and health care team was associated with significantly better ratings of the overall experience of end-of-life care by bereaved family members. J Pain Symptom Manage. 2021 Jan 4. Online ahead of print.
Periprocedural complications in patients with SARS-CoV-2 infection compared to those without infection: A nationwide propensity-matched analysis. Lal BK, Prasad NK, Englum BR, Turner DJ, Siddiqui T, Carlin MM, Lake R, Sorkin JD. Pulmonary, septic, and ischemic complications are increased in COVID-19 positive patients, compared to negative patients. Am J Surg. 2020 Dec 28. Online ahead of print.
Healing after Covid-19: Are survivors at risk for development of pulmonary fibrosis? McDonald LT. This review examines current basic and clinical data regarding fibrogenic mechanisms of viral injury in the context of SARS-CoV-2. Am J Physiol Lung Cell Mol Physiol. 2020 Dec 23. Online ahead of print.
Coronavirus disease 2019 in Veterans receiving care at Veterans Health Administration facilities. Luo J, Jeyapalina S, Stoddard GJ, Kwok AC, Agarwal JP. Elderly Veterans and Veterans with a history of cardiovascular disease represent a large proportion of the VA COVID1-9 cases and deaths. Black Veterans had higher mortality rates, but lower case fatality rates when compared with white Veterans. Ann Epidemiol. 2020 Dec 15. Online ahead of print.
COVID-19 infections among healthcare personnel in the United States Veterans Health Administration, March – August, 2020. Oda G, Sharma A, Lucero-Obusan C, Schirmer P, Sohoni P, Holodniy M. Between March and August 2020, nearly 6,000 VA health care workers contracted COVID19. Of those, 18 died after infection. J Occup Environ Med. 2020 Dec 11. Online ahead of print.
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Facial personal protective equipment: Materials, resterilization methods, and management of occupation-related dermatoses. Yu J, Goldminz A, Chisolm S, Jacob SE, Zippin JH, Wu PA, Hylwa S, Dunnick CA, Chen JK, Reeder M, Honari G, Atwater AR. There are increasing reports of occupational dermatoses associated with facial personal protective equipment. This review discusses the components of facial PPE, mask resterilization methods, and strategies for prevention and management of facial dermatoses. Dermatitis. 2020 Dec 1. Online ahead of print.
Association of PTSD with COVID-19 testing and infection in the Veterans Health Administration. Haderlein TP, Wong MS, Yuan A, Llorente MD, Washington DL. Veterans with PTSD were more likely to be tested for COVID-19 than those without PTSD. However, Veterans with PTSD were less likely to test positive. J Psychiatr Res. 2020 Nov 23. Online ahead of print.
Metformin is associated with decreased 30-day mortality among nursing home residents infected with SARS-CoV2. Lally M, Tsoukas P, Halladay C, O’Neill E, Gravenstein S, Rudolph JL. Nursing home residents taking metformin-containing diabetes drugs has a reduction in 30-day mortality after COVID-19 infection. J Am Med Dir Assoc. 2020 Oct 26;S1525-8610(20)30924-5.
Acute kidney injury in a national cohort of hospitalized US Veterans with COVID-19. Bowe B, Cai M, Xie Y, Gibson AK, Maddukuri G, Al-Aly Z. Acute kidney injury is common during hospitalization with COVID-19 and associated with higher risk of health care resource use and death. Clin J Am Soc Nephrol. 2020 Nov 16. Online ahead of print.
Cycle threshold to test positivity in COVID-19 for return to work clearance in health care workers. Domeracki S, Clapp RN, Taylor K, Lu CM, Lampiris H, Blanc PD. Considering estimated viral load testing may help inform return-to-work planning and decision making beyond solely relying on positive/negative test results. J Occup Environ Med. 2020 Nov;62(11):889-891.
Emerging mechanisms of pulmonary vasoconstriction in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS) and potential therapeutic targets. Karmouty-Quintana H, Thandavarayan RA, Keller SP, Sahay S, Pandit LM, Akkanti B. In this review, the authors outline emerging mechanisms of pulmonary vascular dysfunction in COVID-19 and outline potential treatment options that have been clinically tested. Int J Mol Sci. 2020 Oct 29;21(21):E8081.
Association of poor housing conditions with COVID-19 incidence and mortality across US counties. Ahmad K, Erqou S, Shah N, Nazir U, Morrison AR, Choudhary G, Wu WC. Counties with higher percentage of households with poor housing had higher incidence of, and mortality associated with, COVID-19. PLoS One. 2020 Nov 2;15(11):e0241327.
Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: Clinical services and patient characteristics associated with utilization. Ferguson JM, Jacobs J, Yefimova M, Greene L, Heyworth L, Zulman DM. Veterans with high clinical or social need had higher likelihood of virtual service use early in the COVID-19 pandemic. However, older, homeless, and rural Veterans were less likely to have video visits, raising concerns for access barriers. J Am Med Inform Assoc. 2020 Oct 30. Online ahead of print.
ACE2 mouse models: A toolbox for cardiovascular and pulmonary research. Jia H, Yue X, Lazertigues E. The purpose of this review is to provide researchers with the genetic tools available for further understanding of angiotensin-converting enzyme 2 biology and for the investigation of ACE2 in the pathogenesis and treatment of COVID-19. Nat Commun. 2020 Oct 14;11(1):5165.
Impact of exposure to patients with COVID-19 on residents and fellows: an international survey of 1420 trainees. Cravero AL, Kim NJ, Feld LD, Berry K, Rabiee A, Bazarbashi N, Bassin S, Lee TH, Moon AM, Qi X, Liang PS, Aby ES, Khan MQ, Young KJ, Patel A, Wijarnpreecha K, Kobeissy A, Hashim A, Houser A, Ioannou GN. Exposure to patients with COVID-19 is significantly associated with higher burnout rates in physician trainees. Postgrad Med J. 2020 Oct 21. Online ahead of print.
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.
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
Longitudinal examination of COVID-19 public health measures on mental health for rural patients with serious mental illness. Riblet NB, Stevens SP, Shiner B, Cornelius S, Forehand J, Scott RC, Watts BV. Rural patients with serious mental illness may be fairly resilient in the face of the COVID-19 pandemic when they have access to treatment and supports. Mil Med. 2020 Dec 30. Online ahead of print.
Emergency physicians and personal narratives improve the perceived effectiveness of COVID-19 public health recommendations on social media: A randomized experiment. Solnick RE, Chao G, Ross R, Kraft-Todd GT, Kocher KE. Personal messages from a physician were the most effective means of disseminating COVID-19 information on social media. Acad Emerg Med. 2020 Dec 2. 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. Psychiatr Serv. 2020 Nov 1;71(11):1143-1150.
“At home, with care”: Lessons from New York City home-based primary care practices managing COVID-19. Franzosa E, Gorbenko K, Brody AA, Leff B, Ritchie CS, Kinosian B, Ornstein KA, Federman AD. Keeping older, medically complex patients safe in their homes requires considerable flexibility, transparency, teamwork, and partnerships with outside providers. J Am Geriatr Soc. 2020 Nov 12. Online ahead of print.
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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.
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
Does universal testing for COVID-19 work for everyone? Dumyati G, Gaur S, Nace DA, Jump RLP. The authors propose a structured approach for facility-wide testing of nursing home residents and staff. J AM Med Dir Assoc. 2020 Nov;21(11):1525-1532.
No community left behind A call to action during the COVID-19 pandemic. Sullivan SR, Bell KA, Spears AP, Mitchell EL, Goodman M. This open forum attempts to answer two questions: What are the specific considerations in working with economically compromised Hispanic/Latino and Black/African American populations with mental illness? How can mental health providers and researchers best help with mental health problems related to pandemic stress? Psychiatr Serv. 2020 Oct 27. Online ahead of print.
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.
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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.
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.
Photo: ©iStock/South_agencyTo 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.
