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COVID-19 Research at U of U Health Overview

Audio transcript:

We've never been in a situation like this before where a pandemic is affecting nearly every aspect of our lives. And if you think about it, when you look across the entire university, we have experts in almost all of these areas. Right now, a lot of them are diverting their focus from their normal work to solving the problems that are associated with this pandemic. In fact, we estimate there are about 131 projects across the university that's related to researching COVID-19 and its impact on our populations.

The university is doing a great job of really stepping up to the plate and supporting this research. Right now, they're supporting 56 projects with $1.3 million in funding. Additional projects are getting national funding through foundations and government agencies amounting to about $5.4 million being invested into 13 projects. If you think about it, that's a vote of trust in our experts.

U of U research spans many aspects of the pandemic

When you look across the spectrum of what's happening at the University of Utah, there's a lot that's going on and I'm just going to give a few examples. The College of Engineering is putting a big focus on developing new technologies. One example is a sensor that could be embedded into your smartphone, detect the virus on your breath and give a readout within minutes.

Economists are looking at the financial impact on our city and our region. The Department of Metropolitan Planning is looking at disaster response, especially when there's stress added to an emerging crisis. An example of this is when we were all shaken by the earthquake that happened back in March when the pandemic first made its way to Utah. How can we better respond and coordinate our public safety systems when there's a double threat to our people? As you can imagine at the university, there's a focus on how the pandemic is affecting our education. And the College of Fine Arts has a National Center for Voice and Speech that's looking at safe singing practices.

Health-related research

At U of U Health, our research is mostly health-focused, as you might expect. A lot of efforts are being put into testing and treatments, and I'll talk a little bit more about that in a little bit. A lot of great work has been done looking at infection and transmission, for example, in modeling when the next surge might happen or how interventions like masking might flatten the curve.

This pandemic is causing a big stress on our mental health, as we're being asked to keep away from one another, stay away from loved ones. One area of focus is on mental health and also, in particular, on our frontline workers is how they can learn to be resilient during these really tough times.

Population health is a big issue especially in the area of health disparities. A lot of segments of our population: Native Americans, Pacific Islanders and Hispanics are much more greatly affected by this pandemic than others. And so, what are the societal and health issues that are contributing to this difference?

There are other social impacts that are being investigated too. Lockdowns, as you can imagine, create a big problem when you are trapped in a house with an abuser. And so, what are some support systems we can put into place during these unique circumstances?

A disease of populations

I want to take a step back and talk about COVID-19 as a disease of populations. There are very few illnesses like this one where there is such a huge range of symptoms ranging from no symptoms at all, to death. The CDC estimates that 40% of us will have no symptoms when we're infected with the virus. But on the other end of the spectrum, somewhere between 0.3% to 2% will die. And in Utah, that number is around 0.7%.

Something I just want to point out is that because a lot of us have no symptoms, this is exactly the reason why we need to wear a mask in public places when we're closer than 6 feet to another person. We may have the virus and be transmitting it to others and not even know it. We need to wear masks to prevent transmission, especially to those people who are going to end up with a severe form of the illness. We don't always know who those people are going to be.

We know that people who are older are predisposed to serious illness. We know certain people with certain preexisting medical conditions are as well, but there are a lot of people who are otherwise healthy and active and who do end up hospitalized or dying from the disease. And we don't know why. Finding novel susceptibilities is another area of investigation here at University of Utah Health.

There are a lot of uncertainties with how this disease will play out in a single person, including for those who end up in the hospital. There are very few indications that let healthcare providers know who will recover and who is likely to die. Finding those markers is another research effort.

Treatments and therapies

A lot of us think of COVID-19 as a disease of the lungs. There are reports about how people have a difficulty breathing when they have this disease. But really, this is a systemic disease that can affect many different organs: the gastrointestinal system, the liver, the kidney, we know there are heart complications that develop, some people even get strokes or seizures. Given that there is no way to prevent illness, researchers are now putting a lot of effort into refining therapies and finding ways to help those who will get these severe forms of the disease.

Here at the University of Utah Hospital and also across the nation, remdesivir is a drug that is the standard of care, but it's by no means a miracle cure. It reduces the time to recovery. But still, this is 11-day recovery on average which is a long time in the hospital. There's a clear need for better therapies. Hydroxychloroquine is an anti-malarial drug that has been shown not to be effective in severe COVID-19, but here at the university, we're doing a clinical trial to determine whether it might prevent people with mild COVID-19 — people who are recovering at home — from ending up in the hospital. That remains to be determined.

Another interesting clinical trial that's taking place here is testing the effectiveness of amniotic fluid as a therapy for severe COVID-19. It might sound a little bit surprising, but actually there's a lot of evidence that amniotic fluid has anti-inflammatory properties. In our burn unit, it's used to treat patients with severe burns. This has already made it through the phase 1 safety trials and it is being tested in larger phase 2 clinical trials now.

Convalescent plasma is not being tested in a clinical trial here, but it is another course of treatment that can be given to patients. It's safe. Its effectiveness is being examined in other clinical trials throughout the country. But what's happening here is that plasma from patients who have recovered from COVID-19 is being given to patients who are severely ill in the hopes that the antibodies that are contained within that plasma might prevent someone's disease from getting worse.

Mechanisms of disease

There's some really interesting work from the university about the mechanisms of the disease. What is the virus doing to our body? Doctors here are taking samples from severely ill patients. Those samples are being examined in the laboratory to see what happens at a cellular level in response to this disease. Some exciting results that have come out just in the last month that are telling a story that an overactive immune response may be contributing to some of these complications that lead to organ failure in some patients.

Dr. Robert Campbell in Internal Medicine has found that there are changes in gene expression that happens in platelets. Platelets are cells that contribute to blood clotting. And this effect might lead to some of the blood clotting that is seen in patients with severe COVID-19. It's thought that this blood clotting might be leading to some of these complications. And so, understanding those underlying mechanisms could provide insights into ways to overcome that problem.

Similarly, work from Dr. Christian Con Yost and Dr. Joshua Schiffman has found that another inflammatory response also goes out of control. This is a response called the NET response. If you look at this picture here, the cells, the blobs in green are infection-fighting cells and next to them are these purple web-like substances. This is actually a normal immune response that happens when our body is invaded by viruses or bacteria. These neutrophils send out these NETs to capture invading pathogens and target them for destruction.

But what they're seeing in COVID-19 patients is that this mechanism goes out of control and there's evidence that this may also lead to that blood clotting that we think might be really troublesome and leading to complications in the disease. And so, now, a company called PEEL Therapeutics is building a therapeutic based on these results and they're determining whether that might also be effective in helping to quiet the disease.

Spread of COVID-19 in Utah's population

Utah HERO is a collaboration between the David Eccles School of Business at the University of Utah and epidemiologists here at University of Utah Health. There are doing continuing randomized swab and antibody tests on 10,000 Utahns. The results that come back can inform how prevalent the disease is in our population and whether it's spreading over time or maybe not spreading as much as before. And this type of data can inform decisions about whether or not to open schools and businesses. What this study is showing is so far is that about 1% of our population has antibodies, meaning 99% of us are still susceptible to getting COVID-19.

Another interesting point here is that they're finding that two of three cases of COVID-19 go undetected. So, when you're looking at those case counts in the newspaper or on the website, that's probably a third of what's really out there in the population.

I think another interesting insight is that when one person tests positive in a household, there's about a 12% likelihood that somebody else in the household will test positive. I actually find that to be a surprisingly low number. I would think that if I'm in the same house with somebody breathing the same air, that I would be very likely to get the disease. And that's just not the case. Our epidemiologists are doing additional work to determine why that might be.

What I want to end with is that the world is watching. The work we're doing here is being reported on by news outlets across the globe. I know that in the weeks and months to come, there's only going to be more information that's going to help us to get through all of this. I look forward to telling you more about it as that information comes in.