COVID care and research: Learning as we go

January 12, 2021

Doctors, nurses, respiratory therapists and many other health care professionals have been busy at the bedside taking care of COVID-19 patients since March 2020.

COVID-19 affects different people in different ways. Some have had a wide range of symptoms, while others have had no symptoms at all.

Researchers at the CAMC Institute for Academic Medicine also have been busy during the pandemic, studying many aspects of the virus and participating in national trials as well as local studies.

In the early days of the pandemic, there were conflicting reports about how COVID-19 was spread, how to treat it, and who was affected most by it. For scientists, medical experts and health care workers it was like on-the-job training.

A variety of research teams from CAMC representing several specialties have scoured a multinational database to identify patients with confirmed COVID-19 infection to look at how COVID has affected patients with illnesses related to the kidneys, heart, brain and cancer. Scientists at CAMC also have looked at how COVID affects people based on sex and age.

Their examination of global data showed that females have lower COVID-19 mortality than males. They also found that COVID patients who had a stroke "had higher comorbidities including diabetes, high blood pressure, heart failure, obesity and history of stroke."

CAMC has developed a COVID-19 registry to monitor demographics, clinical findings, treatments and outcomes of patients and compare them to available national benchmarks. Research scientists are following trends in areas such as mortality, whether patients are cared for in an ICU vs. non-ICU, how long they are hospitalized, treatment and outcomes.

"This registry is an example of how research is entrenched in assisting in making everyday decisions, allowing them to be evidence-based," said Dan Lucas, PharmD, Center for Clinical Sciences Research, CAMC Institute for Academic Medicine.

Some COVID-19 statistics:

37.2% of patients have been admitted to an ICU.
The mortality rate of patients in ICUs is 40.65%.
Patients cared for in ICUs are hospitalized about 17 days.
Patients cared for in non-ICU units are hospitalized about 8 days.
The positivity rate for African Americans is 6.8% (3% of people in West Virginia are African American).
More males (54.9%) have been infected than females.

CAMC started a second registry for outpatient administration of the monoclonal antibody (bamlanivimab). The purpose is to track demographics, risk factors and symptoms of patients receiving the drug, and adverse events and most importantly the rate of admission after infusion.

CAMC participates in the Society of Critical Care Medicine Registry receiving benchmark information on patients from more than 300 centers nationally/internationally.

Antibody testing

CAMC received multiple requests by community providers for COVID IgG antibody testing to help health care providers make informed recommendations about patient care.

Antibody tests check your blood to look for signs that you had a previous viral infection. Antibodies are proteins produced by the immune system to help fight off a particular infection. They are found in the liquid part of blood specimens (plasma).

"Additionally, the CAMC Clinical Trials Center enrolled front-line health care workers and essential workers within the community (police, fire, EMS, teachers, grocery store workers, restaurant workers, security, etc.)," said Kristi Sutphin, CAMC Clinical Trials Center. "The purpose of the study is to see who might have antibodies to COVID-19."

Convalescent plasma

The CAMC Clinical Trials Center worked with CAMC infectious disease physicians on the Mayo Clinic Expanded Access Program to provide severe and critically ill patients with COVID-19, convalescent plasma. Blood donated by people who've recovered from COVID-19 has antibodies to the virus that causes it. The donated blood is processed to remove blood cells, leaving behind liquid (plasma) and antibodies. These can be given to people with COVID-19 to boost their ability to fight the virus. Convalescent plasma therapy may help people recover from COVID-19. It may lessen the severity or shorten the length of the disease.

By participating in this program with Mayo, CAMC was able to provide convalescent plasma to patients earlier in the pandemic and before several hospitals in the surrounding area. Upon conclusion of this program at the end of August, CAMC continued to provide convalescent plasma through an Emergency use authorization to severe or critically ill patients with COVID. The CAMC Clinical Trials Center and CAMC virology lab worked closely with the American Red Cross to ensure the demand for the plasma was able to be met. CAMC was able to provide plasma in less than 12 hours from time of ordering to qualified COVID patients.

GI disorders

Doctors studied the effects of the COVID-19 pandemic on patients with underlying gastrointestinal (GI) disorders and related procedures. Patients with underlying GI disorders are considered to be at higher risk of poor outcomes compared to the general population. Researchers wanted to explore the risk of acquiring infection, baseline characteristics, outcomes and the prognosis to help doctors manage acute and chronic GI disorders.

Pediatric non-accidental trauma

Researchers looked at the impact of COVID-19 on the incidence of pediatric non-accidental trauma. The closure of classrooms and child care during the outbreak in combination with stresses placed on family members increases risks for child abuse and neglect. The aim of this study is to determine if the incidence of pediatric non-accidental trauma requiring visits to the emergency department and/or hospital increased during the pandemic.

Telemedicine usage

The COVID-19 pandemic forced many physician practices to reconsider the necessity of face-to-face office encounters. Seeking to reduce patient exposure, many offices transitioned to telemedicine. In analyzing the numbers of face-to-face, audio and audiovisual encounters, CAMC Urology reported that 82% of patients surveyed were likely to elect for a telemedicine encounter over a face-to-face encounter for a routine visit during future flu seasons.

Due to the nature of clinical trials, many of these studies will continue for several months and even years. It may take a while before full results are available on some studies. Patients will continue to be followed and scientists will continue to explore databases to learn more about COVID-19.

Publications

Researchers have studied all age groups and demographics during the past few months and have published several articles based on their findings. Below are links to some of the articles.