COVID-19: Fighting the Pandemic
With the onset of a global pandemic caused by the novel coronavirus, hundreds of GW researchers have trained their attention and expertise on the virus and its disease, COVID-19, to better understand, track, treat and stop the virus’s spread.
As the global pandemic caused by the novel coronavirus nears its one-year mark, it has wreaked a special kind of havoc on its human hosts, social networks, health care systems and economies around the world.
Even as public health officials encouraged people to shelter at home, medical workers, researchers and others remained on the front lines and behind the scenes, working tirelessly. At GW, as at numerous other research institutions and labs across the world, a flurry of research activity around the novel coronavirus has emerged. Many GW faculty researchers and their students have refocused their work on the virus, seeking to understand its enigmatic ways, its effect on society, and how to prevent its spread.
Collaborations across disciplines and new funding streams from sponsors and GW’s own Office of the Vice President for Research and the Technology Commercialization Office are facilitating the new work.
The following provides a snapshot of some of the COVID-19-related research activities underway at the university.
UNDERSTANDING THE VIRUS
A Fine Specimen
In April, GW researchers set up a specimen bank to accelerate research around the novel coronavirus by housing samples provided by COVID-19 positive patients at GW Hospital and the GW Medical Faculty Associates.
Each patient provides four samples, with the first taken during the first 11 days of infection, as well as samples taken at 10 weeks, at six months and at a year after recovery.
The samples will help researchers in public health and medicine gain insights into the virus, such as how long it sheds, how long it takes for the human body to produce neutralizing antibodies, and what links exist between the virus and cardiovascular and neurologic diseases.
Researchers also are working to understand what happens with cells that play a role in the body’s immune response, which is important for vaccine development.
“We have so many questions, and we have so many talented researchers at GW who have expertise that can be applied to solve problems regarding the coronavirus that desperately need to be solved,” says Aileen Chang, an assistant professor of medicine who helped establish the specimen bank thanks to her decades-long experience navigating regulatory processes to study viruses such as dengue, chikungunya and Zika.
Diving deep into the data
Leaning on advances in genomic technologies and machine learning, GW researchers are developing a deep-learning bioinformatics platform to help scientists and health care professionals understand the genomic diversity of the novel coronavirus and why it behaves so differently from patient to patient.
The platform’s data integration will link unique characteristics of different viral genomes and proteins to different health outcomes, and provide data on viral genetics, therapeutic strategies and patients, among other relevant information. The tools can also be used to inform DNA tests that could predict the severity and status of the COVID-19 disease in patients.
“Understanding the viral and host genomic diversity and how this diversity is associated with differences in patient health outcomes will lead to better treatments, a better understanding of the different impacts observed in different populations of people, paving the way towards more-informed vaccine development, and investigation of newly detected strains for viruses,” says project lead Gholamali Rahnavard, an assistant professor of biostatistics and bioinformatics in the Milken Institute School of Public Health.
Rahnavard, whose project is supported by a Rapid Response Research grant from the National Science Foundation, is working with Keith Crandall, professor of biostatistics and bioinformatics and director of the Computational Biology Institute, and Marcos Pérez-Losada, an assistant professor in CBI.
Researchers and medical professionals around the world are scrambling to understand how underlying health conditions, chronic diseases and other risk factors affect outcomes for patients who test positive for COVID-19. At GW, researchers are taking a closer look at how COVID-19 affects patients with comorbidities.
Adam Kilian, an assistant professor of medicine in the School of Medicine & Health Sciences’ rheumatology division, is the regional leader for the COVID-19 Global Rheumatology Alliance, which collects, analyzes and shares information about COVID-19 and rheumatology to improve care of patients. The alliance created a secure registry to curate de-identified patient information that can be shared with patients, physicians and other rheumatology specialists in an effort to assess risk of COVID-19 infection and improve treatment for those who test positive.
Kilian is overseeing GW’s data collection efforts on clinical outcomes in COVID-19 patients with rheumatic diseases and those being treated with antirheumatic disease therapies. He says the alliance will address gaps in knowledge, increase understanding of who is at the greatest risk and combat misinformation.
“Many medications that have been discussed as potential treatments are commonly used by rheumatologists,” Kilian says. “We strongly believe that building a worldwide registry is one of the most valuable ways to contribute desperately needed reliable and evidence-based information.”
As a result of the alliance, Kilian and colleagues conducted a large literature review in record time that synthesized all significant published data regarding the frequency and severity of acute viral respiratory adverse events related to antirheumatic disease therapies. The review was published in Seminars in Arthritis and Rheumatism.
Jamie Rosenthal, an asthma and allergy specialist and assistant professor of medicine, is conducting a new study to better understand the risk asthmatic patients face and how best to help them. She and her colleagues are collecting information on hundreds of patients at GW Hospital—those with asthma who contracted COVID-19 and patients without asthma who also have the virus. Rosenthal says that before they started this research, they could only assume that patients with asthma were at a higher risk for complications based on what they knew from asthmatic patients who had contracted other respiratory viruses, like the flu.
Studies, for example, suggest steroids could help with COVID-19 treatment, and the researchers are looking at whether inhaled steroids in particular may also protect people with asthma.
“This is definitely a scary time, but it’s important to be able to contribute to the field and make a difference, especially for the patients we see on a day-to-day basis, and change the course of their trajectory,” Rosenthal says.
Carlos Santos-Burgoa, a professor of global health, and William Dietz, chair of GW’s Sumner M. Redstone Global Center for Prevention and Wellness, analyzed COVID-19 reports from China and Italy and compared them with data collected from the H1N1 influenza pandemic 10 years ago, when obesity led to decreased respiratory function, difficulties with ventilation and increased inflammatory cytokines that contributed to death in H1N1-infected patients. In a letter to the editor of the journal Obesity, they warned that the same problems may be occurring with COVID-19 patients who are obese.
Their findings have implications for the United States, where an estimated 42 percent of all U.S. adults are considered obese or severely obese, according to the Centers for Disease Control and Prevention.
Taming the Data
As the virus known as SARS-CoV-2 has exploded around the world, so has the trove of information about this mysterious virus and its disease, COVID-19. Doctors, nurses and front-line medical workers are simultaneously treating COVID-19 patients and looking for up-to-date, reliable information to help guide treatment and practice. Researchers have published tens of thousands of peer-reviewed and preprint papers on the virus and its disease, creating a global corpus of research articles. Researchers at GW are creating tools to help harness the available data and information for the benefit of health-care providers and fellow researchers.
WEB TOOL FOR HEALTH-CARE WORKERS
GW’s Jordan Selzer and Lance Hoffman created the website Disaster Consult, to help health-care providers respond quickly in a crisis by giving them quick, digestible information about best practices in the face of various emergencies, including the current pandemic. The site provides comprehensive clinical resources for a range of care providers, from ICU staff managing patients on ventilators to emergency medical technicians tasked with transporting suspected COVID-19 cases or people hurt by civil unrest.
“The site is designed for people staring into the mouth of the lion,” says Selzer, an emergency physician and disaster and operational medicine fellow at GW’s School of Medicine & Health Sciences. The COVID-19 pandemic was the kind of emergency Selzer had been anticipating—one in which health care providers in rural care centers and large urban hospitals alike were overwhelmed, under-resourced and faced with conflicting accounts of how the virus presents and how to care for patients.
Hoffman, a research professor of computer science and founder of GW’s Cyber Security and Privacy Research Institute, recruited a team of developers—most of them undergraduates—from the School of Engineering & Applied Sciences to help build the web presence. The team consulted with emergency medicine doctors and other care providers to determine what format the site should take, what kind of information was needed and what information was counterproductive.
“We went to great pains to listen to the doctors and the other professionals who were going to use this and ask what they wanted and didn’t want,” Hoffman says.
Third- and fourth-year medical students are helping to manage the continuous flow of information about COVID-19 and other disaster medicine on the site, disasterconsult.org.
VIZ TOOL FOR RESEARCHERS
A GW research team is answering a call by the White House to tame the fast-growing body of research and data around COVID-19 with a unique visual search engine called Graggle. The customized search engine uses powerful graph representation and machine learning techniques to capture the complex contextual relationships between hundreds of thousands of documents, helping researchers more quickly locate relevant academic papers around the novel coronavirus.
“This is all enabled by the underlying graph representation whose nodes are the papers, and edges are highly important words shared between them,” says Professor of Electrical and Computer Engineering Howie Huang.
Through his Graph Computing Lab, Huang and his doctoral student, Isaiah King, developed the site, which uses an open research dataset consisting of more than 150,000 scholarly articles written about COVID-19 and related coronaviruses.
“Graggle provides a visual, interactive web of interrelations between papers so that one may understand the context of each individual paper’s contribution,” King says. “It’s a great research tool for visual learners like myself, and I hope it will help anyone out there researching the virus.”
Visualizing the Enemy Within
The 3D image of a patient’s lungs ravaged by COVID-19 makes clear the indiscriminate damage this disease is capable of. GW Hospital is using virtual reality to create 360-degree views of the lungs of COVID-19 patients.
“You do not need an MD after your name to understand these images,” said Keith Mortman in a GW Hospital podcast in April. Mortman is an associate professor in GW’s school of medicine and director of the division of thoracic surgery at GW Hospital. “This is something the general public can take a look at and really start to comprehend how severe the amount of damage this is causing the lung tissue. The damage we’re seeing is not isolated to any one part of the lung. This is severe damage to both lungs diffusely.”
The first in the country to use 360 virtual reality for thoracic surgical planning and patient education, GW adapted the technology to study the novel coronavirus.
Mortman says a research study is now underway using 360 VR in COVID-19 patients to determine if the amount of infected lung tissue, along with certain admission labs, can predict patient outcomes.
TRACKING, TREATING AND PREVENTING THE SPREAD
Researchers at GW’s Milken Institute School of Public Health, in collaboration with the GW Hospital and the School of Medicine and Health Sciences, are conducting surveillance testing among GW health-care workers to look for signs of previous infection and immunity to the virus that causes COVID-19.
The study will address important issues around how to keep essential health-care workers and their families safe, says Lynn R. Goldman, dean of the public health school. “The many illnesses and deaths of health-care workers worldwide have been tragic.”
Cindy Liu, an associate professor of occupational and environmental health, leads the surveillance testing team, which is using a rapid, polymerase chain reaction test to look for and confirm active infections among health-care workers who are not showing overt symptoms of COVID-19.
“One of the big mysteries of this virus is how it can cause devastating illness in some people, while others can be infected with no noticeable symptoms,” says Liu, whose lab produces its own reagents and contracted a 3D-printing company to manufacture swabs, given the scarcity of supplies. “Unfortunately, people who are infected without symptoms may unwittingly spread the disease.”
In addition, the study would identify if, when and the extent to which those who are infected but only have mild or no symptoms develop antibodies to the virus. Liu and her lab built upon an existing antibody test to develop an in-house approach that can measure COVID-19 antibodies.
The research team has now expanded the surveillance testing across the GW community.
BY THE NUMBERS
The size of threads in nanometers comprising a GW-developed microscopically fine mesh whose pores may be able to filter coronavirus.
The number of downloads of a GW research team’s paper on the design of a 3D-printed mask. Students and faculty in GW’s School of Engineering & Applied Science and the Corcoran School of the Arts & Design collaborated with GW Hospital staff to design, test and manufacture reusable face shields and N95-grade masks.
Clinical Vaccine Trial
GW was one of about 90 sites in the United States selected to participate in clinical trials of experimental vaccines and monoclonal antibodies, laboratory-produced molecules engineered to serve as substitute antibodies.
This research is part of the COVID-19 Prevention Network, established by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH). GW participated as a trial site in a Phase 3 clinical trial of the mRNA-1273 vaccine, co-developed by NIAID scientists and the biotechnology company Moderna, Inc. The vaccine uses a chemical messenger called ribonucleic acid or RNA that instructs the body’s cells to create a protein that mimics one found on the outer surface of the virus that causes COVID-19. The hope is the injections will spur the body to mount an immune response that will protect against the novel coronavirus.
GW’s David Diemert with the School of Medicine and Health Sciences and Manya Magnus with the Milken Institute School of Public Health are leading the trial, which was held up as a model for successfully recruiting participants among communities hardest hit by the virus.
The Plasma Brush-Off
Cold atmospheric plasma is certainly a versatile variety of the fourth state of matter. It can propel small satellites. It selectively kills cancer cells around a tumor without damaging the surrounding healthy tissue. Engineering professor Michael Keidar has helped pioneer both uses of cold plasma. Now, he’s turned his attention—and plasma beam—to COVID-19 with the development of a plasma brush that he hopes can swiftly and safely decontaminate surfaces and personal protective equipment.
Plasmas are a form of ionized gas—meaning they contain a proportion of charged particles—that are highly effective in disarming harmful microbial pathogens. Typically, they exist at extremely high temperatures, but “cold” atmospheric plasma requires only the gas’s electrons to be at an elevated temperature, making it safe for use around humans. And because atmospheric cold plasma doesn’t use a liquid agent like traditional disinfectants do, it’s also safe for use on damage-prone surfaces.
The National Science Foundation awarded Keidar’s team a Rapid Response Research grant to develop the disinfection system using cold adaptive atmospheric plasma. With help from Christopher Mores, a virologist in GW’s Milken Institute School of Public Health, Keidar is testing the effectiveness of the plasma brush on COVID-19-infected surfaces and materials. He also organized a symposium on the use of plasma-based technologies to fight COVID-19 at the American Physical Society’s annual plasma physics meeting, and recently entered into a corporate research agreement that will explore adapting cold plasma devices to combat the spread of the virus on biological surfaces and in the air.
Though still at an early stage of development and testing, Keidar hopes the cold plasma tools could be used in current or future pandemics.
“We may well have another phase [of COVID-19] next year, so we need to be prepared,” he says.
The novel coronavirus can slip through masks, lurk in cuticle crevices and hide in the hollows of hands. To thwart an enemy so small, one must think and deal in nanometers.
Danmeng Shuai, an associate professor of civil and environmental engineering, and Yun Shen, an assistant research professor of occupational and environmental health in GW’s public health school, are developing electrospun nanofibers that could be used to filter airborne COVID-19 in personal protective equipment and industrial or residential HVAC systems. Their process involves ejecting a polymer solution from a needle under high voltage. The solution droplets polarize and repel each other to form threads as thin as 100 nanometers, creating a microscopically fine mesh with pores so minute that they exclude almost all pathogens and allergens.
“Think about it like the mesh screen on a window, except that these fibers are so small that you cannot see the grid,” says Shuai, whose COVID-19 work is supported by a National Science Foundation Rapid Response Research grant.
Shuai and Shen want to go beyond conventional electrospinning techniques and objectives, though, to combat COVID-19 even more effectively.
One possibility is to manufacture organic polymer “branches” atop the nanofibers, simulating microscopic virus receptors in the human body. (Coronaviruses cause infection by attaching to these receptors on target cells.) Like locks fitting keys, these branched nanofibers could capture COVID-19 viruses more effectively than a simple filter would, preventing them from detaching. The team is also investigating ways to safely increase the surface charge of the nanofibers, causing higher electrostatic attraction and therefore tighter binding between it and the naturally charged coronavirus particles.
Online behavior, Offline Virus
“There is a new world war online surrounding trust in health expertise and science, particularly with misinformation about COVID-19, but also distrust in big pharmaceuticals and governments,” says physics professor Neil Johnson, a member of the Institute for Data, Democracy, and Politics. “Nobody knew what the field of battle looked like, though, so we set out to find out.”
Johnson led a team of researchers who tracked conversations about vaccines among 100 million Facebook users during the height of the 2019 measles outbreak, developing the first system-level map. The researchers found that communities on Facebook that distrust establishment health guidance are more effective than government health agencies and other reliable health groups at reaching and engaging “undecided” individuals. Their study was published in the journal Nature.
According to the study, there are nearly three times the number of anti-vaccination communities on Facebook than pro-vaccination communities; pro-vaccination groups remained mostly peripheral to online conversations about vaccines; and anti-vaccination communities offered more diverse narratives around why people should oppose vaccines.
“Instead of playing whack-a-mole with a global network of communities that consume and produce (mis)information,” Johnson says, “public health agencies, social media platforms and governments can use a map like ours and an entirely new set of strategies to identify where the largest theaters of online activity are and engage and neutralize those communities peddling in misinformation so harmful to the public.”
MODELING HUMANS AND THE VIRUS
Also looking to distill meaning from the noise of social media, GW engineering professor David Broniatowski and colleagues from other universities launched a platform to collect data resources and publications to facilitate research around how social media can be used to prevent the spread of COVID-19.
The open online database, housed on the website Social Media for Public Health could help combat misinformation, support messaging from public health organizations and track information about the ongoing pandemic.
Broniatowski and his team are supported by a RAPID grant from the National Science Foundation. They are collaborating with mathematical modelers at New York University to use the online database to develop a new model that predicts human behavior and how human behavior and the spread of the virus interact with one another.
“People change their behaviors to drastically reduce the spread of the virus, such as by distancing or wearing masks,” Broniatowski says. “However, not all people will do so at the same time or in a coordinated way. Their decisions might be driven by the information that they have access to. The virus can also change behaviors — as people see their friends and neighbors become sick, they might take the disease more seriously. Therefore, behavior and disease spread are coupled. We plan to model how these behaviors co-evolve.”
In a recent study published in the American Journal of Public Health, Broniatowski and a team of researchers analyzed more than 250,000 posts on 204 Facebook pages expressing opposition to vaccines over a 10-year period. They found that anti-vaccination discourse on Facebook increased over the last decade, uniting around the argument that vaccine refusal is a civil right. The finding could have critical public health implications.
As COVID-19 deaths stretch funeral capacity, GW researchers are studying how sudden changes in religious, funeral and commemorative practices due to the pandemic affect the ability to mourn and grieve. Led by anthropologists Sarah Wagner, Roy Richard Grinker and Joel Kuipers, the Rituals in the Making project is observing and analyzing how rituals typically conducted in the physical presence of others are being transformed into virtual practices. Specifically, will affected parties accept or resist changes, and how will they improvise? In addition to interviewing more than 100 mourners, faith leaders and funeral directors, the group is viewing video-recorded funerals and virtual memorials while also attending some in-person events. The study, titled “Rituals in the Making” and funded by the National Science Foundation, will be completed in May 2021.
The distance between us
An expert in spatial event modeling, Michael Mann has forecast wildfires in California and droughts in Ethiopia. Now the associate professor of geography is using GPS data to create a block-by-block map of the Washington, D.C., region, pinpointing social distancing behavior. By charting people’s locations, Mann is collecting information on the degrees to which individuals within neighborhoods are following distancing guidelines. Once completed, the model will be able to detect patterns by comparing real-time information—such as the number of hours people are away from home—to social distancing metrics.
“Everyone in the scientific community is looking for something they can do to help out,” Mann said. “I’m trying to fill gaps for policymakers and health officials and who ever else can make use of [social distancing] data.”
As part of a data-sharing agreement, Mann is filtering massive amounts of commercial GPS data, anonymized location information from mobile devices compiled by the private firm SafeGraph and made available to academics and researchers for public health-related studies. He is designing an online dashboard for viewing and analyzing the data, which he hopes local and regional policymakers will be able to use to target areas requiring greater social distancing education. The dashboard would also help public health officials determine the effectiveness of social distancing strategies and chart the direction of future COVID safety measures.
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