– USF RESPONDS: COVID-19 –
By Sarah Worth ’86
THE SEVERE ADULT RESPIRATORY SYNDROME coronavirus-2 (SARS-CoV-2), the agent that causes COVID-19, is a novel and deadly strain of a relatively common benign class of viruses. In fact, coronaviruses cause a quarter of common colds.
Just a few months ago this new virus was unknown. Now, the world’s most brilliant medical minds are focused on every detail, and knowledge about COVID-19 is expanding exponentially on how to diagnose, to treat and to prevent this pandemic.
It’s a valiant effort and an incredible example of the power of academic medicine and its unity on a global scale. But it’s still early. We are still in the midst of this pandemic.
Leading experts at USF Health offer perspective on the past few months, what they’ve experienced and what they’ve discovered about society, our institutions and themselves.
While most hindsight concerning existential events has the vantage point of years of reflection, we have only months. Still, reflections are important. So, what are the lessons learned thus far? What valuable experiences will be remembered and which will prove useful in this and further epidemics?
BE RESOURCEFUL, AND REACT EARLY AND QUICKLY. Those are some of the key lessons of the past six months learned by Dr. Charles J. Lockwood, senior vice president for USF Health and dean of the Morsani College of Medicine.
Resourcefulness has been displayed on many fronts, he says, but one of its earliest manifestations came when we realized that there was an acute national shortage of viral collection kits for COVID-19.
As cases began popping up in Florida and complete testing kits were not available, Lockwood turned to the resourcefulness of USF Health faculty to create nasal swabs and viral transport media that are included in the kits.
“We recognized almost immediately at USF Health that we must be able to test for this virus to track it and contain it,” Lockwood says. “USF Health began producing its own transport media using a World Health Organization ‘recipe.’ And for the swabs, I approached Dr. Summer Decker, who directs our USF Health Morsani College of Medicine Department of Radiology 3D printing facility, and asked if she could develop a nasopharyngeal flocked swab prototype and mass produce it. And she did. Within a couple of days, she, the 3D printer company FormLabs and Northwell Health in New York were able to design, perfect and produce this really outstanding swab that had outstanding viral collecting capacity.”
The result: Faculty ingenuity and resourcefulness led USF Health to manufacture more than 50,000 nasal swabs and 10,000 viral transport media specimens, and build and supply thousands of testing kits to local hospitals and for Hillsborough County. Moreover, the 3D flocked swab formula has been disseminated across the nation and globe.
Another example of resourcefulness was exemplified in resolving another testing bottleneck: Ensuring there were adequate assays for COVID-19 in the lab. An assay is a procedure for measuring the biochemical or immunological activity of a sample. The plethora of different manufacturers making the COVID-19 assays, and the incredible demand for testing capacity, resulted in a critical shortage of the reagents necessary in the assay process.
“Working with our infectious disease faculty, the Esoteric Testing Lab team at Tampa General Hospital stood up six different platforms so they always had reagents to run assays from different manufacturers,” Lockwood says. “Initially it was 50 assays a week, now it’s close to 1,000, and they continue to ramp that up.”
Reacting early and quickly was another key lesson learned, he says, which played out on many fronts, including launching a mature telehealth platform, converting the entire USF Health educational program to remote learning, and standing up multiple clinical trials within several weeks.
Over a matter of days, USF Health shifted hundreds of in-person appointments into virtual telehealth appointments, an effort that helped patients stay connected with USF Health specialists for much-needed care.
“We literally stood up telehealth in a week and went from zero to 1,000 telehealth visits a day in just a few weeks, and had very high patient satisfaction,” Lockwood says.
By early May, USF Health had conducted more than 22,000 telehealth appointments.
For remote learning, medical students over just a few days connected to nearly every part of their curriculum.
“We completely ‘virtualized’ our curriculum for the medical school and other USF Health schools in one week,” Lockwood says. “We use Microsoft Teams for small-group learning, patient simulation, standardized patients, and lectures. You name it, it’s all online now. That is going to be a vast treasure trove of additional learning material even if we go back to small-group learning.”
And for clinical trials, USF Health was quick to start an array of clinical research, opening several dozen trials examining potential treatments for COVID-19, including participation in several national studies. The typical start-up timeframe for new clinical trials in an academic medical center is 90 days or more. USF Health has been able to start up COVID-19 trials in five days or less. Communication, collaboration and prioritization from many areas enabled the success, including budget and contract analysts, onsite legal counsel, USF Institutional Review Board (IRB), central IRBs, investigators, study teams and regulatory manager.
COVID-19 WILL UNDOUBTEDLY linger in our immediate future, Lockwood says.
In this “new normal,” from a scientific perspective, he says, a lot will depend on having novel medications that prevent death, developing an effective vaccine while avoiding a phenomenon called antibody-dependent enhancement, where giving the vaccine makes you even sicker than if you get COVID-19.
From a public health perspective, this new normal will depend on us.
“For most of us, the ‘new normal’ will look very much like the main Tokyo train station did last time I was there about five years ago,” he says. “Most people wore masks then, and many wore gloves, and they don’t shake hands. It’s perhaps what we need to do. We have to get used to wearing face masks, we have to get used to washing our hands a lot and using hand sanitizers and washing and cleaning all public surfaces.”
This new normal may also depend on our behavior as a species, he says, noting that the worldwide COVID-19 pandemic reflects another manifestation of the impact of over-population and over-development and disruption of natural habitats. In the case of COVID-19, Lockwood says, it was that of the bat.
“That encroachment allowed bats, which carry a large number of different viruses, including coronaviruses, to come in contact with domesticated animals, and that led to the Wuhan incident,” he says.
“Maybe, in the end, Mother Nature will have taught us a lesson, that we won’t need to encroach on natural habitats anymore, and we will stop unrestrained population growth and development.”
Maybe, in the summer of 2020, with COVID-19 only a few months old, we have shown how nimble we can be. Lockwood adds, “And perhaps we’re so much better than just nimble.”