Research in a time of crisis

In science as in life, the past 16 months have been nothing short of a crucible: “a situation of severe trial… leading to the creation of something new,” as the Oxford dictionary describes it. The pandemic charged in on a cloud of confusion that gave way to ingenuity, promising to forever change how research at the University of Utah is done.

Those early days proved critical for setting the U on a trajectory to make a difference. When COVID-19 shifted from threat to reality, scientists faced a difficult decision. Should we keep ourselves, co-workers, and their families safe by staying home? Or should science soldier on? After all, the one thing that would hasten the end of the pandemic is a set of science-based solutions to combat the virus and its endless impacts.

While research programs across the country quickly shut down, the U’s Office of the Vice President for Research (VPR) eliminated the dilemma by building a safe environment so researchers could continue their work. Personnel donned personal protection equipment, deployed sanitation stations, staggered work hours, and shrank their in-person workforce to an essential few. Just weeks after the first COVID-19 cases emerged in Utah, the Office of the VPR, in collaboration with the U’s Immunology, Inflammation, and Infectious Disease Initiative (3i), made another critical decision. They invested $1.3 million in seed funding to jump-start more than 55 COVID-19 research projects across campus.

(5 minute video) In a time of crisis, University of Utah researchers mobilized rapidly to meet the challenges of a global threat. Video credit: Charlie Ehlert

Today, the number of COVID-19 research projects at the U has swelled to more than 400, rooted in every discipline imaginable, from political science to engineering, medical research to health disparities, environmental science to business.

With a deep understanding of the immense importance and immediate need, investigators and administrators moved mountains to make COVID-19 research happen. They innovated and applied their knowledge in different ways. If their new work required resources that didn’t exist, they built them. If they needed additional expertise, they reached across campus—and out to the public and larger scientific community—to form collaborations. To share insights and resolve issues, 3i initiated regular, COVID-19-focused symposia, uniting scientists from across campus in a way that had not been done before.

“I’m humbled by how much our research community has stepped up to the plate,” says Andrew Weyrich, PhD, Vice President for Research. “Their collaborative spirit and values allowed us to overcome challenges throughout the pandemic.”

Beyond research, U scientists’ in-depth knowledge equipped them to serve as guiding voices for the public and policymakers. Media called on them to explain intricacies of the disease and its solutions, while state and national agencies consulted with them on strategies for protecting communities and forming evidence-based decisions.

(1 hour video) Seminar to the community about the U of U COVID-19 research response.

Data reveal truths, and the numbers from this time tell a story of impact. U investigators have published more than 200 COVID-19 scientific papers that have become resources for the global scientific community, and their expertise has been cited in more than 500 news stories. Government agencies and private foundations are also relying on the U, investing more than $62 million in U-led COVID-19 research. “University of Utah is on track for having one of the most comprehensive COVID-19 research programs in the country,” Weyrich says. As the fight against the pandemic and its long-lasting effects plays out over the years to come, these contributions will only continue to grow.

The world had never encountered a virus like this one, but the challenges it brought made an already robust research enterprise even stronger. Newly honed connections within and beyond the university mean that, moving forward, researchers can respond quickly and comprehensively to demands of the future, whatever they may be.

“The pandemic has taught us that when we work together, we can accomplish anything,” Weyrich says.

COVID-19 complications more likely in Black and Native American populations

Black people and Native Americans with health problems prior to contracting COVID-19 are more likely to have longer hospital stays, require treatment with a ventilator and have a higher risk of death than White people who have similar preexisting conditions, according to a new nationwide study led by University of Utah Health scientists.

The researchers say these results refute the notion that Black, Indigenous and People of Color are at greater risk of COVID-19 complications because they have one or more previous illnesses or diseases.

“Our findings contest arguments that Blacks and other racial and ethnic minorities are dying from COVID-19 at higher rates than their White counterparts because they have more comorbidities,” says Fares Qeadan, an assistant professor of biostatistics in the Division of Public Health and lead author of the study. “In fact, when we compared Blacks, Native Americans and Whites who had the same number of prior conditions, Blacks and Native Americans were still at higher risk of dying or being put on a ventilator.”

The study appears in Scientific Reports.

Preexisting conditions such as cancer, heart disease and obesity could be driving factors in higher risks for hospitalization, need for ventilation and death due to COVID-19, according to the Centers for Disease Control and Prevention. Blacks, Latinos and Native Americans all tend to also have more preexisting conditions than Whites. As a result, some researchers have suggested this could account for the higher rate—up to 3.7 times greater—of hospitalization and other COVID-19 complications among these racial and ethnic minority groups compared to Whites.

However, few studies have scrutinized whether populations with health disparities that have similar types of preexisting conditions as Whites have the same risk of COVID-19 complications. To address this concern, Qeadan and colleagues examined more than 52,000 medical records of patients who were diagnosed or who had tested positive for COVID-19.

Using a computerized analytical tool called the Elixhauser comorbidity index (ECI), they identified 31 common preexisting conditions that could contribute to COVID-19 complications. Each patient received a comorbidity score based on disease history and was then compared to patients with similar scores. This apples-to-apples approach, as well as multi-level regression models, allowed the researchers to more precisely identify differences in COVID comorbidities among racial and ethnic groups.

Specifically, compared with Whites, Blacks who had similar comorbidity scores had:

  • Longer hospital stays (1.22 days vs. 1.07 days)
  • Were more likely to be ventilator-dependent (85% more when the comorbidity score is low and 23% more when the score is high)
  • Were more likely to die (47% more when the comorbidity score is low and 13% more when the score is high)

Compared with Whites, Native Americans with similar comorbidity scores had:

  • Longer hospital stays (1.42 days vs. 1.07 days)
  • Higher odds of ventilator dependence across all comorbidity scores and
  • Higher odds of death (234% higher when the comorbidity score is low and 169% higher when the score is elevated)

The researchers note that their study only included patients who sought treatment for COVID-19. As a result, medically underserved and minority populations without health insurance may be underrepresented in this research. Differences in medical record coding within and between health care facilities also could have influenced these results.

“We hope the results of this study will help us better understand what’s going on in medical care that creates these disproportionalities,” says Elizabeth VanSant-Webb, a study co-author and project manager at the Sorenson Impact Center at University of Utah. “Hopefully, this will lead to better interventions to close the health care gap in this country.”

Moving forward, the researchers plan to potentially conduct a qualitative study to better explore patients’ experiences, provider behavior and hospital practices that may have contributed to these disparities.

“Our study did not explicitly examine the influence of social determinants of health such as structural racism, which could have contributed to the inequities we found,” says Charles R. Rogers, an assistant professor of Public Health and senior author of the study. “Decades before the pandemic, the value based on an individual simply because of the color of their skin has likely contributed to both poor health outcomes and health care access at alarmingly high rates for communities of color and warrants further investigation.”

The study, “Racial Disparities in COVID-19 Outcomes Exist Despite Comparable Elixhauser Comorbidity Indices between Blacks, Hispanics, Native Americans, and Whites,” appears in Scientific Reports. The V Foundation for Cancer Research, 5 for the Fight, Huntsman Cancer Institute and the National Cancer Institute partly supported the study financially. The content does not necessarily represent the official views of any of these entities and is solely the responsibility of the research team.

Test to play and to stay

When COVID-19 cases began to rise dramatically in Utah in November 2020, schools faced a difficult choice. They could maintain normal activities, giving students valuable in-person instruction and social interaction but risking spread of COVID-19. Or they could send students home, keeping them safe from disease but putting their education, emotional health and social well-being at risk.

With a goal of preserving the best of both worlds, Utah Department of Health (UDOH) implemented two COVID-19 testing programs in collaboration with local health departments and Utah schools. These programs helped students participate in extracurricular activities and stay in school while likely reducing spread of the virus.

“For most students, being able to attend school in-person and participate in extracurricular activities is best for their learning as well as their social and emotional well-being,” says Adam Hersh, senior author on the study, professor of pediatrics at University of Utah Health, and Utah HERO investigator. Hersh collaborated with UDOH to study these testing programs. “When combined with other prevention strategies, most importantly masking, these testing strategies helped keep our schools safe and open.”

Testing allowed for the completion of 95% of more than 11,000 high school extracurricular competition events and saved an estimated 109,752 in-person instruction days for students. The results were published in the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR).

“Before the school year started, our school communities advocated for safe in-person education and participation in extracurricular activities,” says Kendra Babitz, COVID-19 State Testing Coordinator, UDOH. “Their dedication to maintaining optimal environments for learning and growth made these programs a success and kept kids in school.”

One COVID-19 testing program, “Test to Play”, was implemented in 66% (127 of 193) of Utah’s public high schools. In order to participate in extracurricular activities such as sports, students took part in mandatory, rapid antigen testing every 14 days.

“Test to Stay” was presented as an option when schools had outbreaks. Of the 28 high schools that reported outbreaks, 13 elected to conduct school-wide Test to Stay events. Students who tested positive were required to isolate for 10 days while students who tested negative could continue in-person learning.

Between November 30, 2020, and March 20, 2021, schools reported 165,078 tests. Among the 59,552 students tested, 1,886 (3.2%) had a positive result.

The study authors say that by identifying these positive cases, the testing programs likely helped reduce the spread of COVID-19 in schools and the community by enabling the students who tested positive to isolate while their close contacts could quarantine.

“Utah’s high school testing programs could not have been successful without the willingness, flexibility, and innovation of school staff,” said Commander William A. Lanier, lead author of the study and U.S. Public Health Service officer who was assigned to the UDOH to help with COVID-19 testing. “Their hard work helped preserve extracurricular and in-person learning opportunities for Utah students during a very challenging time.”

Will COVID-19 become a seasonal nuisance?

Within the next decade, the novel coronavirus responsible for COVID-19 could become little more than a nuisance, causing no more than common cold-like coughs and sniffles. That possible future is predicted by mathematical models that incorporate lessons learned from the current pandemic on how our body’s immunity changes over time. Scientists at the University of Utah carried out the research, now published in the journal Viruses.

“This shows a possible future that has not yet been fully addressed,” says Fred Adler, professor of mathematics and biological sciences at the U. “Over the next decade, the severity of COVID-19 may decrease as populations collectively develop immunity.”

The findings suggest that changes in the disease could be driven by adaptations of our immune response rather than by changes in the virus itself. Adler was senior author on the publication with Alexander Beams, first author and graduate student in the Department of Mathematics and the Division of Epidemiology at University of Utah Health, and undergraduate co-author Rebecca Bateman.

Although SARS-CoV-2 (the sometimes-deadly coronavirus causing COVID-19) is the best-known member of that virus family, other seasonal coronaviruses circulate in the human population—and they are much more benign. Some evidence indicates that one of these cold-causing relatives might have once been severe, giving rise to the “Russian flu” pandemic in the late 19th century. The parallels led the U of U scientists to wonder whether the severity of SARS-CoV-2 could similarly lessen over time.

To test the idea, they built mathematical models incorporating evidence on the body’s immune response to SARS-CoV-2 based on the following data from the current pandemic.

  • There is likely a dose response between virus exposure and disease severity.
  • A person exposed to a small dose of virus will be more likely to get a mild case of COVID-19 and shed small amounts of virus.
  • By contrast, adults exposed to a large dose of virus are more likely to have severe disease and shed more virus.
  • Masking and social distancing decrease the viral dose.
  • Children are unlikely to develop severe disease.
  • Adults who have had COVID-19 or have been vaccinated are protected against severe disease.

Running several versions of these scenarios showed that the three mechanisms in combination set up a situation where an increasing proportion of the population will become predisposed for mild disease over the long term. The scientists felt the transformation was significant enough that it needed a new term. In this scenario, SARS-CoV-2 would become “Just Another Seasonal Coronavirus,” or JASC for short.

“In the beginning of the pandemic, no one had seen the virus before,” Adler explains. “Our immune system was not prepared.” The models show that as more adults become partially immune, whether through prior infection or vaccination, severe infections all but disappear over the next decade. Eventually, the only people who will be exposed to the virus for the first time will be children—and they’re naturally less prone to severe disease.

“The novel approach here is to recognize the competition taking place between mild and severe COVID-19 infections and ask which type will get to persist in the long run,” Beams says. “We’ve shown that mild infections will win, as long as they train our immune systems to fight against severe infections.”

The models do not account for every potential influence on disease trajectory. For example, if new virus variants overcome partial immunity, COVID-19 could take a turn for the worse. In addition, the predictions rely on the key assumptions of the model holding up.

“Our next step is comparing our model predictions with the most current disease data to assess which way the pandemic is going as it is happening,” Adler says. “Do things look like they’re heading in a bad or good direction? Is the proportion of mild cases increasing? Knowing that might affect decisions we make as a society.”

The research, published as “Will SARS-CoV-2 Become Just Another Seasonal Coronavirus?”, was supported by COVID MIND 2020 and a seed grant from the University of Utah Vice President for Research and the Immunology, Inflammation and Infectious Diseases Initiative.