Office of Research & Development |
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For VA investigators: Please check our funding page for news about new funding opportunities relating to COVID-19. |
In response to the COVID-19 pandemic, VA Research has undertaken a wide array of activities to support and advance VA's clinical and research missions and help Veterans affected by the disease. These efforts have spanned biomedical research, therapeutics and vaccine clinical trials, and data analyses that leverage VA's rich electronic health record system. VA Research has coordinated closely with internal VA and external partners—such as the National Institutes of Health and other federal agencies, and pharmaceutical companies—to identify the areas in which VA's nationwide research capacity, resources, and infrastructure could make the greatest contribution.
On this web page, we summarize recent and current COVID-19 research across the VA system.
Simple COVID-19 severity definition helps track pandemic
A simple definition of COVID-19 severity can help track pandemic severity and spread, according to a study by VA Boston researchers. COVID-19 hospitalization tracking often does not include disease severity. The researchers looked at data on COVID-19 admission to a VA hospital between March 2020 and November 2021. They defined moderate-to-severe COVID-19 as cases needing supplemental oxygen or a blood oxygen level of less than 94%. Among 67,000 patients, moderate-to-severe COVID-19 cases fell from 64% of total cases to 56%, driven by lower rates in vaccinated patients. Cases of more severe disease were highly correlated with dexamethasone medication receipt. They also increased after July 2021, corresponding to the emergence of the delta variant. The results show that this objective definition of COVID-19 severity can be used to detect trends in vaccine effectiveness and guide treatment and risk factor assessment, say the researchers. (Infection Control and Hospital Epidemiology, Jan. 11, 2022)
Blood pressure medications do not increase COVID-19 risk
Blood pressure and heart disease medications do not increase the risk of COVID-19 death, according to a VA study. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are medicines often used to treat high blood pressure, as well as heart disease and heart failure. Some have speculated that these drugs could increase the risk of COVID-19 because they increase ACE-2, the receptor through which the SARS-CoV-2 virus enters cells. Researchers examined data on more than 27,000 Veterans who tested positive for COVID-19. ACEI/ARB use was not associated with increased risk of death or worse outcomes in these patients. In fact, patients taking ACEIs/ARBs had a lower risk of intensive care admission and all-cause mortality compared with other patients. Those taking ACEIs did have higher odds of sepsis within 60 days of testing positive for COVID-19. The results suggest that these drugs are safe to take during the pandemic, according to the researchers, but more studies are needed on how specifically they interact with the virus. (Drugs, January 2022)
Two monoclonal antibodies do not appear to improve COVID-19 outcomes
Two monoclonal antibody therapies were not shown to be effective for treating COVID-19, in an international study in which VA participated as part of the ACTIV-3 trial platform, an NIH initiative. Monoclonal antibodies are a type of drug created from human proteins designed to bind to the virus and neutralize it. Researchers tested two new monoclonal antibodies (sotrovimab or BRII-196 plus BRII-198) compared with placebo in more than 500 volunteers with COVID-19. Neither drug provided patients with higher odds of favorable pulmonary or complication outcomes, compared with those who received placebo. Some evidence suggested that BRII-196 plus BRII-198 could be beneficial to patients who did not naturally produce antibodies to the virus. The results do not support the use of monoclonal antibody treatment for patients hospitalized with COVID-19, conclude the researchers. (Lancet Infectious Diseases, Dec. 23, 2021)
Cancer screenings and diagnoses fall during pandemic
Cancer screening procedures and new cancer diagnoses in VA fell in 2020 due to the pandemic, found a VA Maryland Health Care System study. Researchers analyzed data from more than 9 million VA patients. Screenings and diagnoses were significantly lower than in the previous two years. This change was likely caused by disruptions in non-emergency care due to the pandemic. New cancer diagnoses dropped between 13% and 23%, depending on type of cancer. In 2020, colonoscopies in VA decreased by 45%, prostate biopsies dropped 29%, cystoscopies for bladder cancer fell by 21%, and chest scans for lung cancer fell by 10%.The researchers hope that the results will help physicians and health care organizations plan and allocate resources to re-engage with patients. (Cancer, Dec. 6, 2021)
Vaccine comparison shows slightly better protection from Moderna vaccine
In the first head-to-head comparison of the effectiveness of the Pfizer and Moderna COVID-19 vaccines, Moderna was shown to offer slightly better protection. Researchers looked at health data from more than 400,000 VA patients who received vaccines. Both vaccines were highly effective in prevention COVID-19 infection, hospitalization, and death. But patients who received the Moderna vaccine had a 21% lower risk of infection and a 41% lower risk of hospitalization. The study confirms that both vaccines are extremely effective, say the study authors, and either one in recommended to any individual offered a choice between the two. The differences may be meaningful for public-health officials setting policy or making decisions on a wide scale, they explain. (New England Journal of Medicine, Dec. 1, 2021)
Clinical Trials
The effect of povidone-iodine nasal spray on COVID-19 nasopharyngeal viral load in patients: A randomized control trial. Zarabanda D, Vukkadala N, Phillips KM, Qian ZJ, Mfuh KO, Hatter M, Lee IT et al. Data suggest that dilute version of povidone-iodine nasal spray are safe for topical use in the nasal cavity, but that the spray does not demonstrate virucidal activity in COVID-19 positive outpatients. Laryngoscope. 2021 Nov 1. Online ahead of print.
Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): A randomised, double-blind, parallel-group, placebo-controlled phase 3 trial. Marconi VC, Ramanan AV, de Bono S, Kartman CE, Krishnan V, Liao R, Piruzeli ML et al. Although there was no significant reduction in the frequency of disease progression overall, treatment with baricitinib in addition to standard of care (including dexamethasone) had a similar safety profile to that of standard care alone, and was associated with reduced mortality in hospitalized adults with COVID-19. Lancet Respir Med. 2021 Aug 31. Online ahead of print.
Baricitinib plus remdesivir for hospitalized adults with Covid-19. Kalil AC, et al. Baricitinib plus remdesivir was superior to remdesivir alone in reducing recovery time and accelerating improvement in clinical status among patients with COVID-19, notably among those receiving high-flow oxygen or noninvasive ventilation. N Eng J Med. 2021 Mar 4;384(9):795-807.
A neutralizing monoclonal antibody for hospitalized patients with Covid-19. ACTIV-3/TICO LY-CoV555 Study group, Lundgren JD, et al. Monoclonal antibody LY-CoV555, when coadministered with remdesivir, did not demonstrate efficacy among hospitalized patients who had COVID-19. N Engl J Med. 2020 Dec 22. Online ahead of print.
Laboratory Studies
Detection of antibody responses against SARS-CoV-2 in plasma and saliva from vaccinated and infected individuals. Klingler J, Lambert GS, Itri V, Liu S, Bandres JC, Enyindah-Asonye G, Liu X et al. Although saliva levels were significantly lower, a strong correlation was observed between plasma and saliva antibody levels in vaccinated and convalescent COVID-19 patients. Front Immunol. 2021 Dec 20;12:759688.
BNT162b2 vaccine induces divergent B cell responses to SARS-CoV-2 S1 and S2. Brewer RC, Ramadoss NS, Lahey LJ, Jahanbani S, Robinson WH, Lanz TV. Messenger RNA vaccines for COVID-19 produced strong immune responses, and this response was strongly boosted by the second does, which delivers potently neutralizing antibodies against SARS-CoV-2 and several of its variants. Nat Immunol. 2021 Nov 30. Online ahead of print.
Glycosylation and disulfide bonding of wild-type SARS-CoV-2 spike glycoprotein. Zhang S, Go EP, Ding H, Anang S, Kappes JC, Desaire H, Sodroski JG. The study examined the biology of the SARS-CoV-2 virus spike protein, which allows it to enter cell membranes. The findings could expedite the improvement of vaccines and therapies for COVID-19. J Virol. 2021 Nov 24. Online ahead of print.
Heterogeneous longitudinal antibody responses to Covid-19 mRNA vaccination. de la Monte SM, Long C, Szczepanski N, Griffin, Fitzgerald A, Chapin K. Host responses to SARS-CoV-2 spike mRNA vaccines vary in magnitude, duration, and occurrence. This study raises concern about the lack of vaccine protection in as many as 8% of otherwise normal people. Clin Pathol. 2021 Oct 7;14:2632010X211049255.
Osteoclast-mediated bone loss observed in a COVID-19 mouse model. Awosanya OD, Dalloul CE, Blosser RJ, Dadwal UC, Carozza M, Boschen K, Klemsz MJ, Johnston NA, Bruzzaniti A, Robinson CM, Srour EF, Kacena MA. This study demonstrated significant bone loss within two weeks after COVID-19 infection in surviving asymptomatic and moderately affected mice. Bone. 2021 Oct 1. Online ahead of print.
Data Analysis/Review
Association of vitamin D status and COVID-19-related hospitalization and mortality. Seal KH, Bertenthal D, Carey E, Grunfeld C, Bikle DD, Lu CM. Vitamin D blood concentrations are inversely associated with COVID-19-related hospitalization and mortality. J Gen Intern Med. 2022 Jan 1:1-9. Online ahead of print.
COVID-19 infection in the Veterans Health Administration: Gender-specific racial and ethnic differences. Upchurch DM, Wong MS, Yuan AH, Haderlein TP, McClendon J, Christy A, Washington DL. American Indian/Alaska Native, Hispanic, and Black women and men Veterans are disproportionately impacted by COVID-19 infection. Womens Health Issues. 2022 Jan-Feb;32(1):41-50.
Patient and provider predictors of telemental health use prior to and during the COVID-19 pandemic withing the Department of Veterans Affairs. Connolly SL, Stolzmann KL, Heyworth L, Sullivan JL, Shimada SL, Weaver KR, Lindsay JA et al. Findings demonstrate a digital divide, such that older and lower income patients, and older providers, engaged in less video care. Non-psychologists also have lower video use. Am Psychol. 2021 Dec 23. Online ahead of print.
Premorbid traumatic stress and veteran responses to the COVID-19 pandemic. Fein-Schaffer D, Hawn SE, Annunziata AJ, Ryabchenko K, Miller MW, Wolf EJ. The results suggest that preexisting PTSD and alcohol use disorder are markers for adverse pandemic-related psychiatric outcomes and COVID-19 illness. J Trauma Stress. 2021 Dec 3. Online ahead of print.
Trends in US surgical procedures and health care system response to policies curtailing elective surgical operations during the COVID-19 pandemic. Mattingly AS, Rose L, Eddington HS, Trickey AW, Cullen MR, Morris AM, Wren SM. The initial shutdown period in March through April 2020 was associated with a decrease in surgical procedure volume. After the reopening, the rate of surgical procedures rebounded to 2019 levels. JAMA Netw Open. 2021 Dec 1;4(12):e2138038.
Other Research
The impact of the COVID-19 pandemic on mental health, occupational functioning, and professional retention among health care workers and first responders. Hendrickson RC, Slevin RA, Hoerster KD, Chang BP, Sano E, McCall CA, Monty GR et al. The results show potentially treatable psychiatric symptoms in health care workers and first responders, impacting both well-being and the health care system. J Gen Intern Med. 2021 Dec 16. Online ahead of print.
Do pliexiglass barriers reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)? Cadnum JL, Jencson AL, Donskey CJ. In simulations, physical barriers with no openings were effective in reducing contamination with an aerosolized benign virus or fluorescent microspheres, but barriers with openings were not. Infect Control Hosp Epidemiol. 2021 Nov 2;1-4.
Attitudes and intentions of US Veterans regarding COVID-19 vaccination. Jasuja GK, Meterko M, Bradshaw LD, Carbonaro R, Clayman ML, LoBrutto L, Miano D et al. Survey findings provide information needed to develop trusted messages to address Veteran vaccine hesitancy. Conversations need to emphasize societal reasons for getting vaccinated and benefits to one’s own health. JAMA Netw Open. 2021 Nov 1;4(11):e2132548.
Impact of exposure to patients with COVID-19 on residents and fellows: An international survey of 1420 trainees. Cravero AL, Kim NJ, Feld LD, Berry K, Rabiee A, Bazarbashi N, Bassin S et al. Exposure to patients with COVID-19 is significantly associated with higher burnout rates in physician trainees. Postgrad Med J. 2021 Nov;97(1153):706-715.
Does a lack of vaccine side effects correlate with reduced BNT162b2 mRNA vaccine response among healthcare workers and nursing home residents? Ovebanji OA, Wilson B, Keresztesy D, Carias L, Wilk D, Payne M, Aung H et al. Subjects who reported post-vaccination reactions developed higher antibody levels. Aging Clin Exp Res. 2021 Oct 15:1-10
Commentary
Chasing the storm: Recruiting non-hospitalized patients for a multi-site randomized controlled trial in the United States during the COVID-19 pandemic. Hu K, Tardif JC, Huber M, Daly M, Langford AT, Kirby R, Rosenberg Y et al. Researchers share difficulties and strategies for recruiting participants to COVID-19 trials during the pandemic. Clin Transl Sci. 2021 Dec 24. Online ahead of print.
Suicide prevention in the COVID-19 era. Rothman S, Sher L. With the COVID-19 pandemic affecting mental health and creating social isolation, preventative measures need to be implemented universally. Prev Med. 2021 Nov;152(Pt 1):106547.
Conquering COVID-19: How global vaccine inequality risks prolonging the pandemic. Oehler RL, Vega VR. Wealthier countries must do more to eliminate the inequality that exists in COVID-19 vaccine availability in less-developed nations. As long as the pandemic rages in any corner of the globe, the world will never be truly rid of COVID-19. Open Forum Infect Dis. 2021 Sep 9;8(10):ofab443.
Addressing and inspiring vaccine confidence in Black, indigenous, and people of color during the coronavirus disease 2019 pandemic. Marcelin JR, Swartz TH, Bernice F, Berthaud V, Christian R, da Costa C, Fadul N et al. This article explores the impact of inequities on vaccine acceptance and ways to establish trustworthiness in health care institutions; increase vaccine access in minority communities; and inspire confidence in COVID-19 vaccines. Open Forum Infect Dis. 2021 Aug 0;8(9):ofab417.
The face mask at the intersection of prevention science, domestic politics, and international diplomacy: A historical perspective. Kristo G, He K, Whang E, Fisichella PM. From a historical perspective, when cooperation rather than division becomes the norm in the global response to pandemics, the face mask can then unite rather than divide us. J Laparoendosc Adv Surg Tech A. 2021 Apr 23. Online ahead of print.
As of November 2021, nearly 70 VA medical centers are involved in one or more COVID-19 clinical trials. Below are several examples. A full list of COVID-19 Clinical Trials in VA is also available.
VA official encourages minorities to make educated decisions about participating in COVID-19 trials
Former Navy Surgeon General wants Veterans to know that vaccines are safe and effective for most
Veteran determined to help 'win this war' against COVID-19
Continuing to serve: Army Veteran signs up for coronavirus research
For a concise overview of current VA Health Services Research and Development (HSR&D;) efforts on COVID-19, visit COVID-19 Efforts.
To rapidly stand up new research and optimize resources during the COVID-19 pandemic, the VA Office of Research and Development (ORD) has coordinated with the National Institutes of Health, the Department of Defense, the Department of Energy, other federal agencies, and several industry partners—namely, pharmaceutical companies. Further, as part of the larger Veterans Health Administration system, ORD has supported other VHA offices by providing research expertise and personnel to assist with public health and informational demands.
Prior to the pandemic, ORD had been pursuing three strategic priorities: enhancing Veteran access to clinical trials; putting VA data to work for Veterans; and increasing the real-world impact of VA research. These priorities continue to guide ORD’s efforts and have positioned the program to quickly respond to COVID-19 through the creation and expansion of research partnerships; optimization of resource allocation; and streamlining and modernization of processes and policies. Part of this effort has involved creating new ways to rapidly support VA investigators eligible for VA research funding, and quickly evaluating research ideas proposed by VA scientists.
ORD is engaged in a wide array of research activities on COVID-19, with the support and cooperation of many internal VA and external partners. These activities encompass a range of studies, as well as innovative approaches to planning, coordinating, and expediting research:
To help prevent the spread of COVID-19, reduce exposures among both research staff and patients, and decrease the burden on the health care system, ORD instituted an administrative hold that stopped non-critical, in-person research contacts for all VA-funded research. (Some of this activity has begun to resume as of June, depending on local conditions.) Additional guidance was issued to ensure the safety and protection of all those involved in research. To ensure communication and understanding, ORD has developed a common communication platform for providing written guidance and sharing resources and tools, issued FAQs for field staff, and conducted a series of informational webinars for VA research personnel.
As protective measures were implemented for personnel, ORD recognized the importance of continuing research when possible, given the public investments made to date. In this context, regulatory guidance was issued on options and requirements for conducting research through alternative methods. Additionally, ORD worked with the VA Office of Information Technology to issue guidance on the use of communication technologies for research purposes. A field operations workgroup was also set up to examine ongoing research challenges and to develop more uniform guidance for all research programs.