COVID-19 FACT SHEETFor 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.
Genetic links between severe COVID-19 and other diseases
A VA Million Veteran Program study identified genetic links between COVID-19 severity and certain serious medical conditions. Researchers analyzed genetic and health record data on more than 650,000 Veterans who volunteered for MVP. They compared gene variations previously found to be linked severe COVID-19 risk with gene variants connected to other conditions. The analysis showed that gene variants linked to severe COVID-19 are also linked to medical conditions known to be COVID-19 risk factors. The strongest links were found for venous embolism and thrombosis, as well as type 2 diabetes and ischemic heart disease. The study also showed genetic links between severe COVID-19 and neutropenia—low white blood cell count—in Veterans of African and Hispanic ancestry. This link was not seen in Veterans of European ancestry. Conversely, gene variants associated with severe COVID-19 were associated reduced risk of immune-related conditions such as lupus and rheumatoid arthritis. The findings shed light on genetic risk for COVID-19 and could lead to paths for new treatments, say the researchers. (PLOS Genetics, April 28, 2022)
Older and underweight Veterans at higher risk of death from COVID-19
Older and underweight Veterans had a higher risk of death from COVID-19, in a study by Salt Lake City VA researchers and colleagues. Researchers studied data on more than 400,000 Veterans who tested positive for COVID-19 in 2020 and 2021. Those 65 and older and those who were underweight were more likely to require mechanical ventilation and die in the hospital, compared with younger Veterans and those with normal weight. Veterans 85 and older had an almost five times greater rate of death. Asian and American Indian/Alaska Native Veterans also had higher risk of ventilation and death compared to white Veterans. Black Veterans had a 31% higher risk than white Veterans of hospitalization, but did not have a higher risk of death. Hospitalization, ventilation, and death rates decreased for all groups over time. The results show that age and weight are important variables to consider in COVID-19 risk, say the researchers. (Annals of Epidemiology, April 21, 2022)
Similar rates of moral injury in pandemic health care workers and combat Veterans
Potential for moral injury is as high for health care workers during the pandemic as it is for combat Veterans, according to a study by VA Durham researchers. Moral injury refers to feelings of guilt or shame when a person’s values or beliefs conflict with their actions or the way they see others acting. The researchers surveyed nearly 2,100 health care workers during the COVID-19 pandemic, along with more than 600 military Veterans who had deployed to combat zones. About 46% of Veterans and 51% of health care workers had potential moral injury related to the actions of others. Self-induced moral injury was seen in 24% of Veterans and 18% of health care workers. Moral injury was linked to higher depression symptoms and worse quality of life. Among health care workers, moral injury was tied to burnout. These feelings could stem from being unable to provide adequate care to dying patients and seeing others around them refuse to take steps to slow the spread of the virus, according to the researchers. Interventions related to moral injury in Veterans may be useful for health care workers in the aftermath of the COVID-19 pandemic, they say. (Journal of General Internal Medicine, April 5, 2022)
Video enabled tablets could decrease suicide in rural Veterans
Giving rural Veterans tablets for telehealth reduced suicidal behavior and increased mental health care use during the pandemic, found a VA Palo Alto study. Many fear that the COVID-19 pandemic has intensified suicide risk factors for people in rural areas. Researchers looked at mental health care use for more than 13,000 rural Veterans who were given video-enabled tablets. They compared this group to more than 458,000 Veterans who did not receive tablets. Those with tablets had an average increase of 1.8 in-person psychotherapy visits and 3.5 video visits per year. Tablets were linked to a 22% reduced likelihood of suicidal behavior. The tablet group had 20% lower odds an emergency department visit, and 36% lower odds of a suicide-related emergency room visit. The findings suggest that VA and other health systems should consider using tablets to increase access to mental health care via telehealth, say the researchers. (JAMA Network Open, April 1, 2022)
COVID-19 increases diabetes risk
COVID-19 increases the risk of developing diabetes, found a VA St. Louis study. Researchers studied data on more than 180,000 VA patients who had recovered from COVID-19. They compared these patients to over 4 million people who did not contract COVID-19 and over 4 million controls from before the pandemic. Those who had COVID-19 were at a 40% higher risk of being newly diagnosed with diabetes at least 30 days after infection, compared with controls. Odds of being prescribed medication for glycemic control were also increased. Diabetes risk was increased even in patients with mild COVID-19. More severe COVID-19 symptoms were linked to greater risk of developing diabetes. The results show that diabetes should be considered a facet of long COVID, and that strategies to address rising diabetes cases are needed, say the researcher. (Lancet Diabetes and Endocrinology, March 21, 2022)
Clinical Trials
A multicenter evaluation of the Seraph 100 microbind affinity blood filter for the treatment of severe COVID-19. Chitty SA, Mobbs S, Rifkin BS, Stogner SW, Lewis MS, Betancort J, DellaVolpe J et al. Findings suggest that broad spectrum, pathogen agnostic blood purification can be safely deployed to meet new pathogen threats while awaiting targeted therapies and vaccines. Crit Care Explor. 2022 Mar 25;4(4):e0662.
Efficacy and safety of baricitinib plus standard care for the treatment of critically ill hospitalised adults with COVID-19 on invasive mechanical ventilation or extracorporeal membrane oxygenation: An exploratory, randomised placebo-controlled trial. Ely EW, Ramanan AV, Kartman CE, de Bono S, Liao R, Piruzeli MLB, Goldman JD et al. In a small exploratory study of critically ill, hospitalized COVID-19 patients on ventilation or extracorporeal membrane oxygenation, treatment with baricitinib reduced mortality. Lancet Respir Med. 2022 Feb 3. Online ahead of print.
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.
Laboratory Studies
Inhibition of IRAK4 dysregulates SARS-CoV-2 spike protein-induced macrophage inflammatory and glycolytic reprogramming. Umar S, Palasiewicz K, Meyer A, Kumar P, Prabhakar BS, Volin MV, Rahat R et al. The study explores the molecular mechanism of how the SARS-CoV-2 virus affects the inflammatory response through the IRAK4 enzyme. Cell Mol Life Sci. 2022 May 19;79(6):301.
Severe acute respiratory syndrome coronavirus 2 viremia is associated with coronavirus disease 2019 severity and predicts clinical outcomes. Jacobs JL, Bain W, Naqvi A, Staines B, Castanha PMS, Yang H, Bolts VF et al. Levels of virus particles detected in the blood correlate to COVID-19 disease severity. Clin Infect Dis. 2022 May 3;74(9):1525-1533.
Prospective validation of a rapid host gene expression test to discriminate bacterial from viral respiratory infection. Ko ER, Henao R, Frankey K, Petzold EA, Isner PD, Haehne AK, Allen N et al. A host response bacterial/viral test accurately discriminated bacterial from viral infection among patients with acute respiratory illness with fever. JAMA Netw Open. 2022 Apr 1;5(4):e227299.
T-cell expression of angiotensin-converting enzyme 2 and binding of severe acute respiratory coronavirus 2. Welch JL, Xiang J, Chang Q, Houtman JCD, Stapleton JT. T-cells exposed to SARS-CoV-2 demonstrate reduced proliferation, indicating that direct interaction of the virus with T-cells may alter T-cell growth. This may contribute to impaired T-cell function observed in patients with severe disease. J Infect Dis. 2022 Mar 2;225(5):810-819.
Effect of monoclonal antibody therapy on the endogenous SARS-CoV-2 antibody response. Kim PS, Dimcheff DE, Siler A, Schildhouse RJ, Chensue SW. Passive immunization therapy may cause immunologic interference. Clin Immunol. 2022 Feb 24;236:108959.
Data Analysis/Review
Evaluating primary endpoints for COVID-19 therapeutic trials to assess recovery. Douin DJ, Grandits G, Phillips A, Aggarwal NR, Baker J, Brown SM et al. Among patients hospitalized with COVID-19, 20% had clinically significant post-discharge events within 90 days after study, in patients that would be considered “recovered” using the hospital discharge approach. Clinical trials should extend follow-up times to assess recovery more accurately. Am J Respir Crit Care Med. 2022 May 17. Online ahead of print.
Prior trauma exposure, posttraumatic stress symptoms, and COVID-19 vaccine hesitancy. Nishimi K, Borsari B, Tripp P, Jiha A, Dolsen EA, Woolley JD, Neylan TC, O’Donovan A. Socio-demographic and pandemic-related factors appear more important than trauma or mental health for understanding COVID-19 vaccine intentions. J Psychiatr Res. 2022 May 12;151:399-404.
Relative vaccine effectiveness of a SARS-CoV-2 mRNA vaccine booster dose against the Omicron variant. Butt AA, Talisa VB, Shaikh OS, Omer SB, Mayr FB. While the relative vaccine effectiveness of an mRNA booster vaccine dose in preventing infection against the Omicron variant is low, the effectiveness is substantial in preventing hospitalization and high in preventing the most severe COVID-19. Clin Infect Dis. 2022 May 3. Online ahead of print.
Psychiatric disorders newly diagnosed among Veterans subsequent to hospitalization for COVID-19. Chen JI, Hickok A, O’Neill AC, Niederhausen M, Laliberte AZ, Govier DJ, Edwards ST et al. Eight percent of VA patients developed a new mental health diagnosis following COVID-19 hospitalization. The most common diagnoses were depression, anxiety, and adjustment disorders. Psychiatry Res. 2022 Apr 22. Online ahead of print.
Risk prediction for acute kidney injury in patients hospitalized with COVID-19. McAdams MC, Xu P, Saleh SN, Li M, Ostrosky-Frid M, Gregg LP, Willett DL et al. Researchers developed and externally validated a model to accurately predict acute kidney injury in patients with COVID-19. Kidney Med. 2022 Apr 8. Online ahead of print.
Other Research
Communications to promote interest and confidence in COVID-19 vaccines. Thorpe A, Fagerlin A, Drews FA, Butler J, Stevens V, Riddoch MS, Scherer LD. Messages with information on the benefits of vaccination, reframing the likelihood of side effects, and emphasizing that post-vaccine symptoms indicate the vaccine is working increased vaccine interest. Veterans were more interested and confident in vaccines than non-Veterans. Am J Health Promot. 2022 Apr 12. Online ahead of print.
An assessment of Veterans attitudes and willingness to receiving the COVID-19 vaccine: A mixed methods study. Gardner J, Brown G, Vargas-Correa J, Weaver F, Rubinstein I, Gordon HS. The study illustrates the complexity of patients’ deliberation about COVID-19 vaccination and may help physicians and other health care providers understand patients’ perspectives about vaccination. BMC Infect Dis. 2022 Mar 29;22(1):308.
Cognitive and functional abilities in an older adult Veteran before and after contracting COVID-19. Okolichany R, Padala PR, Mooney S. No patterns of cognitive changes occurred in a 76-year-old Veteran before and after he contracted COVID-19. High levels of resilience, social support, and exercise, coupled with lower levels of perceived stress and loneliness may protect against cognitive and functional decline in older adults who contract COVID-19. J Alzheimers Dis Rep. 2022 Mar 25;6(1):115-120.
Home health aides’ increased role in supporting older Veterans and primary healthcare teams during COVID-19: A qualitative analysis. Franzosa E, Judon KM, Gottesman EM, Koufacos NS, Runels T, Augustine M, Hartmann CW, Boockyar KS. Home health aides played a central role in coordinating care during the COVID-19 pandemic, providing hands-on functional, medical, and emotional support. J Gen Intern Med. 2022 Mar 22. Online ahead of print.
Worse sleep, worsening post-traumatic stress disorder (PTSD): Poor sleep quality associated with increases in PTSD symptoms amongst those experiencing high threat of the COVID-19 pandemic. Straus LD, Dolsen EA, Nishimi K, Neylan TC, O’Donovan A. Poor sleep quality may enhance vulnerability to later PTSD symptoms during the pandemic, particularly among those who perceived the pandemic as threatening for their future. J Sleep Res. 2022 Feb 23. Online ahead of print.
Commentary
Smoking enhances suicide risk—A significant role in the COID-19 pandemic? Sher L. Tobacco smoking cessation may be needed to reduce suicidal behavior during and after the COVID-19 pandemic. QJM. 2022 Jan 5;114(11):767-769.
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.
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 research spells out COVID's down-the-road risks for cardiovascular and mental health
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
For a concise overview of current VA Health Services Research and Development (HSR&D;) efforts on COVID-19, visit COVID-19 Efforts.
Photo: ©iStock/South_agencyTo 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.
