FIGHTING CURRENT AND FUTURE PANDEMICS

Nurse practitioner Tiffany Vasey prepares to enter an isolation room in the monoclonal antibody treatment infusion center.

The Global Emerging Diseases Institute is battling COVID-19 while keeping an eye out for new health threats

BY KAREN FELDMAN

The swift and vicious rise of the COVID-19 pandemic has delivered a powerful lesson in just how critical research into infectious diseases is, and how urgent the need is to prepare the next generation of infectious diseases physicians. With the World Health Organization reporting more than 5.1 million deaths worldwide from the novel coronavirus by mid-November 2021, and the emergence of viral variants that threaten to undercut the effectiveness of vaccines designed to combat it, expanded research and treatment are vital.

That’s what the Global Emerging Diseases Institute (GEDI) was established to do in late 2020. A collaborative effort between Tampa General Hospital and the USF Health Morsani College of Medicine, the institute is dedicated to conducting groundbreaking research, treating patients with diseases from emerging pathogens, and training a new generation of infectious diseases specialists in medicine, nursing and ancillary support services.

As a leading academic medical center, TGH and the College of Medicine are dedicating valuable resources to the fight against COVID-19, both in research and patient care. Since March 2020, the hospital has admitted more than 5,240 COVID patients, treated more than 3,600 patients with monoclonal antibodies, administered more than 257,500 COVID tests, and is currently conducting more than 58 clinical trials.

Dr. Andrew Myers makes multidisciplinary rounds in a COVID-19 unit with TGH team members and University of South Florida infectious diseases doctors.

Joe Kimmins, a TGH respiratory therapist, writes information about ventilator settings on the window glass of a patient’s room in a TGH COVID unit.

Leading the Way

A pioneer in teaching, research, and clinical care, TGH was the first hospital in Florida to offer monoclonal antibody treatments to COVID-19 patients, a therapy that is now used broadly to help reduce the virus’s effects. Monoclonal antibodies are molecules that can restore, enhance, or mimic the immune system’s attack on cells. In treating COVID-19, they may block the virus from attaching to cells, making it more difficult for the virus to reproduce and cause harm. They may also neutralize the virus and are most effective when administered within a week of infection.

Dr. Seetha Lakshmi is the medical director of the GEDI and

TGH’s associate epidemiologist; she has worked with her team on the front lines since the beginning of the pandemic. She is also an assistant professor in the Division of Infectious Disease and International Medicine at the Morsani College of Medicine. “Historically, infectious disease is part and parcel of every health care system,” Lakshmi said. “Our specialty pertains to protecting patients and health care workers from infections.” Infectious diseases specialists work diligently to treat their patients with infections whether they contract it in the community or become susceptible to them when they are in the hospital. However, when COVID-19 was added to the equation, Lakshmi said, a “whole new branch of pandemic preparation and response became highlighted, a specialty on its own,” requiring even more stringent measures to ensure the highly contagious viruses doesn’t spread through the hospital. The GEDI’s post-COVID focus will be on contagious pathogens and sepsis, the leading cause of mortality in hospitals, according to Lakshmi. “As long as humans interact with the environment and have 100 trillion bacteria normally living in their guts, they will always be susceptible to sepsis,” she said. “In terms of getting better at controlling it, there are very few new antibiotics. We don’t have new ways to fight it.” What the GEDI staff does have is the ability to act swiftly, as evidenced by their implementation of monoclonal antibody treatment just three days after the U.S. Food and Drug Administration approved it for use against COVID-19.

Their use has resulted in a dramatic reduction in hospitalization, Lakshmi said, but the surge in new cases from the Delta variant that began this summer again strained hospital staff and resources—and many of the serious illnesses could have been prevented with higher vaccination rates.

“More than 90 percent of COVID hospitalizations and deaths could have been prevented from vaccinations,” Lakshmi noted. The medical teams continue to strive to help ease patients’ suffering and get them home to their loved ones to the best of the teams’ abilities, regardless of patients’ vaccination status. “Our goal as health care providers is to help our patients through sickness and harm regardless of what led to it,” said Lakshmi.

While treating an avalanche of very ill COVID patients, the Institute’s researchers continue to delve into the mysteries of how such viruses cross from one species into another, which is the prevailing theory of how COVID-19 made its way into the human population.

“We hope to give future generations a better chance at controlling pandemics,” Lakshmi said. ”It’s our No. 1 goal. We strive to provide patient-centered, team-based infectious diseases care for everyone, every day.”

The Long Haul

Once renovations to what was previously a rehabilitation center are complete, the GEDI will have 28 private beds and will operate in a stand-alone building on the TGH campus, so it’s close to all the hospital’s resources but self-contained. It also operates an outpatient clinic to provide follow-up care for those who have been hospitalized and are on the road to recovery, as well as to provide monoclonal antibodies, COVID long-hauler treatment, and a travel vaccination clinic.

The GEDI team also is working to treat what’s known as “longhauler syndrome,” in which people who no longer have active coronavirus continue to experience a puzzling range of symptoms.

Dr. Lucy Guerra is the division director of Internal Medicine and professor of general internal medicine at the Morsani College

Tampa General Hospital nurse Vanessa Arroyo, who works with COVID-19 patients, becomes the first nurse in Florida to receive a COVID vaccine when this shot is administered by nurse Rafael Martinez on Dec. 14, 2020. Florida Governor Ron DeSantis was on hand to see the vaccines arrive.

of Medicine as well as a member of the GEDI COVID Clinic staff. In August, the clinic was receiving 40 to 50 calls a day from people experiencing long-haul symptoms, and it already had 80 patients with such symptoms. Many of these patients, she noted, are younger people. She cited the case of a young woman in her late 20s who is a graduate school student and ran in a 5K race a year ago. She contracted COVID in April 2020—prior to the availability of vaccines—at a funeral where 12 others came down with it as well. Three family members have since died. “She was hospitalized in the ICU for 12 weeks and was on a ventilator for four weeks,” Guerra recalled. “It was pretty horrific, and she had no underlying conditions.” Today the young woman must carry an oxygen tank with her to her classes. She also has pulmonary fibrosis and has been referred to a lung transplant clinic. In another case, an attorney in her 40s with mild asthma contracted COVID in the summer of 2020 at an outdoor barbecue. After a month’s hospitalization, she recovered, but her memory did not. Her brain fog was so bad she had to take a leave of absence while working to improve the condition.

“Symptoms fall into several buckets,” Guerra explained.

“The vast majority will have pulmonary symptoms: shortness of breath, chest pain, or feel like their endurance for walking or running is significantly decreased. Second are heart-related: tachycardia (palpitations), a tightness in their chest, and they can have pulmonary symptoms. And the third variety, the most common, are neurological symptoms—they don’t feel as sharp as they were before. They have trouble recalling people’s names or words they use all the time. It also takes longer to do their jobs.” One overriding symptom, Guerra added, is an inability to recover from “tremendous fatigue.”

The medical team is finding that this brain fog generally improves with time, as does the loss in ability to taste or smell. Using National Institutes of Health guidelines, the GEDI team assesses these patients to determine their symptoms, then conducts whatever tests or scans they deem necessary to ensure they have the full picture. That may involve echocardiograms for heart issues, or perhaps an MRI (magnetic resonance imaging) or PET (positron emission tomography) scan to explore organs in greater detail than can be seen with an X-ray or CT (computerized tomography) scan. Patients complaining of brain fog might try physical therapy or occupational therapy to improve their endurance and cognition in much the same way physicians treat patients with traumatic brain injuries or concussions.

Guerra is also a principal investigator in a study of a medication being tested on those with lung impairment. Results of that study are not yet available.

Although Guerra said many long-haulers may not fully recover, most do see improvement with treatment. “Longhauler patients require a lot of intense treatment,” she said. “They see you frequently and require close follow-up. The worst thing you can say to any COVID long-hauler is that there is nothing we can do. That is not true.”

But the best advice both Lakshmi and Guerra can offer is simple: Get vaccinated, use masks, and practice physical distancing when in public.

Although the institute’s primary focus has been on COVID, its researchers and medical staff remain vigilant to combat any new diseases that may emerge to prevent another such pandemic from occurring.

The TGH Global Emerging Diseases Institute, established in late 2020, was the first in Florida to administer monoclonal antibody treatments to COVID-19 patients.

The team members on the front lines of Tampa General’s COVID units are fueled by dedication and persistence.

Infectious diseases physician leaders of the USF Health Morsani College of Medicine stand in front of origami birds that are symbols of hope and loss in the fight against COVID-19. From left to right: Dr. Kami Kim, Dr. John Sinnott, and Dr. Seetha Lakshmi.

For more information on the Global Emerging Diseases Institute, visit tgh.org/institutes-and-services/ global-emerging-diseases-institute or call 813-844-4715.