Propelling Our Pandemic Response by Rush University System for Health

Propelling Our Pandemic Response An Impact Report to the Generous Supporters of RUSH’s Efforts to Combat and Contain the Coronavirus May 2022

Thank You

Together Our Work Resounds Rush University System for Health, or RUSH, has been at the forefront of our region’s response to COVID-19 since it first reached our shores at the beginning of 2020. While much has changed and evolved since those first frightening weeks, our resilience has remained steadfast — even as we enter an unthinkable third year of the pandemic. We continue to adapt to the pandemic’s ever-changing landscape, all while delivering extraordinary, award-winning care to our many patients with conditions other than COVID-19. From day one, RUSH’s pandemic response has been driven by our mission to improve the health of the individuals and diverse communities we serve. We lead with compassion, courage and a commitment to providing equitable support to those who need our help. RUSH was built to respond to crises exactly like the ongoing pandemic, but all we have accomplished — and continue to achieve — would not be possible without the support of our philanthropic partners. Your support is a shining example, providing the resources we needed to combat the coronavirus, igniting progress through research and bolstering our efforts to lift up our neighbors during the pandemic. On behalf of our battle-tested but ever-resilient team: Thank you. The impact of your gift is felt by more than 42,000 friends and neighbors — including almost 7,000 hospitalized patients — confirmed with COVID-19 whom Rush University System for Health has treated throughout the pandemic. Countless more have benefited from the scientific findings our experts have published, guiding care for COVID-19 patients across the globe. The work we’ve accomplished together reverberates throughout the Chicago area and beyond and has received national recognition. The actions we’re taking now, as we confront the ongoing evolution of the pandemic, and the preparations we’re making for a more hopeful future are strengthened by your support.

You stepped forward when RUSH and the communities we serve needed it most, and we will forever be grateful for your partnership in this historic fight.

Introduction

We Were Built for This — Then and Now At the first signs of danger in early 2020, RUSH quickly created the COVID-19 Command Center to organize the infrastructure, preparations and plans needed to combat the coronavirus. We: •

Organized testing centers

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Safely maintained care for all patients by rapidly shifting to telehealth platforms

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Halted elective procedures as mandated by the state to safeguard the availability of intensive care unit beds

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Used our voice as an anchor institution in the community with over 14,000 trusted employees to educate people about COVID-19

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Supported our community partners, such as homeless shelters, to provide testing, vaccinate clients and deliver care

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Launched numerous programs to ensure the safety and well-being of our staff on the front lines

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Championed our experts in infectious disease and critical care as they represented RUSH in nearly every major clinical trial for COVID-19 while launching studies of their own

The challenges we faced — head-on with your support — made us stronger and solidified our standing as a nationally recognized health care leader. We now have much more knowledge about COVID-19, informed by our experience treating patients, conducting leading-edge research, and developing our genomic testing and biorepository capabilities. We have new tools — such as lifesaving vaccines, boosters and antiviral drugs — as well as the infrastructure and playbook to face the evolving challenges of the pandemic, like the omicron surge earlier this year. While RUSH was built to fight diseases like COVID-19, no health system could be fully prepared for the long-term disruptions and challenges this pandemic has created for two full years — and counting. We’ve responded to trends in health care catalyzed by the pandemic, such as the shift from inpatient to outpatient care, the growth of telehealth, clinician burnout and workforce shortages. In the following report, primarily focused on our pandemic response since 2021 and the initial distribution of vaccines, we outline how your support helped us save lives and achieve our mission to keep as many people as possible safe and healthy through outstanding leadership in: 1. 2. 3. 4. 5.

Clinical care Vaccine research and distribution Data science Laboratory studies Equitable community outreach 3

1. Clinical Care

Leading the U.S. in Treating Severe COVID-19 Illness Saving lives has always been the overarching goal of our pandemic response. It is impossible to fully quantify the total number of lives we have saved or positively changed through our work to combat the coronavirus, but we can view measures of our impact through certain metrics. Vizient Inc. tracks a mortality index (observed deaths over expected deaths) of academic medical centers around the nation that are part of its network, and Rush University Medical Center ranked among the top 10 — higher than all other Chicago academic medical centers and national leaders like the Mayo Clinic — for our lifesaving care for severely ill patients. This measure would be impressive on its own, but when we factor in that Rush University System for Health has cared for more than 42,000 COVID-19-positive patients to date, including almost 7,000 patients who required intensive care or an inpatient stay — the vast majority of whom have been discharged and are resuming their lives — our quality of care truly sets us apart.

COVID-19 Discharges in Illinois (April – December 2020) Hospital

Inpatient Beds (Med-surg, ICU)

Discharge Count (Inpatient, observation, ED)

% of Total

Rush University Medical Center

488

5,480

2.87%

John H. Stroger Hospital

326

5,321

2.78%

Advocate Christ Medical Center

564

5,113

2.69%

Northwestern Memorial Hospital

645

4,594

2.40%

Elmhurst Memorial Hospital

235

4,424

2.31%

Macneal Hospital

234

4,005

2.10%

University of Chicago Medicine

652

3,938

2.06%

We cared for more severely ill COVID-19 patients than any other hospital in the state. We continue to enhance our care protocols and treatment approaches using lessons learned from lived experiences and shared knowledge from medical experts worldwide. With your support, we were able to study a multitude of treatments for their effectiveness against COVID-19, including antiviral drugs like remdesivir, antibody treatments for cytokine storms (overactive immune responses to the virus that can harm patients’ vital organs), convalescent plasma treatments for severely ill patients and more. We also quickly created a post-COVID care clinic to help patients recovering from a COVID-19 infection who experience long-lasting health effects.

2. Vaccine Research and Distribution

Protecting Our Friends and Neighbors RUSH played a vital role in vaccine research and distribution, which have been pivotal in preventing people from becoming severely ill with COVID-19 and requiring hospitalization. Our team seized every possible opportunity to be part of vaccine studies and quickly mobilized to get shots in arms once vaccines received emergency use authorization in the U.S.

Participating in Initial Vaccine Research In late 2020, Rush University Medical Center conducted clinical trials of the vaccine developed by the University of Oxford and AstraZeneca, furthering the scientific community’s understanding of its safety and efficacy. Though this vaccine was not used in the U.S., it has been critical in 170 other countries, including many in the developing world. RUSH also received multimillion-dollar grant awards from Janssen (the maker of the Johnson & Johnson vaccine) and Pfizer for research related to COVID-19 prevention and vaccine safety. Additionally, three RUSH-affiliated physicians — Robert A. Weinstein, MD, the C. Anderson Hedberg MD Professor of Internal Medicine; Larry J. Goodman, MD, president emeritus of Rush University and infectious disease specialist; and Latania K. Logan, MD, MSPH, chief of the Section of Infectious Diseases in the Department of Pediatrics — participated in the city of Chicago’s Scientific COVID-19 Vaccine Work Group. The clinician-scientists independently evaluated the scientific and regulatory review of both Moderna and Pfizer mRNA vaccines to propel local vaccine rollout in late 2020 and early 2021.

Distributing the First Vaccines to Health Care Workers RUSH acted quickly once the U.S. Food and Drug Administration approved emergency use of the mRNA-based Pfizer and Moderna vaccines. On Dec. 17, 2020, the first doses of the Pfizer vaccine were administered to RUSH staff members — an emotional day in the timeline of the pandemic, filled with hope and the enormity of all the world endured in the previous year. A symbolic group of 10 clinicians who had worked with COVID patients from the pandemic’s first days was selected to participate in a moving celebration of the vaccine rollout. We’re proud the vast majority of our staff and students immediately stepped forward to receive the vaccine and promote its safety and efficacy as trusted community leaders.

Ten RUSH clinicians gather for a photo on Dec. 17, 2020, at the Medical Center’s Edward A. Brennan Entry Pavilion after receiving the health system’s first doses of the Pfizer vaccine. In a speech during a trip to Chicago on Oct. 7, 2021, President Joe Biden praised RUSH’s employee vaccination rate. By the end of October, 99% of our employees were compliant with the vaccine requirement, which allows for exemptions for religious or medical reasons.

Mobilizing to Provide Vaccinations to the Public When vaccines became available to the public in early 2021, RUSH strategically communicated with patients who met eligibility requirements. Dozens of volunteers, including a fleet of retired nursing staff, helped vaccinate thousands of patients daily at a special clinic in the Medical Center’s Edward A. Brennan Entry Pavilion. We also offered shots at a drive-through at the Medical Center and select outpatient clinics, where we continue to vaccinate people ages 5 and older. In the weeks and months that followed FDA authorization: •

A multidisciplinary team of employees and volunteers worked with community organizations and leaders to provide vaccinations in communities disproportionately impacted by the pandemic. (For more on these community vaccination efforts, see page 9.)

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In April 2021, the Medical Center celebrated the distribution of its 100,000th vaccine.

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In November 2021, when children as young as 5 years old received clearance for the immunization, RUSH provided vaccinations at its three school-based health centers and to children through a special pediatric vaccine clinic.

Participating in Continued Vaccine Research to Evaluate Efficacy RUSH continues to participate in research led by the CDC to analyze how well vaccines work in the real world and health care settings. RUSH staff who undergo COVID-19 testing may elect to complete a survey from the CDC two weeks after their test to contribute to nationwide knowledge of how vaccines impact symptoms in breakthrough infections. Hundreds of staff have also volunteered for a study where they regularly provide blood samples to evaluate how coronavirus antibodies change over time. The Medical Center led numerous clinical trials related to vaccines, including current studies to: •

Identify motivations and barriers for health care workers to receive vaccinations

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Evaluate how the immune system responds to mRNA vaccines in people without previous COVID-19 infection

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Assess COVID-19 infection, viral shedding and subsequent transmission in people immunized with the Moderna vaccine versus unvaccinated people

3. Data Science

Collaborating and Collecting Information on COVID-19 RUSH clinicians and researchers identified and promptly acted on an opportunity to organize data for the benefit of scientists everywhere with a shared goal of slowing and stopping the pandemic.

Storing and Cataloging Biospecimens for Scientists Everywhere RUSH spearheaded the creation of the COVID-19 Patient Registry & Biorepository — a database of patients’ demographic and medical history information, blood samples, oropharyngeal and nasopharyngeal swabs, tissues, bodily fluids, stool, urine, and other residual samples collected with consent as part of clinical care. This database has been used by researchers and pharmaceutical companies around the country to develop potential treatments for COVID19, better understand the novel disease and investigate how it impacts people differently.

Investigating the Long-Term Effects of COVID-19 Through Digital Tools Rush University Medical Center is serving as the lead research site in a national collaboration with technology company Hugo Health and seven other academic medical centers for INSPIRE. This collaboration, funded through a $9.1 million grant from the CDC, seeks to determine the longitudinal effects of SARS-COV-2 and produce actionable insights and tools to combat the pandemic. The collaboration is working to rapidly produce real-time data, analysis and reporting using digital tools — all while protecting participants’ privacy. Nearly 4,000 patients with COVID-19 enrolled in the INSPIRE registry.

Partnering With Peers in Chicago To Pool Data and Identify Local Challenges Even before the pandemic, the Medical Center shared data locally to help neighboring health care providers, the city of Chicago and surrounding governmental agencies make better predictions about how many people will need treatment and plan containment measures. We’re part of the Chicago Area Patient-Centered Outcomes Research Network, or CAPriCORN — a partnership of 10 clinical and academic health systems in the Chicago area that aims to improve patient outcomes through shared data. In response to COVID, the Medical Center and CAPriCORN members have contributed clinical and operational data to shape the local public health response and identify time-sensitive research needs. For example, the network is analyzing data related to patients developing coagulopathy (a bleeding disorder that often impairs the formation of blood clots) in response to a COVID-19 infection.

4. Laboratory Studies

Advancing the Medical Community’s Understanding of the Coronavirus The world has learned so much about the coronavirus since spring 2020 because of an unprecedented, heroic response from the research community, including investigators at RUSH. We’re home to leaders in laboratory and clinical studies — including distinguished infectious disease faculty long-regarded as experts in HIV and AIDS research. To date, these RUSH experts have published more than 200 papers outlining their findings about the coronavirus. This research benefits the entire medical community. Donor-funded research studies are excellent launching points for scientists to investigate hypotheses and establish a base of viability on which they can apply for other grants, including those issued by the federal government, to further their research. To date, Rush University Medical Center clinician-scientists have secured four such grants for COVID-19-specific research projects from the National Institutes of Health, or NIH.

Regional Innovative Public Health Lab Keeps Finger on Pulse of Circulating Coronavirus Strains A crowning achievement in RUSH’s research response was the opening of the Regional Innovative Public Health Lab in March 2021. Rush University Medical Center was awarded a $3.5 million contract from the Chicago Department of Public Health, or CDPH, to establish this lab, which works to detect new strains of the virus and determine which are spreading fastest and where. Our lab detected the first case of the omicron variant in Illinois on Dec. 7, 2021, and continues to conduct research to determine whether emerging variants of the coronavirus can evade immunity provided by vaccines and if people who have been infected by COVID-19 multiple times had different strains of the virus each time.

Breakthrough Research

Examining COVID in the Vaccinated Two Rush University research scientists received a two-year, $1.4 million grant from the Walder Foundation to study breakthrough COVID-19 infections in people who are fully vaccinated and have received their booster shots. This research is conducted in collaboration with Loyola University’s School of Medicine. The researchers, led by Jeffrey Schneider, PhD, and Jeffrey Borgia, PhD, aim to accomplish three objectives: • Better understand why some vaccinated people get breakthrough infections • Gauge the durability of the antibody response generated by boosters and breakthroughs in vaccinated individuals • Determine whether boosters can help immunocompromised people, many of whom did not have a strong antibody response to the first two doses of vaccine

5. Equitable Community Outreach

Mobilizing Our COVID-19 Care in the Community RUSH strives to create a more equitable health care ecosystem for residents of the Chicago area, with the goal of measurably reducing health disparities that plague our surrounding neighborhoods and serving as a national model for other health systems. The pandemic underscored the many disparities in how COVID-19 impacted Black and Latinx communities, particularly those from the West Side neighborhoods in the Medical Center’s own backyard. In addition to our lifesaving clinical care — survival rates for Black and Latinx patients treated at RUSH far exceeded national averages — our health system stepped forward in countless ways to support our community.

A Systemwide Response To COVID-19 in the Community •

During the earliest days of the crisis in March 2020, we stood up the Community Command Center to gather information about community needs with a goal to organize an equitable pandemic response. Community members raised concerns about topics like food insecurity and a need for increased COVID-19 testing. Feedback from our neighbors and patients continues to inform our pandemic response today.

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RUSH experts were invited to lead the city of Chicago’s Racial Equity Rapid Response Team that aimed to improve health outcomes and slow the spread of COVID-19 by improving care and pandemic-related education provided to communities of color, particularly on Chicago’s West Side. The team provided wellness checks, food distribution, internet access expansion and the delivery of educational support and supplies to congregate living facilities.

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RUSH brought tests and vaccinations to communities in need throughout the pandemic, which included: o

Providing more than 8,000 vaccinations through the Rush College of Nursing’s Office of Faculty Practice and an additional 4,000 vaccinations in Chicago’s Austin neighborhood as part of the city of Chicago’s Protect Chicago Plus initiative

Conducting more than 43,000 tests in communities

Connecting people experiencing homelessness to care through the Chicago Homelessness and Health Response Group for Equity, or CHHRGE

Providing more than 200 vaccinations to homebound adults

Offering pop-up vaccine clinics five days a week in collaboration with the CDPH

Giving vaccinations through Chicago Public Schools’ school-based health centers

Offering vaccines at weekly neighborhood vaccine clinics, residential shelter-based service organizations, and grant-supported testing and vaccine sites

Partnering with faith leaders and community members to dispel misinformation and help people overcome hesitancy or fear over the vaccine

To learn more about our community response to COVID-19, visit our COVID-19 and Health Equity at Rush digital experience at rush.edu/covidhealthequity. 9

Staying the Course

What’s Happening Now and What’s Ahead Fall 2021 was initially thought to be a turning point in the pandemic: Vaccines were widely available and approved for children 5 and older, boosters were rolled out, and the delta variant had begun to subside. At a time when we’d hoped to look back at all we overcame and celebrate before the holiday season, the emergence of the relentless omicron variant changed everything. While we’re hopeful we are now on a path toward celebrating the fading effects of COVID this summer, our resilient staff members recommitted themselves to our patients and community in response to the most recent surge. •

During the omicron surge, we once again stood up our COVID-19 Command Center, which operated 24/7, closely monitored our capacity and did everything possible to ensure the needs of our patients — regardless of COVID-19 infection — were met.

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The third surge of COVID-19 cases superseded both the first and second waves at a time when many were experiencing pandemic fatigue. In early January 2022, RUSH hospitals had approximately 250 hospitalized COVID patients at a given time, a figure not observed since the first surge in April 2020.

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We adapted our flexible facilities to increase hospital capacity and access by again expanding the Emergency Department into the Edward A. Brennan Entry Pavilion, converting the fourth floor of Rush Oak Park Hospital into a 20-bed acute medicine unit, changing an observation unit into a general medical unit, delivering more virtual care, reinstating visitor restrictions and increasing our testing capacity.

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We created a monoclonal antibody clinic and a COVID-19 infusion clinic (for the administration of intravenous treatments) to provide patients with the most effective treatment options possible. Our teams researched and developed a risk-scoring tool and began recommending infusions and recently approved oral medications for appropriate high-risk patients to prevent progression to severe disease.

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Our physicians worked with patients to postpone elective procedures when possible during the omicron surge to reduce patient risk and safeguard the availability of hospital beds for the region.

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Our staff continues to vaccinate community members in shelters and other sites where access to care is a challenge. In late March, we recognized the provision of more than 28,500 hours of care to people experiencing homelessness at a COVID-19 isolation shelter at A Safe Haven. The isolation shelter was open for nearly two years in partnership with CDPH and closed in response to decreased need.

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Health care staffing shortages are a national crisis, as COVID-19 led many clinicians to retire early or leave the field altogether. In response, we have worked adamantly to retain valued staff, and recruit, train and hire across the organization while expanding our wellness resources for employees.

The landscape is different with the coronavirus, but so are we. We are battle-tested and better equipped to treat COVID-19 — including the most serious cases — than ever before. We are committed to providing extraordinary care to our community members who need us.

In Gratitude All we have been able to do to prepare for and actively respond to the changes of the ongoing pandemic has been made so much stronger by your support. We prioritize providing outstanding clinical care, administering vaccines daily and continuing our extensive research to help control the pandemic worldwide — and, ideally, bring it to an end. During a March press conference on campus held by Illinois Gov. J.B. Pritzker regarding the end of the mask mandate in Illinois, Dr. Omar Lateef, Rush University Medical Center president and CEO, said, “The pandemic is not over, and we must continue to be mindful that there are still many who are vulnerable. We are deeply proud that RUSH is where this milestone is marked, but I can say with certainty that these acts of heroism have taken place at every hospital in Chicago and our country. Today we extend deep and sincere thanks to all — here at RUSH and health care workers across Chicago and Illinois — for their extraordinary commitment.” We hope you share our sense of pride in being part of the solution to the pandemic. Your support has made our work possible. Thank you. 11