BATTLING COVID-19

By Nancy A. Ruhling and Lina Zeldovich

"It always seems impossible, until it's done." - Nelson Mandela

At the height of the COVID-19 pandemic, waves of patients arrived at area hospitals so many that treating them all seemed impossible. But the NJMS health care team met this challenge, and continues to meet it.

In February, the Centers for Disease Control and Prevention warned that the U.S. should brace for a coronavirus outbreak. Since then, the number of COVID-19 cases in this country has skyrocketed to nearly 2.6 million as of early July, and more than 128,000 have died.

No place in the country has been harder hit than the tri-state area, with New York as the epicenter. Across the Hudson, the Garden State has the second highest confirmed case count in the U.S. As of June 8, more than 12,000 have died from the virus and more than 160,000 have been infected. New Jersey’s busy streets and neighborhoods are now eerily quiet. With COVID comes a new vocabulary too: self-isolation, social distancing, flattening the curve. All this in an astonishingly short period of time.

Throughout this crisis, a few things stand out. The first is the sheer volume of suffering: the critically ill patients, their anxious families, and the millions who are self-isolating. The second is the heroism of those who go to work while the rest of the world shelters in place: emergency and sanitation workers, scientists, food producers, grocery store staff, public transportation workers, and others. The most amazing heroes of all are the health providers who put their own lives at risk to care for those who are infected.

In Newark, just 13 miles from the epicenter, the New Jersey Medical School and University Hospital (UH) medical team is on the front lines. Showing creativity and innovation, they’ve stayed one step ahead of the virus to meet surging patient demand and save lives.

PROVIDING CARE: A MARATHON, NOT A SPRINT

As the COVID-19 threat approached New Jersey, the NJMS team began preparations. Elective surgeries were cancelled and ambulatory visits rescheduled. Resources were shifted and hospital space reconfigured to create new ICUs and isolation rooms for the anticipated wave of patients.

“From podiatry to OB/GYN residents, everyone was recruited to be on COVID-19 teams. It was overwhelming and humbling to see everyone so ready to help,” notes Mark H. Einstein, MD, MS, NJMS chair of obstetrics, gynecology and women’s health and UH interim chief medical officer. Many efforts were directed at training staff in the care of COVID-19 patients, including respiratory care and the use of personal protective equipment.

“We set up several tents outside the emergency department to triage and screen patients with respiratory symptoms,” says infectious disease specialist Debra Chew, MD, assistant professor of medicine at NJMS, who heads the COVID-19 preparedness effort. “As patients began to arrive, the team was ready, carrying out testing, hospitalization and intubation when necessary. We mobilized all efforts to save lives.”

Newark, the most populous city in New Jersey, is in the heart of Essex County, with a rate of infection that’s one of the highest in the state. During the peak period of infection, the medical team strived to maintain a sense of order amid the crisis. The entire hospital was turned over to COVID-19 care, and hundreds of patients were treated in the triage tent, emergency department, ICU, and more than 40 isolation rooms.

At varying points, nearly every patient who came through the hospital’s doors tested positive for coronavirus or was suspected of having it, pending test results. Through teamwork, expertise, and collaboration, clinicians were able to withstand the COVID-19 surge, saving lives.

“Through this difficult and unprecedented time, I’m very inspired by our teams and our staff,” says Chew. “We’re all working together to treat patients and save lives—and we will continue to do so.”

New Jersey has turned the corner, but the battle is far from over. As COVID-19 has quickly become a leading cause of death, NJMS faculty are working to find new ways of diagnosing and controlling the disease.

DEVELOPING RAPID TESTING TOOLS

In late March, a team of NJMS researchers completed the first evaluation of a new rapid COVID-19 test that has received emergency use authorization by the Food and Drug Administration (FDA). The test, now being used in hospitals throughout New York and New Jersey, was developed in collaboration with molecular diagnostics company Cepheid. It is fast and easy to perform, without the need for a centralized laboratory.

SARS-CoV-2, the organism that causes COVID-19 disease, poses a huge diagnostics challenge. With limited supplies of testing, there were also no globally established testing procedures for diagnosing it. In some cases, tests had to be sent to remote labs, yielding results in five hours to five days—an unacceptably long time.

The ability to establish a diagnosis quickly is crucial for disease treatment and containment, says David Alland, MD, chief of infectious diseases and director of the NJMS Public Health Research Institute (PHRI). “Imagine 20 patients you have to hospitalize, some of whom have COVID, but others who have something else. To prevent the infection’s spread, one must separate those who have COVID from those who do not, so waiting five days or even five hours is too long.”

Alland’s laboratory has many years of expertise in developing innovative diagnostic testing for infectious diseases. When the first U.S. COVID-19 case was reported in January, he and his NJMS colleagues Padmapriya Banada, PhD, and Sukalyani Banik, PhD, immediately went to work to create the new test, adapting a tuberculosis test they had previously developed. The scientists put in nine-hour shifts inside a Biosafety Level 3 lab, wearing the equivalents of space suits. Their efforts paid off, and the new test was approved by the FDA in record time.

“Our test delivers results in 45 minutes,” Alland notes. “Instead of taking your test to a lab, the lab comes to you in a form of a plastic cartridge.” The test must be processed by Cepheid technology, which is currently in use in area hospitals.

Another COVID-19 rapid test that recently received FDA emergency use authorization utilizes molecular beacons technology invented by PHRI researchers. Molecular beacons provide powerful tools for imaging RNA in living cells, and can determine if COVID-19 is present in a clinical sample. The technology is being used as part of a COVID-19 test from global health leader Abbott Laboratories. A simple nose swab, it takes just 15 minutes to complete.

To coordinate Rutgers University’s research and public health efforts to combat COVID-19, Rutgers has created the Center for COVID-19 Response and Pandemic Preparedness. Alland serves as the center’s inaugural director.

EVALUATING BLOOD PLASMA AS A POTENTIAL CURE

While COVID-19 infections and fatalities continue to increase, many thousands of people have recovered from the infection. Their blood plasma contains antibodies that may help critically ill patients fight the virus.

NJMS and UH are collaborating on an FDA-approved study using blood plasma from patients who recovered from COVID-19 to treat new patients who are severely ill with the infection.

Marc Klapholz, MD, chair of the NJMS Department of Medicine, is the principal investigator. The researchers have treated a small number of patients with convalescent plasma and will study them closely over the next few months.

“This is a real team-based approach and requires a strong clinical assessment,” Klapholz says. “It involves our team for infectious diseases, critical care, our internal review board and, of course, partnering with our blood bank and our nurses and clinicians taking care of these patients.”

People interested in donating plasma must have had a confirmed positive test for COVID-19. For more information, call 973-972-5474 or email at covidplasma@uhnj.org.

David Alland, MD

Padmapriya Banada, PhD

Sukalyani Banik, PhD

CORONAVIRUS HOTLINE

The state’s Coronavirus Hotline (800-962-1253), has assisted more than 15,000 New Jersey callers throughout the pandemic. Operated by the New Jersey Poison Control Center at the NJMS Department of Emergency Medicine, it delivers up-to-date information about the pandemic 24/7, in any language, including best practices for prevention.

NJMS INITIATIVES PROMOTING LUNG HEALTH

NJMS has long been a leader in research and clinical care for lung disorders, focusing on a broad range of conditions, from tuberculosis (TB) to pneumonia and vaping. Here is a look at some of this work.

NJMS residents share their experiences treating COVID-19 patients at bit.ly/pulsesummer2020.

TUBERCULOSIS

David Alland, MD, has collaborated with Cepheid for nearly two decades to develop innovative diagnostics, including a test for TB that was the first new test in more than 100 years to be approved by the World Health Organization. The test took 10 years to bring to market. This hard work paid off in other ways, proving crucial in the COVID-19 fight.

The NJMS Global Tuberculosis Institute is seeking ways to better diagnose and treat latent TB infection. One of only four Centers for Disease Control and Prevention TB Centers of Excellence in the country, it provides treatment, holds clinical trials, and collaborates with PHRI scientists to understand TB immunology.

Researcher Jason H. Yang, PhD, assistant professor of microbiology, biochemistry, and molecular genetics, and Chancellor Scholar, is developing machine learning methods to study the factors that play a role in treating TB. He uses mathematical models to simulate the biology of each specimen and then deploys machine learning to uncover bacterial mechanisms that might cause reinfection.

VAPING

The dramatic rise in vaping, followed by a spike in associated lung injuries and deaths, made NJMS faculty focus on this new frontier. “Additives to vaping oils, such as honey and vitamin E acetate, can be lethal when inhaled,” says Andrew Berman, MD, NJMS professor of medicine and director of pulmonary medicine. “The problem will only get worse, since e-cigarettes are not regulated like traditional tobacco products.” NJMS faculty have launched a series of educational campaigns to increase awareness of vaping’s dangers. Vaping has also been incorporated into the pulmonary coursework for first-year medical students.

Debra Chew, MD

Mark Einstein, MD

Marc Klapholz, MD

OTHER RESEARCH INITIATIVES

Dane Parker, PhD, assistant professor of pathology, immunology, and laboratory medicine, Center for Immunity and Inflammation (CII), is investigating host-pathogen interactions with Staphylococcus aureus and other organisms.

Amariliz Rivera, PhD, assistant professor, CII, examines the significant health problems of pulmonary infections caused by fungal pathogens. She’s developing a vaccine strain of Cryptococcus neoformans capable of conferring broad antifungal protection.

Mark C. Siracusa, PhD, assistant professor, CII, Chancellor Scholar, is honing in on parasitic infections to help identify factors that regulate lung inflammation related to asthma.

William C. Gause, PhD, director of the Institute for Infectious and Inflammatory Diseases, is studying a possible treatment that would stem the progression of emphysema.