SAEMF Grantees Make a Difference in the Understanding of COVID-19

Last year, as we began to navigate the pandemic and its impact on emergency medicine, the Society for Academic Emergency Medicine Foundation (SAEMF) awarded two important grants to aid in the understanding of COVID-19. The first $25,000 grant was awarded to Bernard Chang, MD, PhD from Columbia University for his study “The Psychological Effects of COVID-19 Amongst Emergency Providers.” Here’s a bit of background about his meaningful study and its goals:

The emergency department is the gateway to the health care system, and the safety net for our society. This is not our first pandemic or disaster, and previous work has established that front line health care workers (HCWs), such as emergency physicians and nurses, are vulnerable to the development of adverse behavioral and psychological sequelae, which may persist long after the disaster. This SAEMF-funded study will look at the longterm development of psychological distress amongst emergency staff following the COVID-19 pandemic. The results will inform our understanding of psychological stress among front line providers following COVID-19 and ideally lead to the development of interventions aimed at protecting the mental and physical well-being of our critical front line, as we navigate this and future public health crises.

Now over halfway through the completion of his project, Dr. Chang has found striking results:

“In our study we successfully enrolled 244 participants to date (target n=250; 98% enrollment target), with enrollments across four hospital sites in the New York Metropolitan area. Our preliminary findings identified that

approximately 60% of health care providers endorsed some anxiety and/or depressive symptoms in the wake of the early phase of the COVID-19 pandemic during March and April, with those working in areas of high acuity, most vulnerable to development of anxiety and/or depressive symptoms. “In our study we also had participants wear accelerometer devices (e.g., Fitbit watches) capturing sleep and resting heart rate, in addition to daily home blood pressure readings with a Bluetooth enabled monitoring device. Physiologically, sleep was disrupted in providers, with clinicians sleeping on average 6.12 hours a day compared to 6.45 hours prior to the pandemic (based on another existing dataset of cardiovascular data Bernard P. Chang, MD, PhD, we have among emergency department providers that Recipient of the 2020-21 we have conducted here at Columbia). SAEMF COVID-19 Research

Grant - $25,000 “Finally, resting blood pressure and heart rate was within normal limits among our sample; however, interestingly, post-shift resting heart rate and blood pressure was increased by 20% and 8% respectively, over a period of 12 hours after shift completion, suggesting some prolonged ‘stress response’ in the wake of shifts. “Thanks to this generous SAEMF grant, we were able to use this pilot work to submit an R01 grant to National Institutes of Health (NIH) that was favorably reviewed and received a fundable score after study section review. If this five-year longitudinal study (R01) from (HL HL157341) is ultimately funded by the NIH, this will be among the largest prospective longitudinal studies on front line provider psychological and cardiovascular health in the wake of the COVID-19 pandemic. Thank you again to the individual and institutional donors of SAEMF. We are so grateful for your support!” The second SAEMF COVID-19 grant of $25,000 was awarded to Evan Bradley, MD, PhD, and the University of Massachusetts Medical School, for "Nasopharyngeal Microbiome and Clinical Outcomes in Patients with COVID-19.” Dr. Bradley’s research focused on the effects of SARS-nCOV2 on the nasopharyngeal microbiome. He hypothesized that there may be reliable features of the nasopharyngeal microbiome that are associated with COVID-19 that may aid in the diagnosis of infection, even if standard testing is negative. The community

of microorganisms that inhabit the human nasopharynx, known as the nasopharyngeal microbiome, is known to interact with respiratory viruses and influence how the host initially responds to infection and potentially influence disease course. How it interacts with SARS-nCOV2, the virus that causes COVID-19, may have important effects on the virus’ ability to establish a productive infection and host’s response to the virus. Through this SAEMF-funded study, Dr. Bradley performed a prospective cohort study of patients presenting to the UMass Memorial Emergency Department under investigation for COVID-19. They performed microbiome analysis on nasopharyngeal swabs to determine the effect SARS-nCOV2 has on the nasopharyngeal microbiome, and if there are microbiome factors associated with a benign or severe clinical course.

Dr. Bradley recently shared the following update with us:

“Since beginning our study of the microbiome among COVID-19 patients, we have enrolled 156 patients in the emergency department being tested for, or already diagnosed with, COVID-19. We collected swabs and information about their clinicals course with a special emphasis on need for respiratory support and symptom duration. Utilizing high-throughput DNA sequencing of these swabs, we identified bacterial species and microbial metabolic pathways present in the oropharynx. Using a machine-learning based random forest classification model, we identified clinical factors, bacterial species, and metabolic pathways that were associated with the need for respiratory support and the development of persistent COVID-19 symptoms.

“We found that microbiome factors were the most important predictors in our models for both the need for respiratory support and the development of persistent COVID-19 symptoms, showing greater importance in our models than known risk factors for severe COVID-19 such as body mass index and high blood pressure. Unexpectedly, it was an increased abundance of certain commensal organisms and metabolic pathways associated with bacterial products synthesis which appeared to be protective against the need for respiratory support. This suggests that bacteria within the oropharyngeal microbiome may play a protective role against severe COVID-19, as opposed to representing a source of opportunistic pathogens. Evan Bradley, MD, PhD, Recipient of the 2020-21 SAEMF COVID-19 Research Grant - $25,000 “Several bacterial species found to be predictive of persistent COVID-19 symptoms had been previously described as being associated with chronic fatigue syndrome (CFS), suggesting a possible link between CFS and long-COVID. This finding is particularly relevant now as a significant number of COVID-19 patients who recover have persistent and debilitating symptoms, even if they were fully vaccinated against COVID-19 and did not develop disease severe enough to require hospitalization. We are currently preparing two manuscripts to publish our findings and are actively planning larger follow-up studies to investigate the interplay between the immune system and the oropharyngeal microbiome to understand the mechanisms behind our results.” These are just two reports about the meaningful progress being made in vital areas of research that will benefit emergency medicine providers and patients in the future. Visit SAEMF’s Donor Impact section for more Researcher Highlights. We are grateful to all those who contributed to make these projects possible and look forward to updating you about the work of other SAEMF grantees in 2022. Learn more about Dr. Bradley's research in this article published in the October 2021 JCI Insight: Inflammation-type dysbiosis of the oral microbiome associates with the duration of COVID-19 symptoms and long COVID.