UAlbanySPH COVID-19 Response (March-June 2020)

THE CORONAVIRUS PANDEMIC: UAlbany School of Public Health Research & Response March - June 2020

Friends and family, Here at the University at Albany School of Public Health, we are focused on training outstanding public health practitioners and providing defining experiences in public health. Now, more than ever, our work to save lives and promote social justice as we educate future public health leaders is absolutely critical.

This unprecedented time has been filled with many challenges and emotions. As we implemented social distancing, we were reminded of pressing public health issues such as homelessness, mental health, access to care, health disparities and key social factors such as systemic racism that compound the barriers people face for living a healthy life. So many public health problems have been further magnified by the pandemic, and as we grieve for those we have lost to coronavirus, the School of Public Health stands committed helping communities around the world and implementing real, lasting change for a better future.

In March 2020, our School started working on urgent coronavirus research projects and initiatives.

Faculty, staff and students were involved in active response alongside the New York State Department of Health, local health departments and community organizations. We also contributed through SUNY committees and University-level projects, such as UAlbany President Havidán Rodríguez’s major effort to address racial and ethnic health disparities in COVID-19. Our School is honored to be a partner in this work, and a number of our faculty and students are

working on projects which will not only identify health disparities, but also suggest ways to better build health equity.

Our School’s continued research and engagement on coronavirus has led to over 200 placements in local, national and international media such as CNN, Politico, Reuters, CNBC, the Times Union and WNYT’s Health Beat with Dr. Benita Zahn. School expertise has been requested from radio programs and journalists around the world, in places like Colombia, Russia and Germany.

And as we continue to navigate our changing world, we couldn’t be prouder of our exceptional students, who saw so clearly over the course of the Spring 2020 semester the importance of a strong public health system. They worked as investigators and contact tracers, volunteered as translators, assisted vulnerable populations and more while completing coursework for their academic programs.

In the following pages, you will learn more about our School’s initial pandemic response and research.

We are proud to contribute to efforts to improve the health and well-being of many communities, and are grateful for support from family and friends like you as we work to build a better world.

David Holtgrave

Dean, School of Public Health Distinguished Professor SUNY Empire Innovation Professor

PROUDLY WORKING ALONGSIDE THE NEW YORK STATE DEPARTMENT OF HEALTH The University at Albany School of Public Health is celebrating 35 years of partnership with the New York State Department of Health (NYSDOH). Over the years, faculty and students at the school have joined forces with NYSDOH researchers to help conduct groundbreaking research and better the health of New Yorkers.

In reponse to the COVID-19 pandemic, Dr. Eli Rosenberg from the Department of Epidemiology and Biostatistics has been embedded with the Division of Epidemiology at the NYSDOH, providing support for their data monitoring system.

School of Public Health experts Dr. David R. Holtgrave, Dr. Tomoko Udo and Elizabeth Rosenthal, as well as a number of the school’s graduate research assistants, were initially embedded in the NYSDOH in the Corning Tower in Albany, contributing their expertise to the fight against the coronavirus.

UALBANY & NYSDOH PARTNER ON EPIDEMIOLOGICAL REPORT OF COVID-19 IN NEW YORK The School of Public Health and the NYSDOH developed a detailed report of the emergence of COVID-19 in New York State (outside of New York City). It was the first comprehensive epidemiological report on the emergence of COVID-19 from a U.S. state in a peer-reviewed publication.

While there are national reports that track the progression of COVID-19 diagnoses and several states have created digital “dashboards” of outbreak data, these overviews are often limited to basic information such as age, sex, and fatality.

Collecting more in-depth data can often pose a challenge, especially during a rapid expansion of cases.

However, an extensive testing campaign implemented early on by the NYSDOH made it possible to collect more data on those infected with COVID-19. This new and timely report, published in Clinical Infectious Diseases, uses that critical information to provide details on the outbreak in New York as it continues to unfold— creating a vivid “snapshot” of testing, risk factors, outcomes, and infections within households for March 2020.

Of note, the report’s information on household spread is particularly unique.

Collected when family members of infected individuals were also tested for the virus, the information provides valuable insight into the efficacy of quarantine. The results showed that 57% of COVID-19 patients’ household members also received positive diagnoses.

In years to come, this report will be particularly valuable as a scientific record of the COVID-19 outbreak in New York.

While websites and dashboards may alter what data they share, this report from UAlbany and the NYSDOH will remain as an available document in the scientific community.

“Health departments across the U.S. are working tirelessly in the fight against COVID-19, a necessary focus that has slowed the release of epidemiological papers,” says Eli Rosenberg, Associate Professor of Epidemiology and lead author. “Our university’s close relationship with the NYSDOH enabled our faculty, staff and students to quickly embed within the state’s COVID-19 response, providing technical assistance on special studies and helping generate evidence.”

Pictured: School of Public Health staff and students working at the New York State Department of Health on COVID-19 response.

This capture of epidemiological and health services history during the pandemic is critical to help inform the direction of COVID-19 response in New York and serves as an example to other states for potential reports.

FINDINGS FROM OBSERVATIONAL STUDY OF HYDROXYCHLOROQUINE AND AZITHROMYCIN ON PATIENTS WITH COVID-19 IN NEW YORK STATE

Dr. David R. Holtgrave, Dr. Tomoko Udo, Dr. Eli Rosenberg and Dr. Janine Jurkowski worked with the Division of Epidemiology at the NYSDOH to design and plan a study to provide timely information on the safety and efficacy of treatments for COVID-19.

Results from their observational study of hydroxychloroquine and azithromycin have been released; the findings were published in the Journal of the American Medical Association (JAMA).

The study did not involve randomization of treatments but rather was an observational cohort study of medical records for hospitalized patients with a COVID-19 diagnosis.

Medical records were reviewed for a sample of 1438 patients from 25 hospitals in the greater New York City region. All patients had a hospital admission date between March 15 and March 28, 2020.

Analysis of the records reviewed indicate the following: •

• • • •

METRICS IN EARLY JUNE 2020 FROM PUBLICATION:

478,100 views on JAMA

250+

media placements, including CNN

6,200+

mentions on Twitter

#8

Hydroxychloroquine and azithromycin (sometimes in combination) were being most influential paper utilized during this timeframe by healthcare providers in their treatment of ill from JAMA of all time patients hospitalized with COVID-19 (735 patients received hydroxychloroquine with azithromycin, 271 hydroxychloroquine alone, 211 azithromycin alone, and 221 received neither drug); Chloroquine prescribing was so limited in use (less than 2% of the first several hundred records screened) that it was dropped from further analysis; Patients were more likely to receive the medications if they had underlying risk factors for severe illness or more severe illness at presentation (making it vital in statistical analyses to attempt to determine if the patients’ course of clinical progression was due to more severe illness upon hospitalization or administered drugs); Everyone had hoped for a large and immediate beneficial impact of these therapies, but for this group of seriously ill patients, the researchers did not observe a significant benefit of the administered drugs; Hydroxychloroquine taken in conjunction with azithromycin (compared to neither drug) was associated with significantly elevated levels of cardiac arrest even after statistical adjustment for sex, age, underlying health conditions, and more severe illness upon admission.

These data and analyses are not meant as a clinical recommendation. The findings of observational studies should be considered by physicians and patients in concert with findings from randomized controlled trials, other empirical studies, NIH treatment guidelines and FDA drug safety communications.

COVID-19 RESEARCH FUNDING FOR PUBLIC HEALTH FACULTY

University at Albany School of Public Health faculty have received research seed grants from the State University of New York (SUNY) for their COVID-19 research proposals:

Implications for College Students “Tracking the Social, Psychological, and Economic Implications of COVID- 19 among SUNY Students and Families.”

Principal Investigator: Dr. Benjamin Shaw

COVID-19 and the Black Church*

*“Black Americans are more likely to contract coronavirus than other racial/ethnic groups. In times of anxiety and uncertainty, Black faithbased institutions represent trusted spaces offering solace and information. Faith-based institutions have significantly and consistently enhanced psychological, health, educational, and cultural well-being. COVID-19 related health behavior can be enhanced and reinforced by working closely with Black clergy and health ministries.” - Text from project proposal.

Pictured above: Dr. Julia Hastings, Principal Investigator for “COVID-19 and the Black Church.”

“COVID-19 and the Black Church: Plans to Prosper and Hope in a Pandemic.”

Principal Investigator: Dr. Julia Hastings

Regional food recovery and redistribution “An Assessment of the Produce Recovery and Redistribution System in New York’s Capital Region to Address Food Insecurity During COVID-19: Environmental and Health Impacts.”

Principal Investigator: Dr. Beth Feingold

Diagnostic Tools “Multiplexed LAMP Assay for COVID-19 (developing an efficient, low-cost assay for influenza and COVID-19).”

Principal Investigator: Dr. Sridar Chittur

MATERNAL & CHILD HEALTH PROGRAM PARTNERS WITH STATE’S COVID-19 MATERNITY TASK FORCE The School of Public Health’s Maternal and Child Health program (MCH) has been tapped to support the state’s COVID-19 Maternity Task Force by helping to review the impact of COVID-19 on pregnancy.

The task force was established in April by Secretary to the Governor Melissa DeRosa and the New York State Council on Women and Girls, and was convened to address challenges related to COVID-19 for pregnant women and mothers. Part of the task force’s charge includes conducting a comprehensive literature review.

Clinical Associate Professor Rachel de Long, co-director of the MCH program with Associate Professor Christine Bozlak, is working with a small team of staff at the New York State Department of Health’s Division of Family Health on the literature review that will assist the state in making recommendations and assessing the impact of COVID-19 on pregnancy. The Division of Family Health is a longstanding partner of the MCH program.

SPH graduate students Rachel Craig, Amanda Kocienski and Brunella Maravi-Calenzani have also been engaged in the review.

“The Maternal and Child Health Program is pleased to support this important work and to have the opportunity for our students to be involved,” said de Long. “This unprecedented public health challenge is impacting all facets of life, and we are looking forward to engaging further with the task force and our colleagues at the Division of Family Health to examine its impacts on pregnancy.”

"As a Master of Public Health student at the University at Albany, I was honored to be able to collaborate on this review with the School of Public Health and Department of Health,” said Kocienski. “It was a fulfilling experience to be a part of an emerging public health issue."

At the conclusion of the review, the MCH program will deliver a summary of its findings to the task force as well as regional perinatal centers.

De Long and Bozlak, who are faculty in the Health Policy, Management, and Behavior department, say the MCH program will continue to partner with NYSDOH on a variety of maternal and child health initiatives.

Pictured: Drs. Bozlak and De Long, Co-Directors of the Maternal and Child Health Program at the University at Albany School of Public Health.

THE HEALTH WORKFORCE The Health Workforce Technical Assistance Center at the Center for Health Workforce Studies at UAlbany developed an online resource dedicated to sharing data and information on efforts to develop, deploy and replenish the health workforce in response to COVID-19.

FACE MASK GUIDANCE A research team including UAlbany’s Dr. Jennifer Manganello examined how face mask guidelines differ across 25 nations and regions, finding that all examined countries and regions had some form of guidance online, although detail and clarity differed.

Although nine countries and regions recommended surgical, medical, or unspecified masks in public and poorly ventilated places, 16 recommended against people wearing masks in public. Two countries explicitly recommended against fabric masks. In addition, 12 failed to outline the minimum basic World Health Organization guidance for face masks.

PUBLIC HEALTH STUDENTS RISE TO THE OCCASION School of Public Health students quickly adapted their plans to help with the COVID-19 crisis. Many students picked up volunteer positions and others quickly changed tasks at their internships and jobs to help with the pandemic. Many acknowledge the educational value of watching a global public health crisis of this magnitude unfold right before their eyes: Tristan Nowak, a PhD student in the Biomedical Sciences program, is tracking new case intakes, conducting wellness calls to COVID-19 positive individuals and helping with database management at the Schenectady County Department of Health. “The work is very rewarding, we are happy to be here supporting public health in their time of need,” said Nowak.

Pictured: MPH student Erica Miller in protective gear working at the NYSDOH Wadsworth Center on COVID-19 antibody testing.

MPH student Dustin Moore is interning at the Community Health Care Association of New York State and sums it up simply:

“It’s been incredibly exciting, and concerning, seeing public health in action.”

“Last summer, I completed my MPH internship with the NYSDOH Wadsworth Center Bloodborne Viruses Laboratory where I tested newborn dried blood spots for maternal Hepatitis C virus antibodies on the Luminex Immunoassay.

This assay requires essentially the same procedure as that for the high throughput coronavirus antibody testing! When I heard that the coronavirus antibody testing would be going on, and I knew I could be of help given my experience, I jumped at the opportunity!”

- Erica Miller, MPH student

MPH student Kathryn Simpson works for the New York State Association of County Health Officials, a state membership organization serving as a liaison between local health departments and the NYSDOH and the Governor’s office. In her role, Simpson is cross referencing resources for local health departments, helping assess their funding needs for COVID-19 response and is drafting a letter to congressional leaders about what local health departments are doing locally and why public health funding is vitally important.

Ariela Zamchek, completing a Fellowship of Applied Public Health, is working with the communicable disease division of the NYSDOH, helping with advisories, guidelines and a guide for officers that advises them of the latest guidance and protocols. She also has been active in the City of Troy’s response, and led a webinar for community members.

“This experience has been very eyeopening. Skills I’ve learned in public health communication and translating evidence based medicine into real practice have been the most helpful,” she said.

Many more students are engaged in COVID-19 response with their communities, standing as an excellent representation of the School of Public Health family.

Pictured: MPH student Makensy Jabbour working at the Albany County Department of Health as a contact tracer.

ASSISTING LOCAL COUNTY HEALTH DEPARTMENTS

UAlbany School of Public Health students are working on COVID-19 response at the Albany and Schenectady County health departments.

Monroe Marshall and Makensy Jabbour, MPH students, are working with the epidemiology team at the Albany County Department of Health. When a person’s test comes back positive, they are part of the team that notifies them and works to trace contacts who may have been exposed. “It’s so interesting to experience a health department during a pandemic,” said Marshall, who is also completing a certificate in public health preparedness and surveillance. “It’s intense.”

Jabbour echoes that sentiment, saying “Outbreak investigation and response is what I want to do with my career, so this has been an amazing experience that I couldn’t have gotten in the classroom.”

“The most rewarding part of this work are the wholesome phone calls I have with individuals who are positive cases or on mandatory quarantine, who appreciate us checking in on them and helping them be safe.”

Pictured: MPH student Monroe Marshall, working as a case investigator at the Albany County Department of Health.

- Monroe Marshall, MPH student

INVEST IN THE FUTURE OF PUBLIC HEALTH albany.edu/sph/give Your support of the University at Albany School of Public Health enables faculty and students to continue their work to improve the health of communities, both here in New York’s Capital Region and around the globe.

Our students work exceptionally hard and take nothing for granted. They push themselves to be influential public health leaders who can make a difference not just when they graduate, but while they’re here at UAlbany, too.

Together, we’ve made it possible for so many students to dream big and tackle the most pressing public health issues, and we look forward to continuing to do so for many years to come.

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