EHSRC in the fight against COVID-19
EHSRC investigators wear many hats, both inside and outside of their membership with the Center. Many have been active contributors in response to the emerging questions and needs during the COVID-19 pandemic. As experts in the fields of respiratory health, industrial hygiene, engineering, aerosol science, patient care, vaccine development, and community engagement, they are tirelessly offering up their expertise to the cause by developing new technologies and interventions, working the front lines of patient care, delving into the complex infrastructural challenges, and advising governmental authorities and the general public. We are proud to count them among our members and pay tribute to their ongoing efforts in this fight.
ENGAGEMENT AND GUIDANCE PROVISION
In February, 2022, Dr. Patrick O’Shaughnessy provided an update to The Daily Iowan on the most effective masks recommended to protect against COVID-19 transmission on campus. He reported that N95 masks are most effective because of the tight seal formed to the face while wearing them, while the surgical masks are least effective. He reiterated that the surgical masks were never designed to be a complete protection for the person wearing them, and that it is very important that the entire UI campus community together to be wearing the [KN95] masks to inhibit the spread of COVID-19. The UI announced on Jan. 12 that it would stock each university building health station with KN95 masks, an upgrade from the blue surgical masks given out during the first semester.
On March 24, 2021, Dr. Alejandro Comellas participated as an expert speaker for a Spanish COVID-19 Vaccine Information Session hosted by the Iowa Commission of Latino Affairs.
He and fellow physician Rolando Sanchez, of UIHC Internal Medicine-Pulmonary, Critical Care and Occupational Medicine were able to provide updates about vaccine availability and concerns and address questions from members of Iowa’s Spanish-speaking populations.
In addition, Dr. Comellas has been instrumental in establishing Iowa’s only clinic dedicated to caring for people who have recovered from COVID-19. The clinic’s team of doctors cooperate with other specialists at leading medical institutions around the world who are focused on caring for patients who have recovered from COVID-19 and share the latest information about how to identify symptoms of the effects of COVID-19 as well as the most up-to-date treatment plans. https://uihc.org/post-covid-19-clinic
Dr. Diane Rohlman, Professor and Endowed Chair in Rural Safety and Health and Director of the Healthier Workforce Center for the Midwest (HWCMW) has developed an employer guide to address the various challenges and risks around COVID-19 in the workplace. As part of this effort, her group launched a national webinar to talk about the guide’s recommendations that attracted 600 attendees. The guide and other COVID-19 resources can be found on the HWCMW web page: https://hwc.public-health.uiowa.edu/covid-19/
She has also worked with Washington University to develop a Survey of Employees looking at employee well-being, which prompted a similar survey sent out to UI Faculty, Staff and postdocs. The UI survey included questions about types of stress workers are experiencing will follow-up with respondents every three months until February.
Dr. Kelly Baker, Assistant Professor of Occupational and Environmental Health is contributing to the development of the COVID-19 Hygiene Hub, a free service that supports actors in low- and middle-income countries (LMICs) to rapidly design evidence-based hygiene interventions to combat the coronavirus.
This COVID-19 Hygiene Hub platform has three principal functions:
- to connect institutions and organizations implementing hygiene programs in response to COVID-19 with technical and creative experts who can answer questions and provide detailed advice in real time
- to provide access to a searchable set of resources which summarize current evidence and guidelines and make practical recommendations for crisis-affected or LMIC settings
- to offer a platform for sharing what is working among governments, international organizations, and civil society actors
Dr. Baker is also advising the National Academy of Medicine on preparedness for COVID-19 in Africa.
Craig Just, Associate Professor of Civil and Environmental Engineering is providing technical support to EOS International, a nonprofit social enterprise that works toward the goal of providing rural families in Central America with access to safe water through simple technological solutions and education. The COVID-19 pandemic has caused a significant change to EOS international’s distribution system, posing challenges to continuing advancement of water treatment of these rural communities through strategic chlorine distribution centers..
David Cwiertny, Professor of Civil and Environmental Engineering has collaborated with investigators from eight organizations to pull together a synthesis of peer-reviewed, government, industry, and nonprofit literature relevant to the implications of water stagnation in the plumbing systems of buildings closed long-term and subsequently re-opened and decontamination practices for water quality. The document addresses preventative practices, challenges and limitations associated with recommissioning procedures with consideration for worker and occupant safety.View the manuscipt here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323006/
Dr. Cwiertny is also partnering with Patrick O’Shaughnessy, Professor of Occupational and Environmental Health and Charles Stanier, Professor of Chemical and Biochemical Engineering to develop alternative PPE (a material comparable to removal in N95 respirators) using electrospun nanofibers at the request of the University of Iowa. To date, some promising materials have been identified and in partnership with an industry collaborator the team is working on options for scaling up the materials made in their laboratories to a size necessary for integration into PPE.
Renée Anthony, Professor of Occupational Health and Director of the Great Plains Center for Agricultural Health, is advising the University COVID-19 planning team. As an environmental engineer, industrial hygienist, and safety professional, Dr. Anthony provides public and occupational health guidance to the University to recommend adoption of protective measures for essential workers in this time of great uncertainty. She advises the team in real-time on new information and recommendations on diverse topics, including disinfection practices, benefits and limitations of less protective personal protective options available to non-healthcare workers, and optimal protocols for COVID-19 symptom screening to minimize the risk of outbreak among University of Iowa workers. Within her NIOSH-funded center, Dr. Anthony is collaborating with faculty and staff to develop information and tools for farmers and farmworkers to guide them on steps to prevent COVID-19 infection.
Brandi Janssen, Clinical Assistant Professor of Occupational and Environmental Health, and Director of Iowa’s Center for Agricultural Safety and Health is providing insight into the unique challenges to farmers, distributions systems and the food supply during the pandemic. These challenges include now-limited interactions with input dealers to co-op staff to custom applicators to feedlot operators to livestock plant workers, as well as having so many of their customers facing Covid-related layoffs or salary cuts, in addition to the other financial, meteorological, physical and psychological variables that all farmers have to navigate.
COVID-19 RESEARCH AND TECHNOLOGY DEVELOPMENT
Alejandro Comellas contributed to a study on post-COVID brain fog and fatigue, revealing a negative impact on daily activities, work/employment and interpersonal relationships. Post-acute sequelae of SARS-CoV-2 (PASC) is a poorly understood condition with significant impact on quality of life. This study aimed to better understand the lived experiences of patients with PASC, focusing on the impact of cognitive complaints (“brain fog”) and fatigue on (1) daily activities, (2) work/employment, and (3) interpersonal relationships. The team conducted semi-structured qualitative interviews with 15 patients of a Midwestern academic hospital’s post-COVID-19 clinic. Participants frequently used descriptive and metaphorical language to describe symptoms that were relapsing-remitting and unpredictable. Fatigue and brain fog affected all domains and identified subthemes included symptoms’ synergistic effects, difficulty with multitasking, lack of support, poor self-perception, and fear of loss of income and employment. Personal relationships were affected with change of responsibilities, difficulty parenting, social isolation, and guilt due to the burdens placed on family. Furthermore, underlying social stigma contributed to negative emotions, which significantly affected emotional and mental health. Our findings highlight PASC’s negative impact on patients’ daily lives.
Gary Pierce participated in a study team to evaluate the activity levels of college students during the pandemic. The Activity Questionnaire for Adults and Adolescents estimated physical activity and sedentary time before, early, and later in the pandemic. Barriers and facilitators to physical activity were assessed at early and later timepoints. Open-ended questions examined additional impacts. Comparing before vs. early/later pandemic assessments, respondents reported a significant decrease in physical activity metabolic equivalent (MET)-minutes/week and a significant increase in sedentary MET-minutes/week. The top barrier was schoolwork (47.7%). The top facilitator was social support (21.5%). Responses to open-ended questions indicated that most individuals reported sitting more during the pandemic, with variation in physical activity patterns. Adverse changes in physical activity and sedentary behavior observed early in the pandemic were sustained.
Paul Romitti co-authored a publication reporting a study on the relationship between trimester of SARS-CoV-2 infection, illness severity, and risk for preterm birth. Data was analyzed for 6336 pregnant persons with SARS-CoV-2 infection in 2020 in the United States. The study found that pregnant persons with critical COVID-19 or asymptomatic infection, compared to mild COVID-19, in the second or third trimester were at increased risk of preterm birth. Pregnant persons with moderate-to-severe COVID-19 did not show increased risk of preterm birth in any trimester.
Julia Klesney-Tait was part of a study to determine whether recipients of lung transplantation (LT) for COVID-19-related lung disease have comparable outcomes to other recipients with a similar level of lung dysfunction. Lung transplantation is an acceptable and potentially life-saving treatment option for coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome and pulmonary fibrosis. A total of 37,333 LT candidates from all causes were compared with 334 candidates from COVID-19-related respiratory failure. COVID-19 recipients were more likely to be younger (50 vs 57 years), male (79% vs 60%), require extracorporeal membrane oxygenation (56.3% vs 4.0%), and have worse lung function (lung allocation score, 82.4 vs 47.8) at transplantation. Patients who received a transplant for COVID-19 had similar rates of mechanical ventilation, extracorporeal membrane oxygenation, postoperative complications, and functional status at discharge compared with controls. There was no difference in overall survival or risk of death from COVID-19.
Brandi Janssen contributed to a study on how the coronavirus disease 2019 pandemic affected food availability and accessibility for many older adults, especially those experiencing food insecurity. Food citizenship is a theoretical framework that encourages the use of alternate over industrial food sources and can characterize where foods are acquired and how food choices are made. The purpose of this study is to explore how Iowans aged 50 years and older made choices about what foods to acquire and where to acquire foods during the coronavirus disease 2019 pandemic using food citizenship as a theoretical framework.
Article: Damage to lungs linked to long-haul COVID-19 breathing problems, Iowa study finds
Damage to the small airways in the lungs is an aftermath of COVID-19 that may cause long-lasting side effects, even for those who did not have a serious illness, according to a new study from the University of Iowa.
Researchers at the UI Post-COVID Clinic conducted CT scans of patients previously infected by the coronavirus and uncovered physical changes in the small airways — which may explain ongoing breathing problems associated with long-haul COVID-19. Link to full article from the Gazette
Article: Inhaled COVID-19 vaccine prevents disease and transmission in animals
In a new study assessing the potential of a single-dose, intranasal COVID-19 vaccine, a team from the University of Iowa and the University of Georgia found that the vaccine fully protects mice against lethal COVID-19 infection. The vaccine also blocks animal-to-animal transmission of the virus. The findings were published July 2 in the journal Science Advances.
“The currently available vaccines against COVID-19 are very successful, but the majority of the world’s population is still unvaccinated and there is a critical need for more vaccines that are easy to use and effective at stopping disease and transmission,” says Paul McCray, MD, professor of pediatrics-pulmonary medicine, and microbiology and immunology at the UI Carver College of Medicine, and co-leader of the study. “If this new COVID-19 vaccine proves effective in people, it may help block SARS-CoV-2 transmission and help control the COVID-19 pandemic.” Link to full article from July 6, 2021
Paul McCray, Professor of Pediatrics, is leading the effort to develop a vaccine for COVID-19 at the University of Iowa. A recent study tested a parainfluenza virus 5 (PIV5)-based vaccine against the coronavirus that causes MERS (Middle East Respiratory Syndrome), an extremely virulent respiratory disease caused by a virus belonging to the same family as the one responsible for COVID-19.
PIV5 is an ideal vector for vaccine development because it infects many mammals, including people, without causing any disease. “We know people have been exposed to PIV5, but it seems to be an innocuous virus in humans,” said McCray, M.D., a pediatric pulmonologist and coronavirus expert at the University of Iowa.
In vaccine development it is important to assure the treatment itself does not present more harm than good. Mice were tested for the vaccine; however, the MERS virus can’t replicate in mice, so McCray’s team genetically engineered the mice to express a protein used by MERS to enter human cells. A single dose of the vaccine caused an immune response and the generation of antibodies against the virus.
All of the mice that received the intranasal PIV5-based vaccine survived MERS infection, while all of the mice that received the inactivated form of the vaccine died from lethal infection.
These results suggest that a PIV5-based vaccine could be effective against coronaviruses in humans, but additional animal studies and humans trials are necessary before it would be administered. This research was published in early April in mBio, the Journal of the American Society for Microbiology https://mbio.asm.org/content/11/2/e00554-20
Aloysius Klingelhutz, Professor of Microbiology and Immunology and his research team are working on developing relevant human airway cell and endothelial cell model systems that can be used by researchers for assessing SARS-CoV-2 pathogenesis and for testing potential therapeutics.
Patrick O’Shaughnessy, Professor of Occupational and Environmental Health and Director of the Heartland Center for Occupational Health and Safety is contributing to several projects in response to the COVID-19 pandemic.
He has been tasked with undertaking an investigation of disinfection methods for N95 masks to address the lag between the increased need for them in hospital settings and a current lack of availability. Hospital workers are re-using masks in the absence of a ready supply, and his group is attempting to identify the most effective contamination method. One method used at the UIHC, called SteraMist™, has a fairly high decontamination level. This method ionizes hydrogen peroxide and turns it into molecules that fumigate the masks and eliminate any contaminants. One question is whether the current practice of repeated sterilization using this method affects the filtration efficiency of the mask. The masks are being tested and re-tested after one, two, and six sterilizations.
Another project is exploring alternatives to the lack of N95 masks, including use of the material in which surgical instruments are wrapped before autoclaving for disinfection, and creative approaches to enhancing surgical masks to create an airtight seal, as surgical masks are more widely available than N95 masks at present but do not form a tight seal around the face.
EHSRC Center members Drs. Patrick O’Shaughnessy and Peter Thorne , working with Dr. Jack Stapleton, received funding from the Veterans Administration (VA) to evaluate the performance of air filtering materials for use in a 3D printed respirator called the Stopgap Surgical Facemask. The VA has the capacity to print many thousands of these nylon masks but has been unable to identify filtering material that will protect against SARS-CoV-2 aerosols. Working in the EHSRC Exposure Science Facility, Thorne and O’Shaughnessy are testing candidate materials to establish their capture efficiency across a broad range of particles sizes and benchmarking these to N95 respirator performance standards. Additionally, they are measuring the pressure drop as a function of flowrate to insure breathability of the respirator. Once they identify filtering materials with satisfactory performance, they will evaluate their performance after multiple rounds of disinfection with high heat or hydrogen peroxide. The goal is to produce a reusable respirator with performance approaching the N95.
Dr. Kai Wang, Professor of Biostatistics has released a series of publications on mediation analysis. The studies examine various biostatistical models of mediation analysis to determine causality. They focus on several fundamental issues including power anomalies regarding total effect, direct effect, and indirect effect, treatment-mediator interaction, nonlinear modeling, and binary mediators. New methods are proposed. Misleading results in the literature are corrected. These developments are useful for path analysis and causal inference.
- Wang K. (2020). Direct effect and indirect effect on an outcome under nonlinear modeling. The International Journal of Biostatistics. In press
- Wang K. (2020). Relating parameters in conditional, marginalized, and reduced logistic models when the mediator is binary. Statistics and Its Interface. In press
- Wang K. (2019). Maximum likelihood analysis of linear mediation models with treatment-mediator interaction. Psychometrika 84(3):719–748
- Wang K. (2018). Understanding Power Anomalies in Mediation Analysis. Psychometrika 83(2):387-406