COVID-19 treatments and research

COVID-19 treatments and research refers to local efforts to study and develop public health responses to the COVID-19 pandemic.

Epidemiological research

UAB developed a "COVID-19 Symptom Tracker" which encouraged members of the general public to report any changes in possible symptoms over time, helping the university identify "hot spots" for public health intervention and to conduct research on the early indicators of the disease. Mohanraj Thirumalai led the development of the tool with assistance from citizen-science advocate Sarah Parcak and health informatics specialist Sue Feldman, along with several university departments and research centers.

On April 24 UAB began administering antibody tests, blood tests to determine if an individual had been exposed to SARS-CoV-2. The results of the program fed into larger-scale epidemiological studies, with the associated benefit of identifying prospective donors of convalescent plasma. That study, in collaboration with Johns Hopkins University and the Mayo Clinic, was led at UAB by Sonya Heath.

In early May 2020 the Alabama Department of Public Health broadened its criteria for processing COVID-19 tests in its laboratory to better address the need to test front-line healthcare workers and residents of long-term care facilities, whether or not they had symptoms of illness.

Robert Kennedy of UAB's Center for Clinical and Translational Science, Eric Ford of the UAB School of Public Health, and Jennifer Croker of the UAB School of Medicine led a national serological study of blood samples for the National Institutes of Health to help shed light on the percentage of Americans who may have been infected with SARS-CoV-2 without knowing it.

In January 2021 a more easily transmissible strain of SARS-CoV-2's Alpha variant, designated B.1.1.7, was reportedly present in states bordering Alabama. The strain was first identified in the United Kingdom. Limited use of genetic sequencing made it difficult to trace the spread of the newer strain in the U.S.

UAB Department of Radiology researcher Benjamin Larimer announced the development of a new type of at-home test for COVID-19 neutralizing antibodies. The test will be further developed through the startup P3 Diagnostics, which Larimer co-founded with Joe Gay and Chris Paule in 2020.

In September 2021 researchers at Auburn University's Samuel Ginn College of Engineering announced the development of a near-instantaneous test for the COVID-19 virus spike protein, permitting rapid testing at lower levels of infection. The project was led by Masoud Mahjouri-Samani and Michael Hamilton.

Preventatives

Because the SARS-CoV-2 virus was entirely new, no immunity or specific antidotes were available before it caused a worldwide pandemic. Because of the ease of transmission, the first priority in hospitals was to seal off wards where COVID-19 could be treated and to establish protocols for the use of protective equipment by healthcare workers, in the context of local, national and global shortages.

A study conducted by the UAB Comprehensive Diabetes Center and the Hugh Kaul Precision Medicine Institute found that use of Metformin to treat diabetes significantly reduced mortality from COVID-19.

Immunization

UAB and Southern Research conducted early trials of vaccine candidates created by Altimmune of Gaithersburg, Maryland and Tonix Pharmaceuticals of Chatham, New Jersey. UAB also enrolled volunteers in a large-scale human trial of a vaccine candidate developed by Oxford University and Cambridge-based AstraZeneca.

With the FDA's first Emergency Use Authorizations for vaccines developed by Pfizer and Moderna in early December, the Alabama Department of Public Health prepared to implement its distribution plans, prioritizing first-line workers in healthcare settings.

By late January Alabama was receiving 50,000-60,000 doses per week. The restricted supply slowed the progress of vaccination beyond the initial group. UAB opened large-scale drive-through vaccination sites at the Hoover Met and at Parker High School in early February as the Biden administration ramped up allotments to states. A third vaccine from Johnson & Johnson was expected to become available during February, greatly expanding the rate of immunizations.

Treatments

Antiviral drugs

One of the drugs used on a trial basis for the treatment of COVID-19 patients was remdesivir, a drug under development at the Antiviral Drug Discovery and Development Center under UAB's Richard Whitley. During the 2020 pandemic, UAB Hospital participated in a clinical trials with remdesivir, as well as a separate clinical trial of the use of nitric oxide in ventilators for those whose lung function was severely compromised. Nitric oxide had earlier shown some promise with SARS patients. Cardiologists Pankaj Arora and Vibhu Parcha led that study.

Pfizer won approval for its "Paxlovid" anti-viral pill to treat acute COVID in May 2022. The drug has been found to be effective at reducing viral load early in infections. UAB is among the institutions studying whether it is also effective in addressing symptoms of long COVID. That research is being conducted by Nathan Erdman. The United States subsidized the distribution of Paxlovid under its Emergency Use Authorization through the end of 2023. Pfizer agreed to continue providing the drug at no cost to patients enrolled in Medicare or Medicaid, and to operate a Patient Assistance Program for uninsured and underinsured patients. For all others covered by private medical insurers, the company entered into negotiations, with an anticipated retail cost of $1,390 for each 5-day course (a total of 30 tablets).

Inhibitors

The Hugh Kaul Precision Medicine Institute at UAB contributed to development of trials at VA Medical Centers in West Los Angeles and elsewhere to measure the effectiveness in male patients of the androgen deprivation drug Firmagon (degarelix), which may suppress production of a certain protein in the lungs that COVID-19 utilizes.

UAB conducted clinical trials on 15 hospitalized COVID-19 patients to evaluate the safety and effectiveness of Alvelestat, a human neutrophil elastase inhibitor under development by Mereo BioPharma Group of London, England. Results of the trials showed improvement of respiratory symptoms.

Monoclonal antibodies

Researchers in the UAB Division of Infectious Diseases and the UAB Department of Microbiology, led by James Kobie and Mark Walter, worked with the Texas Biomedical Research Institute to develop a therapeutic treatment based on the delivery of a "highly potent monoclonal antibody" (AR-711) nasally to non-hospitalized COVID-19 patients. A global study of the candidate treatment was conducted in early 2021.

An intravenous antibody "cocktail" developed by Regeneron Pharmaceuticals of Tarrytown, New York was approved by the FDA for emergency use to treat "mild to moderate" cases of COVID-19 in November 2020. It had been used a month earlier to treat President Donald Trump at Walter Reed National Military Medical Center. The treatment has been observed to be effective at preventing serious symptoms of administered early-on in an infection. Infusion of approved antibody treatments can be conducted an a wide range of medical settings under emergency provisions ordered by Governor Kay Ivey.

On January 24, 2022 the U.S. Food & Drug Administration recommended against the use of Regeneron's and Eli Lilly's monoclonal antibody treatments because they had been shown to be ineffective in infections caused by the Omicron variant, which then accounted for 99% of new cases.

Long-term treatments

In November 2020 UAB launched a "Post COVID Treatment Program" to better manage health care for individuals suffering lengthy recoveries from lingering COVID-19 symptoms. Turner Overton directed the program.

UAB Department of Psychology professors Edward Taub and Gitendra Uswatte-Aratchi researched the effectiveness of existing constraint-induced therapies on COVID patients experiencing memory loss and impaired cognition. The UAB Heersink School of Medicine is one of 15 institutions conducting research on long COVID with funding from the National Institutes of Health's "RECOVER" initiative.

A "Household Pulse" survey conducted between June 1–13, 2022 by the U.S. Census Bureau and analyzed by CDC's National Center for Health Statistics (NCHS) found that Alabama had the nation's second-highest rate of "Long COVID" reported, with 12.1% of respondents reporting lingering symptoms. State health officer Scott Harris blames the state's relatively high rates of chronic disease and low vaccination rates as factors.

Nathan Erdman of UAB's Post COVID Treatment Program supports the use of subcategories of long COVID presentations to improve research and treatment of the disease. The most concerning subtype, affecting approximately 34% of long COVID sufferers, many of them older males requiring hospital care, involves heart, kidney and circulation problems. Another common subtype, affecting around 33% of sufferers, presents with respiratory, sleep, anxiety, headache and chest pain. This group of symptoms is less likely to require hospital care and is more likely to result from later variants of the novel Coronavirus. 23% of long COVID patients suffered musculoskeletal symptoms, and 10% had a combination of digestive and respiratory symptoms.

References

• Pillion, Dennis (April 8, 2020) "UAB testing new coronavirus treatment on its sickest patients." The Birmingham News
• Yurkanin, Amy (April 13, 2020) "Early, but promising results for coronavirus drug developed at UAB." The Birmingham News
• Windsor, Matt (April 29, 2020) "Coronavirus antibody testing now is available at UAB. Here’s what that means — and what it doesn’t" UAB Reporter
• Gore, Leada (May 7, 2020) "ADPH expands criteria for coronavirus testing." The Birmingham News
• Patchen, Tyler (May 15, 2020) "UAB collaborating with Mayo Clinic, Johns Hopkins on plasma therapy research for Covid-19." Birmingham Business Journal
• Gainer, Holly (June 9, 2020) "Study aims to determine the number of undetected COVID-19 cases in the United States." UAB News
• Patchen, Tyler (June 11, 2020) "UAB finds possible drug candidate for Covid-19." Birmingham Business Journal
• Patchen, Tyler (September 2, 2020) "UAB launching another Covid-19 clinical trial." Birmingham Business Journal
• Patchen, Tyler (October 19, 2020) "UAB-discovered drug makes headway in Covid-19 treatment." Birmingham Business Journal
• Yurkanin, Amy (November 16, 2020) "COVID-19 vaccine in Alabama will be free, first doses could be available by December." The Birmingham News
• Yurkanin, Amy (November 18, 2020) "New program in Alabama for COVID ‘long-haulers’ with lingering symptoms." The Birmingham News
• Stanley-Becker, Isaac; Yasmeen Abutaleb; Lena H. Sun; & Josh Dawsey (December 17, 2020) "States report confusion as government reduces vaccine shipments, while Pfizer says it has ‘millions’ of unclaimed doses." The Washington Post
• Whites-Koditschek, Sarah (December 18, 2020) "Alabama shorted 20,000 vaccines in next week’s shipment, say feds cut allotment." The Birmingham News
• Vollers, Anna Claire (December 18, 2020) "At this COVID-19 unit, things were getting better. Now, its nurses fear a ‘tsunami’ is coming." Reckon / Al.com
• "'The vaccine is coming': Alabama health officials call for patience amid slow rollout." (January 6, 2021) Associated Press / The Birmingham News
• Whites-Koditschek, Sarah (January 6, 2021) "UAB housing cancer patients in hotels as COVID rises." The Birmingham News
• Whites-Koditschek, Sarah (January 7, 2021) "New COVID-19 strain now found in three states bordering Alabama." The Birmingham News
• Patchen, Tyler (January 19, 2021) "UAB-led study identifies drug that helps fight Covid-19." Birmingham Business Journal
• Patchen, Tyler (January 20, 2021) "UAB researcher develops Covid-19 antibody test." Birmingham Business Journal
• Pillion, Dennis (February 24, 2021) "UAB researchers take aim at COVID ‘brain fog’." The Birmingham News
• Whites-Koditschek, Sarah (August 18, 2021) "Monoclonal antibodies ‘the answer’ to Alabama’s COVID surge, doctors say." The Birmingham News
• Whites-Koditschek, Sarah (August 18, 2021) "Monoclonal antibodies for COVID: Who needs it? Where can you get it? How does it work?." The Birmingham News
• McAdory, Joe (September 10, 2021) "Auburn engineers create device that instantly reveals COVID-19 test results." Auburn University Samuel Ginn College of Engineering
• Pope, Adam (October 25, 2021) "RECOVER post-COVID study to enroll participants from the Deep South." UAB News
• Patchen, Tyler (December 29, 2021) "UAB and Mereo BioPharma Group post positive results from Covid-19 clinical trial." Birmingham Business Journal
• "Nearly One in Five American Adults Who Have Had COVID-19 Still Have 'Long COVID'." (June 22, 2022) National Center for Health Statistics
• Whites-Koditschek, Sarah (January 12, 2023) "New study involving Alabama patients sorts long COVID into four types." AL.com
• Whites-Koditschek, Sarah (December 13, 2023) "Paxlovid, the powerful COVID-19 drug, no longer free in 2024." AL.com