COVID-19 treatments and research

2020 Coronavirus pandemic treatments and research refers to local efforts to study and develop public health responses to the 2020 Coronavirus pandemic.

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.

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.

The UAB School of Medicine's Division of Infectious Diseases opened a COVID Respiratory Clinic in the former Regions Bank branch in the Kirklin Clinic Parking Deck at 539 Richard Arrington Jr Boulevard South. The clinic conducted telephone or video consultations with UAB Health patients who have tested positive but are convalescing at home. In-person appointments could be made when warranted to determine if hospital treatment was required, without burdening emergency room capacity.

On April 24 UAB began administering antibody tests, blood tests which can determine if an individual has been exposed to SARS-CoV-2. The antibody test can not determine if an infection is active or if the individual is immune to re-infection. The major use of the test was expected to be in identifying candidates who could donate convalescent plasma, and as part of larger-scale epidemiological studies. That clinical study, in collaboration with Johns Hopkins University and the Mayo Clinic, was led at UAB by Sonya Heath.

In early May the Alabama Department of Public Health broadened the 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 have symptoms of illness.

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.

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.

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 is planned for early 2021.

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

In January 2021 a more easily transmissible strain of SARS-CoV-2, 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 variant in the U.S.

Vaccine research

Research teams headed by Troy Randall of the UAB Division of Clinical Immunology and Kevin Harrod of the UAB Department of Anesthesiology and Perioperative Medicine joined with several researchers from the UAB Department of Microbiology in performing certain preclinical studies of an "AdCOVID" trial vaccine developed by Altimmune of Gaithersburg, Maryland. The potential vaccine, which would be administered by nasal injection, showed promising therapeutic results and advanced to Phase 1 safety trials in late 2020. Additional preclinical trials were conducted under UAB Department of Microbiology chair Frances Lund.

Southern Research carried out pre-clinical studies of another vaccine candidate, TNX-1800, in a partnership with Tonix Pharmaceuticals Holding Corp. Raj Kalkeri of Southern Research’s Infectious Disease Research Group led the research. The company's Phase 1 trials concluded in November with positive results and an aim to begin human trials in early 2021. Kalkeri's team also studied the immune responses of individuals who had been exposed to SARS-CoV-2 and no longer showed symptoms.

Beginning in late July, UAB began enrolling volunteers for a portion of a larger human trial study of a vaccine candidate developed by Oxford University and AstraZeneca. The research was led locally by Paul Goepfert. In September UAB began a clinical study of the effectiveness of tranexamic acid (TXA) in suppressing the virus' infectivity in patients with elevated levels of the extracellular protease plasmin due to comordities. Sadis Matalon and Timothy Ness were involved in developing the study.

Vaccine distribution

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

Alabama was set to receive 40,000 doses of the Pfizer vaccine during the first wave of shipments in mid-December, which was only enough to vaccinate 20,000 of the state's 300,000 healthcare workers. Pfizer's first shipment of vaccines reached Alabama on December 15. The Birmingham VA Medical Center was the first to administer the vaccine in Birmingham, and Lee Elm Creel of Snowtown was the first to receive it there. On December 17 ADPH learned that a second expected shipment of 20,000 doses would not arrive, greatly reducing the number of healthcare workers who could be vaccinated early. Moderna's vaccine candidate earned FHA emergency use authorization on December 18, with an initial shipment of 84,000 doses expected in Alabama on Monday, December 21 for distribution to healthcare workers.

Most Alabamians not prioritized due to age, medical condition or essential status, would begin to have access to vaccination in early summer 2021. No timeline has been established for vaccinating children under 16. The cost of the vaccines is free to all Americans, though some service fees may be charged to insurers or reimbursed through the Health Resources and Services Administration's Provider Relief Fund.

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
• Patchen, Tyler (April 21, 2020) "UAB opens new clinic focused on COVID-19." Birmingham Business Journal
• 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 (July 13, 2020) "Covid-19 vaccine trial involving UAB shows promising results." Birmingham Business Journal
• Thornton, William (July 22, 2020) "Southern Research collaborating on COVID-19 vaccine tests." The Birmingham News
• Pillion, Dennis (July 24, 2020) "Alabama hospital seeking volunteers for COVID vaccine trial." The Birmingham News
• Patchen, Tyler (September 2, 2020) "UAB launching another Covid-19 clinical trial." Birmingham Business Journal
• Patchen, Tyler (October 13, 2020) "More promising news for UAB vaccine efforts with Altimmune." 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
• Patchen, Tyler (November 19, 2020) "Southern Research and Tonix make headway in Covid-19 vaccine." Birmingham Business Journal
• Whites-Koditschek, Sarah (December 6, 2020) "Here comes the vaccine. But will Alabamians take it?" The Birmingham News
• Gore, Leada (December 9, 2020) "COVID vaccine in Alabama: Everything you need to know." The Birmingham News
• Yurkanin, Amy (December 15, 2020) "World War II veteran receives first COVID-19 vaccine in Birmingham." 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
• Whites-Koditschek, Sarah (December 21, 2020) "Moderna vaccine expected to arrive today in Alabama." The Birmingham News
• Whites-Koditschek, Sarah (December 21, 2020) "When will Alabamians get a vaccine?" The Birmingham News
• "'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