Research Spotlight: Advancing our understanding and ability to treat COVID-19
COVID-19 – Clinical and Research Studies at North York General Hospital (NYGH)
NYGH has launched several COVID-19 clinical and research studies, involving multiple frontline physicians and staff members from different programs across the hospital to advance our understanding and ability to treat this virus. Dr. Eneko Arhanchiague, a physician in the Division of General Internal Medicine; Dr Elad Mei-Dan, a physician in the Department of Obstetrics and Gynecology; and Mona Sawhney, a nurse practitioner in the Surgery Program provide a snapshot of their COVID-19 studies, as well as their thoughts on the future of this disease.
Dr. Eneko Arhanchiague
Could you tell us a bit about the COVID-19 studies you are performing?
Currently, there are only a few treatment options for COVID-19, and their efficacy is still being investigated. In a few other diseases, antibodies from recovered patients have been used as treatment for newly infected patients. However, this has never been rigorously studied. CONCOR-1 (CONvalescent Plasma for Hospitalized Adults with Acute COVID-19 Respiratory Illness) is a large, Canadian-led, randomized study using this treatment modality for COVID-19. Individuals who have recovered from COVID-19 donate their blood so that antibodies can be extracted. This is called convalescent plasma, which is then given to someone who is newly infected with COVID-19. The goal with this treatment is to reduce complications, such as intubation or death. We are enrolling patients for this study who have developed COVID-19 symptoms within 12 days, who require oxygen therapy but are not intubated.
What is the importance of your COVID-19 studies within our community/hospital setting?
CONCOR-1 is a large study that could potentially yield a meaningful impact on the treatment of COVID-19. At North York General we are both proud and excited to be part of this promising research. Our research team is not as large as academic teaching hospitals, but the fact that we are one of the sites for this study is a testament to the strength and dedication of our team. Our hope is that the use of convalescent plasma proves to be effective in treating COVID-19 and that our patients and broader community ultimately benefit.
How do you see the future of COVID-19?
COVID-19 has caused tremendous disruptions in our society and we are still feeling its effects. Until an effective vaccine is developed or herd immunity is reached, COVID-19 will continue to have an impact on our life. Social distancing measures have proven useful and will remain in place, so it is likely that we will have to learn to live safely with COVID-19 for the foreseeable future.
Dr. Elad Mei-Dan
Could you tell us a bit about the COVID-19 study you are performing?
Our team is leading a study to assess the prevalence of COVID-19 in pregnant individuals admitted for delivery at NYGH. These individuals are of special concern as they may be asymptomatic carriers during exposure to multiple caregivers. During a four-week period, pregnant individuals admitted for delivery completed a questionnaire for COVID-19 signs, symptoms and risk factors, and underwent a nasopharyngeal swab that detects the presence of the virus. We are now comparing the results of the individuals who were flagged as suspected COVID-19 by the questionnaire (questionnaire-positive) and the results of the individuals who were not flagged by the questionnaire (questionnaire-negative) with the COVID-19 positive and negative results of the nasopharyngeal swabs. We aim to determine if those who submitted questionnaires indicating they were negative proved to be COVID positive thereby indicating they were asymptomatic. We hope that our attempt to implement a questionnaire will be a helpful tool for the COVID-19 pandemic.
What is the importance of your COVID-19 study within our community/hospital setting?
Given the current laboratory technology and specimen turn-around time, the use of a questionnaire in areas with low incidence of COVID-19 is easy to implement. This allows for a reasonable allocation of resources to keep people safe, both patients and staff, when COVID precautions are necessary.
Special acknowledgements:
The research team includes, Drs. Elad Mei-Dan, Tal Cahan, Marian Leung, Kevin Katz and Abheha Satkunaratnam.
Supporting teams and departments: Andrea Hollingshead, Christie Vermeiren, Sheri Ferkl and the Labour and Delivery team.
Mona Sawhney
Could you tell us a bit about the COVID-19 studies you are performing?
In response to the outbreaks of COVID-19 in long-term care homes, the Government of Ontario reached out to hospitals for assistance in the form of COVID-19 Infection Prevention and Control (IPAC) program outreach teams, or “IPAC SWAT team.”
In April 2020, the NYGH IPAC SWAT Team and long-term care engagement strategy were developed by Stacey Daub, Vice President Strategy Integration and Digital Health; Rudy Dahdal, Vice President Planning Redevelopment and Support Services; Dr. Kevin Katz, Medical Director of Infection prevention and Control; and other senior leaders in Infection Control and Environmental Services. This strategy was supported by two project managers who managed the relationships between NYGH and the external facilities.
The NYGH IPAC SWAT team was led by:
- Two physicians (a physician from Internal Medicine, and another from Infectious Diseases and Internal Medicine)
- A Nurse Practitioner from the Surgical Program
- Eight registered nurses (a nurse coordinator, a nurse from Geriatric Emergency Management, five nurses from the Emergency Department and a nurse from the Nursing Resource Pool)
The objective of this study is to report the strategy and outcomes of interventions implemented by the NYGH IPAC SWAT team that was deployed to long-term care facilities, retirement homes, transitional care units and congregate care homes in NYGH’s regional catchment.
What is the importance of your COVID-19 studies within our community/hospital setting?
The NYGH approach to assisting our community partners and external facilities was implemented in a unique and comprehensive manner. Between April 28 and June 30, our team assisted a total of 25 of these facilities to observe the infection prevention and control practices, and to provide education and support in implementing effective practices. The NYGH IPAC SWAT team regularly reassessed the facilities to evaluate the implementation of recommendations and changes. This approach was effective and, by July 2020 all the facilities that NYGH was assisting were free of COVID-19 outbreaks. The facilities that received an NYGH IPAC SWAT assessment were very satisfied with the assistance they received and were better informed about COVID-19, and how to protect their residents and their staff after the education interventions.
How do you see the future of COVID-19?
The future of COVID-19 is uncertain but the NYGH IPAC SWAT team is prepared to assist with any future COVID-19 outbreaks in long-term care and has shown how hospitals can create new and important links in the community that lead to a more seamless health care system. The goal is to ensure facilities that have received assessments and education by the NGYH SWAT team are better prepared and equipped for possible future waves, by avoiding or significantly reducing outbreaks.
Special acknowledgements:
The research team includes, Mona Sawhney, NP (Adult), PhD (surgery), Dr. Michael Lamb (internal medicine), Dr. Anthony LaDelfa (infectious diseases), Dr. Kevin Katz (IPAC).