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Stopping COVID-19

Emory researchers embark on an epic journey to tackle humanitys big test

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a photo of dr. sheesh mehta looking at a computer screen.

Dr. Aneesh Mehta at Emory University Hospital

Dr. Aneesh Mehta at Emory University Hospital

Dr. Aneesh Mehta stood in the still hallway outside the hospital room where his patient lay dying.

Just days earlier, Mehta had discussed treatment options with the vital and alert elderly businessman who came in with COVID-19. The patient was interested in Emory’s clinical trial of the antiviral remdesivir, which Mehta was leading. 

Now he was in intensive care at Emory University Hospital, having taken a rapid turn for the worse. His only companion was a nurse in full protective gear. She held his smartphone in one hand. On the line, his family was saying goodbye, their grief playing out in a room far away. Mehta watched as the man’s granddaughter told stories of their life together. It was unclear if the man, who was heavily sedated, understood. He stopped breathing soon after.

Even months later, Mehta gets emotional as he recalls that day in April. An infectious disease doctor and researcher who cut his teeth during the Ebola outbreak, Mehta has seen his share of death. But to watch a man die without his loved ones at his bedside was wrenching.

“No one wants to see a patient die. What is heartbreaking about COVID-19 is that so many patients are dying and they are dying alone,” Mehta says.

It also crystallized for Mehta what was at stake. The final trial results for remdesivir, which had failed for this patient, turned out to be so promising that top infectious disease expert Dr. Anthony Fauci hailed it as the new standard of care. It became the first treatment for COVID-19 approved by the U.S. Food and Drug Administration.

“It shows that what we do scientifically and medically has a tremendous impact,” Mehta says. “This is research being done to save the lives of our patients in our hospitals right now. This is why we are here.”

a factoid that reads Emory ranks number 3 nationwide in NIH awards for COVID-19 among universities.

Since the pandemic began, federal funding agencies such as the National Institutes of Health (NIH) have ramped up their support, entrusting academic research institutions such as Emory to do what they do best: help solve big challenges. 

In response, Emory mobilized its discovery enterprise to safely and quickly accelerate research, emerging as a national leader in coronavirus-related research; in a span of months, its investigators had launched 177 studies, including more than 30 clinical trials, and published more than 350 papers on COVID-19.

When the fiscal year closed at the end of August, Emory had earned a record $831 million in research funding. More than 10 percent of the total ($88.3 million) was for COVID-19 research, a testament to the ability of researchers to shift course rapidly to tackle the world’s biggest public health crisis in more than a hundred years.

Record year for research funding

an animated pie chart that states the following numbers for funding, Federal $578 million, University/Other $66.4 million, Corporate $71 million, State $16.5 million, Private $88 million, International $11 million, and total $831 million.

Funding totals by source: fiscal year 2020

Funding totals by source: fiscal year 2020

“In my short time at Emory, I’ve been deeply impressed by the dedication of our researchers and clinicians, whose cutting-edge discoveries are opening new pathways of understanding in the prevention and treatment of COVID-19. Emory’s record research funding this year reflects well upon not only their expertise, but the trust they have earned in helping to meet the greatest global health challenges.

—Gregory L. Fenves, Emory president

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Research funding over the years

A bar chart animation that reads as followed, Research funding over the years (title), First bar, non-federal funding, year 2016 $184.8 million, year 2018 $293.2 million, and year 2020 $253.3 million. Second bar, federal Funding, year 2016 $389.7 million, year 2018 $440.7 million, and year 2020 $577.8 million. Third bar, total source funding, year 2016 $574.5 million, year 2018 $734 million,  and year 2020 $831.2 million.

Top 10 federal funding agencies

a chart with various sizes of circles showing the various grant amounts. NIH $489.8 million, CDC $27.3 million, NATIONAL SCIENCE FOUNDATION $15.9 million, DEPARTMENT OF DEFENSE $12.5 million, ASST SECTY FOR PREPAR. & RESPONSE BARDA $11 million, HUMAN RESOURCES AND SRVC. ADMIN $6.3 million, DEPT OF VETERANS AFFAIRS $4 million, DEPT OF ENERGY $2.9 million, SUBSTANCE ABUSE AND MENTAL HEALTH SERVICE $1.7 million, and US AGENCY FOR INTERNATIONAL DEVELOPMENT $1.1 million.

At a time of great uncertainty, our researchers, staff, and clinicians are responding with grit, courage, and compassion. They are working day and night to improve lives and provide hope through the development of new vaccines and by discovering new ways to diagnose and treat people with COVID-19.”

Dr. Jonathan S. Lewin, executive vice president for health affairs, Emory University; executive director for Woodruff Health Sciences Center; and CEO and chair of the board, Emory Healthcare

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The Emory difference

A culture of collaboration and nimbleness

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a photo of a woman researcher doing a covid-19 test in a research lab.

COVID-19 trained a spotlight on what Emory has long done well: Research with impact.

Soon after the pandemic swept the country, biomedical research found itself confined to a select few labs at Emory. Researchers pivoted, shifting their expertise and resources toward fighting an unprecedented threat in a variety of ways. For instance:  

  • Virologist Dr. Mehul Suthar and immunologist Dr. Jens Wrammert took on the ambitious task of understanding immunity among those infected with SARS-CoV-2. One strand of their research looks at the durability of immunity—in other words, could those who were once infected be reinfected? How long will protection provided by a vaccine last?

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Groundwork for successful COVID-19 research was laid a long time ago

Emory’s deep background in HIV research paved the way for an experimental COVID-19 treatment, illustrating how life-saving research sometimes happens. It began with virologist Dr. Raymond Schinazi, who had a theory that anti-inflammatory drugs being tested for HIV could help COVID-19 patients. He and his team partnered with infectious disease specialist Dr. Vince Marconi, who tried out the experimental therapy at the Atlanta Veterans Affairs hospital—with encouraging results. The collaboration between these two researchers from different disciplines, combined with their external partnerships and associations, sowed the seeds for the drug’s inclusion in a federally sponsored nationwide clinical trial. How? Watch the video below.

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COVID-19 and beyond

2020’s brightest moments for research faculty

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“This research funding milestone is a wonderful tribute to our faculty and staff and demonstrates the confidence our peers and funding agencies have in Emory’s ability to generate impactful research even under extraordinary pressures. Infectious diseases research continues to be a jewel in Emory’s crown, and I am proud of the richness of our diverse research portfolio that spans many disciplines from health sciences to environmental studies to the arts and humanities.”

Deborah Bruner, senior vice president for research, Emory University

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Click on the images below to see what a few of our brightest minds were up to in fiscal year 2020.

Whats next:

Finding answers to six big COVID-19 questions

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1. How do we prevent COVID-19 transmission?

Public health experts agree that while nonpharmaceutical measures may reduce transmission, only effective vaccines will help end the pandemic.

In March, a record-short 66 days after the coronavirus’s genetic sequence was first published, Emory was one of two sites to begin testing the first COVID-19 vaccine in the United States. The vaccine, which uses a new mRNA approach, harnesses the body’s own cells to produce SARS-CoV-2 viral spike proteins. That Phase I trial , led at Emory by investigators Dr. Nadine Rouphael and Dr. Evan Anderson, has since progressed to an advanced-stage efficacy study that has completed enrollment nationwide. Preliminary results released by the company are encouraging.

“Having this trial take place at Emory gives Atlanta-area residents the opportunity to participate in a study that, if successful, has the potential to help stem the tide of this disease,” says Anderson, who has also advocated for accelerating clinical trials for vaccines in children.

Emory is also testing a single-dose vaccine candidate in a Phase 3 trial. Additionally, researchers at Emory are in the middle of developing a vaccine that is currently being evaluated in animal models. Apart from vaccines, Emory investigators are also studying therapeutics as preventive agents and antiviral antibodies in high-risk environments, such as nursing homes.

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2. What can we learn from modeling disease transmission and super-spreading events?

Governments around the world are discussing how to ensure people’s safety while lifting lockdown restrictions. Emory public health researchers Ben Lopman and Samuel Jenness are on the trail for answers. They are looking at how people interact to understand how educational, work, and leisure spaces should modify practices.

“Given that we’re often presented with two extremes—where we do nothing or we completely shut society down—the interesting scientific question is, where do we find that middle ground?” Jenness says.

He and Lopman adapted a model that simulated COVID-19 transmission on university campuses. They used the tool a few months ago to help Emory safely reopen for its fall semester.

A phenomenon seen in COVID-19 is the ability of a tiny number of infected people to spread the disease to a much larger group. Lopman and another colleague, Max Lau, studied what are known as “super-spreaders” in Georgia using data from the state’s department of health. They found that 2 percent of symptomatic COVID-19 cases appeared to be responsible for 20 percent of new infections during spring.

The study found that younger people seemed to be the main drivers of super-spreading events. The results indicated that maintaining social distancing is crucial and curtailing super-spreading events will be essential to control the pandemic.

an illustration showing a group of green and red figures of people. The red figures representing covid spreaders., image

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3. How long does immunity to SARS-CoV-2 last?

News reports in summer 2020 conveyed some anxiety over this issue: how fast does immunity drop off after SARS-CoV-2 infection? Levels of antibodies do decline after an acute infection has passed but Emory experts say this is normal – it is how the immune system de-escalates to avoid injury to the body.

Still, a quick decline could set limits on what levels of protection a vaccine could achieve and how long it could last. To answer these questions in a detailed and comprehensive way, Emory Vaccine Center director Rafi Ahmed along with researchers Jens Wrammert and Mehul Suthar will look at both antibody levels and memory B and T cells, the reserves for reengaging the antiviral immune response, over the next two years.

They have teamed up with their counterparts at Fred Hutchinson Cancer Research Center in Seattle. Their goal is to have 500 participants from the Seattle and Atlanta areas— all COVID-19- confirmed, with a mix of milder, nonhospitalized and more severe hospitalized cases.

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4. How many people have been exposed to the virus?

In early summer 2020, the United States was not even close to “herd immunity.” About 3 percent of first-time blood donors had antibodies against SARS-CoV-2, according to the American Red Cross. Later estimates put exposure in some areas of the country at more than 10 percent.

For a more definitive answer to this question, we can look to studies such as Emory’s COVID-Vu, a nationwide, population-based study using antibody and virus tests taken at home. In June, Emory public health researchers Aaron Siegler and Patrick Sullivan received a $6.6 million grant to launch the study, which is designed to sample everyone, whether they are sick or not.

Soon after receiving the award, the COVID-Vu team began mailing out test kits, reporting a few months ago that 15,000 test kits had already been sent. Once the researchers have gauged how response rates vary geographically and among different demographic groups, they will adjust to ensure that the study looks at the population proportionally.

The surveillance data will help public health agencies better understand how the virus is spreading through the population over time. The antibody test results will also provide information about previous infections in people who may have been asymptomatic.

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5. What type of tests are accurate, quick, and easy to administer?

Fast, affordable, and accurate testing is crucial to help treat, isolate, or hospitalize people who are infected with COVID-19. Access to rapid and reliable testing remains important for containing the spread.

Emory and partners are playing a leading role on this front as part of a national initiative supported by more than $50 million in federal funding.

In a three-phase vetting process that includes a Shark Tank-style competition, biomedical engineer and pediatrician Dr. Wilbur Lam and his colleagues at the NIH-funded Atlanta Center for Microsystems Engineered Point-of-Care Technologies are evaluating hundreds of diagnostic products for COVID-19 submitted by private companies. The eventual goal is to provide millions of accurate and easy-to-use COVID-19 tests available for at home or other point-of-care use as early as this winter.

Lam, critical care specialist Dr. Greg Martin, and Georgia Tech nano-engineer Oliver Brand and their team have been assessing hundreds of tests; some resemble pregnancy kits, with specimen swab, reagents, and test strip combined into a single tube. Others are more Star Trek tricorder-like, capable of providing results with a hand-held machine in 30 minutes. Emory was involved in evaluating most of the tests chosen by the NIH in its first round for scale-up.

a photo from the covid testing site done during the summer in Gainesville Georgia. Two Rollins public health students are seating behind a table ready to take patients to conduct a covid-19 test. , image

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6. How do we roll out a vaccine equitably?

When a COVID-19 vaccine is ready, who gets it first? The elderly? Essential workers? Persons of color? People who live in underserved communities? These are some of the questions being explored before a vaccine becomes available because even if more than one vaccine is approved, supply is expected to lag demand for the first months.

Delivering the vaccine will also need to take into account community context and the differential impact of COVID-19. The virus has hit some communities much harder than others, with racial and ethnic minorities at increased risk of getting sick and dying.  To track and respond to this differential health impact, public health researcher Shivani Patel and her colleagues have developed the COVID-19 Health Equity Dashboard to show the interplay between social determinants and COVID-19 epidemiological metrics at the county level. The public-facing tool curates, disseminates, and ultimately synthesizes actionable information to guide localized response to the epidemic over time.

A national committee co-led by former CDC director and Rollins distinguished professor emeritus Dr. Bill Foege has advocated for a phased approach to vaccine allocation that is based on assessing individual risk factors. “The virus simply doesn’t understand race, color; it does understand vulnerabilities,” he says.

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