USF Health thought leaders unite against COVID-19

Sponsored by USF Health, the Deans of its four colleges -- Medicine, Nursing, Pharmacy, and Public Health -- recently held an informative videoconference entitled “Advances in the Fight Against COVID-19.”

The program highlighted USF Health’s continuing clinical, public health, and research activities to combat the pandemic, including a recent visit from the White House COVID-19 Task Force.

The Deans Panel noted widespread efforts to meet the educational challenges of their recent graduates. 

Dean of the College of Public Health Donna Peterson, ScD-MHS-CPH, indicated their students utilize three learning options -- in person, remote, or a hybrid model, while Usha Menon, Ph.D.-RN and Interim Dean of the College of Nursing, noted they had developed a customized and nationally recognized software program for senior student curricula “so they could graduate on time” in the summer and August graduations.

Dr. Charles Lockwood, Dean of the Morsani College of Medicine and Senior VP for USF Health, recalled that the medical students, who have been back in classes and in hospital-training for 8 weeks, not only adhere to the school’s mandatory policy requiring face masks and social distancing but behave as model citizens in public.

Dr. Peterson, chairperson of USF’s COVID-19 Task Force reported that they have worked hard to prepare for the university’s reopening, including training 120 people to ensure that mitigation efforts such as face coverings, social distancing, and hand hygiene are universally applied and enforced across all three of USF’s campuses.

“As a result of this approach to our student community we have had no incidents at all in regard to face coverings” she reported.

Here are six takeaways from the meeting -- all things you may not know:

Pool testing: A novel testing strategy

USF Health received national attention during a visit in August from the White House COVID-19 Task Force. Dr. Lockwood described their meeting with Vice President Mike Pence and Dr. Deborah Birx, who suggested USF Health roll out “pooled testing” using its numerous research labs to facilitate campus re-opening -- and she and FDA Commissioner Dr. Steve Hahn “promised to help us do it.”

Pooled testing is a novel testing approach that screens large groups by using samples from multiple people, testing them simultaneously, and with results obtainable within 24 hours.

If positive signals are detected, diagnostic testing using a CLIA certified lab can be directed at a small group of high-risk individuals.

With the help of FDA scientists, USF Health researchers led by Dr. Tom Unnasch rolled out the program smoothly. It is now being used across all three campuses.

The effort, initially funded by private donations from the USF Corona Virus Pandemic Research Fund, grew out of a project initially proposed by Dr. Kevin Sneed, Dean of the College of Pharmacy, to pool test the athletic teams.

The current campus pool testing project represents an extraordinary collaboration between the USF Health colleges of Public Health, Pharmacy, and Medicine and the USF College of Engineering.

Telehealth: The time has come

Likening rapid changes in technology to those witnessed during WWII, Dr. Lockwood noted much the same phenomena is happening as a result of the global pandemic.

A prime example: telehealth, a technology that had been discussed by USF Health leadership for nearly four years but lacked implementation for various reasons.

Following the COVID-19 lockdown, a mature and complete telehealth program was rolled out within one week and it has now become an integral part of the health care landscape, probably for good.

Using Microsoft Teams as its platform, telehealth has now reached 75,000 visits according to Dr. Lockwood and with considerable satisfaction among patients surveyed, 96% of whom ranked it a 9 or 10 (out of 10).

In telehealth satisfaction scores, USF Health recently scored in the top 20% nationally for patient satisfaction as measured in the Press-Ganey survey.

USF addresses the pandemic at home

Dr. Kevin Sneed, Dean of the College of Pharmacy, addressed another USF Health program, “WE CARE,” that provides information and messaging to underserved populations in Hillsborough County at greater risk of COVID-19 and its complications.

Higher rates of co-morbidities -- medical conditions -- rather than ethnicity itself are what appear to be driving the increased risk of severe disease observed among Blacks, Latinx, and other at-risk populations he explained. Minority populations, he added, provide an educational opportunity in that those very groups at greater risk also have a disproportionate distrust of vaccines.

In another ambitious local effort, Dr. Lockwood noted USF Health volunteers have manned all the Hillsborough County testing sites (now consolidated into one USF site) and in partnership with the Hillsborough County Health Department, have established the COVID Continuity Clinic, to address follow-up of all COVID-19 positive patients in Hillsborough County.

Using medical and nursing students, monitored by USF Health Infectious Disease physicians and internists, COVID-19 positive patients are called daily, monitored, and, when necessary, referred to the hospital, and upon discharge, referred back to the Continuity Clinic completing a seamless cycle.

COVID-19 diagnostic tools developed at USF Health

Early in the pandemic, viral testing was hampered by the lack of availability of Dacron swabs used for oral and nasal sampling. The world’s largest manufacturer of such swabs was located in Northern Italy which had been particularly ravaged early in the crisis. This led to a major shortage in the USA.

Sensing this was going to be an issue, Dr. Lockwood asked the Radiology Bioengineering group, who are experts in 3-D printing of anatomic models for surgeons, to try and produce a swab. Again, within a week, led by Dr. Summer Decker, they produced a 3D-printed flocked Nasal Swab test, using FDA approved surgical resin.

When compared with commercially available swabs, it performed as well or better at viral detection. The USF Health swabs have been produced by hospital systems including the VA system, the US Armed Forces, multiple states including Ohio and New York, and 25 other nations.

Dr. Lockwood reports that 40 million of these swabs have now been produced worldwide. This innovative USF effort was recently nominated for Time magazine’s Invention of the Year award.

Pediatric cases of COVID-19 in Florida: Numbers remain low

Responding to a viewer’s question asking about numbers of pediatric COVID-19 cases, Dr. Lockwood noted that the state’s database (Agency for Health Care Administration) provides regular accounting of numerous metrics, among which three of the most critical are percentages of cases, hospitalizations, and deaths.

In Florida, data shows that patients ages 5-14 years, for example, represent only 4% of cases, 1% of hospitalizations, and only 4 deaths (a fraction of 1%), virtually all associated with serious preexisting medical conditions. The numbers are even lower for children under 5 years of age. The data remains reassuringly low at present.

COVID-19 statistics explained: It’s all in the timing

Confusion around COVID-19 statistics abound. People want to know: When am I most likely to become infected if exposed? Are treatments like convalescent plasma or remdesivir effective? 

The panelists agreed that much is determined by timing. For example, while transmission of COVID-19 may occur over a period of 8 days, the 4 days beginning the day before symptoms emerge through the third day of symptoms represent the highest points of transmissibility.

Regarding most treatments, including convalescent plasma and remdesivir, while both can be effective, they are much more likely to be so when given early in the illness, making early diagnosis of paramount importance in successful treatment. 

Convalescent plasma therapy effectiveness is also greater if the plasma donor was older, male, or who had a more severe case of COVID-19. Dr. Menon pointed out that overlap in symptoms among colds, flu, allergies, and COVID-19 make early testing -- and early treatment -- urgent and necessary to control the pandemic.

Another factor complicating an understanding of COVID-19 statistics are lags in reporting. This refers to the fact that a delay exists between an event and the reporting of it.

Reported numbers of cases lag about 1 week behind COVID-19 illness onset (due in part to delay in reporting test results); reported increases in hospitalizations lag 2-3 weeks after rising cases; and reported deaths lag by about 3-4 weeks behind new diagnoses. Taking these factors into account provides a contextual basis for making better sense of numbers reported in the media.

The Deans Panel report and answers to audience questions revealed an extraordinary model of collaboration that exists among the four colleges that come under the USF Health umbrella. That collaboration, which may well have been strengthened as a result of the pandemic, led to an integrated public health response involving testing, tracing, direct health care, and continuing research.

The university now participates in 25 approved clinical trials involving novel therapies, monoclonal antibodies, a pediatric vaccine, as well as studies involving traditional drugs like remdesivir.

With several Phase III vaccine trials proceeding rapidly, a vaccine may be available by the end of the year or early in 2021. 

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Read more articles by Dr. Bruce Shephard.

Dr. Bruce D. Shephard, a retired Obstetrician-Gynecologist and Affiliate Associate Professor, Department of Obstetrics and Gynecology, USF Morsani College of Medicine, is best known locally for delivering more than 7,350 babies. He now occasionally teaches and always practices good health, dabbles in writing, and raises monarch butterflies. He and his wife, Coleen, live in Tampa.