Special report: COVID-19
UF Health leads the way in Florida in combatting COVID-19
As the COVID-19 pandemic rages across the world, University of Florida researchers and clinicians continue to work tirelessly to unlock the mysteries of the novel coronavirus, to develop therapeutics and to treat patients in the grip of the disease. Here are several highlights of recent research breakthroughs and treatment advancements emerging from UF laboratories and bedsides. — Compiled by Erin Van Wey, Bill Levesque and Frank Faust
Dr. Leon L. Haley Jr. becomes the first person in Florida to receive the Pfizer-BioNTech COVID-19 vaccine.
UF Health first in Florida to vaccinate for COVID-19
At 10:39 a.m. on Dec. 14, Leon L. Haley Jr., M.D., became the first person in Florida to receive the Pfizer-BioNTech COVID-19 vaccine.
Haley, a board-certified emergency room physician, CEO of UF Health Jacksonville and dean of the University of Florida College of Medicine – Jacksonville, was followed by other physicians, nurses, a pharmacist and other health care workers who work in areas of the hospital that most frequently care for patients with COVID-19.
UF Health Jacksonville received a shipment of 20,000 doses after being designated one of the “Pfizer Five” — a handful of sites in Florida selected to receive the initial distribution. UF Health officials began working with local, state and federal agencies to administer the vaccine for free based on the criteria the Centers for Disease Control and Prevention has established.
UF Health Jacksonville also is working with the Florida Department of Health to coordinate distribution to other hospitals and health care providers in Jacksonville, along with UF Health’s health campuses in Gainesville and Central Florida. Simultaneously, state officials are designating some shipments to long-term care facilities, whose residents are among those at highest risk for serious or even deadly complications of COVID-19.
Samuel J. Overly, B.S.N., receives the inaugural vaccine shot in Gainesville at the UF Health Shands Cancer Hospital.
Two days later, on Dec. 16, UF Health clinical caregivers in Gainesville who are most at risk of being exposed to COVID-19 began receiving vaccinations at the UF Health Shands Cancer Hospital.
Samuel J. Overly, B.S.N., R.N.-B.C., a trauma nurse and clinical leader in the UF Health adult emergency department, received the inaugural vaccination as media, UF Health leaders and staff looked on. He was followed by Joseph A. Tyndall, M.D., M.P.H., a practicing board-certified emergency medicine physician who regularly sees patients and is also the associate vice president for strategic and academic affairs for UF Health.
Tyndall reflected on the importance of the moment.
“I have personally known many who have died, and more who are recovering from COVID-19,” said Tyndall, who is also a professor and chief of the UF College of Medicine’s department of emergency medicine. “By taking this vaccine, all of us — literally all of us — will have an opportunity to alleviate suffering and save lives.”
“We are optimistic about the future even as we’re mindful of the tragic toll the coronavirus has taken on so many in the communities we serve,” said David R. Nelson, M.D., senior vice president for health affairs at UF and president of UF Health. “We think of them as we work toward ending this pandemic. These first vaccinations will ensure our front-line employees are able to do their part to care for us all. One day, we’ll look back on this moment as the beginning of the end of the pandemic.”
The arrival of the vaccine was a welcome moment for those at UF Health who have spent months fighting the pandemic on multiple all fronts.
“You can arguably say this is the most exciting day of my career to see this moving forward,” said Michael Lauzardo, M.D., M.Sc., deputy director of the UF Emerging Pathogens Institute and a public health specialist who directs the UF Health Screen, Test & Protect initiative.
“We get to play offense now,” he added. “We have been playing defense for the last nine months. The challenges are huge, but this is exactly what we all needed.”
The following day, UF Health Central Florida began vaccinating its Leesburg- and The Villages®-based front-line health care workers most at risk of being exposed to the novel coronavirus that causes COVID-19 on the campus of UF Health Leesburg Hospital.
“Today, science won,” said Dr. Elias Maroun after receiving his vaccine at the UF Health Leesburg Hospital.
Elias N. Maroun, M.D., a practicing board-certified infectious disease physician who regularly sees patients and is also the medical director of infectious disease at UF Health Central Florida, received the inaugural vaccination.
“I am humbled to be able to receive this important vaccine as it represents the first step toward ending the COVID-19 pandemic, a virus that has taken from so many in our country and around the world,’’ Maroun said. “Today, science won,” said Dr. Elias Maroun after receiving his vaccine at UF Health Leesburg Hospital.
In the months to come, vaccines will begin to become available to the wider community, starting with those who have medical conditions, such as diabetes, that make them especially vulnerable to the virus.
“The ability to have an FDA-approved vaccine to begin vaccinating Tier 1 staff at UF Health Central Florida is an extremely exciting development, at a time when we are seeing cases rise,” said Don Henderson, CEO of UF Health Central Florida. “We are grateful for the ongoing support from the teams at UF Health Jacksonville and UF Health Shands in Gainesville, without whom this rapid vaccine deployment would not be possible.”
The vaccine does not introduce the coronavirus itself, so those who are vaccinated cannot be infected with COVID-19 through its administration.
Lauzardo noted people need to trust all the work done by scientists and all the data showing the vaccine’s safety and effectiveness.
“There is an infodemic out there as well as a pandemic,” he said. “People need to listen to the experts, trust the experts and trust the science.”
UF Health among first in world to use diaphragmatic pacer on COVID-19 patients
After Emergency Use Authorization approval from the U.S. Food and Drug Administration, UF Health has become the first health center in the Southeast to implant a novel diaphragmatic neurostimulator in a coronavirus patient requiring a ventilator. This is the third instance of this in the United States.
With the temporary transvenous diaphragmatic neurostimulator, a central line goes into a vein under the patient’s left collarbone. It contains electrodes that stimulate the phrenic nerves responsible for spurring the diaphragm to contract. This creates negative pressure ventilation, helping to mimic a more natural way of breathing in tandem with the positive pressure caused by the ventilator.
With the temporary transvenous diaphragmatic neurostimulator, a central line goes into a vein under the patient’s left collarbone. It contains electrodes that stimulate the phrenic nerves responsible for spurring the diaphragm to contract. This creates negative pressure ventilation, helping to mimic a more natural way of breathing in tandem with the positive pressure caused by the ventilator, explained Ali Ataya, M.D., an assistant professor within the UF College of Medicine’s division of pulmonary, critical care & sleep medicine.
“Although there are some diaphragmatic pacers already available, they are all surgically placed, and not feasible to use in this population,” Ataya said. “But this uses a temporary central line, like any that the patient would get, so it is much less invasive and easily performed at bedside.”
Thus far, Ataya said, the results have been promising.
“This can improve the inspiratory pressure generated by the diaphragm by almost 250%,” he said. “If this works the way we hope it does, the patient will potentially come off the ventilator sooner than predicted, and with a smoother recovery.”
Many COVID-19 patients who contract the virus and require hospitalization are not able to breathe on their own and need to be intubated. For some, this may be for a couple of weeks; others for several months.
But ventilators are like respiratory quicksand — getting in is easy; getting out, however, is another story.
“When we discuss artificial ventilation, we often explain that the vent is giving your body time and body to heal while the machine does the work,” said Erin Silverman, Ph.D., a clinical research assistant in the division of pulmonary and critical care and sleep medicine. “But that neglects the reality of artificial ventilation. From the second someone is placed on mechanical ventilation, their diaphragm muscles begin to atrophy.”
The diaphragmatic pacemaker helps prevent the muscles from “forgetting” how to breathe on their own, and strengthens them after they’ve been weakened by critical illness, steroids, paralytics and acute respiratory distress syndrome.
In the long run, lack of diaphragmatic muscle atrophy also means patients are less likely to linger on a ventilator and require reintubation, freeing up precious bed space and equipment. – Dorothy Hagmajer
Leah Reznikov, Ph.D., and David Ostrov, Ph.D., are shown in Reznikov’s lab.
Jesse S. Jones
Common antihistamine drugs show early promise against COVID-19 virus
Three common antihistamine medications have been found in preliminary tests by University of Health researchers to inhibit infection of cells by the coronavirus that causes COVID-19.
Their findings, based on laboratory tests of cells and a detailed analysis of nearly a quarter-million California patients’ medical records, may support the launch of a randomized, controlled clinical trial to determine whether the specific antihistamines can treat or even prevent COVID-19 in humans, the researchers said.
Leah Reznikov, Ph.D., an assistant professor of physiological sciences in the UF College of Veterinary Medicine and the study’s principal investigator on the study, and David A. Ostrov, Ph.D., an immunologist and associate professor in the UF College of Medicine’s department of pathology, immunology and laboratory medicine, tested the antihistamines for their ability to inhibit the coronavirus in a combination of human and primate cells.
Three of the drugs — hydroxyzine, diphenhydramine and azelastine — showed direct, statistically significant antiviral effects on the SARS-CoV-2 virus. Hydroxyzine, sold as Atarax, and the nasal spray azelastine are prescription medications while diphenhydramine is sold over-the-counter as Benadryl, a treatment for cold and allergy symptoms.
“We discovered epidemiological data showing that the usage of specific drugs was associated with a reduced likelihood of testing positive for SARS-CoV-2, the virus that causes COVID-19. We then found that these specific drugs exhibited direct antiviral activity against SARS-CoV-2 in the lab,” Ostrov said.
While there is an association between the medications and infection rates, the researchers stressed there is much more to be learned and no cause and effect has been formally established.
“The fact that these drugs actually inhibit the virus in the lab does not necessarily mean that they will inhibit it actively in people — but they might,” Ostrov said.
While the findings are encouraging, Ostrov cautions against self-medicating with antihistamines as a COVID-19 prevention or treatment. So-called “off-label” use of medications should only take place after a detailed consultation with a physician, he said.
Because of the urgency of the COVID-19 pandemic, Ostrov said there is a possibility that the antihistamine candidates could go directly to human clinical trials without first being tested in animal models. That is the case with famotidine, an antihistamine and antacid that is undergoing clinical trials elsewhere as a therapy for severely ill COVID-19 patients. — Doug Bennett
A health care worker provides information about COVID-19 screening to a woman at a testing site.
Universities, health centers join on COVID-19 outreach to minority communities
Armed with a $1 million award from the National Institutes of Health, universities and health care entities throughout the state of Florida are collaborating to provide outreach and engagement to ethnic and racial minority communities disproportionately affected by the COVID-19 pandemic.
Led by population health experts and physicians with the University of Miami Miller School of Medicine, the effort, titled “Community Engagement Alliance Against COVID-19 Disparities,” includes a diverse group of experts at the University of Florida, Florida International University, Florida A&M University, Moffitt Cancer Center and Health Choice Network, collectively known as the Florida CEAL Team.
Working with community organizations, the Florida CEAL Team will develop community-based outreach activities to advance evidence-based COVID-19 health promotion practices and participation in clinical trials. They will also implement and evaluate the impact of strategies that increase the enrollment of minorities into COVID-19 vaccine and therapeutic trials.
UF will be involved in two projects. The CaRE2 Health Equity Center at UF will coordinate COVID-19 outreach efforts to some of the hardest-hit communities in North and Central Florida, including Alachua, Duval, Lake, Orange, Osceola and Seminole counties. As the coordinating center for the OneFlorida Clinical Research Consortium, UF will also work to increase minority enrollment in its COVID-19 clinical trials. — Diana Tonnessen
A UF Health staff member gets a flu shot recently.
Lou Brems
UF Health study shows flu vaccination might confer protection against severe COVID-19
A flu vaccination might do more than protect against influenza. It might also shield some people from a severe case of COVID-19 — even though the infection is caused by an entirely different virus.
People who received a flu vaccination in the year before testing positive for the novel coronavirus were nearly two-and-a-half times less likely to be hospitalized for COVID-19, the disease caused by the coronavirus, than those who were unvaccinated, an analysis of patient data by University of Florida Health researchers has found.
And those with a flu vaccination were more than three times less likely to be admitted to an intensive care unit. Why the vaccination might benefit COVID-19 patients remains unclear. The effect could be the result of a general priming of the immune system that boosts the body’s readiness to attack, no matter the invader.
The study, published in the Journal of the American Board of Family Medicine, is the first peer-reviewed investigation to document this protective effect. It examined de-identified information for the 2,000 patients at UF Health who tested positive for COVID-19 between March and August.
Arch G. Mainous III, Ph.D., is the study’s senior author and a professor in the department of health services research, management and policy at the UF College of Public Health and Health Professions. The lead author of the study is Ming-Jim Yang, M.D., a third-year resident in family medicine at UF Health.
The researchers said it is important to note the limitations of their work, including that it involved just one medical center. So, it’s unclear if results would also be seen in patients across the nation. Additionally, the number of vaccinated patients in the group studied is relatively low — 10.7% of the total, or 214 people. However, all of the data, including COVID-19 tests, hospitalizations, ICU admissions and influenza vaccination status, come from the patients’ electronic health record and not surveys of patients.
The researchers said nothing in the study should be construed as suggesting COVID-19 is identical to flu — COVID-19 is still more lethal than influenza and a far more serious public health concern. — Bill Levesque
UF Health and UF computer scientists are developing a smartwatch app that notifies users when they touch their face. It’s hoped the app will help prevent the spread of respiratory illness such as COVID-19 and the flu.
Lou Brems
UF Health researchers look to smartwatch app to fend off pandemic face touching
Many Americans are simply touching their faces too often during the novel coronavirus pandemic, public health officials have observed, potentially increasing their exposure to the pathogen. But just try to stop.
What if a smartwatch beeped or vibrated every time your hand touched your face?
University of Florida researchers have launched an effort to build a smartwatch application, or app, that will do just that, essentially training wearers to avoid touching their faces and thus reducing the spread of COVID-19, the disease caused by the coronavirus. The hope is that, after being warned repeatedly, users begin conditioning themselves to avoid the behavior altogether.
Designing an app to accurately detect the movement of hands to face, however, is an extraordinarily complex task. Differentiating someone simply adjusting their glasses, for example, from someone rubbing an eye poses difficult programming challenges.
Using that baseline data and artificial intelligence techniques, researchers will design an algorithm they hope will accurately detect hand motions with the sensitivity necessary to separate the scratched nose from an innocent wave to a friend.
Mamoun Mardini, Ph.D., an assistant professor in the UF College of Medicine’s department of aging and geriatric research who is affiliated with the UF Institute on Aging, and co-principal investigator Lisa Anthony, Ph.D., an associate professor in the Herbert Wertheim College of Engineering’s department of computer & information science & engineering, received a $20,000, six-month pilot grant from the UF Informatics Institute for their project. — Bill Levesque
