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VA research during the COVID-19 pandemic

COVID-19 FACT SHEET

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For VA investigators: Please check our funding page for news about new funding opportunities relating to COVID-19.

Overview

In response to the COVID-19 pandemic, VA Research has undertaken a wide array of activities to support and advance VA's clinical and research missions and help Veterans affected by the disease. These efforts have spanned biomedical research, therapeutics and vaccine clinical trials, and data analyses that leverage VA's rich electronic health record system. VA Research has coordinated closely with internal VA and external partners—such as the National Institutes of Health and other federal agencies, and pharmaceutical companies—to identify the areas in which VA's nationwide research capacity, resources, and infrastructure could make the greatest contribution.

On this web page, we summarize recent and current COVID-19 research across the VA system.

VHA COVID-19 Research Dashboard

This interactive map shows active VA studies on COVID-19. Use the search bar or menus on the left to find studies on specific topics or locations. View larger version

News Briefs

COVID-19 reinfection increases risk of death and health problems
COVID-19 reinfection increases the risk of death and health problems, found a VA St. Louis study. Researchers used VA’s health care database to compare health outcomes of nearly 444,000 Veterans who had COVID-19 once, nearly 41,000 who had it two or more times, and over 5 million who never had it. They found that those who had multiple COVID-19 infections were at higher risk of death and hospitalization than those who only had COVID-19 once. They were also at higher risk for a variety of health problems, including lung and heart problems, diabetes, and mental health disorders. The risk was highest when people were first sick, but many still had elevated risk six months later. Risk of death and health problems increased with the number of infections. The results show that strategies are needed to prevent COVID-19 reinfection to protect against additional health risks, say the researchers. (Nature Medicine, Nov. 10, 2022)

Paxlovid lowers risk of Long COVID
The medication Paxlovid lowers the risk of Long COVID, according to a VA St. Louis study. The study included more than 56,000 Veterans with a positive COVID-19 test. Those given Paxlovid—an oral antiviral medication that has been shown to reduce the risk of severe COVID-19 and hospitalization—had a 25% decreased risk of developing 10 of 12 different Long COVID conditions studies. The decreased risk was found regardless of whether it was a participant’s first COVID-19 infection or a reinfection, and regardless of whether the participants were unvaccinated, vaccinated, or boosted. Paxlovid could be an important asset to address the serious issue of Long COVID, said the researchers. The study was released as a pre-print in the interest of public health. (medRxiv, Nov. 5, 2022)

COVID-19 increases risk of neurologic disorders
COVID-19 increases the risk of long-term neurologic disorders, according to a VA St. Louis study. Researchers compared data on over 150,000 VA patients who contracted COVID-19 with more than 11 million people who had not had COVID-19. A year after recovering, COVID-19 patients had higher risk of a wide array of neurologic conditions, including stroke, memory disorders, nervous system disorders, migraines and seizures, Guillain-Barré syndrome, and sensory disorders. COVID-19 patients had elevated risks and burdens even when they did not require hospitalization during their illness. The results highlight a need for health care system planning to address the potential long-term consequences of COVID-19, say the researchers. (Nature Medicine, Sept. 22, 2022)

New prediction model to estimate risk of COVID-19 death

VA researchers developed a new prediction model to estimate the probability of death from COVID-19. The mathematical model, called PDeathDx, uses diagnostic codes from medical records to survey all of a patients’ preexisting conditions to estimate the risk that COVID-19 poses. Starting with data from 1997, the researchers used diagnoses from the first time a patient sought care until 14 days before a positive COVID-19 test, then compared that to COVID outcomes for nearly 350,000 patients treated in VA. They found that the new model outperformed other conventional prediction models. The study also showed that certain underlying conditions—such as neurological diseases, dementia, and severe disability—are much more likely to result in severe COVID or death. The approach used here could be adapted to predict outcomes for other diseases and conditions, say the researchers. (Biological Methods & Protocols, Aug. 4, 2022)

COVID-19 boosters effective against Omicron and Delta variants
COVID-19 vaccine boosters were highly effective against recent virus variants, found a study by VA White River Junction researchers and colleagues. The study included data on more than 110,000 Veterans, mostly older and male, who had a COVID test between November 2021 and January 2022. Protection against both the Omicron and Delta COVID-19 variants was better in those who also had a booster dose of an mRNA vaccine, compared with those with only a two-dose vaccine. Boosters were 64% effective against Omicron infection, while initial vaccination was only 12% effective. For the Delta variant, booster vaccination was 90% effective, versus 54% for initial vaccination. Booster doses were 89% effective during the Omicron period and 94% effective during the Delta period at preventing hospitalization. Against hospitalization, two-dose vaccines were 63% effective against Omicron and 75% effective against Delta. With a booster dose, vaccines were 94% effective at preventing death during Omicron and 96% against Delta. The results show that vaccine boosters increase the effectiveness of COVID-19 vaccination against infection, hospitalization, and death, according to the researchers. (BMJ Open, Aug. 3, 2022)

View all studies

Selected Studies by VA Researchers

Clinical Trials

The effect of povidone-iodine nasal spray on nasopharyngeal SARS-Co-V-2 viral load: A randomized control trial. Zarabanda D, Vukkadala N, Phillips KM, Qian ZJ, Mfuh KO, Hatter JN, Lee IT et al. Dilute versions of povidone-iodine nasal spray are safe for topical use in the nasal cavity, but the spray does not demonstrate virus-eliminating activity in COVID-19 positive patients. Laryngoscope. 2022 Nov;132(11):2089-2095.

Efficacy and safety of ensovibep for adults hospitalized with COVID-19: A randomized controlled trial. ACTIV-3/TICO Study Group et al. Compared with placebo, the medication ensovibep did not improve clinical outcomes for hospitalized participants with COVID-19 standard care, including remdesivir. No safety concerns were identified. Ann Intern Med. 2022 Sep;175(9):1266-1274.

A pilot randomized controlled trial of supervised, at-home, self-administered transcutaneous auricular vagus nerve stimulation (taVNS) to manage long COVID symptoms. Badran BW, Huffman SM, Dancy M, Austelle CW, Bikson M, Kautz SA, George MS. Supervised, self-administered stimulation of the vagus nerve to relieve mental fatigue symptoms related to long COVID is safe and feasible. Larger studies can safely investigate the effectiveness of this treatment. Bioelectron Med. 2022 Aug 25;8(1):13.

Randomized trial on metformin, ivermectin, and fluvoxamine for Covid-19. Bramante CT, Huling JD, Tignanelli CJ, Buse JB, Liebovitz DM, Nicklas JM, Cohen K et al. Metformin, ivermectin, and fluvoxamine did not prevent low blood oxygen, emergency department visits, hospitalizations, or death associated with COVID-19. N Engl J Med. 2022 Aug 18;387(7):599-610.

Baricitinib versus dexamethasone for adults hospitalised with COVID-19 (ACTT-4): a randomized, double-blind placebo-controlled trial. Wolfe CR, Tomashek KM, Patterson TF, Gomez CA, Marconi VA, Jain MK, Yang OO et al. In hospitalized patients with COVID-19 requiring supplemental oxygen, baricitinib plus remdesivir and dexamethasone plus remdesivir resulted in similar mechanical ventilation-free survival by day 29, but dexamethasone was associated with significantly more adverse events. Lancet Respir Med. 2022 May 23. Online ahead of print.

Laboratory Studies

Anti-membrane antibodies persist at least one year and discriminate between past coronavirus disease 2019 infection and vaccination. Amjadi MF, Adyniec RR, Gupta S, Bashar SJ, Mergaert AM, Braun KM, Moreno GK et al. After COVID-19 infection, antibodies persist for at least one year and can be used to differentiate between people who have been infected, vaccinated, or neither. J Infect Dis. 2022 Nov 28;226(11):1897-1902.

SARS-CoV-2 anti-spike IgG antibody and ACE2 receptor binding inhibition levels among breakthrough stage Veteran patients. Chensue SW, Siler AF, Kim PS, Dimcheff DE, Daghfal DJ, Prostko J, Frias E et al. Antibody levels declined significantly 150 days after initial two-dose COVID-19 vaccination, while vaccination after resolved infection and booster vaccination conferred longer immunity. Microbiol Spectr. 2022 Nov 21. Online ahead of print.

Regression of lung cancer in mice by intranasal administration of SARS-CoV-2 spike S1. Sheinin M, Jeong B, Paidi RK, Pahan K. In lab-cultured cells and mouse models, the spike protein from the SARS-CoV-2 virus caused lung cancer cell death, suggesting it may have potential for lung cancer treatment. Cancers (Basel). 2022 Nov 17;14(22):5648.

The association of baseline plasma SARS-CoV-2 nucleocapsid antigen level and outcomes in patients hospitalized with COVID-19. ACTIV-3/TICO Study Group, et al. Elevated plasma antigen is highly associated with both severity of pulmonary illness and clinically important patient outcomes. Findings suggest a potential role of ongoing viral replication in patients hospitalized with COVID-19. Ann Intern Med. 2022 Oct;175(10):1401-1410.

Programmable antivirals targeting critical conserved viral RNA secondary structures from influenza A virus and SARS-CoV-2. Hagey RJ, Elazar M, Pham EA, Tian S, Ben-Avi L, Bernardin-Souibgui C, Yee MF et al. “Programmable antivirals” have potential to stop transition of viruses, including SARS-CoV-2. Nat Med. 2022 Aug 18. Online ahead of print.

Data Analysis/Review

Hospital readmissions among Veterans within 90 days of discharge following initial hospitalization for COVID-19. Weaver FM, Niederhausen M, Hickok A, O’Neill AC, Gordon HS, Edwards ST, Grovier DJ et al. In the first year of the pandemic, about one in six Veterans discharged after hospitalization for COVID-19 were readmitted within 90 days. More severe COVID-19, more risk factors, and earlier discharges due to hospital over-capacity increased the risk of rehospitalization. Prev Chronic Dis. 2022 Dec 1. 19:E80.

Post-traumatic stress disorder and risk for hospitalization and death following COVID-19 infection. Nishimi K, Neylan TC, Bertenthal D, DOlsen EA, Seal KH, O’Donovan A. Individuals with PTSD and other psychiatric disorders had heightened vulnerability to severe adverse COVID-19 outcomes. Transl Psychiatry. 2022 Nov 2022;12(1):482.

A MUC5B gene polymorphism, rs35705950-T, confers protective effects against COVID-19 hospitalization but not severe disease or mortality. Verma A, Minnier J, Wan ES, Huffman JE, Gao L, Joseph J, Ho YL et al. Researchers identified a gene variant that may confer protection in COVID-19 hospitalizations. Respir Crit Car Med. 2022 Nov 15;206(10):1220-1229.

Healthcare access and delivery during the COVID-19 pandemic for Black Veterans with chronic pain: A qualitative study. Matthias MS, Burgess DJ, Eliacin J. Black patients with chronic pain described mostly negative effects from the shift to telecare after the pandemic’s onset. J Gen Intern Med. 2022 Nov 14:1-6.

Association between vitamin D supplementation and COVID-19 infection and mortality. Gibbons JB, Norton EC, McCullough JS, Meltzer DO, Lavigne J, Fiedler VS, Gibbons RD. Vitamin D supplementation reduced the risk of COVID-19 infection and death from COVID-19 in VA patients. Black Veterans, those with low baseline vitamin D levels, and those given higher doses saw the biggest benefits. Sci Rep. 2022 Nov 12;12(1):19397.

Other Research

Real-world evidence on the effectiveness of plexiglass barriers in reducing aerosol exposure. Cadnum JL, Jencson AL, Memic S, Osborne AO, Torres-Teran MM, Wilson BM, Deshpande A, Donskey CJ. In real-world settings, plexiglass barriers vary widely in effectiveness in reducing staff exposure to aerosols, and some barriers may increase risk for exposure if not positions correctly. Pathog Immun. 2022 Nov 4;7(2):66-77.

Moral injury and psychosocial functioning in health care workers during the COVID-19 pandemic. Weber MC, Smith AJ, Jones RT, Holmes GA, Johnson AL, Patrick RNC, Alexander MD et al. Moral injury is prevalent and impairing for health care workers, which establishes a need for interventions with health care workers in organized care settings. Psychol Serv. 2022 Nov 10. Online ahead of print.

COVID-19 traumatic disaster appraisal and stress symptoms among health care workers: Insights from the Yale Stress Self-assessment. Olson KD, Fogelman N, Maturo L, Alvarado J, Ball S, Forray A, Hu M et al. Findings suggest adverse effects of the pandemic on total worker health, care quality, professionalism, retention, and acute and chronic mental health. J Occup Environ Med. 2022 Nov 1;64(11):934-941.

Mood and activity changes during the COVID-19 pandemic in rural and urban Veterans and their cohabitants. Lennon JC, Hantke N, Mattek N, Wu CY, Dodge H, Wall R, Beattie Z, Kaye J, Silbert LC. The COVID-19 pandemic-associated health precautions, while necessary to curb acute health risks, have created a unique situation that places vulnerable populations at increased risk of low mood. Clin Gerontol. 2022 Oct 8:1-8. Online ahead of print.

Misrepresentation and nonadherence regarding COVID-19 public health measures. Levy AG, Thorpe A, Scherer LD, Scherer AM, Drews FA, Butler JM, Burpo N et al. Nearly half of survey participants reported misrepresentation and/or nonadherence regarding public health measures against COVID-19. JAMA Netw Open. 2022 Oct 3;5(10):e2235837.

Commentary

Global vaccine inequality threatens to unleash the next COVID-19 variant. Oehler RL, Vega VR. The emergence of COVID-19 variants from under-vaccinated regions is a direct consequence of the virus replicating unchecked through an unprotected population. Much more needs to be done to address global vaccine inequities and prevent the next devastating variant. Int J Infect Dis. 2022 Aug 18. Online ahead of print.

Estimated impact of the US COVID-19 vaccination campaign-Getting to 94% of deaths prevented. Jones M, Khader K, Branch-Elliman W. Substantial investments into national data infrastructure and research are needed to increase vaccine uptake and prevent more COVID-19 deaths. JAMA Netw Open. 2022 Jul 1;5(7):e2220391.

Approaches to long COVID care: the Veterans Health Administration experience in 2021. Gustavson AM, Eaton TL, Schapira RM, Iwashyna TH, Adly M, Purnell. Even well-resources health care systems such as VA are grappling with how to best address long COVID care. BMJ Mil Health. 2022 Jul 1;e002185.

Leveraging anthropological expertise to respond to the COVID-19 global mental health syndemic. Azevedo KJ, Riendeau RP, Sweet PA, Holmes SM. Anthropologists collaborating directly with mental health clinicians and the public can contribute to solutions to improve mental health issues exacerbated by the COVID-19 pandemic. Am Anthropol. 2022 Jun. Online ahead of press.

Awakening: The unveiling of historically unaddressed social inequities during the COVID-19 pandemic in the United States. Andrasik MP, Maunakea AK, Oseso L, Rodriguez-Diaz CE, Wallace S, Walters K, Yukawa M. Long-standing inequities paved the way for the disproportionate burdens of COVID-19 among people of color across the country. Infect Dis Clin North Am. 2022 Jun;36(2):295-308.

Active and Recently Completed Research

Clinical trials

As of November 2021, nearly 70 VA medical centers are involved in one or more COVID-19 clinical trials. Below are several examples. A full list of COVID-19 Clinical Trials in VA is also available.

  • VA CURES—The wide-reaching VA CURES master protocol, launched in August 2020, enables a series of clinical trials across VA. The initial study examined the effects of convalescent plasma. VA CURES stands for “Coronavirus Research and Efficacy Studies.” The initiative aims to give Veterans faster access to potential COVID-19 treatments and to test their effectiveness. As a master protocol, VA CURES offers a standardized framework for studies on many potential treatments for COVID-19, without the need for a new study design and protocol each time. VA CURES now serves as a partnering network for trials and VA trial sites.
  • VA has been part of two major national research initiatives on COVID-19 vaccines and therapeutics:  Operation Warp Speed (OWS) and the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) initiative.
    • Through OWS and other efforts, VA was an active participant in several clinical trials designed to evaluate potential COVID-19 vaccines. These trials have included:
      • The Moderna/COVE trial, which took place at one VA site. In December 2020, Moderna obtained an emergency use authorization for its vaccine from the FDA.
      • The AstraZeneca trial, now closed to enrollment.
      • The Janssen ENSEMBLE trial, which included 17 VA sites and is now closed to enrollment. The vaccine received FDA emergency use authorization in late February 2021.
      • The Pfizer trial, now closed to enrollment. In December 2020, Pfizer obtained an emergency use authorization for its vaccine from the FDA.
      • The Novavax trial, now closed to enrollment in VA.
    • ACTIV, led by the National Institutes of Health, brings together multiple groups within VA, the Department of Health and Human Services, and the Department of Defense, as well as outside organizations, to conduct large-scale clinical trials. VA is participating in two ACTIV protocols:
      • ACTIV-2 is a trial platform for outpatients with mild COVID-19 with risk of worsening illness. It is investigating multiple new drugs for potential COVID-19 treatment through clinical trials. ACTIV-2 has completed studies on six monoclonal antibodies, an antiviral, and an immunomodulator, and is currently studying multiple other possible therapeutics. Six VA sites have participated in ACTIV-2.
      • ACTIV-3 is a trial platform for inpatients with COVID-19. It is designed to test neutralizing monoclonal antibody and antiviral treatments in rapid succession. ACTIV-3 has completed trials of four monoclonal antibodies and one antiviral, and is enrolling participants for testing of a new antiviral. ACTIV-3 trials are also investigating patients with severe COVID-19 pneumonia, the drugs aviptadil and remdesivir alone or in combination as a COVID-19 treatment, and strategies for post-COVID-19 illness vaccination. Twenty VA sites have enrolled patients in ACTIV-3 studies.
  • CDC SUPERNOVA—In partnership with the Centers of Disease Control and Prevention, VA has undertaken the Surveillance Platform for Enteric and Respiratory Infectious Organisms at the VA (SUPERNOVA) project. A network of five VA medical centers is conducting active and passive surveillance for acute gastroenteritis, a symptom of COVID-19 and other illnesses. Monitoring includes both laboratory-confirmed testing for SARS-CoV-2 and norovirus, as well as electronic health system data from patients’ charts. The project will help track pathogen distribution over time.
  • Trials with industry—VA took part in a number of industry-sponsored studies of promising medications for COVID-19. These included, for example, studies of the drug tocilizumab with Hoffman-La Roche, and sarilumab with Regeneron. Both drugs are used in arthritis care and block an inflammatory protein known as IL-6.
  • Remdesivir trial with NIH—VA sites took part in a randomized, placebo-controlled study of remdesivir and other medications for hospitalized patients with COVID-19, sponsored by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health.
  • PURIFY blood filter technology—Scientists with VA, DOD, and partner institutions are testing a new technology called the Seraph 100 blood filter that may be able to filter out viral particles and harmful molecules from the bloodstreams of COVID-19 patients. The PURIFY program is a four-part, multi-site clinical evaluation that involves 13 participating sites across the U.S., including one VA medical center. Preliminary data suggests that severely ill patients treated with the Seraph filter had lower mortality rates than other patients.

Observational studies

  • Natural history study—VA is collaborating with the Department of Defense on an observational, natural history study of COVID-19 illness titled “Epidemiology, Immunology and Clinical Characteristics of COVID-19” (EPIC3). Researchers are collecting data and biospecimens from volunteers for up to two years to better understand the clinical course of COVID-19. The study also aims to establish repositories of clinical data and specimens, along with a participant registry, to support future studies of COVID-19 and other health conditions. Recruitment at up to 16 sites began in July 2020.
  • COVID-19 and cancer—The National Cancer Institute COVID-19 in Cancer Patients Study, or NCCAPS, is a natural history study of COVID-19 in people with cancer. In a natural history study, researchers follow people and collect medical and other information about them over time to learn more about how a disease and its symptoms develop and change. Diagnosis and treatment of a disease are not part of natural history studies. The knowledge gained through this study will help doctors better manage treatment for people with cancer and COVID-19 in the future. As part of the NCCAPS study, researchers will collect blood samples, medical information, and medical images from 2,000 people with cancer who also have COVID-19. Each person will be followed for up to two years to help doctors understand how cancer affects COVID-19 and COVID-19 affects cancer. The study is recruiting volunteers nationwide, including at 11 VA locations.

Data analysis projects

  • COVID-19 Insights Partnership—VA is a key partner in the COVID-19 Insights Partnership, along with the departments of Energy (DOE) and Health and Human Services (HHS). The initiative aims to coordinate and share health data as well as research and expertise to aid in the fight against COVID-19.The Partnership creates a framework for VA and HHS to use DOE’s world-leading high-performance computing and artificial intelligence resources to conduct COVID-19 research and analyze health data.
  • Million Veteran Program—VA’s Million Veteran Program (MVP) has deployed a COVID-19 questionnaire to participants to collect information about their experience with COVID-19. In addition, MVP has prioritized a series of research questions to examine the genetic basis of infection by SARS CoV-2; complications of infection; disease severity and outcomes; and response to various medications. MVP is working to identify disease mechanisms and new treatment targets for COVID-19. Given MVP's racially and ethnically diverse participant population (~ 20% African American and 7% Hispanic), the influence of race and ethnicity on disease susceptibility, severity, and outcomes is an integral part of the analyses.
  • VA SHIELD—The VA Science and Health Initiative to Combat Infectious and Life-Threatening Diseases (VA SHIELD) is a comprehensive, secure biorepository of specimens and associated data related to COVID-19 and other emerging diseases. The specimens and data are available to authorized investigators to advance scientific understanding and support of developing diagnostic, therapeutic, and preventive strategies for use in clinical care.
  • VA SeqCURE—VA SeqCURE, short for VA Sequencing Collaborations United for Research and Epidemiology, is a network of VA research labs funded by the American Rescue Plan of 2021. Five VA sites are included: Cleveland, Durham, Iowa City, Boise, and Temple. The network will generate genetic sequencing data for public health surveillance. Projects under VA SeqCURE will include studying the effectiveness of COVID-19 vaccines, analyzing antimicrobial-resistance organisms, and working with VA SHIELD to establish protocols for handling biospecimens.
  • Synthesizing evidence from publications—Researchers from the HSR&D Evidence Synthesis Program are working to help synthesize publications about the novel coronavirus and COVID-19, and to translate that information quickly into usable guidance for clinicians. The ESP’s completed reports can be found here.
    Additional evidence reviews can be found at www.covid19reviews.org. The goal of this resource is to capture the work of evidence synthesis groups, like VA’s, around the US and the globe, and thereby avoid duplication of effort and maximize the contribution of these researchers. The catalog is maintained by the VA ESP Coordinating Center in Portland, Oregon. New evidence reviews and reviews in progress are identified through literature searching and correspondence with colleagues and content experts. The team has also set up a listserv to facilitate collaboration among systematic review researchers.
  • International collaboration—Researchers with the VA Informatics and Computing Infrastructure team are participating in the Observational Health Data Sciences and Informatics (or OHDSI, pronounced "Odyssey") program, an international, interdisciplinary collaborative to maximize the value of health data through large-scale analytics.
  • COVID-19 Observational Research Collaboratory (CORC)—A VA research initiative is bringing together VA experts to analyze the use and effects of COVID-19 drugs with clinical partners interested in the safety and efficiency of these therapies. VA’s Health Services Research and Development ServiceClinical Science Research and Development Service, and Cooperative Studies Programestablished the collaboratory soon after the pandemic took hold earlier this year. CORC is conducting a national three-year study of VA inpatients and outpatients diagnosed with COVID-19, compared with matched controls. The study will use electronic health record data and surveys to assess risk factors and long-term symptoms.
  • Dementia patients—VA researchers in Providence have funding from the National Institute on Aging to study COVID-19 risk factors and outcomes among Veterans with dementia who live in VA community living centers.

Other research activities

  • COVID-19 and mental health—In addition to studying how to prevent or treat COVID-19, VA is examining the mental health impact of the pandemic. To date, ORD has funded nearly 30 studies looking at mental, behavioral, and social health and COVID-19. Some are new projects focused wholly on COVID-19, whereas others are supplements to existing projects that are broader in scope. The following study titles indicate some of the themes being explored:
    • Inflammatory and Mental Health Sequelae of COVID-19 in Veterans
    • An Integrative Technology Approach to Home-Based Conjoint Therapy for PTSD  
    • Impact of COVID-19 On Mental Health, Relationship Functioning and VA Telemental Health Service Use in a Longitudinal Cohort Study    
    • Impact of COVID-19 and Social Distancing on Mental Health and Suicide Risk in Veterans
    • Piloting a Self-Help Intervention to Improve Veteran Mental Health During the COVID-19 Pandemic
    • Mixed-Methods Pilot Study of the Impacts of Telemental Healthcare for High-Risk Veterans with Opioid Use Disorder During COVID-19
    • Adapting Caring Contacts to Counteract Adverse Effects of Social Distancing among High-Risk Veterans During the COVID-19 Pandemic
    • Virtual Pain Care for High-Risk Veterans on Opioids During COVID-19 (and Beyond)
    • Changes in the Delivery of Evidenced-Based Psychotherapies for Depression and PTSD as the Result of the COVID-19 Pandemic
    • Impacts of COVID-19 on African American Veterans with Chronic Pain
  • Biomedical studies—VA biomedical researchers are part of the fight against COVID-19. The following project titles illustrate the scope of the VA lab studies already completed or being conducted to better understand how the virus works, and to identify new ways to keep it from spreading and causing disease.
    • 3D-Printed Respirator Mask Performance with and without Virus Inactivation 
    • A Safe Validation to Test the Efficacy of Disinfectants on Reusable 3D-Printed Face Masks During the COVID-19 Pandemic 
    • Leukocyte Rewiring as a Mechanism of COVID-19-ARDS 
    • Viral and Immune Dynamics of Sars-Cov-2 Infection in Moderate and Severe COVID-
    • Predictive Immune and Airway Monitoring in Healthcare Workers and Hospitalized COVID-19 Patients 
  • Boosting the VA supply chain—Rehabilitation researchers are helping to build a more resilient supply chain for VA. Researchers from several centers are involved, such as the Human Engineering Research Laboratories (HERL) in Pittsburgh; the Center for Limb Loss and Mobility at the Puget Sound VA; the Minneapolis Adaptive Design and Engineering Program; and the Advanced Platform Technology Center in Cleveland. Partners in this effort include the VA Innovation Ecosystem, the U.S. Food and Drug Administration, the National Institutes of Health, and America Makes. These researchers and their colleagues have been designing, fabricating, and evaluating personal protective equipment (PPE) and other supplies to support VA’s response to this pandemic, such as masks, face shields, desk shields, nasal testing swabs. In many cases, 3D printing is involved.

COVID-19 work highlighted on HSR&D site

For a concise overview of current VA Health Services Research and Development (HSR&D) efforts on COVID-19, visit COVID-19 Efforts.




Infectious disease specialist consultation improves long-term <em>S. aureus</em> outcomes - Photo: ©iStock/South_agencyPhoto: ©iStock/South_agency

To rapidly stand up new research and optimize resources during the COVID-19 pandemic, the VA Office of Research and Development (ORD) has coordinated with the National Institutes of Health, the Department of Defense, the Department of Energy, other federal agencies, and several industry partners—namely, pharmaceutical companies. Further, as part of the larger Veterans Health Administration system, ORD has supported other VHA offices by providing research expertise and personnel to assist with public health and informational demands.

Prior to the pandemic, ORD had been pursuing three strategic priorities: enhancing Veteran access to clinical trials; putting VA data to work for Veterans; and increasing the real-world impact of VA research. These priorities continue to guide ORD’s efforts and have positioned the program to quickly respond to COVID-19 through the creation and expansion of research partnerships; optimization of resource allocation; and streamlining and modernization of  processes and policies. Part of this effort has involved creating new ways to rapidly support VA investigators eligible for VA research funding, and quickly evaluating research ideas proposed by VA scientists.

Contributing to understanding COVID-19 and potential treatments

ORD is engaged in a wide array of research activities on COVID-19, with the support and cooperation of many internal VA and external partners. These activities encompass a range of studies, as well as innovative approaches to planning, coordinating, and expediting research:

  • Working with industry partners to include VA sites in clinical trials for new treatments. In one case, through a coordinated effort, VA was able to get a trial started in under a week—a dramatic reduction over the usual timeframe.

  • Coordinating with other federal agencies on national-scale studies on understanding the natural history of and treatments for COVID-19 or specimen collections from patients with COVID-19, to aid in vaccine and therapeutics development.

  • Facilitating expanded access (a.k.a. compassionate use) of investigational medications pending FDA approval. Efforts have included establishing a regulatory and pharmaceutical support team consisting of more than 80 VA research field staff for helping facilities obtain approvals for use of these medications.

  • Creating opportunities to rapidly fund VA investigators with meritorious research proposals on COVID-19.

  • Quickly evaluating research ideas proposed by VA scientists, in large part through a steering committee composed of leading VA experts in virology, infectious disease, and epidemiology.

  • Using data and informatics expertise to create common elements for harmonizing research and examining off-label use of approved medications.

  • Rapidly synthesizing evidence from the available scientific literature, and translating this evidence into usable guidance for clinicians in VA and beyond.

  • Coordinating the establishment of a central VA COVID-19 registry and biorepository.

Ensuring the safety and well-being of research personnel and study participants

To help prevent the spread of COVID-19, reduce exposures among both research staff and patients, and decrease the burden on the health care system, ORD instituted an administrative hold that stopped non-critical, in-person research contacts for all VA-funded research. (Some of this activity has begun to resume as of June, depending on local conditions.) Additional guidance was issued to ensure the safety and protection of all those involved in research. To ensure communication and understanding, ORD has developed a common communication platform for providing written guidance and sharing resources and tools, issued FAQs for field staff, and conducted a series of informational webinars for VA research personnel.

Enabling continuity of operations

As protective measures were implemented for personnel, ORD recognized the importance of continuing research when possible, given the public investments made to date. In this context, regulatory guidance was issued on options and requirements for conducting research through alternative methods. Additionally, ORD worked with the VA Office of Information Technology to issue guidance on the use of communication technologies for research purposes. A field operations workgroup was also set up to examine ongoing research challenges and to develop more uniform guidance for all research programs.



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