Responding to a pandemic
Faculty, staff and students from across the college have stepped in to respond to the COVID-19 crisis
Editor’s note: Many of the images in this article were taken prior to national guidelines on face coverings and physical distancing.
In mid-March, a group of faculty, technicians and students in the college’s department of environmental and global health pulled off an enormous feat. In just 10 days, they built a lab in the UF Emerging Pathogens Institute to process COVID-19 tests, a process that might typically take several weeks.
Those efforts to fill a major gap in testing are just one example of the many contributions the College of Public Health and Health Professions’ faculty, staff and students have made to the pandemic response. Read on for more.
Tracking the spread
Disease modelers in the department of biostatistics in PHHP and the College of Medicine have been working to predict the virus’ spread and how factors such as stay-at-home orders and reopenings affect the curve. In the latest model, Ira Longini, Ph.D., a professor of biostatistics, shows how Floridians’ mobility and close contact has changed these past few months and reinforces that control measures are still needed.
Longini and colleagues also examined the effect of travels bans to and from Wuhan, China early in the pandemic. They found that the travel ban may have only delayed the epidemic’s spread by three to five days in mainland China. Travel restrictions did help to slow the international progression by nearly 80% until mid-February. By then, the research indicates a large number of people exposed to the virus had been traveling undetected, allowing COVID-19 to spread internationally, including to Italy, South Korea and Iran. Their findings were published in Science.
Preparing for clinical trials
In a paper published in April in the New England Journal of Medicine, Natalie Dean, Ph.D., an assistant professor of biostatistics, Longini and colleagues propose a core protocol for conducting clinical trials during a disease outbreak. Unpredictability in size, geographic location and the duration of the outbreak can make it difficult for scientists to determine if a drug actually works.
“The key principle of the core protocol is that the best way to answer these important health questions is to accumulate information across outbreaks,” Dean said. “A trial implemented in a single outbreak may not be large enough to fully answer the question of whether a vaccine or treatment is safe and effective. As a result, we should include a plan for trials to extend across outbreaks.”
Dean, Longini and colleagues are currently working with the World Health Organization on multicountry trial strategies for vaccines once these are ready to be tested in large clinical trials.
Disease detectives
Students Emily Klann, Rebecca Fisk and Veronica Richards at the Broward County Health Department in April.
One of the most effective behavioral strategies for infection control is identifying close contacts of people with COVID-19 so they can isolate and monitor their health. But with thousands of infections and thousands of contacts, Florida needed to rapidly expand their contact tracing capabilities. The state turned to universities to recruit students and faculty to serve as contact tracers. More than 30 UF master’s and doctoral students in epidemiology, along with faculty members, answered the call. Several deployed to health departments across the state, while others have helped in the Gainesville area. On top of classes, research and teaching assistant responsibilities, these students have worked long days to contact people who have contracted COVID-19 or been exposed to it, to determine how the disease is spreading.
“I’m incredibly proud of these students,” said Cindy Prins, Ph.D., M.P.H., a clinical associate professor of epidemiology, director of the Master of Public Health program and PHHP’s assistant dean for educational affairs. “They want to help so badly. All of our students do.”
On campus, the university has introduced Screen, Test & Protect, a science- and data-driven program designed to minimize the spread of the novel coronavirus, and allow faculty, staff and students to gradually and safely return to campus. Jerne Shapiro, M.P.H., a faculty member in the department of epidemiology, serves as the program’s chief epidemiologist.
Filling the testing gap
Volunteers prepare to conduct drive-thru testing at P.K. Yonge Developmental Research School.
Early in the pandemic, authorities struggled to understand the scope of infection in the absence of COVID-19 tests and equipment. John Lednicky, Ph.D., a research professor in the department of environmental and global health and an expert on coronaviruses, had developed a test four years ago to detect betacoronaviruses in the Brazilian free-tailed bat, one of the most common bats in the Americas. When SARS-COV-2, the virus that causes COVID-19 started to spread, Lednicky dusted the test off and found that it was an excellent match for the virus.
That test has been used by environmental and global health faculty and staff to test more than 6,500 Floridians, including residents of The Villages® retirement community, first responders and city employees in Gainesville, homeless populations and health workers in Jacksonville.
Sarah McKune, Ph.D., Eric Nelson, M.D., and Anthony Maurelli, Ph.D., also faculty members in the department of environmental and global health, used the test for a study designed to improve scientists’ understanding of the role children play in community transmission of COVID-19. Their findings may help scientists incorporate children into predictive models on when, and if, the benefits of herd immunity might manifest in communities, such as Alachua County.
“The study has been designed to contribute foundational knowledge necessary for public health officials to make evidence-based decisions on when to reopen schools, as well as model COVID-19 transmission in the general population,” McKune said.
Reaching patients through telehealth
Dr. Dawn Bowers, Dr. Russell Bauer and Dr. David Marra run through a teleneuropsychology screening with Dr. Kristin Hamlet (on the screen).
As UF moved to limit in-person activities in mid-March, the department of clinical and health psychology quickly transitioned patients of the UF Health – Psychology Specialties to telehealth appointments. In just 10 days, they converted nearly all of their care to telehealth visits.
The department was also among the first in the country to adopt telehealth for neuropsychology, emerging as a national leader in telehealth for this specialty. Faculty members published a procedure manual for neuropsychological telehealth on the Society for Neuropsychology website and provided input and suggestions to many other academic health centers and private practitioners. Russell Bauer, Ph.D., a professor in the department, participated in a national webinar for practitioners on risk management for teleneuropsychology.
Department members David Marra, Ph.D., a postdoctoral researcher, Kristin Hamlet, Ph.D., a clinical assistant professor, Bauer and Dawn Bowers, Ph.D., a professor, recently authored a systematic review of teleneuropsychology literature to examine its validity for older adults. They determined that some cognitive tests can be administered just as well via telehealth as in person.
“Prior to COVID-19, very few clinicians outside of a Veterans Affairs facility would utilize teleneuropsychology in their clinical practice,” Marra said. “Now that our field has been forced to adopt and integrate this tool into our practice, I believe aspects of teleneuropsychology will persist. While teleneuropsychology will likely never replace the gold standard, in-person evaluation, I think it will continue to be used to provide services to a wider patient population, especially those in rural populations who are typically underserved.”
Teleneuropsychology may also find a place in routine wellness screenings for older adults who may have difficulty coming into a clinic, Bauer said.
“It may find use in providing a more rapid, easily accessible means to determine, based on screening results, whether a more comprehensive evaluation is necessary,” he said. “One important aspect of teleneuropsychology is that, if used expeditiously together with in-person exams, it may reduce ‘time-to-service’ (the amount of time that elapses between referral and visit), thus potentially catching potentially treatable illnesses earlier in their course.”
Hamlet said the telehealth approach has worked well in the Perioperative Cognitive Anesthetic Network program, or PeCAN, where clinicians assess pre-surgical patients age 65 and over in order to identify older adults who may be at risk of developing cognitive problems after surgery so that clinicians can intervene to lessen the risk.
“We created a telemedicine neurobehavioral screening protocol that very closely mirrored that of our in-person assessment,” she said. “We have found a lot of success with this model. We have been able to reach more patients by being more flexible with scheduling. Many patients preparing for surgery at UF Health are traveling from far distances and may not have time to complete our PeCAN appointment on the day of their referral. We have even been able to expand our care to another pre-op clinic at UF Health since our physical location does not dictate our accessibility to patients in this model.”
Protecting health care workers
Photo by Louis Brems
One of the first lines of protection for health care workers is personal protective equipment, but if supplies are limited, workers may reuse masks beyond their intended use. In addition, most masks can capture viruses but not necessarily kill them.
In a new study funded by the National Science Foundation, researchers are wrapping nanomaterials — very small synthetic particles — in soap molecules designed to kill the virus once it is filtered by a face mask. The work is led by Tara Sabo-Attwood, Ph.D., chair of environmental and global health, Lednicky and Prins, in collaboration with Navid Saleh, Ph.D., of the University of Texas.
Serving the community
Students in the COVID-19 Service Corps conduct drive-thru testing. Photo by Jesse S. Jones
Students from across the six UF health colleges teamed up to establish the UF chapter of the COVID-19 Student Service Corps. Their 30-plus ongoing community projects include performing COVID-19 testing; delivering meals for ElderCare; conducting phone surveys of UF HealthStreet members on food insecurity, loneliness, stress, anxiety, depression and overall needs; and writing thank you notes to health care workers.
Kim Dunleavy, P.T., Ph.D., a clinical professor of physical therapy and director of professional education and community engagement, brought the idea to UF after learning about Columbia University’s model for the corps at the Global Forum for Innovation in Health Professions Education.
“For students doing COVID-19 testing, this is something they’re never going to forget. For students working to provide other nonmedical services to those without resources during this time, it gives them a perspective on the much broader problems we’re experiencing with this epidemic,” Dunleavy said. “It prepares students for not only their roles as health care providers but also sets them up to be better, more well-rounded clinicians who address their patients’ priorities and everything that impacts care, including the social determinants of health.”
Attention health care providers
The best way to thank you is to learn from you.
By joining the HERO Registry, you can provide valuable information to help researchers nationwide understand what your experience is like on the front lines of COVID-19.
By participating in the HERO Registry, you will become part of a national response to address the problems our health care heroes face in real time—and over time.
After joining, you will receive surveys, opportunities to participate in future studies, and learnings from the HERO research community.
You can participate as much or as little as you like.
