From the new isolation tents outside the Emergency Department to the masked nurses at every entrance of UHealth Tower, there are visible signs that the University of Miami Health System is ready for the expected surge of patients infected with COVID-19.
But the war against the novel coronavirus that has much of the world at a standstill is also taking place behind the scenes—in the laboratories of researchers who are working on vaccines and diagnostic tests that, one day, could help put us at ease, or even raise early alarms about other dangerous outbreaks.
By mid-January, as the UHealth emergency management and supply chain teams began ordering head-to-toe protective gear and other supplies for doctors and nurses, the Miller School of Medicine’s Natasa Strbo knew she had to enlist the cancer and infectious disease vaccine she’s worked on for more than decade in this new fight.
“As soon as I heard that something pretty bad was happening in China, I was excited to investigate the potential of our vaccine, which is a really different approach. It’s based on a natural protein, gp96, that is present in our cells and activates immune responses,” said Strbo, assistant professor of microbiology and immunology, whose team is working on the COVID-19 vaccine with Heat Biologics, the biopharmaceutical company that now owns the gp96 platform she helped develop. “We already have tremendous knowledge from our previous vaccine studies, so I think the gp96 platform has a lot of potential in inducing a protective immunity against COVID-19.”
And this week, as teams of masked nurses, Patient and Visitor Services staff, and graduate students and faculty from the School of Nursing and Health Studies began asking every person entering UHealth Tower, its Emergency Department, and other UM facilities about their recent travel history and COVID-19 symptoms—including fever, cough, and shortness of breath—multiple teams of researchers were working to move rapid-detection tests from their laboratories to clinical samples for validation, or to the field for actual use.
Using a specimen taken with a cotton swab from a prospective patient’s mouth, the field test—developed by Sylvia Daunert, chair of the Department of Biochemistry and Molecular Biology, and her colleagues—would confirm the presence of COVID-19 in less than 30 minutes. This would be a vast improvement over the two to three days it takes physicians to currently get results from state or commercial labs.
“It looks like a pregnancy test, and it’s almost as easy for the end user to administer, which in this case would be health care providers,” said Daunert, who developed the single-strip test with Sapna Deo and Jean-Marc Zingg based on their previous work for a Zika field test. “But our end goal would be to eventually make these tests available, for example, to a TSA officer at the airport, who would be able to screen people with a fever or other COVID-19 symptoms. That’s the idea, and that’s what we’re working toward.”
Mark Sharkey, assistant professor of medicine, who works with Mario Stevenson, chief of the Division of Infectious Diseases and director of the Institute of AIDS and Emerging Diseases, is also developing a diagnostic test for COVID-19. It also would produce results just as quickly, but in a lab.
“It’s based on fluorescence, so after the sample is amplified, if it’s positive it will glow green in the reaction tube when a blue light shines on it,” Sharkey said, noting that the rapid test platform could be used to randomly sample the community to gauge the reach of COVID-19. “The problem with this virus is a lot of people don’t have symptoms, and there are guidelines for who can be tested. You have to have symptoms. And, you’ll be tested for other pathogens like flu, before they’ll order a test for COVID-19, so this could give us an idea of community spread.”
Vincent Torres, the Miller School’s emergency manager who worked with the Emergency Department and nursing educators to train hundreds of doctors and nurses to use the protective gear and other equipment for the expected spike in COVID-19 cases, said rapid tests and vaccines would help allay the fear and panic over the highly contagious virus that, as Sharkey noted, will produce only mild symptoms in most people.
“By this time, next year, cold and flu season will probably be known as cold, flu, and COVID-19 season because it will be endemic like the flu,” Torres said. “The difference is we know flu. We have a vaccine. We have Tamiflu. We have heard about flu our entire lives, so even though 310,000 have been hospitalized with the flu in the United States this season—and about 20,000 have died from it this year alone—flu is not on a big scary map on the internet with red dots on it. But COVID-19 is novel, because there’s not a vaccine, because there’s no actual treatment, it’s scary to people.”
Yet, the presence of masked nurses who are screening all visitors at the entrances of UHealth Tower and the sight of isolation tents outside the Emergency Department, where patients who meet the guidelines are further screened for COVID-19 symptoms, seem to have a calming effect.
“Patients have been very grateful, even those we send home with the understanding that they self-isolate until they get their results,’’ said Natalia Fernandini, manager of the Emergency Department. “They thank us for being here. They know there is a national crisis; and, for the most part, they want to do their part to help us curtail it.”
They can do even more, Torres emphasized, if they just stay home if they have the sniffles or other minor symptoms.
They can call ahead if they think their symptoms meet the criteria for a test.
“The message is not everyone needs to be tested,” he added. “If you have severe respiratory symptoms, a fever, and known contact with a confirmed COVID-19 patient, contact your primary care physician or your nearest emergency department, but call before you go so they can prepare for you.”
Sylvia Daunert and Mario Stevenson's COVID-19 research is supported by the University of Miami Clinical and Translational Science Institute, which awarded each of their rapid-test projects Emerging Diseases funding.
