A team of Duke scientists and clinicians are working together to bridge the knowledge gap between patient care and basic science research associated with COVID-19.
Emily Ko, MD, PhD, assistant professor of medicine and hospitalist at Duke Regional Hospital, recently developed and distributed a survey to clinicians working on the frontlines, asking them about what they’ve observed in terms of patient symptoms, complications, infection, and re-infection in hospitalized patients with COVID-19.
Ko presented the results of the survey to a consortium of Duke scientists—many of which are affiliated with Duke’s Center for Applied Genomics and Precision Medicine (CAGPM)—who are developing studies to improve diagnostics, determine genetic susceptibility, and understand the biological response to COVID-19. The consortium is led by Drs. Geoff Ginsburg, MD, PhD, director of the Center for Applied Genomics & Precision Medicine, Svati Shah, MD, MHS, associate dean of genomics and director of the Duke Precision Genomics Collaboratory, and Chris Woods, MD, professor of medicine and pathology and associate director of the Duke Center for Applied Genomics and Precision Medicine.
“This kind of data is crucial to inform COVID-19 research going forward, said Ginsburg. “Insights from Dr. Ko’s survey give us a much better handle on what is happening in our patients and can help us develop questions and conduct research so we can contribute to the national COVID-19 research agenda.”
Ko surveyed 49 clinicians working at hospitals across the nation, including four in the Triangle area. According to Ko, a lot of the information reported by clinicians—including blood clotting, heart and lung complications, loss of sense of smell and taste, and neurological effects—is not new, but survey responses shed more light on just how often these conditions are seen in hospitalized patients with COVID-19. According to those surveyed, neurologic effects from the virus were a top concern of frontline workers caring for these patients.
“Ninety-two percent of clinicians surveyed reported neurological effects in COVID-19 patients that I think surprised basic and translational scientists,” said Ko. “Anyone in the COVID-19 clinical research community recognizes neurologic effects are a big problem but unless you’re taking care of those patients it’s sometimes hard to recognize how frequently it occurs and how much it impacts patient care.”
Neurological effects in COVID-19 patients can range from milder effects such as headache, dizziness, and changes in taste or smell, to more severe effects such as confusion, stroke and seizure. Studies conducted early in the pandemic demonstrated that 60 to 80 percent of all COVID patients have mild neurologic symptoms. More severe neurological effects occurred in hospitalized patients, with eight percent of COVID patients experiencing confusion, two percent experiencing stroke, and less than one percent experiencing seizure, said Ko. (Nepal et al. Crit Care. 2020; 24: 421; Liotta et al, Ann Clin Transl Neurol. 2020 Nov;7(11):2221-2230.)
“These studies demonstrate that many of these effects subside with treatment of the infection,” she said. Another take away from the survey, said Ko, is the need for the development of blood biomarker tests to determine whether a person presenting with COVID-19 symptoms is at risk for developing blood clotting, or other cardiac, pulmonary, or neurologic complications.
“If clinicians had biomarkers that could tell them whether someone is going to run into trouble, they could monitor that patient even more closely, avoid radiologic or more invasive testing, and prescribe potentially beneficial medications, such as blood thinners or heart medications,” she said.
Micah McClain, MD, PhD, associate professor of medicine, and his team in the CAGPM are studying biomarkers. Their research is aimed at understanding the differences in the biological response to COVID-19 compared to other viruses. They are using this information to develop biomarkers that utilize the body’s response to quickly discriminate COVID-19 from other respiratory infections, such as the flu or common cold viruses.
Moving forward, Duke researchers that are part of the inter-disciplinary consortium, are also working to better understand why some patients with COVID-19 become critically ill and develop complications. Genetic data from CAGPM clinical trials that enroll patients with COVID-19 are being shared with the COVID-19 Human Genetics Initiative, an international consortium working to identify genetic risk factors and inform potential treatments.