Update on COVID-19 Research at CHR and KPNW

COVID Research Update

Since we reported on CHR’s COVID-19 research in April, new findings have emerged, and new studies are underway at CHR and at Kaiser Permanente Northwest (KPNW).

Progress on COVID-19 Treatment

Richard Mularski, MD
Stephen Fortmann, MD

In March, CHR began a randomized clinical trial that tested the antiviral drug remdesivir (brand name Veklury) as a treatment for members hospitalized with COVID. The trial, led by Senior Investigator Richard Mularski, MD, tested treatment for five days compared with treatment for ten days. Distinguished Investigator Stephen Fortmann, MD, a study Co-Investigator, reports that equivalent results between the groups have led health care providers to use a 5-day regimen of remdesivir for members hospitalized with COVID in most cases. A different remdesivir study conducted by the National Institutes of Health (NIH), which CHR was not a part of, found that patients with severe COVID who received remdesivir recovered more quickly than patients who received a placebo.

Two more studies funded by NIH and led by Dr. Mularski have been completed at Kaiser Permanente Northwest’s Sunnyside and Westside hospitals. These studies tested adding treatments to remdesivir. In the first study, baricitinib (brand name Olumiant), a drug used to treat rheumatoid arthritis, was tested. The study compared remdesivir plus a placebo with remdesivir plus baricitinib, enrolling 1,033 people worldwide.

The results, which were published in December 2020 in the New England Journal of Medicine, showed that combining remdesivir and baricitinib was more effective at treating COVID-19 than remdesivir alone. More patients recovered in the group receiving the combination, and patients in this group had a shorter time to recovery. Hospitalized patients needing oxygen appeared to benefit the most. These results represent important progress in understanding how to treat COVID-19. Kaiser Permanente Northwest and CHR were the only KP sites nationally participating in this particular trial.

The second NIH study at KPNW compared remdesivir plus a placebo with remdesivir plus interferon-beta 1a (brand name Rebif), a drug used to treat Multiple Sclerosis. This trial closed enrollment on November 11th, and results are not yet available.

Progress on COVID-19 Vaccine Testing

In July, CHR began testing the efficacy and safety of the Pfizer/BioNtech mRNA COVID-19 Vaccine. This Phase 3 trial involves KPNW, KP Northern California, and KP Southern California, as well as sites worldwide. In this placebo-controlled, randomized clinical trial, the Pfizer vaccine is being tested in 44,000 participants. At our site in Portland, Oregon, we have enrolled 100 participants ages 15–85 and will follow them for two years. Although data are still being collected, results are encouraging. Pfizer recently reported 95% effectiveness for this vaccine.

Allison Naleway, PhD

Several more COVID-19 studies are underway at CHR, all of them led by Distinguished Investigator Allison Naleway, PhD.

Influenza vaccination receipt in the Vaccine Safety Datalink (VSD): A survey study

For the past 2 years, the Kaiser Permanente Colorado Institute for Health Research, in partnership with the Center for Health Research, has led research within the VSD using surveys and electronic health data to find out more about when and where people receive their influenza vaccines. VSD is a collaborative project between the Centers for Disease Control and Prevention, and 8 health care organizations across the country. The VSD conducts vaccine safety studies based on questions and concerns from the medical, scientific and public communities.

We are starting our 3rd year of surveys in the VSD. This year, we are surveying 1800 women across the United States who are currently pregnant or were pregnant during the influenza season. We are also asking several questions about the COVID vaccine, such as willingness to get a vaccine when available.

Studying COVID in Healthcare Workers

In the CDC-funded RECOVER study, Naleway and a team will describe COVID infection and re-infection in healthcare personnel, first responders, and essential workers. In this study, participants collect weekly nasal swabs for COVID testing. Researchers will assess antibodies at three different times and at 28 days after infection. Currently, 400 KPNW employees are enrolled. This work is expected to evolve into a vaccine effectiveness study in 2021.

Monitoring COVID in Pregnancy

The Epidemiology of SARS-CoV-2 in Pregnancy and Infancy (ESPI) study will use electronic medical records to describe COVID-19 infection among pregnant health plan members, as well as symptoms and treatment, and will monitor parent and child for up to six months after delivery.

Closing Gaps in COVID Testing

The Vitals Study will first describe virtual visits and e-visits for COVID-19 and clinical care and COVID testing patterns. Researchers will then identify gaps in outpatient testing and try to close these gaps using self-collected nasal swab specimens. The study will offer self-collection kits to members who were referred for COVID testing but did not get tested. CHR is partnering with the Oregon State Public Health Laboratory for testing.

Assessing COVID Burden and Flu

The VISION COVID Study will use the electronic medical records of KPNW health plan members to assess the burden of COVID-19 infection, its complications, and the course of illness among patients with severe illness. The study will also assess the impact of circulating COVID-19 virus on flu illness and vaccination rates. CHR will partner with Westat (Rockville, Maryland), University of Colorado, Health Partners (Bloomington, Minnesota), and University of California at Irvine.

Forecasting Pandemic Impact

Mark Schmidt, PhD

CHR Investigator Mark A. Schmidt, PhD, an infectious disease epidemiologist who spent six years in pandemic planning at the Centers for Disease Control and Prevention (CDC), has been helping to forecast the pandemic for KP nationally and regionally since January 2020. Dr. Schmidt is part of a team of researchers from across KP that uses modeling to forecast increased demand for hospitalization and personal protective equipment. Nationally, KP cares for more than 12 million members and operates 39 hospitals.

In addition, Dr. Schmidt helps KPNW health plan leaders maintain preparedness and determine how to shift their response and potentially reimplement surge plans with further waves of disease. He also works with a group of local health care organizations and public health agencies that share forecasting methods and results and discuss key changes in hospitalization rates and testing.

CHR-Northwest