Jacobs School Continues to Aid Community During Pandemic

“Whether it be through hospital rounds, clinical and translational research or behind-the-scenes support, our Jacobs School faculty are doing whatever it takes to provide the utmost care for community members during this pandemic,” says Allison Brashear, MD, UB’s vice president for health sciences and dean of the Jacobs School.

“It is a crucial part of our mission to seek novel solutions to the most critical public health issues, including providing the most up-to-date information and guidance regarding treatments and vaccines for COVID-19,” she adds.

One area that the Jacobs School is taking the lead in the fight against COVID-19 is in the Department of Pediatrics, where Steven E. Lipshultz, MD, A. Conger Goodyear Professor and Chair of pediatrics, is leading efforts to encourage vaccinations for children age 5 and older.

“In Western New York, like the rest of the country, children are the single largest group that is unvaccinated — principally because they only just recently became eligible to be vaccinated — but we still have probably less than 30 percent that have been vaccinated,” he says.

“As a result, we have a highly vulnerable population, and especially in Western New York, we see the value of staying in school face-to-face and being in daycare face-to-face,” Lipshultz says. “What we are seeing is a very high percentage of the children who are testing positive for COVID-19 have underlying medical conditions.”

Conditions such as asthma, diabetes, chronic lung disease, immune deficiencies, and heart and kidney diseases are among the most common comorbidities seen in children testing positive, says Lipshultz, president of UBMD Pediatrics.

UBMD Pediatrics physicians, which represent about 95 percent of all the pediatric subspecialists in Western New York, recently issued pediatric COVID-19 vaccine guidance for parents.

“That’s important because the overwhelming majority of children who are getting severely sick and hospitalized have underlying chronic diseases,” Lipshultz says. “They have very little reserve, so when they contract COVID-19 on top of their other conditions, they wind up being in the category of patients we often have to admit to the hospital.”

Of the Western New York children screened, Lipshultz estimates about 200 are testing positive and about 100 are being admitted to the hospital each month.

Lipshultz notes that while area hospitals are seeing a lot of incidental cases in adults — for instance, they come in for surgery and before they can go to the operating room they are tested and it comes back positive — that is not the usual case with children.

“What we are seeing are kids with underlying health conditions becoming the most affected, that is why we worked very hard with the Erie County Health Department and New York State Department of Health to get approved to give vaccines at the UBMD Pediatrics location on the fourth floor at the Conventus Medical Office Building,” he says. “We got the latest revisions of the Pfizer vaccine for kids so they have more stability.”

“We did a lot of research and spoke to the families and what we found was that when families bring their children to see our specialists, it would really help them if during that same visit they could discuss getting their child vaccinated and then actually letting that happen,” Lipshultz says.

“As families come in, not only will we vaccinate their child, but we will vaccinate the rest of the family as well,” he says. “We are specifically focused on the children who are most likely to get hospitalized when infected. If their family is vaccinated, they are going to be less likely to bring COVID-19 into their household and have their highly vulnerable child be exposed and possibly be hospitalized.”

“That is what makes us different than any other place in Western New York for children to get vaccinated,” Lipshultz adds.

Lipshultz has been studying the effects of viruses on children since 1984 and has been funded continuously by the National Institutes of Health since 1986 to study the longterm effects of a child getting an HIV infection.

He is also editor-in-chief of the medical journal Progress in Pediatric Cardiology, published by Elsevier.

The Jacobs School’s Department of Pediatrics faculty has had a working group since the start of the COVID-19 pandemic to come up with what is the best way to manage, diagnose and treat children with COVID-19 and his journal has published about 20 articles about COVID-19 infections in children, he notes.

“We were able to put together infectious disease specialists, general pediatricians, intensivists, neonatologists, cardiologists, pulmonologists — they all got together to publish this comprehensive guide to help providers manage most effectively when your child has COVID-19,” Lipshultz says.

The group’s editorial, titled “COVID-19 Associated Multisystem Inflammatory Syndrome in Children (MIS-C) Guidelines; A Western New York Approach,” published in June 2020 “is one the most downloaded and cited articles in the history of the journal,” Lipshultz notes.

“In September 2021, our knowledge had advanced and our whole UB working group published a revision, so it is an example of UB teaching the world how to get the best care for children infected with COVID-19,” he adds.

The Jacobs School is also involved in many behind-the-scenes efforts in the fight against COVID-19 in Western New York.

One such example is the production of viral transport media (VTM) tubes by the lab group of Anthony A. Campagnari, PhD, SUNY Distinguished Professor of microbiology and immunology and senior associate dean for research and graduate education.

VTM are critical for any tests involving viral detection. This media contains proteins that stabilize the virus until the sample can be properly analyzed. VTM includes buffers to control pH as well as antibiotics and antifungals to prevent or eliminate bacteria or fungi from contaminating the clinical sample.

The group produced more than 100,000 tubes of VTM in 2020 and early 2021 for the testing labs of Kaleida Health, Catholic Health and the Erie County Medical Center.

In mid-September of 2021, the group was contacted by Kaleida Health and asked if it would be willing to restart production of VTM tubes in anticipation of the need for increased COVID-19 testing.

“My group was more than willing to help in support of our local community,” Campagnari says. “So once again they were willing to dedicate the extra time and effort needed to produce the VTM tubes, in addition to their regular work responsibilities in support of our ongoing laboratory research projects.”

VTM is fairly simple to make, but it is not an automated process, Campagnari notes.

“It is not difficult to make as it consists of common laboratory buffers, reagents and antimicrobial compounds. The medium is filter sterilized and analyzed for contamination,” he says. “The real time-consuming step is carefully aliquoting 3 milliliters of VTM into 15-milliliter conical tubes while maintaining sterility.”

“We have been producing 3,000 VTM tubes every month since November 2021 and we will continue to provide Kaleida labs with as many tubes as needed in support of the increased COVID-19 testing,” Campagnari adds.

Other members in Campagnari’s lab group are: Nicole Luke-Marshall, PhD; Shauna Sauberan; Lisa Hansen and Greg Stowell.

Another important behind-the-scenes endeavor is the Department of Psychiatry’s COVID-19 Emotional Support Task Force and its ongoing efforts to support frontline health care workers. It was launched in 2020 to provide health care workers with services and techniques to ease emotional distress brought on by the pandemic.

The task force consists of UBMD psychiatrists, psychologists, social workers and psychiatry residents and fellows, as well as therapists at the Oishei Children’s Hospital Children’s Psychiatry Clinic and elsewhere. Currently, more than 30 professionals are involved.

“We continue to offer support, brief psychotherapy, and referral for more extended treatment for any staff members, clinicians and residents at the Erie County Medical Center (ECMC), Kaleida Health, and UBMD sites who feel stressed by working with COVID-19 patients,” says Steven L. Dubovsky, MD, professor and chair of psychiatry and president of UBMD Psychiatry. “We now coordinate this program with the ECMC Physician Wellness Committee.”

Dubovsky says the main focus of the task force remains to — “provide rapid intervention for colleagues experiencing the stress of working with COVID-19.”

The Emotional Support Warmline (716-859-2010) is the linchpin of the task force’s initiative. Calls to the warmline are forwarded directly to the cell phone of one of a dozen faculty psychiatrists who have volunteered to field the calls.

“We remain available every day. Utilization varies. It decreased as COVID-19 hospitalizations and the severity of inpatient illnesses declined, but it has recently increased with the resurgence of infections,” Dubovsky says. “People continue to find it helpful and we evaluate outcomes regularly.”

Teresa Quattrin, MD, UB Distinguished Professor of pediatrics and senior associate dean for research integration, says scores of Jacobs School physicians and physician-scientists are working on the fight against COVID-19 on a daily basis.

“People are stepping up through clinical rounds and through conducting clinical trials to help people through COVID-19,” she says.

Inside UB’s Clinical Research Office (CRO), about 50 Jacobs School faculty members are investigators in COVID-19 research.

The CRO was created to streamline and centralize all of the clinical research throughout the university. Much of its work deals with investigational new drug studies mostly supported by big pharma, says Pamela K. Anderson, RN, associate director of operations at the CRO, along with Kimberly A. Brunton, RN.

“For instance, if Pfizer has a drug it wants in clinical trials to test safety and efficacy, it will reach out to individual investigators and we will enroll the patients and administer the drug,” she says. “Prior to that, individual departments and practice plans had the responsibility of coordinating the study and storing the product.”

“We piloted a study where we brought Denise Swiatek, PharmD, on because she is a licensed pharmacist and has a lot of research experience and we thought it would be good if it could make our operations more centralized,” Anderson adds.

“A lot of these drugs that are investigational, there are certain exclusion criteria for the products that may be complex such as drug interactions with other medications the patients may be taking,” Anderson says. “Pharmacists are trained to understand the mechanisms of action and the reaction they can have that maybe the physician might not be aware of, so we thought that would be an added service to our study team.”

Swiatek works as the outpatient clinical research pharmacist at the CRO and UB’s Clinical and Translation Research Center (CTRC).

The CRO Pharmacy, located at the CTRC, is not a licensed pharmacy space, but is a medication room with a locked medication cabinet for storing controlled substances, Swiatek says.

“The pharmacy allows us to also have the proper accountability for the product itself so we have a secure location and 24/7 temperature monitoring of the product,” Anderson says. “We receive the shipments and make sure they arrive in good condition — managing these studies requires a lot of documentation.”

“During the COVID-19 pandemic, some of our clinical trials were halted, but for other studies, in order to keep the patients on study medication, we facilitated delivery of study product to the patients’ homes,” she says.

The CRO opened up a COVID-19 clinic in Amherst and Swiatek would prepare the product and it was delivered to the clinic so the patients could receive the drug.

“For that particular study, the preparation was in a hood because we do have a biological safety cabinet,” Swiatek notes.

The principal investigators and study teams are typically blinded if it’s a double-blind trial — they don’t know who is receiving the placebo and who is receiving the drug — but often the pharmacist is unblinded because they are the one who is preparing the medication.

The CRO currently has roughly five interventional, clinical trials involving COVID-19 and another 38 that are surveys, registries, observational and chart reviews.

“Those are looking at patterns, collecting data on people who tested positive for COVID-19, or observing specific characteristics of people with COVID-19 or who had symptoms, but tested negative,” Anderson says.

“We have had a lot of collaboration. We have had an incredible amount of support from our institutional partners,” she says. “It has definitely been a team effort — with ECMC, Kaleida Health and UB. It has been all hands on deck.”