As the first cases of the novel coronavirus became visible in the United States, the COVID-19 Healthcare Coalition heard the call to action. The response: Organize industry to save lives and protect health systems from being overwhelmed.
When coronavirus cases surged around the country, health systems faced patient deaths at a rate most healthcare workers had never seen. At the same time, staff faced dire shortages in personal protective equipment (PPE) and other critical equipment.
The world soon realized that governments and health systems would need several innovative techniques, including up-to-the-minute data on how the virus spreads and geographic analysis on the impact of non-pharmaceutical interventions (NPIs). One of the leading groups in the fight against this global scourge is the COVID-19 Healthcare Coalition.
At the request of private industry, MITRE is managing the coalition to help save lives by using data-driven, real-time insights to improve clinical outcomes. More than 800 organizations from numerous fields, including health systems and technology companies, have joined and are working on three primary areas: data-driven clinical outcomes, supply chain, and social policies.
Working groups tackle specific issues—for example, standardizing COVID-19 data to drive clinical care outcomes. By working across the health information technology community to develop standard vocabularies around COVID-19, the group can query many kinds of databases to identify patterns and best practices.
The coalition priorities are focused on solutions that have the most potential for real-time impact at scale. “Data-driven clinical outcomes, supply chains for critical, frontline equipment, and informing and educating decision-makers on best social policies were quickly identified as the areas of greatest need,” says Rich Byrne, MITRE’s senior vice president of programs and technology.
Supply Chain: PPE and Decontaminating N95 Masks
The coalition focused its efforts on the supply chain, including buying masks, developing methods to decontaminate and reuse masks, modifying snorkel masks for healthcare settings, and PPE demand modeling.
Ventilator and N95 respirator mask shortages were the first problem the coalition tackled. The coalition worked with international suppliers to deliver 575,000 Food and Drug Administration (FDA)-certified respirators—KN95 masks—to New York City hospitals, working through Governor Cuomo’s procurement office, and 100,000 to Masks4America.
Because of PPE shortages, the coalition looked at what hospitals and frontline organizations could do to protect themselves when approved PPE was not available. For example, coalition members researched the current best methods for decontamination and reuse (i.e., recharging, reusing) of N95 respirators. The coalition identified three methods—vaporized hydrogen peroxide, ultraviolet (UV) germicidal irradiation, and moist and dry heating—as the most effective. Institutions ranging from hospitals in Massachusetts to the sheriff's department in Los Angeles began using decontaminated N95 respirator masks in April.
For example, Partners HealthCare, which runs Massachusetts General Hospital, Brigham and Women’s Hospital, and others, has embraced the vaporized hydrogen peroxide cleaning system to decontaminate masks, while some Boston facilities have adopted the UV light method.
Innovations in 3D Printing of Medical Devices
In addition, the coalition looked at innovative products coming from the 3D-printed field. The maker community mobilized to design and produce prototypes to fill the gap. Companies created 3D-printed reusable masks and face shields to get protection to those who needed it most when approved equipment isn’t available.
Government agencies such as the FDA, Centers for Disease Control and Prevention, and the National Institute for Occupation Safety and Health have established standards for PPE, such as N95 respirators, that protect healthcare workers exposed to the coronavirus. While no 3D-printed designs meet those requirements, the National Institutes of Health has reviewed many 3D-printed designs and has designated some as “Clinically Reviewed” or “Community Use.”
Another innovation in the fight to protect healthcare workers is the adaption of snorkel masks designed for healthcare settings. Coalition members worked with researchers in Stanford’s Prakash Lab who pioneered a modified snorkel mask that incorporates a commercial medical filter and a 3D-printed adapter. Stanford is freely distributing its mask kits to healthcare workers who need them.
For example, we have shipped over a thousand modified snorkel masks to Mount Auburn Hospital in Massachusetts and to the University of Miami health system in Florida. Belgium and France are currently using 40,000 of these masks.
Social Policies: NPI Dashboard
The coalition’s work on social policies brings together nonpharmaceutical intervention (NPI) models, contact tracing experiments, and MITRE’s Sara Alert™ symptom monitoring. Sara Alert allows remote monitoring of individuals at risk, either because of travel or to exposure to a confirmed case in the United States.
One of the most important elements for battling the coronavirus are NPIs—such as social distancing, quarantine, and isolation. The NPI dashboard enables local, state, and national leaders to make decisions based on actual data, not models.
Many coalition members have contributed data or analytic tools to this dashboard, which is updated regularly. It is now being redesigned to reflect new challenges for government and business. As states begin to relax NPIs and businesses consider bringing workers back to the office, the tools will help leaders understand the possible outcomes of these actions based on real-time data.
The dashboard features a heat map that shows states that have implemented NPIs. You can see details of a state’s NPI, which states acted early, and which acted later in their epidemiological curve.
The dashboard also includes a hex map where you can toggle between cases and deaths. This is a good baseline indicator of which states are hot spots. You can also select a specific date to see case counts and NPI implementation on a specific day.
This dashboard can help authorities and care providers understand what role, if any, NPIs played in affecting the curve within that state.
Clinical Care: Testing and Vaccines
The coalition’s clinical care work is concentrated on federated patient treatments to discover what works and what doesn’t, such as convalescent plasma.
People who recover from COVID-19 do so, in part, because their blood contains substances called antibodies. Antibodies can fight the virus that causes the illness and can be used to develop treatments for COVID-19, like vaccines.
Many members of the coalition are working with the Mayo Clinic, a co-founder of the coalition, to discover how the blood of people who recover from COVID-19 can help others recover. Mayo leads the national effort to collect, analyze, and use convalescent blood plasma. In the near term, severely ill patients are being transfused with this plasma to increase their chance of recovery.
There are many questions to answer about this approach, and in the long term, coalition researchers will study blood plasma to learn more about the antibodies and how they work.
The Fight Continues
“The resources the coalition convened in just two months have truly helped health systems and communities mitigate the impact of COVID-19,” said Dr. John Halamka, president of Mayo Clinic Platform. “The Mayo Clinic is ready for the next phase of combating this virus and will continue convalescent plasma research and other efforts to improve the outcomes for patients dealing with COVID-19.”
Understanding of the best clinical practices in the fight against COVID-19 is ongoing. In the months ahead, testing and contact tracing are critical to reopening society and easing the impact of COVID-19.
Dr. Jay Schnitzer, MITRE’s chief technology and medical officer, notes, “My sense is that we’re entering a transition into the next phase of this pandemic, both in terms of the activities of the coalition and the national outbreak itself.
"Now we must think about, anticipate, and hopefully—to some degree—predict what’s next and position ourselves accordingly.”
—by Aishia Caryn Freeman