Facing down infectious disease

Addressing the novel coronavirus global pandemic may be a recent challenge, but managing the impact of diseases threatening human health is nothing new for professors Julio Ramirez, Ruth Carrico, Forest Arnold and their colleagues in the UofL Division of Infectious Diseases. You could say they have been preparing for a pandemic for their entire careers.

These experts have equipped health care workers to deal with Ebola, SARS and other disease threats. They have developed programs to treat and prevent hepatitis and AIDS. They have studied the impact of pneumonia worldwide and conducted population surveillance of Group B Streptococcus and infectious diarrhea.

In January, UofL and Pfizer Inc. announced the designation of the UofL Division of Infectious Diseases as the first Center of Excellence in Pfizer’s global network for epidemiological research of vaccine-preventable diseases in adults. Pfizer selected UofL based on the division’s high-quality research, its international credibility and the well-established relationships the researchers have with hospitals and health care providers in the community.

Through this collaboration, UofL researchers study diseases in the adult Louisville population to estimate the public health impact vaccines may have. This informs the U.S. Centers for Disease Control and Prevention and independent policymakers in setting vaccination policy for adults.

Two studies with Pfizer already were underway in January when researchers began bracing for a major new threat. News from China was revealing the quick spread and serious illness caused by a new coronavirus. Ramirez, chief of the division, and the rest of the team recognized it was very likely the virus, SARS-CoV-2, would spread to Louisville. UofL’s experts prepared to combat a disease they had never seen before.

In February, the division began working with Kenneth Palmer, director of the UofL Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases, to develop the ability to test for SARS-CoV-2, and to do surveillance of COVID-19, the disease caused by the virus, in all hospitals in the region.

The first case of COVID-19 was announced in Louisville March 9. The UofL labs worked nearly around the clock to perform diagnostic tests, process patient samples, notify hospitals of test results and gather information on infected patients to determine effective local policy and approaches. In addition, the Infectious Diseases Biorepository was expanded to include samples from COVID-19 patients.

“If we have an understanding of this illness in terms of where the cases are and how many cases we’re seeing among what types of patients, that gives us the epidemiology behind the illness so we can better understand risk factors and how we need to approach it from a preventive perspective,” Carrico said.

Over the next six weeks, more than 5,000 samples were tested at UofL, identifying 730 positive cases from 15 hospitals and 17 long-term care facilities throughout the Metro Louisville region. By identifying sooner who was infected, local hospitals were able to isolate earlier the patients and health care workers who had the virus, protecting others and preserving scarce personal protective equipment.

Area hospitals had acquired the ability to perform most of their own tests by mid-May, allowing Ramirez and the research team to focus on examining the COVID-19 data while also continuing work on the Pfizer studies examining bacteria that cause invasive disease, pneumonia, severe diarrhea and colitis.

“Louisville is one of the most sophisticated population-based sites for studying infectious diseases in adults that is managed by a team of world-renowned experts in infectious diseases,” said Luis Jodar, chief medical and scientific affairs officer for Pfizer Vaccines.

The UofL studies also benefit from the fact that the population of Jefferson County, Kentucky, closely reflects the United States as a whole in terms of racial and ethnic makeup, socioeconomic distribution and proportion of rural and urban residents. Information gathered about the Louisville population can be extrapolated to the United States.

“With this type of clinical research, we create new knowledge. This new knowledge advances medicine and will help not just one patient, but every patient with the disease in the world,” Ramirez said.

The COVID-19 clinical research data is promptly made available to researchers and health care workers around the world. Additional studies are planned to document the physical and mental impact the pandemic has on front-line health care workers.

Ramirez personally is feeling the impact of working around COVID-19. “In January we were having a happy life. In February, we started to be concerned and knew we needed to prepare. At the beginning of March, we had the first case in Louisville. Since then, we have had so many cases,” he said. “We had such an involvement — seven days a week. I lost total perspective of time.”

While the initial crush may have subsided, the pandemic is not over and neither are other diseases including those Pfizer currently is studying. So the division continues planning for the future.

Carrico, who directs the UofL Vaccine and International Travel Clinic, was a key organizer for the largest mass immunization ever held in the United States, administering more than 19,000 immunizations over a two-day period in 2009 for H1N1 influenza. She’s now working on a plan for COVID-19.

“We expect that a COVID-19 vaccine will be available in the near future and we are going to need to vaccinate nearly the entire population,” Carrico said. “We have the experience to do that and we will be ready.”