Population Health

April 30, 2020

Initiative announces award of 21 COVID-19 rapid response grants

CDC coronavirus imageThe University of Washington Population Health Initiative announced the award of approximately $350,000 in COVID-19 rapid response grants to 21 different faculty-led teams. These teams are composed of individuals representing 10 different schools and colleges. Funding was partially matched by additional school, college and departmental funds, bringing the total value of these awards to roughly $820,000.

“A challenge of this magnitude requires us to draw upon the breadth of the university’s expertise to respond, and the range of innovative, collaborative project ideas that were quickly developed for this funding call was both impressive and truly inspiring,” shared Ali H. Mokdad, the university’s chief strategy officer for population health and professor of health metrics sciences. “We believe the 21 projects selected for funding are all well positioned to rapidly accelerate our understanding of, or approach to mitigating, the impacts of this pandemic, which is touching every aspect of our lives.”

The Population Health Initiative COVID-19 rapid response research grants are intended to rapidly accelerate, or jumpstart, novel research designed to better understand or mitigate the impact of COVID-19 on multiple facets of life. The awardees are:

Identification of High Affinity Aptamers that Bind to SARS-CoV-2 Spike Protein

Suzie Pun, Professor, Department of Bioengineering
Nataly Kacherovsky, Research Scientist IV, Department of Bioengineering

Project abstract
The 2019 outbreak of the novel severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, and its associated disease, COVID-19, was named a pandemic by the World Health Organization. SARS-Cov-2 is an enveloped RNA virus that has a spike protein that protrudes from the lipid membrane and mediates host cell binding and infection.

The goal of this proposal is to develop new DNA-based aptamers that bind with high affinity to the SARS-CoV-2 spike protein. The identified SARS-CoV-2 aptamers would be valuable in both therapeutic and diagnostic applications. We hypothesize that aptamers that bind to the S protein and inhibit interaction with human receptor of virus entrance ACE2 could be engineered as therapeutic drugs that prevent virus infection.

We propose to perform Systematic evolution of ligands by exponential enrichment (SELEX) to identify aptamers against recombinant S protein. To identify high-affinity spike protein aptamers, we will employ strategies that include positive/negative selection and competitive elution using soluble ACE2 receptor. Aptamer pools from selection rounds will be characterized and analyzed by next generation sequencing. We will then select aptamer sequences for binding validation studies to characterize S protein binding specificity and affinity. These aptamers could also be used in diagnostic devices to sensitively and quickly determine intact virus concentrations in patient and research samples.

Optimization of Environmental Surveillance Methods for SARS-CoV-2

John Scott Meschke, Professor and Associate Chair, Department of Environmental and Occupational Health Sciences

Project abstract
Environmental surveillance of viruses (ES) involves sampling of wastewater as a composite measure of virus circulation in a population. It is a powerful population health tool, particularly for viruses with a high rate of asymptomatic cases, SARS-CoV-2. Over the last 7 years we have developed and validated an improved method for poliovirus ES. We would like to adapt and validate that method for SARS-CoV-2.

Our method has potential application as part of a national surveillance program, and will have application in low and middle income countries where clinical surveillance systems may be lacking. ES is well suited for SARS-CoV-2 because of the documented shedding of the virus in feces, the high rate of asymptomatic infections, and the relative short persistence in persistence in the environment (suggesting any detection represents recent or current infection). We intend to perform seeded laboratory studies to validate our method recovery, using another less hazardous human coronavirus as a surrogate for SARSCoV-2.

Once methods are validated in seeded studies, we will evaluate the method’s utility to detect SARS-CoV-2 in archived Seattle wastewater samples that we have been collecting and freezing. We hope to demonstrate quantitative detection of SARS-CoV-2 RNA in wastewater.

Based on results with poliovirus, the method is expected to provide early detection of virus circulation prior to recognition of clinical cases in populations where the virus has not been identified, and provide guidance on when it is appropriate to remove interventions like social distancing based on the viral population dynamics in the sample.

Using Machine Learning on the UW Medicine Electronic Health Record to Optimize COVID-19 Response

Stephen J Mooney, Assistant Professor, Department of Epidemiology
Dustin R Long, Critical Care Fellow, Department of Anesthesiology,
Jimmy Phuong, Research Analyst/Developer, University of Washington Medicine Research IT
Monica Vavilala, Professor, Department of Anesthesiology, School of Medicine
Sean D Mooney, Professor, Department of Biomedical Informatics and Medical Education
Janet Baseman, Professor, Department of Epidemiology

Project abstract
Our cross-disciplinary team will address the challenge of allocating limited resources such as diagnostic tests, personal protective equipment, and ICU beds during the COVID-19 pandemic. UW coinvestigators from intensive and perioperative care, biomedical informatics, epidemiology, data science, and Microsoft Research scientists will jointly explore a research dataset drawn from UW Medicine’s electronic health records of persons receiving COVID-19 diagnostic tests and hospital care among those testing positive.

Our machine learning models will identify predictors of positive tests for COVID-19 from the test population to inform future decisions about whom to test and will predict clinical progression and care requirements after COVID-19 diagnosis to inform clinical decision making and utilization planning.

Using predictions from these models and publicly available administrative data, we will identify subpopulations within King County that may be at elevated risk of COVID-19 infection and geographic regions at greater risk of community outbreak. We will use the risk estimates to identify targets for enhanced surveillance amid social distancing rollback decisions.

Assessing and Addressing Impact of COVID-19 Outbreak among Latino Immigrants in King County

India Ornelas, Associate Professor, Department of Health Services
Deepa Rao, Professor, Department of Global Health
Jen Balkus, Assistant Professor, Department of Epidemiology

Project abstract
Recent public health surveillance suggests that Latinos are at increased risk for poor outcomes from COVID-19 in Washington state. While Latinos comprise 13% of the Washington state population, they represent 22% of all COVID-19 cases statewide. This may be due to underlying social determinants of health such as housing, transportation, employment and immigration policies.

In order to address the potential added burden of COVID19 on Latino communities, we propose to leverage existing expertise, community relationships and participant data from a current NIMHD funded intervention trial. Our current study assesses the impact of the Amigas Latinas Motivando el Alma (ALMA) intervention to reduce stress, depression, and anxiety among Latina immigrant women.

We propose to collect additional data from participants we have already recruited (N=150) in order to: 1) Assess impact of the COVID-19 outbreak on Latino immigrant households in King County, including exposure to COVID-19, disease severity, access to testing, health care seeking, as well as the mental health, economic and social impacts of the outbreak; 2) Develop and pilot test an online versions of the ALMA intervention to reduce stress, depression and anxiety symptoms among Latina immigrants during the COVID-19 outbreak.

Our study will help mitigate the impact of COVID-19 by directing participants in need of services to local resources and pilot testing an intervention that has the potential to reduce the negative mental health impacts of the outbreak. We will also share our findings with state and local agencies coordinating the COVID-19 response, so that Latino communities can be targeted for future prevention and recovery efforts.

COVID-19 Contact Tracing and Privacy: Informing the Debate Through User Study

Tadayoshi Kohno, Professor, Paul G. Allen School of Computer Science & Engineering
Ryan Calo, Associate Professor, School of Law
Franziska Roesner, Associate Professor, Paul G. Allen School of Computer Science & Engineering
Lucy Simko, PhD Student, School of Computer Science & Engineering

Project abstract
There is rapidly growing interest in technology-enabled contact tracing, the process of identifying potentially infected COVID-19 patients by finding recent contacts of an infected person. Governments, technology companies, and research groups recognize the potential for smartphones, IoT devices, and wearable technology to automatically track “close contacts” and identify prior contacts in the event of an individual’s positive test. However, there are significant public discussion about the tensions between effective technology-based contact tracing and the privacy of individuals.

To inform this discussion, we have begun running – and propose to continue – an online survey to capture current and longitudinal public opinion on location tracking for the purposes of COVID-19 contact tracing. Our results will uncover the diversity of opinions of individuals around the world and inform the public discussion on how to leverage technology to reduce the spread of COVID-19.

We have been running this survey weekly since April 1, 2020, with 200 people per week, and propose continuing to run it throughout the course of the pandemic, to capture snapshots of public opinion after, say, certain countries release contact tracing apps, as well as the changes over time. The funds would allow us to significantly lengthen the study longitudinally, as well as support a PhD student. We plan to disseminate our results broadly, to inform national discussions; indeed, one member of our team (Ryan Calo) recently testified before the U.S. Senate Commerce Committee about the use of technology and information to combat COVID-19.

Codeveloping Culturally Relevant Messages for Farmworker Safety and Health in the COVID-19 Pandemic

Edward Kasner, Clinical Assistant Professor, Department of Environmental and Occupational Health Sciences
Carmen Gonzalez, Assistant Professor, Department of Communication
Gino Aisenberg, Associate Professor, School of Social Work
June Spector, Associate Professor, Departments of Medicine & Environmental and Occupational Health Sciences
Maria Blancas, PhD Candidate, Environmental and Forest Sciences
Elizabeth Torres, Research Coordinator, El Proyecto Bienestar

Project abstract
Immediate and culturally appropriate public health messages about COVID-19 are needed for thousands of domestic and migrant seasonal farmworkers in the Northwest. Many of these workers are arriving from other countries and moving into dense temporary housing units for the growing season.

As the pandemic impacts rural areas, we aim to amplify ongoing efforts to build accurate occupational safety and health messages for farmworkers. We plan to use an approach that supports farmworkers with identifying and filtering scientifically sound messages. These techniques can be applied to the ongoing pandemic and other emerging issues going forward.

The project will result in COVID-19 specific public service announcements, radio spots, social media messages, and infographics. It will also outline what is learned about emergency communication in rural agricultural communities. These findings will have both regional and national impact by leveraging the networks of the co-investigators and the Pacific Northwest Agricultural Safety and Health Center’s cooperative agreement with the Centers for Disease Control and Prevention.

Rumor Dynamics Online During the COVID-19 Crisis

Emma Spiro, Assistant Professor, Information School
Kate Starbird, Associate Professor, Department of Human Centered Design and Engineering
Jevin West, Associate Professor, Information School

Project abstract
On January 24, we started collecting tweets containing hashtags and search terms related to COVID-19. On February 2, the World Health Organization declared a “massive infodemic,” pointing to an overwhelming information ecosystem flooded with both true and false information about COVID-19. Today, we now have more than 400 million tweets capturing conversations filled with rumors, reliable information, misinformation and disinformation.

At the Center for an Informed Public, we are uniquely positioned to interrogate this data, track these rumors and ask, for example, how non-experts have risen so quickly in influence and directed the conversation sometimes more than the experts and public health officials. We can examine specific rumors and conspiracy theories to see where they are amplified and where they are refuted. We can examine the variance of reported statistics (e.g., estimates of disease spread and infection counts) and how this differs and spreads on social media based on network position.

In addition to our own research questions, we look to collaborate with others at UW, especially health experts, to ask questions specific to their communities. It is at this interface we see the most potential with this data. Ultimately, the goal is to better understand online discourse during this pandemic and come up with strategies for improving collective action and sensemaking within science and society.

UVGI Decontamination and Reuse of N95 Respirators for First-Responders

Jonathan D. Posner, Professor of Mechanical Engineering and Family Medicine (adjunct)
Tom Rea, MD, Professor of Medicine, Harborview Medical Center, Medical Program Director, EMS Division, King County Public Health
Michele Plorde, Director of EMS Division,
Michael Sayre, Professor, Department of Emergency Medicine, Medical Director, Seattle Fire Department
C. Dennis Dahline, Deputy Chief, Battalion 3 – Medic One, Seattle Fire Department
Dave Van Valkenburg, Deputy Chief, Kirkland Fire Department

Project abstract
The COVID-19 pandemic has driven a global shortage of PPE for doctors and first responders, specifically N95 respirators. Currently, many first responders have been assigned multiple N95 respirators and are being asked to reuse them to conserve the supply. U.S. regulatory institutions (e.g. CDC, FDA) and several peer-reviewed reports have provided guidelines for acceptable N95 decontamination, including ultraviolet germicidal irradiation (UVGI) which UW Medicine has adopted at three hospital locations.

Although the CDC has provided some recommendations on several disinfection technologies, we are recommending UVGI decontamination as a viable solution because it has gained traction in King County (UW Medicine, Kirkland Fire), has limited risk to operate, only requires electricity to function, requires minimal training, and has solid research that supports acceptable levels of decontamination while retaining adequate performance of N95 masks for reuse. Fire, police, and EMS operate out of more than 100 locations distributed throughout King County, have multiple shifts, and have a culture of handling their own PPE. These unique working conditions would require significant logistics and coordination to use UW Medicine centralized UVGI decontamination services (if capacity exists and is feasible).

Seattle and Kirkland Fire, and King Country EMS have expressed the need for decentralized, small-scale, rapid, decontamination of N95 and will not be able to centralized UVGI decontamination services. We propose to design and construct UVGI decontamination boxes (on the scale of a small refrigerator) that can be placed in individual first-responder buildings to decontaminate N95 masks for reuse. Local firefighters and EMS will be engaged in the design process and the UVGI boxes will be fabricated by local contractors. We will verify that recommended UV dosage is achieved over a 10- to 15-minute period.

Assessment of Disparities in COVID-19 Testing and Outcomes in King County, WA: Implications for Cumulative Impacts in Low-Income, Minority, and Health Compromised Communities

Stephanie Farquhar, Clinical Professor, Department of Health Services and Department of Environmental and Occupational Health
Edmund Seto, Associate Professor, Department of Environmental and Occupational Health Sciences
Esther Min, PhD student, Department of Environmental and Occupational Health Sciences
BJ Cummings, Manager of Community Engagement, Interdisciplinary Center for Exposures, Diseases, Genomics and Environment (EDGE Center), Department of Environmental and Occupational Health

Project abstract
Recent data from Milwaukee, Detroit, and New York City have highlighted racial disparities in the death rates from COVID-19, with African American and Latino populations experiencing higher death rates than whites in those cities.

Washington State has just begun to report demographic data on COVID-19 deaths, but the publicly-released data is still incomplete. The state also reports zip code data, which can be correlated with demographic data to examine geographic disparities associated with low-income and minority populations, though the publicly-released data for COVID-19 testing in these reports is also incomplete.

The proposed research project will (1) compile publicly available but not yet released data to develop a comprehensive understanding of racial and geographic disparities in Covid-19 testing and deaths in King County, Washington; and (2) compare any disparities detected to known risk factors for susceptibility to COVID-19 by race and zip code within the county.

Candidate risk factors will include underlying health conditions, including prevalence of asthma, heart disease, and diabetes; environmental conditions, particularly air quality metrics (e.g., PM 2.5); and socioeconomic influences related to access to health care, such as poverty rates and medical insurance coverage. Implications for cumulative health risks of COVID-19 and pre-existing health disparities will be explored and evaluated to inform future research and policy recommendations.

Examining the Impact of the COVID-19 Pandemic on Food Systems, Food Security, and Food Access in Washington State

Adam Drewnowski, Professor, Department of Epidemiology
Jennifer Otten, Associate Professor, Department of Environment and Occupational Health Sciences
Sarah Collier, Assistant Professor, Department of Environment and Occupational Health Sciences
Laura Lewis, Associate Professor, Community and Economic Development, Washington State University,
James Buszkiewicz, Doctoral Candidate, Department of Epidemiology
Chelsea Rose, Research Coordinator, Department of Epidemiology
Alan Ismach, Research Coordinator, Department of Health Services and Center for Public Health Nutrition

Project abstract
The COVID-19 pandemic has disrupted multiple components of the food system, affecting the food supply and greatly reducing consumer purchasing power. Food production, processing, and delivery systems are experiencing instability. There is an unprecedented need for unemployment benefits, public assistance programs, and food from local food banks. Food systems are changing, perhaps forever, and the consequences on diets, health, and wellbeing of US households remain to be assessed. Moreover, local, state, and federal measures to mitigate the dietary and health consequences of COVID-19 lack geo-located and granular data to aid in decision-making.

The proposed online survey will assess recent changes in food access pathways, the types of foods acquired, their nutritional value and their price. We also propose to assess food insecurity and economic well-being, with an emphasis on lower-income households. The survey will focus on households in five most affected Washington State counties: King, Snohomish, Pierce, Yakima and Spokane.

Using the survey data, we will make and map estimates of prevalence of measures and compare the responses to pre-pandemic estimates, and we will explore differences in measures by relevant characteristics and location. The study will provide insights to Washington State agencies trying to respond to rapid-scale alterations in the food system and in food demand, inform Washington State efforts currently under way and led by WSU that are measuring and mapping food bank system needs by County, and be used to model food systems resilience and preparedness for future pandemics, disaster events and large-scale shocks.

Design Determinants of COVID-19 Impacts to Essential Business and Service

Jan Whittington, Associate Professor, Department of Urban Design and Planning
Gundula Proksch, Associate Professor, Department of Architecture

Project abstract
How do the physical design and service models of essential services and businesses worsen or improve the prospect of business continuity, economic success, and social welfare in the COVID-19 pandemic? Physical distance reduces the reproducibility (R0) of the virus and therefore the rate of infection of SARS-CoV-2 in the population. Services critical to our continued health and well-being are encouraged or required by policy to continue operations, yet providers may find that their facilities and service models leave them with limited ability to maintain a physical distance of six feet or more. With the advent of social distancing policy, physical facilities can limit the adaptability of service delivery, leading to differential pressure on organizations to change or curtail services, seek outside funding, furlough or lay off employees, form partnerships, seek hard-to-find protective equipment, or close.

This research examines facilities and services in the City of Seattle, including 1) public infrastructure services (e.g., electricity, water, parks, transportation), 2) private and non-profit organizations in the food service industry, such as retail grocery and restaurant services, newly recognized as essential businesses in COVID-19 related policy, and 3) the delivery access to housing, on the rise since the advent of physical distancing policy.

This is empirical, mixed-methods research, surveying for patterns of facility designs, service models and modifications, and economic outcomes for providers, prior to and during the pandemic. This analysis will allow us to deduce likely economic effects of continued or renewed social distancing policy and make design recommendations that ease their implementation.

Prevailing Impacts of COVID-19 on Rental Housing Markets Across Metropolitan Areas and Neighborhoods

Rebecca J. Walter, Assistant Professor, Runstad Department of Real Estate
Arthur Acolin, Assistant Professor, Runstad Department of Real Estate
Kyle Crowder, Professor, Department of Sociology,
Christian Hess, Postdoctoral Fellow, Rutgers University-Camden, Center for Urban Research & Education
Ian Kennedy, Graduate Student, Department of Sociology

Project abstract
The purpose of this project is to model the immediate impacts of the COVID-19 pandemic on housing markets in the 100 most populated metropolitan areas in the United States. Early signs indicate that the pandemic has led to an immediate slowdown in rental housing markets, but the longer-term impacts are likely to vary dramatically across metropolitan areas and their neighborhoods. The public health crisis is likely to affect volume of rental listings, rental rates, residential mobility decisions, and evictions, and there is reason to believe that the effects will be felt most strongly in relatively disadvantaged neighborhoods.

Using a novel national rental database, we will specifically assess the impact of the first COVID-19 case and death in each metro area and the timing of stay-at-home orders on the volume of online rental listings and asking rents across different markets and housing types, with a particular focus on affordable units. We will use a difference-in-difference research design to estimate trends corresponding to the COVID-19 outbreak and a regression framework to adjust for relevant population and housing differences between metropolitan areas and neighborhoods. The initial findings will inform an application for external funding to support research on the long-term impacts of the COVID-19 pandemic on housing markets and neighborhoods across the United States.

Measuring and Assessing Occupational Health and Safety in Low-Income Countries During COVID-19

Rachel Heath, Associate Professor, Department of Economics
Tyler McCormick, Associate Professor, Department of Statistics and Department of Sociology

Project abstract
In low-income countries, data on occupational health for many workers in large industrial settings (e.g., garment manufacturing) are extremely scarce and millions of individuals live in perpetually precarious economic circumstances. Extreme social distancing measures are likely counterproductive in areas where work cannot easily be shifted to workers’ homes, so many factories are still operating.

Given that the steps required to conduct a standard survey are infeasible in a time frame that is useful in understanding response to COVID-19, this proposal develops and implements a mobile-phone based network sampling strategy to quickly obtain representative samples of workers in low-income settings, providing critical insights about the scope and scale of COVID-19 responses in the workplace.

This project will (i) develop a sampling strategy for telephone-based interviews that begins with a convenience sample but yields representative estimates of key population quantities; (ii) leverage an existing convenience sample of garment manufacturing works to survey 2,000 workers using this strategy; and (iii) analyze these results to better understand the reaction of large garment manufactures to the COVID-19 pandemic.

This project will then answer the following policy-relevant questions: 1. What is the prevalence of factory shutdowns, and the prevalence of measures to prevent the spread of COVID among factories that continue operating? 2. Are the measures taken by factories effective at preserving workers’ health? 3. What are the socioeconomic consequences of factory shutdowns?

Washington State COVID-19 Pregnancy Collaborative

Kristina Adams Waldorf, Professor, Department of Obstetrics & Gynecology
Erica Lokken, Post-Doctoral Associate, Department of Global Health
Ronit Katz, Research Associate Professor, Department of Biostatistics
Shani Delaney, Associate Professor, Department of Obstetrics & Gynecology
Sheela Sathyanarayana, Associate Professor, Department of Pediatrics
Amritha Bhat, Assistant Professor, Department of Psychiatry & Behavioral Sciences

Project abstract
The objective of this proposal is to investigate the effects of a highly communicable infectious disease leading to severe pneumonia and death (COVID-19) in pregnant women in Washington State. The World Health Organization (WHO) recently declared a 2019 novel betacoronavirus (SARS-CoV-2) as a pandemic and public health emergency. Pregnant women are typically a highly vulnerable group to pathogenic respiratory viruses and have the highest WHO priority for influenza vaccination in a pandemic.

Our central hypothesis is that COVID-19 infections in pregnancy increase the risk for spontaneous abortion, preterm birth, stillbirth, intrauterine growth restriction and mental health disorders in the mother. We have obtained University of Washington (UW) Institutional Review Board (IRB) approval and site IRB reliances for a multi-site prospective chart review of prenatal and neonatal medical records across the majority of health systems in Western Washington (6 hospitals/hospital systems, >20 investigators).

In Aim 1, we will determine the natural history of COVID-19 infections in pregnancy and the impact on maternal, fetal and neonatal outcomes. The PHI Rapid Response Grant will provide critical bridge funding for project management and to launch additional study sites across the State of Washington.

Our objective is to rapidly inform clinical care through a series of publications targeting questions that have immediate relevance for public health and clinical care provided by obstetrical, pediatric and psychiatric providers. Collectively, these studies will provide novel information on how COVID-19 disease impacts the health of pregnant women and their neonates in a large population-based prospective cohort.

COVID-19 Maternal and Infant Mental Health Responses in a Sample of Low-income Families

Liliana Lengua, Professor, Department of Psychology
Stephanie Thompson, Research Scientist, Department of Psychology
Becca Calhoun, Training and Evaluation Specialist, Department of Psychology

Project abstract
COVID-19 is likely to impact the mental health of parents and children, not only through exposure to illness, but also through changes in employment and social factors. These effects may be particularly pronounced for individuals experiencing prior economic strain, mental health symptoms, and disadvantage.

The current proposal seeks to assess COVID-19 related concerns, social and economic stressors, and mental health in 210 mothers and their infants who were living in low-income contexts (<2x Federal poverty cutoff) prior to the outbreak of COVID-19. This sample is currently participating in an on-going study on the impact of pre- and postnatal adversity, maternal mental health, and parenting on infant cognitive, emotional, and social development.

Children in the study are currently 6-36 months of age. The sample is racially and ethnically diverse (respondents endorsed all that apply: 41% African American or Black, 13% Asian American, 20% Latino or Hispanic, 8% Native American or Alaskan Native, 4% Hawaiian or Pacific Islander, 44% White). Mothers were recruited while pregnant with their first child, and have participated in either 3 or 4 of 5 total assessments in the ongoing study. The ongoing study has comprehensive assessments of income-related stressors, family context, maternal mental health, parenting, cortisol, and infant physiological stress responses and emotional adjustment.

This study will provide critical information on the COVID-19 specific experiences of this vulnerable population, the prior/existing family context that contributes to resilient or vulnerable responses to COVID-19, and the changes in maternal and infant mental health specifically related to COVID-19 experiences.

Mitigating the Mental Health Consequences of the COVID-19 Crisis

Jonathan Kanter, Research Associate Professor, Department of Psychology
Christine Leibbrand, Acting Assistant Professor, Department of Sociology
Adam Kuczynski, PhD Student, Department of Psychology

Project abstract
Science suggests that the mental health consequences of the COVID-19 crisis should not be underestimated, with profound effects on physical and mental health for many individuals.

Aim 1 of this project is to understand and document the mental health consequences of the crisis with a Seattle (n = 500) and national (n with funding = 2,000) sample. Participants complete a smartphone survey every evening for 75 (Seattle) and 28 (national) days asking about infection status, social interactions, anxiety, depression, loneliness, and other psychological and behavioral responses. We aim to identify who is and is not coping well. To inform responses to the crisis, we will disseminate these data to public health officials, other scientists, and the public with a real-time visualization dashboard. Leading authorities, such as the World Health Organization, identify the need for scalable, low-cost interventions that can be administered to large numbers of people during this crisis.

Aim 2 is an evaluation of a scalable, mobile-based intervention to improve coping with the crisis and to maximize mental and relational health, prioritizing depression. Participants from our national sample are randomly assigned to intervention or control. Intervention participants will receive the intervention daily on their smartphones across Days 7 – 21 of the study, and all will receive maintenance assessments at 8 and 16 weeks. Funding will increase our sample size to 2,000, allowing us to speak to national trends over time, to conduct crucial moderator analyses and identify groups in need, and to help as many people as possible.

The Staying in Touch and Engaged Project

Seema L. Clifasefi, Associate Professor, Department of Psychiatry & Behavioral Sciences
Susan E. Collins, Professor, Department of Psychology
Lonnie Nelson, Assistant Professor, College of Nursing (Washington State University)
Noah Fay, Director of Housing, Downtown Emergency Service Center

Project abstract
People experiencing chronic homelessness are multiply affected by psychiatric, medical and substance use disorders and, even when housed, are living in congregate settings. These risk factors make this population among the most vulnerable to contracting and dying from the 2019 novel coronavirus disease (COVID-19).

Given the “Stay at Home” directive, residents in supportive housing are not allowed visitors, which puts them at additional risk for social isolation and its sequelae: increased mental health and substance-use symptoms. These concerns were raised by our longtime research partners who are management, staff and residents at the Downtown Emergency Service Center (DESC), Puget Sound’s largest provider of supportive housing to people experiencing chronic homelessness.

In response, we cocreated the “Staying in Touch and Engaged Project” (STEP), which aims to support DESC residents in staying in touch with researchers and in engaging in meaningful activities during the COVID-19 outbreak and social distancing directives. A 16-week, two-group randomized controlled pilot trial will compare remote assessment of substance-use and health-related quality of life assessment paired with immediate versus delayed provision of remotely delivered meaningful activities. Weekly contacts will be made as preferred by participants (via postal mail, online, phone) and comprise packages and online content comprising information about COVID-19, physical and mental health-supportive messaging, and meaningful activities (creative writing prompts, art project ideas, puzzles, art supplies).

Findings will determine whether the STEP’s remote assessment and intervention strategies can facilitate data collection, maintain participants’ engagement, and ameliorate substance use and health-related quality of life (HR-QoL) outcomes.

Preparing the Global Vaccine Cold Chain for COVID-19 Immunization Campaigns

The funding for this award came via a partnership with the UW Office of Global Affairs, which seeks to enhance the UW’s global engagement and reach.

Richard Anderson, Professor, Paul G. Allen School of Computer Science and Engineering
Waylon Brunette, Post-Doctoral Scholar, Paul G. Allen School of Computer Science and Engineering

Project abstract
When a COVID-19 vaccine is available there will be massive immunization campaigns around the world to make sure that everyone is protected. While there is much uncertainty on how long vaccine development will take, and what the formulation of the vaccine of the will be, it is critical that planning begins early to ensure that proper logistical systems are in place as the COVID-19 campaigns will likely be the largest ever undertaken. For low-income countries, a significant concern is the capacity and quality of the vaccine cold chain so that there is adequate cold storage to keep vaccines safe until administered. This will require national assessments of the vaccine cold chain. It will also be essential to have information systems that allows real-time reporting of vaccine stocks during the campaign.

This work will focus on strengthening information systems to support cold chain equipment assessment, immunization campaign planning, and vaccine logistics during a COVID-19 immunization campaign. This project will build on our existing work in creating a Cold Chain Information System that allows district-level workers to communicate with the national system on the status of immunization logistics. Our current cold chain system includes an Android application built on UW’s ODK-X. Currently, the application is being piloted in Uganda with additional deployments launching in collaboration with WHO in DRC, Pakistan, and Bangladesh. We will extend the system to support immunization campaigns with dashboards for cold chain capacity planning and tools for tracking and managing distributions of vaccines and reporting immunizations.

Readying Pharmacies to Participate in COVID-19 Testing and Vaccination in Washington State

Jennifer L. Bacci, Assistant Professor, Department of Pharmacy
Jenny Arnold, Director of Pharmacy Practice Development, Washington State Pharmacy Association
Parth Shah, Assistant Member, Fred Hutch
Bryan Weiner, Professor, Department of Global Health

Project abstract
Pharmacies play a vital role in preparedness and response to pandemics and other public health emergencies in Washington State. The Washington Statewide Pharmacy‐Local Health Jurisdiction Memorandum of Understanding (MOU) and its Activation Plan are statewide templates that help coordinate existing pharmacy infrastructure and workforce to support the health and medical needs of an affected population during a public health incident, emergency, or disaster.

Given the existing statewide template MOU for local public health jurisdictions to enter into with pharmacies, there are significant opportunities to leverage the pharmacy workforce in population-level responses to the SARS-CoV-2 (COVID-19) outbreak in Washington State and better prepare for future pandemics and disease outbreaks and epidemics. Specifically, pharmacies can be used to expand testing for COVID-19 and for mass vaccination once COVID-19 vaccines are Food and Drug Administration approved and become available. However, ensuring community pharmacy’s readiness for pandemic response and adapting statewide standardized templates to COVID-19 will be critical to successfully deploying this health care workforce to help mitigate the novel COVID-19 pandemic.

This project seeks to rapidly increase community pharmacies’ organizational readiness to implement COVID-19 testing and vaccination through adaptation of the MOU Activation Plan to the context of the current COVID-19 pandemic using facilitated discussions with public health and community pharmacy partners. The project will result in the (1) development and dissemination of an updated MOU Activation Plan specific to COVID-19, (2) identification of tasks and resources that are needed to assist pharmacies in implementing COVID-19 testing and vaccination, and (3) increase community pharmacies’ organizational readiness for COVID-19 testing and vaccination.

Ultimately, this project serves to expand COVID-19 testing in Washington State by using community pharmacies and preparing these settings for eventual COVID-19 vaccination efforts.

Artificial Intelligence-Based Analysis of Electrocardiograms to Predict Life-Threatening Cardiovascular Outcomes in Patients with Coronavirus Disease of 2019 (COVID-19)

Patrick Boyle, Assistant Professor, Department of Bioengineering
Alison Fohner, Assistant Professor, Department of Epidemiology
Arun Sridhar, Assistant Professor, Department of Medicine (Cardiology)
Neal Chatterjee, Assistant Professor, Department of Medicine (Cardiology)
Jeanne Poole, Professor, Department of Medicine (Cardiology)

Project abstract
Since its initial identification, the coronavirus disease of 2019 (COVID-19) has spread to over 190 countries across the world, killed nearly 20,000 people, and brought the global economy to a standstill. COVID-19 is highly infectious, with nearly twice the reproduction number (R0 value) as seasonal influenza. It is also lethal, with a mortality rate ~340 times that of seasonal influenza and even higher in aged patients and those with comorbidities. COVID-19 has been declared a pandemic by the World Health Organization.

The most common morbidity of the disease is severe pneumonia leading to Acute Respiratory Distress Syndrome (ARDS), but many COVID-19 patients also experience poor cardiovascular outcomes (e.g., arrhythmia, myocarditis, sudden cardiac death). Given the infectious nature of the disease, routine testing with serial electrocardiograms (EKGs) and echocardiograms to monitor for cardiovascular risk is impossible since would expose healthcare professionals to an unacceptably high risk of exposure.

Thus, our team has devised a plan to use artificial intelligence (AI) to pinpoint COVID-19 patients at risk for adverse cardiac outcomes using a single EKG recording acquired at hospital intake. Identifying these patients most in need of care will allow clinicians to monitor and provide treatment, while minimizing their own risk and eliminating unnecessary testing. AI has been used successfully in similar areas, such as identifying patients with atrial fibrillation using EKGs acquired in the absence of arrhythmia. Thus, we surmise that AI can be used to identify those with risk of life-threatening cardiovascular complications using COVID-19 intake EKGs.

FIRST Universal SARS-CoV-2 Vaccines

James I Mullins, Professor, Department of Microbiology
Deborah H. Fuller, Professor, Department of Microbiology
Jesse Erasmus, Postdoctoral Scholar, Department of Microbiology
Jim Fuller, Research Scientist, Department of Microbiology

Project abstract
Nearly all SARS-CoV-2 vaccines efforts are aimed at directing neutralizing antibodies (NAb) towards the viral Spike protein, intended to block the virus from entering cells through its normal receptor. However, these same Spike-directed NAb also have the potential to facilitate viral entry into immune cells through a different receptor, which can lead to Antibody Dependent Enhancement (ADE) of infection and disease. Antibodies from SARS virus infected persons induce ADE in cell culture but it is unclear if this occurs in people. Furthermore, we do not know how much the Spike gene might evolve before possibly returning with new waves of infections. Hence, new Spike vaccines may need to be developed each year the virus returns, as is needed to fight influenza.

We therefore need to rapidly develop alternative vaccines to stop COVID-19 pandemics from current and mutated strains that might circulate in future years. To this end, we designed vaccines to Focus Immune Responses on the Structural inTegrity (FIRST) of SARS-CoV-2 viral proteins. FIRST vaccines are intended to drive T cell and antibody responses that avoid antigenic features of each protein most likely to result in ADE while targeting features unlikely to change rapidly. Here, we will determine the expression of FIRST immunogens in cells and immune responses elicited in mice following delivery as RNA. Subsequently, lead immunogens will be tested with alternative delivery platforms to enable greater stability, lower manufacturing costs and needle free vaccination and a lead formulation selected to take forward into non-human primates and clinical trials.