Population Health

February 9, 2021

Initiative-funded COVID-19 rapid response grantees report final results

CDC coronavirus imageThe University of Washington Population Health Initiative funded 21 COVID-19 rapid response grants to faculty-led teams in April 2020. Since April, the interdisciplinary project teams have made significant progress towards understanding and mitigating the impacts of COVID-19 on multiple facets of life. The projects are now closing out, and highlights of each one are shared in the accordions below.

“The results from these 21 projects exceeded even our highest expectations for the level of impact that could be quickly realized by our faculty, students and staff,” said Ali H. Mokdad, the university’s chief strategy officer for population health and professor of health metrics sciences. “The project teams’ findings helped to advise governments and community groups on pandemic response, expanded the scientific community’s understanding of the virus and its impacts through publications in peer-reviewed journals, influenced individual action through reporting in the mass media, rapidly developed proofs-of-concept that could be scaled through additional grant funding, and more.”

The interdisciplinary project teams that realized these results were collectively composed of individuals representing 10 different UW schools and colleges. The $350,000 in initiative funding was partially matched by additional school, college and departmental funds, bringing the total value of these awards to roughly $820,000.

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

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

Project summary
The goal of this project was to use protein-SELEX to identify SARS-CoV-2 S protein-
binding aptamers using recombinant SARS-CoV-2 S protein. The team designed several selection strategies and conducted multiple rounds of selection for each strategy. Selection rounds were then characterized by next generation sequencing followed by sequence analysis to select top sequences for evaluation.

The identified SARS-CoV-2 aptamers would be valuable in both therapeutic and diagnostic applications. These aptamers could also be used in diagnostic devices to determine intact virus concentrations sensitively and quickly in patient and research samples.

Through this approach, the team identified two aptamer sequences that were enriched by multiple selection strategies. They evaluated binding characteristics of these aptamers through flow cytometry analysis with recombinant proteins and found that the aptamers bind to SARS-CoV-2 S protein, but not to SARS-CoV1 or MERS S protein. The team is fully characterizing the SARS-CoV-2 binding aptamers for binding constants and kinetic constants through biolayer interferometry and additional flow cytometry studies.

The specificity of these aptamers suggest they will be promising agents for SARS-CoV-2 diagnostics. The results from these studies were submitted for follow-on funding to the NIH and other granting organizations.

Optimization of Environmental Surveillance Methods for SARS-CoV-2

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

Project summary
This project focused on environmental surveillance of SARS-CoV-2 with the goal to adapt environmental surveillance methods developed for other viruses to SARS-CoV-2 and to monitor for the virus in Seattle area wastewater. Environmental surveillance involves sampling wastewater as a composite measure of virus circulation in a population, as it is well suited for SARS-CoV-2.

The project team performed seeded laboratory studies to validate their method recovery, using another less hazardous human coronavirus as a surrogate for SARSCoV-2. The Bag-Mediated Filtration System (BMFS), with and without VertrelTM extraction, had the highest effective volume assayed (11.90 and 10.41 mL, respectively) when compared to four other methods. However, this did not translate to the highest percent recovery. Because the BMFS concentrated the largest volume of sewage of the methods tested, it is likely that inhibitors present in the wastewater reduced detection.

Direct sludge extraction performed the best for two of the wastewater treatment plants, while the third plant had equal detection using the BMFS and skimmed milk (with and without VertrelTM extraction). This indicates the need for selecting the concentration method depending on the specific water matrix.

SARS-CoV-2 environmental surveillance could be used as an early warning system with additional research focused on improving enumeration via digital PCR use and determination of ideal sampling locations. The work will continue for the foreseeable future, providing a baseline of the area of other researcher, WA State Department of Health, and king County Wastewater Treatment Division.

This research has already informed Washington State’s application of CARES (Coronavirus Aid, Relief, and Economic Security) funding for wastewater surveillance, guiding the method chosen for sampling and concentration. This work has or will inform the submission of multiple grant applications including NIH U01, NIH R21, and US EPA Environmental Justice grants.

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

Investigators
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 summary
The cross-disciplinary team aimed to 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 jointly explored 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 to predict clinical progression and care requirements after COVID-19 diagnosis.

The team developed a dataset comprising tests and predictors for over 72,000 patients. They examined demography of patients, confirming that, as in the county at large, positive tests were more common among Hispanic men. Geography also played an important role. Although the positive test rate was comparable throughout the region in the beginning of the pandemic, a substantial cluster grew in the Federal Way area though the summer. Models were able to predict initial COVID-19 test results with high precision. Information in the clinical records could accurately identify 60% of those who would ultimately test positive. Machine learning prediction was also more accurate on inpatients than on outpatients or community testing patients, both because more clinical data was available for inpatients.

The results show that data currently collected in routine clinical care can be used to triage COVID-19 testing, with the most informative predictor of test results being home geography. The team has three steps to extend and apply their research results. The team is now looking to extend and apply their research results, including drafting manuscripts targeting clinical research audiences, partnering with King County DOH to help influence COVID relief strategies, and seeking follow-on funding to broaden insights of COVID in King County.

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

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

Project summary
The project team proposed to leverage existing expertise, community relationships and participant data from a current NIMHD funded intervention trial to address the potential added burden of COVID19 on Latino communities . Their current study assessed the impact of the Amigas Latinas Motivando el Alma (ALMA) intervention to reduce stress, depression, and anxiety among Latina immigrant women.

The team collected additional data from participants they 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 version of the ALMA intervention to reduce stress, depression and anxiety symptoms among Latina immigrants during the COVID-19 outbreak.

After completing the survey, the results reported higher rates of mental health issues, work and financial concerns due to the pandemic. The two focus groups highlighted aspects of the intervention that were especially helpful: breath, body and emotional awareness practices, doing the sessions during an already stressful time, and having time together to dedicate to themselves and relax.

The project team plans to disseminate a research brief summarizing their survey findings to their community partners, including Casa Latina, El Centro de la Raza, SeaMar Community Health Centers, and Public Health – Seattle King County. They will be adapting the full ALMA curriculum from an eight-week in person program to a six-week program delivered via Zoom and will have an opportunity to test this adaptation in their currently funded NIMHD trial. The focus group results will also be helpful for Public Health-Seattle King County in developing COVID-19 prevention messaging for this key population that is overly burdened by COVID-19 morbidity and mortality in our region.

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

Investigators
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 summary
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, this project aimed to present the results of a sequence of online surveys focused on contact tracing and privacy, each with 100 participants.

The survey has been running weekly since April 1, 2020 and has captured snapshots of public opinion over time. The team’s key findings were robust, and broadly touch these three points:

  1. Adoption of contact tracing applications is increasing, though slowly.
  2. Public opinion over time is largely stable. For example, when accounting for those who have already downloaded contact tracing apps, questions about those who say they would be somewhat or extremely likely to download a contact tracing application in the best possible privacy situation (perfect privacy) is essentially stable, with a 0.25% decrease per week (p=.012).
  3. The public have longitudinally stable and clear values and concerns about data sources and sharing.

The team plans to continue gathering and analyzing their data to submit a future version of this report to conferences and academic journals in the field.

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

Investigators
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 summary
The goal of this rapid response project was to co-develop accurate and approachable public service announcements, radio spots, social media messages, and infographics about COVID-19 for agricultural employees. As the pandemic increasingly impacted farmworkers in rural communities, the team aimed to identify trusted sources of information and techniques that could be applied to the ongoing pandemic and other emerging public health issues like wildfire smoke events.

Surveys from 50 farmworkers identified trusted sources of COVID-19 information. Among those who responded, about 65% made changes to their behavior as a result of information from a trusted source (30% news/internet, 10-15% each for work, clinic, family/friends). Approximately 25 COVID-19 multimedia products were co-developed with key messages about mask use, cleaning, disinfection, and other agricultural safety and health measures. These products were disseminated through print, radio, and online media. Alongside the efforts of community health workers, local health districts, and other stakeholders, this project broadened the reach of COVID-19 information in agricultural communities.

The overall findings show that while online tools have helped us stay connected, informed and responsive, it has also enabled an infodemic that can jeopardize control of the pandemic. Resources are needed to help communities, including agricultural communities, evaluate messages for truth, stay updated about changing messages and decide what information is worth sharing.

Rumor Dynamics Online During the COVID-19 Crisis

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

Project summary
The research team focused on narratives surrounding mask recommendations, as well as the scientific evidence and arguments for mask-related public health guidelines. They have specifically focused on social media posts from state governors that contain mask-related content and the public response and engagement with this content (via replies). Significant work over the summer was devoted to developing a qualitative coding scheme to categorize different dimensions of this content, for example the different scientific theories and evidence brought to bear for both pro- and anti-mask arguments.

Preliminary analysis indicates that not only did governors activity increase greatly in late May and June, but the public response to the content was largely negative, questioning the actions and information posted by the governors, as well as negative sentiment directed at the governors themselves and largely ignoring the post content itself.

A primary aim of this project was to support pilot work for a competitive funding proposal. The research supported by this grant provided the basis for an NSF RAPID Award. The NSF-funded work builds on this PHI-funded research and aims to understand how scientific knowledge, expertise, data, and communication affect the spread and correction of online misinformation about an emerging pandemic.

UVGI Decontamination and Reuse of N95 Respirators for First-Responders

Investigators
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 summary
The project team designed and constructed 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 were engaged in the design process and the UVGI were fabricated by local contractors. This is response to the global shortage of PPE for doctors and first responders, specifically N95 respirators.

The project’s designed decontamination box delivers at least 1000 mJ/cm2 dose of 254 nm light to all surfaces of each respirator. Computer simulations and detailed dose validation studies showed that all the surfaces of each of the fifteen masks received at least the recommended dosage. The box is designed to be robust for use by first responders and fabricated from stainless steel, aluminum, and heavy-duty components. It only has a single button to operate and three indicator lights to show that the box is receiving power, the lamps are running, and the cycle is complete.

Fifty-four UVC N95 boxes have been fabricated and 40 of them have been distributed to King County public service organizations. Dave Van Valkenburg, Deputy Chief of Kirkland Fire, served as the liaison between UW and the various King County public service organizations who have received boxes. Demand for additional boxes has remained strong and the team will continue to raise funds to manufacture and distribute boxes at subsidized cost. The public service organizations agreed to partially support this effort by either providing gifts or being invoiced by UW, as reflected in the budget.

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

Investigators
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 summary
This study assessed community-level social and environmental factors that are associated with risk of exposure to COVID for the Seattle, King County, Washington region. The study sought to compare COVID-19 test positivity rates to other risk factors, such as environmental risks, socioeconomic factors, and health conditions at the census tract level.

As of July 12th, 2020, many communities with greater than 10% positivity rates (number of positive cases among all tests distributed) had below average testing rates. Of the 397 census tracts in King County, 64 tracts had 10% or greater positivity rates and 83% of these 64 census tracts also had below average testing rates compared to the rest of the county. These same communities are also highly impacted by environmental health disparities, with residents exposed to high concentrations of pollution. Many of the communities that have high positive tests are in Hispanic and Black neighborhoods.

The findings highlight the continued need for increased testing and disease control resources in the southwestern region of King County. In addition, they suggest that culturally appropriate multilingual outreach and community engagement may be important considerations for regional efforts to slow the spread.

Finally, because communities affected by COVID-19 positivity rates are also impacted by higher levels of PM 2.5 and other environmental health disparities, community level vulnerabilities and chronic stressors for low income communities and communities of color should be considered when assessing for risk of exposure to and health complications resulting from COVID-19. It will be important to assess the role of community-level factors that continuously affect equity in the pandemic and post-COVID recovery efforts.

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

Investigators
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 summary
The goal of the project was to examine COVID-19’s impacts on both household food access and economic security across Washington State. Using surveys, the team assessed recent changes in food access pathways, the types of foods acquired, their nutritional value and their price. The team also assessed food insecurity and economic well-being, with an emphasis on lower-income households.

Overall, 30% of respondent households were found to be food insecure. Over half (58%) of respondents with incomes less than $15,000 and 44% of respondents without a college degree were found to be food insecure. Respondents of color were more than 1.5 times as likely to be food insecure compared to white respondents. However, despite the burden of food insecurity, little change the proportion of respondents using food assistance was observed during COVID-19, compared to the prior year. Overall, 33% of households in the sample sought some form of food assistance. Of those, most were satisfied with benefits received, although there were issues reported with both access and variety.

The data has helped highlight areas of particular need throughout Washington State. Northwest Harvest plans to utilize the findings as a resource in a case being built by their network calling for Congressional action on a COVID-19 relief package. WSU Extensions plans to utilize these findings to better inform the COVID-19 responses being carried out through WSU Extension offices. The findings have been shared with the National Food Access and COVID Research Team, and will help to inform the study and survey designs of other researchers across the nation responding to COVID-19.

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

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

Project summary
This research examined 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 allowed us to deduce likely economic effects of continued or renewed social distancing policy and make design recommendations that ease their implementation.

For the food retail industry (n=926), policies to restrict in-person dining resulted in the closure of 25 percent of businesses (n=237). Results suggest that facility design was a determining factor, as businesses with parking lots, within strip malls, with drive-thru facilities and in converted homes were more often open, and storefronts were closed in the same proportion as the population as a whole, while food courts, marketplaces and storefront on alleys were more likely to be closed.

For the public sector, results suggest that employees maintained business continuity through the initial months of social distancing policy despite relocating an estimated 85 percent of employees to remote work. This involved repurposing tasks for several groups over a peak period of about six weeks, exhausting all existing supplies of technology useful to remote workers, and supporting personnel whose critical functions for the city necessitated work on premises.

Data collection has been completed and analysis begun on our Population Health Initiative Economic Recovery Research grant, which allowed for a continuation of observations and expanded analysis of variables in our examination of the food retail industry. Our results are being joined with the Population Health Initiative Economic Recovery Research grant (PI Dermisi) on the office sector of downtown Seattle, for a series of publications that culminate in a city-wide perspective on the economic effects of the pandemic for journals in architecture, urban planning, urban studies, health and urban economics. The research team has identified three potential sources for follow-on research on the economic effects of the pandemic (Lincoln Institute of Land Policy, the Robert Woods Johnson Foundation, and the American Real Estate Society).

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

Investigators
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 summary
The purpose of this project was to model the immediate impacts of the COVID-19 pandemic on housing markets in the 100 most populated metropolitan areas in the United States.

Using a novel national rental database, the team assessed 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. There are important differences in the pandemic’s impact based on whether the location is in a central or suburban county, with central counties like King County, WA showing a substantial persistent slowdown in the rental market compared to suburban counties which saw initial declines in rents that quickly rebounded as the summer progressed. The impact of COVID-19 on rental housing markets has been greatest in the largest counties in terms of population.

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 and writing two academic research papers. The first of these research directions builds on the descriptive market analysis shown above by using multi-level regression and poststratification to adjust county-level estimates to the population of renter households as measured by the Census in the American Community Survey. The second paper will focus on a neighborhood-level analysis where this project team will assess the importance of neighborhood characteristics like density and population diversity for changes in a listing’s advertised rent related to the pandemic.

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

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

Project summary
This proposal developed and implemented 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 (i) developed a sampling strategy for telephone-based interviews that began with a convenience sample but yields representative estimates of key population quantities; (ii) leveraged an existing convenience sample of garment manufacturing works to survey 2,000 workers using this strategy; and (iii) analyzed these results to better understand the reaction of large garment manufactures to the COVID-19 pandemic.

The project team developed a sampling strategy known as Randomized Network Recruitment (RNR). Based on the results of the survey, the team found that most factories were closed for about four weeks, in line with the government orders to prevent the spread of covid-19. Workers’ income dropped substantially during the first half of 2020, though it is unclear whether this will result in permanent or systematic departures from the industry.

Both symptoms and knowledge about COVID-19 were clustered, with workers being substantially more likely to report a symptom and provide correct answers to questions about COVID-19 knowledge if others on their production team did as well. There was substantial variation across workplaces in both of these measures. Most workers feared getting covid-19, but reported relatively low stigma about a positive diagnosis. Prevention strategies were very common, though there were still significant gaps in knowledge about prevention, especially among the lowest paid workers.

The team secured follow-on funding for the project from the International Growth Centre ($10,288 USD) and the Gender, Growth, and Labour Markets in Low Income Countries Programme. They will use this funding to conduct another survey round that assesses how the results from their initial survey have changed over time. They will also expand several modules that displayed interesting results in the initial survey such as firms’ behavior immediately after reopening in April/May, and workers’ mobility between factories during covid-19.

Washington State COVID-19 Pregnancy Collaborative

Investigators
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 summary
The objective of this proposal was to investigate the effects of a highly communicable infectious disease leading to severe pneumonia and death (COVID-19) in pregnant women in Washington State. Pregnant women are typically a highly vulnerable group to pathogenic respiratory viruses and have the highest WHO priority for influenza vaccination in a pandemic.

The team’s central hypothesis was 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. They conducted 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). Overall, the Washington State COVID-19 in Pregnancy Collaborative sites captured approximately 61% of deliveries in Washington State during the study period.

The team successfully collected data to establish a large, population-based registry in Washington State. Analyses have been completed of the sociodemographic and clinical outcomes of 240 pregnant patients who contracted COVID-19. Work remains ongoing to calculate infection rates, disease severity, co-morbidity, symptom length and possible vascular injury that could impair fetal growth.

The team will continue working toward research to determine how COVID-19 impacts maternal-child physical and mental health. Further grants have been applied and awarded from the Center of Disease Control, Royalty Research Fund and partnerships with Washington State Department of Health.

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

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

Project summary
The current proposal sought 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 prior to the outbreak of COVID-19. This sample was 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 were 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.

COVID-19 health risk and COVID-19-specific contextual risk predicted greater increases in maternal mental health symptoms during COVID-19. Preliminary results indicated that infant internalizing symptoms were correlated with COVID-19 health risk reported by mothers but not with Pre-COVID-19 contextual risk. Infant internalizing and externalizing symptoms were associated with both Pre-COVID-19 and COVID-19-specific levels of maternal anxiety and depression.

The study provides empirical support for the impact of the pandemic on families living in the context of economic disadvantage via disruptions to their access to income, quality childcare, and stable housing (COVID-19 contextual risk) independent of significant pandemic health experiences (having or knowing someone with COVID-19).

The results of the analyses with the first survey have already been submitted for presentation at two international conferences and in a letter of intent for publication in a special section of a developmental journal. The results of this study will be made readily available for researchers, providers, and parents/families on the Center for Child and Family Well-being resource page, as well as to the research and provider community.

Mitigating the Mental Health Consequences of the COVID-19 Crisis

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

Project summary
Aim 1 of this project was 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. The project team aims to identify who is and is not coping well.

Aim 2 was 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 were randomly assigned to intervention or control. Intervention participants received the intervention daily on their smartphones across Days 7 – 21 of the study, and all received maintenance assessments at 8 and 16 weeks.

Loneliness and depression have not substantially increased for the general public during the crisis, but the team is identifying risk factors that predict increases. These factors include: having lower income, not being married, living alone, having no children, and previous diagnoses of depression or anxiety. The team also identified social interaction variables that may help people cope with the crisis, including talking more about how one really feels (versus talking about the crisis) and feeling understood and cared for by others.

The team is processing and submitting their national sample outcomes and have had several groups express interest in interventions. The group is also planning a second webinar event with the Substance Abuse and Mental Health Services Administration (SAMSHA) to share their findings, and will also approach King County Public Health when analyses are complete. The team is also collaborating with HowWeFeel.org, a non-profit app development team that is planning to incorporate mental health data and may employ the project’s intervention tips.

The Staying in Touch and Engaged Project

Investigators
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 summary
The “Staying in Touch and Engaged Project” (STEP) aimed to support Housing First 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 compared remote assessment of substance-use and health-related quality of life assessment paired with immediate versus delayed provision of remotely delivered meaningful activities. The aim of this project was to test whether the meaningful activities package (MAP) engages residents and improves their mood, substance-use outcomes, and physical and mental health-related quality of life.

The project team mailed study invitations to residents in five housing programs (estimated mailed N=538). To date, 32 Housing First residents reached out to consent to participate, responding via mailed consent forms, phone, video conferencing or online survey completion. Of those who consented, 26 have completed baseline assessments, and 11 have completed one-month follow-ups. The study highlighted the difficulties in reaching residents, partly due to the lack of communication technologies.

The team found that the technological divide has grown deeper and more consequential during the pandemic and must be bridged to facilitate social connection, physical and mental health, and basic communication for people marginalized by the lived experience of homelessness and psychiatric, medical and substance use disorder. The team is working to locate additional funds through the UW and WSU to continue participant recruitment and evaluation efforts, achieve the originally proposed sample size and further improve follow-up rates.

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.

Investigators
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 summary
The project work was to develop a mobile application for supporting immunization cold chain logistics and massive immunization campaigns. This was particularly relevant to countries as they prepare for roll out of Covid-19 vaccines. The mobile application that is being developed allows immunization workers to track the status of the vaccine cold chain, and aims to provide accurate information to the national level for planning upgrades of the vaccine cold chain to support vaccine introduction.

Over the summer, the team continued development of the system to support a nationwide deployment in Uganda, as well as smaller deployments in the Democratic Republic of Congo, Pakistan and Bangladesh. The three components of the work were developing the Android application, preparing the data set for Uganda, and developing a dashboard for the Ministry of Health to utilize the collected information. We met our development objectives over the summer, including developing a prototype of the dashboard.

The country deployment of the application is moving forward. The team anticipates delivering the application and dashboard to Uganda at the start of 2021, at which point the country will update their national cold chain equipment inventory, which will be an important baseline for them as they start planning for COVID-19 immunization campaigns. The immediate next steps are to complete the application, support the trainings, and extend the application to support various forms of temperature monitoring. Once the Uganda deployment is underway, the team will look for funding and opportunities to deploy the application in other countries, likely targeting other East African nations, and then partner with an African organization to manage the program in the long term.

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

Investigators
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 summary
This project sought to rapidly increase community pharmacies’ organizational readiness to implement COVID-19 testing and vaccination through adaptation of the Memorandum of Understanding (MOU) Activation Plan to the context of the current COVID-19 pandemic using facilitated discussions with public health and community pharmacy partners.

The intended project results were 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.

Online surveys demonstrated an increase in community pharmacies’ overall organizational readiness, including change commitment and change efficacy, for COVID-19 testing and vaccination. This work has contributed to expanding COVID-19 testing in Washington State and preparing for eventual COVID-19 vaccination in pharmacies. More broadly, it has improved understanding of readiness for leveraging community pharmacy and public health partnerships in a pandemic response.

The study has been accepted to be presented as an interactive poster at the upcoming 13th Annual Conference on the Science of Dissemination and Implementation in Health in December 2020. The team is also currently drafting a manuscript for publication in a public health practice-oriented peer-reviewed journal. The findings related to COVID-19 testing in community pharmacies informed work completed by a statewide private-public partnership (P3) workgroup in late summer 2020 tasked with developing a strategy for expanding access to COVID-19 testing in Washington. It has also led to a partnership with the Washington State Department of Health to pilot a state program for offering COVID-19 testing at community pharmacies.

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

Investigators
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 summary
The project team has devised a plan to use artificial intelligence (AI) to pinpoint COVID-19 patients at risk for adverse cardiac outcomes using a single electrocardiograms (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, the hypothesis is that AI can be used to identify those with risk of life-threatening cardiovascular complications using COVID-19 intake EKGs.

During this funding period, the team took five steps towards their goals: (1) Established an international project team; (2) Set up a Case Report Form; (3) Extracted clinical data for 186 COVID-19 patients in the UW System; (4) Created a high-performance computing infrastructure for AI problems; and (5) Created pilot neural networks to solve ECG classification problem. Results so far show that the model is able to differentiate between intake ECGs of patients who eventually experienced an adverse outcome from those of event-free individuals. The network had fairly high sensitivity (i.e., true positive rate >80%) but only moderate specificity (i.e., >30% false positive rate).

The team will continue to collect and analyze data and improve the predictive power of the model. The goal is to eventually show that the algorithm can be used to prospectively assess risk of complications at the time of hospital intake. Within 2-3 months they will begin proof-of concept for this type of usage and within one year should be able to launch the proposed web-based risk assessment tool.

FIRST Universal SARS-CoV-2 Vaccines

Investigators
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 summary
We sought to design vaccines to Focus Immune Responses on the Structural inTegrity (FIRST) of SARS-CoV-2 viral proteins. These vaccines are intended to drive T cell and antibody responses that avoid antigenic features of each protein. We will determine the expression of FIRST immunogens in cells and immune responses in mice. Then, lead immunogens will be tested with alternative delivery platforms to enable greater stability, lower manufacturing costs, and needle-free vaccination.

Using our initial DNA constructs we have evaluated Ab induction in mice, following administration by electroporation. Full-length Spike constructs were superior to the C-terminal truncated (1208) and FIRST3 antigens in overall Ab production. Each of the two FIRST Spike antigens and a FIRST nucleocapsid antigen were also used to assess antibody induction in Rhesus macaques, also following electroporation. Overall, FIRST immunogens were inferior to full-length constructs for generating binding antibody responses, however, our goal was not to generate high level responses, but rather to direct response to conserved structural features of the virus.

We have completed the design and construction of six DNA templates encoding each of the FIRST antigens within our alphavirus replicon backbone to be used for delivery as RNA. Studies in cells and in mice will determine if there are candidates for further development for future vaccines.