This year’s cohort includes five MSJC students: John Assadi, Tanner Garvin, Lauren Mole, Jake Olson, and Ana Noel, who will spend the coming year immersed in advanced stem cell and regenerative medicine research environments.

The program, funded through the California Institute for Regenerative Medicine (CIRM), provides students with access to cutting-edge research experiences that prepare them for careers in medicine, biotechnology, and scientific research.

For Jake Olson, the opportunity represents the next step in a journey that began unexpectedly.

“I was first interested in biology in high school,” Olson said. “I came here to MSJC, where a biology professor introduced me to the honors program. Through the honors program, I started a year-long project doing genetics research, and from there, I was introduced to the stem cell internship as an opportunity after MSJC.”

Olson, who plans to transfer to the University of California, San Diego after completing his studies at MSJC, hopes to pursue an MD-PhD in regenerative medicine. During the internship, he expects to conduct research involving vascularized neural organoids using advanced 3D-printed structures.

“My advice for incoming students, if you’re unsure of exactly what you want to do, is to take as many different kinds of classes as possible,” Olson said. “One of them you’re going to get interested in. And when you do, when you feel that, go for it.”

For Tanner Garvin, the program opened doors to possibilities she had never previously considered.

“I came into the college as a nursing major, but upon taking microbiology, I got really inspired by my professor,” Garvin said. “A research career didn’t really feel like an accessible path to me at first, but hearing about research made me realize this was something that I could do.”

Garvin credits MSJC faculty and the Honors Program with helping her discover new opportunities.

“I thought that I was just going to go into nursing,” Garvin said. “But because I allowed myself to think about other things, I was given this opportunity.”

Returning to encourage this year’s cohort was MSJC alumna Joia Miller, who currently works at a San Diego research laboratory focused on disease modeling.

“This program has been very rewarding,” Miller said. “I couldn’t be more grateful because now I’m marketable on the job market.”

Miller encouraged the new cohort to stay organized and embrace the experience.

“For students going into the program, stay on top of your lab notebook,” Miller advised. “If you start with your notebook, then everything should be okay.”

Dr. Roger Schultz, Superintendent/President of Mt. San Jacinto College, said the continued success of MSJC students in the program demonstrates the power of community colleges to create life-changing opportunities.

“Programs like CIRM Bridges demonstrate what is possible when talented students are provided access to mentorship, research opportunities, and pathways that connect education with real-world experiences,” Schultz said. “We are incredibly proud of these students and excited to see how they will continue transforming lives through science, research, and innovation.”

Through partnerships like CIRM Bridges, MSJC continues expanding opportunities for students to participate in research experiences typically associated with four-year universities while building pathways into high-demand STEM careers.

To learn more about this program, watch the students’ interviews: https://youtu.be/rSqqoF65JqE

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The Nobel Prize in Medicine was awarded Monday to two scientists whose work led to the mRNA vaccines against COVID-19.

As countries prepared to roll out those shots, The Associated Press took a look at how the vaccines were developed so quickly. Below follows the original story, first published on Dec. 7, 2020.

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How could scientists race out COVID-19 vaccines so fast without cutting corners? A head start helped — over a decade of behind-the-scenes research that had new vaccine technology poised for a challenge just as the coronavirus erupted.

“The speed is a reflection of years of work that went before,” Dr. Anthony Fauci, the top U.S. infectious disease expert, told The Associated Press. “That’s what the public has to understand.”

Creating vaccines and having results from rigorous studies less than a year after the world discovered a never-before-seen disease is incredible, cutting years off normal development. But the two U.S. frontrunners are made in a way that promises speedier development may become the norm — especially if they prove to work long-term as well as early testing suggests.

“Abject giddiness,” is how Dr. C. Buddy Creech, a Vanderbilt University vaccine expert, described scientists’ reactions when separate studies showed the two candidates were about 95% effective.

“I think we enter into a golden age of vaccinology by having these types of new technologies,” Creech said at a briefing of the Infectious Diseases Society of America.

Both shots — one made by Pfizer and BioNTech, the other by Moderna and the National Institutes of Health — are so-called messenger RNA, or mRNA, vaccines, a brand-new technology. U.S. regulators are set to decide this month whether to allow emergency use, paving the way for rationed shots that will start with health workers and nursing home residents.

Billions in company and government funding certainly sped up vaccine development — and the unfortunately huge number of infections meant scientists didn’t have to wait long to learn the shots appeared to be working.

But long before COVID-19 was on the radar, the groundwork was laid in large part by two different streams of research, one at the NIH and the other at the University of Pennsylvania — and because scientists had learned a bit about other coronaviruses from prior SARS and MERS outbreaks.

“When the pandemic started, we were on a strong footing both in terms of the science” and experience handling mRNA, said Dr. Tal Zaks, chief medical officer of Massachusetts-based Moderna.

Traditionally, making vaccines required growing viruses or pieces of viruses — often in giant vats of cells or, like most flu shots, in chicken eggs — and then purifying them before next steps in brewing shots.

The mRNA approach is radically different. It starts with a snippet of genetic code that carries instructions for making proteins. Pick the right virus protein to target, and the body turns into a mini vaccine factory.

“Instead of growing up a virus in a 50,000-liter drum and inactivating it, we could deliver RNA and our bodies make the protein, which starts the immune response,” said Penn’s Dr. Drew Weissman.

Fifteen years ago, Weissman’s lab was trying to harness mRNA to make a variety of drugs and vaccines. But researchers found simply injecting the genetic code into animals caused harmful inflammation.

Weissman and a Penn colleague now at BioNTech, Katalin Kariko, figured out a tiny modification to a building block of lab-grown RNA that let it slip undetected past inflammation-triggering sentinels.

“They could essentially make a stealth RNA,” said Pfizer chief scientific officer Dr. Philip Dormitzer.

Other researchers added a fat coating, called lipid nanoparticles, that helped stealth RNA easily get inside cells and start production of the target protein.

Meanwhile at the NIH, Dr. Barney Graham’s team figured out the right target — how to use the aptly named “spike” protein that coats the coronavirus to properly prime the immune system.

The right design is critical. It turns out the surface proteins that let a variety of viruses latch onto human cells are shape-shifters — rearranging their form before and after they’ve fused into place. Brew a vaccine using the wrong shape and it won’t block infection.

“You could put the same molecule in one way and the same molecule in another way and get an entirely different response,” Fauci explained.

That was a discovery in 2013, when Graham, deputy director of NIH’s Vaccine Research Center, and colleague Jason McLellan were investigating a decades-old failed vaccine against RSV, a childhood respiratory illness.

They homed in on the right structure for an RSV protein and learned genetic tweaks that stabilized the protein in the correct shape for vaccine development. They went on to apply that lesson to other viruses, including researching a vaccine for MERS, a COVID-19 cousin, although it hadn’t gotten far when the pandemic began.

“That’s what put us in a position to do this rapidly,” Graham told the AP in February before the NIH’s vaccine was first tested in people. “Once you have that atomic-level detail, you can engineer the protein to be stable.”

Likewise, Germany’s BioNTech in 2018 had partnered with New York-based Pfizer to develop a more modern mRNA-based flu vaccine, giving both companies some early knowledge about how to handle the technology.

“This was all brewing. This didn’t come out of nowhere,” said Pfizer’s Dormitzer.

Last January, shortly after the new coronavirus was reported in China, BioNTech CEO Ugur Sahin switched gears and used the same method to create a COVID-19 vaccine.

Moderna also was using mRNA to develop vaccines against other germs including the mosquito-borne Zika virus — research showing promise but that wasn’t moving rapidly since the Zika outbreak had fizzled.

Then at the NIH, Graham woke up on Saturday Jan. 11 to see Chinese scientists had shared the genetic map of the new coronavirus. His team got to work on the right-shaped spike protein. Days later, they sent Moderna that recipe — and the vaccine race was on.

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Pigs have been the most recent research focus to address the organ shortage, but among the hurdles: A sugar in pig cells, foreign to the human body, causes immediate organ rejection. The kidney for this experiment came from a gene-edited animal, engineered to eliminate that sugar and avoid an immune system attack.

Surgeons attached the pig kidney to a pair of large blood vessels outside the body of a deceased recipient so they could observe it for two days. The kidney did what it was supposed to do — filter waste and produce urine — and didn’t trigger rejection.

“It had absolutely normal function,” said Dr. Robert Montgomery, who led the surgical team last month at NYU Langone Health. “It didn’t have this immediate rejection that we have worried about.”

This research is “a significant step,” said Dr. Andrew Adams of the University of Minnesota Medical School, who was not part of the work. It will reassure patients, researchers and regulators “that we’re moving in the right direction.”

The dream of animal-to-human transplants — or xenotransplantation — goes back to the 17th century with stumbling attempts to use animal blood for transfusions. By the 20th century, surgeons were attempting transplants of organs from baboons into humans, notably Baby Fae, a dying infant, who lived 21 days with a baboon heart.

With no lasting success and much public uproar, scientists turned from primates to pigs, tinkering with their genes to bridge the species gap. Pigs have advantages over monkeys and apes. They are produced for food, so using them for organs raises fewer ethical concerns. Pigs have large litters, short gestation periods and organs comparable to humans.

Pig heart valves also have been used successfully for decades in humans. The blood thinner heparin is derived from pig intestines. Pig skin grafts are used on burns and Chinese surgeons have used pig corneas to restore sight.

In the NYU case, researchers kept a deceased woman’s body going on a ventilator after her family agreed to the experiment. The woman had wished to donate her organs, but they weren’t suitable for traditional donation. The family felt “there was a possibility that some good could come from this gift,” Montgomery said.

Montgomery himself received a transplant three years ago, a human heart from a donor with hepatitis C because he was willing to take any organ. “I was one of those people lying in an ICU waiting and not knowing whether an organ was going to come in time,” he said.

Several biotech companies are in the running to develop suitable pig organs for transplant to help ease the human organ shortage. More than 90,000 people in the U.S. are in line for a kidney transplant. Every day, 12 die while waiting.

The advance is a win for Revivicor, a subsidiary of United Therapeutics, the company that engineered the pig and its cousins, a herd of 100 raised in tightly controlled conditions at a facility in Iowa.

The pigs lack a gene that produces alpha-gal, the sugar that provokes an immediate attack from the human immune system.

In December, the Food and Drug Administration approved the gene alteration in the Revivicor pigs as safe for human food consumption and medicine.

But the FDA said developers would need to submit more paperwork before pig organs could be transplanted into living humans.

“This is an important step forward in realizing the promise of xenotransplantation, which will save thousands of lives each year in the not-too-distant future,” said United Therapeutics CEO Martine Rothblatt in a statement. Experts say tests on nonhuman primates and last month’s experiment with a human body pave the way for the first experimental pig kidney or heart transplants in living people in the next several years.

Raising pigs to be organ donors feels wrong to some people, but it may grow more acceptable if concerns about animal welfare can be addressed, said Karen Maschke, a research scholar at the Hastings Center, who will help develop ethics and policy recommendations for the first clinical trials under a grant from the National Institutes of Health.

“The other issue is going to be: Should we be doing this just because we can?” Maschke said.

CARLA K. JOHNSON | AP News

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The move standardizes regulatory review across the nationwide system and is a major step in the evolution of VA research into an enterprise with uniform processes across all sites.

ORD transitioned the 105 VA medical centers with research programs, as well as the VA Central IRB, to the IRBNet platform. The unified platform provides a cohesive system for all VAMC research operations. It generates one authoritative enterprise research dataset to give ORD a comprehensive overview of all nationwide activity at any point in time.  

The switch to IRBNet also reduces regulatory risk, eases policy and education implementation, decreases the administrative workload for local research offices and increases transparency for research oversight committee members, researchers and other staff.

“This enterprise approach will decrease the need for national data calls and will enable the Office of Research and Development to have an ‘air traffic control board’ to see where studies, by topic, are happening across the system,” said Office of Research Protections, Policy and Education Director Molly Klote, M.D. “Among other benefits this will enable improved implementation of multisite clinical trials.”

Increasing Veterans’ access to clinical trials is one of ORD’s top strategic goals. VA’s Central IRB was established a few years back to enhance oversight of clinical trials that take place at multiple VAMCs. It has been a vital resource for VA research in support of this goal. The implementation of IRBNet is another milestone in this process.

In fiscal year 2020, more than 10,000 Veterans took part in clinical trials at more than 70 VAMCs. The topics ranged from COVID-19, cancer, diabetes and heart disease to Post-Traumatic Stress Disorder and substance use disorders. Funding for clinical trials in VA comes both from VA and from outside sources such as the National Institutes of Health, the Department of Defense, nonprofits and industry. Learn more about VA clinical trials and VA research.

IRBNet is a commercially available platform. The version being deployed in VA is known as the VA Innovation and Research Review System.

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The School of Medicine at the University of California, Riverside, will serve as lead site for a Phase 2 clinical trial evaluating ecopipam, an investigational first-in-class drug being tested for the treatment of stuttering in adults and Tourette syndrome in pediatric patients.

Emalex Biosciences Inc., a clinical-stage biopharmaceutical company that developed ecopipam, is conducting the clinical trial. The first adult patient has been dosed to evaluate ecopipam, the company announced.

The Speak Freely Study is for adults who were diagnosed with a stuttering disorder as a child and who still struggle with speaking clearly. The study examines the safety of ecopipam and whether it may help a person’s ability to speak without stuttering. The trial is being conducted in eight sites across the U.S. and is StutteringResearch@medsch.ucr.edu“>seeking volunteers. Enrollment is planned to continue through April 2021.

“Knowing first-hand how stuttering can be detrimental to a person’s overall well-being, I am excited to be part of this journey and the meaningful work being done by Emalex,” said Dr. Gerald Maguire, professor and chair of psychiatry and neuroscience at UC Riverside and a world-class expert on stuttering who has spent the bulk of his professional career seeking an effective treatment for the childhood-onset fluency disorder. “Many people are unaware that stuttering is a treatable neurological condition, so there is a significant educational opportunity here that will serve those who stutter, their families, and even the public.”

It is estimated that more than 3 million people in America and over 70 million people worldwide stutter, with males affected more frequently than females. The U.S. Food and Drug Administration has not approved any medications for the treatment of stuttering.

“Having the first patient dosed is a huge stride toward developing a safe and effective treatment for people who stutter,” said Dr. Atul Mahableshwarkar, chief medical officer and senior vice president of drug development at Emalex. “We are very optimistic that clinical trial outcomes will result in a life-changing treatment for people who stutter and the Emalex team is deeply committed to achieving that goal in this area of significant unmet need.”

Ecopipam has been generally well tolerated in clinical trials conducted to date, including a previous Phase 2a study in adults who stutter. Adverse events affecting primarily the central nervous system — sedation, insomnia, psychiatric changes — and the gastrointestinal system — nausea and vomiting — are the most frequently reported side effects.

The drug selectively blocks the actions of the neurotransmitter dopamine at the D1 receptor. Dopamine is a neurotransmitter in the central nervous system, and its receptors have been classified into two families based on their genetic structure: “D1” (including subtypes D1 and D5) and “D2” (including subtypes D2, D3, and D4). D1-receptor super-sensitivity may be a mechanism for the repetitive and compulsive behaviors associated with Tourette syndrome.

“If ecopipam is found at the end of this trial to be a potentially safe and effective treatment for stuttering, it would help millions of people who stutter, including myself,” Maguire said. “By helping us communicate more freely, it has the potential to greatly improve the quality of our lives and be a tremendous opportunity for an underserved patient population.”

Above is a modified version of the Emalex news release written by Evelyn M. O’Connor.

The University of California, Riverside (http://www.ucr.edu) is a doctoral research university, a living laboratory for groundbreaking exploration of issues critical to Inland Southern California, the state and communities around the world. Reflecting California’s diverse culture, UCR’s enrollment is more than 24,000 students. The campus opened a medical school in 2013 and has reached the heart of the Coachella Valley by way of the UCR Palm Desert Center. The campus has an annual statewide economic impact of almost $2 billion. To learn more, email news@ucr.edu.

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UCR received a $1.75 million University of California Multicampus Research Programs & Initiatives — MRPI — award for the purpose of forming a “Coronavirus Assembly Research Consortium.”

Physics professor Roya Zandi will be the principal investigator overseeing the project, which also involves UC Davis and UC Merced.

“This consortium will aim to understand the physical principles underlying the formation of coronaviruses,” Zandi said. “We will also explore the impact of some drugs on the assembly process.”

Scientists are still sorting out the elements at work in the replication of SARS-COV-2 pathogens and their assembly pathways, using in vitro experiments and computer simulations to gain understanding.

However, a complete picture is lacking, and having one may enable researchers to improve methods of combating COVID-19 and its cohorts, according to UCR.

“With the goal of determining ways to disrupt viral assembly, this consortium will investigate the roles of structural proteins in SARS-CoV-2 assembly, using an integrated, multidisciplinary approach across multiple scales and environments,” Zandi said.

The grant funds are required to be expended over the next four years.

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A new COVID-19 study is currently enrolling patients, and researchers believe it has the potential to change the course of the virus around the world.

The study is examining the effects of Colchicine, a widely available and inexpensive anti-inflammatory drug on one of the most common, and most debilitating side effects of SARS-CoV-2–acute respiratory distress syndrome (ARDS).

ARDS is caused by an intense inflammatory response that results in what’s called a cytokine storm. Cytokines are molecules that signal to inflammatory cells that there’s a problem within the body that needs their attention. Any normal immune response involves cytokines. In a cytokine storm however, they’re released in larger numbers than necessary, resulting in an immune response out of proportion to the threat at hand, whereby immune cells attack healthy tissues.

Cytokine storms in COVID-19 are common and potentially do more damage than the virus itself, causing some patients to develop pneumonia or ARDS, which are life-threatening lung conditions. Many such patients require admission to ICU wards to be provided with respiratory support via mechanical ventilation.

One research team believes they may have the solution, however. Dr. Jean-Claude Tardif, director of the Research Centre at Montreal Heart Institute, professor of medicine at the University of Montreal, and primary investigator of the study, believes that these cytokine storms seen in COVID-19 patients are manufactured by a tiny inflammatory cell part, or organelle, called inflammasome. Colchicine, targets that one tiny organelle.

“More than 10 years ago, it was shown that the most closely related virus to SARS-CoV-2, which causes COVID-19, is Sars-CoV-1. That’s the virus that caused SARS caused 15 years ago,” says Dr. Tardif. “It’s very close to SARS CoV-2 and it was shown in this very elegant paper that SARS CoV-1 directly activates inflammasome.”

Dr. Tardif and his team are currently enrolling patients with a positive COVID-19 diagnosis for a Colchicine study. If his hypothesis is correct, it could change the way COVID-19 is treated globally. Colchicine is a widely available, inexpensive drug that has already been in use for years in the treatment of conditions like gout, familial Mediterranean fever (FMF) and viral pericarditis. The side effect profile is well-known and side effects are rare.

The groundbreaking study is called COLCORONA. Like most studies, patients are assigned either a course of the study medication or a placebo for 30 days. However, this study is unique as it is contact-less, helping protect health care workers and the population at-large from unnecessary risk of virus exposure.

To enroll, patients can call the hotline to speak with a dedicated healthcare professional who will explain the study and verify their eligibility, as well as to receive and sign the informed consent document. The study medication is then delivered to the patient’s door within four hours and the patient is remotely followed for 30 days.

To enroll or learn more, visit https://en.colcorona.net or call the 24-hour Hotline at 1(877) 536-6837, which is available in English, Spanish, Portuguese and French.

The COLCORONA trial is currently available in a number of countries as well as the New York Tri-State area, San Francisco, Los Angeles, Miami, Dallas, and Houston, with plans to open in Jacksonville, Gainesville as well as throughout Arizona, Mississippi, and Alabama. The team also plans on expanding the study into Georgia and the Carolinas. The trial is funded by the Government of Quebec (Canada), the National Heart, Lung, and Blood Institute, part of the US National Institutes of Health and the Bill and Melinda Gates Foundation, and Sophie Desmarais, Montréal philanthropist, daughter of the late business mogul, Paul Desmarais Sr.

Interested patients should consult their health care providers for more information and to find out if study materials are available in their area.

-StatePoint

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Researchers and physicians from the Mailman School of Public Health and Columbia University Irving Medical Center weigh in on what we have learned so far about the novel coronavirus.

The world has been living through the COVID-19 pandemic for nearly eight months.

Much is still unknown about the illness that has stricken 14.8 million people and killed more than 610,000 worldwide, but every day brings new insights and developments.

Columbia experts have been at the forefront of the international response to this crisis. We asked them to review what we’ve learned, so far, and to discuss the most significant challenges ahead.

The Second Wave

Q: We have had some success in flattening the curve, but there are worrying signs that infections are surging. Do you see a second wave coming?

A: While some states h​a​​ve made progress on flattening the curve​ of the infection​, many have recently reported record numbers of new cases. The daily coronavirus death toll in the United States increased in mid-July after months of decline as hospitals in hot-spot states, such as Florida and Texas, fill up with new patients. I’m hopeful that enough people will wear masks and practice social distancing most of the time and flatten these additional waves.

On the other hand, the Spanish flu started in the winter of 1918, quieted down in the summer and came back with a vengeance in the fall of 1918, in part because of mutations in circulating virus strains. We don’t know if mutations in the SARS-CoV-2 virus will lead to a similar scenario with COVID-19 this fall. Although we have learned a great deal about this virus in the first half of 2020, there are still many unknowns. We have to hope for the best and be prepared for the worst.

Jessica Justman, Associate Professor of Medicine in Epidemiology and the International Center for AIDS Care and Treatment Programs at the Columbia University Irving Medical Center (MAKE THIS SENTENCE IN ITALICS)

A Surge in Infections Among Young Adults

Q: Why is the uptick in young adult cases happening now, and what could this mean for the direction of the outbreak overall? What are the risk factors for this otherwise healthy population?

A: The number of coronavirus hospitalizations among 18- to 29-year-olds is four times what it was a few months ago; the major thrust is in the South and West where the virus is still surging. We know that behavior has a lot to do with the spike in younger people. The elderly, well known to be at greater risk for more severe disease or death, are more likely to stay home or be cautious when they go out.

Young adults, on the other hand, have heard that they are at far lower risk for severe disease and are more inclined to take greater risks. Everyone is tired of lockdowns. We’ve all seen photographs of beach parties with people in close quarters and congregating in crowded bars; these are invitations to disasters. When we’re bored and eager to get back to normal life, this is when we have to be especially careful and to take seriously all those precautions: masks, social distancing, good ventilation and hand hygiene. Proportionately, young adults have a much lower risk (per capita) of severe illness or death, but they can still get infected and spread the virus to others, often unknowingly.

It’s a numbers game. If you have enough infected people, numbers of severe illnesses will go up. There are also a variety of factors that can increase severity of disease even in the young, including obesity, smoking, weakened immunity, diabetes and heart, lung or kidney disease; and deaths occur, even in young adults. Unfortunately, these horror stories will increase as more young adults get infected. This is not the time to let down our guard.

Stephen S. Morse, Professor of Epidemiology and Director, Infectious Disease Epidemiology Certificate, Mailman School of Public Health (MAKE THIS SENTENCE IN ITALICS)

Treatments and Vaccines

Q: What is the timeline for a coronavirus vaccine and treatments? What are the stages of development for the vaccine?

A: Operation Warp Speed, a public-private partnership to facilitate vaccine and drug development within the United States, has set a goal of a safe and effective vaccine by January 2021. Vaccines go through various stages of development. In the preclinical stage, vaccines are tested within animal models of disease to ensure they provide robust protection without signs of adverse reactions. They then typically proceed through three additional phases of development within humans in which larger and larger numbers of volunteers are treated with the vaccine to test for safety and efficacy.

There are currently more than 100 vaccines in development, with several that have completed Phase I human trials (testing for safety and dosage); some that are in Phase II trials (expanded human trials to test for safety and dosage); and others are scheduled to begin large-scale Phase III trials this summer, where a vaccine is given to tens of thousands of people to test for its efficacy.

What we don’t know is the level of protection that each vaccine will provide; whether certain age groups will show a difference in the efficacy of the vaccine; and if the disease enhancement will occur, which means that people who receive the vaccine develop a more severe form of disease if infected (as has been observed in some previous animal studies with vaccines against SARS-CoV-1).

Alejandro Chavez, Assistant Professor of Pathology and Cell Biology at Columbia University Irving Medical Center (MAKE THIS SENTENCE IN ITALICS)

Children and COVID-19

Q: Why do some children develop an inflammatory syndrome from coronavirus?

A: What we do know about is that the demographics of MIS-C, or Multisystem Inflammatory Syndrome in Children.

To date there have been 383 patients with MIS-C described in the literature. The average age is 8 years, with 49 percent of the patients male and 37 percent of African origin. There have been no significant co-morbidities reported apart from the fact that about 16 percent were overweight or obese. We also know there is a temporal association with the height of COVID-19 pandemic and the appearance three to five weeks later of MIS-C.

What we do not know is the etiology and why some children develop MIS-C.

MIS-C appears to be caused by a delayed, dysregulated immune response to the coronavirus that somehow goes into overdrive, causing inflammation that has multisystemic effects via a cytokine storm. SARS-CoV-2 could act as a direct trigger or cause a post-infectious IgG antibody-mediated phenomenon. Coronaviruses are known to block interferons which help in viral clearance. This delayed interferon response and subsequent higher viral burden results in worsening inflammation via the uncontrolled release of cytokines. A genetic predisposition is suspected but a unified theory as to why some children in certain geographical areas develop MIS-C is yet to be elucidated.

Anne Ferris, Assistant Professor of Pediatrics at the Columbia University Irving Medical Center (MAKE THIS SENTENCE IN ITALICS).

Public Health Measures

Q: What level of public health and social measures must be put in place to prevent high-risk exposure as we move forward?

A: As communities reopen we will need to maintain many of the public health and social measures we adopted over the past months. Without a vaccine or medical cure, suppressing the epidemic requires each of us to do our parts. Public health and social measures for COVID-19 have worked. We don’t know precisely how much of the impact is down to which tool. Most of us didn’t really start physical distancing, avoiding gatherings and washing our hands frequently until the pandemic was upon us, just as lockdown orders were issued. And facemasks have only been recommended for the general public since April, and they are still contentious in many places.

We know that none of these is sufficient alone and that they are more effective when used together. We know they can slow transmission, even when people don’t know they’re infected. But only when most of us practice them consistently. Together, they can keep infections within manageable numbers that we can contain through widespread testing, contact tracing and isolating affected people.

Some critics have decried these measures as an infringement on individual freedom. Instead, we ought to celebrate them as the keys to lifting more imposing restrictions and liberating us to re-engage cautiously in renewed economic and interpersonal activity. Pushing aside effective public health and social measures before the epidemic is declining has almost certainly contributed to the rising numbers of cases currently being reported throughout large parts of the country.

S. Patrick Kachur, Professor at Columbia University Irving Medical Center and the Mailman School of Public Health (MAKE THIS SENTENCE IN ITALICS).

The Long-term Impact

Q: What do we know or suspect about the long-term impacts of COVID-19 on the body?

A: Scientists are still learning about the many ways the virus that causes COVID-19 affects the body, both during initial infection and as symptoms persist. Patients can suffer long-term effects, including lung damage, thromboembolic complications, heart damage, neurocognitive manifestations and uncontrolled inflammation. Not every patient with COVID-19 makes a full recovery. By the time the first lung transplant for a COVID patient was performed at Northwestern Memorial Hospital in Chicago, it was clear that some people’s lungs never recover from the disease. Similar to SARS, which left 30 percent of survivors with permanently scarred lungs, COVID-19 is leaving a number of survivors with irreversible lung damage.

Among the most devastating of COVID-19’s thromboembolic complications are strokes, which may occur in patients requiring hospitalization as well as in those with mild or moderate illness. Although mortality rates are lower in younger people who suffer strokes, about half of them become disabled and are unable to return to work. Also devastating is amputation of limbs because of arterial clotting complications. Clots in the legs and pulmonary emboli can result in long-term issues, such as chronic leg swelling, marked limitation in physical activity and challenges performing the simple activities of daily living.

COVID-19 patients with pre-existing chronic conditions, as well as previously healthy patients, can develop irreversible damage to heart tissue, and there is a high incidence of neurological complications in patients requiring hospitalization, including intensive care treatment. Acute respiratory distress syndrome, which can develop in COVID patients, is associated with long-term cognitive impairment in about one in five individuals. Patients also may develop a late inflammatory process resulting in disorders such as pediatric multisystem inflammatory syndrome, with an expected risk of myocardial and vascular complications in coming years; Guillain-Barré syndrome, with paralysis; autoimmune hemolytic anemia; and a growing number of other autoimmune symptoms.

Daniel Griffin, Instructor in Clinical Medicine and Associate Research Scientist at Columbia University Medical Center (MAKE THIS SENTENCE IN ITALICS).

COVID-19 and Psychiatric Disorders

Q: What do we know about COVID-19, depression and psychiatric disorders?

A: We know that the pandemic has had a profound effect on the mental health of infected individuals and on the community in general, and that the impact and psychological effects of the COVID-19 crisis differs for each generation. A study by the CDC in the spring of 2020 revealed that about one-third of Americans have clinically significant anxiety or depression, a three- to four-fold increase compared to the same time last year; the youngest age groups (18-29 years) and those from minority communities had the highest rates.

From prior studies of MERS and SARS, we know there is an increased incidence of cognitive impairment, depression, anxiety and insomnia in the acute phase of infection and of PTSD in the post-infection phase. While the acute mental health effects of COVID-19 are beginning to be clear, the long-term impacts on the central nervous system will take time to uncover; neuropsychiatric manifestations may emerge long after the virus has been contained.

There are several reasons why severe infections might have psychiatric consequences, including direct effects of the virus itself on the central nervous system; the impact of the human immune response to the infection (inflammatory cytokines, post-infectious autoimmunity); and the impact of interventions (prolonged intubation and use of sedatives).

But there are other factors to consider. For example: How much of the increase in anxiety and depression are due to the effects of the virus itself versus the collateral effects of the pandemic—social isolation, personal loss, economic insecurity, fear of infection and death and uncertainty about the future?

Columbia researchers are attempting to learn more from neuropsychiatric and immunologic studies that will track the health of COVID-19 survivors from childhood to old age. In the meantime, clinicians must be alert for both the acute and potential long-term mental health effects of the virus, such as depression, fatigue, cognitive problems and PTSD. Mental health systems throughout the country have set up rapid response and outreach teams. CopeColumbia, for example, provides mental health services and resilience training to all members of the Columbia University Irving Medical Center community.

Brian A. Fallon, Professor of Clinical Psychiatry and Director of the Lyme and Tick-Borne Diseases Research Center at Columbia University Irving Medical Center (MAKE THIS SENTENCE IN ITALICS).

-Carla Cantor and Caroline Harting

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