Author Interviews, Brigham & Women's - Harvard, COVID -19 Coronavirus / 25.03.2021
COVID-19: SARS2 Risk Equations Estimate Risk of Hospitalization and Death
MedicalResearch.com Interview with:
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Dr. Dashti[/caption]
Hesam Dashti, PhD
Brigham and Women's Hospital, Harvard Medical School
Senior Computational Scientist
The Broad Institute of MIT and Harvard
MedicalResearch.com: What is the background for this study? What parameters does the SARS2 score take into consideration?
Response: While complex models have been developed for predicting the severity of COVID-19 from the medical history, laboratory, and imaging results of patients, simplified models with similar accuracy would be more practical for individualizing the decision making, especially when detailed medical history of patients is not readily available. In this study, we developed the SARS2 risk equations for estimating risk of hospitalization of patients with COVID-19 and also the risk of mortality among hospitalized patients. The “SARS2” risk equations are named for their input variables: Sex, Age, Race, Socioeconomic and Smoking status.
To develop and validate the models, we used the electronic records from 12,347 patients who tested positive for COVID-19 at the Mass General Brigham medical centers in Massachusetts between 02/26/2020 and 07/14/2020 to construct derivation and validation cohorts for estimating 1) risk of hospitalization within 30 days of COVID-19 positive PCR test, and 2) for the hospitalized patients, risk of mortality within approximately 3 months.
Dr. Dashti[/caption]
Hesam Dashti, PhD
Brigham and Women's Hospital, Harvard Medical School
Senior Computational Scientist
The Broad Institute of MIT and Harvard
MedicalResearch.com: What is the background for this study? What parameters does the SARS2 score take into consideration?
Response: While complex models have been developed for predicting the severity of COVID-19 from the medical history, laboratory, and imaging results of patients, simplified models with similar accuracy would be more practical for individualizing the decision making, especially when detailed medical history of patients is not readily available. In this study, we developed the SARS2 risk equations for estimating risk of hospitalization of patients with COVID-19 and also the risk of mortality among hospitalized patients. The “SARS2” risk equations are named for their input variables: Sex, Age, Race, Socioeconomic and Smoking status.
To develop and validate the models, we used the electronic records from 12,347 patients who tested positive for COVID-19 at the Mass General Brigham medical centers in Massachusetts between 02/26/2020 and 07/14/2020 to construct derivation and validation cohorts for estimating 1) risk of hospitalization within 30 days of COVID-19 positive PCR test, and 2) for the hospitalized patients, risk of mortality within approximately 3 months.
Dr. Grant[/caption]
Leilah K. Grant, PhD
Postdoctoral Research Fellow in Medicine
Brigham and Women’s Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study?
Response: The prevalence of obesity increases in women around the age of menopause which increases the risk of diseases like diabetes and heart disease. Changes in hormones, like estrogen, are thought to contribute to weight gain during menopause, but other common symptoms of menopause such as sleep interruption may also play a role. While short sleep is known to adversely affect metabolism, little is known about the metabolic consequences of the type of sleep disruption most common in menopausal women – increased nighttime awakenings (i.e., sleep interruption) caused by hot flashes, but no change in overall sleep duration. We therefore did this study to see how an experimental model menopause-related sleep interruption would affect metabolic outcomes that may contribute to weight gain. 
Benjamin E. Gewurz MD, PhD
Broad Institute of MIT and Harvard, Cambridge,
Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital,
Department of Microbiology, Harvard Medical School
Boston, MA
MedicalResearch.com: What is the background for this study?
Response: When the Covid-19 virus infects cells, it takes over and redirects our cells resources towards the projection of virus building blocks and new viruses. Building blocks include large amounts of RNAs that encode for the viral proteins, much as the mRNA vaccines direct our bodies to make the spike protein. We wondered how the virus changes cell metabolism in order to support the synthesis of vast amounts of viral RNAs within hours of infection.
Dr. Saha[/caption]
Abhishek Saha, PhD
Assistant Professor
Department of Mechanical and Aerospace Engineering
University of California San Diego
MedicalResearch.com: What is the background for this study?
Response: At a very early stage of COVID 19 pandemic, the scientific community identified that respiratory droplet is the primary mode of transmission of the SARS-CoV2 virus. Naturally, the health agencies have encouraged facemasks to restrict these droplets from spreading during respiratory events, like coughing, sneezing, talking, etc. While WHO recommended using either N95 masks or other types of three-layer masks, due to a sharp increase in demand and scarcity in supplies, a variety of either home-made or locally purchased masks became popular. Naturally, one wonders if these single- and double-layer masks provide enough protection. To provide some insight into this critical question, our team, which also includes Professor Swetaprovo Chaudhuri from the University of Toronto, and Professor Saptarshi Basu of the Indian Institute of Science, experimentally analyzed what happens to the respiratory droplets when they impact single- and multi-layer masks. 
Dr. Jacob[/caption]
Jesse T. Jacob, MD
School of Medicine
Director, Antibiotic Stewardship Program
Emory University, Atlanta, Georgia
MedicalResearch.com: What is the background for this study?
Response: Since coronavirus disease 2019 (COVID-19) was recognized in the United States in January 2020, the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attributed to exposures in the health care workplace has been studied with conflicting results, and the role of job functions (such as nurse) or specific workplace activities, including care for individuals with known and unknown SARS-CoV-2 positivity, increase the risk of SARS-CoV-2 infection.
We assessed more than 24,000 healthcare providers between April and August 2020 across four large academic medical systems (Emory, Johns Hopkins, Rush University Medical Center, and University of Maryland) which collaborate in the CDC’s Prevention Epicenter Program and conduct innovative infection prevention research. Each site conducted voluntary COVID-19 antibody testing on its health care workers, as well as offered a questionnaire/survey on the employees’ occupational activities and possible exposures to individuals with COVID-19 infection both inside and outside the workplace. We also looked at three-digit residential zip-code prefixes to determine COVID-19 prevalence in communities. 
Dr. Lee[/caption]
Brian P. Lee, MD, MAS
Assistant Professor Clinical Medicine
University of Southern Californi
Keck School of Medicine
Los Angeles, California
MedicalResearch.com: What is the background for this study?
Response: The COVID-19 pandemic has been associated with mental health stressors, including anxiety, loneliness, and social instability. We hypothesized the pandemic may have led to increased alcohol and tobacco use as a coping mechanism for these stressors. National retrospective questionnaires had suggested higher reports of substance use, but these are limited by selection and recall biases, in addition to subjective report – we sought to address this knowledge gap by using a nationally-representative longitudinal cohort (Nielsen National Consumer Panel) tracking real-time purchases of households across the US. 
Dr. Traverso[/caption]
Carlo Giovanni Traverso, MB, BChir, PhD
Associate Physician, Brigham and Women's Hospital
Assistant Professor,
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Dr. Chai[/caption]
Peter R. Chai, MD, MMS
Emergency Medicine Physician and Medical Toxicologist
Harvard Medical School
Brigham and Women's Hospital
Department of Medicine
MedicalResearch.com: What is the background for this study? What are some of the functions that Dr. Spot can facilitate?
Response: During the COVID-19 pandemic, we wanted to consider innovative methods to provide additional social distance for physicians evaluating low acuity individuals who may have COVID-19 disease in the emergency department. While other health systems had instituted processes like evaluating patients from outside of emergency department rooms or calling patients to obtain a history, we considered the use of a mobile robotic system in collaboration with Boston Dynamics to provide telemedicine triage on an agile platform that could be navigated around a busy emergency department. Dr. Spot was built with a camera system to help an operator navigate it through an emergency department into a patient room where an on-board tablet would permit face-to-face triage and assessment of individuals.
Dr. El Khoudary[/caption]
Samar El Khoudary, PhD, MPH, BPharm, FAHA
Associate Professor of Epidemiology
University of Pittsburgh Graduate School of Public Health
MedicalResearch.com: What is the background for this study?
Response: Research increasingly shows that it isn’t so important how much fat a woman is carrying, which doctors typically measure using weight and BMI, as it is where she is carrying that fat. To investigate this, we looked at 25 years of data on 362 women from Pittsburgh and Chicago who participated in the 
Dr. Zimmerman[/caption]
Frederick Zimmerman, PhD
Professor, Department of Health Policy and Management
Fielding School of Public Health
UCLA
MedicalResearch.com: What is the background for this study?
Response: The science on school transmissions of COVID is becoming clearer all the time in its conclusion that there is little to no transmission in school environments as long as reasonable precautions are taken. Yet one recent study got a lot of attention for claiming that states that allowed their schools to remain open in the early days of the pandemic saw more cases. That study did not control for several important factors that might explain this association, so our study aimed to correct that work.
Dr. Gordon[/caption]
Terry Gordon PhD
Professor, Department of Environmental Medicine
NYU Grossman School of Medicine
NYU Langone Health
MedicalResearch.com: What is the background for this study?
Response: We are air pollution researcher and interested in unique exposure scenarios. Based on the work by Dr. Steve Chillrud, Columbia University, we did a study 5 years ago to assess air quality in over 30 subway stations in NYC. We found poor air quality in all of the underground stations but the air quality was better in some locations. So we wondered what would be air quality in different transit systems in NE United States. David Luglio, pre-doctoral candidate, led a team of students to monitor particles in the air of subway stations in metropolitan NYC's MTA, LIRR, and PATH systems, Boston, Philadelphia, and Washington, DC.
Dr. Garantziotis[/caption]
Stavros Garantziotis MD
Division of Intramural Research
National Institute of Environmental Health Sciences
Research Triangle Park, NC
MedicalResearch.com: What is the background for this study? How does hyaluronan differ from other medications for COPD? Is it used for other medical conditions?
Response: Hyaluronan is a natural sugar found in the human body, including in the lung. We have found that when the lungs are exposed to pollution, this sugar breaks down, and the breakdown fragments cause inflammation in the lung. We also found that if we give back the natural form of hyaluronan, it protects the lung from inflammation. Patients suffering from COPD also have a lot of hyaluronan breakdown in their lungs. We therefore reasoned, that giving them back the natural form of hyaluronan, as an inhalation treatment, would help them reduce inflammation. We tested this, as a first step, in the treatment acute inflammation of the lungs in COPD patients who are suffering an exacerbation of their disease.
Hyaluronan is different from existing medications in that it is a natural product of the body. It is used in Europe for conditions like cystic fibrosis, and after sinus surgery to humidify the airways. Because it is given by inhalation, it acts locally in the lungs. 
Elodie Warren[/caption]
Elodie C. Warren, MPH
Columbia University Mailman School of Public Health Graduate
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We know that the US has been experiencing an opioid crisis for the past two decades. And we know that among communities of color, rates of overdose deaths are continuing to increase, even though overall national rates decreased between 2017 and 2018.
To better understand how the opioid crisis has differently affected racial/ethnic groups, we looked at how heroin treatment admissions changed over time by race/ethnicity, age, and sex. We found that there were stark differences when comparing non-Hispanic Black men and women to non-Hispanic White men and women.
Importantly, our study suggests the existence of an aging cohort of Black men and women (likely including survivors of a heroin epidemic that hit urban areas more than 40 years ago) that continues to struggle with heroin addiction. This points to the need for targeted interventions in chronically underserved communities. 
Dr. Master[/caption]
Christina L. Master, MD, FAAP, CAQSM, FACSM
Professor of Clinical Pediatrics
Perelman School of Medicine at the University of Pennsylvania
Co-Director, Minds Matter Concussion Program
Pediatric and Adolescent Sports Medicine, Division of Pediatric Orthopedics
Attending Physician, Care Network - Karabots Center
The Children's Hospital of Philadelphia
Philadelphia, PA 19104
MedicalResearch.com: What is the background for this study?
Response: There have been multiple studies investigating potential sex differences in outcomes from concussion which have sometimes had conflicting results with some studies indicating that females take longer to recover than males and some studies reporting no difference in recovery between females and males, with most of these studies being conducted either retrospectively or prospectively in smaller cohorts. This large-scale multi-center prospective study in collegiate athletes provided an opportunity to compare females and males across comparable sports to examine both potential intrinsic or biologic factors (sex differences) or extrinsic (environmental or gender differences) that contribute to outcomes.
Dr. Kovács[/caption]
Balázs Kovács PhD
Associate Professor of Organizational Behavior
Yale School of Management
MedicalResearch.com: What is the background for this study?
Response: Our study looks at the association between the prevalence of legal cannabis stores, called “dispensaries”, and opioid-related mortality rates in the U.S. We find that higher cannabis dispensary counts are associated with reduced opioid-related mortality rates. We find this relationship holds for both medical dispensaries, which only serve patients who have a state-approved medical card or doctor’s recommendation, as well as for recreational dispensaries, which sell to adults 21 years and older. The statistical associations we find appears most pronounced with the class of opioids that includes fentanyl and its analogs. 
Dr. Pedersen[/caption]
Eric R. Pedersen, Ph.D.
Adjunct Behavioral Scientist, RAND
Associate Professor of Psychiatry and Behavioral Sciences
Keck School of Medicine
University of Southern California
MedicalResearch.com: What is the background for this study?
Response: In November of 2016, CA voted to legalize cannabis for sale and possession to adults 21 and older for recreational use. It wasn’t until January of 2018 that stores in most parts of LA County (we call these “outlets”) were legally able to begin selling recreational cannabis. We were collecting data from about 2,500 young adults in LA County as part of a longitudinal study (Principal Investigator Elizabeth D’Amico at RAND) and were able to look at cannabis use and intentions assessed at a period prior to the opening of the recreational cannabis outlets (pre-January 2018) to a period when those outlets were open (after January 2018). It has been suggested that once cannabis was more available for recreational purchase (and not just for medical purposes among those enrolled in CA’s medical marijuana program), use of cannabis among young adults would increase. 