It’s now been more than one year since the first case of COVID-19 was detected in the United States, and Feinberg investigators continue to investigate the disease, its evolution and its impact on society. Most recently, countries around the world, including the U.S., have begun to roll out widespread COVID-19 vaccination efforts — a sign of the significant progress and scientific breakthroughs that have been made since March 2020.
U.S. Vaccination Effort Must Prioritize Equity
As the U.S. races to vaccinate as many people as quickly as possible, this effort must also prioritize equity, according to a recent editorial published in JAMA.
With every state now organiazing their own COVID-19 vaccination campaigns, concerns have also been raised that more-detailed approaches to vaccinate vulnerable populations may be too difficult to implement and could ultimately slow overall vaccine rollout. These calls to sacrifice equity for speed are horrifying, said Muriel Jean-Jacques, MD, associate vice chair for Diversity, Equity, and Inclusion in the Department of Medicine and lead author of the paper.
“After months of watching the devastation and the heavy toll of COVID-19 on seniors, nursing home residents, frontline workers and other essential workers, and particularly upon our Black and Brown communities, and after months of listening to the public wringing of the hands about the social inequities laid bare by the pandemic, were we again going to turn our back on our professed commitment to equity just because it’s hard?” said Jean-Jacques, who is also an assistant professor of Medicine in the Division of General Internal Medicine and Geriatrics.
According to Jean-Jacques, prioritizing vulnerable populations — for example, individuals aged 65 and older — is a logical approach. However, if that approach doesn’t explicitly promote health equity, health disparities for this patient population will be exacerbated.
“A vaccine sign-up policy that favors those with high-speed internet access, those who are tech-savvy, those who are able to easily and quickly drive far and wide to get to the limited available slots, and those who don’t care whether they get the vaccine from their long-trusted healthcare provider or a pop-up vaccine site, is doomed to fail to reach our most vulnerable seniors,” Jean-Jacques said.
An equity-based vaccine distribution approach would also enable communities to generate daily data to understand who is being vaccinated, Jean-Jacques wrote. Additionally, local health departments and health institutions need to respond to these data in real time to identify where COVID-19 vaccine uptake is not matching disease burden.
“Many state and local health departments have already put much planning and resources into advancing the strategies outlined above. These efforts need to be further bolstered, not abandoned, in the push to get ‘shots into arms’ as quickly as possible,” Jean-Jacques wrote.
Northwestern Investigators Identify COVID-19 Variants in Chicago
Since the beginning of the COVID-19 pandemic, a team of Northwestern Medicine scientists based in the Division of Infectious Diseases and supported by the Emerging and Re-emerging Pathogens Program (EREPP) have been tracking the evolution of SARS-CoV-2 in the city of Chicago. The team working on tracking the virus includes: Ramon Lorenzo-Redondo, PhD; Egon Ozer, MD, PhD, ’08, ’12 GME; Judd Hultquist, PhD; Lacy Simons; Michael Ison, MD, MS; Chad Achenbach, ’02 MD, ’02 MPH and Alan Hauser, PhD.
In January 2021, the Chicago Department of Public Health and the Illinois Department of Public Health announced the team had found Illinois’ first case of a SARS-COV-2 variant that was originally identified in the U.K., called B.1.1.7. In early March 2021, the team also identified the first case of the COVID-19 variant originally identified in Brazil, called P.1. That variant, which was first identified in the U.S. in January, has several mutations in the virus’ notorious spike protein, including one shared with the U.K. variant.
“We are allowing the virus to become better by replicating, generating diversity and selecting mutations. The main message is we need to lower the prevalence of the virus, because if not, the virus is going to keep improving — they keep evolving all the time,” said Lorenzo-Redondo, a research assistant professor of Medicine in the Division of Infectious Diseases.
Research suggests that antibodies generated through vaccination with currently authorized vaccines recognize these variants. However, it is still unclear whether either variant can cause more severe disease.
“It’s important to stay ahead of the game and know which strains are emerging, where they are emerging and what the implications of the new mutations are. These are all critical tools for public health departments to plan their interventions,” said Babafemi Taiwo, MBBS, ’06 GME, the Gene Stollerman Professor of Medicine and chief of Infectious Diseases in the Department of Medicine.
Feinberg recently featured investigations into COVID-19 variants on an episode of the Breakthroughs Podcast, “Tracking COVID-19 Variants with Ramón Lorenzo-Redondo, PhD.”
Lorenzo-Redondo was recently awarded a NUCATS Institute COVID-19 Collaborative Innovation Award to examine if changes in the SARS-CoV2 virus while inside a patient’s body during infection can influence severity of the disease.
COVID-19 Misinformation and Bias
Public attitude toward COVID-19 is more “infectious” than the disease itself, thanks to social media, according to a new Northwestern Medicine study published in the Journal of Medical Internet Research.
“In the pandemic, social media has contributed to much of the information and misinformation and bias of the public’s attitude toward the disease, treatment and policy,” said Yuan Luo, PhD, chief artificial intelligence officer at the Institute for Artificial Intelligence in Medicine and a co-author of the study.
For the current study, Luo and colleagues used artificial intelligence to analyze tweets about the virus, and studied the influence of Twitter on COVID-19 health beliefs and the competing influence of scientific evidence versus political rhetoric.
The team found that a user’s bias is magnified when they read tweets about COVID-19 from other users. Additionally, the more it’s retweeted the more they believe it and retweet it themselves. They also found that “scientific events”, such as scientific publications, and “non-scientific events,” such as speeches of politicians, influence health belief trends on social media equally.
“Our study helps people to realize and re-think the personal decisions that they make when facing the pandemic. The study sends an ‘alert’ to the audience that the information they encounter daily might be right or wrong and guide them to pick the information endorsed by solid scientific evidence,” said Luo, who is also an associate professor of Preventive Medicine in the Division of Health and Biomedical Informatics and chief artificial intelligence officer at NCUATS.
PPE Production Exacerbates Issue of Forced Labor
The COVID-19 pandemic led to a worldwide shortage of personal protective equipment (PPE) and in response, governments, health systems and businesses in the U.S. and abroad employed various optimization strategies to obtain PPE that relied on global medical supply chains linked to forced labor, according to a recent editorial published in Annals of Internal Medicine.
“With so many consumers clamoring for PPE, state or local governments, health systems and other businesses were willing to do virtually anything to gain an edge. In many cases, this included ignoring well-described concerns that certain companies abroad were engaging in forced labor practices,” said Andrew Carlo, MD, MPH, assistant professor of Psychiatry and Behavioral Sciences and a co-author of the paper.
While several non-governmental organizations have identified companies they believe are associated with inhumane work conditions for adult and child workers, the demands of the pandemic have often led these concerns to take a backseat, according to Carlo.
In response, Carlo and colleagues strongly advised U.S. PPE purchasers to reach out to established organizations with expertise in forced labor and global supply chains to effectively and actively address this issue. U.S. hospitals should also purchase PPE from suppliers that monitor their supply chains or use traceability-enhancing technology and transparent labeling, and to consider providing economic incentives for suppliers to take these steps. Additionally, healthcare professionals should encourage leadership to consider supplier adherence to ethical labor standards when purchasing medical supplies.
“If medicine truly wants to bring its actions in line with its oath to do no harm, it can no longer turn a blind eye to where the tools of its trade come from,” the authors wrote. “To contain the human cost of the pandemic, there is no doubt that we should maximize effective use of PPE, but we must also ensure better work practices for those who enable us to wear it in the first place.”