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Military hospital lends research expertise to global pandemic effort

Michelle Mendoza, pharmacy technician, reconstitutes the remdesivir research drug under an intravenous hood at Brooke Army Medical Center

Michelle Mendoza, pharmacy technician, reconstitutes the remdesivir research drug under an intravenous hood at Brooke Army Medical Center, Fort Sam Houston, Texas, April 29, 2020. BAMC is participating in a COVID-19 treatment trial centering on the antiviral drug, remdesivir. The National Institute of Allergy and Infectious Diseases (NIAID)-sponsored study has enrolled hundreds of people across the nation as it looks to determine if the antiviral drug is effective against COVID-19. (U.S. Army photo by Jason W. Edwards)

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas (AFNS) --

Within weeks of the pandemic’s spread, Brooke Army Medical Center drew on its deep bench of research expertise and joined the global race to find a COVID-19 treatment.

“We knew early on that with BAMC’s strong research and academic foundation, our clinicians would want to quickly launch or join studies to help find answers,” said Dr. Christopher A. Rábago, Human Research Protection Office chief. “We took immediate action by reducing all non-essential research to enable us to focus our efforts on the pandemic.”

BAMC explored every opportunity to participate in local, national and global studies and research efforts in a concerted effort to save lives and ensure the health and welfare of the force, said Col. Heather Yun, chief, Department of Medicine and professor of medicine, Uniformed Services University of the Health Sciences, Infectious Diseases.

“Research is truly a mission-essential activity, particularly in times like these where there is so much still to be learned about a novel and emerging infectious disease,” Yun said.

Promising treatment

Alongside military and civilian organizations, BAMC soon joined the nation’s first clinical trial to evaluate an experimental treatment for the virus. The Adaptive COVID-19 Treatment Trial, or ACTT, centered on an antiviral drug called remdesivir, formerly touted as a potential Ebola treatment.

The National Institute of Allergy and Infectious Diseases (NIAID)-sponsored study enrolled over a thousand people across the nation as it looked to determine if the antiviral drug was effective against COVID-19.

NIAID released promising preliminary results April 29 indicating that hospitalized patients with advanced COVID-19 and lung involvement who received remdesivir recovered faster than similar patients who received a placebo, according to a NIAID press release.

“As of yesterday, we didn’t have a proven treatment for COVID for hospitalized inpatients and now we do,” said Maj. (Dr.) David Lindholm, infectious disease doctor and BAMC’s principal investigator on the remdesivir trial. “The trial started in late February, and we went from having limited information to promising results. To see the rapidity at which this has happened is unprecedented.

“This was an incredible opportunity to collaborate with national and international clinical research experts, while exploring potentially lifesaving treatments,” Lindholm said, he also serves as an assistant professor of medicine at Uniformed Services University of the Health Sciences. BAMC will also have a role in NIAID’s ACTT 2 trial, which is currently being designed, he noted.

Based on preliminary research on the drug, BAMC has joined an Army-sponsored force health protection clinical protocol that will enable providers to use remdesivir on a case-by-case, emergency basis to treat military personnel and protect deployed or remote service members as needed, explained Army Col. (Dr.) J. Shen-Gunther, Department of Clinical Investigation chief.

“Doctors will be able to prescribe and use remdesivir under this expanded-access treatment protocol,” Shen-Gunther noted.

The military is also looking into additional treatment options to include the use of convalescent plasma, which is blood donated by people who have recovered from the virus. Researchers are hoping this antibody-containing blood will boost COVID-19 patients’ ability to fight the virus.

While many of these research efforts are highlighted in the news, Rábago cautioned people to keep experimental drugs and treatment trials in perspective; only a small, severely-ill population will ever need them.

“Our doctors are doing the normal, everyday standard of care, and patients are getting better. Not everyone needs an extraordinary intervention, but we are prepared to do that because BAMC is laying the groundwork to be ready.”

Behind the scenes

National-level studies are important; however, much of the work happens quietly and on a smaller scale behind the scenes, Rábago noted. “From documenting cases to process improvement efforts, our clinicians are doing their part every day. And their efforts are just as vital and important.”

Shen-Gunther praised BAMC’s participation in national and global registries, which are repositories of patient data that researchers and healthcare professionals can use to increase understanding of medical conditions, track trends and more.

“Registries enable us to step back and look for trends that may offer a roadmap for a cure or different course of treatment,” she said. “For example, we can look at certain populations based on demographics or conditions, and make discoveries or change our technique.”

Looking to the future, BAMC has joined a study launched by the Uniformed Services University’s Infectious Disease Clinical Research Program called Epidemiology, Immunology and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential, or EpICC-EID. This multicenter study follows patients with suspected or a confirmed case of COVID-19 for six months to better understand the varying characteristics of the virus, Lindholm explained.

‘In our wheelhouse’

Spurred by this national emergency, research and subsequent approvals have been expedited through the system. Fortunately, BAMC, with the second largest research portfolio in the Defense Department, has some experience in swiftly and safely navigating the process.

“Being a Level I Trauma Center, we are well-versed in working with the (Food and Drug Administration) and dealing with emergency-use treatments,” Rábago said. “We are able to apply this knowledge locally while also providing guidance and insight to other military treatment facilities. Research is in our wheelhouse.”

Along with COVID trials, over 300 studies and 150 clinical trials, which can’t be halted due to patient safety or continuity, are ongoing at BAMC. In the weeks ahead, Rábago expects there will be a host of new study and process improvement proposals from across the organization aimed at better understanding the pandemic and outlining best practices for the future.

“One example is a multidisciplinary new project, led by Dr. Lindholm, which looks at our drive-thru COVID screening operations and how to best refine testing criteria for optimal capture of COVID cases,” Rábago said. “That will be highly important not just for current operations, but also for future training and implementation.”

While the pandemic is unprecedented, the collaboration taking place at BAMC is not, Shen-Gunther noted. “The collaboration between specialties and departments – infectious disease, public health, pharmacy, lab, emergency medicine, to name just a few -- has been incredible, but we collaborate every day of every year.”

“I can’t speak highly enough about the researchers and clinicians working so diligently behind the scenes to aid our community and our nation,” Rábago agreed. “I’m very proud to be a part of this incredible team of professionals who are making their mark on science and in history.”

BAMC’s focus on research is vitally important on multiple levels, Yun said.

“If we are in a war against the virus, medical research is the intelligence operation that enables us to stay agile and one step ahead of the enemy,” she said. “These are the studies that will drive innovation, change practice, and ensure that we have all the tools available to provide the best care for our patients, now and in the future.”