June Health Matters: Pandemic forced Nebraskans to innovate | Health-matters | omaha.com

2022-06-15 15:46:03 By : Ms. Stephanie Chow

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Health Matters in the Heartland is a monthly series by the Omaha World-Herald and Lincoln Journal Star, examining the evolution of the practice and policy of health care. It’s produced with the support of presenting sponsor Blue Cross Blue Shield of Nebraska and this month’s sponsor, Ovation Heartwood Preserve. Go to https://omaha.com/exclusive/health-matters for multimedia content, new stories and previous monthly installments.

In the early months of the COVID-19 pandemic, researchers, clinicians, businesspeople and everyday men and women spun out new ways to deal with the coronavirus.

The result was a host of innovations, including new designs for masks and face shields, intubation shields for COVID patients, ultraviolet disinfection methods for protective gear and 3D-printed nasal swabs. Along with those came a flurry of new tests for the virus, some treatments and highly effective vaccines brought to market in record time.

While protective gear was short early in the pandemic, Nebraska Medicine used ultraviolet light towers like this one to decontaminate masks so they could be used multiple times instead of just once. 

Some of the innovations, including a UV disinfection system and the intubation shields, largely went by the wayside as supplies of protective gear improved and knowledge about the disease increased. But others — including the tests and vaccines — likely will be around for as long as COVID-19 itself.

Among the COVID tests was a saliva-based version developed by the University of Nebraska Medical Center's Emerging Pathogens Laboratory, directed by Dr. Jana Broadhurst. The test still is still used on campus and by partners in the region where access to high-quality testing remains a challenge.

Lab staff developed the test to both get around supply shortages that plagued the nasal swab and PCR-based testing early in the pandemic and meet the demand for screening programs in the community.

"That was a whole new regime of innovation that we and others around the country and world were grappling with during that really sustained high-volume testing phase of the pandemic," Broadhurst said. 

Work continues on tests, treatments and vaccines. Another group of UNMC researchers has developed a nasal rinse device that is an alternative to the long nasal swabs used in many PCR tests.

Meanwhile, doctors, nurses and other providers came up with ways to perform procedures that were backlogged during the worst viral surges. They include expanding same-day surgeries such as knee and hip replacements and even some cardiac procedures. Similarly, bars and restaurants pivoted to takeout food and beverages and businesses shifted to remote or hybrid workplaces.

In a way, the boom in innovation is no surprise. When things are going well, there's little need for new solutions. But a pandemic, like other disruptions, drives people to seek better ways to get things done. 

"Everyone wants to innovate and make things that solve problems," said Michael Dixon, president and CEO of UNeMed, which helps UNMC and the University of Nebraska at Omaha obtain patents and licensing.

Many researchers, he said, dropped what they were working on in other fields to pitch in on pandemic projects. 

The same thing happened nationally. Surveys of scientists in 2020 and 2021 indicate that roughly a third of researchers in the U.S. and Europe contributed to the effort, according to Scientific American.

Some of those efforts yielded products. Dixon said UNeMed saw more than twice as many new inventions — 73 — in the last two quarters of 2020 than in the first two quarters, marking the most productive six-month span in the organization's history.

Shortly after the virus emerged, Doug Hannah, assistant professor for strategy and innovation at Boston University, began tracking organizations that popped up across the country to address pandemic needs. 

His database now includes 234 organizations reflecting around 500 innovations, including technologies such as UV disinfection and organizational innovations involving supply chains and the coordination of human capital.

The challenges at the start of the pandemic, he said, involved addressing the fast-emerging needs for protective gear and more complex medical devices in the face of long lead times and a small number of suppliers. On top of that came new demands for such items as hand sanitizer and ventilators.  

"Not only was it just replacing all the personal protective equipment and devices we couldn't get anymore but rather we needed to create new ones," Hannah said.

A particularly interesting aspect of the response, he said, was its grassroots nature. People in their homes — feeling powerless and seeking ways to protect themselves and their loved ones — made due with items they had on hand. 

With millions of people experimenting with different ways to do things, using different supplies, Hannah said, "you're going to come up with really clever ideas." Examples include a plethora of mask and face shield designs. People sewed masks for themselves and health care systems. They churned out face shields in garages and fabrication shops. 

Dr. Jana Broadhurst and her team developed a modified PCR saliva test that’s still used on the University of Nebraska Medical Center campus and by partners in the region where access to high-quality testing remains a challenge.

"In some sense, the grass-roots response to the pandemic was a heck of a silver lining," Hannah said. "It was one of the most impressive human mobilizations that we've had in two generations, and in some sense had a lot of parallels to the war effort 70 years ago."

The other impressive innovation, he said, were the systems developed to coordinate the efforts of thousands of people who wanted to help. One of the best examples involved mask donations, using a kind of reverse supply chain to collect masks from individuals and deliver them to health care systems.

The efforts, he said, ranged from individuals organizing on Facebook to GetUsPPE, a national group that collected and delivered some 17 million pieces of protective gear to those in need between March 2020 and June 2021.

Hannah predicted that ventilation and clean air will continue to be important topics. A number of technologies around low-cost ventilation and air purification already have emerged from the pandemic. In March, the Biden administration launched a Clean Air in Buildings Challenge to improve indoor ventilation and reduce the spread of COVID-19 in buildings.

Early studies by researchers at UNMC involving patients who had returned from a COVID-stricken cruise ship contributed to the eventual recognition that the coronavirus spreads through the air.

The process by which innovations are brought to market also appears poised to change, Hannah said, with the Food and Drug Administration offering flexible funding and approval models that potentially could speed the process. 

Joe Runge, associate director of UNeTech, which coordinates the creation of business startups from research at UNMC and UNO, said the pandemic also has changed how inventors innovate. One example is 3D printing, which allows inventors to quickly build prototypes that allow them to ask and answer questions in the course of developing a product in ways they couldn't before. 

An example is a device called Microwash, a self-contained specimen container that can be used to squirt saline into a patient's nose and collect what drains out for testing for viruses. Designed in a year, it's now in clinical trials. Anticipating a fall surge of COVID, UNeTech is working to bring the product, invented by UNMC's Thang Nguyen and Dr. Michael Wadman, to market. 

Here's a look at a few more pandemic-inspired innovations, some of which met an immediate need but are no longer used and others that are meeting ongoing needs and could spark other uses in the future.

Before testing was widely available for surgical patients, Drs. Thomas Schulte and Michael Ash designed a plastic shield to protect health care workers from infectious particles during intubation procedures. Schulte is an anesthesiologist and director of peri-operative services at Nebraska Medicine and Ash is a Nebraska Medicine vice president.

Early in the pandemic, a team of UNMC physicians worked with a local plastic fabricator to design a box to protect health care providers from contagion during intubation, a procedure used to help people breathe, and to conserve protective gear. 

At the time, protective gear was scarce and was being conserved for nurses working with known COVID patients, Schulte said. Anesthesiologists were concerned about being exposed to aerosolized virus particles when they intubated patients. 

Researchers in China had developed a box-shaped shield. Schulte said their version was more angled and folded flat for storage. It served a great purpose in those early pandemic days, he said, but isn't used much anymore.

Still, Schulte said he would do the work all over again, even if he knew it wouldn't become a routine part of life in the operating room.

"It's innovating and using your creativity to solve a problem or make something easier ... or a better model of it," he said. "We were trying to do that."

Similarly, another group of UNMC researchers developed a method of decontaminating masks with UV radiation. Dixon said UNeMed no longer is licensing the technology.

"It solved a big problem at that time," he said. "They published the recipe, and people all over the world used it."

While testing for COVID-19 was in short supply early in the pandemic, dozens of different tests now are available, including a multitude of at-home tests that look for the virus's proteins. 

The emerging pathogens lab Broadhurst heads developed its saliva test, adapted from a Yale University design, by fall 2021. Not only is it still available for use by students, staff and faculty on campus, it's also offered through six partnerships with groups in Omaha, organizations serving immigrant groups in central and western Nebraska and the Oglala Sioux Tribe on the Pine Ridge Reservation. 

Staff at the University of Nebraska Medical Center's emerging pathogens laboratory developed this modified PCR saliva test to get around supply shortages that plagued the nasal swab and PCR-based testing early in the pandemic and meet the demand for screening programs in the community.

Rather than having their nasal passages swabbed, users simply spit through a short straw into a small tube. Test kits, which cost less than $2, include a tube, a straw and alcohol wipes. Samples don't need preservatives or cold storage.

Broadhurst said the lab is now running a couple hundred tests a week. Demand was much higher during last winter's omicron surge, and the lab is prepared for future surges should they arise.

The lab initially partnered with the Omaha Public Schools to conduct saliva testing in several South Omaha schools. Additional researchers led collection and testing of air, surface and wastewater samples. 

While the OPS program has ended, wastewater surveillance now continues in locations across the state under a Centers for Disease Control and Prevention-based initiative that's administered through state health departments. 

"It's really neat to see that technology blossom into a large-scale program," Broadhurst said.

The researchers, working with UNMC's Dr. David Brett-Major, now are taking testing in a different direction. Through a recently launched Community Threat Assessment study, they're seeking to get a pulse on shifting COVID-19 risk in the community from another surge and from new variants. To do so, they're collecting information, finger stick blood samples and saliva specimens from volunteers out in the community, working under agreements with partners such as the Omaha City Parks, Recreation and Public Property Department, malls and other venues.

Through the study, Broadhurst said, the researchers hope to get an idea of how many infected people are moving around in the community and  gauge the level of immunity in the community, among other measures.

During surges of COVID-19, hospital beds were in short supply, and many elective procedures were canceled or postponed. 

So some surgeons adapted their procedures to be performed on a same-day basis — without an overnight hospital stay — accelerating a shift that already was underway. 

Dr. Clayton Thor, an orthopedic surgeon with CHI Health, recently estimated that most of his hip and knee replacement patients before the pandemic spent at least one night in the hospital. Now, roughly 80% to 85% go home the same day. 

Dr. Andrew Goldsweig, medical director for structural heart disease at Nebraska Medicine, said he now is conducting same-day procedures for most operations to place devices that block off a potentially clot-producing appendage in the heart in patients with atrial fibrillation, or irregular heartbeats, and to patch holes between upper heart chambers. Both procedures are aimed at reducing stroke risk.

The key change has been in the imaging used to guide the procedures. Previously, that involved threading an ultrasound device into the patient's esophagus, which required general anesthesia and the help of another specialist. During surges, those specialists typically were busy intubating COVID patients.

Now, Goldsweig is using a smaller device in a process called intracardiac echocardiography, or ICE. In it, the device is threaded into the heart through the same vein in the leg that Goldsweig is accessing to place the repair devices.

Similarly, he has shifted to placing most stents in heart arteries by going through an artery in the wrist. Most of those patients also go home the same day. 

"We've moved everything to a less invasive, same-day kind of platform," he said. "And less general anesthesia."

The shift toward using ICE for imaging in such cardiac procedures, meanwhile, is helping to drive innovation in those devices. Goldsweig said he expects to be using new 3D ICE devices within the next couple of months.

"This made it happen faster," he said of the pandemic, "and it's here to stay. There's no reason to go back. We've got a better way now."

The greatest innovation of the pandemic, however, was the mRNA vaccines, which were based on a technology researchers began developing nearly 20 years ago.

What was unique about the vaccines was the ability of researchers to pivot to bring the technology to bear on the pandemic in such a short time, said Dr. Tyler Martin. A Nebraska native, Martin now runs the Lincoln-area biotechnology consulting firm Great Plains Biotechnology. He spent much of his career developing protein vaccines and vaccine adjuvants, which are added to vaccines to further stimulate the immune system.

Teams that Martin led developed two of the four adjuvanted vaccines approved by FDA, one against influenza and the other targeting hepatitis B. 

Martin said he estimated at the start of the pandemic that vaccine-makers would be lucky to produce a protein-based vaccine in two years. 

"The fact that the mRNA vaccines worked so well and were so rapid to manufacture has really been a tremendous thing," he said. 

That success has spurred researchers and companies to pursue mRNA vaccines for a number of other infectious diseases, including flu and HIV. The National Institute of Allergy and Infectious Diseases announced in March that it had launched a phase 1 clinical trial of three experimental HIV vaccines based on the mRNA platform. 

Martin said he thinks the mRNA technology will be useful for other conditions. "It'll just be a matter of searching out where it is and where it isn't helpful," he said. "And that's going to take some time and some experimentation."

Researchers also are looking at using mRNA technology for cancer and gene therapy. 

Jerry Swiercek uses a leaf blower to clear hail and leaves stripped from trees following a hail storm outside the home he shares with his wife, Annette, at 44th Avenue and F Street in Omaha on Tuesday evening.

Haydn Nichols, 9, rides the Musical Chairs ride during Taste of Omaha at Elmwood Park in Omaha on Friday.

Drone photography after a three-alarm fire at the Nox-Crete chemical warehouse in Omaha on Tuesday.

Andrea Vanderheyden, the artist behind this community art project, ties a ribbon to help create a pride flag on the corner of the Ashton building on Tuesday to kick off the start to Pride month.

A man sprays down the roof of a neighboring building while also filming the scene of a three-alarm fire at Nox-Crete, Inc., 1415 S. 20th St on Monday.

Lighting can be seen behind the scene of a three-alarm fire at Nox-Crete, Inc., 1415 S. 20th St on Monday.

Flames shoot up at the scene of a three-alarm fire at Nox-Crete, Inc., 1415 S. 20th St on Monday.

Ben Crawford, a Native American Graves Protection and Repatriation Act assistant with the Winnebago Tribal Historic Preservation Office, watches as dogs search for the cemetery site.

julie.anderson@owh.com, 402-444-1066, twitter.com/julieanderson41

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Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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Just before the COVID pandemic broke out, UNMC's Global Center for Health Security received a grant from the CDC to strengthen infection control training, education and tools.

The pandemic forced medical professionals, including Nebraska-based researchers and physicians, to innovate. Some innovations likely will be around for good.

Just before the COVID pandemic broke out, the University of Nebraska Medical Center’s Global Center for Health Security received a grant from …

Dr. Jana Broadhurst and her team developed a modified PCR saliva test that’s still used on the University of Nebraska Medical Center campus and by partners in the region where access to high-quality testing remains a challenge.

Staff at the University of Nebraska Medical Center's emerging pathogens laboratory developed this modified PCR saliva test to get around supply shortages that plagued the nasal swab and PCR-based testing early in the pandemic and meet the demand for screening programs in the community.

While protective gear was short early in the pandemic, Nebraska Medicine used ultraviolet light towers like this one to decontaminate masks so they could be used multiple times instead of just once. 

Early in the pandemic, a team of UNMC physicians worked with a local plastic fabricator to design a box to protect health care providers from contagion during intubation, a procedure used to help people breathe, and to conserve protective gear. 

Health Matters in the Heartland is a monthly series by the Omaha World-Herald and Lincoln Journal Star, examining the evolution of the practice and policy of health care. It’s produced with the support of presenting sponsor Blue Cross Blue Shield of Nebraska and this month’s sponsor, Ovation Heartwood Preserve. Go to https://omaha.com/exclusive/health-matters for multimedia content, new stories and previous monthly installments.

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