A leader in COVID-19 research

Hand holding a vial

Within weeks after the pandemic began, Emory researchers across a wide variety of disciplines mobilized their resources and applied their expertise to address various dimensions of COVID-19, some pivoting from existing research to redirect their energies and skills to ending the relentless onslaught of a new virus.

At the close of 2020, Emory investigators had launched more than 115 research projects and studies, including several clinical trials, and published more than 580 papers on COVID-19. The university had earned more than $130 million in COVID-19 research funding, ranking it third in the nation—a testament to the ability of researchers to shift course rapidly to tackle the world’s biggest public health crisis in more than 100 years.

“In my short time at Emory, I’ve been deeply impressed by the dedication of our researchers and clinicians, whose cutting-edge discoveries are opening new pathways of understanding in the prevention and treatment of COVID-19,” says Emory President Gregory L. Fenves.

The intricate tapestry of COVID-19 activities spans the spectrum of disease—from advancing understanding of the virus to coming up with quicker and more accurate tests to finding treatments and a vaccine. Here’s a small sample of the wide-ranging COVID-19 research at Emory.

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Vaccines

Volunteer receiving vaccine as part of a clinical trial at Emory

Emory was one of two testing sites for the first COVID-19 vaccine developed in the United States. The vaccine, developed by the National Institute of Allergy and Infectious Diseases and the biotech firm Moderna, was found to be safe and effective and later progressed to advanced-stage trials. In December, it became the second vaccine after Pfizer’s to be issued an emergency-use authorization (EUA) by the US Food and Drug Administration (FDA). Emory Healthcare began vaccinating its frontline health care workers roughly a week after the first EUA had been issued. Both the Moderna and Pfizer vaccines require two doses.

Emory also has been involved in advanced-stage clinical trials of two other vaccine candidates, Novavax and Johnson & Johnson. The latter is the only one-dose vaccine with emergency- use authorization.

A key objective for vaccine trials nationwide was to ensure adequate representation among racial minorities. For the Moderna trial, Emory’s Hope Clinic recruited the second-highest number of African Americans in the country. At two of the three Emory testing sites for that vaccine, the participation rate averaged around 40 percent for Black and Latinx communities, higher than the reported national average of 30 percent for that trial.

Emory researchers led by Rama Amara are also working on their own vaccine, drawing from their extensive research on an MVA vaccine for HIV/AIDS. MVA is a harmless version of a poxvirus with a proven record of promoting long-lasting immune responses. The Emory MVA COVID-19 vaccine has proven safe and effective in mice and monkeys. It is easily adaptable to address disease variants, can be used in combination with existing vaccines to improve their ability to combat variants, and has the potential to be equally effective with a single dose.

Emory researcher Ram Amara

In addition, Emory scientists are evaluating novel adjuvants that can help produce more effective vaccines. Adjuvants are stimulants in the vaccine that can significantly accelerate the

speed, quantity, and longevity of the body’s ability to make virus-neutralizing antibodies. Researchers expect to release their findings in the next couple of months.

Emory researchers have been awarded a contract by the Centers for Disease Control and Prevention (CDC) to characterize the diversity and evolution of SARS-CoV-2 strains circulating in Georgia. Their aim is to understand whether new variants make the virus spread faster or make people sicker than known varieties.

Along with assessing vaccine candidates for safety and protection, Emory scientists are investigating models for optimal COVID-19 vaccine-distribution strategies. This work by public health researchers will help inform both direct protection and herd-immunity benefits of various COVID-19 vaccination approaches.

Therapeutics

Emory researcher working on drugs to prevent and treat COVID-19

Could drugs that have already been approved for a different use be effective against COVID-19? Emory researchers are investigating several drugs that have shown antiviral activity in cell culture for COVID-19 and in animals infected with MERS and SARS—coronaviruses similar to COVID-19. Many of the drugs being tested are already on the market and some are relatively inexpensive.

Two such repurposed drugs— remdesivir and baricitinib—were both tested at Emory as part of federally funded global trials. Antiviral remdesivir, originally developed for Ebola, was the first COVID-19 treatment authorized by the FDA for emergency use. Anti-inflammatory baricitinib has shown faster recovery among hospitalized patients when used in combination with remdesivir. The FDA recently granted an EUA for baricitinib as well.

Studies are underway to gauge whether manufactured versions of infection-fighting antibodies are effective in protecting against and treating COVID-19. Produced in laboratories, these synthetic antibodies are known as monoclonal antibodies (mAB) and require transfusion. Emory is conducting trials to test the effectiveness of several different mAB therapies, alone or in combination with other drugs. Two of these mABs have now received EUAs for treating COVID-19 and are thought to be most useful during the early stages of the illness.

Merck has bought rights to an antiviral compound that was discovered at Emory. EIDD-2801 was invented by Drug Innovation Ventures at Emory, a not-for-profit biotech firm. The agent was effective against previous coronaviruses such as MERS and SARS and is currently in Phase II trials nationwide. An oral therapeutic could reduce transmission as it is likely to be easier to dispense compared to drugs that require transfusion.

Researchers at Emory have found that nearly all people hospitalized with COVID-19 develop virus-neutralizing antibodies within six days of testing positive. Although most other studies on the topic have focused on the immune response after hospitalization, Emory used its biosafety level-3 laboratories to do the more time-consuming work of studying patients’ antibody response during hospitalization. The study’s findings have implications for convalescent plasma therapy and vaccine development. Using this research, clinicians are evaluating the use of convalescent plasma with high levels of neutralizing antibodies as a treatment for COVID-19. The FDA has authorized the emergency use of convalescent plasma therapy as an experimental treatment in clinical trials and for critically ill COVID-19 patients.

Diagnostics, apps, and tools

Screen capture of the COVID Symptom Checker

Emory is one of three Atlanta institutions selected to vet the most promising COVID-19 diagnostic technology. Working with their counterparts at Children’s Healthcare of Atlanta and Georgia Institute of Technology, Emory researchers are putting the technologies through a competitive, rapid, three-phase selection process

to identify the best candidates for at-home and point-of-care COVID-19 tests. The $31 million funding for this project is the largest NIH grant Emory has received in a single budgetary year. The FDA recently authorized two of the testing kits that were evaluated at Emory for home use. In February, the Biden administration invested $231.8 million in Elume, the manufacturer of one of these testing kits, to scale up production. The test can send results to a smartphone within 15 minutes of receiving a sample.

Researchers, to expand the program and reach more underserved communities, have begun a collaboration with the Atlanta Public Schools (APS) and will offer testing in APS schools for students, staff, and parents.

Emory has developed a SARS-CoV-2 antibody test to enhance disease detection. Antibody tests can help answer critical questions such as disease progression in populations, exposure to the virus, and infection spread. Antibody tests vary in accuracy. Emory’s antibody test identifies the exact type of antibody that prevents the COVID-19 virus from entering human cells, which allows physicians to better predict whether someone with a positive antibody test result is likely to be protected from future infection.

Emory experts are also evaluating devices that collect plasma samples from blood droplets—taken by a finger prick—which can be transported safely through the mail/courier to Emory Medical Labs for the Emory antibody test. This innovation would combine point of care testing, which is convenient but less informative than needed, with the rigor of Emory’s antibody test.

Emory doctors have collaborated with Vital, a digital platform for the emergency department, on a COVID-19 symptom-checking app to help reduce the flood of patients to hospitals. C19check.com acts as an easy way to digest expert information and choose the best plan of action. Based on the answers to questions about symptoms, age, and other medical problems, a person is directed to guidance based on CDC guidelines and is placed into one of three categories: high risk (needs immediate medical attention), intermediate risk (can contact their doctor for guidance about how best to manage their illness), or low risk (can most likely administer self-care or recover at home).

Surveillance, modeling, and health impact

Researchers have built a dynamic and interactive web-based dashboard that displays the interplay between social determinants and COVID-19 epidemiological metrics at the county level. The public-facing dashboard allows anyone

to quickly compare each county’s COVID-19 cases, deaths, and social characteristics to the state and national average; visualize the relationship between social determinants (such as percentage of the population that is African American, that is living in poverty, that is more than 65 years old, etc.) and COVID-19 outcomes; and create side-by-side maps comparing key metrics at the county level.

Public health experts have launched a sweeping NIH-funded national probability survey of active infections and seropositivity to understand how many adults in the US without a confirmed history of COVID-19 infection have antibodies to the virus. The presence of antibodies in the blood indicates a prior infection. The findings, which are being published on the study website, COVIDVu.org, will help illuminate the extent to which the virus has spread undetected in the country.

An estimated 40 percent of all deaths from COVID-19 in the US have occurred among nursing home residents or employees, and even the strictest measures have not slowed the spread. Mathematical models using specific data are key to developing effective response plans. A public health research team is generating nursing home data needed to understand and reduce disease transmission in these settings.

Emory nursing researchers are leading the way in documenting some of the processes that were set up to make caring for COVID-19 patients more effective and efficient. At the Emory Clinic, a Care Coordination and Transitions Management (CCTM) team comprising registered nurses, social workers, and primary and hospital medical providers established a multidisciplinary model for transitioning COVID-19– positive patients from hospital to community. The team created a mechanism for discharged patients to connect with a primary care provider (PCP) who followed up with the individuals via telemedicine. The PCP was responsible for then creating an individualized plan of care. The CCTM team will follow up with the patient by telephone on a consistent schedule for up to four weeks postdischarge. In addition, the CCTM team supports the patient’s psychosocial needs after they are discharged.

Emory researchers are also looking at the longer-term impact among COVID-19 survivors, including neurological and respiratory effects. One study by a team of Emory rheumatologists has identified similar activation patterns among COVID-19 patients as they had seen in lupus, which has possible implications for those who report “long-haul” symptoms.