Our research changes lives for COVID-19 patients

By Ana Gajic

(May 14, 2020) – Before March 2020, a handful of research teams at Unity Health were exploring COVID-19 in their projects. Now, less than two months later, more than 110 teams have come together across Unity Health to launch innovative research examining the biology, prevention, diagnosis and treatment of COVID-19.

To highlight these research teams and their commitment to knowledge generation during the COVID-19 pandemic, we’re sharing stories of how our research changes lives for different patient populations. This week, we’re spotlighting three projects underway at all sites of Unity Health that impact patients living with COVID-19:

Learn more about each project in the spotlights below, and stay tuned for more stories about how our research changes lives for vulnerable populations, health care providers and those at higher risk of contracting COVID-19.

Striving for evidence-based care: Understanding the impact of anti-coagulation medication in COVID-19

Dr. Michelle Sholzberg

Dr. Michelle Sholzberg

Twitter may seem like an unlikely setting for medical inspiration, but it was there, before the first diagnosis of COVID-19 in Canada, that Dr. Michelle Sholzberg noticed a string of conversations about abnormal blood tests that piqued her interest. The tests were suggesting patients with the virus had a tendency to develop blood clots. As the virus continued to spread, the number of medical professionals reporting the same findings increased.

The cases included larger numbers of younger people. Some health-care practitioners decided to try to provide these patients with higher doses of a medication called Heparin to treat the clotting.

Dr. Sholzberg, Director of the Coagulation Lab and Hematology-Oncology Clinical Research Group at St. Michael’s, saw an immediate need for evidence-based administration of the medication. She teamed up with Dr. Peter Jüni, Director of the Applied Health Research Centre, and Dr. Mary Cushman from the University of Vermont to launch a randomized clinical trial to determine whether a higher dose of heparin is effective and safe for these patients.

Dr. Peter Jüni

Dr. Peter Jüni

The trial aims to compare the low dose, already given as a standard to COVID-19 patients admitted to hospital, to a higher dose typically reserved solely for treating blood clots.

“Everyone is reacting emotionally to COVID-19, which is understandable and appropriate,” Dr. Sholzberg said. “But unfortunately, we’ve seen that this sometimes includes clinicians who need scientific evidence before administering these medications.”

Not only has the clinical trial kicked off rapidly – the first five centres being St. Michael’s, St. Joseph’s Health Centre, Sinai Health System, Southlake Regional Health Centre and Trillium Health Partners – but many hospitals across Canada, the United States and Europe have agreed to launch it rapidly as well. They’ve also tapped into existing resources to ensure enough patients are recruited.

“This is truly remarkable,” Dr. Sholzberg said. “Normally, full funding is secured by the lead institution in advance of a trial launching. Science is not only our best hope to defeat COVID-19, it’s truly our only hope. We know we aren’t the only team of experts – there are other commendable efforts in the same arena. But time is of the essence. Everything has to come together – funds, research and the right teams – to give us the best chance at fighting this virus.”

While the study has a lot of support from the medical community, the lead investigators continue to look for additional opportunities for funding for the trial.

With expertise in general internal medicine, critical care, hematology and clinical trial methods, the scientists say that Unity Health Toronto is uniquely positioned to lead this work.

“It’s the perfect marriage of areas we excel in,” says Dr. Sholzberg.

By tracking the possible impact of different doses of the medication and how it influences a patient’s need for critical care, ventilation or death at 28 days post- COVID-19-diagnosis, the team will have a good grasp on how best to use this medication.

“Instead of decision-making based on anecdotes,” Dr. Jüni said, “We’ll have sound scientific evidence.”

Can a small, inexpensive and easy-to-use ventilator be introduced to a hospital setting? This research team is going to find out

Dr. Paul Dorian holding an Oxylator.

Dr. Paul Dorian holding an Oxylator.

In ambulances, out-of-hospital medical emergencies, and remote areas, where there is no access to mechanical ventilation, a small, compressed gas-powered ventilator is used to bridge the gap for people who need support breathing. Could this little device the size of a fist help give hospitals more ventilator capacity?

Dr. Paul Dorian, a cardiologist at St. Michael’s and a scientist at the Keenan Research Centre for Biomedical Science, has always had an interest in resuscitation research. Through his research and clinical connections, he has become familiar with the Oxylator, a small Canadian designed and built ventilator that provides breathing support outside of hospital settings.

As reports projected COVID-19 would cause ventilator shortages around the world, Dr. Dorian’s mind turned to the Oxylator and if it could be adapted for use in hospital settings where there is less access to ventilation or experts trained in using complex machines.

“It was a natural idea,” he says. “In a setting where ventilators are expensive, hard to make and take experts to run, a ventilator the size of your fist that is a fraction of the cost and can be used easily could save lives.”

The Oxylator.

The Oxylator.

Teaming up with critical care researchers and fellow and Keenan Resarch Centre scientists Dr. Laurent Brochard and Dr. Art Slutsky, they collaborated with the manufacturer to add a small valve to the device making it adaptable to the ICU setting.

So far the device has proven to be safe in pre-clinical models and recent funding awarded to Dr. Dorian and his team will allow for more complex testing. The device, he says, could have implications beyond COVID-19, by allowing small hospitals in remote communities to ventilate more patients.

“If a regular ventilator in a well-resourced hospital is considered to be a Lamborghini, our device is like an average sedan,” he says. “It might not be as fancy, it might not be as expensive, but it still gets the job done. It gets you where you need to go safely.”

This research has been supported by the University of Toronto’s Toronto COVID-19 Action Fund, the St. Michael’s Hospital Foundation, and the manufacturer of the device, CPR Medical Devices Inc., which has donated devices for the research.

Understanding atypical COVID-19 symptoms in older adults across Unity Health Toronto

Dr. Jennifer Watt

Dr. Jennifer Watt

Falls and general confusion are some of the vague symptoms sending people over the age of 65 to emergency departments only to be diagnosed with COVID-19.

Dr. Jennifer Watt noticed this puzzling trend in her clinical practice. These older adults weren’t sick with the typical symptoms associated with this respiratory illness like coughing or chest pains.

”We became very worried that cases were being missed or caught late,” said Dr. Watt,  a geriatrician at St. Michael’s and a researcher at the Li Ka Shing Knowledge Institute who started to study how these atypical symptoms of the virus could be better captured.

Teaming up with Dr. Ashley Verduyn, Chief and Director of Medical Affairs at Providence Healthcare, the two have started looking at the data of older St. Michael’s and Providence Healthcare patients diagnosed with COVID-19 to see what their initial symptoms were, what treatment was administered and what the outcomes were.

Dr. Ashley Verduyn

Dr. Ashley Verduyn

Dr. Verduyn said the impact of this virus on seniors has been “heartbreaking and devastating.” She watched firsthand as a COVID-19 outbreak unfolded in an older population in the Houses of Providence; the outbreak was declared over on May 6.

“When we diagnosed our first resident in the Houses with COVID-19, we were surprised to discover that nine additional residents who tested positive did not have the typical symptoms of COVID-19, like coughing,” Dr. Verduyn said.

The two researchers hope the knowledge this study generates will help inform broader screening criteria in the future.