Identifying New Treatment Targets
Rapid Identification of Therapeutic Targets to Optimize Care of Critically Ill COVID-19 Patients
Winner: Douglas Fraser
This ambitious study collected hundreds of samples from infected ICU patients and then performed proteomic, metabolomic and transcriptome measurements to better understand how the human body reacts to COVID-19 and to identify new therapeutic targets to improve outcomes. The study team was the first in the world to profile COVID-19 inflammatory, thrombotic and serological changes in critically ill patients. They found that COVID-19 instigates an extensive systemic inflammation. They then documented the profile of the inflammatory responses in ICU patients. Their published evidence suggested that COVID-19 results in persistently elevated tumor necrosis factor and a “protease storm” secondary to early activation of lymphocytes leading to release of Granzyme B, followed by neutrophil activation and release of Elastase 2. Their measurements facilitated 12 publications to date. Their current studies are focused on inhibition of serine proteases, as novel therapeutic targets, in COVID-19. They believe that microvascular activation and injury may contribute to the new clinical syndrome referred to as “Long COVID”. To ensure adequate knowledge translation, they regularly meet with Healthcare Advisory Teams to provide insight into the feasibility and validity of additional studies.
Virtual Health Care
Evaluating Telephone-Based Specialist Care Provided During a Pandemic to Inform Best Practice Guidance
Winners: Jeff Mosko and Charles Kassardjian
The pandemic necessitated that specialists employ telephone visits which were appreciated by patients and providers. Most physicians will continue to employ telephone-based care after the pandemic. However, not all virtual visits are ideal and may not be appropriate in some circumstances. Both patients and providers are looking for direction on which visits should be virtual and which should be in person. This project analyzed the efficacy and acceptability of virtual specialist care from the point of view of both patients and providers in 7 different specialties. The project team surveyed 216 patients with descriptive qualitative interviews and also collected administrative data. Their preliminary analysis indicated that one size does not fit all, and the best results may be achieved with a blended model combining in-person and virtual visits when each is most appropriate. They determined that a patient-centered approach to care delivery with virtual (telephone) visits were particularly well-suited for follow-up appointments and discussion of non-urgent matters. However, additional evaluations will be necessary to establish the best practice in each of the subspecialties. This project has the potential to have a major impact on care delivery since most patients and providers now have experience with virtual visits. They only need to know when in-person and when virtual visits should be scheduled.
New Approaches for Critically Ill COVID-19 Patients
A phase IV randomised, controlled, implementation trial of volatile based sedation in patients with COVID 19 (the ANACONDA study)
Winners: Angela Jerath and Brian Cuthbertson
This is a transformative project which provides evidence of the benefits of inhaled volatile anesthetics for the sedation of ventilated COVID 19 ICU patients. The 50-patient pilot trial funded by the Innovation Fund demonstrated the feasibility and potential efficacy of this original concept for theses critically ill patients. Particularly when the availability of intravenous sedative medication was limited in early days of the pandemic, the use of inhaled anesthetics was found to be feasible (with a multidisciplinary group), accelerated awakening and reduced lung inflammation. The project has generated considerable attention internationally and resulted in the funding of a national randomized trial (SAVE-ICU). Many centres around the world have followed the process established by the Sunnybrook investigators to deliver volatile anesthetics for sedation during COVID necessitated ventilation. Active sub-studies include cost effectiveness, cognition and biomarkers.
Reducing Risks to Health Care Workers
Risks to medical teams caring for Obstetrical and Surgical patients with COVID-19: Is SARS-CoV-2 virus present in the female reproductive tract, the peritoneal surface, surgical smoke and/or surgical masks?
Winner: Patricia Lee
This project sought to identify the level of risk and exposure of health care workers during laparoscopic surgery in patients with COVID-19. At the outset of the pandemic, two hospitals in Toronto banned laparoscopic surgery because of the perceived risks to their staff. The hospitals were concerned that the positive pressure insufflation used during laparoscopy could result in aerosolization of the virus and could infect the staff. This ban reduced access to the most appropriate care for some patients and possibly increased their morbidity during open abdominal surgery. The investigators therefore performed a cross sectional study at two Toronto hospitals to identify the risks to health care workers. They found SARS-CoV-2 RNA in the surgical and obstetrical operative environment, but they found no detectable virus inside the masks worn by the medical teams. They concluded that health care workers had a low risk of infection using appropriate personal protective equipment. The team plans to continue to study patients with COVID-19 who require urgent surgery or obstetrical delivery to compare rates of contamination between the different variants. They have also initiated an electronic survey, to ascertain the late outcomes of the health care workers in their study. Understanding the risk is critical for staff safety as well as patient care. This study contributes to the body of research that is relevant to risks to health care workers and the sustainability of health care systems.
Measurement of SARS-CoV-2 Protein and RNA in Wastewater; Real-Time Measurement of Community Viral Load
Winners: Alex Mackenzie, Robert Delatolla, and Tyson Graber
This was a game-changing innovation when the study was initiated and has since achieved high impact and widespread implementation. This team (a physician, engineer and cellular biologist) implemented a multidisciplinary SARS CoV2 wastewater surveillance program, one of the first in North America. They were the first to report daily levels of viral RNA on a publicly accessible website. Since the project’s inception, wastewater surveillance has become a crucial marker of pandemic spread. The project has already expanded across the province and has provided critical data cited by local health authorities and the provincial government to justify various public health interventions over the past two years. The Ottawa initiative helped guide the formation of a $12 million province-wide Wastewater Surveillance Initiative in Fall 2020 led by the Ministry of Environment, Conservation and Parks. As of August 2021, all 34 public health units had joined the initiative with approximately 160 sampling locations covering over 80% of Ontarians. In addition, this approach has allowed the monitoring of individual facilities such as penitentiaries and long-term care facilities. The team lead the country in developing variant specific PCR assays. Efforts are now underway to apply this approach to respiratory syncytial virus, influenza and other pathogens. In addition, the team is developing techniques to measure viral proteins in the wastewater, which may be far more sensitive than measuring viral RNA.
Improving Well-Being of Health Care Workers
Caring for Our Physicians and TeamUHN During the COVID-19 Pandemic: Rapid Delivery and Evaluation of the Multi-Component Mental Health Support Program
Winner: Susan Abbey, Suze Berkhout, and Kathleen Sheehan
Mental health concerns, including anxiety, depression, insomnia and burnout, have been increasingly voiced by health care workers as the COVID-19 pandemic has progressed. Despite well documented mental health challenges during this and past pandemics, there is limited knowledge about how to best support health care workers during these challenging times. This project describes the approach employed at one institution which has been well received. The investigators present a well-structured and novel stepwise program to deliver and evaluate mental health support for health care workers that could easily be transferable to other institutions, providing an important resource. In this stepped model, health care workers were asked to self-identify and self-triage. Then, their care was stepped up or down depending on their individual needs. Step 1 is self-directed care with counselling from a therapist. Step 2 is group-based care supported by professionals. Steps 3 and 4 involve individual mental health care directed by psychologists or psychiatrists. As part of this effort, the team developed “curated online resources” that have been viewed over 12,000 times. The team has undertaken a number of knowledge translation activities in Ontario and abroad.
Managing Wait Lists During COVID-19
Cardiac surgery triaging tools to reduce mortality while maximizing intensive care resources during the COVID-19 crisis
Winner: Louise Sun
During the pandemic, ICUs were overrun and elective surgery was cancelled to ensure sufficient beds for COVID patients. Cancelling and delaying needed surgery put many patients at risk of complications from their disease which could have been ameliorated if surgery could proceed. This project permits surgery to proceed while preserving ICU capacity for COVID patients. The best of both worlds. The University of Ottawa Heart Institute developed, validated, and implemented algorithms to identify patients who could undergo surgery but would not block ICU or hospital beds needed for COVID patients. Employing this tool, they were able to maintain >95% of their surgical volumes and still have beds for COVID patients. The algorithm employs a combination of statistical and machine learning techniques and was specifically tailored to the cardiac surgery workflow. The tool may also be transferable to other surgical specialties. The team is currently coordinating strategies with CorHealth Ontario to systematically implement these tools across the province, to improve patient outcomes and optimize health care resource allocation during the pandemic and beyond.