While the current science on COVID-19 has by necessity focused on the urgent need to diagnose, treat and prevent the virus, a BUSM physician and researcher is working to understand what happens to those who are infected, both during illness and after recovery.
Associate Professor of Medicine Nahid Bhadelia, MD, MA, is an infectious diseases physician, medical director of BUSM’s Special Pathogens Unit, and an investigator at the Boston University National Emerging and Infectious Diseases Laboratories (NEIDL). In 2014 and 2015, she was on the frontlines of the Ebola crisis in West Africa. Over the last few years, she has been serving as the clinical lead for the U.S.-Ugandan Joint Mobile Emerging Disease Intervention Clinical Capability program, which is creating clinical research capacity to combat viral hemorrhagic fevers in Uganda. Today, she is caring for patients closer to home, at Boston Medical Center, where 82 percent of patients treated during the surge of the virus were Black or Hispanic.
“As with earlier pandemics, we believe the virus may have long-term effects for survivors. We also do not know what immunity to this disease looks like after recovery,” said Dr. Bhadelia.
Recent research has identified potential lingering symptoms of COVID-19 such as loss of taste and smell, seizures, headaches and residual impact on lung function. With the 1918 flu pandemic, adults exposed to the flu in early life were more likely to die from cardiovascular and respiratory disease. In the wake of the 2014-16 Ebola outbreak in West Africa, some survivors were affected by memory loss, mobility and other disabilities. And a study of SARS survivors who were hospitalized revealed psychological stress – including symptoms of depression, anxiety and post-traumatic symptoms – for nearly a year after recovery.
To investigate how the virus wreaks havoc on the bodies of those afflicted, Dr. Bhadelia is leading (along with BUSM physician faculty Karen Jacobson, MD, MPH, and Nina Lin, MD) a Natural History Study of patients admitted to Boston Medical Center with confirmed COVID-19 and the diagnosed health-care workers treating these patients. Studying clinical data and biospecimens, she and her colleagues are investigating the course of COVID-19 and any additional illnesses that may emerge. Samples are being stored in a biorepository at the NEIDL and are accessible to scientists from other institutions who are studying the virus. “Our goal,” explains Dr. Bhadelia, “is to identify what factors result in a milder or more severe course of disease in our population. We also hope to assess the risk of transmission to healthcare workers working with COVID19 patients.”
Given the baseline patient population seen by Boston Medical Center, the city’s recognized safety nest hospital, an important component of the Natural History Study is its inclusion of a racially and socioeconomically diverse patient pool. “Many US cities have found poorer COVID-19 outcomes faced by African American individuals and in many minority communities,” says Dr. Bhadelia. “This project could help to identify factors associated with these health disparities.”
Dr. Bhadelia is eager to extend the Natural History Study to a 1- to 2-year follow-up study of ~200 COVID-19 survivors. This supplemental study will identify any persisting debilitating physical symptoms and the psychosocial impact of COVID-19 on survivors, as well as how long survivors can maintain antibody titers against SARS-CoV-2 after recovery.
“If there is a continued burden of disease in survivors, knowing the magnitude of this burden will help the healthcare system plan for care of these patients,” says Dr. Bhadelia. “The answer to the second question, measuring the level of immunity and how this changes over time is central to how we open up society.”