Research

Study Shines Light on COVID-19 Racial Disparities

Posted on May 21, 2020 in Expanding Access, Research, Scroll Images, Uncategorized

Differences in How People Access Care Contribute to Inequalities

SACRAMENTO, CALIF. – As the COVID-19 pandemic spreads throughout the U.S., evidence is mounting that racial and ethnic minorities and socioeconomically disadvantaged groups are bearing a disproportionate burden of illness and death. Here in California, African Americans are about 6% of the California population, but make up 10.3% of COVID-19 deaths where race/ethnicity is documented.

To better understand how this issue impacts patients in Sutter Health’s network, and to help develop solutions, Sutter’s Advancing Health Equity team undertook a thorough data analysis of the not-for-profit system’s COVID-19 patients. The resulting study, published today by the journal Health Affairs, revealed that African American COVID-19 patients are 2.7 times more likely to be hospitalized than their Non-Hispanic White counterparts, and they tend to arrive at Sutter healthcare facilities sicker and with more severe symptoms.

The findings underscore the fact that race and ethnicity still play a pivotal role in determining how and when care is accessed. Despite having health coverage, African American COVID-19 patients may not seek testing and care until it is an emergency requiring hospitalization.

Stephen Lockhart, M.D., Ph.D.

“The COVID-19 pandemic has ripped a Band-Aid off of the structural inequities that exist within our society – we must address these disparities right away because the cost of not addressing them is measured in human life,” said Stephen Lockhart, M.D., Ph.D., chief medical officer at Sutter Health. “With lives on the line, we as a state can and should do better in connecting minority patients to culturally competent care – that is why Sutter Health has committed to advancing health equity and this study is just one part of our mission and work. We have a moral obligation to do so and must work together to meet this moment and lean into the opportunity to advance health equity for generations to come.”

The study, “Disparities In Outcomes Among COVID-19 Patients In A Large Health Care System In California,” was conducted using Sutter’s electronic health record (EHR) data to characterize COVID-19 tested and confirmed cases by key sociodemographic and clinical characteristics, including self-reported race and ethnicity, across the 22 Northern California counties served by Sutter’s network.

A number of factors uniquely position Sutter to offer early insights into the reasons for the disparities in health outcomes that have been noted nationally. As an integrated healthcare delivery network serving more than 3.5 million patients a year, Sutter had been studying healthcare disparities for close to three years when it became one of the first in the nation to treat patients with COVID-19. And Sutter’s integrated system-wide electronic EHR includes race/ethnicity data throughout its service area, which is one of the most diverse regions of the country.

Sutter Health also operates in an environment that is one of the closest to universal healthcare coverage of any state in the U.S., mitigating one of the known causes of healthcare disparities – unequal rates of medical coverage – and making other factors driving disparities more visible. But coverage is not the same as access, and the higher hospital admissions and mortality rates for African American COVID-19 patients in California revealed by the study illustrate that expanded healthcare coverage is not enough to resolve health disparities.

Kristen M.J. Azar

“The real value of the study lies not in the disparities it reveals but in its utility to inform our work to develop solutions that will address the equity gaps we are seeing with programs such as community outreach and engagement in at-risk neighborhoods,” said Kristen M.J. Azar, R.N., MSN/MPH, Sutter Health’s lead author for the study and research scientist within the Sutter Health Center for Health Systems Research. “This pandemic underscores the need to develop innovative solutions that are specifically tailored to address the unmet needs of those at highest risk.”

Sutter has extensive experience looking for and analyzing disparities within its own network and beyond.

The results of the COVID-19 study mirror the patterns Sutter observed in a 2017 study about African American patients with asthma and how they access care. The asthma study found 72% of patients drove up to eight miles to a hospital emergency department to access care, even though they lived within one mile of a primary care clinic. We observed they were doing so because of a lack of culturally competent care.

After reviewing the findings of the 2017 study, Sutter developed its Advancing Health Equity Adult Asthma Program. Since the program began in April 2017, nearly 600 African American patients suffering from asthma attacks have been connected to a respiratory therapist to participate in the asthma program. As a result, very few have returned to the emergency room. The asthma program serves as a model for trusted outreach, education and treatment in a public health crisis – and how they can reduce health disparities.

Provider organizations like Sutter Health are on the front lines and, while not able to address all of the complex societal factors at issue, can play a unique role in developing solutions. For example, as part of its commitment to advancing health equity, Sutter developed a novel metric, the Health Equity Index (HEI), to identify and quantify disparities in outcomes across patient groups and develop targeted interventions to enhance equity. Through the HEI, our Advancing Health Equity team is taking major steps, like those detailed here, to build on the benefits of our integrated network of care to further health equity within the Sutter system and across the country.

Our health equity work and the findings of the study released today highlight the importance of community-based outreach and access to culturally competent care within the African American community, which hold the promise of reducing disparities. Additional research is needed to understand where healthcare disparities exist, what drives them, and what targeted interventions work best to address them. Sutter remains committed to continued advancement and leadership in this field.

SARS-CoV-2/COVID-19 Tests: An Educational Series

Posted on May 18, 2020 in Affiliates, Expanding Access, Innovation, Quality, Research, Safety, Scroll Images

COVID-19 tests

Testing is conducted to diagnose, understand and help prevent the spread of SARS-CoV-2/novel coronavirus. We encourage people who test positive for the virus to quarantine and isolate themselves to prevent viral spread to others. This is particularly important with COVID-19, the diseased caused by SARS-CoV-2, because some infected people have no symptoms and may unknowingly infect others.

Follow our Educational Series on testing to learn about polymerase chain reaction (PCR) and serology testing, and stay abreast of the latest updates at Sutter. We feature expert perspectives from Jeffrey Silvers, M.D., Sutter Health’s medical director of infectious diseases. In Part 1 of this series, we describe SARS-CoV-2 testing with PCR.

Overview:
Polymerase chain reaction tests, known as PCR, are the most common and most accurate tests for determining whether someone is currently infected with the SARS-CoV-2/2019 novel coronavirus.

A healthcare provider administers a PCR test by taking a nose or throat swab from a patient, processing the sample in a machine, and then looking for unique genetic materials that indicate the presence of SARS-CoV-2. The test sample is commonly taken from the back of the patient’s throat or nose, generally using a long, thin swab. The swab is stored in a sterile tube and then sent to a lab for testing, where lab testing personnel extract nucleic (genetic) material from the test sample (sometimes called a “specimen”).

The purified genetic material is mixed with other compounds including some derived from the SARS-CoV-2 virus, which are known as “reagents.”

The combined solution is placed in a testing instrument. If a person’s specimen contains SARS-CoV-2, part of the virus’s genetic material will be multiplied several times (amplified) to a high enough level to yield a positive test result—meaning SARS-CoV-2 is detected. The test result is negative, or “not detected,” if the specimen lacks SARS-CoV-2.

As with all lab tests, a number of factors determine the accuracy of a COVID-19 test result. These include not only the instrument and chemical reagents used to perform the test, but also the timing and quality of specimen collection and the biology of the individual patient.

Laboratory tests are characterized by their ability to detect a positive case (sensitivity) and their ability to determine a negative case (specificity). So a sensitive test is less likely to provide a false-negative result and a specific test is less likely to provide a false-positive result.

How accurate are PCR tests?

  • Like most laboratory tests, several factors determine the accuracy of a COVID-19 test result. These include the testing instrument and chemical reagents used to perform the test, as well as the timing and quality of specimen collection and the biology of the individual patient. Laboratory tests are characterized by their ability to detect a positive case (sensitivity) and their ability to determine a negative case (specificity). A sensitive test is less likely to provide a false-negative result and a specific test is less likely to provide a false-positive result.
  • In general, PCR tests are the most effective diagnostic test to detect SARS-CoV-2 infection. However, a follow-up PCR test is sometimes indicated to confirm a negative result. PCR tests are less reliable in detecting very early infections because several days may pass before the virus starts replicating in a person’s throat and nose. Although PCR tests usually convert to negative with 10 days after first becoming positive, they may remain positive in some patients for up to three to six weeks. It is unknown whether this reflects ongoing potential contagion in these extended carriers.
  • The PCR tests are also less reliable with late disease, often starting at about 14 days after initial symptoms, because the virus is no longer replicating and the body is clearing the virus. With optimal sample collection and timing for testing, the PCR test will detect disease in most, but not all, patients with COVID-19.
  • Based on limited studies and according to the U.S. Centers for Disease Control and Prevention (CDC), most PCR tests are highly reliable with less than five percent chance of false negatives.
  • During the course of the SARS-CoV-2 pandemic, PCR testing has been refined from the initial testing procedures and has been conducted with greater automation to help reduce errors.

Are PCR tests administered at home or in pharmacies effective?

  • Rapid point-of-care PCR tests have also recently become available. On April 21, 2020 the U.S. Food and Drug Administration (FDA) approved the first at-home PCR test for COVID-19. The test permits testing of a sample collected from the patient’s nose using a designated self-collection kit that contains nasal swabs and saline. Once patients self-swab to collect their nasal sample, they mail their sample to the specified laboratory for testing.
  • The ability to detect COVID-19 disease for home collection depends on closely following the collection instructions and the timing of collection (time point in disease). With optimal sample collection and timing of collection, the ability to detect disease can be similar to collection and testing performed at a healthcare facility.

Testing at Sutter Hospitals:
Sutter Health is following CDC guidelines on testing for SARS-CoV-2 within our hospitals and emergency departments.

As part of Sutter Health’s comprehensive response to the novel coronavirus pandemic, we sourced multiple PCR tests for COVID-19. For the safety of our patients, we continually monitor evidence on newly emerging investigational and approved diagnostic tests, and we run our own performance testing to verify results for effectiveness.

Testing with PCR can produce a positive test result in as little as five minutes, and enables us to perform “close proximity”—conducted on site or nearby—COVID-19 testing for 10 of our hospitals that see the highest volume of patients.

“Close proximity” testing at our busiest hospitals allows us to quickly diagnose and correctly treat our most vulnerable patients, which improves infection-control measures and preserves valuable personal protective equipment (such as masks and gowns) for Sutter’s frontline healthcare workers.

Sutter’s core laboratory in Livermore also supports prompt diagnosis and treatment—delivering COVID-19 test results to our hospitals and outpatient facilities within 24 to 36 hours.

Currently (July 6, 2020), Sutter is performing approximately 2,400 COVID-19 tests daily (seven-day average) on samples collected from Sutter patients and employees, and our Sutter labs have the capacity to meet this demand. Indications for testing continue to expand as more testing supplies become available.

We implemented a process that includes repeat testing with an alternative method, on negative test results that do not “fit” with the patient’s clinical picture and other cases when clinically indicated. This helps eliminate suspicion of negative test results.

We are following test manufacturers’ recommendations for optimal swab collection and test performance. Beginning in April 2020, labs affiliated with Sutter have been performing comparison testing to further optimize test performance.

Respiratory Clinics Outside Sutter Hospitals (Ambulatory Respiratory Clinics):
For patients outside the hospital setting, Sutter offers designated respiratory sites where patients can be evaluated by a clinician to see if they meet the criteria for the COVID-19 test. There are respiratory clinics in the San Francisco Bay Area, and designated urgent care clinics in the Sacramento Valley Area.

If you feel ill, schedule a video visit or call our COVID-19 advice line at 866-961-2889 to receive guidance on whether you need to be further evaluated at a Sutter testing site. Please present identification at the testing site to confirm your appointment.

If you meet the criteria for testing, a specimen will be collected and sent to a lab for analysis. If the result is positive, your clinician will arrange for appropriate care.

Testing Locations (Specimen Collection Sites): There are approximately 24 test collection locations, primarily at urgent care locations throughout Sutter’s Northern California service area.

Patients are asked to call a phone number from their car. Staff then provide guidance and coordinate collecting test samples.

Respiratory Clinics: There are approximately 17 respiratory clinics currently located within medical office buildings, clinics, parking garages or tents:

  • Many offer car triage
  • Some require an appointment (a doctor’s note is required for all testing)
  • All of these locations also offer test collection (a doctor’s note is required for all testing)

The test samples that Sutter collects from non-hospitalized patients who have been tested for SARS-CoV-2 are sent primarily to the Sutter core laboratory in Livermore. Results are usually available in one day.

SARS-CoV-2 Testing for Sutter Healthcare Workers:
Sutter is prioritizing prompt testing of exposed, symptomatic healthcare workers to provide prompt treatment, support family safety and foster their safe return to the front lines of care. Our approach is consistent with CDC guidelines.

Part 2 of this Educational Series on SARS-CoV-2/COVID-19 tests describes antibody/serology tests. Learn more.

Data Detectives Track the Pandemic

Posted on May 13, 2020 in California Pacific Medical Center, Expanding Access, Innovation, Palo Alto Medical Foundation, Quality, Research, Scroll Images, Transformation

Like a shadow lengthening at sunset or a dark cloud slowly obscuring the sun, the novel coronavirus has the potential to spread silently before positive tests confirm diagnoses in people infected with the virus.

To help get ahead of the curve and prepare Sutter’s integrated healthcare system to manage a potential surge in infections or a re-emergence of novel coronavirus later this year, Sutter leaders are collaborating with researchers and statistical analysts to track infection rates in the Sutter patient population and predict the course of viral spread.

Sutter researchers are experts in data analysis who leverage current and new methods aligned with Sutter privacy safeguards. Their work helps strengthen Sutter’s response to the pandemic. Here’s how:

1. TRACK THE VIRUS: Sutter Health Biobank
Sutter researchers are exploring ways to detect the novel coronavirus before it spreads further, by assessing exposure rates in Sutter’s patient population. This effort is led by Gregory Tranah, Ph.D., Scientific Director of CPMC and Director of Sutter’s Center for Precision Medicine Research.

The COVID-19 Seroprevalence and Surveillance Study will identify blood and serum samples from Sutter Biobank volunteer participants that show antibodies against the novel coronavirus. “Seroprevalence” means the level of a virus or other pathogen in a population, as measured in blood.

“Understanding the surge of infection rate and spread is an important part of preparedness. Epidemiological studies of emerging COVID-19 infections can help determine the burden of disease, develop better estimates of morbidity and mortality, and guide return-to-work and personal-safety decisions based on exposure history,” says Dr. Tranah.

The Sutter Biobank has been enrolling patient volunteers to give blood samples when a blood draw is ordered for clinical reasons. From early December 2019 through March 21, 2020 over 700 Biobank participants had blood samples drawn and archived.

“These samples provide Sutter with a unique opportunity to perform population-based surveillance of COVID-19 exposure when the virus began to spread in Northern California. They represent highly diverse patient data from Sutter’s integrated network. This is meaningful information that will allow us to determine the rate and timing of peak exposure and leveling of exposure rate,” says Dr. Tranah.

“Further, we can use the Biobank samples to find potential evidence of a resurgence of COVID-19 infection this fall. Earlier detection means we can plan for early containment of the virus.”

2. MONITOR VIRAL SPREAD: COVID-19 Surveillance
Researchers and statistical analysts at Sutter’s Center for Health Systems Research (CHSR) are collaborating with Sutter’s Enterprise Data Management, Informatics, Information Services and other operational departments to perform much-needed surveillance on the COVID-19 pandemic and provide insights to Sutter leaders.

Each morning, the CHSR team prepares reports for all Sutter hospitals on the number of patients who have tested positive or are suspected of being positive for COVID-19. They also track total hospital capacity and intensive care unit bed occupancy to help front-line staff with surge-capacity planning.

“Surveillance helps us understand how COVID-19 may be spreading amongst the patients we care for and our healthcare workers, and how we can prepare for potential surges in viral infection rates in the coming months,” says Alice Pressman, Ph.D., MS, Co-Director of CHSR.

Dr. Pressman and her colleagues at CHSR are developing the COVID-19 Universal Registry for Vital Evaluations (CURVE)—a centralized resource for research and quality improvement activities for COVID-19 disease surveillance and modeling, as well as health services and epidemiologic analyses.

“The registry will allow us to conduct research to assess the impact of COVID-19 on the healthcare system, Sutter patients, and our community of employees and healthcare workers,” says Dr. Pressman.

This registry develops the structure for the minimum necessary data to be used for each project, securely within the Sutter network. In turn, the knowledge gained can help to inform patient care and operations as Sutter continues to face COVID-19.

In support of Sutter’s Advancing Health Equity initiative, the CHSR team studied the demographics and clinical characteristics of COVID-19-infected individuals and their outcomes, which helped identify patient subgroups that may be more vulnerable to the disease. Early results indicate there may be inequities by sex, race, ethnicity and socioeconomic status.

“Research during a pandemic is vital to determine which parts of our communities and sub-groups of patients are most affected, so that we can allocate resources and care for our most vulnerable patients,” says Dr. Pressman.

3. A MATHEMATICAL CRYSTAL BALL: Statistical modelling to help predict the future of viral spread
One of the challenges of the COVID-19 pandemic is that scientists don’t fully understand the impact of the virus or its prevalence in our communities.

“One way to help answer these questions is through statistical modeling,” says Dr. Pressman. “We can use infectious-disease models as tools to help us predict the future of the novel coronavirus spread and the potential impact of social distancing and containment efforts on flattening the curve.”

Dr. Pressman and her team are collaborating with researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to understand the models IHME has published for California state COVID-19 data. “We hope to apply these models to our system to help us allocate healthcare resources and make decisions about future containment efforts.”

Data crunching to help halt a pandemic:
Surveillance is the systematic collection, analysis and interpretation of health-related data. For surveillance of the novel coronavirus and COVID-19, Sutter is using surveillance systems to monitor COVID-19 disease across the system. Surveillance and biobanking can help:
• Monitor the spread and intensity of COVID-19 disease
• Understand disease severity and the spectrum of illness
• Understand risk factors for severe disease and transmission
• Monitor for changes in the virus that causes COVID-19
• Estimate disease burden
• Produce data for forecasting COVID-19 spread and impact
• Improve patient care and help improve Sutter’s response to the pandemic

Solutions for Sleeplessness: A New Study Tests Behavioral Therapy and Medications

Posted on May 6, 2020 in California Pacific Medical Center, Expanding Access, Innovation, Quality, Research

More than 20 million Americans suffer from chronic insomnia. This sleep disorder can cause emotional distress, impaired functioning and reduced quality of life. It can even contribute to an increased risk for other health problems such as depression and high blood pressure.

Researchers at Sutter Health’s San Francisco Coordinating Center (SFCC) are collaborating with investigators at the University of Pittsburgh and other leading institutions nationwide to help improve insomnia treatment. Their collective focus begins with attempts to better support people suffering from the disorder in remote communities since access to sleep clinics may be limited.

The newly launched COZI (Comparative Effectiveness of Zolpidem and Cognitive Behavioral Therapy for Insomnia in Rural Adults) study will assess the effectiveness of web-based cognitive behavioral therapy for insomnia (CBT-I) compared with a common prescription sleep medication (zolpidem) or the combination. COZI is the largest, multicenter, randomized clinical trial of its kind to be conducted in rural primary care practices.

The study uses a self-guided online approach to CBT for insomnia developed by collaborators at the University of Virginia. COZI will enroll 1,200 people ages 18 to 80 with chronic insomnia in rural primary care practices affiliated with eight U.S. academic medical centers. Treatment effects will be evaluated at nine weeks, and at six and 12 months.

Katie Stone, Ph.D.
Katie Stone, Ph.D.

“Both zolpidem and CBT-I have been proven effective in treating chronic insomnia. However, COZI is the first randomized trial to comprehensively explore how these therapies compare in providing sustained sleep improvements, as well as their potential side effects and impact on other health outcomes,” says Katie Stone, Ph.D., senior scientist at SFCC and lead investigator of COZI for Sutter.

“People in rural areas with insomnia may have difficultly traveling to sleep clinics for care. Our goal is to test an approach that delivers insomnia treatment in their homes, making it easier for them to use an innovative, convenient approach to manage their sleep disorder,” said Daniel Buysse, M.D., Professor of Psychiatry and Clinical and Translational Science at the University of Pittsburgh School of Medicine, and co-lead investigator of COZI.

“We anticipate this new approach to delivering insomnia treatment will help lead to sustained improvements in how providers care for adults in rural communities with this common sleep disorder,” said Dr. Stone.

“This project was selected for PCORI funding for its scientific merit and commitment to engaging patients and healthcare providers in a major study conducted in real-world settings. COZI may help answer an important question about chronic insomnia and fill a crucial evidence gap,” said PCORI Executive Director Nakela Cook, M.D., MPH.”

The four-year, $5.7 million study is sponsored by the Patient-Centered Outcomes Research Institute (PCORI).1

Contact Katie Stone, Ph.D. for more information about the COZI study.

A Dose of Technology to Aid Sleep Therapy:

Many clinical studies test whether a treatment works under ideal conditions in specialized research centers, but health care is rarely delivered in such idealized situations and settings. Pragmatic clinical studies such as COZI test a treatment’s effectiveness in “real-world” practice situations such as outpatient settings, and also can include a wider range of study participants—making their findings more applicable to a broader patient population.

While CBT-I is well-established as an effective strategy for treating insomnia,2,3 it is usually delivered in person by behavioral health specialists. CBT-I broadens access to insomnia treatment and provides sleep disorder education, monitoring and individualized behavioral recommendations to improve sleep. In rural communities, use of CBT-I may be even more important because these types of sleep therapies can be limited in remote areas.

Citations:

  1. PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit www.pcori.org.
  2. Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and pharmacological therapies for late‐life insomnia: a randomized controlled trial. JAMA. 1999;281(11):991‐9. PubMed PMID: 10086433.
  3. Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder‐Frederick L, Frederick C, Quigg MS, Cohn WF, Morin CM. Effect of a Web‐Based Cognitive Behavior Therapy for Insomnia Intervention With 1‐Year Follow‐up: A Randomized Clinical Trial. JAMA Psychiatry. 2017;74(1):68‐75. Epub 2016/12/03.

Coronavirus Science: Two Studies Raise New Concerns

Posted on May 5, 2020 in Carousel, Innovation, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Pediatric Care, People, Research, Scroll Images, Uncategorized

Every day brings new scientific insights into COVID-19 and the coronavirus that causes it. Studies authored by Sutter Health experts examine the virus’s impact on children and diabetic adults.

COVID-19 and Kawasaki Disease

Recently, doctors began warning of a potential consequence of COVID-19 infection in children; some youngsters appear to develop an abnormal immune response that results in symptoms commonly associated with Kawasaki disease or toxic shock syndrome – two rare, but well-characterized inflammatory conditions. The first known U.S. case of Kawasaki disease possibly connected to COVID-19 was reported by Veena Jones, M.D., (lead author) and Dominique Suarez, M.D., both pediatric hospitalists with the Palo Alto Medical Foundation, part of the Sutter Medical Network.

Veena Jones, M.D.

Their six-month-old patient was diagnosed with classic Kawasaki disease, admitted to the hospital for treatment, and subsequently received a positive test result for COVID-19. The main reason for treatment in children with Kawasaki disease is to prevent further complications of the disease on the heart. The patient received appropriate treatment and has since fully recovered and has maintained normal heart function. But the case caused the doctors to question: could the COVID-19 infection have led the patient to develop Kawasaki disease?

“Our patient met the classic criteria for Kawasaki disease, so there was little doubt about the diagnosis or treatment plan,” said Dr. Jones. “But we do wonder if the COVID-19 infection could have caused the Kawasaki disease, especially because Kawasaki disease is widely thought to be triggered by an infection or an abnormal immune response to an infection.”

Dominique Suarez, M.D.

A careful review of the existing medical literature found that COVID-19 co-occurring with Kawasaki disease had not previously been reported, so the doctors decided to write up the case and submit it to the Journal of Hospital Pediatrics for publication. “Researchers still know very little about exactly why Kawasaki disease develops in some patients, so our hope was to accurately describe the novel case that we encountered and share that with the medical community to encourage further investigation and dialogue,” said Jones. In the race to understand the burden of COVID-19 on the human body this kind of early observation by doctors on the frontline can help inform future decisions around diagnosis and treatment.

COVID-19 and Diabetes

Since the start of the coronavirus pandemic many have warned that people with existing chronic illness who contracted the infection would become sicker than those without. Now, research authored by Sutter Health clinician David Klonoff, M.D. suggests that diabetes, one of the most serious chronic illnesses in the world, is strongly correlated with death among hospitalized patients diagnosed with COVID-19.

David Klonoff, M.D.

Accepted by the Journal of Diabetes Science and Technology, Dr. Klonoff’s paper represents the largest study yet reported on outcomes of patients with COVID-19 and diabetes or uncontrolled hyperglycemia. The observational study of 1122 inpatients with COVID-19 at US hospitals between March 1 and April 6, 2020, found that those with diabetes or hyperglycemia throughout their hospital stay had a four-fold greater inpatient mortality than those without diabetes or hyperglycemia. In a further subset analysis, death rates were seven-fold greater among those who did not have evidence of diabetes prior to admission, but developed hyperglycemia during their hospitalization.

The study also demonstrated that during a hospitalization for COVID-19, the presence of diabetes or hyperglycemia was associated with a longer hospital stay and slightly worse kidney function.

“I am now analyzing the same database to determine whether COVID-19 patients with diabetes and uncontrolled hyperglycemia, who were better controlled in the hospital, had better outcomes,” said Klonoff. If an association between greater survival and achieving target glycemia (following initial hyperglycemia) is demonstrated, and acted on, lives could be saved.

“These data may have wide implications for how we care for COVID-19 positive patients who experience hyperglycemia during their hospital stay or who have already been diagnosed with diabetes.”

Paying it Forward: Sutter Teams with Vitalant to Offer COVID-19 Survivor-Donated Blood Plasma to Patients

Posted on Apr 27, 2020 in Alta Bates Summit Medical Center, California Pacific Medical Center, Community Benefit, Expanding Access, Innovation, Quality, Research, Scroll Images, Transformation

Convalescent plasma, rich in protective antibodies, is the liquid component of blood.

With experts predicting that a vaccine for COVID-19 is at least a year away, Sutter and Vitalant are collaborating to offer investigational treatment with convalescent plasma—blood plasma collected from people who have recovered from COVID-19—to hospitalized patients with severe cases of the disease under requirements recently outlined by the U.S. Food and Drug Administration (FDA).

Convalescent plasma, rich in protective antibodies, is the liquid component of blood. Not-for-profit Sutter Health is the first non-academic hospital system in California to participate in this research, launching expanded access program testing the use of convalescent plasma at its affiliates California Pacific Medical Center (CPMC), Sutter Medical Center Sacramento and Alta Bates Summit Medical Center, with other Sutter sites beginning the clinical trial in the coming weeks.

“By collaborating with community partners like Vitalant, we’re bringing an opportunity for the latest cutting-edge research to our patients,” says Sean Townsend, M.D., an intensive care medicine specialist in CPMC’s Division of Pulmonary and Critical Care. “Convalescent plasma is a potentially promising treatment for COVID-19 that we will test in clinical trials across the Sutter integrated network of care. We hope to build a supply of convalescent plasma that will add to our arsenal of emerging treatments to fight the virus.”

Vitalant physician colleague, Chris Gresens, M.D., adds, “We hope this therapy will serve as a type of ‘stop-gap vaccine substitute’ by providing severely affected patients just enough of an ‘immune boost’ to help them to recover more fully and quickly.”

The plasma donor must test negative for COVID-19 and be otherwise healthy. Convalescent plasma from one donor may be used to treat as many as four hospitalized patients with the illness who consent to participate in a clinical trial of the treatment.

Convalescent plasma has been studied for the treatment of numerous illnesses, most recently for infectious diseases such as Ebola, SARS, MERS and H1N1.

How you can help:

  • Under the new U.S. FDA guidelines, eligible blood donors who have had a documented diagnosis of COVID-19, and remain asymptomatic for at least 14 days post-recovery, may donate their plasma.
  • Sutter patients and health care workers who previously tested positive for COVID-19 can book an appointment for free donor screening at Sutter walk-in clinics: make a video appointment through My Health Online or call Sutter’s COVID-19 Advice Line (866) 961-2889 for more information.
  • Vitalant will only accept donors who meet all FDA-required general donor eligibility criteria in addition to the COVID-19 convalescent plasma qualifications.
  • Non-Sutter affiliated potential donors may apply to donate plasma at a Vitalant site by completing the form at Vitalant.org/covidfree. Donors cannot walk in for this procedure; they will be contacted by Vitalant to schedule an appointment.