Q: What prepared Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital at Vanderbilt infectious disease teams for the COVID-19 pandemic?
A: What prepared us? Decades of investment in basic science discovery, vaccinology, immunology, molecular diagnostics, infection prevention, epidemiology and implementation science. Without this type of vision, Vanderbilt would not have been prepared to lead the way we have for the last year.
Pandemic preparation begins well before the first case of disease. For over three decades, the (Mark) Denison Laboratory has been studying the fundamental aspects of coronaviruses in the laboratory. This commitment to basic discovery fueled development of therapeutics (like remdesivir and other antiviral drugs) and provided resources by which to measure the immune response to infection and vaccination. Once the first cases of COVID-19 were seen, we had to identify the best ways to prevent infection and launch a robust testing strategy.
Our infection prevention colleagues worked tirelessly to protect our health care workers and limit the hospital spread of SARS-CoV-2. Our colleagues in the Molecular Infectious Diseases Laboratory were committed to providing reliable results as quickly as possible — this was essential for not only our patients, but also our providers who were frequently exposed to SARS-CoV-2 and needed a way to evaluate potential COVID-19 symptoms quickly. Once our hospital began to fill with COVID-19 patients, we needed to standardize the way we cared for patients. Our infectious diseases, ICU and hospitalist colleagues took the lead and provided excellent care, sharing best practices, codifying treatment approaches and leading clinical trials. Then, in summer 2020, as vaccine trials launched, VUMC was uniquely positioned to conduct these pivotal studies, conducting numerous trials of vaccines now available under EUA, by leveraging robust clinical research units such as the Vaccine and Treatment Evaluation Unit in the Vanderbilt Vaccine Research Program and the HIV Vaccine Trials Network. Our news and communications team has also played a unique role to help our teams communicate new and vital information about disease activity and vaccines to the public.
Q: What are some of the key studies you’ve been involved in with the COVID-19 pandemic?
A: Our group has been principally involved in three areas. Early in the pandemic, we led trials of the antiviral drug, remdesivir, as well as an immune modifying drug, baricitinib, in hospitalized patients. Then, in summer 2020, we launched the Moderna phase 3 vaccine trial, followed by the Johnson & Johnson phase 3 vaccine trial. We recently completed enrollment for a study evaluating a new variant vaccine, made by Moderna, that targets the Beta variant of SARS-CoV-2, and are actively recruiting children younger than 12 years in a Moderna vaccine trial. Finally, we are actively engaged with the CDC, in a project led by Dr. Kathryn Edwards, to evaluate the safety of vaccines in various populations, recognizing that rare side effects can occur.
Q: What have we learned about how COVID-19 impacts children?
A: Fortunately, the direct, viral effects of the virus on children have been less than adults; however, we have seen more COVID-19-related deaths this year than we would expect from other viral illnesses, such as influenza. We have seen recent increases in the number of children infected with the Delta variant, and we see some children who develop an inflammatory condition after exposure to COVID, called MIS-C. While the direct impact has been less than in older adults, it is still a virus we want our children to avoid.
Q: What advice would you give parents considering vaccination for their adolescent children?
A: I would encourage vaccination. Have a conversation with your teenager. Let them know the importance of protecting themselves and those around them. We are social creatures, and we’ve seen the devastating effects of social isolation on adolescents this year. The side effect profiles of each of the vaccines authorized for emergency use are encouraging, and the significant side effects that have been seen are, importantly, very rare — so rare that an individual is more likely to be struck by lightning than to experience a severe side effect of vaccination.