COVID-19 has affected virtually every facet of life in Alabama, and since the crisis began, the University of Alabama at Birmingham (UAB) has been leveraging its expertise to fill a critical leadership role in response to the pandemic.

“The COVID-19 pandemic has showcased the vital importance of UAB to Alabama and the world,” says UAB President Ray Watts, M.D. “We continue to leverage research and innovation, community service, patient care, and education to make a big difference.”

As the country began to take notice of the novel coronavirus, UAB’s world-renowned infectious diseases experts provided accurate and timely information across Alabama and beyond, and they have continued to collaborate with local, state, and federal elected leaders, deliver critical information to our community, and inform media audiences worldwide.

As a world-renowned research-intensive academic medical center, the state’s eyes turned to UAB Medicine for guidance on how to protect against the virus, medically prepare for a pandemic, and care for patients once it arrived.

Personal protective equipment face masks hang from clips while awaiting UV light sterilization for N95 face mask reprocessing at UAB Hospital, April 2020.

Preparing for the Worst

“When the COVID-19 crisis started, UAB Medicine took the position that we were going to do everything we could to help Alabama regardless of the cost,” says Will Ferniany, Ph.D., CEO of the UAB Health System. “We planned and prepared and shared what we knew to help others across the state plan and prepare as well.”

These preparations included:

UAB experts prepared treatment guidelines and best practices and shared them with hospitals across the state.

UAB supply chain leaders provided support and advice to the governor’s office, the Alabama Hospital Association, and Jefferson County’s supply chain efforts to secure personal protective equipment (PPE), not just for UAB, but for all health care providers across the state.

UAB pulmonologists helped the state evaluate proposals to purchase additional ventilators and made recommendations on the most appropriate options.

As the pandemic grew, UAB worked with state and local health departments, emergency management agencies, and Jefferson County on a plan to transform the Sheraton Birmingham Hotel’s 377 rooms into treatment rooms for patients in the event of a surge.

Plans were also coordinated with the U.S. Army Corps of Engineers on creating two 36-bed acute care units, if needed, in the Birmingham Jefferson Civic Center.

UAB physicians served on advisory panels and task forces to collaborate with and provide critical medical insights with local and state officials.

The UAB Health System and the Division of Geriatrics created a five-point plan to help nursing homes cope with the pandemic. Town hall meetings with the Alabama Nursing Home Association, Alabama Hospital Association, and state and local health departments resulted in a care continuum to develop strategies to fight the spread of infection in nursing facilities and provide a best practices care plan for testing and treating infected patients.

A UAB health care worker is wearing Personal Protective Equipment (PPE) while working in the Hospital during the COVID-19 pandemic, March 2020.Caring for Those Infected

UAB leveraged its large team of critical care physicians and nurses, as well as advanced knowledge and technologies, to care for complex COVID-19 cases, supporting higher recovery rates and saving lives. In addition to patient care, UAB led efforts to care for frontline health care heroes at UAB and beyond.

UAB Medicine made rooms available at nearby hotels for health care providers who did not want to return home and risk infecting their families. The university even offered a residence hall for self-isolating UAB staff and Birmingham-area first responders who had tested positive for COVID-19 or who had not tested positive but were worried about going home to their families. With the university’s full backing, the belongings of student residents who had returned home were packed and stored. The facility was thoroughly sanitized, and rooms were offered at no cost to frontline health care heroes.

UAB Health System member Baptist Health did the same, working with Auburn University at Montgomery to offer free housing to team members who had been exposed to COVID-19 or had family members at home with compromised immune systems.

Medical West Hospital, also a member of the UAB Health System, ramped up telemedicine in all of its primary care clinics to provide needed continuing care and testing ability. The hospital is also working with area nursing homes to contain the spread of the virus in those facilities through aggressive testing and best practices of evaluation and mitigation.

Addressing Disparities

Recognition of the disproportionate burden of disease on minority populations was highlighted in an editorial by Selwyn Vickers, M.D., FACS, senior vice president for Medicine and dean of the UAB School of Medicine, along with 14 medical school deans and health leaders. The editorial, published in USA Today online and in print under the headline “Coronavirus magnifies racial inequities, with deadly consequences,” drew attention to the higher rates of infection and mortality in persons of color, and called for refining governmental and health care responses to pandemics to provide greater access to resources for the underprivileged and underserved.

A second thought-provoking editorial penned by Vickers stated the case for increased medical education in social determinants of health. The editorial, published by the American Association of Medical Colleges on their website, calls for changes in the medical school curriculum to better educate the next generation of physicians on the effects of health disparities on population health. “The coronavirus pandemic has illustrated, perhaps more vividly and starkly than any event in our lifetimes, the critical importance of addressing these health disparities,” Vickers writes. “Certainly no one can reasonably expect physicians to solve societal problems like poverty and racism. However, continuing to equip medical students with an understanding of cultural competence, help them recognize and address racial bias in medicine, and teach them about the costs of health disparities—both as they affect patient outcomes and the health care system at large—is vital to improving care and reducing costs in the long run.”

In a partnership between JCDH, Birmingham Strong, federally funded health centers in the area, and UAB’s NIH-funded Minority Health and Health Disparities Research Center, UAB launched additional testing sites in disadvantaged neighborhoods across the Greater Birmingham area. A call center for appointments was set up and neighborhoods identified. The clinics feature drive-in and walk-up testing, and they test between 50 and 100 individuals per day at each site.

“As we reopen across the state, we know that it will be vitally important to continue community testing,” says Jordan DeMoss, vice president for Clinical Operations at UAB Hospital. “We understand that not everyone is capable or willing to come to our downtown testing site. We feel it is important that we reach out, especially to our underserved communities, for testing, for education, and for awareness as we build trust in the health care system.”

The health system also supports underserved residents of Jefferson County as it moves forward with plans to operate Cooper Green Mercy Health Services as part of a University Authority. The Authority will provide better access to UAB’s high-quality care for Cooper Green patients.

Albert Pierce II, M.D., professor of Anesthesiology, is photographed while being fitted with a respirator that was adapted to include a medical grade filter at the UAB Hospital COVID-19 Command Center, April 14, 2020.Testing Innovative Therapies

UAB is also on the front lines of drug discovery, spearheading the development of possible therapeutics against COVID-19. One of the most promising treatments is remdesivir, developed under the guidance of the UAB-led Antiviral Drug Discovery and Development Center, which the NIH’s Anthony Fauci, M.D., has called the standard of care for hospitalized patients with moderate to severe illness. UAB is the only hospital in Alabama able to offer these treatments for our citizens through multiple clinical trials:

• Remdesivir
• Nitric oxide
• Convalescent plasma
• Selinexor
• Tocilizumab
• Canakinumab on cytokine release syndrome

Supporting Testing

UAB Hospital administrators and leaders in pathology have been able to secure hard-to-get testing equipment, materials, and PPE to expand testing in the region, as well as expand testing into previously underserved areas. UAB medical students volunteered at community testing sites and manned phones lines to deliver results.

Due to UAB’s efforts in molecular testing led by Sixto Leal, M.D., UAB was among the first academic medical centers in the country to offer in-house testing by launching a laboratory-developed test in March. Leal and his team are able to test between 300 and 500 samples daily with COVID-19 RNA testing, confirming the presence of the virus in patients, with a turnaround time of less than 24 hours. This includes all inpatient admissions and health care workers, as well as all patients undergoing surgical procedures at UAB Hospital, and labor and delivery patients. A second COVID-19 RNA testing platform with less than two hours’ turnaround time is now operational as well.

To support the Jefferson County Department of Health, UAB developed a testing call center and drive-in site on UAB property. That site has now tested more than 5,000 community members. Hospital laboratories quickly geared up to increase testing capacity, now processing 600 tests per day.

Medical West Hospital worked closely with mayors in west and southwest Jefferson County, and tested more than 600 patients with the help of Cahaba Medical Care, a local community-based health organization with locations across rural and urban Alabama.

Baptist Health quickly opened two Coronavirus Care Clinics in mid-March, within a week of one another, with phone screening/testing and a drive-up appointment model. As of early May, the clinics have served nearly 20,000 patients via phone screenings and more than 2,500 patients via drive-up screenings. These clinics helped identify COVID-19-positive patients in a drive-up clinic setting allowing for a safe and seamless referral to appropriate medical care.

Jeanne Marrazzo, M.D., MPH, director of the Division of Infectious Diseases, speaks at a UAB Medicine COVID-19 News Conference in April 2020.

Reopening the State

On the eve of Alabama’s updated stay-at-home measures that allowed greater access to retail, UAB partnered with the City of Birmingham to distribute posters through an extensive grassroots effort for retailers and individuals to encourage safe shopping to allow businesses to remain open.

In addition to awareness, tracking the virus is a critical element of the reopening plan. A group of UAB experts created www.helpbeatcovid19.org, a symptom tracker to help determine hotspots across the state where the spread of the virus could be prevalent. More than 80,000 people are using this tool to track their daily symptoms, providing up-to-date information that tracks the progression of symptoms in communities in real time. The resulting interactive map shows hot spots that indicate a rise in symptoms.

UAB experts also serve on a number of panels looking at ways to safely and effectively reopen the state:

• Vickers serves on the executive committee of the governor’s task force.
• Jeanne Marrazzo, M.D., director of the UAB Division of Infectious Diseases, serves on the state coronavirus task force.
• Other medical professionals are serving as advisers to elected officials at the local, regional, and state levels on the progress of the virus, and of the efficacy of efforts to flatten the curve and reduce the incidence of infection.
• The UAB Health System has worked with hospitals in the region on guidelines for opening elective surgery and returning to normal patient volumes.

Kevin Harrod, Ph.D., professor of Anesthesiology, conducts coronavirus disease research in his laboratory, May 2020.

Revving Up Research

In addition to ongoing drug development and clinical trials work, UAB has ramped up new research in the fight against COVID-19. In March, UAB launched the Urgent COVID-19 Research Fund, and in three weeks raised $1.1 million from Birmingham and state business leaders.

The money was dedicated to clinical and basic research projects proposed by UAB faculty in the School of Medicine, in conjunction with the Hugh Kaul Precision Medicine Institute. A request for applications for basic science proposals was issued in mid-March to faculty of the school. Fifty-two proposals were submitted. In late April, 14 projects were selected for funding, including:

• Vaccine development
• Repurposing FDA-approved medications for use against COVID-19
• Discovery of novel therapeutic targets
• Disease tracking systems
• Improvements in testing platforms
• Creation of reagents for use in antibody immunity studies
• Bio-repositories
• Clinical registry of COVID-19
• Creation of animal models of COVID-19
• Understanding the cytokine release syndrome implicated in patients with severe disease

Local and Global Outreach

UAB began regular media briefings in February to better inform the public about the novel coronavirus threat, prior to the first identified cases in Alabama. Since then:

• UAB faculty have been regular fixtures on local and national television and quoted in major media outlets around the world.
• UAB has presented regular media briefings to state media outlets, in conjunction with the City of Birmingham, Jefferson County Department of Health, and Emergency Management Agency.
• UAB’s uab.edu/coronavirus website offers information, videos, images, infographics, and more that have been shared widely in social and traditional media, reaching hundreds of thousands of people online.
• The helpbeatcovid19.org website provides a place for the public to donate money, material, or just show their support for frontline health care workers, first responders, or those in need.

Educational Leadership

UAB and the University of Alabama System have taken a leadership role in helping institutions of higher education plan toward a safe return to campus when in-person classes and activities resume. The UA System established a task force made up of representatives of all three campuses and leveraging UAB’s extensive medical expertise to develop plans for reopening universities—guidance that is being shared with other institutions across the state. The task force is co-chaired by Vickers.

“We are extremely fortunate that UAB, home to one of the world’s foremost academic medical centers, is part of our system,” said UA System Chancellor Finis St. John. “With knowledge and guidance from the scientists, doctors, researchers, and numerous higher-education experts on our campuses, we are developing comprehensive plans to make sure our three campuses are the safest in America when our students return. Our task force will consider strategies of all kinds: testing measures, enhanced cleaning, classroom procedures, housing policies, security and wellness programs, and more.”

Watts says UAB will continue to work aggressively to support Alabama’s fight against COVID-19 and the state’s recovery. “We have worked very hard to respond to the pandemic from every aspect of our organization,” Watts says. “I’m proud of the people of UAB: frontline health care workers, researchers, support staff, faculty, and students as we adapt to a new reality. We are also hard at work planning for when this is over, so that UAB will be an even stronger and better organization to serve the people of Alabama.”

By Bob Shepard