From the pandemic’s earliest days, faculty, staff and students at the University of Arizona Health Sciences contributed to the fight against COVID-19 on several fronts. COVID-19 is now an endemic disease and for a significant percentage of people leads to long COVID where symptoms can last for weeks or months. For the UArizona Health Sciences Aegis Consortium, the work continues.
At the outset, the Aegis Consortium, a strategic initiative, united experts from across disciplines, government agencies, communities and industries around the world to build upon lessons learned from SARS-CoV-2 and COVID-19. The goal: to create a pandemic-free future.
“We have learned a lot about the coronavirus and COVID-19, but there is still more to learn,” said Janko Nikolich, MD, PhD, director of the Aegis Consortium, and professor and head of the Department of Immunobiology at the UArizona College of Medicine – Tucson. “We do know that this will not be the last pandemic we see. The Aegis Consortium is uniting experts in research, technology and innovation to develop solutions that protect the world from future pandemics.”
Pandemic control, prediction and preparedness
As of September 2023, more than 1.14 million deaths in the United States have been attributed to COVID-19, according to the Centers for Disease Control and Prevention.
“We firmly believe the Aegis Consortium has the potential to change the way the world prepares for and mitigates the impact of infectious diseases that may be decades away or just over the horizon,” said Michael D. Dake, MD, senior vice president for UArizona Health Sciences.
As part of the Aegis Consortium, a statewide collaboration of doctors, scientists and other researchers are focusing on quantifying extended illnesses associated with COVID-19. Nikolich is leading the effort to study the long-term effects of COVID-19 as part of the National Institutes of Health’s Researching COVID to Enhance Recovery, or RECOVER, initiative. The goals of RECOVER are to understand, treat and prevent post-acute sequelae of SARS-CoV-2 infection, or PASC. Long COVID is a form of PASC.
UArizona researchers lead one of 15 adult cohorts that contributed to the development of a clinical definition of PASC. The group published findings in JAMA in May 2023.
“This is a very important first glimpse into the clinical complexities of long COVID. We now have an initial roadmap on how to better diagnose it, and we need to validate it in ongoing studies,” Nikolich said.
Nikolich and his team are now launching RECOVER-VITAL and RECOVER-NEURO clinical trials. RECOVER-VITAL will study viral persistence, which could occur if the SARS-CoV-2 virus stays in the body and causes the immune system to not function properly or causes damage to organs. RECOVER-NEURO will examine interventions for cognitive dysfunction related to long COVID, including brain fog, memory problems, and difficulty with attention, thinking clearly, and problem solving.
In addition to RECOVER, Aegis Consortium members are studying the immune responses to SARS-CoV-2 in various groups of people, specifically older adults. The team also is examining the virus’s escape potential, or its ability to evade the immune system, and the probability of reinfection.
The knowledge researchers gain about the coronavirus and COVID-19 can be used to develop new therapies and methods to protect vulnerable populations now, while also providing a framework for future pandemics.
“The Aegis Consortium is working to identify new pandemic threats before they strike. We are building a robust virus evolution and escape prediction system that will allow us to create new models of care delivery and community coordination,” said Nikolich, who is co-director of the UArizona Center on Aging and a member of the university’s BIO5 Institute.
Post-acute effects of pandemics on individuals and societies
Under the second of the Aegis Consortium’s three areas of focus, researchers will address the intermediate and delayed impact of virus-related disruptions of social, educational and economic activities.
Many of the pandemic’s effects are visible and quantifiable, such as disruptions to the global economy and supply chains, and rising levels of poverty. According to the Congressional Research Service, as many as 75 million people may have entered extreme poverty in 2020, with 80 million more undernourished compared to pre-pandemic levels. These problems are not only devastating by themselves, but also provide fertile ground for virus escape, recombination and the creation of new variants.
At the individual and societal levels, mental health issues, addiction and social unrest are less measurable but equally as destructive effects of the ongoing pandemic.
The long-term effects of the pandemic are unknown. Through the Aegis Consortium, wearable sensors will help researchers track the secondary and long-term effects of COVID-19, while social scientists are developing tools to model human emotions and behavior during pandemics.
Specific research projects are being developed to understand the impact of K-12 school closures on children. Early research suggests that many children fell behind academically while also facing social isolation that resulted in increased loneliness and suicidal thoughts, especially among teenagers. Children with developmental disabilities and those with racial and economic disparities were disproportionately affected by widespread and lengthy school closures.
“Arizona students in several districts experienced some of the longest school closures of any state, and teachers and parents are voicing their concerns,” said Jim Buizer, PhD, associate director of the Aegis Consortium, director of the Arizona Institutes for Resilience and a professor in the UArizona College of Agriculture, Life and Environmental Sciences. “To address those concerns, we need to better understand how pandemic-related school changes affected children and their education, and how we can do better in the future.”
Hospitals also were severely impacted by the pandemic. Aegis Consortium collaborators are examining why some hospitals dealt with the influx of patients and medical uncertainty better than others to improve hospital preparedness and health outcomes in the future.
Resilience of built and natural environments in pandemic control
As researchers raced to identify how the coronavirus spread, one thing was clear: environment matters. It has become increasingly clear that the built environment – the buildings in which we live, work and play – can be part of the solution or part of the problem during a pandemic.
Still, little is known about how the environment influences human vulnerability and resiliency. Aegis Consortium collaborators are investigating how the coronavirus and its human hosts change depending on different indoor and outdoor environments and how the built environment can be altered to promote resilience.
Individual projects will examine the use of adaptive design in buildings, create a building index system to rate the risk of infection, develop new technologies to reduce the spread of infectious diseases in the built environment, and find ways to detect SARS-CoV-2 in the air in real time.
Two issues critical to older adults are aging-in-place and senior living facilities. Older adults were disproportionately affected by COVID-19, and mandatory quarantines posed unique and significant threats to their health and quality of life. In collaboration with the UArizona Center on Aging, Aegis Consortium members aim to develop strategies to make senior living more resilient in the face of future pandemic threats.
“We are combining our expertise in creating smart and adaptive built environments with innovative ways of delivering state-of-the-art health care at home to ensure that older adults, wherever they choose to live, are protected from the devastating effects of pandemics,” said Mindy J. Fain, MD, co-director of the UArizona Center on Aging and a professor in the College of Medicine – Tucson’s Department of Medicine.
The Aegis Consortium’s three-pronged proactive approach is designed to find immediate solutions to mitigate the effects of COVID-19 while putting in place mechanisms and strategies to predict and stave off new pandemics. The consortium’s leaders say they are convinced that, working together across universities, foundations, nonprofits, governments, communities and industries around the world, a pandemic-free future is achievable.
