Poor outcomes in COVID-19 and immunity to the virus: UB physicians study the social and biomedical factors at play

BUFFALO, N.Y. – The sudden appearance of a novel, sometimes deadly, highly infectious disease about which not much is known is terrifying enough. But when combined with pronounced health disparities among the underserved in communities like Buffalo, the COVID-19 pandemic became all the more devastating.

Now, a team of University at Buffalo physicians have launched a project to explore both biomedical and public health factors of the pandemic, looking at how immunity to COVID-19 works by studying those who have recovered and at the same time, working to mitigate its dire effects on underserved populations through community engagement and educational interventions.

The project was discussed at the “Virtual Colloquium to Advance Health Equity Research in Buffalo” held by UB’s Community Health Equity Research Institute last month.

Initial collection of samples has been funded by the State University of New York’s Research Seed Grant Program.

Disproportionate effects

“Our project will specifically address the problem of health inequity in Western New York directly associated with COVID-19,” said Oscar G. Gómez, MD, PhD, associate professor of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB, Division Chief, Infectious Diseases and a physician with UBMD Pediatrics.

“COVID-19 has disproportionally affected African Americans, Hispanics and Native Americans in different regions in the U.S. To address these disparities in health, our project goals are to assess the community’s risk of COVID-19-associated poor outcomes through an evaluation of the social determinants of health, underlying health conditions and other demographic factors,” he said.

Through a partnership with local clinics and community health workers, UB researchers led by Roberto O. Diaz Del Carpio, MD, clinical assistant professor of medicine in the Jacobs School and a physician with UBMD Internal Medicine at Hertel-Elmwood, will work on educational interventions in the community, including prevention measures, addressing comorbidities, and providing information about access to health care for the uninsured.

Diaz Del Carpio explained that studies have shown that interventions delivered by community health workers can improve health while reducing costly hospitalizations and readmissions.

“In Buffalo, the community health worker network is doing important work by delivering cultural competency and health literacy training in collaboration with other community-based organizations, with the objective to have a more inclusive and healthy community,” he continued. “This has emerged as a community-based response to the COVID-19 pandemic, functioning as a bridge between systems, sectors, organizations, grassroots efforts and our community members.” 

At the same time, the UB researchers are focused on the question of how immunity to COVID-19 can develop. The possibility that people with COVID-19 antibodies could be immune from subsequent infection or that their antibodies could help others develop immunity is a key way that the novel coronavirus could be curbed before an effective vaccine is developed.

Not much is known about COVID-19 immunity.

“This coronavirus is dangerous and research on it requires special laboratory conditions not available at most research institutions,” said Gómez. “Due to the COVID-19 pandemic, many laboratories at academic institutions are closed, and there are limited reagents specific for COVID-19 research.”

These factors limit an institution’s ability to conduct research, he said. But despite these obstacles, samples from both children and adults infected with COVID-19 have been collected and processed in the laboratory of Mark D. Hicar, MD, PhD, associate professor of pediatrics in the Jacobs School, a physician in the Division of Infectious Diseases at UBMD Pediatrics and a co-collaborator on the study. These samples will be used in initial studies on how immunity to the virus works.

“There is limited information on how the immune system may work to fight infection and how individuals who recover differ from those who die of this infection,” said Gómez. “SARS-CoV-2, the virus that causes COVID-19, is highly contagious and may be transmitted by people who may be asymptomatic or do not manifest significant symptoms, mainly children.”

He explained that while active infection with the virus or a vaccination will provide the patient with active immunity, passive immunity may also be protective.

Leveraging passive immunity

“Leveraging passive immunity with neutralizing antibodies may offer promise,” Gómez said. “That means that by giving a patient specific antibodies against a pathogen in the form of convalescent plasma from someone with high levels of neutralizing antibodies against that pathogen, it may be possible for the patient to acquire immunity passively.”

He noted that this strategy has been effective in preventing other viral infections, as neutralizing antiviral antibodies may block viral binding to specific receptors on a pathogen like COVID-19, blocking further replication of the virus.

Gómez added that there is evidence that in mild cases of COVID-19, secretion of cytokines, proteins released by the immune system to fight inflammation, may induce antibody and cellular immune responses against the virus. At the same, it is known that in severely affected patients there can be abnormally high secretion of cytokines, a phenomenon associated with poor outcomes, called a cytokine “storm.”

The UB researchers will be studying what might be responsible for such widely varying immune responses.

To further investigate the nature of immune responses that COVID-19 triggers, the UB researchers have established a biobank of clinical samples, including blood cells, plasma and saliva of infected children and adults. They will also conduct genetic studies aimed at identifying markers that might be protective against COVID-19 infection in the general population.

In addition to Gómez, Diaz Del Carpio and Hicar, other Jacobs School faculty involved in the project are John Tomaszewski, MD, SUNY Distinguished Professor and Peter A. Nickerson, PhD chair of the Department of Pathology and Anatomical Sciences and president of UBMD Pathology, and Sanjay Sethi, MD, professor and chief, Division of Pulmonary, Critical Care and Sleep Medicine in the Department of Medicine and a physician with UBMD Internal Medicine.