Bridging The Gap Between The Bedside And The Bench In The Fight Against COVID-19

On March 16 — the same day that the nation’s first shelter-in-place orders were announced in the San Francisco Bay Area — a Seattle woman rolled up her sleeve to take the first experimental dose of a possible COVID-19 vaccine.

“We all feel so helpless,” she told reporters. “This is an amazing opportunity for me to do this.”

Also making history that day was Lisa A. Jackson, MD, MPH, physician-researcher with a leading health care research institute in Seattle who led phase 1 safety trials for the COVID-19 vaccine developed by Moderna and the National Institute of Allergy and Infectious Diseases. It was an experimental dose of the vaccine developed by Dr. Jackson’s team that had been injected into the Seattle woman’s arm.

Dr. Jackson emphasized the urgency in developing a vaccine, saying she and her research team initiated “the first clinical trial of a COVID-19 vaccine, which was developed, produced, and put into a first-in-human clinical trial in record time.”

Dr. Jackson is one of the thousands of physicians across the United States who are collaborating on critical research to improve our understanding of how COVID-19 spreads and are developing tools to prevent and treat the novel coronavirus SARS-CoV-2. They effectively bridge the gap between the patient’s bedside in the clinical world and the research bench. Almost as quickly as the disease turned into a global pandemic, physicians were asking, analyzing, and answering critical clinical questions, all the while urgently pushing to shift the slow-and-steady research paradigm toward more rapid, applicable evidence-based results to inform the medical community how best to help COVID-19 patients.

During this unprecedented global pandemic, physicians are demonstrating in real time the many ways they are part of the solution to this challenging, novel, and deadly virus.

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The drive to conduct research

Physicians are driven to conduct research not in spite of their all-consuming clinical dedication to their patients, but because of that dedication. Their close proximity to SARS-CoV-2 has now put them in the unique position of playing pivotal roles in the fight against the disease.

In particular, physicians working in integrated health care systems, in which medical groups and health plans work in partnership to provide value-based care, often conduct studies borne from their vested interest in patient outcomes. As they pursue their mission of caring for patients, physicians naturally identify research questions — “How can I take care of my patients more effectively?” “How can we reach the most people to help them with their health?” “Could we identify this condition sooner?” — and turn to scientific methodology to find answers.

Many integrated health care systems are affiliated with independent research centers — including Geisinger, HealthPartners, Kaiser Permanente, Marshfield Clinic, and Sutter, to name a few. These centers specialize in targeted clinical studies aimed at improving individual and population health. With such robust scientific infrastructure in place, physicians have advanced projects that further our understanding of COVID-19 in prevention, screening, testing, disparities, comorbidities, and treatment, providing the critical link between research and the application of the science to improve the health of communities dealing with the disease.

Delivering true benefits to patients

From the earliest days of the pandemic, physicians collaborated among a range of health care systems, research institutes, and nations to enroll people in clinical research, from vaccine trials to investigational drugs to new therapeutic and testing strategies. Following Dr. Jackson’s successful phase 1 safety trial, for example, physician-researchers with Baylor College of Medicine, Brigham and Women’s Hospital, and Meridian Clinical Research took the lead on the phase 3 trials of the Moderna/NIAID candidate vaccine. Now Dr. Jackson and researchers at hundreds of sites nationwide are enrolling patients to ensure that the vaccine is effective.

At the Mayo Clinic, Michael Joyner, MD, an anesthesiologist, launched a large study of convalescent plasma — antibodies harvested from the blood of people who have recovered from COVID-19 — in April at a time when very little was known about treating COVID-19. Dr. Joyner and colleagues posted results from the first 3 months of their study in August. While the jury is still out on the effectiveness of convalescent plasma, their research contributed information to support of the Food and Drug Administration’s emergency use authorization.

Likewise, physicians again partnered with investigators for a large study published in August of nearly 7,000 COVID-19 patients. The study found that obesity plays a profound role in the risk of death from the disease. While the study confirmed a major risk factor for severe illness from COVID-19, it also showed no ethnic nor social disparities in COVID-19 death rates within that health care system, a proof-point for the power of equitable health care access in such capitated systems.

COVID-19 awakened the intellectual need to understand disease that is innate among all physicians, triggering a sense of urgency rarely seen in the past century. One only had to see images and stories from China, New York, and Italy early in the pandemic to reaffirm the responsibility physicians have as members of the global health care community to seek answers grounded in thoughtful science.

Clinical research is the gateway for greater understanding of SARS-CoV-2, and it is our shared mission to apply the knowledge we gain through research for the benefit of humanity.

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