The fight back against COVID-19

The current approach to management of COVID-19 involves managing symptoms while the disease runs its course.^1,2 But with millions of cases worldwide and the death toll continuing to rise,³ the race is on to find effective treatments to mitigate the pandemic.⁴

Given that respiratory failure is the main cause of death in critically ill COVID-19 patients,² interventions that improve lung function could be life-saving. Recognising this, Vitafon realised that their hand-held medical device, which delivers low intensity vibration to reduce local inflammation and has shown some benefits in improving lung function in COPD patients,⁵ could theoretically be used to treat moderate-to-severe respiratory disease resulting from COVID-19.

Vitafon wanted to offer their medical device to clinical research centres to investigate any possible benefits it may provide to patients with COVID-19. To facilitate this, EIT Health introduced Vitafon to University Hospital Centre Sisters of Charity, Zagreb, Croatia and both organisations are now investigating the value of proceeding with a clinical trial to evaluate the effects of the device in COVID-19 patients.

References
1. Cunningham AC, Goh HP, Koh D. Treatment of COVID-19: old tricks for new challenges. Critical Care. 2020; 24: 91.
2. Vincent JL, Taccone FS. Understanding pathways to death in patients with COVID-19. Lancet Respir Med. 2020 [epub ahead of print] doi: 10.1016/S2213-2600(20)30165-X
3. World Health Organisation. Coronavirus disease 2019 (COVID-19) Situation Report – 91. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports (last accessed 7 April 2020).
4. Mahase E. Covid-19: what treatments are being investigate? BMJ. 2020;368:m1252.
5. Boshko R. Influence of vibroacoustic effect of “Vitafon” on ventilation rate and respiration mechanism in patients with chronic lung obstruction (COPD).

In the most severe cases, patients with COVID-19 experience severe respiratory failure requiring mechanical ventilation.¹ Respiratory failure is the main cause of death in critically ill COVID-19 patients.²

Ventilators support the most severely affected patients by improving oxygen levels in the blood, and supporting respiratory muscles to reverse or avoid fatigue.^3,4 This saves lives by keeping patients breathing while they fight the infection and their lungs recover.²

Many countries are struggling to meet the demand for extra resources resulting from unprecedented numbers of patients contracting COVID-19, global supply chain disruption and quarantine measures preventing movement of medical equipment.^1,5  Researchers and hospitals are therefore exploring innovative methods to meet the demand, such as splitting a single ventilator to support multiple patients.^1,5

This approach has been considered by SERMAS, the Madrid healthcare system. As part of their COVID-19 scenario planning, they wanted to understand the clinical impact of using one ventilator for multiple patients.

Together, the EIT Health teams in Spain and France introduced SERMAS to a lung specialist at the University Hospital of Brest, who has expertise in this area. The specialist was able to share his protocols and offer his support and expertise on this topic. He’s also offered his help to SERMAS to prepare hospitals with that solution if needed to meet patient demand.

References
1. Clarke AL, Stephens AF, Liao S, et al. Coping with COVID-19: ventilator splitting with differential driving pressures using standard hospital equipment. Anasthesia. 2020 [epub ahead of print] doi: doi:10.1111/anae.15078
2. Vincent JL, Taccone FS. Understanding pathways to death in patients with COVID-19. Lancet Respir Med. 2020 [epub ahead of print] doi: 10.1016/S2213-2600(20)30165-X
3. Roever L, Resende ED. Invasive mechanical ventilation in adults in emergency and intensive care: a brief review. J Intensive Crit Care. 2015; 1(1).
4. American Thoracic Society. Mechanical Ventilation. Am J Respir Crit Care Med. 2020; 196: 3–4.
5. Clarke AL. 3D printed circuit splitter and flow restriction devices for multiple patient lung ventilation using one anaethesia workstation or ventilator. Anaesthesia. 2020 [epub ahead of print] doi: 10.1111/anae.15063

In response to the global spread of COVID-19, researchers worldwide rapidly began gathering evidence to better understand the virus and the disease it causes.^1–3 While scientific knowledge about the virus is incomplete, data and evidence is accumulating rapidly, with research investigating the spread of the virus, as well as effective approaches to manage and treat COVID-19. ^3–5 Given the evolving nature of this ongoing global pandemic, there is a need to synthesise the evidence to maximise the insights that can be gained from this increasing pool of data.¹

Recognising this need, Hungarian company Epidy Health Research Ltd developed an online evidence synthesis platform and risk assessment tool for factors associated with the development and prognosis of COVID-19. Their platform brings together up-to-date evidence to provide information summaries, as well as using the data to inform a risk assessment tool that can evaluate risk of SARS-CoV-2 infection and development of COVID-19. However, the company needed help with user interface development, data management and GDPR.

To facilitate this, EIT Health introduced Epidy Health Research Ltd to Ententee, a software development company based in the Czech Republic. Ententee who had the skills that Epidy were looking for, were keen to leverage their knowledge and expertise to help in the fight against COVID-19. The two companies are now exploring ways they can further develop the platform together.

References
1. Keenan C et al. The role of evidence synthesis in COVID-19. Available online at: https://evidenceaid.org/the-role-of-evidence-synthesis-in-covid-19/
2. Yang et al. Characteristics of registered studies for Coronavirus disease 2019
(COVID-19): A systematic review. Integr Med Res 2020; 9(3): 100426.
3. Adhikari SP et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1):29.
4. Zhai P et al. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020; 55(5): 105955.
5. Tu YF et al. A review of SARS-CoV-2 and the ongoing clinical trials. Int J Mol Sci 2020; 21(7): 2657

While governments worldwide continue with attempts to contain and manage the coronavirus outbreak, the pandemic is revealing the fragility of health systems in many countries.¹ Healthcare workers have faced the incredibly difficult task of treating and caring for huge numbers of patients, while relying on personal protective equipment (PPE) to prevent further spread of the virus. But demand for PPE has outstripped supply in many places, placing healthcare workers at risk of infection. ²

Part of the problem is that most PPE is single-use³ – once worn, it is contaminated and must be disposed of. However, the Portuguese medtech company, Delox, believe their decontamination device could provide an answer to shortages, offering a way for hospitals to safely reuse PPE. The device uses a proprietary technology, dry Vaporised Hydrogen Peroxide (VHP), to bio-decontaminate anything from small PPE pieces such as respirators or masks up to laboratory enclosures such as biosafety cabinets.

While the device will be soon used to bio-decontaminate PPE at the Hospital of Armed Forces in Lisbon, Delox was looking for collaborators to test and implement the technology further afield. With the help of the EIT Health Making Connections platform, Delox was contacted by a Swedish laboratory and an Austrian medical equipment developer and manufacturer. Delox is now exploring opportunities to collaborate with both companies in the future, enabling them to test the decontamination device in different environments, in the hope that it will help to protect those on the frontline of the coronavirus pandemic at a time where PPE is in high demand.

References
1. WHO. WHO releases guidelines to help countries maintain essential health services during the COVID-19 pandemic. 2020. Available from: https://www.who.int/news-room/detail/30-03-2020-who-releases-guidelines-to-help-countries-maintain-essential-health-services-during-the-covid-19-pandemic
2. WHO. Shortage of personal protective equipment endangering health workers worldwide. 2020. Available from: https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide
3. Public Health England. COVID-19 personal protective equipment (PPE). 2020. Available from: https://www.guidelines.co.uk/infection/covid-19-personal-protective-equipment-ppe/455274.article