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Medical schools considering early graduation for students – CNN

New York University started offering this option on Tuesday, becoming the first medical school to do so. And now other medical schools are considering doing the same.

"While the AAMC has not yet surveyed its member medical schools, the [Liaison Committee on Medical Education] has been working with several other schools that are considering or offering their students the option of graduating early," said Dr. Alison Whelan, chief medical education officer for the Association of American Medical Colleges.

In Massachusetts, all four medical schools are in discussions with Massachusetts Health and Human Services to have a fast-track option. Tufts University School of Medicine, University of Massachusetts Medical School, Boston University School of Medicine and Harvard Medical School are all contemplating the idea, said Massachusetts HHS Secretary Marylou Sudders on Thursday.

Dr. Whelan confirmed that they have been working with the deans of the medical schools in Massachusetts to graduate students early.

Whelan told CNN that they are aware that nearly every school in the US is thinking about early graduation to battle the coronavirus pandemic.

In New Jersey, Cooper Medical School of Rowan University also sent an email to its senior medical students to see if they were interested in early graduation.

And it's not just young doctors who want to pitch in and help. In Illinois, retired healthcare workers are stepping up to the plate. Illinois governor J. B. Pritzker tweeted that 450 retired and former healthcare workers have signed up to work during the pandemic. Those that rejoin the workforce will help staff hospitals and health care centers throughout the state, the tweet said.

The governor had issued a call last week for former healthcare workers to rejoin the work force during this crisis.

Around the US, physicians who are not infectious disease specialists or pulmonologists are training and joining the frontlines.

"We are hearing that there are individuals from other specialties being drawn into clinical care," said Dr. Janis Orlowski, chief health care officer for the AAMC on Friday.

Orlowski added that they are being trained very quickly to get them up to speed in the use of personal protective equipment and ventilators. These additional trainings will ensure that physicians are safe to work in areas that might not be their specialty.

"Safety and quality remains a high priority -- the number one priority -- even though people are having to work fast and work smart," Orlowski added.

The US has now reported more coronavirus cases than any other country in the world, according to CNN's tally. It has surpassed China and Italy.

CNN Health's Minali Nigam and Gina Yu contributed to this report.

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Option to Serve – Harvard Medical School

This years graduating Harvard Medical School students will have the option to receive their diplomas early so that, if they choose, they can quickly be deployed into hospitals where regular staff might soon be overwhelmed with COVID-19 patients.

Fourth-year HMS students who have completed all their training and degree requirements, as well as graduating MD students from Boston University, Tufts University and the University of Massachusetts, are being given the option to receive their diplomas before their scheduled graduation date in May.

Get more HMS news here

The change comes in response to a request to the schools from Massachusetts Gov. Charlie Baker and Massachusetts Secretary of Health and Human Services Marylou Sudders, citing an expected escalation in local health care workforce needs.

Approximately 700 medical students in the Boston area are slated to graduate this spring.

Because Harvard University grants HMS MD degrees, there are administrative issues to address before the option becomes official for HMS students, including deliberation and voting over the weekend by the Harvard Corporation and the universitys Board of Overseers. Harvard is expected to agree to the states request.

Students enter our medical schools aspiring to serve and heal. I have never been more proud of our students, many of whom have already expressed their eagerness to graduate early so they can join our hospitals on the frontlines to help treat patients amid this pandemic, said HMS Dean George Q. Daley. We need their skill and compassion now more than ever, and many are ready, willing and able to answer the call.

HMS Dean for Medical Education Edward Hundert told graduating students on a teleconference on March 26 that a number of details must be worked out in the coming weeks. He also emphasized that early graduation will be entirely voluntary and that individual hospital programs where students have matched may or may not build this option into their COVID-19 contingency plans.

This is evolving, Hundert told the students, and it will be entirely optional. We want to make this available for those who would like to respond if asked and give our students the option to serve in this way.

Hundert and HMS Dean for Students Fidencio Saldaa told students that those meeting all degree requirements could be allowed to graduate as early as mid-April, more than a month before regularly scheduled commencement ceremonies and two months before most internships begin.

Any studentcan also choose to wait until May to graduate.

Students considering the early graduation option will have to considerhow losing student status early might affect their health insurance, their housing and visas and their student loan deferral status. Hundert and Saldaa said HMS is working to provide answers to all such questions before mid-April.

This decision is a personal one, and no one should feel pressured by it, said Saldaa.

Graduating HMS student Josephine Fisher, who matched last week to Massachusetts General Hospitals internal medicine/primary care program, said she is excited that HMS will be offering the early graduation option.

One of the hardest parts for me is feeling that, as of right now, we are not able to help on the frontlines as much as we would like, Fisher said. Though I feel nervous about the risks posed to myself, and even more so to my family, who I risk exposing when I return home from work, I feel very lucky that I am on the cusp of completing medical school at this time because it means I have been trained with skills that might allow me to make a meaningful difference providing clinical care during this pandemic.

Hundert said educational leaders at HMS teaching affiliates, such as Mass General, Brigham and Womens Hospital, Beth Israel Deaconess Medical Center and Cambridge Health Alliance, welcomed the news that they might be able to build the possibility of MD student reinforcements into their COVID-19 contingency plans, particularly if current interns and residents become ill and are unable to care for patients.

They all said this was new information for them as it is for us, and that they would assess how this new possibility could potentially enhance their options as they consider workforce needs, Hundert said, telling the students on the call that it would likely be at least a week before hospitals let HMS know how and when graduating students might be invited to participate as needs evolve over the coming weeks.

Each hospital, and each clinical department, will decide whether and how this would enhance their efforts, Hundert said. The hospitals will let HMS and the students know what their needs are.

For many of the graduating students, the next few weeks will be a time of uncertainty.

I know that some residency programs reached out to their future interns inquiring about their willingness to volunteer and join the intern workforce earlier. I will wait and see if my program has such an offering, said graduating HMS student Ameen Barghi.

According to Sudders, the Massachusetts Board of Registration in Medicine is prepared to grant MD students who choose to take the early graduation option a special 90-day limited provisional license to practice, after which they would be able to start in a pre-internship COVID-19 service role, according to Hundert.

Students also have the option of graduating early and not working in the hospitals immediately, Hundert said, and some hospital programs may not issue a call for them.

It is unclear whether the provisional license issued by Massachusetts would be accepted in other states where HMS students have matched. Saldaa and Hundert said medical schools across the U.S. are considering early graduation options, with New York universities leading the way in giving students the choice.

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Young Medical Graduates Find Themselves on the Front Lines of Italy’s Coronavirus Fight – TIME

On the morning of March 8, Francesca Tamburelli was in her apartment in Heidelberg, Germany, when she learned that part of Italy was entering lockdown due to the spread of the novel coronavirus. Upon hearing the news the 25-year-old, who graduated from medical school just last summer, quickly boarded a bus to her hometown of Turin. Within a few days, she was working in a hospital in Cremona, a city in the epicenter of Italys outbreak, where nearly 500 patients suffering from COVID-19 are treated. Other than internships and volunteer work in Tanzania, its her first professional experience in a hospital.

Tamburelli is one of the many young doctors in Italy responding to the calls recently put out by local administrations to meet the shortage of medical staff in hospitals experiencing unprecedented levels of pressure. Italy is one of the worst affected countries by the coronavirus; over 86,000 people here have so far tested positive, and more than 9,000 have died. In the most severely hit cities like Cremona, entire hospitals have been converted to centers for the exclusive treatment of COVID-19 patients. Every doctor, whether they specialize in dermatology or gynecology, is drafted in to deal with the virus.

On her first day on the job, Tamburelli was assigned to the pulmonology ward, which treats patients with serious respiratory problems not yet requiring intensive care. After four days she was moved to the neurology department, converted to a ward where COVD-19 patients are in less critical condition. I am learning a lot every day, but even specialists with 20 years of experience are learning. Its a new experience for everyone, she says. The hospital hierarchical structure has changed suddenly: now its the pulmonologists and anesthesiologists who are at the top.

Although her hospital hasnt yet suffered from the shortages of personal protective equipment (PPE) seen in many other medical facilities, she is taking a risk, like the majority of doctors in this moment. In total, nearly 6,500 doctors and nurses in Italy have contracted the disease. I know theres a strong chance that Ill be infected too, says Tamburelli. Its not easy thinking that I dont know when Ill see my family and my boyfriend again, but they support me and I know Im doing the right thing.

Tamburelli is staying in a hotel with a former university classmate, Ornella Calderone, originally from Messina, in Sicily. Calderone, 32, has a degree in biology and one in medicine. Until last week she was studying for the entrance exam to specialize as a surgeon while working several temporary jobs. After applying to help at the worst-hit hospitals, she received a call within two hours. It was an unknown number and I realized immediately that my life was about to change. In the two days before arriving at the hospital she studied like crazy, she says, looking for practical information and updates on procedures she had never seen done live, such as ventilation. She is now on the pulmonology ward, one of the hospitals most critical. I cant say that I felt prepared to set off immediately, but since I arrived in Cremona there hasnt been a single second when Ive felt I wasnt in the wrong place, says Calderone.

Not every recent graduate feels ready for the front lines. Paolo Rubiolo, 26, completed his studies in medicine at the University of Turin just last week and says he is now thinking about how he could best help out. I dont feel Im ready to work on the hospital wards, he admits. I think Id be more useful in helping provide services that have been disrupted due to the emergency, such as primary health care or medical care for the elderly who have problems other than the virus, he says.

But the front lines are where the doctors are most needed. Apart from the government decree allowing hospitals to contract doctors just out of school, the Civil Protection Agency recently put out a call to create a task force of another 300 volunteers. Doctors Without Borders is providing support to hospitals in areas most in need, and reinforcements are also coming from other countries. Experts and supplies have arrived from China and Russia, while last week a brigade of 52 doctors and nurses from Cuba landed in Lombardy. In the parking lot in front of Cremona hospitals main building is now occupied by a field hospital run by the medical staff of a U.S. Christian organization.

It is easy to compare this scenario with that of a war, talking about trenches and heroes, says Samin Sedghi Zadeh, 29, who has been working on the pulmonology ward in Cremona for the past three weeks. But I dont like this comparison. War is something we bring on ourselves, this is an emergency that we are all trying to get out of together. Sedghi Zadeh was born in Italy to Iranian parents, and earned his medical degree in Turin a year and a half ago. Until the crisis began, he was employed as a doctor at an e-commerce company. He says hes now glad to have the opportunity to be helpful in the public health system.

The three young doctors, Sedghi Zadeh, Tamburelli and Calderone, are technically only contracted to work for one month. But all think their contract will probably be renewed at least until the end of the emergency whenever that is. Afterwards theyre all ready to go wherever the need is greatest. The experience we are accumulating could be useful in other places in Italy or in the world, and I dont think any of us will back out, Sedghi Zadeh says. When you are a doctor, youre not an Italian, French or Greek doctor. You are a doctor and you go where you are needed.

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Explore the 2021 Best Medical Schools for Research – Yahoo Finance

See the top 40 medical research schools.

Aspiring doctors who dream of discovering vaccines and treatments for diseases like cancer should find a program that emphasizes research. Discover which universities earned a top 40 spot in the 2021 U.S. News Best Medical Schools for Research rankings.

40 (tie). Albert Einstein College of Medicine (NY)

Full-time enrollment: 779

2019-2020 tuition: $53,709

2019 acceptance rate: 4.3%

More about the Albert Einstein College of Medicine.

40 (tie). University of California--Davis

Full-time enrollment: 463

2019-2020 tuition: $38,340 (in-state), $50,585 (out-of-state)

2019 acceptance rate: 3.1%

More about the UCD School of Medicine.

40 (tie). University of Florida

Full-time enrollment: 561

2019-2020 tuition: $32,744 (in-state), $45,000 (out-of-state)

2019 acceptance rate: 5.1%

More about the UF College of Medicine.

40 (tie). University of Minnesota

Full-time enrollment: 1,019

2019-2020 tuition: $39,402 (in-state), $56,547 (out-of-state)

2019 acceptance rate: 4.9%

More about the University of Minnesota Medical School.

38 (tie). Brown University (Alpert) (RI)

Full-time enrollment: 598

2019-2020 tuition: $63,082

2019 acceptance rate: 2.8%

More about the Warren Alpert Medical School.

38 (tie). University of Utah

Full-time enrollment: 500

2019-2020 tuition: $40,538 (in-state), $76,745 (out-of-state)

2019 acceptance rate: 4.7%

More about the University of Utah School of Medicine.

34 (tie). Ohio State University

Full-time enrollment: 813

2019-2020 tuition: $30,690 (in-state), $41,798 (out-of-state)

2019 acceptance rate: 5.7%

More about the OSU College of Medicine.

34 (tie). University of Iowa (Carver)

Full-time enrollment: 609

2019-2020 tuition: $36,382 (in-state), $57,157 (out-of-state)

2019 acceptance rate: 7.1%

More about the Roy J. and Lucille A. Carver College of Medicine.

34 (tie). University of Maryland

Full-time enrollment: 629

2019-2020 tuition: $37,810 (in-state), $66,905 (out-of-state)

2019 acceptance rate: 6.6%

More about the UMD School of Medicine.

34 (tie). University of Rochester (NY)

Full-time enrollment: 423

2019-2020 tuition: $59,100

2019 acceptance rate: 5.7%

More about the Rochester School of Medicine and Dentistry.

31 (tie). University of Alabama--Birmingham

Full-time enrollment: 799

2019-2020 tuition: $28,978 (in-state), $62,714 (out-of-state)

2019 acceptance rate: 6.0%

More about the UAB School of Medicine.

31 (tie). University of Colorado

Full-time enrollment: 744

2019-2020 tuition: $40,348 (in-state), $66,304 (out-of-state)

2019 acceptance rate: 3.7%

More about the University of Colorado School of Medicine.

31 (tie). University of Southern California (Keck)

Full-time enrollment: 747

2019-2020 tuition: $64,538

2019 acceptance rate: 4.6%

More about the Keck School of Medicine.

29 (tie). Boston University

Full-time enrollment: 709

2019-2020 tuition: $62,872

2019 acceptance rate: 6.5%

More about the BU School of Medicine.

29 (tie). University of Virginia

Full-time enrollment: 615

2019-2020 tuition: $43,828 (in-state), $53,952 (out-of-state)

2019 acceptance rate: 11.7%

More about the UVA School of Medicine.

28. Oregon Health and Science University

Full-time enrollment: 630

2019-2020 tuition: $43,488 (in-state), $66,844 (out-of-state)

2019 acceptance rate: 4.0%

More about the Oregon Health and Science School of Medicine.

27. University of Wisconsin--Madison

Full-time enrollment: 731

2019-2020 tuition: $36,266 (in-state), $50,201 (out-of-state)

2019 acceptance rate: 5.5%

More about the School of Medicine and Public Health at University of Wisconsin--Madison.

26. University of Texas Southwestern Medical Center

Full-time enrollment: 911

2019-2020 tuition: $19,910 (in-state), $33,010 (out-of-state)

2019 acceptance rate: 7.0%

More about UT Southwestern Medical Center.

24 (tie). Case Western Reserve University (OH)

Full-time enrollment: 943

2019-2020 tuition: $65,476

2019 acceptance rate: 7.0%

More about the Case Western School of Medicine.

24 (tie). Emory University (GA)

Full-time enrollment: 582

2019-2020 tuition: $51,000

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I’m a final-year medical student being rushed to the frontline. I’m nervous but I’m ready – The Guardian

So, were being conscripted?

On Tuesday, the health secretary, Matt Hancock, announced that 5,500 final year medical students would be joining the frontline of the NHS. On hearing this news, I rushed down the stairs of my flat to my equally bewildered housemates. We had just finished six years of medical school and had completed our hurriedly reorganised final exams remotely. But we werent supposed to officially qualify and start as doctors until August. NHS staff shortages and a hugely increased demand for care mean that we will be reaching for the scrubs early.

Starting on the lowest rungs, foundation training is the term for the first two years working as a doctor and serves as the culmination of a journey spanning over half a decade of medical school. Becoming a doctor is a dream I have had since I was 14 years old. But I can think of few things more nightmarish than starting my career in the middle of a global pandemic.

I certainly feel a strong moral obligation to assist however possible in the midst of this unprecedented struggle. Many medical students, including those at my university, have completed their final examinations and were already actively seeking ways to volunteer before this was announced.

This sense of duty is nonetheless matched by fear and trepidation. A lack of testing means many healthcare workers are self-isolating at a time when demand looks set to soar. There is an overwhelming sense that the health service is heading towards a cliff edge, about to experience several months that will dwarf the winter crisis that has become an annual occurrence.

Indeed, despite being highly trained, foundation doctors the most junior of junior doctors in a hospital still require significant senior supervision to support their development. I worry that the approaching challenges could place myself or one of my peers in a position where that support is not available, risking jeopardising patient safety through no fault of our own.

Meanwhile, rumours continue to filter through of the previously fit and well patients now finding themselves on ventilators and I question if my colleagues pleas for adequate personal protective equipment will continue to fall on deaf ears.

I speak to my dad, whos back in Grimsby, on the phone. Stephen, its like the war. You need to roll your sleeves up and get to work. Hes right. Our medical schools would not graduate us, nor would the General Medical Council register us to work, if they had any doubts about our competence. Were not being conscripted, but this does feel like a battle in which we all have our part to play. I, for one, am ready.

Stephen Naulls is a final-year medical student at Imperial College London

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Duke Researchers Pivot to Attack the New Coronavirus – Duke Today

In the race to understand the new coronavirus and generate solutions, Duke research teams are well underway.

In fact, you could say theyve been working on it for decades. Everything Duke experts have learned over the years about the spread of new diseases, the biology of viruses, and the techniques of developing treatments and vaccines is now being applied to the new coronavirus, SARS-CoV-2, and the illness it causes, COVID-19.

These experts work across the medical school and campus as well as abroad. They work in the Duke Human Vaccine Institute (DHVI), the Duke Global Health Institute (DGHI), and the Duke-NUS Medical School in Singapore, among many other centers, institutes, and departments. And they are collaborating with other experts across the globe.

Duke also has state-of-the-art facilitiessome of which are uncommon on university campusesthat are speeding up the development of new treatments and vaccines.

Weve got years of experience working with viruses and other pathogens, says Colin Duckett, PhD, vice dean for basic science in the School of Medicine. Because we have the infrastructure and highly trained experts, weve been able to pivot rapidly to confront this new challenge.

Slowing the Spread

Epidemiologists and those who work in global health are hard at work learning more about how the virus spreads, with the immediate goal of slowing the spread.

If we string out cases over time, especially for those likely to have severe disease, our intensive care units wont be overrun and we can help them survive, says Gregory Gray, MD, MPH, FIDSA, professor of medicine in the Division of Infectious Diseases and member of the Duke Global Health Institute. He also has appointments at Duke-NUS Medical School in Singapore, Duke Kunshan University in China, and the Duke Nicholas School for the Environment.

Grays lab members are conducting investigations both in Durham and Singapore to discover how far the virus can travel in the air. The investigators are setting up bio-aerosol samplers at various distances from patient beds to collect and identify virus and virus particles. Current thinking suggests the virus doesnt typically travel beyond 2 meters (6 feet) from an infected person; Grays studies will help confirm or revise this.

Gray, an epidemiologist, is also working to collect and analyze data related to close contacts of infected people to learn more about the incubation period and what sorts of interactions are likely to result in transmission. Refining those two pieces of information will improve mathematical models of the spread.

In the lab, Grays team is starting work to identify animal reservoirs, which are animals in which a virus multiplies prolifically, often without causing symptoms. The etiology of SARS-CoV-2 hasnt been nailed down, but it may have started in bats as some other coronaviruses have, and then become amplified in animals that have more contact with humans, perhaps wild animals in markets or domesticated livestock. In any case, if animal reservoirs can be identified, limiting or modifying contact with those animals can slow the spread.


Faced with rapid spread of disease and a limited supply of test kits available to the state, a variety of private labs and universities, including Dukeand UNC Chapel Hill, quickly developed their own tests for SARS-CoV-2. These tests provide a yes-or-no response to quickly identify patients who have been infected.

Other types of tests will be needed to facilitate treatment and research. For example, knowing how much virus is present could be useful. These kinds of assays are often used for HIV, where viral load guides treatment decisions.

The lab of Thomas Denny, chief operating officer of DHVI, develops these kinds of assays and assay validations in support of HIV clinical trials. Denny says the National Institute of Allergy and Infectious Diseases (NIAID) asked his lab and other labs it funds focusing on HIV assays to shift to the new coronavirus.

We have expertise that can flip over and develop assays for other viruses, he says. Its a frame shift. Weve been doing things similar to this for HIV, for H1N1 and other flu viruses, and now were working to do that for this virus.

Denny and others in DHVI work with partners in African countries, which have the potential to be hit hard by the combination of SARS-CoV-2 and high rates of HIV. Denny and others are anxious to share assays with those labs to help them respond to the new disease.

Dennys lab is also helping to validate assays created by others, including the University of Texas Medical Branch in Galveston. Speed was of the essence to help respond to the shortage of tests kits from the CDC. Our work with the UT team was to get that done quickly so there would be an approved test kit that other institutions or labs could [use], he says.

Treatments and Countermeasures

Duke has been approved to participate in a nationwide clinical trial sponsored by NIAID evaluating remdesivir in patients hospitalized at Duke University Hospital with COVID-19.

Remdesivir is a broad-spectrum antiviral drug that was developed for use with Ebola and has since shown some effectiveness against severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which are both coronaviruses.

Cameron Wolfe, MD, associate professor of Medicine, is the Duke lead on the trial. The fact that our teams operationalized this substantive study in the space of a week or a week and a half is astonishingly fast-paced, Wolfe says. It is a credit to folks in multiple departments. There hasnt been a single person who hasnt rolled up their sleeves and said, Lets make this happen.

In addition to getting the studies off the ground quickly, Wolfe expects data will also be available quicker than usual. Because of the incredible efforts of individual people trying to make it happen, and the adaptive nature of the trial,we would anticipate getting nationwide, actionable data in a matter of months, not the usual extended length of time, he says.

Remdesivir is a so-called small molecule drug, as are most pharmaceuticals. A newer class of therapies are monoclonal antibodies, also called large-molecule drugs or biologics. These typically have the suffix mab, such as denosumab (Prolia) and pembrolizumab (Keytruda), and are given as injections or infusions rather than pills. Monoclonal antibodies may also prove to be a powerful tool in the fight against SARS-CoV-2.

Developing such a treatment is underway in the Duke Human Vaccine Institute (DHVI) in the lab of Greg Sempowski, PhD, professor of Medicine and Pathology. My research program focuses on developing antibody treatments for viral pandemic pathogens, he says. This is a temporary treatment, or medical countermeasure, to help blunt or stop a pandemic in its tracks.

An antibody treatment doesnt confer lasting immunity as a vaccine does, but would help infected patients beat the disease. It also could be used as a temporary preventative for groups being exposed to the disease, such as healthcare providers or people in the military. Its something that would be a short-term measure while the vaccines are being developed, optimized and tested, Sempowski says.

Sempowskis lab is one of four nationwide thats been funded for several years by the Defense Advanced Research Projects Agency (DARPA) to develop rapid responses to pandemics. That means, for any unknown virus, being able to isolate the virus and antibodies from humans that are infected, select the antibodies that can neutralize the virus, and engineer delivery methods for these antibodies.

DHVI has a state-of-the-art laboratory where highly trained specialized personnel work with potentially dangerous pathogens. The National Institutes of Health (NIH) funded the construction of 14 of these facilities about 15 years ago, including the one at Duke. Its a highly secure facility with redundant safety mechanisms so we can safely work with these materials to develop drugs, diagnostics, and therapeutics, Sempowski says. Its an amazing resource for our region.

The DHVI also has its own in-house Good Manufacturing Practices (GMP) facility, which makes small batches of vaccines and medical countermeasures for initial phase 1 clinical testing. This rapid and cost-effective in-house manufacturing saves precious time. The Duke University School of Medicine and DHVI also have robust clinical trials units, including the Duke Vaccine Trial Unit (DVTU), led by Emmanuel (Chip) Walter, MD.

At DHVI, were able to use in-house resources to rapidly go from bench to bedside, Sempowski says.

Sempowski is pursuing a new technique thats faster than engineering the antibodies themselves: creating genetic blueprints for the antibodies, in the form of messenger RNA (mRNA). When the mRNA is injected, the body follows the encoded instructions to make the antibodies itself.

Switching to RNA-based manufacturing and delivery could help accelerate manufacturing and delivery of both vaccines and countermeasures, Sempowski says.


Vaccines are designed to prevent rather than treat an infection or disease. Used in a vaccine, mRNA would tell the body how to make fragments of the SARS-CoV-2 virus called spike proteins. These would spur the body to produce antibodies and memory cells that could respond if confronted with the actual virus later.

The vaccine effort at Duke is led by the director of DHVI, Barton Haynes, MD, the Frederic M. Hanes Professor of Medicine. Haynes has long worked to develop a vaccine for HIV, a notoriously sneaky and frequently mutating virus. He leads a multi-institution consortia that has received hundreds of millions of dollars in funding from NIAID and the Bill and Melinda Gates Foundation since 2005.

NIAID Director Anthony Fauci, who was an early mentor of Haynes, recently told Duke Magazine, Youre dealing with a superstar who is leading a very impressive group of people. If were going to get a vaccine for HIV, it almost certainly is going to be all or in part by this group.

Haynes is now turning his focus to SARS-CoV-2 in an attempt to develop a mRNA-based vaccine, using all the combined expertise of his team and the DHVI in-house production facility and clinical trials unit. In this effort, Haynes is collaborating closely with Drew Weissman, MD, PhD, professor of Medicine at the University of Pennsylvania.

All of the past 15 years worth of work on the HIV vaccine has led to the development of the technologies that are now being used to rapidly respond to the COVID-19 pandemic, Haynes said. This includes the antibody-isolation technology we are using to isolate neutralizing antibodies and the rapid movement to vaccine and antibody production for clinical trials in our own vaccine production facility. Coupling these technologies with the state-of-the-art Regional Biocontainment Facility provides a powerful approach for rapid development of solutions to pandemics.

Vice Dean Duckett says, Bart Haynes is truly a pioneer in vaccine development, especially with his experience in HIV. His group is poised to make seminal contributions to the development of a vaccine for SARS-CoV-2.

Preventing Future Pandemics

As an epidemiologist, Gray wants to be able to identify the next pandemic-causing virus before it causes a pandemic.

He is leading an effort to conduct a study at eight sites in six Asian countries to identify and keep tabs on zoonotic pathogens present in people who work in animal markets or who process meats. Benjamin Anderson, PhD, assistant professor of Global Health at Duke Kunshan University, will be leading the effort for three sites in China.

The immune systems of people who work closely with animals are repeatedly attacked or insulted by animal pathogens, but they usually are able to shrug it off. Sometimes, however, an animal pathogen adapts to life in a human host and gets better at multiplying in its new home. The real problem occurs when the pathogen begins moving from one human to another. Its a progression, Gray says: Insult, adaptation, effective replication, and then human-to-human transmission.

The new project will harness genomic sequencing and big data tools to identify new pathogens that have adapted to the human respiratory tract and show transmission potential.

That puts us ahead of the curve before the virus becomes highly effective at causing disease and human to human transmission, Gray says. If we can show that this works, it will be a novel tool that would help us get ahead of these outbreaks.

Developing an Antibody Test

On the other side of the world, in Singapore, researchers at the Duke-NUS Medical School were among the first in the world to isolate the new virus, after China and Australia. They were also among the first, if not the first, to develop a blood test for antibodies to the virus, which makes it possible to identify people who have had COVID-19 even after they have recovered and cleared the virus.

The Duke-NUS Medical School was established in 2005 to provide graduate-level medical education in Singapore, which at the time had only medical schools that were designed for undergraduate-entry.

We were brought by explicit invitation of the Singapore government to establish a research-intensive school that would train students to become clinician-scientists, says Thomas Coffman, dean of the school. The school is organized around interdisciplinary public health issues, one of which is emerging infectious diseases, which are a particular concern for Singapore. This region has been a fountain of new viruses, Coffman says.

The schools Programme in Emerging Infectious Diseases is directed by Linfa Wang, PhD. Wang is an expert in zoonotic virusesthose that jump from animals to humans, as SARS-CoV-2 did.

I have been in this business for last 25 years, Wang says. This is my fifth emerging zoonotic disease outbreak and they all look like bat-borne viruses. We were ready [for the current outbreak] in many ways.

Several years ago, Duke-NUS established a biocontainment facility (an animal biosafety level 3 laboratory) in Singapore, which has been a critical resource for work during the current outbreak. And Wang explicitly trains his lab members, doctoral students, postdocs, and junior faculty to be prepared for outbreaks.

As a basic scientist, I think this concept of peace time and war time is so important, he says. I always tell my junior scientists: during peace time, publishing and working on your CV and grants are important, but during an outbreak, its about having an impact on the ground.

Researchers at Duke-NUS, including Danielle Anderson, PhD, scientific director of the Duke-NUS biocontainment lab, isolated the live virus just days after receiving a sample from an infected patient at the end of January. Once the researchers had the virus and could grow it in the lab, they could begin developing a blood-based test to detect antibodies, called a serological test.

With that test in hand, the research team was able to use it to describe how a coronavirus outbreak in one church in Singapore led to an outbreak in another. A couple from one church, unknowingly infected, spent time with a man from the other church. Using the antibody test, researchers could determine that both members of the couple had indeed been infected with COVID-19 even though they were no longer symptomatic. One of them no longer had any virus in the bloodstream, so a standard SARS-CoV-2 test would have been negative.

Wang is setting up collaborations with research teams around the world on studies using the antibody test. In particular, it could be used to understand whether children are less likely to acquire COVID-19, or whether they simply dont show symptoms. If its the latter, Wang says, you can prove that by serology because even if the infection is mild, it still produces antibodies.

Researchers at Duke-NUS will also be collaborating with others to test vaccines in clinical trials. Duke-NUS, in collaboration with the SingHealth team, has extensive clinical trials capacity, and Singapore, with its multi-ethnic population, is an ideal site. Wang is in conversations with the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI) about potential vaccine trials.

Mary-Russell Roberson is a freelance writer in Durham. She covers the geriatrics and aging beat for the Department of Medicine in the Duke University School of Medicine.

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