COVERED study aims to reduce risk of COVID-19 among emergency department staff

Reviewed by Emily Henderson, B.Sc.Apr 29 2020

A $3.7 million grant from the Centers for Disease Control and Prevention (CDC) has been awarded to the University of Iowa Carver College of Medicine and the David Geffen School of Medicine at UCLA to study ways to reduce the risk of COVID-19 infection among frontline health care workers in hospital emergency departments.

The study, called the COVID-19 Evaluation of Risk for Emergency Departments (COVERED) Project, is a 12-week study involving 1,600 emergency department personnel in 20 academic health care institutions across the country. It includes physicians, nurses, and staff, such as clerks, social workers, or case managers.

We don't get many opportunities to gauge the risk of transmission during a global pandemic, so this study is somewhat unique. It is critical, however, to identify ways to reduce the risk of infection transmission to health care workers so that we can continue to take care of the people in our communities who need our help."

Nicholas Mohr, MD, co-principal investigator of the COVERED study and vice chair for research in the Department of Emergency Medicine at the University of Iowa

Mohr, also a UI associate professor of emergency medicine, anesthesia, and epidemiology, is collaborating with co-principal investigator David Talan, MD, professor of emergency medicine and infectious diseases at the David Geffen School of Medicine at UCLA and at the University of Iowa. Talan leads EMERGEncy ID NET, a network of 12 US emergency departments to study emerging infectious diseases supported by a CDC-cooperative agreement since 1995. The COVERED study is a collaboration between EMERGEncy ID Net and the National Emergency Airway Registry (NEAR). The UI participates in both research networks. The UI serves as the national Data Coordinating Center for the COVERED Project.

The goal of the study is to determine what practices and personal protective equipment (PPE) are most effective at preventing acquisition of COVID-19 in an emergency setting, where teams often don't know if incoming patients have the virus and where emergency procedures can increase the risk of spreading the virus through the air. PPE includes face masks, face shields, gowns, and gloves, among other equipment. In addition to COVID-19, other coronaviruses include SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).

Four groups of emergency health care workers will be enrolled in the study:

• Emergency department physicians who perform endotracheal intubation (inserting a breathing tube) in confirmed COVID-19 patients
• Emergency department physicians who do not perform endotracheal intubations
• Emergency department nurses
• Non-clinical staff in emergency departments

"The reason we are focused on endotracheal intubation procedures is that these are aerosol-generating procedures that have been shown in past SARS and MERS epidemics to increase the risk of virus transmission to health care workers," Mohr says.

Emergency medicine providers enrolled in the study will be followed for three months and undergo screenings and biweekly blood tests to evaluate for COVID-19 exposure. Questionnaires also will be completed weekly so that procedural practices are documented.

Mohr says the timing is right to rapidly ramp up a study during the COVID-19 pandemic.

"We went from brainstorming about the need for this study, to writing a grant application, securing funding and enrolling participating institutions in the COVERED network in just three weeks," Mohr says. "It was all done in record time because the CDC has deemed this information critical to protecting health care workers and the health care system in this and in future epidemics and pandemics."

In addition to resources from the CDC, Mohr notes that the Carver College of Medicine is well positioned to co-lead this study. "We have trained for years on how to deal with the emergence of highly transmissible infections, as have other institutions. This is a chance to see how our collective best practices work and to share the best methods so that we can keep health care workers healthy and on the frontlines of care."