Early in the novel coronavirus pandemic, Nick Fugate figured he would probably get infected sooner or later. As a paramedic with King County Medic One, he and his colleagues were transporting gravely ill patients every day, amid an atmosphere of uncertainty and urgency. Even now that hospitalizations have declined, Fugate puts his odds at 50-50.
“We are still seeing COVID patients pretty regularly, particularly in the nursing home facilities and our other vulnerable populations,” he said.
So Fugate, who lives in Edmonds, was eager to sign up for an unusual research project that aims to monitor front-line workers for six months to better understand the risks they face and follow the progression of the disease in those who do get sick. Among the goals is figuring out why some people develop symptoms and others do not, and whether people can be infected again after recovering from COVID-19, the disease caused by the new virus.
“These are people who are still out there, who cannot totally avoid close contact with others,” said Dr. Michael Boeckh, head of the infectious disease sciences program at the Fred Hutchinson Cancer Research Center and the study’s lead investigator. As society begins to slowly reopen, their chances of being exposed will only increase.
“It’s a big social experiment and nobody knows what’s going to happen,” Boeckh said. “This is where we want to position ourselves so we can follow people over the late spring and into summer and early fall as we try to get to a new normal and see how many are still getting infected.”
The project, called CovidWatch, is a collaboration between the Fred Hutch and Amazon, which is providing technical support, web hosting and funding. The company has collaborated with the research center in the past, helping scientists harness cloud computing to analyze massive genomic data sets and developing a machine learning system to sort through patient records and identify those who might benefit from certain treatments.
Looking for a way to make a difference and avoid duplicating other research efforts, the team decided to focus on long-term monitoring — something few studies have yet tackled, Boeckh explained. They plan to enroll 250 grocery store clerks, health care personnel, first responders, bus drivers and other essential workers mainly from King, Pierce and Snohomish counties. Nearly 100 have already volunteered, a few from as far away as Yakima.
“People are super-motivated to help,” Boeckh said.
Participants will visit Fred Hutch at least twice for blood draws, but most of the monitoring will be done remotely. A six-month supply of nasal swabs for weekly tests is sent to volunteers’ homes, along with instructions on how to report any signs of illness.
Self-swabbing is still allowed for research projects like CovidWatch that operate under strict oversight, said a spokesman for the U.S. Food and Drug Administration (FDA). A coronavirus surveillance program called SCAN that was using self-swabs to test volunteers in King County shut down last week after the FDA ordered the group to stop reporting results until it receives federal emergency use authorization.
CovidWatch volunteers also get a unique gadget called a Tasso device, which attaches to the upper arm and extracts a tiny sample of blood for monthly testing.
The blood will be analyzed to track the antibody response in volunteers who become infected, while the nasal swabs will allow the researchers to monitor viral loads.
One of the key questions about the virus is whether most cases begin without symptoms, and how viral loads and infectiousness change over time as symptoms develop. People without symptoms can also spread the disease, so it’s important to understand how they differ from people who develop fever, cough, nausea and other complaints, Boeckh said.
Most of the information about the disease so far comes from people who don’t go to the doctor or hospital until they feel terrible, so little is known about the earliest stages of infection. By starting with volunteers who initially test negative, the researchers hope to pinpoint the moment the virus takes hold and document the entire course of the illness in those unlucky enough to contract the virus.
“If, by the end of our day, everyone in our study remains negative and the virus seems to be gone, we would all be happy,” Boeckh said. “Unfortunately, I don’t think that’s going to happen.”
Infection rates in Washington have plateaued for nearly a month, with about 200 new cases diagnosed almost every day. Many of the new cases are in younger people, but it’s not clear what percentage are essential workers because health officials haven’t yet released data by occupation.
Project volunteer Jeffrey Todd, who works with homeless people, knows many of his clients are at high risk of infection. In ordinary times, his job at the Downtown Emergency Service Center (DESC) is to help people find places to live. These days, he’s been commuting from his Seattle home to the Red Lion Hotel in Renton where about 200 DESC clients are being housed in individual rooms to help prevent the spread of the virus in crowded shelters.
Two of DESC’s formerly homeless clients have died from the disease and a few others have been infected, according to the center’s website. Residents at the Red Lion get regular testing, and anyone with a positive result is moved to a different location for quarantine.
“CovidWatch is an opportunity for people like me, who are regularly interacting with a whole bunch of people who aren’t able to stay at home, to help out in another way,” Todd said.
Because he takes precautions, always wearing a mask at work, maintaining social distancing, and cleaning like crazy, Todd isn’t too worried about getting sick. The thing that makes him most nervous is his daily bus ride to and from Renton.
During his initial visit to the Fred Hutch for a blood draw, he also tested out the Tasso device, which essentially sucks a small sample of blood out through capillaries in the skin. “It doesn’t really hurt,” he said. “You feel a little pinch when it goes in and then it takes a while to peel it off.”
Researchers at the Fred Hutch helped pioneer home testing techniques to monitor cancer and stem-cell transplant patients who are vulnerable to respiratory infections, Boeckh explained. The methods are now being used in a wide range of coronavirus research projects.
Scientists from Amazon are helping analyze the data from CovidWatch, which will be freely shared. The company would not say how much it’s spending on the project — but volunteers are eligible for up to $500 in compensation.
Amazon is also building its own testing laboratory and may expand screening for the coronavirus to all its employees.
More information on CovidWatch is available at: https://www.fredhutch.org/en/research/divisions/vaccine-infectious-disease-division/research/infectious-disease-sciences/covid-watch.html