From efforts to gauge the effectiveness of community responses to assessing the resources and needs of Kansas health departments to designing a medical mask that could be printed on a 3D printer, the COVID-19 crisis has provided fertile ground for KU School of Medicine-Wichita faculty to put their expertise and interests to work.

Health departments: What do you have and need?
As the pandemic developed, Talkad Raghuveer, M.D., a pediatric neonatologist and clinical professor, was struck by the fact that little research had been done on a front-line player in responding to and combatting COVID-19: local health departments.

He reached out to colleagues and the medical school and quickly formed a research team with Bob Wittler, M.D., an infectious disease specialist and professor in the Department of Pediatrics, and Rosey Zackula, a statistician and senior research analyst. Together, they developed a survey to answer the question of what health departments have and need for COVID-19 response.

"He deserves the bulk of the credit," according to Wittler, who said his input involved making sure the survey was consistent with CDC guidelines.

The 25-question online survey, set up by Zackula, asked about staffing, supplies, testing capabilities, contact tracing and other resources. It was conducted April 15-24, and the findings were to be published in late May by the Kansas Journal of Medicine, with Raghuveer, Wittler and Zackula as authors. Three-quarters of 104 county health department directors completed the survey.

"Most local health departments hadn't had an increase in the number of staff, which was surprising. Another surprising finding was the slow test turnaround time. Responses showed it was three days or more in at least 62% of counties, and five days or more in 14%," Raghuveer said.

"We asked about (nasopharyngeal) swabs as a way to assess resources," he said. "That was pretty striking. The average number of swabs available was just five on the day they responded."

Overall, the top three needs respondents identified were testing, public education/communication and contact tracing.

"It's a very rural state and one size doesn't fit all. The big lesson is to have some flexibility" in supplies and staffing, Wittler said.

The study reinforces the need for public health funding both short term and long term, said Raghuveer. He noted federal funds for state, local and tribal health preparedness were cut from $940 million in 2002 to $675 million in 2019. About 50,000 public health positions have been lost nationwide since 2008.

"This is the first wave," Raghuveer said. "We need a funding reserve that can be drawn upon, along with a stockpile of PPE and testing kits, so we don't scramble when the next wave arrives. It's not the time to relax."

Running the numbers
As the COVID-19 crisis developed, Bob Badgett, M.D., professor in the Department of Population Health, did what comes naturally, he looked to the numbers: first to judge whether KU clinics should adjust operations and then for issues fourth-year students could examine in his Population Health in Practice course.

"Weeks before COVID was really apparent, you would hear conflicting statements, like ‘it's not going to be a big deal,' or ‘it's going to be a big deal.' So I thought, let's find some numbers and see what it looks like," said Badgett, drawing on data from state and other sources and models in March. "Even when Kansas only had that first handful of cases, it was remarkable how right the projections of exponential growth were." He said the projections helped spur the motivation "to change out clinical workflows."

The monthlong Population Health course puts teams of students to work on quality improvement projects at clinics and hospitals. "We try to make them all immediate," Badgett said of topics chosen, "but COVID makes itself immediate."

This year, two of five teams tackled projects related to COVID-19. In one, students looked at several departments at the medical school to assess changes in burnout and stress among staff. Not surprisingly, stress had increased, but so had information and access to counseling to help those feeling it.

Another group of students, drawing on data from media and other sources, found five counties of similar demographics that did better and five that did worse than specific Kansas counties. It was an attempt to use a "positive deviance" approach, which finds outliers and then scrutinizes them for keys to their success. Once the 10 counties were identified, students then did internet and other research to more closely examine them and their methods.

"It turned out they couldn't come up with a clean answer. Defining a county that was good overall proved to be challenging, but it was fun for the students to get that experience," said Badgett, noting the approach could prove beneficial down the road.

Designing a better, reproducible mask
Spurred by the shortage staring doctors and other providers in the face, Mohinder Vindhyal, M.D., M.Ed., a hospitalist and assistant professor of internal medicine, and others put their interest in 3D printing to use and tried to refine and design a readily produced medical mask that can be reused after proper sterilization.

The Wichita group included radiology resident Justin Kerby II, M.D.; Shuo Li, M.D., an assistant professor and interventional radiologist; and Hayrettin Okut, Ph.D., an associate professor in the research department. They drew assistance from Kamal Gupta, M.D., professor and vice chair of academics at the Kansas City campus, and from Elizabeth Ablah, Ph.D., MPH, associate professor in Wichita, and K. James Kallail, Ph.D., associate dean of research.

>Using home printers starting in March, team members worked to refine designs for N95 respirator masks shared by the Food and Drug Administration and the Medical University of South Carolina. The challenge, of course, is to make a mask that not only doesn't allow viruses or other particles in, but lets the user safely breath as well.

The Medical University of South Carolina model mask was a complicated model, as it had filters to the side to allow air entry into the mask along with a detachable nose piece with HEPA filters. The Wichita team worked to refine that model by making changes to the detachable nose piece, moving the holes to a different place and securing the air entry.

Printing their variant on the South Carolina mask took about nine hours on a home-level 3D printer, and cost about $20 for the filament and other materials, Vindhyal said. One issue was ensuring steady power and Wi-Fi for the printers, as hours could be wasted if either was disrupted during printing. Another challenge was choosing materials that could stand up to repeated use and sterilization methods.

Producing masks was only part of the issue. Testing it in the clinical setting was a completely different and difficult task. In order to test the mask, the team needed a bioaerosol sampler that was not available locally. The Wichita team collaborated with the Environmental and Chemical Engineering department at Washington University in St. Louis to procure the device to help conduct the study.

Their plan is to freely share the design so others can make them. Their prototype ran into a roadblock when they couldn't obtain grant or other funding to test it.

"We're hoping once fall comes there will be more research funding coming in," Vindhyal said. "Hopefully we will give it another shot."