FOCUS ON COVID-19 RESEARCH
How the drive to stop a virus mobilized Canada's research community
From producing face shields and hand sanitizer to monitoring wastewater and immune responses, Canadian researchers have become a critical front-line defence in fighting a global pandemic
By Debbie Lawes
Canada's colleges, universities and research hospitals are home to some of the most sophisticated expertise and resources in the world. That's why the Canadian government didn't hesitate when the COVID-19 pandemic first started to invest a staggering $1.4 billion on research to combat a disease that was threatening the lives and livelihoods of millions of people worldwide.
It wasn't only governments that were looking to the research community for help. Early supply chain disruptions left hospitals, companies and other organizations scrambling to find personal protective equipment (PPE) such as gloves, masks, gowns and face shields to protect staff, patients and customers.
Suddenly 3D printers were one of the hottest commodities around.
One academic who stepped up to help was Patrick Galipeau-Bélair. The mechanical engineer had joined Cambrian College's applied research department just two months before the Sudbury campus was closed in March 2020 in response to lockdown measures. Although most equipment was on campus and inaccessible, Galipeau-Bélair had the foresight to take home three small desktop 3D printers.
Working from his garage, he began adapting open-source designs he found online so he could batch print headbands for face masks using a smaller printer. That ingenuity caught the attention of Laurentian University which invited him to join a wider community effort to produce PPE for local hospitals and long-term care homes.
"I was able to make 600 in my garage. One batch would make nine every four hours, so I'd wake up early in the morning, collect the prints from the night before, hit print for the next one and I'd get a yield of 27 per day on busier days," said Galipeau-Bélair, whose day job usually involves designing and developing equipment prototypes for industry, including mining companies.
He said the experience has taught him two valuable lessons. One is how local businesses and community groups can come together quickly to address a global supply chain challenge.
The second? "If we are ever sent home again for something like this, I'm not going to hesitate to put those printers in the back of my truck and keep them in my garage on standby."
Memorial University of Newfoundland
PPE shortages were also a problem in Newfoundland and Labrador. In response, a group of local business leaders invited Memorial University to help design, fabricate and test PPE as part of a new social enterprise called TaskforceNL. The volunteer group needed Memorial's expertise, including researchers and technical staff from a variety of disciplines, to ensure that materials used for surgical face masks and medical isolation gowns met Health Canada's strict safety standards.
"TaskforceNL found that replacing this supply wasn't so easy because of the testing and certifications required. Memorial wasn't set up as a certified testing authority but we did have certain expertise on the testing side, including researchers and technical staff," said Dr. Neil Bose, Memorial's Vice-President (Research). The university moved quickly to build this capability, making it among a handful of labs in the country initially able to do such testing.
One unexpected source of help came from the university's Hibernia Enhanced Oil Recovery Research Group, led by process engineering professor Dr. Lesley James. Her team worked to re-configure some labs, including designing and fabricating custom components to do the required testing. They were then able to test whether the locally designed and manufactured PPE met certification standards. The team, which includes
Dr. George Zahariadis from Memorial's Faculty of Medicine and Dr. Kapil Tahlan from the Faculty of Science, is testing the efficacy of sterilizing and re-using commercially available medical masks against coronavirus-sized particles.
The pandemic has also given Memorial a new perspective on the potential for online learning. Like other educational institutions, much of its curriculum had to move online. What it didn't expect, however, was an unprecedented spike in student admissions.
"Memorial's enrolment went up in the spring semester and then we saw our highest enrolment ever in the fall from across Canada and international as well," said Bose. "It speaks to the strengths of our programs and our research and shows that you don't have to be in a major city to meet local needs or attract promising students."
Similar supply chain challenges were happening across Canada, including in southern Ontario. Niagara College responded by collecting PPE from various departments to donate to frontline workers. It also retooled its Teaching Distillery - the only one of its kind in Canada - from making its small-batch artisan spirits to producing a 70% alcohol disinfectant for hand sanitizer and surface wipes.
Having manufacturing capacity on site created other opportunities to help. In normal times, its Walker Advanced Manufacturing Innovation Centre (WAMIC) uses its expertise in engineering design, 3D laser scanning technologies, lean manufacturing processes and additive manufacturing to help companies develop working prototypes of promising technologies.
WAMIC soon discovered that some of these tools, notably its computer design technology and laser-cutting machines, could also be used to produce 500 face shields a day for frontline health professionals and other essential workers in the region.
"We worked with Niagara Health to develop a face shield design that could be made much faster than using a 3D printer," said Centre Manager Gordon Maretzki. "We had the resources and were able to pivot to become a little manufacturing facility. We ended up producing over 37,000 face shields."
Niagara College recently received $50,000 from the Canada Foundation for Innovation to purchase a specialized 3D printer that can rapidly produce medically safe materials for various PPE, including face shields/masks, nasal swabs and a patient-administered saliva collector.
"These new printers have a vast pallet of biomedical materials which allows us to address more healthcare needs," said Maretzki. "It also saves times in production by eliminating the machine tooling step so we can go straight to a medical device that can be put in the hands of the healthcare practitioner."
The new equipment will also enable WAMIC to collaborate with McMaster University and Hamilton Health Sciences to develop a 3D-printed video laryngoscope sheath prototype that could be used when COVID-19 patients need intubation.
"People used to think 3D printing is for printing parts," added Maretzki. "But COVID-19 has forced us to think more creatively about how these technologies can be also used to respond to immediate healthcare needs."
Southern Ontario Network For Advanced Manufacturing Innovation
The laryngoscope project was one of 31 high priority COVID-19-related projects supported by the Niagara College-led Southern Ontario Network for Advanced Manufacturing Innovation (SONAMI).
The network of six colleges and McMaster University collaborates with small- and medium-sized enterprises (SMEs) to turn innovations into manufactured products. Companies have access to faculty, students and specialized equipment and services, including automation, additive manufacturing, process optimization, simulation and modeling, information and communications, technology and cybersecurity and product testing and validation.
The Federal Economic Development Agency for Southern Ontario - which has invested in SONAMI since 2016, including a second contribution of $14 million announced in 2019 - approved the network's request to redirect six months' worth of its budget to pandemic-related projects. The government agency also agreed to waive the usual matching funding requirement, enabling SONAMI to cover 100% of project costs, approximately $750,000, during the first critical months of the pandemic.
"We were able to move very fast at this point," said Sarah Dimick, Project Manager at SONAMI. "It opened the door for not just the SMEs, but also the regional healthcare system, the family health teams to work with our network and to mobilize on all of these urgent needs."
Academic institutions were also able to launch projects quickly because strong relationships were in place with key local collaborators.
"If you don't have the supply chain, the connections, and the planning already in place when an emergency hits you're so far behind the eight ball it's hard to respond," said Dimick. "Because our network already existed and the funding was already in place, our members were able to execute all 31 projects in just over six months."
For example, Conestoga College received funding from SONAMI to develop a mobile software application to help critical supply chain workers maintain physical distancing, working in partnership with a Kitchener-based cold-storage company. The new software allows drivers to remain in their trucks and avoid face-to-face contact.
"It's touchless delivery. The driver never has to interact with another person, and that protects your supply chain," said Dimick.
Not all research is about inventing something new. Often an existing product just needs some high-tech tweaking. That was the case with a low-cost and portable diagnostic tool developed by design company Tech4Life, in collaboration with Sheridan's Centre for Mobile Innovation.
The NewPneu device was initially made for children with pneumonia. With $75,000 in rapid response funding from the Natural Sciences and Engineering Research Council, the team is reconfiguring the system to provide real-time, vital signs monitoring of individuals who test positive for SARS-CoV-2, the virus that causes COVID-19. The adapted system would keep patients connected to healthcare providers who can quickly triage and hospitalize those who may need additional support.
"With this device, a frontline physician can monitor a patient wherever they are. If there are signs the person is running into trouble the doctor can call them into the hospital," said Dr. Vicki Mowat, Director of Research at Sheridan College. "This will facilitate faster diagnosis and ongoing monitoring so people can get the hospital help they need when they need it. The goal is to have this in the hands of healthcare professionals this year."
The Centre for Mobile Innovation is one of six research and incubation centres at Sheridan. Mowat said this breadth of research expertise enabled them to tackle a variety of pandemic-related challenges. Another rapid-response project, for example, is designing, testing and disseminating creative interventions aimed at combating the online spread of misinformation about COVID-19, while a third is focused on combatting food insecurity amongst the elderly living on their own.
Mowat said she's been impressed with how fast research funding agencies have made grants available to colleges and universities during a public health emergency. Application processes that typically take months were often reduced to just a few weeks. "These are big government, bureaucratic organizations but they were able to pivot quickly and redirect other sources of funds to create these new COVID-specific calls for researchers. They've been amazing," she said.
University Health Network
A large amount of new basic and clinical research on COVID-19 is being conducted at the University Health Network (UHN). The network of four Toronto hospital sites has attracted $30 million to date in new funding for more than 185 COVID-related research projects.
"That's entirely due to the fact that we have this huge research expertise and infrastructure studying all kinds of diseases and all kinds of health conditions at all levels - from health services and clinical research to fundamental discovery - that could be deployed to address the most urgent questions in this brand new disease," said Dr. Bradly Wouters, UHN's Executive VP, Science and Research.
As Canada's largest research hospital, UHN was able to take an all-hands-on-deck approach to study this mysterious disease. "Given that COVID-19 is a brand new disease, we, like the rest of the world, had no ongoing COVID-related research; however, given our researchers' broad expertise, we were able to leverage existing knowledge to help tackle the disease from different angles. For example, we had researchers studying interactions of cancer-related proteins who used their unique technology platform to examine how COVID-19 proteins interact with our human proteins, with important implications for discovering drugs that could disrupt those interactions," said Wouters.
UHN also has cardiovascular researchers investigating the potential for a common blood thinner to prevent the need for intensive care for patients with severe COVID-19, and experts in liver disease looking at how antiviral molecules can help boost the body's immune response upon exposure to the SARS-CoV-2 virus.
Another key example is the work of Dr. Eleanor Fish, Scientist Emeritus at the Toronto General Hospital Research Institute. Her study, performed very early in the pandemic with researchers from Wuhan, China, found that a commonly used antiviral drug - interferon - can help speed up the recovery of COVID-19 patients.
We have this huge research expertise and infrastructure studying all kinds of diseases and health conditions that could be deployed to address the
most urgent questions in this brand new disease
Dr. Bradly Wouters
Executive Vice President, Science and Research
University Health Network
"Eleanor Fish is an infectious disease specialist and her study was related to some of her early work on interferons as an effective treatment for individuals with Ebola," said Wouters. Fish is now participating in an international clinical trial involving 300 families in Santiago, Chile to determine whether the drug can stop the virus from spreading in people who are asymptomatic, offering a potentially powerful new tool to reduce the spread of the virus in households.
Ryerson University is one of several research institutions across Canada working with provinces and municipalities on an innovative way to catch COVID-19 outbreaks earlier - by sampling what's travelling down our toilets.
A lot of different expertise comes to bear on a project like this, including environmental biology, chemistry, geography, watersheds, civil engineering and computing modeling. This multidisciplinary team of Ryerson researchers, led by Dr. Kimberley Gilbride and Dr. Claire Oswald, is conducting tests in several Toronto neighbourhoods to discover how SARS-CoV-2 circulates through municipal sewers. The technique could be used to build an early warning system for COVID-19, one that can identify the presence of a virus down to an individual building, even if those infected don't have symptoms.
"It just so happens that there's considerable link to shedding of the virus through the gastrointestinal track (through feces) and hence the presence of the virus in sewer waters and indications of changes," said Dr. Steven Liss, VP, Research and Innovation at Ryerson and one of the researchers on the study, which is being funded by the COVID-19 Immunity Task Force.
"At the moment we're sampling more at the system level, but you could sample near where the wastewater discharges, including individual buildings such as long-term care facilities, to identify the prevalence and occurrence of the virus, as well as emerging variants," he explained.
Such a system could eventually be used to monitor other substances in wastewater, including other infections or emerging pathogens, as well as pharmaceuticals. It could even become an early warning system for antibiotic resistance.
"This is a wakeup call for Canada to think about the wide variety of different things that can be studied and analyzed from wastewater systems," said Liss. "It also demonstrates how in times of crisis, governments look to universities to mobilize their research talent and research infrastructure in response to specific needs.
Canada's elderly have borne the brunt of COVID-19 illness and death and Dr. Lisa Barrett wants to know why. The infectious disease specialist at Dalhousie University is working with her colleagues at the university and the Nova Scotia Health, along with the Northwood long-term care facility in Halifax, to better understand immunity in elderly people. Northwood is Atlantic Canada's largest long-term care home and in early May 2020 accounted for 87% of all coronavirus deaths in Nova Scotia.
"We know very little about older people's immunity, why they get infections and die, particularly as it relates to COVID-19. That's also important for understanding how well, or not, a vaccine will work," said Barrett, who leads Dalhousie's Senescence Aging Infection and Immunity Lab, a team that includes research scientists, physicians and nurses.
The 350-person study is looking at both natural immunity and vaccine-induced immunity over about a 12-month period. Previously, she studied how immune response to Cytomegalovirus - a common virus that can infect people of all ages - could affect a person's susceptibility to the HIV virus.
"This current study will help us to know exactly how our older population is going to respond to vaccines and that helps us to make better policy decisions about how protected or not to consider them as we go forward," said Barrett, adding the trial results will also be applicable to other infections.
This current study will help us to know exactly how our older population is going to respond to vaccines and that helps us to make better policy decisions about how protected or not to consider them as we go forward
Dr. Lisa Barrett
Assistant Professor, Division of Infectious Diseases and Principal Investigator, Senescence, Aging, Infection and Immunity (SAIL) Laboratory
When not working on immunity research, Barrett has been busy organizing pop-up testing sites in Halifax primarily aimed at testing asymptomatic people who unknowingly spread the virus at home, work and the community.
"We recruited volunteers to run the testing events at places like, libraries, Lions Clubs and universities. It only takes about 40 minutes to train someone to do a nasopharyngeal swab."
The model is being replicated in the United Kingdom and Barrett said it may be used for mass vaccinations in Nova Scotia, recruiting people who already know how to give an injection, including veterinary technicians.
"What's great about this model is that is uses minimal health care resources and also increases community engagement, which has helped to destigmatize testing," said Barrett. "We believe it will also get more community buy in for getting vaccinated."
Long-term care deaths have accounted for nearly 80% of COVID-19 cases in Canada, double the average of other countries. Could the design of these facilities be changed to better protect both residents and staff?
This under-studied research question is one that Prof. Chantal Trudel and her team†
at Carleton University's School of Industrial Design are tackling in a project funded by the university and the Foundation for Health Environments Research in the US.
While infection prevention and control protocols are well established for hospitals and other healthcare settings, they can be a challenge in long-term care, especially during a pandemic when protocols need to be developed and deployed rapidly.
"The staff in these facilities are already overworked and complying with all the steps of infection prevention and control protocols just adds to their workload. That's when we tend to see errors happen," said Trudel, whose team is studying daily workflows to see if changes can reduce the burden.
Another complicating factor is that unlike hospitals, which are clinical in nature, long-term care environments are residents' homes. "In a hospital setting you don't typically leave your patient room and go to a lounge to socialize. But that's the daily living experience of long-term care residents."
The research is still ongoing but already Trudel sees potential solutions in how facilities are designed, structured and organized, including decentralizing core support areas like nursing stations. "This would limit the number of staff interactions," she said.
The longer term and most effective solution, however, may appear the most expensive to governments: replacing large institutional models of care developed over 50 years ago with smaller facilities.
"There's definite value in looking at these small home models but the question that is going to keep coming up is the finances to do this," said Trudel. "There is some evidence showing the smaller home approach can lower costs, such as reduced use of medications and reduced staff turnover. That evidence is starting to come to light so it will be important to begin now to build the evidence for de-institutionalization."
† Susan Braedley and Dennis Kao, School of Social Work, Carleton University; Amy Hsu, Heidi Sveistrup and Chantal Backman, Bruyère Research Institute and University of Ottawa; Frank Knoefel, Systems & Computer Engineering, Carleton University and University of Ottawa; Sophie Orosz, Ontario Centres for Learning, Research and Innovation in Long-Term Care, Bruyère; Bruce Wallace, Systems & Computer Engineering, Carleton University and Bruyère Research Institute.
The COVID-19 pandemic has taken its greatest toll on the most vulnerable, including people who are homeless. Over the past year, the federal government has responded with increased support for urban areas to deal with the unique needs of this population, which typically suffers from poor health, limited access to nutritional food, and compromised immune systems.
But one group that continues to be overlooked are those who are homeless in rural and remote areas, including Indigenous peoples who are over-represented in homeless populations. It's an issue that wasn't even widely acknowledged until recently.
Rural and remote communities face unique challenges that need to be addressed in pandemic planning … because they’re not funded in the same way as urban homelessness services
Dr. Rebecca Schiff
Associate Professor and Chair of Health Sciences
Evidence is now emerging showing that rural and remote communities experience homelessness rates equivalent to or potentially higher than rates experienced in urban areas, said Dr. Rebecca Schiff, Associate Professor and Chair of Health Sciences at Lakehead University in Thunder Bay. Yet these communities, which are already vulnerable to fewer healthcare and social service resources, have received little to no funding to help in caring for homeless people during the pandemic.
"Rural areas have a lot of challenges just in providing any services to homeless people, including shelters, because they're not funded in the same way as urban homelessness services," said Schiff. "If people don't have a place to go they're more likely to be on the streets or be in places where they could raise the risk of transmission between others and between those who are not homeless."
Schiff's previous research on the effect that the H1N1 outbreak had on homeless people in cities contributed to policy changes that led to urban homeless being included in pandemic preparedness plans. She now wants to see those efforts extended to rural and remote areas.
"These communities face unique challenges that need to be addressed in pandemic planning." She added that more research is also needed to ensure rural communities are better prepared. "That's the main goal because there will be future waves of COVID-19 and other pandemics that follow in the future."
Preventing future pandemics and mitigating global health threats like antimicrobial resistance is the mission of a new global initiative led by McMaster University. The university's leadership in this area is recognized by the more than $50 million McMaster researchers have attracted already in research funding for some 150 COVID-19 related research projects.
The university also received a $2-million donation last year from philanthropist Stephen Jarislowsky to launch Canada's Global Nexus for Pandemics and Biological Threats, a new network focused on developing innovative treatments and vaccines, novel diagnostics, data for informed policymaking, epidemiological models and evidence-based plans and protocols to neutralize threats.
A hallmark of the network will be its interdisciplinary approach to manage the human and economic devastation of COVID-19 and avert future pandemics. Research teams will include medical specialists, engineers, social scientists, history and policy researchers, as well as economics and business experts drawn from across Canada and internationally.
"The network is a natural extension of the work we've been doing in the Michael G. DeGroote Institute for Infectious Disease Research which was started about 15 years ago. We already had a lot of those multidisciplinary and multi-faculty collaborations in place," said McMaster's VP Research Dr. Karen Mossman, whose own lab studies how viruses like SARS-CoV-2 evade host immune defenses.
Further fundraising is underway for a new building to house Canada's Global Nexus in a former glass warehouse at the McMaster Innovation Park in Hamilton. It will include pharma-grade drug screening platforms, ambulatory clinical space and expanded biosafety level 3 facilities capable of dealing with highly contagious viruses like SARS-CoV-2.
So called "wicked problems" that transcend national borders require a global response that draws on the world's top experts across diverse sectors and disciplines, including social sciences like behavioural psychology and economics, said Mossman. "A great example is around vaccine development and distribution, which involves issues like supply chains and vulnerable populations. Also, how you get anti-vaxxers and other people to understand and accept vaccines. You have to involve that human element."
"Our collaborative approach," she added, "has taught us that the best research results come from working together across disciplines and that's exactly what this will allow us to do both at McMaster and with our global partners."
Debbie Lawes, Debbie@dovercourteditorial.ca, is an Ottawa-based writer specializing in science, technology and innovation.