As soon as COVID-19 arrived in Washington back in January, infectious disease epidemiologist Eric Lofgren devoted the entire focus of his lab to studying the virus.
Lofgren, an assistant professor at Washington State University, typically studies how infections spread within health care settings. His lab is one of a handful funded by the Centers for Disease Control and Prevention to do so, and it's now working specifically on learning how COVID-19 spreads within such facilities.
"We're trying to understand, really, just how hospitals are working during COVID-19 and how we can prevent transmission and protect workers in the hospital," Lofgren says.
His research could inform clinicians and policymakers and contribute to CDC guidelines on how to prevent spread in certain settings.
Lofgren gets data from hospitals around the country that tells him how patients and clinicians moved around before COVID-19, and how they have adapted since the pandemic. Hospitals locally, for instance, stopped elective surgeries and changed the way they operated during stay-home orders.
Using what is currently known about how the virus is transmitted from person to person, he builds models on how hospitals may function. What happens if COVID-19 patients are isolated in their own unit? What happens if intensive care units are structured differently? How will the disease spread when patients begin to come back for elective procedures?
Admittedly, these models can be complicated by the availability of personal protective equipment (PPE) in hospitals, he says.
"It's easier to figure out how to protect patients and health care workers if you can assume everyone can change PPE all the time," he says.
But his work can also apply to other settings, like jails. In April, he published a preprint — a scientific paper that has not been peer-reviewed — that found that a significant and rapid loss of life would occur if jails continued to operate normally during the pandemic. In a medium-sized city, reducing arrests and releasing people from jail could save over 1,500 lives.
"The work on jails felt very urgent because the predictions were essentially, you are having an outbreak in the jail now and you need to do something about it," Lofgren says.
Similar logic can be applied to nursing homes and long-term care facilities. It's difficult to simply isolate those vulnerable individuals and let everyone try to build up some kind of herd immunity to the virus.
"It's very hard to say, 'I will just quarantine the elderly people.' Where do they get their food from? Who takes care of them?" Lofgren says.
Already in Spokane, there's been an outbreak at the Spokane Veterans Home that's caused residents to be transferred to a more secure hospital setting at the Mann-Grandstaff VA Hospital. Lofgren's research is trying to provide more clarity on the best practices for similar situations in the future.
"What do you do when you have a whole nursing home that's sick? Those patients in the nursing home already are in need of medical care — what does that look like, and who does that?" Lofgren says. "They're all really important questions."
Lofgren anticipates being able to share some more findings soon. As someone who researches epidemics, he says he's gotten used to working at an "outbreak pace."
"The phrase we keep saying is that 'it's a marathon not a sprint.' For some of us, it's a really long sprint," he says. "That's where myself and a lot of my colleagues are at. It's fairly relentless."♦
