Tapping Data to Improve Care for COVID-19

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As the medical director of the Johns Hopkins Biocontainment Unit, pulmonologist Brian Garibaldi was among the first to care for patients coming into the hospital with severe COVID-19. Almost immediately, he began meeting with other front-line clinicians to share observations that could help shape care protocols and clinical trials — at Johns Hopkins and beyond.

Bedside Ultrasound Proves Critical

One tool that has proved crucial to Johns Hopkins doctors in diagnosing COVID-19 — particularly early in the pandemic, when limited resources made it difficult to transport patients for X-rays — is a hand-held “point-of-care” (POC) ultrasound device. It can be used right at the bedside to examine patients’ heart and lungs.

Two years ago, Center for Innovative Medicine CIM donor and Board member Susan Immelt saw the value in this “little gadget” that Brian Garibaldi and his colleagues were pioneering to improve the quality of bedside care. To help support their efforts in improving bedside training, she funded Garibaldi as the Douglas Carroll, MD, CIM Scholar, in memory of her father, who launched the Department of Rehabilitation Medicine at Baltimore City Hospitals (which later became Johns Hopkins Bayview Medical Center) and who enjoyed a long and esteemed career at Johns Hopkins, where his portrait now hangs.

“Thanks to Susan Immelt’s support and funding from Dr. Hellmann and the Women’s Board of Johns Hopkins Hospital, we had these POC ultrasounds all ready to use for our patients with COVID-19. The ultrasounds proved incredibly important in our ability to gather clinical information, and their investment in our work has really benefited our patients during this pandemic,” says Garibaldi. 

And the impact didn’t end there, he notes. A grateful patient, impressed by his COVID-19 care that utilized POC ultrasound, made a gift to fund additional devices, and The Johns Hopkins Hospital matched that gift. 

“So now we have an entire fleet of hand-held devices,” says Garibaldi, “which not only helps patients but also boosts our ability to teach medical residents in how to use them.” 

High Calling

When COVID-19 caused Donald Trump to be hospitalized in October, Johns Hopkins’ Brian Garibaldi was among the team of physicians tapped to provide medical treatment to the president. In a press briefing held the day before President Trump’s release from Walter Reed National Military Medical Center, Garibaldi noted “what an honor and privilege it is to take care of the president [and] to be part of such a talented and multidisciplinary team here at Walter Reed.”

“We were only about two or three weeks into the pandemic,” recalls Garibaldi, “when Antony Rosen, vice dean for research for the school of medicine and the Cosner Family CIM Scholar, asked me a simple question: ‘What percentage of our patients have had a lab value of this particular amount?’ And I replied, ‘Gee, Antony, I can tell you anecdotally, but I can’t recall all of them.’”

“’We don’t have a data repository?’ Antony asked. ‘We have to create one right now!’”

And so they did. In the course of a weekend, the scientists conceived and submitted a plan for what has become the JH-CROWN registry, a collection of data and information about patients having suspected or confirmed cases of COVID-19 infection. While the main source is Johns Hopkins’ electronic medical record system, Epic, the registry also includes data from other sources, such as biospecimen repositories and physiologic device monitoring systems.

The registry, which utilizes the Johns Hopkins Precision Medicine Analytics Platform, offers a treasure trove of data that scientists across Johns Hopkins are tapping into for their COVID-19 research.

“The JH-CROWN registry currently includes data from 3,500 inpatients who tested positive for COVID-19 as well as data from tens of thousands of others who have been tested for COVID-19 at one of our Johns Hopkins locations,” says Garibaldi, the Douglas Carroll, MD, CIM Scholar. “Already, there are 25 approved research projects in the works, and many more will be coming online soon.”

“There are some truly exciting things happening with this data set,and it is really informing how we provide clinical care.” — Brian Garibaldi

Some investigations are descriptive, offering insights into the disease trajectory of a particular cohort of patients: “For instance, we are seeing ‘X’ number of Latinx patients with COVID-19, and this is how that rate is changing over time,” Garibaldi says. Other areas of inquiry are more complex — “such as scientists who are conducting comparative analyses of various treatments.”

In a paper published in late September in Annals of Internal Medicine, Garibaldi and biostatistician Jacob Fiksel provided insights into the disease trajectory of hospitalized patients with COVID-19 and the risk factors associated with severe outcomes. “Progression to severe disease or death can be rapid,” notes Garibaldi, “so the hope is that these insights can help clinicians intervene effectively during the narrow window after a patient is admitted.”

A number of other scholarly papers are currently under review, and Garibaldi expects them to be published soon. “There are some truly exciting things happening with this data set,” he says, “and it is really informing how we provide clinical care.”

Data from the JH-CROWN registry is also being shared with the National COVID Cohort Collaborative, a resource that is collecting data from electronic health records of different institutions across the country and harmonizing it into a “data enclave” for use by investigators all over the nation.

“By tapping into all of these data resources,” says Garibaldi, “we are really hoping to make discoveries that will change the way we think about COVID-19 and the way we manage it.”