November 24, 2021
To accelerate understanding of COVID-19, the UNC Gillings School of Global Public Health funded seven research projects in 2020 through a special round of Gillings Innovation Laboratory awards (GILs). These awards, generously provided by the Gillings Gift in 2007, are innovative and interdisciplinary research projects that have tacked a broad range of public health issues related to the coronavirus pandemic – from tracking cases to improving public health communication strategies and vaccination rates.
Five of the COVID-19 GILs have now been completed, and the two remaining are expected to wrap in early 2022. Their work has been critical in influencing local and global pandemic response efforts through policy, practice and community engagement.
Getting Pediatric Vaccination Back on Track in the United States
Noel Brewer, PhD, Gillings Distinguished Professor in Public Health, led a study to address the pandemic-related drop in childhood and adolescent vaccinations in the U.S. Informed by state pediatric vaccination trends and a survey of primary care providers, the study team developed a toolkit for to improve adolescent vaccination during the pandemic and beyond.
The team included postdoctoral fellow Qian Huang, PhD, and doctoral students Charles Wright and Ben Kahn, all in the Department of Health Behavior at Gillings School.
Responses from a survey of over 1,000 pediatric primary care providers (PCPs) demonstrated that substantial work still needs to be done to get adolescent vaccination back on track, with more than one-third of PCPs indicating they were unlikely to plan promotional activities to increase adolescent vaccine uptake. Most PCPs supported COVID-19 vaccine mandates for health care workers, and PCPs also reported widespread use of and predominantly positive attitudes toward adolescent telehealth.
These findings have been published in the Journal of Medical Internet Research, with several other publications under review. Results from this GIL were foundational in securing $12 million in additional grant money to improve communication training for health care providers and to support primary care clinics in areas with low rates of vaccination. It provides for coaching, data and community partnerships to get more people vaccinated, especially Black and Latino patients.
Leveraging Rural, Black Faith-Based Social Connections to Optimize COVID-19 Rapid Risk Communication Readiness
This unique implementation science pilot study, led by Lori Carter-Edwards, PhD, MPH, former associate professor in the Public Health Leadership Program, involved the design and testing of remote risk communication strategies in the Word Tabernacle Church (WTC), a Black, rural faith community in Rocky Mount, North Carolina. The study team identified drivers of trust and social cohesion and designed and tested remote COVID-19 risk communication strategies for appropriateness, acceptability and effectiveness.
Three Gillings students worked with Carter-Edwards on the study, including Jada Gailliard, undergraduate in the Department of Health Policy and Management, Snigdha Peddireddy, MPH, recent alumna from the Department of Health Behavior, and Maya Wright, MPH, doctoral student from the Department of Epidemiology.
The study resulted in an evergreen COVID-19 instructional risk communications guide for public health messengers. An abstract was accepted for presentation at the upcoming 14th Annual Conference on the Science of Dissemination and Implementation in Health, and WTC received a $50,000 follow-on community grant to continue this important work.
Household Transmission Modeling of SARS-CoV-2 in N.C.
This observational study, which demonstrated how quickly COVID-19 can spread through households, included five members of the Gillings School: Kimberly Powers, PhD, associate professor, and Rebecca Rubinstein, MPH, doctoral student, both in the Department of Epidemiology; and Feng-Chang Lin, PhD, associate professor, Katie Mollan, MS, biostatistician and doctoral student, and Haoming Zhang, MS, recent graduate, all with the Department of Biostatistics.
Results showed that COVID-19 transmits early and often among household members — findings that are consistent with the two other currently published prospective household transmission studies in the U.S. This study led to publication in a peer-reviewed journal and over $250,000 in follow-on funding. In additional analyses, the rich data collected in this cohort study is being used to describe COVID-19 symptom trajectories and to estimate key transmission parameters through statistical and epidemiological modeling.
Establishing a Sentinel Surveillance System for COVID-19 in N.C.: Using Routine Antenatal Care Visits to Estimate Real-Time COVID-19 Seroprevalence in Diverse Populations
Led by Whitney Robinson, PhD, associate professor of epidemiology, this antenatal COVID-19 testing study produced a major novel finding: there was a very large disparity in infection risk between Latinx versus non-Hispanic white and Black populations in 2020 — sometimes three times as great as in other groups. Findings also showed that positive test rates for SARS-CoV-2 were slightly higher in populations of Asian descent than in white and Black populations, which may indicate greater infection risk among the Karen Burmese refugee community.
The study team included postdoctoral fellow Heather Root, PhD, from the UNC School of Medicine, and doctoral students Isabel Morgan from the Department of Maternal and Child Health and Samantha Tulenko, MS, and Mekhala Dissanayake, MPH, from the Department of Epidemiology.
Overall study results proved very useful to stakeholders at the state level and at the U.S. Centers for Disease Control and Prevention — helping to inform N.C.’s public health response and leading to further funding to examine test positivity during pregnancy and potential effects on pregnancy and birth outcomes.
Pandemic Ethics Dashboard
This GIL funded an effort led by Jim Thomas, PhD, MPH, professor emeritus of epidemiology, to develop a Pandemic Ethics Dashboard to guide policymakers through ethical issues encountered during a pandemic. It includes consensus ethics guidance from established documents and emerging ethical issues in the COVID-19 pandemic. Thomas collaborated with doctoral student Margaret Holly from the Department of Health Policy and Management and recent Master of Public Health alumna Madeleine Valier, MPH.
The National Association of City and County Health Officials (NACCHO) has become a cosponsor of the website. As a result of this GIL work, Thomas has been asked to collaborate on a public health code of ethics for Europe.
Two GILs are still underway.
Understanding the Impact of COVID-19 on Behavioral, Social and Structural Factors in South Africa: Strengthening Pandemic Response in Low-Resource Settings
A team at UNC-Chapel Hill, led by Audrey Pettifor, PhD, professor of epidemiology, is continuing to collaborate with the South African Medical Research Council-funded Wits Rural Public Health and Health Transition Research Unit of the University of the Witwatersrand to understand the impact of COVID-19 on social determinants of health and examine access to information, prevention tools and vaccines.
Postdoctoral fellow Nev Bhushan, PhD, from the UNC Institute for Global Health and Infectious Diseases and doctoral student Nicole Kelly from the Department of Epidemiology at the Gillings School are a part of the study team.
Through a survey conducted in the fall of 2020, the team interviewed over 1,500 households randomly selected from the Agincourt rural demographic platform in Mpumalanga, South Africa. The team just began a second survey following up with those interviewed in the first round. It continues to focus on social determinants but also focuses on COVID-19 vaccine uptake and hesitancy.
Qualitative interviews will assess perceptions of COVID-19 risk and vaccines. This information will inform the next steps for interventions to improve pandemic preparedness, vaccine uptake and communication of prevention intervention messaging. The work is expected to be completed in February 2022.
Residence Time and Viability of Coronavirus in Airborne Respirable Particles in Public Spaces
Led by Karsten Baumann, PhD, assistant professor of environmental sciences and engineering, this study is examining air from the dorm rooms of UNC students who tested positive for COVID-19 to learn how to reduce the risk of exposure to infectious viruses.
Two Gillings researchers from the Department of Environmental Sciences and Engineering, postdoctoral fellow Megan Stallard, PhD, and doctoral student Naomi Chang, are collaborating with Baumann on the project.
This work, with analyses still underway, laid the groundwork for National Science Foundation research investigating several methods to inactivate infectious aerosol. It is contributing to a better understanding of outdoor exposures and potential methods to prevent indoor exposures, such as modifications to ventilation systems. This work also resulted in the development of a chamber with well-controlled, reproducible conditions that allows the study of the behavior of a wide variety of aerosol-borne non-infectious viruses to learn how the structure of viruses affects their viability under a range of conditions in indoor and outdoor air.
The project is expected to be completed in March 2022.
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