Fighting for Lives in the ICU

Washtenaw County saw its first positive test result on March 11, 2020. Within a month, Viglianti and her ICU colleagues were seeing a wave of very sick people. Both the University of Michigan and the VA medical centers opened special COVID-19 ICUs.

“There was this gust of energy, of everyone unifying and ready to battle,” Viglianti said. At weekly meetings, ICU doctors discussed what they were seeing and the latest evidence on taking care of people who were critically ill with COVID-19. “Early on, there weren’t any therapies,” Viglianti said. “The only thing we had was supportive care.” Based on a study done several years earlier in France, the ICU staff started turning patients onto their stomachs part of the time; the staff found that it helped, and they continue to do so today.

Late in the summer of 2020, a study from Brazil gave new hope: Dexamethasone, an inexpensive medicine that suppresses the immune system, helped COVID-19 patients in the ICU. “That was the biggest surprise, the biggest relief,” Viglianti said. That simple medicine has kept a lot of people off ventilators.

As time went on, other therapies began to appear. Although early hopes for the malaria drug hydroxychloroquine faded, thanks to an NIH-funded trial that found the medicine had no benefit in COVID-19 cases, better treatments came along. Monoclonal antibodies were found to help, including for people who were not sick enough to be hospitalized. After an NIH-sponsored study, the U.S. Food and Drug Administration (FDA) approved the antiviral drug remdesivir for use in treating COVID-19.

While the ICU staff worked to keep people alive through the fall of 2020, the success of vaccine trials brought them hope. “When we hit December of 2020, when the vaccines came around, there was this huge sense of relief,” Viglianti said. She knew her own immune system would finally be ready to fight the virus and that the pandemic would surely slow as everyone in the community got vaccinated.

Many people with COVID-19 have ended up with long stays in the ICU; Viglianti has her own NIH-funded research project on how to identify such patients. In 2021, she began collecting data from her colleagues to understand how they make predictions about how a person will fare in the ICU and whether they are likely to stay for a long time.

Getting Vaccines to Everyone

From the beginning of the pandemic, Erica Marsh, M.D., M.S., FACOG, noticed who was being most affected. Marsh is a reproductive endocrinologist and infertility specialist at the University of Michigan Health in Ann Arbor. She also works on an NIH-funded grant to study racial disparities in reproductive health.

In Washtenaw County, African Americans make up only 12% of the population — but by the summer of 2020, more than 25% of people who had died of COVID-19 in the county were African American. The hardest-hit areas were in Ypsilanti, a city near Ann Arbor with a high proportion of African Americans and a high poverty rate. At the same time, in the wake of George Floyd’s death, people across the country were paying more attention to police violence and health disparities. “All of that was just weighing on me, as a human being,” Marsh said.

In August 2020, Marsh was about to go on vacation when she got an email about funding for the NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities. CEAL works closely with the communities most affected by COVID-19, and with CEAL support, Marsh knew she could make a difference for people in her area. She knew the opportunity was more important than her vacation, so she and her colleague Barbara Israel at the University of Michigan School of Public Health spent most of that week working on the application. “We turned in that grant, found out we were funded, and hit the ground running — and it’s been nonstop since,” she said.

In the fall of 2020, Marsh’s CEAL team focused on how to get the word out about masks, social distancing, and handwashing. People from hard-hit communities told the team that they wanted to hear from their own neighbors, not just national voices. So the team started a communications contest, Take the Mic, to share community members’ messages about preventing transmission.

When vaccines became available, CEAL quickly shifted gears. Marsh’s team has focused on getting people the facts they needed to make an informed decision about the vaccine and trying to understand the reasons for hesitancy. She was frustrated that people kept saying minorities were refusing to get vaccinated. “There were many people who were hesitant, but many people who wanted the vaccine just didn’t have access. They couldn’t take time in the middle of the day to go to a stadium and stand in line,” she said.

Marsh and her colleagues partnered with faith-based and public health organizations to get vaccines to residents of Ypsilanti and other places throughout the four counties covered in their CEAL grant. The group has supported vaccination clinics in churches, community centers, and schools. The vaccine itself comes from the state and the counties, but Marsh’s team provided everything else, from tables and easels to masks and hand sanitizer. The team supported hundreds of vaccine events in the summer and fall of 2021.

The CEAL team also created a community gallery where people could upload a picture of themselves and a message about why they got vaccinated. The messages helped counter the deluge of vaccine misinformation, Marsh said. “What we realized is, if you get everyday people to be a voice of truth, that’s relevant to their neighbor, to their family member, to their church member, to their mosque member — that was very powerful.” She said it was impressive to watch communities and neighborhoods in Washtenaw County mobilize and take action to help keep one another safe.

Marsh, her team, and community leaders are continuing to work together to fight COVID-19, and she is proud of the work they’ve done. “I did it because it was the right thing to do, and I knew that I wanted to contribute to the end of COVID,” Marsh said. “I’m not an infectious diseases doctor, but I am a citizen who cares about my community.”