New Directions for COVID-19 Research at CHOP: Q&A With Audrey Odom John, MD, PhD

Audrey Odom John, MD, PhD, chief of Division Infectious Diseases, discusses COVID-19 research here at CHOP.

Editor’s note: During a recent Children’s Hospital of Philadelphia virtual COVID-19 Town Hall Meeting, we heard Audrey Odom John, MD, PhD, chief of the Division of Infectious Diseases, speak with Susan Coffin, MD, MPH, associate chief, Division of Infectious Diseases, and faculty in the Perelman School of Medicine at the University of Pennsylvania, about new directions for novel COVID-19 research. We sat down with Dr. John to continue that conversation.

Dr. John arrived at Children’s Hospital of Philadelphia in August 2019 as a highly accomplished physician scientist who has particular research interests in Plasmodium falciparum, the microscopic parasite that causes the infectious disease malaria. She joined CHOP’s pediatric Infectious Diseases Division, which has distinguished itself through expertise in the diagnosis and treatment of infectious diseases, unsurpassed prevention efforts through vaccine development and education, and cutting-edge clinical and laboratory research.

Q: Dr. John, thank you for taking the time to speak with us during this busy and complicated time. Day-to-day life has shifted dramatically for all of us. How has the Division of Infectious Diseases adapted and taken a leadership role during the COVID-19 pandemic?

The Division of Infectious Diseases takes on COVID-19 research.

A: Our Infectious Diseases Division has really been put to the task and has been leading the efforts against COVID-19 at CHOP on so many levels — from directing infection control protocols, to integrating and advising local public health efforts, to studying and making treatment recommendations that we might use for children with COVID-19 who become severely ill. And of course, our efforts on the research side are underway. It’s been just a massive team effort in our Division, and it’s been amazing to watch everyone pitch in. Every single person has taken on new work and new roles and has really been so flexible with the continuously changing situation.

Q: Usually, your research area of interest is malaria and malaria parasites. Your lab, like so many others, has paused its efforts, in order to concentrate on the novel COVID-19 crisis. How is your expertise and ability to dissect different sections of pathogenesis and host immune response translating to solve questions about COVID-19 in the pediatric population?

A: I’m not used to getting to see the disease I study. And so being on call — to actually see children with a brand-new infection that we’ve really not ever taken care of before — I think it raises so many questions about what we don’t know about who’s infected:

What does the disease look like in children? What symptoms are we seeing in these kids that are actually due to this disease or due to other things? And then, the basic biology of this virus is just so unknown. It is inspiring to see a new infection and think about what we need to study.

My lab is working on developing a breathalyzer test for malaria. We’re looking at compounds that are present in the breath of children — with and without malaria — and identifying compounds that could be detected for a noninvasive test for malaria.

We’re interested in applying the knowledge gained from studying breath in children with malaria, to doing the same thing with children with COVID-19. There are many potential advantages to a breath test for COVID-19, even if it’s not the test to use in a doctor’s office with a symptomatic child. For example, it could be used to screen travelers, or children who are about to go into a classroom. It could potentially screen healthcare providers who are coming into a clinical setting.

Q: What are your top research questions about the novel COVID-19 virus?

A: What does it mean to be protected against this virus? That would be my number one question. For instance, the people who had COVID-19 — whether they are employees who were exposed in our community, or children — do they get it again? And if they do get it again, is it a milder version, or could it be even more severe than before? That’s what we need to learn. I think that is important for both protecting our healthcare workforce and the public, and ultimately for developing a vaccine.

Q: How is CHOP uniquely positioned to conduct novel COVID-19 research?

A: A lot of research is being done in adult hospitals where they are overwhelmed operationally with severely affected adults. But it’s particularly helpful to do some of this research in children because they tend to have such mild or even asymptomatic disease. Now that we’re screening every child admitted from the emergency room at CHOP, we have a little bit of a luxury to do studies across the spectrum of illness. We need to understand what it is about pediatric patients that seems to make them relatively protected from severe disease. What makes the disease different in children from adults?

Q: What are some of the research projects underway here at CHOP?

A: Dr. Coffin is leading a study to try to understand the natural history of COVID-19 in children. What does the spectrum of COVID-19 disease look like in children, and how long does it live in children? That’s what we’re looking for. Soon we’ll be collecting samples from every child at CHOP who consents to be in the study, so we can look at how long the virus lives. Does the virus stay in the stool? And if there’s shedding in the stool, how long does it shed? Shedding has real infection control implications, especially in a pediatric hospital. This research should reveal a lot about what COVID-19 looks like in children.

We’re also going to study leftover blood samples collected from children at CHOP to see which children already have antibodies for this disease, because, again, this is a disease that is often asymptomatic or mildly symptomatic in children. Since we don’t have a good understanding of how many children in our community have been exposed or how widespread this infection has been, this study could give us information to help guide the public health response.

And soon, Brian Fisher, DO, MPH, MSCE, and Jeffery Gerber, MD, PhD, will be leading a study of CHOP’s healthcare workforce. We’re very interested in understanding what kinds of exposures have already happened for our healthcare workers, as well as the risk factors for acquiring infection during this pandemic. We hope to enroll many individuals — not just those with patient- and family-facing jobs — but also other roles in the hospital, such as environmental services or lab workers. This will enable us to get a sense of the spectrum of exposures.

By sampling blood, the researchers will be looking for antibodies over time so that we can go back and understand who ultimately was exposed, who was protected, and how we might best protect people. By looking at people’s symptoms over time and whether or not they are diagnosed with COVID-19, we hope to gain some understanding of whether or not antibodies to SARS-CoV-2, the virus that causes COVID-19, actually confer protection against getting infection again.