As our nation, and the entire world, confronts the emergence and rapid spread of COVID-19, a respiratory illness caused by the novel coronavirus SARS-CoV-2, the NHLBI is working with our federal partners to swiftly address this unprecedented public health crisis.
Grounded in our commitment to excellence in groundbreaking discovery science, the NHLBI and partner NIH Institutes and Centers are leveraging our resources and engaging stakeholders to bring forward the best scientific strategies to not only contain the spread of COVID-19, but to enable effective diagnostic tests and therapies for people infected with SARS-CoV-2.
Although there is much we do not know about this virus, preliminary data from the Centers for Disease Control and Prevention (CDC) and other sources indicate that people with underlying health conditions such as chronic lung disease, cardiovascular disease, and diabetes appear to be at higher risk for severe COVID-19-associated complications and mortality.[,,,] We also know that in the most severe cases, the virus triggers an inflammatory response that can damage many organs and systems in the body, including the lung, heart, blood, and vascular systems. With some of the most serious comorbidities of this disease connected directly to NHLBI’s portfolio, there has never been a more important time than now to fulfill our mission, which is to “seek fundamental knowledge about the nature and behavior of living systems … to enhance health, lengthen life, and reduce illness and disability.”
A Multi-Pronged Scientific Strategy Spanning the NHLBI Portfolio
The multi-organ, multi-system impact of severe COVID-19 prompts critical questions about its immediate and long-term impact on the cardiovascular, pulmonary, and hematologic systems. Bolstered by $103.4 million in additional support from Congress’s Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the NHLBI has formed a trans-NHLBI COVID-19 Response Team to address this rapidly evolving biomedical threat. This team is working quickly to refine and implement a multi-pronged research program strategy with both short- and long-term goals in mind that span NHLBI’s portfolio. These prongs are:
- Translational Research. Addressing the public health threat posed by novel coronaviruses will require foundational pre-clinical research to understand the host response to viral infection across pulmonary, cardiac, vascular and blood systems. A deeper understanding of the pathobiology of COVID-19 will catalyze the development of new therapeutic options.
- Clinical Trial Networks. The Institute will build upon its existing clinical trial networks to rapidly launch randomized-controlled trials with patients-participants affected by COVID-19 to assess the safety, effectiveness, and long-term consequences of various treatments designed to ameliorate the course of the disease.
- Clinical Epidemiology. This research program will leverage existing clinical and community-based research platforms to establish patient registries and clinical cohorts that will facilitate the systematic characterization of the clinical features and disease course of COVID-19. These resources should enable researchers to discover biomarkers that facilitate patient risk stratification and refine therapeutic strategies.
- Population Science and Data Resources. An important element of the NHLBI’s research response to the public health threat posed by COVID-19 is to leverage the legacy of community-based cohorts and surveillance capabilities across our heart, lung, and blood science portfolios. For example, blood safety surveillance systems are likely to be valuable assets in detecting seroconversion among a subset of the population that has been exposed to COVID-19 within the community, yet may not have been captured within the medical care system. Similarly, the NHLBI’s networks may be well-suited to accelerate the development of blood-derived products potentially useful for treating patients with COVID-19.
- Investigator–Initiated Proposals. Another important element of NHLBI’s approach is to fund investigator-initiated proposals involving other types of clinical research that are (1) patient-oriented, 2) epidemiologic and behavioral, or 3) focused on outcomes research and health services research, and which complement or expand on the high priority objectives and approaches above.
Advancing & Accelerating Science to Save Lives
As a first step to implement this cross-portfolio strategy, the NHLBI issued a Notice of Special Interest (NOSI) to stimulate urgently needed research on COVID-19. This funding opportunity invites currently funded investigators to quickly leverage existing research projects to help us better understand the body’s response to the virus; with the intersections between COVID-19 and heart, lung, and blood diseases; the potential impacts on transfusion safety; and clinical outcomes of infected individuals. Additional funding opportunities have also been announced and the NHLBI COVID-19 Response Team continues to develop other new initiatives and funding opportunities, including a new webpage with COVID-19-related guidance for researchers, practicing clinicians and the general public. We encourage you to bookmark and check back often for updates.
In addition, the NHLBI is receiving valuable input from the research community about projects that could be rapidly implemented to address COVID-19, including identifying the most promising treatment interventions. Those interventions include both host-directed approaches that slow the progression of the virus, and viral-directed interventions that are ready to be tested in clinical trials in COVID-19 patients.
Hydroxychloroquine, an antiviral that limits virus-to-cell fusion, has been used in some small randomized trials with mixed results. It is now being moved into larger clinical trials to determine if it is effective and safe as a treatment for COVID-19. An additional NIH-supported intervention currently in clinical trials is the investigational broad-spectrum antiviral treatment, remdesivir. Previously tested in people infected with the Ebola virus, remdesivir has shown promise in animal models for treating Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), which are caused by other coronaviruses. These two trials will provide data on the effectiveness and safety of each agent versus placebo in the urgent race to find effective therapies for treating COVID-19.
For decades, the NHLBI’s wide circle of partners—researchers, patients, advocates, policymakers, industry and many others—have supported and advanced our mission to enhance health for all individuals. With ongoing input from this committed community, we are gaining new knowledge about COVID-19, examining critical, unresolved questions, and seeking ways to accelerate priority research that will provide the answers we need to curtail this outbreak and protect people around the world from its potential detrimental effects on the heart, lung, blood and vascular system.
Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382–386.
 Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. Shi S. Qin M, Shen B, Cai Y, Liu T, Yang F, Gong W, Liu X, Liang J, Zhao Q, Huang H, Yang B, Huang C. JAMA Cardiol. 20 March 2020.
 Covid-19 in Critically Ill Patients in the Seattle Region – Case Series. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L, Kritek PA, West TE, Luks A, Gerbino A, Dale CR, Goldman JD, O'Mahony S, Mikacenic C. N Engl J Med. 30 March 2020.
 Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, Iotti G, Latronico N, Lorini L, Merler S, Natalini G, Piatti A, Ranieri MV, Scandroglio AM, Storti E, Cecconi M, Pesenti A; COVID-19 Lombardy ICU Network. JAMA. 6 April 2020.