As the coronavirus first started to spread across the globe last March, Yale experts came together to build a biorepository — or library — of COVID-19 patient samples. Their goal was to provide researchers across the University with access to the human material needed to unveil the mysteries of what, at the time, was an unfamiliar virus.

The team of experts decided to call themselves Yale IMPACT, which stands for “implementing public health action against coronavirus CT.” Yale IMPACT conveys the weight of biomedical research in an unprecedented pandemic and represents a partnership between the School of Medicine, School of Public Health and the Yale New Haven Hospital. The team is led by YSPH department chair of epidemiology Albert Ko and Director of the Yale Institute of Global Health Saad Omer. 

The project aims to respond to demands for COVID-19 biosamples — the team works with the community and YNHH to consolidate a robust bank of material for scientists to access for research. According to professor of immunology Akiko Iwasaki, the project became less active after the summer, when COVID-19 case rates started to stabilize and funding ran out.

“In my career, in science and [in] medicine, I have never seen such a large-scale, organic study be organized so fast,” Craig Wilen, a member of the IMPACT team and an assistant professor in laboratory medicine and immunobiology, said.

Examples of groundbreaking research performed at Yale and enabled by Yale IMPACT include some of the first studies suggesting that the coronavirus could infiltrate the brain and an important series of papers that unpacked the sex differences in COVID-19 outcomes.

Iwasaki explained that the project began over bagels and coffee at YSPH, where she, Ko, assistant professor of medicine Shelli Farhadian and Director of the Center for Pulmonary Infection Research and Treatment Charles Dela Cruz met for an entire day to discuss the initiative’s scientific foundation. Farhadian and Dela Cruz served as lead clinical investigators for the project.

Ko explained that collaboration between Yale New Haven Hospital faculty, outpatient services, researchers and other health care workers enabled scientists to collect more data to understand the molecular mechanisms and effects of COVID-19.

According to Farhadian, the samples –– which included blood, saliva and nasal swabs –– were either stored in freezers inside Ko’s lab at the School of Public Health or sent to a biobank at the National Institutes of Health, where researchers at other institutions would be able to access them. At Yale, all researchers had to do to access local samples for their studies was submit requests on a central website where they would be forwarded to the IMPACT board of governors for review.

“Through IMPACT, we’ve shared samples with researchers who were and were not involved with establishing the repository, studying a range of questions across immunobiology and pathophysiology and epidemiology,” Farhadian said.

Wilen explained that there were three main groups providing patient samples to the project: health care workers, community members and hospitalized patients. According to Wilen, this diversity in sample sources was one of Yale IMPACT’s strengths.

“[The diverse samples] offer many benefits,” Willen said. “There’s a more diverse population, there’s more diversity exposures or risk factors.”

Melissa Campbell, a clinical fellow at Yale who led the health care worker arm of the initiative, said that they enrolled over 600 health care workers at the Yale New Haven Hospital in the study and actively surveilled those who had asymptomatic COVID-19 infections.

The samples collected from health care workers, which included self-administered swabs, saliva specimens, serums and plasma, were all analyzed between March 30 and June 30 of last year. In doing so, before health care workers even presented with clinical symptoms, the IMPACT team was able to detect whether they had tested positive. This surveillance allowed for a deeper understanding of the natural course of the SARS-CoV-2 infection back when information on the topic was still limited.

“These samples … with the cooperation and commitment of this cohort, continue to contribute to our knowledge of the natural immune response to this virus, waning of natural antibodies and re-infection as well as the immune interactions of the virus in healthy, but continuously exposed, individuals,” Campbell wrote.

Wilen also explained that due to the urgency of the pandemic, the project was organized in “record time.” According to him, biosample repositories are usually organized over the span of years, making the team’s organization and commitment even more impressive.

Due to the manpower of several research labs working together to organize the repository, scientists had already started collecting and storing samples within days of the project’s launch. Throughout the course of the project, the team collected thousands of samples.

“In these types of pandemics, you need a lot of people working together,” Ko said. “You have to think outside of the box. The worst thing you can do in a public emergency … [is] using the same [strategies of the] past. That was a problem here in the United States. If you see our response to COVID, we didn’t think outside of the box, we used old paradigms, and we were very rigid.”

Omer spoke of Yale’s position as a research institution with faculty passionate about working together to make scientific advances — especially during the crisis of a pandemic. For example, Omer is currently working with Ko on an ongoing study examining how health care workers interact with one another during a pandemic.

“Yale is fortunate to be among a smaller number of places where you have folks who are good at what they do but they [also] collaborate with each other,” Omer said. “That really helps, especially in a pandemic. People coming together and saying, ‘How can I help?’ ‘How can [we] do this together?”

Although the IMPACT initiative saw great success, Iwasaki pointed out that the team did encounter challenges along the way, including a nationwide lack of nasal swabs to collect patient samples and a shortage of human serum to freeze down cells for analysis. She also recalled an instance when people in her lab had to work late into the night to be able to complete their PCR tests. Although the experience was “taxing,” it underscored how driven all of them were to contribute to this public health crisis through their research, she said.

Iwasaki also mentioned that there was initially limited funding for setting up the repository, which meant many of the team’s researchers had to use part of their own research funds to launch the project.

“In medicine and research in general, experts tend to mention serendipity and embracing unexpected opportunities,” Campbell wrote. “This project represented just that for many of us who found ourselves contributing to the fund of knowledge of this pandemic.”

According to NBC Connecticut, the first coronavirus case in New Haven was reported on March 14. 

Maria Fernanda Pacheco | maria.pacheco@yale.edu

Beatriz Horta | beatriz.horta@yale.edu

Sydney Gray | sydney.gray@yale.edu