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Strange times fueled UVa physician during pandemic

When the going got weird, Dr. Amy Mathers got going.

The associate director of clinical microbiology at the University of Virginia Medical School, Mathers joined other researchers and clinicians in switching from their normal studies to working on the mysterious virus that caused COVID-19 at a time when little was known about the disease.

Her efforts led the school’s creation and distribution of COVID-19 tests at a time when the test were scarce across the country, wastewater testing for the virus to help monitor students returning to grounds and expanded genome sequencing when variants raised their ugly heads.

For her efforts, Mathers was named the UVa Licensing & Ventures Group’s Innovator of the Year award.

Mathers said most of 2020 was just responded to whatever the virus, and state and federal governments, threw at us.

“In the medical world, we were all caught a bit flat-footed. If you go back to late December, we started hearing murmuring about some pneumonia in China and most of us were, like, ‘meh,’” she recalled. “I was, too. I thought it wouldn’t likely be affecting me, to be honest.”

The first case reported in January 2020 didn’t shake the tree, either.

“With that case in Seattle, there still had not been confirmed human transmission so we went into February with the Centers for Disease Control saying, ‘we got this,’” she said.

It turned out, they did not have it.

“We were looking to our public health officials, at the time,” Mathers said. “Here in Charlottesville, we started seeing people with pneumonia-like illnesses that were negative for flu but who hadn’t traveled. When we called for public health testing to see if it could be COVID, there was no testing availability.”

Despite federal assurances from the CDC and Food and Drug Administration and even then-President Trump, those who needed tests found they couldn’t find one.

“It was around March 8 that Dr. Mendy Poulter said we have to figure this out and how are we going to do it? I realized no one else was going to do this, so we better,” Mathers recalled.

While Mathers and others on the team dealt with the CDC and the FDA to get test ingredients approved, an extra bureaucratic layer installed at the pandemic’s start, COVID started to hit home.

“It unfolded very rapidly. On March 13, the schools closed in Charlottesville and we still didn’t have a test available. There were people who were symptomatic, but we couldn’t say for sure if they had COVID or if COVID was even circulating in the community,” she said. “We didn’t know if kids would get infected, we didn’t know all the things we know now. We didn’t even know exactly how transmission was occurring and we couldn’t get enough tests to put people into isolation or say ‘you don’t have COVID.”

On March 11, commercial COVID-19 tests became available, and the university medical teams joined thousands of others in sending hundreds of tests to the labs. That created 15-day turnarounds for test results.

On March 19, Mathers’ crew came up with a test. On March 20, the first local COVID case was diagnosed at Sentara Martha Jefferson Hospital. On March 23, the first case was confirmed at UVa Medical Center.

On April 1, the crew began running 100 tests a day. On April 3, UVa Medical Center had 15 patients in the hospital with COVID-19 and four people on ventilators.

The first Charlottesville death occurred on April 5, 2020.

As materials were sourced and tests manufactured and distributed to other agencies in need, Mathers attention turned to how to keep COVID-19 in control after school administrators determined that they would reopen classes for fall 2020.

Studies that showed the virus’ RNA would show up in wastewater led Mathers and others to create ways of checking the student effluent.

“I’m probably best known for wastewater,” Mathers laughed. “I guess it’s fun to talk about. Well, fun and gross. There are some limitations to the testing, but during the fall semester I really think it did help prevent widespread transmission in the dorms. That was the work of a lot of people in Facilities Management.”

Monitoring wastewater to track viruses is not new. It’s been used in the past to track down polio and other viruses around the world. In some countries, including Russia, wastewater is monitored regularly to watch for the return of polio. There have been studies in several countries, including the United States, on monitoring wastewater for the presence of illegal drugs.

Mathers helped devise a plan that used small sampling robots named after “Star Wars” characters that dipped their mechanical proboscises to drink deep the discharge that flowed from dormitories and other buildings on grounds.

The samples were tested for RNA under the assumption that a positive test would be an indicator of an undiagnosed COVID-19 case.

“Early on, I did a lot of the testing myself. We didn’t know for sure if the virus would be viable and I didn’t want anyone to get COVID testing sewage,” she said.

Although the virus sheds in mass quantities with human stool, it does not survive well in the interesting mix that is wastewater being discharged from a building into a sewage system.

“It was soon clear that it was safe and we started testing samples several times a day,” she said.

Mathers and the sample team also worked with the Virginia Department of Health to monitor wastewater from nursing homes during outbreaks. They tested student-athlete dorms when the players returned in July, comparing their results with the regular testing of the athletes.

Then the pandemic brought in the variants. That sent public health officials scurrying to find testing for whole genome sequences to determine what version of COVID was causing illness across the state.

“We stood up whole-genome sequencing very quickly when it looked like variants were going to make a big difference,” Mathers said. “We’ve been doing that for the state on a contract for a while and doing more sequencing than a lot of other sites, about 250 a week, so we can keep ahead of variant versions.”

With all the curveballs Mathers hit, perhaps the hardest one thrown at her was impact the disease had in spring 2020 when it hit nursing homes.

“That was some of the hardest times,” she said. “A third of the deaths occurred in long term care facilities in Virginia. We were just trying to get the testing we had available to nursing homes so they could get people isolated who had been exposed and get those who were sick to treatment, although there wasn’t much treatment at the time.”

Mathers said she appreciates the innovation award and said she shares it with all those with whom she worked to get things done.

“I feel honored and lucky and humble because so many people did so much during the pandemic,” she said. “I feel like it’s an award for a lot of people who did a lot of work and I was just sort of the face for a lot of it.”


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