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Here's how Houston researchers are doing their work amid COVID-19

The University of Houston explores how research is being conducted in the age of the pandemic. Graphic by Miguel Tovar/University of Houston

As far as COVID-19 goes, Level 1 is the worst threat level. Harris County remains at Level 1, or "Severe Threat" for infection of the novel coronavirus. Yet, as they say in the theater, "The show must go on!" And for the most part, research is continuing in many ways. Surveys, interviews and other socially-distanced research has been easy to keep up during the COVID crisis.

How far away is six feet?

Some research must be done in person, though. Try to picture two golden retrievers standing nose to tail. Or a regular mattress. Or even the width of the front of your car. All of these measure in at about six feet. The droplets in the air are what can get you sick and when you stand at least six feet away from a person who is talking, laughing or coughing, you have a better chance of not breathing those virus molecules.

In the beginning... 

In human subjects research, the safety of participant volunteers is always of the utmost importance. This has only become more critical with the entrance of the pandemic in March 2020, and remains so today. In early March, PIs at the University of Houston were asked to review each of their studies and to let the University know whether missing visits would be detrimental to the safety or well-being of human subjects.

Some clinical studies (specifically those taking part in clinics that provide paid health services) were often allowed to continue under COVID precautions adopted by the medical community. Just as if you went to a doctor's office, there were rules: the 6-foot apart rule, mandatory mask-wearing, extra disinfecting and temperature checks. In some cases, modifications made such as the addition of plexiglass to instrumentation increased the safety of research procedures. Additional protections are in place to protect research staff and students; student involvement in research remains strictly voluntary.

What about IRBs?

At the University of Houston (UH), the Research Integrity and Oversight office is working with groups of faculty investigators, general counsel, Environmental Health and Safety and Emergency Management to put in place safety precautions for re-starting human subjects research where subjects are within six feet of the research team. This will happen once Judge Lina Hidalgo determines that Harris County may be downgraded to Level 2. These institutional requirements are in addition to and on top of the normal precautions taken by the Institutional Review Board, which is formally designated to, among other tasks, review, approve, require modifications in (to secure approval), or disapprove all research activities involving human subjects.

Up close and personal

In the instance Harris County is downgraded to Threat Level 2, COVID-19 procedures have been approved for subjects undergoing research procedures at the UH College of Optometry and in Health and Human and Performance exercise physiology studies. Physiology test subjects are often on treadmills or are exhaling more droplets into the air through exertion brought on by exercise.

COVID-19 procedures for other research that include test subjects that need to be closer than six feet apart (examples: applying sensors, walking in an exoskeleton, completing manual tasks, etc.) have been submitted for review and are currently being evaluated. As this group encompasses such a wide variety of research procedures, it has taken the longest to draft.

Contact tracing

Screening questions, non-recorded temperature checks and a log of updated contact information are now required for all research endeavors. Screening questions mirror those recommended by CDC, including attestations as to whether the participant has had symptoms, travelled out of the country, or has been in contact with anyone who has tested positive for COVID.

The contact information is so that correct information is available should the researcher be contacted by a city or county health department for contact tracing purposes if a positive test result is reported for a subject or research team member. Finally, all subjects are asked to read and sign a document (in addition to the consent form) that explains the increased protections the university has put in place for those coming to campus during the pandemic, including face coverings, social distancing when possible and additional protections depending on the type of research being conducted.

Exceptions

Kirstin Holzschuh, executive director of UH's Research Integrity and Oversight office said, "If there is a compelling justification – for example, a PI is conducting a long-term longitudinal study and missing data points might invalidate the study, or we are one of many research sites and are in jeopardy of losing funding because other (typically non-academic) sites are enrolling and we are not – the PI can contact the Research Integrity and Oversight office and request to use the procedures approved for Level 2 under Threat Level 1." But this also goes through a review process and requires a signed agreement by the investigator that they will follow all approved COVID procedures.

Better safe than sorry

There are always risks and benefits to participating in research, but what must be kept at the foreground of one's human subjects research is that we are considering volunteers. Research subjects must always weigh the risks and benefits of participating in research; a researcher must provide these risks and benefits in clear language that allows the subject to make an informed decision.

"During times of increased risk, such as a pandemic, the university must take further precautions to protect and inform our research subjects regarding the risks of being on campus during a pandemic. Research subjects and their commitment to the greater good fuel our research enterprise, and their safety is always paramount," said Holzschuh.

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This article originally appeared on the University of Houston's The Big Idea. Sarah Hill, the author of this piece, is the communications manager for the UH Division of Research.

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Building Houston

 
 

Cheers Health has expanded its product line as it evolves as a wellness-focused brand. Photo courtesy of Cheers

Houston-based startup Cheers first got a wave of brand devotees after it was passed over by investors on Shark Tank in 2018. In the years since, Cheers secured an impressive investment, launched new products, and became a staple hangover cure for customers. When the COVID-19 pandemic disrupted businesses, the company rose to the occasion and experienced its first profitable year as drinking and wellness habits changed across America.

Cheers initially started its company under the name Thrive+ with a hangover-friendly pill that promised to minimize the not-so-fun side effects that come after a night out. The capsules support the liver by replacing lost vitamins, reduce GABAa rebound and lower the alcohol-induced acetaldehyde toxicity levels in the body. The company's legacy product complemented social calendars and nights on the town, providing next day relief.

With COVID-19 lockdowns and social distancing measures, the days of pub crawls and social events were numbered. Cheers founder Brooks Powell saw the massive behavior change in people consuming alcohol, and leaned into his vision of becoming more than just a hangover cure but an "alcohol-related health company," he says.

When the pandemic first hit, Powell and his team noticed an immediate dip in sales — a relatable story for businesses in the grips of COVID-19.

"There is a three day period where we went from having the best month in company history to the worst month in company history, over a 72 hour stretch," he remarks.

He soon called an emergency board meeting and rattled off worst-case "doomsday" scenarios, he says.

"Thankfully, we never had to do any of these strategies because, ultimately, the team was able to rally around the new positioning for the brand which was far more focused on alcohol-related health," he says.

"We found that a lot less people were getting hangovers during 2020, because generally when you binge drink, you tend to binge drink with other people," he explains.

He noticed that health became an important focus for people, some who began to drink less due to the lack of social gatherings. On the contrary, some consumers began to drink more to fill the idle time.

According to a JAMA Network report, there was a 54 percent increase in national sales of alcohol for the week stay-at-home orders began last March, as compared to the year prior.

"All of a sudden, you have all of these people who probably aren't binge drinking but they're just frequently consuming alcohol. Their drinks per week are shooting up, and they're worried about liver health," explains Powell.

Outside of day-after support, Cheers leaned into its long-term health products to help drinkers consume alcohol in a healthier way. Cheers Restore, a dissolvable powder consumers can mix into their water, rehydrates the body by optimizing sodium and glucose molecules.

For continued support, Cheers Protect is a daily supplement designed to increase glutathione — an antioxidant that plays a key role in liver detoxification — and support overall liver health. Cheers Protect, which was launched in 2019, became a focus for the company as they pivoted its brand strategy and marketing to accommodate consumer behavior.

"The Cheers brand is just trying to reflect the mission statement, which is bringing people together through promoting fun, responsible and health-conscious alcohol consumption," says Powell. "It fits with our vision statement, which is a world where everyone can enjoy alcohol throughout a long, healthy and happy lifetime,."

At the close of 2020, Cheers had generated $10.4 million in revenue and over $1.7m in profit — its first profitable year since launch.

During the brand's mission to stay afloat during the pandemic, the Cheers team was also laying the groundwork for its entry into the retail space. When Powell launched the company during his junior year at Princeton University, bringing Cheers to brick-and-mortar stores had always been a goal. He envisioned liquor and grocery stores where Cheers was sold next to alcohol as a complementary item. "It's like getting sunscreen before going to the beach, they kind of go hand in hand," he says.

"When we spoke with retailers, specifically bars and liquor stores, what we learned is that a lot of these places were hesitant to put pills near alcohol," he says. Wanting an attractive and accessible mode of alcohol-support, the Cheers team created the Cheers Restore beverage.

Utilizing the technology Cheers developed with Princeton University researchers, the Cheers Restore beverage incorporates the benefits of the pill in a liquid, sugar-free form. The company states that its in-vivo study found that the drink is up to 19 times more bioavailable than pure dihydromyricetin (DHM), a Japanese raisin tree extract found in Cheers products and other hangover-related cures.

"What we figured out is that if you combine DHM — our main ingredient — with something called capric acid, which is an extract from coconut oil, the bioavailability shoots way up," says Powell. He notes the unique taste profile and the "creaminess" capric acid provides. "Now you have this lightly carbonated, zero-sugar, lemon sherbert, essentially liver support, hangover beverage that tastes great in 12 ounces and can mix with alcohol," he explains.

The Cheers Restore beverage is already hitting the Houston-area, where its found a home on menus at Present Company. The company has also run promotions with Houston hangouts like Memorial Trail Ice House, Drift, and The Powder Keg.

Currently, the beverage is only available in retail capacity and cannot be ordered on the Cheers website. As Powell focuses on expanding Cheers Restore beverage presence in the region, he welcomes the idea of expanding nationally in the future to come. While eager customers await the drink's national availability, they can actively invest in Cheers through the company's recently-launched online public offering.

Though repivoting a company and launching a new product is exciting, the process did not come without its caveats and stressors. While Cheers profited as a business in 2020, the staff and its founder weren't immune to the struggles of COVID-19.

"I think 2020 was the first year that it really became real for me that Cheers is far more than just some sort of alcohol-related health brand and its products," says Powell. "Cheers is really its employees and everything that goes into being a successful, durable company that people essentially bet their careers on and their family's well-being on and so forth," he continues.

"It really does weigh on you in a different way that it's never weighed on you before," says Powell, describing the stress of the pandemic. The experience was "enlightening," he says, and he wants others to know it's not embarrassing to need help.

"There is no lack of great leaders out there that at long periods of their life they needed help in some way," he says. "For me that was 2020 and being in the grinder and feeling the stress of the unknown and all of that, but it could happen to anyone," he continues.

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