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Using Mathematics and Computer Science to Help Identify the Riskiest COVID-19 Patients

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Imagine two COVID-19 patients entering the emergency room at the same time. Their symptoms are similar, but one may be at greater risk of experiencing a severe inflammatory response (often referred to as a “cytokine storm”) and developing blood clots, which can result in the patient needing to go on a ventilator or incurring permanent liver or kidney damage. Now imagine there is a test that will enable you to identify the patient that has the microclots that precede these major clots, so you can treat this patient early with blood thinners.

A pilot study for this kind of testing is commencing soon, led by Edward Castillo, Research Scientist in the Radiation Oncology Department at the Beaumont Health Research Institute and Adjunct Associate Professor in the Computational and Applied Mathematics Department at Rice University, and his collaborator Girish B. Nair, MD, a pulmonary and critical care physician at William Beaumont Hospital. The Beaumont Healthcare system is the largest healthcare system in the state of Michigan.

Dr. Castillo has been doing research on CT (Computed Tomography) scans and how they can be used to calculate ventilation, which is how much air is being moved in the lung during inhalations and exhalations. Calculating ventilation from CT scans is a challenging image processing problem that involves several aspects of computational science, including mathematical modeling, numerical optimization, and parallel computing on graphics processing units (GPUs). Previous methods for computing ventilation were not always reliable. Dr. Castillo developed the first method for reliable CT-ventilation and has since been conducting research on how to use the technology to help doctors identify patients with life threatening pulmonary embolism, which is a sudden blockage in a lung artery caused by an errant blood clot. Pulmonary embolism is now a common occurrence in patients with life threatening COVID-19.

When COVID-19 began to impact the Beaumont Health System, pulmonologists like Dr. Nair were inundated with new patients. They reported the problem of blood clots forming and impacting patient’s lungs, permanently scarring them, as well as causing liver and kidney failures. Dr. Nair also saw patients who would seemingly recover, only to later die from pulmonary emboli caused by COVID-19. And the patients being impacted with these clots covered a wide age range from children to senior citizens, people seemingly healthy to those with compromised immune systems. There is currently no way to determine who might be impacted. While blood thinners can slow or prevent the onset of these blood clots, such medications carry their own risks and cannot be used indiscriminately.

Using CT Scans and the medical image processing and analysis methodologies, Dr. Castillo and his collaborators doctors hope to be able to identify microclots early in COVID-19 patients who are at risk of developing severe disease to intervene early and aggressively. The use of this technology would have a major impact on being able to triage and treat COVID-19 patients.

“The team working on this project represents many disciplines including pulmonologists, emergency medicine docs, imaging experts, computational scientists,” said Edward Castillo. “COVID-19 has brought together scientists around the world in an unprecedented fashion to focus on this fight. COVID-19 is a terrible disease and the long-term impact on those who suffer from it is very real. I advise everyone I know to protect themselves from getting it, no matter what their age or state of their health.”

To learn more about the Beaumont Quantitative Lung Function Imaging to Characterize Patients With SARS-COV 2 study go to https://clinicaltrials.gov/ct2/show/NCT04320511. To learn more about Edward Castillo’s research go to https://sites.google.com/view/edward-castillo-phd/research?authuser=0 .