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Searching for clues under the microscope to understand COVID-19

Image of a researcher placing a drop of fluid under a microscope. Click to open a larger version of the image. Pathologists at the Joint Pathology Center are searching for clues to understand how COVID-19 is harming patients. (U.S. Air Force photo by Staff Sgt. Matthew J. Wisher)

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Pathologists at the Joint Pathology Center meticulously piece together clues to help health care providers better understand COVID-19. By studying tissue samples under the microscope, patterns emerge of the damage that the respiratory virus leaves in the human body, said Army Col. (Dr.) Joel Moncur, director of the JPC. The center consults with medical facilities in New York City on adult and pediatric cases of COVID-19 to help further unravel the mysterious effects of the disease.

Nestled within the Defense Health Agency, the JPC serves as the reference pathology lab for the entire Military Health System, the Department of Veteran’s Affairs, and the federal government on the most challenging cases, according to Moncur. By serving as a centralized review site, the pathologists at JPC compare findings across multiple patients and compile data in order to track disease trends that may affect the fighting force, he added.

With 19 subspecialties, JPC’s pathologists provide expertise in all the major organs of the body, including the lungs. “By looking through a microscope at tissues, we can learn if a disease is related to inflammation or if it’s cancerous and, if it is cancer, if it is slow growing or highly aggressive,” explained Moncur.

COVID-19, a type of coronavirus, ravages the human body in new and unprecedented ways—from causing blood clots and lung damage to creating dangerous immune responses in adults and children, according to Moncur. “Pathology has an enormous amount to contribute because if we can understand the disease, then it’s possible to suggest logical treatments and potential methods of prevention,” he said.

JPC’s long history provides many examples of pathologists playing a key role in changing the way the medical and scientific communities view disease. “In fact, many of the pathologists at the JPC have made discoveries that are now part of the official classifications of diseases as a result of their thoughtful observations,” he said, adding that an average of 70% of medical decisions for any patient result from laboratory testing and analysis.

Like detectives, pathologists search for evidence within tissue samples, but those at JPC also use the lab’s rich historical data to help tell the story of a disease or outbreak. The center maintains the world’s largest collection of preserved human tissue samples, going back to 1917, said Moncur. An official audit in 2006 found over 55 million glass slides and at least 35 million tissue block samples. These samples span every major epidemic and pandemic in the past century, including the 1918 Spanish flu pandemic. In fact, according to Moncur, in 1997 a scientist using tissue from the JPC repository published research stating that a novel H1N1 influenza virus served as the source of the so-called Spanish flu, which killed over 50 million people, and that a bacterial pneumonia acted as a common secondary cause of death. “It was really significant information because it changed the face of public health from that point forward,” he added, noting public health scientists have used information from that research to help prevent future outbreaks.

Working in collaboration with civilian medical facilities in New York City, JPC pathologists scour for clues to understand COVID-19. JPC pathologists also work with researchers at the U.S. Army Medical Research Institute of Infectious Disease, the Uniformed Services University of Health Sciences, and the National Institutes of Health to analyze and study how COVID-19 causes damage within the body.

The JPC is part of the DHA's National Capital Region Market. Markets are groups of military treatment facilities in specific regions of the United States that operate as a system, sharing patients, staff, administrative functions and budgets across facilities to improve coordination in the delivery of military health care.

“By examining the tissues, we hope to understand how COVID-19 is harming patients and understand the second and third order of effects of that infection, just like with the 1918 flu,” said Moncur. “That information can point to possible treatments that could be investigated.”

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