‘Before a tsunami hits’ By The Harvard Gazette

Seven Broad Institute researchers discuss COVID-19 work and pandemic preparedness, the value of teamwork, and the fragility of life.

The initial surge of COVID-19 patients in Boston-area hospitals has passed, but the memories of caring for them will forever remain with physicians involved in that care. We asked seven physician-scientists from the Broad Institute community to talk about what they learned from their time helping COVID-19 patients, and how their experiences have affected their research.

Deb Hung

Core faculty member, co-director of the Infectious Disease and Microbiome Program at Broad, infectious disease physician and attending critical care physician at Brigham and Women’s Hospital.

The thing that struck me the most, from the experience of treating COVID-19 patients, was how heartbreakingly dehumanizing it was. Patients weren’t allowed to have visitors, and those intubated and sedated in the ICUs couldn’t talk to you. As a physician, I only knew a name and the medical parameters associated with the individual. During usual times, we get to know a little more about the patient — the personal and human side, with families and friends visiting. But with COVID, it was heartbreaking to see people dying alone, and their families couldn’t come in.

On top of that, we, as physicians and healthcare workers wearing protective equipment and face masks, feel like there is another kind of barrier between our patients and us. Quite frankly, because everyone is wearing a mask in the hospital, even that’s dehumanizing among the people you know and your colleagues — you can’t even exchange a smile.

What was challenging, from the scientific side, is that everyone was so desperate to do something, to try anything to help the patients. It was crazy and frustrating, but everyone felt this acute sense of desperation.

As things have calmed down a bit, there is now more time to evaluate a lot of data that has been collected to better assess what interventions are actually effective. But there is still a lot of work to do and we still have a lot to learn.

Michael Gillette

Senior group leader in the Proteomics Platform at Broad, attending physician in pulmonary and critical care medicine at Massachusetts General Hospital (MGH).

One thing that was striking during the first surge of the pandemic was the number of critically ill patients relative to hospital capacity. At MGH, we got up to about 180 patients requiring ICU-level care. To put that number into perspective, our main medical intensive care unit, where I spent most of my time during the last couple of months, is an 18-bed unit.

To accommodate the influx, our medical-surgical intensive care, surgical intensive care, cardiac intensive care, neurointensive care, pediatric intensive care, and burn units all were converted to adult COVID-19 intensive care units. There were two general medicine floors in one of our buildings that had the necessary physical infrastructure and also got turned into COVID-19 intensive care units.

Our conventional ICU ventilators were in short supply, and other equipment was pressed into service: travel ventilators, operating room ventilators, and the like. Dialysis machines used for renal replacement had to be circulated between patients. Even ECMO (extracorporeal membrane oxygenation) circuits that oxygenate and scrub CO2 from the blood outside the body to allow the lungs to rest were in full utilization.

With that sort of patient census, we didn’t have the number of pulmonary or anaesthesia critical care doctors we needed. It was extraordinary to watch all kinds of care providers stepping forward to provide care for COVID-19 patients outside their usual roles. The number of people who worked extraordinary hours under very stressful circumstances, dealing with a disease that nobody understood very well, in many cases operating outside of their area of domain expertise, and did it with a positive attitude, was remarkable and heartwarming.

The biggest takeaway was probably the degree to which the pandemic highlighted all sorts of fundamental inequities in our healthcare system and our social structure. Not that one isn’t aware of them, but there hasn’t ever been anything in my lifetime that has made it this impossible to ignore.

After working 90- or 100-hour weeks in the hospital, it wasn’t easy to focus on research, which during other times of the year is my principal occupation. My proteomics group at the Broad has a translational research focus where I help scientists understand the ramifications of their work for clinical applications. We make sure that we are focusing our questions in the most meaningful way and serve the patients that the research ultimately is intended to serve.

Pradeep Natarajan

Associate member of the Program in Medical and Population Genetics at Broad, director of preventive cardiology at MGH, clinical cardiologist at the MGH Cardiovascular Disease Prevention Center.

During the first COVID-19 surge in Massachusetts, we converted one of our inpatient cardiology units at MGH to a COVID-19-specific cardiology unit. During this time, I was on clinical service, supervising that unit during this first surge of COVID-19.

The overwhelmingly large knowledge gap that physicians were dealing with in the face of this public health emergency was immediately apparent as I began treating patients with COVID-19. We don’t have multiple high-quality randomized controlled trials to go back and immediately reference in order to figure what’s the right thing to do for our patients. We are depending a lot on clinical intuition from experience with other acute respiratory processes, rapidly gaining experience, synthesizing and vetting scientific literature in real-time, and then immediately applying it to patients with COVID-19. None of us learned about COVID-19 in medical school. There are commonalities with other respiratory illnesses, but there are a lot of unique features as well.

It has been remarkable to see the resiliency and the adaptability of our local health systems to deal with this once-in-a-century pandemic. I certainly can’t be prouder of my colleagues — the nurses, physicians, technicians, and administrative staff — rallying together to address these needs.

Marcia Goldberg

Associate member of the Infectious Disease and Microbiome Program at Broad, infectious disease physician and Professor of Medicine and of Microbiology at MGH and Harvard Medical School.

I participate in remote analysis of hospitalized patients in two capacities: First, I provide advice to the primary caretakers caring for COVID-19 infected patients. In essence, I respond to specific questions from primary caretakers that may relate to the management, diagnosis, and/or treatment of these patients. Second, I am part of an infectious diseases team that interprets the testing of inpatients who could be infected with COVID-19, including whether an individual is infected and, for infected individuals, when it is safe for them to come out of isolation.

What struck me the most with the patients was the rapidity with which they might go from having relatively mild illness to severe and life-threatening illness.

There are two things that stay with me from this experience: when we work together, we can transform healthcare in response to any threat; and how unpredictable and fragile life is.

My indirect interactions with patients have afforded me a small window into the enormity of their suffering and isolation, which highlight the importance of identifying new therapeutics. I believe the best way to achieve this goal is to improve our understanding of the underlying mechanisms of the disease. This is what drives me to work harder and harder on our research into the immune response to COVID-19.


 lan Mochari, Namrata Sengupta, Kelsey Tsipis – Read more on harvard.edu


 

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