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Yale Radiologists Share COVID-19 Expertise At Home and Abroad

April 15, 2020
by Jane E. Dee

From 2003-2008, after training at the Yale School of Medicine (YSM), Amit Mahajan, MD, worked as an infectious disease specialist at Southwest Community Health Center in Bridgeport, treating patients with HIV and Hepatitis C.

Dr. Mahajan previously had practiced in India. “Infections are so common and varied in India, from GI bugs to TB, as well as typhoid and malaria,” he said. “As an infectious disease doctor, you are trained to work with many kinds of infections and can practice in multiple clinical settings, from infection control in hospitals to outpatient care.”

This knowledge of infectious disease informs his work as a neuroradiologist at YSM, where he was appointed as an attending physician in the Department of Radiology & Biomedical Imaging in 2011, returning to the specialty he had practiced in India. “I have a better feel for what’s going on with patients when I interpret medical records,” he said. “Problems are solved not by book learning alone, but with real-life perspective.”

His knowledge of neuroradiology and infectious disease converged during the early weeks of the COVID-19 pandemic when he published one of the first medical reviews written about the coronavirus. The paper, “Novel Coronavirus: What Neuroradiologists as Citizens of the World Need to Know,” appeared in March in the American Journal of Neuroradiology (AJNR).

In April, Dr. Mahajan and his co-author, J.A. Hirsch, MD, of Massachusetts General Hospital, were named co-chairs of the COVID response team by the American Society of Neuroradiology. The task force of 10 people from across the country will create a standardized response to the current pandemic for their colleagues, reviewing what worked during the COVID-19 response and recommending a common strategy for dealing with the next crisis, Dr. Mahajan said.

“With the expertise that I gained while doing an infectious disease fellowship at Yale, I felt it would be appropriate to use my knowledge to write to my fellow physicians,” he said. “Neuroradiologists, as medical providers, are expected to provide guidance to the general public. Having the best available information will help us take better care of our families, friends, patients, and ourselves.”

Updating Africa

Like Dr. Mahajan, Frank Minja, MD, is a neuroradiologist at YSM as well as the director of Global Outreach in the Department of Radiology & Biomedical Imaging.

Since 2008, Dr. Minja has supported the diagnostic radiology residency program at the Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. In 2017, he launched the Tanzania Interventional Radiology Initiative to train that country’s radiology residents in interventional radiology in their home hospitals.

Since the COVID-19 outbreak, Dr. Minja has been providing clinicians in Africa with the most current information about the virus, specifically the radiology manifestations of the disease. As a panelist on weekly webinars sponsored by the Africa CDC Institute for Workforce Development, (IWD), Dr. Minja has discussed indications for chest X-ray and CT scans and the choice between them, and the risk of transmission for radiology personnel. The IWD is a partnership between the Africa CDC and the Rollins School of Public Health at Emory University.

“There are 3,000 clinicians across the African continent who are very interested in COVID-19, especially as our curve in the U.S. is three weeks ahead of theirs,” Dr. Minja said. “We’ve also been engaging people on social media to dispel myths about the virus. We talk about this in layman’s terms, in Swahili, as otherwise information would get lost in translation,” he added.

“This is global health care geared toward advocacy and education at a time when our radiologists and health care teams from the U.S. are not able to travel to Tanzania because of the pandemic,” Dr. Minja said. “We’re trying to bring lessons from the U.S. to Africa because with fewer resources, they can’t afford to make mistakes,” he said.

“New York City, for example, has a large hospital capacity, and still they are getting overwhelmed. Our capacity in East Africa is much less. We have a younger population, but the first person to pass away in Tanzania from COVID-19 was 49 years old.”

Africa’s experience with the Ebola virus helped Minja to recognize COVID-19 trends earlier than most people. He suspended his team’s travels to Tanzania a week before the first stay-in-place orders were issued in the United States. “There were multiple signals, and the signals were getting stronger and stronger,” Dr. Minja said.

Forecasting a Pandemic

Living through a prior pandemic, such as the Ebola crisis, helps people to better understand the threat of a new virus, says Howard Forman, MD, MBA, an emergency radiologist and public health expert at Yale.

When asked during an interview why some people in the U.S. initially didn’t take the threat of the coronavirus seriously, Dr. Forman answered with one word: fear. Unlike other countries, the U.S. has not, in most people’s lifetimes, experienced a pandemic. "This is the first time we've had something of this magnitude, and I think it will linger with people,” he said.

In addition to being a professor at the Yale School of Public Health, Dr. Forman – who prefers to be called “Howie” – holds joint appointments as a professor of economics, management, and of radiology and biomedical imaging. He has taught at Yale for 22 years and founded Yale’s MD/MBA program. He currently directs both the Yale School of Public Health’s Health Care Management program and the Yale School of Management’s Executive MBA program (health care track).

Dr. Forman has been an international voice on health care policy during the COVID-19 pandemic. He has published about 20 articles and opinion pieces about the pandemic in newspapers such as The Guardian, the Los Angeles Times, the Hartford Courant and USA Today, and has been interviewed on NBC, MSNBC, and has appeared on Chinese TV twice. He also is a prolific tweeter.

Dr. Forman mentioned the fear factor during a COVID-19 Right Now broadcast hosted by the Yale School of Public Health. Moderator James Hamblin, MD, MPH, a lecturer in public health at YSM and a staff writer for The Atlantic Magazine, introduced Dr. Forman as “someone I’ve been talking to almost daily for the last few months about this…he’s been a long-time mentor to me. He knows the numbers very well and has been a brilliant forecaster of what they mean. I keep asking him to help me make sense of everything.”

Dr. Hamblin is not alone. Dr. Forman, a well-known mentor at Yale, has been collaborating with other physicians and public health experts throughout the pandemic, as well as advising students, some of whom have co-authored articles with him.

For an opinion piece in The Philadelphia Inquirer, he and Joseph Cavallo, MD, a radiology fellow and MBA candidate at Yale, and former student Ben Albright, MD, came up with an estimate of how much money hospitals are losing by suspending non-essential medical procedures during the pandemic. Their number was almost precisely in line with what Congress later came out with in its stimulus bill.

“While I don't have a formal background in infectious disease, the combination of my medical and management training allows me to collect, synthesize and analyze data,” Dr. Cavallo said. “In the health care-focused MBA track, I have taken classes in global health, which examined other historical infectious disease, health care operations, and population health, among more standard courses like probability and statistics; all of which have given me different lenses through which to analyze what is happening now,” he said.

“When COVID demonstrated community transmission in the United States in late January/early February, the chances of this becoming a significant issue, both in the U.S. and throughout the world, increased significantly. I began to follow its development closely, both in the lay press and the few published academic articles were trickling out,” he added. “I was also fortunate enough to have a mentor (Dr. Forman) with whom I could discuss the topic with.”

Submitted by Angel Machon on April 15, 2020