As the COVID-19 infection rates rose throughout Connecticut, Department of Internal Medicine clinicians, educators, and researchers responded quickly to support the clinical needs of COVID-19 positive patients at Yale New Haven Hospital (YNHH).
For many junior investigators, the COVID-19 pandemic had the potential to derail their career progression. In academia, milestones are set for faculty members depending on their rank and chosen track. Faculty also have a specified amount of time to fulfill research requirements. For example, an assistant professor in the Traditional, Investigator, and Clinician-Scientist tracks may devote between 50-80 percent of their time to research. But as the clinical demands of the pandemic required more of their time and research was halted across Yale, these faculty members were at risk of not meeting these requirements in the allotted amount of time.
Yale University and Yale School of Medicine (YSM) made some programmatic changes to support the faculty during the pandemic. In March of 2020, Provost Scott Strobel announced that Yale would grant tenure-track faculty a one-year extension to their current appointment. YSM partnered with departments across the school to offer gap funding to support junior investigators who needed additional financial support. The program was announced in August of 2020. A new section on the CV supplement was also added to note COVID-19 clinical work.
“COVID-19 forced many to pause their research programs. In the midst of the barriers that already exist—such as competing time commitments and uncertainty about funding—the pandemic introduced new and unexpected challenges,” said Nancy J. Brown, MD, Jean and David W. Wallace Dean of Medicine and C.N.H. Long Professor of Internal Medicine. “One of the steps we took to help investigators at our institution was to offer gap funding to early-career scientists. We also extended the tenure clock by one year. These incremental measures were aimed at alleviating some of the pressure on our faculty so they could stay on track. Recent reporting in Nature confirms the critical importance of institutions supporting their junior scientists, and we were very glad to be in a position to do so at the medical school."
Department Chair, Gary V. Desir, MD, and Mark Holter, vice chair of Finance & Administration, along with other department chairs, collaborated with YSM leadership to develop a funding model. Desir, Holter, Vice Chair of Basic Research Lloyd Cantley, MD, and department section chiefs worked to ensure that every eligible junior researcher was included on the eligibility list. Cantley contacted each researcher personally to ask them to submit an application.
Desir applauded the school’s dedication to the future leaders of research. “The creation of this funding source, led by Dean Nancy Brown, shows the school’s commitment to our clinical and research missions. They are crucially intertwined. The school and the department remain committed to advancing all careers. This program shows how deep the commitment runs,” said Desir.
Eligible faculty are assistant professors on the Traditional, Investigator, and Clinician-Scientist tracks with 50 percent or more effort dedicated to research. “Our junior researchers are vital to the success of our research mission,” said Cantley.
Of the 33 members of the department who applied for the funding, 100% received it.
For physician-scientist Heidi Zapata, MD, PhD, assistant professor of medicine (infectious diseases) the funding has been critically important. Zapata, like her infectious disease colleagues, dove into a heavy clinical workload as COVID-19 patients were admitted to YNHH. She had been on the brink of enrolling subjects for her grant research in March 2020. The pandemic hit, and human subject research was shuttered on March 13. Zapata’s research project was put on hold.
“At the beginning, we were caring for COVID-19 positive patients, and grappling with what was the best way to treat them. We spent our days in meetings discussing patient cases, debating about different possible treatments, and trying to keep up with the literature of which there was something new every day,” said Zapata. “In April when our resident run service was dissolved, at the peak of the first wave, I was monitoring a unit of patients, trending inflammatory markers, and other clinical parameters, hoping I was doing the right thing for each patient. I worked the entire month of April without a day off. I tried to catch up on my research and academic work in between clinical duties-but it was difficult.”
May and June were much the same. “I was doing my best to be productive but it was very hard. I feel like I lost a year of research,” acknowledged Zapata. “This funding gave me the funds to pay my postdoc; it is vital support.”
Despite the challenges, Zapata has been inspired by her patients. “The patients I saw definitely inspired some research that I’m working on now because every patient made me think about what was going on with their immune system. Some patients deteriorated and went to the ICU, and some did not. It was very clear that this was being mediated by the immune system. It mattered how old you were, what comorbidities you have, which coincides with my pre-COVID work,” said Zapata, who studies how the immune system changes with age, HIV infection, and how it's influenced by comorbidities.”
Zapata received approval on her study protocol and hopes to start recruiting for the study in March 2021.
For Lauren Ferrante, MD, MHS, assistant professor of medicine (pulmonary), and her colleagues within the Section of Pulmonary, Critical Care & Sleep Medicine (Yale-PCCSM), the funding provided a similar lifeline.
“Our first priority was to take care of our patients. We were all doing extra time in the ICU because the ICU patient census increased exponentially. We also participated in other projects. I spent weeks as part of a small group (drawn from the hospital ethics committee) that worked on developing a triage protocol for the health system. We convened very often because we had to review the literature, develop a triage framework and write the policy, and make sure the steps were there to implement it in a very short time frame.” said Ferrante.
“I think a lot of us were concerned about the ongoing depletion of funds from our career development awards while our studies were shut down,” she said. Ferrante’s study, which focuses on functional outcomes of older intensive care unit patients, was the third arm of her K award, which would provide the preliminary data for her R01 application. She had enrolled half of the necessary patients when the research was shut down. She was able to resume enrolling patients in July 2020 and aims to complete the study in April 2021.
“I am very grateful for the funding because it helped plug the financial hole that opened up during the spring surge,” said Ferrante. “I was very excited to hear that this funding was being offered by the school in conjunction with the department. I am grateful that they worked together to create this opportunity.”
Dennis Moledina, MBBS, PhD, assistant professor of medicine (nephrology), is a clinical translational researcher who generally dedicates 75% of his time to research. Like other faculty, Moledina also volunteered to provide medical care to patients with kidney diseases at YNHH. Moledina’s research on acute interstitial nephritis (AIN), which was a necessary part of his recent R01 submission, was also put on hold during the first phase of COVID-19. In July 2020, select research projects were able to restart, which included Moledina’s kidney biopsies for his AIN research.
“Thankfully, our protocol got approval to restart and my postgrad was allowed to come back. We started enrolling patients again and generated some good preliminary data to support the R01,” said Moledina.
Moledina plans to pay for his postgrad support with a portion of the funding he received. ”She’ll be able to help me enroll patient in my studies and help write manuscripts. I also want to use some of the funds to measure certain biomarkers in my study.”
When the pandemic struck, Clemente Britto-Leon, MD, assistant professor of medicine (pulmonary), also took on more clinical time.
“Our first thoughts were, ‘We have to be involved. We have to be there.’ We never gave a second thought to our priority, which is taking care of patients,” stated Britto-Leon. “But we did not yet fully appreciate the large impact our increased clinical workload would have on our research,” he said.
“We started to realize several months into it that we were going to have to restructure our lives in order to maintain clinical and research output, and lab activity. There were other limitations, like not being physically present in the lab, disruptions in the supply chain, and shutdowns due to infection control. So all these things came together to complicate the progress of our academic and scholarly activity,” he explained.
Britto-Leon and his colleagues brought their concerns about the pressures of clinical care, academic concerns, and family life to Naftali Kaminski, MD, Boehringer Ingelheim Pharmaceuticals, Inc. Professor of Medicine (Pulmonary) and section chief, Yale-PCCSM. Britto-Leon, Kaminski, and others within Yale-PCCSM drafted a letter to Dean Brown outlining their concerns.
“In the face of these major challenges, Yale doubled down on its commitment to our investigators,” said Kaminski. “Dean Brown and YSM leadership stepped up in many ways to support the faculty during the pandemic. The efforts set Yale apart and are to be commended.”
As a past president of the Association of Pulmonary, Critical Care and Sleep Division Chiefs, Kaminski has been in discussions with numerous other academic institutions and with the National Institutes of Health on how to help early career physician scientists during the pandemic, worried that a generation of researchers will be lost. “Many expressed the same concerns,” he said. “But I am not aware of any other of our peer institutions that making a similar effort for gap funding. I feel this is a true testament of the school’s commitment to biomedical research.”
“I am very thankful for the additional funding,” said Britto-Leon. “My lab is functioning right now in part because of this support. I am able to keep my lab staff here because of this investment.”
Whitney Besse, MD, assistant professor of medicine (nephrology) also applauded the COVID gap funding and the tenure clock extension.
“I can’t emphasize enough how much these efforts are morale-boosting. The ladder track term extension announced early in the pandemic really helped me to deal with the struggle to try to manage my two kids, including supervising remote kindergarten, keep up with colleague emails, and try to get work done at home. I also had extra clinical time added. It was only possible thanks to my terrific husband,” acknowledged Besse. “The extension took some pressure off, and made me comfortable thinking that any progress was progress, and the inefficient days weren’t directly a setback. The bridge funding helped to compensate financial losses due to the pandemic, so that I’m not starting my career off behind.”
Her fellow investigators agree. “I commend Yale for once again being at the forefront of novel thinking in trying to support junior faculty,” said Ferrante. “I am proud to be at an institution that took the extra steps to help us.”
Moledina concurred. “I feel well supported here at Yale.”
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