For many junior investigators at Yale School of Medicine (YSM), the COVID-19 pandemic upended carefully calibrated schedules that allotted time for patient care as well as deadline-sensitive research projects. But as the hospital’s medical intensive care unit (MICU) filled with critically ill patients in the spring of 2020, these physicians found themselves dedicating many more hours to their patients. They would find time for research as best they could.
Balancing clinical care and scholarly projects is vital for physician-scientists as they progress through their academic careers. But as the clinical demands of caring for patients with COVID-19 increased, some faculty were at risk of not completing their career objectives on time. Add to this the need to balance work and home lives, including caring for young children, and the situation presents special challenges for many junior faculty members.
And yet, at YSM’s Section of Pulmonary, Critical Care & Sleep Medicine (Yale-PCCSM), whose physicians care for critically ill patients including those with COVID-19, something interesting happened. The number of scientific papers published during the pandemic didn’t decline or simply match the number from the previous year – it nearly doubled, from 134 papers published in 2019 to 232 in 2020.
Maor Sauler, MD, an assistant professor of medicine (Yale-PCCSM), put off getting rest after a 12-hour shift in the MICU in December to work on a paper about the role of microRNAs in chronic obstructive pulmonary disease (COPD). His colleague, Clemente Britto-Leon, MD, tweeted a photo of Sauler leaning back in a chair while working on his laptop.
“This is Maor,” Britto-Leon tweeted, “working on a paper after a 12-hour shift in the MICU. His groundbreaking work on the role of microRNAs in COPD is now on JCI Insight.”
An early-career physician-scientist, Sauler cares for patients with respiratory illnesses such as COPD while managing research programs that can lead to a greater understanding of lung disease. Early in the pandemic, he realized that his research potentially could add to the knowledge of the new severe acute respiratory syndrome, SARS-CoV-2. Among his current responsibilities, Sauler is a clinical trialist for a drug target for COVID-19, Ibudilast, with Geoffrey Chupp, MD, professor of medicine (Yale-PCCSM).
“In our lab, we work on projects to improve our understanding of biologic mechanisms that contribute to chronic lung diseases like COPD, trying to determine why individuals with COPD may be susceptible to acute lung injury,” Sauler explained. “For us, it is a question of determining what makes the lung resilient, and identifying therapeutic targets to improve lung resiliency for those with chronic lung disease.”
Sauler’s recent research includes a single-cell analysis of the COPD lung, “Single-cell RNA sequencing identifies aberrant transcriptional profiles of cellular populations and altered alveolar niche signalling networks in Chronic Obstructive Pulmonary Disease (COPD),” which can be viewed on MedRx.
Although Melissa Knauert, MD, PhD, assistant professor of medicine (Yale-PCCSM), has two scientific papers in review, she has faced a particular problem during the pandemic: her research is conducted in the MICU, not in a lab. Under normal circumstances, she and her team study acute sleep deprivation in the ICU, atypical ICU sleep, and ICU circadian disruption. But during the pandemic, it has not been safe to conduct research in the MICU, where COVID-19 patients are cared for.
“We collaborate extensively with the bedside nurses, and they have had an overwhelming amount of work during the pandemic, which has made it hard to add even the smallest study task,” Knauert said. “Unlike lab-based investigators, I had to stop enrollment in the fall and winter during the second surge due to safety concerns for my study staff.”
Also, unlike Sauler’s research into chronic lung disease, Knauert’s studies don’t align as seamlessly with COVID-19 research. “Though I am passionate about the importance of sleep and circadian function as a means to support normal function in virtually every human organ system, I do not think this is a widely held view,” she said.
Knauert identified one other issue affecting research output – moving papers through the review stage. “This has also been a challenge during the pandemic since journals are having a very hard time finding clinical investigators who have the time to review manuscripts,” she explained.
Sauler and Knauert’s colleague, Britto-Leon, also an assistant professor (Yale-PCCSM), has worked double-time to keep up with his scholarly projects when he is not caring for patients. Britto-Leon is acutely aware that many health care providers have felt frustrated, and mentally and physically exhausted during the pandemic because he is one of them. His pre-COVID-19 schedule included brief breaks that allowed him to indulge in a short walk once a month from the medical school campus to the Yale Art Gallery, where he looked upon Post-Impressionism art. He had more time to spend with his family, and even to sleep.
“These small respites in our daily lives were re-budgeted towards maintaining all operations at pre-COVID levels,” Britto-Leon said. “Our research output didn't change, our grant application output didn't change.” This is why he snapped a photo of Sauler, slightly reclined in a chair after a 12-hour shift, working on a research paper.
“Seeing my friend go to an MICU night shift, then come back here and keep writing a paper, and then go back to another shift, then come back and work on another paper without any complaining or expectation of recognition – without any expectation other than accomplishing the work that he set out to do – just moved me to try to get some recognition for him in that very small measure,” Britto-Leon said.
During the first several months of the pandemic, Sauler and Brito-Leon quarantined for 14 days after their clinical shifts in an effort to protect their families: Sauler in a hotel, Britto-Leon at home. Britto-Leon had been on call in the MICU on a night early in the pandemic when a critically ill patient with COVID-19 was admitted – a time when much less was known about the disease.
“It was never a question of, ‘Should I show up to work to take care of patients with this potentially lethal disease that may infect me and my loved ones?’“ Britto-Leon said. “The risk assessment didn't really matter because this is what we are trained to do. So, just like any other day at the office, we went to work.”
Back home, quarantined in his room, he interacted with his two children, who were 2 and 4 years old, by reading a bedtime story with them over Zoom.
For Knauert, juggling work and childcare has been an ongoing issue. “I have definitely lost a ton of work time to support my kids being at home, or to support a short school day without before and aftercare,” she said. “There are clearly additional barriers to productivity for myself and my colleagues with childcare constraints versus colleagues who do not have childcare constraints.”
As a member of the COVID-19 Recovery Program at Yale, Britto-Leon believes the U.S. will be dealing with the long-term impacts of the pandemic for years to come, especially those patients who are dealing with respiratory, neurologic, and mental health issues.
For Sauler and Knauert, witnessing the effects of COVID-19 on patients has been one of the most difficult parts of the pandemic. “COVID is a terrible, terrible disease,” Sauler said. “Most people will be fine, but some will become very sick. And although we have better treatments now than we did in the early days of the pandemic, it’s still difficult to see people become so ill.”
The Section of Pulmonary, Critical Care, and Sleep Medicine is one of the 11 sections within YSM’s Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM’s website, or follow them on Facebook and Twitter.