Archive for March, 2020

 

Mar 31 2020

Life in the Time of Corona(virus) – Day 16

by at 8:27 am

So, we are in it for the long haul. It was so good to visually connect with many Lombardi members and staff at our all hands virtual Q and A session at noon on Monday. We will get through this together. We are lucky to have so many wonderful faculty and staff, all of them doing their best at this challenging time in our history.

There is not much new to report on the clinical front, even as we prepare for what we hope will be a wave as opposed to a tsunami of new COVID-19 cases over the next few weeks. However, two very interesting new clinical reports caught my eye this afternoon. One, in JAMA, describes five ventilator-dependent COVID-19 patients in China treated with convalescent serum immunoglobulin; three had rapid, dramatic improvement and eventually were able to be discharged from the hospital, and the other two stabilized; but remain hospitalized. It’s very early, and obviously anecdotal, but this could prove to be a path forward toward disease control while we wait for more sophisticated prevention strategies and therapies to be developed and properly tested. As many of you know, I have always been fond of antibody therapies!

The other report, in the New England Journal of Medicine, highlights how much we don’t know about this virus. It turns out that this coronavirus enters cells through the ACE receptor, and in a related conversation, Maria Laura Avantaggiati pointed out that freshly obtained retrospective data from the COVID-19 outbreak in Italy suggest that hypertension and the use of ACE inhibitors are associated with higher mortality rates from this infection. However, the authors of the article in the New England Journal of Medicine point out that ACE inhibitors, which may increase the expression of the target receptor, may also tamp down the viral induced inflammatory response. So, the clinical recommendations regarding the use of ACE and ARB inhibitors, which are very commonly used, remain more than a bit muddy.

Speaking of so much to learn, we had a very well-attended and lively Zoom conference-call-based brainstorming session today to identify important ideas and collaborative opportunities to address the COVID-19 pandemic. Please remember that 1-2 page proposals for high impact research in this space are due by midnight on Wednesday; we hope to make decisions about which proposals will be prioritized for laboratory access, targeted philanthropy and operational support by the end of the week.

Take care, be safe, and remember to always pay serious attention to physical distancing and frequent, meticulous hand-washing.

Lou

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Mar 29 2020

Life in the Time of Corona(virus) – Day 15

by at 10:35 pm

Two weeks of social isolation, and counting. I communicated on Sunday afternoon with our colleague Dr. Ihor Sawczuk, senior VP for Hackensack Meridian Health’s northern New Jersey region. New Jersey now has the second-most cases (more than 16,000) in the United States. Hackensack University Medical Center just converted its cafeteria into a 60-bed inpatient unit. 140 hospital beds have been converted into ICU rooms. He doesn’t think it will be enough. The Washington Post website just reported that there are more than 2,000 cases in Maryland, Virginia and DC, with 346 cases in the District, and 40 deaths in these regions.  Maryland reported 246 new cases overnight on Saturday. It will get worse before it gets better. We are ramping up as best as we can in anticipation of a surge of cases, and the next month or so promises to be extremely difficult. But, it will get better. Pandemics end. We will lose some people, and save many more patients, and even more won’t even need our help. However, it did not need to be this bad. We were given fair warning.

Today, when Harriet and I took our daily walk, I saw what is now commonplace: evidence of the Boomer Zombie Apocalypse. Members of my generation are walking around, carefully avoiding each other, with nowhere in particular to go. It is an apt metaphor. Many of us are accustomed, at least in this region, to positions of leadership and relevance. But the heroes of this particular battle will be those who care directly for the COVID-19 afflicted patients, and those who brave their own lives to provide all of us with essential services. Few of these essential people are Baby Boomers; most are in our children’s generation or the “tweeners” born between 1965 and 1980. It’s their turn to lead. And when this nightmare ends, we will have found a new generation of leaders forged in the cauldron of existential battle.

Speaking of my generation, we pretty much blew it. We helped end the Vietnam War (no small accomplishment) and have contributed greatly to the betterment of society in countless ways, but in these Divided States of America, we have permitted bitter social and cultural fault lines to widen, and have permitted or advocated for a system in which we can’t achieve consensus on whether the federal government should be the answer for problems that are simply too big to be effectively managed at the state or local level. COVID-19 has exposed these fault lines as never before, and history will judge us harshly. There has not been and there may never be a President from our generation, and perhaps we do not deserve one.

However, I have hope for our future. Our children will lead us.

Stay well.

Lou

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Mar 27 2020

Life in the Time of Corona(virus) – Day 11

by at 8:27 am

I had clinic today. I saw two patients in person — one of them a second opinion. Driving to the medical center was like driving through a zombie apocalypse. No cars, no commerce, and a bunch of people, many of them elderly, wandering around the streets, slightly dazed. I went to the office, got a bit of work done (including a Zoom interview of a job candidate), and headed over to the hospital. At the main entrance I received my mask and walked over to the clinic without a coat or tie (we wash everything we bring into the hospital when we get back home). There is a vague sense of foreboding, coupled with an eerie quiet. I headed out and then saw two patients from my home office using a telehealth option, which I like very much. The future, and there will be one, will most certainly contain more telehealth care.

After I finished my charting, I came across John Marshall’s daily clinical update, and with his permission it is below. His update includes incredibly valuable information from our colleague Dr. Sean Whelton, who is clearly on the front lines in battling this pandemic. I hope you find the information useful. I find it frankly inspiring.

I want to pause a moment to remind you about the Georgetown Lombardi Q&A session that will take place Monday, March 30, at noon via Zoom. It will be an all-hands conversation devoted to your questions and concerns with the new working, researching and learning environment in regard to COVID-19. Join us online at https://georgetown.zoom.us/j/9211240636 or phone 646-558-8656 (New York/East Coast – Main Line), Meeting ID: 921 124 0636.


Daily Briefing 3/26/2020

Global numbers for confirmed cases are over 500,000. The true amount is clearly much higher. The U.S. will likely be the country with the most confirmed cases in the near future. We are testing extensively, though not universally. Keep in mind that denominators matter but information matters most of all. More testing will give us more information.

The Senate passed a $2 trillion package to help pay for all the job losses. Crocs is donating shoes to health care workers. Dr. Fauci reminded us, “The virus makes the timeline.”

Yesterday when I stopped at a store to buy tonic water, the cashier saw my MedStar Georgetown badge and said, “Thank you, and thank all the others on your team who are doing what they are doing.”

This morning started with a rousing review of the GI manifestations of COVID-19 from our excellent GI team. Also just released this morning is another review that goes over GI symptoms from not only all data published on COVID-19 but articles posted about SARS and MERS as well.

At noon we had a great talk on ARDS by Dr. Jamieson. I’ll get a link to you tomorrow to watch. I’ll be sure to watch it again before being pressed into service in the ICU.

Next week we will have a talk from Dr. Adams on communication in COVID-19. Please complete this survey ahead of time so that the talk can be customized: https://www.surveymonkey.com/r/X6TXS9D

Topic: Communication Strategies During COVID – Dr. Adams
Time: March 30, 2020, 12:00 p.m. ET (US and Canada)
Join Zoom Meeting https://georgetown.zoom.us/j/888753577
Meeting ID: 888 753 577

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Mar 25 2020

Life in the Time of Corona(virus) – Day 10

by at 7:09 pm

I am in the middle of another busy day in which the most important information comes from our consortium partners in New Jersey. Hackensack Meridian Health is at or near the epicenter of the COVID-19 pandemic in the New York area, and the health system is bearing the full force of that particular hurricane. They have supplies, but the acuity of patient care is incredibly high. They have a well-oiled clinical machine and are making the best of an immensely challenging moment. We have much to learn from them, since they are probably 10 days to two weeks ahead of where we are with respect to the full brunt of acute illnesses. Hopefully, our efforts to maintain social distance will lessen that impact, but it is hard to imagine that we’ll get a knowledgeable “all clear” any time soon.

Our colleagues have been engaged in a number of urgent clinical trials that provide their patients access to treatments such as anti-IL6 antibody, convalescent serum infusions, hydroxyquinine plus azithromycin, and antiviral agents. We are working to determine which of these trials can be opened here, so that we are prepared when the storm hits.

Today we submitted a response to NCI with some research proposals to combat COVID-19; if we are successful we would be eligible for a CCSG supplement. NIAID just released an urgent appeal for supplement applications for individuals holding existing NIAID grants. All hands truly are on deck.

I hope you saw the note from Ed Healton and the other EVPs Wednesday afternoon instituting a “one-year extension of the tenure probationary period for all faculty who in Academic Year 2019-20 are in the sixth year or earlier of their probationary period (including those whose probationary period has been adjusted for any other reasons).” This is a welcome development.

Time to go back to work. Be careful and stay well.

Lou

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Mar 24 2020

Life in the Time of Corona(virus) – Day 9

by at 7:14 pm

Life goes on at this very strange time, and so does work. I hope all of you are well and finding ways forward as we acclimate to this new, temporary reality.

Many of us have wondered how the research pause might affect our NCI-funded research. A Bottom Line blog post published recently by NCI Director Dr. Ned Sharpless, titled “NCI Grant Funding During the COVID-19 Public Health Emergency,” provides some clarity that you might find useful.

In this post, Dr. Sharpless stresses NCI’s efforts to continue operations that support the NCI extramural research community during this time. Specific areas highlighted include: flexible formats to allow previously scheduled NCI peer reviews to continue, where grant applicants should turn for questions, and the guidance NCI is following related to grant awards. In addition, he shares several resources and updates that are available through NIH.

You might find it useful to know that a new page on the Georgetown Lombardi website featuring information about COVID-19 and cancer is now live. The page includes two explainer videos that John Marshall has put together for patients, with more to be posted soon.

Those of you who want to join today’s expanded “Lunch with Lou” video meeting can do so through this link: https://georgetown.zoom.us/j/9211240636 Meeting ID: 921 124 0636.

Be well, and stay safe.

Lou

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Mar 24 2020

Life in the Time of Corona(virus) – Day 8

by at 8:24 am

The eerie calm continues, even as coronavirus cases gradually ramp up. I am socially isolated but deeply engaged in work. I basically had nonstop calls from 9 a.m. until about 7 p.m. today, with two brief breaks. No movies tonight!

Dr. Weiner in his home officeMy busy day was tinged by some sadness. I learned that a dear family friend died today, in her late 90s, from natural causes. Her history with our family dates back to 1945, after the end of World War II, when survivors of the concentration camps straggled back to their home cities. She returned home to Brussels, having survived the horrors of Auschwitz, delivered by a train to a future nearly as bleak as her horrific past. She sat on a curb by the train station, sobbing, a young woman who had lost her entire family to the horrors of the Holocaust. My grandfather went to the station every day, seeing if he recognized anybody that he could help. He remembered her from before the war, and brought her back to his apartment. His entire nuclear family, including my mother, had managed to survive intact.

Etyl lived with my mom’s family for about two years until she identified some family members living on New York City’s Upper West Side. She moved to the United States in 1947 or thereabouts. She met a young actor, they fell in love and married, ultimately having three children who are living testimony to the power of hope that ultimately triumphs over evil.

My mother visited the USA in 1948, met my father, fell in love, returned to Belgium (immigration laws!) and moved back to marry him in 1950. She and Etyl stayed in touch until the day she died in 1992. In fact, I may have ended Etyl’s husband’s acting career when I inadvertently slammed the lid of a steamer trunk on his nose when he was staying at our apartment during the Broadway tryout of a musical in Philadelphia. I was just a toddler. They held no lasting grudges. When I was 12, our family spent a summer with them in L.A., where they eventually moved so he could pursue a moderately successful career as a movie director. His children have all been fabulously successful in the film business. Take that, Hitler.

Our families have always been there for each other, through thick and thin. With her passing, the world is just a little bit less bright, but overall better for her having been part of it for so long. She saw it all, survived the worst of times, and emerged triumphant. If she could get through all that, we surely will get through the very serious challenges poses by coronavirus by being strong, smart and resilient.

Stay well!

Lou

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Mar 23 2020

Life in the Time of Corona(virus) – Days 5 through 7

by at 8:36 am

Day 5

 

The reality is setting in — a challenging mix of hard work, isolation, a disquieting dread, and more than a bit of boredom. We miss being with our extended family. We miss our friends. I miss being at Lombardi. This is how it is — at least for now. One of my colleagues mentioned to me that he thinks this is not a looming apocalypse, that it will be more like SARS — serious, but not disabling to our lives. I hope he is right.

However, I live by the oncologists’ credo: Plan for worst, hope for the best. Every single precaution we are being asked to take is sensible and appropriate. Please follow the guidelines — I will be so glad if it turns out I have been wrong.

Work continues to provide a welcome home-based diversion. I again had a bunch of Zoom meetings, and find that the approach really works. For some reason (perhaps the novelty of it) I find myself more deeply engaged, and the meetings thus far have been remarkably productive. I think we all hunger for our familiar human interactions, so Zoom it is.  Our monthly Council of Chairs meeting had about 35 attendees, all by Zoom or conference call. It was a great meeting. Ed Healton is the kind of leader GUMC needs at this time; he is calm, reassuring and focused on winning the moment.

My weekend will look a bit like this past week, just without the Zoom meetings. I am revising a manuscript and working on a new grant. I will exercise. Harriet and I have started to review the “Top 100” lists of the greatest movies of all time and plan to start seeing the ones we have missed. Tonight, she gets to pick. My turn is tomorrow. We also are thinking about having a “virtual” family meal so we can spend time together with our kids. I hope to replicate that exercise for “Lunch with Lou,” albeit without the lunch (though we all are free to bring our own meals to the event).

Stay well. We need you. The cure for all cancers still awaits.

 

Day 6

 

Life has settled into a monotonous rhythm, slower on the weekend because work is not as much of a diversion. I have finished editing the draft of the paper in progress, and am thinking a lot about upcoming grants. I got a lot of exercise in an increasingly deserted city. I took a long walk in the neighborhood, struck by the absence of moving vehicles and humans. It was not difficult to maintain appropriate social distance!

Like many of you, I have tuned into the daily White House coronavirus briefings. I have been so impressed by Anthony Fauci’s uncanny ability to put the facts before the American people time and time again, cutting through the noise to assure that we know where we stand and what we need to do. Like some of you, I have had the privilege of working on NIH committees with him and can assure you that what we see on our screens indeed reflects the man that he is. He makes me feel safer.

As I noted last night, Harriet and I have begun to work through a catalog of great and good movies. Last night, it was Citizen Kane — still among the greatest, if not the best film of all time. It is an astonishing film-making feat, and it has one of the best, most memorable endings I have ever seen. Tonight, we are doing something a bit less towering — Judy, starring Renee Zellweger. Tomorrow will be either The Seven Samurai or In the Mood for Love. With luck, we will pull off our virtual family dinner tomorrow night.

 

Day 7

 

Sunday, March 22.

I miss watching live sports on TV. Of course, I seem to have a lot more time for other weekend activities (perhaps there is a lesson there!), though those are restricted as well. I got a lot of work done today, and Harriet and I took a nice walk, running into a former Lombardi Gala co-chair and her husband. We had a lovely long-distance conversation with them. We cleaned up our home office, watched a couple of movies (we really liked Bohemian Rhapsody, and thought that Ford vs. Ferrari was pretty good). We FaceTimed our kids and grandkids, and sort of shared dinner with them.

So many important life events are being altered by the pandemic. I revised the paper Reham Ajina has written, based on her PhD defense from earlier this month (it seems like so long ago). With everyone sheltering in place and commencement delayed, it seems almost certain that Reham will be returning home to Saudi Arabia before we get a chance to give her that sushi party I had promised, which now will have to wait until she returns for a visit.

Another disappointment was not being able to celebrate the achievement of Jeanne Mandelblatt, who was to receive the Joseph F. Fraumeni Jr. Distinguished Achievement Award, the top honor given by the American Society of Preventive Oncology, at the ASPO annual conference today. While portions of the conference moved to a virtual forum, the awards ceremony could not. Jeanne is one of the world’s foremost authorities in cancer control and the problems of aging and cancer, and the award is very well deserved. She’ll be honored at a later date.

Sheltering in place is of course wise and necessary. It is also isolating. We need to be part of communities to feel fully alive and engaged in this project we call life. The coming work week will help me re-engage with my Georgetown community, and I imagine that will be true for many of us. But I am looking for ways we can use technology to help us deepen and enrich our sense of belonging. I am open to any and all reasonable suggestions, and will start with one idea. My monthly “Lunch with Lou” is scheduled for Wednesday at noon, with 7 or so attendees. Even though I cannot provide lunch, and we cannot break bread together in the same physical location, perhaps we can join by Zoomas many as would likeand we can talk about life and science in the time of coronavirus. I for one plan to be sitting at a table, with my lunch, eating and speaking with my friends. We’ll send out the Zoom link soon.

I usually close my weekly blog with wishes for you to have a good and productive week. May the coming week also bring good health for you and yours.

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Mar 19 2020

Life in the Time of Corona(virus) – Day 4

by at 4:37 pm

So now, we wait. I don’t have a lot new to report today. We all have done what we can; hopefully it will have been enough. Interestingly, one of the foundations that has supported us over the years contacted me to determine how they can help us continue caring for our patients at this challenging moment. I am grateful for that support.

Dr. Weiner in his home officeMy Thursday morning was highlighted by a two-hour-long lab meeting using Zoom; the technology worked seamlessly. I found it very therapeutic to talk about our science. The afternoon had been set aside for an abbreviated clinic, but patients canceled their appointments out of an abundance of caution. Fortunately, none were on active therapy.

So, this will be another work-from-home day. I am grateful that my work gives me purpose. I am working on a response to that foundation’s request, editing a manuscript coming from our lab, and working on the revision of a pending grant application. If I was truly penned in the house with nothing to do, it would drive me crazy.

I have found myself thinking about my late mother a lot over the past week. As many readers of this blog know, she was a Belgian survivor of the Holocaust, a so-called “hidden child.” She spent the better part of four years in quiet rooms with nothing to do, living under an assumed identity, with little opportunity to get out and be a part of the world. She had no access to TV or the Internet (they did not exist!) or to many of the normal social interactions that are part of contemporary teenage life. Living here in a pseudo “wartime” Washington, DC, I am frankly awed by how she and so many like her managed to get through the horrors of that war. Unlike the coronavirus, the Nazis acted with targeted intentionality, and Europe was largely helpless against that plague for far too long. Looking back on it, she carried those unhappy memories and lived with the aftershocks of those experiences for the rest of her life.

Our plague will recede, but I wonder how we all might be changed by the experience of life without the personal safety and health buffers many Americans have long experienced and come to expect. When this is over, will we be better, and more appreciative of our bounty and the blessings of good health? Or will we simply resume life as it was before? I suspect the latter will be the case, but there will be aftershocks. However, amidst the scars, perhaps we will have been changed, if only a bit, for the better.

Now, back to work…

Stay safe.

Lou

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Mar 18 2020

Life in the Time of Corona(virus) – Day 3

by at 5:49 pm

I write today’s blog from home again, where I am hunkered down for a while. It all seems so surreal. I am not bored, though. I seem to have meeting after meeting, albeit via Zoom. Some of those meetings are related to how we are responding to the challenges we face, but actual cancer-focused work is now liberally sprinkled into the mix of my daily routine. This is good, and it is important as well.

Dr. Weiner in his home officeThe coronavirus pandemic is indeed horrible. It is disruptive to our daily lives, science, educational mission, economy, communal psyches, and for too many among us, our health. It can cause serious illness, and in some cases death. The magnitude of risk demands our decisive action, and necessarily resets our priorities. I am incredibly grateful to my colleagues on the front lines of the battle against this virus, which will be won, though the ultimate toll remains uncertain. It feels odd to be on the sidelines, and I will pitch in to help in any way I can. But for the most part we are not public health experts, coronavirus researchers, infectious disease practitioners or critical care clinicians. We do know a lot about cancer, though, and we must continue to push forward with our mission. It is important to remember that by the end of today (Wednesday), about 5,000 Americans will have died of cancer just in the past three days. We have work to do.

How do we accomplish this at such an uncertain time, when laboratories have been placed into “nap” mode, clinical research bandwidth is reduced, and our frequently fragile patients face unknown risks simply by coming in for doctor visits? Well, we succeed by doing the best we can — all day, every day. For example, we continue to care for our cancer patients. We offer cancer patients who need them access to potentially life-saving clinical trial participation. We write papers and research grants. We analyze data and explore the scientific literature to help us understand our findings. We meet (virtually) on a regular basis to discuss collaborations and have lab meetings to provide exchanges of data and ideas. We have online lectures. Our research does not stop; it just changes form for a short time. And when we eventually get the green light to physically get back to our labs and offices, we will have mapped out the next critical experiments and will be ready to move forward with a renewed burst of energy.

This is not a bunch of malarkey. Just today, through the miracle of technology, I individually met with two of my laboratory members, and we have a general lab meeting scheduled for Thursday morning, with a formal agenda replete with data presentations. This will continue. I approved several new grant submissions from Georgetown Lombardi investigators just this morning, and I have my own papers to review and grants to write. Earlier today, we refined the policies and procedures that will be used to screen incoming outpatients for COVID-19 symptoms so they can be diverted to other areas for action, thus preserving our ability to care for our cancer patients, who need our help now and not “once the dust has settled.”

I know that I am not alone in pressing forward, making all necessary accommodations to this temporary new world created by this emerging pandemic. But make no mistake — our work continues. It is no less compelling and important than it was three months ago. We are in it for the long haul.

Stay healthy, and remember to wash your hands in social isolation!

Lou

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Mar 17 2020

Life in the Time of Corona(virus) – Day 2

by at 5:41 pm

Well, these certainly are interesting times. The university is now in remote learning mode, and research continuation measures are in full swing. With great support from Elliott Crooke, Mary Glasscock and Sharon Levy, I spent a lot of time over the past two days figuring out how to assure research continuity that protects both the work and the people who perform it. I am grateful for the faculty’s willing and uniformly gracious participation in this challenging process.

Dr. Weiner at work in his home officeOn Tuesday afternoon, I took a walk with Harriet to clear my head after a long series of video conferences and meetings. I remarked how the feeling in our neighborhood reminded me of New York City in the weeks following 9-11, with an eerie quiet, almost a hush, on the streets. Back then there was a feeling of vulnerability, grief and uncertainty, but today I sensed only vulnerability and uncertainty. I likened it to the calm before the storm.

So, when we got back from our walk, we learned that New York City might issue a shelter-in-place order within the next 48 hours. Hospitals in our region are beginning to feel the stress from screening for COVID-19, and the number of cases in our region is rising. A storm indeed is coming, and the swells have begun to hit our shores.  It is a storm that we will weather by following guidelines that maximize our safety and reduce risks of viral transmission.

Since we will be dispersed for some time, life and work must go on. I have five meetings (all by video conference) on Wednesday, and a virtual laboratory meeting on Thursday. Our research can continue — this is a great time to have those meetings (remotely) that you have been meaning to have to develop collaborations, write papers and work on grants. The NCI expects no less. In his conference call with NCI cancer center directors yesterday, Ned Sharpless, the NCI Director, suggested that there will be some necessary flexibility with respect to various grant deadlines. And today he let us know that the submission deadlines for submission of CCSG supplements, several of which are of interest to Lombardi researchers, have been extended to May 25. I am sure we will receive other information from NCI as time passes, and I will keep you updated with all pertinent information.

Talk to you soon.

Lou

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