As the COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 sweeps around the globe, business as usual has come to a screeching halt. Schools and universities, shops, and offices have shut down, and people around the world are sheltering in place, either suddenly unemployed or trying to retain some semblance of normalcy while working from home. The worldwide shutdown has dramatically affected pain research, too.
In late March and April 2020, PRF spoke with the heads of four research groups – two in the US, one in Canada, and one in India – each with different challenges as they navigate the pandemic. There is no denying the incredibly difficult situation in which pain research labs now find themselves, along with the rest of the world. A lot of uncertainty remains, and it will be a long slog for research labs to get back up and running at full strength once it is safe to do so.
Researchers are hopeful that, in the long run, at least some positive changes from the crisis might emerge, including a renewed public appreciation for science and perhaps a rethinking of graduate education.
The biggest heartache
For Catherine Cahill, who leads a research group together with her husband Christopher Evans at the University of California, Los Angeles, US, the stoppage of lab activities at her institution has been disruptive, to say the least. Cahill’s work focuses on opioids in pain and addiction, which entails long-running animal experiments, often with unique mouse lines that they have created over many years. With the shuttering of the campus in mid-March, Cahill was faced with the difficult task of shutting down her lab. “It’s been a chaotic couple of weeks,” she said. But the hardest part, she added, has been reckoning with the loss of animal lives.
“The biggest heartache is that we breed animals for research, and I just hate seeing anything wasted. It feels terrible,” according to Cahill.
At UCLA, the Division of Laboratory and Animal Medicine (DLAM) is charged with caring for all animals on campus, and that responsibility continues during the shutdown. DLAM staff are among the only people allowed on campus, but in the case that the staff is reduced or unable to keep working, they will be forced to cull many animals. To prepare for that possibility, Cahill was instructed to identify the highest priority animals: those in ongoing research, and breeding pairs from mouse lines that would be irreplaceable.
“We all go through training and sign off on protocols through IACUC [the Institutional Animal Care and Use Committees]. A big focus is on reduction and refinement of animal use. So this is a hard one to get your head around. It brings up a lot of ethical issues.”
But Cahill feels fortunate that two ongoing experiments have been approved to continue. After an appeal process that had to clear multiple levels, one project scientist and one postdoc will continue to make the trip to campus to finish those experiments over the next few weeks.
“They need to keep going because of the chronic nature of the experiments,” she said. Cahill herself will not go to campus: “just the key people, and when the experiment is done, they stay home.”
She said both scientists made their own decision to continue working, and she is taking measures to help keep them safer, like using soft grant money to pay for them to use ride-sharing services rather than riding public transportation as they normally did.
A pretty abrupt stop
Christine Chambers is a clinical pediatric pain researcher at Dalhousie University, Halifax, Canada, and director of Solutions for Kids in Pain (SKIP), a knowledge mobilization network to help improve children’s pain care (see PRF related interviews about SKIP).
“For my lab, it was a pretty abrupt stop with not much notice, because we’re based in a hospital. We went to lockdown, and everything on-site had to stop immediately and transition to virtual work from home. We’re all trying to navigate through this, but for the most part our research has had to stop.”
Chambers’ role as SKIP director has also changed, in different ways.
“We are putting science into practice at the hospital, trying to make pain management a priority. The challenge is how to do that in the face of other demands. We’ve had to pivot to figuring out how to support virtual care delivery online, promoting self-management, and working with partners to see how we can scale and spread effective innovations.”
Chambers, like parents everywhere, is balancing her work with caring for her kids. With four school-age children at home, “I’m feeling not as able to support my team as I would without the childcare responsibilities. We’re stripped of all our supports, the people in our lives who make it possible” to work full-time.
Because women often take on more of that childcare responsibility than do men, “I’m worried that this is a big setback for women in science. We’re already working from a disadvantage, and this is another challenge.”
She also urges scientists not to feel pressured to do more than they are able to during the pandemic.
“On Twitter, there was a lot of talk about, ‘now’s your chance to be productive and do lots of writing.’ I have a problem with that. I’m trying to urge students to be good to each other and to themselves. In academia, we have very high expectations of each other and ourselves. We need to adjust our expectations of what we can achieve.”
On the other hand, the crisis has revealed what’s possible to achieve from home.
“There are a lot of layers. This has really highlighted a lot of our technology fails – that there are better ways we could have been working, but we were not using them. There are a lot of barriers that were not really barriers, which we’ve blown through pretty quickly,” said Chambers.
Another silver lining might be a renewed appreciation for scientific discovery.
“I think this does provide an opportunity to remind the world how important science is, and you never know when you’re going to need it,” Chambers said.
On the front lines
Babita Ghai, a physician scientist at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, finds herself on the front lines. Research at PGIMER was halted in March, and much of the clinical care for chronic pain has shifted to telemedicine.
“Definitely our healthcare system is at the point that is troublesome for patients with chronic illness; we haven’t been running the chronic pain clinic for the last month or so,” said Ghai.
Meanwhile, a building on campus that was nearing completion was rapidly made ready to care for COVID-19 patients. As a tertiary care facility, PGIMER was not previously set up with an emergency department or intensive care unit (ICU), but now it is, with 300 beds.
“We created it, we got good governmental support, and it’s fully functional now,” Ghai told PRF.
As a senior faculty member, Ghai’s role at the moment is not caring for patients but running the COVID-19 control room. “I’m looking after the administrative aspects: running all the facilities, obtaining PPE [personal protective equipment], and other equipment.”
In mid-April, they had just four patients in the ICU, but she expected that number to climb. As it does, the center will rotate other faculty in to care for patients as needed. “Some of us will get exposed. We’re all anxious, because we are seeing tested, symptomatic patients. But we really don’t know how many are asymptomatic.” In addition, the residence Ghai shares with her family is located just 300 meters from the makeshift hospital.
But Ghai is hopeful that India’s early and drastic measures to socially isolate will succeed at “flattening the curve,” a phrase that has become all too familiar.
“We acted fast, and that’s the reason the curve is [flattened] a bit. We are going to see more cases, but at least it’s not going to be a sharp peak,” which would overwhelm the medical system.
Pitching in to help local hospitals
Theodore (Ted) Price, who runs a large lab together with Greg Dussor at the University of Texas at Dallas, US, said that despite the huge disruption, they were managing relatively well, particularly because of a shift in the lab that already happened to be underway before the pandemic hit.
“We’ve been in the process of moving from wet lab to more computational work for the last two to three years, so everyone in the lab has some aspect of the work they do that is computational, much of it sequencing. When it became apparent what was coming, I decided we might as well get ahead of that, and we started shutting down gradually in early March. On Friday the 13th I told everyone to not expect to come back for some time.”
Like many other labs around the world, Price continued, “all of our staff is now working from home. We emptied out the labs of laptops, and they’re at people’s houses. We have a Webex meeting every other morning. So far, it’s going okay.”
Further, just as in India, hospitals and medical facilities in the US are facing shortages of PPE for healthcare workers. So Price and his colleagues at UT Dallas tried to mitigate that shortage by donating gloves and other PPE from research labs.
“We donated an amazing amount of PPE. The entire research building got together and filled a big transport van and took it to Parkland Hospital, and they were very grateful. It was nice to see everyone pitch in.”
Price’s wife, a trauma surgery nurse practitioner at Parkland Hospital, made the initial request for spare PPE. Other research labs around the world have also made such donations to local hospitals.
Defending a dissertation – on Zoom?
As the researchers who spoke to PRF explained, trainees have been hit particularly hard by the crisis.
“For students, this has an enormous impact; thesis work had to be paused,” said Chambers. Graduate students may be affected in different ways depending on the stage of their training and data collection, but it presents enormous challenges in any case.
“Students have goals and dreams and timelines; there’s a grief associated with this.”
Perri Tutelman, a senior PhD student in Chambers’ lab, feels that grief. After recruiting 57 families to participate in her study on chronic pain in pediatric cancer survivors (see related RELIEF interview), she was just 10 participants away from wrapping it up.
“I’m fortunate to be in this position,” with so much data already collected. “It’s still really disappointing, because recruitment was going so well. We had families traveling to participate in the study,” according to Tutelman.
Now, she said, “I’m going to be writing my dissertation from my apartment using the data I have, but even getting access to that data has been challenging,” because it was only available on hospital computers. With all the uncertainty, she wonders, “Am I going to have to defend my dissertation over Zoom?”
Timelines – and expectations – have been radically adjusted, too. “I was so excited about the conference season this year. I feel like I’m finally at the stage where I have data I’m excited about, and I’m establishing my own expertise,” Tutelman said.
She was invited to give a talk at a meeting that has been canceled. “It’s challenging as a trainee who’s almost done. These conferences are key opportunities for networking.”
The challenges are more immediate, too. Like many graduate students, Tutelman lives alone in a small apartment, across the country from family.
“It can be really isolating,” she said. And without a car of her own, getting groceries poses a bigger hurdle.
“I do worry a lot about our graduate students,” Price said. “There’s so much uncertainty.” But perhaps, he said, “this crisis might help us mentors think about how we do graduate education, and to reassure students there’s a path to creating new knowledge for the world even when your experiments don’t work.”
A long road back
What’s the outlook for researchers hoping to get back into the lab? That depends on many factors, but for Cahill, “it’s going to be nine months at least to get things back up and do an experiment – that’s once we get back in,” she said. “It’s unprecedented and extraordinary; there’s no question about it. It’s really going to take a toll on our research.”
Researchers are also concerned about what will happen with funding from the National Institutes of Health and other sources (see the NIH’s information page). While Price and Chambers said they feel lucky to be in a good position when it comes to funding, they worry about colleagues who are not in the same position. Cahill is in the final year of a Department of Defense grant, and wonders whether it will be extended so that she can finish collecting the data necessary for the study.
“We’re saving money now, but the lost productively is going to hurt,” Price said.
Coincidentally, Price recently published two studies with potential relevance to the pandemic (Ruhl et al., 2020, and Barragán-Iglesias et al., 2020), and is planning to extend that work in efforts to identify therapeutic targets for SARS-CoV-2.
“I never dreamed we’d be working on something related to a worldwide pandemic. Then again, I never dreamed we’d have another worldwide pandemic,” despite experts’ warnings, Price said. “We should have listened. We thought it was just the stuff of good movies.”
Stephani Sutherland, PhD, is a neuroscientist and freelance journalist in Southern California. Follow her on Twitter @SutherlandPhD
Image credit: Konstantin Pelikh/123RF Stock Photo.