Emory Medicine Magazine Fall 2020 by Emory University

Medicine SPECIAL COVID -19 ISSUE | FALL 2020

The Two Traumas

At the collision point of health and social justice

W H AT â&#x20AC;&#x2122; S I N S I D E :

CHILDREN AND COVID 22 READY SET PIVOT 28 SURVIVOR STORIES 36

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@gradydoctor Academic internist Kimberly Manning (right), Emory professor of medicine, with trainees at Grady Memorial Hospital in Atlanta.

Influencers: Cutting through the Chaos 42

PHOTO KIMBERLY MANNING

FROM THE DEAN

Pandemics, Plural

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Emory Medicine Editor Mary Loftus Art Director Peta Westmaas Director of Photography Jack Kearse Contributors Jim Auchmutey, Pam Auchmutey, Susan Carini, Janet Christenbury, Quinn Eastman, Kelley Freund, Jerry Grillo, Jennifer Johnson, Camile Matthews, Shannon McCaffrey, Doug Shipman, Roger Slavens, Kofi Stiles, Rajee Suri, Emily Weyrauch, Caroline Yang Production Manager Stuart Turner Advertising Manager Jarrett Epps Web Specialists Wendy Darling, John Mills Associate VP, Health Sciences Communications Vince Dollard Director of Communications, Emory School of Medicine Jen King Executive Director of Content Jennifer Checkner Associate VP, Creative Dave Holston

Emory Medicine is published twice a year for School of Medicine alumni, faculty, and staff, as well as patients, donors, and other friends. © 2020 Emory University Emory University is an equal opportunity/equal access/affirmative action employer fully committed to achieving a diverse workforce and complies

with all applicable federal and Georgia state laws, regulations, and executive orders regarding nondiscrimination and affirmative action in its programs

and activities. Emory University does not discriminate on the basis of race, color, religion, ethnic or national origin, gender, genetic information, age,

disability, sexual orientation, gender identity, gender expression, or veteran’s status. Inquiries should be directed to the Office of Equity and Inclusion, 201 Dowman Drive, Administration Bldg., Atlanta, GA 30322. Telephone: 404.727.9867 (V) | 404.712.2049 (TDD).

PHOTO STEVE NOWLAND

BEHIND THE STORY: Doug Shipman, an Emory alumnus,

writes about being a father and the spouse of Emory emergency physician Bijal Shah 06M, who is working at Grady Memorial Hospital in Atlanta on the front lines of the coronavirus pandemic. He tells their daughters, 8 and 6, “how their mom is a hero, and how we do our part to help by brushing our teeth, washing our hands, and keeping a good attitude.” (p. 35)

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and inequities have resulted in disproportionate death rates among African Americans and other minorities from the virus, so too has systemic racism cost far too many lives. Black Lives Vikas P. Sukhatme, md, s c d Matter and White Coats for Black Dean, Emory School of Medicine Lives protests that took place Chief Academic Officer, Emory here, as well as in many other Healthcare parts of the country, called attention to this additional threat to communities of color. We must commit to fighting prejudice and violence with the same energy we have focused on the global pandemic. I invite you to read this issue’s cover story, “The Two Traumas,” about an Emory medical alumni couple in Minneapolis who are doing good work at the intersection of health and social justice (p. 12). Many of our alumni, faculty, students, and trainees are on the front lines of such battles. As our incoming first-year MD students began orientation in July—and were fitted for their N95 respirators—other medical students were already back at work in our hospitals and clinics. Plans for teaching and training were carefully made through consultation with experts in the Emory Department of Medicine’s Division of Infectious Disease, our hospital epidemiologists, and leaders across our medical school and university. Our patients and communities need the next generation of physicians. As soon as the pandemic hit, many of our medical faculty quickly pivoted to COVID-19 research (p. 28). Due to these efforts, the faculty have garnered more than $91 million in COVID-19-directed NIH funding in FY2020, the third highest of any academic medical center in the US. Our clinical teams have worked tirelessly, caring for COVID-19 patients and ramping back up other medical services. And many of our faculty have embraced roles as public scholars and media sources (p. 42). Never have I been more proud of our medical community. Blessings on them, and on us all.

The Emory Brain Health Center and Georgia Public Broadcasting (GPB) are partnering on a news magazine hosted by Emory’s Jaye Watson. To learn more, go to pbs.org/show/ your-fantastic-mind/.

PHOTO COURTESY OF DOUG SHIPMAN

COVID-19 is not the only pandemic we faced this year. Just as health disparities

“

As a physician, I know what death looks like, and I was viewing a dead man.” —physician Iesha Galloway-Gilliam 10MR

PHOTO CREDIT: CAROLINE YANG

FEATURES

The Two Traumas 12

“

When the brutal death of George Floyd in Minneapolis stirred national protests in the middle of the COVID-19 pandemic, alumni physicians Iesha Galloway-Gilliam 10MR and her husband, Kevin L. Gilliam II 9MR, found themselves at the collision point of health and social justice.

Children and COVID 22

Pediatric cases of the novel coronavirus range from asymptomatic to a serious inflammatory syndrome. More is being learned with each new case but the unknowns are still daunting for families and doctors.

Ready, Set . . . Pivot 28

Within weeks of the pandemic beginning, reseachers across the School of Medicine mobilized their resources and expertise to address the largest infectious disease threat to humankind in more than 100 years: COVID-19.

Survivor Stories 36

African Americans are at greater risk from COVID-19, but these four survivors made it through with compassionate care, support from family and friends, and their faith.

THE BARE BONES Letters 4 Briefs 5

AND MORE

Of Clocks and COVID 46

Writer Susan Carini shares the story of

“Grandmama doesn’t sound right,” Mikisha told her mother, Barbara.

losing her “sweet and salty” mother to the

Experts Weigh In: COVID-19 20

virus: “She was more than just a number.” Class Notes 48

Visit us online at emorymedicinemagazine. emory.edu for bonus content. Send letters to the editor to mloftus@emory.edu.

THE BARE BONES

Letters What an awesome article [“Man on Fire,” Winter 2020]. I love the pictures, video interviews, and layout of the whole piece. Great job to you and your team at Emory. Mr. Jalen Richardson is a true fighter and an inspiration for many.

Capt. Dion Bentley PIO, DeKalb Fire Rescue

I read with great interest the story

I felt connected to Richardson’s journey from beginning to end, the emotions, his road to recovery, and I also felt very proud to be a part of an organization with such talented physicians as Dr. Juvonda Hodge. NICOLE SMITH, ADMINISTRATIVE ASSISTANT, EMORY SAINT JOSEPH’S HOSPITAL, ATLANTA

of Jalen [“Man on Fire,” Winter 2020]. As a graduate of Emory’s cardiac surgery program and a Harley rider, I can relate to what happened to him. Riding in a large group demands that rider etiquette be followed. In my experience, a rider “edging” his way in unfortunately isn’t unusual. The suffering Jalen went through could not ever be compensated.

resident 1973, and urology 1976), I am proud of the tradition of excellence that you featured in this essay.

Dale Waters, MD

story. The videos, the educational pieces, and the pictures were fantastic. I felt connected to Richardson’s journey from beginning to end, the emotions, his road to recovery, and I also felt very proud to be a part of an organization with such talented physicians as Dr. Juvonda “Mama Hodge” (as Jalen called her). I wanted to let you know that I appreciate senior staff writer Kimber Williams for writing such an amazing piece!

Sandia Park, NM

[“Man on Fire,” Winter 2020] is an incredibly amazing work of journalism that transported me into this man’s world of brutal trauma and recovery through the help of dedicated, compassionate physicians and the unconditional love of a dog. WOW! Just WOW! I like to think how this story will help other burn victims to learn, endure, and eventually thrive.

Karen Thurston San Diego, CA

I want you and your staff to know that I found this feature [“Man on Fire,” Winter 2020] to be one of the finest pieces of journalism I have ever experienced. A heart-warming example of how Emory and its thousands of caring members have changed lives. As a former student and house officer (Emory College 1967, medical school 1971, general surgery

Charles M. Holman Jr. 71M 73R 76F Ocean Springs, MS

Your words [“Man on Fire,” Winter 2020] held me captive from begining to end. This was truly a well written

Nicole Smith Administrative Assistant, Emory Saint Joseph’s Hospital Atlanta

I’m retired, am social distancing, and am catching up on reading my Annals of Thoracic Surgery back issues. I do miss surgery, which has

giving me the opportunity to fulfill my dream of doing surgery. Emory Medicine magazine remains superb. As a medical student and for several years afterward, I contributed essays to its forerunner, Medicine at Emory. Dr. Tom Sellers was wonderful to work with. I have hosted a monthly Art of Medicine Rounds series at the University of Alabama School of Medicine in Tuscaloosa since 2012, which was created to remind health professionals of the reason they entered their fields: people. The practice of medicine is far more than diseases, laboratory and X-ray findings, operations, and medications. A well-rounded physician must not only know how to prescribe medications but also to listen to patients’ concerns. Music, art, sculpture, and dance might not at first be thought of as integral to the practice of medicine, but the humanities can in fact help connect students with teachers, colleagues with peers, and patients with physicians.

Alan Blum Professor and Gerald Leon Wallace Endowed Chair in Family Medicine University of Alabama Tuscaloosa, AL

changed dramatically, and will forever be indebted to Drs. Charles Hatcher, Ellis Jones, Joe Craver, Kamal Mansour, and all my other Emory medical professors for

We like to hear from you. Send us your comments, questions, suggestions, and castigations. Address correspondence to Emory Medicine magazine, 1762 Clifton Road, Suite 1000, Atlanta, GA 30322; call 404.727.0161; or email mloftus@emory.edu.

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Flu Shots: Never More Important Get your flu shot—now, if you haven’t already.

That’s the advice from experts this year, who fear a “twindemic” of COVID-19 and influenza during the normal flu season. “It takes two to three weeks for the vaccine to build immunity in the body, and getting vaccinated early can help prevent transmission,” says Walt Orenstein, associate director of the Emory Vaccine Center and professor of infectious diseases at Emory’s School of Medicine. And the flu virus, like the novel coronavirus, can be wily. “Once exposed to influenza, an individual tends to get sick in a range of one to four days,” Orenstein says. “People are most contagious in the first three to four days of illness. But some people can transmit the virus before they even get sick and can also transmit from five to seven days after becoming sick.” The flu virus can mutate, Orenstein says. There are about four major strains of influenza viruses in most vaccines. In the overall population, the CDC says studies show a vaccine can reduce the

risk of flu by about 50% to 60% when the vaccine is well matched. Experts estimate the vaccine for the 2019–20 influenza season was about 38% effective. “We’d like a more effective vaccine,” Orenstein says, “but the [current vaccines] are still a lot better than zero percent, which is the effectiveness of no vaccination.” Pregnant women are encouraged to get a flu shot to protect their newborns, since only babies 6 months of age and older can be vaccinated; the mother’s vaccination provides passive immunity to the newborn. With the threat of COVID-19 as well as other illnesses that could lead to pneumonia, it’s even more important to get a flu shot this year. Having influenza and COVID-19 at the same time could be catastrophic for an individual, and having simultaneous or overlapping epidemics of influenza and COVID-19 would put tremendous stress on the health care delivery system.—Dr. Walter Orenstein, speaking to WABE-FM, Sept. 16, 2020.

CDC estimates* that, from October 1, 2019, through April 4, 2020, there have been:

39 million to

56 million flu illnesses

18 million to

26 million

flu medical visits

410,000 to

740,000

flu hospitalizations

24,000 to

62,000

flu deaths *These estimates are calculated based on CDC’s weekly influenza surveillance data.

A New Hope: The Addiction Alliance of Georgia

With needs growing amid the pandemic, Emory Healthcare and the Hazelden Betty Ford Foundation are partnering with collaborators throughout Georgia in a long-term venture to reduce addiction, improve recovery, and save lives.

More than 20 million Americans needed substance-use treatment in 2019, but only about one in 10 received the specialty care they needed. Addiction to alcohol, opioids, and other drugs is a leading cause of disease, disability, and premature death, with drug overdoses alone taking a record 72,000 lives in the US in 2019. The Addiction Alliance of Georgia will focus initially on outreach, education, and reducing stigma by providing a better understanding of addiction as a chronic, treatable disease. In 2021, it plans

to offer clinical services in Atlanta. Currently, “in response to the pandemic and the dramatically increased demand, Emory and Hazelden Betty Ford have both used telehealth effectively and extensively to help people with substance-use disorders,” said Mark Hyman Rapaport, chair of Psychiatry and Behavioral Sciences at Emory School of Medicine and chief of Psychiatric Services at Emory Healthcare. Information on existing services can be found at AddictionAllianceOfGeorgia.org.—Jennifer Johnson

Fall 2020

THE BARE BONES

Animal Care during COVID As part of its research mission, Emory cares for thousands of animals across the enterprise—at

Yerkes National Primate Research Center alone there are about 5,000 mice, rats, and voles, and 3,400 nonhuman primates split between Yerkes’ 25-acre main campus and its 117-acre field station in Lawrenceville, Georgia. These animals require many human caregivers, from vets and vet technicians to behavioral management specialists, resource managers, and animal care technicians, as well as the researchers and research assistants whose work translates into new therapies, vaccines, and discoveries that aid health and well-being— including research on COVID-19. “Our biggest challenge has been working through reduced staffing, which we had to facilitate initially because we split our groups into teams so we would not expose all of our personnel at the same time,” says veterinarian Joyce Cohen, associate director of the Yerkes Division of Animal Resources. “Now it’s because of virtual learning considerations for our employees’ children.” Everyone stepped up to the plate, working doubly hard, says Cohen, associate professor in the division of psychiatry and behavioral science at Emory’s School of Medicine. “And they are all wearing Personal Protective Equipment (PPE) every time they work with the nonhuman primates, to protect the animals from diseases we carry as well as to protect staff from natural diseases the monkeys carry. Even before COVID, this was the case.” During the height of the pandemic, Yerkes tamped down some of its research, and the only new studies accepted were COVID-19 research. But staff tried to preserve as many ongoing studies as possible. “Our Biosafety Level 3 lab is up and running, which takes a tremendous amount of time and energy,” Cohen says. “We always feel there is a need for animal research, and an emerging infectious disease is a great example of why we still need to have it.

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Nonhuman primates are very good models for emerging infectious diseases like COVID. It is absolutely critical to have these animals ready so we can jump right on vaccines and treatments.” The field station’s monkey colonies also require constant, careful tending. For example, the rhesus macaques—Yerkes’ primary species—came into baby season during the pandemic, which meant a lot of work for caregivers. Animals are housed in pairs when possible to make sure they have a social partner. At the field station, where the behavioral research social colonies are housed, workers monitor social interactions of large groups, from five to 150. Chimpanzees can no longer be used in research so Yerkes’ chimps were “retired,” but Emory still provides them the same level of care while it pursues donation opportunities. “Chimps are notorious for being susceptible to human respiratory infections, and many of them are geriatric at this point,” Cohen says. “We are doing PHOTO CREDIT: DENISE BONENBERGER our best to protect them.” Emory School of Medicine researchers have ongoing studies involving a plethora of animals kept in vivariums and research buildings across campus, including 75,000 mice plus rats, pigs, sheep, rabbits, guinea pigs, hamsters, gerbils, songbirds, voles, spiny mice, zebra fish, and lampreys. “Our challenges are centered around caring for animals in nine housing locations,” says Michael Huerkamp, director of the Division of Animal Resources and professor of pathology and laboratory medicine at Emory School of Medicine. Certain species have unique attributes that make them valuable for specific lines of scientific inquiry, Huerkamp says. “We’re fortunate to have dedicated pros on our teams, with longevity and specialized skills,” he says. “This work is vital to the mission of the university. We also want to get everyone to the other side of COVID, staying healthy along the way.”—Mary Loftus

Stocking up on PPE J. William Eley, executive associate dean for education (left), and Haian Fu, chair, pharmacology and chemical biology, stand beside 6,200 masks donated by the Global Emory Scholars in China.

PHOTO COURTESY OF BILL ELEY

huge challenge during the pandemic for hospitals around the world has been keeping a constant supply of personal protective equipment (PPE), such as medical-grade masks, gloves, and gowns, in stock for health care workers.

As demand intensified, Emory Healthcare used multiple supply chains from around the world, as well as local distributors and manufacturers, to stabilize its supply. It also opened a drive-through community donation center on the Emory campus for PPE in March. “We have been ordering from other countries— Mexico, Central America, Vietnam, and other Southeast Asian countries as well,” says Lee Partridge, director of Supply Management at Emory Healthcare. Emory secured a robust stock of PPE in the form of masks, gloves, and sanitary wipes, numbering in the hundreds of thousands. A significant portion of these donations came from China. For example, Global Emory Scholars in China, a group of former School of Medicine trainees who returned home after their training, donated more than 6,000 masks purchased through a fundraising effort called Love Emory (see photo, above). Although constant restocking is required, PPE supply chains have normalized a bit after the initial surges. “We have focused on sourcing from American manufacturers as much as possible,” Partridge says.

Sent with the Global Emory Scholars donation was a poem:

Returned to homeland as better scholars / our love and support for Emory again brings us together. / Although thousands of miles apart, / a shared universe connects our hearts. / The darkness of winter never stays forever, / the hope and joy of spring is just around the corner. / Hand in hand we stay strong, / fighting for a COVID-free world where

we all belong.

“This has eliminated long lead times and has made the supply chain more secure.” By purchasing from these manufacturers in bulk and opening a warehouse for future needs, Emory Healthcare is now stable with most required protective garb. Partridge says Emory Healthcare will continue seeking reliable sources that can provide the requested supplies. These protective products are more valuable than ever as the coronavirus makes a resurgence in different areas around the country. Preserving multiple supply chains is key to ensuring that medical professionals remain safe when treating patients with COVID-19, he says. Medical teams have also been charged with making their PPE last longer, by disinfecting and reusing their personal supplies. The Centers for Disease Control and Prevention (CDC) provides guidelines so that doctors and nurses can extend their use of protective gear such as N95 respirator masks and face shields. According to Kari Love, program director of infection prevention at Emory Healthcare, one of the ways this equipment is being conserved is through an Emergency Use Authorization for reprocessing N95 respirators. “The reprocessing includes sending the N95 to the sterile processing department where they placed the masks in sterilizers that we also use for surgical instruments,” says Love. “Once the mask has gone through the process, it is returned to its owner.” Under normal conditions, hospital staff would dispose of the masks after initial use, but those practices needed adjustment as the virus continued to spread. The CDC also recommends eye protection when treating patients with COVID-19, so rather than throw away these face shields, Emory Healthcare workers disinfect their shields. “Our supply chain team has also sourced a variety of different types of eye protection, including face shields and goggles,” Love says. “Georgia Tech also worked with us to create a face shield that has a headband that is sturdy enough to be reused.”—Kofi Stiles

Fall 2020

THE BARE BONES

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Breathing Space A group of Emory and Morehouse medical students worked with metroâ&#x20AC;&#x201C;Atlanta governments to declare racism a public health crisis. The Emory Chapter of the Student National Medical Association (SNMA) is committed to supporting current and future underrepresented minority medical students. PHOTO PROVIDED BY EMORY SNMA

Fall 2020

THE BARE BONES

Your Doctor Is Calling Matthew Pombo is demonstrating how to conduct a telehealth visit for knee pain. “You should first make sure the patient is wearing shorts and is at least six feet from their camera. If you suspect a meniscal tear,” he says, “have the patient do a squat on one leg and twist. If they say their knee hurts on one side, you consider the meniscus.” Specialists from across Emory, from ortho to ENT to GI, are using their lunch hour to demonstrate to medical colleagues and trainees how best to conduct a telehealth visit, because that is the way they are seeing many of their patients these days. Emory Healthcare has seen exponential growth in telehealth visits during the COVID-19 pandemic, with more than 215,000 from mid-March to July. Prior to COVID, Emory Healthcare conducted several telehealth visits per week in only a few specialties. Since mid-March, Emory has been conducting an average of 12,000 telehealth visits per week across 38 specialties.

Emory Connected Care enables patients to consult with health care providers from their home using technologies such as a webcam or a mobile device with a camera.“The speed and quality in establishing a robust telehealth practice from very few visits a week to around 12,000 per week has been an amazing transformation,” says Gregory Esper, professor of neurology, associate chief medical officer at Emory Healthcare, and lead for telehealth initiatives. During the COVID-19 peak in April, when in-person doctor’s appointments were limited, Emory Healthcare conducted 57% of its visits via telehealth.“These remarkable achievements, supported by tremendous behind-thescenes efforts, have allowed our patients to continue seamless care with their health care providers during the COVID-19 crisis,” says Jonathan Lewin, CEO, Emory Healthcare. “While many of our specialty areas are now gradually and safely resuming in-person appointments, telehealth has been an essential offering to patients, and many continue to use this service.”—Janet Christenbury ILLUSTRATION DARIA KIRPACH

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9/14/20 5:05 PM

When a Heart Stops: Improving Cardiac Arrest Survival Rates through CARES The mother of five, in her mid-50s, was talking away one minute and had collapsed onto the carpet in her bedroom the next. Her husband noticed the sudden quiet and

found her on the floor not breathing. He called 911 and started cardiopulmonary resuscitation (CPR) under the direction of the dispatcher. An ambulance came minutes later and first responders used a defibrillator to shock her heart to a perfusing rhythm before transporting her—awake and alert—to the hospital, where she had coronary artery bypass surgery. She was one of the lucky ones. Most victims of sudden cardiac arrest who are not already in the hospital are not so fortunate. Sudden cardiac arrest results from an abrupt loss of heart function and is the leading cause of death among adults in the US. Each year, nearly 350,000 people experience a cardiac arrest outside of the hospital, most in their own homes, and about 90% of them die. “Cardiac arrest develops due to electrical instability in the heart and might be precipitated by a heart attack, a congenital heart defect, or occur during exercise or from an unknown cause. Patients often have no warning or preceding symptoms. The person is walking and talking one minute and the next is collapsed, clinically dead,” says Bryan McNally, executive director for CARES and Emory professor of emergency medicine. The chain of events that begins that very moment can determine if the person lives or dies. “For every minute that person’s heart has stopped, survival drops 7 to 10 percent,” says McNally. “But if a bystander performs chest compressions (hands-only CPR), that can double or triple survival.” Communities that measure outcomes and perform basic improvement activities, like dispatcher CPR education, can improve survival. Enter CARES (the Cardiac Arrest Registry to Enhance Survival), which collects data on cardiac arrest survival rates and other performance metrics. “Prior to CARES, most communities had no understanding of what

happens to a patient whose heart stops, making it impossible to understand how the EMS system is performing or how to improve,” McNally says. Developed by the Centers for Disease Control and Prevention (CDC) and Emory’s Department of Emergency Medicine in 2004, the registry links crucial information from three sources—911 dispatch centers, EMS providers, and receiving hospitals—to create a single record for each person who experiences a sudden cardiac arrest outside of hospitals. “CARES helps communities identify how to improve cardiac arrest survival rates by acting locally,” says McNally. “The program uses data to drive performance and improve care.” Since its inception at Emory and use in Atlanta, the registry has grown to include 28 statewide registries and 50 additional communities in 13 states. CARES has recorded the details of more than 500,000 cardiac arrests. And now it’s expanding to reach all states in the US. “We’ve gotten such great support from Emory and the Woodruff Health Sciences Center,” says Allison Crouch, CARES director of operations and strategic planning. “This isn’t a clinical trial with a beginning, middle, and end. There’s ILLUSTRATION DANIEL NEVINS a need for continuous data collection to assess performance and improve over time. CARES is a unique program that, hopefully, will allow us to increase survival rates across the country.” Survival rates of people who experience sudden cardiac arrest are low overall but vary as much as 10-fold across communities. Victims’ chances of survival increase with early activation of 911 and prompt handling of the call, early bystander-provided CPR, rapid defibrillation, and early access to definitive care. CARES allows communities to measure each link in their “chain of survival” quickly and easily and use this information to save more lives. “You can measure things as much as you want,” McNally says, “but to have an impact you need to make changes in the system.”—Mary Loftus

Fall 2020

“ It’s uncomfortable and it’s hot,” he says, “but it’s not different from what I had to wear when I saw some patients at Grady.” 12

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PHOTO COURTESY OF KEVIN L. GILLIAM II

C0LLISION POINT

THE TWO TRAUMAS By Jim Auchmutey

Photos Caroline Yang

When the brutal death of George Floyd stirred national protests in the midst of the COVID-19 pandemic, these alumni physicians found themselves at the collision point of health and social justice. ON THE LAST SATURDAY IN MAY, AFTER A WEEK IN WHICH HE HELPED TEST DOZENS OF PATIENTS FOR THE CORONAVIRUS, Kevin L. Gilliam II 09MR,

a family medicine doctor at the NorthPoint Health & Wellness Center in Minneapolis, put his welltrained hands to work at another urgent task. He used a power drill to screw sheets of plywood over the windows of his church. Gilliam attends Liberty Community Church with his wife, Iesha Galloway-Gilliam 10MR, whose parents co-pastor the Presbyterian congregation. Liberty had received warnings that African American churches in the Twin Cities might be targeted for vandalism or worse. After George Floyd was killed in police custody on a street in south Minneapolis, the city boiled with protest and burned with anger. Post offices and a police station were destroyed. Government sources told the church that white supremacist groups were filtering into the city to fan the flames. The congregation didn’t want to take any chances. Gilliam and other members had to finish covering the windows in time to get home before

the citywide curfew of 8 p.m. The boards stayed up through most of June. A memorial to Floyd at the corner of 38th Street and Chicago Avenue, near where he was killed, continued to grow as Black Lives Matter protests spread across the nation. “That killing shocked us,” says Galloway-Gilliam, an internal medicine physician. “It was like we were in a house fighting a fire and then a bomb goes off. You can’t hear for a while.” Being doctors, they use medical terminology to describe the public health emergency and

Kevin Gilliam II, a family medicine physician, and Iesha Galloway-Gilliam, an internal medicine physician, live in Minneapolis and found themselves navigating the pandemic and Black Lives Matter protests.

Fall 2020

the social uprising that dramatically intersected so close to their home, and then spread across the country. “We think of them,” Gilliam says, “as the two traumas.”

Racism and a runaway virus At first glance, persistent racism and a runaway virus might not seem related. But to these two doctors—who did their residencies at Emory, who have spent their careers studying the links between health and poverty, between well-being and ethnicity—the momentous events of 2020 bear a telltale resemblance.

It’s one they’ve learned to recognize, and made efforts to rectify, over the course of their lives and careers. Galloway-Gilliam decided she wanted to be a doctor when she was six years old. Born in Minneapolis, where her father has roots, she moved with her family to Atlanta at a young age so her parents could pursue their seminary education at the Interdenominational Theological Center. When a younger sister, Iyana, was born with severe, life-threatening jaundice, they took Iesha to visit her in the hospital. “Iyana had tubes in her head and her arm, and that really made an impression on Iesha,” says their father, the Rev.

Ralph Galloway. “She could sense our fear and grief, and she was powerless to do anything about it. She announced right then that she wanted to be a doctor. We thought she’d grow out of it, but she stayed focused.” Gilliam had a more casual early brush with his future profession. His mother, Jackie Gilliam, worked as a medical assistant and took him to her hospital for bring-your-child-to-work day. Just nine years old, he donned a lab coat and stethoscope. But he didn’t seriously consider medicine until he was in high school and took part in an Upward Bound program at Howard University in Washington, D.C., near his family’s

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PHOTO CREDIT: JUSTIN BERKEN / SHUTTERSTOCK.COM

“ That killing shocked us,” Iesha Galloway-Gilliam says. “It was like we were in a house fighting a fire and then a bomb goes off. You can’t hear for a while.”

COLLISION POINT

For months after George Floyd’s death, people came to this makeshift memorial to leave flowers, signs, and cards under a mural on the sidewalk near the spot where he was killed.

home outside the district in Maryland. “I like working with my hands, and I like teaching, and doctors do both,” he says. Both were exemplary students in high school, winning scholarships to attend historically Black colleges in the South—Tennessee State University in Nashville for him, Stillman College in Tuscaloosa, Alabama, for her. They went on to the University of Cincinnati College of Medicine, where they met at a picnic with an opening line worthy of a romantic comedy: “He came up to me and said, ‘You’re tall. I like tall girls,’ ” Galloway-Gilliam remembers, “and he had this big smile on his face.” They began studying together and have been a couple ever since, marrying after they graduated from med school 13 years ago. They did their residencies at Emory, Gilliam in family medicine (2009) and Galloway-Gilliam in internal medicine (2010), splitting their time between various hospitals around Atlanta. The experience that left the deepest mark was at Grady

Memorial Hospital, where they came face-to-face with the reality of health care inequalities. Galloway-Gilliam remembers one patient, an indigent African American woman who had to be hospitalized with pneumonia. “When we sent her home with antibiotics, she started to cry and said, ‘I get medicine? You mean I can have some medicine?’ I’ve never forgotten that. Some people in the United States don’t know what it is to have medicine. That’s the effect of poverty closely tied to racism. I saw that sort of thing day-to-day at Grady.” After their residencies, the couple moved to Minneapolis, where Gilliam became a family doctor at NorthPoint, a county clinic that treats mostly minority patients, and Galloway-Gilliam landed a position at Hennepin County Medical Center, a downtown safety-net hospital not unlike Grady. She runs an integrative medicine primary care clinic and is codirector of the Comprehensive Weight Management Center.

They live close to Gilliam’s clinic in a 1926 house on the Near North side. They’re not too far from Galloway-Gilliam’s parents’ church, where Gilliam serves as an elder and they help in outreach ministries. They have an eight-year-old daughter who was in the second grade when the pandemic struck earlier this year, suddenly disrupting their busy lives.

‘What if we both got sick?’ The physicians had read about pandemics in medical school—especially the great influenza of 1918—but now they were living through one as health care professionals in the middle of their careers. It was surreal and frightening when they considered how it could affect their family. “My nightmare was, what would happen if Kevin and I both got sick?” Galloway-Gilliam says. “You go through loops of panic, and you think of the worst-case scenario. We didn’t want to leave our daughter without us.”

Fall 2020

“ Social constructs often affect health,” Gilliam says. “The more we’ve practiced medicine, the more we’ve come to see that these chronic conditions are related to inequalities.”

The couple decided to mitigate their risk. Since Gilliam couldn’t avoid seeing COVID-19 patients, Galloway-Gilliam tried to limit her exposure at the hospital, where she teaches residents in addition to her other roles. She still encounters coronavirus patients in other settings but does not work in the viral screening clinic. Since March, Gilliam has tested patients for the coronavirus twice a week in NorthPoint’s walk-in clinic and in a drive-through testing center set up outside on a parking ramp. He armors himself in full PPE—scrubs, booties, gloves, gown, N95 respirator covered by a surgical mask, and a face shield. NorthPoint doctors wore masks over their respirators in the early days of the pandemic, when there were shortages of precious N95s and they were trying to reuse them. “It’s uncomfortable and it’s hot,” he says, “but it’s not different from what I had to wear when I saw some patients at Grady.” The most unpleasant part of the experience came when the clinic was training nurses to do tests and Gilliam served as a guinea pig, his nasal passages swabbed repeatedly to demonstrate how it was done. His own tests have come back negative, as have Galloway-Gilliam’s. The pandemic has changed the family’s lives, as it has for millions of Americans. They haven’t dined inside a restaurant for months, which they really miss, since they consider themselves foodies and once took a pizza

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tour of Italy. They haven’t been to the movies or the theater. They haven’t attended church services since March, settling for virtual worship. They haven’t socialized with family members for many weeks, except online or through drivein encounters when Galloway-Gilliam’s parents visit with their granddaughter from their car. They both turn forty this year and had planned to celebrate Gilliam’s milestone birthday in May with a trip to Hawaii; they settled for a Zoom meeting with family and friends. “We like to walk, and I like to ride my bicycle,” Gilliam says. “I’ve been taking long rides just thinking about things.” No one in their family has contracted COVID-19, but they know many friends and church members who have been touched by the virus. They are not the least bit surprised that the pandemic has affected communities of color disproportionately. CDC statistics show that the infection rate for African Americans and Latinos is triple what it is for white Americans, a disparity they see among patients in Minneapolis. It fits an old pattern in which minorities are more affected by diabetes, hypertension, asthma, and many other afflictions related to environment and poverty. “Social constructs often affect health,” Gilliam says. “The more we’ve practiced medicine, the more we’ve come to see that these chronic conditions are related to inequalities.”

COLLISION POINT

Fall 2020

“ It was not an easy time for us,” says Gilliam’s father, Kevin Gilliam I. “Both our sons are young Black males, and they have to be careful. I’ve always told them if the police pull them over, they need to roll down the windows, put their ID out where it can be seen, and keep their hands on the steering wheel.”

Stages of grief

A burned-out Minneapolis post office Gilliam photographed with his smartphone (above); Liberty Community Church, where Galloway-Gilliam’s parents are co-pastors (above, bottom.) PHOTOS COURTESY OF KEVIN L. GILLIAM II

On the evening of Memorial Day, a convenience store employee in south Minneapolis phoned 911 to report a man he suspected of buying cigarettes with a counterfeit $20 bill. Police responded quickly. Seventeen minutes later, the man lay unresponsive on the pavement. George Floyd, 46, was pronounced dead at Hennepin—the hospital where Iesha Galloway-Gilliam works. An autopsy showed that he was positive for the coronavirus. Galloway-Gilliam was on vacation that week, sheltering at home, and didn’t hear about the incident until the following day. She couldn’t bring herself to watch the graphic videos of Officer Derek Chauvin pressing his knee into Floyd’s neck for an extended period of time, bearing down as he pleaded and repeated, “I can’t breathe.” “Watching that would not have been good for my mental health,” she says. She did see the still photos from the encounter and recognized what she was seeing. “As a physician, I know what death looks like, and I was viewing a dead man.”

‘Not an easy time’ They were appalled but not surprised. Though African Americans make up less than 20% of Minneapolis’s population, police records show that they are much more likely to be pulled over on the roads, arrested, or subjected to force than white residents. A number of fatal police shootings have occurred in the Twin Cities in recent years, making martyrs of African Americans such as Jamar Clark and Philando Castile and feeding the rise of the Black Lives Matter movement.

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During the protests and disturbances that followed the Floyd killing, Gilliam’s parents in Maryland worried about the safety of their sons and families. “It was not an easy time for us,” says Gilliam’s father, Kevin Gilliam I, a maintenance supervisor with the Department of Defense. “Both our sons are young Black males, and they have to be careful. I’ve always told them if the police pull them over, they need to roll down the windows, put their ID out where it can be seen, and keep their hands on the steering wheel.” Gilliam assured his parents that they were safe, but in truth, they were profoundly unsettled. “We wanted to get out in the community and protest,” Galloway-Gilliam says, “but we had to weigh doing that in the middle of a pandemic. We’re doctors and parents, and we didn’t want to be getting out in those crowds and putting our daughter or our patients at risk. We went through a lot of inner turmoil about it.” As the protests spread and sometimes got out of hand, looting and violence struck the West Broadway commercial district near the family’s home. They had to explain to their daughter why businesses were burned out or had smashed glass and why their church windows were covered with plywood. Gilliam’s clinic was boarded up as well because it was considered a possible target as a county facility. While they ultimately decided not to attend the protests in person, many of their fellow church members did, including Iesha’s parents, both in their sixties, who drove as close to the action as they

COLLISION POINT

“ We like to walk, and I like to ride my bicycle,” Gilliam says. “I’ve been taking long rides just thinking about things.”

could and cheered from their cars. Gilliam drove past the scenes of the disturbances and took pictures with his cell phone, texting a snapshot of a gutted Minneapolis post office to a friend in Texas. Wayne Baudy 03MPH, an administrator and physician at Houston Methodist Hospital, attended college with Gilliam at Tennessee State and then earned a master’s of public health at Emory. “There’s a group of us from college who have stayed close, and Kevin is sort of our elder statesman, the one we reach out to when we need to talk,” Baudy says. “This time he was reaching out to me. He sounded burned out and a little sad. It didn’t seem like him. I think he was going through the stages of grief.”

Holistic medicine Since the pandemic started, Gilliam has been speaking about the virus at online

community meetings. In the sessions held after the George Floyd killing, he found himself speaking less about guarding against respiratory infection and more about the psychic and physical burdens of racism. He found it easy to pivot from one trauma to another because he and his wife believe in a holistic approach to integrative medicine. “We both work in the middle of underserved communities and realize that the answers to our problems are often found beyond what we learned in medical school,” he says. “In thinking about how we can be more impactful, we felt that something was missing. We as doctors often separate the physical body from the mind and the spiritual, and they’re quite integrally connected.” In addition to his work at the clinic, Gilliam has decided to pursue

a master’s of divinity at Luther Seminary, a Lutheran institution across the Mississippi River in St. Paul. He isn’t sure exactly what he’ll do with a theological degree, but he believes it could be critical in ministering to the greater wellness of the community he and his wife have committed themselves to serving.

Look for the healers Dealing with disease and social injustice have deepened their religious faith. None of this surprises Galloway-Gilliam’s mother, the Rev. Alika Galloway. “Most of what Jesus did was heal,” she says. “Churches talk a lot about heaven and hell, but Jesus didn’t really talk about them that much. Mostly he gathered people together, taught them, and healed them. “That’s who they are,” she adds. “That’s who we all are: healers.” n

Fall 2020

“

COVID Coverage

“It is difficult to see pictures of all the people at bars and restaurants, socializing, making play dates, and ignoring social distancing recommendations when I know my husband (an Emory emergency physician) and many other health care workers are risking their lives to treat more sick patients.

Please, take this pandemic seriously.”

Rachel Patzer, assistant professor, Division of Transplantation, Department of Surgery, in a series of tweets that went viral and was retweeted by former President

“We are no longer even talking about flattening the curve, we just

don’t want it to look like a ski slope.”

Colleen Kraft, infectious disease physician and associate professor of pathology and laboratory medicine, “Weekend TODAY”

“I can’t even imagine not being able to hold my loved one. Nobody

wants to die alone. It’s awful for the patient. It’s awful for the family. It’s traumatic for health care workers.” Nadine Kaslow, professor of psychiatry, AJC

Barack Obama

“If we go back to less testing, then we go back to flying blind.” Jay Varkey, associate professor of infectious diseases and hospital epidemiologist, Facebook Live

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“It’s a scary time. We don’t want to add fuel to the fire. Good information won’t cure us, but

it will help to calm us.”

“I lived through 9/11 and invading Iraq and tying the yellow ribbon around the tree and coming together for our country. I was

never prepared for the public to be resistant to health interventions.”

“The decisions and choices that we make in society today will have

a direct impact on the number of people who get hospitalized (with COVID-19) two weeks from now.” Jay Varkey, ID physician, Facebook Live

Colleen Kraft, ID physician, National Geographic

“I very much trust CDC. They need to be given resources to do their job.

The cuts to CDC and public health security that the administration pushed in the past are not helping. As Dolly Parton stated, ‘You have no idea how expensive it is to look this cheap.’ ” Carlos del Rio, Distinguished

Ruth Parker, professor of pediat-

Professor of Medicine, Division of

rics, expert on health literacy, AP

Infectious Diseases, AJC

“We are learning at light speed about the disease. Things that previously might have taken us years to learn, we’re learning in a week or two. Things that might have taken us a month to learn beforehand, we’re learning in a day or two.” Craig Coopersmith, professor of surgery, director of the critical care center, NPR

EXPERTS WEIGH IN

“We have a patchwork of responses as opposed to a national response.

We really need a coordinated national response.”

Carlos del Rio, Distinguished

“We’re using diagnostic testing right now in

ways we’ve never thought about using diagnostic testing.” Colleen Kraft, ID physician, “COVID-19 Fireside Chat with Dr. Anthony Fauci,” Facebook Live

Professor of Medicine, WebMD

“How you don and doff Personal Protective Equipment (PPE)? All of those small details are very challenging. One of the reasons we were successful with Ebola, without any of our staff becoming infected, was because the only people who came into contact with those patients were those who had special training.” Bill Bornstein, professor of medicine, aamc.org

“We’re learning so much about the virus every day and

“Air circulation systems on planes are quite good.

how it can impact us in ways we might not expect.”

They have high-efficiency particulate air (HEPA) filters and high rates of air exchange. But that still doesn’t protect you from what is happening immediately around you.”

Jonathan Lewin, executive VP for health affairs; executive director, Woodruff Health Sciences Center, Emory News Center

“I want to thank

every single volunteer for the vaccine studies. Those are real heroes, saying, ‘I want to go first.’” Carlos del Rio, Distinguised Professor of Medicine, Facebook Live

“We’ve got to figure out how can we protect people at the same time they’re going about their daily lives. We have to

focus on living with COVID. There’s not going to be a post-COVID world for a long time.”

“We are fighting an epidemic of virus, and we’re fighting an epidemic of misinformation. I think misinformation is causing infections and it’s causing problems. . . . This is the first pandemic of social media, which becomes an echo box. What I tell

Henry Wu, associate professor of medicine, director of Emory TravelWell Clinic, NPR, Goats and Soda

“My mask protects YOU. Your mask protects ME. OUR masks protect EACH OTHER.

Professor of Medicine,

Anyone can be Batman. Anyone can be a hero. Be the hero your community needs. Be the hero your community deserves.”

Facebook Live

Jay Varkey, ID physician,

people is, look at trusted sources... and be a little skeptical.” Carlos del Rio, Distinguished

Twitter

Colleen Kraft, ID physician, CNN

Fall 2020

Sam Friday, 8, gets a COVID-19 test near his home in Alabama after experiencing troubling symptoms, including stomach and chest pains.

EMORY MEDICINE

COVID CAUTION

CHILDREN AND

COVID-19

PEDIATRIC CASES OF THE NOVEL CORONAVIRUS RANGE FROM ASYMPTOMATIC TO A SERIOUS INFLAMMATORY SYNDROME. MORE IS BEING LEARNED WITH EACH NEW CASE. BUT THE UNKNOWNS ARE STILL DAUNTING, FOR FAMILIES AND DOCTORS. By Mary Loftus

Hannah Friday doesn’t want to hear anyone say, “Kids don’t get sick from COVID.” In fact, it infuriates her. That’s because she watched her son Sam suffer intensely from the virus. “To have an 8-year-old beg you to take him to the hospital …” she says, her voice trailing off. Patrick and Hannah Friday, both Emory Candler School of Theology alumni and former missionaries, live in Birmingham, Alabama, with their twins, Sam and Clinton, where Patrick leads a United Methodist church and Hannah is an adjunct professor at Beeson Divinity School at Samford University. At the end of June, they took their son to their local ER with a severe stomachache, pain in the area of his spleen, and severe pain in his chest (“He said it was 10 out of 10 pain, for at least a week”). He was also dragging one of his legs behind him. Initially, Sam was given two diagnoses: indigestion and constipation. “I had done research and knew he had symptoms that children get with COVID-19 and multisystem inflammatory syndrome in children (MIS-C),” says Hannah. “I’m in a high-risk group and so I asked that the whole family be tested. Everyone we called said no, we’re not going to test you, just assume you have it and quarantine.” The Patricks had been extremely careful, isolating and masking, with Hannah going grocery shopping every two weeks and Patrick switching to “drive-in” services at church.

The pandemic hit home for Emory alumni Hannah and Patrick Friday and twin sons Clint and Sam (l-r, above, at Patrick’s church in Birmingham) when Hannah and Sam tested positive for the virus.

PHOTOS COURTESY OF HANNAH AND PATRICK FRIDAY

Fall 2020

Sam “is our calm child, and if you looked at him, he looked healthy . . . but that wasn’t the case,” says his mom, Hannah Patrick, who also tested positive for COVID-19.

“We only took the kids out three times,” Hannah says, but at one of those gatherings—a family funeral held outside at a farm—she believes they were exposed to the virus. On July 1, Sam’s test came back positive. They were told to isolate Sam from the rest of the family. Instead Hannah moved the boys into her room, with Sam sleeping on one side and Clint on the other. “I couldn’t leave my 8-year-old son in his room and bring food to him,” Hannah says. “He was sleeping with me, I had him by my side.” Finally, the entire family was tested, and this time Hannah tested positive for COVID-19 as well. “It was a relief to finally get the test and the results, actually.”

Hannah’s symptoms included a severe headache and chills that caused her to bundle up in heating pads and an electric blanket. She could feel the virus moving down into her lungs. “At my worst, I didn’t even have enough energy to walk outside,” says Hannah, who started intense self-care, including steam with eucalyptus, immune boosters, and over-the-counter medications. “I also had steroid inhalers and a nebulizer, as well as a pulse oximeter and blood pressure cuff at home.” Patrick was worried and not sure what to do. “To see your child affected by COVID in such a mysterious way, and then your wife catches it,” he says. “It was pretty overwhelming.” During the worst of his symptoms, Sam asked his parents, “Do you have to breathe in heaven?” At the same time that her family was suffering, Hannah was seeing all the doubters on social media, people saying COVID was fake, children couldn’t get it, and there was no need for masks. “No illness should be politicized,” she says. “I was actually questioned by people online, after we knew that Sam had it. I posted a photo of him in the hospital. People need to know it is real and children can get sick from it.” COVID-RELATED SYNDROME IN CHILDREN Children can, indeed, get COVID-19, says Preeti Jaggi, associate professor of pediatric infectious diseases and a clinician at Children’s Healthcare of Atlanta. And while pediatric deaths from COVID are rare, and 94% of children’s cases are considered mild to moderate, some children can become seriously ill. Children with underlying medical conditions are particularly vulnerable. “Kids can become ill from COVID requiring hospitalization, just not at the same rates as adults,” Jaggi says. A subset of children who may have initially had very mild to undetectable illness can become critically ill. These are the ones suffering from COVID-related multisystem inflammatory syndrome (MIS-C.) MIS-C is a condition where body parts can become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal (GI) organs. As with the Fridays’ son Sam, one of the earliest symptoms can be GI distress, so the symptoms could be mistaken for a stomach bug, indigestion, or food poisoning.

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COVID CAUTION Kawasaki disease, an inflammation of the blood vessels that usually affects children younger than 5. At first, she and many other experts thought that’s what they were seeing in children with this type of severe inflammation, but “they were older than the norm—most were over 5 years of age and the median age was 9.” And, unlike the normal adult symptoms of COVID-19, Jaggi and her fellow clinicians were seeing children who didn’t have respiraFraternal twins Sam and Clint enjoy outside time at home, where their family spent most of their time tory symptoms or coughs, isolating during the pandemic. but presented with fever, gastrointestinal symptoms, and hypotension. “They were really sick, it was scary,” she says. “Some needed oxygen, their bellies were distended. There were cases of severe cardiac dysfunction.” The belief now among the CDC and medical experts after studying cases nationwide, says Jaggi, is that MIS-C has two different phenotypes: “The first are children who do not test PCR-positive (by nasal or throat swab saliva tests) but are only identified through serologic testing, which probably means an old infection. While caring for young paThen there are the children who test positive tients with COVID-19, Emory and Children’s Healthcare from the swabs, and in that case, MIS-C overlaps pediatrician Preeti Jaggi and with acute COVID.” colleagues also have been Some adults experience a lot of inflammaconducting research on how tion with COVID-19 as well, which is why the the virus affects children. -C was added to the diagnosis, meaning specifically multisystem inflammatory syndrome in children. And MIS-C is, by definition, serious: a child must be sick enough to have stayed in the hospital in general for about 48 hours to earn the diagnosis. There may even be lingering cardiac issues. “We are tracking everything in these kids,” Jaggi says. “We are carefully monitoring their follow-up with specialists, like cardiology, to make sure they don’t have long-term issues with their hearts.” The Fridays’ pediatrician told Patrick and Hannah the same about Sam—that he might have lingering effects from the virus. s

“We do not yet know why some children develop MIS-C. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care,” reads the CDC site on MIS-C. Symptoms include fever, abdominal pain, vomiting, diarrhea, neck pain, a rash, bloodshot eyes, and feeling extremely tired. “MIS-C was only identified on April 27, so basically clinical care and research started at the same time,” Jaggi says. As well as caring for children with COVID and COVID-related illnesses at Emory Healthcare and Children’s Healthcare of Atlanta, Jaggi and colleagues have been conducting studies as rapidly as they can collect data, hoping to find out more about pediatric transmission, manifestation, and treatments. For example, in their study on “Burden of Illness in Households with SARS-CoV-2 Infected Children,” published in the Journal of the Pediatric Infectious Diseases Society, they investigated the dynamics of illness among household members of SARS-CoV-2 infected children who received medical care (sample size was 32 children who had tested positive for COVID-19). “We identified 144 household contacts: 58 children and 86 adults. Forty-six percent of household contacts developed symptoms consistent with COVID-19 disease. Child-to-adult transmission was suspected in seven cases,” the authors said. Jaggi has also been involved in studies to: n describe the similarities and differences in the evaluation and treatment of MIS-C at hospitals in the United States, in the absence of evidence-based therapies for multisystem inflammatory syndrome in children. n measure SARS-CoV-2 serologic responses in children hospitalized with MIS-C compared to COVID-19, Kawasaki disease, and other hospitalized pediatric controls. “Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children and its temporal association with COVID-19 is important, given the clinical and public health implications of the syndrome,” says Jaggi, who has seen about 30 to 40 children diagnosed with MIS-C. Some children’s blood serum was stored and they were diagnosed retrospectively, she says. Jaggi has long had a research interest in

Fall 2020

The Fridays met at Emory, graduated from Candler School of Theology in 1998, married in 2000, and later found out they were having twins. They named them after two United Methodist ministers and missionaries who died in an earthquake in Haiti—Samuel and Clinton. The twins are in no way identical—Sam is larger and steady; Clint is smaller and more dramatic. Where one goes, they both go, says their mom. So when Sam started complaining about his pain, his parents knew something serious was wrong. “He is our calm child and if you looked at him, he looked healthy. So even doctors were saying, ‘He’s fine, just take him home.’ But that wasn’t the case.” Hannah and Patrick want to let other parents know that they need to be advocates for their children, especially with a new disease, like MIS-C, that even some of the medical workers they encountered had never heard of. Hannah and Sam are feeling better, although they are both suffering some aftereffects. “My body has not quite regained its ability to regulate my temperature, and I am still having pretty severe joint pain,” she says. “Sam is starting to do a little exercise, including tennis practice.” After Hannah told people that she and Sam had COVID, and posted a picture of him at the hospital on social media, other people started writing to her to let her know they or their family member had it too, she says: “A month later, everyone knew someone who had it.” n

COVID-19 Helpers A book to let children know ways they can help during the pandemic, by author Beth Bacon and illustrator Kary Lee, won the Emory Global Health Institute COVID-19 children’s eBook competition, along with a $10,000 prize. The contest, which was aimed at providing information for 6- to 9-year-olds, was proposed by COVI D -19 Jeff Koplan, director of the HELPERS institute and VP for Global Health at Emory, and inspired by his grandchildren’s questions. To view the winning and runner-up books, go to: by Beth Bacon and Kary Lee links.emory.edu/covidkids.

EMORY MEDICINE

The Paradox of COVID-Related Inflammation in Children

easuring blood antibody levels against SARS-CoV-2, the virus that causes COVID-19, may distinguish children with multisystem inflammatory syndrome (MIS-C), a serious but rare complication, say researchers at the School of Medicine and Children’s Healthcare of Atlanta. Children with MIS-C had significantly higher levels of anti-

viral antibodies—more than 10 times higher—compared with children with milder symptoms of COVID-19, the research team found. The results, published in the journal Pediatrics, could help doctors establish the diagnosis of MIS-C and figure out which children are likely to need extra anti-inflammatory treatments. Children with MIS-C often develop cardiac problems and low blood pressure, and require intensive care. The high antibody levels may represent an exaggerated immune response or a delayed complication of COVID-19, or a combination of both, says Christina Rostad, assistant professor of pediatrics at Emory and an infectious disease specialist at Children’s. Senior author Preeti Jaggi, associate professor of pediatrics (infectious disease) at Emory School of Medicine and Children’s, says that “one of the challenges in interpreting these findings in children with MIS-C is that we do not know when they were actually infected with the virus. The rapid emergence of MIS-C has required physicians at Children’s and researchers at Emory to work collaboratively to quickly understand the clinical course of the disease, treatments, and pathophysiology and has required a huge team effort from clinicians and basic scientists.” Children’s physicians have continued to see cases of COVID-19, and more than 50 cases of MIS-C have met the definition of MIS-C requiring hospitalization, in the Children’s Healthcare system. “These cases underscore the importance of all the efforts we are taking as a community to decrease transmission of this virus. By wearing a mask, washing your hands, and avoiding large gatherings, you may be saving someone’s life,” Rostad says. Patients with MIS-C usually present with persistent fever, abdominal pain, vomiting, diarrhea, and skin rashes, and severe cases have low blood pressure and shock, according to the Centers for Disease Control and Prevention. How MIS-C develops remains mysterious. Recent reports have suggested that it arrives in a second wave of inflammation, after the initial viral infection. None of the children with MIS-C studied by the Emory and Children’s researchers recalled having a previous fever or respiratory illness, even though they had high levels of antiviral antibodies. However, the majority tested negative for an active infection at the point of their hospitalization. The authors remark that it “seems paradoxical” that children without preceding symptoms of SARS-CoV-2 infection

COVID CAUTION Multisystem Inflammatory Syndrome in Children (MIS-C)

Inflammation of eyes Inflammation of mouth Swollen lymph nodes

Extremity swelling with redness, rash, skin peeling Renal failure

Fever, headache, muscle aches, lethargy Low blood oxygen, lung problems, chest pains Inflammation of heart muscle, low blood pressure, sped-up heart beat (100+ per minute) Low platelet level in blood

Nausea, vomiting, and pain, diarrhea Lab evidence of current or past infection with SARS-CoV-2

develop such intense immune responses. It may hint that although some children with active infections lack symptoms, they are still capable of developing robust immune responses. “These studies provide supportive evidence that MIS-C represents an aberrant immune response to SARS-CoV-2 infection in children,” Rostad says. “However, the mechanisms of this disease process and the reasons some children develop symptoms while others don’t remain areas of active research.” When they first came to the hospital, children with MIS-C mainly displayed gastrointestinal and respiratory symptoms. Several of them developed myocardial dysfunction with decreased ejection fraction—a measure of the heart’s ability to pump blood. All patients with MIS-C needed to be hospitalized in intensive care because of low blood pressure. Between March and May 2020, the researchers studied 10 children hospitalized with MIS-C, 10 with symptomatic COVID-19, five with Kawasaki disease, and four hospitalized “control cases.” Kawasaki disease is a pediatric inflammatory disease affecting blood vessels, including the coronary arteries, which shares some features with MIS-C. The average age of the children with MIS-C was 8.5 years. The time elapsed between symptom onset and antibody samples being taken varied, generally between zero and 20 days, with a few in the MIS-C group later than 20 days. The researchers used tests for antibodies against the receptor binding-domain

“Making a COVID-19 vaccine is hard. Making one for kids is harder.”

of the viral spike protein and the viral nucleocapsid protein using assays “We should not be leaving children developed in the laborabehind in the warp-speed efforts, tory of coauthor Jens and that’s clearly what we’re doing Wrammert, assistant now,” says Evan Anderson, a pediatprofessor of microbiology and immunology. ric infectious disease researcher at They also performed Emory. Along with colleagues at the live-virus neutralization National Institutes of Health, he’s assays in the laboratobeen developing a protocol to help ry of coauthor Mehul Suthar, assistant profesCOVID-19 vaccine makers navigate sor of pediatrics. the process of pediatric trials and The children with compare the results for different MIS-C were treated with vaccines. “I think there’s an imperaintravenous immunoglobulin (a mixture of tive to get off our derrières and get donated antibodies) going on doing careful trials.”—from and half received cortiWired, 8.14.2020. costeroids, a common anti-inflammatory medication. Some of the COVID-19 group were treated with antiviral or immunomodulatory drugs such as remdesivir (four) and convalescent plasma (two). All the children with MIS-C eventually returned home. Two of the patients with symptomatic COVID-19 were being treated for leukemia and died due to their underlying disease.—Quinn Eastman

Fall 2020

DINNER WITH A DOCTOR: SLEEP

Ready, Set...Pivot

SCHOOL OF MEDICINE RESEARCHERS REFOCUS TO ADDRESS COVID-19 By Quinn Eastman, Shannon McCaffrey, and Rajee Suri

Photos Jack Kearse

Within weeks after the pandemic began, Emory School of Medicine researchers, working with colleagues from across the university and at partner institutions around the globe, mobilized their resources and expertise to address the largest infectious disease threat to humankind in more than 100 years: COVID-19. Some researchers began anew while others pivoted from their existing work to address the new coronavirus. These COVID-19 activities span the spectrum of the disease—from advancing understanding of the virus to coming up with quicker and more accurate tests to finding treatments and a vaccine. Emory’s work is well positioned to go from bench to bedside because of the breadth and interdisciplinary nature of its research; its numerous research centers and facilities, which include one of the world’s largest national primate centers; and its comprehensive health system, which is hosting clinical trials for the next lifesaving drug, therapeutic, and vaccine. School of Medicine COVID-19 research projects have received more than $91 million in federal grants in FY2020. Here is a sampling of the work in progress:

THE NETWORK

VACCINES

Emory is helping to lead the new COVID-19 Prevention Trials Network (CoVPN), which centralizes efforts to protect against the coronavirus. The federally funded network is recruiting and enrolling thousands of volunteers to participate in the large-scale clinical testing of investigational vaccines and monoclonal antibodies. CoVPN links four existing clinical trial networks including the Infectious Diseases Clinical Research Consortium (IDCRC) based at Emory.

Clinics at Emory and affiliates are playing a key role in testing one of the leading COVID-19 vaccine candidates. Co-developed by scientists at Moderna and the National Institute for Allergy and Infectious Diseases (NIAID), mRNA-1273 was the first investigational vaccine in widespread human trials in the US. Early results have been encouraging; studies published in the New England Journal of Medicine examining Phase 1 of the trial showed the vaccine was generally well tolerated and stimulated an immune response.

INVESTIGATOR: David Stephens

School of Medicine COVID-19 research projects have received more than $91 million in federal grants.

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Including the CoVPN, Phase 3 is expected to enroll some 30,000 volunteers around the country, with hundreds taking part at three Atlanta clinics. INVESTIGATORS: Evan Anderson, Colleen Kelley, and Nadine Rouphael

Work is also under way on a home-grown vaccine candidate. Funded by a two-year grant from NIAID, the effort is aimed at taking Emory’s extensive research on an MVA vaccine for HIV and adapting it for the new coronavirus. MVA is a harmless version of a poxvirus with a proven record of prompting long-lasting antibody and T cell responses. MVA vaccines can be used in combination with other vaccines to enhance the immune system’s response. A trial in mice is complete, and nonhuman primate studies are in progress. INVESTIGATOR: Rama Amara

REPURPOSING DRUGS Could drugs already approved for one use be effective against COVID-19? Emory researchers are investigating drugs that have shown antiviral activity in cell culture for COVID-19 and in animals infected with MERS and SARS, coronaviruses similar to COVID-19. Since the drugs work at different points in the viral life cycle, they might work in combination with each other or with antivirals, like remdesivir. Other drugs being tested in novel cell culture assays may dampen the excessive immune response often seen in severely ill patients. All of these drugs are already on the market, widely available, and inexpensive. INVESTIGATORS: Rabindra Tirouvanzia, Joshy Jacob, Manoj Bhasin, Raymond Schinazi, Vikas Sukhatme

MONOCLONAL ANTIBODIES

Monoclonal antibodies

Monoclonal antibody

Viral cell

Antigen-protein on the cell that can cause the immune system to respond. The monoclonal antibody locks onto the antigen. This can cause the immune system to attack the viral cell.

MEDICAL ILLUSTRATIONS MICHAEL KONOMOS

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Studies are also under way to gauge whether manufactured versions of infection-fighting antibodies are effective in protecting against and treating COVID-19. Produced in laboratories, these synthetic antibodies are known as monoclonal antibodies. The CoVPN is focused on monoclonal antibody testing efforts. Here are some of the trials being conducted at Emory: n A Regeneron–sponsored trial to test the effectiveness of a human monoclonal antibody cocktail. Emory is participating in two programs for REGN-COV2, which comprises two antibodies. One targets patients in the hospital with COVID-19, including those on ventilation; the other studies outpatients with the disease. n An Eli Lilly–sponsored trial is studying a monoclonal antibody candidate for treating

RESEARCH ROUNDUP: COVID hospitalized, but noncritical, COVID patients. The drug candidate (LY-CoV555) is being tested in nonhospitalized COVID-19 patients. In another trial, jointly funded by NIAID and Lilly, investigators will evaluate the same monoclonal for its ability to prevent moderate to severe COVID-19 in residents of nursing home and assisted-living facilities in Georgia. This statewide study is part of a larger, nationwide research project. n A NIAID-sponsored clinical trial to evaluate the safety and efficacy of an experimental monoclonal antibody (LY-CoV555) in combination with an antiviral, remdesivir, for treating patients who have been hospitalized with mild to moderate COVID-19. n A study that will assess the efficacy and safety of the human monoclonal antibody, gimsilumab, in patients with lung injury or acute respiratory distress syndrome due to COVID-19. Researchers have received a grant from Kinevant Sciences, which is part of the pharmaceutical that makes the drug compound. INVESTIGATORS:: Marshall Lyon, Nadine Rouphael, Sri Edupuganti, Michael Hart, Jens Wrammert, Carl Davis, Bradley Leshnower n

Researchers are studying monoclonal antibodies from lampreys to better understand the new coronavirus. Lampreys are an ancient species of fish resembling eels and provide important clues for researchers about the evolution of our immune system and potential ways to fight new pathogens. The monoclonal antibodies produced by this project will be used for virus isolation and diagnosis and could support the work of other researchers to develop therapies. INVESTIGATORS: Max Cooper,

pact of remdesivir, an experimental medication administered by infusion. Emory is also taking part in the next iteration of the study, which combines remdesivir with baricitinib, an oral, anti-inflammatory drug already approved by the FDA for rheumatoid arthritis. The study will explore baricitinibâ&#x20AC;&#x2122;s ability to calm the hyper-inflammatory response (also called cytokine storm) that the novel coronavirus causes in the lungs and determine whether the drug is best used alone or in combination with remdesivir. INVESTIGATORS: Aneesh Mehta, Nadine Rouphael, Emory Vaccine Center Infectious Diseases faculty

Researchers have launched another trial with an immunomodulator called imatinib or nilotinib to limit hyperinflammatory responses characteristic of severe COVID-19 disease. INVESTIGATORS: Vincent Marconi, Nadine Rouphael, Ray Schinazi, Marshall

Lyon, Daniel Kalman, Emory Infectious Diseases faculty

A research team is using low-dose radiation therapy (LD-RT) to treat COVID-19 patients to reduce the pulmonary inflammation that severely affects these patients and threatens their ability to breathe on their own. The first cohort in this Phase 1/2 trial will consist of five critically ill, hospitalized patients not currently on ventilators, and it is hoped that the LD-RT will reduce their risk of requiring mechanical ventilation.

Studies will gauge whether monoclonal antibodies are effective against COVID-19.

INVESTIGATORS: Mohammad Khan, Clayton Hess

Emory investigators are testing whether an anticancer drug can reduce lung inflammation in hospitalized COVID-19 patients, possibly preventing the need for intubation and lowering

Masayuki Hirano

THERAPEUTICS When the Food and Drug Administration this spring granted emergencyâ&#x20AC;&#x201C;use authorization to use the drug remdesivir to treat COVID-19 patients, Emory shared in the good news. Emory is part of the Infectious Diseases Clinical Research Corsortium (IDCRC), and a global network of NIAID sites that tested the antiviral. Emory recruited more patients than any other site around the globe. Researchers are continuing to evaluate the longer-term im-

Fall 2020

mortality. The drug is called duvelisib, and it was FDA-approved in 2018 for the treatment of a certain type of leukemia. This Phase 2 study is supported by duvelisib’s manufacturer, Verastem Oncology. The Emory team plans to recruit 40 patients hospitalized with COVID-19 pneumonia. INVESTIGATORS: Edmund Waller, Aneesh Mehta, Marshall Lyon

VIRUS-NEUTRALIZING ANTIBODIES

Virus-neutralizing antibodies develop within days.

Researchers at Emory have found that nearly all people hospitalized with COVID-19 develop virus-neutralizing antibodies within six days of testing positive. While most other studies on the topic have focused on the immune response after hospitalization, Emory used its biosafety level 3 laboratories to do the more time-consuming work of studying patients’ antibody response during hospitalization. The study’s findings have implications for convalescent plasma therapy and vaccine development. Using this research, clinicians will evaluate the use of convalescent plasma with high levels of neutralizing antibodies as a treatment for the new coronavirus. The FDA has authorized emergency use of convalescent plasma therapy as an experimental treatment in clinical trials and for critically ill COVID-19 patients. INVESTIGATORS: John Roback, Sean Stowell, Colleen Kraft, Nadine Rouphael,

Aneesh Mehta, Rafi Ahmed, Jens Wrammert, Mehul Suthar

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RESEARCH ROUNDUP: COVID

Fall 2020

Positive

(sample positive for SARS-CoV-2 antibodies)

Emory is one of the sites selected by NIH to vet diagnostic COVID-19 tests.

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three Atlanta institutions selected to vet the most promising diagnostic technology. Working with their counterparts at Children’s Healthcare Emory administered its first dose of the Moderna mRNA COVID-19 vaccine at the Hope Clinic of Emory Vaccine Center in mid-August. Hundreds of adult volunteers 18 and older of Atlanta and Georgia are enrolled at three clinics: Emory Children’s Clinic, the Hope Clinic, and Grady Health’s Institute of Technology, Ponce de Leon Center. Emory researchers will put the technologies through a competitive, rapid threephase selection process to identify the best BLOOD CLOTTING candidates for at-home and point-of-care COVID Georgia is in the so-called stroke belt, a swath -19 tests. The $31 million funding for this project of Southern states where age-adjusted stroke is the largest NIH grant Emory has received in a mortality levels are high. So, COVID’s links to single budgetary year. INVESTIGATORS: Wilbur Lam, Greg blood-clotting problems were particularly Martin, and Oliver Brand worrisome. Emory researchers are leading Emory has developed a SARS-CoV-2 antibody a study to identify blood tests that can help test to enhance disease detection. Antibody or sedetermine which COVID-19 hospital patients are at the highest risk for developing blood clotting rological tests can help answer critical questions disorders that cause stroke, heart attack, or clots such as virus neutralization, disease progression in populations, exposure to the virus, and infecin the lungs, legs, or arms. Preliminary studies tion spread. Emory’s antibody test identifies the have showed that certain blood biomarkers can exact type of antibody that prevents the COVID-19 identify high-risk patients early and, with early virus from connecting with and entering human use of blood thinning medications, prevent cells, which allows physicians to better predict clotting complications. Another study is lookwhether someone with a positive antibody ing to understand why an enzyme that causes test result is likely to be protected from future clotting becomes dysregulated during the infection. Emory experts are also evaluating course of the infection, which can be especially devices that collect plasma samples from blood harmful to patients with pneumonia who are at droplets—taken by a finger prick—which can be high risk for respiratory failure and require, in transported safely through the mail or by courier extreme cases, an artificial lung. INVESTIGATORS: Emory to Emory Medical Labs for the Emory antibody stroke, neurology, and heart and vascular researchers test. This innovation would combine “point-ofcare” testing with the rigor of Emory’s antibody DIAGNOSTICS test. To facilitate widespread antibody testing in Millions of accurate, widely accessible COVID-19 the state, a reliable device for at-home sample tests in time for flu season—that’s the ambicollection is important. INVESTIGATORS: Rafi Ahmed, John tious goal of a $1.5 billion National Institutes Roback, Mehul Suthar, Jens Wrammert of Health (NIH) initiative. Emory is one of

FIRST PERSON

Hugs All Around There are two kinds of days for my family during this time of staying home. The days

I wake up, make the coffee, stir my 8- and 5-year-old daughters from their beds and get ready for another day of virtual school, Zoom calls with colleagues, finding something special to cook to raise everyone’s spirits, and making the best of a tough situation. These are the normal days within our abnormal times. Then there are the days where my wife isn’t here. We are living through two weeks of those days right now. Those are the days I take care of the girls alone while waiting each day for an update from the medical front line. You see, my wife is an emergency physician at Grady Memorial Hospital, and we have decided that during and after her stints of shifts treating dozens of COVID-19 patients every day that she will stay elsewhere, alone, to keep us healthy—a double sacrifice. Being the spouse of a health care worker in this pandemic is a mix of pride, worry, practical sacrifices, and a deep sense of powerlessness. She and her colleagues have volunteered for extra shifts, dealt with equipment shortages, and have worried about their own health while caring for others. I do my best to make sure the house runs smoothly, the kids’ hair is combed for our Facetime sessions with mom, and that we do our part to lessen her stress (clean bathrooms get us bonus points). I’m reminded from these experiences that we never really know what our neighbors or friends are dealing with—I think about those who have watched loved ones from afar battle the virus, those who have health conditions we can’t see, and the kids, who know something is deeply wrong but don’t have the experience to put it into any context. I’m not sure I have a way to help them understand except to tell them how their mom is a hero and how we do our part to help by brushing our teeth, washing our hands, and keeping a good attitude even though story time is through the computer on those nights she is away. The frontlines in this battle are not only the hospitals, but the grocery store lines, the UPS deliveries, the manufacturing plants of essential goods. I’ll be giving my frontline heroine a big hug in a couple of weeks when she returns home to us. I hope you’ll thank your frontline friend or family member today—and maybe their partner, too. Emory alumnus Doug Shipman wrote about his spouse, Emory Associate Professor of Emergency Medicine Bijal Shah 06M, in mid-April for GPB’s “All Things Considered.” ILLUSTRATION BY JON KRAUSE

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SURVIVOR

STORIES By Jerry Grillo

Photos by Jack Kearse

Black communities have been hit hard by COVID-19. Here, four families share their experience with the novel coronavirus and what itâ&#x20AC;&#x2122;s like to come out on the other side, alive and grateful.

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PATIENT CENTERED CARE

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CLAUDETTE HIMES HAD JUST SPENT 12 AND A HALF DAYS IN AN ISOLATED HOSPITAL BED AS A VENTILATOR PUSHED AIR IN AND OUT OF HER LUNGS WHILE HER HUSBAND, LEONARD, WAITED ANXIOUSLY FROM A SAFE DISTANCE, WONDERING IF SHE WOULD LIVE OR DIE. Though Claudette’s body had been slipping toward the latter, she rallied suddenly on the 13th day, emerging from an induced coma with tears on her face and a prayer on her lips. “It was Psalm 91. When I woke up, I was saying that prayer,” recalls Claudette, a 63-year-old accountant who spent several weeks in Emory Saint Joseph’s Hospital battling COVID-19. It was a prayer she and Leonard, associate pastor at Beulah Baptist in Decatur, said together every morning before they went to work and every night before they went to sleep. “The prayer of protection. It was part of our life,” Claudette says. It was a prayer the couple had been saying together for months, long before an unexplained high fever and breathing trouble sent her to the hospital on March 16. She doesn’t remember many of the days that followed. “The next thing I know, my eyes are

open and a lady is telling me, ‘Ms. Himes, don’t cry. We thought we’d lost you.’ She also said, ‘You are our miracle.’ ” Lost her? Miracle? Claudette had no idea what her nurse meant; at the time she didn’t even know what it was that had tried to kill her. These were the early days of the global pandemic, and she was an unfortunate pioneer. Health care providers and patients alike were grappling with a massive medical mystery. Several Atlanta-area families who have been acutely affected by COVID-19 agreed to speak with us about their experiences. The patients are a diverse group: a PhD psychotherapist infected while working on the frontline of the pandemic; a kidney transplant recipient who fought the virus in the hospital while his wife recovered at home; the beloved grandmother of a close-knit family; and the Himeses. The families share a few common threads: their illness was severe enough to require hospitalization at one of Emory’s facilities in metro Atlanta; the patients all are African Americans, which places them in a high-risk group during the pandemic; and they credit their deep faith with pulling them through.

Claudette Himes (above, with husband Leonard Himes) credits her care team, her deep faith, and Leonard’s help and support for her recovery from COVID-19.

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HERE BECAUSE OF LOVE Psychotherapist Andrea Young was working in the emergency room with a mental health patient who was in isolation for COVID-19. Within two to three weeks, she started feeling symptoms, which she figured was an allergic reaction to March’s high pollen count. But a persistent fever and breathing trouble sent her to Emory Decatur Hospital. Andrea drove herself. “It was an excellent set-up, I was impressed,” she says. “They had something like a MASH unit outside the ER—it took me back to my military days. I remember thinking, ‘Somebody here really knows what they’re doing.’ It was all very orderly.”

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That was Friday. She was isolated in a hospital room before her virus was confirmed. On Sunday she was discharged and told to quarantine at home. On one hand, she was relieved to be well enough to go home. On the other, there was the matter of Chico, her beloved shih tzu— what would happen if she exposed him to the virus? “My doctor wasn’t sure of how COVID-19 would affect animals, and I really love my animal. But I had to send him away for a few weeks,” she says. “That was hard on both Chico and me.” When she got home, Andrea put herself on a regimen of, “hot tea, all day and night. I’m convinced I would not be here without it. All kinds of tea. And the only medicine I took was Tylenol and blood thinner.” Her get-well program also included liquid B-12 and zinc supplements every day, “the natural approach,” she says. As her appetite returned (“That was the worst symptom,” Andrea says), she got back into exercising. Being active made a difference for her, she says, along with her deep faith. “I’m a very spiritual woman,” she says. “I take no credit for my healing. I prayed for that to happen.”

PHOTO COURTESY OF ANDREA YOUNG

Black Americans are more likely to be infected by COVID-19 and, once infected, are more likely to die. In fact, they have been dying at about 2.4 times the rate of white Americans. As emerging data continues to show that African Americans are disproportionately harmed by the pandemic, it reflects an entrenched reality of health and health care disparity. “Social determinants of health that are deeply rooted in structural racism have created a lot of gaps,” Tracey Henry, assistant professor of medicine at Emory, told a virtual audience during a webinar in June hosted by Emory School of Medicine about the impact of COVID-19 in communities of color. “Specifically, I’m talking about the poverty gap—in the US, race and ethnicity is very much tied to poverty,” said Henry, a physician at Grady Memorial Hospital in Atlanta and a health policy expert. “People of color are much more likely to have less access to basic resources for health and wellness. So Black people were generally starting at a disadvantage at the onset of this pandemic, in terms of getting the care they need and being able to successfully overcome the virus.” Henry and other panelists shared information, statistics, and anecdotes that told the grim story of health and health care inequity in Georgia and the US, illustrating the challenges that a global pandemic has brought. Panelist Janice Newsome, director of Interventional Radiology and Image Guided Medicine at Emory Hospital Midtown, said the pandemic has uncovered, “a lot of small cracks that turned out to be gaping holes. This disease has humbled us quite a bit.”

A persistent fever and breathing problems sent psychotherapist Andrea Young (above) to the hospital, where COVID-19 was confirmed.

“ THE DISPARTIES WE’RE SEEING IN THIS PANDEMIC ARE NOT NEW. WE’VE HAD ENORMOUS HEALTH CARE DISPARITIES IN THIS COUNTRY WE HAVE NOT ADDRESSED. MY HOPE IS THAT, AS A RESULT OF THE PANDEMIC, WE’RE GOING TO IMPROVE THE RACIAL AND ETHNIC DISPARITIES THAT HAVE BEEN SO UNACCEPTABLE.” —Carlos del Rio, NPR Health, Sept. 13, 2020

PATIENT CENTERED CARE When she retested as negative, Andrea was able to get a long-awaited hug from her son, Julian, and cried in his arms. Chico came home and Andrea insists she feels better now than before she got sick. She returned to work the first of June and is adamant about the importance of wearing proper Personal Protective Equipment (PPE). “If you love your community, you’ll wear a mask,” she says. “I’m here because of love and compassion,” she says. “The love and compassion given to me by other human beings, and also God’s love. I am alive because of love.” A LONELY DISEASE You don’t have to be an expert in risk management, like Walter Gilstrap, to realize that he was the classic high-risk patient to develop COVID-19. At 65, he’d had a kidney transplant in 2007 as a result of polycystic kidney disease, and he has a heart murmur. And thanks to his suppressed immune system, he battled a case of pneumocystis pneumonia (PCP) so severe in 2010 that he spent a month in the hospital. At one point during that stay, the hospital chaplain called for Walter’s wife, Theresa. “He

told her she’d better get to the hospital fast,” Walter says. “Of course, I pulled through.” Walter spent almost another month in the hospital during his COVID-19 ordeal, which began in late February. He had symptoms of a urinary tract infection, and took antibiotics and kept tabs on the fever, which would never quite leave. By the weekend of March 13, when it was obvious that he wasn’t getting better—now he was experiencing low energy and diarrhea, too—he went to the emergency room at Emory University Hospital, where he spent the night. His son, Justin, stayed with Walter through the weekend. On Monday, Walter was diagnosed with COVID-19—and a urinary tract infection. “And from there, it was like a long roller coaster ride,” Walter says. “I wasn’t having any noticeable respiratory symptoms of COVID-19 or anything to suggest my lungs were impaired. But my oxidation numbers were very low.” Several days later he was placed on a ventilator. That lasted for two days. But his breathing was still troublesome, and he was placed on the ventilator again for several days. It looked bad. “My numbers were not good,” he says. “Then literally overnight, my oxygen levels went from precarious to 100 percent. I started feeling better.”

For Walter Gilstrap (below, far right, with his family) recovery from COVID-19 was “like a long roller coaster ride.” His wife, Theresa (in pink), had a milder case.

Fall 2020

Blacks are more likely to be infected by COVID-19 and, once infected, are more likely to die, than whites. In fact, Blacks have been dying at about 2.4 times the rate of whites during the pandemic. Other communities of color, including Latino and Native American populations, have also been hard hit by the virus. The CDC attributes this difference to health inequities, such as poverty and health care access, discrimination, more crowded housing, and more underlying health conditions, such as high blood pressure and diabetes. Also, ethnic and racial minority groups are disproportionately represented in essential work settings such as health care, farms, factories, grocery stores, and public transport, and thus at higher risk of getting the virus.

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He was taken off the ventilator; the virus was diminishing, but he had dangerously high levels of a protein called creatine kinase (CK), which happens in about 14 percent of COVID-19 patients. To avoid going on dialysis he was put on an IV therapeutic cocktail that eventually brought his CK levels down from the danger zone (high CK levels can lead to renal failure). “I was finally able to go home after 27 days in the hospital, 17 of those in the ICU,” he says. Meanwhile, Theresa had also tested positive for COVID-19. She was able to isolate at home, in her own bed. Their children, wearing PPE, became caregivers. Justin lives just minutes away and their daughter, Janna, flew home from New York and spent several months in her parents’ Decatur home, helping to care for Theresa. Theresa and Walter communicated, when they were able, via Facetime. By the time Walter went home on April 10, Theresa had recovered. But after so many days in a bed, the muscles in Walter’s legs had atrophied, and he couldn’t walk. “I went from a wheelchair to a walker, then completed six weeks’ worth of physical therapy in three weeks. I had some catching up to do,” says Walter, who retired several years ago after 40 years in risk management with a Fortune 50 client list that included Coca-Cola and UPS, among others. The Gilstraps believe they were infected while visiting Walter’s younger sister in the hospital (for a non-COVID issue) in early February. Walter seldom leaves home now and, when he does, he wears a mask. He thinks back on his four weeks in the hospital: “What a lot of people miss is, this is a very lonely disease, which makes it mentally challenging, in addition to the physical and emotional toll. Not being able to see your loved ones makes it even more difficult than it would be otherwise.” PRAYER FOR PROTECTION The trouble started on Friday the 13th. Claudette Himes felt like she had the flu, but her fever wouldn’t go down and her primary care physician sent her to the emergency room at Emory Saint Joseph’s, where she was tested for COVID-19. They should have the results in a few days, the Himeses were told. Go home and rest. Leonard Himes, who has been married to Claudette for eight years, picks up the story: “Her symptoms only got worse, and then late that

Sunday night, she had trouble breathing. She was confused. I found out later that confusion is part of the COVID course of events for some people.” On Monday he brought his very sick wife back to the hospital. With low blood-oxygen saturation and failing lung capacity, Claudette was placed on a ventilator. Leonard was sent home alone but spoke with her physician every day, and called the ICU nurse regularly, for almost two weeks. Her test had come back positive for COVID-19. “That was the toughest part, not being there with her,” he says. “She seemed to be getting steadily worse. For every step forward, two steps back. She was having kidney issues, and her lungs were full of pneumonia. Her physician said we needed to discuss palliative care.” On Friday, March 27, through a baby monitor placed in Claudette’s room by the hospital chaplain, Leonard spoke with his wife for what he believed could be the last time. He hoped that Claudette could hear him saying, “I love you.” Saturday morning, Leonard met virtually with Claudette’s attending physician, as well as the chaplain, an epidemiologist, a pulmonologist, and several others, including his niece, who works in infectious diseases. They were going to discuss his wife’s end-of-life plan. That’s when Leonard’s phone started ringing. The nurse was calling. Claudette was sitting up in bed. Several days later, on April 2, she celebrated her birthday in a different hospital room, surrounded by joyful hospital staff. The next day, still testing positive for the virus, she went home. Leonard wouldn’t consider a rehab facility. He was going to care for her. Having been a firefighter and paramedic, he felt well suited to the difficult task. “I had some great nurses in the hospital, but my husband was the best nurse I had,” Claudette says. “The Bible talks about no greater love than a man who will lay down his life for a friend. I am so thankful and grateful to have a husband who loves me so much he would put his own life in jeopardy to care for me.” As she started feeling better, the Himeses were able to celebrate their wedding anniversary with a quiet dinner at home. “Don’t take your health for granted, please, I implore you,” Claudette says. “Wear your mask, social-distance. I am just so glad that I can see my husband, I can sit at the table and eat dinner with him, we can pray, we can sit on the back porch and enjoy looking out at the birds and just being together.” n

PATIENT CENTERED CARE Three generations—(l to r) Barbara Johnson, Elizabeth Matthews, and Mikisha Johnson—supported each other during 83-year-old Elizabeth’s recovery from COVID. “I thank the Lord I made it through,” she says.

THREE

MIKISHA JOHNSON HAD JUST HUNG UP THE PHONE. On the call, her 83-yearold grandmother, Elizabeth Matthews, had struggled to string words together and sounded disoriented. “Grandmama By Shannon doesn’t sound right,” Mikisha told her mother, Barbara. When Barbara Johnson arrived the following morning at her parents’ home in the southwest Atlanta neighborhood of Collier Heights, her mother didn’t look right either. Barbara told her, “Mama, you’re slurring your words, your mouth is twisted, and your hand is trembling. You are going to the hospital.” Elizabeth already had a pretty good idea what was wrong, but she didn’t want to worry her daughter. “I said to my husband, ‘I believe I had a stroke,’ ” she recalled. She was right. But that wasn’t all. At that visit in early August, doctors at Emory Saint Joseph’s Hospital told Elizabeth she’d also tested positive for COVID-19. “I got real emotional when they told me that,” she says. “I was thinking, ‘Am I going to die?’ ” Since the COVID-19 outbreak began late last year, it has largely been understood as an assault on the respiratory system. Telltale symptoms are often a fever, hacking cough, and difficulty breathing; patients in the worst shape end up on respirators. What is still less understood but just as alarming is the damage the virus may be doing to the brain, from strokes to reports of headaches, seizures, and confusion. And that doesn’t take into account the staggering toll of the pandemic on our mental health.

Today, more than 300 studies from around the world have looked at links between neurological problems and COVID-19. More are under way. “We are now recognizing COVID-19 McCaffrey disease actually has a significant neurological implication or neurologic effect,” says Byron Milton III, a physiatrist in physical medicine and rehabilitation at Emory University Hospital who has helped COVID patients cope with dementia-like symptoms and other neurological problems. Even as they care for patients, researchers and health care providers at the Emory Brain Health Center are among those leading the way toward understanding the short- and long-term neurological implications of the pandemic on the brain and the mind. Those efforts are featured in Season 2 of the “Your Fantastic Mind” television series from Georgia Public Broadcasting and Emory, at pbs.org/show/your-fantastic-mind/. Elizabeth spent six days at Emory Saint Joseph’s Hospital battling COVID-19 and recovering from a stroke. Once back home, she was told to quarantine for 14 days, although she did 17 days for good measure. She doesn’t know whether COVID-19 contributed to her stroke. Retired as a factory worker at the now defunct General Motors plant in Doraville, she’s taking it easy these days. Her breathing can still be labored; she gets winded easily. The trio miss their T.J. Maxx shopping trips together. But they’re also grateful that Elizabeth will be around when her granddaughter has her first baby. n

GENERATIONS OF

CARING

Fall 2020

09:24:20 | A COVID-19 FIRESIDE CHAT WITH DR. ANTHONY FAUCI

CUTTING THROUGH THE CHAOS DURING THE PANDEMIC, SCHOOL OF MEDICINE FACULTY HAVE BEEN CALLED ON TO WRITE OP-EDS, APPEAR ON LIVE NEWS BROADCASTS, AND SERVE AS EXPERT ADVISERS. THEY’VE TURNED HOME OFFICES INTO TEMPORARY STUDIOS AND USED SOCIAL MEDIA TO GET HEALTH FACTS OUT. HERE ARE JUST A FEW OF OUR PUBLIC SCHOLARS:

| CARLOS DEL RIO Executive Associate Dean for Emory at Grady Memorial Hospital, Carlos del Rio, Distinguished Professor of Medicine in the Division of Infectious Diseases and professor of global health and epidemiology in Rollins School of Public Health, is a sought-after expert on COVID-19. And he doesn’t pull any punches on what he sees as the mishandling of the pandemic in this country. “While this is heartbreaking, what has to be said over and over is that this did not need to happen,” he says. “What drops my stomach through the floor is the irresponsible political leadership during this pandemic that has us in a crisis.”

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From appearing live on CNN and MSNBC’s “The Rachel Maddow Show,” to coauthoring several viewpoint articles on the novel coronavirus in the Journal of the American Medical Association, to serving on the National Collegiate Athletic Association’s (NCAA) COVID-19 advisory panel, to his more than 33,000 followers on Twitter, del Rio doesn’t back away from challenging misinformation and calling out poor decisions. This is not the first pandemic del Rio has battled publicly and clinically. Since his days as a physician in training, del Rio has worked to reduce the spread of HIV on multiple fronts, directing the NIH-sponsored HIV Prevention Trials Network at Emory and codirecting the Emory Center for AIDS

INFLUENCERS Research. He also serves as Foreign Secretary of the National Academy of Medicine. Del Rio has turned his office into a broadcast studio of sorts, with improved lighting and an abstract painting of lungs on the wall behind him, painted by his daughter. “She did a series some years ago on the organs—the lungs, the heart, and the brain—which I loved. Now it turns out they are the three organs most impacted long term by COVID-19.” He understands the power of social media to reach people directly. Del Rio has done several Facebook live webinars and tweets nearly every day. Del Rio’s tweets sometimes highlight an upcoming media engagement: “Will be joining @ JohnKingCNN in @CNNPolitics tomorrow to talk about how quickly a vaccine can be approved, public trust about safety and questions of political pressure on @US_FDA to fast track a #SARSCoV2 vaccine before the election.” Or he may simply remind people of basic protective measures: “As health care workers, we are tired, we are frustrated, and we are mad. If March–April was a wave this is a tsunami and could have been prevented. Please everyone #WearAMask #WatchYourDistance & #WashYourHands.”—Mary Loftus | SANJAY GUPTA Perhaps the Emory physician with the most airtime during the pandemic is Associate Professor of Neurosurgery Sanjay Gupta, CNN’s chief

medical correspondent and host of “Sanjay Gupta MD,” for which he has won multiple Emmy awards. Gupta continues to see patients as a general neurosurgeon at Grady Memorial in Atlanta. He is a frequent contributor to numerous CNN shows covering the crisis, and hosts a weekly town hall with CNN anchor Anderson Cooper. Each week, on CNN Health, the father of three answers kids’ questions about COVID-19, such as “Why do some people get the coronavirus but don’t feel sick?” and “When can I hang out with Grandma and Grandpa again and not have to worry about giving them coronavirus?” Gupta also hosts a “Coronavirus: Fact or Fiction” podcast, (cnn.com/audio/ podcasts/corona-virus) where he covers such topics as frontline workers at the breaking point, Doctors without Borders helping American nursing homes, and how this pandemic compares with the 1918 influenza pandemic. As a trusted medical journalist, viewers look to Gupta for understandable medical explanations and implications of the ever-evolving discoveries about COVID-19, such as the recent finding that up to 35 percent of Big Ten athletes who had the virus now show signs of heart inflammation. “This is pretty frightening,” he says, before describing the fact in more detail. Gupta (@drsanjaygupta on Twitter) sees his role as “setting the record straight” on inaccurate information that is circulated, much of the time on social media.

“Since I started reporting on the coronavirus, I’ve heard a lot of myths and theories about it,” Gupta says. “The outbreak has unleashed so much information, the World Health Organization has called it an infodemic. And there’s so much misinformation that goes along with it.” One specific appearance by Gupta on the big screen has gone viral—when he portrayed himself in the 2011 movie Contagion. “In one scene, Dr. Sanjay Gupta is featured on a TV news program discussing preventive measures [against a fast-spreading, lethal virus]. Now, nine years later, he’s doing it for real on CNN,” says an article in Variety.— Mary Loftus | DAVID HOLLAND Associate Professor of Infectious Diseases David Holland spent years working on HIV, tuberculosis, sexually transmitted infections, and viral hepatitis with the Fulton County Board of Health. “The strongest public health agencies in the US maintain strong connections with academia, and I am very grateful to be in this position,” he says. But when the novel coronavirus pandemic came to the US, Holland’s role as chief of Medical and Preventive Services for Fulton County pivoted to focus on COVID19—a disease that would need to be managed through testing and contact tracing, with no vaccine available. “In a lot of ways this was not a pandemic that we planned for,” says Holland, who oversees the board’s COVID-19

testing activities. But they adapted. Holland said that by July, the Board of Health and its partners were testing up to 25,000 people per week at fixed and mobile sites within the county. “We’re hoping sometime in the not-toodistant future, we’ll be able

to convert testing to vaccine administration,” Holland says. Holland’s work during the HIV crisis taught him a crucial lesson: The most effective testing strategy is to engage the community from the start. “For any sort of intervention to work,” he says, “it has to be something that is meaningful to the people.” Working closely with minority communities that experience disproportionate impact from disease, Holland says, is a responsibility to which public health agencies have recommitted during this time of national awareness of systemic racism. “I’m proud to work for two organizations—Fulton

Fall 2020

and Emory—that are engaged in definitive anti-racist activities, particularly around health care,” he says. “We can never achieve any of our goals in public health until we assure health equity for everyone.”—Emily Weyrauch | NADINE KASLOW Professor of Psychiatry and Behavioral Sciences Nadine Kaslow is often called on by the media to comment on effective coping strategies during times of crisis. So, understandably, she has been called on frequently during the pandemic, by everyone from CNN to Georgia Public Broadcasting. She has written op-eds for CNN.com, done Q&As on social media on the topic of mental health and COVID-19, and speaks about how children are being impacted by COVID-19. “It’s really, really hard on kids. And they don’t developmentally have the same coping strategies as adults do. There’s no way they can.” Kaslow suggests families have at least one meal together a day and “try to build in pleasurable activities. I do think our kids are picking up on our anxieties, so we need to be mindful of that. . . . Now is the time to say, ‘I’ll bet this must be hard for you, not getting to see your friends.’ Be patient and tolerant, and remember what our kids need most from us right now is our love.” Kaslow is often called on to help health care providers who are stressed or experiencing PTSD. At Emory she launched a series of support groups—Caring Communities

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for COVID Caregivers—held in ICUs and hospital units treating COVID-19 patients. The groups use a peersupport framework to help medical workers share coping strategies. Kaslow and her colleagues also run support groups for medical workers who have tested positive for COVID-19 and for those who are grieving. In addition, she has partnered with the World Health Organization–Africa and the US Department of State to offer education, guidance, and support to frontline medical providers in Africa and other regions with a shortage of mental health care providers. She encourages everyone to embrace compassion. “All of us having to change our normal routines is extremely stressful, and we’re all scared of getting sick and dying or losing people we care about,” Kaslow says. “I think escapism is absolutely fine, even if it involves Netflix and snacks. Be easy on yourself as well as those around you.”—Mary Loftus | COLLEEN KRAFT Associate Professor of Infectious Diseases and Pathology Colleen Kraft is no stranger to pandemics. Five years ago, she played a lead role in treating Ebola patients who came to Emory during the 2014–16 outbreak. Now she’s helping to coordinate her hospital’s response to COVID-19 as an associate chief medical officer at Emory University Hospital. Kraft is helping to shape the national conversation—

04:09:20 | LIFE WITH COVID-19 CALMING THE MIND

09:01:20 | CNN NEWSROOM

09:14:20 | CNN NEWSROOM

and public health policies— on the coronavirus pandemic. She’s made appearances on CNN, NBC, and NPR programs; written op-ed pieces; and was profiled in the Los Angeles Times and the AJC. Kraft also was named to the NCAA COVID-19 advisory panel, and serves on Georgia Governor Brian Kemp’s

coronavirus task force. “I’ve learned to enjoy this public-facing aspect of the job,” she says. “I look at these opportunities as a way to get the truth about COVID-19 out there to as many people as possible. I work hard to try and make challenging topics understandable and

INFLUENCERS accessible, yet I’m not afraid to challenge the audience with a little bit more complexity than most people usually see on social media and the news. It’s a different form of teaching for me, on a larger scale.” When stress is running high, she does what many of us do: “I read novels. I try to get some exercise or a walk in every day. And I love spending time with my kids. We’ve been watching Disney’s The Mandalorian. It’s a fun, grounding ritual, because everything else is so upside down right now. Most important, when we’re together, we try not to talk about the coronavirus.” —Kelley Freund and Roger Slavens | KIMBERLY MANNING Professor of Medicine Kimberly Manning decided for her birthday this year, she wanted one thing: to raise money for Grady Memorial Hospital in downtown Atlanta. So she posted on social media: “2020 has been a year that many of us would soon prefer to forget. Along with all the tragedy, I am reminded that this year also includes two major milestones in my life: the start of my 20th year as a Grady doctor, and my 50th year. Here is my birthday dream: To raise $50,000 for the Grady Health Foundation, specifically targeting our Grady COVID-19 Response Fund. Given the disproportionate impact that COVID-19 has had on the Black community, this is personal to me. I hope you’ll let it be personal to you, too.”

Manning’s Twitter handle is @gradydoctor, and for the past 11 years, she’s been writing the blog “Reflections of a Grady Doctor,” in which she tells about her experiences as a physician and clinical educator with honesty, poignancy, and humor. It was named a top medical blog by O, the Oprah Magazine. She has more than 50,000 followers on Twitter. “I impulsively decided to start a blog,” says Manning, who joined Emory’s faculty in 2001 after training at Case Western Reserve’s MetroHealth Medical Center in internal medicine and pediatrics. “In my time at Grady, I’ve realized just how much magic is happening there and how much

humanity is inside. But that isn’t what people see when they turn on the news. I tell stories that show the positive and beautiful aspects of a safety-net hospital.” If Manning experiences something that impacts her, “particularly if the person is underrepresented in medicine, I’m going to use my position to get that voice out. I care about diversity, equity, inclusion, and humanizing patients who are underserved. I care about kindness. If that’s something that makes someone an influencer, I think we can all be influencers.” —Camile Matthews

| INGRID PINZON Assistant Professor of Hospital Medicine Ingrid Pinzon, a physician at Emory Saint Joseph’s Hospital, became concerned when she saw a jump in younger Hispanic patients coming into the hospital with COVID-19. Many had no underlying health conditions but “because they came in sicker, they developed more complications,” she says. Indeed, like other people of color, Latinos and Hispanics are more likely to contract COVID-19. While making up 19% of the US population, they make up nearly 31% of all US COVID-19 cases. Because language can be a barrier for teaching Spanish-speaking residents how to protect themselves from the virus, Pinzon and other bilingual Emory Healthcare physicians are working to reach Atlanta’s Latinx community, reaching out to them in areas where they live, work, shop, and socialize, and making signs with prevention tips in Spanish. “This population needs specific guidelines in Spanish, I think that’s the key,” Pinzon told Fox5 Atlanta.—Mary Loftus | JAY VARKEY Associate Professor of Infectious Diseases Jay Varkey was also on Team Ebola, helping to care for the first Ebola patients on US soil in 2014, in the serious communicable diseases unit at Emory University Hospital. Varkey, a hospital epidemiologist, addressed how lessons from Eb-

ola can help fight COVID-19 in US News & World Report: “The first is that caring for a patient with COVID-19 is clearly a team sport. “Certainly, there’s been a lot of focus on frontline health care workers within the hospital itself, but given how prevalent this infection is, it’s really impacted everyone, including those who keep our hospital environments safe by cleaning up every day in areas where there is environmental contamination, where they are putting themselves at risk. “The last piece where there’s a really important parallel with Ebola is that the key to preventing COVID-19 is strict adherence to basic infection prevention principles. Personal protective equipment, or PPE (such as masks, gloves, gowns), works. It’s strict attention to the basics that keeps us safe.” Varkey has done a series of Q&As on social media called “COVID-19: What You Need to Know,” with his ever-present Batman costume draped with a stethoscope in the background. He’s answered questions on vaccine, therapies, and school openings on SiriusXM with Olivier Knox. He’s active on Twitter (@jaybvarkey), mixing in a good dose of humor with COVID science and medical information. And he has appeared on CNN Newsroom, where he said on February 27, near the beginning of the pandemic: “This notion of community spread is not a reason to panic, it’s a reason to prepare.”—Mary Loftus

Fall 2020

Susan Carini, Emory graduate school alumna and executive director of Communications and Public Affairs, with her mother, Pat (right and far right), and her Siberian husky, Sable.

Of Clocks and COVID By Susan Carini

LOSING MY MOTHER TO COVID-19 MADE ME REALIZE THE VALUE OF HEALTH CARE PROFESSIONALS WHO SAW HER AS MORE THAN A NUMBER.

Call it the effect of growing up without health care in a large farm family of limited means: my mother avoided doctors, fearing that a visit for one ailment would yield another, until one’s pockets were empty and patience at an end. In 2006, her worst fears were realized when, experiencing acute back pain, she was seen at Emory University Hospital on New Year’s Eve. Abnormalities were spotted on her lungs, liver, and kidneys. Though she voiced myriad complaints about the doctors’ motives, I somehow got her to take the follow-up tests, all of which turned out fine.

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At the age of 80, in 2013, my mother was sent by her assisted-living facility to the nearest hospital—not one owned by Emory—for a UTI. While she was there, a doctor breezed in, put his hand on her forehead, and said to me as if she were not in the room, “You can tell from the shape of her skull that she has dementia now.”

THE LAST WORD She might not have heard him or chose to ignore him. The news rocked me. And, to be honest, I felt a bit skeptical for my mother: who gets to say that you have dementia based on the shape of your skull? But I had to admit, my mother had been experiencing some cognitive decline, noticeable to those closest to her. So, I prevailed on her to become a patient at Emory’s Cognitive Neurology Clinic (CNC). For me, the merits of beginning treatment were obvious: I knew that rigor and science would prevail along with—sorry, Mom—that pesky penchant of the doctors to consider every possibility. The early days of her treatment there were a little rocky: my mother hated drawing clocks (a diagnostic test for dementia) and had the same sinking sensation that everyone experiences when answers to test questions don’t come easily—or at all. Two things helped her turn the corner to acceptance and, eventually, appreciation. As our family archivist, she wished to hold onto that title as long as she could, wanting to remember what the rest of us had forgotten. There’s power in such a skill, and she liked that. The other piece of good fortune was that we were paired with a nurse practitioner, Stephanie Vyverberg, who lit up my mother’s world. Her professional competence was obvious and reassuring to me. For my mother, it was her compassion. My mother reveled in being directly addressed by Stephanie, who often held her hand as they talked. No visit was rushed; she gave my mother the time and space to be heard. Stephanie did what my mother, for so long, believed those practicing medicine don’t do: she treated the whole person. And in being willing to travel that road, what she got from my mother was a combination of sweet and salty. By this time, my mother resided in a skilled-nursing facility where chasing down a nurse was a challenge and getting time with a physician even more elusive. In this environment, the value of “a Stephanie” came into sharp relief. As my mother’s trust deepened, she started saving up things to tell Stephanie—things that, despite our being close, she didn’t tell me. At one appointment, in response to gentle questioning, my mother confessed her struggle with depression. She cried openly—my tough-as-nails mother for whom tears were rare.

More than any medicine—and Stephanie also made many good calls on that front, enhancing my mother’s quality of life—her greatest gift to my mother was the assurance that she was not alone. All that changed with the advent of COVID-19, which left my mother, like so many residents of skilled-nursing facilities, alone and deprived of all visits or contact with the outside world. In late June, I got a call from a nursing supervisor; my mother had been exposed to COVID-19 by a staff member. Many days later, my mother’s nurse finally got back to us that she had tested negative for the virus. Then, just two days before she died, I got a call saying she had been tested again and was positive.

For my sister and me, the likelihood that she had the virus before it was confirmed had become abundantly clear: she was out of breath, running a low-grade fever, and having nausea and diarrhea. Her speech had become degraded, and the only people with the patience to understand her were my sister and me. Yet we were on the outside looking in, facing what increasingly felt like silence with regard to my mother’s fate. Regarding cases, my mother’s facility had seemed to be doing well until, in an instant, it wasn’t. My sister and I frequently went online for the Georgia Department of Community Health stats. In mid-July, the calmingly low numbers spiked, prompting an audible gasp from us.

Hospice went in a week before my mother died. However, with the virus spreading like wildfire, they could not go back in until July 20, at which time the hospice nurse was pronouncing my mother dead. My beautiful, sweet (and salty) mother has since been joined in death by 27 of her fellow residents. And still the virus exacts its relentless toll. One of my regrets is that she never got to return to the CNC. The pandemic caused us to cancel our last appointment. She might have proudly told Stephanie that her title as family memoirist remained uncontested, for she had just helped my sister recall facts about her childhood best friend. At the CNC, my mother was not a number, despite sometimes being unpredictable. In the course of a visit, she could start out compliant, then go sullen, and not lose any ground with Stephanie. That kind of grace one usually receives only through family members and close friends. Had my mother been tested again, her rendering of a clock might have needed some work. But her humanity was never in question. n

Fall 2020

News and views from Emory School of Medicine alumni FALL 2020

IN TUNE TO A

Different Rhythm As Deputy Director for Public Health Service and Implementation Science at the Centers for Disease Control and Prevention (CDC), Rear Admiral Stephen C. Redd 83M spent March 11 testifying during a House Homeland Security Committee hearing on “Confronting the Coronavirus: The Federal Response.” “As we begin to see community spread of this virus, it will be important for all of us to take action in preventing its spread through common sense public health precautions,” Redd told the committee on the day the virus’s spread was declared a pandemic, in the hearing covered by C-SPAN. Redd had been thinking about such a threat for a while. In a podcast for the National Association of County and City Health Officials that aired in August 2019, Redd talked about the health threats that keep him awake at night: an influenza pandemic, other contagious respiratory disease outbreaks, and weather disasters related to climate change. Redd’s words were prophetic given the events of 2020: the coronavirus pandemic, wildfires in California, and powerful hurricanes. “The nature of our work is to be ready for the threats we can identify and be able to pivot to respond to events that are of even greater consequence,” said Redd in the podcast. “When we’re in an emergency response, we can fail to accept or appreciate the uncertainties, and we think we know more than we do. Maintaining a sense of humility and

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contingency is really important.” Redd is poised to retire from CDC this year. One lesson he has carried with him throughout his 35-year career is that medicine and public health have distinct tempos. He became aware of the difference following his second year of study at Emory School of “My training at Emory was a great experience, I had Medicine, when he held the chance to rotate through Grady, the Atlanta VA a summer job in CDC’s Medical Center, and Emory’s hospitals.” reproductive health division. He happened to work there in 1981, when the first cases of “There was a different rhythm at AIDS were diagnosed. “CDC was a much CDC,” Redd says. “During my residency smaller place then,” says Redd. “Even and at Grady, I stayed up nights taking though I didn’t work on HIV, I was able care of patients The hours were long and to attend lectures on pneumocystis and the feedback from patients was immediKaposi’s sarcoma. Everyone at CDC was ate. As an EIS officer, I investigated disease trying to figure out how to deal with the outbreaks, which was totally different.” growing AIDS epidemic. It gave me a taste Shortly after completing EIS training, of something different that I could do Redd traveled to West Africa to assess the with my medical degree.” feasibility of conducting a pneumococcal Redd went on to graduate from vaccine trial in Senegal. Following EIS, Emory and complete a medicine resRedd remained at CDC, leading childidency at Johns Hopkins University hood survival projects (acute respiratory School of Medicine. In 1985, he returned infections and malaria) in Africa and to Atlanta, his hometown, and CDC to efforts to eliminate measles in the United serve as an officer with the Epidemic States (achieved in 2000). Intelligence Service (EIS). For some time, When terrorists attacked the US in he also volunteered as an attending 2001, Redd was working in CDC’s National on the medicine service at Grady Center for Environmental Health to Memorial Hospital. reduce the burden of asthma. A few weeks

later, he was on a charter plane to Trenton, New Jersey, to assist with the emergency response to the anthrax attacks following 9/11. Letters containing anthrax had been sent from a Trenton post office and thus put its workers at risk. The response brought home another important lesson for Redd: knowing when to pivot. “On our first day in New Jersey, a Sunday, we went to the post office and swabbed the noses of employees who had worked there,” he says. “The next day, we learned that all the tests were negative and that our method for determining exposure was inadequate. We then contacted hospitals in New Jersey and asked them to send a daily report of suspected cases of anthrax, either from the emergency room, the intensive care unit, or the laboratory. We developed questionnaires that the hospitals completed and faxed to us every day. That made it easier to determine if anyone had been exposed and get them on treatment as quickly as possible.” Redd’s response skills would be further tested as director of the Influenza Coordination Unit. CDC formed the unit in 2006 based on national and global concerns that the H5N1 avian influenza virus could become a human pandemic. At the time, the virus had spread in birds from Asia to Africa and occasionally in people. The human mortality rate was 60%. “The spread of the H5N1 virus in humans was unprecedented and led to a global effort to prepare for a possible pandemic,” says Redd. “CDC was on the leading edge of that effort. That’s when the Influenza Coordination Unit was formed.” Its first rule of operation: practice, practice, practice. Working with ex-military experts, CDC staff wrote a response plan grounded in different exercise theories. In 2007 and 2008, the unit conducted five real-life exercises in the agency’s Emergency Operations Center. During each exercise, a group of experts worked “behind the curtain,” injecting information to which staff had to respond. “We set up our daily rhythm,” says Redd. “We held mock press conferences and daily briefings, knowing that the scenario could change at any moment.

Through those exercises, we learned a lot about what we would have to do during a real pandemic.” In 2009, when the first cases of H1N1 influenza were reported, CDC went into action. “We activated the Emergency Operations Center but still weren’t sure

5 THINGS TO KNOW ABOUT Stephen Redd

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Redd will soon retire as deputy director for public health service and implementation science at the CDC. He oversees four areas: the Office of Minority Health and Health Equity, the Center for Global Health, the Center for Preparedness and Response, and the Center for State, Tribal, Local, and Territorial Support. He is also a rear admiral in the US Public Health Service and an assistant surgeon general. Born in Augusta and reared in Atlanta, he majored in history at Princeton University and went on to medical school at Emory. His late father, Stephen S. Redd 63MR, was a pediatrician. His wife, Atlanta radiologist Judith Chezmar, did a fellowship at Emory. They have two grown children. Redd is an avid runner and eclectic reader. Recent book picks include The Silmarillion (a prequel to the Lord of the Rings series by J.R.R. Tolkien), Zen and the Art of Motorcycle Maintenance, and a new translation of Beowulf.

how severe the disease would be,” says Redd. “The first two patients in the US had already recovered by the time they were identified. We suspected there was widespread transmission but didn’t know the severity.”

The seminal moment occurred late on a Thursday afternoon when CDC received a report from Canada where specimens from people hospitalized in Mexico had been tested and confirmed as H1N1 cases. “Some of the people who subsequently died were among the cases,” says Redd. “There was more severe disease in Mexico than we had seen in the US. From that moment on, everything changed.” Emergency responses, drill sessions and real ones, highlight perhaps the biggest challenge of all—making a decisive call to protect individuals and populations. “The reality is you have to make decisions without having all of the information that you would like to have,” Redd explains. “If you delay, that’s a decision in itself—it’s deciding not to do something. There’s a timeframe for every decision, from martialing the best evidence you have to making a decision when it has to be made.” Two decades have passed since measles was eliminated in the US. Yet measles cases have resurged in recent years. In 2019, more than 1,000 cases were confirmed in 31 states—the highest number since 1992. Key factors are driving the increase. Although global measles control has improved immeasurably, the disease is still common in many countries. Unvaccinated travelers to those countries bring the disease back to the US, where it spreads easily among unvaccinated people. Many have avoided immunization, believing it is unsafe. To combat the resurgence, CDC has taken steps to remove financial barriers to vaccination and provide constant assurance that the MMR (measles, mumps, rubella) vaccine is safe and effective. “The vaccination coverage for measles has been over 90% in the past 15 years or so,” says Redd. “Ultimately, the global elimination of measles is the answer to ending the outbreaks we are having here. It’s hard to say how soon that day will come. As long as measles can be imported, we’ll be at risk in the US.” —Pam Auchmutey

Fall 2020

During medical school, Levy founded a national health education campaign called Music Inspires Health, teaming up music industry celebrities with physicians, medical students, and public health experts.

WHERE IN THE (VIRTUAL) WORLD If ever there were a time to help people reduce feelings of stress, anxiety, and isolation, this is it. Who knew it would involve playing a cello at a baseball field, though? And that’s exactly what School of Medicine alumnus Benjamin Levy 08M decided to give viewers during the TEDxWrigleyville livestream event, “Humanity, A View from Inside the Pandemic,” on Sunday, June 28, from Wrigley Field in Chicago. Levy, division head of gastroenterology at Mount Sinai Hospital, Holy Cross Hospital, and Schwab Rehabilitation Hospital in Chicago as well as founder of a refugee clinic, brought music to the frontlines of COVID-19 as a featured TEDx speaker, an independently organized event licensed by TED. Levy’s talk, “Motivating Health Education with Music,” featured cello performances from himself and internationally acclaimed cellist Yo-Yo Ma, whom Levy has known since he was nine years old. He arranged for Ma’s performance as an extension of Ma’s #SongsofComfort series during the pandemic. Using examples, Levy discussed how the rock band Queen and Elton John innovated HIV prevention campaigns through live concerts and made HIV prevention “cool.” He talked about how music can empower audiences and break down barriers to ensure messages are shared broadly. Levy also spoke about his own efforts to use music to promote health, such as the “Music Inspires Health” concert tour he organized during medical school at Emory, and weekly virtual concert series, “Cocktails and Concerts,” he founded and organized by introducing collaborations between musicians and doctors and nurses on the frontlines of the pandemic.

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Emory Medicine Magazine Fall 2020

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