March 2021 marks a very somber event in our history, a year since the COVID-19 pandemic put brakes in our normal lives. Since the report of the first cases of COVID-19 in late February of 2020, today, a year later, we are privileged to bear witness to three vaccines approved to be distributed, with close to 18.1 percent of the US population having received at least one dose of the COVID-19 vaccine.
In this month’s issue, we look back at SARS-CoV2 and how these surging viral pandemics may not be the last. The pandemic brought to our attention the tremendous efforts and sacrifices made by women- we mention that as we celebrate International Women’s Day. We also hear the career journey of two inspiring women- a UMB alum and a UMB faculty and where their careers might take them.
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Ganna Galitska Metzger
Black swan? Rather not.
Is the COVID-19 pandemic a “black swan”? The worldwide web is filled with opinions, memes, and satiric descriptions that claim as much. According to Nassim Taleb, the originator of the concept, a black swan is “an outlier, lying outside of the realm of regular expectations, while carrying an extreme impact; nothing in the past can point to its possibility.” 1 However, the COVID-19 pandemic is no such thing. Experts have been warning for decades that a global pandemic involving a highly transmittable respiratory disease, most likely caused by an RNA-based virus, was not a question of “if” but rather “when.” Why did no one listen? The answer is a combination of overwhelming numbers of new zoonotic viruses and a lack of research focus on them.
In the twentieth century, humanity encountered hundreds of new diseases and the rate has been increasing since the 1980s. Over thirty new human pathogens have been detected in the last three decades, 75 percent of which are zoonotic – meaning that they originated in animals and came into the human population primarily from the wild. 2, 3 In developed countries, most of these new infections are due to antibiotic-resistant bacteria. However, in developing countries, RNA viruses are the primary public health concern. Due to their remarkable ability to change their genomes and accumulate mutations, these pathogens evolve quickly and adapt extremely well to new environments. Practically, this means they can change their hosts successfully, promoting spillovers from animal reservoirs into human populations. 3, 4
How does it happen?
The most prominent example of such a case is the Hendra virus, identified in 1994 in the suburbs of Brisbane on the eastern Australian coast. It is a rare endemic (local) disease, with only seven cases of human infections reported. The natural reservoir of the Hendra virus is the flying fox, a bat from the genus Pteropus.5 For eons, these bats lived in Australia, but only in the last decades have they started to have close contact with humans. Australian rescue centers provide rehabilitation and return injured bats to their natural habitat. Unsurprisingly, many of these workers have been bitten albeit without serious consequences. Hendra became a life-threatening disease when horses began to serve as an intermediate host. Bats, which were spending their nights in the trees next to the horse farms, defecated in the grass and spread viral particles. Horses, which became infected from consuming the grass, turned out to be suitable hosts. The virus quickly adapted, and today Hendra kills 75 percent of infected horses. The virus then made the jump to yet another host, humans. It can be spread from horse to human via contact with body fluids such as saliva and sometimes results in fatal infections.
As an extremely uncommon pathogen, Hendra seems irrelevant to general public health (although Australian farmers may disagree here), but its close relative the Nipah virus is a much more dangerous agent.6 In 1998, the first spark of the Nipah epidemic took the lives of 105 people and millions of pigs in Malaysia and Singapore. In 2001, the virus spread to India and Bangladesh, where cases have regularly appeared ever since with variable fatality rates. The identified host was none other than a Pteropus bat. These bats consume fruits from farms, which they clumsily drop in the barrels for collecting Date Sap (Khejur Ras). The fruit, containing drops of bat saliva, contaminates the extracted sap, eventually infecting people who consume it. In Malaysia, these bats passed the virus to pigs via excretions in water supplies. Pigs are widely acknowledged as incubators for viruses (as in the case of H1N1) that subsequently infect humans. In recent years, the list of countries with a high risk of Nipah has expanded and now includes Cambodia, Ghana, the Philippines, Thailand, and Madagascar. In all these countries, Pteropus bats have been found seropositive for Nipah, however, only limited surveillance has been conducted to assess the risk for infection by this deadly emerging virus.
Although Hendra and Nipah are dangerous, they are hardly so compared to the notorious Ebola and Marburg viruses, which emerged from the tropical forests of central Africa. Both are extremely dangerous and contagious, classified as biological weapons, and bats serve as reservoirs for both. Marburg infects people via contact with bat excretions – as happened in Uganda’s mines. Ebola is most often transmitted via poaching of apes and small ungulates that transfer the virus from bats. Fortunately, transmission happens mainly via close contact, which has allowed for outbreaks to be relatively well contained.
In the case of the new bat coronaviruses, such as SARS-1 and MERS, human-to-human spread occurred via the respiratory pathway. SARS-CoV-1 appeared in late 2002, infected over 8,000 people, and left 800 dead. Most likely, as with SARS-CoV-2, the infection appeared at a wet market, where a civet was identified as an intermediate host, having caught the virus from a bat. In retrospect, these were the very first red flags of the future pandemic.
Are the animals really to blame? Surely not.
Bats, the reservoirs of all these infections, used to occupy impenetrable forests of South-East Asia, Congo, Uganda, and the Australian bush. When people arrived, they created mines in which the bats quickly settled. Nearby pig and horse farms, now in the bats’ natural habitat, offered the viruses new suitable hosts. The felling of forests drove the bats to do the only thing they could do to survive – adapt, carrying their “viral passengers” along with them. Massive and destructive expansion of civilization into tropical forests, fragmentation of biotopes for the sake of farms and plantations, and the popularity of wet markets, where domestic and wild animals are butchered – all these activities created a perfect playground for evolutionary experiments and opened “new viral horizons.” Furthermore, agriculture and other human activities contribute to climate change, allowing some key pathogens to expand their habitats and move north. Rift Valley Fever (RVF), Dengue, and Chikungunya are excellent examples of fast-spreading tropical diseases; all of them associated with climate change. As humidity rises, it creates new suitable ecosystems for mosquitoes to inhabit, including farms, barns, basements, and storage facilities.
International trade and transcontinental travel add fuel to the fire of new infections.7 The outbreak of bird flu in South-East Asia started in 2004 when over 5000 chickens were transported from Lhasa to Lanzhou (1600km). RVF was delivered to Yemen from Africa with a huge number of imported cattle, which is actively traded between these countries.
West Nile Fever, transmitted by Culex mosquitoes that feed on birds, drew wide attention in 1999. Originally limited to Africa, it was most likely brought to the New World via airplane, possibly from Israel or Tunisia. A massive outbreak happened in 2002, with the virus proving itself to be lethal to a high number of North American birds. The mosquito especially loved feeding on Turdus migratorius, a bird easily found on front lawns of suburban America. The virus mutated rapidly and successfully spread from Canada to Venezuela via migratory birds.8
Why did host changes of these zoonotic viruses not trouble us before? Most of the population, except for a small number of virologists, tropical disease specialists, and epidemiologists, was not bothered by far-off exotic diseases in developing countries that took lives on the far side of the globe. The voices of researchers and epidemiologists, who stressed the importance of investigations into new transmission methods and of screening of potential intermediate hosts, stayed unnoticed on the pages of scientific journals. As a result, we still have a very poor understanding of how changes happen in viral populations enabling them to infect completely new hosts or what factors contribute to and accelerate such processes, generating new lethal mutants. Unsurprisingly, there are also no specific treatments for or vaccines against almost all the above-mentioned pathogens.
The highly virulent, transmittable, and adaptive coronaviruses needed only to wait patiently while humans created the perfect environment for them to thrive. It seems they waited long enough. And they are here to stay.9
The wide gender gap in STEAM fields is evident. This gap persists today, in the number of women employed, their salary, opportunities for them to grow professionally, and get promoted. Although women make up almost 50 percent of the doctoral degrees awarded in this country in the fields of biological sciences, psychology, and social sciences, they account for only 15 percent of the jobs held in these fields. Less than 30 percent of the researchers in the world are women and this, in turn, leads to fewer publications by women scientists. Gender inequity, motherhood, care responsibilities for the elderly, have been, for decades now, some of the main reasons impeding the career development of women in research. Despite efforts by individuals, organizations, and the government to narrow the gender gap, it is only continuing to increase since the emergence of COVID-19.
In comparison to 2019, the number of female first author and female last author publications has decreased by 5 percent in 2020. COVID-19 brought in-person learning in public schools to a grinding halt and with limited childcare options available, women were the first to bear the responsibility of domestic labor. Publishing your research is not only about sharing your work with the community, but is also a necessity to be on tenure track and promotions. Passionate and driven women scientists who had been working tirelessly to secure grant funding in order to set up their own labs are forced to put their plans to rest, in some cases for a very long time. Motherhood has always been a major stumble for women scientists, with studies indicating that female scientists in tenure-track positions are 20% less likely to have children, compared to their male counterparts. COVID-19 has added extra burden to this existing problem, with women who have child care responsibilities facing the threat of being forced out of the workforce.
The role of women in science is crucial, as they make the difference. More than 70 percent of the health and social care workers on active duty during the pandemic are women. Researchers working in the field of SARS-COV2 are making major contributions in this field. Özlem Türeci, a female scientist and physician is the co-founder of BioNTech, one of the first biotech companies to have developed a successful vaccine against SARS-CoV2 that is being distributed globally today. Tireless efforts by researchers like Katalin Kariko, who worked on the therapeutic potential of mRNA formed the basis of developing the mRNA vaccines today for COVID-19. Kizzmekia Corbett, a leading scientist at NIH was a part of the team that worked with Moderna in developing the COVID -19 vaccine. UMB’s very own Kathleen Neuzil was recognized as “Marylander of the Year” for her unprecedented leadership and achievements in testing the vaccines against SARS-CoV2.
What do these stories tell us? Women can perform brilliantly in science. They are also perhaps better equipped in handling domestic burdens. However, it is time we recognize that, again, in these challenging times. Universities need to consider re-evaluating and changing terms for tenure track and extending the clock. Flexible working hours and subsidies for child care would also help in giving women time to work and manage their domestic duties. However, institutions need to also address that gender inequities are deep-rooted, it is evident in recruitment, pay raises, benefits, and promotions. UMB’s culture diversity dashboard gives us a preview of this reality. The School of Medicine has 78 female professors who are either tenured or on tenure-track compared to 220 male professors. Although disheartening, this is progress, as we are acknowledging the gender gap. Initiatives by WIMS (Women in Medicine and Science) group at UMB will gain more attention to ensure enhanced recruitment of women and promotion of women into positions of leadership.
Today COVID-19 is adding another layer of complexity for women to prove their place in Science, but it’s time to change the narrative.
Natasha A. Tonge
NT: Can you tell us about your specialty area in consultation-liaison psychiatry? (The specialty was previously known as psychosomatic medicine) and what role you have on the medical team?
AF: Consultation-Liaison psychiatry is actually a relatively new accredited subspecialty - probably in the last 10 years or so. The defined core aspect of the subspecialty is psychiatric management, evaluation, and treatment of people who are medically ill so that's what separates us from most general psychiatrists - we have more subspecialized training in managing specific diseases. We do a lot with delirium which is a sequalae of medical illness in the hospital and acute management when patients are in the hospital for other reasons than a defined psychiatric problem. We like to describe ourselves as the psychiatrists who practice on the border of medicine and psychiatry. We have to be very updated on medical illnesses and treatments, psychiatric manifestations of disease, acute management in the hospital, and also working in certain specialty areas like transplant psychiatry, women's mental health, HIV psychiatry...So there are further refinements n the subspecialty as well, based on the person’s expertise… Part of what we do is work with the treating medical team to further the care of the patient. I think everywhere else in psychiatry the person is referred to that psychiatrist for ongoing management, away from the person who did the referral, but we work in a much more synchronized fashion with the teams that are taking care of the person in the hospital and sometimes in the outpatient setting like with HIV and oncology.
NT: What brought you to this discipline and this area of specialty within psychiatry?
AF: I was a psychology major in college. I was torn between pursuing a PhD and going to medical school. I never seriously considered any other specialty so when I was in medical school I wanted to be a child psychiatrist…what I learned later is that you have to objectively be able to treat children like patients, which was hard for me to do. And so, as a fourth-year medical student, I wanted to do a child psychiatry rotation and it just so happened that the child psychiatry rotation was full. And the consultation-liaison was open and I did it and I loved it and I didn't even know that this was a subspecialty in psychiatry. I've never looked back.
NT: What attracted you to research in women's health and how did that interact with your specialty in CL?
AF: I kind of have this history of finding out about things I didn't know about before because I encounter them (laughs). When I was a second-year resident working on the consult service we - for whatever reason during the time that I was there, we kept getting a lot of consults from labor and delivery. And I was like "why are we getting 5 or 6 consults a day from one service?" What we had found out was that they had started to administer the Edinburgh Postpartum Depression screen, which is a well-known standardized screen to detect postpartum depression, but they were administering it on [emphasis added] labor and delivery within 24 hours after giving birth when most women are not at their best. Even if you had a perfect delivery with no issues, you're just not in the right space to fill out a questionnaire. It piqued my interest - "what is this survey? What is this screen? Why are we doing this?" So I did a lot on my own finding out about the screening, understanding why…they felt it was something important to do on labor and delivery, then translating that into what we need to do on the consult service…Women's mental health is a very expansive field. One of the other psychiatrists in our Department [Dr. Nicole Leistikow] recently published an op-ed piece about why women's mental health should be its own specialty within psychiatry because of the specialization and the information that's needed to really properly counsel a woman before she's pregnant, after she's pregnant, manage psychiatric illness during that time, recognize symptoms that should be of concern and that can be problematic for the OBGYNs taking care of the woman while she's pregnant. Then also after pregnancy: thinking about menopause, infertility, women that have had multiple losses. Those are things that there's so much information and specialization on but it's not a formally accredited subspecialty…and most psychiatrists are really not comfortable managing women when they're pregnant. Which for me is an equity issue…it's a pervasive issue…Women's mental health has its own specific needs and we need people that understand all of the complexities and the layers.
NT: You are also the Department of Psychiatry Diversity Committee. Can you say a little about how that started?
AF: The committee started out as a fact-finding mission to understand why we had a high level of turnover in terms of faculty but very specifically underrepresented minority faculty, which is already a smaller number…We’ve had great investment from our department chair, Dr. RachBeisel who really made it clear that she wanted to participate in this process, she wanted to understand the issue, and she was invested in cultural transformation for us that we would have less turnover but also more specifically that we would recruit and retain qualified underrepresented minority faculty. So that’s how it started and then the summer happened…We’ve been in the process, over these past few months, of really identifying where we are as a culture in the Department of Psychiatry, what needs do we have, what are we doing well, what do we need to improve on. That’s been a fascinating process so far…
NT: What did you learn about what it means to be underrepresented in the context of Psychiatry and how it interacts with other identities?
AF: We just had National Women Physicians Day. I posted something to our Teams group. Only a third of physicians are women but 2% of that third are black women and less than 2% are Hispanic or Latina women. Anything that affects an underrepresented group will affect them much more disproportionately…Since we have a societal existential crisis - who are we, what do we value Who is our leadership? Who is in charge of moving things forward? I think what people realize is that we're not as progressive as we thought we were. A lot of things have been happening in a pro-forma, this-is-how-we've-always-done-it sort of fashion. It is not until you have the right sort of people, including the people that are in charge who can actually make a difference, who come together and really commit to changing what is going on.
NT: For postdocs, do you have any advice coming from your many experiences (president, in C-L), advice for developing postdocs.
I don't know everything about people's journeys as postdocs but I see a lot of messaging around recruiting underrepresented groups to STEM fields for science and research careers, but I don't see the other side of amplification of the voices that are currently in the STEM fields talking about what it is like and what is needed to keep the field moving and progressing. So, I would encourage any postdoc - you don't have to just look at yourself to talk about diversity and inclusion but it should be a part of everything that you do - is to really start to consider and think about what's happening in the field. Why it's been traditionally non-inclusive. What needs to change to really make a career more attractive to somebody who is in a traditionally marginalized group and has been historically excluded from careers in STEM. I think the people who are in it that need to talk about. You all are the young, fresh voices, and you all have to start talking about it while advocating for change. Part of how systems and practices get perpetuated is that people feel powerless to really talk about it and facilitate needed change.
Awadhesh K. Arya
This month, I interviewed a renowned scientist and alumnus of UMB; Katrina Williams, who is currently a Biomedical Scientist at Leidos, working for the National Institute of Health (NIH). Last month, Dr. Williams was an invited speaker for PDAC’s career event where she discussed her career path. In the current interview, she shares her experiences during her stay at UMB and her current job.
AA: Can you tell us about your experience throughout your stay at the University of Maryland, Baltimore (UMB)?
KW: I started at UMB initially as a Research Assistant. That experience was instrumental in my interest in applying to graduate school. I stayed at UMB for my time in graduate school and then into a post-doc as well. Having that long of a stay at the University I think really benefitted me in having a better grasp of the resources available. The faculty/staff being largely supportive and collegial really helped shape how I think about an academic environment.
Q: Can you tell us about your current job and what does that demands?
KW: Currently I’m working for Leidos as a Biomedical Scientist. I work primarily to support the governance demands of the All of Us Research Program at NIH. This support varies quite a bit, from setting up and managing large scientific conferences, to designing workflow for study incident reporting to the IRB, to project management. Leidos is a contracted company, and so NIH is technically our “customer.” My team is fairly well-integrated to our customer office (not all contract positions are like this), so we feel like a unified team; however, contracting rules and our “statement of work” regulate how we are allowed to interact with other people in the program, and what types of work we are allowed to work on.
AA: What does a typical day look like in your current position?
KW: Every day looks different. There are usually a few meetings throughout the day. These are either more production-oriented and help drive the projects I’m working on forward or they might be informational. In-between, I’m either writing up protocols or project plans, designing slide decks, or reviewing data.
AA: How did the pandemic alter your work and your responsibilities?
KW: I’ve been lucky during the pandemic in that my job was easily converted to telework. The one downside is that working from home means that you are always “at” work. I’ve needed to maintain as many boundaries as possible so that my time off is indeed a rest.
AA: You did your postdoctoral training and PhD from UMB and performed high-quality research; how did you get motivated and prepared to make the transition from academia to your current role?
KW: The biggest push for me was to feel like I was in a secure position. Academia can be stable, but it takes a career-worth of time to get to that place. I wanted to enjoy the parts of my life that were outside of work now. I think the “management” roles I had as a post-doc were incredibly valuable. This includes mentoring grad students, supervising lab techs, planning projects, and my roles on PDAC.
AA: What advice do you have for fellow postdocs who wish to venture into a career outside of academia?
KW: Think about where your skills work best, and what you enjoy doing in and out of the lab. A lot of the time, those simple things (e.g. being a people-person) can be highly transferable job skills. Own those things and be proud of how they could help a team!
James Borrelli, PhD
Borrelli joined UMB as an Advanced Rehabilitation Research Training Fellow to work with Dr. Mark Rogers in the Physical Therapy and Rehabilitation Science department. He now works with Drs. Vicki Gray and Kelly Westlake. Dr. Borrelli's research is focused on fall avoidance, fall injury avoidance, and improving mobility among older adults and clinical populations such as stroke. In some of his recent work, he used a mathematical construct, Hof stability, to evaluate group differences in successful and less-successful protective stepping reactions aimed at recovering balance. The work provided compelling evidence in support of perturbation-based and power-based training interventions aimed at reducing fall risk. In another line of research, Dr. Borrelli has developed the FALL simulator For Injury prevention Training and assessment (FALL-FIT) system (Borrelli, Creath, Rogers, 2020). There are currently no known fall injury avoidance programs. The FALL-FIT system has been validated in older adults and feasibility as a strength-based/power-based training intervention has been demonstrated.
His research at UMB has led to 7 publications in the last two years. While Dr. Borrelli enjoys being a postdoctoral fellow, he is passionate to continue his research as a research scientist or assistant professor or step outside academia. If you know of someone who would benefit from having Dr. Borrelli’s expertise in their lab, contact him at JBorrelli@som.umaryland.edu
Grant Writing Class- Panel of Grant Awardees. Mar. 10th 9-10 am. Register here
Tips for Scientific Writing with a Focus on Clarity/Editing. Mar. 11th 9-10 am. Register here.
March Responsible Conduct of Research Training. Mar. 16th 3-5 pm. Register here
Strategy for a Successful Postdoc: Mentoring Relationships. Mar. 18th 12-1 pm. Register here
Leadership—"Making the Leap to Leader”, by Joanne Kamens. Mar. 22nd 12-1 pm. Register here
Tips for Developing the Budget and Justification for an NIH Grant Application. Mar. 24th 9-10 am. Register here
Did you know that overweight individuals are more likely to get severe COVID-19 that requires hospitalization? The past year, the World Obesity Federation (WOF), in association with the World Health Organization has collected data from studies around the globe addressing, the link, if any between obesity and severity of disease caused by SARS-CoV2. This year, March 4th, 2021, marking World Obesity Day, WOF published the report “COVID-19 and Obesity: The 2021 Atlas”. Global Obesity Crisis needed attention and the cost of not having done so is evident with the emergence of COVID-19.
In February, we celebrated and honored Black History and this month we honor and applaud women. We hear stories of unsung black heroes who have changed the course of history and women who have revolutionized the world with their breakthroughs. In this article, published in health.com and written by Patrick Peck, we uncover the hardworking spirit and headstrong nature of seven black women who have been a tremendous force in the battle against COVID-19.