By: Hannah Lin (CC '23)
Can you describe your COVID-19 research at the moment?
I am a cardiologist focused on heart arrhythmias, which is electrophysiology. I’m a clinician, so I see patients, I do surgeries, I do procedures, but I’m also a physician-scientist, so my main career is research on animal models of heart arrhythmias that affect humans. My specializations include atrial fibrillation, as well as ventricular arrhythmias such as ventricular tachycardia and ventricular fibrillation. My career is not focused on COVID research.
I am funded by the National Institute of Health for my studies on the mechanisms of heart arrhythmias in humans, which I am working on in mice. I have a special imaging laboratory that images the electrical activations of the heart, so it is not COVID-specific. You may have read on the news that what were thought to be possible treatment modalities for COVID, such as hydroxychloroquine, can lead to heart arrhythmias. That is where my clinical work became involved in COVID research--looking at heart arrhythmias in patients who are and are not treated with hydroxychloroquine. Some patients, even without treatment with hydroxychloroquine or azithromycin, have heart arrhythmias.
I published a paper during this COVID pandemic that is now in circulation--Arrhythmia and Electrophysiology, on the cardiac arrhythmias that affect patients with COVID. Some of the heart arrhythmias that patients with COVID-19 experience include atrial fibrillation, and that’s due to the lack of oxygen because of lung failure--ARDS, or acute respiratory distress syndrome. They also experience other things such as atrioventricular block, so the node that connects the atrium to the top of the heart in the ventricle, is malfunctioned. Patients with COVID-19 unfortunately, towards the end of their disease due to multi-organ dysfunction, have what we call pulseless electrical activity, so the heart may have some electrical activity, but there’s actually no heart contraction to deliver a pulse. Unfortunately, that leads to death. One of the heart arrhythmias that patients on hydroxychloroquine and azithromycin can experience due to the prolonged QT interval, which is the repolarization of the heart when we see it on the electrocardiogram, is something called QT prolongation. And that’s something that’s been reported. We are analyzing data on measuring the QT interval in patients with and without COVID-19 being treated with hydroxychloroquine, and also doing research on the heart arrhythmias that patients with COVID-19 have.
Are you still enrolling patients in studies?
We are conducting a retrospective chart review on patients who have COVID-19 and comparing them to patients who were COVID-tested but were negative, so who don’t have COVID-19. And we want to see what the difference is between the heart arrhythmias in patients with and without COVID-19. What is special about COVID-19 and heart arrhythmias? It is a retrospective trial, so we’re looking back. Now, as you know, the number of patients is decreasing, thankfully, so it is not a prospective trial.
So this is ongoing?
It is ongoing research, but not ongoing enrollment.
What is the general timeline of your research right now? When do you think this retrospective review will be over?
All COVID research is time sensitive because it’s highly competitive and people want information as soon as possible. We are working as fast and as hard as we can.
Has there been anything in your research in the past few months that has surprised you?
I think that the underlying mechanisms in which COVID-19 causes severe sickness in patients is really unclear. I think all of the specialists--virologists, cardiologists, nephrologists, endocrinologists, pulmonologists--we’re all learning about this disease. I don’t think anyone can claim that we know exactly how it works. If we did, we would have more treatment modalities for it. One thing we’re definitely learning is that COVID-19 can affect many organs, the heart being one of them. Obviously, it is a team approach between different specialists to take care of a patient with COVID-19, because they can develop not only lung problems but also heart problems as well as kidney problems and blood problems like blood clots. It’s really a multi-systemic disorder.
Is your team still keeping prior research projects going while you engage in this COVID research?
Yes. I think that’s the difficulty of being a physician as well as a scientist. So there’s clinical work that obviously is COVID-19, but as a scientist, I’m trying to understand cardiac arrhythmias, even before COVID-19 happened, why and when cardiac arrhythmias occur. That is still ongoing.
Are you still seeing patients through telemedicine?
Yes, I think all of us have been and I have been even during the surge. I worked at the hospital during the surge and I was doing televisits to take care of patients who were at home and not at the hospital. I think one of the great things about electrophysiology or being a heart arrhythmia doctor is a lot of our devices, like pacemakers and defibrillators and monitors, they all do remote downloads. The patient does not need to be physically in my clinic or in the hospital for me to check on how they’re doing. They have a remote monitoring device where the device downloads information from their monitor wirelessly and it gets sent to our clinic for review within the same day--the longest is 24 hours. That is one great thing about advanced technology--it allows us to remotely monitor these patients. They do not need to be physically in front of us.
Can you talk about your experience of working in the hospital during the surge?
One, I’m very thankful for the Columbia New York Presbyterian Hospital leadership. It was truly exceptional, and they had constant transparent communication about the number of patients in the hospital and how they were preparing staff and the hospital facility to take care of these patients. I think that there was also exceptional teamwork, especially in the beginning of the surge, when there were obviously a lot of sick patients coming in. Although our colleagues in Asia and Europe had a lot of experience with COVID-19, we were still learning on our own if there were any differences in the patients in America compared to all the patients internationally, if it all presented the same way. I think we were all very shocked as to how the infection could attack so many parts of the body. It really called to all of our abilities to take care of these sick patients. I am very proud of a lot of the trainees--the medical students and residents and fellows who were on the frontlines, how we all worked together. All those things were key in addition to keeping calm under such intense pressure, teamwork, and constant communication to support one another and how to improve care to COVID-19 patients while protecting ourselves.
Are there any common misconceptions you’ve heard regarding COVID-19 that you would like to rectify or respond to?
A couple of things: physicians who have taken care of these patients know that it can really happen to anybody. It is not only older patients or patients with preexisting conditions. They are the majority of patients, but we’ve seen very sick patients who were young and without any prior health conditions.
And it is not just the flu. There was a flu vaccine, whereas there isn’t a COVID-19 vaccine as of yet. It is contagious, and also COVID-19 has a lot of sequelae; it attacks many organ systems. Patients that we saw were much sicker than those with the common flu.
What is your perspective on the future--both in terms of your research and the broader impacts of COVID-19?
I think this is a great time for students and trainees to pursue a career in research. COVID-19 has shown that scientists and research are essential. The only way to really overcome this disease is healthcare workers taking care of these patients and advancement in science to develop treatment modalities.
I think it’s very inspiring for me as a physician-scientist and I feel very privileged that I can be both a physician to take care of patients and also engage in science research to try to understand the mechanisms of COVID infection and hopefully develop new treatments for patients with arrhythmias due to COVID infection. It’s a really good time to re-engage students in the importance of doing scientific research and considering a career in science. Being a physician-scientist is difficult because you are doing three jobs everyday: being a teacher, doing research, and taking care of patients. But it is very important that we have specialists who understand what you see in the clinic or the hospital taking care of patients and also being able to translate this to perform science to understand what’s going on underneath it all.