By: Hannah Lin (CC '23)
Could you talk about your background as a researcher and your research prior to COVID-19?
I do a lot of research on asthma, mostly asthma in children, and I’m also very interested in health disparities. I’ve been very much inspired to investigate sources of disparities in asthma outcomes, particularly in minority and underrepresented populations in urban communities.
One of the areas I’ve worked on a lot in recent years is looking at air pollution exposure and, more specifically, the effects of being physically active in polluted communities. We know that physical activity is really good for the lung health of all individuals, but sometimes if you're active in areas where there’s high pollution, there’s a potential that you might be inhaling more pollution particles, and that might mitigate the effects of physical activity. This is the area where I’ve spent most of my time studying in the last several years.
Given your expertise and prior work, it must have been a pretty natural step, once the pandemic came around, to switch the course of your research to analyzing COVID-19 in people with asthma.
Absolutely. Not only do I do research in this field, I take care of children with asthma. As the pandemic started to hit, there was this question of, “are my pediatric patients or any patients who have asthma at greater risk for having bad outcomes from COVID-19?” It was a natural question that we felt we were in a great position to be able to answer, being at the epicenter of the COVID-19 pandemic.
Could you talk more about your COVID-19 research and the work you’ve been doing in the past couple months?
We have one project that we put together and we’re waiting to hear back from a journal on whether it was accepted for publication. It’s looking at all of the patients that came into the Columbia University Medical Center, so that’s over at our adult Milstein Hospital, at the Morgan Stanley Children’s Hospital, and at the community hospital up at the Allen Pavilion. We looked at all people who came in who had COVID-19 and were younger than 65 years of age, and we compared those who had diagnoses of asthma before they came in for their hospitalization and those who did not have asthma.
We were really interested in seeing if having an underlying diagnosis of asthma set people up for worse outcomes. We looked at mortality, intubations, and how long people were hospitalized. Basically, the punchline is that we didn’t see any significant differences in those individuals who had an underlying diagnosis of asthma compared to those individuals who didn’t have a diagnosis of asthma.
It’s really important, though, that I recognize one of the limitations: we’re not able to say from this analysis if having a diagnosis of asthma puts you at greater risk for actually getting COVID-19 because, as you know, we don’t have universal testing here and we didn’t have it specifically at the beginning of this pandemic. A select group of people who were sick enough to be hospitalized were the ones early on who were actually able to get a COVID-19 test. We can only really say that if you were sick enough to either be hospitalized or die in the emergency room in one of those three hospitals I mentioned, then your overall outcome, having had a diagnosis of asthma, was not significantly different than those people who did not have asthma.
We also looked at people with asthma and underlying comorbidities including heart disease, high blood pressure, and diabetes, because those have all been associated with worse outcomes of COVID-19. We also looked at people who had obesity, comparing asthmatics with obesity versus non-asthmatics with obesity. Then, we looked at children, since I’m a pediatrician, so I’m really interested in that younger-than-21 age group. While we didn’t see any differences even when we accounted for the different comorbidities and obesity, we did see that the incidence of asthma among those hospitalized with COVID-19 was a bit higher in that younger age group (those less than 21 years old)—about 24% of them had a history of asthma, whereas in the older patients that were older than 21 and up to 65 years of age, the prevalence of asthma was about 13%.
Have you faced any setbacks in your COVID-19 research?
Yes. I will say that it was really a tedious task to gather these data. The first issue was how we were going to find the data, how we were going to get access. We knew that there were hundreds and hundreds of patients coming in, but trying to figure out the best way to access those medical records was a bit of a challenge. We started by using the clinical data warehouse, for which Columbia University has a team of people who are able to pull data from electronic health records for reasons like this, to be able to do scoping analyses in large groups of patients.
But the one thing we realized early on was that the definition of asthma was not very good when we used that data source, so while we were able to get the numbers, we had about 1400 patients who we realized fit our criteria of being hospitalized in our centers and being younger than 65 years of age. I assembled a team of amazing trainees that helped me and we went through the arduous task of going through each of these 1400 medical records to confirm the diagnosis of asthma and to look for comorbidities. That was a bit painstaking. There was a lot of time spent in terms of going through each chart and looking through the notes, orders, medication lists, and things like that. But I do think that was the only way for us to get really good data that we could believe in and feel confident about the message that we’re actually sending out of this study.
What do the next steps look like for your research?
I have a couple of other things in the pipeline related to COVID-19, although I never imagined myself to be a COVID-19 researcher. I don’t think I ever imagined myself to be a researcher during the time of a global pandemic. I think, in science, we have to go where the questions take us, so right now, the question is: how is COVID-19 affecting our population and the people we care for?
I’m working with colleagues in the allergy/immunology division to do a similar study looking at allergic disease and immunodeficiencies and differences in outcomes in hospitalized patients with COVID-19. I’m also working with another group of really brilliant researchers, some within Columbia and some outside, to look more at the health disparity issues associated with COVID-19, and we’re really interested in healthcare access and delivery. We’re hoping to combine data across a few centers to see if we can get at whether certain populations in New York City are more disadvantaged in terms of their access to care and the quality of care that they receive during this global pandemic. Those are the projects related to COVID-19 that I have on my plate right now.
I was also a part of another effort looking at health disparities in COVID-19. We have a manuscript that’s currently awaiting publication as well. It’s less data-specific and more theoretical frameworks of how racism sets certain populations up for worse outcomes of disease and giving information to our colleagues on why that might be. It has some action items that people can work towards to help mitigate health disparities as they relate to COVID-19. That’s what I’ve been doing the last couple of months and where I see the next couple of months going, but I do have a lot of work ongoing from before COVID-19 that I’d like to continue focusing my efforts on.
You sound so busy just from that, but you don’t only do research. You’re a physician scientist, so you are obviously a physician as well. Are you seeing patients in person or over telemedicine right now?
At the beginning of the COVID-19 pandemic, we mostly transferred all of our outpatient care to telemedicine, which was an interesting experience, and I think we’ve been able to provide good quality care to our patients who really needed us in the middle of a pandemic when people were really scared to come into the medical center. I’m continuing to see patients via telehealth both here at Columbia and at a practice that I share with a colleague at Harlem Hospital, where we do community-based pulmonary care. But our doors are now open to see patients here at Columbia as well. We’ve made a lot of efforts towards keeping our hospital COVID safe to protect our patients and our teams. I’ve also been attending on inpatient service, rounding on our inpatients and doing consults during this whole pandemic.
For the general public, as a medical doctor, what are the big pieces of advice you want to shout from the rooftops?
Let me tell you: with everything opening up right now, people who have been hibernating for many months, and people who are just itching to get out there and be connected with their loved ones, doing things that make them feel normal again because there is nothing that has felt normal in the last three months, I’m a little nervous. What I want people to keep in mind is that this was bad. This was really, really bad. It didn’t affect everyone equally, and I think the fact that some people felt it harder than others adds to why certain populations might feel more and more comfortable as we open up.
So I think what I want to shout from the rooftops is: please, people, be thoughtful, be safe, and be careful. Now that we know what COVID-19 is and we know what strategies have helped to taper its severity in terms of its effects on our communities, we cannot abandon the things we’ve been doing to maintain social distancing, not gathering in large crowds, wearing our masks when we are around other people, and not being around other people when we’re feeling sick and ill. These are really, really important measures because we’re all a bit scared of what is going to happen in the fall. We don’t know, so we need to do our best right now to protect ourselves and to protect everyone around us.
Lastly, to end with some optimism, I always like to ask: what gives you hope for the future? Related to your research, science more broadly, or life in general.
I think one of the things this pandemic has taught us is resilience. I think so many of us were forced, pushed, and shoved into a setting that none of us thought we would be comfortable with, but somehow we’ve managed to survive and thrive. I think that is what gives me the most hope: knowing that we are a resilient group of people and when thrown in an environment that is unfamiliar or unconventional, we have figured out ways to adapt and continue to thrive. I think that’s an important thing to recognize in all of us—that we’re still here, we’re still doing okay, we’re still committed to our mission of providing great care, we’re still committed to our patients in terms of understanding what it is that’s affecting them and how we can improve health overall. I find that to be incredibly inspiring, how we’ve all managed through this and here we are on the other side, still standing, many of us. That’s hopeful for me.