By Allen Chen

“You’ve trained to become physician-scientist’s and I salute you. Use the tools of science to prevent the next pandemic, and to cure all of the other diseases that afflict humanity.”

• Michael S. Brown, MD Physician-Scientist Nobel Laureate speaking via Zoom at Renaissance School of Medicine Class of 2020 Graduation Ceremony

Physician-scientist Michael Brown gave an inspiring and reassuring zoom graduation speech, amidst the COVID-19 pandemic. Mirroring his speech, many of our MSTP cohort across all classes have quickly joined the fight against COVID, becoming “COVID Warriors”, volunteering their scientific and medical knowledge to quell the pandemic, one that particularly afflicts those in NY and the Stony Brook area.

In this time, MSTP trainees have been in a call to arms in the form of RNA sequencing, plasma clinical trial research, guiding geriatric services, and using 3D printing to generate PPE for the hospital. MSTP students across the student body dedicated nearly 1000 hours total to help in these efforts. We highlight just some of the amazing way’s that SB’s MSTP members (even those who recently graduated) have given back to the Stony Brook’s Hospital and the Renaissance School of Medicine.

“COVID Warrior” PCR Diagnostic Testing

Nuri Kim (GS4) led the MSTP effort to secure and expand COVID-19 diagnostic testing at Stony Brook University Hospital under Pathology Department Chair Dr. Kenneth Shroyer, MD/PhD. Nuri described her experience there as fast-paced and demanding. Nationwide shortages of CDC-approved SARS-CoV-2 testing reagents meant the COVID-19 diagnostic volunteers had to find flexible and creative solutions on a day-to-day basis. Relying on prior experience with RNA extraction and PCR, Nuri and other MSTPs served as an important component of the hospital’s COVID-19 response. The student volunteer team provided results within 24-hour turnaround for over 800 patients and healthcare providers through the peak of the pandemic surge, during a period when New York State Health Department testing facilities were overwhelmed.

When asked how she got involved, Nuri responded, “I felt pretty helpless watching the pandemic arrive in New York. When the email came around from Dr. Kaushansky and Dr. Shroyer seeking volunteers with RNA experience, I registered immediately. It was a no-brainer.” From the beginning, Nuri worked alongside John Yuen (GS2) and under the supervision of pathology resident Dr. Karen Bai. She credits the team’s early success in establishing an in-house testing protocol to the team’s dedication, resourcefulness, and rapport. “Through the first weeks of volunteering, the hours were long. I feel extremely fortunate to have spent those early weeks with John and Karen.” Nuri also acknowledged RNA experts among their fellow MSTPs, Allen Yu (MS4) and Lilly Talbot (GS2), for their help in troubleshooting and soliciting scarce reagents from RNA labs across campus.

More MSTP students and Stony Brook graduate students soon joined the fight, demonstrating the generosity of our student body. Of the MSTPs’ response, Nuri said: “The most remarkable aspect of this experience was the immediate and ruthlessly capable response from fellow students. Other MSTPs were raring to go as soon as we had a protocol and workflow in place.” Trainees spanning all phases of the program formed a highly-trained ensemble cast: Rachel Kéry (MS3), Allen Lee (GS3), Kelvin Chan (MS3), Kevin Murgas (GS1), Lucia Yang (MS2), Allen Yu (MS4), Camelia Zhang (GS1), Steven Lewis (MS2), Joshua Kogan (GS2), Soma Kobayashi (GS2), Michael Martinez (GS3), Craig Marshall (GS2) collectively volunteered over 500 hours.

By late April, the team had a deep enough roster to run RNA testing 90 hours per week to sustain COVID-19 testing through the month of April. A picture emerges (literal ones below) of the PCR team, fiercely pipetting, loading samples, and determining diagnoses while dedicating long hours. With such a great team of students involved in the PCR testing, it is was a great demonstration of how powerful joined efforts from the MSTP could be.

Dr. Ken Shroyer, a physician-scientist mentor at Stony Brook recognizes the efforts of our student body (Stony Brook Medicine website): “We are now about a month out since we began to ramp up efforts to provide in-house testing for SARS-Cov-2… I know that Karen Bai, Nuri Kim, John Yuen, and many others have been putting in long hours, even 7 days a week and late into the night to generate clinical data that has been invaluable to guide the clinical management of our patients.” The Department of Pathology and their facilities guided the diagnostic testing and procurement of resources for it. Dr. Ken Shroyer has mentored SB MSTP students and has been a great contributor to our education. We hope that such effective interdepartmental interactions may arise in the future.

3D Printing of PPE for hospital

While the PCR team had been busy at work in the midst of uncertain reagent supplies, there was even less certainty regarding hospital supplies of personal protective equipment (PPE). Given that people had been under duress, it is not surprising that hospitals across the country developed a need for such supplies, critical for standard of care. Without factories in the MSTP’s backyard, creativity and craftiness was required. Working in this regard students such as Agatha Lyczek (MS3) and Mikhail Gurevich (MS3). We interviewed Agatha and she described how it started: “Mikhail Gurevich and I wanted to help combat COVID with a creative approach. We first asked ourselves, where do we think the need will be? Our original plan was to create mechanical actuator for a bag valve mask that will act as a “helping hand” to help ventilate patients that would otherwise be without one. We assembled a team with other stony brook students and alumni to help with design.”

How does one go about generating PPE or ventilators? Agatha and Mikhail used Auto-Desk 3D modeling and printing to create adaptors that would serve to join readily available parts such as HEPA filters and scuba masks. A picture of such an adaptor is shown below. “Dr. Mikhail Guzman offered his laboratory to us to design and test the “helping hands” and also invited Mikhail Gurevich and me to join his other efforts of designing PPE to help protect healthcare workers.”

On an average day Agatha and Mikhail would engage in zoom meetings to discuss design and programming issues regarding the ventilator (Well, also upon their recent return to Medical School they announced their engagement! CONGRATULATIONS!!!). For the PPE, the team would monitor 3D printers and assemble parts as they were produced. Agatha led the modeling adaptor parts in order to repurpose scuba diving masks to be used as hospital PPE. It was a great learning experience for those involved, practicing aspects of teamwork, material design, and project completion. Raja Pillai (graduated April), Eric Roth (GS4) and Johansen Amin (MS3) also volunteered for separate efforts for PPE assembly. Well done!

2020 MSTP graduate’s hit the hospital floors as Assistant Physician’s

Brinda Alagesan, Greg Kirschen, and Bryce Shroeder, recent MSTP graduates, joined the fight in early April as freshly graduated medical students were asked to join the hospital staff as Assistant physicians. Jump starting their careers as interns they used their recently donned medical degree’s in order to crucially help manage patients in the hospital. When interviewed, Greg noted how he and other assistant physicians were involved in managing COVID patients across multiple floors, while leaving the most critically ill patients to intensivists and other attendings. Each assistant physician generally worked with two other residents and an attending physician. Greg commented about how at first, he was nervous but that he was overall well-prepared for the experience. When asked how it impacted his view on the physician-scientist career, he said “Inspired me further, if anything! It shows the strength of our basic science training, important for determining what is a reproducible or valid finding.” To sum up his experience, Greg lamented “An interesting note to leave on, a social worker who I worked with told me he was a part of the AIDS crisis. He told me that like the AIDS crisis, the COVID19 Pandemic is something that will shape how you will handle your career as a physician and scientist.” Greg and other assistant physician’s learned from this experience while contributing to management of the pandemic. We will miss them as they go on to become residents across the country.

COVID Plasma Study

Amidst the efforts in helping patients at the front lines, one MSTP student wondered how COVID-19 may impact those very people, the hospital staff. Using their sharp research acumen, a team of Stony Brook clinical researchers including MSTP’s Lillian Talbot (GS3) asked “what percentage of our Stony Brook University hospital staff have serum antibodies to COVID-19? And “are staff members who care directly for COVID-19 patients more likely to have serum antibodies than those without direct patient contact?” Lillian Talbot, working under the direction of Department of Anesthesiology’s Dr. Elliott Bennett-Guerrero, alongside a group of research coordinators, conducted antibody testing on 500 Stony Brook health care workers using a point-of-care assay developed by a local Long Island company. In their efforts, the COVID-19 Health Care Worker study team found that surprisingly, there were not significant differences in plasma COVID-19 antibody levels when comparing high risk departments (critical care, emergency medicine) to those at less risk. Lillian and colleagues thus provided evidence that hospital PPE may be sufficient to protect even the most high-risk hospital staff from COVID infection.

While the Health Care Worker Antibody Study was progressing, Principal Investigator, Dr. Bennett-Guerrero initiated an even more ambitious multi-departmental COVID-19 clinical study, a randomized controlled trial examining the efficacy of fresh frozen plasma donated from recovered or “convalescent” COVID-19 patients as a therapy for severe COVID-19 infection.  Lillian in collaboration with two other MSTP students Jason Carter (MS4) and Margaret Shevik (GS3) were instrumental team members on the convalescent plasma clinical trial, helping on the donor recruitment and plasma recipient sides of the trial.

Beginning in April, Lillian, Jason and Margaret have (with their thesis advisors’ approval) collectively worked hundreds of hours on the COVID clinical trial and have collaboratively authored two manuscripts detailing their work and findings. As Margaret and Lillian return to graduate school and Jason to the clinic, these experiences will certainly help them as they move on to their future physician-scientist careers. Learning how to establish clinical studies and communicate effectively to faculty across departments are valuable skills these MSTP students will continue to cultivate.

Geriatric Outreach Services

So much of the above great work was done to help those facing COVID within the hospital, but what about outside of the hospital facility? Locked indoors, many geriatric patients and others particularly at risk for the severe respiratory sequelae of the infection find it difficult to carry out daily tasks and stay upbeat. Thankfully, in order to help with this, Steven Lewis (MS2) led and helped organize efforts to help bring daily functionality and care to the homes of geriatric patients. When asked how he got into this service, he said “Social distancing had just recently begun and I was keeping in regular contact with my grandma, who is still isolating at home in New Jersey by herself. From talking to her, it became clear that a great burden of social distancing would fall on older patients, people like my grandma who told me she was crying each morning (luckily not anymore!) and scared to go outside for groceries.” Steven knew that there was great interest and motivation to help out from students around him, inspiring him to take action.

Steven contacted geriatrician specialist Dr. Strano-Paul, Assistant Dean for Clinical Education and a familiar mentor to the MSTP to see what could be done. They were able to set up two teams of students (including MSTP student Rachel Kéry (MS3) ) that were assigned to geriatric patients. They would act in reassurance, answering questions, providing emotional support, and initiating communication with their physicians if necessary. This organized effort allowed many phase II and III students to provide support calls to patients. Medical students in phase 1 helped in delivering medications and groceries that patients needed. The SB community is thankful that services like these were put in place for those vulnerable and stuck indoors.

Conclusion

The physician-scientist training is a long-term pursuit, with many roadblocks and hurdles that may arise, making the career both challenging and interesting. The COVID-19 pandemic has not been an easy time period for any Stony Brook MSTP trainee. Yet, during these times students from each year have been creative and generous, using their knowledge and skills gained thus far to help those affected. Here we have covered the highlights of these efforts that we hope represents the best of SB MSTP, but of course by no means have covered in detail all efforts from every student. We are thankful for all such efforts and for the fact that we have such a strong and talented student body that gives back to the community.

Allen Chen (GS4) studies neural circuit mechanisms and cognitive behaviors that underlie neuropsychiatric disease in Shaoyu Ge’s and Qiaojie Xiong’s labs.