Before Michael Zwick, PhD, enters a lab at Emory University School of Medicine, he’s confronted by signs of the times: “9 Persons Max in This Room.” “Must Wear Mask When Entering.” “Wash Hands After Entering.”
Those directives and others like them are posted outside and inside labs throughout Emory — part of the new atmosphere as medical schools cautiously restart lab experiments unrelated to COVID-19 while instituting unprecedented procedures to keep everyone safe as the disease continues to spread.
For researchers, the unlocking of the spaces at the core of their life’s work is emotionally and professionally uplifting.
“I desperately wanted to be there, just doing science,” says Anne West, MD, PhD, who runs a lab at Duke University School of Medicine.
At the same time, restrictions to curb the spread of the virus somewhat subdue any celebration. As labs began opening in May and June (at different paces, depending on coronavirus infection levels in their local areas), schools implemented procedures that have kept many projects on hold and curtailed gatherings of researchers to work together on projects. Compliance is strong, but some staff remain wary about returning to campus.
The situation at most labs is summed up by Curt Civin, MD, associate dean for research at the University of Maryland School of Medicine (UMSOM), and Zwick, associate dean of research at the Emory School of Medicine:
“We’re reopening slowly but robustly,” Civin says.
“It’s not business as normal,” Zwick says.
Process to open
School administrators began working on how to reopen the labs safely as soon as they started closing them in March and April (while maintaining research on COVID-19 projects). It was an immensely collaborative process: Research deans worked with leaders in departments across universities — such as human resources, environmental health and safety, and information technology — and consulted with colleagues at other medical schools, even sharing plans as they developed them and going through a course developed for medical schools to return to campus safely.
“We see how damaging the shutdown is to our research enterprise,” Zwick says. “We want to avoid having to shut down again.”
The deliberations produced new processes and scores of rules — some that are implemented across the universities and others that apply specifically to the labs. Among the procedures:
- Training about COVID-19 safety precautions, including social distancing protocols and proper use of personal protective equipment. Several medical schools, such as those at Duke and Emory, require staff to complete this training before allowing them into the labs.
- Passing a COVID-19 screening process to get into campus buildings. These processes, carried out at campus entry points or online, include answering questions about whether they have had any COVID-19 symptoms or have been exposed to anyone with symptoms. Some schools conduct temperature checks as well. Those who might be infected get virus tests and might be required to isolate at home.
- Occupancy limits. The standard social distancing guideline of six feet works better in a grocery store line than in a research lab, where people work at adjacent bays and routinely walk around. Administrators calculated how much space one person needs around them in a lab and then used that figure to calculate how many people are allowed in each lab at once. One common ratio — used by Emory and the University of California (UC), Davis, School of Medicine — is 250 square feet per person. Other schools, such as Duke, established a rule of one person at each bay.
- Reserved time slots at some schools, usually via online sign-ups, to control the number of people in each lab. Emory’s slots are typical: 7 a.m. to 3 p.m., then 3 p.m. to 11 p.m. At UMSOM, Civin says the most popular choices when the labs started to reopen were half-day stints on Monday, Wednesday, and Friday.
With the labs ready, the question was: Are the researchers?
Excited and wary
Many researchers leapt from their laptops at home to get back to the labs. At Duke, West says one of her researchers called the return date “the happiest day of her life” because it renewed her “love for science.” Another, who lives alone, embraced the release from solitude: “Coming back was an absolutely huge, essential thing.”
Still, some have been wary about returning to campus while the virus continues to spread — especially in new hot spots like Texas.
“We are experiencing some anxiety from faculty and researchers; they don’t all feel safe coming back,” says Andrea Giuffrida, PhD, vice president for research at the University of Texas Health Science Center at San Antonio and a professor at its Joe R. and Teresa Lozano Long School of Medicine.
In fact, so few had returned to campus several weeks after the labs started reopening in early May that “we were a little nervous,” he says. The school held town halls to discuss the safety measures on campus, but it gave faculty and researchers leeway to work with their department chairs on when they will return to campus while ensuring that they are productive at home in the meantime.
“We are respectful of the anxiety,” Giuffrida says.
Other schools are extending work-at-home accommodations as well, both for safety concerns and family obligations. Some staff have children at home whose schools and summer camps have been closed because of the virus, notes Angela Haczku, MD, PhD, associate dean for translational research at UC Davis.
“I couldn’t just say, ‘You have to prioritize lab work over taking care of your children,’” Haczku says. “We have to consider competing priorities when organizing the logistics for people returning to the labs.”
The limits on lab capacity and the restricted hours have forced schools to prioritize which experiments to resume — and in what order. To do that, principal investigators and department chairs triage experiments based on such criteria as what resources they require (including equipment, time, and staff) and what’s at stake if an experiment remains postponed.
At UMSOM, Civin says, the factors include publication and grant deadlines for the project results, career development milestones (such as a thesis based on the project), and the need to coordinate services with core labs that are running under similar staff limits.
The unusual circumstances require researchers and decision-makers to be particularly understanding of each other’s situation. “The goal of beating this disease has unified the research communities in ways I have not seen before,” says Haczku.
Researchers who also administer a lab, as Haczku does, know how it feels to be on both sides of the process.
“We’ve done a lot of careful consideration of what is time-sensitive,” she says — then adds, laughing, “But I’m an investigator. Everything is time-sensitive! Everything has to be done now.”
Although schools hope to avoid canceling any projects simply because there isn’t enough room on the tight schedules, some experiments might be adjusted to make room for others. West says that a project at Duke that involved observing mouse behavior won’t be resumed because it was deemed to have already collected enough data to meet the goals of the study. “We can always do more” on any project, West says. “The truth is that some of the projects will fall off.”
Studies involving animals can be especially complicated to restart. Many labs euthanized most of their mouse colonies as they prepared to shut down; bringing them back up to the required levels, as well as ramping up care for the added animals, takes time. Projects that involve larger animals that are bred and raised elsewhere might have to wait for the other institutions to provide access.
That’s why Haczku cannot move forward with an experiment to test a new asthma treatment. She and her colleagues on the project had identified and recruited a cohort of 62 rhesus macaque monkeys at the California National Primate Research Center that meet the research criteria, including having asthma. But the center is now focused on COVID-19 research and it’s not clear whether the selected monkeys will become available or if she’ll need to identify other ones. “It’s a little bit stressful,” she says.
Haczku understands the priority on COVID-19, but like many who are doing work not related to that disease, she worries about the risk to research on other afflictions. “We’ve been working on this project for almost a year,” she says.
A good start
Compliance with the new procedures has been strong but not perfect, and enforcement creates some awkward social dynamics.
“I have not seen anyone not following the rules,” says West, who runs a lab at Duke. Lab researchers, she notes, “are procedure-oriented people” for whom safety measures are already routine.
The principal investigators are typically responsible for compliance in their own labs, while school administrators and environmental safety staff conduct occasional cop-on-the-beat patrols. Some find it tricky to call out violators without coming off as an overbearing hall monitor.
“This isn’t a police state,” says Colin Duckett, PhD, vice dean for basic science at Duke. “I’m trying to find my tone.”
He recalls an early encounter with an inappropriately exposed face: “Somebody came out of the elevator not wearing a mask, along with someone who was wearing a mask. I confronted her: ‘What are you doing?’” He notes that she apologized and pulled up her mask, but he says, “I wish I could take that back a bit.”
Even more delicate is one lab worker calling out another. “We tell people that it’s okay to remind somebody, ‘You’re not wearing a mask,’” says Zwick, who runs his own lab in the Department of Human Genetics at Emory. “Try not to do it as a personal attack. But you feel weird doing it.”
What’s lost, what’s ahead
Even though researchers are thrilled to return to their benches, the virus infiltrates the atmosphere in nonbiological ways.
“What we lost was momentum,” says Civin. “I’m concerned about safety but also about regenerating our momentum, getting the rust off.”
Getting up to speed is impeded by procedures that inherently slow the pace — chief among them the gradual startup of experiments and the lab capacity limits.
“If you have six people assigned to your lab, you can’t have all six come back in at the same time,” says Zwick.
That cuts down on the in-person, often spontaneous discussions among researchers about findings and new ideas — a loss that some rank as among the most significant of all.
“We can’t stand in groups and really talk together,” Civin says. “Science is social. Medicine is social. How many discoveries do we see nowadays that come from one person?”
Haczku agrees, lamenting that communicating by phone calls, emails, and web updates is “sluggish” and makes it difficult for her to mentor younger researchers.
“The personal interaction is just so important in research work,” she says. “Sometimes you have to ‘hold hands’ of people to show how things work. That hand-holding is lost at the moment.”
And still, despite all the protocols to prevent anyone with the virus from entering a lab, Civin echoes others when he predicts, “We will have cases.”
That doesn’t mean the cases will spread in the labs. At Duke, any coronavirus cases among lab staff have been traced to contagion outside campus and did not spread within the labs, Duckett says. Administrators worry about the increased risk of such infiltrations from the community after students and staff return to campus.
“It doesn’t seem rational to think you’re going to have any environment in which there is no illness; it’s going to happen,” says West. “How do you deal with it? You want there not to be rapid transmission.”
That will require everyone to remain vigilant even when the sense of urgency fades.
“We need to not get complacent,” Duckett says. “We’re early in this game.”