In Conversation with John Chan | Macaulay Honors College

02/14/2020

Student and Alumni News

John Chan, M.D. is a member of the Macaulay Parents’ Council. His son Luming Chan is a Macaulay senior. Parent Liaison Stephanie Straffi interviewed John about his experience running a laboratory at Albert Einstein College of Medicine during the pandemic.

As a physician, professor, and infectious disease expert (focusing particularly on tuberculosis), what was your reaction at the beginning of the coronavirus pandemic?

The early pre-pandemic stage of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection evolved rapidly. On the 31st of December 2019, health officials in Wuhan, China reported for the first time a cluster of cases of pneumonia of unknown cause. A week later, Chinese scientists had linked a novel virus — severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – to the cluster of cases of pneumonia, designated then as COVID-19 (coronavirus disease 2019). Soon thereafter, the potential threat posed by this novel coronavirus prompted the United States Centers for Disease Control and Prevention to activate its emergency operations center. By the end of January 2020, the World Health Organization (WHO) pronounced COVID-19 an international public health emergency. Six weeks later (in mid-February 2020), WHO declared COVID-19 a pandemic.

Prior to 2019, two coronaviruses had caused serious outbreaks of severe respiratory illnesses – SARS in the period 2002 to 2004 and MERS (Middle East Respiratory Syndrome) that began in 2012. Given these precedents, I realized with much trepidation, in the early pre-pandemic period, the potential threat of COVID-19. Although not yet proven at the time, it is possible that SARS-CoV-2 can be transmitted through the respiratory route, as pneumonia is a major manifestation of COVID-19. This mode of transmission enables the infection to spread with high efficiency, which can be further enhanced by high population mobility as a result of the expediency of modern-day mass transportation. Indeed, in the pre-pandemic period, I had advised friends and relatives who had made plans to visit China to delay their trips until we learned more about this novel coronavirus and the trajectory of COVID-19 became clearer.

Tell us about your role at Einstein and the work of your research lab. Do you mentor any Macaulay graduates?

I am an infectious diseases physician scientist at the Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx. In addition to seeing patients on our teaching infectious diseases consultation service, I run a laboratory that works on tuberculosis (TB). My lab is interested in studying the interactions between the host and Mycobacterium tuberculosis, the causative agent of TB. My research focuses on understanding host defense mechanisms against M. tuberculosis, such as those mediated by B cells and antibodies and specific subsets of T lymphocytes. We are  also interested in understanding how the tubercle bacillus evades anti-TB immunity to establish asymptomatic latent infection in an infected individual, and how such dormant bacilli can reactivate to cause diseases when the immune status of the host is compromised, by characterizing M. tuberculosis-intrinsic and host-intrinsic factors that regulate these processes.

I am the Associate Director of the Albert Einstein College of Medicine Medical Scientist Training Program (MSTP). I have had experience interacting with graduates of the Macaulay Honors Program at Einstein. For example, I was on the thesis advisory committee of a Macaulay graduate who matriculated into the Einstein MSTP who, upon graduation, had matriculated into a residency training program in neurosurgery. I mentor graduate students, postdoctoral fellows, medical students, MSTP students, interns and residents, and infectious diseases fellows on the ward and in the lab, depending on their career interests.

How have your lab research and team been affected by Covid-19 and the subsequent lockdown? What were/are the biggest challenges?

As in all other research organizations in New York, the restrictions mandated by the city and state have affected the daily operation of our laboratories. We understand that such measures are necessary to mitigate transmission of SARS-CoV-2 and to ensure safety of all personnel. When the restrictions were initially announced in March, there was certainly a decrease in the lab’s productivity, which was a major challenge that all investigators had to deal with. Since then, we have found ways to become more productive while maintaining physical distancing in the lab, including setting up “shifts” and doing a lot of written work from home. The biggest challenge is to adjust to the restrictions in place to ensure continuity of the research despite a decreased ability to move forward quickly.  For example, one must be vigilant in maintaining critical reagents used for experiments conducted in the lab, such as essential cell lines and specialized mouse strains. 

Has your lab been able to re-open and, if so, what are the safeguards that have been put in place to protect your team and the integrity of your research environment?

All laboratories have gone through re-opening in phases. Safeguards designed to mitigate transmission are in place and must be followed. For example, there is a pre-screening process involving answering questions regarding signs and symptoms of COVID-19 and temperature monitoring prior to entering the premises. Researchers and staff must wear masks in the buildings. The practice of hygiene (for example, using sanitizers, avoiding touching mucous membrane), hand washing, and physical distancing must be rigorously followed. And all meetings and seminars are virtual. 

How has this pandemic influenced your thinking about infectious diseases and how medical professionals and government agencies can best work together to inform citizens and protect public health?

History has taught us that microbes know no boundaries. Infectious pathogens had exacted their toll on humans as far back as the pre-historic era. It has been estimated that the 1918-1920 Spanish Flu pandemic, which began a few months before the end of World War I, caused 100 million deaths. The massive movement of the troops living in crowded conditions and the poor nutritional status of the population during the war no doubt contributed to the devastating casualties of the Spanish Flu pandemic.  With the advancement of technology and mass transportation and immigration, international population mobility has increased remarkably since.  Fluid population mobility is highly conducive to the transmission of pathogens (particularly those that can be spread via the respiratory route) across countries globally. Such a scenario has been recapitulated in the current COVID-19 pandemic, causing countries around the world to impose stringent travel restrictions and physical distancing rules, which, in turn, have a huge impact on our daily life, health care, education, and the global economy. But this devastating pandemic has shown once again the resilience and the ingenuity of the human race – in less than a year from the discovery of the causative agent of COVID-19 infection, great progress has been made in the development of effective drugs and vaccines against SARS-CoV-2.

 

Since the 1918 Spanish Flu pandemic, we have witnessed that emergent viruses have the capacity to ravage society and to wreak havoc on our daily life — the coronavirus SARS epidemics in the early 2000’s followed by the H1N1 pandemic, and more recently, another coronavirus MERS in 2012. But humans have short memory spans, particularly when it comes to adverse experiences. The current novel coronavirus SARS-CoV-2 sends a cogent message that the world should heed the power of microbes and be better prepared for the real possibility of another pandemic.

International collaboration among strong apolitical governing bodies dedicated to capacity building that seeks to develop a robust health care infrastructure for the effective and efficient control of emergent pathogens is key to avoiding or limiting the damage of another pandemic.  Such governing bodies should include, first and foremost, scientists and public health experts specializing in infectious diseases and medical professionals, as well as informatics system specialists, whose skills can enable the timely detection of a pathogen and the tracking, in real time, of the evolution and the trajectory of the infection globally, thereby facilitating implementation of policy regarding the containment of the infection.  Close interaction and cooperation between these governing bodies and leaders of private sectors, including industry (particularly biotechnology and pharmaceutical companies) are most important. Such collaborative efforts should enhance the capacity to produce equipment (for example, ventilators, dialysis machines, and personal protective equipment) needed for the treatment and care of infected patients; and to develop novel interventions, including vaccines, against emergent pathogens. International organizations dedicated to global public health issues, such as the WHO, should be supported and empowered to take a leadership role in the fight against future pandemics. Resources should be redistributed to dedicate adequate funds to the development of a robust health care infrastructure. But most important of all, let’s not forget the lessons we have learned and are still learning from the 2019 COVID-19 pandemic.