Emory Medicine Magazine - Winter 2022 by EmoryWeb

Medicine WINTER 2022

“It didn’t hurt” BRAVE YOUNG VOLUNTEERS MADE

CHILDREN’S COVID-19 VACCINE POSSIBLE FOR OTHERS

W H AT ’ S I N S I D E

BACK TO OUR FUTURE

PARENTING IN A PANDEMIC BEYOND PLATITUDES

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On Campus MACROSCOPE

During the 2021 White Coat Ceremony Oct. 16, 141 first-year medical students gathered on Clairmont Campus’s Grand Lawn. A white coat was placed on each student’s shoulder, signifying their entrance into the medical profession. M1 Lauren Jenkins looks back at Professor Kimberly Manning, who snapped the shot.

FROM THE DEAN

When Worlds Collide The Emory Brain Health Center and Public Broadasting (PBS) have partnered on an Emmy–award– winning news magazine hosted by Emory’s Jaye Watson, at pbs.org/show/your-fantastic-mind/.

Vikas P. Sukhatme, md, s c d Dean, Emory School of Medicine Chief Academic Officer, Emory Healthcare

The best, most productive partnerships occur when institutions that share goals and values, but have different spheres of expertise, come together for the common good. Emory School of Medicine benefits from such partnerships with Children’s Healthcare of Atlanta, Grady Memorial

Hospital, the Atlanta VA Medical Center, Morehouse School of Medicine, and Georgia Institute of Technology, to name just a few. Woven throughout this issue of Emory Medicine are exciting discoveries, programs, and relationships that exist because our organizations combined forces: • Children five and older can now be vaccinated for COVID-19, in part due to clinical trials by Emory and Children’s Healthcare of Atlanta. That families are willing to participate in this research is a testament to their confidence in our institution and our clinical partners (p. 12). • Molnupiravir, an antiviral pill to treat COVID-19, was invented at the nonprofit DRIVE (Drug Innovation Ventures at Emory) and licensed to Merck for production and distribution. “To advance a drug quickly and

Emory Medicine Editor Mary Loftus Art Director Peta Westmaas Director of Photography Jack Kearse Contributors Eric Butterman, Carol Clark, Quinn Eastman, Suanne Engle, Jodie Guest, Shannon McCaffrey, Kelundra Smith, Rajee Suri Production Manager Stuart Turner Copy Editor Susan Carini Advertising Manager Jarrett Epps Web Specialists Lindsay Paroczai, Stuart Turner Associate VP, Health Sciences Communications Nikki Troxclair Director of Communications, Emory School of Medicine Jen King Executive Director of Content Jennifer Checkner Associate VP, Creative Dave Holston

Emory Medicine is published twice a year for School of Medicine alumni, faculty, and staff; patients; donors; and other friends. © 2022 Emory University. Emory University is an equal opportunity/equal access/affirmative action employer fully committed to achieving a diverse workforce and complies with all applicable federal and Georgia state laws, regulations, and executive orders regarding nondiscrimination and affirmative action in its programs and activities. Emory University does not discriminate on the basis of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, or veteran’s status. Inquiries should be directed to the Office of Diversity, Equity, and Inclusion, 201 Dowman Drive, Administration Bldg., Atlanta, GA 30322. Telephone: 404.727.9867 (V) | 404.712.2049 (TDD).

FOLLOW UP

COVID-19 kids’ book

ity of a company like Merck,” says George Painter, professor of pharmacology and chemical biology and CEO of DRIVE. The drug received emergency use authorization by the FDA in December (p. 5). • The Emory and Georgia Tech Coulter Biomedical Engineering Program allows students and researchers to explore the fertile intersection of medicine and engineering (p. 26). • Emory, Morehouse School of Medicine, the Atlanta VA Healthcare System, and Kaiser Permanente of Georgia are leading the Atlanta hub of a nationwide study to identify why some people develop long COVID (p. 8). I appreciate all of our learners, alumni, faculty, staff, partners, and donors who—with open hands and open hearts—have shared their talents, ideas, and resources with us. I’m happy to admit we couldn’t have done it on our own. Your support has exponentially expanded our impact and carried it forth into the broader world, inspiring change and improving lives.

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Nashville pediatrician and Emory alum Diana Pontell 09C reads COVID-19 Helpers to her children. Written by Beth Bacon and illustrated by Kary Lee, the children’s book won an Emory Global Health Institute competition and was included in the Fall 2020 alumni issue of Emory Medicine. Pontell’s mother, Ana Maria Pimentel 91R, is co-medical director of a Grady neighborhood clinic and assistant professor of pediatrics at Emory. “I’d encourage parents to read and discuss this book with their children,” Pimentel says. “I like that the pandemic is explained in a way that’s easy for young children to understand.” Download COVID-19 Helpers at: links. emory.edu/covidkids.

22-SOM-DEAN-0005

across the globe in all the countries where it is needed, you need the capac-

“ 12 FEATURES

Back to Our Future 12

Brave young volunteers took part in a clinical trial by Emory and Children’s Healthcare of Atlanta to test the COVID-19 vaccine for children five to 11, paving the way for other kids to be able to get the vaccine as well.

I thought it was beneficial. We just wanted to do something,” says Decatur

physician Rashante Harris, of her daughter, Autumn, participating in the COVID-19 vaccine clinical trials.

“

Dinner with a Doctor: Parenting during a Pandemic 20

Child and adolescent psychiatrist Jennifer Holton hosts our virtual Dinner with a Doctor to answer parent panelists’ most pressing pandemic questions, from how much to tell young kids about COVID to why parents need to lower their expectations.

Best of Both Worlds: When Engineering and Medicine Collide 26

For more than two decades, Emory and Georgia Tech have collectively asked, “What happens when medicine and engineering combine forces?” Spoiler alert: life-saving and -enhancing discoveries and technologies.

biomedical engineering

Beyond Platitudes 32

Spurred by racial inequities of “virus and violence,” the School of Medicine’s first Diversity, Equity, and Inclusion strategic plan moves beyond platitudes to action through education, outreach, and communication.

THE BARE BONES Letters 4

Briefs 5 An antiviral pill for COVID-19, The Plant Hunter memoir, inflammation may lead to depression, obesity is a risk of business travel, investigating long COVID, combating HIV, grandmothers’ love, smartphone app helps rural midwives.

“I think every person in

AND MORE

Ask a Top Pediatrician 24 Lee Beers 96M, president of the American Academy of Pediatrics, addresses issues concerning children and COVID-19. What’s Up, Doc? Class Notes 40

Visit us online at emorymedicinemagazine. emory.edu for bonus content. Send letters to the editor to mloftus@emory.edu.

should do undergraduate research, because so much of the job market is research related.” Shaefali Padiyar

THE BARE BONES

Letters After the Summer 2021 issue of Emory Medicine came out, I started to get lots of

I read all my Emory Medicine magazines cover to cover because they

outreach from people about the article on my family’s experience [“The Circle: Grief, Joy, and Proton Therapy”]. Readers shared personal things they endured and suffered, and told me how important my story is, especially during these times. You can imagine the flood of emotions whirling around within me. On one hand, I am happy that it’s a true story. I am happy it’s true because it humanizes tragedy. It’s not just “those people somewhere over there.” It’s right here, close to home. It’s every Emory Proton Therapy Center patient. It’s every Winship Cancer Institute patient. It’s them. It’s us. It’s me. On the other hand, I am saddened that it’s a true story. I am saddened because baby Graceson is no longer here. No need for two sets of clothes. No need to come up with secret ways of trying to tell [the twins] apart. No need to do any of that because baby Graceson is gone (for now). Mostly though, I am so overwhelmed with joy and gratitude that our story is touching many lives in a meaningful way.

take me into another world. I want to ask you if, in the next issue, an article could be done by a psychologist about the effect the isolation caused by the coronavirus pandemic has had on older people? We heard about children who have not been able to attend school, participate in games, or play with their friends. But what about adults (like me) who live alone and how they have been affected mentally and emotionally by the isolation? What are people doing to keep their balance and how do you get back into the old routine without fear? Vaccinations are protecting our bodies but how do we protect our emotional and mental health from this long dark cloud that is hovering over us?

Jacynta Brewton

Edye Bradford

Atlanta

Clayton, GA

Years ago, I was asked by my supervisor

would be felled by one. We met for lunch, and she told me I needed to carry on bringing awareat the TV station to put together a video for a ness to brain health. I told her what I’d said dozfundraiser for Alzheimer’s disease research, hostens of times, that I was comfortable in local TV ed by Mary Rose Taylor, who had lost her husband news. “It’s my dying wish that you take this job,” to the disease. She liked the video but came back she said. I told her that was unfair. She didn’t with edits. My annoyed reaction was, “Who is this answer, just took her next bite. And that is how I woman anyway?” The worst part is that the edits came to leave a career I loved to work at Emory’s made the video better. I learned Mary had been Brain Health Center, where I produce and direct a 60 Minutes producer long before she was an the Emory/PBS series Your Fantastic Mind. Atlanta philanthropist. I did the video every year When I visited Mary after she could no longer after, and we became friends. speak, she asked questions using her eye gaze Then the Emory Brain Health Center opened. device, remaining focused on brain health. She Mary marshaled the forces of her community to Mary Rose Taylor’s portrait hangs died in November 2020 at 75. A dear friend of fund raise, helping to create a place that would in the Emory Brain Health Center’s Mary’s said, “A light has gone out in Atlanta.” address depression, addiction, brain injury, sleep, lobby, which is named in her honor. But she lit a light in countless others, urging us dementias, and other diseases involving the toward that greater good. I’m so proud of her—that I knew her, that brain. She wanted me to come work at the center, saying I could I loved her, and that I can try to do right by her. tell the good stories that would change lives and empower people. I told her I was doing that already. This went on for two years. Then Mary was diagnosed with ALS. It was horrific irony, that a woman who had devoted herself to the cause of curing brain diseases

Jaye Watson Atlanta

We like to hear from you. Send us your comments, questions, suggestions, and castigations. Address correspondence to Emory Medicine magazine, 1762 Clifton Road, Suite 1000, Atlanta, GA 30322; call 404.727.0161; or email mloftus@emory.edu.

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G AM E C HANGE R

Drug invented at Emory authorized to treat COVID-19

E Q UIN

ALI

2016: Emory receives a Defense Threat Reduction Agency contract to develop countermeasures against EEVs.

March 2020: DRIVE licenses EIDD2801 to Ridgeback Biotherapeutics as a potential COVID-19 therapy.

COVID-19

TIS

In November, Merck announced that a final analysis of its phase 3 clinical trials, conducted globally across more than 170 sites, showed that molnupiravir reduced the risk of hospitalization or The drug, molnupiravir, was okayed for death by about 30 percent, compared to treating adults who test positive, have placebo, in patients with mild-to-modmild-to-moderate COVID-19, are at high erate COVID-19. Molnupiravir can be prorisk for progression to severe COVID-19, vided as a pill in an outpatient setting, including hospitalization or death, and which could ease distribution around for whom alternative the world. It works by authorized treatment targeting an enzyme options for the disease needed for the virus to were not accessible or make copies of itself, clinically appropriate. introducing errors into The FDA recommendthe viral genome. The ed that molnupiravir, drug has been apavailable by prescripproved for emergency tion only, should be use against COVID-19 in “I’ve spent my career initiated as soon as other countries as well, possible after diagnosuch as the United as a drug developer, sis of COVID-19 and Kingdom and India. always nose down, within five days of many researchgetting things done, and ers, Like symptom onset. when the pandemI hadn’t even thought Merck and Ridgeic began, Emory scienabout the magnitude of tists led by DRIVE CEO back Biotherapeutics licensed molnupiravir George Painter sought what was happening from Drug Innovation and the breadth of the to quickly repurpose Ventures at Emory a broad-spectrum impact molnupiravir (DRIVE), a nonprofit antiviral drug they had might have.” drug development been developing for company formed by influenza and other —George Painter the university to adcoronaviruses. Painter, vance development of early-stage professor of pharmacology and chemidrug candidates for viral diseases of cal biology at Emory School of Medicine, global concern. and colleagues soon realized they had a “Emory is uniquely positioned potential treatment for COVID-19. “This because of our significant experience de- drug is a direct intervention at a time veloping successful therapeutics for HIV, when this pandemic is not yet over,” Hepatitis C, and Hepatitis B, and we will says Painter. “When you look at the daily continue to use our expertise to focus death toll and you think that this can on viral diseases of global concern,” says help—it doesn’t require enormous medJonathan Lewin, Emory’s executive vice ical infrastructure to give, can be distribpresident for health affairs, executive uted easily and self-administered—you director of Woodruff Health Sciences think about the impact all that could Center, and CEO of Emory Healthcare. have. It’s overwhelming.” ■ An oral, antiviral drug discovered by scientists at Emory has received emergency use authorization by the US Food and Drug Administration (FDA) for treatment of COVID-19.

2013: Emory begins screening ribonucleoside analogs against equine encephalitis viruses (EEVs). Spread by mosquitoes, EEVs can be fatal and were weaponized during the Cold War.

2019: Emory receives an NIH award to develop antivirals against in uen a

April 2020: The FDA grants DRIVE an Investigational New Drug application. Ridgeback begins Phase 1 clinical trials.

May 2020: Ridgeback partners with Merck.

Oct. 2021: Merck submits Emergency Use Authorization application to the FDA.

Dec. 2021: Molnupiravir receives Emergency Use Authorization from the FDA for the treatment of COVID-19.

Sept. 2020: Merck and Ridgeback begin pivotal Phase 2/3 clinical trial.

Nov. 2021: Britain becomes the first country to approve molnupiravir for COVID-19.

Winter 2022

THE BARE BONES

Botanical Adventures

‘A Vicious Cycle’

Cassandra Quave’s life is like a tropical forest:

Inflammation can impact motivation and lead to depression, say Emory School of Medicine researchers. In a paper

varied, colorful, bursting with life yet laced with hidden paths and obstacles. Her new memoir, The Plant Hunter: A Scientist’s Quest for Nature’s Next Medicines (also available as an audiobook read by Quave), begins with a spirited childhood in rural Florida marked by dozens of painful surgeries but also joyful explorations of nature, and moves to her pivotal years as an Emory undergrad, travels to investigate the native flora of other lands, and adventures as a medical ethnobotanist. Quave, curator of the Emory Herbarium and associate professor of dermatology and of the Center for the Study of Human Health, follows clues hidden in ancient plant remedies to search for new compounds to combat the modern-day scourge of antibiotic-resistant infections. “We’ve barely scratched the surface of the medicinal value of plants,” she says, “yet two in five plants are estimated to be threatened with extinction due to the destruction of the natural world.”—Carol Clark

in Pharmacological Reviews, the researchers propose that low-grade inflammation affects brain chemicals and circuits that regulate motivation, leading to motivational deficits and a loss of interest or willingness to engage in usual activities, including work and play. These deficits can be reflected as anhedonia, the inability to feel pleasure—a core symptom of depression and likely the most disabling. The energy demands of inflammation require conservation of resources and thus the shutting down of certain behaviors. Low-grade inflammation can be caused by lifestyle changes such as diet and sedentary behavior. “A vicious cycle can occur where poor lifestyle habits lead to increased inflammation that, in turn, reduces the wherewithal or motivation to change those habits,” says Andrew Miller, William P. Timmie Professor of Psychiatry and Behavioral Sciences. This may be especially relevant during pandemic life, when even greater energy is required to sustain healthy eating and physical activity, says Miller, who coauthored the paper. ■

“This pandemic has shown us how essential our healthcare workforce is. To launch this campaign now means that we’re investing in the future. Emory is the best place to work toward a better future because we have the best people. “This is a place that invests in our people—people who have really committed their lives to serving us and to keeping our community and our loved ones healthy and safe. An investment in these students is an investment in the health of our community’s future.” Karen Law 11MR

Emory School of Medicine Program Director, J. Willis Hurst Internal Medicine Residency Program Associate Vice Chair of Education Associate Professor

2036.emory.edu

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Risky Business: Obesity Can Be a Side Effect of Business Travel

Seen & Heard

As employees return to business travel, albeit with masks on, a new study out of Emory shows that frequent travel for work may pose additional health risks not related to COVID-19. Busy and stressful travel schedules may increase the risks of obesity, which can lead to conditions such as heart disease and diabetes. The study was published in the Journal of Occupational and Environmental Medicine and is the first to e aluate the association of usiness travel with all three body-composition measures: body-mass index (BMI), body-fat percentage, and belly fat. Most research on health risks associated with travel has focused on the international travel-related risks of infectious diseases. mory researchers re iewed de identified health information from 795 people who had physicals at Emory’s Executive Health Center from to artici ants filled out a health history questionnaire about frequency for domestic and international business travel, and shared information about work hours, exercise habits, amount of sleep, and more. Mode of travel was not asked. “From this research, we found that business travel has a connection with body-composition metrics; those traveling most frequently had a higher body-mass index, body-fat percentage, and belly fat, and therefore were at the highest

risk of developing chronic disease,” says lead author Sharon Horesh Bergquist, associate professor of medicine and medical director of Emory Executive Health Center. “The health risk increased when the sum of travel was extensive, exceeding 20 days per month.” In the study, 651 participants were male and 144 were female, with a mean age of 52 years. Most of the participants were Caucasian followed by African American. Both men and women worked an average of 53 hours a week. Median travel frequency was six days per month, with 83 percent being domestic. Males traveled more than females, and more than half of the sample did not travel internationally. Inadequate sleep and exercise had a more pronounced effect on body-composition measures in female travelers. “Our results suggest that attention to lifestyle factors, s ecifically e ercise and adequate slee , is important for all business travelers and of particular importance for women,” says Bergquist, who says other ways to reduce health risks include healthier eating options, ample water for hydration, and scheduled downtime for rest and re ection e ha e a tremendous o ortunity to challenge old ways and start afresh,” she says. hese data su ort alancing the enefits of business travel with the potential health risks.” ■

“Why is surveillance testing so important? Well, this virus is different than other viruses. With most viruses, when you’re actually contagious and spreading it, you are sick. You’re coughing, sneezing, things like that.

But with this virus, you can feel completely fine and still spread it. And that’s why testing is so important.” —Sanjay Gupta, Emory associate professor of neurosurgery, answering children’s questions about COVID-19 on CNN.

Winter 2022

THE BARE BONES

Investigating Long COVID-19 Of the more than 45 million COVID-19 cases in the U.S., it is estimated that between 10 and 30 percent have long COVID. Long COVID conditions are now referred to by a wide range of names, including postCOVID, chronic COVID, and long-haul COVID. Emory and local partners are leading the Atlanta hub for a nationwide study to identify why some people have prolonged symptoms or develop new or returning symptoms after an acute bout of COVID. Emory, Morehouse School of Medicine, the Atlanta VA Healthcare System, and Kaiser Permanente of Georgia are projected to receive close to $20 million over four years to be part of a comprehensive initiative called Researching COVID to Enhance Recovery

(RECOVER). Through funding from the National Institutes of Health, the consortium brings together scientists, clinicians, patients, and caregivers to take on the problem of long COVID, which can affect multiple organs. “Survivors of COVID-19 who are experiencing long COVID symptoms deserve answers and relief from their symptoms,” says Igho Ofotokun, Emory professor of medicine and one of three principal investigators (PIs) for the study in Atlanta. “This is a critically important public health problem that we need to understand,” says Rachel Patzer, professor of surgery and director of the Emory Health Services Research Center, who also serves as a PI. According to the Centers for Disease Control and Prevention, persistent symptoms clinicians see in patients reporting long COVID include increased respiratory effort, fatigue, “brain fog” or cognitive impairment, chest pain, headaches, heart palpitations, insomnia, fever, impaired daily function and mobility, pain, mood changes, and menstrual cycle irregularities. ■

o find out more a out the study, go to the national site at https://links.emory.edu/e6. To volunteer for the study in the Atlanta area, contact: recover.atlanta@emory.edu. ADVERTISEMENT

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WHERE SCIENCE AND SOCIAL JUSTICE MEET

Progress in Combating HIV prevention and interventions. What drew you to infectious diseases and, in particular, HIV? I first had an inkling

about becoming a physician in high school. Once exposed to research in medical school at Emory, I was hooked on that as a career path. I have a love/ hate relationship with HIV. I love HIV science but hate the human impact. I was drawn to HIV to work at the intersection of fascinating, cutting-edge science and social justice. I can’t think of a field where this intersection is more palpable than infectious diseases, and it’s truly my privilege to be an HIV doctor and researcher. Do you think you’ll see an HIV “cure” or vaccine in your lifetime? Yes, an HIV cure or a vaccine

may not look the way we’re expecting, but I do believe it’s possible to reduce new HIV infections to rare events and significantly improve longevity and quality of life for those with HIV.

What are the most effective ways to help in areas where HIV rates are still high? There

are two requirements to have an impact on areas where HIV is still prevalent: political will to support health equity and the resources to implement effective interventions. Poverty, racism, and homophobia as well as equitable access to health care and education must all be addressed. IL L U S TRATION BY KEITH N EG L EY

Emory physician-scientist Colleen Kelley has focused on the spread of HIV/AIDS and sexually transmitted infections among sexual and gender minorities, as well as disparities in HIV

As we look past COVID-19, what gives you hope for the future and what is the biggest

challenge? The ability of the scientific community, the federal government, and industry to come together and give the world several effective COVID-19 vaccines in one year’s time gives me great hope. Our capabilities to tackle difficult problems are near limitless with political will, resources, and the scientific community all on board. The challenge is ensuring equitable access and uptake of these amazing scientific advances across the globe—we are not healthy until the planet is healthy.—Shannon McCaffrey

Above: Associate Professor of

Medicine and Epidemiology Colleen Kelley was awarded the HIV Medicine Association’s 2021 Award for Excellence in HIV Research.

The Power of a Grandmother’s Love For the first time, scientists have scanned grandmothers’ brains while they’re viewing photos of their young grandchildren—providing a neural snapshot of this special, intergenerational bond. “What really jumps out in the data is the activation in areas of the brain associated with emotional empathy,” says James Rilling, lead author of the study and professor in the School of Medicine’s Department of Psychiatry and Behavioral Sciences and the Department of Anthropology. “That suggests that grandmothers are geared toward

feeling what their grandchildren are feeling when they interact with them. If their grandchild is smiling, they’re feeling the child’s joy. And if their grandchild is crying, they’re feeling the child’s pain and distress.” In contrast, the study found that when grandmothers view images of their adult child, they show stronger activation in an area of the brain associated with cognitive empathy.

That indicates they may be trying to understand cognitively, more than emotionally, what their adult child is thinking or feeling and why. “Young children have likely evolved traits to be able to manipulate not just the maternal brain but the grand-maternal brain,” Rilling says. “An adult child doesn’t have the same cute ‘factor,’ so they may not illicit the same emotional response.”—Carol Clark IL L U S TRATION BY MU BAI

Winter 2022

THE BARE BONES | INNOVATIONS IN ACTION

Every Mother, Every Baby Biomedical engineer Gari Clifford and anthropologist Rachel Hall-Clifford, were their own first test subjects for a device they invented that helps assess maternal and fetal health. Living in the United Kingdom at the time, they had been keeping tabs on their first child in utero with a orrowed fetal monitor hey reali ed such low cost monitoring of pregnant women could e hel ful, es ecially in countries where prenatal care is minimal. Clifford, chair of the biomedical informatics de partment at Emory, imme diately saw the otential of smart hones and weara le fitness de ices to gather ersonal health data and use it to signal indi idual health warnings or to track u lic health trends. And the prevalence of smartphones solved one of the challenges of health care technology—that it’s prohib itively expensive. Clifford looks for easier, chea er ways to get results or e am le, while doing fieldwork in outh frica, he used a cent egg cu with a hole drilled in it to replace a stethoscope. He applied the same logic to a prenatal monitor ing kit. The kit, called safe natal, uses a smart phone, a small doppler ultrasound de ice, lood

EMORY MEDICINE

ressure cuff, ulse o imeter, and s eaker wo headphone jacks, one for the cell phone and the other for a speaker, amplify the heartbeat. Each kit costs a out FIELD TEST Hall-Clifford

lived in Guatemala while doing field research on childhood diarrheal diseases: “I became aware of all the challenges to health care delivery. Gari would visit, and Guatemala pulled us in. We fell in love with the place and the people.” Women in Guatemala have one of the highest rates of maternal mortality in Latin America. In rural communities, up to 75 percent give birth at home with midwives and often have difficulty getting care in medical facilities. They developed their kit with a local non-governmental organization, the Maya Health Alliance. By this point, they had an enormous database of some 20,000 recordings. “Our son is part of the archive,” Clifford says. Being able to set normal baselines allowed them to pick up on warning signals. The smartphone application records and securely transmits patient information for review by clinical staff, flagging serious complications for immediate follow-up. The

safe+natal program, deser e any ur ose veloped with funding from The safe+natal app is NIH and the Charles Hood made to be as simple and Foundation, includes regular user friendly as ossi le monitoring and 24-hour ocal midwi es modeled for access to clinical support the hotos hel utton from Maya Health Alliance. tells you what you should do The device is now used by ne t t requires ero literacy about 42 midwives in rural e retend the manual Guatemala. exploded,” Clifford says. “We aren’t just cooking he est art, they say, was something up here and their last international trip dropping it off there,” says efore , Hall-Clifford. when they met “We develwith midwi es oped a shared in uatemala vision and who resented goals with the the program midwives and back to them, the patients.” “We provide good critalking the tiques of each other’s cou le through work. Rachel holds my CO-DESIGN the safe+natal tech accountable.”–Gari Clifford and kit t was Clifford (with family, above) all lif all theirs,” ford share all lifford a lab and teach classes at says. The kit has become mory on co design for re the standard of care there source constrained settings and several years later is still s a isual aid, lifford will growing hey ha e lans to often ull out a can o ener expand the program—in the used in the ietnam ar near term, to the southeast one iece, with a hinge, easy ern ere in eorgia, to manufacture ou can we ha e the highest ma kee a can o ener with you ternal mortality rate in the at all times, and you ll ha e a , all lifford says he weight and a ia le tool t s same principles are applica a iece of tech ust as much ble here at home.” The are as fancy electronics.” eginning the o esign all lifford adds, he a for ealth quity in m control arm for our safe na ory s enter for the tudy of tal kit was actually a iece of uman ealth e want to a er with all the ste s on e and safe natal and use it. A crazy little part of me co design to roaden our was rooting for the a er reach.”—Mary Loftus Tech for tech’s sake doesn’t

PHOTO BY BRYAN W ATT

How a (married) couple of Emory professors invented a device to monitor fetal health with a smartphone app

The safe+natal app is designed to be as simple and user-friendly as possible. Local midwives in Guatemala (above) posed for the app photos. Winter 2022

“The faster we do this . . . The faster the world gets back together.”

Left: ack hae er,

, as one of the volunteers for the children’s vaccine trial. Right: ack plays basketball ith his older brothers the hae er family takes a alk near their home in ecatur.

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SMALL SHOT, BIG GAIN

BACK TO OUR

FUTURE BRAVE YOUNG VOLUNTEERS TOOK PART IN A CLINICAL TRIAL TO TEST THE I

By Quinn Eastman

, SO OTHER KIDS CAN GET IT TOO

Photos by Jack Kearse

THE PLEA “THINK OF THE CHILDREN” HAS BECOME SUSPECT. POLITICIANS DEPLOY THE PHRASE TACTICALLY. OVERWROUGHT CHARACTERS ON THE SIMPSONS USE IT. Still, early in the COVID-19 pandemic, thinking of the children was precisely what

pediatricians and vaccine researchers at Emory were urging everyone to do. They wanted effective vaccines to be available to children as soon as possible—to protect both the children themselves and the adults around them. Last year, initial studies described few COVID-19 cases among children, and most were mild. Headlines proclaimed, “Children Mysteriously Untouched by Coronavirus,” “Coronavirus Sparing Kids” And “Why Children Are Faring Better than Adults.” This was before a better understanding of the delayed complications of COVID, the emergence of the more infectious Delta and Omicron variants, and the mid-2021 surge of infections that affected children and adults. Now one vaccine, from Pfizer and partner BioNTech, has been approved by the Food and Drug Administration (FDA) for children as young as 5. Another, from Moderna, will likely follow. On top of that, booster shots of Pfizer’s vaccine recently became available for teens ages 12 to 15. These are the same vaccines that have been distributed across the

country for adults but given at lower doses for children. The vaccines’ approvals for children are expected to add an important piece to the puzzle of community defense against COVID-19, facilitating a safer return to in-person education, sports, and other activities for children and their families, teachers, and other adults. Early data indicates that despite its increased infectivity, Omicron is not more severe for children, and vaccination is still effective at preventing hospitalization as a result of Omicron infection. More than 400 young volunteers who participated in clinical trials at the Vaccine Research Clinic at Emory-

Winter 2022

Children’s Center have been a part of making the vaccine approvals happen. In May 2021, when Emory announced the opening of COVID-19 vaccine studies for children younger than 12, there was strong interest from Atlanta-area parents. Organizers received inquiries from more than 2,000 families, considerably more than the site was allowed to enroll for the 5-11 age group. Both studies are continuing to enroll for younger ages, and participants are being followed closely. Although the kids who participated got something out of the trials— being vaccinated before their peers— they also took a risk. They were trying something that was then untested in children. They, in turn, provided benefits to others their age as well as adults in the community. “I hate the pandemic and want it to be over,” says Isabel Saneda, a 10-year-old participant in the trial of the Moderna vaccine. Isabel’s mother, Samantha Saneda, signed her up after a recommendation from a friend. A nurse from the Vaccine Research Clinic called Saneda on a Wednesday with a list of detailed questions. She was told they might need to come in on short notice. The next day, Saneda drove through the pouring rain from Cumming to Atlanta to get her daughter there, canceling a dentist’s appointment along the way. Isabel wasn’t looking forward to a shot, but this one was relatively easy. “We told Isabel this is helping her friends and people she doesn’t even know,” Saneda says. “At that point, nobody knew about the Delta variant. We feel very fortunate.” WARP SPEED VERSUS STUCK IN NEUTRAL The development of COVID-19 vaccines for adults has

progressed at “Warp Speed,” as the federal government’s program to accelerate them was called. In the US, three highly effective vaccines have

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been authorized for adults, and millions of doses have been distributed and delivered. But last year, vaccines for children were “stuck in neutral,” as Emory Professor of Medicine and Pediatrics Evan Anderson and colleagues from other universities would point out in an influential article that appeared in September 2020 in Clinical Infectious Diseases. Anderson is a pediatrician at Children’s Healthcare of Atlanta and leader of the Vaccine Research Clinic. “We called for initial pediatric studies for COVID-19 vaccines to begin at the same time as the Phase 3 studies for adults,” Anderson says. Although Pfizer did include teenagers in its 2020 COVID-19 vaccine studies, other vaccine studies in younger children did not begin until months later. Anderson says the delay in testing vaccines for children was partly due to a perception that developed early on that SARS-CoV-2 infection did not affect children as seriously as adults—especially older adults, in whom the mortality risk was highest. The delay was also partly by design. Children are not simply small adults; their physiology and metabolism are different. Children’s immune systems can respond more strongly to vaccines than adults do, and vaccine side effects could be more intense for them. Researchers needed to work out the best and safest dose. As it turns out, kids’ apparent invulnerability to COVID-19 was an illusion. Although SARS-CoV-2 infection is often mild or even asymptomatic in children compared with adults, they are clearly capable of being infected. And, when they are, studies show that kids shed about as much virus as infected adults do, so they pose a comparable transmission risk. “Among the most important methods of COVID-19 transmission are from inside the household and from household visitors,” Anderson says. “Having a vaccine available for

our children will have the potential to significantly impact transmission to parents, grandparents, and other adults.” In addition, though the risk of mortality from COVID-19 is lower for children, they can certainly die from it. As Anderson pointed out last year, more kids had already died from COVID than during the past several flu seasons combined—and kids are routinely given flu shots. For kids, COVID can lead to frightening complications, such as MIS-C (multisystem inflammatory syndrome in children). In the surge of coronavirus infections that began in fall 2021, children were affected more than in previous waves. In Georgia, the proportion of COVID cases among children rose to 30 percent of the total—partly because of the reopening of schools and also because some adults already had been vaccinated. THE WORLD GETS BACK TOGETHER Faced with uncertainty about the risks of COVID, many

Georgia school districts closed for in-person teaching and transitioned to online learning. Some parents and children found online learning difficult to manage or access. Schools reopened only to shut down again after local outbreaks. In Decatur, after much debate, the local school district gave families the option of returning to classrooms in spring 2021. Concerned about the wave of infections at the time, 11-yearold Jack Shaeffer’s family opted for him to “stay virtual” until the end of the school year. “We didn’t want to go back too early,” says his mother, Suzanne Shaeffer. But as vaccines became available for adults, Jack began to feel like he was missing out on his favorite activities, such as lacrosse. His father, Francis, a dentist, had participated in the placebo-controlled study of the Moderna vaccine in adults.

SMALL SHOT, BIG GAIN THE POSSIBILITY OF A SALINE SHOT The studies at Emory’s Vaccine

Above: Jack is looking forward to returning to all his favorite activities, such as

lacrosse and band. But he decided to volunteer for the vaccine trial because “so many people are dying. It makes me sad and disappointed.”

Jack missed hanging out with his cousins, while his older brothers were already eligible to be vaccinated. That’s why he was eager to take part in the pediatric study when it started at Emory. “I was excited,” Jack says. “The faster we do this vaccine, the faster the world gets back together.” “It’s worth the risk,” he adds. “So many people are dying. It makes me so sad and disappointed.”

Jack’s parents say they all regained some confidence about socializing after Jack was vaccinated as part of the study. Jack has taken to suggesting names for the alarming viral variants he learns about in the news, favoring mythological characters, such as the Norse god Loki. “He floats a new name for the variants each time we go to the clinic,” his mother says, laughing.

Research Clinic were testing the same mRNA vaccines that were approved in adults, but they came in two stages. The first tested various doses. Participants and their families knew they were getting a known amount of the vaccine. The uncertainty that occurs in some clinical trials, about whether participants received a placebo or the actual drug, was not present. The second stage of the vaccine studies was placebo-controlled, using information gleaned from the first stage to set the doses. For the Moderna study, investigators decided on a dose for children ages 6-11 that was half the adult dose. This produced a level of coronavirus-neutralizing antibodies that was actually greater than the response seen in young adults immunized with the higher dose. Although more study participants received active vaccine than placebo (the odds were 3:1), young volunteers were still made aware of the uncertainty. “I didn’t know if it was going to be a COVID shot or a saline shot,” says 9-year-old Autumn Gilford, a participant in the second stage of the Moderna pediatric vaccine study. Autumn says she wasn’t scared of the shots. Her younger brother, London, is signed up to participate in the next stage of the pediatric studies, for children under five. “I thought it was beneficial,” says their mother, Rashante Harris. “We just wanted to do something.” “If anything, I’m the one posing a risk to Autumn,” she adds, because of her job as a physician at a local urgent-care clinic. Harris was among the first to be vaccinated in December 2020. Autumn and her family have been cautious about venturing back out even after businesses in Georgia were reopened last year. They’ve avoided restaurants and parties. “She’s more cautious than I am,” says Harris’s husband, Michael Gilford,

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“I didn’t know if it was going to be a COVID shot or a saline shot.”

Right: Autumn Gilford, 9, is a participant in the second stage of the Moderna pediatric vaccine study.

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SMALL SHOT, BIG GAIN

Above: Autumn’s family (from left), dad, Michael Gilford; Autumn; brother, London; and mom,

Rashante Harris. Right: Autumn and London play in a park near their home.

whose job at Georgia Power is performed out of the office. “At our clinic, we have been seeing people getting sicker,” Harris says. Harris acknowledged the history of distrust among Black communities for medical research conducted by white-dominated institutions. As a physician, Harris’s familiarity with vaccines and research made crossing that bridge easier. “I didn’t tell most people [about Autumn’s participation in the study],” Harris says. “People who know me would come to me if they had questions.” CHECK OF SAFETY One purpose of the pediatric vaccine studies is to look for harmful side effects; the health of the young participants was closely monitored. The pediatric studies were not expected to provide statistical confirmation that the vaccines prevented COVID-19 in the same way as adult studies performed in 2020 did. Instead, researchers monitored kids’ antibody levels and other immune responses to see whether the vaccines were likely to be effective, an approach called “immunobridging.”

In summer 2020, reports emerged of teenagers—predominantly males— experiencing myocarditis or pericarditis (inflammation of the heart muscle or lining) after immunization with the mRNA vaccines. Symptoms such as chest pain brought them to the hospital, where doctors could detect signs of heart trouble, such as elevated levels of the cardiac marker troponin or altered electrocardiogram or cardiac MRI scans. For most young patients, the symptoms resolved with conservative treatment after a few days and they were able to return home. Myocarditis or pericarditis cases in adults and teenagers appear to be rare enough that the 2020 vaccine studies, with tens of thousands of participants, did not catch them beforehand. This summer, the FDA asked Moderna and Pfizer to increase the size of their pediatric studies so more data on these events might be available. Preliminary results from the Pfizer pediatric study indicate no cases of myocarditis reported in children under age 12. According to data from the Centers for Disease Control and Preven-

tion (CDC), the risk of myocarditis or pericarditis occurring after Pfizer/BioNTech vaccination in teens is about 37 cases for every million doses. The risk of developing myocarditis from coronavirus infection itself is much higher. CDC calculations say that in boys ages 16-17, vaccination with the Pfizer/BioNTech vaccine could be expected to prevent more than 50,000 cases of COVID-19 and 500 ensuing hospitalizations for every million doses distributed. That would have to be balanced against about 70 cases of myocarditis. A similar risk-benefit calculation could be worked out for older age groups; the risk for myocarditis after vaccination appears to decrease after puberty. “Carefully conducted studies have been able to pinpoint the risks associated with these vaccines,” Anderson says. “The benefit to teenagers of vaccination clearly outweighs the miniscule risk.” LOOKING AHEAD Anderson

recalls that last spring, because of the crush of the pandemic and the urgency of starting vaccine studies for adults, “there was barely any time to think. Everything had gotten very

Winter 2022

KEL S O PHOTO BY J O HN ATHON

Above: Emory Professor of Medicine and Pediatrics Evan Anderson urgently called for

the approval of a well-tested and safe COVID-19 vaccine for children.

distorted by the pandemic and I often felt like I was in the middle of one of Picasso’s paintings,” he says. He credits his colleague, pediatrician Carol Kao, with pushing him to complete an article with her for the journal Clinical Infectious Diseases, on “The Importance of Advancing SARSCoV-2 Vaccines in Children.” The article had a snowball effect and helped prompt the National Institute of Allergy and Infectious Diseases (NIAID) to develop template plans for pediatric vaccine studies. Anderson’s Vaccine Research Clinic is part of Emory’s Vaccine Treatment and Evaluation

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Unit, one of several in a network supported by NIAID. That effort also led to the “stuck in neutral” paper, media attention, and pressure from organizations such as the American Academy of Pediatrics. Seeing the delay in pediatric COVID-19 vaccine trials, some experts have been arguing that COVID-19 exposed a mismatch between the normal processes of vaccine development and the challenge the pandemic posed to society. Back in 2003, Congress passed the Pediatric Research Equity Act, giving the FDA the authority to require pediatric studies for drugs and products

such as vaccines. Looking ahead to future infectious disease threats, a proposed strengthening of the act’s policies could require concurrent enrollment of children in clinical trials once initial safety studies in adults have been completed. After vaccines become available for children, the “real world” test is whether parents accept them. Surveys indicate that parents are roughly divided between those eager to have their children vaccinated and those who are skeptical, with parents in between taking a “wait and see” attitude. Parents are often more risk-adverse on behalf of their kids than for themselves. Indeed, researchers at Children’s Healthcare of Atlanta asked the parents of children who had been diagnosed with COVID-19 last year about their plans. Only about half said they intended to have their children vaccinated when a vaccine became available. Common reasons for declining vaccination were concerns about side effects or safety. The rate of vaccine acceptance, however, increased to almost 70 percent when the survey included information about the objective effectiveness of the vaccine in adults. “We’ve seen the dramatic effects of COVID-19 upon children’s health, mental outlook, and well-being,” Anderson says. “The approval of a well-tested and safe vaccine for children will help parents get their children safely back to school and something resembling prepandemic life.” ■

SMALL SHOT, BIG GAIN

ULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C) is a rare but serious complication of coronavirus infection. It appears to be a delayed response, emerging weeks after an initial COVID-19 infection that is often asymptomatic. A paper published in July by researchers from Emory and Children’s Healthcare of Atlanta describes five patients who developed neuropsychiatric symptoms as a consequence of COVID-19 or MIS-C. These symptoms may result from viral infection of the brain, as well as the immune system’s inflammatory response to the infection. Three of the five patients developed acute psychotic symptoms, such as hallucinations. One, an 11-year-old girl, was a recent immigrant to the United States, who was temporarily separated from her parents. She developed respiratory failure and went into shock, then experienced hallucinations and agitation while in the hospital. Her altered mental state lasted a few days, dissipating after treatment with anti-inflammatory drugs. (The children with MIS-C were treated with anti-inflammatory corticosteroids and another immune-calming drug, intravenous immunoglobulin.) Another of the three was a 15-year-old male who, after becoming ill, displayed “obsession with numbers, hyper-religiosity, hyper-sexuality, visual hallucinations, fast speech, and disorganized thoughts,” according to the paper.

IN CHILDREN

Two of the five were younger—less than two years old— and they experienced seizures and altered mental status. Doctors know that all of the children were infected with the coronavirus because their blood or spinal fluid contained antibodies against it, but sometimes their nasal swabs tested negative for the genetic material of the virus itself. “There has been an increase in psychiatric symptoms in general during the pandemic, due to factors outside of COVID and inflammation,” says the lead author, pediatric neurologist Grace Gombolay. “These factors include anxiety about the pandemic and COVID itself, social isolation, economic stressors, loss of loved ones, and how our lives have changed. Even though these patients received immune therapy related to MIS-C, most patients with psychiatric symptoms improve with medication and do not need immunotherapy.” Even though neuropsychiatric symptoms from pediatric COVID-19 or MIS-C are frightening, they’re relatively rare, says Emory Assistant Professor of Pediatrics Christy Rostad, an infectious disease specialist at Children’s Healthcare of Atlanta. What brings kids to the hospital are persistent fever, abdominal pain, vomiting, diarrhea, and rashes. Children with MIS-C can develop low blood pressure (shock) or cardiac problems, such as chest pain and an irregular heartbeat, requiring intensive care.“Those are what we worry about the most,” Rostad says. ■

What brings kids to the hospital [with MIS-C] are persistent fever, abdominal pain, vomiting, diarrhea, and skin rashes.

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Parenting DURING A

By Mary Loftus

PANDEMIC

Illustration by Cathy Gendron

DINNER WITH A DOCTOR

The pandemic has been stressful for children and families. Some have endured great losses, including the death of a loved one. Fears of getting sick from the virus, or of a family member getting sick, have been ever present. With many prepandemic support systems unavailable, daycares and schools closed, and isolation from friends, children of all ages suffered disruption in their lives and routines. They learned to wear masks, to distance from others, and to wash their hands longer and with more frequency. There were terrifying news reports. Spending day after day at home began to feel long and tedious. For parents, the pandemic has been a double stressor.

Below: Emoy child and ado-

lescent psychiatrist Jennifer Holton (below with her son, 8, and daughter, 5) has first hand kno ledge of the multiple roles parents have been called on to fill during the pandemic.

You’re making life and safety decisions for yourself and your children, as well as taking on roles you may feel unqualified for: teacher, counselor, social events coordinator, infectious disease expert. Indeed, you might be in need of a little professional advice yourself. To that end, Emory Medicine invited child and adolescent psychiatrist Jennifer Holton, assistant professor of psychiatry and behavioral sciences at the School of Medicine, to host our virtual Dinner with a Doctor panel. Holton took questions from six panelists about their parenting concerns (including one mom who Zoomed in from the sidelines of her child’s soccer game). As the program director for Emory’s Child and Adolescent Psychiatry (CAMP) Fellowship Program, she has expertise in the treatment of ADHD, anxiety, and mood disorders in children and adolescents. “And I’m a mom of two, so I’m also parenting during a pandemic,” Holton told panelists. “I sympathize on multiple levels.”

A JAMA Pediatrics article from August 2021 reported that the prevalence of depression and anxiety among children and adolescents around the world has doubled from prepandemic rates. “These issues existed before, but they certainly have been exacerbated,” Holton says. “I think we can all appreciate, having kids, that we’ve seen increases in other things, like sleep disruption—whether from anxiety or changes in schedules and routines—and attentional issues related to anxiety or depression or just

Zoom fatigue. It’s challenging to know, is this ADHD or the pandemic fog we’re all experiencing?” Everyone is home, and parents are under a tremendous pressure. “You’re not only trying to do your normal job, suddenly you’re supervising your children at the same time and helping to teach the older kids,” she says. “Throw in cleaning, cooking, all these things 24/7. Some have had job losses and financial stressors. We’re tired, right? As human beings, it’s a lot.”

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PARENT PANELIST: I have little ones and they are precocious, so they ask a lot of questions. They’re always wanting to know about everything, but I worry that they’re being burdened by too much information. For example, back in March my little one caught COVID-19 and I caught it. I didn’t think it made sense to tell him at the time, he was asymptomatic. I just didn’t want him to have that stress. How much information is too much? How do we as parents strike a balance between shielding our kids from everything that is going on and wanting to be completely open and honest with them? Dr. Holton: First, you are the experts on your own individual children; you know them better than anyone else. Sometimes you have to go with your gut on what you think they can handle and what might be too much. Pay attention to how they’re responding when you talk to them. If it feels like it’s too much, back off a bit. How much information to give, in part, depends on their developmental stage. Start with whatever they asked and try to answer that in a straightforward way, without a bunch of additional information. Just give a simple answer, one that isn’t infused with a lot of emotion, and move on. Sometimes they don’t want a huge answer. If they want more, they will ask. Other times they catch us off guard. Feel free to say, oh, that’s a good question, mommy has to think about that, let’s talk about it at dinner. PARENT: My question is on friendship formation and distancing and masking. I’m very, very pro-mask, but my kids were in school all last year, and it’s a long time to have been masked up all day. I wonder if you think that masks are changing interaction styles or their ability to connect or to read other people’s expressions? Dr. Holton: I have wondered about that myself, especially with babies and young children learning about speech by watching our mouths and the way they

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move. For the most part, kids have been super resilient. Grown-ups complain about masks, but most kids will just put it on and keep it on—even kids you don’t think will, like those with ADHD. As far as kids’ abilities to connect, being back together in person is huge. It’s probably better than seeing someone’s whole-face on Zoom but not being together. And they are still getting that no-mask, whole face interaction with their families. So while there are potentially some negatives to wearing masks and returning to school in person, I think the benefits outweigh the downside. For children with disabilities and those who rely on lip reading, there are options, such as clear masks. PARENT: For those of us with teens and young adults, my teen “knows everything.” They get their news from TikTok, etc. I’ll say, where did you hear that information? And she’ll say, the internet. How do you talk to a teen who has become extremely opinionated about masking, who to be around, who not to be around? It’s all very black and white to her. Dr. Holton: Oh, the teen years. They are in that stage where they know more than you and you can’t tell them anything. The good news is that, developmentally, she is right on target. How I might approach it, and it sounds like you’re already doing the right thing, is to talk to her. How did you come to that conclusion? If you say, “Oh no, that’s not right, it’s XY and Z,” that will not go over well. I’d use Socratic questioning and help her see there are other sources of information, other evidence, other ways people might be thinking—kind of open her eyes to other possibilities. Bucking up against you is what they are supposed to be doing as a teenager. But look for other adults they think are cool or interesting, someone you can pull in who might be able to help them look at things a different way. Sometimes they can get stuck in thinking their ideas are the only ones. Also, you don’t want them to get into a situation where they are being hurtful

to someone else. Go back to your family values. It sounds like there are things you could validate: I like how you’re being careful and trying to protect your family. I’m afraid too, and I don’t want to get sick either. At the same time, we don’t want to treat anyone badly or hurt anyone’s feelings. How can you still engage with this person in a way that feels safe? Our society has become polarized in many ways right now, and we want to model for our kids how they can still be kind, even if others have different beliefs. PARENT: Going back to being masked

and social interactions, I have a teen who is introverted by nature and would still be doing school remotely if she could. We are supporting her as she makes the transition of going back to school and making new friends. She’s a sophomore, and she kind of lost her freshman year, which is a pivotal year to make connections, so high school is still pretty new to her. How can I help her to break through the masks when she has the tendency to hunker down, get on the computer, and have her own little insular world? Dr. Holton: I’ve worked with so many people who, when the pandemic hit, I thought, oh this is going to be tough for them. And for some, it was incredibly hard. But there were others who thrived. That’s not an uncommon situation, where people who have more social anxiety feel more comfortable at home. So after a year of being at home, for some of us it’s difficult to go out there and get back to it. In an ideal world, there would be a more gradual transition for people who are struggling. If there are ways to get her involved in smaller groups, that can sometimes be helpful, rather than, “Here I am in my whole big school with all these people I don’t really know because I’ve only seen them on the computer.” Also, just acknowledge for her that, yes, this is hard for a lot of us. Especially if you have similar issues. Sometimes it’s just knowing they are not alone in what they are experiencing.

DINNER WITH A DOCTOR PARENT: We made the decision to keep our child at home for a year, although he’s preschool age. Do you have any advice about the importance of socialization for a preschooler, what impact that has on them? He’s an only child and mostly around adults. His only engagement with kids his age is via YouTube. We do take him to parks and such, but outside of that, I feel like he’s missing out by not being in school. Dr. Holton: Preschool or not, for most young children at home during the pandemic, there have been less interactions available for them with other kids. And you are correct, socialization is an important part of development. It’s the way young children learn to play with others and share. But he’s young, he’s going to get that, I wouldn’t be worried about it. When you are ready and comfortable with having him around other kids more, think about families you feel comfortable with whose children are similar ages and who have similar COVID practices to your own family. Be mindful about creating ways for him to play and engage with others—your child and another

child. It can be with masks or outside. It can be a gradual reintroduction. PARENT: My daughter has some social anxiety. Toward the end of last year, she said, “Mom, I hate to say this, but 2020 has been one of my very best years ever.” She enjoyed the opportunity to lay low. Dr. Holton: Her experience is like many others’ experiences. On the flip side, at some point, the world will return to normalcy. So for those who enjoyed the break from all these social expectations, as we shift, we must be mindful that they might struggle a bit more. I’m delighted she’s had a wonderful year. Some young people did really well during the pandemic, and thank goodness for that. PARENT: We’ve talked about our kids living through it. But what about us as parents? Working parents have so many things pulling at us all the time. My biggest fail of last year was not being able to help my kids; they basically parented themselves. During the day they were either doing virtual school or laid in their beds. Now that we’re back at it and I’m taking them

to school and coordinating activities, I feel like I’m constantly drowning. How do you suggest that working parents cope with that? Dr. Holton: We probably need to be kinder to ourselves. We expect we can do all these things and forget we’ve been through the wringer. Do as much as you can to lower your expectations— for yourself as a parent and for them. Sounds to me like you did just fine and they did just fine. They learned how to do things for themselves, gained some independence. Now that we’re getting back in the swing of things, we may need to say, “OK, why do you need this number of activities, why am I hauling you to everything?” It’s OK to cut back if things feel overwhelming. Also is there any way you can get help? This has been a huge shift and transition. It was not gradual; it went from zero to 60 instantaneously. Get creative, find ways to lighten the load, such as carpooling. And find a few moments of quiet, or a bit of time to be with each individual child. Tell them, “It’s just you and me, let’s do something you want to do.” It’s a chance to do something fun or meaningful they will remember from this time. ■

TOP THREE TIPS FROM DR. HOLTON: ONE It’s important not only to take care of yourself but also to model self-care for kids. Just basic things, like getting enough sleep, eating healthy foods, finding enjoyable or relaxing activities to engage in.

Watch your children and be attuned to changes in mood, concentration levels, sleep, appetite, energy, participation in activities. Take notice if they have preoccupations, persistent fears and worries that are having a negative impact on their day-to-day life or a change in their engagement

TWO

with others. If you sense a serious issue, reach out to someone for help: a school counselor, mental health professional, or another mental health resource.

THREE Validate the resourcefulness of older kids. Teens, even early in the pandemic, were finding creative ways of meeting up, hanging out in parks or pulling their cars up next to each other so they could eat their food and talk while socially distancing. They have a lot to bring to the table.

PARENT PANELISTS

Tionna Carthon

Jennifer Checkner

Leah Gottesman

Martha Nolan

Roger Slavens

Krystal Woods

Winter 2022

Ask a Top Pediatrician WHAT DO PARENTS NEED TO KNOW ABOUT KIDS AND COVID-19? Lee Beers 96M, of Children’s National Hospital in Washington, D.C., and president of the American Academy of Pediatrics, addresses important questions about serious illness in children, COVID-19 vaccinations for a younger age group, and other pressing pandemic concerns. To watch the full conversation, which took place in October, scan this QR code with your smartphone camera.

lescents aren’t using good and safe mitigation measures.

Q: Why are pediatric cases of COVID-19 continuing to rise? A: Pediatric cases of COVID-19 have

steadily risen since August. Several reasons account for this. First is that children and adolescents are a larger percentage now of our unvaccinated population in the US, so they’re really the group who are most vulnerable to being infected. Second, the Delta variant has been more transmissible and spreads much more quickly in places like big group gatherings or schools, especially when children and ado-

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medical conditions. We want to keep all our children safe.

What puts a child at greater risk of severe illness from COVID-19?

Q: What is MIS-C and how does it affect children with COVID-19?

Children with disabilities and health care needs that impact the functions of the lungs or heart are at higher risk for severe outcomes. Children with obesity are also at higher risk. Even previously healthy children, however, are also at risk for severe illness. Between one-third to one-half of children hospitalized with COVID-19 have no underlying

A: Some children infected with COVID-19 have developed a rare con-

dition called multisystem inflammatory syndrome in children (MIS-C). More than 5,200 cases of this syndrome have been diagnosed, with 46 associated deaths, in the US. It is an uncommon syndrome, which is a good thing, but even a small percentage of a large number of children is

Q&A

a large number. In communities with high rates of COVID transmission, more children are at risk of infection and complications like MIS-C. Because the syndrome is multisystem, it can cause anything from serious heart and lung problems to issues with digestion and neurologic functions. It often is pretty serious in kids and can last for some period of time and cause challenges.

very confident that anything that’s authorized by the FDA is a safe and effective vaccine. They’re incredibly cautious with adults, and then there’s an extra layer of caution added with kids. The vaccines that are authorized to date for adolescents ages 12 and up and in adults are very safe and effective, and I have every confidence that if and when the FDA authorizes a vaccine for younger children, it will be safe for them as well. Editor’s Note: The FDA authorized a COVID-19 vaccine for emergency use in children 5 and older after this interview took place.

What are symptoms of MIS-C that parents should watch for?

Parents should watch for children who feel unwell, are unable to participate in their usual activities, or Q: Will vaccines help curb pediatric tire easily. I’m a parent too. You know cases of COVID-19? when there’s something off with your A: If children become eligible for vacchild, so if something seems really cination, they will be at less risk of off, that is an important reason to developing illness from COVID-19 and give your pediatrician a call, because spreading the virus in their commuit can be a bit difficult to diagnose. nities. So, I do think it’s an important MIS-C can occur in both children part of helping to get the pandemic who tested positive for COVID-19 and under control and helping to protect children who had asymptomatic those around us—helping to protect infections and were never tested. adults who are vaccinated but are immunocompromised, or young If COVID-19 vaccines become babies who still don’t have access to available for children ages 5-11, the vaccine. I would also add, as a parwill they be safe? ent, this is always important to know The safety and efficacy review the and remember—that it’s also really Food and Drug Administration goes important protection for your child. through is incredibly cautious and Vaccinating your child with a safe rigorous and careful, and so I feel and effective vaccine has benefits for

the community, but it also has really important benefits for your child. Q: Will the vaccine for children be the same as the vaccine for adults? A: It is definitely the same vaccine. But

because children’s immune systems work differently from those of adults, vaccines for children are often administered in a smaller dose. You want to make sure you’re using the lowest possible dose of the vaccine to be most effective. Another question parents ask a lot: “My 11-year-old is bigger than my 13-year-old, so why is there a different dose?” But it’s really about the age and maturity of the immune system. Based on data from the most recent pediatric clinical trials, researchers determined that one-third of a regular dose of Pfizer’s COVID-19 vaccine is safe for children ages 5-11. If approved for use, the vaccine for this younger age group will also be packaged differently. To make sure the vaccine is administered safely and everything is very clear, the vaccine is going to be packaged in a vial that looks a little bit different, so it will be easy to determine which is the vaccine for the adult dose and which is the vaccine for the pediatric dose. It is the exact same vaccine, just a slightly smaller dose.—compiled by Shannon McCaffrey

Winter 2022

For more than 20 years, Emory and Georgia Tech have collectively asked: What happens when medicine and engineering combine forces?

BEST OF BOTH By Kelundra Smith

Illustrations by Peter and Maria Hoey

FEARLESSNESS + INGENUITY That’s what drew Manu Platt to Georgia Tech and Emory’s then newly minted Wallace H. Coulter Department of Biomedical Engineering in 2001. He joined the PhD program as part of its second class of doctoral students. Platt had recently graduated from Morehouse College in Atlanta and had planned to go straight to work for NASA. But he knew the complementary strengths of both universities—Georgia Tech’s prowess in engineering and Emory’s excellence in the life sciences—and was intrigued by what could happen when these two institutions put their collective minds together. Even though it was risky and unprecedented, to Platt and many others, it seemed to bring together the best of two worlds.

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While working in the lab of Hanjoong Jo, distinguished faculty chair at Coulter and professor of medicine at Emory School of Medicine, Platt confirmed he had made the right career move. He helped research how mechanical forces can affect blood flow and be used to treat human heart disease. Platt found the work exhilarating, knowing he was contributing to discoveries and potential innovations that could someday help save lives. Now, the former student is a teacher. In Platt’s lab at Georgia Tech, PhD students are looking at how they can halt debilitating strokes in children living with sickle cell disease. He hopes to identify a “druggable target” that will help protect kids as young as two. “We’ve identified these enzymes that are highly elevated in people with sickle cell,” says Platt, associate chair for graduate studies for Coulter. “We’ve found a drug that works well with mice but it’s too harsh for humans.

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We’re working with a chemical engineer to figure out a safer way of delivery.” Platt’s path—and his work—are just one example of what Emory and Georgia Tech envisioned when they created the Coulter biomedical engineering joint program 20 years ago. Researchers at both universities talked about the need for such a groundbreaking, interdisciplinary effort, with the goal of finding solutions to seemingly unsolvable problems. It was a perfect fit for the two universities, to partner on joint degrees for undergraduate and graduate students, since they’d previously collaborated on the Emory/Georgia Tech Biomedical Technology Research Center. The department was approved by the Board of Regents and Emory Board of Trustees in 1997, and the first under-

graduate and PhD students enrolled in 2000. With a $25 million gift from the Coulter Foundation in 2001, the Walter H. Coulter Department of Biomedical Engineering was officially named. “We had the right ingredients for an excellent program to take shape thanks to expertise in engineering at Georgia Tech and the incredible medical research at Emory,” says Emory Provost Ravi Bellamkonda, who served as the program’s chair from 2013 to 2016. “The connection was natural, but the partnership, which links a public and private university in a joint degree program, was audacious, visionary, and the first of its kind—a truly bold and imaginative move.” Today, Georgia Tech students attend mostly as undergraduates and Emory students mostly as graduate students,

WORLDS

Above: Manu Platt 06G, professor and associate

chair for graduate studies in the Coulter Department of Biomedical Engineering.

though they also can opt to complete their bachelor’s degree at Emory and earn a second bachelor’s at Tech through a special accelerated path. The PhD in

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Above: In Manu Platt’s lab at Georgia Tech, PhD students are looking at how

they can halt debilitating strokes in children living with sickle cell disease.

Below: Shaefali Padiyar, biomedical engi-

neering student.

biomedical engineering is a joint degree given by both universities. The campuses are connected by a shuttle that takes students to classes and labs. Faculty and students are researching everything from COVID-19 vaccine development to better ways to diagnose traumatic brain injuries. Research collaborations during the past 20 years have yielded more than 70 startup companies and 60 products in the development pipeline—and it all starts in the classroom.

CUTTING-EDGE CLASSROOMS The biomedical engineering department emphasizes learning through problem-solving. Faculty member and senior associate chair Paul Benkeser says the partnership also has allowed the two institutions to inform each other’s

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teaching styles. Problem-driven learning was growing popular in medical schools, and now retired faculty member Wendy Newstetter has introduced that model to the engineering department, he says. Undergraduate students who enter the biomedical engineering major are required to take a course in which they’re tasked with finding a solution to a real disease or medical challenge. It’s a class that Benkeser teaches himself, which he says helps students think critically and collaboratively. The focus on solving real-world problems makes the classroom experience less theory based so students are ready to work in labs, research institutes, and think tanks after graduation. “Both institutions have been good to the department in providing the infrastructure to allow us to grow,” Benkeser says. “On the Emory side, we’re anticipating the completion of the Health Scienc-

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es Research Building II, which will allow us to attract new faculty and further integrate across both campuses.” Hope Mumme 27G earned her bachelor’s from Georgia Tech and is now pursuing a PhD in bioinformatics from Emory. She credits the connections she made at both universities with helping her find her passion for researching childhood cancers. In summer 2019, she interned at Open Medical Institute in Mountainview, California, where she was exposed to single-cell sequencing. When Mumme returned to Atlanta, she was looking for more opportunities in single-cell analysis and professor Jo was seeking a research assistant with that experience. For her PhD research, Mumme is examining how individual cells look when disease is present, to identify patterns that will allow doctors to treat cancer in ways previously considered impossible. “I’m getting a PhD to develop my skills and get instruction from Emory because they’re one of the best hospitals in the country,” Mumme says. “Getting exposure to all of these diseases and problems will prepare me for a research position where I can take on new projects and develop new tools.” The problem-driven approach is working. Coulter is ranked in the top three for undergraduate and graduate biomedical engineering programs by US News & World Report. It’s also one of the most diverse in the nation—60 percent of its undergraduates are women and 22 percent are from underrepresented ethnic groups. In addition, students are encouraged to bring their whole selves to the learning environment and share their stories. Susan Margulies, who served as Coulter chair for the past four years before taking the prestigious leadership of the National Science Foundation’s Directorate of Engineering this August, says more and more often, Coulter is

attracting students who have personal stories that inspire them to want to make a difference. Margulies, who will remain a professor at Emory and Georgia Tech after taking her new position, says nearly everyone experiences instances with a friend or family member where medical science and engineering have (or have not) come together to help. Coulter students are asked to craft their personal narratives in a story-driven class made possible through a renewable grant from the Kern Entrepreneurial Engineering Network. Being able to effectively tell their stories helps them translate their research into grant writing, lectures, and interviews with prospective employers. “We embrace transdisciplinary impact and welcome different ways of being able to do things,” Margulies says. “The problems are commonplace, so that attracts a wide range of people interested in this profession. Then, as students in the field, their personal stories motivate them to gather a broad range of knowledge and learn how to translate it to applications to help humanity.” This reputation for inclusion and innovation is what attracted Georgia Tech senior and aspiring cardiologist Shaefali Padiyar. Padiyar, who grew up in Peoria, Illinois, always had an affinity for math and science, but her interest in biomedical engineering grew after her younger sister was diagnosed with Type I diabetes at age 8. She saw the toll the diagnosis took on her sibling and her family, and it made her wonder how the chronic disease impacted people who didn’t have access to the same treatment. Since enrolling in the biomedical engineering department, Padiyar has taken advantage of every opportunity that comes her way. She’s conducted undergraduate research in predictive echocardiography,

Above: Leslie Chan, assistant professor of

biomedical engineering.

which uses a sample set of echocardiographs to find patterns that can predict heart disease. She’s also just finished her term as president of the biomedical engineering student advisory group. This summer, she interned at Medtronic for the second year in a row in the cardiovascular division in research and development. It’s a full-circle moment, since her sister, now 16, uses a Medtronic insulin pump to help control her diabetes. “The partnership between Emory and Georgia Tech provides us access to so many research opportunities,” Padiyar says. “I think every person in biomedical engineering should do undergraduate research, because so much of the job market is research related. Having the Emory shuttle to go back and forth between the campuses allows you to tailor your education for your unique interests.”

TEACHERS + RESEARCHERS The labs are, indeed, where Coulter comes alive. During the past 20 years, several alumni, like Platt, have returned to enhance the department. In addition to teaching, Platt is making a path for the next generation of biomedical researchers.

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According to the National Institutes of Health, less than 10 percent of STEM PhD recipients identify as African American, Latino/a/x, or Native American. As the co-director of Project ENGAGES, Platt aims to diversify the field through a partnership with seven high schools in the city of Atlanta, where students get to work in labs on Emory and Georgia Tech campuses. So far, they have served 140 students and counting, and two have gone on to enroll at Emory and 18 at Georgia Tech for their bachelor’s degrees. “The importance of diversity in the sciences is that every person’s experience helps shape how they approach a problem,” Platt says. Diversity is also what drives biomedical engineering alumna Leslie Chan, who begins as a faculty member at Coulter this fall. Chan says she is grateful for the strong female mentors she had as a student in the department and that she will have as peers on faculty. Biomedical engineering is an outlier in the field, with about 40 percent women—twice that of other engineering concentrations. Chan says women such as Margulies provide a strong example for how to navigate the profession. In her lab, Chan and her students will be developing nanoscale materials to detect and treat bacterial infections in the body. Antimicrobial drug resistance is becoming a big issue, and things that were treatable before are not as easy to treat now. Her hope is for doctors to be able to identify the presence of infection before the situation becomes dire. “Currently, it takes days to identify the cause of infection, which prevents timely, informed treatment,” Chan says. “The rate-limiting step is growing the microbial pathogen from patients’ samples to large enough quantities that it can be identified in a Petri dish. In our approach, we eliminate the need for this step by building nanosensors that are

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administered directly to the patient and detect pre-existing pathogen growth in the patient.” Ming-fai Fong 14G, who earned a PhD in neuroscience from Emory, is returning to teach at Coulter this fall. Fong spent the past seven years as a researcher at the Massachusetts Institute of Technology, where she earned her bachelor’s degree. She says she had little background in biology prior to enrolling at Coulter and the neuroscience training she received at Emory provided rigor and support.

Above: Wilbur Lam, associate professor of

pediatrics at Emory School of Medicine and associate professor of biomedical engineering.

Fong’s lab will focus on designing technology that leverages neural plasticity for treating neurological disability and disease. “Through preclinical research, I hope we can develop tools ranging from state-of-the-art neural prosthetics to low-cost portable interventions,” Fong says. “I’m excited to work with both Emory and Georgia Tech students to tackle these goals.”

INNOVATION EXPLOSION Leveraging new technologies to make quality health care more accessible is the ultimate goal of the partnership.

During the past two decades, faculty and students have taken products to market that truly change, and even save, lives, ranging from tools designed to make cardiac surgery less invasive to a device that collects lung particles to diagnose pneumonia. This past year, Coulter professor Philip Santangelo and his students have been testing ways to improve vaccine delivery via microneedles through a company called Vaxess, as well as developing CRISPR RNA-based treatments for COVID-19. The latter uses a nebulizer to deliver the virus’s mRNA and guide RNA into the body. Santangelo likens it to a game of Pac-Man. Once it’s inside the body, the mRNA attaches to cells and produces a protein that couples with the guide strand to look for the virus. As the guide strand identifies the virus, it starts chewing up RNA to eliminate it from the body. The CRISPR RNA research is a part of a larger project under DARPA PREPARE, for which Santangelo is the principal investigator. This approach allows treatments to be developed faster and can be replicated for other RNA-based viruses simply by changing out the mRNA. They plan to move the COVID-19 treatment to clinical trials in the near future. “Current technology is slow for vaccines and therapeutics because it uses cells, but CRISPR RNA is developed in tubes so it’s easier to scale,” Santangelo says. “The whole idea with the nebulizer is that you would be able to go to a pharmacy and pick it up to treat yourself at home and not in a hospital. My goal is to offer people options, safety, and autonomy.” Wilbur Lam, who serves as the W. Paul Bowers Research Chair in the Department of Pediatrics at Emory School of Medicine and as a professor at Coulter, is passionate about designing products for the ways people live. He

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Wallace H. Coulter Department of Biomedical Engineering

BY THE NUMBERS O F F I C I A L LY N A M E D 2 0 Y E A R S A G O through a

$25M

gift from the Wallace H. Coulter Foundation

Above: Emory Provost Ravi Bellamkonda, who served as the Coulter Department of Biomedical Engineering’s

chair from 2013 to 2016, says, “The ethos of imagination, bold thinking, and can-do attitudes permeates this department.”

and students in his lab created a smartphone attachment, called the CellScope, which can help reduce doctor’s visits for ear infections. It was acquired by a major corporation two years ago and the company is working to scale it to market. Recently, Lam and his students have been working on an at-home tool that allows people to measure their hemoglobin levels and a correlating smartphone app that can diagnose anemia by capturing photos of a person’s nail beds. It’s a part of the AppHatchery program, which Lam leads at the Georgia Clinical and Translational Science Alliance. The smartphone technology has been licensed to Sanguina and the app is in beta testing. “The partnership between Emory and Georgia Tech allows for a direct link between technology and medicine,” Lam says. “What we have here is a much more streamlined process because you have faculty and students who live on both sides of the equation. That allows for much faster translation of new technology, which means patients can get helped and we can improve the lives of patients much faster.” As the largest and most diverse biomedical engineering program in the nation, the fearlessness and ingenuity that established Coulter continue. With 70 faculty members and more

than 1,400 undergraduate and graduate students, leaders from both universities believe there is much more to come from the unique partnership. “A key part of the Emory School of Medicine strategic plan is to further grow biomedical engineering and also to foster linkages between Georgia Tech and Emory that are anchored in other areas,” says Vikas Sukhatme, dean of Emory’s School of Medicine. “Georgia Tech is also committed to expanding our research at the intersection of medicine and engineering,” adds Raheem Beyah, dean of Georgia Tech’s School of Engineering and Southern Company Chair. “The connections between our two institutions are essential to our missions as we improve the lives of people here in Atlanta and around the world.” Emory Provost Bellamkonda agrees, saying the partnership works because both universities took a leap of faith. “What makes the Coulter program so special is that its founders took a big risk, unafraid of failure but in pursuit of truly inventing the future of medicine using technology and engineering,” Bellamkonda says. “The ethos of imagination, bold thinking, and can-do attitudes permeates this department, a crown jewel on both campuses, a symbol of what can be when imagination meets determination.” ■

70 1,400 3

FA C U LT Y M E M B E R S and more than

U N D E RG R A D UAT E & G R A D UAT E ST U D E N TS unique joint graduate programs

PhD

at Georgia Tech and Emory

MD/PhD

at Emory University School of Medicine and Georgia Tech

PhD

at Georgia Tech, Emory, and Peking University

N E A R LY

$57M

in annual research awards

faculty recipients of the

N AT I O N A L AC A D E M Y OF ENGINEERING GORDON PRIZE among the highest honors in engineering education MORE THAN

STA RT- U P S

& 60

BIOMEDICAL PRODUCTS

in the pipeline from faculty and student research projects

75%

of undergraduates engage in

BIOMEDICAL ENGINEERING RESEARCH DIVERSITY G R A D UAT ES T H E L A RG EST N U M B E R O F S T U D E N T S F R O M H I S T O R I C A L LY EXCLUDED ETHNIC GROUPS of any biomedical engineering program in the country

39%

OF PHD STUDENTS GO ON TO W O R K I N I N D U S T R Y, including medical device and pharmaceutical companies, as well as consulting firms

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Beyond Platitudes Diversity, Equity, and Inclusion By Sam Marie Engle 90C

The two doctors looked at each other in awe. Were that many people really peering expectantly at them through Zoom on a hot Friday afternoon, united in celebration of Juneteenth? “It was an incredible moment,” says Carolyn Meltzer, the medical school’s chief diversity and inclusion officer and executive associate dean for faculty academic advancement, leadership, and inclusion. “We had just witnessed the George Floyd, Breonna Taylor, and Ahmaud Arbery. We were seeing the disproRight: A participant in

Emory’s White Coats for Black Lives demonstration in June 2020.

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portionate toll COVID-19 was taking on people of color. Everywhere we looked we saw the deadly fingerprints of racism. We thought the panel discussion on the significance of Juneteenth would be of interest.”

PHOTO BY KAY HINTON

police killing of Rayshard Brooks here in Atlanta and before that the killings of

WALKING THE WALK

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Above: Carolyn Meltzer, the

medical school’s chief diversity and inclusion o cer, at the “Giving Voice” event in June. Above right: Sheryl Heron

interviews M. Gerald Hood, a doctor denied admission to Emory School of Medicine six decades ago due to his race, at the event, where he received a formal apology from Emory.

“And then 1,000 people showed up,” finishes Sheryl Heron, the school’s associate dean for community engagement, equity, and inclusion. “Systemic racism had been laid bare. What I saw every day in the ER, in my own life, was what our entire nation finally could not unsee: Black people dying in staggering numbers from virus and violence. Asian people vilified and terrorized. In the midst of all this darkness, having so many people show up for Juneteenth reignited our passion for bold action.” Passion drives both Heron, one of the first African American women in the US to achieve the rank of full professor in emergency medicine, and Meltzer,

“This was about people’s lived experiences of marginalization, their life’s work of confronting inequities. I wasn’t just a facilitator of a process; I also became a keeper of knowledge and a witness to pain.” Rachel Sedlack-Prittie the William P. Timmie Chair of the Department of Radiology and Imaging Sciences and a longtime advocate for gender equality in medicine. The Sunday after George Floyd was killed, Meltzer and Heron joined other Emory officials in discussions about action. “We all agreed our response had to be different this time. Platitudes and prayers weren’t going to cut it,” Meltzer recalls. “When we floated the idea of the Juneteenth celebration as well as a race and social justice webinar series, the answer was, ‘Do it!’,” Heron adds. An Intensely Personal Process

Led by Meltzer and Heron, groups met over nine months to create the School of Medicine’s first diversity, equity, and inclusion strategic plan. An

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18-member steering committee defined the overarching goals and then stakeholder groups—one each for faculty, staff, and learners—prioritized initiatives to achieve those goals. Stakeholder groups worked independently to ensure the plan would address each constituency’s needs. The process was unusual. Participants Zoomed into work sessions from the hospital, their kitchens, their cars. Even without physical proximity, the work felt deeply personal, says Rachel Sedlack-Prittie, senior director of strategic initiatives and innovation, who co-facilitated the planning process with colleague Jaimie Keough. “This was about people’s lived experiences of marginalization, their life’s work of confronting inequities. I wasn’t just a facilitator of a process; I also became a keeper of knowledge and a witness to pain,” says Sedlack-Prittie. “It really changed me, and I came out of it with a profound respect for our leaders and the work they’re doing.” Heron and Meltzer turned to Carol Henderson—vice provost for diversity and inclusion, chief diversity officer, and adviser to the president—for a linguistic compass and found it in the Institutional Statement on Diversity issued by Henderson’s office in August 2020, which included foundational definitions of diversity, equity, inclusion, and equity-mindedness. “Because the School of Medicine team has been working so closely with my office, this important plan aligns with the university’s broader DEI plans, and I’m excited by the synergy,” says Henderson. The result is an ambitious, actionable plan for ensuring that diversity, equity, and inclusion are consistently understood, practiced, and embraced across the School of Medicine. The goals: an inclusive culture and climate that nurtures awareness, learning, and growing with meaningful community

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Left to right: Drs. Michelle Wallace, Jason Schneider, and Jada Bussey-Jones talk outside Grady Memorial Hospital in Atlanta.

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Above left: Mariam Torres Soto 24M of the Learners Stakeholder Group. Center: Jada Bussey-Jones

88C 92M, professor and chief of general medicine and geriatrics at Grady, chairs the Antiracism Subcommittee. Right: Nancy DeSousa, assis-

tant director of the ce of ulticultural A airs, Learner Diversity Program.

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engagement and impactful research. Let’s meet some of the people putting the plan into action. GOAL 1 | Promote and sustain a healthy and inclusive climate that provides a sense of authenticity and belonging for all community members to feel valued, supported, and fully engaged through equitable and accessible opportunities. First-year medical student Mariam Torres Soto 24M felt flattered when asked to join the Learners Stakeholder Group. Proudly Puerto Rican, Torres Soto chose Emory for medical school because it serves such a diverse metropolitan area: according to the 2020 US Census, 62 percent of the population is nonwhite and 13 percent is Latinx. She loves the region’s vibrancy but was surprised by the paucity of Latinx learners and faculty in the School of Medicine—something she wants to help change. “I’m glad DEI is on the school’s radar, and I love it here, but there needs to be more input from our Latinx students and faculty. That’s why I’m staying involved,” Torres Soto says. The School of Medicine is committing resources to better support affinity groups such as the Latino Medical Student Association and the Asian Pacific American Medical Students Association to ensure all learners experience a genuine sense of belonging, engagement, and achievement. Jason S. Schneider, associate professor of medicine, has devoted his career to promoting inclusion and equity in the clinical-care setting and across medical education. Of particular concern is ensuring equity and safety for gender-diverse people. He’s the founder of the LGBTQ Faculty Affinity Group, whose work on recruiting, onboarding, and retaining eminent LGBTQ faculty physicians, scientists, and advanced-practice providers will be strengthened, as will the LGBTQ learner group. An LGBTQ staff group is next.

Schneider’s leadership in establishing the Grady Gender Center, a multidisciplinary clinic addressing the health care needs of transgender and gender-nonbinary patients, shows how the DEI framework can expand inclusive clinical care for vulnerable populations. GOAL 2 | Design and implement an educational portfolio for learners, staff, and faculty that infuses principles and competencies of equity, cultural humility, antiracism, bias mitigation, and respect for all members of our community. During summer 2020, the Racism and Social Justice webinar series explored topics such as Bias in Clinical Decision Making, Inclusive Leadership, Microaggressions under the Microscope, and Being an Authentic Ally. “Enriched by these sessions, we then gathered all the information needed to guide priority setting,” says Natalie Fields, director of faculty advancement and inclusion in the school’s Office of Faculty Academic Advancement, Leadership, and Inclusion. “We also studied DEI programs already operating in the medical school so we could build on what works.” The result is the Actionable Education Initiative, which moves the School of Medicine community from awareness of internal biases and external forces of marginalization and oppression to learning about their origins and repercussions and growing into antiracist allies actively working for change. It has four pillars. ANTIRACISM Jada Bussey-Jones 88C 92M, professor and chief of general medicine and geriatrics for Grady Memorial Hospital, chairs the Antiracism Subcommittee, which she calls “a transformational process. As someone who has been with Emory for close to three decades—first as an undergraduate, then a medical student, and now as a faculty member in a leadership position—I have lived the evolution of this institution.”

WALKING THE WALK Antiracism work, she says, starts with grace. “Discussions of race are so challenging. We have to start by giving each other grace and assuming good intent. When we find commonality, we can start to unpack the painful past and move to a shared healing in the present.” HISTORY Co-chairs Nate Spell, professor of medicine and associate dean for education and professional development, and Tyrese Hinkins-Jones, associate director of medical education, explain the history project as a “living repository to which knowledge of the past will be added as it is garnered and to which the lived experiences of our community are added as they occur.” It expands the university’s larger reckoning with its past to include Emory Healthcare, Grady Hospital, and Children’s Healthcare of Atlanta. IMPLICIT BIAS EDUCATION Co-chair Nancy DeSousa leads the Office of Multicultural Affairs’s diversity programs for residents and fellows in the medical school’s 27 departments. She combines implicit bias training with an action-based framework to help learners respond to microaggressions, misconduct, and other behaviors that threaten an inclusive environment, including exercises on cultural humility.

“As someone who has been with Emory for close to three decades—first as an undergraduate, then a medical student, and now as a faculty member in a leadership position—I have lived the evolution of this institution.” Jada Bussey-Jones That approach is important for Michelle Wallace, assistant professor and chair of the Department of Pediatrics Diversity and Inclusion Committee, who studies bias in clinical decision-making. “Medicine is really an apprenticeship,” she says. “Our learners gain a lot from textbooks, certainly, but there’s a lot more they learn from the way we handle things in clinics, in our interactions with patients.” The plan calls for everyone in the School of Medicine to complete Implicit Bias Training to grow from awareness and understanding to action for change. FROM BYSTANDER TO “UPSTANDER” Kimberly Manning, professor of medicine and associate vice chair, diversity, equity, and inclusion for the Department of Medicine, and Christopher Ho, associate professor of radiology and director of the Diagnostic Radiology Residency Program, regularly teach an action-based framework for responding to microaggressions, misconduct, and other behaviors that

threaten an inclusive environment. Their work will be adapted for both synchronous and asynchronous training to equip faculty, staff, and learners with the skills to respond when they witness or are recipients of microaggressions or other negative behaviors. GOAL 3 | Intentionally integrate the principles of equity and inclusion in our interactions, spaces, policies, and practices to break down structural and systematic racism, homophobia, transphobia, gender inequities, ableism, and all other barriers that impact marginalized groups. As executive administrator of human resources for the School of Medicine, Cliff Teague co-led the Staff Stakeholder Group. “I came to the table humbled by the opportunity to hear and amplify what it’s like for staff to navigate the recruitment and employment life-cycle,” he says. To Teague, a diverse workforce is more than numbers. “The plan is to blend community engagement with recruitment so we can attract candidates from parts of the community not traditionally targeted in the staff-recruitment process.” This work also applies to the curriculum. Case in point: “We looked at the dermatology curriculum through a DEI lens and saw opportunities for change,” explains Loren Krueger, assistant professor of dermatology and chair of the department’s Committee on Diversity, Equity, and Inclusion. Mary Spraker, associate professor and clerkship director, and Jamie MacKelfresh, associate professor and vice chair of education, championed these efforts, co-leading the “skin” portion of the Skin, Muscle, Bone, Joint course all first-year medical students take. The revised curriculum uses culturally diverse cases so learners can see how disease incidence, prevalence, and presentations vary in skin of color. Conditions such as dyschromia and hair loss are included, as is a unit on cultural humility taught by Krueger. “Dermatology is the second-least-diverse specialty when you look nationally at who becomes a dermatologist. Making DEI visible in the curriculum not only better prepares young doctors to treat an increasingly diverse patient population; it also helps diversify the profession itself,” says Krueger. GOAL 4 | Creating a clear sense of visibility and engaging the Emory community, alumni, the Atlanta community, and regional institutional partners to promote equity (health, education, economic, and access to resources). Jasmin Eatman 23M 23G is adamant: no one person can speak on behalf of everyone. “What happens in predominantly white institutions is that certain students from ‘minority backgrounds’ are singled

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Below, left to right: li Teague, e ecutive administrator of HR Rachel edlack rittie, senior director of strategic initiatives and innovation and atalie ields, director of faculty advancement and inclusion, in the chool of edicine.

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WALKING THE WALK out for leadership positions and that’s extremely isolating. That’s why I only work collaboratively with other students and that’s both students of color and white allies.” Eatman founded the Council for the Advancement of Black Voices in Medical Education with Alyssa Greenhouse 22M 22PH and Mollie Elson 21M. One of the council’s first projects is a narrative database to gather Emory medical students’ experiences in medicine and at Emory. “If we’re talking about making Emory Medicine more inclusive, then include us in the conversation. We don’t need to be planned for; we need to be the planners,” Eatman says. Last year Eatman and her classmates used the community-based research process to urge the DeKalb County Board of Commissioners to pass a resolution declaring racism a public health crisis. As president of the Student National Medical Association Emory chapter, Eatman made the pitch. Chapter members crafted the resolution with DeKalb County Commissioner Larry Johnson and dozens more attended the virtual meeting. The resolution unanimously passed. The students also collaborated with the Morehouse School of Medicine chapter to pass a similar resolution in Fulton County. “When we look at what’s happening, we have to ask, ‘Do students of color feel empowered and dignified in this space, in this conversation, in this activity?’ If at any time the answer is no, then it’s wrong. Work with us to get to yes. The DEI plan is a start,” Eatman says. GOAL 5 | Commit institutional energy and resources, including infrastructure and programming, to create and sustain the long-term cultural and representational change necessary for the success of the journey from excellence to eminence to expand idea creation and stimulate discovery and innovation. For 20 years, Yolanda Hood, director of the School of Medicine’s Office for Multicultural Affairs and the national Health Careers Opportunity Program, has worked to close the achievement gap for students underrepresented in medicine. Hood led the Learners Stakeholder Team during strategic planning and served on the steering committee and leadership team. “The plan provides a clear structure to our work,” Hood says. “It directs institutional resources to what we say we value and it aligns with the vision of our institutional leadership. Now we’re actually walking the walk.” The walk includes the Emory Pipeline Collaborative (EPiC), which provides students from

disadvantaged backgrounds with pathways to health sciences careers. High school students enjoy three years of college prep and health-career exploration to help them go to college. Those who matriculate to Emory receive scholarships and more. “The scholarship money covered most of my tuition, which allowed me to invest in extra study materials to help me succeed. It took away the worry about affording scrubs and even gas to get to classes. Pipeline gave me a mentor who cared about me and supported me while my mom was being treated for cancer.” Barcus now works for Emory Healthcare as a CT technologist.

Above: Jasmin Eatman 23M 23G (at Children’s Healthcare of Atlanta where she is doing her third-year rotation) cofounded the Council for the Advancement of Black Voices in Medical Education.

“If we’re talking about making Emory Medicine more inclusive, then include us in the conversation. We don’t need to be planned for; we need to be the planners.” Jasmin Eatman 23M 23G

GOAL 6 | Be intentional and transparent in how we communicate, implement, and measure equity and inclusion initiatives/innovations. Celebrate our accomplishments locally, regionally, nationally, and globally. Sharing good news about the medical school’s DEI efforts is as collaborative as the work itself. For example, the Woodruff Health Sciences Center’s Health Sciences Update debuted a monthly “DEI Highlights” section to showcase DEI successes from across Emory’s health sciences enterprise. It was inspired by a team of 2021 Woodruff Leadership Academy fellows whose members included Heron and Calli Cook, clinical assistant professor in the Nell Hodgson Woodruff School of Nursing. As Cook says, “Oftentimes we don’t celebrate what we do well because we’re so busy doing the work. It’s important to share what works in the medical school, for example, so the nursing school can do it too, and vice versa. Celebration increases momentum.” ■

The School of Medicine’s Office of DEI will track and

report progress in coordination with Emory’s other DEI entities. Bookmark https://med.emory. edu/departments/ medicine/about-us/ diversity-inclusion/ index.html.

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News and views from Emory School of Medicine alumni WINTER 2022

DISASTER DOC: A Life-Threatening Storm Leads

to a Career in Emergency Preparedness

T CAME SWIRLING FROM THE SKY. Mark Keim was playing the

album Led Zeppelin I in the modest house he and his wife were renting for $150 a month while he pursued his undergraduate degree at Southern Illinois University. It was 1982. Keim, just 20, already had taken on many adult responsibilities. He had lost both his parents and was guardian to his then 13-year-old brother. All things considered, the Keims were doing all right. They had settled in Marion, a coal mining town in the southern tip of Illinois. There was a sizable lake nearby for fishing and boating, a few car dealerships, a Walmart. It seemed to be a typical Memorial Day weekend, if unseasonably warm.

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PHOTO PROVIDED BY MARK KEIM

That Saturday, Keim’s brother was at a friend’s house, Keim was studying, and his wife was cleaning the house. Keim and his wife were walking their puppy outside when the town’s storm siren sounded. Looking off to the west, he saw darkened clouds and suddenly a twister came into focus. He remembered a book his mother had once purchased for him when he was young. They didn’t have much but she somehow found a little extra when it came to books, instilling the value of knowledge and where it could take you. This book, he remembered, was on tornadoes. It was as if his mother were reaching out with one final gift for her diligent, intelligent boy. The pages appeared in his mind, and he knew that this was not the

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FIVE THINGS TO KNOW ABOUT Mark Keim Completed a disaster medicine fellowship at Emory’s School of Medicine in 1997. Has been an adjunct professor in Emory’s Rollins School of Public Health since 2008 and faculty for Harvard Medical School’s disaster medicine fellowship since 2010. Earned an MBA from Emory’s Goizueta Business School in 2014. Has received the CDC Special Service Award and the HHS Secretary’s Award for Distinguished Service . Just released a new book, Disaster Planning.

kind of storm you waited out. He spotted bricks flying through the air from a nearby schoolhouse. Keim and his wife sprinted for their aging Mustang. It was not always the most reliable car, but he prayed that this time the engine would turn over. Key in the ignition, the engine came to life. He recalled that tornadoes cannot make abrupt turns, so he quickly took a sharp right turn away from the storm. After outrunning the storm’s destruction, Keim was thankful to be alive. But now, he had to return. Forced to park 10 to 15 blocks away from his street, he saw that many structures—homes of people he knew, homes his friends and neighbors had worked hard to afford—were reduced to rubble. But what about his brother? Keim, powerless, realized fate had made its decision and all he could do was wait for the verdict. As he got closer to the house where his brother had been visiting, he breathed deep. He saw nothing. Then, he made out a standing figure and thought he recognized the posture. He ran to his brother and hugged him hard. Keim and his family looked at what was left of their house. It had been picked up from the foundation, its walls and roof stripped away, and the main structure relocated to the driveway. Marion, Illinois, had been hard hit: 10 people would be reported dead, more than 1,000 families displaced, and Keim, his wife, Kelly, and his brother, Bryan, were forever changed. Keim never forgot that they were spared. He never forgot that others weren’t. A LIFE CHANGED

Receiving his MD from Southern Illinois University in 1991, Keim would choose an emerging specialty, disaster medicine, for the direction of his career. Keim completed a disaster medicine fellowship at Emory’s medical school in the department of emergency medicine in 1995. He served as chief medical officer for the US National Disaster Medical

System’s deployment to the Red River flood and a medical officer helping after Hurricane Marilyn, the most powerful hurricane ever to strike the Virgin Islands. “The responses taught me a lot about quick reactions but also limitations,” Keim says. “These devastations would sometimes take me back to my own experience, and all I wanted to do was help these people.” Keim, who completed research with the Centers for Disease Control and Prevention (CDC) during his two-year fellowship, would join the CDC after fellowship completion, staying with the agency for more than 15 years. He became an associate director for science at the CDC in 2012, reviewing the organization’s documents as a scientist participating in the clearance process. “Each one of the centers has an associate director for science and I was responsible for peer review,” he says. “I’d either authorize the document, send it back for revision, or deny it. I worked in association with multiple associate directors around the CDC.” He also served on the White House Subcommittee for Disaster Reduction for almost a decade. “We would meet monthly, and I was a rep for the CDC. There were reps from cabinets and the HHS, NIH, and more,” says Keim, who received the United Nations Sasakawa Certificate of Merit in 2015. DISASTERDOC DEPLOYED

Retiring from the CDC in 2015, Keim started the Atlanta-based DisasterDoc, an international firm specializing in consultation, education, and research related to public health emergencies. As CEO, Keim travels the globe to consult on disaster planning—and he believes climate change will cause even more natural disasters to occur on a more rapid trajectory. “People sometimes think disaster medicine is only about going in after a disaster and minimizing the damage,” he says. “But that’s not where you prevent the fallout. It’s not just how you deal with the

first disaster but in how you prepare for the disasters that could come after. You also do a lot of facilitating and organizing—but it’s the people who live there that have the knowledge. You just help figure out how they would deploy it.” Recently, he worked on a project funded by the CDC as a private consultant for territories in Puerto Rico—one on the coastline and one in the mountains. They developed a plan that could be put in place four or five days in advance of potential hurricanes, to prevent damage or loss of life. TIME OF IMPACT IS TOO LATE

“It’s about asking questions such as, ‘Where do we evacuate people to beforehand?’ ‘What are our options?’ About 80 percent of all disaster-related deaths occur at the time of impact, when the water is coming up or the wind is blowing, and no one can help you then.” He also served as a field manager after the Indian Ocean tsunami in Indonesia. “I thought I’d seen everything—disasters of war, natural disasters—but you could see absolute devastation even after flying for three hours over the area impacted by the tsunami,” he says. Not all of his work has Keim deep in the field where disasters have recently struck. A project for the World Health Organization involved reviewing and revising literature around the world concerning public health emergencies. Keim looks back on that devastating tornado in Illinois some 40 years ago. “It was just a regular day in Marion and then it wasn’t,” he says. He believes he would still have been a doctor, even if there had not been a tornado. “But my career path would have been so different,” he says. When large-scale, life-threatening situations emerge, such as the pandemic, says Keim, they make every day precious. “So many people are going through their own experience of this now,” he says. “To survive makes you appreciate life even more.”—Eric Butterman

Winter 2022

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