Can you tell us about your role at Tufts Medical Center?
I am an attending physician in the Division of Geographic Medicine and Infectious Diseases at Tufts Medical Center and Tufts University’s Infection Control Health Director. I am also an Assistant Professor of Medicine and Public Health and Community Medicine at Tufts University School of Medicine.
At the Medical Center, I have a number of roles. One role is to see patients who are admitted to the hospital with a variety of infectious diseases. In this role, I treat patients and teach and mentor medical students, internal medicine residents and fellows studying infectious diseases.
I also am the Principal Investigator of the Tufts Medical Center/Tufts University COVID-19 Biorepository and Comprehensive Database. We have established a biorepository of multiple different specimen types from patients infected with SARS-CoV-2, the virus which causes COVID-19. The goal of the Biorepository and Comprehensive Database is to create a shared resource for qualified investigators who are studying COVID-19 across the Medical Center and University. Development of these unique resources underscores Tufts’ leadership in the fight against SARS-CoV-2 and supports transdisciplinary research efforts required to control the current pandemic and lays the foundation for future research directed at other emerging pathogens.
I also represent Tufts Medical Center and Tufts University on the Massachusetts Consortium Board on Pathogen Readiness (Mass CPR) Accelerator Committee. Mass CPR was established in 2020 to link multiple universities and hospitals in Massachusetts in the fight against COVID-19. The goal of the Consortium is to establish biorepositories and share resources and data across institutions to rapidly advance COVID-19 research and to foster development of a common infrastructure enabling us to study other emerging pathogens and develop novel strategies to prevent and treat them.
An additional and extremely important role at the Medical Center, which I enjoy very much, is mentoring infectious disease fellows. Over the past 14 years, I have been fortunate to mentor many outstanding fellows, several of whom now hold academic positions or important positions at the United States Centers for Disease Control and Prevention.
What were your areas of research prior to COVID-19?
Between 2010 and 2013, I held a staff position at the WHO in Geneva, Switzerland. During this period, I worked in the Department of HIV/AIDS, where I led and supported the development of multiple surveillance methods for HIV drug resistance (HIVDR). HIVDR surveillance methods, which I developed, have been implemented in over 60 countries worldwide and continue to be vital in informing optimal first- and second-line antiretroviral therapy (ART) regimens in low- and middle-income countries. In addition, I supported development of clinic- and ART program-level quality of care indicators associated or predictive of HIVDR. This subset of quality of care indicators are commonly referred to as Early Warning Indicators (EWI) of HIVDR. The monitoring of ART program associated with HIVDR alerts national program planners to situations favoring the unnecessary emergence of drug-resistant HIV or virological failure. EWI results form the basis of recommendations for quick action, either at the clinic level or, if many clinics do not achieve desired targets, at the national ART program level. Examples of EWI of HIVDR include on-time pill pickup (a measure of adherence to ART), and estimates of clinic-level HIV viral load suppression and attrition form care. My goal when developing EWI of HIVDR was two-fold: First to develop indicators with targets firmly grounded in available scientific and medical literature and second to empower ART clinics and civil society to work together to find sustainable solutions at local levels to what are often complex determinants leading to successful or poor indicator outcomes.
Before I worked at WHO, I led a HIVDR research laboratory at Tufts Medical Center. In my laboratory, I developed assays to characterize HIVDR mutations present at low abundance in patients infected with HIV. That work has led me to support low- and middle- income countries in setting up quality-assured HIV drug resistance testing laboratories for patients taking HIV antiretroviral therapy.
While I am no longer at WHO, I continue to be very involved at the global level in the fight against HIV/AIDS. I am co-Chair of WHO’s HIV Drug Resistance Surveillance and Epidemiology Working Group and am a Steering Group member of WHO’s HIV Drug Resistance Network (WHO HIVResNet). In addition, I continue to actively support Ministries of Health in many low- and middle-income countries in ART program optimization and in operationalizing ways to prevent, monitor and respond to HIVDR.
What sorts of research projects involving COVID-19 are you working on now?
I have recently received funding to develop sequencing assays for SARS-CoV-2. The overall goal of this research is to identify intra- and inter-host diversity of SARS-Co-V2, the molecular basis of resistance to antiviral drugs such as remdesivir, which has emerged as a promising treatment for COVID-19.
True to my insistence on the importance of a transdisciplinary approach to research, I am working with experts at Tufts Veterinary School and others to characterize biological sex-based differences in susceptibility to SARS-CoV-2 infection in transgenic mice and plan comparative analyses of the inflammatory reaction of humans and mice to SARS-COV-2 infections. In addition, my collaborators and I plan to investigate social gender-based factors contributing to increased SARS-CoV-2 susceptibility and mortality in men, as well as the impact and consequences of the crisis on men, women and LGBT+ communities.
Much is unknown about how COVID-19 will impact low- and middle-income countries. What concerns do you have in regard to the spread of COVID-19 in under-resourced areas of the world?
My greatest concern is inequity with respect to vaccine access. There is an urgent need for rapid deployment of life-saving COVID vaccines in low- and middle-income countries.
What are the most gratifying and challenging aspects of practicing infectious disease medicine during this pandemic?
While a pandemic brings pain, suffering and economic hardship, the spirit, energy and incredible resilience of front-line Tufts Medical Center health care workers has been unflagging and inspirational. It has been both very gratifying and humbling to work alongside the city’s finest doctors, nurses and health care workers eagerly pitching in to provide exceptional care for our sickest COVID-19 patients. Everyone has really been giving 120% effort! It has also been gratifying to see the scientific community rapidly mobilizing across countries and disciplines in efforts to find treatments and a vaccine for SARS-CoV2.
Because this is a new infectious disease, one challenge we face is that we are learning as we go along. Just a year and a half ago, no one would have ever thought that we would be living through a century or perhaps millennial defining event that has touched all of our lives in so many different ways -ways which will likely have profound impacts on the way we live our lives and how societies and the global economy functions. Indeed, the pandemic in the United States underscores the urgent need we face – we must build and continually strengthen a robust well-informed public health infrastructure, which can easily adapt to new and emerging threats. Equally, we must renew the social contract between Americans and our government and national, state and local public health authorities to minimize the impact of the current and potential future public health threats.