key: cord-0768618-0h7afujd
authors: Queen, Jessica; Karaba, Sara; Albin, John; Karaba, Andrew; Howard-Anderson, Jessica; Skinner, Nicole; Herman, Jonathan David; Paras, Molly L; Melia, Michael T
title: The Time is Now: A Call for Renewed Support of Infectious Disease Physician-Scientist Trainees in the COVID-19 Era
date: 2021-03-26
journal: J Infect Dis
DOI: 10.1093/infdis/jiab162
sha: 3ed563a737be334df83a8f36fde8a097b41d3848
doc_id: 768618
cord_uid: 0h7afujd

nan

A c c e p t e d M a n u s c r i p t 4 The COVID-19 pandemic has caused unfathomable changes across society. This challenge, like the 1918 influenza pandemic, has highlighted the importance of physicians who can rigorously answer critical research questions. As was the case then, we are now confronted by daunting, pressing needs spanning basic, translational, and clinical research. Now more than ever, there is widespread, progressive appreciation of the devastating ways in which structural racism, social determinants of health, and health disparities tragically enhance and perpetuate the pathogenesis, morbidity, and mortality of infectious diseases. Among the many lessons learned from this first year of the COVID-19 pandemic, a critically important one is the way in which a nimble, effective, well-funded infectious diseases research community is needed to immediately pivot and respond to public health emergencies in real-time.

As was the case for our predecessors who faced prior infectious diseases (ID)-related public health emergencies, this pandemic has provided us, ID fellows-in-training, with incredible educational opportunities. Unlike prior crises, however, the current pandemic is likely to fundamentally alter the ID research priorities and landscape. Prior to this pandemic, concerns were raised regarding declining numbers of ID physician-scientists and research career development awards, prompting the National Institute of Allergy and Infectious Diseases (NIAID) to pledge $15 million over five years to promote research training [1] . While that is an excellent start, we now know that it must only be the start. Without clear, concerted efforts such as K payline and award duration increases, reappraisal of the K review process, and funded T32 extensions from the NIAID as well as funding innovations from the ID and academic medicine communities to support early-career investigators through this challenging time, we risk new leaks in the physician-scientist pipeline and an inability to effectively respond to future public health crises [2] [3] [4] .

A c c e p t e d M a n u s c r i p t 5 On March 11, 2020, the World Health Organization declared COVID-19 a pandemic. Over the next month, universities in the United States closed and required cessation of existing research activities while encouraging COVID-19-related research to expand [5, 6] . Laboratories remained shuttered for 3-4 months, after which non-COVID research began to tentatively resume. However, physical distancing guidelines and shutdowns limiting supply chains continue to slow research. Due to restrictions on travel and public gatherings, many fellows undertaking global health or communitybased research found their projects halted. Additionally, publishing non-COVID-related research slowed alongside a concomitant influx of COVID-related submissions [5] .

Coinciding with the research slowdown, many upper-level ID fellows were redeployed from research back to clinical work. Clinical responsibilities for ID fellows included additional inpatient consult time, covering COVID-19 response pagers, helping with testing, and collaborating with hospital leadership on outbreak responses [7] . On a national call for ID fellows hosted by the Infectious Diseases Society of America (IDSA), many expressed a desire to help with COVID-19 efforts. However, as the pandemic continues, ID fellows worry about continuing to leave their research careers on hold.

The pandemic has created other less tangible, but no less daunting, strains on productivity including social and financial stressors that risk deepening healthcare workforce disparities. Serving on the frontline has exacerbated high baseline rates of anxiety and depression, a problem particularly prevalent among women physicians [8, 9] . Fellows from racial and ethnic backgrounds While we appreciate the recently announced opportunity for early career scientists impacted by COVID-19 to apply for F and K award extensions, it is not enough [12] . Restoring the K payline to something closer to the values of a decade ago and extending the K award duration to 6 years would be good first steps toward encouraging fellows to remain in research careers. The NIH's own analysis shows K-funded researchers are more likely to progress in their careers and be awarded an R01. We A c c e p t e d M a n u s c r i p t 7 urge the NIH and academic institutions to strategically reinvest and help early career scientists progress to K and then R awards, thus ensuring a future generation of physician-scientists.

Re-focus the K review process. A corollary of the shrinking payline at NIAID is the stringent standards for review. The requirement for publications and preliminary data challenges applicants' abilities to meet reviewers' expectations with two years of dedicated research time during fellowship training. While we have been privileged to receive grant funding to support two or more dedicated research years during our fellowships, many fellows are afforded at most 12 months for research activities; during the pandemic that number may have shrunk even smaller because of pandemic-related clinical demands. Specific to the pandemic, accommodations must be made for K award applicants who have been unable to collect needed preliminary data due to past, current, and future research interruptions. The NIH policy of directing reviewers to consider COVID-19 impacts on proposed research should be extended at least through the next fiscal year. Additionally, applications should be allowed at least two resubmissions rather than one, as COVID-19 challenges may limit an applicant's ability to expeditiously respond to reviewer comments. Finally, fellows who contributed to COVID-19 research should be viewed positively for this work even if it is unrelated to their ultimate career development plan. Now more than ever is the time to reward young physicianscientists who have a well-developed plan, a prior history of completing research projects, and a strong mentoring team. We encourage study sections to remain focused on the goal of supporting ID physician-scientist career development.

Provide T32 Supplements: Fellows newly committed to research careers may need additional time in fellowship to bolster their research portfolios before submitting K applications. Taking the unprecedented step of allowing fellows supported by a T32 during the pandemic to extend their A c c e p t e d M a n u s c r i p t 8 time on T32 National Research Service Awards without compromising subsequent fellows' ability to secure pivotal T32 spots (i.e., pandemic-related T32 Supplements) would permit research fellows to be better poised to submit competitive K applications.

Increase non-NIH sources of funding: The NIH cannot be expected to shoulder the entirety of this weight. New awards and grants from organizations such as the IDSA, Gates Foundation, and Howard Hughes Medical Institute targeting young ID investigators would help retain talented and driven physician-scientists. Moreover, academic institutions can help weather this storm by providing salary support to protect research time for fellows and junior faculty delayed in securing independent funding. Because many academic medical centers have suffered financially during the pandemic, they should be incentivized and rewarded for these efforts. Supporting emerging physician scientists will help institutions fulfill their academic mission and reap the rewards of their prior investments in fellow and junior faculty futures.

As in 1918, today's pandemic illustrates why we need more physician-scientists. Infections can have sudden and massive impacts on human health in ways that few non-communicable diseases can.

Even as we face the current pandemic, the threat of rising antibiotic resistance, the tremendous infectious disease burden throughout the world, and future, novel pandemics illustrate the urgency of supporting ID physician-scientists. We, physician-scientists in training, want careers in which we will be able to build on the investments already made in us to combat current and future infectious disease challenges. Our training, however, is not complete. If we are to realize our potential for aiding human health, we need our leaders to support us now. We know it will be expensive. But given the catastrophic devastation of the past year, the questions that remain unanswered, and the

The National Institute of Allergy and Infectious Diseases and Scientific Societies Meeting on Research Training Efforts: Summary of Recommendations to Address Early-Stage Investigators

Policy recommendations for optimizing the infectious diseases physician-scientist workforce

Improving the Infectious Diseases Physician Scientist Workforce from the View of Junior Investigators: Vision, Transparency, and Reproducibility

Saving the endangered physicianscientist-a plan for accelerating medical breakthroughs

Non-COVID-19 research and publications must never be at the mercy of COVID-19 research

The COVID-19 pandemic and research shutdown: Staying safe and productive

The Pandemic Academy: Reflections of Infectious Diseases Fellows During COVID-19

COVID-19-related stress, anxiety and depression during the pandemic in a large population

A c c e p t e d M a n u s c r i p t