KATHLEEN DURKIN I’m Kathleen Durkin of Columbia’s Zuckerman Institute.
DEVIN POWELL And I’m Devin Powell of the Zuckerman Institute.
KATHLEEN Welcome to Lab in the Time of Coronavirus. This podcast follows the lives of brain scientists who are pivoting to combat COVID-19 in this time of crisis.
DEVIN Today’s episode starts with a doctor who spends his days helping COVID patients to breathe. He’s trying to stay safe in the middle of this pandemic, and he reached out to some engineers and some scientists at our Institute for help. Together, they’re creating a new way to protect healthcare workers on the front lines.
KATHLEEN Our story begins with Dr. Isaac Wu.
DEVIN and his experiences inside the hospital.
ISAAC WU I’m an anesthesiologist at Columbia University. Patients who show symptoms of COVID-19, like shortness of breath, fever, they come in through the emergency room. Over time, due to difficulty breathing, the physicians and nurses down there may feel like the patient requires intubation.
KATHLEEN COVID-19 is a respiratory disease. It attacks the lungs and makes it hard to breathe.
DEVIN Physicians who are attending to COVID patients often have to help them breathe. And they do this by inserting a tube into their throat. This is intubation.
KATHLEEN It squeezes air into the lung, like a bellows in a fireplace.
ISAAC When we’re intubating or extubating patients we use the standard recommended PPE. We wear an N95 mask, we wear a face shield, we wear a gown and we double glove.
Since COVID-19 has come about there’s always a need for greater protection. A lot of what we know now shows that it can be spread very easily through either droplets and also through aerosols.
KATHLEEN Dr. Wu thought some kind of shield, positioned between the doctor and patient, could minimize exposure to these droplets and aerosols.
ISAAC Basically the inspiration behind this airway shield is from an anesthesiologist in Tawian, his name is Dr. Lai Hsien-yung. I came across his design online and felt it could offer some added protection for healthcare providers who are performing aerosol-generating procedures. I reached out to the engineers and scientists at the Zuckerman Institute, specifically to Darcy and Tanya.
One of the really nice things about our project is that we’ve been able to have direct contact with the clinicians at Columbia. And I think the nature of the crisis has made people really step out of their immediate comfort zone and area of expertise.
DEVIN Let’s meet one of the scientists who answered the call.
KATHLEEN Darcy works with researchers at the Zuckerman Institute to create images of brain cells and new tools and technologies for looking inside the brain.
DEVIN His work typically focused on answering deep questions about the brain, not on making medical devices.
KATHLEEN And yet a lot of his skills transfer.
DARCY We’re used to working in interdisciplinary ways. And in this case that helped us put together kind of a crack team that can work specifically on this problem.
DEVIN So the first step for this team was to figure out what exactly is the problem that Dr. Wu and his colleagues are facing.
DARCY When the people who are suffering from COVID-19 have respiratory difficulties, anesthesiologists or the healthcare practitioner would essentially stick a tube in the throat of the patient. It’s basically like if you had an air hose and you put it in a thing of water, it fizzes and blows saliva and mucous and everything else around. So we’re making this splash guard, this intubation shield. Like a bullet-proof screen so that none of the droplets directly hit the practitioner.
The original design started off as a simple box with two round holes and one side missing that can go over the patient. And for visibility we tilted one face like a windshield. So with the doctors we went through and constructed this box. We made a few prototypes, delivered them, tested, refined, made new ones, tested again, refined, tested again. Until finally we think we’re at the stage that it allows for convenient use.
And now the next stage is to add and qualify the negative pressure environment.
KATHLEEN A negative pressure environment just means implementing a slight vacuum on the box to ensure that virus particle don’t come flowing out of the arm holes that the doctors are reaching into.
DEVIN And to create this airflow system, the team has turned to an electronics whiz who has set up an unusual laboratory in his own home.
KATHLEEN He spoke to us from his home lab in his New York City apartment.
RICK HORMIGO I’m Rick Hormigo and I work at the Zuckerman Institute as an electrical engineer doing research and development for electronics. I’m very lucky in having my own home lab so I can stay a little bit more insulated. And I can test some of the stuff, even simulate the same kind of box that they are using.
DEVIN Rick has to test the box with something like a body inside of it to understand how the air would flow around an actual patient. So what do you do when you don’t have a patient or volunteer or mannequin available in your home lab in your New York City apartment?
KATHLEEN Creative thinking is the hallmark of a smart engineer.
DEVIN It turns out you borrow dolls from your daughter.
RICK I have to go and steal one of the big dolls from my daughter and she gets really mad at me. Actually she has a Santa Claus doll. She says, “What are you doing to Santa?” But it works, so that’s the point.
DEVIN So we have to stop for a second here, Kathleen, and explain to people what Rick is showing us because this scene is incredible.
KATHLEEN Poor Santa Claus is having breathing difficulties, and we know this because he is lying on his back and his face is covered by an intubation box. And you can see his little striped legs sticking out of the box.
DEVIN And then there’s the smoke.
RICK To simulate the flow of gas inside of a box, the ideal way of doing it is to put in smoke. I’m so lucky that my daughter had one of those smoke machines for Halloween around and it works like a charm for this project.
DEVIN And Rick isn’t the only team member working from home.
ARMEN ENIKOLOPOV And it’s a funny thing, all of us have kind of turned our living rooms and bedrooms into makeshift laboratories. My name’s Armen Enikolopov. I was a graduate student in the lab of Nate Sawtell, PhD, Zuckerman Institute Principal Investigator, up until about a year and a half ago.
DEVIN Armen is working with Rick on adding negative pressure to the box and cleaning any infected air inside it.
ARMEN My parents’ house which is where I’m at has become a kind of storage space for every single filter manufactured around the United States to send samples of their materials, and tubing, and this kind of filter and that kind of filter, and pre-filters and barb connections and God knows what else.
The air that the patient is breathing out is loaded with lots of virus. What you don’t want happening is for that virus to flow out of the box, which has lots of holes. What we’re trying to do is to suck that air out and filter it, making sure that all the virus is gotten rid of, and exhaust is just pure, clean air into the environment that can then be breathed in by other patients.
One of the really nice things about our project is that we’ve been able to have direct contact with the clinicians at Columbia. And I think the nature of the crisis has made people really step out of their immediate comfort zone and area of expertise. Someone who’s a scientist becomes an engineer. Someone who’s an engineer starts thinking about clinical things. I spend hours on the phone effectively doing sourcing, which I never thought about at all. And that’s true for everybody: Everyone’s jumped in and done what they can. There’s often the feeling of knowing I’m probably not the best person in the world to be doing this, but I am the only person doing it, and that often seems to be the more critical point.
TANYA TABACHNIK A month ago I thought I was busy, I was wrong. Sunday, Saturdays, no evenings, it doesn’t matter anymore. My name is Tanya Tabachnick and I’m Director of Advanced Instrumentation and shared resources at Zuckerman Institute. We really feel the sense of urgency. It’s a new level of fast for us.
DEVIN So how fast is fast for Tanya, Darcy and their team? Well, they created the first version of their device, without the negative pressure, in 48 hours.
TANYA The first prototype it was like two days. We want to get it to the hospitals as fast as possible.
KATHLEEN It’s important to get the intubation box out as fast as possible, but it’s also important that it’s correct. And that means taking into account all the variables that make it work.
DEVIN That also means taking into account all the real-world circumstances that affect its use. Intubations take place in the ER, they place in the ICU, in surgery. And the inbuation box has to be usable in all fo those circumstances.
TANYA They have like five different sizes of bed in the hospital, and it needs to stay on all of them. We are learning as we go. Every day we learn more and more how the hospital operates. We gave it to our clinicians. And they also were giving us constant feedback. “I need a little bit more space.” “I need to move my arms like this.” “Make me openings on the left, make me openings on the right.”
KATHLEEN The hope is that this intubation box, once it’s finalized, will be able to be produced and distributed all over the city and all over the country.
TANYA Today, as we speak today, we delivered six boxes to our anesthesiology department. We have a few good vendors who are on standby, who are waiting. They will be happy to start manufacturing and bringing it into New York or any small local hospitals.
DEVIN And for Tanya and her team, they hope this could change the way intubation is done in the long-term.
TANYA It is an amazing piece of equipment which I hope people will continue using even after COVID because there are plenty of other horrible diseases for them to be protected from.
DEVIN With the team working around the clock to get the shield into the hands of people who can use it, we went back to Dr. Wu on the front lines to see what the road ahead looks like.
ISAAC I think a lot remains to be seen about what’s going to happen with COVID-19. There’s certainly hope that at least in New York we’ve already reached the peak, we’re plateauing now. But I think a lot remains to be what’s going to happen in a few months, how long this is going to be around. And I think there may be a role for additional protective equipment like the airway shield not only immediately but also in the future, potentially until a definitive treatment like a vaccine is developed.
KATHLEEN Thanks for listening to Lab in the Time of Coronavirus. Take a look at the show notes for links to all the things we discussed. You can find all of our episodes at https://zuckermaninstitute.columbia.edu or on iTunes. Take a moment to rate and review us on iTunes. That makes it easier for other people to find us.
DEVIN Special thanks to Rui Costa, Jennifer Farris, the researchers who sat down with us for this episode, and the entire Zuckerman team. The music was provided by Miguel Zenón, Jazz Artist-in-Residence at the Zuckerman Institute. If you have thoughts or questions, you can find us on Twitter and Instagram @ZuckermanBrain. Our DMs are open! But before we go, Kathleen I think you had one last question for our researchers?
KATHLEEN What is the first thing you plan to do, post-pandemic?
RICK Have a good drink.
ARMEN I want to go out dancing terribly. I want to see loads of sweating people writhing together.
DARCY Sending my kids back to school.
ISAAC I’m probably going to try to visit my parents, so our kids can see their grandparents again once it’s safe to do that.
TANYA I will bring everyone I can on the roof and have a toast. Thinking of that keeps me going forward, and it’s hard for me to say. I’m almost crying.
Note: This transcript has been edited for clarity.