No time, no data: how the COVID-19 pandemic turned medical research upside down

Maastricht research physicians on the influence of the pandemic on their studies

12-04-2022 · Background

Hardly getting around to doing research because of working overtime at an ICU that was bursting at its seams. Or having extra time for research because of treatments being postponed, but not being able to collect the necessary patient data. Research physicians in MUMC+ saw the COVID-19 pandemic influence their work in various ways, but the common denominator seems to be: delayed research.

Frontline

“Infectious diseases, artificial respiration, moving IC patients,” researcher Dennis Bergmans sums up his areas of attention. Slightly cynically, you could say that he had his bread buttered on both sides the past two years: the COVID-19 pandemic provided him with more research possibilities than he could handle.

Except, for a long time it wasn’t possible to focus on it. In addition to his research and teaching tasks, Bergmans actually also works as an internist and intensivist at the Maastricht ICU. “Normally speaking for sixty per cent of my time, but during the first wave it turned into one hundred per cent – and far beyond that. All on-going research came to a halt.”

A frustrating time, says Bergmans, as there were still a lot of questions regarding the treatment of Covid patients. “For example, the effect of certain anti-inflammatory agents. In order to research this kind of thing, we kept track of all patient data. But we never actually got around to analysing them.”

It wasn’t just the overflowing ICUs and nursing wards that impeded the researchers. “Although I myself was not called upon very much for Covid care, I had a lot less time for research,” says lung specialist Lizza Hendriks, who - in addition to clinical work - also carries out research into metastasis in lung cancer patients. “The hospital wanted doctors with particular expertise to continue doing their work. But because other lung specialists were being called upon for Covid care, some of their regular tasks came to us. Also, adapting protocols and the logistics around lung cancer treatment took a lot of time.

"The inequality between researchers has only increased during the pandemic"

To have at least one day a week to carry out research, Hendriks worked longer on the other days. But this still could not prevent a delay in her studies. “Part of my research came to a halt anyway. Initially because patient-related studies, to a large extent, were not allowed to take place, but also afterwards fewer patients came to the hospital. Moreover, the approval of research proposals suffered a delay too. This all resulted in much of the patient data, but also tissue that needed to be studied in the lab, could no longer be collected.”

Bergmans also saw that collecting data was not always possible, even from the patient group that was present in abundance. “One of my PhD candidates was doing research into artificial respiration in the ICU. Because of the possible risk of becoming infected with COVID-19 she was, however, no longer allowed to expose herself to the patients’ exhalation. As a result, she has suffered a delay of six months.”

After the first wave, a lot of research could be restarted, in order to (partly or fully) continue in subsequent waves, albeit sometimes in an adapted form. “Fortunately, we received support in this – for example with data analysis – from researchers from other departments, who had more time because care was postponed,” says Bergmans.

Moreover, extra budget for extensions of PhD tracks and research grants eased the pain to some extent, said both researchers. But getting rid of backlogs completely? It was too busy for that. “The upcoming time there will be no time for catching up in research because of all the delayed care that needs doing,” Hendriks remarks. “Annoying, because the inequality between researchers during COVID-19 has only increased. Those who suffered less of an upheaval due to Covid care or working from home – for example, because they don’t have children – had more time to apply for grants.”

"All-in-all, we now have more studies in progress than planned"

Were the past two years all bad for scientific studies? No, Bergmans also sees positive effects. “In addition to delays, in our case there was also expansion of the research. We gathered a huge cohort of Covid patients in the ICU, of which a lot of data was collected. A large number of people are now doing research with that, and it also provides extra possibilities for future PhD tracks and student projects.”

Moreover, because of the crisis situation a lot more was possible. “Where medical ethics testing of studies normally took a couple of months, it went much quicker for us now, as Covid-related research was given precedence. All-in-all, we now have more studies in progress than planned.”

More time, less data

Where the pandemic sucked away research time on the frontline, it freed up time in other places. A lot of non-urgent care was postponed, there were fewer consultations, and congresses, symposia and drinks were called off as well. “Suddenly, I went from one and a half days to two or three days for research,” says professor of Spinal Neurosurgery Henk van Santbrink. “You could then think: ‘Nice, more time and peace, the pressure is off’. But it gave me a very unpleasant feeling. While others were working their butts off, I felt a bit useless.”

Besides, more time doesn’t automatically mean that you can do everything you want. “We do a lot of clinical research, which came to an immediate standstill during the first wave,” says Van Santbrink. “For example, our studies with elderly patients, as this group was no longer allowed to come to the hospital. Operations, of which we needed the results, were cancelled.”

"While others were working their butts off, I felt a bit useless"

A problem that caused a disruption in other departments too. “For example, the analyses of treatments which need to take place periodically for patients,” says professor of Plastic Surgery René van der Hulst. “Because of cancellations, the treatments no longer went according to plan. Eventually, we were able to correct this with statistic methods, but that was not without a struggle. Moreover, we mainly focused on large studies, we removed the smaller projects.”

So, making swift work of the on-going studies was not an option for many researchers. What could be done with the extra research time? Neurosurgeon Van Santbrink decided to transfer his attention to literature and the data archive. “We took another look at old data, but then with different objectives than originally intended. In addition, we wrote about five to six overview articles. All those things that would normally, most likely, not have happened, or at least now happened at an accelerated speed.” However, these ‘unexpected’ activities did not yield any major new insights, says Van Santbrink. “But it did lead to more depth and expansion of our knowledge.”

"During COVID-19 we achieved a higher impact factor"

For plastic surgeon Van der Hulst the extra free time also had its advantages. “Normally, it is a constant running and dashing. Now, we were able to take a real critical look at our articles. Of course, you never know for sure if it was because of that, but during COVID-19 we achieved a higher impact factor.” There was also more time to think about new research projects. “But on the other hand: without congresses or drinks with colleagues you come up with fewer new ideas. Also, you can’t immediately start up such a new project, so it is not a case of replacing the research that has come to a standstill.”

Van der Hulst used the extra time mainly to supervise PhD candidates. As far as that was actually possible, because a lot of PhD research was also at a standstill because of postponed care. “Nevertheless, few people were at home. Many PhD candidates helped out on Covid wards and the ICU.” Even though this meant that thesis writing came to a halt for weeks or even months. “But eventually, things will work out due to the regulation for an extension of the PhD track. It requires extra creativity and capability to adapt, but there is nobody who will not obtain their PhD.”

Doing a PhD during a pandemic

Even there where ongoing research wasn’t completely brought to a halt by the pandemic, the Covid spectre was flitting about. Two PhD candidates talk about their experiences.

“For the first time in my life, I had to convey bad news in talks with family members”

Zaid Al-Difaie: “I started my PhD track – in which I focused on techniques used to detect thyroid cancer – at the beginning of 2021, in the middle of the second wave. One of my projects encountered some delay because of the pandemic, but I was fortunate to have plenty of other studies on which I could work. So, compared to some other PhD students, I was lucky.

Still, my research did almost come to a standstill for a while. The hospital inquired whether I could help out on the ICU, which I eventually did twice for a period of four weeks. Another PhD student took over some of my tasks for those weeks. I answered my e-mails in the evenings, and if something really needed to be done, I did that at the weekends. When it was quiet, I even worked on my research while on the ICU.

When I look back, I am glad that I did this. Those eight weeks’ delay is not so bad: I hope to complete my PhD research within two and a half years, while in principle there is budget to take four years to do so. But this way, I was able to contribute, while it was very educational for me too. For example, having to convey bad news in talks with family members for the first time, or having to intervene during emergencies. That was tense at times, but it also provided valuable experience for when I return to the clinic in a couple of years’ time. I would otherwise not have had that: during my PhD, I was supposed to only do research.”

“Eventually, people will ask: what did you do during the pandemic?”

Aurelia Wildeboer: “The question as to whether I wanted to help out on the ICU put me in a difficult predicament. I was not doing a fixed, four-year PhD track, but I had a collection of temporary contracts. Because of this, I was not eligible for the funds freed up to extend PhD research, which were offered by the faculty. So, I knew that if I helped out on the ICU, my PhD would most likely be ruined. But on the other hand, you do still want to make a contribution. A time will come when people ask: what did you do during the pandemic?

In the end, I didn’t do it, because there were enough people who wanted to help out. Fortunately, I was able to help out in another way: during the first round of vaccinations and the booster campaign, I worked for the Area Health Authority as a medical supervisor. I was able to combine that better with my research and besides, I was able to fund part of my research by doing so.

Ultimately, the pandemic didn’t have much impact on my research, which is about complications after intestine surgery. I wasn’t able to collect part of my data, but you have to work with what you’ve got. It did greatly influence how I worked, among others because I suddenly had to do everything from home. That challenges your motivation considerably. The fact that I got through it, was a clear message for me that doing a PhD was the right choice.”